PSYCHIATRIC NURSING Rvw Ctr

Beliefs—Feelings—Behavior
Sigmund Freud – Father of Psychoanalysis -structure of personality
Id : impulsive part, pleasure principle -eat, urinate, have sex -it’s all “I”

Superego – small voice of God -conscience -should not eat yet, should not eat yet
Ego- arbiter, decision maker -in touch with reality
Id___________________Superego
EGO
ID DOMINANT – needs a superego-needs a conscience
M- manic
A- antisocial – serial killer
N- narcissistic
SUPEREGO DOMINANT –needs an Id
O- Obsessive Compulsive
A- Anorexia nervosa
EGO – impaired reality perception (RN will present reality) S-
schizophrenia- cant distinguish fact from reality

Libido- sexual energy

FREUD – PSYCHOSEXUAL THEORY ORAL – 0-18 months Cry, suck – mouth- survival
Id dominant Maternal deprivation if not feed, not given milk/water, not kept warm.
Narcissistic – seeks the Id – I love myself Regression – return to an earlier stage or earlier
level Fixation – stopped in a stage ANAL- 18 mos-3yrs Toilet training Mom is superego.
Superego is being formed Child is caught in ambivalence – pulled in 2 opposing factors Too
much toilet training with punishment will result to a child who is:

Obedient, organized, clean

Rebel, dirty, disobedient

= OC =anal retentive PHALLIC – 3-6 yrs old -penis & vagina -love of parent of opposite sex
Oedipal-boy loves mom Electra-girl loves dad

=Anti-social =anal expulsive

Identification- boy imitates dad Castration fears- fear that dad is angry at him and will cut off
penis Penis envy- girls envy little boys Dr. Karen Horney- detractor of Freud, didn’t believe
in penis envy. Freud said that it is maybe in her unconscious mind. Or repressed. Conscious-
highest level of awareness Pre-conscious- at tip of tongue Unconscious – forgotten
Repression-kept in unconscious. Unconscious forgotten. Suppression – conscious forgetting
LATENT- 6-12 years old Latent- Logtu = sexual energy asleep School age – School phobia-
1st time to go to school – Separation anxiety Child is busy with Reading, writing, arithmetic.
Sublimation –putting anger into something more productive putting all energies into
schooling Ex. Angry at life, pour anger in singing. GENITAL –12 years old Genital-Gising
sexual energy Sexual intercourse most important in this stage!! PHARMA MOMENTS Anti-
anxiety Drugs (used also for alcohol withdrawal) Valium Librium Ativan Serax Miltown
Equanil Vistaril Atarax ERIK ERIKSON STAGE 0-18 months (Oral) 18 mos- 3yrs old
(Anal) (+) Trust vs Autonomy vs Au-(anal) To-ilet training No-No! Favorite word. My
Initiative vs (Initiate 1st steps) Phallic-oedipal,electra Industry vs Identity vs Intimacy vs
Generativity vs Ego Integrity vs (-) Mistrust Shame/doubt FACTOR Feeding Toilet training

Tranxene Inderal
Buspar

3-6 yrs old (Phallic) 6-12 yrs old (Latent) 12-20 (Genital) 20-25 25-45 45 up

Guilt –anger turned inward Independence Inferiority Role confusion Isolation Stagnation
Despair Industry Induskul Peers Love Parenting Reflection

Newly admitted pt- develop trust 1st

-pts are dependent=self care deficit -develop/teach autonomy -then pt will develop initiative
-etc

Frontal lobe- personality, learning, judgment, language Occipital- vision Temporal- hearing,
smell Parietal-taste, touch Sensory Integration Motor Somatic nervous system- voluntary
movements Acetylcholine- responsible for voluntary movements - on switch of movement
Autonomic nervous system- involuntary movements -Sympathetic(Anti cholinergic) and
parasympathetic (cholinergic) Heart Respiratory GI (opposite effect) GU (opposite effect)
Neurotransmitter Pupils Blood vessels BP SYMPATHETIC (alert) tachycardia tachypnea
Slow, constipation Slow, oliguria, retention Dry mouth Epinephrine, Norepinephrine Dilated
(dilat when alert) (Midriasis) vasoconstriction increased PARASYMPATHETIC (relax)
bradycardia bradypnea diarrhea Polyuria, frequency Moist mouth Acetylcholine (AcH)
Constricted (Myotic) vasodilated decreased

Anti-cholinergic / anti-parasympathetic =effect is sympathetic! Sympathetic drug

classifications: A- anxiety P- psychotic

Anti
mARplan nARdil pARnate

C- cholinergic D- depressants

MONO AMINE OXIDASE INHIBITORS:

DEFENSE MECHANISMS:

coping mechanism from stress:

DISPLACEMENT- -------------Your boss shouts at you, you shout at your subordinate.

SUBLIMATION - ---------------putting anger into something more productive or + putting all
energies into schooling Ex. Angry at life, pour anger in singing.
DENIAL----------------------“I am not” an alcoholic! DISSOCIATION – --------------
psychological flight from self. Amnesia. Ex. Rape, trauma
REGRESSION – ----------------RETURN to an earlier developmental stage FIXATION –
---------------------stuck in a stage of development
REPRESSION – -----------------unconscious forgetting
SUPPRESSION – ---------------conscious forgetting. Avoidance. “I don’t want to talk about it.
I don’t want to remember it.”
RATIONALIZATION – -------uses “because”. Has illogical reasoning. “I drink because I
don’t want to waste the beer in the ref.”
REACTION FORMATION----plastic. Doing opposite of intention.
UNDOING----------------------show true feeling/color then feels guilty after.
IDENTIFICATION – -----------models a certain behavior from a certain role model.
PROJECTION – -----------------blame other people, pass load to others. Looks for a
scapegoat. “Not me, but them.”
INTROJECTION – --------------assume another persons trait as your own. “Not just you, me
too.” “Ako din, gusto ko yan.”
CONVERSION – repression. Anger turned inward to herself. Converted to physical
symptoms. Sensory-numbness. Motor-paralyzed, tremors.
COMPENSATION – -----------defects of the person, overachieve to cover a defective part.
SUBSTITUTION – -----------when you replace a difficult role with a more accessible one.
Ex.Wants to go to Disneyland but can’t afford it. Went to Enchanted Kingdom instead.
Defense mechanism: Affects/interferes with ADL Harm to self or others

Behavior Model – Ivan Pavlov Classical Conditioning -behavior learned-repeated (+) BF

Skinner – operant conditioning-reinforcement Confront (-) behavior to make it extinct.
MASLOW’S HEIRARCHY OF NEEDS: 5. Self-actualization 4. Self-esteem 3. Love and
belonging 2. Safety and security 1. Air, food, water, shelter, clothing, sex –Basic physiologic
needs LEVELS OF PREVENTION PRIMARY Healthy Community teaching Community
demographics STAGES OF INTERACTION ORIENTATION Assessment Establishment of
trust Tell patient about termination Set contract Patient is resistant SECONDARY ill Crisis
intervention Treatment and diagnosis TERTIARY Relapse avoidance Rehab centers Al anon

WORKING Problem solving Discussion Patient is most cooperative

TERMINATION Evaluation Summarize Say goodbye Grief-ANGER-focus of RN Pt might

become violent/suicidal

ANTI-PARKINSON DRUGS (Capables) –used with anti-psychotics

Anti-cholinergic ABC CAPABLESCogentin Artane Parlodel Akineton Benadryl Larodopa

Eldepryl Symmetrel

Dopaminergic PLSE

THERAPEUTIC COMMUNICATION 1. Offer self“I’ll stay/sit with you.” 2. Explores –use

what, when, where, how 3. Silence 4. Active listening-nodding, eye contact, leaning forward-
show active participation. 5. Make observations. “You see/ I have observed/ I have
noticed…” 6. Broad opening- “How are you?” “You have combed your hair today.” 7.
Clarification-“What do you mean by ploopplank?” 8. Restating-“I don’t want to eat.” (Word
per word repetition!) “You don’t want to eat?” 9. General leads- “And then/What else/Go
on…” 10. Refocusing-“We were talking abt the exam…” 11. Focusing-“Tell me more abt
this.” ABG ANALYSIS Ph & PCO2-Respiratory-opposite signs Ph & HC02-Metabolic –
same signs Compensation:

NON- THERAPEUTIC “Don’t worry, be happy.” Why? – Puts pt in defensive position.

Change the subject. “Everything’s going to be alright.” – giving False reassurance. Ignore the
patient. Prejudicial. “Nice weather today.” –value based judgment. Flattery – don’t use too
much adjectives. “You have the most beautiful hair in the ward.” Arguing with the patient
Don’t impose your opinion.

Ph is normal=Fully compensated. C02 & HC03 –same signs = Partially compensated

ANXIETY -vague sense of impending doom. Sympathetic activation. Assessment: Level of
anxiety MILD-------------------sit restlessly, widened perceptual field, enhanced learning
experience. “You seem anxious.” MODERATE----------patient is pacing, selective inattention.
Give PRN meds-Anti-anxiety drugs-valium… SEVERE----------------patient can’t make
decisions. “I don’t know what to do or say.” RN directs patient. “Sit down on the chair.” –
Directive. PANIChighest level of anxiety. Suicidal. Priority: safety. Stay with patient. Don’t
touch pt. Sympathetic activation. “I think I’m having a heart attack!” Nrs Dx: -----------------
Ineffective Individual Coping P/I: Decrease anxiety, decrease stimuli HT: relaxation
technique E: Effective Individual Coping

GENERALIZED ANXIETY DISORDER – 6 months excessive worrying. Patient knows

what the problem is. Cant sleep, concentrate, seat Fatigue and palpitations PANIC ATTACK –
------------------------------15-30 minutes, happens without warning. SNS activation. -with or
without agoraphobia -------------------- fear of open space -social phobia
–------------------------------------- fear of public -provide safety -alkalosis-brown bag -stay
with patient -be directive POST TRAUMATIC STRESS DISORDER Victims – rape,
accident, war zone, disaster, trauma 1. 2. 3. Survivor Flashback > 1 month Memory –
nightmares

MALINGERING------------------------------------- no organic basis (no tissue change)

-pretending to be sick, conscious -decrease anxiety – for primary gain -increase attention
from RN– secondary gain SOMATOFORM DISORDER –------------------unconscious, not
pretending, no organic basis - goes doctor hopping

Nervous system CONVERSION -loss of sensory/motor fx -s/sx real (biglang nabulag)

Minor discomfort -Feels like illness -HYPOCHONDRIASIS

BODY DYSMORPHIC DISORDER -illusion of structural defect -S/sx not real

PSYCHOSOMATIC DISORDER (Psychophysiologic)– real illness, real s/sx, real pain, with
organic basis (with change in tissue) - stress ulcers, migraine, HPN
PHOBIA---------------------------------------------------------- irrational fear Etiology –
knowledge, experience Immediate nsg intervention: Remove object of fear (Increase
stimuli=increase level of anxiety) (Decrease stimuli=decrease anxiety) Belief Object will hurt
patient Feeling Scared Behavior Avoidant=interferes with ADL

Gradual exposure to feared object- SYSTEMATIC DESENSYTHEZATION Individual

Therapy 1. Hypnosis – --------------relaxed state 2. Free association –------ ideas shared to
psychoanalyst 3. Catharsis – --------------free to express feeling 4. Transterence- -----------
patient feels something for psychoanalyst 5. Countertransterence –--RN feels something for
patient

Green light-Go – Epi & Norepinephrine Red light – Stop – G-gamma A-amino B-butyric A-
acid Anxiety Increase GABA AntiGIGUcholinergic S/E constipation retention Effect of
GABA: Drowsy, drink, don’t drive, orthostatic hypotension Anti-anxiety drug Withdrawal
from drug – abrupt – REBOUND PHENOMENA – leads to seizures. 1 week effect. Gradual
withdrawal – tapered dose Dependence- Can’t live without valium ANTI-PSYCHOTIC
AGENTS – STELAZINE SERENTIL THORAZINE TRILAFON Sympathetic effect. Effect
– 2-4 weeks

CLOZARIL MELLARIL HALDOL PROLIXIN

SCHIZOPHRENIA-------------------------------impaired reality perception. Ego disintegration.
Genetic vulnerability. Stress. -Chose fantasy over reality. Increase dopamine theory. Cause:
unknown. Increase dopamine, increase schizophrenia. 4 A’s: 1.
Affect---------------------------------------------feelings & emotions (smiles, laughs). External,
readily observable. Mood, internal, does not match affect. (sad inside) 2.
Ambivalence-------------------------------------pulled between 2 opposing forces 3. Autism
--------------------------------------------self absorbed. Trapped in his own world.Attached to odd
objects.Poor eye contact. 4. Associative looseness---------------------------talk about so many
things but unrelated ideas. Disturbed thought process-------------------------Nsg dx Content of
thought---------------Hallucinations/Illusions------------ADL----------------------------Harm

Disturbed thought process Disturbed sensory Perception P/I: Reality/Orient/Safety Eval:

Improved thought process S & Sx of Schizophrenia: (-)neg sx hypoactive withdrawn quiet,
flat affect poverty of words Self care deficit Self Other Directed Violence

(+) positive sx hyperactive flight of ideas restless talkative delusions many queen of the
world illusions

hallucinations ideas

7Types of schizophrenia: 1. Disorganized schizo---------------------------------sad inside, happy

outside – inappropriate affect (+) flat affect – no affect (-) disorganized manner/speech –flight
of ideas (+) Hebephrenic- giggling (+) Sx: both (+) and (-). 2. Catatonic
---------------------------------------------ambivalence –anal stage (-) No! Negativisim-rebel-anal
(-) Waxy flexibility--------------raise arm of patient. Patients arm remains up for a long time.
(-) (-) > (+) 3. Paranoid ----------------------------------------------uses projection. Mistrust
Scared/withdrawn/violent Based on history

Develop trust: orientation -1:1 interaction -consistent approach -short/frequent interaction

-food: sealed container -meds: wrapped in tamper resistant foil 4. Unclassified/
Undifferentiated-----------------------can’t be classified anymore. 5.
Residual-------------------------------------------------no more (+), (-). Social withdrawal

-Leave door open -Distance from pt: 1 arms length -stay near door not window -have
visibility:stand halfway in & out to be able to call for reinforcement. -calm and firm

THOUGHT PROCESS DISTURBANCE 1. LOOSENESS OF ASSOCIATION----------------

topics have connection but no thought. “I am going to the mall. The mall is in town. The town
flies. Flies are here.” 2. FLIGHT OF IDEAS ---------------------------------New unrelated
topics. “I am going to the mall. Where is the light? I treasure this chalk. Hurray!” 3.
AMBIVALENCE-------------------------------------Pulled by 2 opposing forces. 4. MAGICAL
THINKING----------------------------- believes he has magical powers. “I can turn you into a
frog.” 5. ECHOLALIA------------------------------------------repeat what is said. Parrots. 6.
ECHOPRAXIA----------------------------------------repeats what you do. Repeats what is seen.
7. WORD SALAD----------------------------------------mixes words that don’t rhyme. 8.
CLANG ASSOCIATION----------------------------uses words that rhyme. “Flank, blank,
prank.” 9. NEOLOGISM------------------------------------------invents new words not in the
dictionary. “Ploopplank, pisnok.” 10. DELUSIONS-----------------------------------------false
belief Grandeur--------------I am a queen/ king/millionaire! Persecution------------NBI out to
get me! Ideas of reference-----They talk and write about me! 11. CONCRETE
ASSOCIATION-----------------------pilosopo. “What will you wear tomorrow?” “Clothes!”
12. HALLUCINATIONS----------------------ILLUSIONS (with stimuli) Stimuli N Y Visual N
Y Auditory N Y Tactile N Y Present reality!!! H A R D-Directive. “Let’s go in the garden.”

Acknowledge: “I know the voices are real to you. =Assess what voices are saying to know if
patient will harm himself.

Present reality. “But I can’t hear them.”

8Increase Dopamine = increase schizo Decrease dopamine = decrease schizo Extra Pyramidal
Side Effects (EPSE) (Happens when acetylcholine is up and dopamine is down) 1.
AKATHISIA-------------------------- restless, inability to sit still. 2. AKINISIA
---------------------------- rigidity 3. DYSTONIA--------------------------- affects neck
TORTICOLLIS -------------wry neck OCULOGYRIC CRISIS – fixed stare
OPISTHOTONUS ---------arched back, contracted 4. TARDIVE DYSKINESIA------------lip
smacking, tongue is protruding, puffy cheeks. Irreversible! 5. NEUROLEPTIC
MALIGNANT SYNDROME- hyperthermia, unstable BP, increase CPK, diaphoresis, pallor
-discontinue meds, medical emergency. 6. PHOTOSENSITIVITY------------------wear shades,
sunscreen 7. WBC- Agranulocytosis---------------sore throat, fever, malaise, leukopenia
AUTISM- boys > girls. 1:100 kids gift-autistic savants -echolalis, poor eye contact, can’t
express verbally. Assess: A- appearance- neat, OC, wants constancy B- behavior- ritualistic
behavior, flat affect, repetitive C- communication – difficulty communicating Nsg Dx:
Impaired social interaction – cant form IPR (Interpersonal relationship) Impaired verbal
communication Self mutilation – cant express anger. Express it inward. Risk for injury P/I: E:
constancy, promote safety Expressive therapy – uses art, music, poetry, decreasing risk for
injury, improved social interaction, be able to express feelings. -Safety

ADHD- ATTENTION DEFICIT HYPERACTIVITY DISORDER (can progress to conduct

disorder to anti-social behavior) Cant focus on anything. Onset 7 yrs old and below Duration
>6 months Setting: House & school ID dominant: Mom or RN will act as superego
Assessment: A- appearance: dirty B- behavior: clumsy, impatient, easily distracted C-
talkative Nsg Dx: High risk for injury Safety Structure- provide place to study, eat,
play,bath,etc. Schedule – time for everything Set limits Residual ADHD grows up not anti-
social Meds: Ritalin, Dexedrine,Pemoline, Adderal Best time to give meds: If once a day give
AFTER MEALS- to prevent loss of appetite. Don’t give at bedtime-it’s a stimulant-will cause
insomia. Can be given 6hours before bedtime (if q2d)

ANOREXIA NERVOSA – diet, underweight < 85% of expected fat, 3 months amenorrhea,
failure to recognize problem. BULIMIA NERVOSA – induce vomiting, takes laxative,
normal weight, irregular menstruation, dental carries, diarrhea - knows problem but ashamed
and embarrassed, Priority: Fluid volume balance Weight gain – monitor weight, eating
pattern, stay 1 hour after eating, accompany in toilet Problem: NI: Body image Disturbance 1.
Establish nutrition pattern 2. Teach stress management, journal keeping 3. Monitor eating
pattern and weight. 4. Anti-depressant MANIA – needs mood stabilizing agents- Lithium.
Group therapy L- 0.5-1.5 mEq/L (If level is near 2.5-3 mEq/L –will cause ataxia and mental
confusion) I- increase urination T- tremors H- H20- 3L/d I- increase T- uu M- mouth dry N-
Na- 135-145 mEq/L – to hold water Check kidney(blood level) before administration of
Lithium – BUN, CREA, electrolyte Lithium toxicity – n/v, diarrhea = Diamox BIPOLAR
DISORDER – 2 poles, happy (more dominant) & sad -female, >20 yrs old, stress, obese Self
actualization Task to decrease self esteem Family therapy Risk for injury, risk for other
directed violence Decrease eat, decreased sleep, hyperactive, increase sex – masturbate in
front of others Nsg Dx: High risk for self or other directed violence Risk for injury Give task,
no group games, any competition will increase anxiety, water the plants, activities using gross
motor skills, escorted walk, punching bag-displacement. 3 or more signs confirms disorder: G
– grandiose, increase risk activities F – flt of ideas S - sleeplessness P – pressured speech E –
exaggerated SE E – extraneous stimuli (easily distracted) D – distractability PERSONALITY
DISORDER

1. Schizoid – --------doesn’t care about people, believes that he can stand on his own, never
had a best friend
avoid groups & activities – no enjoyment cares more about computers, pets 2. Avoidant
----------avoid group – fear criticism, have talent but no confidence. 3. Anti-social– ------as
child steal, lie, always get reprimanded Adult – grand robbery, illegal activities against the
law. drug addiction, drives fast, unsafe sex, thrill seeker. Good talker, charmer, witty,
manipulator. Motto – “I will break the law”

4. Borderline -------Favorite line – “ life is an empty glass.” Splitting, suicidal, superficial

relationship, labile-sudden change of
Mood, self mutilation. (+) fill glass with friends have happy moments (-) suicide sad moment

LABILE AFFECT

labile- change from good to bad in a split moment

5. Dependent ---------Decrease self esteem, dependent

Poor decision making skills “I cant live if living is without you”

6. Histrionics ----------excited, dramatic, manipulative

- CENTER OR ATTENTION 7. Narcissistic----------“I love myself” – insensitive, arrogant,
self absorbed - exaggerated Self esteem, ambitious “I am the best” 8. OC ------------------
perfectionist, organized, constancy in environment. Provide time to do rituals.

9. Paranoid ----------- always jealous, suspicious, violent 10. Passive aggressive ------always
say “yes”, but resistance is hidden.
Nsg Intervention: Improve IPR, build trust A-LCOHOL ABUSE ----------------------happy –
socializing -escape from problem -peer pressure B-blackout ---------------- awake but unaware
C-confabulation ---------- invent stories to increase Self-Esteem D-denial -------------------“ I
am at not an alcoholic.” D-dependence ------------“ I cant live without alcohol.” a. physical –
tremors, tachycardia, restless b. psychological – craving E-enabling/codependency
(significant others tolerate abusers) DISULFIRAM voids alcohol version therapy ntabuse
(DISULFIRAM) lcoholics anonymous beer n/v hypotension interval of alcohol & antabuse:
12h interval after alcohol intake Narcotic oversode-give Narcan Narcotic detox- Methadone
Aversion therapy-Antabuse

B1 – Thiamine Complications

wernickes Encephalopathy Korsakoff psychosis

Wernickes – VROOM – Motor sx effect Korsakoff – memory- confabulation

24 – 72h after alcohol intake Delirium tremors – happens due SNS activation Tremors,
hallucinations, illusions. Well lit room – to avoid hallucinations ANTI DEPRESSANTS –
decrease serotonin problem Anti depressants – full stomach All meds take on a full stomach,
except anti anxiety. ASENDIN NORPRAMIN TOFRANIL SINEQUAN ANAPRANIL
AVENTYL VIVACTIL ELAVIL PROZAC PAXIL ZOLOFF LUVOX TCA TCA TCA TCA
TCA - OC TCA TCA TCA SSRI SSRI SSRI SSRI

Serotonin ---------makes us happy Decrease serotonin – pt becomes sad – depression Increase

serotonin – antidepressant SSRI: Selective Serotonin Reuptake Inhibitors S S – (decrease
S/E) R– I – (1 – 4 weeks)

If SSRI don’t work, give TCA Tri Cyclic Antidepressants –( TCA) ----------2 – 4 wks has
increased S/E increased Serotonin & Norephinephrine

MAOI-------------------------- effect 2 – 6wks Increase E, NE, serotonin kills serotonin -

MAOI increase MAO = decrease serotonin * decrease MAO = increase serotonin give MAOI
Most dangerous, most S/E Diet – avoid tyramine food – eat SARIWA, fresh foods HPN crisis
– dangerous! Increase CR, diaphoresis Tyramine rich food: Avocado Pickles Alcohol
Fermented foods Beer Eggplant Chocolate preservatives – tocino, bologna,canned meat etc.
Cheese – mozerella, swiss cheese W – ine S – soysauce Anticholinergic = antidepressants –
antiparasympathetic Dry, constipation, retention, tachycardia Male erectile dysfunction
MAOI

mARplan NARdil PARnate

DEPRESSION – decrease serotonin. If unresponsive to drugs, ECT-electroconvulsive therapy
Assess: 1. Denial – this cant be happening. This cant be real. 2. Anger – Why me, why now,
why God?! 3. Bargaining – If returned, I will give reward. 4. Depression – 2 wks or more of
sx = clinical depression 5. Acceptance – client acts according to situation. Pt prepares living
will. Increase risk for self directed violence. Maslows: 5– 4 – decrease Self-esteem – give
TASK 3 – Pt is withdrawn 2 – Risk for self directed violence suicide 1 – eat (wt gain) or not
eat(wt loss), sleep or not sleep, hypoactive, decrease sex SUICIDE CUES: “I wont be a
problem any longer” “Remember me when I’m gone” “This is my last day” “This is my
wedding ring. Give it to my son” - Sudden change in mood. Pt is suicidal, RN should: D –d
irect question – “Are you going to commit suicide? I – irregular interval of visit to pt room E
– early am & endorsement period - time pt’s commit suicide.

Who will commit suicide? S – sex – male (more successful)/female (hesitant) A – age – 15 –
24yo or above 45 D – depression P – pt with previous attempts will try again E – ETOH –
(Ethanol) alcoholics R – irrational S – lacks social support O – organized plan – greater risk
N – no family S – sickness, terminal Suicide Triad: - Loss of spouse - Loss of job - Aloneness
Best approach for suicide: Direct approach Nursing Mgt: close surveillance Hospital area
majority suicide happens at: weekends 1 – 3 am Sunday Weekend – less staff personnel Early
am – every one is asleep Give simple task. Don’t give complex task – no jigsaw puzzle Water
the plants Wash the dishes except sharp objects

SUBSTANCE ABUSE Type of Addict: 1. Nervous -----tremors Give downers Sx of overdose

1. Identify if drug is upper or downer 2. Check effect 3. Sx of withdrawal If patient takes a
downer, all vital signs are down! If he stops taking it (during withdrawal), patient will
experience the opposite effect of a downer. All his vital signs will shoot up! Same with
uppers. Ex: Pt had cocaine intoxication. Pt will manifest hyperactivity, tachypnea, seizure.
During withdrawal, pt will manifest bradypnea or coma. Substance Abuse Moments (downer)
A – alcohol B – barbiturates O – opiates N – narcotics M – marijuana Morph CODE HERO

Antidote - Narcan (narcotic antagonist)

(uppers)
C – cocaine H – Hallucinogens A – amphetamines Uppers Seizure Tachypnea Downers
decrease RR, decrease HR constricted pupil Moist mouth Dilated Blood Vessels Coma Asleep
Decreased GI constriction Decrease GU retention Decrease BP State of euphoria

Para

Sx of withdrawal – reverse of effect 1. Know if upper or downer 2. Opposite of effect

Overdose Alcohol – coma Morphine – bradypnea Withdrawal (opposite of withdrawal is
overdose) seizure tachypnea

Detox – withdrawal with MD supervision

14 Methadone 2. Depressed - Sits down on chair Uppers Codeine Hallucinogen

Amphetamine

sympathetic

increased heart increase HR increase pupils- dilate Mouth – dry Decrease appetite - thin
Depressed

- BP increase, awake seizure GI - diarrhea

Stop uppers Tremors Fatigue

crash syndrome

Suicide

LEVELS OF MENTAL RETARDATION Profound severe moderate IQ 20 35 50

mild 70

borderline 90

normal 110

Profound Mental retardation IQ <20 =thinks like an INFANT. Cant be trained. Stay with
patient. Severe MR 20-35 Moderate 35-50 = Can be trained. Mental age is 2-7yo. Pre-
operational stage. Mild 50-70 = (mild 7) Mental age is 7-12. Educable. Can go to school.
Borderline- 70-90 Normal- 90-110 JOHN PIAGET COGNITIVE THEORY 0-2 yrs old – S-
ensory motor. Baby can sense, see, perceive and hear. Object permanence 2-4 yoP-
reconceptual- language. 4-7 yoI-ntuitive stage. Unidimentional classification or
unidimentional characteristic. Child can fix toys according to size, color, height=one at a time
only. 7-12 yoC-conservation/concrete association. Multidemensional 12yoF-ormal operation
– good in abstract thinking. Can interpret proverbs.

CHILD ABUSE

B=burns,

bruises, bone fractures, bungi Don’t bathe child. Don’t brush teeth. Body of evidence will be
lost. Bantay Bata 163
ALZHEIMER
Anomia- don’t know name of object Agnosia – problem with senses (smell, taste, hear,
touch) Aphasia – can’t say it Apraxia – can’t do it Dissociative Fugue- takes a new
personality from a tar away place. New place new identity. Dissociative Identity Disorder –
multiple personality Dissociative Amnesia – don’t know who/where I am.

DEPERSONALIZATION- believe that they are not persons anymore PERSEVERATION-

kulit. “I want to talk about something because this is something that I want to do. It is
something that I need to talk about. This is something that I want to do.”
ELECTROCONVULSIVE THERAPY- sign informed consent. For depressed pt. If meds
don’t work, use ECT. Pre-ECT N-npo 6 hours A-atropine sulfate – dry mouth B-barbiturate
S- succinylcholine chloride – to relax muscles Post-ECT Side-lying- lateral S/E headache,
dizziness, temporary memory loss (distinct sx)=RN-orient pt.

EXAMS: Nsg intervention: Look for words like:

S=safety,support, stay, set limits, assist Provide safety. Mobilize support system. I will stay
with you. Assist in activity. Set limit- don’t allow patient to misbehave. Look for words like:
Orient=orient pt post delirium, ECT, pt with dementia Accept “Seem, observed, noticed,
comment, feelings…” Group therapy- facilitator is RN. Rape, battered pt ALTRUISM –
Victim becomes a counselor, shares experience to new victim. Self-help group=facilitator is
the pt themselves. AL ANON groups –Alcoholics Anonymous