Mental Health Mental Health Nursing IINursing II

NURS 2310NURS 2310

Unit IIUnit II

Growth and Growth and Development in Development in Mental HealthMental Health

Objective 1Objective 1

Reviewing Maslow’s Hierarchy of Needs

Objective 2Objective 2

Exploring the concepts and theories associated with personality development

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 individual’s manner of reacting to the environment, and ultimately his or her developmental progression.

Psychoanalytic TheoryPsychoanalytic TheoryFreud believed an individual’s basic

character isformed by the age of 5, and includes thesecomponents: Id

– Instinctual drives Ego

– Mediator Superego

– Ego Ideal internalized value system

– Consciousness

Theory of Psychosocial Theory of Psychosocial DevelopmentDevelopment

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

Objective 3Objective 3

Reviewing Erikson’s Stages of Development

Stage 1Stage 1Trust vs. MistrustTrust 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

Stage 2Stage 2Autonomy vs. Shame and Autonomy vs. Shame and

DoubtDoubt 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

Stage 3Stage 3Initiative vs. GuiltInitiative 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

Stage 4Stage 4Industry vs. InferiorityIndustry 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

Stage 5Stage 5Identity vs. Role ConfusionIdentity 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 one’s role in life

Stage 6Stage 6Intimacy vs. IsolationIntimacy 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

Stage 7Stage 7Generativity vs. StagnationGenerativity 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

Stage 8Stage 8Integrity vs. DespairIntegrity vs. Despair

Age: 65 years and older Major Task: View one’s 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

Objective 4Objective 4

Recalling the majorfunctions controlled byvarious areas of the brain

CerebrumCerebrum 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

DiencephalonDiencephalon

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

MesencephalonMesencephalon – integration of reflexes (visual, auditory,

righting)

PonsPons – respiration – skeletal muscle tone

MedullaMedulla – regulates heart rate, blood pressure, and respiration – swallowing, sneezing, coughing,

vomiting reflexes

CerebellumCerebellum – involuntary movement, such as the

coordination/maintenance of posture

NeurotransmittersNeurotransmitters – essential functions of human emotion

and behavior

– many psychotropics work here – categories of neurotransmitters include

cholinergics, monoamines, amino acids, and neuropeptides

Neurotransmitters (cont’d)Neurotransmitters (cont’d)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

Neurotransmitters (cont’d)Neurotransmitters (cont’d)Amino Acids Gamma-aminobutyric acid (GABA)

– decreased levels in anxiety and movement disorders

– Huntington’s disease, epilepsy Glutamate

– decreased receptor activity can induce psychotic behavior

Neuropeptides Somatostatin

– low concentrations in Alzheimer’s disease

Autonomic Nervous SystemAutonomic 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

Objective 5Objective 5

Reviewing diagnostic procedures used to detect altered brain function

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

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

Objective 6Objective 6

Discussing commonly used physiological and

psychological tests utilized in evaluating the function of the

brain

Physiological TestsPhysiological Tests

Basic Metabolic Profile (BMP)– electrolytes– glucose

Complete Blood Chemistry (CBC)

Thyroid Panel

Urinalysis

Mental Status Examination Mental Status Examination (MSE)(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

Objective 7Objective 7

Reviewing the steps of the nursing process in the

psychiatric/mental health setting

The Nursing Process:

Provides a systematic framework for the delivery of nursing care

Consists of six steps

Uses a problem-solving approach

Accepted as nursing’s scientific methodology

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

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.

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 client’s progress toward the attainment of expected outcomes and the effectiveness of nursing care.

In the psychiatric/mental health setting –

Nursing care is always goal-directed Nursing diagnoses are prioritized

according to life-threatening potential– Maslow’s Hierarchy of Needs– Concept mapping

Documentation– SOAP notes– SBAR charting– DAR (data/action/response)

Objective 8Objective 8

Describing the nurse’s role in psychiatric evaluation

Assessment Observation

– Thought processes– Behaviors

1:1– Mood scale– Subjective data

Diagnosis (NANDA)Evaluation Documentation Treatment planning

Objective 9Objective 9

Examining documentation practices of the

psychiatric/mental health nurse

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 = nurse’s 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

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 client’s

response to any part of the medical or nursing care

_____________________________________ Assessment = observations about the

client Intervention = nursing actions that

address the observations Response = client’s response to actions

Objective 10Objective 10

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

Defining the DSM-VDefining 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

Relevance to Nursing PracticeRelevance 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