ABRA VALLEY COLLEGES

COLLEGE OF NURSING
BANGUED, ABRA

A.Y. 2023 – 2024, 2ND SEMESTER

MODULE
In

NCM 117

CARE OF CLIENTS WITH MALADAPTIVE

PATTERNS OF BEHAVIOR, ACUTE &
CHRONIC

LECTURE & RLE

FINAL TERM MODULE

Prepared by:

JAIME A. BUMOGAS, RN
Nurse Educator

Noted by:

DR. TERESITA J. GARCIA

VPAA

3. Mental Health Gap Action Programme (MhGAP)

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a. Acute Stress (ACU)
 Occurs when symptoms develop due to a particularly stressful event.
The word “acute” means the symptoms develop quickly but do not usually last long. The events are
usually very severe and an acute stress reaction typically occurs after an unexpected life crisis.
Examples:
 A traffic jam
 An argument with your spouse
 Criticism from your boss
b. Grief (GRI)
 Refers to the subjective emotions and affect that are normal response to the experience of loss.
c. Moderate – severe depressive disorder (DEP)
 Is generally marked by low mood and irritability most days as well as a loss of interest or enjoyment in
activities that were previously pleasurable.
 There is no single thing that causes depression. But there are other things that can contribute to
depression:
o Genetics
o Having parents or other family members with depression
o Having another mental health conditions
o Poverty
o Chronic health conditions
o Certain medications
 Treatments
1. Psychotherapy
2. Medication
3. Or a combination of the two
 Medications
1. Antidepressants (selective serotonin reuptakes inhibitors/ SSRIs)
o Zoloft – sertraline
o Prozac – Fluoxetine
o Paxil - paroxetine
d. Post - traumatic stress disorder (PTSD)
 Is a disturbing pattern of behavior demonstrated by someone who has experienced, has witnessed, or has
been confronted with a traumatic event such as natural disaster, combat, or an assault.
 The person with PTSD was exposed to an event that posed actual or threatened death or serious injury
and responded with intense fear, helplessness, or terror.
 Clinical course:
o The 3 major elements of PTSD are:
1) Experiencing the trauma through dreams or recurrent and intrusive thoughts
2) Showing emotional numbing such as feeling detached from others
3) Being on guard, irritable or experiencing hyperarousal.
 Etiology
o PTSD has long been associated as an anxiety disorder, though it differs from other diagnoses in
that category.
There has to be a causative trauma or event that occurs prior to the development of PTSD, which
is not the case with anxiety disorders.
The effects of the trauma at the time, such as being directly involved, experiencing physical
injury, or loss of loved ones in the event, are more powerful predictors of PTSD for most people.
Children are more likely to develop PTSD when there is a history of parental major depression
and childhood abuse.
 Treatment:
1. Cognitive Behavior Therapy (CBT)
 A type of psychotherapy in which negative patterns of thought about the self and the world
are challenged in order to alter unwanted behavior patterns or treat mood disorders such as
depression.

Pharmacology
1) SSRI antidepressants
2) SNRI unlafaxine
3) SGA risperidone
 Nursing Interventions
1. Promote the client’s safety
2. Help the client cope with stress and emotions
3. Help to promote the client’s self – esteem
4. Establish social support
e. Psychosis (PSY)
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 Cluster of symptoms including delusions, hallucinations, and grossly disordered thinking and behavior.
f. Epilepsy
 Is sometimes called seizure disorder, is a disorder of the brain.
A person is diagnosed with epilepsy when they have had two or more seizures.
A seizure is a short change in normal brain activity.
Seizures are the main sign of epilepsy.
Some seizures can look like staring spells.
 Causes
1. Neurological issue like a stroke or a brain tumor
2. Genetic abnormalities
3. Prior brain infection
4. Prenatal injuries
5. Developmental disorders
 Epilepsy: seizure triggers warning signs and symptoms:
1. Temporary confusion often described as a “fuzzy” feeling
2. Staring spell
3. Uncontrollable jerking movements of the arms and legs
4. Loss of consciousness or awareness
5. Psychic symptoms – out - of – body feelings or not feeling “in the moment”
 Treatment
1. Antiepileptic drugs (AED)
2. Surgery to remove a small part of the brain that’s causing the seizure
3. A procedure to put a small electrical device inside the body that can control seizures
4. A special diet (ketogenic diet) that can help control seizures

Types of AEDS
 Sodium valproate
 Carbamazepine
 Lamotrigine
 Lavetiracetam
g. Intellectual Disability (ID)
 Is a term used when there are limits to a person’s ability to learn at an expected level and function in daily
life.
 Levels of intellectual disability vary greatly in children.
Examples of intellectual and developmental disabilities:
 ADHD
 Autism spectrum disorder
 Cerebral palsy
 4 levels of ID
1. Mild
2. Moderate
3. Severe
4. Profound
 Causes
1. Down syndrome
2. Fetal alcohol syndrome
3. Fragile x syndrome
4. Genetic conditions
5. Birth defects
6. Infections
h. Harmful use of alcohol and drugs (SUD)
 Use and abuse of drugs and alcohol by teens is very common can have serious consequences.
 In the 15-24 year age range, 50% of deaths (from accidents, homicides, suicides) involve alcohol or drug
abuse.
 Drugs and alcohol also contribute to physical and sexual aggression such as teenage experience with
alcohol and drugs include:
o Abstinence (non-use)
o Experimentation
o Regular use (both recreational and compensatory for other problems)
o Abuse
o Dependency
 Repeated and regular recreational use can lead to other problems like:
o Anxiety
o Depression
 Warning signs of teenage drug or alcohol abuse may include:
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o A drop in school performance
o A change in groups of friends
o Delinquent behavior
o Deterioration in family relationships
i. Suicide (SUI)
 Is the intentional act of killing oneself.
 Suicidal thoughts are common in person with mood disorders, especially depression.

Key terms:
1. Suicide ideation
 Thinking about killing oneself
2. Suicide precaution
 Removal of harmful items; increased supervision to prevent acts of self – harm
3. Suicidal gestures
 Are a person’s nonlethal self – injury acts, including:
o Cutting of skin areas
o Burning of skin areas
o Injection of small amounts of drugs
 Refers to suicide plan / actions that are unlikely to succeed.
 Often others see these gestures as, “attention getting” measures and do not consider than serious
problems that may lead to a suicide attempt or completion.
4. Suicidal threats
 Are a person’s verbal statements that may declare their intent to commit suicide.
Threats often precede an actual suicidal attempt.
5. Suicide plan
 A specific method designed to inflict – self – injury or self-destruction as verbalized by an individual.
6. Completed suicide
 Results in deaths
 Suicide rates for men are partly the result of the method chosen.
Examples:
 Shooting
 Hanging
 Jumping from a high place
Women are more likely to overdose on medication.
 The 2nd leading cause of death (after accidents) among people 15 to 24 years of age, and the rate is
increasing most rapidly in this group.
7. Passive suicidal ideation
 Is when a person thinks about wanting to die to wishes he/she were dead but ahs no plans to cause
his/her death
8. Attempted suicide
 Is a suicidal act either failed or was incomplete
9. Incomplete suicide attempt
 The person did not finish the act because:
i. Someone recognized the suicide attempt as a cry for help and responded or
ii. The person was discovered and rescued.

Psychiatric D/Os associated with increased risk for suicide:

1. Bipolar disoders
2. Depression
3. Schizophrenia
4. Substance abuse
5. Post traumatic stress disorder
6. Personality disorder
Chronic Medical Illness associated with increased risk for suicide include:
1. Cancer
2. HIV / AIDS
3. Diabetes
4. Cerebrovascular accidents
5. Head and spinal cord injury

Environmental Factors that increase suicide risk

1. Isolation
2. Recent loss
3. Lack of social support
4. Unemployment
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5. Critical life events
6. Family history of depression or suicide

Behavioral factors that increase risk include:

1. Impulsivity
2. Erratic or unexplained changes from usual behavior
3. Unstable lifestyle

Risk factors for completed suicide

1. Hopelessness
2. General medical illness
3. Severe anhedonia
4. Male
5. Caucasian and native American
6. Living alone
7. Prior suicide attempts
8. Age 60 and older
9. Unemployed or financial problems

Assessment
1. Mood
2. Motor activity
3. Language thought process

Nursing Diagnosis
1. Altered nutrition
2. Dysfunctional grieving
3. Constipation
4. Hopelessness
5. Powerlessness
6. Altered role performance
7. Self – care deficit
8. Self – esteem disturbance
9. Sleep pattern disturbance
10. Social isolation
11. Spiritual distress
12. Potential for violence directed to self

Plan/ Implementation
1. Begin a therapeutic relationship
2. Ensure safety of clients with low self – esteem
3. listen closely for behavioral cues to suicidal thoughts
4. create a structures and schedules but nondemanding environment
5. promote independence by encouraging client to perform
6. ADL- assist only when he cannot perform
7. Closely monitor for the side effects of antidepressants / anti-manic agents
8. Ensure that nutritional and fluid balance needs are met

Evaluation
1. Gradual progress in being able to keep self-safe; learn to manage stress and emotions; being able to function in
daily life.
4. Treatment and Modalities
a. Somatic Therapies
1) Electroconvulsive therapy
 A treatment for severe depression and certain mental disorders
 A brief seizure is induced by giving electrical stimulation to the brain through electrodes placed on
the scalp.
Also called ECT and electroschock therapy.
2) Alternative / Complementary Treatments
 Alternative medicine is a term that describes medical treatments that are used instead of traditional
therapies complementary therapies are used alongside conventional medicines or treatments
3) Other Therapies
 Breath work
 Meditation
 Visualization

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 Massage
 Grounding
 Dance
 Sensation awareness work
b. Psychotherapies
1) Individual psychotherapy
 Is one type of psychotherapy in which a trained professional helps a single person work through
personal issues they have been facing
It is an effective treatment for a variety of emotional difficulties and mental illness
2) Group therapy
 Is a form of psychotherapy that involves one or more therapists working with several people at the
same time
 The most common types of group therapy include:
i. Cognitive behavioral groups
 Which caters on identifying and changing inaccurate or distorted thinking patterns, emotional
responses and behavior
ii. Interpersonal groups
 Which focus on the interpersonal relationships and social interactions, including how much
support you have from others and the impact these relationships have on your mental health
iii. Psychoeducational groups
 Which focus on educating clients about their disorders and ways of coping often based on the
principles of (CBT) cognitive behavior therapy
iv. Skills development groups
 Which focus on improving social skills in people with mental disorders or developmental
disabilities
v. Support groups
 Which provides a wide range of benefits for people with a variety of mental health conditions
as well as their loved ones.

Group therapy meetings may either be:

1. Open sessions
 To which new participants are welcome to join at any time
2. Closed session
 To which only a core group of members are invited to participate
3. Family Therapy
 Is a type of psychological counseling (psychotherapy)
 The usual goals of family therapy are:
a. Improving the communication
b. Solving family problems
c. Understanding and handling special family situations
d. Creating a better functioning home environment
e. If also involves, exploring the interactional dynamics of the family and its
relationship to psychopathology
4. Play therapy
 Is a form of psychotherapy and can be effective in helping children through emotional and
mental issues
 Primary goal
o To help children who might struggle with expressing themselves or their emotions to
express themselves through play.
 Types of play therapy
a. Directive play therapy
 The therapist takes a hands – on approach and leads the child through guided play
activities to help them express themselves.
They’ll typically give specific instructions and supervise the child as they go through
it.
b. Non-directive play therapy
 NDPT makes use of a less controlled environment. The therapist leaves the child to
engage in whatever play activities they might enjoy and express themselves with
limited interference.
 Some of the most common techniques used by play therapists:
a. Using building blocks
b. Using art
c. Sand play
d. Board games
e. Play with dolls

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f. Puppet play
g. Tea party play
h. Card games
i. Strategy games like chess or checkers
j. LEGO play
 There has been some research into the effectiveness of play therapy on children with the
following conditions.
a. Autism
b. Attention deficit hyperactivity disorder (ADHD)
c. Depression
d. Anxiety disorders
e. Post – traumatic stress disorders
f. Physical and emotional trauma
g. Sexual abuse
h. Physical or emotional abuse
 Benefits of play therapy
a. Gives children who are having a hard time communicating verbally to express themselves
through play activities.
For instance, a child who refuses to speak might instead draw or paint out their thoughts
or needs
b. It creates a space where a child will feel comfortable being themselves instead of other
more traditional forms of psychotherapy
c. It allows the child to take charge of their therapy process.
Effective play therapy allows the child to use toys and mediums they are most
comfortable with and go at their own pace.
d. It helps children understand their emotions, especially if they had struggled with doing
this before.
e. It helps children build up their communication and social skills with time.
After several sessions, a child who wasn’t speaking might start to utter several phrases.
5. Gestalt Therapy
 Is a form of psychotherapy that is centered on increasing a person’s awareness, freedom and
self – direction.
 It’s a form of therapy that focuses on the present moment rather than past experiences.
Gestalt therapy is based on the idea that people are influenced by their present environment
 Goal:
o To teach people to become aware of significant sensations within themselves and
their environment so that they respond fully and reasonably to situations.
6. Client – centered therapy
 Also known as person – centered therapy or Rogerian therapy;, is a non – directive form of
talk therapy developed by humanist psychologist Carl Rogers during the 1940’s and 1960’s.
In this approach, you act as an equal partner in the therapy process, while your therapist
remains non – directive – they don’t pass judgments on your feelings or offer suggestions or
solutions.
 Techniques
o Mental health professionals who utilize this approach strive to create the conditions
needed for their clients to change.
This involves a therapeutic environment that is:
 Comfortable
 Non – judgmental and
 Empathetic
o They use 3 techniques to achieve this:
1. Genuineness and congruence
 They always act in accordance with their own thoughts and feelings,
allowing themselves to share openly and honestly.
2. Unconditional positive regard
 The therapist will show unconditional positive regard by always accepting
you for who you are and displaying support and care no matter what you are
facing or experiencing.
They may express positive feelings to you or offer reassurance, or they may
practice active listening, responsive eye contact, and positive body language
to let you know that they’re engaged in the session.
3. Empathetic Understanding
 The therapist will act as a mirror of your feelings and thoughts.
They will seek to understand you and maintain an awareness and sensitivity
to your experience and your point of view.

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 Effectiveness
1) Appear to lead to better outcomes, especially when they are used in
school counseling setting
2) Also effective particularly at improving overall well – being for people
with mood or anxiety disorders
3) Empathetic understanding appears to promote positive outcomes,
especially for people experiencing depression and anxiety
c. Behavioral Therapies
 A term used that describes a broad range of techniques used to change maladaptive behaviors.
The goal:
 To reinforce desirable behaviors and eliminate unwanted ones.

Cognitive Therapies
 A relatively short – term form of psychotherapy based on the concept that the way we think about things
affects how we feel emotionally
 Cognitive therapy focuses on present thinking, behavior, and communication rather than on post
experiences and is oriented toward problem solving.
 Examples of cognitive therapy techniques
o Activity scheduling
o Graded exposure assignments
o Mindfulness practices
o Skills training
o Cognitive restructuring
o Successive approximation

Milieu Therapy Therapeutic Milieu

 Is a safe, structured, group treatment method for mental health issues.
It involves using everyday activities and a conditional environment to help people with interaction in
community settings.
 Milieu therapy is flexible treatment intervention that may work together with other treatment methods.
 Components of milieu therapy
1) Support
2) Structure
3) Validation
4) Involvement
5) Containment
 Benefits
1) Freedom from a construct system that might hinder treatment
2) Encouragement to adopt healthy behavior while trying out new coping skills
3) A sense of security
4) Direct of security
5) Direct feedback from caregivers and the community to motivate progress
6) A supportive environment
Therapeutic Milieu
 Safety protocols and infection control in the psychiatric nursing.
d. Adjunction / art – based, dance / music therapies
e. Psychopharmacology
 Antispychotics
 Anti – anxiety or anxiolytics
 Antidepressants
 Lithium and mood stabilizers
f. Basic intervention for tobacco control
i. Introduction to the drug nicotine
ii. Smoking cessation vs. nicotine dependence
iii. Treatment approach and holistic model
 Physical well being
 Emotional well being
 Mental well being
 Spiritual well being
g. Complementary and alternative therapy
h. Nutrition and dietary therapy

D. Health Education
E. Recording and Reporting
F. Evaluation of Care
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Standards of Psychiatric – Mental Health Nursing Practice

A. Structure criteria and standards

1) Qualification of the nurse
 Personal
 Professional
2) Functions of the nurse
3) Physical facilities and equipment
B. Process criteria and standards
C. Outcome criteria and standards
1) Progress and effects of nursing care

Antipsychotic Drugs:
 Formerly known as neuroleptics
 Used to treat the symptoms of psychosis, such as the delusions and hallucinations seen in schizophrenia,
schizoaffective disorder and the manic phase of bipolar disorder.
 Mechanism of action
 The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter
dopamine; however the therapeutic mechanism of action is only partially understood.
 Conventional or first – generation antipsychotics

Phenothiazines
 Chlorpromazine (Thorazine)
 Perphenazine (Trilafon)
 Fluphenazine (Proxilin)
 Thioridazone (Mellaril)
 Mesoridazole (Serentil)
 Trifluoperazine (Stelazine)

Thioxanthene
 Thiothixene (Navane)

Butyrophenones
 Haloperidol (Haldol)
 Droperidol (Inapsine)

Dibenzazepine
 Loxapine (Loxitane)

Dihydroindolone
 Molindone (Moban)

 Atypical or second – generation antipsychotics

Clozapine (Clozaril)
 Fazaclo (Clozapine)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetapine (Seroquel)
Ziprasidone (Geodon)
Paliperidone (Innega)
Iloperidone (Farapt) Newest second generation agents
Asenapine (Saphris)
Lurasidone (Latuda)

 Third – genereatoion antipsychotic

Aripiprazole (Abilify)

Drugs used to treat Extrapyramidal Side Effects:

Generic (Trade) Name Oral Dosages (mg) IM / IV Drug Class

Doses (mg)
1. Amantadine (Symmetrel) 100 bid or tid - Dopaminergic agonist
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2. Benztropine (Cogestii) 1-3 bid 1-2 Anticholinergics
3. Biperiden (Akineton) 2 tid – qid 2 Anticholinergic
4. Diazepam (Valium) 5 tid 5 – 10 Benzodiazepine
5. Diphenhydramine (Benadryl) 25 – 50 tid / qid 25 – 50 Antihistamine
6. Lorazepam (Ativan) 1-2 tid - Benzodiazepine
7. Procyclidine (Kemadrin) 2.5 – 5 tid - Anticholinergic
8. Propranolol (Inderal) 10-20 tid to 40 qid - Beta – blocker
9. Trihexyphenidyl (Artane) 2-5 tid - Anticholinergic

Side effects of antipsychotic drugs

1. Extrapyramidal side effects
Extrapyramidal symptoms (EPSs), serious neurologic symptoms are the major side effects of antipsychotic drugs,
they include:
a. Dystonia
 Includes:
o Acute muscular rigidity and cramping
o A stiff or thick tongue with difficulty swallowing
o In severe cases, laryngospasm and respiratory difficulties
 Most likely to occur in:
o The first week of treatment
o In clients younger than 40 years
o In males
o In those receiving high – potency drugs such as haloperidole and thiothixene
 Spasms or stiffness in muscle groups can produce:
o Torticollis
 Twisted head and neck
o Opisthotonus
 Tightness in the entire body with the head back and an arched neck)
o Oculogyric crisis
 Eyes rolled back in a locked position

b. Drug – induced parkinsonism or pseudoparkinsonism

 Symptoms resemble those of Parkinson’s disease and include:
o A stiff stopped posture
o Mask – like arm swing
o A shuffling, festinating gait (with small stepso)
o Cogwheel rigidity (ratchet – like movements of joints)
o Drooling
o Tremor
o Bradycardia
o Coarse pill-rolling movements of the thumb and fingers while at rest

c. Akathisia
 Is intense need to move about; characterized by:
o Restless movements
o Pacing
o Inability to remain skill
o The client’s report of inner restlessness
 Akathisia can be treated by a change in antipsychotic medication or by the addition of an oral agent
such as beta – blocker, anticholinergic or benzodiazepine.

d. Neuroleptic Malignant Syndrome (NMS)

 Is a potentially fatal idiosyncratic reaction to an antipsychotic (or neuroleptic) drug.
 The major symptoms:
o Rigidity
o High fever
o Autonomic instability such as:
 Unstable blood pressure
 Diaphoresis
 Pallor
o Delirium
o Elevated levels of enzymes, particularly creatinine phosphokinase
 Clients with NMS usually are:

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o Confused and often mute
o May fluctuate from agitation to stupor
 The following increases the risk for NMS
o Dehydration
o Poor nutrition
o Current medical illness
 Treatment include
o Immediate discontinuance of all antipsychotic meds
o Institution of supportive medical care to treat dehydration and hyperthermia until the client’s
physical condition stabilizes.

e. Tardine dyskinesia (TD)

 A late onset, irreversible neurologic side effect of antipsychotic medications.
 Characterized by:
o Abnormal, involuntary movements such as:
 Lip smacking
 Tongue protrusion
 Chewing
 Blinking
 Grimacing
 Chloreiform movements of the limbs and feet
 About 20% to 30% of patients on long-term /treatment develop symptoms of TD
 After the symptoms had developed, TD is irreversible, although decreasing or discontinuing the drug
can arrest its progression

f. Anticholinergic side effects

 Often occur with the use of antipsychotics and include:
o Orthostatic hypotension
o Dry mouth
o Constipation
o Urinary hesitance or retention
o Blurred near vision
o Dry eyes
o Photophobia
o Nasal congestion
o Decreased memory

g. Other side effects

 Increased blood prolactin levels
o Elevated prolactin may cause breast enlargement and tenderness in men and women.
 Diminished libido
 Erectile and orgasmic dysfunction and menstrual irregularities
 Increased risk for breast cancer and may contribute to weight gain.

Antidepressant Drugs:
 Are primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar
disorder and psychotic depression.
 Antidepressants are divided into 4 groups:
1) Tricyclic and the related cyclic antidepressants
2) Selective serotonin reuptake inhibitors (SSRIs)
3) MAO inhibitors (MAOIs) (Monoamine Oxidase Inhibitors)
4) Other antidepressants such as:
a. Desvenlafaxine (Pristiq)
b. Venlafaxine (Effexor)
c. Bupropion (Wellbutrin)
d. Duloxetine (Cymbalta)
e. Trazodone (Desyrel)
f. Nefazodone (Serzone)
 Selective serotonin reuptake inhibitors
 Fluoxetine (Prozac)
 Fluvoxamine (Luvox)
 Paroxetine (Paxil)
 Sertraline (Zoloft)
 Citalopram (Celexa)

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 Escitalopram (Lexapol)

Cyclic compounds
o Imipramine (Tofranil)
o Desipramine (NOrpramin)
o Amitriptyline (Elavil)
o Nortriptyline (Pamelor)
o Dozepin (Sinequan)
o Trimi[ramine (Surmontil)
o Protriptyline (Vivactil)
o Maprotiline (Ludiomil)
o Mirtazapine (Remeron)
o Amoxapine (Asendin)
o Clomipramine (Anafranil)

Other compounds
o Bupropion (Wellbutrin)
o Venlafaxinee (Pristiq)
o Trazodone (Desyrel)
o Nefazodone (Serzone)
o Duloxetine (Cymbalta)

 Monoamine oxidase inhibitors

 Phenelzine (Nardil)
 Tranylcypromine (Parnate)
 Isocarboxazid (Marplan)

Mood – stabilizing drugs

 Are used to treat bipolar disorder by stabilizing the client’s:
 Mood
 Preventing or minimizing the highs and lows that characterize bipolar illness
 Treating acute episodes of mania
 Lithium is the most established mood stabilizer.
a. Carbamazepine (Tegretol)
b. Valporic acid (Depakote, Depakene)
 Other anticonvulsants
 Gabapentin (Neurontin)
 Topiramate (Topamax)
 Oxcarbazepine (Trileptal)
 Lamotrigine (Lamictal)

Antianxiety drugs (Anxiolytics)

 Are used to treat anxiety and anxiety disorders, insomnia, O.C.D,depression, pos traumatic stress disorder, and
alcohol withdrawal.

Antianxiety (Anxiolytic) Drugs

Benzodiazepines:
 Alprazolam (Xanax)
 Chlordiazepoxide (Librium)
 Clonazepam (Klonopin)
 Chlorazapate (Tranxene)
 Diazepam (Valium)
 Flurazepam (Dalmane)
 Lorazepam (Ativan)
 Oxazepam (Serax)
 Temazepam (Restoril)
 Triazolam (Halcion)

Nonbenzodiazepine:
 Buspirone (BuSpan)

Foods (containing Tyramine) to avoid when taking MAOIs:

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1. Nature or aged cheese or dishes made with cheese, such as lasagna, pizza. All cheese are considered aged, except
cottage cheese, cream, cheese, ricotta cheese and processed cheese slices.
2. Aged meats such as pepperoni, salami, mortadella, summer sausage, beef logs, meat extracts, and similar products.
Make sure meat and chicken are fresh and have been properly refrigerated.
3. Italian broad beans (fava), bean curd (tofu), banana peel, overripe fruit, and avocado
4. All tap beers and microbrewery beer. Drink no more than 2 cans or bottles of beer (including nonalcoholic beer) or 4
ounces of wine per day
5. Sauerkraut, soy sauce or soybean condiments, or marmite (concentrated yeasts)
6. Yogurt, sour cream, peanuts, brewer’s yeast, and monosodium glutamate (MSG)

Related Laws in Mental Health

A. Philippine Mental Health Law (RA No. 11036)

 An act establishing a national mental health for the purpose of enhancing the delivery of integrated mental health
services, promoting and protecting the rights of persons utilizing psychosocial health services, appropriating funds
therefore and other purposes.
B. Other laws and ethical context of psychiatric mental health nursing
1. Patient’s Bill of Rights
a. Right to appropriate medical care and humane treatment
b. Right to informed consent
c. Right to privacy and confidentiality
d. Right to information
e. Right to choose health care provider and facility
f. Right t to self – determination
g. Right to religions belief
h. Right to medical records
i. Right to leave
j. Right to refuse participation in medical research
k. Right to correspondence and to receive visitors
l. Right to express grievances
m. Right to be informed of his rights and obligations as a patient
2. Magna Carta of Women (RA 9710)
 Is a comprehensive women’s human rights law that seeks to eliminate discrimination though the
recognition, protection, fulfillment, and promotion of the rights of Filipino women, especially those
belonging in the marginalized sectors of the society.
3. Magna Carta of disabled person (RA 7277)
 An act providing for the rehabilitation, self – development and self – reliance of disabled persons and
their integration into the mainstream of society and for other purposes
4. Magna Carta of Health Workers (RA 7305)
 To ensure that health workers are properly compensated, which will in turn benefit patients through the
delivery of quality health care services
C. Ethico – Legal Considerations
1. Legal Psychiatric Nursing Issues
o Torts
 A wrongful act or infringement of a right (other than under contract) leading to civil legal liability
o Commitment Issues
 Is a term often used in reference to romantic relationships, but a person who finds it hard to commit
may experience this difficulty in other areas of life.
 Also known as commitment phobia, fear of commitment or relationship anxiety
2. Independent and collaborative interventions that protect client’s health care rights

Documentation in Psychiatric Nursing Practice

1. Elements of documentation in monitoring and evaluation
2. Methods of charting
o Problem – oriented recording (SOAPIE)
o Focus charting (DAR)
o ADPIE or PLE method
o Electronic communication – HER
o Process recording
3. Integrity of client’s records and information
4. Health information privacy

Interdisciplinary mental health team collaboration

A. The psychiatric – mental health nurse as a member of the mental health team
B. Team approach in nursing care
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C. Principles and functions of the PMHN collaboration with inter – agency, intra – agency, multidisciplinary and sectoral
teams
D. Interpersonal relationships with other members of the mental health team
1. Referrals
2. Transport
E. Managing and conflicts resolution for better working relationships
F. Safety and security measures

Leadership and Management Roles of the PMHN

A. Organizational structure of a mental health facility
1. Mental health team
2. Roles and functions
B. Policies and Procedures
C. Physical set – up and resources
D. PMHS roles
1. Coordination of multidisciplinary health for integrated delivery of client services
2. Resources allocation
E. Positive practice environment in psychiatric nursing practice
F. Quality assurance, continuous quality improvement and /risk management programs in psychiatric nursing practice

Psychiatric Nurse’s Role as member of the research team

The role of Nurses in Research

1. Coordinate and manage research
2. Collect data
3. Ensure the well – being of study participants
4. Present at conferences

Continuing Professional Development Program

A. In – service training programs
 Is administered by an employer; it is designed to upgrade the knowledge or skills of employees.
For example:
o An employer might offer an in-service program to inform nurses about a new piece of equipment, specific
isolation practices or methods of implementing a nurse theorist’s conceptual framework for nursing.
 Some in – service programs are mandatory such as:
o Cardiopulmonary resuscitation
o Fire safety programs
B. Continuing Education Program
 Refers to formalized experiences designed to enlarge the knowledge or skills of practitioners
 It is the responsibility of each practicing nurse
 Constant updating and growth are essential to keep abreast of scientific and technological change and changes
within the nursing professions
C. Formal Education
 Refers to the structured education system that runs from primary (and in some countries from nursery) school to
university / college, and includes specialized programmes for vocational, technical and professional training.
Examples:
o Classroom instruction
o E-learning courses
o Web-based training
D. Self – directed learning initiatives
1. On-line learning
 Is education that takes place over the internet.
 It is often referred to as “e-learning” among other terms. However, online learning is just one type of
“distance learning” – the umbrella term for any learning that takes place across distance and not in a
traditional classroom.
E. Health Advocacy Programs
1. Positive mental health
2. Suicide prevention
3. Prevention of substance abuse
4. Healthy life – style
5. Tobacco – free programs

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ACTIVITY

1. Make a research on Filipino culture, values and practices in relation to the care of clients with maladaptive
patterns of behavior.
2. Submit an online database / journal articles related assessment and provision of care of clients with maladaptive
patterns of behavior
3. The attributes and core values of a nurse in psychiatric mental health practice.

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