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Compilation of Psych Notes

Compilation of Psych Notes

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PSYCHIATRIC NURSING

   

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. 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. Schizophrenia LIBIDO

  

 

Sexual energy responsible for survival.

1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.] ORAL STAGE
 

0 – 18 months evident. ID is developed.

*FIXATION – Person is stuck in certain developmental shape. *REGRESSION – Return to an earlier developmental stage. *EGO – Developed on the 6th month. ANAL STAGE
   

18 months – 3 years old. Able to control bladder, bowel. Best time for toilet training. SUPEREGO is developed. TOILET TRAINING

Good Mother Successful Dirty - Disorganized - Disobedient - Anti-social

Bad Mother

Clean - organized - obedient - O.C - Anal retentive

- Anal expulsive PHALLIC STAGE
        

3 – 6 years old. Experience pleasure by manipulating genitals. Love – hate relationship. Oedipus Complex boy loves parent of the opposite sex. Imitates daddy called IDENTIFICATION. Castration fears. Electra Complex girl loves parent of the opposite sex. Imitates mommy called identification. Penis envy. 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

*Conscious – upper level of thinking. *Preconscious – tip of tongue. *Unconscious – protects us from traumatic experiences. LATENCY STAGE
    

6 – 12 years old. School age. Separation anxiety. Reading, Writing, Arithmetic. Lasts for 6 years.

GENITAL STAGE
  

12 years old and above Sexual reawakening. Very important stage.

PHARMACOLOGY NOTES ANTI ANXIETY DRUGS
     

[S.A.T.L.V.M. – E.V.A.B.I.]
    

Serax Ativan Tanxene Librium Valium Miltown

Equanil Vistaril Atarax Buspar Inderal

ERIC ERIKSON
   

There is more to life than just sex. Psychosocial Theory of development. You can develop a positive side or a negative side. Developmental task begins at 0 – 18 months.

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Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

0 – 18 mos. 18 mos. – 3 yrs. 3 yrs. – 6 yrs. 6 yrs. – 12 yrs. 12 yrs. – 20 yrs. 20 yrs. – 25 yrs. 25 yrs. – 45 yrs. 45 yrs. - above

POSITIVE Trust Autonomy Initiative Industry Identity Intimacy Generativity Ego Integrity

NEGATIVE Mistrust Shame & Doubt Guilt Inferiority Role Confusion Isolation Stagnation Despair

FACTOR Feeding Toilet Training Independence School Peers Love Parenting Reflection

BEHAVIORAL MODELS Ivan Pavlov
 

Classical Conditioning All behaviors are learned.

BF Skinner
   

Behavior can be learned and unlearned. Operant conditioning. If given reward there is repetition. If punished behavior becomes extinct.

LOBES OF BRAIN 1. FRONTAL LOBE
   

3. PARIETAL LOBE
 

Language Learning Personality Judgment Hearing Smell

Touch Taste

4. OCCIPITAL LOBE Visual

2. TEMPORAL LOBE
 

3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory – eyes, ears, tongue 2. Integration 3. Motor – voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM
 

1

Also called as SOMATIC Motor nerve to muscle fiber you need ACETYLCHOLINE which is an “On switch”. Brain

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

Spinal Cord Motor Nerve Synapse Muscle Fiber INVOLUNTARY NERVOUS SYSTEM

Also called AUTONOMIC nervous system.

AUTONOMIC NERVOUS SYSTEM SYMPATHETIC (Awake, ADRENERGIC) Increase Increase Decrease (Dry mouth, Constipation) Decrease (Urinary Retention) Epinephrine, Norepinephrine PARASYMPATHETIC (Relax, CHOLINERGIC) Decrease Decrease Increase (Moist mouth, Diarrhea) Increase (Urinary Frequency) Acetylcholine

Heart Rate Respiratory Rate GI GU Neurotransmitter

DRUGS WITH ANTICHOLINERGIC EFFECTS
   

Anti – Anxiety Anti – Psychotic Anti – Cholinergic Anti – Depressants

PHARMACOLOGY NOTES MONOAMINE OXIDASE INHIBITORS
  

Marplan Nardil Parnate DEFENSE MECHANISMS 1. DISPLACEMENT – transfer of feelings to a less threatening object rather than the one who provoked it. 2. DENIAL – failure to acknowledge an unacceptable trait or situation. 3. DISSOCIATION – psychological flight from the self. 4. REGRESSION – return to an earlier development state. 5. REPRESSION – unconscious forgetting. 6. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation. 7. REACTION FORMATION – doing the opposite of what you have done. 8. UNDOING – doing the opposite of what you have done. 9. IDENTIFICATION – assuming trait for personal, social, occupational role. 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

10. PROJECTION – attribute to others one’s unacceptable trait. 11. INTROJECTION – assume another person’s trait as your own. 12. SUPPRESSION – conscious forgetting. 13. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive endeavors. 14. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms. 15. COMPENSATION – over achievement in one area to cover a defective part. 16. SUBSTITUTION – replace difficult goal with more accessible one. PHARMACOLOGY NOTES ANTI – PARKINSON DRUG [C.A.P.A.B.L.E.S]
       

Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetrel SYMPATHETIC Dilate Constrict Increase PARASYMPATHETIC Constrict Dilate Decrease

AUTONOMIC NERVOUS SYSTEM Pupils Blood Vessels Blood Pressure

THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. Offer Self 2. Silence – provide time to think 3. Making observation – what you see you say 4. Active Listening – nodding, eye contact 5. Broad Opening – how are you today? 6. General Leads – Go on, I’m listening 7. Restating – I’m sad “You’re sad?” FEAR – protects us from something bad. ANXIETY
  

NONTHERAPEUTIC 1. Don’t worry be happy 2. Changing the topic/subject 3. Ignore the client 4. Value based judgment – never assume 5. Flattery 6. Advising 7. Giving Opinion

Vague sense of impending doom. Triggers the sympathetic nervous system. Assess level of anxiety of client.

1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

TYPES OF ANXIETY MILD ANXIETY
   

+ 1 level of anxiety. Widened perceptual field. Restless (say you seem restless). Enhanced learning capacity. + 2 level of anxiety. Client pace. Give PRN meds. + 3 level of anxiety. Don’t know what to do/say. Directive orders (please sit down).

MODERATE ANXIETY
  

SEVERE ANXIETY
  

PANIC
     

+ 4 level of anxiety. May commit suicide. Promote safety. Never touch patient. Hyperventilation (Respiratory Alkalosis) Breathe into paper bag. NURSING DIAGNOSIS PLANNING/IMPLEMENTATION
  

  

Ineffective individual coping. Powerlessness. Impaired skin integrity EVALUATION

Decrease level of anxiety. Decrease environmental stimuli. Relaxation techniques

Effective individual coping.

GENERALIZED ANXIETY DISORDER
 

6 month excessive worrying. Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability.

PANIC ATTACKS/ DISORDER
 

15 – 30 minutes sympathetic nervous system escalation. Example is AGORAPHOBIA fear of open spaces.

1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

POST TRAUMATIC STRESS DISORDER

Victims become survivors and experience flashbacks or nightmares.

MALINGERING
  

Pretending to be sick (conscious). Primary Gain anxiety decreases, able to escape source of anxiety. Secondary Gain able to get attention.

SOMATOFORM DISORDER
  

No protection Unconscious No organic basis of being sick

DIFFERENT TYPES OF SOMATOFORM 1. Conversion Disorder
 

Cannot speak, see, hear. Nervous system affected. 2. La Belle Indifference

Do not care what happens to them.

HYPOCHONDRIASIS
 

has minor discomfort and interprets it as major illness. Focus on clients feelings. Illusion of structural defect. Favorite past time is doctor hopping. Focus on clients feelings. Real pains/illness Real symptoms because of anxiety

BODY DYSMORPHIC DISORDER
  

PSYCHOSOMATIC
 

PSYCHOSOMATIC


Increase Anxiety

1


SNS

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

Increase BP & HR


Hypertension


Fat Deposits


Atherosclerosis


Calcium


Arteriosclerosis


Decrease Oxygen


Angina Pectoris


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

SYMPATHETIC NERVOUS SYSTEM
 

GABA (Gamma Amino Butyric Acid) – stop Epinephrine and Norepinephrine – Go 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

ANTI- ANXIETY MEDICATIONS
    

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 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 Impaired verbal communication Impaired social interaction Self mutilation Risk for injury Maslow’s hierarchy of needs Expressive Therapy – use of art as mode of communication Enhanced communication Improved social interaction Safety

 

AUTISM
     

NURSING DIANOSIS
   

PLANNING/IMPLEMENTATION
 

EVALUATION
  

ATTENTION DEFICIT HYPERACTIVITY DISORDER
      

7 years and below onset Duration: 6 months and above Settings: house and school Assessment Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus Behavior Communication: talkative 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

NURSING DIAGNOSIS
 

Risk for injury Impaired social interaction Structure: place to play, sleep, eat and study Schedule: there is always a time for everything that you do Set limits Safety Minimize risk for injury Improved social interaction FRONTAL LOBE OF ADHD Decreased glucose

PLANNING/IMPLEMENTATION
   

EVALUATION
 


Decreased judgment


Increase impulsiveness ADHD/ Hyperactivity
    

Need a drug that brings glucose level up. Give RITALIN as stimulant May result in loss of appetite Given after meals Given 6 hours before bedtime EATING DISORDERS BULIMIA NERVOSA Eat, eat, vomit Normal weight Irregular menstruation

  

ANOREXIA NERVOSA Eat, eat, eat Less 85% expected body weight 3 months Amenorrhea

  

BULIMIA NERVOSA
   

Metabolic alkalosis (vomiting results to decreased hydrochloric acid) Metabolic acidosis (diarrhea results to decreased bicarbonate) Dental caries Wound in knuckles Fluid and electrolyte imbalance Meal contract Weight gain for client After eating stay with client for 1 hour and accompany when going to the comfort room 1

MANAGEMENT
   

PHARMACOLOGY NOTES

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

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 Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete) Ambivalence: pulled into 2 opposing forces AUTISM: Looseness, no idea, not related to one another ASSESSMENT

ASSESSMENT
  

NEGATIVE Hypoactive Withdrawn Thought Blocking Apathy I. ASSESS

POSITIVE Hyperactive Sociable Flight of ideas

Content of thought Disturbed thought process Present reality Provide safety 1

NURSING DIAGNOSIS

PLANNING/IMPLEMENTATION
 

EVALUATION

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

Improved thought process

II. ASSESS

Hallucinations/ Illusions Disturbed sensory perception Present reality Safety Improved sensory perception

NURSING DIAGNOSIS

PLANNING/IMPLEMENTATION
 

EVALUATION

III. ASSESS

Suspicious Risk for other directed violence Present reality Safety Eliminate/minimize risk for other directed violence

NURSING DIAGNOSIS

PLANNING/IMPLEMENTATION
 

EVALUATION

IV. ASSESS

Suicidal Risk for self directed violence Present reality Safety Eliminate/minimize risk for self directed violence

NURSING DIAGNOSIS

PLANNING/IMPLEMENTATION
 

EVALUATION

1 LOOSENESS OF ASSOCIATION

There is connection with statements

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

FLIGHT OF IDEAS

Jumping from on topic to another Pulled between 2 strong opposing forces acting like magician Client repeats what you say Client repeats what you do Just words no rhyme Words that rhyme Formation of new words (needs clarification) “The NBI is out to get me” “I am Jesus Christ the savior” “ I am the queen of the world” “The nurses are talking about me” Also known as “pilosopo” Unable to think

AMBIVALENCE

MAGICAL THINKING

ECHOLALIA

ECHOPRAXIA

WORD SALAD

CLANG ASSOCIATION

NEOLOGISM

DELUSION: PERSECUTORY

DELUSION: RELIGIOUS

DELUSION: GRANDEUR

DELUSION: IDEAS OF REFERENCE

CONCRETE ASSOCIATION

THOUGHT BLOCKING

STIMULUS VISUAL AUDITORY TACTILE
   

HALLUCINATIONS ABSENT ABSENT ABSENT ABSENT Present reality to clients experiencing hallucinations Technique in handling clients with hallucinations Hallucinations Acknowledgement “I know the voices are real to you”

ILLUSIONS PRESENT PRESENT PRESENT PRESENT 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

  

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 Torticollis (wry-neck) Fixed stare Arched back Lips – smacking Tongue – protruding Cheeks – puffing The 3 are irreversible and called TARDIVE DYSKINESIA NEUROLEPTIC MALIGNANT SYNDROME  Hyperthermia

DYSTONIA

OCULOGYRIC CRISIS

OPISTHOTONUS
     

ANTI – PARKINSON DRUGS 1 ANTICHOLINERGICS (Decrease ACh) DOPAMINERGICS (Increase Dopamine)

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |


Artane, Akineton Benadryl Cogentin OTHER SIDE EFFECTS OF DECREASE DOPAMINE
   


Parlodel Larodopa Eldepryl Symmetrel

Photosensitivity AGRANULOCYTOSIS – decrease WBC Clients prone to infection due to decrease WBC First sign for infection is sore throat CATATONIC - Ambivalence - Waxy flexibility - Favorite word is “No” - Negativism (client do not follow what you tell them to do) Nursing management: Meet needs PARANOID - Suspicious - Mistrust, scared, withdrawn Nursing management: - Gain TRUST by 1 to 1 short interaction but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: - Keep door open - Position near door - Don’t touch client - Call for reinforcement - One arms length away from the client. RESIDUAL - No more positive symptoms just withdrawn UNDIFFIRENTIATED UNCLASSIFIED - Mixed classification, cant be classified

TYPES OF SCHIZOPHRENIA DISORGANIZED - Sad but smiles (Inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech) - Giggling (hebephrenic giggle) - Combination of positive and negative signs and symptoms

PHARMACOLOGY NOTES BI-POLAR, MANIC
  

Lithium: undergo first kidney test and check for blood levels Level: .6 – 1.2 meq/L Increase urination

1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

    

Tremors, fine hand Hydration of 3L/day Increase Uu (diarrhea) Mouth dry Nausea, vomiting, diarrhea Increase sodium

Signs of Lithium toxicity
 

**** WAIT FOR 2 – 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS
BIPOLAR DISORDER/ MANIC PROFILE
   

20 years old Female Stress Obese Decrease appetite (give finger foods) Decrease sleep (place in a private room) 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

ASSESSMENT
       

 

HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS? T - no sports (basketball, volleyball), no fine motor skills only gross motor skills A -llot energies toward more productive endeavors (sublimation) S - escorted walk outdoors K - punching bag (displacement) PHARMACOLOGY NOTES ANTI – DEPRESSANTS
  

1
  

Asendin Norpralamin Tofranil

Sinequan Anafranil Aventyl

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

  

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 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

MANAGEMENT
    

 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 Problem with memory 24 – 72 hours after last dose of alcohol expect:

KORSAKOFF’S PSYCHOSIS

 Delirium Tremens: sympathetic nervous system  Prevent hallucinations/Illusions by placing client in a well lit room  Formication: feeling of bugs crawling under the skin

ALZHEIMERS DISEASE Axon (away) and Dendrites (toward) nerve Neurofibrillary tangles Neurotic plaques ALCOHOL/ DELIRIUM ALZHEIMERS 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

ONSET LEVEL OF CONSCIOUSNESS DURATION MEMORY

Abrupt Fluctuating Hours to days Short term memory loss

Gradual Unaffected Progressive Short term and long term (orient patient)

5 A’s OF ALZHEIMERS 1. Amnesia – memory loss 2. Anomia – don’t know the name 3. Agnosia – sensory problems smell, taste, sight 4. Aphasia EXPRESSIVE: cant say/express Frontal lobe is affected particularly broca’s area RECEPTIVE: cant hear Temporal lobe is affected particularly wernicke’s area 5. Apraxia – can’t do simple things Reminiscing Therapy – talk about past

Patients with Alzheimer’s may experience hallucinations, illusions thus becomes restless and may wander As sun goes down client becomes restless, agitated, 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 SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks Increases serotonin and affects only serotonin PROZAC, PAXIL, ZOLOFT TRICYCLIC ANTI DEPRESSANT Two – four weeks C A
 

 

1 Has higher incidence of side effects Also increases norepinephrine

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, 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, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis Avoid tyramine rich foods  Avocado, Alcohol  Beer  Chocolates, Cheese (aged)  Fermented foods  Pickles  Preserved foods  Soy sauce

 

There is increase incidence of side effects after 2 – 6 weeks MARPLAN, NARDIL, PARNATE

PERSONALITY DISORDERS 1. Schizophrenia

They avoid people because there is no enjoyment 2. Avoidant They avoid people because they are afraid of criticisms They have talent but has no confidence 3. Anti-Social
   

 

Constantly breaks law Project charm They are witty and articulate Manipulative They perceive life as an empty glass They like splitting friends Sudden change in mood “labile affect” Prone to suicide “Cant live if living is without you”

4. Borderline
   

5. Dependent

6. Histrionic
 

1 Constantly wants to be the center of attention Excited, dramatic, manipulative

7. Narcissistic

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

 

“I love myself” They get jealous even with achievement of family members

8. Obsessive – Compulsive

“I am so organized” 9. Paranoid Suspicious May lead to domestic violence

 

ANTI – DEPRESSANT SIDE EFFECTS

MALE – Erectile dysfunction, prone to impotence

GRIEF PROCESS [D.A.B.D.A] 1. 2. 3. 4. 5. Denial – shock/disbelief Anger – question “why me?” Bargaining – if, then Depression – 2 weeks or more sign and symptoms becomes major clinical depression 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, increase/decrease sleep, hypoactive, decrease sexual urge Be sensitive to clients needs

FOR SUICIDAL OBSERVE FOR Verbal communication
  

“I wont be a problem” “This is my last day on earth” “I’ll soon be gone” Giving away of valuables Sudden change in mood

Non-verbal communication
 

WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: “Do you plan to commit suicide?” Irregular/interval visits Endorsement period, EARLY MORNING clients are most likely to commit suicide 1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

DOWNERS [A.B.O.N.-M.M.C.H.] Alcohol Barbiturate Opiates Narcotics Resulting to:
         

Marijuana Morphine Codeine Heroine

Bradycardia Bradypnea Moist mouth Pupils constrict Constipation Urinary retention Hypotension Coma Weight gain Narcotics overdose: give narcotic antagonist (NARCAN, NALOXONE HYDROCHLORIDE)

UPPERS [C.H.A.R.] Cocaine Hallucinogens Amphetamines Resulting to:
       

Tachycardia Awake Tachypnea Dry mouth Pupils dilate Hypertension Seizures Weight loss

1

Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

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