Professional Documents
Culture Documents
Psychiatric Nursing
Sigmund Freud
• Father of Psychoanalysis
• Structure of Personality (Id, Ego, Superego)
Dominant ID
I Mania
D eat Antisocial
mpulsive drink Narcissistic
want to urinate
want PLEASURE defecate S
PLEASURABLE PRINCIPLE E
Pain Avoidance
It’s all “I”
CONSCIENCE PRINCIPLE E
GO
Xecutive Secretary Impaired Reality
Schizophrenia
REALITY PRINCIPLE
PSYCHOSEXUAL THEORY
1. ORAL STAGE
• 0 – 18 Months old
• Survival
• I want to eat, sleep, urinate, defecate
• ID formation
• Cry & Suck mouth
Child Cries
Defense Mechanism:
o FIXATION when a person is stuck in a certain developmental
stage
o REGRESSION return to an earlier developmental stage
2. ANAL STAGE
• Ateen – 3 years old (18 mos – 3 y.o.)
• Toilet training
• Super Ego develop
Toilet Training
SE
Too Rigid Training Dirty
↓ Disorganized
Clean Disobedient
Organized ↓ Small
Obedient ANTISOCIAL SE
BIG
SE ↓ (Anal Expulsive)
OBSESSIVE – COMPULSSIVE
(Anal Retentive)
3. PHALLIC
• 3 – 6 y.o.
• Penis/ Vagina
• Parents is the significant person
• Called as Preschooler
• Level of Awareness
o Conscious highest level of awareness
o Preconscious Tip of the tongue
o Unconscious deepest level of awareness
4. LATENCY STAGE
• 6 – 12 years old
• SCHOOlatency
• Sexual energy is dormant
• Reading, Riting, Rithmetic
5. GENITAL STAGE
• 12 y. o. – above
• Gising
• Genital
PHARMA MOMENTS
ANTIANXIETY
VLAST ME VAIB
Valium – ate V Miltown - Meal Vistaril - largavista
Libreum - L Equanil – Aqua Kneel Attarax – Mga bato (rocks)
Ativan - Ate Guy Inderal – hindi ralph
Seraks – Sera Ulo Busfar – sasakay ng bus
Tranxene - Transit
ERIK ERIKSON
• PSYCHOSOCIAL THEORY OF DEVELOPMENT
Age + - Affecting Major
Factor
0-18 mos. Trust Mistrust Feeding
18 mos. – 3 y.o. Autonomy Shame/ doubt Toilet Training
AU nal
TO ilet training
NO favorite word
MY
3 – 6 y.o. Initiative Guilt Independence
6 – 12 y.o. Industry Inferiority In da-school
12 – 20 y.o. Identity Role confusion Peer
20 – 25 y.o. Intimacy Isolation Love
25 – 45 y.o. Generativity Stagnation Parenting
45 y.o. and above Ego Integrity Despair Reflection
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
Sensory
Integration Voluntary
Motor
Involuntary
Urinary Urinary
retention Frequency
Neuro Epi/ Nor Acetyl Choline
PHARMA MOMENTS
MONOAMINE OXIDASE INHIBITORS
AR
M PLAN
N DIL
P NATE
ANTIPARKINSON
CAPABLES
Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetryl
THERAPEUTIC COMMUNICATION
Therapeutic Non-Therapeutic
• Offer your self I’ll stay with • Don’t worry be happy
you • Everything’s gonna be alright
• Silence • Ignoring the client
• Making observations • Changing the subject
o You seem sad • Nice weather we’re having
• Active listening o Adjectives – value
o Nodding based perception,
o Eye contact should not be use
o Lean forward • You are the most beautiful
• Who, what, when, where client
• General leads • Why
o Go on, I’m listening, • Arguing
what else? • Flattery
• Broad opening - best Opening • You should do this now
line • In my opinion
GO Epinephrine/ Norepinephrine
SNS Exitatory
Anti-Anxiety Dependence
Withdrawal
Drowsy
No Alcohol
No Coffee
Develop Orthostatic
Hypotension
Prevetion of O.H.
1. Sit Down
2. Dangle feet Gradually
3. Stand Up Gradually Tapered Dose
RELAXED
ANXIETY
• Vague sense of impending doom
PANIC DISORDER
• 15 – 30 Minutes escalation of SNS
• AGORAPHOBIA fear of open space/ public places
Trauma
Disaster
Accident Flashbacks
War VICTIMS Survivors
Rape Nightmares
Earthquake
Soldier
SOMATOFORM DISORDERS
SOMATOFORM
PSYCHOSOMATIC DISORDERS
↑ Anxiety
SNS PNS
↓
↑BP Vasoconstriction Bronchoconstriction
↓ ↓
Hypertension Cerebral Artery Left Gastric Artery Asthma
↓ ↓
Migraine Stress Ulcer
OBSESSIVE – COMPULSIVE
Obsession → ↑ anxiety
(thought) ↓
Returns to house
(Action)
↓ Anxiety ← Compulsion
PHOBIA
• Irrational fears
• Etiology
o Knowledge
o Experience
• Immediate Nursing Intervention remove the stimuli
• SYSTEMATIC DESENSITIZATION
o Gradual exposure to feared object
PHARMA MOMENTS
ANTIPSYCHOTIC AGENT
SSTTCMHP
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
DETOXIFICATION
• Withdrawal with MD supervision
• Check Alcohol, Mouthwash, Elixer
void alcohol
version therapy
lcoholics Anonymous self help group
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
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
EATING DISORDERS
Vomiting
Diarrhea
Interventions
• Restore fluid and electrolyte balance
• Collaborative regarding menu contract
• Target weight gain
• After meals: stay 30 mins – 1 hour
PHARMA MOMENT
LITHIUM
ANTIPARKINSON
ANTICHOLINERGIC DOPAMINERGIC
ABC PLSE
Artane Parlodel
Akineton Larodopa
Benadryl Symmetyl
Cogentin Eldepryl
SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
o Too much stress in the reality will lead client to escape it and go to
the fantasy world
• Biological Theory
o Dopamine level is High
• The exact cause is unknown
Symptoms
Negative Positive
Hypoactive Hyperactive
Withdrawn Sociable
Apathy Flight of Ideas
Talkative
Assess : Suspicious
Nx Dx : Risk for other directive behavior
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Eliminate/ minimize risk for other-directed violence
Assess : Suicidal
Nx Dx : Risk for self directive behavior
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness
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
Halucination Illusion
s
Stimulus Absent Present
Visual X √
Auditory X √
Tactile X √
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
Normally
Acetylcholine = ON Dopamine = OFF
classified
differentiated
Your always ON High Dopamine=
Residual • Mixed classification
Schizophrenia
• Can’t be classified
With parkinsON
• No more positive • 1st paranoid, then
s/sx, just withdrawndisorganized then
catatonic, etc etc
o Lip smacking
o Tongue protruding
o Cheeks puffing
• NEUROLEPTIC MALIGNANT
SYNDROME
o Hyperthermia among client
taking antipsychotic
o Hyperthermia with muscle
rigidity
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
• Stressful life
• Obese
G randiose
F light of ideas
S leeplessness
P ressured speech
E xagerated SE
E xtraneous stimuli (easily distracted)
D istractibility
PERSONALITY DISORDERS
SCHIZOID
• I don’t want people
• Believes he can stand on his own
• Never had a best friend
• Avoid groups and social activities no enjoyment
• Cares more about computers and pets
AVOIDANT
• I avoid people, I fear criticism
• Have talent but no confidence
ANTISOCIAL
• I break the law as motto
• 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
Dependent
• I can’t live without you
• ↓ self esteem
• poor decision making skills
Histrionic
• excited, dramatic but manipulative
• center of attention
Narcissistic
• I love myself
• Insensitive, arrogant
• I am the best
Obsessive – Compulsive
• I am organized
• Perfectionist
• Provide time to do rituals
Paranoid
• Suspicious
Passive Aggressive
• Always say yes but resistance is hidden
Serotonin
↑MAO ↓ Serotonin
↓MAO ↑ Serotonin
↓ Serotonin ANTIDEPRESSANTS
Antidepressant
hocolate ↓
Anticholinergic Side Effects
(Syphathetic)
ermented Foods ↓
Male Erectile Dysfunction
ickles
reserved Foods
oy Sauce
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 Morph
Barbituates Code NARCAN antidote
Opiates Hero
Narcotics
Marijuana
Uppers (CHA)
Cocaine
Hallucinogen
Amphetamines
OVERDOSE
Alcohol Cocaine
HR
RR
BP
Coma
Bradycardia LOC Seizure
Bradypnea
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. Psychiatric Nursing
Tachycardia
Tachypnea
Pupil Dilation
DETOXIFICATION withdrawal with MD Supervision
Dry mouth
METHADONE
Hypertension
Seizure
Awake
Weight Loss
↓Self Actualization
↓Self Esteem C TASK
withdrawn Stay
Risk for self directed violence
SUICIDE
SUICIDE TRIAD
• Loss of spouse
• Loss of job
• Aloneness
Give simple task. Don’t give complex may cause depression ex. Jigsaw
• Water plants
• Wash the dishes except sharps
ALZHEIMER
NOMIA don’t know name of objects
GNOSIA problem with senses
PHASIA can’t say it
PRAXIA can’t do it
Cocaine Nasal Septum perforation
Marijuana impaired Lung Structure
eroine withdrawal
ikab
atsing
u hu hu
CRITICAL REVIEW
ABC ASSESS
3. Good Word/ Bad Word
4. S Technique
eek support
it
tay
upervised
ee = observed
eem = notice
assi t
feeling
5. 2 same answer/ 2 same mistake
6. Words to watch out for
Inappropriate
Most
Not included
Except
All but one
7. Umbrella
RELATIONSHIP
PRACTICE OF NURSING
Level of Prevention
1 2 3
Endogenous Reactive
Internal external
Chemical
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?