Chapter v Psycho Dynamics

8/9/2019 Chapter v Psycho Dynamics

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PSYCHODYNAMICS

BIOLOGICAL

PSYCHOLOGICAL ENVIRONMENTALPrenatal Infancy

(0-1)Toddlerh

ood(1-3)

Preschool

(3-6)

Schoolage

(6-12)

Adolescence(12-20)

Youngadulthood

(20-40)

Internal External

y Bothpaternal andmatern

al sideof Mr.Capsfamilyhas noknownhistoryof any

mentalillnesseshowever inthemothersidethey

havehistoryof livercancerand thefatherhasdiabete

s

y He wasawantedbaby.

y Hismotherhadregularcheckups whenshe was

pregnant.

y Hismotherwasworkingwhilebeing

pregnant

y Mr.Capsmotherwas

y Theclientwasborn

through acaesareansection atBrokenshire

hospital inDavaoCity.

y He wasahealthy

baby,weighed 7pounds andnophysical

y He hadalargebody

builtcomparingtootherchildren.

y

Teethingstarted attheageof 8months.

y Hewasstarted attheageof o

y Playswithhisbroth

erandotherneighbor.

y Hewas

veryshy ofinteractingwithotherpeoplevisitin

gtheirhouse.

y Whentheirfather

y Hewascircumcised

at theage of7

y Mostof thedeciduous

teetharelostandreplacedwithpermanent

teeth.

y Helovesto playbasketballwith

y A changein voicepitch isevident.

y Duringhis highschoolyear, hebecameanathlete.

y He was asportsmindedperson,he wasaffiliatedin sportsgroup in

theirschool.

y He wasonceparticipants ofSMARAA

y Becomesaloof withhisbrother

since hisbrotherwasstudyingat Davaoand hewas withhis

parents inDavaoOriental inhis highschoolyears.

y Atcollege,

hisfavoritesubjectwas math

y Hefinishedhis

y Feels thathis fatherdoesntlove him

when hewas achild.

y He wasin hiscollegeyears

when hebegan tousedrugs

y Findshimselfeasily getirritable

y Healwayssmokesanddrinksalcoholwith

y He grewin a familywhere hisfather was

alcoholicand asmoker.

y He wasraised byhis fatherthrough a

militarytraining.

y His fatherset a rulesandregulationinside thehouse

that mustbefollowed.

y He wasshy ininteractingwith other


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mellitus.

y Patientand hisbrotherhavesimilarcharacteristicssuchas

shyness,silentandfemininemovements

y Inmaternalgrandlineagethereare 12childre

n whileinpaternalgrandlineagethereare 14childre

veryhappyandexcited

duringherpregnancy.

y Bothhismother

andfatherhaveharmoniousrelations

y Thefatherwas notpresentduringthepregnancybecaus

e he isout forhiswork.

y Hisfatheraccepte

d fully

deviationfound.

y Hewasonlybreastfedonceon the

day hewasbornbut hismother wasnotable toproducemilk.

y Duringthisstage,Mr.Cap

wasunderthecaredof anannybecause his

parent

months.

y Hewasveryplayful,lovestoplaywith

hisbrotherandactive.

y Follows hismotherandfather'scommand.

y Disciplinedby hisfatherthroughspanking

even

is athometheywere

notallowed toplayoutside.

y If

rulesaredisobeyed,theyarebeingpunishedby thefather.

y If athome, heonly

watchestelevision.

y Mostof hisfriend

s

hisbrother andother

neighbors.

y Scared ofhismother when

itcomeswithhiseducation, hestudies hislessonwell tomakehismotherproud.

y He

usedtoteasehisclassmateofopposite sex.

and inter-schoolcompetition in

soccerevent.

y He wasnot thatapproachable tosome

girls,y He did

not evenhave anyrelationship tooppositesex atthisstage.

y Hisrelationshiptowardshisbrother

lie-lowed

y Hebecamealoof tohisfamily.

collegeyears witha operatoron year

1995.vocationalcourse ofradio

y He hadhisserious

relationship with theoppositesex afterhegraduatedin college

y At year2000, heproceeded intoBusinessManagementcourse inPanabo

StateCollege.

y He gotinto circleof friendsthat wereinvolved

in drug

friendsand withhisbrother

y Impairedconcentration, heeasily getbored

y Low self esteem

and isdepressed due tohisadmission

y Has anintrovertpersonality.

y Aloofpersonality.

y Wasdepresse

d whenhe knewhis fatherwasadmitteddue tocomplications of

diabetes.

people.

y Heassumesthat hewas theone beingtalkedabout byothersandlaughed

at.

y Believesthat hesawobjectswhichotherscannotsee.

Inference:

y Althoughtheprecisecause ofthe BPDremainsunknown,it isgenerallyassumed


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n.

Inference:

Considering thenumber oftherelatives ofthe patientand the

similarity ofthe traitsbetweenhim andhis brotherwe wouldlike tobelieve

that thepatient isvulnerableto developthe illnessundertheseinferences;

y BiologicTheory:Temperamentis aproces

thepregnancy ofthe

clientsmotherandensured thatheprovided and

supported hisfamilyevenhe isawayfromhome.

y At thisstageclientsbrotheraccepted thepregnancy of

hismotherand didnot felt

jealousandenvy.

Inference

s arebusytotheir

work.

y HisnannyensuredthatMr.

Capwillreceive hisphysiologicneedsevenbothparents isnotpresent.

y Hisnanny

actedas hissecondmother andshereallyloved

thoughthesesmall

mistakes.

y Wasscared ofhisfather

everytimehisfatheris athome. Heimposescertainrulesandregulationinsidetheir

housethatmustbefollowed.

y Hismoth

wereof thesamesex.

y Thepatientattemptedsuicide

Inference:

y InPsychose

xualtheory,preschoolbelongs tothe

phallicstageinwhich aboychild

y Veryfocused onhisstudiesbecause hewasafraidof

beingscolded byhisfather

Inference

y

InFreudspsychosexualtheory,

school agebelongs tothelatencystage

y Secretiveeven tohismother

y He wascloser tohisfriendsthat hisfamily.

y He dontusuallygo tochurch.

Inference:

y

Thisstage isthe stageof identityvsconfusionaccording to ErikErikson.;

Dramaticphysiologicalchangesassociated withsexualmaturatio

addiction

y They tookcoughsyrup,cannabisand evenshabu

y Helearnedhow to

smokeand drinkin collegewith hisfriends.

y Feels

hesitant ingoing intoa jobbecausehe isscaredthe drugtest.

y Causedfrustrations to hisfather dueto hisunemployment.

y Wants togive upsince hecantunderstandeverythingabouthimself.

y The

attemptedsuicide.adhisseriousrelationshiphoweverit only

lasted for3 monthsand theotherrelationship is 1month

y Drugabuser

Inference:y Depressi

on andanxiety isvery

that BPDis anacquiredcondition

derivingfrom theexperience ofgrowingup in aviolentfamily.(An

tai-Otong,2003)

y It isperhapsnotsurprisingthatindividuals withBPD aremuchmorelikely tosufferfrom

mooddisorder(depression),substanceabusedisorders,or otherassociate


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ses ofsensation,associ

ationandmotivation thatunderlieintegration of

skillsandhabitsbasedonemotion and itis veryfamilial

since itruns tothefamily(Videbeck,2008)

y Withthesameconcept,temperamenthave 4traits

:

y Consideringtheage oftheMrs.Earswhichis 38,pregn

ancywouldbe notveryidealsincetheeggcellthatsheproduced isnotthatreallygood

andtheageidealforpregnancyor theprime

Mr.Capanddid not

eventry tospankhim.

y He

wasbeingfedusually byhisnannyand

mother, hisfathersometimesfeedhim.

y He

crieswhenhismotherseizesfromcradlin

er didnothavedifficu

lty intraining himtourinate anddefecate.

Hewasbeingtrainedeverymorning byhis

mother ornanny.

y Hedepends in

hismother intermsofdecision forchoosing a

deeplylove

hismother(OedipusComplex)and

thegirlchilddeeplyloveherfathe

r(ElectraComplex)inwhich

theyareableto actaccordingtotheir

whereinsexua

lattraction issuppressedandattention is

divertedtowardsplaying,groupactiviti

es,peersandstudies.Socialization is

important inordertoharnessinterperson

n markedthisstage.There is

a markedpreoccupation withappearance andbodyimage.This

stage inwhichidentitydevelopmentbeginswith thegoal ofachieving

someperspective ordirectionanswersthequestion,Who am

I?(Antai-Otong)

y It is bynaturethat anadolescent is

y He drinksalcoholicdrinkswith his

olderbrother

y After hefinishedcollege,he wasencourag

ed by hisfather tofind a joband get adriverslicensebut herefusedbecausehes afraidthatothers willknow thathes usingdrugs.

y Argues

with hisfatherabout hisbeingunemployed and hisnointerest ingoing to

event topatientsdiagnose

d withborderlinepersonality disorder(Lewinson, Rhode,Seelly, et

al. 2000)

y Cluster Billnessesoftencorrelated withhistory

withmooddisorder,alcoholism,somatizationdisorders

amongfamilymember,parentaldeprivation,inconsistentdiscipline

dpersonalitydisorders,

particularly AntisocialPersonalityDisorder,thanperson

withoutBPD(Alloy,2004).

y Achildhoodhistory ofphysicalabuse is

common(Videbeck, 2008).

y Environment is oneof thefactorsthat affect

humanpsychology,ethnicityandsurrounding helives in(Hartwell,


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andtheseareharm

avoidance,noveltyseeking,rewarddependence

andpersistence,inpersonalitydisorders suchparanoi

d, theharmavoidance isveryhigh, inobsessive-

compulsivethere ishighpersistence,innarcissist

eggcell isfrom15-40

(Piliterri,2007).Theeggcellshesprodu

cing isdiminishing.

According toGregorMendels

theory, agoodseedwillgrow agoodfruit

(Kneisl,2004)

y Duringtheintrauterinestage

g him.

y Like hismother, hisfatherwasalsobusyso hewasnot

able totakegoodcareof himwhenhewasaninfant.

y Whenhisfatherwenthomehe

ensuredthattheywillhavetime toboundand

dress.

y At thepresentpatient isstillunmarried,

jobless,

drugdependedanddepends tohisparents.

Inference:

y AccordingtoFreudspsychosexualtheory themajorsource of

gender

yStageofInitiative vs.Guilt.

y AccordingtoErik

EriksonChildrenlike topretendand

tryoutnewroles(Antai-Otong).

y Children trytoinitiatebothmotorand

alrelationship

y School-agechildren areeagertoapplythems

elvestolearningsociallyproductive

skillsandtools.Theylearntoworkandplay

withtheirpeers.Withoutpropersupport for

becoming moreclose tofriends

than thefamilysincepeers isthe majormode forsocialization

(Knesl,2004)

church.

y Observati

onspatientrarelytalks toeverybodyelse andevidentsocial

withdrawal.

inference:

y Accordingto ErikErikson,

this is thestage ofintimacyvsIsolation;Youngadultshavedeveloped

a sense ofidentity,deepenstheircapacityto loveothersand care

for them.

andfailure ofthe child

todevelopintegratedcognitive,affectivebehavioral moods

in earlylife maylead tocluster bdisorder.

y BorderlinePersonali

tyDisorderhavegeneralize lowselfesteem,need to

controlenvironment andpeopleandunstableordelayed

2001)


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personalityhere ushigh

noveltyseeking andborderlinepersonalityhave

highrewarddependence.Theresponse willbeoccurri

ngduringat ageof 2 to3 yearsold(Svrakic and

Cloninger,2005)

y Neurochemical andNeuroanatomi

ofdevelopment,the

embryoor fetusrelieson thematernal bloodflowthrough

theplacenta tomeet itsbasicsurvivalneeds.Thehealth

of themotherisessential forpropergrowthand

development(Buchanan,CuretandHis,2002).

helovedto playpick a

boo

y He wasin hiseighthmonthwhenhe

hadhisfirsttooth.

y He wasbaptized asRomanCatholic.

y Observation: datagathered thatpatientissmoker andhedrinks.He

gratification is

throughanal;toilettraining isthefirst

confrontationwithexternaldemands

whichdevelopsegoandcontrol

impulses.Thispleasurecanberegul

intellectualactivity. If

toddlers aremadeto feelinadequateabouttheir

behavior orinterest,theymayemergefrom

thisperiod withasenseofguiltabout

self-initiatedactivity(Kneisl,2004).

learning ofnewskills

or ifskillsaretoodifficult,children may

thendevelop asenseofinadequacyandinferio

rity.

y School ageperiodis atime inwhich

peerassumesmajorimportance.

y Thenegati

This is thetime tobecomefully

participative in thecommunity,enjoyingadultfreedomand

responsibility. Ifyoungpersonshave notachieveda sense ofpersonalidentity,

they mayexperience feelingsofisolationfromothersand the

inability toformmeaningfulattachment (Antai-Otong,2003).

gratification(Kneisl,

2004)


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caltheorybelieves that a

personwithMentalillnesshavelessbraintissue,

lessspinalfluidandhighlevelsofserotonin,

dopamine,norepinephrineandepinephrinemalfun

ctionneuronalnetworks andtransmission(Egan&

y Consideringthenature

of Mrs.Ears

jobwhichis anelementaryteacher

, duringthispregnancy shehadundergonetremendous

stressandthoughsheclaimedthatshehadnt

experienceloneliness letus thinkaboutthe factthat hishusban

keepshimselfdistant

toothersand hewantsto bealone.Duringthe

orientationphase,apprehensiontowards thestuden

t nurseisevidentandlackcooperativeness.

Inference:

y Caesarianbirth

atedif thechild

copeseffectivelyhowever ifhefails

hisegowouldundergogreatanxie

tythatengenderspersonalityproblem

(Alloyet al,2004).

y Thedevelopme

y The

childis

abletomoveindependentlyandvigoro

usly.Byplaying withpeers, childlearnshowto

interactwithothers(Antai-Otong

).

y Togain asenseofinitiative,child

veoutcome ofthis

stagemaydevelop fromseveralsources such

discriminationagainst toschool; maybe toldthat

he isinferior; thechildmaybeoverprotec

ted athomeorexcessivelydependenton theemotio

y Positiveresolutionmaymanifest

the abilityto giveandreceivelove,commitments,mutuality,

collaboration inwork, andresponsible sexualbehaviors.Unresolvedbehaviors

arepersistentaloneness,prejudice,lack ofestablished vocation

andseekingintimacythroughcasualsex(Balita,2008).


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Hyde,2000).

yBorderlinepersonalityDisorder aremoreprevale

nt inwomenthan inwomen, 5 outof 15patientsdiagnosedwithBorderlinePersonalityDisorder are

men(Alloy,2004).

y 10%-23% ofthegeneral

d wasmost ofthetime

absentand asapregnantwomanthewanting

ofbonding andlongingisevident.

Astressed

Pregnantwomanwouldhave afluctuating andincreas

e levelsofdifferenthormones suchasestrogen,

placesnewborn to

greater riskforrespiratoryillnessessince

thechestlackspressurethatpromotes

respirationsandeffectivelyexpelsfluidsfrom

thelungsunliketothosenewbornswho

ntaltaskof thetoddle

ryearsacc.toEriksonspsychosoci

altheory isthatthedevelopment ofa

senseofautonomyversusshame and

doubt(Kneisl,2004).

y According to

needsexposure toa

widevariety ofexperiencesandplaymater

ialssotheycanlearnasmuchaboutthe

worldaspossible(Elderet al,2005).

y Suicide inBorderlinepersonalitydisor

nalsupport ofthe

family;or thechildmaycomparehimself

unfavorablywiththesame-sexparent.

y Goodteachers andgoodparents whoencourage

theirchildren tovaluediligence andproductivityand to


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populationhaveperson

alitydisorders andarehigherinincidence in

peoplewhobelongtolowersocio-economicand

disadvantagedgroups(Videbeck,2008)

epinephrine,progesterone

andamongothers,that willtriggerchildresponse

towardsstressandeventuallyputtingthefetus indistress

(Pilliteri, 2007)

undergonevagina

l birth;at thispointthebondingbetween the

childandmother ishinderedsincethe

mother didnotmakeanyeffortto givebirth

to thechild(Pilliteri,2007)

y Stageof

ErikErikson,this is

thetimeeithertoretainfeces(holding in)

or toeliminate(letting go),bothbehaviorhavin

g aneffectonthemother.Wherein

toorigoroustoilettraining canproduce anoverly

derpatients

canbeinterpretedas acryforhelp

forbeingpowerlessorselfpunishmen

t forfeeling toomuchguilt(Alloy,2004

).

preserve in adifficult

enterprisearebulwarkagainst asense

ofinferiority.

y Thisstageissocially

decisivebecause thechildlearnshow towork

withothersto anddevelops asenseofdivision of


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TrustvsMistrust

beginsat thisage.

According toErikErikson, an

impairmentofbasictrustleadstobasicmistru

st. Anaffectionate,lovingmother whogivesconsis

tent,high-qualitycareprovides thebasisfor thedevelo

compulsivepersonality

that isstingy,meticulousandselfish. If

parentspermit thechildtofunctionwith

someautonomyandaresupportivewitho

utbeingoverprotective,toddlersgainself-

laborandequality of

opportunity.


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pmentoftrust.Prolon

gedseparationfromthemother atthis

timecanlead todepression,hospitalism,analytic

depression,ordepressivetonethatbecom

espart ofpersonsadultcharacterstructure.

confidenceandfeel

theycancontrolthemselvesandtheir

world.Otherresolutionslikeselfdoubt,depe

ndency, andsenseofbeingout ofcontrol of

oneslifeoccurwhenparents areoverlyprotective


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Fixationswouldindicat

eunmetneeds(Balita,2008).

y Trust

issynonym tolove.

y By thewayinfantsarehandle

d, fedandheldtheylearnto loveandrecog

nizethattheyareloved(Kozier,2008).

anddiscourageindep

endence(Balita,2008).

y Childr

enwhoaremadeto feelit iswrongto feelindep

endentmayleavethestagewith astron

gersenseofshamethanofautonomy


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y Infantswhohavenumer

ouscaregivers,whomaybe fedoneday on

a rigidscheduleandthenextonlywhenthey

arehungry, whosometimesaretreated

roughly andsometimesgently,canhavedifficulty

(Antai-Otong,

2003).


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learning totrust(Antai-

Otong,2003).

y Ifinfantscannottrust,theycannot

enjoydeeplysatisfyinginteractionswithothersand

canhavedifficultytrustingthemor

experiencinghighselfesteem.Theymayhave


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difficultyestablishing

relationshipsasadults(Alloy,2005).

Vulnerability todevelopillness

StressfulPrenatalLife

Mistrust Shameand Doubt

Guilt Inferiority Identity Isolation Confusion and Frustration


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Weakened Ego

Low self-esteem

State of Equilibrium

Predisposing Factorsy Age: 34 years old

y Gender: male

y Introvert Personality

y Intake of prohibited drugs (cough

syrup, shabu, marijuana)

Precipitating factors:

y Confrontation with the father

STATE OF DISEQUILIBRIUMDepression, anger, agitation and anxiety

BALANCING FACTORS


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R: Benzodiazepine help anxiety and depression

5. Anti-convulsant

R: Anti-Convulsant may improve global functioning of patient.

6. Serotonergic Agent

R: Serotonergic Agents are helpful in some cases of personality

disorder.

7. Psychotherapy

R: this is an area of intensive investigation and has been treatment

of choice.

8. Behavioral therapy

Nursing Intervention:

y When first communicating with the client, use simple, direct

sentences; avoid complex sentences or directions

R: The clients ability to perceive and respond to complex stimuli isimpaired

y Be comfortable sitting with the client in silence. Let the client

know you are available to converse, but do not require the

client to talk.

R: Your silence will convey your expectation that the client willcommunicate and your acceptance of the clients difficulty withcommunication

y Provide positive feedback at each step of the process. If the

client is not satisfied with the chosen alternative, assist the

- Pharmacokinetics

Absorption- Rapidly absorbedDistribution- PB: 90%Metabolism- t1/2: 24 h

Excretion: In urine 70% and feces 14% Rivotril 2mg tab Hs

- Classification: Anticonvulsant, Atypical

- Pharmacokinetics

Absorption- PO: 1-2 hMetabolism- t1/2:18-50 hExcretion: urine

- Pharmacodynamics

Duration: weeksNursing Interventions:

Promote clients safety

R: since client has attempted suicide prior to admission, he

needs to be monitored closely for suicidal ideation.

The patients vital signs were checked and recorded

R: This is to note if there are alteration in patients health

The student nurse established therapeutic

communication with the patient

R: Therapeutic communication is essential to build trustbetween the student nurse and the patient

Assisted during Activities of daily living.

R: This is to help patient attain his needs

Encouraged patient to participate in the different


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client to select another alternative.

R: Positive feedback at each step will give the client manyopportunities for success, encourage him or her to persist in

problem solving and enhance confidence. The client also can learnto survive making mistake.

y Provide a safe environment for the client

R: Physical safety of the client is a priority. Many common itemsmay be used in a self destructive manner

y

Continually assess the clients potential for suicide. Remainaware of this suicide potential at all times

R: Depressed clients may have a potential from suicide that may ormay not be expressed and that may change with time

y Reorient the client to person, place, and time as indicated

R: Repeated presentation of reality is concrete reinforcement for theclient

y Spend time with the client

R: Your physical presence is reality

y If the client is ruminating, tell him or her that you will talk

about reality or about the clients feelings, but limit theattention given to repeated expressions of rumination

R: Minimizing attention may help decrease rumination. Providingreinforcement for reality orientation and expression of feeling willencourage these behaviors

y When approaching the client, use a moderate, level tone of

activities and therapies.

R: To enhance patients self esteem and improve hishealth

Encouraged patient to verbalize his feelings.

R: Exploring patients feelings can allow the nurse identifypatients concerns

Ensured clients safety by staying with him and being

a good observant in all of his actions

R: Ensuring the clients safety is one of the priorities of thestudent nurse.

Encouraged patient to increase fluids intake before

and after taking his medication

R: Due to some side effects of medication, increasing fluidintake can replace the fluid loss of the patient and helppatient to swallow medicine easily

Nurse Patient Interaction was established.

R: It allows the nurse gathers pertinent information of theclient such as the history of his admission and can help ingaining trust of the patient

Therapies Performed:

Introductory:y Frame my Name

y First Impression Pop-outR: These therapies are designed to help the studentnurse and the patients know each other and gain trustin the part of the patient; It aids in establishing rapport.


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voice. Avoid being overly cheerful.

R: Being overly cheerful may indicate to the client that beingcheerful is the goal and that other feelings are not acceptable

y Use silence and active listening when interacting with the

client. Let the client know that you are concerned and that

you consider the client a worthwhile person

R: The client may not communicate if you are talking too much. Yourpresence and use of active listening will communicate your interestand concerns.

Working Phase:

y Rhythm of my Life

y Easter Egg Painting

y Pinoy Lympics

y Masquerade BallR: Therapies of the working phase allows the patient toparticipate in such activities that will give them idea onhow to enjoy life and improve their current situation; italso gives them idea on the possible occupation theywanted in the future.

Termination Phase:

y Environmentalist WallR: This phase evaluates the patients learning on thepast days that they were together with the studentnurses; this is a phase where they will be detachedfrom the student nurses.

Documents

Chapter v Psycho Dynamics