00:02
Now let's think about something
a little bit different.
00:07
Let's think about internal
and external stimuli.
00:12
And what do we mean by
internal and external stimuli?
Internal stimuli means
it's a thought that I have.
00:22
It's something that's
coming from inside of me.
00:27
It might be a thought.
00:30
It might be a delusion,
which is a thought.
00:34
It might be a hallucination, which could
be visual, auditory, tactile, olfactory.
00:45
That's internal,
coming from inside.
00:48
My brain is creating it or another part of
my body is creating some sort of stimulus.
00:58
External is when I'm in a room,
and I'm having a lot of
stimuli coming towards me.
01:05
It could be something as simple as the
wallpaper might be overstimulating.
01:12
It could be the amount of noise in
the room, the amount of movement.
01:17
So let's start with
internal stimuli.
01:21
Let's start with the idea
of intrusive thoughts.
01:25
What do we think are
intrusive thoughts?
Intrusive thoughts are when you
have a thought that will not stop.
01:37
Perhaps the person comes
into the unit and says,
the world's going
to end tomorrow.
01:44
I didn't want to come into the hospital
because the world's going to end tomorrow.
01:50
You say what makes
you think that?
I don't know.
01:53
I just have this
feeling, it's in my head.
01:55
I can't get it out.
01:57
That is an intrusive thought.
02:00
No matter how hard the person tries to
not think about it, it keeps coming back.
02:07
Another internal stimuli
is delusionary thoughts.
02:11
Thoughts that even
when you offer facts
to demonstrate that that
thought is not correct,
the person cannot believe you.
02:22
A delusion might be,
"I am the Queen of England."
And you say, "No Brenda,
you are not the Queen of England.
02:30
You happen to be a
psychiatric nurse.?
And I say,
"That's what you think.
02:36
You don't know the truth.
02:38
The truth is,
I am the Queen of England."
That is a delusion.
02:42
That is a false fact that
I have adopted in my mind,
and I believe it,
I believe it to the core of me.
02:51
And no matter what you tell me,
you cannot make me think otherwise.
02:58
Another one would be illusions.
03:01
We see this sometimes
post operatively.
03:05
As someone has an IV,
and they look up and they see the tubing
to the IV and they say is that a worm?
Well, there's actually a tubing there,
they actually see something there.
03:19
But they are missrepresenting,
they see it as something that it
is not and that is an illusion.
03:27
Hallucinations,
on the other hand.
03:30
Hallucinations are something
that do not exist in reality,
in our environment
or on our skin.
03:40
And we either see them or hear them,
feel them, touch them or taste them.
03:50
So, those are all the ones that emanate
from inside us external stimuli.
03:59
And it's it's difficult
with internal stimuli for us
to be able to control them until
we actually know what's going on.
04:07
And usually with internal stimuli,
we are able to find medications
that help to reduce that
level of internal stimuli.
04:18
External stimuli, on the other hand,
is the noise, the noise that surrounds you.
04:26
There might be some disruption in
the environment that is going on.
04:32
There might be an
influx of new people.
04:35
Suddenly,
you have four new admissions.
04:38
And now you have patients
getting somewhat agitated.
04:41
Because these people don't know the
rules, they don't know the regulations,
they're doing things
outside of them.
04:48
Overcrowding.
04:49
And this is something
that we've noticed
especially during
the COVID period,
where people were supposed to be a certain
amount of distance from each other.
05:03
And then you had too many people in one
area, and people would get agitated.
05:09
Because even though the
room was large enough,
there shouldn't be six
people in this room.
05:15
And so the agitation increases.
05:20
Or it could be a number multiple
stimuli all happening at once.
05:24
It might be a fire engine
passing by and people talking.
05:31
Anything that affects our five senses
can be causing external stimuli.
05:38
And it can happen one at a time.
05:41
It could happen multiple things
happening at the same time.
05:45
So we have to think about the impact
of internal and external stimuli,
and how it affects
us emotionally.
05:57
If it is causing agitation,
if it's external stimuli,
we really want to be able to
reduce that external stimuli.
06:07
When I am speaking to students who are
going to go onto a psychiatric floor,
I will tell them,
"Don't wear bright colors."
It might be stimulating
for someone.
06:18
Don't talk to the patient
the way you may be
talking to your friends
when you go on the phone.
06:25
Don't say, "Hey, my name is Brenda and
I really am here to talk to you today.
06:28
I hope that you really are
going having a nice time.
06:31
I mean, I don't know very
much about your hospital.
06:33
I'm not that I don't
know about your hospital.
06:35
I mean I've never been in
a psychiatric hospital.
06:37
Oh, I hope that doesn't,
you know, hurt your feelings."
That is stimuli.
06:43
That kind of agitated
chatter brings
that kind of stimuli
into an environment
and can cause a person to
start getting agitated.
The lecture Impact of Internal and External Stimuli by Brenda Marshall, EdD, MSN, RN is from the course Accessing Acute Psychiatric Care (Nursing).
Which are the examples of internal stimuli? Select all that apply.
The client states to the nurse, "I can't stop these thoughts of doing something violent that may upset my partner." This client is experiencing which type of stimuli?
Which client does the nurse suspect is likely responding to external stimuli?
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