PSYCHIATRIC NURSING Rvw Ctr

BeliefsFeelingsBehavior Sigmund Freud Father of Psychoanalysis -structure of personality Idimpulsive part, pleasure principle -eat, urinate, have sex -its all I!

Royal Pentagon

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

/e$el, dirty, diso$edient

@ (0 @anal retentive P6,44I0 =-A yrs old -penis B vagina -love of parent of opposite sex (edipal-$oy loves mom #lectra-girl loves dad

@,nti-social @anal expulsive

Identification- $oy imitates dad 0astration fears- fear that dad is angry at him and &ill cut off penis Penis envy- girls envy little $oys )r< Caren 6orney- detractor of Freud, didnt $elieve in penis envy< Freud said that it is may$e in her unconscious mind< (r repressed< 0onscious- highest level of a&areness Pre-conscious- at tip of tongue .nconscious forgotten /epression-%ept in unconscious< .nconscious forgotten< Suppression conscious forgetting 4,-#+-- A-9> years old 4atent- 4ogtu @ sexual energy asleep School age School pho$ia- 9st time to go to school Separation anxiety 0hild is $usy &ith /eading, &riting, arithmetic< Su$limation putting anger into something more productive putting all energies into schooling #x< ,ngry at life, pour anger in singing< "#+I-,4 9> years old "enital-"ising sexual energy Sexual intercourse most important in this stageDD P6,/*, *(*#+-S ,nti-anxiety )rugs 1used also for alcohol &ithdra&al2 Ealium 4i$rium ,tivan Serax *ilto&n #Fuanil Eistaril ,tarax #/IC #/ICS(+ S-,"# 8-9: months 1(ral2 9: mos- =yrs old 1,nal2 1G2 -rust vs ,utonomy vs ,u-1anal2 -o-ilet training +o-+oD Favorite &ord< *y Initiative vs 1Initiate 9st steps2 Phallic-oedipal,electra Industry vs Identity vs Intimacy vs "enerativity vs #go Integrity vs 1-2 *istrust Shame;dou$t F,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- develop trust 9st

>

-pts are dependent@self care deficit -develop;teach autonomy -then pt &ill develop initiative -etc

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

,nti-cholinergic ; anti-parasympathetic @effect is sympatheticD Sympathetic drug classifications? ,- anxiety P- psychotic

,nti
mARplan nARdil pARnate

0- cholinergic )- depressants

*(+( ,*I+# (7I),S# I+6IBI-(/S?

DEFENSE MECHANISMS?

coping mechanism from stress?

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

M(/CI+" Pro$lem solving )iscussion Patient is most cooperative

-#/*I+,-I(+ #valuation Summari3e Say good$ye "rief-,+"#/-focus of /+ Pt might $ecome violent;suicidal

,+-I-P,/CI+S(+ )/."S 10apa$les2 used &ith anti-psychotics

,nti-cholinergic ,B0 0,P,B4#S0ogentin ,rtane Parlodel ,%ineton Benadryl 4arodopa #ldepryl Symmetrel

)opaminergic P4S#

-6#/,P#.-I0 0(**.+I0,-I(+ 9< (ffer selfIll stay;sit &ith you<! >< #xplores use &hat, &hen, &here, ho& =< Silence I< ,ctive listening-nodding, eye contact, leaning for&ard-sho& active participation< H< *a%e o$servations< 5ou see; I have o$served; I have noticedO! A< Broad opening- 6o& are youN! 5ou have com$ed your hair today<! P< 0larification- Mhat do you mean $y ploopplan%N! :< /estating- I dont &ant to eat<! 1Mord per &ord repetitionD2 5ou dont &ant to eatN! Q< "eneral leads- ,nd then;Mhat else;"o onO! 98< /efocusing- Me &ere tal%ing a$t the examO! 99< Focusing- -ell me more a$t this<! ,B" ,+,45SIS Ph B P0(>-/espiratory-opposite signs Ph B 608>-*eta$olic same signs 0ompensation?

+(+- -6#/,P#.-I0 )ont &orry, $e happy<! MhyN Puts pt in defensive position< 0hange the su$Ject< #verythings going to $e alright<! giving False reassurance< Ignore the patient< PreJudicial< +ice &eather today<! value $ased Judgment< Flattery dont use too much adJectives< 5ou have the most $eautiful hair in the &ard<! ,rguing &ith the patient )ont impose your opinion<

Ph is normal@Fully compensated< 08> B 608= same signs @ Partially compensated

ANXIETY -vague sense of impending doom< Sympathetic activation< ,ssessment? 4evel of anxiety *I4)-------------------sit restlessly, &idened perceptual field, enhanced learning experience< 5ou seem anxious<! *()#/,-#----------patient is pacing, selective inattention< "ive P/+ meds-,nti-anxiety drugs-valiumO S#E#/#----------------patient cant ma%e decisions< I dont %no& &hat to do or say<! /+ directs patient< Sit do&n on the chair<! )irective< P,+I0highest level of anxiety< Suicidal< Priority? safety< Stay &ith patient< )ont touch pt< Sympathetic activation< I thin% Im having a heart attac%D! +rs )x? -----------------Ineffective Individual 0oping P;I? )ecrease anxiety, decrease stimuli 6-? relaxation techniFue #? #ffective Individual 0oping

GENERALIZED ANXIETY DISORDER A months excessive &orrying< Patient %no&s &hat the pro$lem is< 0ant sleep, concentrate, seat Fatigue and palpitations PANIC ATTACK ------------------------------9H-=8 minutes, happens &ithout &arning< S+S activation< -&ith or &ithout agorapho$ia -------------------- fear of open space -social pho$ia ------------------------------------- fear of pu$lic -provide safety -al%alosis-$ro&n $ag -stay &ith patient -$e directive POST TRAUMATIC STRESS DISORDER Eictims rape, accident, &ar 3one, disaster, trauma 9< >< =< Survivor Flash$ac% R 9 month *emory nightmares

*,4I+"#/I+"------------------------------------- no organic $asis 1no tissue change2 -pretending to $e sic%, conscious -decrease anxiety for primary gain -increase attention from /+ secondary gain SOMATOFORM DISORDER ------------------unconscious, not pretending, no organic $asis - goes doctor hopping

+ervous system 0(+E#/SI(+ -loss of sensory;motor fx -s;sx real 1$iglang na$ulag2

*inor discomfort -Feels li%e illness -65P(06(+)/I,SIS

B()5 )5S*(/P6I0 )IS(/)#/ -illusion of structural defect -S;sx not real

PSYCHOSOMATIC DISORDER 1Psychophysiologic2 real illness, real s;sx, real pain, &ith organic $asis 1&ith change in tissue2 - stress ulcers, migraine, 6P+ PHOBIA---------------------------------------------------------- irrational fear #tiology %no&ledge, experience Immediate nsg intervention? /emove o$Ject of fear 1Increase stimuli@increase level of anxiety2 1)ecrease stimuli@decrease anxiety2 Belief ($Ject &ill hurt patient Feeling Scared Behavior ,voidant@interferes &ith ,)4

"radual exposure to feared o$Ject- S5S-#*,-I0 )#S#+S5-6#K,-I(+ Individual -herapy 9< 6ypnosis --------------relaxed state >< Free association ------ ideas shared to psychoanalyst =< 0atharsis --------------free to express feeling I< -ransterence- -----------patient feels something for psychoanalyst H< 0ountertransterence --/+ feels something for patient

"reen light-"o #pi B +orepinephrine /ed light Stop "-gamma ,-amino B-$utyric ,- acid ,nxiety Increase ",B, ,nti"I".cholinergic S;# constipation retention #ffect of ",B,? )ro&sy, drin%, dont drive, orthostatic hypotension ,nti-anxiety drug Mithdra&al from drug a$rupt /#B(.+) P6#+(*#+, leads to sei3ures< 9 &ee% effect< "radual &ithdra&al tapered dose )ependence- 0ant live &ithout valium ,+-I-PS506(-I0 ,"#+-S S-#4,KI+# S#/#+-I4 -6(/,KI+# -/I4,F(+ Sympathetic effect< #ffect >-I &ee%s

04(K,/I4 *#44,/I4 6,4)(4 P/(4I7I+

SCHIZOPHRENIA-------------------------------impaired reality perception< #go disintegration< "enetic vulnera$ility< Stress< -0hose fantasy over reality< Increase dopamine theory< 0ause? un%no&n< Increase dopamine, increase schi3ophrenia< I ,s? 9< ,ffect---------------------------------------------feelings B emotions 1smiles, laughs2< #xternal, readily o$serva$le< *ood, internal, does not match affect< 1sad inside2 >< ,m$ivalence-------------------------------------pulled $et&een > opposing forces =< ,utism --------------------------------------------self a$sor$ed< -rapped in his o&n &orld<,ttached to odd o$Jects<Poor eye contact< I< ,ssociative looseness---------------------------tal% a$out so many things $ut unrelated ideas< )istur$ed thought process-------------------------+sg dx 0ontent of thought---------------6allucinations;Illusions------------,)4----------------------------6arm

)istur$ed thought process )istur$ed sensory Perception P;I? /eality;(rient;Safety #val? Improved thought process S B Sx of Schi3ophrenia? 1-2neg sx hypoactive &ithdra&n Fuiet, flat affect poverty of &ords Self care deficit Self (ther )irected Eiolence

1G2 positive sx hyperactive flight of ideas restless tal%ative delusions many Fueen of the &orld illusions

hallucinations ideas

-ypes of schi3ophrenia? 9< )isorgani3ed schi3o---------------------------------sad inside, happy outside inappropriate affect 1G2 flat affect no affect 1-2 disorgani3ed manner;speech flight of ideas 1G2 6e$ephrenic- 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;&ithdra&n;violent Based on history

)evelop trust? orientation -9?9 interaction -consistent approach -short;freFuent interaction -food? sealed container -meds? &rapped in tamper resistant foil I< .nclassified; .ndifferentiated-----------------------cant $e classified anymore< H< /esidual-------------------------------------------------no more 1G2, 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 ,SS(0I,-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- (F I)#,S ---------------------------------+e& unrelated topics< I am going to the mall< Mhere is the lightN I treasure this chal%< 6urrayD! =< ,*BIE,4#+0#-------------------------------------Pulled $y > opposing forces< I< *,"I0,4 -6I+CI+"----------------------------- $elieves he has magical po&ers< I can turn you into a frog<! H< #06(4,4I,------------------------------------------repeat &hat is said< Parrots< A< #06(P/,7I,----------------------------------------repeats &hat you do< /epeats &hat is seen< P< M(/) S,4,)----------------------------------------mixes &ords that dont rhyme< :< 04,+" ,SS(0I,-I(+----------------------------uses &ords that rhyme< Flan%, $lan%, pran%<! Q< +#(4("IS*------------------------------------------invents ne& &ords not in the dictionary< Ploopplan%, pisno%<! 98< )#4.SI(+S-----------------------------------------false $elief "randeur--------------I am a Fueen; %ing;millionaireD Persecution------------+BI out to get meD Ideas of reference------hey tal% and &rite a$out meD 99< 0(+0/#-# ,SS(0I,-I(+-----------------------pilosopo< Mhat &ill you &ear tomorro&N! 0lothesD! 9>< 6,44.0I+,-I(+S----------------------I44.SI(+S 1&ith stimuli2 Stimuli + 5 Eisual + 5 ,uditory + 5 -actile + 5 Present realityDDD 6 , / )-)irective< 4ets go in the garden<!

,c%no&ledge? I %no& the voices are real to you< @,ssess &hat voices are saying to %no& if patient &ill harm himself<

Present reality< But I cant hear them<!

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< ,C,-6ISI,-------------------------- restless, ina$ility to sit still< >< ,CI+ISI, ---------------------------- rigidity =< )5S-(+I,--------------------------- affects nec% -(/-I0(44IS -------------&ry nec% (0.4("5/I0 0/ISIS fixed stare (PIS-6(-(+.S ---------arched $ac%, contracted I< -,/)IE# )5SCI+#SI,------------lip smac%ing, tongue is protruding, puffy chee%s< Irreversi$leD H< +#./(4#P-I0 *,4I"+,+- S5+)/(*#- hyperthermia, unsta$le BP, increase 0PC, diaphoresis, pallor -discontinue meds, medical emergency< A< P6(-(S#+SI-IEI-5------------------&ear shades, sunscreen P< MB0- ,granulocytosis---------------sore throat, fever, malaise, leu%openia AUTISM- $oys R girls< 9?988 %ids gift-autistic savants -echolalis, poor eye contact, cant express ver$ally< ,ssess? ,- appearance- neat, (0, &ants constancy B- $ehavior- ritualistic $ehavior, flat affect, repetitive 0- communication difficulty communicating +sg )x? Impaired social interaction cant form IP/ 1Interpersonal relationship2 Impaired ver$al communication Self mutilation cant express anger< #xpress it in&ard< /is% for inJury P;I? #? constancy, promote safety #xpressive therapy uses art, music, poetry, decreasing ris% for inJury, improved social interaction, $e a$le to express feelings< -Safety

ADHD- 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 ,ssessment? ,- appearance? dirty B- $ehavior? clumsy, impatient, easily distracted 0- tal%ative +sg )x? 6igh ris% for inJury Safety Structure- provide place to study, eat, play,$ath,etc< Schedule time for everything Set limits /esidual ,)6) gro&s up not anti-social *eds? /italin, )exedrine,Pemoline, ,dderal Best time to give meds? If once a day give ,F-#/ *#,4S- to prevent loss of appetite< )ont give at $edtime-its a stimulant-&ill cause insomia< 0an $e given Ahours $efore $edtime 1if F>d2

ANOREXIA NERVOSA diet, under&eight S :HT of expected fat, = months amenorrhea, failure to recogni3e pro$lem< BULIMIA NERVOSA induce vomiting, ta%es laxative, normal &eight, irregular menstruation, dental carries, diarrhea - %no&s pro$lem $ut ashamed and em$arrassed, Priority? Fluid volume $alance Meight gain monitor &eight, eating pattern, stay 9 hour after eating, accompany in toilet Pro$lem? +I? Body image )istur$ance 9< #sta$lish nutrition pattern >< -each stress management, Journal %eeping =< *onitor eating pattern and &eight< I< ,nti-depressant MANIA needs mood sta$ili3ing agents- 4ithium< "roup therapy 4- 8<H-9<H m#F;4 1If level is near ><H-= m#F;4 &ill cause ataxia and mental confusion2 I- increase urination -- tremors 6- 6>8- =4;d I- increase -- uu *- mouth dry +- +a- 9=H-9IH m#F;4 to hold &ater 0hec% %idney1$lood level2 $efore administration of 4ithium B.+, 0/#,, electrolyte 4ithium toxicity n;v, diarrhea @ )iamox BIPOLAR DISORDER > poles, happy 1more dominant2 B sad -female, R>8 yrs old, stress, o$ese Self actuali3ation -as% to decrease self esteem Family therapy /is% for inJury, ris% for other directed violence )ecrease eat, decreased sleep, hyperactive, increase sex mastur$ate in front of others +sg )x? 6igh ris% for self or other directed violence /is% for inJury "ive tas%, no group games, any competition &ill increase anxiety, &ater the plants, activities using gross motor s%ills, escorted &al%, punching $ag-displacement< = or more signs confirms disorder? " grandiose, increase ris% activities F flt of ideas S - sleeplessness P pressured speech # exaggerated S# # extraneous stimuli 1easily distracted2 ) distracta$ility PERSONALITY DISORDER

9< Schizoid --------doesnt care a$out people, $elieves that he can stand on his o&n, never had a $est friend >< =<
avoid groups B activities no enJoyment cares more a$out computers, pets A oid!"# ----------avoid group fear criticism, have talent $ut no confidence< A"#i-$oci!% ------as child steal, lie, al&ays get reprimanded ,dult grand ro$$ery, illegal activities against the la&< drug addiction, drives fast, unsafe sex, thrill see%er< "ood tal%er, charmer, &itty, manipulator< *otto I &ill $rea% the la&!

98

I< Bo&d'&%i"' -------Favorite line life is an empty glass<! Splitting, suicidal, superficial relationship, la$ile-sudden change of
*ood, self mutilation< 1G2 fill glass &ith friends have happy moments 1-2 suicide sad moment

4,BI4# ,FF#0-

la$ile- change from good to $ad in a split moment

H< D'('"d'"# ---------)ecrease self esteem, dependent

Poor decision ma%ing s%ills I cant live if living is &ithout you!

A< Hi$#&io"ic$ ----------excited, dramatic, manipulative P< :<

- 0#+-#/ (/ ,--#+-I(+ N!&ci$$i$#ic---------- I love myself! insensitive, arrogant, self a$sor$ed - exaggerated Self esteem, am$itious I am the $est! OC ------------------ perfectionist, organi3ed, constancy in environment< Provide time to do rituals<

Q< P!&!"oid ----------- al&ays Jealous, suspicious, violent 98< P!$$i ' !))&'$$i ' ------al&ays say yes!, $ut resistance is hidden<
+sg Intervention? Improve IP/, $uild trust A-LCOHOL ABUSE ----------------------happy sociali3ing -escape from pro$lem -peer pressure B-$lac%out ---------------- a&a%e $ut una&are 0-confa$ulation ---------- invent stories to increase Self-#steem )-denial ------------------- I am at not an alcoholic<! )-dependence ------------ I cant live &ithout alcohol<! a< physical tremors, tachycardia, restless $< psychological craving #-ena$ling;codependency 1significant others tolerate a$users2 )IS.4FI/,* voids alcohol version therapy nta$use 1)IS.4FI/,*2 lcoholics anonymous $eer n;v hypotension interval of alcohol B anta$use? 9>h interval after alcohol inta%e +arcotic oversode-give +arcan +arcotic detox- *ethadone ,version therapy-,nta$use

B9 -hiamine 0omplications

&ernic%es #ncephalopathy Corsa%off psychosis

Mernic%es E/((* *otor sx effect Corsa%off memory- confa$ulation

99

>I P>h after alcohol inta%e )elirium tremors happens due S+S activation -remors, hallucinations, illusions< Mell lit room to avoid hallucinations ,+-I )#P/#SS,+-S decrease serotonin pro$lem ,nti depressants full stomach ,ll meds ta%e on a full stomach, except anti anxiety< ,S#+)I+ +(/P/,*I+ -(F/,+I4 SI+#U.,+ ,+,P/,+I4 ,E#+-54 EIE,0-I4 #4,EI4 P/(K,0 P,7I4 K(4(FF 4.E(7 -0, -0, -0, -0, -0, - (0 -0, -0, -0, 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;#2 / I 19 I &ee%s2

If SS/I dont &or%, give -0, T&i C+c%ic A"#id'(&'$$!"#$ 1 -0,2 ----------> I &%s has increased S;# increased Serotonin B +orephinephrine

MAOI-------------------------- effect > A&%s Increase #, +#, serotonin %ills serotonin - *,(I increase *,( @ decrease serotonin V decrease *,( @ increase serotonin give *,(I *ost dangerous, most S;# )iet avoid #+&!,i"' food eat S,/IM,, fresh foods HPN c&i$i$ dangerousD Increase 0/, diaphoresis -yramine rich food? ,vocado Pic%les ,lcohol Fermented foods Beer #ggplant 0hocolate preservatives tocino, $ologna,canned meat etc< 0heese mo3erella, s&iss cheese M ine S soysauce ,nticholinergic @ antidepressants antiparasympathetic )ry, constipation, retention, tachycardia *ale erectile dysfunction *,(I

9>

mARplan +ARdil PARnate

DEPRESSION decrease serotonin< If unresponsive to drugs, #0--electroconvulsive therapy ,ssess? 9< )enial this cant $e happening< -his cant $e real< >< ,nger Mhy me, &hy no&, &hy "odND =< Bargaining If returned, I &ill give re&ard< I< )epression > &%s or more of sx @ clinical depression H< ,cceptance client acts according to situation< Pt prepares living &ill< Increase ris% for self directed violence< *aslo&s? H I decrease Self-esteem give -,SC = Pt is &ithdra&n > /is% for self directed violence suicide 9 eat 1&t gain2 or not eat1&t loss2, sleep or not sleep, hypoactive, decrease sex S.I0I)# 0.#S? I &ont $e a pro$lem any longer! /emem$er me &hen Im gone! -his is my last day! -his is my &edding ring< "ive it to my son! - Sudden change in mood< Pt is suicidal, /+ should? ) d irect Fuestion ,re you going to commit suicideN I irregular interval of visit to pt room # early am B endorsement period - time pts commit suicide<

Mho &ill commit suicideN S sex male 1more successful2;female 1hesitant2 , age 9H >Iyo or a$ove IH ) depression P pt &ith previous attempts &ill try again # #-(6 1#thanol2 alcoholics / irrational S lac%s social support ( organi3ed plan greater ris% + no family S sic%ness, terminal Suicide -riad? - 4oss of spouse - 4oss of Jo$ - ,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%< )ont give complex tas% no Jigsa& pu33le Mater the plants Mash the dishes except sharp o$Jects

9=

SUBSTANCE ABUSE -ype of ,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, all vital signs are do&nD If he stops ta%ing it 1during &ithdra&al2, patient &ill experience the opposite effect of a do&ner< ,ll his vital signs &ill shoot upD Same &ith uppers< #x? Pt had cocaine intoxication< Pt &ill manifest hyperactivity, tachypnea, sei3ure< )uring &ithdra&al, pt &ill manifest $radypnea or coma< S-.$#!"c' A.-$' Mo,'"#$ 1do&ner2 , alcohol B $ar$iturates ( opiates + narcotics * mariJuana *orph 0()# 6#/(

,ntidote - +arcan 1narcotic antagonist2

1uppers2
0 cocaine 6 6allucinogens , amphetamines U(('&$ Sei3ure -achypnea Do/"'&$ decrease //, decrease 6/ constricted pupil *oist mouth )ilated Blood Eessels 0oma ,sleep )ecreased "I constriction )ecrease ". 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 ,lcohol coma *orphine $radypnea Mithdra&al 1opposite of &ithdra&al is overdose2 sei3ure tachypnea

)etox &ithdra&al &ith *) supervision

9I

*ethadone >< )epressed - Sits do&n on chair .ppers 0odeine 6allucinogen ,mphetamine

sympathetic

increased heart increase 6/ increase pupils- dilate *outh dry )ecrease appetite - thin )epressed

- BP increase, a&a%e sei3ure "I - diarrhea

Stop uppers -remors Fatigue

crash syndrome

Suicide

4#E#4S (F *#+-,4 /#-,/),-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,+-< 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- P8-Q8 +ormal- Q8-998 L(6+ PI,"#- 0("+I-IE# -6#(/5 8-> yrs old S-ensory motor< Ba$y can sense, see, perceive and hear< ($Ject permanence >-I yoP-reconceptual- language< I-P yoI-ntuitive stage< .nidimentional classification or unidimentional characteristic< 0hild can fix toys according to si3e, color, height@one at a time only< P-9> yo0-conservation;concrete association< *ultidemensional 9>yoF-ormal operation good in a$stract thin%ing< 0an interpret prover$s<

06I4) ,B.S#

@$urns, $ruises, $one fractures, $ungi )ont $athe child< )ont $rush teeth< Body of evidence &ill $e lost< Bantay Bata 9A=

,4K6#I*#/
,nomia- dont %no& name of o$Ject ,gnosia pro$lem &ith senses 1smell, taste, hear, touch2 ,phasia cant say it ,praxia cant do it )issociative Fugue- ta%es a ne& personality from a tar a&ay place< +e& place ne& identity< )issociative Identity )isorder multiple personality )issociative ,mnesia dont %no& &ho;&here I am<

9H

)#P#/S(+,4IK,-I(+- $elieve that they are not persons anymore P#/S#E#/,-I(+- %ulit< I &ant to tal% a$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.4SIE# -6#/,P5- sign informed consent< For depressed pt< If meds dont &or%, use #0-< Pre-#0+-npo A hours ,-atropine sulfate dry mouth B-$ar$iturate S- succinylcholine chloride to relax muscles Post-#0Side-lying- lateral S;# headache, di33iness, temporary memory loss 1distinct sx2@/+-orient pt<

#7,*S? +sg intervention? 4oo% for &ords li%e?

@safety, support, stay, set limits, assist Provide safety< *o$ili3e support system< I &ill stay &ith you< ,ssist in activity< Set limit- dont allo& patient to mis$ehave< 4oo% for &ords li%e? (rient@orient pt post delirium, #0-, pt &ith dementia ,ccept Seem, o$served, noticed, comment, feelingsO! "roup therapy- facilitator is /+< /ape, $attered pt ,4-/.IS* Eictim $ecomes a counselor, shares experience to ne& victim< Self-help group@facilitator is the pt themselves< ,4 ,+(+ groups ,lcoholics ,nonymous

9A