Psychiatric-Mental Health Nursing Notes

Objectives
  • Review normal psychological stages of human development.
  • Explore brain anatomy, physiology, pathophysiology, and pharmacology.
  • Discuss concepts focusing on:
    • Therapeutic communication
    • Stress and defense mechanisms
    • Substance use disorder
    • Dementia and delirium
  • Discuss medical and nursing management of patients with altered thought processes.
Therapeutic Communication
  • Definition: The purposeful use of communication to build and maintain helping relationships with clients and their families.
  • Purpose:
    • Elicit and attend to the client’s thoughts, feelings, and needs.
    • Express empathy and genuine concern.
    • Obtain information and provide feedback on the client's condition.
    • Intervene to promote functional behavior and relationships.
    • Evaluate client’s progress towards goals.
Essential Components
  • Time
  • Active listening
  • Caring attitude
  • Honesty and truth
  • Empathy
  • Non-judgmental attitude
Effective Communication Skills
  • Silence: Allows time for reflection.
  • Active Listening: Involves understanding and providing feedback.
  • Offering General Leads: Encourages continued conversation.
  • Showing Acceptance: Acknowledges the nurse’s interest without judgment.
  • Focusing: Helps the client concentrate on important topics.
  • Giving Information: Provides necessary details for decision-making.
  • Presenting Reality: Helps dispel inaccurate beliefs.
  • Summarizing: Highlights key points to reinforce understanding.
  • Offering Self: Indicates a willingness to spend time with the client.
  • Touch: Communicates caring and comfort (where appropriate).
Questions
  • Open-ended questions: Encourage spontaneous responses.
  • Closed-ended questions: Gather specific data.
  • Projective questions: Help explore feelings with hypothetical scenarios.
  • Clarifying techniques:
    • Restating: Uses the client’s exact words.
    • Reflecting: Focuses back on the client’s feelings.
    • Paraphrasing: Restates the client’s feelings for confirmation.
Barriers to Effective Communication
  • Irrelevant personal questions
  • Providing personal opinions
  • Giving unnecessary advice
  • Offering false reassurance
  • Minimizing feelings
  • Changing the topic abruptly
  • Asking “Why” questions
  • Excessive questioning
  • Giving approval or disapproval
Stress and Defense Mechanisms
  • Stress: A result of perceived threats impacting a person's well-being.
  • Defense Mechanisms: Strategies to cope with stressors; can be adaptive or maladaptive.
    • Adaptive mechanisms: Help in achieving goals and reducing anxiety.
    • Maladaptive mechanisms: Interfere with functioning and relationships.
Types of Defense Mechanisms
  • Altruism: Reaching out to others reduces anxiety.
  • Sublimation: Acceptable expression of unacceptable feelings.
  • Suppression: Voluntarily denying unpleasant thoughts.
  • Repression: Unconsciously forgetting unacceptable ideas.
  • Regression: Childlike behaviors when facing stress.
  • Displacement: Shifting feelings to a less threatening target.
  • Reaction Formation: Converting impulses into opposite behaviors.
  • Rationalization: Providing acceptable explanations for unacceptable actions.
  • Dissociation: Temporarily blocking out uncomfortable aspects.
  • Denial: Refusing to accept reality.
Mental Status Exam
  • Appearance, Attitude, and Behavior: Observation includes grooming, eye contact, motor behavior, and speech.
  • Mood and Affect:
    • Mood: Subjective report of emotion.
    • Affect: Objective emotional expression.
  • Perceptual Disturbances: Assessment for hallucinations.
  • Thought Form and Content: Organization and nature of thoughts assessed (e.g., delusions).
  • Cognition and Sensorium: Orientation, concentration, and memory evaluation.
Neurophysiology
  • Neurotransmitters: Chemical messengers involved in neuron signaling.
  • Criteria for NTs:
    1. Present in the neuron.
    2. Synthesized or uptake by neurons.
    3. Stimulus-dependent release.
    4. Action on post-synaptic neurons.
    5. Mechanism for removal.
Psychopharmacology & Pathology
  • Neurotransmitter Effects:
    • Acetylcholine: Involved in memory and muscle contractions.
    • Norepinephrine: Affects mood and alertness.
    • Dopamine: Influences pleasure and satiety.
    • Serotonin: Regulates mood and reduces pain perception.
    • GABA: Primarily inhibitory, affects sleep and anxiety levels.
Substance Use Disorder Definitions
  • Addiction: Persistent use despite adverse consequences.
  • Abuse: Deviant use from social norms.
  • Dependence: Physical need for substance resulting in withdrawal.
  • Withdrawal: Cluster of signs when stopping the substance use.
  • Tolerance: Decreased effects requiring larger doses to achieve the same effect.
  • Dual Diagnosis: Co-occurrence of substance use disorder and mood disorder.
  • Screening Tools: CAGE questionnaire, AUDIT, CIWA-Ar, COWS.
Delirium vs. Dementia
  • Delirium: Sudden onset, usually reversible, fluctuation in symptoms.
  • Dementia: Gradual decline, structural brain changes, generally irreversible.
Nursing Management for Delirium and Dementia
  • Cognitive Support: Maintain a structured environment, avoid harmful drugs, and ensure adequate nutrition.
  • Medication: Cholinesterase inhibitors, NMDA receptor antagonists, SSRIs for comorbid depression.
Restraints
  • Definition: Physical methods to limit movement; used as a last resort.
  • Criteria: Client must pose a threat to self or others; less restrictive measures have failed.