PSYCHIATRIC NURSING

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 "od -conscience -should not eat yet, should not eat yet #go- ar$iter, decision ma%er -in touch &ith reality Id'''''''''''''''''''Superego #"( I) )(*I+,+- – needs a superego-needs a conscience *- manic ,- antisocial – serial %iller +- narcissistic S.P#/#"( )(*I+,+- –needs an Id (- ($sessive 0ompulsive ,- ,norexia nervosa #"( – impaired reality perception 1/+ &ill present reality2 S- schi3ophrenia- cant distinguish fact from reality 4i$ido- sexual energy F/#.) - PS506(S#7.,4 -6#(/5 (/,4 – 8-9: months 0ry, suc% – mouth- survival Id dominant *aternal deprivation if not feed, not given mil%;&ater, not %ept &arm< +arcissistic – see%s the Id – I love myself /egression – return to an earlier stage or earlier level Fixation – stopped in a stage ,+,4- 9: mos-=yrs -oilet training *om is superego< Superego is $eing formed 0hild is caught in am$ivalence – pulled in > opposing factors -oo much toilet training &ith punishment &ill result to a child &ho is?

($edient, organi3ed, clean @ (0 @anal retentive

/e$el, dirty, diso$edient @,nti-social @anal expulsive

9

u-1anal2 -o-ilet training +o-+oD Favorite &ord< *y Initiative vs 1Initiate 9st steps2 Phallic-oedipal.at tip of tongue .girls envy little $oys )r< Caren 6orney.highest level of a&areness Pre-conscious.nal2 1G2 -rust vs . arithmetic< Su$limation –putting anger into something more productive putting all energies into schooling #x< .-#+-.detractor of Freud.nti-anxiety )rugs 1used also for alcohol &ithdra&al2 Ealium 4i$rium .0-(/ Feeding -oilet training -ranxene Inderal Buspar =-A yrs old 1Phallic2 A-9> yrs old 14atent2 9>->8 >8->H >H-IH IH up 1"enital2 "uilt –anger turned in&ard Independence Inferiority /ole confusion Isolation Stagnation )espair Industry Indus%ul Peers 4ove Parenting /eflection +e&ly admitted pt. &riting.electra Industry vs Identity vs Intimacy vs "enerativity vs #go Integrity vs 1-2 *istrust Shame.A-9> years old 4atent./*.tarax #/IC #/ICS(+ S-. *(*#+-S .P6. didn’t $elieve in penis envy< Freud said that it is may$e in her unconscious mind< (r repressed< 0onscious.44I0 – =-A yrs old -penis B vagina -love of parent of opposite sex (edipal-$oy loves mom #lectra-girl loves dad Identification.fear that dad is angry at him and &ill cut off penis Penis envy.develop trust 9st -pts are dependent@self care deficit -develop.teach autonomy -then pt &ill develop initiative > .ngry at life.tivan Serax *ilto&n #Fuanil Eistaril .$oy imitates dad 0astration fears.4 –9> years old "enital-"ising sexual energy Sexual intercourse most important in this stageDD P6.=yrs old 1.nconscious forgotten< Suppression – conscious forgetting 4. pour anger in singing< "#+I-.dou$t F."# 8-9: months 1(ral2 9: mos.utonomy vs .nconscious – forgotten /epression-%ept in unconscious< .9st time to go to school – Separation anxiety 0hild is $usy &ith /eading.4ogtu @ sexual energy asleep School age – School pho$ia.

hearing. language (ccipital.nti-cholinergic .psychotic ./..utonomic nervous system.anxiety P.voluntary movements . Judgment. oliguria.-6#-I0 1alert2 tachycardia tachypnea Slo&. freFuency *oist mouth .responsi$le for voluntary movements .*I+# (7I). touch Sensory Integration *otor Somatic nervous system. smell Parietal-taste. +orepinephrine )ilated 1dilat &hen alert2 1*idriasis2 vasoconstriction increased P. learning.cetylcholine 1.on s&itch of movement . 1opposite effect2 +eurotransmitter Pupils Blood vessels BP S5*P. constipation Slo&.S# I+6IBI-(/S? = .depressants *(+( .nti cholinergic2 and parasympathetic 1cholinergic2 6eart /espiratory "I 1opposite effect2 ".-6#-I0 1relax2 $radycardia $radypnea diarrhea Polyuria.involuntary movements -Sympathetic1. anti-parasympathetic @effect is sympatheticD Sympathetic drug classifications? .vision -emporal.-etc Frontal lo$e. retention )ry mouth #pinephrine.S5*P.cetylcholine.c62 0onstricted 1*yotic2 vasodilated decreased .nti mARplan nARdil pARnate 0.cholinergic ).personality.

/5 /elapse avoidance /eha$ centers .voidance< I don’t &ant to tal% a$out it< I don’t &ant to remem$er it<! /.+)(I+".BS-I-.ssessment #sta$lishment of trust -ell patient a$out termination Set contract Patient is resistant S#0(+). you shout at your su$ordinate< S. shelter.---------------putting anger into something more productive or G putting all energies into schooling #x< .-I(+ – -----------models a certain $ehavior from a certain role model< P/(L#0-I(+ – -----------------$lame other people.-I(+ .color then feels guilty after< I)#+-IFI0.-I(+ – -----------&hen you replace a difficult role &ith a more accessi$le one< #x<Mants to go to )isneyland $ut can’t afford it< Ment to #nchanted Cingdom instead< )efense mechanism? . tremors< 0(*P#+S.mnesia< #x< /ape.)4 6arm to self or others Behavior *odel – Ivan Pavlov 0lassical 0onditioning -$ehavior learned-repeated 1G2 BF S%inner – operant conditioning-reinforcement 0onfront 1-2 $ehavior to ma%e it extinct< *. food. overachieve to cover a defective part< S./5 6ealthy 0ommunity teaching 0ommunity demographics STAGES OF INTERACTION (/I#+-. pass load to others< 4oo%s for a scapegoat< +ot me. pour anger in singing< )#+I.suicidal I .I am not! an alcoholicD )ISS(0I.0-I(+ F(/*.PP/#SSI(+ – ---------------conscious forgetting< .-I(+ #valuation Summari3e Say good$ye "rief-. trauma /#"/#SSI(+ – ----------------/#-. me too<! . gusto %o yan<! 0(+E#/SI(+ – repression< .-I(+ – -------uses $ecause!< 6as illogical reasoning< I drin% $ecause I don’t &ant to &aste the $eer in the ref<! /#./065 (F +##)S? H< Self-actuali3ation I< Self-esteem =< 4ove and $elonging >< Safety and security 9< . &ater.DEFENSE MECHANISMS? coping mechanism from stress? )ISP4./5 ill 0risis intervention -reatment and diagnosis -#/-I.nger turned in&ard to herself< 0onverted to physical symptoms< Sensory-num$ness< *otor-paraly3ed.ir. sex –Basic physiologic needs LEVELS OF PREVENTION P/I*.4.-I(+.S4(M’S 6#I/.-------------5our $oss shouts at you.interferes &ith .-I(+----plastic< )oing opposite of intention< .l anon M(/CI+" Pro$lem solving )iscussion Patient is most cooperative -#/*I+.%o din.+"#/-focus of /+ Pt might $ecome violent. clothing.-I(+ – ---------------------stuc% in a stage of development /#P/#SSI(+ – -----------------unconscious forgetting S.ffects.0#*#+-. $ut them<! I+-/(L#0-I(+ – --------------assume another persons trait as your o&n< +ot Just you./+ to an earlier developmental stage FI7.-I(+ – -----------defects of the person.---------------------.B4I*.4IK.-I(+ .-I(+ – --------------psychological flight from self< .----------------------sho& true feeling.ngry at life.

+-I-P.6o& are youN! 5ou have com$ed your hair today<! P< 0larification.-I0 0(**. ho& =< Silence I< .-I(+ 9< (ffer selfI’ll stay.-#----------patient is pacing..B4#.Mhat else.-6#/."S 10apa$les2 –used &ith anti-psychotics ./CI+S(+ )/. eye contact.ctive listening-nodding. &idened perceptual field.nti-cholinergic .+I0highest level of anxiety< Suicidal< Priority? safety< Stay &ith patient< )on’t touch pt< Sympathetic activation< I thin% I’m having a heart attac%D! +rs )x? -----------------Ineffective Individual 0oping P.B" . I have noticedO! A< Broad opening. $e happy<! MhyN – Puts pt in defensive position< 0hange the su$Ject< #verything’s going to $e alright<! – giving False reassurance< Ignore the patient< PreJudicial< +ice &eather today<! –value $ased Judgment< Flattery – don’t use too much adJectives< 5ou have the most $eautiful hair in the &ard<! .%ineton Benadryl 4arodopa )opaminergic P4S# -6#/.nti-anxiety drugs-valiumO S#E#/#----------------patient can’t ma%e decisions< I don’t %no& &hat to do or say<! /+ directs patient< Sit do&n on the chair<! – )irective< P. selective inattention< "ive P/+ meds-.+..sit &ith you<! >< #xplores –use &hat.+I0.B0 0. I have o$served.rtane Parlodel .45SIS Ph B P0(>-/espiratory-opposite signs Ph B 608>-*eta$olic – same signs +(+. enhanced learning experience< 5ou seem anxious<! *()#/. &hen.Me &ere tal%ing a$t the examO! 99< Focusing.Symmetrel 0ogentin .-ell me more a$t this<! .rguing &ith the patient )on’t impose your opinion< 0ompensation? Ph is normal@Fully compensated< 08> B 608= –same signs @ Partially compensated ANXIETY -vague sense of impending doom< Sympathetic activation< . &here. decrease stimuli 6-? relaxation techniFue #? #ffective Individual 0oping H . leaning for&ard-sho& active participation< H< *a%e o$servations< 5ou see.#ldepryl S.ssessment? 4evel of anxiety *I4)-------------------sit restlessly.I? )ecrease anxiety.I don’t &ant to eat<! 1Mord per &ord repetitionD2 5ou don’t &ant to eatN! Q< "eneral leads.-I0 )on’t &orry.nd then.P.P#."o onO! 98< /efocusing.Mhat do you mean $y ploopplan%N! :< /estating.P#.

ideas shared to psychoanalyst =< 0atharsis – --------------free to express feeling I< -ransterence. concentrate. trauma 9< >< =< Survivor Flash$ac% R 9 month *emory – nightmares *.voidant@interferes &ith .sx not real PSYCHOSOMATIC DISORDER 1Psychophysiologic2– real illness. real s.S5S-#*. migraine.no organic $asis 1no tissue change2 -pretending to $e sic%. conscious -decrease anxiety – for primary gain -increase attention from /+– secondary gain SOMATOFORM DISORDER –------------------unconscious. no organic $asis . happens &ithout &arning< S+S activation< -&ith or &ithout agorapho$ia -------------------.-I(+ Individual -herapy 9< 6ypnosis – --------------relaxed state >< Free association –-----.sx real 1$iglang na$ulag2 *inor discomfort -Feels li%e illness -65P(06(+)/I.fear of pu$lic -provide safety -al%alosis-$ro&n $ag -stay &ith patient -$e directive POST TRAUMATIC STRESS DISORDER Eictims – rape.fear of open space -social pho$ia –------------------------------------. &ith organic $asis 1&ith change in tissue2 .motor fx -s. not pretending.irrational fear #tiology – %no&ledge.4I+"#/I+"------------------------------------.SIS B()5 )5S*(/P6I0 )IS(/)#/ -illusion of structural defect -S. &ar 3one. 6P+ PHOBIA---------------------------------------------------------.-----------patient feels something for psychoanalyst H< 0ountertransterence –--/+ feels something for patient A .-I0 )#S#+S5-6#K.goes doctor hopping +ervous system 0(+E#/SI(+ -loss of sensory.GENERALIZED ANXIETY DISORDER – A months excessive &orrying< Patient %no&s &hat the pro$lem is< 0ant sleep.)4 "radual exposure to feared o$Ject.stress ulcers. experience Immediate nsg intervention? /emove o$Ject of fear 1Increase stimuli@increase level of anxiety2 1)ecrease stimuli@decrease anxiety2 Belief ($Ject &ill hurt patient Feeling Scared Behavior . accident.sx. seat Fatigue and palpitations PANIC ATTACK – ------------------------------9H-=8 minutes. disaster. real pain.

m$ivalence-------------------------------------pulled $et&een > opposing forces =< .ttached to odd o$Jects<Poor eye contact< I< .nti-anxiety drug drive. does not match affect< 1sad inside2 >< .B.)4----------------------------6arm )istur$ed thought process )istur$ed sensory Perception P.-retention .nxiety Increase ". laughs2< #xternal. don’t .F(+ 04(K.4)(4 P/(4I7I+ Sympathetic effect< #ffect – >-I &ee%s SCHIZOPHRENIA-------------------------------impaired reality perception< #go disintegration< "enetic vulnera$ility< Stress< -0hose fantasy over reality< Increase dopamine theory< 0ause? un%no&n< Increase dopamine."reen light-"o – #pi B +orepinephrine /ed light – Stop – "-gamma . readily o$serva$le< *ood.nticholinergic S.-amino B-$utyric .(rient. drin%.B./I4 *#44.. internal. flat affect poverty of &ords Self care deficit Self (ther )irected Eiolence 1G2 positive sx hyperactive restless tal%ative Fueen of the &orld flight of ideas hallucinations delusions many illusions ideas P . – leads to sei3ures< 9 &ee% effect< "radual &ithdra&al – tapered dose )ependence.+) P6#+(*#+. increase schi3ophrenia< I .acid .# #ffect of "."#+-S – S-#4.KI+# S#/#+-I4 -6(/./I4 6.KI+# -/I4.’s? 9< .+-I-PS506(-I0 .utism --------------------------------------------self a$sor$ed< -rapped in his o&n &orld<.Illusions------------.ffect---------------------------------------------feelings B emotions 1smiles. "I-constipation ".? )ro&sy.Safety #val? Improved thought process S B Sx of Schi3ophrenia? 1-2neg sx hypoactive &ithdra&n Fuiet.0an’t live &ithout valium .ssociative looseness---------------------------tal% a$out so many things $ut unrelated ideas< )istur$ed thought process-------------------------+sg dx 0ontent of thought---------------6allucinations.I? /eality. orthostatic hypotension Mithdra&al from drug – a$rupt – /#B(.

-I(+-----------------------pilosopo< Mhat &ill you &ear tomorro&N! 0lothesD! 9>< 6.freFuent interaction -food? sealed container -meds? &rapped in tamper resistant foil I< .)----------------------------------------mixes &ords that don’t rhyme< :< 04. pisno%<! 98< )#4.44.4#+0#-------------------------------------Pulled $y > opposing forces< I< *.millionaireD Persecution------------+BI out to get meD Ideas of reference------hey tal% and &rite a$out meD 99< 0(+0/#-# .4 -6I+CI+"----------------------------.c%no&ledge? I %no& the voices are real to you< @.SS(0I.$elieves he has magical po&ers< I can turn you into a frog<! H< #06(4. happy outside – inappropriate affect 1G2 flat affect – no affect 1-2 disorgani3ed manner. / )-)irective< 4et’s go in the garden<! . %ing.ssess &hat voices are saying to %no& if patient &ill harm himself< Present reality< But I can’t hear them<! : .+" .4.S ---------------------------------+e& unrelated topics< I am going to the mall< Mhere is the lightN I treasure this chal%< 6urrayD! =< . .0I+."I0.SS(0I.SI(+S-----------------------------------------false $elief "randeur--------------I am a Fueen. pran%<! Q< +#(4("IS*------------------------------------------invents ne& &ords not in the dictionary< Ploopplan%.4I.&ithdra&n.nclassified.speech –flight of ideas 1G2 6e$ephrenic. $lan%.7I.uditory + 5 -actile + 5 Present realityDDD 6 .giggling 1G2 Sx? $oth 1G2 and 1-2< >< 0atatonic ---------------------------------------------am$ivalence –anal stage 1-2 +oD +egativisim-re$el-anal 1-2 Maxy flexi$ility--------------raise arm of patient< Patients arm remains up for a long time< 1-2 1-2 R 1G2 =< Paranoid ----------------------------------------------uses proJection< *istrust Scared.-ypes of schi3ophrenia? 9< )isorgani3ed schi3o---------------------------------sad inside.violent Based on history )evelop trust? orientation -9?9 interaction -consistent approach -short.-I(+S----------------------I44.SI(+S 1&ith stimuli2 Stimuli + 5 Eisual + 5 . 1-2< Social &ithdra&al -4eave door open -)istance from pt? 9 arms length -stay near door not &indo& -have visi$ility?stand half&ay in B out to $e a$le to call for reinforcement< -calm and firm THOUGHT PROCESS DISTURBANCE 9< 4((S#+#SS (F .----------------------------------------repeats &hat you do< /epeats &hat is seen< P< M(/) S.ndifferentiated-----------------------can’t $e classified anymore< H< /esidual-------------------------------------------------no more 1G2.-I(+----------------topics have connection $ut no thought< I am going to the mall< -he mall is in to&n< -he to&n flies< Flies are here<! >< F4I"6.*BIE.-I(+----------------------------uses &ords that rhyme< Flan%.SS(0I.(F I)#.------------------------------------------repeat &hat is said< Parrots< A< #06(P/.

promote safety #xpressive therapy – uses art.------------lip smac%ing. leu%openia AUTISM./)IE# )5SCI+#SI.Increase )opamine @ increase schi3o )ecrease dopamine @ decrease schi3o #xtra Pyramidal Side #ffects 1#PS#2 16appens &hen acetylcholine is up and dopamine is do&n2 9< . poor eye contact.4S.-------------------------. play.4("5/I0 0/ISIS – fixed stare (PIS-6(-(+. diaphoresis.)6) gro&s up not anti-social *eds? /italin.+.S5+)/(*#.4I"+.ritualistic $ehavior.$ath.tal%ative +sg )x? 6igh ris% for inJury Safety Structure. unsta$le BP.CI+ISI. fever. repetitive 0.$ehavior. eat.dderal Best time to give meds? If once a day give .affects nec% -(/-I0(44IS -------------&ry nec% (0.Pemoline. )exedrine. $e a$le to express feelings< -Safety P.I? #? ADHD. ina$ility to sit still< >< . malaise. sunscreen P< MB0.appearance.appearance? dirty B./(4#P-I0 *.restless. medical emergency< A< P6(-(S#+SI-IEI-5------------------&ear shades. tongue is protruding. increase 0PC.rigidity =< )5S-(+I.etc< Schedule – time for everything Set limits /esidual .communication – difficulty communicating +sg )x? Impaired social interaction – cant form IP/ 1Interpersonal relationship2 Impaired ver$al communication Self mutilation – cant express anger< #xpress it in&ard< /is% for inJury constancy.hyperthermia.provide place to study. puffy chee%s< Irreversi$leD H< +#.F-#/ *#.. improved social interaction. (0.granulocytosis---------------sore throat.-6ISI..$oys R girls< 9?988 %ids gift-autistic savants -echolalis. .$ehavior? clumsy.ATTENTION DEFICIT HYPERACTIVITY DISORDER 1can progress to conduct disorder to anti-social $ehavior2 0ant focus on anything< (nset P yrs old and $elo& )uration RA months Setting? 6ouse B school I) dominant? *om or /+ &ill act as superego .--------------------------.S ---------arched $ac%. can’t express ver$ally< . easily distracted 0..ssessment? . ---------------------------. impatient. poetry.neat. contracted I< -.ssess? . pallor -discontinue meds. flat affect. decreasing ris% for inJury.C. music. &ants constancy B.to prevent loss of appetite< )on’t give at $edtime-it’s a stimulant-&ill cause insomia< 0an $e given Ahours $efore $edtime 1if F>d2 Q .

4ithium< "roup therapy 4. drives fast.4 1If level is near ><H-= m#F. stress.%no&s pro$lem $ut ashamed and em$arrassed. o$ese Self actuali3ation -as% to decrease self esteem Family therapy /is% for inJury.increase -. punching $ag-displacement< = or more signs confirms disorder? " – grandiose. pets A oid!"# ----------avoid group – fear criticism. illegal activities against the la&< drug addiction. hyperactive. = months amenorrhea. no group games. under&eight S :HT of expected fat. eating pattern. increase sex – mastur$ate in front of others +sg )x? 6igh ris% for self or other directed violence /is% for inJury "ive tas%.+a. diarrhea . Priority? Pro$lem? +I? Fluid volume $alance Meight gain – monitor &eight.4 –&ill cause ataxia and mental confusion2 I.=4.mouth dry +. dental carries. stay 9 hour after eating.sleeplessness P – pressured speech # – exaggerated S# # – extraneous stimuli 1easily distracted2 ) – distracta$ility PERSONALITY DISORDER 9< >< =< Schizoid – --------doesn’t care a$out people. happy 1more dominant2 B sad -female. manipulator< *otto – I &ill $rea% the la&! 98 .ANOREXIA NERVOSA – diet. ta%es laxative.d I. failure to recogni3e pro$lem< BULIMIA NERVOSA – induce vomiting.uu *.tremors 6. decreased sleep.8<H-9<H m#F. have talent $ut no confidence< A"#i-$oci!%– ------as child steal. $elieves that he can stand on his o&n. escorted &al%. accompany in toilet Body image )istur$ance 9< #sta$lish nutrition pattern >< -each stress management. unsafe sex. normal &eight.6>8.9=H-9IH m#F. lie. any competition &ill increase anxiety. diarrhea @ )iamox BIPOLAR DISORDER – > poles. increase ris% activities F – flt of ideas S . &itty.increase urination -.nti-depressant MANIA – needs mood sta$ili3ing agents.. 0/#. al&ays get reprimanded . &ater the plants. R>8 yrs old. charmer.dult – grand ro$$ery. irregular menstruation. ris% for other directed violence )ecrease eat. activities using gross motor s%ills. thrill see%er< "ood tal%er.+. Journal %eeping =< *onitor eating pattern and &eight< I< .v.4 – to hold &ater 0hec% %idney1$lood level2 $efore administration of 4ithium – B. electrolyte 4ithium toxicity – n. never had a $est friend avoid groups B activities – no enJoyment cares more a$out computers.

self mutilation< 1G2 fill glass &ith friends have happy moments 1-2 suicide sad moment 4. restless $< psychological – craving #-ena$ling.v hypotension interval of alcohol B anta$use? 9>h interval after alcohol inta%e +arcotic oversode-give +arcan +arcotic detox.I love myself! – insensitive.*ethadone .FF#0- la$ile. tachycardia.exaggerated Self esteem.* voids alcohol version therapy nta$use 1)IS. suicidal.0#+-#/ (/ . la$ile*ood. manipulative .change from good to $ad in a split moment H< D'('"d'"# ---------)ecrease self esteem. dramatic. organi3ed.perfectionist.al&ays Jealous.I< sudden change of Bo&d'&%i"' -------Favorite line – life is an empty glass<! Splitting. $ut resistance is hidden< +sg Intervention? Improve IP/.4FI/.a&a%e $ut una&are 0-confa$ulation ---------.I cant live &ithout alcohol<! a< physical – tremors.*2 lcoholics anonymous $eer n. violent P!$$i ' !))&'$$i ' ------al&ays say yes!. arrogant.BI4# .invent stories to increase Self-#steem )-denial ------------------. $uild trust A-LCOHOL ABUSE ----------------------happy – sociali3ing -escape from pro$lem -peer pressure B-$lac%out ---------------.I am at not an alcoholic<! )-dependence -----------.codependency 1significant others tolerate a$users2 )IS. self a$sor$ed .--#+-I(+ N!&ci$$i$#ic---------.version therapy-. am$itious I am the $est! OC -----------------.confa$ulation >I – P>h after alcohol inta%e 99 . dependent Poor decision ma%ing s%ills I cant live if living is &ithout you! Hi$#&io"ic$ ----------excited. constancy in environment< Provide time to do rituals< P!&!"oid ----------.4FI/. suspicious.nta$use A< P< :< Q< 98< B9 – -hiamine 0omplications &ernic%es #ncephalopathy Corsa%off psychosis Mernic%es – E/((* – *otor sx effect Corsa%off – memory. superficial relationship.

2 ----------> – I &%s has increased S. +#.+-S – decrease serotonin pro$lem . -0. s&iss cheese M – ine S – soysauce . serotonin %ills serotonin . SS/I SS/I SS/I SS/I Serotonin ---------ma%es us happy )ecrease serotonin – pt $ecomes sad – depression Increase serotonin – antidepressant SSRI* Selective Serotonin /eupta%e Inhi$itors S S – 1decrease S.(I increase *.# increased Serotonin B +orephinephrine MAOI-------------------------. constipation.+I4 SI+#U. retention.S#+)I+ +(/P/. diaphoresis -yramine rich food? .vocado Pic%les .+-I )#P/#SS. tachycardia *ale erectile dysfunction *.(I *ost dangerous.canned meat etc< 0heese – mo3erella. give -0.+I4 .#2 /– I – 19 – I &ee%s2 If SS/I don’t &or%. -0.# )iet – avoid #+&!.P/.E#+-54 EIE.nticholinergic @ antidepressants – antiparasympathetic )ry. -0.( @ decrease serotonin V decrease *. illusions< Mell lit room – to avoid hallucinations ./IM. -0. fresh foods HPN c&i$i$ – dangerousD Increase 0/.E(7 -0.0 P.i"' food – eat S.0-I4 #4.*. hallucinations.lcohol Fermented foods Beer #ggplant 0hocolate preservatives – tocino.7I4 K(4(FF 4.(I mARplan 9> .+ .(0 -0.)elirium tremors – happens due S+S activation -remors. -0.*I+ -(F/.effect > – A&%s Increase #. ..nti depressants – full stomach . $ologna. -0. except anti anxiety< . most S..( @ increase serotonin give *.ll meds ta%e on a full stomach. T&i C+c%ic A"#id'(&'$$!"#$ –1 -0.+.EI4 P/(K.

4oss of spouse . hypoactive.SC = – Pt is &ithdra&n > – /is% for self directed violence suicide 9 – eat 1&t gain2 or not eat1&t loss2.female 1hesitant2 .. I &ill give re&ard< I< )epression – > &%s or more of sx @ clinical depression H< .loneness Best approach for suicide? )irect approach +ursing *gt? close surveillance 6ospital area maJority suicide happens at? &ee%ends 9 – = am Sunday Mee%end – less staff personnel #arly am – every one is asleep "ive simple tas%< )on’t give complex tas% – no Jigsa& pu33le Mater the plants Mash the dishes except sharp o$Jects 9= .re you going to commit suicideN I – irregular interval of visit to pt room # – early am B endorsement period . terminal Suicide -riad? . #0--electroconvulsive therapy .nger – Mhy me.#S? I &ont $e a pro$lem any longer! /emem$er me &hen I’m gone! -his is my last day! -his is my &edding ring< "ive it to my son! . &hy "odND =< Bargaining – If returned.+ARdil PARnate DEPRESSION – decrease serotonin< If unresponsive to drugs. sleep or not sleep.cceptance – client acts according to situation< Pt prepares living &ill< Increase ris% for self directed violence< *aslo&s? H– I – decrease Self-esteem – give -.time pt’s commit suicide< Mho &ill commit suicideN S – sex – male 1more successful2.I0I)# 0. &hy no&.ssess? 9< )enial – this cant $e happening< -his cant $e real< >< . /+ should? ) –d irect Fuestion – .4oss of Jo$ . – age – 9H – >Iyo or a$ove IH ) – depression P – pt &ith previous attempts &ill try again # – #-(6 – 1#thanol2 alcoholics / – irrational S – lac%s social support ( – organi3ed plan – greater ris% + – no family S – sic%ness. decrease sex S.Sudden change in mood< Pt is suicidal.

lcohol – coma *orphine – $radypnea Mithdra&al 1opposite of &ithdra&al is overdose2 sei3ure tachypnea )etox – &ithdra&al &ith *) supervision *ethadone 9I . – amphetamines U(('&$ Sei3ure -achypnea Do/"'&$ decrease //.-$' Mo.ll his vital signs &ill shoot upD Same &ith uppers< #x? Pt had cocaine intoxication< Pt &ill manifest hyperactivity. retention )ecrease BP State of euphoria Para Sx of &ithdra&al – reverse of effect 9< Cno& if upper or do&ner >< (pposite of effect (verdose . tachypnea. patient &ill experience the opposite effect of a do&ner< . sei3ure< )uring &ithdra&al.sleep )ecreased "I constriction )ecrease ".'"#$ 1do&ner2 .+arcan 1narcotic antagonist2 1uppers2 0 – cocaine 6 – 6allucinogens .ddict? 9< +ervous -----tremors "ive do&ners Sx of overdose 9< Identify if drug is upper or do&ner >< 0hec% effect =< Sx of &ithdra&al If patient ta%es a do&ner.$#!"c' A. pt &ill manifest $radypnea or coma< S-. decrease 6/ constricted pupil *oist mouth )ilated Blood Eessels 0oma . all vital signs are do&nD If he stops ta%ing it 1during &ithdra&al2.ntidote . – alcohol B – $ar$iturates ( – opiates + – narcotics * – mariJuana *orph 0()# 6#/( .SUBSTANCE ABUSE -ype of .

don’t %no& name of o$Ject .nidimentional classification or unidimentional characteristic< 0hild can fix toys according to si3e.Sits do&n on chair .concrete association< *ultidemensional 9>yoF-ormal operation – good in a$stract thin%ing< 0an interpret prover$s< 06I4) ./).praxia – can’t do it )issociative Fugue. $one fractures.ta%es a ne& personality from a tar a&ay place< +e& place ne& identity< )issociative Identity )isorder – multiple personality )issociative .Q8-998 L(6+ PI.nomia."#.S# B @$urns. $ungi )on’t $athe child< )on’t $rush teeth< Body of evidence &ill $e lost< Bantay Bata 9A= . $ruises.4K6#I*#/ .phasia – can’t say it .ppers 0odeine 6allucinogen . touch2 . height@one at a time only< P-9> yo0-conservation. see.gnosia – pro$lem &ith senses 1smell.dilate *outh – dry )ecrease appetite . a&a%e sei3ure "I . hear.B.+-< 0ant $e trained< Stay &ith patient< Severe */ >8-=H *oderate =H-H8 @ 0an $e trained< *ental age is >-Pyo< Pre-operational stage< *ild H8-P8 @ 1mild 02 *ental age is 0-9>< #duca$le< 0an go to school< Borderline.0("+I-IE# -6#(/5 8-> yrs old – S-ensory motor< Ba$y can sense. perceive and hear< ($Ject permanence >-I yoP-reconceptual.P8-Q8 +ormal.-I(+ Profound severe moderate IU >8 =H H8 mild P8 $orderline Q8 normal 998 Profound *ental retardation IU S>8 @thin%s li%e an I+F. color.BP increase.&here I am< 9H .thin )epressed .diarrhea Stop uppers -remors Fatigue crash syndrome Suicide 4#E#4S (F *#+-.4 /#-.>< )epressed .language< I-P yoI-ntuitive stage< .mnesia – don’t %no& &ho.mphetamine sympathetic increased heart increase 6/ increase pupils. taste.

succinylcholine chloride – to relax muscles Post-#0Side-lying.lateral S. assist Provide safety< *o$ili3e support system< I &ill stay &ith you< . di33iness.P5.ccept Seem.*S? +sg intervention? 4oo% for &ords li%e? S @safety.4IK.4SIE# -6#/. set limits.nonymous 9A .sign informed consent< For depressed pt< If meds don’t &or%. support. temporary memory loss 1distinct sx2@/+-orient pt< #7. pt &ith dementia .# headache.-I(+. o$served. use #0-< Pre-#0+-npo A hours .)#P#/S(+.+(+ groups –.facilitator is /+< /ape. stay. $attered pt .don’t allo& patient to mis$ehave< 4oo% for &ords li%e? (rient@orient pt post delirium.lcoholics .%ulit< I &ant to tal% a$out something $ecause this is something that I &ant to do< It is something that I need to tal% a$out< -his is something that I &ant to do<! #4#0-/(0(+E.-I(+. shares experience to ne& victim< Self-help group@facilitator is the pt themselves< . #0-.-atropine sulfate – dry mouth B-$ar$iturate S. comment.4 .ssist in activity< Set limit.4-/.IS* – Eictim $ecomes a counselor. feelingsO! "roup therapy.$elieve that they are not persons anymore P#/S#E#/. noticed.

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