NURS 222 - Week 1

NURS 222 - Week 1 Professor Alfonso ​Key Points

Freud: Levels of awareness

○Conscious​- it contains all the material a person is aware of at any one time, including perceptions, memories, thoughts, feelings ○Preconscious​- just below the surface of awareness is the preconscious which contain material that can be retrieved rather easily through conscious effort.○Unconscious​- include all repressed memories, passions, and unacceptable urges lying deep below the surface. it is believed that the memories and emotions associated with trauma are often placed in the unconscious because the individual finds it too painful to with them.

●Freud: Personality structure

○Id- at birth we all Id, the Id lacks the ability to problem solve. Id cannot tolerate frustration . the hungry screaming infant perfect example ○Ego- Ego develops when childhood begins, the ego is the problem solver and reality tester. it is able to differentiate subjective experiences, memory images, and objective reality . the balance between Id and superego.○Superego- represents the ideal rather than real it seeks perfection, the good side of the personality with wings.●Freud: Transference- refers to feelings that the patient has toward health care workers that were originally held toward significant others in his or her life ● / Countertransference - refers to unconscious feelings that the health care has toward the patient.●Maslow- Introduced the concept of a “self-actualized personality” associated with high

productivity and enjoyment of life. His hierarchy of needs:

Physiological needs​: most basic, food, oxygen, water, sleep etc.

Safety needs:​ once physiological needs are met, safety, security, protection and freedom from fear can be achieved.

Belonging and love needs:​ having a family, home, love and relationship.

Esteem needs:​ if this need is met, they feel confident, valued and valuable.

Self-actualization​- choose a path that brings about inner peace. A writer must write, a painter must paint, etc. if not a state of restlessness will take over.

●Ethical principles ○Beneficence- the quality of doing good.○Justice- fair and equal treatment for all ○Autonomy- the client right to make her own decision ○Fidelity- loyalty and faithfulness to the client and to one's duty ○Veracity- honesty when dealing with a client ●Patient rights –

●Retain their rights as a citizen-right to treatment, refuse treatment (unless an emergency situation), informed consent, lease restrictive intervention, confidentiality

●ACT – Assertive Community Treatment team:

●Non traditional case management and treatment for clients who have severe mental illness and are noncompliant with traditional treatment. Helps reduce recurrences of hospitalization and provides crisis intervention, assistance with independent living and resources for support services.●Tort-wrongful actor or injury committed by an entity or person against another person.●Negligence- an act, or failure to act, that breaches the duty of due care and results in or is responsible for another person’s injuries.●Malpractice - foreseeability of harm, or malpractice is an act or omission to act that breaches the duty of due care and result in or is responsible for a person’s injuries.●Elopement- (escape) most units are locked since some patients are hospitalized involuntary and elopement must be prevented in a way that avoids an atmosphere if imprisonment.● ●Psychiatric case management – (Page 68) A service provided by community mental health centers. They assist patients in finding housing.●Levels of prevention 1.Primary prevention- promotes health and prevents mental health problems from occurring ex- nurse teaches a community about stress reduction 2.secondary- focuses on early detection of mental illness ex- nurse screen for depression 3.Tertiary prevention- focuses on rehabilitation and prevention of further problems in clients who have previous diagnoses ex- nurse leads a support group for clients ●Inpatient psychiatric nursing care ● Criteria for 5150 hold- Either voluntary or involuntary for admission determines a patient's ability to make informed decisions about his or her health care.

• a medical standard or justification for admission must exist.
• a well defined psychiatric problem must present
• it causes an immediate crisis situation
• there must be a reasonable expectation that the hospitalization and treatment will improve the

presenting problem.●Verbal/nonverbal communication- verbal communication- consist of all the words a person speaks. Nonverbal communication- it is often said that its not what you say but how do you say. the real message send through the tone or the pitch of the voice.●Social relationship vs therapeutic relationship - Social relationship that is primarily initiated for the purpose of friendship, socialization enjoyment, or accomplishment of a task. mutual needs are met during social interaction.Therapeutic relationship maximizes his or her communication skills, understanding of human behaviors, and personal strengths to enhance the patients growth.

NURS 222- Week 2 Professor Alfonso Key Points

• Schizophrenia

typical onset: late teens-early 20’s

Individual has at least 1 severe psychotic symptom lasting at least 6 months Extreme difficulty with: self-care, interpersonal relationships, and ability to work

Etiology: genetic predisposition

Prevalence of schizophrenia is 1% worldwide 3.5 million persons in the US

• Positive symptoms:​ The presence of something that should not be present. Which

include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech.-Negative symptoms:​ The​ ​absence of something that should be present. Which include the inability to enjoy activities, social discomfort, or lack of goal-directed behavior.

• Hallucinations: ​Occur when a person perceives a sensory experience for which no

external stimulus exists (e.g. hearing a voice when no one is speaking). Types of hallucination include auditory, visual, olfactory, gustatory, and tactile.

-Delusions:​ Are false beliefs held despite a lack evidence to support them.

-​command hallucination:​ is a particularly disturbing symptom that directs the person to take an action. This type of hallucination must be monitored carefully because they may be dangerous, for example, telling a patient ot “jump out the window”.

- Delusions:

• Ideas of reference- ​A belief that events or circumstances that have no connection to

you are somehow related to you. Example barbara believes that the birds sing songs to cheer her up.

• Persecution-​ feels singled out for harm by others eg, being hunted down by the FBI
• Grandeur-​ believes that she is all powerful and important like a god
• Somatic delusions- ​believes that his body is changing in an unusual way, such as

growing a third arm

• Jealousy-​ believes that her partner is sexually involved with another individual even

though there is not any factual basis for this belief

• being controlled- ​believes that a force outside his body is controlling him
• Thought broadcasting- ​believes that her thoughts are heard by others
• Thought insertion-​ believes that others thought are being inserted into his mind

• Thought withdrawal-​ believes that her thoughts have been removed from her mind by

an outside agency

• Religiosity-​ is obsessed with religious beliefs

-​ Magical thinking-​ believes his actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes him invisible to others

• Paranoia-​ an irrational fear of others that another person is going to kill you.

- Bizarre speech:

• Word Salad-​ is a jumble of words that is meaningless to the listener, perhaps to the

speaker as well.

• Echolalia-​ pathological repeating of another's words
• Clang Association-​ words based on their sound rather than their meaning, often

rhyming or having a similar beginning sound.

• Associative looseness / flight of ideas: ​results from haphazard and illogical thinking

where concentration is poor and individuals loosely associate their thoughts. For example I need to get a band aid. My friend was talking about AIDS.

• Bizarre behavior
• Echopraxia-​ mimicking of movements of another

- Agitation:

• Stereotyped behaviors: ​Repetitive behaviors that do not serve a logical purpose.

- Automatic obedience:

• Waxy Flexibility -​ the extended maintenance of posture, e.g pt. will continue to hold the

arm

• Stupor: ​A condition of greatly dulled or completely suspended sense or sensibility. A

chiefly mental condition marked by absence of spontaneous movement, greatly diminished responsiveness to stimulation, and usually impaired consciousness.

• Negativism-​ A tendency to resist or oppose the requests or wishes of others.
• Medication
• Differences between 1​

st​ gen and 2​ nd​ gen?1​ st​ Generation conventional antipsychotics. Block the D2 receptors for dopamine-antagonist. Reduce dopaminergic transmission. Overactivity of the dopamine system in certain areas of the mesolimbic system may be responsible for at least some of the symptoms of schizophrenia.

Antipsychotics: 1st Gen

Typical / Conventional

Chlorpromazine Thorazine Haloperidol Haldol Fluphenazine Prolixink