PSYCHIATRIC NSG
DR. JAMES M. ALO, RN, MAN, MAP, PhD
Models of Mental Health Biomedical model
Mental health: state of emotional, psychological & social wellness (effective coping, (+) self-concept, emotionally stable).
Mental disorder: Defined generally as health conditions marked by alterations in thinking, mood or behavior taht cause distress, impair ability to function, or both (USDHHS, 1999). Mental illness Is considered a clinially significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or loss of freedom (APA, 200).
James M. Alo, RN, MAN, MAP, PHD.
7/26/2011
What you see is just the tip, what lies beneath is the truth about it.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Factorsinfluencing mental health INDIVIDUAL persons biologic make-up, autonomy and
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience, sense of belonging, reality orientation and coping or stress management abilities. INTERPERSONAL or relationship, may include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness. SOCIAL / CULTURAL or ENVIRONMENTAL - include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of ones world.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
CONCEPT OF POSITIVE MENTAL HEALTH
1.Attitudes toward the individual SELF Involves aspect related to : a. Self-acceptance - regard for oneself with a realistic concept of strengths & weaknesses. b. Self-awareness - is noticing how the self feels, thinks, behaves and senses at any given time. c. Self-concept - encompasses all what a person perceives, knows and holds to be true about his/her identity.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Aspects of self-concept
BODY IMAGE
ROLE PERFORMANCE
PERSONAL IDENTITY
SELF-ESTEEM
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
2. Growth, Development, Self-Actualization Is what a person does with his abilities and potentialities over a period of time. Future goals and investments in living are involved 3. Integrative Capacity Core Concept : the relatedness of all processes & attributes in an individual which influence unified or synchronized personal function. Concerns the ability of the individual to tolerate anxiety and frustration during resistance to stress. Psychoanalysts view : a balance of psychic forces. (id,ego,superego)
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
4. Autonomous Behavior
individuals ability to personally regulate his
decision-making & actions so that these functions relatively independent of physical and social influences. ability to refuse to conform when to do is a social expectation that conflicts with ones value system.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
5. Perception of Reality
How the individual views and reacts toward the world around him . - ability to perceive reality while being free of needs which could
distort individual perceptions.
6. Mastery of Ones Environment
ability to ADAPT, ADJUST and BEHAVE appropriately in situations
and in accordance with culturally approved standards so that satisfactions are achieved in love, work, play and interpersonal relations. - ability to solve problems with expression of appropriate feeling tones and direct attack.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
HISTORICAL BACKGROUND
ANCIENT TIMES
people believed that any sickness indicated displeasure of the Gods and in fact was punishment for sins and wrong doings. mental disorders were viewed as either being divine or demonic depending on their behavior.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
Renaissance (1300-1600)
People with mental illness were distinguished from criminals
Those considered harmless were allowed to wander and live in the
rural areas Those dangerous lunatics were thrown in prison, chained, and starved
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
1547 Hospital of St. Mary of Bethlehem, first hospital for the insane was built
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
1775 visitors at the institution paid to view and ridicule the inmates like animals
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Mentally ill patients were considered evil or possessed and were burned at the stake
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Period of enlightenment
1790s
Phillippe Pinel and Willian Tukes formulated the concept of asylum as a safe refuge or haven offering protection to mentally-ill people
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Dorothea Dix
(1802-1887) began a crusade in the USA to reform treatment of the mentally ill. She opened 32 state hospitals that offered asylum.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Period of scientific discovery
Period of scientific study and treatment of mental illness began
with:
Sigmund Freud (1856-1939) studied the mind, its disorders
and treatment Emil Kraepelin (1856-1926) classified mental disorders according to their symptoms Eugene Bleuler (1857-1939) coined the term schizophrenia
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
LINDA RICHARDS first American psychiatric nurse. She believed that, the mentally sick should be at least as well cared for as the physically sick
The first training of nurses to work with persons with mental illness was in 1882 at McLean Hospital in Waverly,Mass.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
The first psychiatric nursing book Nursing Mental Diseases by Harriet Bailey was published in 1920 In 1913 John Hopkins was the first school of nursing to include a course in psychiatric nursing in its curriculum Two early nursing theorists shaped psychiatric nursing practice: Hildegard Peplau and June Mellow.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
1845 first authentic book on psychiatric disorder was released 1950s birth of psychotropic drugs; first to be created were: Thorazine antipsychotic drug Lithium antimanic drug
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
NEUROSCIENCE: Biology & behavior
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Dendrites Axon
Neuron
Receive impulses Semd impulses away
Neuromuscular junction(NMJ) Glial cell/neuroglia
Connects nerve to muscles Are supporting cells, they include:
Olegodendrocytes produce myelin in the CNS Microglia phagocytes/scavengers of the CNS Astrocytes structural supporting cells Myelin Insulates axons & allow faster impulse conduction Schwann cell - #schwann cell myelinates #axon in the PNS Olegodendrocyte myelinates several axons in the CNS
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
Neurotransmitters
Acetylcholine (Ach)
Is both excitatory (depolarizes membranes) & inhibitory (hyperpolarizes membranes); is used by all motor neurons, the brain, & both sympathetic, & parasympatetic systems. Reduced in alzheimers dementia & myastenia gravis.
Biogenic amines
Tyrosine " Dopamine "Norepinephrine "Epinephrine Tryptophan "serotonin; "histidine "histamine Metabolized by Monoamine Oxidase (MAO) & CathecolO- Methyl Transferase (COMT)
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
Dopamine
Norepinephrine (Noradrenaline) Epinephrine (adrenalin) Serotonin Histamines
Excitatory, seen in midbrain for control of complex movement, motivation, cognition & emotion. $ In Parkinsons ds & depression #in schizophrenia, mania, Tourettes syndrome Excitatory, in postganglionic sympathetic neurons (figt or flight) & in the brain (attention, memory) In anxiety disorders $in depression, low impulse control Inhibitory, in brainstem, linked to impulse control #in depression, low impulsecontrol Modulator, seen in hypothalamus, #in allergies
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
hamino butyric acid (GABA) Glutamate Glycine Nitric Oxide
Amino acids
Primary inhibitory transmitter in CNS $in anxiety, #by benzodiazepines & barbiturates Primary excitatory transmitter in CNS #in Huntingtons chorea, alzheimers Inhibitory in spinal interneurons Inhibitory, gas form, affects central & enteric nervou system Relaxes vascular smooth muscle causing vasodilation.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Neuromodulators
Neuropeptides
Enkephalins,endorphins, substance P, somatostatin, VIP, CCK, Neurotensin, ACTH, angiotensin
Alter sensitivity of synaptic membranes to neurotransmitters
(my enhance, prolong,, or inhibit transmitter effects.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
Central Nervous System
Cerebral Cortex
Divided into 2
hemispheres:
Left: controls right side of
the body as well as logical reasoning & analysis fxns; (reading, writing, &math). Right: controls left side of the body as well as; creative thinking, intuition, & artistic abilities.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
Further divided into 4 lobes Function
Frontal lobes Motor cortex Found in precentral gyrus For voluntary motor activity
Impairment
Mono or hemiplegia depending on the extent Apraxis loss of learned movement Paralysis of head & eye to opposite side Incontinence Expressive aphasia cant speak right
Premotor cortex Planning of movement Contralateral head & eye turning Bowel & bladder inhibition Brocas area Prefrontal area Expression, motor for speech
Personality & emotion, judgment Personality changes: antisocial & inhibition, concentration & behavior, loss of elaboration of thought inhibitions/impulsive, poor concentration.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PSCHOANALYTIC THEORY
SIGMUND FREUD
(1856-1939) Father of Psychoanalysis Modern Psychiatry
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Psychoanalytic theory
Supports the notion that all human behavior is be explained
caused and can be explained
Supports the notion that all human behavior is caused and can
He believed that repressed sexual impulses and
desires motivated much human behavior
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Theory of Psychosexual Development by Sigmund Freud
Oral Phase- 1 yr. old Greatest need- security Greatest fear- if anger anxiety Narcissistic- pleasure seeking is through eating & sucking; primary narcism( self-love) Mouth- erogenous zone, area of satisfaction Insecurity in parting with breast or bottle may cause fixation Tension is relieve by sucking & swallowing Sucking need is independent of hunger satisfaction.
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
Anal phase -Primary source of pleasure is
elimination/retention
This is the critical period
for toilet training Anus- site of tension & sexual gratification Greatest need: power first experience with discipline & authority retention & expulsion (forcing out are experienced as pleasurable especially because these functions come under the child-control.) Child uses his new skill to please or annoy parenting adult.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Theories of Personality
Freudian Concept
Sigmund Freud the father of psychoanalysis stressed that early
childhood experiences is important in the development of personality.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Three Components of Personality
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
ID
part of personality in which we are born it is primitive, it demands immediate satisfaction functions according to pleasure principle unconscious part of the person which serve as the reservoir of primitive & biologic drives & urges reflects basic or innate desires such as pleasure seeking behavior, aggression & sexual impulses. Totally self-centered Developed during infancy Seeks instant gratification Impulsive, unthinking behavior No regard for rules or social convention
James M. Alo, RN,MAN,MAP,PHD.
too much id7/26/2011
Ego
the self or the I known as the integrator of personality Part of the mind which acts with the outside world, partly conscious &
partly unconscious operates on reality- principle. If it develops it supercedes the pleasure principles in guiding behavior this is developed during the toddler period conscious self. the I that deals with reality part of personality thats evident to the environment Balancing or mediating force between the id and the superego. Represents mature and adaptive behavior that allows a person to function successfully in the world. ANXIETY results from egos attempt to balance the impulsive instincts of the id with the stringent rules of the supergo.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Superego
the conscience the automotive or parental directions which incorporated in the
personality as the CENSORING FORCE. this is developed during the preschool age Strict Superego- leads to rigid, compulsive, unhappy person Weak/Defensive Superego leads to antisocial behavior, hostility reflects moral & ethical concepts, values, parental and social expectations controls, inhibits & regulates impulses & instincts whose uncontrolled expression would endanger the emotional well-being individual & the stability of the society. Direct opposition to the id.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
MENTAL DISORDER
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
FREUDS Psychoanalytic/psychodynamic model
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Personality functions @ 3 levels of awareness:
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
= Neurotic benhavior is a result of childhood trauma or failure to complete tasks or needs of psychosexual development:
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Narcissistic defenses
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Anxiety/Neurotic defenses
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Anxiety/Neurotic defenses
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Immature defenses
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Mature defenses
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Examples of psychiatruc disorders & defenses used:
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
ERIKSONS Psychosocial development model
each stage involvinf a task w/ (+) & (-) experiences. ?Completion of said task allows one to achieve life virtues.
?Psychosocial growth occurs in a series of 8 developmental stages w/
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PIAGETs Cognitive Developmental Model = Focus of child devt is on genetics, envi., moral, & intellectual devt.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
KOHLBERGs Moral Developmental Model = Expanded Piagets Moral Developmental Model
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
MASLOWs Heirarchy of Needs Model
Basic human needs are elements, shared by all people that are
necessary for human survival & health Certain needs are more basic than others .i.e. Some needs must be met before others.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Selfactualization Self-esteem Love & Belonging Safety & security: Physical & psychological Physiologic: O2, fluids, food, temp., elimination, shelter, sex
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
PAVLOVs & SKINNERs Behavioral Model
Behavior is observable, predictable & controllable. It can be changed by a system of rewards & punishments.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PAVLOVs Classical Conditioning
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
SKiNNERs Operant Conditioning
Behavior is learned from repeatedly reinfirced experiences
(+) reinforcement /reward a behaviors recurrence (-) reinforcement/ punishment $ a behaviors recurrence
Continuous (+) reinforcement (reward each time behvior occurs) is the fastest way to #a behaviors recurrence but be havior is shortlived after after the rewards have ceased.
Random intermittent reinforcement (reward for desired behavior once in a while) is the slower but more permenent of increasing James M. Alo, RN,MAN,MAP,PHD. 7/26/2011 desired behavior.
SYSTEMATIC DESENSITIZATION
Gradual exposure to feared stimulus while clients are relaxed
Application of conditioning as clients are helped to overcome their PHOBIAS
Untill fear responses is EVENTUALLY
James M. Alo, RN,MAN,MAP,PHD.
EXTINGUISHED
7/26/2011
SELYEs Stress Adaptation Model
Physiological response to stress correlated to anxiety level
GENERAL ADAPTATION SYNDROME (GAS)
Stage 1.Alarm Reaction (fight/flight response)
Physical; #Epinephrine & Nor-epinephgrine= sympathetis response Psychosocial:Alert. #anxiety (1+, 2+), inefficient problem-solving
Stage 2. Ressistance (Optimal adaptation to nstress)
Physical: adrenal cortex & its hormones readjust, weight normalizes Psychosocial: #Coping mechanisms, defense oriented behavior
Stage 3. EXHAUSTION (Inability to cope, depleted resources)
James M. Alo, RN,MAN,MAP,PHD.exaggerated behavior, disorganized thought & personality, delusions, Psychosocial:
hallucinations, stupor/violence. Physical: $immune response, hormones, weight"organ failure
7/26/2011
PSYCHIATRIC ASSESSMENT
PSYCHIATRIC HISTORY
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
MENTAL STATUS EXAM
I. GENERAL DESCRIPTION
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
II. EMOTIONS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
III. SPEECH described terms of quantity, rate of production & quality: ex. Talkative, non-spontaneous, hesitant, slurred
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
IV. PERCEPTUAL SIDTURBANCES process by which physical stimuli are brought to mental awareness
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
V. THOUGHT
A. Process/ form of thought way a person puts together ideas & assoc., form in w/c a person thinks.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
B. CONTENT OF THOUGHT What person is actually
thinking about: beliefs, ideas, obsessions, preoccupations.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
VI. CONSCIOUSNESS (state of awarenes), SENSORIUM
(awareness of special senses), & COGNITION (awareness of thought).
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PSYCHIATRIC DIAGNOSIS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NANDA Accepted Nursing Diagnosis
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
INTERVENTION: Therapies
THERAPEUTIC NURSE-CLIENT REL. (Peplau) Therapeutic use of self focus on both client-nurse needs Has 4 PHASES:
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
TECHNIQUES OF THERAPEUTIC COMMUNICATION
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PYSCHOPHARMACOLOGY
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NURSING INTERVENTION
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
STIMULANT DRUGS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
CLASSIFICATION OF MENTAL DISORDERS
A.
Disorders usually evident in infancy, childhood & adolescence
1. 2. 3. 4. 5. 6. 7. 8. 9.
MR PDD Disruptive behavior disorders Anxiety disorders of childhood & adolescence Eating disorders Gender identity disorders Tic disorders Elimination drs Speech drs
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
B. Organic mental syndromes disorders
1.
Organic mental syndromes a. Delirium
b. Dementia 2. OMD (dementias arising in the sensium & presensium)
Primary degenerative dementia (senile onset) b. Primary degnerative demntia (presenile onset)
a.
3.
Psychoactive substance use drs
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
C. Psychoactice substance use dr'
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
ANXIETY DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
LEVELS OF ANXIETY
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
ANXIETY DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NURSING INTERVENTIONS TO $ANXIETY
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
SOMATOFORM DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
DISSOCIATIVE DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
FACTITIOUS DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
ACHIZOPHRENIAS & OTHER PSYCHOTIC DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
OTHER PSYCHOTIC DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NURSING INTERVENTIONS FOR PSYCHOTIC DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Mood Disorders
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Depressive Disorder
A. Major Depressive Dr
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Intervention for Depressed Px
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Bipolar Disorders
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
INTERVENTION FOR MANIC PX
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
COGNITIVE DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Types of Dementia
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NURSING INTERVENTION FOR COGNITIVE DR
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
PERSONALITY DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
DEVELOPMENTAL DISORDER
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Classification
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Elimination Disorders
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Tic Disorders
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
SUBSTANCE RELATED DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Alcohol Abuse
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
Psychoactive Drug Abuse
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
COMMONLY ABUSE DRUGS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
EATING DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
SEXUAL DISORDERS
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
DEATH & GRIEVING
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
NEXT
James M. Alo, RN,MAN,MAP,PHD. 7/26/2011
ONCOLOGY NURSING
NEOPLASTIC DISEASES A. Characteristics
1.
Etiology
a) b)
Healthy cells transformed into malignant cells upon exposure to certain etiological agents: viruses, chemical & physical agents. Failure of immune response
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
2. Pathophysiology a) Rapid cell division b) Malignant cells metastasize
1. Extending directly into adjacent tissue 2. Permeating along lympathic vessels 3. Traveling through lymph system to nodes 4. Entering blood circulation 5. Diffusing into body cavity
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
3. Classification of tumors
a.
Accdg to type of tissue from which they evolve
1) 2)
Carcinomas begin in epithelial tissue (ex: skin, GI tract lining, lung, breast, uterus) Sarcomas begin in non-epithelial tissue(ex: bone, muscle, fat, lymph system)
b.
Type of cell in which they arise; cell types affect appearance, rate of growth & degree of malignancy.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
4. Staging
a.
Describes extent of tumor
T= primary tumor N= regional nodes M= metastasis
b.
Describes extent of malignancy to which malignancy has # in size
To= no evidence of primary tumor Ts= carcinoma in situ T1,T2,T3,T4= progressive #in tumor, size & involvement Tx= tumor cannot be assessed
c.
Involvement of regional nodes
No= regional lymph nodes not abnormal N1-4= #degree of abnormal size Mo= no evident of distant metastasis M1-M3= #degree of metastasis
d. Metastatic dev.
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
B. Manifestations > Malignant ds (ACS 7 warning signs)
1. 2. 3. 4. 5. 6. 7.
Change in bowel/bladder movement Sore that does not heal Unusual bleeding /discharge Thickening/lumps in breast/ elsewhere Indigestion/difficulty of swallowing Obvious change in wart/mole Nagging cough/hoarseness
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
C. Cancer therapy
1.
1. 2. 3.
Objective: to cure
Prevent further metastasis Relieve manifestations Maintain high quality life
2.
1. 2. 3.
Surgery
Radical Prophylactic palliative
3.
1.
Chemotherapy
Drugs interfere w/ cell division
James M. Alo, RN,MAN,MAP,PHD.
7/26/2011
