1. Foundations of Psychiatric Nursing
Psychiatric Nursing is the "Therapeutic Use of Self" to promote mental health. Tandaan, we don't just treat the diagnosis; we treat the human response to the illness. The Mental Health-Illness Continuum is fluid—pwedeng mag-shift ang tao depende sa stressors at coping mechanisms.
Mental Health
Successful adaptation to stressors, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms.
Mental Illness
Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with norms.
✨ Beshy Nursing Tip!
Beshy, sa Psych Nursing, "Safety" is always the top priority! Pero secondary to safety, ang pinaka-importanteng tool mo ay ang iyong sarili. Be authentic, empathic, and maintain professional boundaries. Huwag kang "friend," be the "Nurse."
2. Therapeutic Communication Techniques
Communication is the core of the nurse-client relationship. Master these techniques for the board exam:
3. Non-Therapeutic Communication (Red Flags)
In the NLE, avoid choices that include these techniques as they shut down communication:
- Giving Advice: "I think you should..." (Nurses don't tell patients what to do).
- Requesting an Explanation: "Why do you feel this way?" (Too defensive/accusatory).
- False Reassurance: "Don't worry, everything will be fine." (Minimizes feelings).
- Giving Approval/Disapproval: "That's good/bad." (Implies the nurse's values are superior).
4. Defense Mechanisms (The Ego's Shield)
Defense mechanisms are automatic psychological processes that protect the individual against anxiety.
Repression vs. Suppression
Repression is UNCONSCIOUS (automatic forgetting). Suppression is CONSCIOUS (intentional "I'll think about it tomorrow").
Reaction Formation
Preventing unacceptable thoughts/behaviors from being expressed by exaggerating opposite thoughts. (e.g., Sobrang bait sa taong kinakamuhian).
Sublimation
Channeling negative impulses into socially acceptable activities. (e.g., Isang aggressive na tao na naging boxing champion). This is a Healthy mechanism!
5. Anxiety Disorders & Levels
Anxiety is a feeling of discomfort and apprehension related to fear of the unknown.
| Level | Characteristics | Nurse's Role |
|---|---|---|
| Mild/Moderate | Sharp senses, learning is possible. Tension, butterflies in stomach. | Active listening, help client identify source of anxiety. |
| Severe/Panic | Distorted perception, learning is impossible. Rapid heart rate, hyperventilation. | SAFETY. Stay with the client. Use short, simple sentences. |
💊 Beshy Meds Hack!
Sa Lithium Therapy, tandaan ang therapeutic range: 0.6 - 1.2 mEq/L. Kapag lumampas ng 1.5, toxic na! Ensure adequate Sodium and Water intake. Bawal mag-diuretics dahil magko-cause ito ng Lithium retention!
6. Schizophrenia & Psychotic Disorders
Schizophrenia involves disturbances in thought (delusions), perception (hallucinations), and affect.
Positive Symptoms (Added)
- Hallucinations: Sensory perception without external stimuli (Auditory is most common).
- Delusions: Fixed false beliefs (Persecutory, Grandiose, Somatic).
- Associative Looseness: Disorganized thinking.
Negative Symptoms (Missing)
- Anhedonia: Inability to feel pleasure.
- Avolition: Lack of motivation.
- Alogia: Poverty of speech.
- Affective Flattening: No emotional expression.
Nursing Care for Hallucinations: "I don't see the voices you are hearing, but I see that you are frightened." (Acknowledge feelings, but present reality without arguing).
7. Mood Disorders: Depression & Bipolar
Major Depressive Disorder (MDD)
Characterized by depressed mood and loss of interest for at least 2 weeks. Priority: Suicide Risk.
Nursing Action: Sit with the client in silence if they are not talking. It shows that you value them.
Bipolar Disorder (Mania)
Extreme highs (mania) and lows (depression). In manic phase, the client is hyperactive and grandiose.
Nursing Action: Provide finger foods (high calorie), decrease environmental stimuli, and ensure physical safety.
🚨 Beshy Warning!
Kapag ang isang depressed patient ay biglang naging "happy" o "peaceful" at nag-uumpisang mamigay ng gamit (giving away possessions), mag-ingat! This is a major warning sign for suicide. They might have already finalized their plan and feel relief. Monitor closely!
8. Personality Disorders
Inflexible and maladaptive patterns of behavior. Tandaan ang "Clusters":
Cluster A (Odd/Eccentric)
Paranoid, Schizoid, Schizotypal. "The weirdos."
Cluster B (Dramatic/Erratic)
Antisocial, Borderline, Histrionic, Narcissistic. "The drama queens/kings."
Cluster C (Anxious/Fearful)
Avoidant, Dependent, Obsessive-Compulsive. "The worriers."
Antisocial: Set firm limits on manipulative behavior. Borderline: Watch out for "Splitting" (viewing staff as all good or all bad).
9. Psychopharmacology: Antipsychotics & Antidepressants
| Drug Class | Examples | Side Effects / Nursing |
|---|---|---|
| Typical Antipsychotics | Haloperidol, Chlorpromazine | EPS (Extrapyramidal Symptoms), Tardive Dyskinesia, NMS (Fever!). |
| SSRIs (Antidepressants) | Fluoxetine, Sertraline | Sexual dysfunction, Insomnia. Avoid giving at night. Watch for Serotonin Syndrome. |
| MAOIs | Phenelzine, Isocarboxazid | Avoid Tyramine-rich foods (Aged cheese, wine) → Hypertensive Crisis! |
10. Psychopharmacology: Mood Stabilizers & Anxiolytics
| Drug Class | Examples | Key Considerations |
|---|---|---|
| Mood Stabilizers | Lithium, Valproic Acid | Monitor serum levels. Valproic acid can be hepatotoxic (check Liver enzymes). |
| Benzodiazepines | Diazepam, Alprazolam | CNS Depression. High potential for addiction/tolerance. Don't stop abruptly! |
| Anti-Parkinsonian | Benztropine, Diphenhydramine | Used to treat EPS caused by antipsychotics. Anticholinergic effects (dry mouth). |
11. Crisis Intervention & Suicide Prevention
A crisis is a sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem.
Types of Crisis
- Maturational: Normal life transitions (Marriage, Graduation).
- Situational: Unexpected external events (Job loss, Illness).
- Adventitious: Disasters/Crimes (Flood, Rape).
Suicide Interventions
- Direct Questioning: "Are you thinking of hurting yourself?" (Be direct).
- Safety Contract: "No-harm contract" (Though controversial, it's a tool).
- Environmental Safety: Remove sharp objects, belts, shoelaces.
- Observation: 1:1 supervision (constant observation) for high-risk patients.
12. RA 11036: The Philippine Mental Health Act
Signed into law in 2018, this ensures that mental health services are accessible to all Filipinos.
Rights of Service Users:
- Right to freedom from social, economic, and political discrimination.
- Right to individual treatment plan and informed consent.
- Right to confidentiality (unless there's immediate risk of harm).
- Right to participate in mental health advocacy and policy-making.
⚖️ Beshy Legal Tip!
Tandaan, Beshy! Patients have the "Right to Refuse Medication" unless they are an immediate danger to themselves or others, or if it's a court-ordered treatment. Voluntary patients can sign out "Against Medical Advice" (AMA), pero involuntary patients cannot leave until they are assessed as safe.
You are the Future of Care, RN! 🩺
Psychiatric Nursing is about empathy, patience, and boundaries. Master the communication and the safety protocols, and you'll ace this part of the NLE. Naniniwala kami sa'yo, Beshy!