-1Beliefs Feelings Behavior Therapeutic Communication Techniques • What you see, you say • What you hear, you say restating Sigmund Freud • Father of Psychoanalysis • Structure of Personality (Id, Ego, Superego)
D mpulsive want to want PLEASURE
eat drink urinate defecate
I
E
PLEASURABLE PRINCIPLE Pain Avoidance It’s all “I”
UPER EGO hould not mall voice of God
Dominant ID Mania Antisocial Narcissistic
DOMINANT SUPER EGO Obsessive - compulsive Anorexia Nervosa
CONSCIENCE PRINCIPLE
GO Xecutive Secretary
REALITY PRINCIPLE LIBIDO sexual energy responsible for survival PSYCHOSEXUAL THEORY 1. ORAL STAGE • 0 – 18 Months old • Survival • I want to eat, sleep, urinate, defecate • ID formation
I E
Impaired Reality Schizophrenia
-2•
Cry & Suck mouth Child Cries Feed the Infant ↓ Successful
Ignore the Infant ↓ Unsuccessful ↓ Narcissistic
Defense Mechanism: o FIXATION when a person is stuck in a certain developmental stage o REGRESSION return to an earlier developmental stage •
EGO is develop in the 6th month 2. ANAL STAGE • Ateen – 3 years old (18 mos – 3 y.o.) • Toilet training • Super Ego develop Toilet Training Good Mother ↓ Successful
Bad Mother ↓ Unsuccessful
SE
BIG SE
3. PHALLIC • • • •
Too Rigid Training ↓ Clean Organized Obedient ↓ OBSESSIVE – COMPULSSIVE (Anal Retentive)
3 – 6 y.o. Penis/ Vagina Parents is the significant person Called as Preschooler
Dirty Disorganized Disobedient ↓ ANTISOCIAL (Anal Expulsive)
Small S E
-3-
• • • • •
Oedipus Complex little boy loves mommy Electra Complex little girl loves daddy Identification boy associates with daddy, girl assoc. with mommy Castration fear of the little boy to daddy Penis Envy envy of little girl towards daddy Dr. Karen Horney opposition to penis envy •
Level of Awareness o Conscious highest level of awareness o Preconscious Tip of the tongue o Unconscious deepest level of awareness
• •
Birth Trauma First traumatic experience of child REPRESSION unconscious forgetting of an anxiety provoking concept SUPRESSION conscious forgetting of an anxiety provoking concept
•
4. LATENCY STAGE • 6 – 12 years old • SCHOOlatency • Sexual energy is dormant • Reading, Riting, Rithmetic • SUBLIMATION placing sexual energies toward a more productive endeavors 5. GENITAL STAGE • 12 y. o. – above • Gising • Genital
-4-
PHARMA MOMENTS
ANTIANXIETY VLAST ME VAIB Valium – ate V Miltown - Meal Libreum - L Equanil – Aqua Kneel Ativan - Ate Guy Seraks – Sera Ulo Tranxene - Transit
Vistaril - largavista Attarax – Mga bato (rocks) Inderal – hindi ralph Busfar – sasakay ng bus
ERIK ERIKSON • PSYCHOSOCIAL THEORY OF DEVELOPMENT + Age 0-18 mos. 18 mos. – 3 y.o.
3 – 6 y.o. 6 – 12 y.o. 12 – 20 y.o. 20 – 25 y.o. 25 – 45 y.o. 45 y.o. and above
Trust Autonomy AU nal TO ilet training NO favorite word MY Initiative Industry Identity Intimacy Generativity Ego Integrity
Mistrust Shame/ doubt
Affecting Major Factor Feeding Toilet Training
Guilt Inferiority Role confusion Isolation Stagnation Despair
Independence In da-school Peer Love Parenting Reflection
MASLOW’S HEIRARCHY OF NEEDS 1. Physiologic Needs o Air, food, water, shelter, rest, sleep, activity and temperature maintenance that are crucial for survival 2. Safety and Security Needs o Safe in physical and psychological aspects 3. Love and Belonging Needs o Giving and receiving affection, attaining a place in a group, maintaining the feeling of belonging 4. Self – esteem Needs o Self esteem – feelings of independence, competence and self respect o Esteem from others – recognition, respect, appreciation
-55. Self Actualization o One’s maximum potential and realize one’s abilities and qualities BEHAVIORAL MODELS 1. Ivan Pavlov • Classical Conditioning Model • All behavior are learned Food dog Salivation Bell Food Dog Salivation Bell Salivation 2. B.F. Skinner • Operant Conditioning • All behaviors are unlearned • Reward (+ reinforcement) and Punishment (Reinforcement) BRAIN LOBES ACTION Frontal Language, Learning, Personality, Judgment Temporal hearing, smelling Parietal Taste, touch Occipital Vision Sensory Integration
Voluntary Motor Involuntary
VOLUNTARY NERVOUS SYSTEM • Somatic Nervous System
AcetylCholine ↓ Brain Spinal Cord Motor Nerve Muscle Fiber
INVOLUNTARY NERVOUS SYSTEM • Autonomic Nervous System Sympathetic HR ↑ RR ↑ GI ↓ Constipation GU ↓ Urinary retention Neuro Epi/ Nor
Parasympathetic ↓ ↓ ↑ Diarrhea ↑ Urinary Frequency Acetyl Choline
-6-
PHARMA MOMENTS
MONOAMINE OXIDASE INHIBITORS AR
M N P
PLAN DIL NATE
ANTIPARKINSON CAPABLES
Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetryl THERAPEUTIC COMMUNICATION • • • •
• • •
• • •
Therapeutic Offer your self I’ll stay with you Silence Making observations o You seem sad Active listening o Nodding o Eye contact o Lean forward Who, what, when, where General leads o Go on, I’m listening, what else? Broad opening - best Opening line o How are you today? o How are you? Restating Clarrification Refocusing we are talking
• • • • •
• • • • • •
Non-Therapeutic Don’t worry be happy Everything’s gonna be alright Ignoring the client Changing the subject Nice weather we’re having o Adjectives – value based perception, should not be use You are the most beautiful client Why Arguing Flattery You should do this now In my opinion
-7about the exam • Focusing tell me about DEFENSE MECHANISMS Fight for stress DISPLACEMENT • Transfer of feelings to a less • Boss shouts at threatening object rather than the you, you shout at one who provoke it your subordinate DENIAL • Failure to acknowledge an • “I’m not an unacceptable trait or situation alcoholic” DISSOCIATION • Psychological flight from self • “Sino ka, Sino ako?” • A type of amnesia REGRESSION • Return to an earlier developmental • Return to stage thumbsucking REPRESSION • Unconscious forgetting of an • Hindi ko maalala anxiety provoking concept RATIONALIZATION • Illogical reasoning for a socially • I drink because I unacceptable trait don’t want to waste the beer in • “sayang ang beer sa ref, kaya ko the ref ininum” REACTION • doing the opposite of your • sasabunutan FORMATION intention kita. . . ay kuklulutin lang kita • plastic UNDOING • Doing the opposite of what you • “ay pinatid kita, have done due to guilt halika punta kita sa clinic” • orocan, plastic, Tupperware IDENTIFICATION • Assume trait for personal, social, • Tulad niya occupational role PROJECTION • Attributing to others one’s • “hindi ako acceptable trait alcoholic, sila yon” • Pasa load INTROJECTION • Assume another person’s trait as • “ako din” your own • Not just you, me • too SUPPRESSION • Conscious forgetting of an anxiety • Hindi ko alam yan provoking concept SUBLIMATION • Placing sexual energies toward a • Angry at life, put more productive endeavors anger in singing CONVERSION • Repressed angers put towards • Biglang mangingig physical symptoms affecting nervous system leading to sensory numbness and motor paralysis COMPENSATION • Overachievement in one area to • Pilay pero cover a defective part magaling kumanta SUBSTITUTION • Replacing a difficult goal with a • Gusto ko more accessible one Disneyland.
-8Enchanted nalang. STOP GABA Inhibitory Gamma Amino Butyric Acid GO Epinephrine/ Norepinephrine Exitatory
SNS ANXIETY
Anticholinergic side effect Constipation Urinary Retention Dry Mouth Blurred Vision
Within 1 week Rebound phenomenon Seizure Abrupt
Anti-Anxiety
Dependence Withdrawal Drowsy No Alcohol No Coffee Develop Orthostatic Hypotension Prevetion of O.H. 1. Sit Down 2. Dangle feet 3. Stand Up Gradually
Gradually Tapered Dose
RELAXED
ANXIETY •
Vague sense of impending doom
Mild Moderate +1 +2 Widened acing Perceptual Field RN Meds Restless Enhanced Learning Capacity “You Seem Restless “
Severe +3 ont know what to say/do IRECTIVE
Panic +4 uicide afety Don’t touch client Respi Alkalosis Bown Bag
-9-
Assess Nx Dx
: Level of Anxiety : Ineffective Individual Coping Powerlessness Impaired Skin Integrity Planning/ Implementation: ↓ level of anxiety ↓ environmental Stimuli Relaxation Technique • Showing pictures of flower, waterfalls • Hearing sounds of chirping birds Evaluation : Effective individual coping
ENERALIZED ANXIETY DISORDER months excessive worrying • Might be mild, moderate and severe anxiety S/Sx • Restless • Difficulty of concentration • Sleep Disorders • Palpitations • Edge of the seat • Easy fatigability
PANIC DISORDER • • •
15 – 30 Minutes escalation of SNS AGORAPHOBIA fear of open space/ public places SOCIAL PHOBIA fear of public
POST TRAUMATIC STRESS DISORDER Trauma Disaster Accident War Rape
Flashbacks VICTIMS Survivors Nightmares
- 10 Earthquake Soldier 6 years old ↓ Assignments/ Homeworks ↓ No Assignments/ Homeworks ↓ You Think “Teacher may get angry”
↑ Anxiety ↓ “I am sick” ↓
SOMATOFORM > no pretension > no organic basis
MALINGERING pretending to be sick (Conscious) ↓ Absent
Escape from Teacher PRIMARY GAIN (Behavior ↓ anxiety)
> unconscious
Mama Care ↓ ↑ Attention SECONDARY GAIN
PSYCHOSOMATIC > Real pains/ illness > Real symptoms > 4 major types * Hypertension * Migraine * Stress Ulcer * Asthma
SOMATOFORM DISORDERS SOMATOFORM Nervous System CONVERSION DISORDER La Belle Indifference emotional disattachment from disability
Illusion of structural defect BODY DYSMHORPIC DISORDER
Minor Discomfort Interpreted as major illness HYPOCHONDRIASIS “Maliit na butas, pinalalaki” Favorite Past Time: Doctor Hopping Nursing Focus: Feelings
- 11 -
PSYCHOSOMATIC DISORDERS ↑ Anxiety SNS ↑BP ↓ Hypertension
Vasoconstriction Cerebral Artery ↓ Migraine
Left Gastric Artery ↓ Stress Ulcer
PNS ↓ Bronchoconstriction ↓ Asthma
OBSESSIVE – COMPULSIVE Belief/ thought Door Open Burglar may go inside
→ →
Feelings ↑ Anxiety
→ ↑ anxiety ↓ Returns to house (Action) ↓ Anxiety ← Compulsion Obsession (thought)
PHOBIA • • • •
Irrational fears Etiology o Knowledge o Experience Immediate Nursing Intervention remove the stimuli SYSTEMATIC DESENSITIZATION o Gradual exposure to feared object
PHARMA MOMENTS
ANTIPSYCHOTIC AGENT SSTTCMHP Stelazine - sexy star Serentil – serena Thorazine – babaeng Tora Trilafon - tri-band phone
Clozaril – closed reel Mellaril – maraming reel Haldol – hahaha Prolixin – pero lick scene
- 12 -
ALCOHOLISM Etiology: Intergenerational Transmission • From one generation to another generation
Alcohol ↓ Blackout awake but unaware ↓ Confabulation inventing stories to ↑ self-esteem ↓ Denial “I am not an alcoholic”
Dependence “I can’t live without it” ↓ Enabling significant other tolerates abusers Another term CO – DEPENDENCY TOLERANCE ↑ Substance to achieve a previous effect DETOXIFICATION • Withdrawal with MD supervision • Check Alcohol, Mouthwash, Elixer void alcohol version therapy lcoholics Anonymous self help group ntabuse DISULFIRAM Never drink alcohol ↓ 12 hour interval/ 12 h last alcohol intake
B1 Vitamin Deficiency ↓
or else: nausea, vomiting and hypotension Wernicke’s Encephalopathy → motor
↓
Korsakoff’s Psychosis → memory
Complications
Delirium Tremens 24 – 72 h after last dose of alcohol ↓ untreated withdrawal syndrome ormocation bugs crawling under the skin amily Therapy mother, father, brother
- 13 -
AUTISM Autistic Savant autistic with a special talent Assess • Appearance flat affect, consistent movement • Behavior repetitive, ritualistic • Communication echolalia, incomprehensible Nx Dx • Impaired verbal communication • Impaired social interaction • Self mutilation • Risk for injury Planning/ Implementation • Maslow’s hierarchy of needs • Constancy, promote safety Evaluation • Expressive therapy drawing, muscic etc • Enhanced communication • Improved social interaction • Safety
ATTENTION DEFICIT HYPERACTIVE DISORDER • • • •
Onset Duration Settings Id Dominant
: 7 y.o. and below : 6 months and above : 2 House and school : Mom or RN will act as superego
ADHD → ↓ Glucose → Frontal Lobe → impaired judgement → ↑ ADHD S/Sx → Ritalin Frontal Lobe → ↑ Judgement → ↓ ADHD S/Sx (stimulant) Assess • Appearance dirty • Behavior clumsy, impatient, easily distracted, hyperactive • Communication talkative, blurts out in class Nx Dx • Risk for injury • Impaired social interaction Planning/ Implementation tructure separate room for eating, playing, sleeping and etc chedule time for everything
- 14 et limits afety Evaluation • Minimize Risk for Injury • Improved social interaction • Safety Residual ADHD grows up not antisocial Meds: Ritalin, dexedrin, pemoline, adderal Best time to give: once a day: AFTER MEALS: prevent lost of appetite Don’t give at bedtime STIMULANT causes insomnia Give 6 hours prior bedtime if bid
EATING DISORDERS 18 mos. – 3 y.o. ↓ Toilet Training ↓ Clean Obedient Organized Thought I Am Fat
6 y.o. class valedictorian/ model student ↓ social inactive/ no BF ↓ weighing
Feeling Behavior ↓ Self Esteem Diet, Diet, Diet
Anorexia Nervosa Diet, diet, diet <85% of expected body 3 mos. ammenorhea Karen Carpenter
Eating Disorders Eating Pattern Weight Menstruation
Bulimia Eat, eat, vomit Normal weight Irregular menstruation Dao Ming Xi Da Ming Sugat/ suka Vomiting Dental caries Wounded knuckles Metabolic alkalosis Metabolic acidosis
Vomiting Fluid Volume Deficit ARRHYTHMIA (fatal complication)
- 15 Diarrhea Interventions • Restore fluid and electrolyte balance • Collaborative regarding menu contract • Target weight gain • After meals: stay 30 mins – 1 hour
PHARMA MOMENT
LITHIUM
Kidney
L evel 0.6 – 1.2 mEq/L Increase urination Tremors, fine hand Hydration 3 L/day Increase Uu diarhea Mouth, dry
ausea, vomiting, diarrhea Lithium Toxicity a+
ANTIPARKINSON ANTICHOLINERGIC ABC Artane Akineton Benadryl Cogentin
DOPAMINERGIC PLSE Parlodel Larodopa Symmetyl Eldepryl
SCHIZOPHRENIA • • • • • •
Ego disintegration Impaired reality perception Genetic vulnerability Stress – Diathesis Model o Too much stress in the reality will lead client to escape it and go to the fantasy world Biological Theory o Dopamine level is High The exact cause is unknown ffect appropriate, inappropriate, flat, blunt (incomplete emotion) mbivalence torn between 2 opposing forces
- 16 utism ssociative Looseness Symptoms Negative Hypoactive Withdrawn Apathy
Positive Hyperactive Sociable Flight of Ideas Talkative
Assess : Content of Thought Nx Dx : Disturbed thought process Planning/ Implementation: • Present reality • Provide safety Evaluation : Improve thought process Assess : Hallucination/ Illusions Nx Dx : Disturbed sensory perception Planning/ Implementation: • Present reality • Provide safety Evaluation : Improve sensory perception Assess : Suspicious Nx Dx : Risk for other directive behavior Planning/ Implementation: • Present reality • Provide safety Evaluation : Eliminate/ minimize risk for other-directed violence Assess : Suicidal Nx Dx : Risk for self directive behavior Planning/ Implementation: • Present reality • Provide safety Evaluation : Eliminate/ minimize risk for self-directed violence Flight or Looseness I am going to the mall.
I am going to the mall.
- 17 Where is the light? Go here. Mineral Water.
The mall is big. Big is the tree. The tree is tall.
Magical Thinking • Believes to have a magical power • I can turn you into a frog Echolalia I repeat what you say Parrots Echopraxia I repeat what you do Word Salad words, no rhyme Clang Association words with rhyme : Dunk, plank, sunk Neologism creation of new words Plinking, hustash • Clarification done in case of neologism Delusion: Persecutory NBI is out to get me/ someone will harm the client Religious I am Jesus Christ Grandeur I am the queen of the world. Ideas of reference Nurses are talking about me. Concrete Association pilosopo “what will you wear?” “clothes” Thought Blocking
Stimulus Visual Auditory Tactile
Halucination s Absent X X X
Illusion Present √ √ √
In case of hallucinations do:
Hallucinations Acknowledgment • I know you the voices are real to you Reality orientation • But I don’t hear them
- 18 -
Diversion •
Lets go to the garden
But if nothing in the preceeding intervention are seen Assess what the voices are saying SCHIZOPRENIA
Disorganized • Sad but smiles o Inappropriate affect • No reaction o Flat affect • Flight of ideas o HEBEPHRENIC • Giggling • Positive and Negative classified S/Sx
Catatonic
Paranoid
• Ambivalence • Waxy Flexibility o Iniwan na posture, ganun forever • No – favorite word • Negativism
• Suspicious • Tendency to be violent Mistrust→Scared→Withdrawn Nrsg. Int: Develop trust • 1 to 1 • short interaction • frequent visit • foods in sealed container • meds wrapped for violent pt. • Doors open • Near the door • Don’t touch the pt. • Eye contact • 1 arms length away • call reinforcement
differentiated
Residual • Mixed classification
• Can’t be classified 1st paranoid, then • No more positive •s/sx, disorganized then just withdrawn catatonic, etc etc
Normally Acetylcholine = ON
Dopamine = OFF
Your always ON With parkinsON
High Dopamine= Schizophrenia
- 19 -
Antipsychotics = makes Dopamine goes down ON
Extrapyramidal Side Effects • AKATHISIA o Restless, inability to sit o Makati siya, ahh kati siya • AKINESIA o Muscle rigidity o Ahh kiniss siya • DYSTONIA o 3 features TORTICOLLIS • Wry neck Anticholinergic OCULOGYRIC CRISIS • Drugs that will make the • Fixed stare AcH down OPISTHOTUNOS o Artane • Arched back o Akineton • TARDIVE DYSKINESIA o Benadryl o Irreversible side effects of o Cogentin antipsychotics o Lip smacking Dopaminergic o Tongue protruding • Dopamine goes up o Cheeks puffing o Parlodel • NEUROLEPTIC MALIGNANT o Larodopa SYNDROME o Symmetryl o Hyperthermia among client o Eldepryl taking antipsychotic o Hyperthermia with muscle rigidity Other Side Effects • Photosensitivity o Sunscreen o Wide brimmed hat • Agranulocytosis o Report immediately Sore throat 1st sign to appear
- 20 -
PHARMAMOMENTS
ANTIDEPRESSANTS ANTSAAVE PPZ
Asendin – ascending Norpramin – sabaw ng knorr Tofranil – Tofu Sinequan – nood ng Sine Quan ang title Anafranil – kina Ana Praning Aventyl – kina Aven Til Midnight tayo Vivactil – Bye Back till next week Elavil – Eh love mo ba ako Prozac – Pero saka na Paxil - Taksil Zoloft – mag Solo ka BIPOLAR DISORDER – Mania more common • Female • 20 years old and above • Stressful life • Obese TASK Caregiver Role Strain Safety Impaired social interaction Safety ↓Self Actualization ↓Self Esteem
Risk for injury/ other directed violence ↓ Eating finger food
↓ Sleep Private room
Lithium – 2 – 4 weeks before effect
Hyperactive
↑ Sex Anxiety
- 21 -
↓SE → ↑Compensation → ↑interfere ADLs, ↑ harm others ↑SE → ↓Compensation → ↓interfere ADLs, ↓ harm others TASK → increases client’s self esteem • • •
Gross motor skills via sublimation Escorted walk outdoors Punching bag
No group games compition will increase anxiety 3 or more signs confirms disorder G F S P E E D
randiose light of ideas leeplessness ressured speech xagerated SE xtraneous stimuli (easily distracted) istractibility
PERSONALITY DISORDERS SCHIZOID • I don’t want people • Believes he can stand on his own • Never had a best friend • Avoid groups and social activities no enjoyment • Cares more about computers and pets AVOIDANT • I avoid people, I fear criticism • Have talent but no confidence ANTISOCIAL • I break the law as motto
- 22 • • •
As a child,: steal, lie, always get reprimanded Adult – grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe sex, thrill seeker Good talker, charmer, witty manipulator
BORDERLINE – my life is an emptyglass
Dependent • I can’t live without you • ↓ self esteem • poor decision making skills Histrionic • excited, dramatic but manipulative • center of attention Narcissistic • I love myself • Insensitive, arrogant • I am the best Obsessive – Compulsive • I am organized • Perfectionist • Provide time to do rituals Paranoid • Suspicious Passive Aggressive • Always say yes but resistance is hidden
- 23 -
Serotonin MAO kills Serotonin
↑MAO ↓ Serotonin ↓MAO ↑ Serotonin ↓ Serotonin
1st Line of Drug Prescribed
ANTIDEPRESSANTS wo – 4 weeks wo neurotransmitter RI
ONO
ide effects low EROTONIN
CYCLIC
MINE
EUPTAKE
NTIDEPRESSANT
XIDASE
afest ELECTIVE
to 4 weeks NHIBITOR PPZ
Higher incidence of Side effects Serotonin/ Epi affected NHIBITOR ANTSAVE
MNP
All neurotransmitter affected Highest Side effects Avoid tyramine rich food ↓ may lead to HYPERTENSIVE CRISES
TYRAMINE RICH FOODS vocado ged Cheese eer hocolate
SSRI
TCA
MAOI
Antidepressant ↓ Anticholinergic Side Effects (Syphathetic) ↓ Male Erectile Dysfunction
- 24 -
ermented Foods ickles reserved Foods oy Sauce
- 25 -
Antidepressant no effect ECT ELECROCONVULSIVE THERAPY • Pre o Informed consent o NPO 6 – 8 hours prior • Meds o Atropine dry mouth o Barbituate Sedative o Succinylcholine muscle relaxant, prevent seizure • Post o Side-lying – lateral o S/E headache, dizziness, TEMPORARY MEMORY LOSS distinct sign • 70 – 110 volts • 20 – 30 seconds • ½ hour asleep post
PHARMAMOMENTS
SUBSTANCE ABUSE Downers (ABONM INE) Alcohol Barbituates Opiates Narcotics Marijuana Uppers (CHA) Cocaine Hallucinogen Amphetamines
Morph Code Hero
NARCAN antidote
- 26 OVERDOSE Alcohol
Coma
Cocaine HR RR BP LOC
Seizure
Bradycardia Bradypnea Pupil constriction
Moist mouth Constipation Hypotension Coma Asleep Weight gain
EUPHORIA
Tachycardia Tachypnea Pupil Dilation Dry mouth Hypertension Seizure Awake Weight Loss
Psych well being NARCAN Narcotic Antagonist narcotic overdose
DETOXIFICATION withdrawal with MD Supervision METHADONE
Withdrawal reverse of effect or opposite of overdose
DEPRESSION ↓ Serotonin, if unresponsive to drugs, ECT
The Grief Process • Denial no! this can’t be true • Anger why me, why me, why now • Bargaining if something happens, then I’ll give something back • Depression I’m down 2 weeks or more s/sx major depression • Acceptance client acts according to situation
- 27 -
↓Self Actualization ↓Self Esteem withdrawn
C TASK Stay
Risk for self directed violence Eating
Sleep
Hypoactive
↓Sex
Sensitivity to client needs
SUICIDE Verbal • I wont be a problem anymore • This is my last day on earth • I’ll soon be gone
Non Verbal • Take this ring, its yours (giving of valuable) • Sudden change in mood
Who will commit Suicide? Sex – Male (more successful)/ female (hesitant) Age – 15 –24 y/o or above 45 Depression Patient with previous attempt ETOH – ethanol - alcoholics Rirrational Social support lacking Organized plan greater risk No family Sickness, terminal SUICIDE TRIAD • Loss of spouse • Loss of job • Aloneness Is Patient is SUICIDAL; nurse should: DIE • Direct question – “Are you going to commit suicide?” • Irregular interval of visit to pt. room • Early AM and period of endorsement – the time pt’s commit suicide Best approach for suicidal pt. : Direct approach Nursing Management: Close surveillance Hospital area majority sucide will happens at: • weekends 1- 3 am Sunday • Weekend less staff personnel • Early AM every one is asleep
- 28 -
Give simple task. Don’t give complex may cause depression ex. Jigsaw • Water plants • Wash the dishes except sharps CHILD ABUSE (think B) • Burns, bruise, bone fractures, BUNGI! • Don’t bathe the child, don’t brush teet. Body of evidence will be lost • Bantay Bata 163 LEVELS OF MENTAL RETARDATION • Profound o < 20 o thinks like an infants o can’t be trained ero – 2 y/o o stay with the patient ensorimotor • Severe evere o 20 – 35 • Moderate Modera e o 35 – 50 hirtyfive – 50 o can be train rainable wo – 7 y/o o mental age is 2 – 7 y/o o pre-operational stage • Mild o 50 – 70 o meantal age is 7 – 12 o educable o can go to school • Borderline o 70 - 90 • Normal o 90 – 100 JOHN PIAGET’S COGNITIVE THEORY 0–2 Sensorimotor Baby can sense, see, perceive and hear. Object permanence 2–4 Preconceptual Language 4–7 Intuitive Unidimentional classification characteristic. Child can fix toys according to size, color, height = one at a time 7 – 12 Conservation Multidimensional Concrete Association Formal Good abstract thinking. Can interpret words 12 ↑ Operation
- 29 ALZHEIMER NOMIA don’t know name of objects GNOSIA problem with senses PHASIA can’t say it PRAXIA can’t do it Cocaine Nasal Septum perforation Marijuana impaired Lung Structure eroine withdrawal ikab atsing u hu hu CRITICAL REVIEW
TEST TAKING TECHNIQUES 1. Assess the answer, use circle 2. Initial priority TRUST
Air food, water
3. 4.
5. 6.
7.
air ABC Good Word/ Bad Word S Technique eek support it tay upervised ee = observed eem = notice assi t feeling 2 same answer/ 2 same mistake Words to watch out for Inappropriate Most Not included Except All but one Umbrella
ASSESS
- 30 RELATIONSHIP Preorientation Self awareness
Orientation Trust Setting Contract Resistance
Working
Termination
Discussion
Evaluation
PRACTICE OF NURSING Level of Prevention 1
2
3
Healthy Ill Community Demog. Crisis Intervention
Relapse AA
SELF HELP GROUPS nique niversality r not alone RESTATE exact words REFLECT use other words DEPRESSION Endogenous Internal Chemical
Reactive external
Barbituate withdrawal LIBRIUM (Chloridiazepoxide) TOFRANIL Antidepressant/ Anticholinergic pupil dilation midriasis Catharsis Feelings Free Association Ideas ATTITUDE THERAPIES Active friendliness ask permission assive Friendliness aranoid anipulative nic atter of Fact
- 31 No Demand Depressed Kind Firmness Anorexic Crisis 4 – 6 weeks Goal Return the client to the pre-crisis level of functioning PSC Perception what do you think about it? Coping what will you do about it? Support who will be there for you? Kulit kulit kulit kulit Perseveration stick to 1 topic Ulit Ulit Ulit Verbigeration DISSOCIATION Dissociative Amnesia don’t know themselves Fugue Far Dissociative Identity Disorder Multiple Personality D.O.