PSYCHIATRIC NURSING
Psych focuses in feelings or self-awareness.
Beliefs determine feelings which affects behavior (manifestation of feelings)
Sigmund Freud is the father of PSYCHOANALYSIS
What happens to childhood will affect adulthood
STRUCTURE OF PERSONALITY ID
Impulsive, “want to”, wants pleasure.
PLEASURE PRINCIPLE
Guiding principle is PAIN AVOIDANCE SUPEREGO
Should not
Small voice of God
To stop EGO
Executive decision maker.
In touch with REALITY principle. ID DOMINANT PERSONALITIES Manic Anti - Social experienced by serial killers Narcissistic SUPEREGO DOMINANT PERSONALITIES Obsessive Compulsive Anorexia Nervosa EGO – if destroyed result in impaired reality perception. Schizophrenia LIBIDO
Sexual energy responsible for survival.
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Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.] ORAL STAGE
0 – 18 months evident.
ID is developed.
*FIXATION – Person is stuck in certain developmental shape. *REGRESSION – Return to an earlier developmental stage. *EGO – Developed on the 6th month. ANAL STAGE
18 months – 3 years old.
Able to control bladder, bowel.
Best time for toilet training.
SUPEREGO is developed. TOILET TRAINING
Good Mother
Bad Mother
Successful Dirty
Clean
- Disorganized
- organized
- Disobedient
- obedient
- Anti-social
- O.C
- Anal expulsive
- Anal retentive
PHALLIC STAGE
3 – 6 years old.
Experience pleasure by manipulating genitals.
Love – hate relationship.
Oedipus Complex boy loves parent of the opposite sex.
Imitates daddy called IDENTIFICATION.
Castration fears.
Electra Complex girl loves parent of the opposite sex.
Imitates mommy called identification.
Penis envy.
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*Conscious – upper level of thinking. *Preconscious – tip of tongue. *Unconscious – protects us from traumatic experiences. LATENCY STAGE
6 – 12 years old.
School age.
Separation anxiety.
Reading, Writing, Arithmetic.
Lasts for 6 years.
GENITAL STAGE
12 years old and above
Sexual reawakening.
Very important stage.
PHARMACOLOGY NOTES ANTI ANXIETY DRUGS
[S.A.T.L.V.M. – E.V.A.B.I.]
Serax
Equanil
Ativan
Vistaril
Tanxene
Atarax
Librium
Buspar
Valium
Inderal
Miltown
ERIC ERIKSON
There is more to life than just sex.
Psychosocial Theory of development.
You can develop a positive side or a negative side.
Developmental task begins at 0 – 18 months.
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Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
POSITIVE Trust Autonomy Initiative Industry Identity Intimacy Generativity Ego Integrity
0 – 18 mos. 18 mos. – 3 yrs. 3 yrs. – 6 yrs. 6 yrs. – 12 yrs. 12 yrs. – 20 yrs. 20 yrs. – 25 yrs. 25 yrs. – 45 yrs. 45 yrs. - above
NEGATIVE Mistrust Shame & Doubt Guilt Inferiority Role Confusion Isolation Stagnation Despair
FACTOR Feeding Toilet Training Independence School Peers Love Parenting Reflection
BEHAVIORAL MODELS Ivan Pavlov
Classical Conditioning
All behaviors are learned.
BF Skinner
Behavior can be learned and unlearned.
Operant conditioning.
If given reward there is repetition.
If punished behavior becomes extinct.
LOBES OF BRAIN 1. FRONTAL LOBE
3. PARIETAL LOBE
Language
Touch
Learning
Taste
Personality
Judgment
4. OCCIPITAL LOBE
2. TEMPORAL LOBE
Hearing
Smell
Visual
3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory – eyes, ears, tongue 2. Integration 3. Motor – voluntary or involuntary
VOLUNTARY NERVOUS SYSTEM
Also called as SOMATIC
Motor nerve to muscle fiber you need ACETYLCHOLINE which is an “On switch”. Brain
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Spinal Cord Motor Nerve Synapse Muscle Fiber INVOLUNTARY NERVOUS SYSTEM
Also called AUTONOMIC nervous system.
AUTONOMIC NERVOUS SYSTEM
Heart Rate Respiratory Rate GI GU Neurotransmitter
SYMPATHETIC (Awake, ADRENERGIC) Increase Increase Decrease (Dry mouth, Constipation) Decrease (Urinary Retention) Epinephrine, Norepinephrine
PARASYMPATHETIC (Relax, CHOLINERGIC) Decrease Decrease Increase (Moist mouth, Diarrhea) Increase (Urinary Frequency) Acetylcholine
DRUGS WITH ANTICHOLINERGIC EFFECTS
Anti – Anxiety
Anti – Psychotic
Anti – Cholinergic
Anti – Depressants
PHARMACOLOGY NOTES MONOAMINE OXIDASE INHIBITORS
Marplan
Nardil
Parnate DEFENSE MECHANISMS 1. DISPLACEMENT – transfer of feelings to a less threatening object rather than the one who provoked it. 2. DENIAL – failure to acknowledge an unacceptable trait or situation. 3. DISSOCIATION – psychological flight from the self. 4. REGRESSION – return to an earlier development state. 5. REPRESSION – unconscious forgetting. 6. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation. 7. REACTION FORMATION – doing the opposite of what you have done. 8. UNDOING – doing the opposite of what you have done. 9. IDENTIFICATION – assuming trait for personal, social, occupational role.
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
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10. PROJECTION – attribute to others one’s unacceptable trait. 11. INTROJECTION – assume another person’s trait as your own. 12. SUPPRESSION – conscious forgetting. 13. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive endeavors. 14. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms. 15. COMPENSATION – over achievement in one area to cover a defective part. 16. SUBSTITUTION – replace difficult goal with more accessible one. PHARMACOLOGY NOTES ANTI – PARKINSON DRUG [C.A.P.A.B.L.E.S]
Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetrel
AUTONOMIC NERVOUS SYSTEM SYMPATHETIC Dilate Constrict Increase
Pupils Blood Vessels Blood Pressure
PARASYMPATHETIC Constrict Dilate Decrease
THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. Offer Self
NONTHERAPEUTIC 1. Don’t worry be happy
2. Silence – provide time to think
2. Changing the topic/subject
3. Making observation – what you see
3. Ignore the client
you say
4. Value based judgment – never assume
4. Active Listening – nodding, eye contact
5. Flattery
5. Broad Opening – how are you today?
6. Advising
6. General Leads – Go on, I’m listening
7.
Giving Opinion
7. Restating – I’m sad “You’re sad?” FEAR – protects us from something bad. ANXIETY
Vague sense of impending doom.
Triggers the sympathetic nervous system.
Assess level of anxiety of client.
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TYPES OF ANXIETY MILD ANXIETY
+ 1 level of anxiety.
Widened perceptual field.
Restless (say you seem restless).
Enhanced learning capacity.
MODERATE ANXIETY
+ 2 level of anxiety.
Client pace.
Give PRN meds.
SEVERE ANXIETY
+ 3 level of anxiety.
Don’t know what to do/say.
Directive orders (please sit down). PANIC
+ 4 level of anxiety.
May commit suicide.
Promote safety.
Never touch patient.
Hyperventilation (Respiratory Alkalosis)
Breathe into paper bag. NURSING DIAGNOSIS
PLANNING/IMPLEMENTATION
Ineffective individual coping.
Decrease level of anxiety.
Powerlessness.
Decrease environmental stimuli.
Impaired skin integrity
Relaxation techniques
EVALUATION
Effective individual coping.
GENERALIZED ANXIETY DISORDER
6 month excessive worrying.
Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability.
PANIC ATTACKS/ DISORDER
15 – 30 minutes sympathetic nervous system escalation.
Example is AGORAPHOBIA fear of open spaces.
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POST TRAUMATIC STRESS DISORDER
Victims become survivors and experience flashbacks or nightmares.
MALINGERING
Pretending to be sick (conscious).
Primary Gain anxiety decreases, able to escape source of anxiety.
Secondary Gain able to get attention.
SOMATOFORM DISORDER
No protection
Unconscious
No organic basis of being sick
DIFFERENT TYPES OF SOMATOFORM 1. Conversion Disorder
Cannot speak, see, hear.
Nervous system affected. 2. La Belle Indifference
Do not care what happens to them.
HYPOCHONDRIASIS
has minor discomfort and interprets it as major illness.
Focus on clients feelings.
BODY DYSMORPHIC DISORDER
Illusion of structural defect.
Favorite past time is doctor hopping.
Focus on clients feelings.
PSYCHOSOMATIC
Real pains/illness
Real symptoms because of anxiety
PSYCHOSOMATIC
↓ Increase Anxiety
↓ SNS
↓
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Increase BP & HR
↓ Hypertension
↓ Fat Deposits
↓ Atherosclerosis
↓ Calcium
↓ Arteriosclerosis
↓ Decrease Oxygen
↓ Angina Pectoris
↓ MI
↓ Necrosis
↓ CHF
↓ Coma
PHOBIA
Irrational fear
Etiology: Knowledge of certain object
Bad experience
Immediate nursing objective: Removal of stimulus will remove anxiety
Systemic Desensitization gradually expose client to stimuli/feared object
Employ relaxation techniques
SYMPATHETIC NERVOUS SYSTEM
GABA (Gamma Amino Butyric Acid) – stop
Epinephrine and Norepinephrine – Go
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ANTI- ANXIETY MEDICATIONS
Increase GABA and client becomes drowsy (no alcohol and coffee)
May develop orthostatic hypotension
Let patient sit then dangle feet and then stand
Develop anti cholinergic effects
If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures
Do it in gradual and in tapered dose
Anti anxiety leads to dependence
AUTISM
Unresponsive and does not want to be touched
AUTISTIC SAVANT: high intelligence and has a ratio of 1:100
Assessment
Appearance – flat affect and loves constancy and ritualistic
Behavior – withdrawn
Communication – echolalia
NURSING DIANOSIS
Impaired verbal communication
Impaired social interaction
Self mutilation
Risk for injury
PLANNING/IMPLEMENTATION
Maslow’s hierarchy of needs
Expressive Therapy – use of art as mode of communication
EVALUATION
Enhanced communication
Improved social interaction
Safety
ATTENTION DEFICIT HYPERACTIVITY DISORDER
7 years and below onset
Duration: 6 months and above
Settings: house and school
Assessment
Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus
Behavior
Communication: talkative
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NURSING DIAGNOSIS
Risk for injury
Impaired social interaction
PLANNING/IMPLEMENTATION
Structure: place to play, sleep, eat and study
Schedule: there is always a time for everything that you do
Set limits
Safety
EVALUATION
Minimize risk for injury
Improved social interaction FRONTAL LOBE OF ADHD Decreased glucose
↓ Decreased judgment
↓ Increase impulsiveness ADHD/ Hyperactivity
Need a drug that brings glucose level up.
Give RITALIN as stimulant
May result in loss of appetite
Given after meals
Given 6 hours before bedtime EATING DISORDERS
ANOREXIA NERVOSA Eat, eat, eat
BULIMIA NERVOSA Eat, eat, vomit
Less 85% expected body weight
Normal weight
3 months Amenorrhea
Irregular menstruation
BULIMIA NERVOSA
Metabolic alkalosis (vomiting results to decreased hydrochloric acid)
Metabolic acidosis (diarrhea results to decreased bicarbonate)
Dental caries
Wound in knuckles
MANAGEMENT
Fluid and electrolyte imbalance
Meal contract
Weight gain for client
After eating stay with client for 1 hour and accompany when going to the comfort room
PHARMACOLOGY NOTES
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
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ANTI – PSYCHOTIC DRUG
Stelazine
Serentil
Thorazine
Trilafon
Clozaril
Mellaril
Haldol
Prolixin
SCHIZOPHRENIA
Ego disintegration
Impaired reality perception
Genetic vulnerability
Stress – Diathesis Model
Biological theory – increase dopamine level
Exact cause unknown
ASSESSMENT
Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
Ambivalence: pulled into 2 opposing forces AUTISM: Looseness, no idea, not related to one another
ASSESSMENT
NEGATIVE
POSITIVE
Hypoactive
Hyperactive
Withdrawn
Sociable
Thought Blocking
Flight of ideas
Apathy I. ASSESS
Content of thought
NURSING DIAGNOSIS
Disturbed thought process
PLANNING/IMPLEMENTATION
Present reality
Provide safety
EVALUATION
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
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Improved thought process
II. ASSESS
Hallucinations/ Illusions
NURSING DIAGNOSIS
Disturbed sensory perception
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Improved sensory perception
III. ASSESS
Suspicious
NURSING DIAGNOSIS
Risk for other directed violence
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Eliminate/minimize risk for other directed violence
IV. ASSESS
Suicidal
NURSING DIAGNOSIS
Risk for self directed violence
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Eliminate/minimize risk for self directed violence
1 LOOSENESS OF ASSOCIATION
There is connection with statements
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
FLIGHT OF IDEAS
Jumping from on topic to another
AMBIVALENCE
Pulled between 2 strong opposing forces
MAGICAL THINKING
acting like magician
ECHOLALIA
Client repeats what you say
ECHOPRAXIA
Client repeats what you do
WORD SALAD
Just words no rhyme
CLANG ASSOCIATION
Words that rhyme
NEOLOGISM
Formation of new words (needs clarification)
DELUSION: PERSECUTORY
“The NBI is out to get me”
DELUSION: RELIGIOUS
“I am Jesus Christ the savior”
DELUSION: GRANDEUR
“ I am the queen of the world”
DELUSION: IDEAS OF REFERENCE
“The nurses are talking about me”
CONCRETE ASSOCIATION
Also known as “pilosopo”
THOUGHT BLOCKING
Unable to think
STIMULUS
HALLUCINATIONS ABSENT
ILLUSIONS PRESENT
VISUAL
ABSENT
PRESENT
AUDITORY
ABSENT
PRESENT
TACTILE
ABSENT
PRESENT
Present reality to clients experiencing hallucinations
Technique in handling clients with hallucinations
Hallucinations
Acknowledgement “I know the voices are real to you”
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
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Reality orientation “I know the voices are real but I don’t hear them”
Diversion “Lets go to the garden”
10% of schizophrenic clients hear voices
PARKINSON’S DISEASE
If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch) ANTI-PSYCHOTIC
↓ Decrease dopamine level
↓ Parkinson like effect
↓ Extra pyramidal side effect
↓ With akathesia
↓ Restless, inability to rest AKINESIA
Muscle rigidity
DYSTONIA
Torticollis (wry-neck)
OCULOGYRIC CRISIS
Fixed stare
OPISTHOTONUS
Arched back
Lips – smacking
Tongue – protruding
Cheeks – puffing
The 3 are irreversible and called TARDIVE DYSKINESIA
NEUROLEPTIC MALIGNANT SYNDROME Hyperthermia
ANTI – PARKINSON DRUGS 1 ANTICHOLINERGICS
DOPAMINERGICS
(Decrease ACh)
(Increase Dopamine)
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
↓
↓
Artane, Akineton
Parlodel
Benadryl
Larodopa
Cogentin
Eldepryl Symmetrel
OTHER SIDE EFFECTS OF DECREASE DOPAMINE
Photosensitivity
AGRANULOCYTOSIS – decrease WBC
Clients prone to infection due to decrease WBC
First sign for infection is sore throat
TYPES OF SCHIZOPHRENIA DISORGANIZED
CATATONIC
PARANOID
- Sad but smiles (Inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech) - Giggling (hebephrenic giggle) - Combination of positive and negative signs and symptoms
- Ambivalence - Waxy flexibility - Favorite word is “No” - Negativism (client do not follow what you tell them to do) Nursing management: Meet needs
- Suspicious - Mistrust, scared, withdrawn Nursing management: - Gain TRUST by 1 to 1 short interaction but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: - Keep door open - Position near door - Don’t touch client - Call for reinforcement - One arms length away from the client.
RESIDUAL - No more positive symptoms just withdrawn
UNDIFFIRENTIATED UNCLASSIFIED - Mixed classification, cant be classified
PHARMACOLOGY NOTES BI-POLAR, MANIC
Lithium: undergo first kidney test and check for blood levels
Level: .6 – 1.2 meq/L
Increase urination
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Tremors, fine hand
Hydration of 3L/day
Increase
Uu (diarrhea)
Mouth dry
Signs of Lithium toxicity
Nausea, vomiting, diarrhea
Increase sodium
**** WAIT FOR 2 – 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS BIPOLAR DISORDER/ MANIC PROFILE
20 years old
Female
Stress
Obese
ASSESSMENT
Decrease appetite (give finger foods)
Decrease sleep (place in a private room)
Hyperactive
Increase sexual activity – only means of addressing anxiety so decrease level of anxiety
Risk for injury/other directed violence
Impaired social interaction (care giver role: strain and stay with client)
Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)
Because there is decrease self esteem there will be increase compensation resulting to increase interference with ADL’s and harm to others
Compensation is the culprit
Management: increase self esteem to decrease compensation and decrease interference with ADL’s and harm to others
HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS? T - no sports (basketball, volleyball), no fine motor skills only gross motor skills A -llot energies toward more productive endeavors (sublimation) S - escorted walk outdoors K - punching bag (displacement) PHARMACOLOGY NOTES ANTI – DEPRESSANTS
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Asendin
Sinequan
Norpralamin
Anafranil
Tofranil
Aventyl
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
Vivactil
Paxil
Elavil
Zoloft
Prozac
ALCOHOL LEADS TO:
Blackout: awake but unaware
Confabulation: inventing stories to increase self esteem
Denial: “I am not an alcoholic”
Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is another term
Tolerance: gradual increase in amount of stimuli to experience the same euphoria
MANAGEMENT
Detoxification: withdrawal with medical doctor supervision
Avoid alcohol therapy
Aversion therapy a more technical term for avoid alcohol therapy
Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting
Alcoholics anonymous
Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension Alcoholism may result to Vitamin B1 (Thiamine) deficiency
WERNICKE’S ENCEPHALOPATHY
Problem with motor
KORSAKOFF’S PSYCHOSIS
Problem with memory 24 – 72 hours after last dose of alcohol expect:
Delirium Tremens: sympathetic nervous system Prevent hallucinations/Illusions by placing client in a well lit room Formication: feeling of bugs crawling under the skin
ALZHEIMERS DISEASE -
Axon (away) and Dendrites (toward) nerve
-
Neurofibrillary tangles
-
Neurotic plaques
1 ALCOHOL/ DELIRIUM
ALZHEIMERS
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
ONSET LEVEL OF CONSCIOUSNESS DURATION MEMORY
Abrupt Fluctuating Hours to days Short term memory loss
Gradual Unaffected Progressive Short term and long term (orient patient)
5 A’s OF ALZHEIMERS 1. Amnesia – memory loss 2. Anomia – don’t know the name 3. Agnosia – sensory problems smell, taste, sight 4. Aphasia EXPRESSIVE: cant say/express Frontal lobe is affected particularly broca’s area RECEPTIVE: cant hear Temporal lobe is affected particularly wernicke’s area 5. Apraxia – can’t do simple things Reminiscing Therapy – talk about past
Patients with Alzheimer’s may experience hallucinations, illusions thus becomes restless and may wander
As sun goes down client becomes restless, agitated, disoriented called “sundowning”
Drug of choice is COGNEX and ARICEPT a cholinesterase inhibitor that increases Ach causing delay in disease progression
SEROTONIN
Responsible for happiness
Decrease serotonin clients becomes sad give anti-depressants SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks
Increases serotonin and affects only serotonin
PROZAC, PAXIL, ZOLOFT TRICYCLIC ANTI DEPRESSANT Two – four weeks C 1
A
Has higher incidence of side effects
Also increases norepinephrine
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, ELAVIL
MONO AMINE OXIDASE INHIBITORS
MAO kills serotonin
Increased MAO results to decreased serotonin the more depressed the client becomes
MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis
Avoid tyramine rich foods Avocado, Alcohol Beer Chocolates, Cheese (aged) Fermented foods Pickles Preserved foods Soy sauce
There is increase incidence of side effects after 2 – 6 weeks
MARPLAN, NARDIL, PARNATE
PERSONALITY DISORDERS 1. Schizophrenia They avoid people because there is no enjoyment
2. Avoidant
They avoid people because they are afraid of criticisms
They have talent but has no confidence 3. Anti-Social
Constantly breaks law
Project charm
They are witty and articulate
Manipulative
4. Borderline
They perceive life as an empty glass
They like splitting friends
Sudden change in mood “labile affect”
Prone to suicide
5. Dependent “Cant live if living is without you”
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6. Histrionic
Constantly wants to be the center of attention
Excited, dramatic, manipulative 7. Narcissistic
Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |
“I love myself”
They get jealous even with achievement of family members
8. Obsessive – Compulsive
“I am so organized” 9. Paranoid
Suspicious
May lead to domestic violence
ANTI – DEPRESSANT SIDE EFFECTS
MALE – Erectile dysfunction, prone to impotence
GRIEF PROCESS [D.A.B.D.A] 1. 2. 3. 4. 5.
Denial – shock/disbelief Anger – question “why me?” Bargaining – if, then Depression – 2 weeks or more sign and symptoms becomes major clinical depression Acceptance – client acts according to situation
ASSESSMENT
Decrease self actualization
Decrease self esteem
Withdrawn: stay with client
Suicidal: risk for self directed violence
Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
Be sensitive to clients needs
FOR SUICIDAL OBSERVE FOR Verbal communication
“I wont be a problem”
“This is my last day on earth”
“I’ll soon be gone”
Non-verbal communication
Giving away of valuables
Sudden change in mood
WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: “Do you plan to commit suicide?” Irregular/interval visits Endorsement period, EARLY MORNING clients are most likely to commit suicide
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DOWNERS [A.B.O.N.-M.M.C.H.] Alcohol
Marijuana
Barbiturate
Morphine
Opiates
Codeine
Narcotics
Heroine
Resulting to:
Bradycardia
Bradypnea
Moist mouth
Pupils constrict
Constipation
Urinary retention
Hypotension
Coma
Weight gain
Narcotics overdose: give narcotic antagonist (NARCAN, NALOXONE HYDROCHLORIDE)
UPPERS [C.H.A.R.] Cocaine Hallucinogens Amphetamines Resulting to:
Tachycardia
Awake
Tachypnea
Dry mouth
Pupils dilate
Hypertension
Seizures
Weight loss
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