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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