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LOBES OF BRAIN 1. FRONTAL LOBE - Language - Learning - Personality - Judgment 2. TEMPORAL LOBE - Hearing - Smell 3.

PAREITAL LOBE - Touch - Taste 4. OCCIPITAL LOBE - Visual 3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory – eyes, ears, tongue 2. Integration 3. Motor – voluntary or involuntary VOLUNTARY NERVOUS SYSTEM • also called as somatic Brain Spinal Cord Motor Nerve Synapse Muscle Fiber • Motor nerve to muscle fiber you need Acethylcholine which is an “On switch”. INVOLUNTARY NERVOUS SYSTEM • also called autonomic nervous system. AUTONOMIC NERVOUS SYSTEM ———————–SYMPATHETIC ————PARASYMPATHETIC ——————-(Awake, ADRINERGIC) ——–(Relax, CHOLINERGIC) Heart Rate ———— Increase ——————– Decrease Respiratory Rate —— Increase ——————– Decrease GI ———————Decrease ——Increase (Moist mouth, Diarrhea) GU ——————– Decrease —- Increase (Urinary Frequency) Neurotransmitter—- Epinephrine, Norepinephrine —-Acethylcholine • 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.

• SUPEREGO is developed. • School age. • Penis envy. • Oedipus Complex boy loves parent of the opposite . • Lasts for 6 years. • Love – hate relationship. *FIXATION – Person is stuck in certain developmental shape. • Imitates mommy called identification. Anal Stage • 18 months – 3 years old. LATENCY STAGE • 6 – 12 years old. • ID is developed. EGO – Developed on the 6th month.C ———————– Anal expulsive ———– Anal retentive PHALLIC STAGE • 3 – 6 years old.O.Clean ————————-disorganized ————— organized ————————.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. *Conscious – upper level of thinking. • Imitates daddy called identification. Schizophrenia LIBIDO • Sexual energy responsible for survival. Writing.obedient ————————. bowel. • Very important stage. Arithmetic. • Reading. • Best time for toilet training. *REGRESSION – Return to an earlier developmental stage. TOILET TRAINING Good Mother———————— Bad Mother Successful —————–Dirty ———————. *Unconscious – protects us from traumatic experiences. Oral Stage • 0 – 18 months evident. *Preconscious – tip of tongue.Anti-social ——————.disobedient —————. • Experience pleasure by manipulating genitals. • Castration fears. . • Electra Complex girl loves parent of the opposite . • Separation anxiety. • Able to control bladder. GENITAL STAGE • 12 years old and above • Sexual reawakening.

10.PHARMA NOTES: ANTI – ANXIETY DRUGS • Valium • Librium • Ativan • Serax • Tanxene • Miltown • Equanil • Vistaril • Atarax • Ideral • Buspar ERIC ERIKSON • There is more to life than just . 9. Denial – failure to acknowledge an unacceptable trait or situation. • Developmental task begins at 0 – 18 months. • You can develop a positive side or a negative side. 12. 4. IDENTIFICATION – assuming trait for personal. —-Autonomy ——-Shame & Doubt —. – above —-Ego Integrity ——— Despair ————Reflection DRUGS WITH ANTICHOLINERGIC EFFECTS • Anti – Anxiety • Anti – Psychotic • Anti – Cholinergic • Anti – Depressants PHARMA NOTES: MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS) • Marplan • Nardil • Parnate DEFENSE MECHANISMS 1. – 3 yrs. —-Identity ———Role Confusion ——— Peers 20 yrs. – 6 yrs. UNDOING – doing the opposite of what you have done. 7. ——————– POSITIVE ——NEGATIVE ——– FACTOR 0 – 18 mos. 6. 3. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive . REACTION FORMATION – doing the opposite of what you have done. DISOCIATION – psychological flight from the self. – 25 yrs. PROJECTION – attribute to others one’s unacceptable trait. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation. 2. 8. REGRESSION – return to an earlier development state. – 45 yrs. • Psychosocial Theory of development. – 12 yrs.Toilet Training 3 yrs. 11. —–Industry ———Inferiority ———— School 12 yrs.Guilt ————–Independence 6 yrs. ———-Trust ———— Mistrust ———— Feeding 18 mos. ——-Initiative ———. —Generativity ——–Stagnation ———–Parenting 45 yrs. – 20 yrs. INTROJECTION – assume another person’s trait as your own. repression – unconscious forgetting. occupational role. 5. Displacement – transfer of feelings to a less threatening object rather than the one who provoked it. social. —-Intimacy ———–Isolation ————–Love 25 yrs. 13. SUPPRESSION – conscious forgetting.

Changing the topic/subject 3. Flattery 6. . • Assess level of anxiety of client. Offer Self 2. Broad Opening – how are you today? 6. COMPENSATION – over achievement in one area to cover a defective part. eye contact 5. SUBSTITUTION – replace difficult goal with more accessible one. Don’t worry be happy 2. Restating – I’m sad “You’re sad?” 1. 14. • Triggers the sympathetic nervous system. Changing the topic/subject 3. ANXIETY • Vague sense of impending doom. Value based judgment – never assume 5. Making observation – what you see you say 4. Giving Opinion NONTHERAPEUTIC 1. PHARMA NOTES: ANTI – PARKINSON DRUG .endeavors. Flattery 6. Advising 7. Ignore the client 4.CAPABLES • Cogentin • Artane • Parlodel • Akineton • Benadryl • Larodopa • Eldepryl • Symmetrel AUTONOMIC NERVOUS SYSTEM —————– SYMPATHETIC ——– PARASYMPATHETIC Pupils —————-Dilate —————-Constrict Blood Vessels ——–Constrict ————. Silence – provide time to think 3. I’m listening 7. Active Listening – nodding. Don’t worry be happy 2. Value based judgment – never assume 5. Giving Opinion FEAR – protects us from something bad. TYPES OF ANXIETY MILD ANXIETY • + 1 level of anxiety. • Widened perceptual field. 15. Ignore the client 4. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms. 16. General Leads – Go on.Dilate Blood Pressure ——–Increase ———— Decrease THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. Advising 7.

NURSING DIAGNOSIS: • ineffective individual coping. • Decrease environmental stimuli. MODERATE ANXIETY • + 2 level of anxiety. GENERALIZED ANXIETY DISORDER • 6 month excessive worrying. • Relaxation techniques. • Never touch patient. SEVERE ANXIETY • + 3 level of anxiety. edge of the seat. PANIC ATTACKS/DISORDER • 15 – 30 minutes sympathetic nervous system escalation. • Give PRN meds. SOMATOFORM • no protection • unconscious • no organic basis of being sick DIFFERENT TYPE OF SOMATOFORM 1. EVALUATION • effective individual coping. • Hyperventilation (Respiratory Alkalosis) • Breathe into paper bag. . sleep disorders. • Directive orders (please sit down). • May commit suicide. • Client pace. La Belle Indifference • do not care what happens to them. difficulty concentration.• Restless (say you seem restless). hear. see. • Impaired skin integrity PLANNING/IMPLEMENTATION: • decrease level of anxiety. • Example is AGORAPHOBIA fear of open spaces. • Promote safety. • Restless. PANIC • + 4 level of anxiety. • Powerlessness. able to escape source of anxiety. 2. • Nervous system affected. Conversion Disorder • cannot speak. palpitations. • Primary Gain anxiety decreases. • Don’t know what to do/say. • Secondary Gain able to get attention. • Enhanced learning capacity. easy fatigability. POST TRAUMATIC STRESS DISORDER • victims becomes survivors and experience flashbacks or nightmares. MALINGERING • pretending to be sick (conscious).

HYPOCHONDRIASIS • has minor discomfort and interprets it as major illness. • Focus on clients feelings. PSYCHOSOMATIC • Real pains/illness • Real symptoms because of anxiety PSYCHOSOMATIC Increase Anxiety SNS 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 SNS • GABA (Gamma Amino Butyric Acid) – stop • Epinephrine and Norepinephrine – Go ANTI-ANXIETY • 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 . BODY DISMORPHIC DISORDER • Illusion of structural defect. • Focus on clients feelings. • Favorite past time is doctor hopping.

Normal weight . eat.Less 85% expected body weight ——.3 months amenorrhea ————— Irregular menstruation BULIMIA NERVOSA • Metabolic alkalosis (vomiting results to decrease hydrochloric acid) • Metabolic acidosis (diarrhea results to decrease bicarbonate) . eat.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 if communication EVALUATION • Enhanced communication • Improved social interaction • Safety ATTENTION DEFICIT HYPERACTIVITY DISORDER • 7 years and below onset • Duration: 6 months and above • Settings: house and school • Assessment • Appearance: dirty. impatient. sleep.Eat. eat ————————— Eat. easily distracted and has no focus • Behavior • Communication: talkative NURSING DIAGNOSIS • Risk for injury • Impaired social interaction PLANNING/IMPLEMENTATION • Structure: place to play. 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 Decrease glucose Decrease judgment Increase impulsiveness ADHD Hyperactivity • Need a drug that brings glucose level up. vomit . • Give Ritalin a stimulant • May result in loss of appetite • Given after meals • Given 6 hours before bedtime EATING DISORDERS ANOREXIA NERVOSA —————BULIMIA NERVOSA . hyperactive. clumsy.

• 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 PHARMA NOTES: 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. no idea. Inappropriate. ASSESS • Hallucinations/Illusions NURSING DIAGNOSIS • Disturbed sensory perception PLANNING/IMPLEMENTATION • Present reality • Safety . Blunt (incomplete) • Ambivalence: pulled into 2 opposing forces Autism • Looseness. ASSESS • Content of thought NURSING DIAGNOSIS • Disturbed thought process PLANNING/IMPLEMENTATION • Present reality • Provide safety EVALUATION • Improved thought process II.Sociable Thought Blocking ——————Flight of ideas Apathy I. not related to one another ASSESSMENT NEGATIVE ————————POSITIVE Hypoactive ———————— Hyperactive Withdrawn ————————. Flat.

and vague with only a tenuous connection between one thought and the next 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 . ASSESS • Suspicious NURSING DIAGNOSIS • Risk for other directed violence PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • Eliminate/minimize risk for other directed violence IV. diffuse. 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 • Thinking that is overgeneralized.EVALUATION • Improved sensory perception III.

———————–HALLUCINATIONS—— ILLUSIONS STIMULUS ———— ABSENT———— PRESENT VISUAL —————-ABSENT———— PRESENT AUDITORY ———– ABSENT———— PRESENT TACTILE ABSENT — ABSENT———— PRESENT • Present reality to clients experiencing hallucinations • Technique in handling clients with hallucinations • Hallucinations • Acknowledgement “I know the voices are real to you” • 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 (wryneck) 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 ANTI – PARKINSON Anticholinergics Dopaminergics (Decrease Ach) (Increase Dopa) Artane.Sad but smiles (inappropriate affect) .No reaction (flat affect) .Flight of ideas (disorganized speech) . 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 SCHIZOPHRENIA .

Suspicious .Favorite word is “No” .Giggling (hebephrenic giggle) .No more positive symptoms just withdrawn UNDIFFIRENTIATED SCHIZOPHRENIA . PARANOID SCHIZOPHRENIA . 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 . vomiting.Mixed classification.Foods should be in a sealed container .Waxy flexibility . cant be classified PHAMRA NOTES: BI-POLAR.2 meq/L • Increase urination • Tremors.. Violent: . MANIC • Lithium: undergo first kidney test and check for blood levels • Level: .Mistrust.6 – 1.Don’t touch client .Ambivalence .Call for reinforcement .Combination of positive and negative signs and symptoms CATATONIC SCHIZOPHRENIA .Negativism (client do not follow what you tell them to do) Nursing management: meet needs PARANOID SCHIZOPHRENIA .Gain trust by 1 to 1 short interaction but frequent . withdrawn Nursing management: .Position near door .Keep door open . scared. fine hand • Hydration of 3L/day • Increase • Uu (diarrhea) • Mouth dry Signs of Lithium toxicity • Nausea.Medications should be in tamper resistant foil.One arms length away from the client.

no sports (basketball.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 HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS T. no fine motor skills only gross motor skills A lot energies toward more productive endeavors (sublimation) S .escorted walk outdoors K – punching bag (displacement) PHARMA NOTES: ANTI – DEPRESSANTS • Asendin • Norpralamin • Tofranil • Sinequan • Anafranil • Aventyl • 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 MANAGEMENT • 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 • 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 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 . volleyball).

Cheese (aged) • Fermented foods • Pickles • Preserved foods • Soy sauce . Anomia – don’t know the name 3. agitated. Norpralamin. dopamine but client becomes prone to hypertensive crisis • Avoid tyramine rich foods • Avocado. 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. Agnosia – sensory problems smell.Has higher incidence of side effects .frontal lobe is affected particularly broca’s area . norepinephrine.receptive: cant hear .Increases serotonin and affects only serotonin .————————–ALCOHOL — ALZHEIMERS ONSET ——————– Abrupt ——– Gradual LEVEL OF CONSCIOUSNESS – Fluctuating —-Unaffected DURATION ———– Hours to days — Progressive MEMORY ————– Short term —Short and long term 5 A’s OF ALZHEIMERS 1.temporal lobe is affected particularly wernicke’s area 5. Vivactil. Paxil. Apraxia – cant do simple things * Reminiscing Therapy – talk about past • Patients with alzheimer’s may experience hallucinations. epinephrine. Alcohol • Beer • Chocolates.Also increases norepinephrine . Zoloft TRICYCLIC ANTI DEPRESSANT Two – four weeks C A . 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 .expressive: cant say/express . Amnesia – memory loss 2. Aphasia . taste.Asendin. Anafranil. Sinequan. Aventyl. sight 4. illusions thus becomes restless and may wander • As sun goes down client becomes restless.Prozac. Tofranil.

Narcissistic . prone to impotence GRIEF PROCESS 1.Project charm . Schizophrenia . Dependent . Borderline .“Cant live if living is without you” 6.“I am so organized” 9. hypoactive.They are witty and articulate .Excited. decrease sexual urge • Be sensitive to clients needs FOR SUICIDAL OBSERVE FOR Verbal • “I wont be a problem” • “This is my last day on earth” • “I’ll soon be gone” Non verbal . Anti-Social .Constantly breaks law . Bargaining – if. increase/decrease sleep.Sudden change in mood “labile affect” . Parnate PERSONALITY DISORDERS 1.Manipulative 4. Obsessive – Compulsive . Denial – shock/disbelief 2.They have talent but has no confidence 3. dramatic. Nardil. Histrioinic .They avoid people because there is no enjoyment 2. Avoidant .Constantly wants to be the center of attention . Depression – 2 weeks or more sign and symptoms becomes major clinical depression 5.Suspicious . manipulative 7.They perceive life as an empty glass .They avoid people because they are afraid of criticisms .They get jealous even with achievement of family members 8.May lead to domestic violence ANTI – DEPRESSANT SIDE EFFECTS: Male – erectile dysfunction.• There is increase incidence of side effects after 2 – 6 weeks • Marplan.“I love myself” . Paranoid .Prone to suicide 5. then 4.They like splitting friends . Anger – question “why me?” 3. 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.

• Giving away of valuables • Sudden change in mood 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 DOWNERS Alcohol Barbiturate Opiates Narcotics Marijuana Morphine Codeine 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 Cocaine Hallucinogens Amphetamines Resulting to: • Tachycardia • Awake • Tachypnea • Dry mouth • Pupils dilate • Hypertension • Seizures • Weight loss .