Midterm Reviewer Psychiatric

NCM_117: PSYCHIATRIC NURSING MIDTERM REVIEWER
I. PSYCHOPHARMACOLOGY
Neurotransmitters include:
Central Nervous System
Dopamine - control of complex
❖ Brain
movements, motivation, cognition,
o Cerebrum
regulation of emotional responses.
o Cerebellum
➢ Low dopamine means inability
o Brain stem
to control movements as result:
o Limbic system
tremors, chafing walk
❖ Nerves that control voluntary acts
DISORDER: PARKINSON’S D.
(neurotransmitters)
➢ High dopamine means
Cerebrum uncontrollable movement as
❖ Two hemispheres result: nakakakita ka antii ng
❖ Four lobes: bagay ng wala naman at
o Frontal lobe nakakarinig ka antii, delusion.
o Parietal lobe DISORDER: SCHIZOPRENIA
o Temporal lobe
o Occipital lobe Norepinephrine - attention,
learning, memory, sleep,
Neurotransmitters wakefulness, mood regulation.
❖ Chemical substances
manufactured in the neuron to aid Epinephrine - flight-or-fight
in transmission of information. response.
❖ Either inhibitory or excitatory ➢ Excitatory ang epinephrine
accla so INCREASE ang VS ng
patient mo.
➢ Emergency hormone also
called adrenaline.
➢ HIGH BP, RR, PR
Serotonin - food intake, sleep,
wakefulness, temperature
regulation, pain control, sexual
behaviors, regulation of emotions.
➢ Serotonin is inhibitory If you
have low serotonin then
depress ka antiii huhu
➢ DISORDER: MAJOR DEPRESSION
(Insomnia/hypersomnia)
➢ TRYPTOPHAN - protein
abundant in milk, precursor of
serotonin (the body converts
the tryptophan into serotonin).
Histamine - alertness, control of
gastric secretions, cardiac
stimulation, peripheral allergic
responses)
1|TICMAN, KATHLEN JOY E .

➢ H1 - ALLERGIC RESPONSE ❖ Half-life

➢ H2 - GASTRIC SECRETION ❖ Role of the FDA
(ranitidine) ❖ Off-label use - drug may be
Acetylcholine - sleep and effective for treating a disease
wakefulness cycle, signals muscles different from one involved in
to become alert original testing
Glutamate - an excitatory amino ❖ Black box warning - serious or life-
acid threatening side effects.
GABA Gamma Amino-Butyric Acid Principles of Psychopharmacology
- modulates other neurotransmitters Effect on target symptoms
➢ GABA is inhibitory Adequate dosage for sufficient
time
Sample Question #1
Lowest effective dose
Is the following statement true or false?
Lower doses for older adults
• The cerebellum consists of four
Tapering rather than abrupt
lobes. (FALSE) cessation to avoid rebound,
recurrence of symptoms, or
Causes of Mental Illness
withdrawal
❖ Genetics and heredity: play a role but
Follow-up care
alone do not account for
Simple regimen to increase
development of mental illness
compliance
❖ Psychoimmunology: a compromised
immune system could contribute, MAJOR
especially in at-risk populations TRANQUILIZERS/ANTIPSYCHOTICS
❖ Infections, particularly viruses, may Examples:
play a role 1. Haloperidol (Haldol)
2. Chlorpromazine (Thorazine)
Nurse’s Role in Research and 3. Clozapine (Clozaril)
Education 4. Olanzapine (Zyprexa)
1. Ensure all clients and families are
well informed
2. Help distinguish between facts and
hypotheses
3. Explain if or how new research may
affect client’s treatment or
prognosis
4. Provide information and answer
questions.
Psychopharmacology
❖ Psychotropic drugs ANTI-PARKINSONIAN AGENTS
❖ Efficacy - maximal therapeutic
effect
❖ Potency - amount of drug needed
for maximum effect

Monoamine Oxidase Inhibitors

(MAOI)
Antidepressants
Examples:
1. Tranylcypromine (Parnate)
2. Isocarboxazid (Marplan)
3. Phenelzine (Nardil)
MINOR TRANQUILIZERS/
ANXIOLYTICS
anxiety disorders
Examples:
1. Diazepam (Valium)
2. Oxazepam (Serax)
3. Chlordiazepoxide (Librium)
4. Aprazolam (Zanax)
Selective Serotonin Reuptake
Inhibitor (SSRI)
Examples:
1. Prozac
2. Zoloft
3. Paxil
TRICYCLIC ANTIDEPRESSANTS
(TCA)
Examples:
1. Imipramine (Tofranil)
2. Amitriptyline (Elavil)

LITHIUM CARBONATE DISULFIRAM

(ANTABUSE)

II. NURSE - PATIENT RELATIONSHIP
Nurse-patient relationship? Major task: identification and

Series of interaction between the resolution of the patient’s
nurse and the patient in which the problems
nurse assist the patient to attain
positive behavioral change.
D. Termination Phase
Major task: to assist the patient to
Characteristics of the nurse-patient review what he has learned and
relationship: transfer his learning to his
It is goal directed, focused on the relationship with others
needs of the patient, planned, time Evaluation
limited and professional.
When to terminate NPR?
Elements of a therapeutic nurse- ✓ When goals have been
patient relationship: accomplished
Trust ✓ When the patient is emotionally
Rapport stable
Unconditional positive regard ✓ When the patient exhibits greater
Setting limits independence
Therapeutic communication ✓ When the patient is able to cope
Phases of NPR with anxiety, separation, fear and
loss
A. Pre-interaction Phase
Begins when the nurse is assigned How to terminate?
to a patient ❖ Gradually decrease interaction
Major task of nurse: to develop time
self-awareness ❖ Focus on future oriented topics
Data gathering, planning for first ❖ Encourage expression of feelings
interaction ❖ Make the necessary referral
B. Orientation Phase Common Problems Affecting NPR

Begins when the nurse and the Transference – the development
patient interacts for the first time of an emotional attitude of the
Parameters of the relationship are patient either positive or negative
laid towards the nurse (pt to nurse).
Major task of the nurse: Establish Countertranference –
rapport, develop trust, transference as experienced by
assessment the nurse (nurse to pt.)
Resistance – development of
C. Working Phase ambivalent feelings towards self-
The longest and most productive exploration.
phase of the NPR.

III. THERAPEUTIC COMMUNICATION
Communication • Public (12–25 ft)

• Exchange of information ✓ Therapeutic communication: most
• Verbal comfortable when nurse and
❖ Content: literal words spoken patient are 3 to 6 ft apart
❖ Context: environment,
TOUCH
circumstances, situation in
Five types:
which communication occurs
1. functional/professional – used in
• Nonverbal
examinations or procedures such
❖ Process: all messages used to
as when the nurse touches a client
give meaning, context to
to assess skin.
message
2. social–polite – used in greeting,
❖ Congruent or incongruent
such as shake hands and air
messages.
kisses/flying kiss.
Therapeutic Communication 3. friendship–warmth – hugs in
• Interpersonal interactions; focus on greeting, backslapping to greet,
client’s needs and akbay.
• Need for privacy 4. love–intimacy – tight hugs and
• Encompasses goals that facilitate kisses between lovers or relatives.
the nursing process 5. sexual–arousal – used by lovers.
• Needed to effectively meet the
• Comforting and supportive when
standards of client care
welcome and permitted
Goals of Therapeutic Communication • Can be possible invasion of intimate
1. Establish therapeutic nurse–client and personal space
relationship • The nurse must evaluate use of touch
2. Identify the most important based on the client’s preferences,
client’s concerns; assess client’s history, and needs.
perceptions o Nurse may find touch
3. Facilitate client’s expression of supportive, but the client may
emotions not.
4. Teach client and family the
Active listening (concentrating
necessary self-care skills
exclusively on what patient says)
5. Recognize client’s needs
Active observation (watching
6. Implement interventions to
nonverbal actions as speaker
address client’s needs
communicates)
7. Guide client toward acceptable
These help the nurse to:
solutions
✓ Recognize the most important issue
PROXEMICS ✓ Know what questions to ask
- Distance zones ✓ Use therapeutic communication
• Intimate (0–18 in) techniques
• Personal (18–36 in) ✓ Prevent jumping to conclusions
• Social (4–12 ft) ✓ Objectively respond to message

Verbal Communication Skills

• Need for concrete, not abstract,
messages
• Concrete messages – words are
explicit and need no interpretation –
the speaker uses noun instead of
pronouns.
• Abstract messages – unclear
patterns of words.
Techniques in Therapeutic
Communication

• Some promote discussion of feelings

or concerns in more depth
• Other techniques useful in focusing
or clarifying what is being said
• Feedback via making an
observation or presenting reality
Avoidance of Nontherapeutic
Techniques
Nonverbal Communication Skills
• Interpretation of signals or cues
• Facial expression
• Overt (clear, direct statements)
1. Expressive – portrays the
• Covert (vague, indirect messages)
person’s moment-by-moment
thoughts, feelings, and needs.
May be evident even when the
person does not want to reveal
their emotions.
2. Impassive – frozen into an
emotionless deadpan
expression similar to a mask.
3. Confusing – opposite of what
the person wants to convey.
Verbally expressing sad or angry
feelings while smiling.
• Body language – gestures, postures,
movements, body positions.
1. Closed body position – such as
crossed legs or arms folded
across the chest, it indicates
that the interaction might
threaten the listener who is
defensive or not accepting.

2. Open posture – sit facing the Cultural Considerations

client with both feet are on the • Cultural assessment
floor, knees parallel, hands at • Use of a translator who can retain
the side of the body and legs original intent without inserting
uncrossed or crossed only at the biases
ankle. It demonstrates • Nurse must understand
unconditional positive regards, differences in how various
trust care, and acceptance. cultures communicate.
• Vocal cues – nonverbal sound
signals transmitted along with the Therapeutic Communication Session
content; voice volume, tone, pitch, Goals:
intensity, emphasis, speed, and ✓ Establishing rapport
pauses. ✓ Actively listening
• Eye contact – looking into the other ✓ Gaining in-depth understanding
person’s eye during of client’s perception of issue
communication, is used to assess ✓ Being empathetic
other person and the environment ✓ Exploring client’s thoughts and
and to indicate whose turn to feelings
speak. It increases during listening ✓ Facilitating client’s expression of
and decreases during while thoughts and feelings
speaking. ✓ Guiding client in developing
• Silence – or long pauses, may problem-solving skills
indicate many different things, the ✓ Promoting client’s evaluation of
client may be depressed or solutions
struggling to find energy to talk. Initiation of session
• Introduction
Understanding Meaning, Context, & • Establishment of contract for
Spirituality of Communication relationship
Meaning: messages often contain more • Identification of major concern
meaning than just spoken word. ❖ Nondirective role (broad
Context openings, open-ended
• Validation with client findings from questions)
verbal and nonverbal information ❖ Directive role (direct yes-or-no
• Assessment focuses on who, what, questions; usually for clients
when, how, and why with suicidal thoughts, in crisis,
Spirituality or who are out of touch with
• Self-awareness of own spiritual reality)
beliefs Open-ended versus yes-or-no
• Need for objectivity and questions
nonjudgmental attitude about Proper phrasing of questions
client’s beliefs • Using “think” versus “feel”
Active listening skills, asking many
open-ended questions, building on
client’s responses

Techniques include clarification and Broken record technique

placing an event in time or Rehearsing responses
sequence.
Asking for clarification Community-Based Care
Addressing client’s avoidance of • Nurses increasingly caring for high-
anxiety-producing topic risk clients in homes; families
Guiding the client in problem-solving becoming more responsible for
and change primary prevention
• Help the client explore possibilities • Therapeutic communication
• Client’s participation is key. techniques and skills are essential
• Avoid inserting own beliefs for caring for patients in the
community.
Assertive Communication • Increased self-awareness,
Expression of positive and negative knowledge needed about cultural
feelings/ideas in an open, honest, differences; sensitivity to beliefs,
direct way behaviors, feelings of others
• Calm, specific, factual • Collaboration with client and family
statements as well as other health care
• Focus on “I” statements providers.
Possible responses:
Self-Awareness Issues
• Nonverbal communication: as
important as verbal
• Awareness of own communication
is the first step toward improving
communication.
✓ Ask for feedback from
colleagues.
✓ Examine own communication
skills.
10 | T I C M A N , K A T H L E N J O Y E .
IV. ANGER, HOSTILITY, & AGGRESSION

Anger • Hwa-Byung
- a normal human emotion. • Bouffée délirante
- a strong, uncomfortable, • Amok
emotional response to a
Treatments
provocation, either real or
Focus on treating underlying/comorbid
perceived.
psychiatric diagnosis
- Results when a person is hurt,
❖ Lithium: bipolar disorder, conduct
frustrated, hurt, or afraid.
disorders, intellectual disability
Hostility ❖ Carbamazepine or valproate:
- also called as verbal aggression. dementia, psychosis, personality
- is an emotion expressed through disorders
verbal abuse, lack of ❖ Atypical antipsychotics:
cooperation, violation of rules or dementia, brain injury,
norms, or threatening behavior. intellectual disability, personality
disorders.
Physical Aggression
❖ Benzodiazepines: dementia
- behavior in which a person
❖ Haloperidol and lorazepam:
attacks or injuries another person
decrease agitation or aggression
or destroys property.
and psychotic symptoms
Hostility and Aggression
- are inappropriate expressions of Plan of Care for a Client: Aggressive
anger. Behavior
Etiology of Hostility and Aggression
❖ Neurobiologic theories: decreased
serotonin, increased dopamine and
norepinephrine; structural damage
to limbic system, damage to frontal
or temporal lobes
❖ Psychosocial theories: failure to
develop impulse control and ability
to delay gratification.
• Impulse Control – ability to
delay gratification.
Cultural Considerations
❖ Cultural views/values affect
expression of anger.
❖ Ethnic or minority status can play a
role in diagnosis and
❖ treatment of psychiatric illness.
❖ Some culture-bound syndromes
involving aggressive, agitated, or
violent behavior.
Application of the Nursing Process

Data Analysis
❖ Common nursing diagnoses:
✓ Risk for other-directed violence
✓ Ineffective coping
❖ Outcome identification: Client will:
1. Not harm self or threaten others
2. Refrain from intimidating/
frightening behaviors
3. Describe feelings and concerns
without aggression
4. Comply with treatment
Intervention
- Interventions are most effective
and least restrictive when
implemented early in the cycle
of aggression.
❖ Managing the milieu/environment
includes:
✓ Having planned activities;
informal discussions.
✓ Scheduled one-to-one
interactions; letting clients know
what to expect
✓ Helping clients with conflicts to
solve their problems, including
expression of angry feelings
❖ Managing aggressive behavior
includes:
TRIGGERING PHASE
✓ Approach in nonthreatening,
calm manner
✓ Convey empathy
✓ Listen
✓ Encourage verbal expression of
feelings/deep breathing
✓ Suggest going to a quieter area,
or use of PRN medications
✓ Physical activity such as walking
ESCALATION PHASE
✓ Take control
✓ Provide directions in firm, calm
voice
✓ Direct client to room or quiet ✓ Calm discussion of behavior; no

area for time out lecturing or chastising; return to
✓ Offer medication again activities, groups, and so forth
✓ Let client know aggression is ✓ Focus is on appropriate
unacceptable and nurse or staff expression of feelings, resolution
will help maintain/regain control of problems or conflicts in
if needed/ stand by staff nonaggressive manner.
✓ If ineffective to that point, obtain
assistance from other staff (show Evaluation
of force) to get client to take ❖ Care is most effective when anger
time out or take medication- 6 defused in an earlier stage.
staff. ❖ Goal is to teach angry, hostile,
CRISIS PHASE potentially aggressive clients to
✓ Staff must take control of situation express feelings verbally and safely
as determined by facility or without threats or harm to others or
agency policy (trained in destruction of property.
techniques for behavioral
management) Workplace Hostility
• Four to six trained staff ❖ Sentinel event alert concerning
members are needed. intimidating and disruptive
✓ Use restraint or seclusion only if behaviors (The Joint Commission
necessary- consent, 24, 15-30 on Accreditation of Healthcare
• Inform client that behavior is Organizations [JCAHO], 2008)
out of control and staff is ❖ Overt actions: verbal outbursts,
taking measures for safety. physical threats
RECOVERY PHASE ❖ Passive activities: refusing to
As client regains control: perform assigned tasks,
✓ Talk about the situation or trigger uncooperative attitude
✓ Help client relax or sleep ❖ Occurrence of disruptive and
✓ Explore alternatives to aggressive intimidating behaviors
behavior ❖ In 2016, the JCAHO added
✓ Provide documentation of any workplace bullying.
injuries
✓ Debriefing ❖ New standards of leadership
✓ Encourage other clients to talk ✓ Code of conduct defining
about feelings acceptable and
• Do not discuss aggressive inappropriate, unacceptable
client in detail with other behaviors
clients ✓ Process for managing
disruptive/unacceptable
POSTCRISIS PHASE behavior
✓ Client is removed from any ✓ Education on expected
restraint or seclusion and rejoins professional behavior
the milieu
✓ Zero tolerance = all are held ❖ Studies on client assaults of staff in

accountable community
❖ Assaults by clients in community
Community-Based Care
residences.
❖ Effective management of comorbid
conditions Self-Awareness Issues
✓ Regular follow-up appointments ❖ Be aware of own management of
✓ Compliance with prescribed anger.
medication ❖ Practice and gain experience in
✓ Participation in community restraint/seclusion before using.
support programs ❖ Be calm, nonjudgmental, and
❖ Anger management groups help nonpunitive.
clients express their feelings and to ❖ Learn from watching experienced
learn problem-solving and conflict- nurses to deal with hostile or
resolution techniques. aggressive clients.
V. ABUSE & VIOLENCE
Clinical Picture of Abuse & Violence role modeling and social

Abuse: wrongful use and maltreatment learning.
of another
❖ Perpetrator typically someone the Cultural Considerations
person knows ✓ Domestic violence spanning
❖ Victims across life span: spouses, families of all ages and from all
partners, children, elderly parents ethnic, racial, religious,
Types of injuries socioeconomic, and sexual
1. Physical orientation backgrounds.
2. Psychological ✓ Battered immigrant women at
particular risk
Characteristics of a Violent Families
❖ Face legal, social, and
- Family violence: spouse
economic problems different
battering; neglect and physical,
from the U.S. citizens
emotional, or sexual abuse of
children; elder abuse; marital
Battered Wife Syndrome
rape
- cycle of domestic violence
1. Social Isolation
characterized by wife beating
- members of these families keep
by the husband, humiliation and
to themselves and usually do not
other forms of aggression
invite others into the home or tell
- Low-Self Esteem - most common
anyone what is happening.
trait of abusive men
2. Abuse of Power & Control
- a member who is abusive always Characteristics of an Abusive Husbands:
holds a position of power and 1. They usually came from violent
control over the victim. families
- abuser exerts not only physical 2. They are immature, dependent,
power but also economic and non-assertive
social control. 3. They have strong feelings of
3. Alcohol and other Drug Abuse inadequacy.
- substance abuse Phases of BWS
- a person who is abusive is also 1. Tension Building Phase- involves
likely to use alcohol or other minor battering incidents
drugs. 2. Acute Battering Incident- more
- alcohol is one of the factor in serious form of battering
acquaintance rape or date 3. Aftermath/Honeymoon stage-
rape. the husband becomes loving
4. Intergenerational Transmission and gives wife hope
Process Priority in the Care of the Battered Wife
- shows that patterns of violence ✓ Provision of Shelter
are perpetuated from one
generation to the next through
Intimate Partner Violence Assessment

- Mistreatment or misuse of one ➢ Victims do not commonly seek
person by another in context of direct help for abuse.
emotionally intimate relationship. ➢ Some may be seeking treatment
- Rates higher among women for other conditions.
- Increased rates during ✓ Ask all clients if they feel safe
pregnancy ✓ Ask questions about safety
- Domestic violence occurs in
same-sex relationships with same
statistical frequency.
• Victims have fewer
protections.
1. Psychological Abuse (emotional
abuse
- name-calling, belittling,
screaming, yelling, destroying
property, making threats as well
as subtler forms, such as refusing
to speak to or ignoring the
victim.
2. Physical Abuse
- shoving, pushing, battering,
choking
3. Sexual
- assaults during sexual relations,
rape
- Sodomy (anal sex)
4. Cycle of Abuse and Violence
- Violent episode → honeymoon
period → tension-building phase
→ violent episode
Clinical picture
✓ Abuse often perpetrated by
Treatment and interventions
husband against wife
➢ Laws related to domestic
✓ Abuser’s view of wife as belonging
violence; arrest
to him; strong feelings of
➢ Restraining order/protection
inadequacy, low self-esteem; poor
order
problem-solving and social skills
➢ Recognition of stalking
✓ Increasing violence, abuse with any
➢ Shelters
signs of independence
➢ Individual
✓ Dependence - most common trait
psychotherapy/counseling,
of abuse women
group therapy, support and self-
help groups
➢ Treatment for PTSD 4. Inadequate parenting skills

5. Socially isolated because they
don’t trust anyone
6. Emotionally immature
7. Negative attitude towards the
management of the abused
Common Indicators of Child Abuse:
1. Serious injuries in various stages of
healing
2. Healthy hair in various length
3. Apathy
4. Depression
5. Low self-esteem
Child Abuse
- happens when an older adult
takes advantage of his authority
over a younger child.
- intentional injury or a child
1. Physical abuse or injuries
- results from unreasonably severe
corporal punishment or
unjustifiable punishments
2. Neglect or failure to prevent harm
- malicious or ignorant withholding
of physical, emotional, or
educational necessities for the
child’s well-being.
3. Failure to provide adequate
physical or emotional care or
supervision
4. Abandonment
5. Sexual Abuse
- Sexual acts on a child younger
than 18 years-old.
- Exploitation such as making, Treatment and Interventions:
promoting, or selling
✓ Child’s safety and well-being is a
pornography involving minors. priority.
6. Overt torture or maiming
✓ Psychiatric evaluation
Clinical Picture of an Abusive Parents: ✓ Therapy may be indicated over
1. Cycle of family violence: adults significant period.
raising children in same way they ✓ Approach depends on the age
were raised. of a child.
2. Frequently view children as ✓ Social services involvement
property
3. Abused also by their parents
✓ Family therapy/requirements for

parents
Elder Abuse
- Maltreatment of older adults
1. Physical, sexual, psychological
abuse
2. Neglect of self-neglect
3. Financial exploitation
4. Denial of adequate medical
treatment
- Estimated 10% of population
over age 65 abused by
caregivers.
- 60% to 65% of victims are
women.
- People who abuse elders almost
always in caretaker role or elders
depend on them in some way.
- Most cases when one older
spouse is taking care of another
- Bullying between residents in
senior living facilities
- Elders often reluctant to report
abuse
1. Want to protect family
members
2. Fear losing support
Clinical picture: variable depending on
the type of abuse
Assessment:
Treatment and Intervention:

✓ Caregiver stress relief
✓ Additional resources
✓ Possible removal of elder or
caregiver
Rape and Sexual Assault

- Perpetration of act of sexual
intercourse with person against
his or her will and without consent
• Will overcome by force, fear
of force, drugs, intoxicants
- Crime of violence and humiliation
of victim expressed through
sexual means
- Also rape if victim cannot
exercise rational judgment
- Only slight penetration necessary
- Committed by strangers (~28% of
rapes), acquaintances, married
- people, people of same sex
- Date rape (acquaintance rape)
- Highly underreported crime
- Most commonly occurs in victim’s
neighborhood, often inside or Assessment:
near home. ✓ Physical examination to preserve
- Most rapes are premeditated. evidence
- Male rape is significantly under ✓ Description of what happened
acknowledged and ✓ Rape kits, rape protocols
underreported. Treatment and Intervention:
Dynamics of Rape: ✓ Immediate support
- Generally accepted that rape is ✓ Education
not sexual crime
• Exertion of power, control,
infliction of pain or
punishment.
- Feminist theory: women
historically objects for aggression.
- Primary motivation of victim is to
stay alive.
- Severe physical and
psychological trauma
- Treatment has improved, but
many still believe a woman
provokes rape with behavior.
Common Myths:
Characteristics of a crisis state:

✓ Lasts for 4-6 weeks
✓ Individualized
✓ Person affective becomes passive
and submissive
Types of Crisis
1. Maturational/Developmental
Crisis
✓ Give control back to victim 2. Situational Crisis
✓ Prophylactic treatment for STIs, 3. Social Crisis
pregnancy
Phases of a Crisis
✓ Counseling
1. Denial - initial reaction
✓ Supportive therapy
2. Increased Tension - the person
recognizes the presence of a
Community Violence
crisis and continues to do ADL
- School violence (homicides,
suicides, theft, violent crimes) 3. Disorganization - the person is
preoccupied with the crisis and is
- Bullying
unable to do ADL
• Ostracism – ignoring and
4. Attempts to Reorganize - the
excluding a target individual,
individual mobilizes previous
has recently emerged as one
coping mechanisms
of the common and
damaging bullying. Violence
- Hazing or initiation rites - refers to the use of force
- Effects on children, young adults Neglect
- Violence on a larger scale (e.g., - lack of provision of those things
terrorism) which are necessary for the
• PTSD and depression child's growth and development
Self-Awareness Issues Physical Abuse
- abuse in the form of inflicting
✓ Be aware of own beliefs.
✓ Contain feelings of horror or pain
revulsion, focus on client’s needs. Psychological Abuse (Emotional Abuse)
- abuse in the form of insults and
• Validate the client’s feelings.
undermining one's confidence
✓ Ask all women about abuse.
✓ Help client focus on the present
CRISIS
- situation that occurs when an
individual’s habitual coping
ability becomes ineffective to
meet the demands of a situation

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NCM_117: PSYCHIATRIC NURSING MIDTERM REVIEWER

1|TICMAN, KATHLEN JOY E .

➢ H1 - ALLERGIC RESPONSE ❖ Half-life

2|TICMAN, KATHLEN JOY E .

Monoamine Oxidase Inhibitors

3|TICMAN, KATHLEN JOY E .

LITHIUM CARBONATE DISULFIRAM

4|TICMAN, KATHLEN JOY E .

II. NURSE - PATIENT RELATIONSHIP

Nurse-patient relationship? Major task: identification and

B. Orientation Phase Common Problems Affecting NPR

5|TICMAN, KATHLEN JOY E .

III. THERAPEUTIC COMMUNICATION

Communication • Public (12–25 ft)

6|TICMAN, KATHLEN JOY E .

Verbal Communication Skills

7|TICMAN, KATHLEN JOY E .

• Some promote discussion of feelings

8|TICMAN, KATHLEN JOY E .

2. Open posture – sit facing the Cultural Considerations

9|TICMAN, KATHLEN JOY E .

Techniques include clarification and Broken record technique

IV. ANGER, HOSTILITY, & AGGRESSION

Application of the Nursing Process

✓ Direct client to room or quiet ✓ Calm discussion of behavior; no

✓ Zero tolerance = all are held ❖ Studies on client assaults of staff in

V. ABUSE & VIOLENCE

Clinical Picture of Abuse & Violence role modeling and social

Intimate Partner Violence Assessment

➢ Treatment for PTSD 4. Inadequate parenting skills

✓ Family therapy/requirements for

Treatment and Intervention:

Rape and Sexual Assault

Characteristics of a crisis state:

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