RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
1.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the clients’
situations.
I.
Content Outline
Applications of terms
A. Agnosia
B. Akathisia
C. Ambivalence
D. Anomia
E. Autism/autistic
F. Blocking
G. Concreteness
H. Creutzfeld-Jakob disease
I. Depersonalization/Derealization
J. Dysthymia
K. Echolalia
L. Echopraxia
M. Euphoric
N. Grandiosity
O. Huntington’s disease
P. Tics & Tourettes disorder
Q. Ideas of reference
R. Labile
S. Loose association
T. Neologism & Word Salad
U. Neuromalignant disorder (NMS)
V. Nihilism
W. Oculogyric crisis
X. Omnipotence
Y. Paranoia/Persecution
Z. Perseveration
AA. Pick’s disease
BB. Rituals
CC. Symbolism
DD. Tangential & Circumstantial speech
MM Undoing
NN. Waxy flexibility
Clinical Objectives
Initiate nursing interventions to
promote client’s psychosocial
well-being.
Learning opportunities
Read:
Varcolis & Halter (2010)
Lehne (2010)
Utilize therapeutic
communication skills when
interacting with clients.
Use communication techniques
and management skills to
maintain professional boundaries
between clients and individual
health care team members.
Select human and material
resources that are optimal, legal,
and cost effective to achieve
organizational goals.
Identify client’s unmet needs
from a holistic perspective.
Advocate on behalf of the client
with other members of the
interdisciplinary health care
team.
Foster and promote client
growth during developmental
transitions and alterations in
health status.
Review:
1) Defense mechanisms from Nursing
I , II, & III
2) Psychotherapies in Nursing III
3) Communication Unit, Nursing I, II
and Nursing III: especially
characteristics of the dysfunctional
family, therapeutic communication
techniques and stages of the
therapeutic relationship.
DVD:
#6018 – Psychiatric Times – AIMS
Video:
#220 – Nurse & Patient Interactions:
Blocks to Therapeutic
Communication
IVD:
#5032 – Therapeutic Communication
Computer Simulations:
#2110 – Tricyclic Anti-depressants
#4052 Care of the Client Experiencing
Mania
#4048 Care of the Client Experiencing
Depression
#4053 Care of the Client with Border
Personality Disorder
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
2.
Behavioral Objectives
Compare and contrast the
neuroanatomy and physiology of the
brain in relation to major psychiatric
disorders.
Content Outline
II. Neuro Anatomy & Physiology
A. Brain (functions of anatomical structures)
B. Nervous System
1. Central Nervous System
a. Brain
b. Spine
2. Peripheral Nervous System
a. Somatic Nervous System
b. Autonomic Nervous System
1) Sympathetic NS –
Adrenergic Pathways
2) Parasympathetic NS –
Cholinergic Pathways
C. Receptors
1. Sympathetic – Adrenergic Receptors
a. Alpha 1, 2
b. Beta 1, 2
c. Dopamine (DA)
d. Norepinephrine (NE)
e. Serotonin 5HT
2. Parasympathetic – Cholinergic
Receptors
a. Nicotinic
b. Muscarinic
c. Histaminic
D. Neurotransmitters
1. DA or D2
2. 5 HT
3. NE
4. Acetylcholine (ACH)
5. Gamma aminobutyric acid (GABA)
6. Glutamate
7. Glycine
8. Endorphins/Enkephalons
E. Blood Brain Barrier
Clinical Objectives
Learning opportunities
Review:
1) Treatment modalities from
maladaptive lecture (milieu,
individual, group, family, behavioral)
2) Psychosocial assessment (plus
MMSE, AIMS)
3) Response of staff to patient’s
maladaptive behavior.
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
3.
4.
Behavioral Objectives
Analyze factors included in the
assessment of the client with a major
psychiatric disorder, including the
developmental and cultural
considerations.
Content Outline
III. Psychosocial Assessment
A. Psychosocial assessment/mental status exam.
1. Mini mental status exam (MMSE)
B. Assessment of Involuntary Movement Scale
(AIMS)
C. Laboratory studies
1. Lithium level
2. Depakote level
3. Tegretol level
4. Liver function tests
5. Complete blood count
6. Thyroid function test
7. Renal function test
D. Radiological studies
E. Cultural influences
1. Hereditary
2. Environmental
3. Health beliefs/practices
F. Developmental
1. Age specific assessment data
2. Behavior/emotional response to HCPs
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected major
psychiatric disorders.
IV. Major psychiatric disorders
A. Schizophrenia
1. Disorganized
2. Catatonic
3. Paranoid
4. Undifferentiated
B. Mood disorders
1. Unipolar depression
2. Bipolar depression
C. Child and adolescent disorders
1. Disruptive behavior disorders
a. Attention Deficit Disorder
b. Oppositional Deviant Disorders
c. Conduct Disorder
2. Pervasive developmental disorders
3. Mental Retardation
D. Cognitive disorders
1. Delirium
2. Dementias
Clinical Objectives
Learning opportunities
Review:
Nursing I, II and III
1. Antiparkinson drugs
2. Anxiolytics drugs
3. Anticholinergic drug: Atropine
4. Antidepressant drugs
5. Anectine
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
Behavioral Objectives
5.
Discuss analysis, planning,
implementation and evaluation for
the nursing management of clients
with major psychiatric disorders
Content Outline
E. Personality disorders
1. Cluster A
2. Cluster B
3. Cluster C
V. Selected nursing diagnoses/nursing
interventions/evaluation
A. Altered thought processes
1. Independent interventions
a. Promote communication that
enhances the client’s sense of
integrity
b. Assist client to differentiate between
own thoughts and reality.
c. Assist client with disordered
thinking to communicate more
effectively.
d. Encourage a more mature level of
functioning.
e. Provide client with opportunities for
positive socialization.
f. Promote physical well being and
prevent injury.
g. Reduce potential for violence to self
and others.
h. Initiate health teaching and referral
as indicated
1) National Alliance for Mental
Illness
2) Alzheimer’s and Related
Disorders Association
3) Manic Depressive Association
4) County Mental Health and
Mental Retardation
Departments
2. Collaborative interventions
a. Treatment modalities
1) Review maladaptive treatment
modalities.
2) Reality Orientation
Clinical Objectives
Learning opportunities
Will spend 2hrs with RN during
clinical rotation
Will complete analysis using DSMIV and
pathology for medical diagnosis.
Will attend treatment team
meetings and group therapy
meetings during clinical rotation.
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
Behavioral Objectives
Content Outline
Monitor for desired effects/adverse
effects/side effects of medications.
1) Antipsychotics
a) Typical- D2 blockers
b) Atypical-SDA’s
c) 3rd gen D2 partial agonists
d) Heroic Combo-SSRI +SDA
2) Antidepressants
a) Tricyclic (TCA)
b) Selective serotonin reuptake inhibitors (SSRI)
c) Serotonin norepenephrine
reuptake inhibitors (SNRI)
d) Norepenephrine reuptake
inhibitors (NRI)
e) Norepenephrine dopamine
reuptake inhibitors (NDRI)
f) Serotonin antagonist
reuptake inhibitor (SARI)
g) Monoamine oxides
inhibitor (MAOI)
3) Mood stabilizers
a) Lithium
b) Carbamazepine (Tegretol)
c) Valproic acid (Depakote)
d) Trileptal
4) Anticholinergics
5) Skeletal muscle relaxants
6) Stimulants
7) Cholinestrase inhibitors
8) Benzodiazepines
c. Electroconvulsant therapy (ECT)
d. Treatment for EPS
a) Benzodiazepines
b) Anticholinergics
e. Emergency Meds
a) D2 blockers or SDAs
b) Benzodiazepines
c) Anticholinergics
Assess for complications
a. Suicide risk
b.
3.
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
Behavioral Objectives
Content Outline
b. Violence risk
4. The client will have improved thought
processes as evidenced by:
a. Recognize changes in thinking,
behavior
b. Identify situations that occur before
hallucinations/delusions
c. Use coping strategies to deal
effectively with hallucinations,
delusions
d. Maintain reality orientation
e. Communicate clearly with others
f. Participate in unit activities
g. Express delusional material less
frequently.
B. Self care deficit
1. Independent nursing interventions
a. Assess causative and contributive
factors
b. Promote optimal participation
c. Promote self esteem and self
determination
d. Evaluate ability to participate in
each self care activity
2. The client will demonstrate improved
ability for self-care
a. Identify preferences in self-care
activities
b. Demonstrate optimal hygiene after
assistance with care
c. Participate physically and/or
verbally in feeding, dressing,
toileting, and bathing activities.
C. Impaired social interactions
1. Independent nursing interventions
a. Provide support for maintenance of
basic social skills and reduce social
isolation
b. Decrease problematic behavior
c. Provide for development of social
skills
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
Behavioral Objectives
Content Outline
Explore strategies for handling
difficult situations
e. Initiate health teaching and referrals
2. The client will demonstrate improved
social interactions as evidenced by:
a. Identify problematic behavior that
deters socialization
b. Substitute constructive behavior for
disruptive behavior.
D. Self esteem disturbance
1. Independent nursing interventions
a. Enhance the client’s sense of self
b. Promote use of coping resources
c. Utilize therapeutic communication
to assist the client in expressing
thoughts and feelings.
d. Set limits on problematic behavior
such as aggression, poor hygiene,
ruminations, and suicidal
preoccupation
e. Assist in identifying positive
evaluations
2. Demonstrate improved self-esteem as
evidenced by:
a. Identify source of threat to selfesteem and work through that issue
b. Identify positive aspects of self
c. Express a positive outlook for the
future
d. Analyze his own behavior and its
consequences
e. Identify ways of exerting control
and influencing outcomes
f. Resume previous level of
functioning
E. Altered family processes
1. Independent Nursing Interventions
a. Identify causative and contributive
factors
b. Facilitate family strengths
d.
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
UNIT I – Care of the Client Experiencing Major Psychiatric Disorders
Behavioral Objectives
Content Outline
Facilitate understanding in other
family members of how client feels
d. Involve parents to learn growth and
development stages, give and
receive support, increase parenting
skills
e. Initiate health teaching and referrals
The client will demonstrate improved
family processes as evidenced by:
a. Family participation in client’s
treatment
b. More effective parenting skills
Clinical Objectives
Learning opportunities
c.
2.
6.
Describe the nurse’s legal
responsibility in care for the client
with major psychiatric disorders.
VI. Legal Responsibilities
A. Documentation
B. Admissions-Commitment Procedures
1. Involuntary
2. Voluntary
C. Client rights
1. Confidentiality
2. Abuse/neglect
3. Restraints/seclusion
4. Right to refuse treatment
N/ADN Syllabus/Soph/Level IV-Spring\Unit I Major Psyc Disorders
Reviewed 06/11
19