Psych Nursing Complete Edited Royal Pentagon

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Psychiatric Nursing

Beliefs  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

S 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

I E

Impaired Reality Schizophrenia

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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

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• •

Psychiatric Nursing

ID formation 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

Too Rigid Training ↓ Clean Organized Obedient ↓ OBSESSIVE – COMPULSSIVE (Anal Retentive)

Dirty Disorganized Disobedient ↓ ANTISOCIAL (Anal Expulsive)

Small SE

3. PHALLIC • 3 – 6 y.o. • Penis/ Vagina • Parents is the significant person

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

•

Called as Preschooler

• • •

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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

5. GENITAL STAGE • 12 y. o. – above • Gising • Genital 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

4. Self – esteem Needs o Self esteem – feelings of independence, competence and self respect o Esteem from others – recognition, respect, appreciation 5. 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 ↓ Jomar Anthony D. Maxion, BSN, RN

Parasympathetic ↓ ↓ ↑ Diarrhea ↑ College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Urinary retention Epi/ Nor

Neuro

Psychiatric Nursing

Urinary Frequency Acetyl Choline

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

Jomar Anthony D. Maxion, BSN, RN

• • • • •

• • • • • •

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 College of Nursing Batch 2009

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Psychiatric Nursing

o How are you today? o How are you? • Restating • Clarrification • Refocusing  we are talking about the exam • Focusing  tell me about DEFENSE MECHANISMS  Fight for stress DISPLACEMENT • Transfer of feelings to a less threatening object rather than the one who provoke it DENIAL

•

DISSOCIATION REGRESSION

• • •

REPRESSION

•

RATIONALIZATION

• •

REACTION FORMATION

• •

UNDOING

•

IDENTIFICATION

• •

PROJECTION

•

INTROJECTION

• •

SUPPRESSION

• •

SUBLIMATION

•

Failure to acknowledge an unacceptable trait or situation Psychological flight from self A type of amnesia Return to an earlier developmental stage Unconscious forgetting of an anxiety provoking concept Illogical reasoning for a socially unacceptable trait “sayang ang beer sa ref, kaya ko ininum” doing the opposite of your intention plastic

•

• • • • •

•

Boss shouts at you, you shout at your subordinate “I’m not an alcoholic” “Sino ka, Sino ako?” Return to thumbsucking Hindi ko maalala I drink because I don’t want to waste the beer in the ref sasabunutan kita. . . ay kuklulutin lang kita “ay pinatid kita, halika punta kita sa clinic” Tulad niya

Doing the opposite of what you • have done due to guilt orocan, plastic, Tupperware Assume trait for personal, social, • occupational role Attributing to others one’s • “hindi ako acceptable trait alcoholic, sila yon” Pasa load Assume another person’s trait as • “ako din” your own • Not just you, me too Conscious forgetting of an • Hindi ko alam anxiety provoking concept yan Placing sexual energies toward • Angry at life, put a more productive endeavors anger in singing

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

CONVERSION

•

COMPENSATION

•

SUBSTITUTION

•

Psychiatric Nursing

Repressed angers put towards physical symptoms affecting nervous system leading to sensory numbness and motor paralysis Overachievement in one area to cover a defective part

•

Biglang mangingig

•

Replacing a difficult goal with a more accessible one

•

Pilay pero magaling kumanta Gusto ko Disneyland. Enchanted 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

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

Psychiatric Nursing

Panic +4 uicide afety Don’t touch client Respi Alkalosis Bown Bag

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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

•

Psychiatric Nursing

SOCIAL PHOBIA  fear of public

POST TRAUMATIC STRESS DISORDER Trauma Disaster Accident War Rape Earthquake Soldier

Flashbacks VICTIMS  Survivors Nightmares

↑ Anxiety ↓ “I am sick” ↓

6 years old ↓ Assignments/ Homeworks ↓ No Assignments/ Homeworks ↓ You Think “Teacher may get angry”

SOMATOFORM > no pretension > no organic basis

MALINGERING pretending to be sick (Conscious) ↓ Absent

Escape from Teacher PRIMARY GAIN (Behavior ↓ anxiety)

> unconscious PSYCHOSOMATIC > Real pains/ illness > Real symptoms > 4 major types * Hypertension * Migraine * Stress Ulcer * Asthma

Mama Care ↓ ↑ Attention SECONDARY GAIN

SOMATOFORM DISORDERS SOMATOFORM Nervous System

Jomar Anthony D. Maxion, BSN, RN

Illusion of structural defect

College of Nursing Batch 2009

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CONVERSION DISORDER La Belle Indifference  emotional disattachment from disability

Psychiatric Nursing BODY DYSMHORPIC DISORDER

Minor Discomfort Interpreted as major illness HYPOCHONDRIASIS “Maliit na butas, pinalalaki” Favorite Past Time: Doctor Hopping Nursing Focus: Feelings

PSYCHOSOMATIC DISORDERS ↑ Anxiety SNS ↑BP ↓ Hypertension

PNS ↓ Vasoconstriction Bronchoconstriction ↓ Cerebral Artery Left Gastric Artery Asthma ↓ ↓ Migraine Stress Ulcer

OBSESSIVE – COMPULSIVE Belief/ thought Door Open Burglar may go inside

→ →

Feelings ↑ Anxiety

Obsession → ↑ anxiety (thought) ↓ Returns to house (Action) ↓ Anxiety ← Compulsion

PHOBIA • •

Irrational fears Etiology o Knowledge

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

• •

Psychiatric Nursing

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

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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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

Complications ↓

Korsakoff’s Psychosis → memory

Delirium Tremens  24 – 72 h after last dose of alcohol ↓ untreated withdrawal syndrome ormocation  bugs crawling under the skin amily Therapy  mother, father, brother

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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Anorexia Nervosa Diet, diet, diet <85% of expected body 3 mos. ammenorhea Karen Carpenter

Psychiatric Nursing

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) 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

Jomar Anthony D. Maxion, BSN, RN

DOPAMINERGIC PLSE Parlodel Larodopa Symmetyl Eldepryl

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 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 Nx Dx

: Suspicious : Risk for other directive behavior

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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.

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 

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Stimulus Visual Auditory Tactile

Halucination s Absent X X X

Psychiatric Nursing

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

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

Catatonic • •

•

Jomar Anthony D. Maxion, BSN, RN

Ambivalence Waxy Flexibility o Iniwan na posture, ganun forever No – favorite word

Paranoid • •

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

College of Nursing Batch 2009

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Normally Acetylcholine = ON

Psychiatric Nursing

Dopamine = OFF

classified differentiated Residual •

•

Mixed classification • Can’t be classified • 1st paranoid, then No more positive s/sx, just withdrawndisorganized then catatonic, etc etc

Your always ON Schizophrenia With parkinsON

High Dopamine=

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 Anticholinergic  TORTICOLLIS • Drugs that will make the • Wry neck AcH down  OCULOGYRIC CRISIS o Artane • Fixed stare o Akineton  OPISTHOTUNOS o Benadryl • Arched back o Cogentin • TARDIVE DYSKINESIA o Irreversible side effects of Dopaminergic antipsychotics • Dopamine goes up o Parlodel o Larodopa Jomar Anthony D. Maxion, BSN, RN College of Nursing Batch 2009 o Symmetryl o Eldepryl

The Royal Pentagon Review Specialist, Inc.

•

Psychiatric Nursing

o Lip smacking o Tongue protruding o Cheeks puffing NEUROLEPTIC MALIGNANT SYNDROME o Hyperthermia among client 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

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 Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

• •

Psychiatric Nursing

Stressful life Obese ↓Self Actualization

TASK Caregiver Role Strain ↓Self Esteem Safety Impaired social interaction Safety

Risk for injury/ other directed violence ↓ Eating finger food

↓ Sleep Private room

Hyperactive

↑ Sex Anxiety

Lithium – 2 – 4 weeks before effect

↓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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 • 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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

Serotonin   MAO kills Serotonin

↑MAO  ↓ Serotonin   ↓MAO  ↑ Serotonin  

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

↓ Serotonin







Psychiatric Nursing

ANTIDEPRESSANTS

1st Line of Drug Prescribed

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

SSRI

TCA MAOI

eer hocolate ermented Foods

Antidepressant ↓ Anticholinergic Side Effects (Syphathetic) ↓ Male Erectile Dysfunction

ickles reserved Foods oy Sauce

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Antidepressant  no effect  ECT

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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

Morph Code Hero

NARCAN  antidote

Uppers (CHA) Cocaine Hallucinogen Amphetamines OVERDOSE Alcohol

Coma Bradycardia Bradypnea

Cocaine HR RR BP LOC

Seizure

Pupil constriction

Moist mouth Constipation Hypotension Coma Asleep Jomar Anthony D. Maxion, Weight gain BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

EUPHORIA

Tachycardia Tachypnea Pupil Dilation Dry mouth Hypertension Seizure Awake Weight Loss

Psychiatric Nursing

 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 ↓Self Actualization

C TASK Stay

↓Self Esteem withdrawn

Risk for self directed violence Eating

Sleep

Hypoactive

↓Sex

Sensitivity to client needs

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 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 Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

• 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 rainable o can be train 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 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 Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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.

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

RELATIONSHIP Preorientation Self awareness

Orientation Trust Setting Contract Resistance

Jomar Anthony D. Maxion, BSN, RN

Working

Termination

Discussion

Evaluation

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 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? Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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.

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009