Psych Nursing Complete Edited Royal Pentagon r5q4b
This document was ed by and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this report form. Report r6l17
Overview 4q3b3c
& View Psych Nursing Complete Edited Royal Pentagon as PDF for free.
More details 26j3b
- Words: 4,853
- Pages: 32
The Royal Pentagon Review Specialist, Inc.
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
S
The Royal Pentagon Review Specialist, Inc.
• •
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 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
The Royal Pentagon Review Specialist, Inc.
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
The Royal Pentagon Review Specialist, Inc.
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 abs 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 • 1 arms length away • call reinforcement
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc.
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 ive 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 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 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? 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
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
S
The Royal Pentagon Review Specialist, Inc.
• •
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 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
The Royal Pentagon Review Specialist, Inc.
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
The Royal Pentagon Review Specialist, Inc.
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 abs 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 • 1 arms length away • call reinforcement
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc.
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 ive 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 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 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? 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
Related Documents 171j1w
Psych Nursing Complete Edited Royal Pentagon r5q4b
July 2020 0
Maternity Nursing Edited Royal Pentagon 6a586z
July 2020 0
Palmer Complete Edited Royal Pentagon 2n6s3s
July 2020 0
Pentagon Review Royal Pentagon 6k3y4f
July 2020 0
Pentagon Review - Nursing Management 3o1340
May 2020 9
Psych Nursing Evolution 14c41
March 2021 0More Documents from "Richard Ines Valino" 6a456
Psych Nursing Complete Edited Royal Pentagon r5q4b
July 2020 0
April 2020 95
November 2019 86
Community Organizing Participatory Action Research 2k1527
November 2019 120
Chn Reviewer 3r5e
July 2020 0