MENTAL HEALTH NURSING Susan Hench, RN, MS Nursing 101. Causes – what do you think?. Emotional weakness Bad parenting The client’s fault, he or she can make it go away Incurable Consequence of sinful behavior Brain malfunction. PRECONCEIVED NOTIONS/IDEAS ABOUT MENTAL HEALTH.
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MENTAL HEALTH NURSING Susan Hench, RN, MS Nursing 101
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Causes – what do you think? • Emotional weakness • Bad parenting • The client’s fault, he or she can make it go away • Incurable • Consequence of sinful behavior • Brain malfunction
16TH to18th Century • Europe • Dr. Phillippe Pinel • William Turk • Colonial America
19th Century • Europe • Sigmund Freud, MD • Id, ego and superego • America • Benjamin Rush, MD • Dorothea Dix
The Asylum Building Era • A calm retreat in the country • “Moral” treatment • Patients were to heal themselves • Chains were forbidden • Emphasis on exercise and employment • Patients were “guests” rather than “inmates”
20TH Century • Hildegard Peplau • Nursing Involvement
The Self System • Awareness - how you see yourself, how you see others • Emotion – affective – do you anger easily, do you cry easily • Thought – cognitive – the processes you go through in thinking
The Self System(Continued) • Behavior – how you behave – are you shy, outgoing – verbal and nonverbal components • Body • Begins forming at birth and continues to grow and change across the entire life span • Manifested as “personality”
Influences in the Development of the Self-System • Remember the developmental theorists like Maslow, Erickson, Freud and Jung • Environment – city, country, mansion, ghetto • Family – birth order, size of family, make-up of family • Culture, religion, socioeconomic status • Values • Patient History Important
Self Concept • An organized group of thoughts we have about our personal traits • Who we think we are • How we think we relate to others • How we see our significance
Self Concept • Consists of - • Body image • Ideal self • Self-esteem • Role performance • Assigned or ascribed • Assumed • Personal identity
Body Image • The mental picture of one’s body • How you think you look to others
Self Image/ Self Ideal • Not self-concept • Two components • Idealized • Committed
Self Esteem • An aspect of self-concept • Can be positive or negative • It reflects self-judgment • Individuals with mental illness typically have low self-esteem
Developing a positive body image is important to adolescents. Nurses can promote a positive body image by teaching adolescents the “three As,” which include all the following except • a. accept yourself for what you are • b. attention: feed, rest and exercise your body based on the cues it gives you • c. apprehension or alarm: be able to recognize when your body is getting too fat • d. appreciation: enjoy your body for the pleasure and safety it provides.
The patient most likely to have a distorted body image is one with • a. a congenital defect resulting in facial disfigurement. • b. a traumatic injury during adolescence resulting in facial disfigurement. • c. a congenital defect resulting in abdominal disfigurement. • d. a traumatic injury during infancy resulting in disfigurement of the legs.
Religiosity and Spirituality • Part of one’s culture but not THE culture • Spirituality is the belief in a higher power of some sort • Religion is a type of worship of that higher power • Impact values and beliefs
Values and Beliefs • Set of personal ideas about what is meaningful and significant in life • General guidelines for behavior • Standards of conduct followed by some people or groups of people
Homelessness • Economic conditions • Abuse • Poor parenting • Although not causes of mental illness, all increase stress and thus threaten mental health.
The spiritual selves of nurses and patients • a. must be based in the belief in a god who is involved in every aspect of daily life. • b. are shaped solely by a belief in an impersonal energy or life force that permeates the universe. • c. are individualized and strive for meaning as a universal phenomenon. • d. are shaped solely by a belief that people control their own destiny.
A client admitted to the unit is Buddhist. Most of the nurses assigned to care for him know nothing about Buddhism and question to what extent spirituality concerns should be recognized in clients. Which of the following is the appropriate nursing approach to this situation? • a. The subject of spirituality should be avoided because it reflects psychotic symptoms in many cases. • b. Healthcare providers frequently have difficulty with their own spiritual issues, therefore, religious issues should be avoided. • c. Nursing should involve holistic care and this includes providing support for a client’s spirituality. • d. The respect the client gives to Buddha may be ignored since it is not God that is being worshipped.
A nurse who is culturally sensitive would do one of the following: • A. Use therapeutic communication to try to change a client’s values. • B. Evaluate his/her own values to determine biases and stereotypes. • C. Jump to conclusions. • D. Approach each client with questions about his/her motives.
Neurobiologic Theories Neurotransmitters Brain Development Genetics and Heredity Stress and the Immune Response Infection
Psychosocial Theories • Psychoanalytic • Use of defense mechanisms • Interpersonal Theory • Therapeutic relationships • Humanistic • Unmet needs in the hierarchy • Behavioralist • Conditioning with positive or negative feedback/reinforcement
Abnormal Neurotransmission Depression Changes in the chemical serotonin or norepinephrine may result in depression Psychotic behavior Changes in dopamine or GABA may result in psychotic behavior
Antipsychotic Side Effects Anticholinergic Effects Sedation Blood Dyscrasias Photosensitivity Decreased Sexual Drive
Antipsychotic Side Effects Extrapyramidal Symptoms (EPS) Pseudoparkinsonism Dystonia Akathisia Akinesia Tardive Dyskinesia Late reaction – after being on meds for months to years, multiple meds, or switching meds
Treatment of EPS Anticholinergics Artane Cogentin Antihistamines Benadryl
Treatment of NMS • Early recognition and discontinuation of offending medication • Supportive measures such as cooling blankets, ice packs, stabilization of vital signs, supplemental oxygen
Nursing Considerations For Antipsychotic Meds Establish baseline vitals Monitor for side effects Monitor bowel function Treat uncomfortable side effects such as dry mouth Patient and family teaching
General Nursing Consideration For Mood Stabilizers Monitor bowel function Monitor vital signs – especially HR & BP Monitor mental status – may get clouding of sensorium Monitor I & O – may develop kidney problems
Lithium Special considerations Toxicity Sodium depletion Dehydration Diuretics
