PSYCHIATRIC NURSING 3.

Working: longest face, achieving goals,

sharing facts, resolve the problem
4. Termination: moving towards
independence, if goals are met; observe for
Nurse-Client Relationship ( 2 way process)
regressive behavior (going back to previous
“series of interaction between the nurse and the behavior)
client” (continuous and consistent)
THERAPEUTIC COMMUNICATION
GOAL: positive behavioral change
- Dynamic process of exchanging information
Q1: When does the therapeutic relationsgip begin - -verbal and non-verbal techniques
 orientation
THERACOM ELEMENTS:
Q2: The only tool available for the nurse  SELF
(Self-awareness) Sender/Encoder: Source of the message
Message: information transmitted
Receiver: recipient of the message
ELEMENTS OF THERAPEUTIC RELATIONSHIP Feedback: receiver’s response
***Barriers: factors that can inhibit the communication
Remember T.R.U.S.T process
T- rust
R- apport NON-VERBAL TECHNIQUES:

U-nconditional positive regard (accept client for Proxemics: Physical space between the nurse and
who they are) the client (3-6 ft/one and half arm)
S- et limitations Kinetics: body movements (gestures, facial
expressions, mannerisms)
T- herapeutic use of self (theracom)
Touch: Intimate physical contact ( have consent )
Q3: When is trust established?  when the
touch conveys empathy and concern
patient start sharing
Silence: conveys interest, agreeing, encourages the
patient to talk
THERAPEUTIC BEHEVIORS
Paralanguage: voice quality, (tone, inflection) how
1. Genuineness: sincerity and honesty the message is conveyed
2. Concreteness: ability to identify client’s
feeling (sensitive)
3. Respect: consideration of patient as a VERBAL TECHNIQUES
unique being
-therapeutic, appropriate, simple, concise,
PHASES OF THERAPEUTIC RELATIONSHIP adaptive, credible
1. Pre-interaction/Pre-orientation: no contact 1. Offering self: let me sit here with you for 5 mins
with client; data  secondary sources (check for the information is SMART)
(chart), SELF-AWARENESS 2. Active listening: (ex: yes, ah huh)
2. Orientation/interaction: Contact with the
client; Establish TRUST, assess client, 3. Exploring: (ex: you said hanna was the best, can
establish mutual agreement (informing you describe her?)
termination)  avoid false reassurance
4. Broad openings: (ex: where would you like to Nurse: PR: I know that the voices seems real to
begin?) opportunity to open up the topic you, but there are no voices here
5. Making observation: I noticed that you comb
your hair today; makes the client feel that you are
really concern SPHERES:
6. Summarizing: (ex: in the past 15 mins we have 1. Id - pleasure principle (anti-social personality
talked about) disorder)

7. Seeking clarification: (ex: Do you mean..) Don’t 2. Ego - SANITY

assume 3. Superego - conscience, ego ideal (Obsessive
Use when there is illusion (with stimuli) and compulsive personality disorder)
hallucinations (w/o stimuli)
8. Encouraging description of perception: with DEFENSE MECHANISM:
stimuli (visual, auditory (most dangerous) , tactile,
gustatory (taste) ) 1. Repression: unconsciously forgetting (di sadya).
(Traumatic experience)
9. Presenting reality: without stimuli
2. Suppression: consciously forgetting (sinasadya)
10. Reflecting: the patient must answer their own
(Traumatic incidence)
problems (ex:aalis na ko sa trabaho, nurse:sa tingin
mo gagaan ba ang loob mo pag umalis ka ng 3. Reaction formation: plastik (iba yung sinasabi sa
trabaho) nararamdaman) BIPOLAR Disorder - Mask of
depression
11. Restating: Rephrasing
4. Projection: blaming others, exact replica of other
Pt: I am down Nurse: Are you depressed? Pt: I feel
people (nawala na yung sariling pagkatao mo) (If
blue Nurse: Are you sad?
idolization-features lang yung kinopya mo)
12: General leads: (ex: tell me more, go on, and
5. Introjection: blaming yourself
then)
6. Rationalization: making excuses
13. Focusing: Let us look at it more closely
7. Identification: idolization/certain features your
going to copy
NON-THERAPEUTIC COMMUNICATION: (to avoid)
8. Compensation: weak on one aspect and strong
1. Giving advice on other aspect

2. Talking about self (patient centered) 9. Denial: Unacceptance of the truth

3. Telling the client is wrong (arouses dispute) 10. Displacement: channeling of your anxiety
(diversion) (ex: pinagalitan ka, nagdabog ka)
4. False reassurance
11. Regression: going back to previous
5. Asking “why questions” it demands answers developmental stage (ex: iniwan, di na naalagaan
(challenge the patient) —>arouses deep seated yung sarili)
feelings (EXCEPTION: suicidal patients)
12. Undoing: hugas kamay (relieve your guilt
Pt: I am hearing voices feeling) (ex: may kabit; bumabait sa asawa)
Nurse: EDP: What are the voices telling you?
13. Conversion: anxiety becomes physical Negativism: “NO” as answer
symptoms (kinakabahan ka, sumasakit yung tyan Circumstantiality: beating around the bush “paligoy-
mo) ligoy” (with an answer)
Tangentiality: beating around the bush (w/o answer)
14. Intellectualization: reasoning out; (detailed and Stilted words: flowery words
with references) Flight of Ideas: slightly related (pangit yung pagkakabuo
a. lack of emotions in delivering message ng idea may meaning
15. Substitution: unavailable gagawin mong  available Loose associations: without meaning, not related at all
(LDR – humanap ng iba) Preservation: going back to the same topic over and
16. Sublimation: unacceptable gagaiwn mong over
acceptable (gusto manigarilyo sa school  nagcandy Echolalia: parrot like imitation
nalang) Palilalia: stereotyped words/ last syllable (table, ble,
ble)
Verbigeration: repetition of the same words over and
STAGES OF DEATH ( D.A.B.D.A) over
Coprolalia: copro (feces) lalia (logic/speech) talk shit
Denial: Unacceptance of the truth curse everyone
Anger: project/introject Neologism: creation of new words
Bargaining: making unrealistic offers Blocking: sudden cessation of thought (mental block”
Depression: Dangerous stage (hopless, unworthy, Word Salad: Mixture of unrelated words
xajbunmotivated)  suicidal Clang association: rhyming
Acceptance: moving forward
DISTURBANCES IN PERCEPTION:
CRISIS:
Delusions: fixed false belief
1. Maturational/ Developmental: Magical thinking: believing in magic
predictable/expected Paranoia: extreme suspiciousness
(marriage, graduation, monthly bills) Religiosity: obsession to religious ideas
2. Situational: unpredictable/unexpected Phobia: irrational fear
(ex: Accidents) Obsession: repetitive thought
3. Adventitious/Social: acts of God/ calamities, Compulsion: reactive actions
hideous crimes (rape abuse, abortion) Preoccupation: idea with intense desire
Thought broadcasting: others know what I am thinking
Delusions of reference: talk of the town/ main character
DISTURBANCES in APPEARANCE

- Automatisms: repeated purposeless behaviors AFFECT: expression/emotions

(problem in neurotransmitter)
- Tics: nerve problems 1. Inappropriate: incongruent (common to pts
- Mannerism: Muscle memory with schizophrenia)
- Psychomotor retardation: slowed movements 2. Blunted: little response
(depression) 3. Restricted affect: display one type of expression
- Waxed flexibility: maintenance of an awkward 4. Labile mood: unpredictable (mood swing)
posturte (retain position) 5. Apathy: absence of emotion
- Catatonia: maintenance of an awkward 6. Ambivalence: presence of “two opposing
posturte (bumabalik sa dating position feelings”
) 7. Anhedonia: absence of pleasure
- Echopraxia: purposeless imitation (mirror like) 8. Euphoria: “high” extreme pleasure, elated
-
DISTURBANCES IN COMMUNICATION
Mutism: act of being mute
STRESS: SIGNS AND SYMPTOMS
 palpitations  trigger SNS response
1. Stage I – ALARM REACTION: Determine that  chest pain
there is stress  headache
2. Stage II – STAGE OF RESISTANCE: Utilize all  insomnia
resources in able for you to solve the problem
 should be “PROBLEM SOLVED” MANAGEMENT
3. Stage III – STAGE OF EXHAUSTION: Utilize all  assist in problem solving
of your resources but the problem is not solved  teach coping behaviors (assess the past
coping mechanism)
ANXIETY (unknown) vs FEAR (known)  DOC: Benzodiazepines(Anxiolytics)
“pam/lam”
-------------LEVELS OF ANXIETY----------------
a. Mild: highest form of thinking (good
anxiety), increase concentration, increase PANIC DISORDER:
alertness
Target  Problem solving approach -recurrent and unpredicitable
-panic attacks
b. Moderate: Decrease attention span,  Trembling
selective inattentiveness (hati na yung isip)  Racing heart (tachycardia)
Target  promote relaxation techniques  Chest pain
(ex: DBE), encourage verbalization of feeling  DOB
Medications: Benzodiazepines (anxiolytics)  Choking
 Numbness
c. Severe: loud and rapid speech, difficulty of
focusing even with assistance, distorted MANAGEMENT:
perception
- Assist in problem solving
Medications: Benzodiazepines
- Teach coping behaviors
Target  Remain with the client
DOC: Benzodiazepines
*** if with addiction to benzo – antihistamines
d. Panic: Suicidal attempts, fixed eyes, (sedative effect; drowsiness)
hysterical/mute, incoherence (decrease OTHER MEDS: Beta-blockers: olol -> blocks
your stimuli) adrenergic receptors
Target  stay with the client (assist in MAOI,s and SSRI = balances neurotransmitters
relaxation breathing -> decrease anxiety
PAPER BAG: Hyperventilation
ACUTE STRESS DISORDER
GENERALIZED ANXIETY DISORDER -s/sx after 2 days -> 4 weeks only (1 month)
(G.A.D)
MANAGEMENT
- “Worry worm”, pacing -progressive review of the trauma
- No apparent reason  to have acceptance
- At least 6 months DOC: Benzodiazepines
- No phobias, no panic attacks, no OC
Manifestations
 POST TRAUMATIC STRESS DISORDER OBSSESIVE COMPULSIVE DISORDER

- s/sx are more than 4 weeks (1 month) -obsession: persistent thoughts

- Recurrent FLASHBACKS (intrusive thoughts) -compulsion: persistent actions
- Re-experiencing trauma
Defense Mechanism: Displacement MANAGEMENT:
*Aversion Therapy: Inflict punishment (set limits)
SIGNS AND SYMPTOMS DOC: SSRI’s
-Start with general numbing  somatic symptoms -give time for ritualistic behaviors unless dangerous
(bodily) -establish limits
 Irritable -diversional activities; SLRC
 Aggressiveness Set limits, Reality, Consistency
 Depression  suicidal
 Anger MANIA: hyperactive, not intact with reality (with
 Social withdrawal illusion, delusions)
HYPOMANIA: Hyperactive, no illusions, delusions
NORMAL
MANAGEMENT:
HYPODEPRESSION: depressed (not suicidal)
Assist in gaining control over angry impulses
MAJOR DEPRESSION: depressed with suicidal ideas
DOC: SSRI
DOC (acute attacks): Benzodiazepines
***if addiction: Anti-histamines BIPOLAR I: Mania to major depression
BIPOLAR II: Hypomania to major depression
PHOBIC DISORDER MANIC DISORDER: Mania to Hypomania
MAJOR DEPRESSIVE DISORDER:
Hypodepression to major depression
- Fear is unreasonable proportion to the
-depressed (suicidal)
actual danger
CYCLOTHYMIA (bipolar like disorder):
Three (3) Main types Hypomania and Hypodepression
-Hyperactive and depressed
1. Agoraphobia: fear of open public places DYSTHYMIA (Minor depression)
-always stay near exits Hypodepression only (not suicidal)

2. Social Phobia: fear of socialization, MAJOR DEPRESSION BIPOLAR DISORDER

conversing with others
-Overdepedence or -Mask of depression
3. Simple phobia: Specific types loss Defense Mechanism:
-Defense mechanism: “Reaction formation”
“Introjection”
-----MANAGEMENT----- SIGNS AND
-Systemic desensitization: gradual exposure to the -SIGNS AND SYMPTOMS:
feared object SYMPTOMS (Negative  Hyperactivity
-Flooding: sudden exposure S/Sx)  Manipulative
-Thought stopping (diversion)- rubber band  Inattentive
-Guided imagery: (conditioning) *Anhedonia
*Psychomotor ATTITUDE THERAPY:
retardation Matter of fact
-Attitude therapy: Kind -Breaking leaves
 firmness -Modeling clay
ACTIVITY: Counting, - Walkinh DOC: ANTIPSYCHOTICS (decrease dopamine) 
Writing leads to pseudoparkinsonism
THERAPY:
THERAPY: Group Solitary therapy: EXTRAPYRAMIDAL EFFECTS:
therapy (non- individual therapy  Dystonia
competitive way) -Non-competitive  Tardive dyskinesia (protruded tongue)
 If with EPS  Give Anticholinergics
WOF: Suicide (Priority *Fingerfoods ANTI-CHOLINERGIC MEDICATIONS
 safety)  Akineton
 Logentin
SCHIZOPHRENIA: Increase dopamine  Artane
 Benadryl
SIGNS AND SYMPTOMS: CATATONIC: Abnormal NMS (Neuroleptic Malignant Syndrome)
motor behavior - Fatal/Life threatening
 Waxy flexibility - Wide BP fluctuations – “STOP and NOTIFY”
 Mutism
 Negativism

Defense Mechanism:  Repression (di nya maalala
yung pagkatao nya

Nursing diagnosis: Impaired motor activity

- Maintain circulation (PROM exercises)
- Prioritize nutrition

2. DISORGANIZED: Bizarre behaviors

SIGNS AND SYMPTOMS: Regression

Nursing Diagnosis: Impaired social functioning

MANAGEMENT: ADL Assistance

4. PARANOID SCHIZOPHRENIA
Suspiciousness/delusions of reference

SIGN AND SYMPTOMS:

 Delusions
 Hallucinations
 Flight of Ideas
Defense Mechanism: Projection

Nursing Diagnosis: Potential for injury directed to

self and others

MANAGEMENT: Nutrition; allow them to open

their own food