Transcript Mental Health Nursing II NURS 2310

Mental Health Nursing II
NURS 2310
Unit II
Growth and
Development in Mental
Health
Objective 1
Reviewing Maslow’s Hierarchy of
Needs
Objective 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 Theory
Freud believed an individual’s 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
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
Objective 3
Reviewing Erikson’s Stages of
Development
Stage 1
Trust 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 2
Autonomy 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

Stage 3
Initiative 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 4
Industry 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 5
Identity 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 6
Intimacy 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 7
Generativity 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 8
Integrity 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 4
Recalling the major
functions controlled by
various areas of the brain
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
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
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
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
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)
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 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 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 6
Discussing commonly used
physiological and psychological
tests utilized in evaluating the
function of the brain
Physiological Tests

Basic Metabolic Profile (BMP)
– electrolytes
– glucose

Complete Blood Chemistry (CBC)

Thyroid Panel

Urinalysis
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
Objective 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
-- Physical
-- Sociocultural
-- Functional Abilities
-- Developmental
-- Lifestyle
following dimensions:
-- Psychological
-- Spiritual
-- Cognitive
-- Economic
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 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 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 10
Defining the DSM-IV-TR and
identifying its relevance to
psychiatric nursing practice
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

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
