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MENTAL HEALTH NURSING Susan Hench, RN, MS Nursing 101

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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  1. MENTAL HEALTH NURSING Susan Hench, RN, MSNursing 101

  2. 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


  4. History Snapshots • http://www.youtube.com/watch?v=IjGG9ObRQg4

  5. 16TH to18th Century • Europe • Dr. Phillippe Pinel • William Turk • Colonial America

  6. 19th Century • Europe • Sigmund Freud, MD • Id, ego and superego • America • Benjamin Rush, MD • Dorothea Dix

  7. 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”

  8. 20TH Century • Hildegard Peplau • Nursing Involvement

  9. A Review of “The Self”

  10. 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

  11. 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”

  12. 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

  13. 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

  14. Self Concept • Consists of - • Body image • Ideal self • Self-esteem • Role performance • Assigned or ascribed • Assumed • Personal identity

  15. Body Image • The mental picture of one’s body • How you think you look to others

  16. Self Image/ Self Ideal • Not self-concept • Two components • Idealized • Committed

  17. 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

  18. 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.

  19. 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.

  20. Influences on Mental Health

  21. Culture • Pattern of learned behavior • Based on values, beliefs and perceptions of the world

  22. An individual’s idea about mental health and mental illness is based on cultural values and understanding • What may be considered “normal” or “abnormal” depends on the specific cultural viewpoint

  23. 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

  24. 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

  25. Homelessness • Economic conditions • Abuse • Poor parenting • Although not causes of mental illness, all increase stress and thus threaten mental health.

  26. 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.

  27. 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.

  28. 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.

  29. So ..... What makes a person mentally healthy?

  30. Theories of Cause and Associated Treatments • Neurobiologic (Nature) • versus • Psychosocial (Nurture) • Probably a little of each

  31. Neurobiologic Theories Neurotransmitters Brain Development Genetics and Heredity Stress and the Immune Response Infection

  32. 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

  33. Basic Neurotransmission Carries messages from one neuron to the next

  34. 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

  35. So if brain chemicals are abnormal, we can improve or fix them with medications. Right?

  36. Psychoactive Medications Breakthrough with thorazine Therapeutic levels Require long term therapy

  37. Antipsychotics Zyprexa Seroquel Risperdal Haldol Abilify Geodon Clozaril Invega

  38. Antipsychotic Side Effects Anticholinergic Effects Sedation Blood Dyscrasias Photosensitivity Decreased Sexual Drive

  39. 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

  40. Treatment of EPS Anticholinergics Artane Cogentin Antihistamines Benadryl

  41. Antipsychotic Side Effects Neuroleptic Malignant Syndrome LIFE THREATENING REACTION

  42. Treatment of NMS • Early recognition and discontinuation of offending medication • Supportive measures such as cooling blankets, ice packs, stabilization of vital signs, supplemental oxygen

  43. 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

  44. Mood Stabilizers/ Antimanics Lithium carbonate Tegretol/carbamazepine Klonopin/clonazepam Depakote/Depakene/ valproic acid Neurontin/gabapentin Calan/verapamil Lamictal/lamotrigine

  45. Side Effects Of Mood Stabilizers Restlessness Tachycardia Constipation Decreased Sweating Loss Of Taste

  46. 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

  47. Lithium Special considerations Toxicity Sodium depletion Dehydration Diuretics

  48. Antidepressants Serotonin Reuptake Inhibitors (SSRIs) Monoamine Oxidase Inhibitors (MAOs) Tricyclic Antidepressants (TCAs)

  49. General Characteristics No effect on normal mood Minimal physical dependence Delayed response relationship Usually given at HS

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