PSYCHIATRIC NURSING

Rvw Ctr

Royal Pentagon

BeliefsFeelingsBehavior
Sigmund Freud Father of Psychoanalysis
-structure of personality
Id-

impulsive part, pleasure principle

-eat, urinate, have sex
-its all I

Superego small voice of God

-conscience
-should not eat yet, should not eat yet
Ego- arbiter, decision maker
-in touch with reality
Id___________________Superego
EGO
ID DOMINANT needs a superego-needs a conscience
M- manic
A- antisocial serial killer
N- narcissistic
SUPEREGO DOMINANT needs an Id
O- Obsessive Compulsive
A- Anorexia nervosa
EGO impaired reality perception (RN will present reality)
S- schizophrenia- cant distinguish fact from reality
Libido- sexual energy
FREUD - PSYCHOSEXUAL THEORY
ORAL 0-18 months
Cry, suck mouth- survival
Id dominant
Maternal deprivation if not feed, not given milk/water, not kept warm.
Narcissistic seeks the Id I love myself
Regression return to an earlier stage or earlier level
Fixation stopped in a stage
ANAL- 18 mos-3yrs
Toilet training
Mom is superego.
Superego is being formed
Child is caught in ambivalence pulled in 2 opposing factors
Too much toilet training with punishment will result to a child who is:

Obedient, organized, clean

Rebel, dirty, disobedient

= OC
=anal retentive

=Anti-social
=anal expulsive

PHALLIC 3-6 yrs old

-penis & vagina
-love of parent of opposite sex
Oedipal-boy loves mom
Electra-girl loves dad
Identification- boy imitates dad
Castration fears- fear that dad is angry at him and will cut off penis
Penis envy- girls envy little boys
Dr. Karen Horney- detractor of Freud, didnt believe in penis envy. Freud said that it is maybe in her unconscious
mind.
Or repressed.
Conscious- highest level of awareness
Pre-conscious- at tip of tongue
Unconscious forgotten
Repression-kept in unconscious. Unconscious forgotten.
Suppression conscious forgetting
LATENT- 6-12 years old
Latent- Logtu = sexual energy asleep
School age School phobia- 1st time to go to school Separation anxiety
Child is busy with Reading, writing, arithmetic.
Sublimation putting anger into something more productive
putting all energies into schooling
Ex. Angry at life, pour anger in singing.
GENITAL 12 years old
Genital-Gising sexual energy
Sexual intercourse most important in this stage!!
PHARMA MOMENTS
Anti-anxiety Drugs (used also for alcohol withdrawal)
Valium Librium
Ativan
Serax
Miltown Equanil
Vistaril
Atarax

Tranxene
Inderal

Buspar

ERIK ERIKSON
STAGE
0-18 months (Oral)
18 mos- 3yrs old (Anal)

6-12 yrs old (Latent)

(+)
Trust vs
Autonomy vs
Au-(anal)
To-ilet training
No-No! Favorite word.
My
Initiative vs
(Initiate 1st steps)
Phallic-oedipal,electra
Industry vs

12-20
20-25
25-45
45 up

Identity vs
Intimacy vs
Generativity vs
Ego Integrity vs

3-6 yrs old (Phallic)

(Genital)

(-)
Mistrust
Shame/doubt

FACTOR
Feeding
Toilet training

Guilt anger turned inward Independence

Inferiority
Role confusion
Isolation
Stagnation
Despair

Industry
Induskul
Peers
Love
Parenting
Reflection

Newly admitted pt- develop trust 1st

-pts are dependent=self care deficit

-develop/teach autonomy
-then pt will develop initiative
-etc

Frontal lobe- personality, learning, judgment, language

Occipital- vision
Temporal- hearing, smell
Parietal-taste, touch
Sensory Integration Motor
Somatic nervous system- voluntary movements
Acetylcholine- responsible for voluntary movements
- on switch of movement
Autonomic nervous system- involuntary movements
-Sympathetic(Anti cholinergic) and parasympathetic (cholinergic)
Heart
Respiratory
GI (opposite effect)
GU (opposite effect)
Neurotransmitter
Pupils
Blood vessels
BP

SYMPATHETIC (alert)
tachycardia
tachypnea
Slow, constipation
Slow, oliguria, retention
Dry mouth
Epinephrine, Norepinephrine
Dilated (dilat when alert) (Midriasis)
vasoconstriction
increased

PARASYMPATHETIC (relax)
bradycardia
bradypnea
diarrhea
Polyuria, frequency
Moist mouth
Acetylcholine (AcH)
Constricted (Myotic)
vasodilated
decreased

Anti-cholinergic / anti-parasympathetic =effect is sympathetic!

Sympathetic drug classifications:
A- anxiety
P- psychotic

Anti

C- cholinergic
D- depressants

MONO AMINE OXIDASE INHIBITORS:

mARplan
nARdil
pARnate

DEFENSE MECHANISMS:

coping mechanism from stress:

DISPLACEMENT- -------------Your boss shouts at you, you shout at your subordinate.

SUBLIMATION - ---------------putting anger into something more productive or +
putting all energies into schooling
Ex. Angry at life, pour anger in singing.
DENIAL----------------------I am not an alcoholic!
DISSOCIATION --------------psychological flight from self. Amnesia. Ex. Rape, trauma
REGRESSION ----------------RETURN to an earlier developmental stage
FIXATION ---------------------stuck in a stage of development
REPRESSION -----------------unconscious forgetting
SUPPRESSION ---------------conscious forgetting. Avoidance. I dont want to talk about it. I dont want to remember it.
RATIONALIZATION -------uses because. Has illogical reasoning. I drink because I dont want to waste the beer in the ref.
REACTION FORMATION----plastic. Doing opposite of intention.
UNDOING----------------------show true feeling/color then feels guilty after.
IDENTIFICATION
-----------models a certain behavior from a certain role model.
PROJECTION -----------------blame other people, pass load to others. Looks for a scapegoat. Not me, but them.
INTROJECTION --------------assume another persons trait as your own. Not just you, me too. Ako din, gusto ko yan.
CONVERSION
repression. Anger turned inward to herself. Converted to physical symptoms.
Sensory-numbness. Motor-paralyzed, tremors.
COMPENSATION
-----------defects of the person, overachieve to cover a defective part.
SUBSTITUTION
-----------when you replace a difficult role with a more accessible one.
Ex.Wants to go to Disneyland but cant afford it. Went to Enchanted Kingdom instead.
Defense mechanism:

Affects/interferes with ADL

Harm to self or others

Behavior Model Ivan Pavlov

Classical Conditioning -behavior learned-repeated (+)
BF Skinner operant conditioning-reinforcement
Confront (-) behavior to make it extinct.
MASLOWS HEIRARCHY OF NEEDS:
5. Self-actualization
4. Self-esteem
3. Love and belonging
2. Safety and security
1. Air, food, water, shelter, clothing, sex Basic physiologic needs
LEVELS OF PREVENTION
PRIMARY
Healthy
Community teaching
Community demographics
STAGES OF INTERACTION
ORIENTATION
Assessment
Establishment of trust
Tell patient about termination
Set contract
Patient is resistant

SECONDARY
ill
Crisis intervention
Treatment and diagnosis

TERTIARY
Relapse avoidance
Rehab centers
Al anon

WORKING
Problem solving
Discussion
Patient is most cooperative

TERMINATION
Evaluation
Summarize
Say goodbye
Grief-ANGER-focus of RN
Pt might become violent/suicidal

ANTI-PARKINSON DRUGS (Capables) used with anti-psychotics

Anti-cholinergic
ABC
CAPABLES-

Dopaminergic
PLSE

Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetrel

THERAPEUTIC COMMUNICATION
1. Offer selfIll stay/sit with you.
2. Explores use what, when, where, how
3. Silence
4. Active listening-nodding, eye contact, leaning
forward-show active participation.
5. Make observations. You see/ I have observed/
I have noticed
6. Broad opening- How are you?
You have combed your hair today.
7. Clarification-What do you mean by
ploopplank?
8. Restating-I dont want to eat. (Word per word
repetition!) You dont want to eat?
9. General leads- And then/What else/Go on
10. Refocusing-We were talking abt the exam
11. Focusing-Tell me more abt this.

NON- THERAPEUTIC
Dont worry, be happy.
Why? Puts pt in defensive position.
Change the subject.
Everythings going to be alright. giving
False reassurance.
Ignore the patient.
Prejudicial. Nice weather today. value based
judgment.
Flattery dont use too much adjectives. You have
the most beautiful hair in the ward.
Arguing with the patient
Dont impose your opinion.

ABG ANALYSIS
Ph & PCO2-Respiratory-opposite signs
Ph & HC02-Metabolic same signs
Compensation:

Ph is normal=Fully compensated.
C02 & HC03 same signs = Partially compensated

ANXIETY
-vague sense of impending doom. Sympathetic activation.
Assessment: Level of anxiety
MILD-------------------sit restlessly, widened perceptual field, enhanced learning experience. You seem anxious.
MODERATE----------patient is pacing, selective inattention. Give PRN meds-Anti-anxiety drugs-valium
SEVERE----------------patient cant make decisions. I dont know what to do or say. RN directs patient. Sit down on the
chair. Directive.
PANIChighest level of anxiety. Suicidal. Priority: safety. Stay with patient. Dont touch pt. Sympathetic activation.
I think Im having a heart attack!
Nrs Dx: -----------------Ineffective Individual Coping
P/I: Decrease anxiety, decrease stimuli
HT: relaxation technique
E: Effective Individual Coping

GENERALIZED ANXIETY DISORDER 6 months excessive worrying. Patient knows what the problem is.
Cant sleep, concentrate, seat
Fatigue and palpitations
PANIC ATTACK ------------------------------15-30 minutes, happens without warning. SNS activation.
-with or without agoraphobia -------------------- fear of open space
-social phobia ------------------------------------- fear of public
-provide safety
-alkalosis-brown bag
-stay with patient
-be directive
POST TRAUMATIC STRESS DISORDER
Victims rape, accident, war zone, disaster, trauma
1.
2.
3.

Survivor
Flashback > 1 month
Memory nightmares

MALINGERING------------------------------------- no organic basis (no tissue change)

-pretending to be sick, conscious
-decrease anxiety for primary gain
-increase attention from RN secondary gain
SOMATOFORM DISORDER ------------------unconscious, not pretending, no organic basis
- goes doctor hopping

Nervous system
CONVERSION
-loss of sensory/motor fx
-s/sx real
(biglang nabulag)

Minor discomfort
-Feels like illness
-HYPOCHONDRIASIS

BODY DYSMORPHIC DISORDER

-illusion of structural defect
-S/sx not real

PSYCHOSOMATIC DISORDER (Psychophysiologic) real illness, real s/sx, real pain, with organic basis (with change in tissue)
- stress ulcers, migraine, HPN
PHOBIA---------------------------------------------------------- irrational fear
Etiology knowledge, experience
Immediate nsg intervention: Remove object of fear
(Increase stimuli=increase level of anxiety)
(Decrease stimuli=decrease anxiety)
Belief
Object will hurt patient

Feeling
Scared

Behavior
Avoidant=interferes with ADL

Gradual exposure to feared object- SYSTEMATIC DESENSYTHEZATION

Individual Therapy
1. Hypnosis --------------relaxed state
2. Free association ------ ideas shared to psychoanalyst
3. Catharsis --------------free to express feeling
4. Transterence- -----------patient feels something for psychoanalyst
5. Countertransterence --RN feels something for patient

Green light-Go Epi & Norepinephrine

Red light Stop
G-gamma
A-amino
B-butyric
A- acid
Anxiety
Increase GABA

AntiGIGU-

cholinergic S/E
constipation
retention
Effect of GABA:
Drowsy, drink, dont drive, orthostatic hypotension

Anti-anxiety drug
Withdrawal from drug
abrupt REBOUND PHENOMENA leads to seizures. 1 week effect.
Gradual withdrawal
tapered dose
Dependence- Cant live without valium
ANTI-PSYCHOTIC AGENTS
STELAZINE
SERENTIL
THORAZINE
TRILAFON

Sympathetic effect.
Effect 2-4 weeks

CLOZARIL
MELLARIL
HALDOL
PROLIXIN

SCHIZOPHRENIA-------------------------------impaired reality perception. Ego disintegration. Genetic vulnerability. Stress.

-Chose fantasy over reality. Increase dopamine theory. Cause: unknown.
Increase dopamine, increase schizophrenia.
4 As:
1. Affect---------------------------------------------feelings & emotions (smiles, laughs). External, readily observable.
Mood, internal, does not match affect. (sad inside)
2. Ambivalence-------------------------------------pulled between 2 opposing forces
3. Autism --------------------------------------------self absorbed. Trapped in his own world.Attached to odd objects.Poor eye contact.
4. Associative looseness---------------------------talk about so many things but unrelated ideas.
Disturbed thought process-------------------------Nsg dx
Content of thought---------------Hallucinations/Illusions------------ADL----------------------------Harm

Disturbed thought process

Disturbed sensory
Perception
P/I: Reality/Orient/Safety
Eval: Improved thought process
S & Sx of Schizophrenia:
(-)neg sx
hypoactive
withdrawn
quiet, flat affect
poverty of words

Self care deficit

Self
Other
Directed Violence

(+) positive sx
hyperactive
flight of ideas
restless
talkative
delusions many
queen of the world
illusions

hallucinations
ideas

Types of schizophrenia:
1. Disorganized schizo---------------------------------sad inside, happy outside inappropriate affect (+)
flat affect no affect (-)
disorganized manner/speech flight of ideas (+)
Hebephrenic- giggling (+)
Sx: both (+) and (-).
2. Catatonic ---------------------------------------------ambivalence anal stage (-)
No! Negativisim-rebel-anal (-)
Waxy flexibility--------------raise arm of patient. Patients arm remains up for a long time. (-)
(-) > (+)
3. Paranoid ----------------------------------------------uses projection.
Mistrust

Scared/withdrawn/violent

Develop trust: orientation

-1:1 interaction
-consistent approach
-short/frequent interaction
-food: sealed container
-meds: wrapped in tamper resistant foil

Based on history

-Leave door open

-Distance from pt: 1 arms length
-stay near door not window
-have visibility:stand halfway in & out
to be able to call for reinforcement.
-calm and firm

4. Unclassified/ Undifferentiated-----------------------cant be classified anymore.

5. Residual-------------------------------------------------no more (+), (-). Social withdrawal
THOUGHT PROCESS DISTURBANCE
1. LOOSENESS OF ASSOCIATION----------------topics have connection but no thought. I am going to the mall. The mall is in
town. The town flies. Flies are here.
2. FLIGHT OF IDEAS ---------------------------------New unrelated topics. I am going to the mall. Where is the light? I treasure this
chalk. Hurray!
3. AMBIVALENCE-------------------------------------Pulled by 2 opposing forces.
4. MAGICAL THINKING----------------------------- believes he has magical powers. I can turn you into a frog.
5. ECHOLALIA------------------------------------------repeat what is said. Parrots.
6. ECHOPRAXIA----------------------------------------repeats what you do. Repeats what is seen.
7. WORD SALAD----------------------------------------mixes words that dont rhyme.
8. CLANG ASSOCIATION----------------------------uses words that rhyme. Flank, blank, prank.
9. NEOLOGISM------------------------------------------invents new words not in the dictionary. Ploopplank, pisnok.
10. DELUSIONS-----------------------------------------false belief
Grandeur--------------I am a queen/ king/millionaire!
Persecution------------NBI out to get me!
Ideas of reference-----They talk and write about me!
11. CONCRETE ASSOCIATION-----------------------pilosopo. What will you wear tomorrow? Clothes!
12.
HALLUCINATIONS----------------------ILLUSIONS (with stimuli)
Stimuli
N
Y
Visual
N
Y
Auditory
N
Y
Tactile
N
Y
Present reality!!!

D-Directive. Lets go in the garden.

Acknowledge: I know the voices are real to you.

=Assess what voices are saying to know if patient will harm himself.

Present reality. But I cant hear them.

Increase Dopamine = increase schizo

Decrease dopamine = decrease schizo
Extra Pyramidal Side Effects (EPSE) (Happens when acetylcholine is up and dopamine is down)
1. AKATHISIA-------------------------- restless, inability to sit still.
2. AKINISIA ---------------------------- rigidity
3. DYSTONIA--------------------------- affects neck
TORTICOLLIS -------------wry neck
OCULOGYRIC CRISIS fixed stare
OPISTHOTONUS ---------arched back, contracted
4. TARDIVE DYSKINESIA------------lip smacking, tongue is protruding, puffy cheeks. Irreversible!
5. NEUROLEPTIC MALIGNANT SYNDROME- hyperthermia, unstable BP, increase CPK, diaphoresis, pallor
-discontinue meds, medical emergency.
6. PHOTOSENSITIVITY------------------wear shades, sunscreen
7. WBC- Agranulocytosis---------------sore throat, fever, malaise, leukopenia
AUTISM- boys > girls. 1:100 kids gift-autistic savants
-echolalis, poor eye contact, cant express verbally.
Assess:
A- appearance- neat, OC, wants constancy
B- behavior- ritualistic behavior, flat affect, repetitive
C- communication difficulty communicating
Nsg Dx: Impaired social interaction cant form IPR (Interpersonal relationship)
Impaired verbal communication
Self mutilation cant express anger. Express it inward.
Risk for injury
P/I:
E:

constancy, promote safety

Expressive therapy uses art, music, poetry, decreasing risk for injury, improved social interaction, be able to express
feelings.
-Safety

ADHD- ATTENTION DEFICIT HYPERACTIVITY DISORDER (can progress to conduct disorder to anti-social behavior)
Cant focus on anything.
Onset 7 yrs old and below
Duration >6 months
Setting: House & school
ID dominant: Mom or RN will act as superego
Assessment:
A- appearance: dirty
B- behavior: clumsy, impatient, easily distracted
C- talkative
Nsg Dx: High risk for injury
Safety
Structure- provide place to study, eat, play,bath,etc.
Schedule time for everything
Set limits
Residual ADHD grows up not anti-social
Meds: Ritalin, Dexedrine,Pemoline, Adderal
Best time to give meds: If once a day give AFTER MEALS- to prevent loss of appetite.
Dont give at bedtime-its a stimulant-will cause insomia. Can be given 6hours before bedtime (if q2d)

ANOREXIA NERVOSA diet, underweight < 85% of expected fat, 3 months amenorrhea, failure to recognize problem.
BULIMIA NERVOSA induce vomiting, takes laxative, normal weight, irregular menstruation, dental carries, diarrhea
- knows problem but ashamed and embarrassed,
Priority: Fluid volume balance
Weight gain monitor weight, eating pattern, stay 1 hour after eating, accompany in toilet
Problem:
NI:

Body image Disturbance

1. Establish nutrition pattern
2. Teach stress management, journal keeping
3. Monitor eating pattern and weight.
4. Anti-depressant
MANIA needs mood stabilizing agents- Lithium. Group therapy
L- 0.5-1.5 mEq/L
(If level is near 2.5-3 mEq/L will cause ataxia and mental confusion)
I- increase urination
T- tremors
H- H20- 3L/d
I- increase
T- uu
M- mouth dry
N- Na- 135-145 mEq/L to hold water
Check kidney(blood level) before administration of Lithium BUN, CREA, electrolyte
Lithium toxicity n/v, diarrhea = Diamox
BIPOLAR DISORDER 2 poles, happy (more dominant) & sad
-female, >20 yrs old, stress, obese
Self actualization
Task to decrease self esteem
Family therapy
Risk for injury, risk for other directed violence
Decrease eat, decreased sleep, hyperactive, increase sex masturbate in front of others
Nsg Dx: High risk for self or other directed violence
Risk for injury
Give task, no group games, any competition will increase anxiety, water the plants, activities using gross motor skills, escorted walk,
punching bag-displacement.
3 or more signs confirms disorder:
G grandiose, increase risk activities
F flt of ideas
S - sleeplessness
P pressured speech
E exaggerated SE
E extraneous stimuli (easily distracted)
D distractability
PERSONALITY DISORDER

1. Schizoid --------doesnt care about people, believes that he can stand on his own, never had a best friend
2.
3.

avoid groups & activities no enjoyment

cares more about computers, pets
Avoidant ----------avoid group fear criticism, have talent but no confidence.
Anti-social ------as child steal, lie, always get reprimanded
Adult grand robbery, illegal activities against the law.
drug addiction, drives fast, unsafe sex, thrill seeker.
Good talker, charmer, witty, manipulator. Motto I will break the law

10

4. Borderline -------Favorite line life is an empty glass. Splitting, suicidal, superficial relationship, labile-sudden change of
Mood, self mutilation.
(+)
fill glass with friends
have happy moments

LABILE AFFECT

(-)
suicide
sad moment

labile- change from good to bad in a split moment

5. Dependent ---------Decrease self esteem, dependent

Poor decision making skills
I cant live if living is without you

6. Histrionics ----------excited, dramatic, manipulative

7.
8.

- CENTER OR ATTENTION
Narcissistic----------I love myself insensitive, arrogant, self absorbed
- exaggerated Self esteem, ambitious I am the best
OC ------------------ perfectionist, organized, constancy in environment. Provide time to do rituals.

9. Paranoid ----------- always jealous, suspicious, violent

10. Passive aggressive ------always say yes, but resistance is hidden.
Nsg Intervention: Improve IPR, build trust
A-LCOHOL ABUSE ----------------------happy socializing
-escape from problem
-peer pressure

Narcotic oversode-give Narcan

Narcotic detox- Methadone
Aversion therapy-Antabuse

B-blackout ---------------- awake but unaware

C-confabulation ---------- invent stories to increase Self-Esteem
D-denial ------------------- I am at not an alcoholic.
D-dependence ------------ I cant live without alcohol.
a. physical tremors, tachycardia, restless
b. psychological craving
E-enabling/codependency (significant others tolerate abusers)
DISULFIRAM
voids alcohol
version therapy
ntabuse (DISULFIRAM)
lcoholics anonymous

B1 Thiamine
Complications

beer
n/v
hypotension
interval of alcohol & antabuse:
12h interval after alcohol intake

wernickes
Encephalopathy
Korsakoff psychosis

Wernickes VROOM Motor sx effect

Korsakoff memory- confabulation

11

24 72h after alcohol intake

Delirium tremors happens due SNS activation
Tremors, hallucinations, illusions. Well lit room to avoid hallucinations
ANTI DEPRESSANTS decrease serotonin problem
Anti depressants full stomach
All meds take on a full stomach, except anti anxiety.
ASENDIN
NORPRAMIN
TOFRANIL
SINEQUAN
ANAPRANIL
AVENTYL
VIVACTIL
ELAVIL
PROZAC
PAXIL
ZOLOFF
LUVOX

TCA
TCA
TCA
TCA
TCA - OC
TCA
TCA
TCA
SSRI
SSRI
SSRI
SSRI

Serotonin ---------makes us happy

Decrease serotonin pt becomes sad depression
Increase serotonin antidepressant
SSRI:
Selective
Serotonin
Reuptake
Inhibitors

S
S (decrease S/E)
R
I (1 4 weeks)

If SSRI dont work, give TCA

Tri Cyclic Antidepressants ( TCA)

----------2 4 wks has increased S/E

increased Serotonin & Norephinephrine

MAOI-------------------------- effect 2 6wks

Increase E, NE, serotonin
kills serotonin
- MAOI
increase MAO = decrease serotonin
*
decrease MAO = increase serotonin
give MAOI
Most dangerous, most S/E
Diet avoid tyramine food eat SARIWA, fresh foods
HPN crisis dangerous! Increase CR, diaphoresis
Tyramine rich food:
Avocado
Pickles
Alcohol
Fermented foods
Beer
Eggplant
Chocolate
preservatives tocino, bologna,canned meat etc.
Cheese mozerella, swiss cheese
W ine
S soysauce
Anticholinergic = antidepressants antiparasympathetic
Dry, constipation, retention, tachycardia
Male erectile dysfunction
MAOI

12

mARplan
NARdil
PARnate
DEPRESSION decrease serotonin. If unresponsive to drugs, ECT-electroconvulsive therapy
Assess:
1. Denial this cant be happening. This cant be real.
2. Anger Why me, why now, why God?!
3. Bargaining If returned, I will give reward.
4. Depression 2 wks or more of sx = clinical depression
5. Acceptance client acts according to situation. Pt prepares living will.
Increase risk for self directed violence.
Maslows:
5
4 decrease Self-esteem give TASK
3 Pt is withdrawn
2 Risk for self directed violence suicide
1 eat (wt gain) or not eat(wt loss), sleep or not sleep, hypoactive, decrease sex
SUICIDE CUES:
I wont be a problem any longer
Remember me when Im gone
This is my last day
This is my wedding ring. Give it to my son
- Sudden change in mood.
Pt is suicidal, RN should:

D d irect question Are you going to commit suicide?

I irregular interval of visit to pt room
E early am & endorsement period - time pts commit suicide.

Who will commit suicide?

S sex male (more successful)/female (hesitant)
A age 15 24yo or above 45
D depression
P pt with previous attempts will try again
E ETOH (Ethanol) alcoholics
R irrational
S lacks social support
O organized plan greater risk
N no family
S sickness, terminal
Suicide Triad:
- Loss of spouse
- Loss of job
- Aloneness
Best approach for suicide: Direct approach
Nursing Mgt: close surveillance
Hospital area majority suicide happens at: weekends 1 3 am Sunday
Weekend less staff personnel
Early am every one is asleep
Give simple task. Dont give complex task no jigsaw puzzle
Water the plants
Wash the dishes except sharp objects

13

SUBSTANCE ABUSE
Type of Addict:
1. Nervous -----tremors
Give downers
Sx of overdose
1. Identify if drug is upper or downer
2. Check effect
3. Sx of withdrawal
If patient takes a downer, all vital signs are down! If he stops taking it (during withdrawal), patient will
experience the opposite effect of a downer. All his vital signs will shoot up! Same with uppers.
Ex: Pt had cocaine intoxication. Pt will manifest hyperactivity, tachypnea, seizure. During withdrawal,
pt will manifest bradypnea or coma.
Substance Abuse Moments
(downer)
A alcohol
B barbiturates
O opiates
N narcotics
M marijuana

Antidote
- Narcan (narcotic antagonist)

Morph
CODE
HERO

(uppers)
C cocaine
H Hallucinogens
A amphetamines
Uppers
Seizure
Tachypnea

Para

Downers
decrease RR, decrease HR
constricted pupil
Moist mouth
Dilated Blood Vessels
Coma
Asleep
Decreased GI constriction
Decrease GU retention
Decrease BP
State of euphoria

Sx of withdrawal reverse of effect

1. Know if upper or downer
2. Opposite of effect
Overdose
Alcohol coma
Morphine bradypnea

Withdrawal (opposite of withdrawal is overdose)

seizure
tachypnea

Detox withdrawal with MD supervision

14

Methadone
2. Depressed - Sits down on chair
Uppers
Codeine
Hallucinogen
Amphetamine

Stop uppers
Tremors
Fatigue

sympathetic

increased heart increase

HR increase
pupils- dilate
Mouth dry
Decrease appetite - thin

crash syndrome

Depressed

LEVELS OF MENTAL RETARDATION

Profound
severe
moderate
IQ

20

35

- BP increase, awake
seizure
GI - diarrhea

mild
50

Suicide

borderline
70

normal
90

110

Profound Mental retardation IQ <20 =thinks like an INFANT. Cant be trained. Stay with patient.
Severe MR 20-35
Moderate 35-50 = Can be trained. Mental age is 2-7yo. Pre-operational stage.
Mild 50-70 = (mild 7) Mental age is 7-12. Educable. Can go to school.
Borderline- 70-90
Normal- 90-110
JOHN PIAGET COGNITIVE THEORY
0-2 yrs old
S-ensory motor. Baby can sense, see, perceive and hear. Object permanence
2-4 yoP-reconceptual- language.
4-7 yoI-ntuitive stage. Unidimentional classification or unidimentional characteristic.
Child can fix toys according to size, color, height=one at a time only.
7-12 yoC-conservation/concrete association. Multidemensional
12yoF-ormal operation good in abstract thinking. Can interpret proverbs.

CHILD ABUSE

=burns, bruises, bone fractures, bungi

Dont bathe child. Dont brush teeth. Body of evidence will be lost.
Bantay Bata 163

ALZHEIMER
Anomia- dont know name of object
Agnosia problem with senses (smell, taste, hear, touch)
Aphasia cant say it
Apraxia cant do it
Dissociative Fugue- takes a new personality from a tar away place. New place new identity.
Dissociative Identity Disorder multiple personality
Dissociative Amnesia dont know who/where I am.

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DEPERSONALIZATION- believe that they are not persons anymore

PERSEVERATION- kulit. I want to talk about something because this is something that I want to do. It is
something that I need to talk about. This is something that I want to do.
ELECTROCONVULSIVE THERAPY- sign informed consent. For depressed pt. If meds dont work, use ECT.
Pre-ECT
N-npo 6 hours
A-atropine sulfate dry mouth
B-barbiturate
S- succinylcholine chloride to relax muscles
Post-ECT
Side-lying- lateral
S/E headache, dizziness, temporary memory loss (distinct sx)=RN-orient pt.

EXAMS:
Nsg intervention:
Look for words like:

=safety, support, stay, set limits, assist

Provide safety. Mobilize support system. I will stay with you. Assist in activity.
Set limit- dont allow patient to misbehave.
Look for words like:
Orient=orient pt post delirium, ECT, pt with dementia
Accept
Seem, observed, noticed, comment, feelings
Group therapy- facilitator is RN.
Rape, battered pt
ALTRUISM Victim becomes a counselor, shares experience to new victim.
Self-help group=facilitator is the pt themselves. AL ANON groups Alcoholics Anonymous

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