Mental Health part 1

• Unconscious refusal to see reality
• *usually first defense learned and used

• Unconscious burying or forgetting
• A step deeper than denial

• Out of body experience
• Painful events or situations are separated or dissociated.

Substituting acceptable reasons for the true causes for personal behavior bc the truth is too threatening

Making up for something a person perceives as an inadequacy by developing some other desirable trait

Similar to compensation except the person usually develops the opposite trait

• Emotionally returning to an earlier time in life when there was far less stress.
• *commonly seen in hospitalized patients

Unacceptable traits or characteristics are diverted into acceptable traits or characteristics

Attributing feelings or impulses unacceptable to oneself to others.

• The “kick the dog syndrome”
• Transferring anger and hostility to another person or object that is perceived to be less powerful.

• Makes amends for behavior one thinks is unacceptable.
• Makes an attempt at reducing guilt.

Emotion that is separated from the original feeling

• Anxiety is channeled into physical symptoms.
• *symptoms disappear when threat is over.

Unconsciously staying away from events or situations that might open feelings of aggression or anxiety.

Blaming others

• “Not me”
• Refuses to believe that death is coming.

• “Why me?”
• Expresses envy, resentment and frustration with younger people and/or those who are not dying.

• “If I could have one more chance”
• May become very religious or good in an effort to gain another chance at life or more time

• Realizes that bargaining isn’t working and death is approaching
• Becomes depressed, weepy, May give up , quits taking medications, quits eating, and so forth

• “Ok... but I don’t have to like it”
• Enters a state of expectation; may begin to call family members near, needs to complete unfinished business.
• Prepared spiritually to die.

• Physiological needs
• Safety and security
• Love and belonging
• Self esteem
• Self- actualization

Food, water, air, sleep, exercise, elimination, shelter and sex.

Avoiding harm, maintaining comfort, structure, physical safety,freedom from fear, and protection.

Giving and receiving affection, companionship, satisfactory interpersonal relationships and identification with a group.

Individual seeks self respect and respect from others. Works to achieve success and recognition in work and desires prestige from accomplishments

Individual possesses a feeling of self fulfillment and the realization of his or her highest potential

• Part of the personality that is concerned with the gratification of self.
• Wants to fulfill primal urges for food, sex, power, and entertainment.

• The balance to ID
• Keeps ID under control.
• “ you go to a party instead of studying (Id response) then later feel a gnawing feeling that you should really study (ego response)”
• *checks and balance.

• Could be considered the conscious
• Part is the personality that allows people to determine what is right, wrong, good and bad.
• Is not chosen or learned.

• Birth-2 yr
• Uses senses to learn about self.
• Senses and motor skills = sensorimotor

• 2-7/8yrs
• Thinks in mental imagines, symbolic play, egocentrism-only sees own point of view.

• 8-12yrs
• Able to logically think
• Moral judgement develops
• Numbers and spatial ability become more logical

• Birth-18mo
• Nurturing builds trust in newborns
• “Sensory stage”

• 1-3yr
• “No!” Phase
• Toddler learns environment can be manipulated
• (Muscular stage)

• 3-6 yrs
• Child learns assertiveness.
• Disapproval leads to guilt in toddlers
• (Locomotor stage)

• 6-12 yrs
• Creativity or shyness develops
• (Latency)

• 12-20yrs
• Individual integrates life experiences or becomes confused
• (Adolescences)

• 18-25yrs
• Main concern is developing intimate relationships with another.
• (Young adult)

• 21-45yrs
• Focus on establishing family and guiding the next generation
• (Adulthood)

• 45yrs-death
• Individual accepts own life as fulfilling if not he/she becomes fearful of death
• (Maturity)

• Birth-18mo
• Use mouth and tongue to deal with anxiety

• 18mo-3yrs
• Muscle control in bladder, rectum and anus provides sensual pleasure and parent pleasing. Toilet training can be a crisis

• 3-6 yrs
• Learns sexual identity and awareness of genital area as a source of pleasure.
• Conflict ends as child repressed urge and identifies with same sex parent.

• 6-12
• Quiet stage in sexual development; learns to socialize

• 12yr- adulthood
• Sexual maturity and satisfactory relationships with the opposite sex.

• Not self responsible
• “You”
• Meant to harm another person
• Attempt to put responsibility on another person.
• Can be nonverbal.
• “You make me so angry when you ....”

• Self responsible
• “I” statements
• Express the speakers thoughts and feelings honestly. “I feel angry when you...”

• Establish trust and a team approach relationship
• Find out what has worked in the past
• Might use sign language, lip reading, and writing notes/having journal.

• Complications with nonverbal communication
• Be detail oriented
• Describe location of call signals and what it sounds like
• Describe where their belongings are.
• Verbalize actions like leaving a room
• May have to touch pt to guide them.
• Relate food positions on plate to a clock face.

• Picture board
• Tablet
• Written messages

Difficult if expressing written or verbal communication

Difficulty interpreting or understanding written or verbal communication

Combo of expressive and receptive aphasia

• 1. False reassurance/social cliches- “don’t worry, everything will be fine” invalidate pts concerns.
• 2. Minimizing or belittling “ we have all felt that way”
• Implies pts feelings aren’t special
• 3. Why? “Why did you...”
• Connotes disapproval and displeasure. Abrasive probing.
• 4.advising “you should....” “if I were you I would.....”
• Sets stage for expectations that the pt may not be able to meet
• 5. Dis/Agreeing “you’re right”
• Places right or wrong on the action and imposes nurses opinions or values.
• 6. Close ended questions
• “Do you smoke”
• Discouraged further discussion
• 7.providing the answer
• “Was the food good?”
• Combo of closed ended question and a solution. Discourages pts from providing their own answer.
• 8. Changing the subject
• Pt :”When can I go home?”
• Nurse:” the weather is nice today “
• Discounts pts need to explore personal thoughts and feelings. Shuts them down. Maybe a reflection of discomfort for the nurse.
• 9.approving or disapproving
• “That’s a great way to think about it!”
• Be can judgmental and set pt up for failure if the dis/approval fails to help.

• 1. Reflecting, repeating, parroting.
• Encourages exploring the meaning but can be irritating it over used
• 2. Clarifying terms
• Encourages pt to restate the comment and provide more information.
• 3.open ended questions
• Encourages pts to express needs in their own terms
• 4. Asking for what you need and want (from pt)
• States purpose of interaction and keeps speaker assertive and self responsible.
• 5.identifying feelings and thoughts
• Helps pt to identify and label thoughts and emotions. May provide insight to concerns and complications of healing.
• 6. Using empathy
• Acknowledged patients feelings. Keeps nursing in position of control and helpfulness
• 7. Silence
• Shows the nurse is comfortable and willing to hear more. Allows for collection of thoughts.
• 8. Giving information (pt teaching)-
• Increases rapport, eases pts anxiety, confirms HCP has given provider information, suggests collaboration
• 9. Using general leads “go on...”
• Pt Feels valued and listened to
• 10. Stating implied thought and feelings
• “You’re not smiling today, is something bothering you?”
• Let’s pt know you pay attention, identifies specific behavior or change in behavior which lowers chance of pt denying it.

It dictates the acceptable scope of nursing practice for the different levels of nursing.

• People became clients who were purchasing services from HCP.
• Looked to protect vulnerable groups.

Cns

Dopamine receptors

Psychotic behavior

Serotonin and dopamine

• Dry mouth, constipation, uti misty retention
• Sedation
• Orthostatic hypotension
• EPS- akathisia, Parkinsonism effects (muscle rigidity, muscle spasm, stiff gait, mask like face. )
• Tardive dyskinesia- tongue protrusion, lip smacking, puckering, chewing.

Typical Antipsychotic

Photosensitivity

Typical Antipsychotic

• Long acting
• Monthly injections
• Deconate injection.

0.5-1.2

Depakote

• Less eps and lower risk of tardive dyskinesia
• Prolongation of the QT interval may occur (light headedness, palpitations, or n/v. Repeat ekg. )

• Angranulocytosis
• Monitor CBC

Lithium, Prozac, tregretol, and depakote.

Atavan

Dry mouth, constipation, urinary retention,Sedation, orthostatic hypo, sexual dysfunctions.

Insomnia/activation, sexual dysfunction, gi effects

• Orthostatic hypotension
• Requires strict diet.

Smokers

Carbamazepine

Manic bipolar/depression