Myk Psychiatric Nursing Notes 3

Myk Psychiatric Nursing Notes 3 DRUGS WITH ANTICHOLINERGIC EFFECTS • Anti – Anxiety • Anti – Psychotic • Anti – Cholinergic • Anti – Depressants PHARMA NOTES: MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS) • 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. DISOCIATION – 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. 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. PHARMA NOTES: ANTI – PARKINSON DRUG - CAPABLES • Cogentin • Artane • Parlodel • Akineton • Benadryl • Larodopa • Eldepryl • Symmetrel AUTONOMIC NERVOUS SYSTEM ----------------- SYMPATHETIC -------- PARASYMPATHETIC Pupils ----------------Dilate ----------------Constrict Blood Vessels --------Constrict ------------- Dilate Blood Pressure --------Increase ------------ Decrease THERAPEUTIC COMMUNICATION TECHNIQUES

THERAPEUTIC 1. Offer Self 2. Silence – provide time to think 3. Making observation – what you see you say 4. Active Listening – nodding, eye contact 5. Broad Opening – how are you today? 6. General Leads – Go on, I’m listening 7. Restating – I’m sad “You’re sad?” 1. Don’t worry be happy 2. Changing the topic/subject 3. Ignore the client 4. Value based judgment – never assume 5. Flattery 6. Advising 7. Giving Opinion NONTHERAPEUTIC 1. 2. 3. 4. 5. 6. 7.

Don’t worry be happy Changing the topic/subject Ignore the client Value based judgment – never assume Flattery Advising Giving Opinion

FEAR – protects us from something bad. ANXIETY • Vague sense of impending doom. • Triggers the sympathetic nervous system. • Assess level of anxiety of client. 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: • ineffective individual coping. • Powerlessness. • Impaired skin integrity PLANNING/IMPLEMENTATION: • decrease level of anxiety. • Decrease environmental stimuli. • 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. POST TRAUMATIC STRESS DISORDER • victims becomes 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 • no protection • unconscious • no organic basis of being sick DIFFERENT TYPE 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 DISMORPHIC 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 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 SNS • GABA (Gamma Amino Butyric Acid) – stop • Epinephrine and Norepinephrine – Go ANTI-ANXIETY • 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 if 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 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 Decrease glucose Decrease judgment Increase impulsiveness ADHD Hyperactivity • Need a drug that brings glucose level up. • Give Ritalin a stimulant • May result in loss of appetite • Given after meals • Given 6 hours before bedtime