Mental Health Nursing II NURS 2310

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Mental Health Nursing IINURS 2310

• Unit II
• Growth and Development in Mental Health

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Objective 1

• Reviewing Maslows Hierarchy of Needs

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(No Transcript)
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Objective 2

• Exploring the concepts and theories associated
  with personality development

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• Personality The combination of character,
  behavioral, temperamental, emotional, and mental
  traits that is unique to each specific
  individual.
• Temperament Inborn personality characteristics
  that influence an individuals manner of reacting
  to the environment, and ultimately his or her
  developmental progression.

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Psychoanalytic Theory

• Freud believed an individuals basic character is
• formed by the age of 5, and includes these
• components
• Id
• Instinctual drives
• Ego
• Mediator
• Superego
• Ego Ideal
• internalized value system
• Consciousness

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Theory of Psychosocial Development

• Erikson studied the influence of social processes
  on the development of the personality
• Individuals struggle with developmental crises
  throughout the life cycle
• Specific tasks in each stage must be completed
  for emotional growth to occur

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Objective 3

• Reviewing Eriksons Stages of Development

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Stage 1Trust vs. Mistrust

• Age Birth to 18 months
• Major Task Develop a sense of trust in others
• Mastery Trust in people and the environment
• Characteristics Social attachment
• Concerns Emotional dissatisfaction,
  suspiciousness, difficulty with interpersonal
  relationships

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Stage 2Autonomy vs. Shame and Doubt

• Age 18 months to 3 years
• Major Task Learn self-control
• Mastery Pride in self
• Characteristics Self-control, language
  development, fantasy play
• Concerns Lack of self-confidence, lack of pride
  in the ability to perform, a sense of being
  controlled by others, rage against self

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Stage 3Initiative vs. Guilt

• Age 3 to 6 years
• Major Task Initiate spontaneous activities
• Mastery Able to initiate activities and enjoy
  learning
• Characteristics Early moral development,
  self-esteem, group play, egocentrism
• Concerns Feelings of inadequacy and guilt,
  accepting of liability in situations for which
  individual is not responsible

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Stage 4Industry vs. Inferiority

• Age 6 to 12 years
• Major Task Develop necessary social skills
• Mastery Acquire skills for, and develop
  competence in, work
• Characteristics Friendship, skill learning,
  self-evaluation, team play
• Concerns Difficulty in interpersonal
  relationships caused by feelings of inadequacy

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Stage 5Identity vs. Role Confusion

• Age 12 to 20 years
• Major Task Integrate childhood experiences into
  a personal identity
• Mastery Strong group identity, readiness to plan
  for the future
• Characteristics Physical maturation, sexual
  relationships, membership in peer group
• Concerns Self-consciousness, doubt, and
  confusion about ones role in life

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Stage 6Intimacy vs. Isolation

• Age 20 to 30 years
• Major Task Develop commitments to others and to
  a career
• Mastery Form close relationships and share with
  others
• Characteristics Stable relationships,
  childbearing, work
• Concerns Withdrawal, social isolation, inability
  to form lasting relationships

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Stage 7Generativity vs. Stagnation

• Age 30 to 65 years
• Major Task Establish a family and become
  productive
• Mastery Nurturing children or helping the next
  generation in other ways
• Characteristics Nurturing of close
  relationships, managing career/household
• Concerns Lack of concern for the welfare of
  others, total preoccupation with self

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Stage 8Integrity vs. Despair

• Age 65 years and older
• Major Task View ones life as meaningful and
  fulfilling
• Mastery Sense of fulfillment about life, sense
  of unity with self and others
• Characteristics Promote intellectual vigor,
  redirect energy to new roles and activities
• Concerns Self-contempt and disgust with how life
  has progressed

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Objective 4

• Recalling the major
• functions controlled by
• various areas of the brain

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Cerebrum

• Frontal lobes
• voluntary body movement
• movements that control speaking, thinking, and
  judgment formation
• Parietal lobes
• perception interpretation of most sensory
  information
• touch, pain, taste, and body position
• Temporal lobes
• auditory functions
• short-term memory
• Occipital lobes
• visual reception and interpretation

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Diencephalon

• Thalamus
• integrates all sensory input except smell
• Hypothalamus
• regulates the pituitary gland
• regulates appetite and temperature
• Limbic system
• associated with fear, anxiety, anger, aggression,
  love, joy, hope, sexuality, and social behavior

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Mesencephalon

• integration of reflexes (visual, auditory,
• righting)
• Pons
• respiration
• skeletal muscle tone
• Medulla
• regulates heart rate, blood pressure, and
• respiration
• swallowing, sneezing, coughing, vomiting
• reflexes

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Cerebellum

• involuntary movement, such as the
• coordination/maintenance of posture
• Neurotransmitters
• essential functions of human emotion and
• behavior
• many psychotropics work here
• categories of neurotransmitters include
• cholinergics, monoamines, amino acids,
• and neuropeptides

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Neurotransmitters (contd)

• Cholinergics
• Acetylcholine
• 1st chemical to be identified as neurotransmitter
• involved in disorders of motor behavior and
  memory
• Monoamines
• Norepinephrine
• fight-or-flight syndrome
• Dopamine
• physical activation of the body
• Serotonin
• levels dictate heightened or lowered sense of
  arousal

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Neurotransmitters (contd)

• Amino Acids
• Gamma-aminobutyric acid (GABA)
• decreased levels in anxiety and movement
  disorders
• Huntingtons disease, epilepsy
• Glutamate
• decreased receptor activity can induce psychotic
  behavior
• Neuropeptides
• Somatostatin
• low concentrations in Alzheimers disease

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Autonomic Nervous System

• Sympathetic nervous system
• dominant during stressful situations
• fight-or-flight response
• increases cardiac and respiratory activity, and
  decreases GI functioning
• involves acetylcholine and norephinephrine
• Parasympathetic nervous system
• dominant in the nonstressful or relaxed state
• promotes efficient GI functioning
• maintains heart and respirations at resting rate
• involves acetylcholine

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Objective 5

• Reviewing diagnostic procedures used to detect
  altered brain function

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• Electroencephalography (EEG)
• measures brain electrical activity
• detects dysrhythmias, asymmetries, and
  suppression of brain rhythms
• epilepsy, metabolic disorder, degenerative
  disease
• Computed tomographic (CT) scan
• measures accuracy of brain structure
• identifies anatomical differences
• schizophrenia, organic mental disorders, bipolar
  disorder

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• Magnetic resonance imaging (MRI)
• measures anatomical and biochemical status of
  various segments of the brain
• detects changes in myelination
• schizophrenia
• Positron emission tomography (PET)
• measures specific brain activity and functioning
• identifies problems with blood flow, oxygen
  utilization, glucose metabolism, and
  neurotransmitter/receptor interaction

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Objective 6

• Discussing commonly used physiological and
  psychological tests utilized in evaluating the
  function of the brain

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Physiological Tests

• Basic Metabolic Profile (BMP)
• electrolytes
• glucose
• Complete Blood Chemistry (CBC)
• Thyroid Panel
• Urinalysis

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Mental Status Examination (MSE)

• Describes all areas of mental functioning
• Appearance
• Mood and affect
• Speech and language
• Thought content
• Perceptual disturbances
• Insight and judgment
• Sensorium
• Memory and attention
• General intellectual level

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Objective 7

• Reviewing the steps of the nursing process in the
  psychiatric/mental health setting

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• The Nursing Process
• Provides a systematic framework for the delivery
  of nursing care
• Consists of six steps
• Uses a problem-solving approach
• Accepted as nursings scientific methodology

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• Assessment a systematic, dynamic process by
  which the nurse, through interaction with the
  client, significant others, and health care
  providers, collects and analyzes data about the
  client.
• Data may include the following dimensions
• -- Physical -- Psychological
• -- Sociocultural -- Spiritual
• -- Functional Abilities -- Cognitive
• -- Developmental -- Economic
• -- Lifestyle

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• Diagnosis clinical judgments about individual,
  family, or community responses to actual or
  potential health problems and/or life processes.
• A nursing diagnosis provides the basis for
  selection of nursing interventions to achieve
  outcomes for which the nurse is accountable.
• Outcome Identification measurable, expected,
  patient-focused goals that translate into
  observable behaviors.

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• Planning developed by the nurse and negotiated
  among the patient, nurse, family, and health care
  team prescribes evidence-based interventions to
  attain expected outcomes.
• Implementation putting in place interventions
  identified in the plan of care.
• Evaluation the process of determining both the
  clients progress toward the attainment of
  expected outcomes and the effectiveness of
  nursing care.

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• In the psychiatric/mental health setting
• Nursing care is always goal-directed
• Nursing diagnoses are prioritized according to
  life-threatening potential
• Maslows Hierarchy of Needs
• Concept mapping
• Documentation
• SOAP notes
• SBAR charting
• DAR (data/action/response)

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Objective 8

• Describing the nurses role in psychiatric
  evaluation

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• Assessment
• Observation
• Thought processes
• Behaviors
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• Mood scale
• Subjective data
• Diagnosis (NANDA)
• Evaluation
• Documentation
• Treatment planning

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Objective 9

• Examining documentation practices of the
  psychiatric/mental health nurse

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• Problem-oriented recording (SOAPIE)
• Subjective data information gathered from what
  the client, family, or other source has said or
  reported
• Objective data information gathered by direct
  observation
• Assessment nurses interpretation of the
  subjective and objective data
• Plan actions/treatment to be carried out
• Intervention nursing actions actually carried
  out
• Evaluation assessment of the problem following
  nursing interventions

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• Focus charting (DAR and AIR)
• Data information that supports the focus or
  describes pertinent observations
• Action nursing actions that address the focus
• Response description of clients response to
  any part of the medical or nursing care
• _____________________________________
• Assessment observations about the client
• Intervention nursing actions that address the
  observations
• Response clients response to actions

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Objective 10

• Defining the DSM-IV-TR and identifying its
  relevance to psychiatric nursing practice

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Defining the DSM-V

• The DSM-V is a handbook for mental health
  professionals that lists different categories of
  mental disorders and the criteria for diagnosing
  them
• The manual has been revised six times since its
  inception
• Organizes each psychiatric diagnosis according to
  different aspects of a specific disorder or
  disability

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Relevance to Nursing Practice

• Provides uniformity and consistency in
  psychiatric diagnoses
• Groups diagnoses by characteristics according to
  specific criteria
• Allows health care team to provide treatment
  based on diagnostic classification
• Used by the nurse to organize patient care and
  determine appropriate priority psychiatric
  nursing diagnosis