COURSE OUTLINE

PSYCHIATRIC NURSING BSN III Other Disorder of Infancy, Childhood or Adolescent

Course outline 1. Separation Anxiety Disorder 3. Reactive Attachment Disorder
Orientation to the course 2. Selective Mutism 4. Stereotypic Disorder
a. Course Content c. Grading system Disorder of Infants and Early Childhood
b. Requirements of the Course 1. Tic Disorder (Tourette’s and Chronic Motor Tic)
2. Elimination Disorder (Encopresis and Enuresis)
I. INTRODUCTION TO PSYCHIATRIC NURSING
a. Benchmarks in psychiatric history. FIRST TERM EXAM
b. Definition of mental Health and mental Illness
c. DSM IV TR 2. Eating Disorders (Anorexia Nervosa and Bulimia)
d. Self-Awareness issues
e. Most common adopted patient’s rights 3. Abuse - Child/Spouse/Elder (1. Sexual 2. Physical 3.
f. Methods of Psychiatric Admission Emotional)
g. Interdisciplinary Mental Health Care Team
h. Roles and Functions of a Psychiatric Nurse 4. Crisis
1. Maturational/Developmental
II. THEORETICAL MODELS 2. Situational
a. Psychoanalytical Models 3. Cultural
b. Psychosocial Model 4. Adventitious
c. Cognitive Model Phases Precrisis – Crisis – Adaptive - Postcrisis
d. Behavioral Models Suicide
e. Humanistic Model
f. Personality Temperament 5. Anxiety 1. GAD 2. Panic 3. OCD 4. Phobic 5. PTSD

III. THERAPEUTIC NURSE-PATIENT RELATIONSHIP 6. Anxiety Related Disorders

a. Elements involved in Nurse-Patient Relationship 1. Somatoform Disorder 4. Hypochondriasis
b. Phases of Nurse-Patient Relationship 2. Somatization Disorder 5. Conversion Disorder
c. Types of Nurse-Patient Relationship 3. Pain Disorder 6. Body Dysmorphic Disorder
d. Self-Awareness and Therapeutic use of Self
e. Factors that diminish N-P relationship 7. Dissociative Identity Disorders
1. Dissociative Amnesia 3. Depersonalization
IV. THERAPEUTIC COMMUNICATION 2. Dissociative Fugue 4. Dissociative Identity Disorder
a. Components of a Communication
b. Types of Communication 8. Sexual Dysfunctions
c. Levels of Communication 1. Sexual Desire Disorder 3. Orgasm Disorder
d. Goals of Therapeutic Communication 2. Sexual Arousal Disorder 4. Sexual Pain Disorder
e. Characteristic of a Successful communication Gender Identity Disorder
f. Essential Ingredients
g. Blocks to Communication Paraphilia
h. Process Recording 1. Pedophilia 6. Voyeurism
2. Incest 7. Fretteurism
V. THERAPEUTIC MILIEU 3. Exhibitionist 8. Transvestic
a. Purpose of TM 4. Fetishism 9. Sexual Masochism
b. Role of Nurse in TM 5. Zoophilia 10. Sexual Sadism
c. Goals of Therapeutic Milieu
d. Character of TM 9. Mood Disorders
e. Elements of a Effective Milieu Depressive Disorder
f. Democratic Environment 1. Seasonal Affective Disorder 3. Post partum psychosis
2. Post-partum Blues 4. Post partum depression
VI. DYNAMICS OF ADJUSTMENT Bipolar Disorder
a. Coping Mechanism 1. Bipolar 1 Disorder 2. Bipolar 2 Disorder 3. Cyclothymic Disorder

VII. PSYCHIATRIC THERAPIES SECOND TERM EXAM

a. Somatic Therapy
b. Psychotherapy 10. Personality Disorders
c. Pharmacotherapy 1. Cluster A Odd/Eccentric
d. Management Therapy 2. Cluster B Dramatic/Erratic
e. ECT 3. Cluster C Anxiety and fearful

VIII. PSYCHIATRIC ASSESSMENT 11. Schizophrenia and other Psychosis

a. Identify factors influencing assessment 1. Catatonic Schizo. 4. Undifferentiated Schizo.
b. Explain contents of assessment 2. Disorganized Schizo. 5. Residual Schizo.
c. Analyzing data collected 3. Paranoid Schizo.
Other Psychosis
IX. MENTAL DISORDERS 1. Schizoaffective 2. Delusional Disorder 3. Schizophreniform Dis
1. Child and Adolescent Psychiatric Disorders
Developmental Disorder 12. Cognitive Disorders
1. MR 2. Pervasive Dev. Disorder 1. Delirium
Specific Dev. Disorders 2. Dementia
1. Autistic 3. Asperger Disorder 3. Alzheimer’s Disease
2. Rett’s 4. Childhood Disintegrative Dis. 4. Parkinson’s Disease
Disruptive Disorders
 1. Conduct Disorder 13. Substance Related Disorder
2. Oppositional Defiant Disorder 1. Substance abuse
3. Attention Deficit Hyperactive Dis. 2. Substance dependence
3. Substance intoxication
4. Substance withdrawal
FINAL TERM EXAM

PSYCHIATRIC TERMINOLOGY
  Abuse - excessive use of a substance that differs from  Disinhibited - a state in which a person is unable to
societal norms. suppress urges or statement which is socially
 Affect - emotional range attached to ideas outwardly unacceptable.
manifested.  Disorientation – disturbances in orientation of time,
 Blunt - slow or dull. place or person.
 Flat - absence or near absence of any signs of  Dysthymia – a 2 years chronic depressed mood
affective expression. disturbances.
 Inappropriate - incongruent between the  Delusion - fixed false beliefs that have no basis in reality.
emotional feeling  Paranoid – (“somebody is going to kill me”)
 Labile - unstable mood with rapid change.  Grandiose – false belief that one is powerful
 Broad – shows full range of emotional (“I am the most handsome male in my class”)
expression.  Religious – (“The devil told me to do this”)
 Restricted – shows one type of expression.  Somatic – (“I might get sick”)
 Agitate - to excitement with severe motor restlessness.  Ideas of reference – (“I hurt my neighbor. The
 Akathisia - motor restlessness generally expressed as lady I saw in the television told me to do it”)
the inability to sit still.  Depression - a mood disorder characterized by sadness,
 Akinesia – absence of movement. despair, apathy and discouragement.
 Alogia - inability to speak.  Denial - avoidance of disagreeable realities, refused to
 Ambivalent – opposing feelings/emotions. (love and recognize.
hate)  Desensitization – gradual exposure to stress-provoking
 Anhedonia - feeling of no joy. stimuli.
 Anxiety - feeling of apprehension or tension. (fear of the  Dyskinesia – abnormal involuntary skeletal movement
unknown) usually producing a jerky motion.
 Apathy - lack of feeling, interest, concern or emotion.  Dystonia – rigidity of muscle that controls posture, gait
 Associative looseness - disorganized thinking that jumps and ocular movement.
from one idea to another with no evident relation ---------------------------------------------------------------------------------
between the thoughts. (“cannot see the sky…oh my  Echolalia - repetition of words heard.
love…just asking…mmm maybe tomorrow”)  Nurse: “Can you please keep the door open.”
---------------------------------------------------------------------------------  Patient: “Can you please keep the door open.”
 Bipolar disorder/manic-depressive - a mood disorder  Echopraxia - repetitive, meaningless movement or
characterized by one episode of manic behavior with or imitating others.
without a  ECT Electro convulsive therapy – doses of electric shock
history of depression. administered to clients with Manic Depressive
--------------------------------------------------------------------------------- Disorders.
 Euphoria - a subjective, exaggerated feeling of well-
 Circumstantiality - client eventually answers the being characterized by confidence, elation and
question being asked, but only after giving an excessive assurance.
amount of unnecessary details.  EPSE – Extra Pyramidal side effects. A drug induced
 Nurse: “Where are you going for the parkinsonism.
weekend?”  Exhibitionism – display of body parts to attract others.
 Patient: “I feel like visiting my sister…I just ---------------------------------------------------------------------------------
remembered she ask me a favor…a picnic  Fear – a response to objective threat/external. Fear of
maybe, in the beach, in hours it gets crowded. the known.
That is why I don’t prefer in that place. So, I  Fetishism – adoring something which serves as a
decided instead to go to my brothers place a substitute of the original love object.
nice and big house but now I prefer to stay in  Flight of ideas - flow of verbalization jumps from
my own house.”) unrelated one topic to another. There is a connection
 Clang association-rhyming of words between some topics but it is difficult to identify.
 (“I am reading a book, in a shady nook, with  (“What is today?…might not be taking a bath…
the food I cooked”) I will be cooking at home…the dog kept on
 Confused - bewildered, unclear. barking… there are flowers around me…the
 Coprolalia – repeating words socially unacceptable. food for sure will be delicious)
 Confabulation - unconscious filling of gaps in memory or  Flooding – exposure to fear.
untrue experiences that a person believes but have no ---------------------------------------------------------------------------------
basis in reality. Detailed fantasy.  Gait – manner of progression in walking.
 Nurse: “How are you Tess?” (who spent the ---------------------------------------------------------------------------------
day in her apartment)  Hallucination - false sensory perception without
 Tess: “Well, I came from my friend’s house external stimuli.
who just arrived from Canada. She gave me a  Visual: (seeing thing that are not there)
lot of gifts, we ate out…it was a wonderful day.  Auditory: (hearing voices which is not present)
I will be going with her when she goes back.  Olfactory: (smelling things that does not exist)
 Cyclothymia - mood swings of hypomania and  Tactile: (feeling touched but absence of
depression. stimuli)
 Gustatory: (experiencing taste in the absence
 Dependence - a state where a drug user takes or of stimuli)
increases dose of a drug in order to prevent the onset of  Helplessness – incapable and powerless.
symptoms or withdrawal.  Hopelessness - despairing, no hope.
 Hypervigilant - alert to danger.
  Hypomania – elevated state that is less intense than full  Somatic – adjective referring to the body.
mania.  Somnambulism – it is when a person sleepwalks.
 Hypersomnia – increased and prolonged sleeping.  Stereotype - persistent repetition of senseless act or
--------------------------------------------------------------------------------- words.
 Insomnia – inability to sleep or disrupted sleep patterns.  Suicide - a self-inflicted death.
 Illusion - misinterpretation of the real sensory stimulus.  Sialorrhea – excessive drooling of saliva
 (Patient insists a gray sock on the floor is a  Xerostomia – reduction of saliva
mouse) ---------------------------------------------------------------------------------
---------------------------------------------------------------------------------  Tardive Dyskinesia (TD)– an irreversible neurologic
 Libido – energy usually associated with sexual instinct. disorder.
 Limit setting – establishing a structured environment  TCA – Tricyclic Antidepressant
with clear ground rules.  Tolerance - to increase amount of substance to achieve
 Lucid intervals – patients reasoning and judgment the same effects.
appears to be normal for a brief period.  Transference – unconscious emotional reaction to a
--------------------------------------------------------------------------------- current situation that is actually based on previous
 Malingering – deliberately pretends an illness or experience.
disability.  Countertransference – a reaction based on the nurses
 Mania - a mood disorder characterized by irritability, past experience.
elation and hyperactivity.  Thought blocking - sudden cessation of thought in the
 Masochism – gaining sexual pleasure from being middle of a sentence, unable to continue the train of
physically hurt. thought. (“I am going to buy a new bag.”………
 Mutism - refusal to speak. I forgot to say what is next)
---------------------------------------------------------------------------------  Thought broadcasting – a delusional belief that others
 Negativism – motiveless resistance to all instruction. can hear or know what the client is thinking.
---------------------------------------------------------------------------------  Thought control – a delusional belief that others can
 Oculogyric Crisis – eyes rolled back in a locked position. control a person’s thoughts against his will.
 Obsession - recurrent disturbing thoughts which is  Thought insertion - a delusional belief that others have
difficult to push out of the mind. the ability to put thoughts in a person’s mind against his
 Compulsion - repetitive behavior that a person is will.
obliged to do to decrease anxiety.  Thought stopping – a technique to stop a client thinking
 Neologism – inventing new words which is meaningful of unwelcoming thoughts.
only to the person.  Tic - involuntary, recurrent muscular spasm. Motor and
 (“I cannot stay with you because you are a nic- vocal tics.
no-kets”) ---------------------------------------------------------------------------------
---------------------------------------------------------------------------------  Word salad - combining of words or phrases that do not
 Paranoid – extreme suspiciousness of others and their have connection & no sense.
action.  (I am fine….apple tree…books…toys
 Pica – ingestion of non-edible food. for sale…be okay)
 Phobia – exaggerated fear of non-dangerous object or  Worthlessness - having no value.
situation.
 Postpartum depression – occurs 30 days or less in the
postpartum period.
 Psychomotor retardation - slow speech and body
movement.
 Psychosis - mental illness during which the patients lose
contact with reality and demonstrate bizarre behavior.
 Psyche – the mind.
 Primary gain – relieving anxiety by an individual to feel
better.
 Perseveration - resistance to change the topic, verbally
repeating of a sentence.
 N – How are you? N –
From, where are you? N –
What is your name?
 P - I am fine.
P – I am fine.
P – I am fine
 Preoccupied - engrossed.
 Religiosity - preoccupied of or with religious idea or
content.
 Resilience - it is the capacity of the individual to move
forward despite psychosocial diversity or genetic
vulnerability.
---------------------------------------------------------------------------------
 Secondary gain – relieving anxiety with the help of
others. INTRODUCTION TO PSYCHIATRIC NURSING
 SSRI – Selective Serotonin Reuptake Inhibitors. Historical Perspective
 Sadism – gaining sexual pleasure by inflicting pain to the
partner.
  mentally ill persons were treated by tribal rites. If their surroundings and their roles in the hospital to the
this failed, they were left alone to die of starvation extent that they resisted returning to their homes.
or to be attacked by wild animals.
Greek and Roman Era Twentieth century
 Their temples were used to house mentally ill  overt change in the hospital system of mental
persons that have fresh air, pure water and health care began. The government believed that
sunlight. Sometimes they were treated with it was necessary to acquire more knowledge
kindness, while at times treatment was harsh and concerning the cause, prevention and treatment of
barbaric. They were treated by bleeding and mental illness and professionally trained workers
were needed to improve the care and treatment of
purging.
the mentally ill persons.
Middle ages
MENTAL HEALTH
 The treatment of the mentally ill was left to the  Is a “state of complete physical, mental, and social
priests, the superstitious beliefs flourished. They wellness, not merely the absence of disease” The
were flogged, fettered scourged and starved in the person is in a state of emotional, physical, and
belief that the devils that possessed them could be social well-being fulfills life responsibilities,
driven out.
function effectively in daily life, and are satisfied
Sixteenth century
with their interpersonal relationships and to
 The mentally ill were locked up in jails, dungeons,
themselves.
or lunatic asylum where the curious could pay to
watch the “performance” of the sick inmates. The MENTAL ILLNESS
harmless inmates were forced to seek charity on
the streets as beggars.  Mental disorder is a behavior or pattern that
Seventeenth century occurs in an individual associated with present
 God and Satan were still thought to be engaged in distress or with an increased risk of suffering
a battle for the possession of one’s soul. The death, pain, disability or an important loss of
dungeons were the only place where violent freedom.
mentally ill person could be committed. Purging
and bleeding was the favorite therapeutic FACTORS CONTIBUTING TO MENTAL ILLNESS:
procedures done. The whip was religiously applied
by the cell keepers. A. INDIVIDUAL:
Eighteenth century 1. Biological
 In 1792, Frenchman Philippe Pinel was 2. Anxiety
instrumental in proving the error of treating 3. Worries
mentally ill persons inhumanely. Benjamin Rush, 4. Fears
the “Father of American Psychiatry,” began 5. Loss of meaning in one’s life.
working in 1783. He believed that the phases of 6. Disharmony in life.
the moon influenced the person’s behavior which
he called “The Lunar Theory of Insanity.” At the B. INTERPERSONAL:
same time he invented the “tranquilizer.”
1. Ineffective communication
Although mentally ill patients were relegated to
2. Excessive dependency
the cellar, they were assured clean beddings and
3. Withdrawal from relationship
warm rooms. .
Nineteenth century 4. Loss of emotional control
 The most shocking to people of today was placing
the poor and the mildly demented on the auction C. CULTURAL AND SOCIAL:
block, where those with a strongest back and the 1. Lack of resources
weakest mind were sold to the highest bidder. The 2. Violence
returns of the sale are being kept in the town’s 3. Homelessness
treasury. 4. Poverty
5. Discrimination
Dorothea Dix, a teacher raised money to build suitable
hospital for mentally ill persons. The institution was PSYCHOPATHOLOGY:
designed to provide a homelike environment that would
also be safe. And because of the remoteness of the setting  It is a systemic study of mental disorder.
the institution had to produce its own food, heat and other
necessities. Patients were able to work on the farm, in the
kitchen, laundry, machine shop, on the grounds or wards. PSYCHIATRIC NURSING:
For some patients, this responsibility proved therapeutic
 It is a process where in a nurse assist a person,
because it provided meaningful activity, which increased
their sense of self-esteem and group cohesiveness. Having individual, or in group to develop a positive self-
no contact with the outside world the patient adapted to
 concept, satisfying interpersonal relationship and NURSING RESPONSIBILITY OF A PSYCHIATRIC NURSE IN
satisfactory role in a society. RESTRAINING AND ISOLATING A PATIENT:

PSYCHOTHERAPEUTIC MANAGEMENT IN THE 1. Documentation has to be justified.

CONTINUUM OF CARE: 2. Alternative was considered and attempted.
3. It has to be ordered by the physician.
A. THERAPEUTIC NURSE-PATIENT RELATIONSHIP: 4. Note the type of restraint used.
1. Communication skills 5. Note the time and duration.
2. Mental mechanism 6. Check the patient every 15 min.
3. Adaptation styles 7. Check every 2 hrs. for continued needs.
4. Coping strategies 8. Offer fluid every hour.
5. Therapeutic intervention skills. 9. Exercise patient’s limb every 2 hrs.
10. Snacks and meals are offered to the patient.
B. PSYCHOPHARMACOLOGY: 11. Assist the patient to the comfort room.
1. Therapeutic and the toxic effect.
2. Drug used during pregnancy. TYPES OF PSYCHIATRIC ADMISSION:
3. Drug used with the elderly. 1. Voluntary- the patient or guardian request for
4. Drug’s side effects. treatment and willingly signed an application
5. Patient health teaching. for treatment.

C. MILIEU MANAGEMENT: 2. Involuntary- the patient refuses to sign consent

1. Safety and is involuntarily detained for
2. Structure treatment.
3. Norms
4. Setting limits TYPES OF INVOLUNTARY TREATMENT:
5. Balance between independence and
dependence 6. Environmental modification. 1. Emergency- the patient is admitted because he is
dangerous to others and to himself.
MOST COMMON ADOPTED PATIENT RIGHTS: 2. Temporary- the patient is involuntarily hospitalized for
a maximum of 6 months.
1. Right to treatment using the least restrictive 3. Extended- the patient is admitted with unspecified
alternative environment. period of time.
2. Right to confidentiality of records.
3. Right to freedom from restraints and
seclusion. MEMBERS OF THE MENTAL HEALTH CARE TEAM:
4. Right to give or refuse consent to treatment.  The health care team consists of health care
5. Right to access to personal belongings. professionals who have their own specialties:
6. Right to daily exercise.
7. Right to have visitors. 1. Psychiatric nurse- a registered nurse that gives
8. Right to use of writing materials and comprehensive care to the patient.
uncensored mail.
9. Right to use of telephone. 2. Psychiatrist- a physician is the leader of the
10. Right to access courts and attorneys. team, ordering the medication and
11. Right to employment compensation. making the medical diagnosis.
12. Right to be informed of rights.
13. Right to refuse ECT or psychosurgery. 3. Clinical psychologist- a person involve in
diagnosing and treating an emotionally
RESTRAINING: person. They use a complex device to assist
them in diagnosing a patient. Which is
 It is a direct application of physical force to a called the “Rorschach test” that consist of 10
person with or without their permission with the pictures of ink blots,5 black and white, 3 black
use of a mechanical device to control their physical and red, 2 multi-coloured.
activity.
4. Psychiatric social worker- a person skilled in
assessing a family, environment, and
SECLUSION: social factor that can contribute to the
 It is an involuntary confinement or isolation of a dysfunctional behavior of the individual and
person. the family.
They plan and implement follow up care for the
patient.
 5. Activity therapist- a skilled nurse who provides Setting limits – limitations in the ward
activities to a specific patient to assess
their behavior. Balance – independent and dependent
behavior
ROLES AND FUNCTIONS OF THE NURSE: Modification – physical features of the ward
1. A creator of a therapeutic environment Norms – client’s behavior
2. A socializing agent
3. A counselor
4. A teacher
B. Medication: Therapeutic effect
5. A surrogate
Side effects
6. A therapist
7. Technical nursing role Health teaching

NURSE’S RESPONSIBILITY:
C. Therapeutic N-P relationship
 The nurse caring for a mentally ill patient is Communication skills
expected to know and anticipate the various types
of hazards which may develop as a result of the Coping strategies
individual patient’s mental status. The nurse can Therapeutic intervention
be held liable if, in the opinion of the court, the
nurse was negligent in providing protection and
care constituting prevention against the Triad of Needs:
development of any situation injurious to the
A. Physical – nutrition, clothing, shelter, exercise
patient. Suicide attempts as well as accidental
and protection from body harm.
injuries, occurring in the hospital.
B. Psychological – love, trust and affection.
Duty to warn: To inform health care team of any harm the C. Social – feeling of being a member of a group
patient might do/plan. and feeling of being valued member of a
family.

SELF AWARENESS:

 It is the process by which the nurse gains

recognition of his own feelings, beliefs, and
attitudes.
 The nurse must learn to accept the differences
among people and view the patient as a
worthwhile person regardless of his opinion or
lifestyle.
 Self-awareness can be accomplished through
reflection, spending time focusing on how one
feels, their values and beliefs.
 The nurse needs to discover himself, what he
believes in before trying to help others with
different views. As a student nurse make sure
personal feelings and beliefs do not interfere with
or hinder the client’s care.
 As a psychiatric nurse you need to be prepared to
make positive use of your own personality, your
primary tool as you work therapeutically with
clients.

Psychotherapeutic therapeutic management in the

continuity of patient care.

A. Environment:
Safe – avoid danger/harm

Structure – settings and ward schedules