Chapter 13 Care of the Psychiatric Patient

1. Chapter 13Care of the Psychiatric Patient

2. Psychiatric Care Settings • Outpatient mental health clinics • Long-term psychiatric care facilities • Acute psychiatric care facilities • Psychiatric rehabilitation facilities

3. Nursing Assistant’s Duties in a Psychiatric Care Setting • Psycho-educational groups—Responsible for making sure patients attend group meetings and supervision during the meetings. • ADL groups—Plays an important role in planning and leading these groups. • Social skill–building groups—Responsible for helping patients to practice the skills they have learned.

4. Nursing Assistant’s Duties in a Psychiatric Care Setting (cont) • Recreational groups—Gives patients the opportunity to engage in enjoyable activities and socialize with others. • Day trips—Responsible for helping to plan activities, encouraging patients to attend, and participating in the activities.

5. Therapeutic Environment • Promotes interaction between patients and staff members • Encourages participation in group activities • Conveys a positive, accepting attitude • Protects the patient from physical and emotional harm • Protects the patient’s dignity and self-esteem

6. Therapeutic Environment

7. Therapeutic Communication • Communication between a health care worker and a patient that is directed at helping the patient express concerns and resolve problems • Listening is very important • Clear, honest communication is essential for maintaining a therapeutic environment

8. Common Therapeutic Communication Techniques

9. Workplace Safety • Follow the facility’s or unit’s policies • Develop trusting relationships with the people you care for • Some conditions require: • Restraints • Seclusion

10. Psychiatric Treatment • Medication • Psychotherapy • Electroconvulsive therapy

11. Four Main Categories of Medications • Antidepressants • Anxiolytics • Mood stabilizers • Antipsychotics

12. Antidepressants • Used to treat clinical depression • Fall into several main categories: • Tricyclic antidepressants • Selective serotonin reuptake inhibitors (SSRIs) • Monoamine oxidase inhibitors (MAOIs) • Other antidepressants work by affecting norepinephrine and epinephrine levels

13. Anxiolytics • Used to treat anxiety disorders (such as obsessive-compulsive disorder, panic attacks, phobias, and PTSD) • Commonly used anxiolytic medications • Benzodiazepines • Buspirone

14. Mood Stabilizers • Used in the treatment of bipolar disorder (manic depression) • Lithium is a commonly used mood stabilizer

15. Antipsychotics • Used to treat psychotic disorders (such as schizophrenia) • Can also be used to treat the manic phase of bipolar disorder

16. Observations That Should Be Reported • Extrapyramidal side effects • Dystonia • Akathisia • Drug-induced parkinsonism • Tardive dyskinesia

17. Psychotherapy • “Talk therapy” • A licensed therapist helps the patient explore feelings, attitudes, thinking, and behavior

18. Electroconvulsive Therapy (ECT)

19. Common Psychiatric Disorders • Anxiety disorders • Clinical depression • Psychotic depression • Bipolar disorder (manic depression) • Schizophrenia • Personality disorder • Substance abuse disorders • Eating disorders

20. JIGSAW ACTIVITY • STUDENTS WILL BE ASSIGNED TO A GROUP USING NUMBERS IN RANDOM ORDER. EACH GROUP WILL BE GIVEN A “PUZZLE PIECE” AND A MENTAL HEALTH DISORDER THAT IS IN THE TEXT. DURING THE TIME GIVEN EACH GROUP WILL GATHER INFORMATION ABOUT THE DISORDER EITHER FROM THE TEXT, PERSONAL EXPERIENCE, MOVIES, OR OTHER SOURCES AND WRITE THE INFORMATION ON THE PUZZLE PIECE. • AT THE END OF THIS TIME, GROUPS WILL EXCHANGE INFORMATION WITH THE PUZZLE PIECE THAT MATCHES WITH THEIR GROUP AND WRITE ANY NEW INFORMATION ON THE PUZZLE PIECE.UNTIL ALL GROUPS HAVE MATCHED THE PIECES TOGETHER TO FORM A “PICTURE” (COMPLETED PUZZLE) OF THE PSYCHIATRIC DISORDERS PAITENTS SUFFER.

21. Anxiety Disorders • Most common form of mental illness • Common anxiety disorders: • Panic disorder • Obsessive-compulsive disorder • Phobia • Post-traumatic stress disorder (PTSD)

22. Clinical Depression • Characterized by intense feelings of sadness and hopelessness • Psychotic depression is severe clinical depression • A person may have suicidal ideation

23. Bipolar Disorder (Manic Depression) • Causes a person to have mood swings • Manic phase of the disorder may cause reckless or impulsive behavior • Lithium is most commonly used to balance a person’s moods

24. Lithium Toxicity Observations to report to the nurse immediately: • The person has diarrhea or vomiting • The person is having trouble moving in a coordinated way • The person complains of ringing in the ears • The person has urinary frequency

25. Schizophrenia • Very disabling form of mental illness • A person with schizophrenia: • May have trouble distinguishing real from imaginary • May have hallucinations and delusions • May hear voices • May have disordered thinking and speech • May become unresponsive to others

26. Behavioral Effects of Schizophrenia • Affect: a person’s facial expression • Flat affect • Inappropriate affect • Polydipsia • Paranoia

27. Personality Disorders • Divided into three main categories • Cluster A: defined by odd or eccentric behavior • Cluster B: defined by dramatic, unpredictable, and emotional behavior • Cluster C: defined by fearful or shy behavior

28. Common Traits of Personality Disorders • They engage in socially unacceptable behaviors. • They tend to be very self-centered. • They tend to manipulate or exploit others. • They do not handle stress well. • They tend to blame others for their problems. • They often lack insight (in other words, they do not recognize that they have a problem). • People with personality disorders are at increased risk for developing other psychiatric disorders, such as eating disorders, substance abuse disorders, anxiety disorders, and depression.

29. Substance Abuse Disorders • Involve excessive or inappropriate use of drugs (legal or illegal) • Can go through withdrawal when receiving treatment for substance abuse

30. Eating Disorders • Anorexia nervosa • Bulimia nervosa

31. Question Who is involved in therapeutic communication? • Doctor and licensed nurse • Health care worker and patient • Licensed nurse and nursing assistant • Doctor and patient

32. Answer B. Health care worker and patient Therapeutic communication is directed at helping the patient express concerns and resolve problems.

33. Question Tell whether the following statement is true or false. Suddenly stopping therapy with benzodiazepines can be fatal. • True • False

34. Answer A. True Abruptly stopping benzodiazepines can cause death. It is important for the patient to take her medication as ordered.

35. Question How many different types of personality disorders are there? • 2 • 10 • 3 • 20

36. Answer C. 3 • Cluster A personality disorders are those defined by odd or eccentric behavior. • Cluster B personality disorders are those defined by dramatic, unpredictable, and emotional behavior. • Cluster C personality disorders are those defined by fearful or shy behavior.