L1: Foundations Of Psychiatric Nursing PSYCHIATRIC NURSING

HEALTH - Nursing specialty that promotes mental

health (ANA)
- State of complete physical, mental, and
social well being and not merely the
absence of disease or infirmity (WHO,
DIAGNOSTIC AND STATISTICAL MANUAL
1948)
OF MENTAL DISORDERS (DSM)
MENTAL HEALTH
- Handbook used by health care provider
- state of well-being in which the as the authoritative guide to the
individual realizes his or her own diagnosis of mental disorders.
abilities, can cope with the normal - No treatment. Diagnosis only.
stresses of life, can work productively - Common language for clinicians to
and fruitfully, and is able to make a communicate about their patients and
contribution to his or her community establishes consistent and reliable
(WHO) diagnosis.
- state of emotional, psychological, and - It was revised on 1952
social wellness evidenced by satisfying - It was changed from roman to number
interpersonal relationship, effective to be more responsive to breakthroughs
behavior, coping, positive self-concept,
and emotional stability (VIDEBECK,
2020) BENCHMARKS IN PSYCHIATRY
Mental Health Continuum A. Ancient Times
- Any sickness indicated displeasure of
- a range of states, with mental health
the Gods
and mental illness at the two extreme
- It is either Divine or Demonic
ends. Depending on the internal and
(punishment for sins and wrongdoing)
external faculties of a person at any
time, they can lie at one point of the
B. Ancient Greece
continuum and shift position as their
situation improves or deteriorates. The 4 humors of Aristotle
MENTAL ILLNESS
- Includes disorders that affect mood,
behavior, and thinking.
- All psychiatric disorders that have
definable diagnosis.
PSYCHIATRY
- Branch of medicine focused on the Pensive Unemotional
Optimistic Bad temper
diagnosis, treatment and prevention of sadness and calm
mental. Emotional, and behavioral
disorders (APA)

Michaela Katrice Macabangun, RN

 C. Early Christianity 3. term least restrictive environment
- Primitive beliefs and superstitions were involved
strong
- Blamed on demons H. Period of Community Mental Illness
- Exorcism, incarceration in dungeons, • Community Mental Health Centers Act
flogging, and starving (1963) United States of America
o Individuals do not need to be
D. Renaissance hospitalized away from family and
- Distinguished from criminals community
- Short lived period (after 100 years) o People have the right to be treated in
- Hospital of St. Mary Bethlehem (hospital their own community
for lunatics) o Advantage: intervention in familiar
surroundings has helped many
E. Period of Enlightenment people is less expensive
• Philippe Pinel of France o Disadvantages: homelessness linked
o Insane no longer treated as less than to deinstitutionalization; many people
human “slip through the cracks” of the
o Asylum movement development system
• William Tuke of England
o Human dignity upheld I. Decade of the Brain
• Congressional Mandate
F. Period of Scientific Study o If we can understand the brain we
• Sigmund Freud can help millions of people suffering
o Valued life experiences from mental disorders
o Mental illness could be studied o An increase in funding for brain
• Emil Kraepelin research; leading to new strategies
o Studied the brain o Has increased our understanding of
• Eugene Bleuler mental disorders
o Was optimistic about treatment

G. Period of Psychotropic drugs HISTORICAL DEVELOMENT OF

PSYCHIATRY (PHILIPPINES)
1944: Lithium If some mental
1950: First antipsychotic disorders are A. Pre-Spanish Regime
(chlorpromazine) caused by - World was equally material and spiritual
chemical - Relied on their belief in healer called
1952: MAOIs imbalances, then babaylan (shaman) and sorcerer healing
1953: Haloperidol chemicals could
restore the B. Spanish rule
1958: Tricyclic balance; people
antidepressants - Accepted that mental illness is caused
would no longer
by an act of sorcery performed by
1960: Benzodiazepine need to be
confined. mangkukulam or manggagaway
Results: - Sick individuals are brought to
herbolarios or to the church for exorcism
1. destigmatization of mental illness or ritual cleansing
occurred
2. parents and others not to blame

Michaela Katrice Macabangun, RN

 C. Early 19th century thinking, problem solving, clinical
- Hospicio de San Jose: place of reasoning and judgment into their
confinement for mentally ill sailors professional practice.
- Carcel de Bilibid: where the dangerous
mentally ill patients and those involved 2. Advanced practitioner- Master’s degree
in criminal acts are kept

D. American Era L2: Psychiatric Models

- 1904: Insane department of San Lazaro
Hospital Risk and Protective Factors- contributing
- 1918: City Sanitarium factors to mental health and well being (WHO)
A. Individual Factors
- Both inborn and learned that makes us
E. Japanese Occupation who we are
- National Psychopathic Hospital (patient • Genogram- graphic representation of
and employees are executed) family tree that displays detailed data on
- Japanese Imperial Army donated relationships among individuals.
electroshock apparatus Analyze hereditary patterns and
psychological factors
F. Liberation Period
- National Psychopathic Hospital changed Self-efficacy- belief that personal
into National Mental Hospital abilities and efforts affect the events in
- They helped Filipinos in rehabilitation our lives
Hardiness- the ability to resist illness
when under stress
MENTAL HEALTH STIGMA 1. Commitment: active involvement in
• Stigma- mark of shame, disgrace, or life activities
disapproval that results in an individual 2. Control: ability to make appropriate
being shamed or rejected by others decisions
3. Challenge: ability to perceive change
Public Self-stigma Label as beneficial rather than just
Stigma avoidance stressful
Publicly Negative Aviding Resilience- having healthy responses to
“marked” as stereotypes treatment or stressful circumstances or risky
being are care in order situations
mentally ill internalized not to be Resources- involves using problem
by people labelled as
solving abilities and believing that one
with mental being
illness mentally ill can cope with adverse or novel
situations
Spirituality- essence of person’s being
THE PSYCHIATRIC NURSE and is/her beliefs about the meaning of
life and the purpose of living
1. Entry level- foundational knowledge
from the biological and nursing
sciences, and they possess a range of
general medical and surgical nursing
competencies. They apply critical
Michaela Katrice Macabangun, RN
 B. Interpersonal Factors ID: pleasure seeking behavior, innate desire
- Immediate social surroundings impact
EGO: mature and adaptive behavior
personal attributes
SUPEREGO: moral and ethical concept
Sense of belonging- feeling of
connectedness with or involvement in a Human Consciousness
Conscious Subconscious
social system of which a person feels
Perceptions, Preconscious Unconscious
integral person
thoughts, and Thoughts The realm of
Social Network- group of people knows
emotions that and emotions thoughts and
with whom one feel connected exist in the not currently feeling that
Social support- essence of a person’s person’s in the motivates a
being about the meaning of life awareness person’s person even
Socio economic status- one’s income, awareness though
education, and occupation he/she is
total unaware
C. Environmental Factors of them.
- Overall environment that affects mental AWARE RECALL
health related to the political climate and
cultural considerations Freudian Slip
- slips of the tongue
Political climate- access and lack of - Not accident or coincidence
access too basic needs and - Indications of subconscious
commodities feelings that are accidently
emerge in casual convo
D. Cultural factors: Ego defense mechanism
• Communication - methods attempting to protect the
• Physical distance or shape self to cope with basic drive or
• Social organization emotionally painful thoughts,
• Time orientation feelings, or events. Operates at
• Environmental control the unconscious level of
• Biologic variations awareness. UNAWARE

1. Compensation- overachievement in
PSYCHOANALYTIC THEORIES one area because of deficiency in other
area
Sigmund Freud
2. Conversion- expression of emotional
- father of psychoanalysis conflict by a development of physical
- Claim: All human Behavior is caused symptom
and can be explained 3. Denial- failure to admit the reality
4. Displacement- ventilation of intense
Components of Personality feelings toward a person
5. Dissociation- dealing with emotional
conflict by temporary alteration in
consciousness
6. Fantasy- creation of mental images
7. Fixation- immobilization of a portion of
the personality results from
Michaela Katrice Macabangun, RN
 unsuccessful completion of task in PSYCHOSEXUAL THEORIES
development stage
• Motivation- hypothetical concept that
8. Identification- modelling actions of
stands for the underlying force impelling
influential others while searching for
behavior and giving it direction
identity
9. Intellectualization- thinking about Need Drive Goal/incentive
stressful things in a clinical way Bodily State of The objective
10. Introjection- accepting others attitude deficit uncomfortable which the
as one’s own tension that motivated
11. Projection- assigning your own spurs activity organism seeks
unacceptable feelings or qualities to util a goal or to attain in order
others. “Takot sa sariling multo” incentive is to satisfy some
12. Rationalization- excusing own’s reached need
behavior to avoid guilt Freudian concept of motivation:
13. Reaction formation- acting the • Libido- driving force of human behavior;
opposite of one thinks or feels sexual energy
14. Regression- reverting to earlier • Sex is not simply confined to genital
behaviors behavior. There is broad application to
15. Repression- unconsciously keeping the term related to several forms of
unpleasant information from your cutaneous satisfactions
conscious mind. (e.g., Being abused as • Claim: repressed sexual impulses and
a child but not remembering the abuse) desires motivates much of the human
16. Resistance- overt or covert behavior. Unresolved conflicts result to
antagonism toward remembering the “hysterical” or neurotic behavior.
anxiety producing information
17. Sublimation- substituting a socially Freud’s Psychosexual Stage
acceptable activity
18. Substitution- replacing the desired
gratification with one
19. Suppression- Consciously keeping
unpleasant information from your
conscious mind (e.g., Being abused as
a child but choosing to push it out of
your mind)
20. Undoing- exhibiting acceptance
behavior to make up for negate
unacceptable behavior

Michaela Katrice Macabangun, RN

 PSYCHOSOCIAL THEORIES
Erik Erikson
- focuses on social and psychological
development

3. Personality Type- a system of

categorizing people accordingly. Myers
Briggs Type Indicator (MBTI)

Carl Jung
- founded analytical psychology
Stage of Person:
• Somatic- the physical body
• Psychic- the mind and spirit
Concepts:
1. Consciousness
Conscious Personal Collective
conscious unconscious
Ego comprises Contains A level of
the thoughts temporarily unconscious
and memories forgotten info shared with other
as well as members of
repressed species
memories Compromising
latent memories
from past

2. Archetypes- images and themes which

have universal meanings across
cultures which may show up in dreams,
literature, art, or religion.
4 major Jungian Archetypes
Self Persona Anima/Animus Shadow
Self- Outward Seeing oneself Animal
hood face you as the opposite side of a
present sex personality
to the Anima- M to F
world Animus- F to M
Michaela Katrice Macabangun, RN
 Birth Order
Eldest Child The larger, stronger,
older
Guardian of law and
order
Power with
reverence
Second/ Middle Child Shadow of older
sibling
Striving for
superiority under
pressure
Youngest Child Constant state of
inferiority
Successful: excels
Unsuccessful:
avoidant
Only Child Sole object for
attention
Dependent to high
degree
Come to see the
world as hostile place
due to their parent’s
constant vigilance

Harry Sack Sullivan

INTERPERSONAL-SOCIAL THEORIES
- cognitive models of experiences
Alfred Adler
- individual psychology

Sense of Inferiority- basic psychological

element of neurosis
Inferiority Complex VS. Superiority Complex

Michaela Katrice Macabangun, RN

 BEHAVIORAL THEORIES
ATTACHMENT THEORIES Ivan Pavlov
John Bowlby - classical conditioning
- early childhood attachments played a
critical role in later development and
mental functioning

Burrhus Frederic Skinner

- Operant conditioning
Mary Ainsworth
- Claim: people learn their behaviors from
- child psychology their past experiences
- Strange Situation Assessment:
observing children 12 to 18 months old
Sequence:
1. Parent and child alone
2. Child explores the room
3. Stranger entrance
4. Parent leaving quietly
5. Parent returns and comforts the child

Michaela Katrice Macabangun, RN

 - Positive and negative reinforcement 2. Negative Self Schema- tend to focus
- Systematic Desensitization: helps to selectively on certain aspects of a
overcome irrational fears and anxiety situation while ignoring equally relevant
associated with phobias. Exposed to information
least to the most anxiety provoking 3. Cognitive Distortions

Albert Bandura
- originator of social cognitive theory.
Study the aggression. Bobo doll
experiment
Modelling process:
Attention, Retention, Reproduction, Motivation

COGNITIVE THEORIES
Jean Piaget
Cognitive Development Theory

Albert Ellis
- founded rational emotive behavior
Aaron Beck
therapy
- Father of both cognitive theory and
Three (3) Basics Must:
cognitive behavioral
1. I must do well and win the approval of
1. Cognitive Triad others or else I am no good.
2. Other people must do "the right thing" or
else they are no good and deserve to be
punished.
3. Life must be easy, without discomfort or
inconvenience.

Michaela Katrice Macabangun, RN

Eleven (11) Irrational beliefs HUMANISTIC THEORIES
1. “I need love and approval from those Abraham Maslow
around me” or “I have to be loved and
Hierarchy of Needs
have the approval of everyone important
who is around me.”
2. “To be valuable, I have to achieve
everything that I set out to do” or “if I am
a valuable person, I always have to be
competent, sufficient, and capable of
achieving everything that I set out to
do.”
3. “Bad people must be punished for their
bad actions.”
4. “It is horrible and catastrophic that
things are not the way I want or desire,
do not go that way, or do not turn out
that way.”
5. “Human unhappiness finds its origin in Carl Rogers
external causes and I cannot do
anything or almost anything to avoid or - client rather than patient
control pain and suffering that this - POSITIVE REGARD: how other people
causes me.” evaluate and judges us in social
6. “I have to constantly think that the worst interaction
can happen.” ➢ Unconditional PR: loves for what he
7. “It is easier to avoid than to face is
responsibilities and problems in life.” ➢ Conditional PR: depend upon a
8. “We have to have someone stronger to person
trust in.” NEUROBIOLOGIC THEORIES
9. “My past is determinant of my present
and future.” • Genetics and hereditary
10. “I have to constantly worry about other - several mental disorders mav be
people’s problems.” linked to a specific gene or
11. “Every problem has a right solution, and combination of genes but that the
it is a catastrophe if I do not find it.” source is not solely genetic;
nongenetic factors also play
important roles. "Nature versus
ABCDE of Emotional Disturbances nurture"
• Chronobiology
- a field of science that studies the
rhythms of life. Disturbances are
exhibited in 'mood disorders' e.g.
depression is often marked by
disturbances with daily sleep-
wake cycle and REM and non-
REM sleep

Michaela Katrice Macabangun, RN

 • Prenatal and Obstetric L4: Legal and Ethical Issues
- Obstetrical complications (fetal
Republic Act No. 11036
hypoxia and subsequent
neurotoxic effects) may lead to - An Act Establishing a National Mental
an earlier onset of psychotic Health Policy for the Purpose of
symptoms (Cannon, 2000) Enhancing the Delivery of Integrated
Prenatal complications interact Mental Health Services, Promoting and
with postnatal brain development Protecting the Rights of Persons
in the pathogenesis of Utilizing Psychosocial Health Services,
Schizophrenia Appropriating Funds Therefor and Other
• Stress and Immune System Purposes
- Psychoimmunology: field of study
RA No 11036 Section 44
that examines the effect of
psychosocial stressors on the Penalty Cause
body's immune system
- A compromised immune system (a.) Failure to secure informed consent
could contribute to the (b.) Violation of confidentiality of information
development of a variety of (c.) Discrimination against a person with
illnesses particularly in mental health conditions
populations already genetically at (d.) Administering inhumane, cruel,
risk. degrading, or harmful treatment not
• Infection based on medical or scientific evidence

Possible causes: Penalty Clause

- the existence of a virus that has an (a) Imprisonment not less than 6 months
affinity for tissues of the CNS, the and not greater than 2 years
possibility that a virus may actually alter (b) Fine not less than 10k and not more
human genes, and than 200k
- maternal exposure to a virus during L6: Nursing Process and Documentation
critical fetal development of the nervous
system National Nursing Core Competencies Standard
- streptococcal bacteria in OCD and tics 2012
- Plasma transfusion: - A collaborative effort of EXPPERTS in
- 50% reduced tics the field of nursing
- 60% reduced sn/sx of OCD - The standard describes core
- enlarged basal ganglia indicative of a competencies defined into 3 major roles
possible autoimmune response to strep that are deemed to be possessed by
infection. every nurse practitioner
NURSING THEORY Two (2) Responsibilities of Beginning Nurse
• Hildegard Peplau- Interpersonal Theory 1. Utilize the nursing process in the
• Dorothea Orem- Behavioral Nursing interdisciplinary care of clients that
Theory empowers the client
• Sr. Calista Roy- Adaptation Theory 2. Promote safe and quality care
• Rosemarie Parse- Theory of Human
Becoming

Michaela Katrice Macabangun, RN

ASSESSMENT Utilize:
- It is the deliberative and systematic • Psychiatric Mental Status Examination
collection and interpretation of • Folstein Mini Mental State Examination
biopsychosocial information or data to • Brief Psychiatric Rating Scale
determine current and past health, • Dementia Rating Scale
functional status, and mental health
problems, both actual and potential
Methods: Mental Status Examination

1. Observing -
An organized systematic
2. Examining approach to assess an
3. Interviewing individual’s current psychiatric
condition
Types of Assessment: 1. General Observation:
1. COMPREHENSIVE ASSESSMENT • Hygiene and grooming
- Data related to the client’s • Dress
biologic, psychological, cultural, • Posture
spiritual and social needs • Eye contact
- Completed in collaboration with
other 2. Motor behavior:
- History • Catatonia- actions that are not
- Gordon’s 11 Functional Health appropriate
Pattern • Waxy flexibility- movements like a
- Physical Examination wax
• Automatisms- repeated purposeless
2. FOCUSED ASSESSMENT (they are not aware they are doing it)
- Collection of specific data • Psychomotor retardation- slow
regarding a particular problem as movements
determined by the client, a family
member, or a crisis situation 3. Orientation:
Risk assessment: • Name, Time, Place
▪ Suicidal Ideation
▪ Assaultive/ Homicidal 4. Mood: current emotional state
Ideation (subjective)
• Euthymic- normal
3. SCREENING ASSESSMENT • Euphoric- extreme happiness
- Collection of predetermined data • Labile- rapid change of mood
regarding a particular data • Dysphoric- dissatisfaction
usually during initial contact. To
determine how the client is 5. Affect: observable cues (objective)
functioning in various areas
• Blunted- little to slow response
• Broad- typical or normal
• Flat- no response
• Inappropriate
• Restricted- displays one type of
affect
Michaela Katrice Macabangun, RN
6. Speech: 10. Cognition and intellectual performance
• Pressured • Attention and concentration
• Fast • Abstract reasoning and
• Slow comprehension
• Fragmented- shattered, or putol • Memory: recall, short term, recent,
putol remote
• Insight and judgment
7. Logical or illogical
• With or without agnosia- ability to
identify one object but can’t identify it DIAGNOSIS
as a whole. Parts only.
- Statement of an existing problem or a
potential health problem
8. Thought Process:
- Clinical judgement about individual,
• Circumstantiality- answers the
family, or community responses to
question but indirect
actual or potential health problems or
• Delusion- false belief of something
life processes
o Reference- object of persection
- Source: NANDA
o Nihilistic- denies presence of
body part
o Grandeur- superior to others
PLANNING (OUTCOMES)
• Flight of ideas- speech is fragmented
• Ideas of reference- he is the - Measurable client-oriented goals that
headline are SMART
• Loose association- fragmented with
little relevance
• Tangentiality- wandering of the topic INTERVENTIONS
but never answers the questions
- Counseling, maintenance of a
• Thought blocking- stopping mid therapeutic environment or milieu,
sentence
structured, psychological, biological,
• Thought broadcasting- others can health education
hear or know what they are thinking - Advanced: psychotherapy,
• Though insertion- someone is psychopharmacologic, consultation
feeding them ideas
• Thought withdrawal- their ideas are
taken away from them EVALUATION
• Word salad- mixture of words
4 possible outcomes:
9. Others: 1. Client will respond favorably to the
• Clang association- rhyme outcome
• Echolalia- parrot like repetition 2. Short term are met, long term unmet
• Neologism- new words 3. Unable to meet any outcomes
• Perseveration- same answers to all 4. New problem arises needing revisions
questions of NCP
• Verbigeration- meaningless
repetition of words

Michaela Katrice Macabangun, RN

 L7: Grief, anger, and Crisis • Loss of security and a sense of
belongingness
Emotions
• Loss of self esteem
- Psychological reactions that depict a • Loss related to Self-actualization
person’s mood. They have their own
GRIEF
innate responses that are automatic
- “emoverse” or “to stir up” or “to move” - Total response to the emotional
experience related to loss. Manifested in
Categories of Emotions:
thoughts, feelings, and behaviors
1. Negative Emotion associated with overwhelming
- There is threat to delay a goal or distress/sorrow
conflict between goals (e.g.,
Theories of Grieving:
anger, fright, anxiety)
2. Positive Emotion 1. Kubler-Ross
- Movement towards or attainment
of a goal (e.g., happiness, relief,
love)
3. Borderline emotion
- Somewhat ambiguous (e.g.,
hope, compassion, empathy,
sympathy)
4. Nonemotions
- Connote emotional reaction but
are too ambiguous (e.g.,
confidence, awe, confusion,
excitement)
BEREAVEMENT 2. John Bowlby
- Subjective response ecperienced by the
surviving loved ones after the death of a
person with whom they have shared a
significant relationship
MOURNING
- Behavioral process through which grief
is eventually altered
LOSS
- Actual/potential situation in which
something that is valued is changed or
no longer available
Types of Losses:
• Physiologic loss
• Safety loss

Michaela Katrice Macabangun, RN

 3. George Engel May due to:
• Relationship has no legitimacy
• Loss itself is not recognized
• Griever is not recognized
• Loss involves social stigma
Dimension of Grieving
• Cognitive Response- you take the
lesson as a lesson
• Emotional Response- crying
• Spiritual Response- Trust or Blames the
Lord
• Behavioral Response- acknowledged
the loss but tend to do other things than
4. Mardi Horowitz grieving
• Physiologic Response- weight loss, loss
Outcry, Denial and Intrusion, Working through, Completion
of hair
Types of Grieving
Cultural Considerations
1. Uncomplicated Grieving (Normal)
- cultural bereavement rituals have roots
• Abbreviated G.- brief but genuinely in several of the world’s major religions,
felt, can be replaced or spiritual beliefs and practices
• Anticipatory G.- occurs when people regarding death.
begins to grapple with the possibility
of the loss in the near future ANGER
2. Traumatic Grieving- normal quick - Strong and uncomfortable emotion
response experienced by combination
with traumatic distress suffered as a Hostility- verbal aggression
result Aggression- physical attack
3. Complicated Grieving
• Chronic Grief (unresolved)- person is Anger expression
frozen or stuck. More than 6 months
1. Anger suppression
• Inhibited Grief- suppressed including - anxious when anger is aroused
somatic (physical manifestation) - acts as if nothing happened
• Delayed Grief- feelings are - withdraw himself
purposely suppressed until a much - physical manifestation (body
later time language)
• Exaggerated Grief- dangerous 2. Unhealthy outward expression
activity to less than the pain of - flying off the handle, expresses
grieving anger: attacking, blaming, yelling,
4. Disenfranchised Grieving- grieving over calling profanities
a loss that is not or cannot be 3. Constructive Anger Discussion
acknowledged openly, mourned - Conveys what his/her feelings
publicly, or supported socially. (catarcist)

Michaela Katrice Macabangun, RN

Etiology of Anger L8: Abuse and Violence
1. Neurobiological Causes- monoamine ABUSE
oxidase, low serotonin, high
testosterone, low progesterone - Wrongful use, maltreatment of another
2. Psychosocial Causes person
a. Psychoanalytic VIOLENCE
- suppression of emotions
- Limitation to express feelings - Extreme aggression
- Does not support catharsis - Use of strong force or weapons to inflict
- Outward expression of anger harm
b. Behavioral Cycle of Abuse and Violence
- Frustration aggression
hypothesis ➢ STAGE 1: incident of abuse
c. Social Learning ➢ STAGE 2: making up stage (honeymoon
- Child observes the stage)
environment and adapt ➢ STAGE 3: Calm stage (as if nothing
d. General Aggression Model happens)
- Cognition, Affect, Arousal ➢ STAGE 4: Tension building phase

CRISIS Types of Violence

- Temporary disequilibrium 1. Family Violence/ Domestic Abuse

- Situation resulted from a failure to • Compasses battling of spouse
coping mechanisms • Neglected physical abuse
• Emotional and sexual abuse
Characteristics of Crisis
• Marital Rape
- 24 to 36hrs or 4 to 6 months
A. Intimate Partner Violence
Types of Crisis:
• Social isolation- jealousy of partner
1. Maturational Crisis- expected • Abuse of power and control
development of person • Alcohol and drug abuse
2. Situational Crisis- unexpected • Intergenerational transmission
3. Adventitious Crisis- traumatic/social
unexpected Republic Act 9262: Anti-Violence Against
Women and Their Children Act of 2004 – is
an act that defines violence against women
and their children, provides for protective
Phases of Crisis
measures to victims and prescribe penalties for
“Problem arises, solution=not effective, Crisis” its violations.
B. Child Abuse
• Physical abuse
Crisis Intervention
• Neglect/ failure to prevent harm
1. Directive Management • Failure to provide emotional and
2. Supportive Management physical care
• Sexual assault
• Over torture

Michaela Katrice Macabangun, RN

Republic Act 7610: Special Protection of
Children Against Abuse, Exploitation and
Discrimination Act – an act that provides a
stronger deterrence and special protection
against child abuse, exploitation, and
discrimination, and for other purposes.
C. Elder Abuse
House Bill 7030: Anti-Elder Abuse Act

2. Rape and Sexual Assault

Republic Act 8353: An Act Expanding the
Definition of the Crime of Rape and
Reclassifying the same as Crime Against
Persons Rape violates a person’s wellbeing
and not just ones virginity or purity. The law
considers that any person, whether a
prostituted person, non-virgin or one who has
an active sexual life may be victimized by rape.

Michaela Katrice Macabangun, RN

 L9: Neurodevelopment Disorders Intelligence Quotient (IQ)- total score
derived from a set of standardized tests
- Begins on childhood to assess human intelligence
- Major impact on social and cognitive
functioning

A. Formerly Diagnoses Disorders

- Set of pervasive development disorders
- They are delays in the developments of
social and communication

1. Rett’s Syndrome
- loss of previously acquired
developmental skills (language,
social, motor skills)
- birth to 5 months
- mostly girls 1. Intellectual Developmental Disorder
- common s/sx: microcephaly - Anytime before 18 years old
(head stop increasing in size)
Intellectual functioning- ability to learn,
2. Childhood Disintegrative reason, solve problem
- Loss of previously acquired Adaptive behavior- everyday social and
development skills after 2 years life skills
of apparently normal growth and
development Etiology
- 3 to 4 years - 50%
- Mostly boys - Genetic syndrome (Down Syndrome)
- Common s/sx: nonspecific - Exposure to toxins during pregnancy
anxiety or agitation
C. Autism Spectrum Disorder
3. Asperger’s Syndrome
- No language or cognitive delays Three (3) Core Feature:
- High functioning form of autism 1. Social communication and interaction
- Mostly boys difficulties
- Common s/sx: motor clumsiness • Social reciprocity
• Joint attention
B. Intellectual Developmental Disorder
• Non verbal communication
Intelligence
• Social relationship
- Learn from experience
2. Restricted or repetition behavior
(acquisition, retention, use of
knowledge), recognize problems • Lining up of toys
(identify possible problems), and • Flapping hands
solve problems (to take what they • Echolalia
have learned to come up with • Fixed/certain routine
useful solution) • Restrictive thinking, specific
knowledge
3. Difficulty in maintaining eye contact

Michaela Katrice Macabangun, RN

Risk Factors and Diagnosis Impulsiveness
- Tendency to act on urges, notions,
• 5x more prevalent in boys
or desires without adequately
• 12 to 18 months considering the consequences
• 3 y/o definitive diagnosis can be made Hyperactivity
• Observed behavior - Excessive motor activity, as
Treatment: No treatment evidenced by restlessness, an
inability to remain seated, and high
Focus: improve functioning, individualized levels of physical motion and verbal
educational program and behavioral therapies output
Nursing Intervention Diagnostic criteria
A. Physical Health Intervention • More than 6 out of 9 s/sx from 1 or each
- Develop a list of activities to be post group
in bedroom • Be present for more than 6 months
- Drawings and symbol for nonverbal • Occur in at least 2 situations
child • Be present before age 12
B. Psychosocial Intervention
- Positive reinforcement 3 presentations of ADHD
- Don’t make them feel that they need
1. Predominantly Inattentive Presentation
“fixing”
2. Predominantly Impulsive Presentation
- Promote interaction
3. Combined Presentation
- Nonverbal social interactions
- Getting the mail or passing out Risk factors:
something
• Boys
C. Behavioral Intervention
- Watch out for tantrums • Familial history of ADHD, bipolar,
- Brief “time out” substance use
- Ignore repetitive behavior • Early exposure to pesticides
- Use head gear • Prenatal tobacco exposure
D. Support the family • High concentration of lead in the blood
- Counseling, education, support, Etiology:
referral to social groups
• Genetics
D. Attention deficit hyperactivity disorder • Hypersensitivity to environmental stimuli
(ADHD) • Biologic theories
- Persistent pattern of inattention, - Dysfunction in the dorsolateral
hyperactivity, and impulsiveness that prefrontal cortex
interferes with functioning - Dysregulation on the
neurotransmitter
Attention
Medical Management
- Involves concentrating on one
activity to the exclusion of others as • Diet: Prevent preservative or food
well as the ability to sustain focus coloring. Increase simple sugar
• Activity: Extensive exercise

Michaela Katrice Macabangun, RN

 • Psychostimulants: enhances dopamine Types of Positive:
and norepinephrine
1. Delusions- false belief of something
- Methylphenidate (Ritalin)
Rebound effect: double effect
after 4 hrs of use
- Atomoxetine
Side Effects
• dizziness and headache
• nauseas
• loss of appetite
Nursing Management
• Ensure safety
• Improve role performance
• Simplifying instructions
• Promoting a structured daily routine

L10: Schizophrenia

- Split mind 2. Hallucinations- sensations are not there

- Scattered thinking
- Syndrome
- Refers to a group of sever, disabling,
psychiatric disorders marked by
withdrawal from reality, illogical thinking,
possible delusions and hallucinations,
and emotional, behavioral, or intellectual
disturbance
Cause and Risk Factors:
- Unknown
- Genetics (Chromosomes 13 & 6)
- High levels of dopamine, serotonin,
norepinephrine 3. Disorganized speech and thoughts
- Environmental Triggers (maternal flue,
childhood trauma, use of marijuana)
- Prevalent in Males
3 categories of Symptoms
A. Positive
- Psychotic symptoms
- Present but supposed to be absent

Michaela Katrice Macabangun, RN

 4. Disorganized behavior- bizarre behavior Treatment (Pharmacologic)
with no purpose
• Neuroleptics (Antipsychotic Drugs)- do
5. Catatonic behavior- movement, posture,
not cure the disease but used to
and responsiveness (hindi mapagalaw,
manage symptoms
or mapa stop)
1st generation 2nd generation
B. Negative ➢ Conventional ➢ Atypical
- removal or reduction of normal ➢ Dopamine ➢ Dopamine &
process antagonist serotonin
➢ Targets the antagonist
Types of Negative: (+) signs but ➢ Targets noth
1. Affect Flat- no emotions no effect on (+) and (-) signs
2. Anhedonia- inability to experience (-) signs
pleasure
➢ Haloperidol ➢ Clozapine
3. Apathy- lack of interest
(Haldol) ➢ Risperidone
4. Avolition- lack of motivation (contraindicated
5. Alogia- poor of speech in dementia)
6. Anxiety and avoids social interaction ➢ Ziprasidone

C. Cognitive
- ability to learn, understand, and Adverse Effect
remember memories • Extrapyramidal symptoms
Phase of Schizophrenia - Dystonia
- Pseudoparkinsonism
1. Prodromal phase- withdrawn socially - Akathisisa
2. Active phase- extreme symptoms - Tardive dyskinesia (twitch, grimace
3. Residual phase- cognitive symptoms or move involuntarily)
Diagnosis • Neuroleptic Malignant Symptoms
- High fever
1. Two (2) of the following symptoms: - Altered mental status
Hallucinations - Muscle rigidity
Delusions - Dizziness
Disorganized speech - Leukocytosis
Catatonic behavior • Seizure
Negative symptoms • Agranulocytosis
2. Ongoing for at least 6 months, which at
least 1 month of active symptoms
3. Not another condition, such as
substance abuse

Michaela Katrice Macabangun, RN

Treatment (Electroconvulsive Therapy)
- Rarely used (with acute schizo) who
can’t tolerate or don’t respond to
medications
- Decrease depressive and catatonic
symptoms
Nursing Management
• Recognize
• Note characteristics and s/sx
• Establish trust and rapport
• Don’t tease or joke
• Maximize level of functioning
Assess:
• Ability to carry out ADL
• (+) and (-) symptoms
• Medial history
• Any medications received
Interventions:
• Establish rapport and trust
• Maximize level of functionin
• Provide independency
• Promote social skills
• Provide support
• Ensure safety
• Ensure adequate nutrition
• Keep it real or present reality
• Promote compliance and monitor drug
therapy
• Encourage family involvement
Related disorder: Schizophreniform Disorder

Michaela Katrice Macabangun, RN