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PAREITAL LOBE - Touch - Taste 4. OCCIPITAL LOBE - Visual 3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory – eyes, ears, tongue 2. Integration 3. Motor – voluntary or involuntary VOLUNTARY NERVOUS SYSTEM • also called as somatic Brain Spinal Cord Motor Nerve Synapse Muscle Fiber • Motor nerve to muscle fiber you need Acethylcholine which is an ―On switch‖.
INVOLUNTARY NERVOUS SYSTEM • also called autonomic nervous system. AUTONOMIC NERVOUS SYSTEM ———————–SYMPATHETIC ————PARASYMPATHETIC ——————-(Awake, ADRINERGIC) ——–(Relax, CHOLINERGIC) Heart Rate ———— Increase ——————– Decrease Respiratory Rate —— Increase ——————– Decrease GI ———————Decrease ——Increase (Moist mouth, Diarrhea) GU ——————– Decrease —- Increase (Urinary Frequency) Neurotransmitter—- Epinephrine, Norepinephrine —-Acethylcholine • Psych focuses in feelings or self awareness. • Beliefs determine feelings which affects behavior (manifestation of feelings) • Sigmund Freud is the father of PSYCHOANALYSIS. • What happens to childhood will affect adulthood. STRUCTURE OF PERSONALITY ID • impulsive, want to, wants pleasure. • PLEASURE PRINCIPLE. • Guiding principle is PAIN AVOIDANCE. SUPEREGO • should not • small voice of God • to stop EGO • executive decision maker. • In touch with reality principle.
• SUPEREGO is developed. bowel.ID DOMINANT PERSONALITIES Manic Anti – Social – experienced by serial killers Narcissistic SUPEREGO DOMINANT PERSONALITIES Obsessive Compulsive Anorexia Nervosa EGO – if destroyed result in impaired reality perception. • ID is developed. TOILET TRAINING Good Mother———————— Bad Mother Successful —————–Dirty ———————. Oral Stage • 0 – 18 months evident. • Able to control bladder. *REGRESSION – Return to an earlier developmental stage. *FIXATION – Person is stuck in certain developmental shape. Schizophrenia LIBIDO • Sexual energy responsible for survival.Clean ————————-disorganized ————— organized ————————. EGO – Developed on the 6th month.disobedient —————. • Best time for toilet training.obedient . Anal Stage • 18 months – 3 years old.
Arithmetic.O. • Love – hate relationship. Writing. *Unconscious – protects us from traumatic experiences. GENITAL STAGE • 12 years old and above • Sexual reawakening.Anti-social ——————. *Conscious – upper level of thinking. • Castration fears. • Imitates daddy called identification. • Oedipus Complex boy loves parent of the opposite . PHARMA NOTES: ANTI – ANXIETY DRUGS • Valium • Librium • Ativan . • Experience pleasure by manipulating genitals.C ———————– Anal expulsive ———– Anal retentive PHALLIC STAGE • 3 – 6 years old. *Preconscious – tip of tongue. LATENCY STAGE • 6 – 12 years old. • Very important stage. • School age. • Imitates mommy called identification. • Lasts for 6 years. • Electra Complex girl loves parent of the opposite . • Separation anxiety. • Reading. • Penis envy.————————.
– 3 yrs. – 12 yrs. —Generativity ——–Stagnation ———–Parenting 45 yrs. —-Autonomy ——-Shame & Doubt —. ———-Trust ———— Mistrust ———— Feeding 18 mos.• Serax • Tanxene • Miltown • Equanil • Vistaril • Atarax • Ideral • Buspar ERIC ERIKSON • There is more to life than just . – 20 yrs.Guilt ————–Independence 6 yrs. ——-Initiative ———. —–Industry ———Inferiority ———— School 12 yrs. – 45 yrs. – 25 yrs. • Developmental task begins at 0 – 18 months. ——————– POSITIVE ——NEGATIVE ——– FACTOR 0 – 18 mos. – 6 yrs. – above —-Ego Integrity ——— Despair ————Reflection DRUGS WITH ANTICHOLINERGIC EFFECTS • Anti – Anxiety • Anti – Psychotic • Anti – Cholinergic • Anti – Depressants PHARMA NOTES: . —-Identity ———Role Confusion ——— Peers 20 yrs. • Psychosocial Theory of development.Toilet Training 3 yrs. • You can develop a positive side or a negative side. —-Intimacy ———–Isolation ————–Love 25 yrs.
15. IDENTIFICATION – assuming trait for personal. 5. 9. 3. social. 4. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation. 7. 11.MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS) • Marplan • Nardil • Parnate DEFENSE MECHANISMS 1. 13. 2. PROJECTION – attribute to others one’s unacceptable trait. REACTION FORMATION – doing the opposite of what you have done. DISOCIATION – psychological flight from the self. INTROJECTION – assume another person’s trait as your own. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms. 8.CAPABLES • Cogentin • Artane . 12. Displacement – transfer of feelings to a less threatening object rather than the one who provoked it. UNDOING – doing the opposite of what you have done. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive endeavors. COMPENSATION – over achievement in one area to cover a defective part. repression – unconscious forgetting. Denial – failure to acknowledge an unacceptable trait or situation. 14. occupational role. SUPPRESSION – conscious forgetting. 16. SUBSTITUTION – replace difficult goal with more accessible one. PHARMA NOTES: ANTI – PARKINSON DRUG . 10. 6. REGRESSION – return to an earlier development state.
Ignore the client 4. Offer Self 2. Restating – I’m sad ―You’re sad?‖ 1.• Parlodel • Akineton • Benadryl • Larodopa • Eldepryl • Symmetrel AUTONOMIC NERVOUS SYSTEM —————– SYMPATHETIC ——– PARASYMPATHETIC Pupils —————-Dilate —————-Constrict Blood Vessels ——–Constrict ————. Don’t worry be happy 2. Value based judgment – never assume 5. Flattery 6. Changing the topic/subject . eye contact 5. Advising 7. Active Listening – nodding. General Leads – Go on. Broad Opening – how are you today? 6. Changing the topic/subject 3. Making observation – what you see you say 4. Don’t worry be happy 2.Dilate Blood Pressure ——–Increase ———— Decrease THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. I’m listening 7. Giving Opinion NONTHERAPEUTIC 1. Silence – provide time to think 3.
Advising 7. • Give PRN meds. Giving Opinion FEAR – protects us from something bad. • Triggers the sympathetic nervous system. • May commit suicide. MODERATE ANXIETY • + 2 level of anxiety. SEVERE ANXIETY • + 3 level of anxiety.3. TYPES OF ANXIETY MILD ANXIETY • + 1 level of anxiety. • Assess level of anxiety of client. • Don’t know what to do/say. Value based judgment – never assume 5. . • Client pace. • Restless (say you seem restless). • Enhanced learning capacity. PANIC • + 4 level of anxiety. • Directive orders (please sit down). • Promote safety. Flattery 6. Ignore the client 4. ANXIETY • Vague sense of impending doom. • Never touch patient. • Widened perceptual field.
edge of the seat. able to escape source of anxiety. EVALUATION • effective individual coping. • Decrease environmental stimuli. palpitations. • Powerlessness. difficulty concentration. • Restless. GENERALIZED ANXIETY DISORDER • 6 month excessive worrying. SOMATOFORM • no protection . POST TRAUMATIC STRESS DISORDER • victims becomes survivors and experience flashbacks or nightmares. • Example is AGORAPHOBIA fear of open spaces. • Primary Gain anxiety decreases. MALINGERING • pretending to be sick (conscious). • Secondary Gain able to get attention. easy fatigability.• Hyperventilation (Respiratory Alkalosis) • Breathe into paper bag. • Impaired skin integrity PLANNING/IMPLEMENTATION: • decrease level of anxiety. NURSING DIAGNOSIS: • ineffective individual coping. sleep disorders. • Relaxation techniques. PANIC ATTACKS/DISORDER • 15 – 30 minutes sympathetic nervous system escalation.
• unconscious • no organic basis of being sick DIFFERENT TYPE OF SOMATOFORM 1. PSYCHOSOMATIC • Real pains/illness • Real symptoms because of anxiety PSYCHOSOMATIC Increase Anxiety SNS Increase BP & HR Hypertension Fat Deposits Atherosclerosis Calcium Arteriosclerosis Decrease Oxygen Angina Pectoris . BODY DISMORPHIC DISORDER • Illusion of structural defect. La Belle Indifference • do not care what happens to them. hear. • Focus on clients feelings. HYPOCHONDRIASIS • has minor discomfort and interprets it as major illness. • Focus on clients feelings. • Favorite past time is doctor hopping. see. Conversion Disorder • cannot speak. 2. • Nervous system affected.
MI Necrosis CHF Coma PHOBIA • Irrational fear • Etiology: Knowledge of certain object • Bad experience • Immediate nursing objective: Removal of stimulus will remove anxiety • Systemic Desensitization gradually expose client to stimuli/feared object • Employ relaxation techniques SNS • GABA (Gamma Amino Butyric Acid) – stop • Epinephrine and Norepinephrine – Go ANTI-ANXIETY • Increase GABA and client becomes drowsy (no alcohol and coffee) • May develop orthostatic hypotension • Let patient sit then dangle feet and then stand • Develop anti cholinergic effects • If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures • Do it in gradual and in tapered dose • Anti anxiety leads to dependence AUTISM • Unresponsive and does not want to be touched • Autistic Savant: high intelligence and has a ratio of 1:100 • Assessment • Appearance – flat affect and loves constancy and ritualistic • Behavior – withdrawn • Communication – echolalia .
sleep. easily distracted and has no focus • Behavior • Communication: talkative NURSING DIAGNOSIS • Risk for injury • Impaired social interaction PLANNING/IMPLEMENTATION • Structure: place to play.NURSING DIANOSIS • Impaired verbal communication • Impaired social interaction • Self mutilation • Risk for injury PLANNING/IMPLEMENTATION • Maslow’s hierarchy of needs • Expressive Therapy – use of art as mode if communication EVALUATION • Enhanced communication • Improved social interaction • Safety ATTENTION DEFICIT HYPERACTIVITY DISORDER • 7 years and below onset • Duration: 6 months and above • Settings: house and school • Assessment • Appearance: dirty. clumsy. eat and study • Schedule: there is always a time for everything that you do • Set limits • Safety . impatient. hyperactive.
eat.Eat.EVALUATION • Minimize risk for injury • Improved social interaction FRONTAL LOBE OF ADHD Decrease glucose Decrease judgment Increase impulsiveness ADHD Hyperactivity • Need a drug that brings glucose level up. vomit . eat.3 months amenorrhea ————— Irregular menstruation BULIMIA NERVOSA • Metabolic alkalosis (vomiting results to decrease hydrochloric acid) • Metabolic acidosis (diarrhea results to decrease bicarbonate) • Dental caries • Wound in knuckles MANAGEMENT • Fluid and electrolyte imbalance • Meal contract • Weight gain for client .Less 85% expected body weight ——.Normal weight . eat ————————— Eat. • Give Ritalin a stimulant • May result in loss of appetite • Given after meals • Given 6 hours before bedtime EATING DISORDERS ANOREXIA NERVOSA —————BULIMIA NERVOSA .
no idea. Inappropriate.Sociable Thought Blocking ——————Flight of ideas Apathy . Flat. not related to one another ASSESSMENT NEGATIVE ————————POSITIVE Hypoactive ———————— Hyperactive Withdrawn ————————.• After eating stay with client for 1 hour and accompany when going to the comfort room PHARMA NOTES: ANTI – PSYCHOTIC DRUG • Stelazine • Serentil • Thorazine • Trilafon • Clozaril • Mellaril • Haldol • Prolixin SCHIZOPHRENIA • Ego disintegration • Impaired reality perception • Genetic vulnerability • Stress – Diathesis Model • Biological theory – increase dopamine level • Exact cause unknown ASSESSMENT • Affect: Appropriate. Blunt (incomplete) • Ambivalence: pulled into 2 opposing forces Autism • Looseness.
ASSESS • Hallucinations/Illusions NURSING DIAGNOSIS • Disturbed sensory perception PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • Improved sensory perception III.I. ASSESS • Suspicious NURSING DIAGNOSIS • Risk for other directed violence PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • Eliminate/minimize risk for other directed violence . ASSESS • Content of thought NURSING DIAGNOSIS • Disturbed thought process PLANNING/IMPLEMENTATION • Present reality • Provide safety EVALUATION • Improved thought process II.
IV. ASSESS • Suicidal NURSING DIAGNOSIS • Risk for self directed violence PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • Eliminate/minimize risk for self directed violence LOOSENESS OF ASSOCIATION • Thinking that is overgeneralized. diffuse. and vague with only a tenuous connection between one thought and the next FLIGHT OF IDEAS • Jumping from on topic to another AMBIVALENCE • Pulled between 2 strong opposing forces MAGICAL THINKING • acting like magician ECHOLALIA • Client repeats what you say ECHOPRAXIA • Client repeats what you do WORD SALAD • Just words no rhyme CLANG ASSOCIATION • Words that rhyme .
NEOLOGISM • Formation of new words (needs clarification) DELUSION: PERSECUTORY • ―The NBI is out to get me‖ DELUSION: RELIGIOUS • ―I am Jesus Christ the savior‖ DELUSION: GRANDEUR • ― I am the queen of the world‖ DELUSION: IDEAS OF REFERENCE • ―The nurses are talking about me‖ CONCRETE ASSOCIATION • Also known as ―pilosopo‖ THOUGHT BLOCKING • Unable to think ———————–HALLUCINATIONS—— ILLUSIONS STIMULUS ———— ABSENT———— PRESENT VISUAL —————-ABSENT———— PRESENT AUDITORY ———– ABSENT———— PRESENT TACTILE ABSENT — ABSENT———— PRESENT • Present reality to clients experiencing hallucinations • Technique in handling clients with hallucinations • Hallucinations • Acknowledgement ―I know the voices are real to you‖ • Reality orientation ―I know the voices are real but I don’t hear them‖ • Diversion ―Lets go to the garden‖ • 10% of schizophrenic clients hear voices .
PARKINSON’S DISEASE • If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch) ANTI-PSYCHOTIC Decrease dopamine level Parkinson like effect Extra pyramidal side effect With akathesia Restless. inability to rest AKINESIA • Muscle rigidity DYSTONIA • Torticollis (wryneck) OCULOGYRIC CRISIS • Fixed stare OPISTHOTONUS • Arched back • Lips – smacking • Tongue – protruding • Cheeks – puffing • The 3 are irreversible and called tardive dyskinesia • Neuroleptic malignant syndrome – hyperthermia ANTI – PARKINSON Anticholinergics Dopaminergics (Decrease Ach) (Increase Dopa) Artane. Akineton Parlodel Benadryl Larodopa Cogentin Eldepryl Symmetrel .
Mistrust.Negativism (client do not follow what you tell them to do) Nursing management: meet needs PARANOID SCHIZOPHRENIA .Combination of positive and negative signs and symptoms CATATONIC SCHIZOPHRENIA . withdrawn Nursing management: .Suspicious .Sad but smiles (inappropriate affect) .Giggling (hebephrenic giggle) . scared.OTHER SIDE EFFECTS OF DECREASE DOPAMINE • Photosensitivity • Agranulocytosis – decrease WBC • Clients prone to infection due to decrease WBC • First sign for infection is sore throat TYPES OF SCHIZOPHRENIA DISORGANIZED SCHIZOPHRENIA . Violent: .Flight of ideas (disorganized speech) .Medications should be in tamper resistant foil.No reaction (flat affect) .Ambivalence .Keep door open .Gain trust by 1 to 1 short interaction but frequent .Waxy flexibility .Favorite word is ―No‖ .Foods should be in a sealed container .Don’t touch client .Position near door .
diarrhea • Increase sodium * Wait for 2 – 4 weeks before lithium therapy takes effects BIPOLAR DISORDER/MANIC PROFILE • 20 years old • Female • Stress • Obese ASSESSMENT • Decrease appetite (give finger foods) • Decrease sleep (place in a private room) . PARANOID SCHIZOPHRENIA .6 – 1..One arms length away from the client. vomiting. fine hand • Hydration of 3L/day • Increase • Uu (diarrhea) • Mouth dry Signs of Lithium toxicity • Nausea. cant be classified PHAMRA NOTES: BI-POLAR. MANIC • Lithium: undergo first kidney test and check for blood levels • Level: .No more positive symptoms just withdrawn UNDIFFIRENTIATED SCHIZOPHRENIA .Mixed classification.2 meq/L • Increase urination • Tremors.Call for reinforcement .
volleyball).• Hyperactive • Increase sexual activity – only means of addressing anxiety so decrease level of anxiety • Risk for injury/other directed violence • Impaired social interaction (care giver role: strain and stay with client) • Self esteem decrease (to cover up their sadness there is compensation to cover defective doing) • Because there is decrease self esteem there will be increase compensation resulting to increase interference with ADL’s and harm to others • Compensation is the culprit • Management: increase self esteem to decrease compensation and decrease interference with ADL’s and harm to others HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS T. no fine motor skills only gross motor skills A lot energies toward more productive endeavors (sublimation) S .no sports (basketball.escorted walk outdoors K – punching bag (displacement) PHARMA NOTES: ANTI – DEPRESSANTS • Asendin • Norpralamin • Tofranil • Sinequan • Anafranil • Aventyl • Vivactil • Elavil • Prozac .
• Paxil • Zoloft ALCOHOL LEADS TO: • Blackout: awake but unaware • Confabulation: inventing stories to increase self esteem • Denial: ―I am not an alcoholic‖ • Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is another term • Tolerance: gradual increase in amount of stimuli to experience the same euphoria MANAGEMENT • Detoxification: withdrawal with medical doctor supervision • Avoid alcohol therapy • Aversion therapy a more technical term for avoid alcohol therapy • Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting • Alcoholics anonymous • Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension • Alcoholism may result to Vitamin B1 (Thiamine) deficiency WERNICKE’S ENCEPHALOPATHY • Problem with motor KORSAKOFF’S PSYCHOSIS • Problem with memory • 24 – 72 hours after last dose of alcohol expect: • Delirium Tremens: sympathetic nervous system • Prevent hallucinations/Illusions by placing client in a well lit room • Formication: feeling of bugs crawling under the skin .
Anomia – don’t know the name 3.temporal lobe is affected particularly wernicke’s area 5. Agnosia – sensory problems smell.expressive: cant say/express . illusions thus becomes restless and may wander • As sun goes down client becomes restless. sight 4. agitated. Apraxia – cant do simple things * Reminiscing Therapy – talk about past • Patients with alzheimer’s may experience hallucinations. Aphasia .frontal lobe is affected particularly broca’s area . Amnesia – memory loss 2. taste. disoriented called sundowning • Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases Ach causing delay in disease progression SEROTONIN • Responsible for happiness • Decrease serotonin clients becomes sad give anti-depressants .receptive: cant hear .ALZHEIMERS DISEASE • Axon (away) and Dendrites (toward) nerve • Neurofibrillary tangles • Neurotic plaques ————————–ALCOHOL — ALZHEIMERS ONSET ——————– Abrupt ——– Gradual LEVEL OF CONSCIOUSNESS – Fluctuating —-Unaffected DURATION ———– Hours to days — Progressive MEMORY ————– Short term —Short and long term 5 A’s OF ALZHEIMERS 1.
Aventyl.SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks .Also increases norepinephrine . Vivactil. Parnate . Elavil MONO AMINE OXIDASE INHIBITORS • MAO kills serotonin • Increased MAO results to decreased serotonin the more depressed the client becomes • MAOI kills MAO and increases all neurotransmitters (serotonin. dopamine but client becomes prone to hypertensive crisis • Avoid tyramine rich foods • Avocado. Norpralamin. Alcohol • Beer • Chocolates. epinephrine. Nardil. Tofranil. norepinephrine. Anafranil. Zoloft TRICYCLIC ANTI DEPRESSANT Two – four weeks C A .Prozac. Sinequan. Paxil.Increases serotonin and affects only serotonin .Asendin.Has higher incidence of side effects . Cheese (aged) • Fermented foods • Pickles • Preserved foods • Soy sauce • There is increase incidence of side effects after 2 – 6 weeks • Marplan.
Suspicious .They have talent but has no confidence 3.Prone to suicide 5. Anti-Social . Dependent .Sudden change in mood ―labile affect‖ .―I am so organized‖ 9.PERSONALITY DISORDERS 1.Manipulative 4.Constantly wants to be the center of attention .They avoid people because they are afraid of criticisms .Constantly breaks law .They avoid people because there is no enjoyment 2. dramatic.Excited. Histrioinic . Narcissistic . Borderline .They like splitting friends .They perceive life as an empty glass .They are witty and articulate . Avoidant . Paranoid .―I love myself‖ . manipulative 7. Schizophrenia . Obsessive – Compulsive .Project charm .They get jealous even with achievement of family members 8.―Cant live if living is without you‖ 6. prone to impotence .May lead to domestic violence ANTI – DEPRESSANT SIDE EFFECTS: Male – erectile dysfunction.
hypoactive. Bargaining – if.GRIEF PROCESS 1. Denial – shock/disbelief 2. decrease sexual urge • Be sensitive to clients needs FOR SUICIDAL OBSERVE FOR Verbal • ―I wont be a problem‖ • ―This is my last day on earth‖ • ―I’ll soon be gone‖ Non verbal • Giving away of valuables • Sudden change in mood WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: ―Do you plan to commit suicide?‖ Irregular/interval visits Endorsement period. increase/decrease sleep. Anger – question ―why me?‖ 3. Depression – 2 weeks or more sign and symptoms becomes major clinical depression 5. Acceptance – client acts according to situation ASSESSMENT • Decrease self actualization • Decrease self esteem • Withdrawn: stay with client • Suicidal: risk for self directed violence • Increase/decrease eat. then 4. early morning clients are most likely to commit suicide DOWNERS Alcohol Barbiturate .
Naloxone hydrochloride) UPPERS Cocaine Hallucinogens Amphetamines Resulting to: • Tachycardia • Awake • Tachypnea • Dry mouth • Pupils dilate • Hypertension • Seizures • Weight loss .Opiates Narcotics Marijuana Morphine Codeine Heroine Resulting to: • Bradycardia • Bradypnea • Moist mouth • Pupils constrict • Constipation • Urinary retention • Hypotension • Coma • Weight gain • Narcotics overdose: give narcotic antagonist (Narcan.
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