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Psych Notes
Psych Notes
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
LIBIDO
Sexual energy responsible for survival.
1
PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.]
ORAL STAGE
0 – 18 months evident.
ID is developed.
ANAL STAGE
18 months – 3 years old.
Able to control bladder, bowel.
Best time for toilet training.
SUPEREGO is developed.
TOILET TRAINING
Successful
Dirty Clean
- Disorganized - organized
- Disobedient - obedient
- Anti-social - O.C
- Anal expulsive - Anal retentive
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.
2
*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 Equanil
Ativan Vistaril
Tanxene Atarax
Librium Buspar
Valium Inderal
Miltown
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.
3
POSITIVE NEGATIVE FACTOR
0 – 18 mos. Trust Mistrust Feeding
18 mos. – 3 yrs. Autonomy Shame & Doubt Toilet Training
3 yrs. – 6 yrs. Initiative Guilt Independence
6 yrs. – 12 yrs. Industry Inferiority School
12 yrs. – 20 yrs. Identity Role Confusion Peers
20 yrs. – 25 yrs. Intimacy Isolation Love
25 yrs. – 45 yrs. Generativity Stagnation Parenting
45 yrs. - above Ego Integrity Despair 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 Touch
Learning Taste
Personality
Judgment 4. OCCIPITAL LOBE
2. TEMPORAL LOBE Visual
Hearing
Smell
3 STEPS TO INTERACT WITH ENVIRONMENT
1. Sensory – eyes, ears, tongue
2. Integration
3. Motor – voluntary or involuntary
4
Spinal Cord
Motor Nerve
Synapse
Muscle Fiber
5
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
AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC PARASYMPATHETIC
Pupils Dilate Constrict
Blood Vessels Constrict Dilate
Blood Pressure Increase Decrease
ANXIETY
Vague sense of impending doom.
Triggers the sympathetic nervous system.
Assess level of anxiety of client.
6
TYPES OF ANXIETY
MILD ANXIETY
+ 1 level of anxiety.
Widened perceptual field.
Restless (say you seem restless).
Enhanced learning capacity.
MODERATE ANXIETY
+ 2 level of anxiety.
Client pace.
Give PRN meds.
SEVERE ANXIETY
+ 3 level of anxiety.
Don’t know what to do/say.
Directive orders (please sit down).
PANIC
+ 4 level of anxiety.
May commit suicide.
Promote safety.
Never touch patient.
Hyperventilation (Respiratory Alkalosis)
Breathe into paper bag.
EVALUATION
Effective individual coping.
7
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
HYPOCHONDRIASIS
has minor discomfort and interprets it as major illness.
Focus on clients feelings.
BODY DYSMORPHIC DISORDER
Illusion of structural defect.
Favorite past time is doctor hopping.
Focus on clients feelings.
PSYCHOSOMATIC
Real pains/illness
Real symptoms because of anxiety
PSYCHOSOMATIC
↓
Increase Anxiety
↓
SNS
↓
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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
9
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
AUTISM
Unresponsive and does not want to be touched
AUTISTIC SAVANT: high intelligence and has a ratio of 1:100
Assessment
Appearance – flat affect and loves constancy and ritualistic
Behavior – withdrawn
Communication – echolalia
NURSING DIANOSIS
Impaired verbal communication
Impaired social interaction
Self mutilation
Risk for injury
PLANNING/IMPLEMENTATION
Maslow’s hierarchy of needs
Expressive Therapy – use of art as mode of communication
EVALUATION
Enhanced communication
Improved social interaction
Safety
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NURSING DIAGNOSIS
Risk for injury
Impaired social interaction
PLANNING/IMPLEMENTATION
Structure: place to play, sleep, eat and study
Schedule: there is always a time for everything that you do
Set limits
Safety
EVALUATION
Minimize risk for injury
Improved social interaction
FRONTAL LOBE OF ADHD
Decreased glucose
↓
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
ANOREXIA NERVOSA BULIMIA NERVOSA
Eat, eat, eat Eat, eat, vomit
Less 85% expected body weight Normal weight
3 months Amenorrhea Irregular menstruation
BULIMIA NERVOSA
Metabolic alkalosis (vomiting results to decreased hydrochloric acid)
Metabolic acidosis (diarrhea results to decreased bicarbonate)
Dental caries
Wound in knuckles
MANAGEMENT
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
PHARMACOLOGY NOTES
11
ANTI – PSYCHOTIC DRUG
Stelazine
Serentil
Thorazine
Trilafon
Clozaril
Mellaril
Haldol
Prolixin
SCHIZOPHRENIA
Ego disintegration
Impaired reality perception
Genetic vulnerability
Stress – Diathesis Model
Biological theory – increase dopamine level
Exact cause unknown
ASSESSMENT
Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
Ambivalence: pulled into 2 opposing forces
AUTISM: Looseness, no idea, not related to one another
ASSESSMENT
NEGATIVE POSITIVE
Hypoactive Hyperactive
Withdrawn Sociable
Thought Blocking Flight of ideas
Apathy
I. ASSESS
Content of thought
NURSING DIAGNOSIS
Disturbed thought process
PLANNING/IMPLEMENTATION
Present reality
Provide safety
EVALUATION
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Improved thought process
II. ASSESS
Hallucinations/ Illusions
NURSING DIAGNOSIS
Disturbed sensory perception
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Improved sensory perception
III. ASSESS
Suspicious
NURSING DIAGNOSIS
Risk for other directed violence
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Eliminate/minimize risk for other directed violence
IV. ASSESS
Suicidal
NURSING DIAGNOSIS
Risk for self directed violence
PLANNING/IMPLEMENTATION
Present reality
Safety
EVALUATION
Eliminate/minimize risk for self directed violence
LOOSENESS OF ASSOCIATION
There is connection with statements
13
FLIGHT OF IDEAS
Jumping from on topic to another
AMBIVALENCE
Pulled between 2 strong opposing forces
MAGICAL THINKING
acting like magician
ECHOLALIA
Client repeats what you say
ECHOPRAXIA
Client repeats what you do
WORD SALAD
Just words no rhyme
CLANG ASSOCIATION
Words that rhyme
NEOLOGISM
Formation of new words (needs clarification)
DELUSION: PERSECUTORY
“The NBI is out to get me”
DELUSION: RELIGIOUS
“I am Jesus Christ the savior”
DELUSION: GRANDEUR
“ I am the queen of the world”
DELUSION: IDEAS OF REFERENCE
“The nurses are talking about me”
CONCRETE ASSOCIATION
Also known as “pilosopo”
THOUGHT BLOCKING
Unable to think
HALLUCINATIONS ILLUSIONS
STIMULUS ABSENT PRESENT
VISUAL ABSENT PRESENT
AUDITORY ABSENT PRESENT
TACTILE ABSENT PRESENT
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Reality orientation “I know the voices are real but I don’t hear them”
Diversion “Lets go to the garden”
10% of schizophrenic clients hear voices
PARKINSON’S DISEASE
If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in
dopamine (off switch)
ANTI-PSYCHOTIC
↓
Decrease dopamine level
↓
Parkinson like effect
↓
Extra pyramidal side effect
↓
With akathesia
↓
Restless, inability to rest
AKINESIA
Muscle rigidity
DYSTONIA
Torticollis (wry-neck)
OCULOGYRIC CRISIS
Fixed stare
OPISTHOTONUS
Arched back
Lips – smacking
Tongue – protruding
Cheeks – puffing
The 3 are irreversible and called TARDIVE DYSKINESIA
NEUROLEPTIC MALIGNANT SYNDROME Hyperthermia
ANTICHOLINERGICS DOPAMINERGICS
(Decrease ACh) (Increase Dopamine)
15
↓ ↓
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel
OTHER SIDE EFFECTS OF DECREASE DOPAMINE
Photosensitivity
AGRANULOCYTOSIS – decrease WBC
Clients prone to infection due to decrease WBC
First sign for infection is sore throat
TYPES OF SCHIZOPHRENIA
DISORGANIZED CATATONIC PARANOID RESIDUAL UNDIFFIRENTIATED
UNCLASSIFIED
- Sad but smiles - Ambivalence - Suspicious - No more - Mixed classification,
(Inappropriate affect) - Waxy flexibility - Mistrust, positive cant be classified
- No reaction (flat - Favorite word is “No” scared, symptoms
affect) - Negativism (client do withdrawn just
- Flight of ideas not follow what you tell Nursing withdrawn
(disorganized speech) them to do) management:
- Giggling Nursing - Gain TRUST
(hebephrenic giggle) management: by 1 to 1 short
- Combination of Meet needs interaction but
positive and negative frequent
signs and symptoms - 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.
PHARMACOLOGY NOTES
BI-POLAR, MANIC
Lithium: undergo first kidney test and check for blood levels
Level: .6 – 1.2 meq/L
Increase urination
16
Tremors, fine hand
Hydration of 3L/day
Increase
Uu (diarrhea)
Mouth dry
Signs of Lithium toxicity
Nausea, vomiting, diarrhea
Increase sodium
**** WAIT FOR 2 – 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS
BIPOLAR DISORDER/ MANIC PROFILE
20 years old
Female
Stress
Obese
ASSESSMENT
Decrease appetite (give finger foods)
Decrease sleep (place in a private room)
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
PHARMACOLOGY NOTES
ANTI – DEPRESSANTS
Asendin Sinequan
Norpralamin Anafranil
Tofranil Aventyl
17
Vivactil Paxil
Elavil Zoloft
Prozac
WERNICKE’S ENCEPHALOPATHY
Problem with motor
KORSAKOFF’S PSYCHOSIS
Problem with memory
24 – 72 hours after last dose of alcohol expect:
Delirium Tremens: sympathetic nervous system
Prevent hallucinations/Illusions by placing client in a well lit room
Formication: feeling of bugs crawling under the skin
ALZHEIMERS DISEASE
- Axon (away) and Dendrites (toward) nerve
- Neurofibrillary tangles
- Neurotic plaques
ALCOHOL/ DELIRIUM ALZHEIMERS
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ONSET Abrupt Gradual
LEVEL OF CONSCIOUSNESS Fluctuating Unaffected
DURATION Hours to days Progressive
MEMORY Short term memory loss 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
19
ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, ELAVIL
20
“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
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
21
DOWNERS [A.B.O.N.-M.M.C.H.]
Alcohol Marijuana
Barbiturate Morphine
Opiates Codeine
Narcotics Heroine
Resulting to:
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
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