Professional Documents
Culture Documents
Rvw Ctr
Beliefs—Feelings—Behavior
Id___________________Superego
EGO
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:
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= OC =Anti-social
=anal retentive =anal expulsive
Dr. Karen Horney- detractor of Freud, didn’t believe in penis envy. Freud said that it is maybe in her unconscious
mind.
Or repressed.
PHARMA MOMENTS
Anti-anxiety Drugs (used also for alcohol withdrawal)
Valium Librium Ativan Serax Tranxene
Miltown Equanil Vistaril Atarax Inderal Buspar
ERIK ERIKSON
Anti C- cholinergic
D- depressants
mARplan
nARdil
pARnate
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DEFENSE MECHANISMS: coping mechanism from stress:
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 SECONDARY TERTIARY
Healthy ill Relapse avoidance
Community teaching Crisis intervention Rehab centers
Community demographics Treatment and diagnosis Al anon
STAGES OF INTERACTION
ORIENTATION WORKING TERMINATION
Assessment Problem solving Evaluation
Establishment of trust Discussion Summarize
Tell patient about termination Patient is most cooperative Say goodbye
Set contract Grief-ANGER-focus of RN
Patient is resistant Pt might become violent/suicidal
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ANTI-PARKINSON DRUGS (Capables) –used with anti-psychotics
Anti-cholinergic Dopaminergic
ABC PLSE
C- Cogentin
A- Artane
P- Parlodel
A- Akineton
B- Benadryl
L- Larodopa
E- Eldepryl
S- Symmetrel
ABG ANALYSIS
Ph & PCO2-Respiratory-opposite signs
Ph & HC02-Metabolic – same signs
ANXIETY
-vague sense of impending doom. Sympathetic activation.
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.
PANIC- highest level of anxiety. Suicidal. Priority: safety. Stay with patient. Don’t touch pt. Sympathetic activation.
“I think I’m having a heart attack!”
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GENERALIZED ANXIETY DISORDER – 6 months excessive worrying. Patient knows what the problem is.
Cant sleep, concentrate, seat
Fatigue and palpitations
-provide safety
-alkalosis-brown bag
-stay with patient
-be directive
1. Survivor
2. Flashback > 1 month
3. Memory – nightmares
PSYCHOSOMATIC DISORDER (Psychophysiologic)– real illness, real s/sx, real pain, with organic basis (with change in tissue)
- stress ulcers, migraine, HPN
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
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Green light-Go – Epi & Norepinephrine
Red light – Stop – G-gamma
A-amino
B-butyric
A- acid
Anxiety
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
STELAZINE CLOZARIL
SERENTIL MELLARIL
THORAZINE HALDOL
TRILAFON PROLIXIN
Content of thought---------------Hallucinations/Illusions------------ADL----------------------------Harm
P/I: Reality/Orient/Safety
Eval: Improved thought process
S & Sx of Schizophrenia:
(-)neg sx (+) positive sx
hypoactive hyperactive flight of ideas
withdrawn restless hallucinations
quiet, flat affect talkative delusions many ideas
poverty of words queen of the world illusions
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Types of schizophrenia:
Acknowledge: “I know the voices are real to you. Present reality. “But I can’t hear them.”
=Assess what voices are saying to know if patient will harm himself.
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Increase 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
Nsg Dx: Impaired social interaction – cant form IPR (Interpersonal relationship)
Impaired verbal communication
Self mutilation – cant express anger. Express it inward.
Risk for injury
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
Safety
Structure- provide place to study, eat, play,bath,etc.
Schedule – time for everything
Set limits
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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,
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
Give task, no group games, any competition will increase anxiety, water the plants, activities using gross motor skills, escorted walk,
punching bag-displacement.
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”
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4. Borderline -------Favorite line – “ life is an empty glass.” Splitting, suicidal, superficial relationship, labile-sudden change of
Mood, self mutilation.
(+) (-)
fill glass with friends suicide
have happy moments LABILE AFFECT sad moment
DISULFIRAM
voids alcohol beer
version therapy
ntabuse (DISULFIRAM)
lcoholics anonymous n/v
hypotension
interval of alcohol & antabuse:
12h interval after alcohol intake
B1 – Thiamine
Complications wernickes
Encephalopathy
Korsakoff psychosis
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24 – 72h after alcohol intake
Delirium tremors – happens due SNS activation
Tremors, hallucinations, illusions. Well lit room – to avoid hallucinations
ASENDIN TCA
NORPRAMIN TCA
TOFRANIL TCA
SINEQUAN TCA
ANAPRANIL TCA - OC
AVENTYL TCA
VIVACTIL TCA
ELAVIL TCA
PROZAC SSRI
PAXIL SSRI
ZOLOFF SSRI
LUVOX SSRI
Selective S
Serotonin S – (decrease S/E)
Reuptake R–
Inhibitors I – (1 – 4 weeks)
MAOI
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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.
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.
Suicide Triad:
- Loss of spouse
- Loss of job
- Aloneness
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.
Morph
CODE
HERO
(uppers)
C – cocaine
H – Hallucinogens
A – amphetamines
Uppers Downers
Seizure decrease RR, decrease HR
Tachypnea Para constricted pupil
Moist mouth
Dilated Blood Vessels
Coma
Asleep
Decreased GI constriction
Decrease GU retention
Decrease BP
State of euphoria
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Methadone
Uppers
Codeine increased heart increase - BP increase, awake
Hallucinogen sympathetic HR increase seizure
Amphetamine pupils- dilate GI - diarrhea
Mouth – dry
Decrease appetite - thin
Stop uppers
Tremors crash syndrome Depressed Suicide
Fatigue
IQ 20 35 50 70 90 110
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
CHILD ABUSE
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.
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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:
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