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TABLE OF CONTENTS I. Psychiatric Nursing, 3 II. Basic Principles of Psychiatric Nursing, 3 III.3 Levels of Psychiatric Nursing (Levels of Health), 3 a.

Primary, 3 b. Secondary, 4 c. Tertiary, 6 IV. Criteria of Mental Health, 6 V. Components of Assessment of Mental Status, 6 VI. DSM V (Diagnostic and Statistical Manual for Mental Health, 7 VII. Conceptual Models of Psychiatric Treatment, 7 VIII. Psychosocial Theory of Eric Erikson, 7 IX. Psychosexual (Psychoanalytical) Theory of Sigmund Freud, 7 a. Freudian Theory Component, 8 X. Essential Elements of Nurse-Client Contact, 9 XI. Four Phases of Nurse-Client Contact, 10 a. Pre-interaction/Pre-orientation, 10 b. Orientation, 10 c. Working Phase,11 d. Termination, 11 XII. Therapeutic Communication, 11 a. Therapeutic Communication Techniques, 11 b. Blocks to Therapeutic Communication, 12 XIII. Behavioral Therapy, 13 A. Terminologies, 13 a. Classical Conditioning, 13 b. Operant Conditioning, 14 c. Behavioral Treatments, 16 XIV. Group Therapy, 16 A. Definition, 16 B. Types of Groups, 16 C. Advantage of Group Therapy, 17 D. Principles of Group Therapy, 17 E. Phases of Group Therapy, 17 XV. Defense Mechanisms, 18 XVI. Anxiety, 20 A. Definition, 20 B. Major Assessment criterion for Measuring Degree of Anxiety, 20 C. Potential Nursing Diagnosis, 21 D. Nursing Intervention, 21 1

XVII. Types of Anxiety Disorder, 22 A. Phobia and Panic Disorder, 22 B. Obsessive-Compulsive Disorder, 22 C. Post Traumatic Stress Disorder, 23 D. Anxiolytic/Anti-Anxiety Drugs, 24 a. Benzodiazepine, 24 b. Barbiturates, 24 c. Atypical Anxiolytics, 25 XVIII. Psychotic Disorder: Schizophrenia, 25 A. Assessment Finding: General Signs, 25 B. Prioritized Nursing Diagnoses for all types of Schizophrenia, 27 C. Five Types of Schizophrenia, 27 D. Principle of Care in Schizophrenia, 28 XIX. Antipsychotics, 28 A. Phenothiazine, 28 B. Butyrophenones, 29 C. Thioxanthenes, 29 D. Atypical Anxiolytics, 29 E. Six Common Anticholinergic Side Effects of Antipsychotics, 29 F. Acute/Common side Effect for Prolonged use of Antipsychotics,30 G. Anti-Extrapyramidal Medications, 31 H. Adverse Effects of Antipsychotic Drugs, 31 XX. Affective/ Mood Disorder, 31 A. Types I. Depressive Disorder, 31 a Antidepressants/ Thymoleptics, 34 i. Selective Serotonin Reuptake Inhibitors (SSRI), 34 ii. 2nd Generation Tricyclic Antidepressants (TCA), 35 iii. MAOI-Monoamine Oxidase Inhibitor, 36 iv. Electro Convulsive Therapy (ECT), 36 II. Bipolar Disorder, 38 a. Mood Stabilizers, 40 XXI. Psychosomatic/ Somatoform Disorder, 42 A. Psychosomatic Disorders, 42 B. Types of Somatoform Disorder/Psychosomatic Disorders, 43 XXII. Dissociative Disorder, 44 XXIII. Personality Disorders, 44 A. Cluster A: ODD/Eccentric, 45 a. Paranoid Personality Disorder, 45 b. Schizoid Personality Disorder, 45 c. Schizotypal Personality Disorder, 46 B. Cluster B: Dramatic/Erratic, 46 a. Antisocial Personality Disorder, 46 b. Borderline Personality Disorder, 47 2

c. Histrionic Personality Disorder, 47 d. Narcissistic personality Disorder, 47 C. Cluster C: Anxious/ Fearful, 48 a. Obsessive-Compulsive Disorder, 48 b. Dependent Personality Disorder, 49 c. Avoidant Personality Disorder, 49 d. Passive-Aggressive Personality Disorder, 49 XXIV: Cognitive/ Organic Mental Disorder, 49 A. Delirium vs. Dementia, 50 B. Types of Dementia C. Alzheimer’s Disease, 50 XXV. Eating Disorders, 55 A. Anorexia vs. Bulimia, 55 XXVI. Drug Addiction/Non-Alcoholic Substance Abuse, 57 A. Non-Alcoholic Abused Substances, 57 XXVII. Sexual Disorder/ Dysfunction, 59 XXVIII. Pervasive Developmental Disorder, 60 A. Autistic Disorder, 60 B. Attention Deficit Hyperactive Disorder, 61 C. Child Abuse, 61

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PSYCHIATRIC NURSING • A specialized area of nursing practice employing theories of human behavior as its science and purposely use of self as its art. Includes the continuous and comprehensive services necessary for the promotion of optimal mental health, prevention of mental illness, health maintenance, management and referral of mental and physical health problems, the diagnosis and treatment of mental disorders and their sequela, and rehabilitation BASIC PRINCIPLES OF PSYCHIATRIC NURSING  Accept and respect the client regardless of his behavior.  Limit or reject the inappropriate behavior but not the individual  Encourage and support expression of feelings in a safe and non-judgmental environment. Increase verbalization, decreases anxiety.  Behaviors are learned.  All behavior has meaning. INTERDISCIPLINARY TEAM PRIMARY ROLES • Psychiatrist: The psychiatrist is a physician certified in psychiatry by the American Board of Psychiatry and Neurology, which requires 3-year residency, 2-years of clinical practice, and completion of an examination. The primary function of the psychiatrist is diagnosis of, mental disorders and prescription of medical treatments. Psychologist: The clinical psychologist has a doctorate (Ph.D.) in clinical psychology and is prepared to practice therapy, conduct research, and interpret psychological tests. Psychologists may also participate in the design of therapy programs for groups of individuals. Psychiatric nurse: The registered nurse gains experience in working with clients with psychiatric disorders after graduation from an accredited program of nursing and completion of the licensure examination. The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically. The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. Registered nurses who obtain a master’s degree in mental health may be certified as clinical specialist or licensed as advanced practitioners, depending on individual state nurse practice acts. Advanced practice nurses are certified to prescribe drugs in many states. Psychiatric social worker: Most psychiatric social workers are prepared at the master’s level, and they are licensed in some states. Social workers may practice therapy and often have the primary responsibility for working with families, community support, and referral.

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Clients are also assisted in job-seeking and job-retention skills. PID (Pelvic Inflammatory disease) #1 cause of sterility in women #1 Drug of choice Erythromycin 2nd drug of choice Cephalosporin 2. but in some instances persons with experience fulfill these roles. Occupational therapy focuses on the functional abilities of the client and ways to improve client functioning such as working with arts and crafts and focusing on psychomotor skills.S. Client and Family Teaching (Health Teaching) 1. perineal 5 .• Occupational therapist: Occupational therapist may have an associate degree (certified occupational therapy assistant) or a baccalaureate degree (certified occupational therapist). Teaching pregnant women relaxation techniques Objective: to prevent complication in labor. Teaching adolescent in preventing contracting STDs CHLAMYDIA: #1 STD in the U. laceration (also can be prevented by Kegel’s exercise) fetal distress. Recreation therapist: Many recreation therapists complete a baccalaureate degree. Primary Objective: PROMOTION & PREVENTION A. Vocational rehabilitation specialist: Vocational rehabilitation includes determining clients’ interests and abilities and matching them with vocational choices. The recreation therapist helps the client to achieve a balance of work and play in his or her life and provides activities that promote constructive use of leisure or unstructured time. as well as pursuit of further education if that is needed and desired. • • 3 LEVELS OF PSYCHIATRIC NURSING (Levels of Health) I. #1 Sign: Greenish & purulent urethral discharge. Vocational rehabilitation specialists can be prepared at the baccalaureate or master’s level and may have different levels of autonomy and program supervision based on their education.

B. hopeless. Conducting rape prevention classes is an example of primary level of prevention. Adolescent (identity crisis) 2. Suicide = Mmajor depression.Stage I of labor (LAT-CAP) L atent C chest breathing A ctive A bdominal breathing T ransitionalent P ant blow breathing 3. Herbal Medicines C. Oral Contraceptive.) 6 . Secondary : Screening. Teaching couples on contraceptives BON (Barrier.) Diet: Finger Food (high caloric.o. ADHD: Aage of onset (6 y. Giving Vaccines II. above) 4. powerless Prone: Mmale Age bracket prone for suicide #1.not for M A M (Malnourished. Screening > Denver Development Screening Test (DDST) #1 test for PDD Pervasive Development Ddisorder (PPD) 1.) 2.o. Alcoholics. Natural) Barrier . Diagnosis & Immediate Treatment A. Post partum depression (7 days/2-4 weeks) D. Middle age men (40 y. Anemics & Menses irregular) 4. dextroamphetamine (Dexedrine) 3. Psychosocial Support – family/friends/peers Needs most support (ASA): Addicts. Elderly (ego-despair) 3.o.Artificial Natural . despair. Conduct disorder: Aage of onset (6 y.CONDOM Oral . high CHO) Rx: Ritalin (Methylphenidate). Autism: Aage of onset (3 y.o. Suicidal.

Types of Crisis: 1. No suicide contract – 24 hrs monitoring . Developmental Maturation Crisis . epidemic.Most common: Ddeath of a loved one NSG DX: Ineffective Individual Ccoping/ Denial .ex. World War I & II. Giving away of prized possessions 3. disaster ex. . less than 2-4 wks (telling a lie) Suicide Interventions: 1. Schizophrenia) 4. Duration: (4-6 wks) Disorganization is a phase in the crisis state which is characterized by the feelings of great anxiety and inability to perform activities of daily living A patient in crisis is passive and submissive. Suicide Prevention/Intervention Impending signs of Suicide 1. curtains 4.Patient is required to verbalize suicidal ideas 3. Crisis Intervention Objective: Tto return the client to its normal functioning or pre crisis level. abortion . murder.Pregnancy . One-on-one supervision and monitoring 2. Delusion of Omnipotence (divine powers) Used by SS (Suicidal. Non metallic/plastic/sharp objects: ex. so the nurse needs to be active and should direct the paient to activities that facilitate coping. Adventitious – calamity. Sudden elevation of mood/sudden mood swings 2. Avoid dark places C. Situational / Accidental crisis – .Adolescence (identity crisis) . belts. When the patient verbalizes that the 2nd Gen TCA is working.Mid-life crisis. tsunami In a DISASTER 1st assess/survey the scene 7 . rape and fire 3.Parenthood 2.B. Case Finding (Epidemics)/Contact Tracing (STDs) D.

Morphine Fibrinolytic / Thrombolytic ANTIDOTES Protamine Sulfate Vit. which start upon admission A.Also use fine motor rehabilitation for Post M. -zolam tranquilizer Tensilon (Endrophonium): Anticholinesterase & Miotic Atropine Sulfate (ATSO4) Anticholinesterase intoxication. anorexia & depression .I. K Calcium gluconate Naloxone (Narcan) Amicar (Aminocaproic acid) *(Neuroleptic Malignant #1 Cardinal Sign : High Dantrolene (Dantrium). Emergency drugs and antidotes DRUGS/ DISEASE Heparin Warfarin (Coumadin) Mg Sulfate Nubain (best). Needed by: addicts & residual schizophrenia due to remission & exacerbation Action / Effect Anticoagulant Anticoagulant Anticonvulsants Narcotics Dissolves clot 8 . Aftercare Support – follow-up. Occupational Therapy – .E. & Post CVA B. Syndrome’s (NMS) Fever / Hyperthermia Bromocriptine (Parlodel) Effect: antiparkinsonian. anti-prolactin. Vocational Skills (Entrepreneur skills) C. antipsychotic Hypertensive crisis (MAOI Antidepressant intoxication Ca channel blocker intoxication) Suffix:(-dipine) Anxiolytics. Sedatives – Sedative hypnotic/ Minor Flumazenil (Romazicon) Suffix: zepam. Tertiary Objective: Rrehabilitation.Usually use behavior modification for PDD (Pervasive Developmental Disorders). Pilorcarpine (Pilocar) intoxication : Miotic III.

1953. includes social sensitivity (empathy) Growth.determination. self. & self-actualization (by Maslow) which includes fully functioning person” (by Rogers) Autonomy: Iinvolves self. Labile Affect: Manic Depression or Bipolar Disorder THOUGHT CONTENT: Self-concept? Areas of concern? Themes? Obsessions? Delusions? Hallucinations? Example: Ddelusion of grandeur (manic). development. 1995) • • • • Reality perception: Aability to test assumptions about the world by empirical thought. Seen also in Parkinson’s Disease & Myasthenia Gravis. delusion of omnipotence ( schizophrenia). balance between dependence and independence. delusion of persecution & delusion of reference (paranoid delusions) THOUGHT PROCESS: Ability to understanding abstract/symbols? Example: Mmagical thinking and animism of Schizotypal personality SPEECH: Coherency? Relevance? Meaning? Quality/Quantity? Example : Slurring of Speech ( alcoholism) and pressured speech (manic depression or bipolar disorder) 9 . Schizophrenia and Manic Depression) AFFECT / MOOD: Appropriateness? Swing? Duration? Intensity? Example: Flat Affect: Schizophrenia & Major Depression. belongingness. self-acceptance. security and wholeness COMPONENTS OF ASSESSMENT OF MENTAL STATUS SENSORIUM: Consciousness? Orientation? Attention? Concentration? Comprehension? Example: Disorientation & Confusion ( Dementia) APPEARANCE: Appropriateness? Grooming? Rigidity? Mannerisms? Example: Poor Grooming (Suicidal Patients.responsible for decisions. and acceptance of the consequences of one’s action Positive attitudes toward self. includes self-identity.CRITERIA OF MENTAL HEALTH (Jahoda. self-awareness. Staurt and Sundeen.

anxiety. Guilt Industry vs. Shame and Doubt Initiative vs. Role confusion Intimacy vs. Kraeplin. Stagnation Integrity vs. Isolation Generativity vs. Focus. impulses). etiologies. diagnoses. Focus: PSYCHOSOCIAL TASKS throughout the life cycle. • Describes the human cycle as a series of eight EGO developmental stages from birth to death. Frances). syndromes.Intrapsychic process (conflicts.0 BEHAVIORAL FRAMEWORK: Focus. Despair Most common task of 40 y/o includes developing responsibility over their own lives 76 y/o male who has a good ego integrity is preoccupied w/ death 10 . INTERPERSOAL MODEL (Sullivan and Peplau). Skinner’s Theory: Operant Conditioning. defense mechanisms. PSYCHOSOCIAL THEORY OF ERIC ERIKSON • Most commonly used theory by health professionals. Focus-Psychosocial tasks EXISTENTIAL MODEL / HUMANISTIC MODEL (Rogers). Focus. (Freud). Pavlov’s Theory: Classical Conditioning. • STAGES OF PSYCHOSOCIAL DEVELOPMENT: AGE Infancy (0-18 mo) Toddler (18 mo-3 yrs) Preschool Age (3-6 yrs) School Age (6-12 yrs) Adolescence (12-20 yrs) Early Adulthood (20-35 yrs) Middle Adulthood (35-65 yrs) Later years / Old Age (65 yrs) PSYCHOSOCIAL TASKS Trust vs. Focus. Inferiority Identity vs.Conscious human experiences BIOMEDICAL MODEL (Meyer. Mistrust Autonomy vs. Focus – Disease approach.Interpersonal relationships PSYCHOSOCIAL THEORY (Erik Erickson).learned behavior.DSM V (Diagnostic and Statistical Manual for Mental Health) Axis I II III IV V Clinical Syndrome (S&Sx) Personality Disorders Pathological Disorders Environmental & Psychosocial stressors Global Functioning (assessment)] CONCEPTUAL MODELS OF PSYCHIATRIC TREATMENT • • • • • • PSYCHOANALYTICAL/PSYCHOSEXUAL MODEL.

logical and governed by REALITY PRINCIPLE.the thoughts. memories and feelings that are repressed and not available to the conscious mind. Schooler: Latency phase. Stage of the Strict Superego Adolescent: Genital phase • • FREUDIAN THEORY COMPONENTS: 1. it cannot be deliberately brought back into awareness unless in disguised or distorted form (dreams) 11 . composed of material that has been deliberately pushed out of conscious level. True desires & motives are here. it cannot be deliberately brought unacceptable to the individual. not logical and governed by PLEASURE PRINCIPLE – and since it is usually painful and unacceptable to the individual. Stage of the Superego (conscience)  Attachment of the child to the parent of the opposite sex and jealousy toward the parent of the same sex  Oedipal Complex: Attachment of the son to his mother and jealousy toward the father. are remembered and easily recalled or available to the individual Subconscious – the Preconscious.PSYCHOSEXUAL (PSYCHOANALYTICAL) THEORY OF SIGMUND FREUD • • • Infancy: Oral Phase. Stage of the Ego Preschooler: Phallic Phase. can be recalled with some effort Unconscious – Composed of the LARGEST BODY OF MATERIAL. LEVELS OF AWARENESS: Conscious Subconscious Watchman of the Personality Unconscious The one who molds the personality Storage bin of traumatic & meaningful memories. • • • Conscious – Composed of past experiences. Stage of the Id Toddler: Anal Phase. helps repress unpleasant thoughts or feelings and can examine or censor certain desires or thinking.  Electra Complex: Attachment of the girl to her father and jealousy toward the mother.

critical. prohibitive forces of the SUPEREGO and is directed by REALITY PRINCIPLE. and is called the CONSCIENCE or EGO IDEAL.feeling part of personality. perhaps next week. pleasure. “I should not want that. controls. It is not good to even wish for it. This is the thinking. EGO: Psychoanalytic term for that part of the psyche that is CONSCIOUS. The Superego says. The Ego says. the reservoir of INSTINCTS.” Adult Superego -Induces guilt  undoing Conscience Principle “Thou shall not. The “I” that is shown to the environment and most in touch with REALITY and the MEDIATOR between the primitive. primitive drives governed by the PLEASURE PRINCIPLE and is SELF. I am not yet ready. “I want. PRINCIPLE -Pleasure Principle LANGUAGE “I want it when I want it. instinctive drives of the ID and the self. what I want.” “Not now. inhibits and prohibits impulses and instincts. “I would want to have it if only I can afford it.” SUPEREGO: Psychoanalytic term for that part of the psyche that RESTRAINS.CENTERED.seeking.” PERSONALITY Infant/child Ego Reality Principle “I can wait. The Ids says.” Parent IMBALANCE or ABNORMAL FUNCTIONING OF THE THREE ELEMENTS OF PERSONALITY ↑Id + ↓SE = Conduct Ddisorder and Antisocial Personality Disorder ↓Id + ↑SE = Obsessive Compulsive Disorder • • ID: Psychoanalytic term for that part of the psyche that is UNCONSCIOUS. 3 AGENCIES OF THE MIND: Three Elements of Personality Id FUNCTION -Animal instinct -Survival of the fittest -Balances (Mediator) the desire of the Id and Superego The ego acts as the integrator of the personality. when I want it”.critical.2. is self. SYSTEMS OF PERSONALITY.” • 12 .

Condition for termination 4. Meeting location / time 3.CLIENT CONTRACT 1. Purpose of a relationship 2. date start & end. Stage of testing. .CLIENT RELATIONSHIP (NCR) A. needs. RN. 24 hrs monitoring B. expectations of clients Identify anxiety level of self and client Set goals of relationship.ESSENTIAL ELEMENTS OF A NURSE.Most difficult phase -. Vverbalization to the nurse of all suicide ideas 2. Roles of RN and patient 6. Stress confidentiality. Responsibilities of RN and patient 7. Contract – 2 famous psychiatric contracts: 1. Goals / Expectations 8. Names of RN and patient 5. Define responsibilities of nurse and client. WORKING PHASE   Promote acceptance of each other Accept client as having value and worth as a unique individual. Diet contract  Eeating disorder The start of termination phase: “Good morning. ORIENTATION (INITIATION) Assessment of problems. Confidentiality FOUR PHASES OF NURSE.Counter transference phase .Stage of Self-Awareness  Tto prevent Counter Transference #1 CORE VALUE OF Psychiatric Nursing B. full name. Pre-interaction/Pre-orientation (For the Nurse) .” C. Establish boundaries of relationship.NCP is on going 13 . shift. session.Stage of resistance . No suicide contract  Mmajor depression = emergency TWO definitions of no suicide contract: A.

oriented. signals. apathy. fetal position when crying.Identification of the problem/exploration .Phase of prognosis  Eevaluation Maintain boundaries Anticipate problems of termination: ο Increased dependency on the nurse ο Recall of previous negative experience. symbols) utilized in a goal. signs. . dynamic process of SENDING and RECEIVING MESSAGES by various verbal or non. adaptive coping mechanisms Personal biases (manifestation by counter-transference & vice versa) are seen during working phase    D.solving techniques Maintain PROFESSIONAL. therapeutic relationship Keep interaction reality.verbal means (words.  14 . thumb sucking. ο Regressive behaviors  Discuss client’s feelings and objectives achieved THERAPEUTIC COMMUNICATION DEFINITION: Continuous.Stage of Separation Anxiety  Signs & symptoms: Rregression: Ttemper tantrums.verbal communication to support client Recognize blocks to communication and work to remove them FOCUS on client’s: Confronting and working through identified problems Problems. abandonment. depression.The #1 Psychiatric Core Value is Consistency  Ffor manipulative patients Be consistent to patient with: BAAAM COPS B orderline C onduct d/o A ntisocial O oral/eating disorder A lzheimer’s P aranoid A utistic S uicidal M anic Use therapeutic and problem.here and now Provide ACTIVE LISTENING and REFLECTION of feelings Use non. .directed professional framework.solving skills Increasing independence ο Help client develop alternative. etc.rejection. TERMINATION Plan for termination of relationship early the relationship .

“It may difficult for you to speak at this time.” And continues being silent. Elaboration/Exploration “Tell me more about your feelings” “Everyone is on my back. You seem concerned. Manic) “What do you mean by…?” (Used in Neologism and word salad) “I could not follow you. service. Alzheimer’s.” Includes statement like “Tell me about your feelings & I will stay w/ you.” Appropriate response for an 80 y/o who says. Nobody in the family is senile.” d. “I can’t be. age 25. “I told my children that I’m ready to die. My husband says. The most appropriate response of the nurse is to say. I will lead you to the group therapy session. “Have you discussed this with your husband about how to cope with these problems? Tell me.” “You seem angry. Clarification – used in neologism and word salad SAM (seen in Schizophrenia. Surrounded by broken glass. This response will convey that the nurse is willing to wait for the patient’s readiness to engage in conversation.” – (Used in flight of ideas and looseness of association) 15 .” *Ursula.” correct 5response of RN includes statement like. “It sounds as if you are shocked over the diagnosis. The best way the nurse should do is to approach Ursula slowly while speaking in the calm voice. b. Offering of self – safety. I will sit here beside you. she sits staring blanking at her bleeding wrist while staff members call for an ambulance. comfort “I am here.” RN’s response to elaborate feelings includes statement like.” c. ‘I don’t do anything right. Reflection: (mirror of feelings) “It must be difficult for you. calling her name and telling her that the nurse is here to help her.’ & my boss wants me to do things differently. perhaps you can do so at another time”. is found on the floor of the bathroom in the day treatment cleaning with moderate lacerations to both wrists. I have nothing to say. This approach provides reassurance for a patient in distress. Daughter of patient newly diagnosed w/ Alzheimer’s says.” When patient with symptoms of severe depression says to the nurse “I can’t talk.THERAPEUTIC COMMUNICATION TECHNIQUES a.

f. “there are no spiders.” A patient admitted to be listening to voices should be assessed by asking. “What do you mean by a good show?” e. restate what the client says... Brilliant & charming patient says. “What does the voice tells you?” “I know that Prof. Giving Leads “Aha.” Best response of the RN includes asking questions like. Reality Orientation/Reality Testing .& he’s still trying to rape me”.” j. “I’ll be better off dead.” Appropriate response by the nurse includes statement like.Delusion.”. correct of RN includes questions like “Are you frightened being unable to control your thoughts?” Post-menopausal woman says. “I’d like to take you out & give you a good show. The appropriate response of the nurse would be..” best response by the RN is asking pt.” Nurse: “You’re frightened. Therapeutic Silence h. rape my mind. “There are spiders crawling on my back”.” Alcoholic pt with delirium tremens states. its only part of your illness”. “Do you have plans of suicide”? Pt says.“The ground is watching us. appropriate intervention includes clarify the meaning of the word. Illusion & delusion Client: “Help! Help! There are spiders on my back!” Nurse: “I don’t see spiders but for you that is real. (Patient: “I can’t believe I cannot go home today. “I’m pregnant by God in heaven.then…mmmh… go on… yes…” g. “You believe something special happened to you?’ 16 . Hallucination. Paraphrasing/restating – repeating Repeats the MAIN IDEA. Validation – interpret Client: “I see a shadow. Summarizing – recap Nurse: “Today you have described your understanding of how you feel when you are upset with your son. Draper tried to rape me.Nsg Dx: Altered Sensory Perception .” Nurse: “You can’t believe that you can’t go home today?”)’ i.

“Are you planning to commit suicide?” – Confrontation c. everything will be all right. opinions “I believe it would be better if you…” h. “How are you?” “How’s your day?” “What are your favorite things?” BLOCKS TO THERAPEUTIC COMMUNICATION a.” e. Closed Ended Question – questions answered by “yes” or “no” Note: Tthe only therapeutic closed-ended question  Ssuicidal pt. “It sounds as if you have much anxiety. Agree/disagree – never argue with client “You are right in doing that.” / “You should not think that way. Advising – never advise because they are sometimes persona.” d. False Assurance “Ddo not worry”  Tto patient who are dying & w/ incurable illness “You have the best doctor. Non therapeutic silence/touch g. OCD who checks door 10-15 times includes statement like. encourages further or broadened communication. Belittling the patient – CHANGING THE SUBJECT f.” “Relax that is nothing to worry about.” k.” is an appropriate response for a suspicious pt saying. Never use why – it demands an explanation and also anxiety provoking b. “I think that my food is being poisoned” RN’s correct response of pt w/. Stereotyping BEHAVIORAL THERAPY 17 . Open-ended question / broad openings Questions NOT answerable by ‘YES’ or ‘NO’.“It must be frightening to feel that way.

condemned. Classical Conditioning (pairing of two stimuli in order to gain a new learning behavior – by Ivan Pavlov) 1.used in Behavior Modification 1. Acquisition (newly acquired behavior or the by product of classical conditioning). Relaxation Technique – light stroking = labor . Extinction B.A. headache 5. excessive. • TARGET BEHAVIOR: Aactivities that the nurse wants to develop or accelerate in the client. TERMINOLOGIES • STIMULUS: Aany event affecting an individual • PROBLEM BEHAVIOR: Ddeficient. Used in eating disorders and depression > Token economy is also effective for toddlers 2. Operant conditioning – Burrhus Skinner . Positive reinforcement (Reward Orientation)  Token Economy – use tokens as a source of reward. • REINFORCER: Aa reward positively or negatively influences and strengthens desirable behaviors.Implosive Therapy – sudden exposure 3. • POSITIVE REINFORCER: Aa desirable reward produced by specific behavior (TV time after doing homework) • NEGATIVE REINFORCER: Aa negative consequence of a behavior (Spanking child for wetting the floor) A. palpitations.Purse Lip Breathing Exercise = COPD/CAL (Chronic Airflow Limitation) 4. unwanted behavior • OPERANT BEHAVIOR: Aactivities that are strongly influenced by events that follow them. 2. Ex.#1 treatment for phobia 2. Desensitization – gradual exposure to the feared object -. Flooding/. Negative Reinforcement (Punishment Orientation)  Aversion Therapy/Aversion Technique Behavioral Treatments 1. Guided Imagery (Child) & Visualization (Adult) 18 . HPN  ↓BP. Biofeedback – mind over matter.

Knowledge of therapeutic modalities enhances the performance of nursing interventions during therapy.elected. TYPES OF GROUPS 1. Increased feelings of closeness→ Reduction on feelings of being alone. Verbalization: Members express feelings and group reinforces appropriate communication.image and self. Responsibility for goal is shared by group and leader 2. DEFINITION: Psychotherapeutic processes that occur in formally organized groups designed to change maladaptive or undesirable behavior. 4. 3. Provides attention to reality and provides development of insight into one’s problems by expressing own experiences and listening to others in groups D. Format: Discussion flows according to group members’ concern 3. ADVANTAGE OF GROUP THERAPY 1.confidence  Increases reality. B. With feedback group→  Corrects distortions of problems  Builds self. Economical: Lless staff used.determined. With opportunities for practicing alternative behaviors and methods of coping with feelings 5. Goals: Nnot pre.GROUP THERAPY A.determined Format: Cclear and specific Factual material: Ppresented Leader: Rretains control 2. Emphasis: Mmore on FEELINGS rather than facts C.testing opportunities  Gives info on how one’s personality and behavior appear to others 4. 8-10 patients are the optimal number of patients in a group. Leader: Nnondirective 5. Structured     Goals: Ppre. 2. PRINCIPLES OF GROUP THERAPY 1. Desired outcome of group therapy includes verbalization of feelings rather than acting them out 19 . Materials and topics are not pre. Unstructured 1.

4. “Maybe you’re someone else’s problems. supportive setting to effect change. best action of the RN is to maintain distance from the pt. Working Phase  Confrontation between members→ Ccohesiveness  Identification of problems→ Pproblem. Initial Phase  Formation of group  Setting and clarification of goals and expectations  Initial meeting. E. 3.solving processes taking on phase In a group therapy when one client says to another.2. “Leave me alone & get away from me. Change: Members have opportunity to try out new and desirable behaviors in group. sharing and communication. Support: Members gain support from one another through interaction. PHASES OF GROUP THERAPY 1. acquaintance and interaction 2. Termination Phase  Evaluation of goals attainment  Support for leave.”. Activity: Provides stimuli to verbalization and expression of feelings.” this shows that they are in the working 3.taking In group therapy if a client says. Behavior indicating that goal is met after socialization in a group therapy includes participation of each group member telling the leader about specific problems DEFENSE MECHANISMS REPRESSSION CONVERSION IDENTIFICATION SUBLIMATION RATIONALIZATION DISPLACEMENT SPLITTING SUPPRESSION DISSOCIATION/SYMBOLIZATION INTROJECTION COMPENSATION PROJECTION UNDOING REACTION FORMATION 20 .

like fashion & fads Ex. 21 . suppress anger  HPN DISSOCIATION Act of detaching of separating a strong emotionally #1 DM: Mmultiple personality= charged conflict from one’s consciousness.  peripheral neuritis (tingling sensation)  ↓ B6 Pyridoxine. disease Ex. Voluntary forgetfulness or “I rather not talk about it. Diarrhea before exam. A soldier experiences sudden blindness after witnessing his best friend dying from a grenade blast. B12  P. SUPPRESSION – used selective Willingly or voluntarily putting unacceptable thoughts or inattention (moderate anxiety) feelings out of one’s mind with the ability to recall the thoughts or feelings at will. or act represents another through some #1 DM: Pphobias common aspect and carries the emotional feeling associated with the other. FORGETFULNESS  Bblackout (alcoholic intoxication) blocking (Alzheimer’s/Dementia)  Mmemory gaps  Cconfabulation = making story to fill in memory gaps also used by Wernicke’s Korsakoff’s = ↓ Vit.REGRESSION INTELLECTUALIZATION DENIAL FIXATION ACTING-OUT FANTASY DEFENSE MECHANISMS Legend: DM means Defense Mechanism 1. anemia. To preserve one’s ego or self. CONVERSION Transferring of mental conflict or emotional anxiety into #1 DM: Ssomatic/somatoform physical symptom to release tension. Imitator. Mimics/simulates external behavior . Ex. SYMBOLIZATION – unconscious. similar to role playing INTROJECTION – INTERNAL Attributing to oneself the good qualities of another. phobias 3. right now!” 2. B1-thiamine. Sexually abused as a child blocks the experience from her consciousness and is confused about inability to respond sexually. Ex. destruction of ego Ex. REPRESSION Involuntary recall painful or unpleasant thoughts or feelings cause they are automatically & involuntarily pushed into one’s unconsciousness. A woman raped found wandering a busy highway – traumatic amnesia. B9 folic acid. idea. Engagement ring symbol of love. IDENTIFICATION – external Unconsciously. Ex. An object. people use it to identify with the DM: Ppreschooler personality and traits of another.

Temporarily alleviates anxiety. Conscious intent often altruistic. internalization” Ex. Unconsciously used to justify #1 DM: Aanti-social disorder ideas. attitude. SUBLIMATION Re-channeling of consciously intolerable or Socially Unacceptable Behaviors or impulses into personally or socially acceptable. problem is still present and connected Ex. An unattractive girl became a very good tennis player. SPLITTING Viewing people as all good. Procrastinate Ex. OVERCOMPENSATION. It is usually seen among alcoholics. Student hating her CI may act very courteously 22 .DM: Ddepression transference counter Incorporate feelings & emotions. “ingestion. Modify the issue. -+ 5. hostility or anxiety from one idea. it is all for the best. DISPLACEMENT – higher to Mechanism that serves to transfer feelings such as lower frustration. Conscious or unconscious. Person rejects unwanted characteristics of self and assigns them to others. An aggressive person joins debate team (behavior modification)++ COMPENSATION The act of making up for a real or imagined deficiency with a specific behavior. Ex. UNDOING OR RESTITUTION – Negation of previous consciously intolerable action or lower to higher experience to reduce or alleviate feelings of guilt. RATIONALIZATION – object Most common ego DM. Blaming others for own faults. anyway. Irrational/illogical excuses to escape responsibility. Ex. person or object to another. It wasn’t worth it. traits and personality. blames it on the poor lectures. values & beliefs. Ex. Problem is not connected. Rationalization is justifying one’s actions which are based on other motives. Yelling at a subordinate after being yelled at by the boss. Usually it is observed in paranoid patients. “scapegoat” 6. Acting & dressing like Jesus Christ 4. actions and/or feelings with good acceptable reasons or explanation. DM: Obsessive Compulsive Ex. Hx of drug addicts & alcoholics DM: Borderline (female) REACTION FORMATION Person exaggerates or overdevelops certain actions by #1 DM: Ppassive-aggressive displaying exactly the opposite behavior. and others as all bad Impulsive = poor self-control Ex.Projection is attributing to others one’s unconscious wishes/fear. 7. or personality disorder feeling from what he or she normally would show in a given situation. & PROJECTION – person #1 DM: Pparanoid Ex. Sending flowers after embarrassing her in public. Student fails an exam.

increased attentiveness. on her first date with a fellow employee. Chain smokers.” is showing denial FANTASY DM: Schizoid Imagined events or mental images. Without stressors Ex.o. diffuse apprehension or vague uneasiness. smoking at parties  chronic regression Permanent or persistence into later life of interests and behavior patterns appropriate to an early age. PTSD. allow one to feel more comfortable. “things will get better. needs. □ Mild: The perceptual field is wide allowing the client to focus realistically on what is happening to him. but the causative conflict or threats is not in the conscious mind or awareness. Alert senses. (permanent flight from reality: autism) ANXIETY A. wishes. feelings. MAJOR ASSESSMENT CRITERION FOR MEASURING DEGREE OF ANXIETY: Client’s ability to focus on what is happening to him in a situation. A 27 year old acts like a 17 y. DENIAL #1DM: Alcoholics. alcoholics = oral fixation The act of transferring emotional concerns into the intellectual sphere. “What’s good about this. Person uses reasoning as a means to avoid confrontation.” This shows that the teen is denying her chronic illness Cancer patient saying.8. “You might have mixed my result with other patients. Ex. and increased motivation. A.OUT 10. Molested child  wants to be comforted  becomes psychologist = Oprah The unconscious refusal /avoidance to face thoughts. soon” 14 y/o girl who is undergoing dialysis says. B. Ex. “Dear John” Letter the groom is trying to figure out with his room mate why his fiancée changed her mind – to avoid confronting her. Wishful thinking. INTELLECTUALIZATION ACTING . is that after it I will look good & thin. □ Low / mild level of anxiety is healthy and helps in individual growth and development. incurable illness towards her. temporary retreat to past levels of behavior that reduce anxiety. Temporary flight from reality to ↓ anxiety. Daydreaming. 23 . DEFINITION: Effective subjective response to an imagined or real internal or external threat. □ Perceived SUBJECTIVELY by the conscious mind is as a painful. REGRESSION FIXATION 9. Unconscious wish turned into reality Ex. and/or reality factors that are intolerable. Ex. Exaggeration of intellect. Blocking the awareness of reality. Ex.

□ Moderate: Another word is selective inattention. The perceptual field narrows and the client is able to partially focus on what is happening if directed to do so and can verbalize feelings of anxiety. □ Severe: The perceptual field is significantly reduced and the client may not be able to focus on what is happening to him and may not be able to recognize or verbalize anxiety. All senses affected; decreased perceptual field; drained energy; Learning and problem-solving not possible. Start of sympathetic symptoms: tachycardia, palpitations, hyperventilation (brown paper bag to prevent Respiratory Alkalosis) and cold clammy skin. □ Panic: The perceptual field is severely reduced and the client experiences feelings of panic and dread. Client overwhelmed and helpless; personality may disintegrate → hallucinations and delusions. Pathological conditions requiring immediate intervention. Client may harm self or others.
A patient stating, “Sometimes I feel like I’m going crazy & losing control over myself,” is showing symptoms of panic attack

POTENTIAL NURSING DIAGNOSES □ Ineffective Individual Coping □ Anxiety C. NURSING INTERVENTION IMPLEMENTATON: □ Identify anxious behavior and anxiety levels and institute measures to decrease anxiety at a level where learning can occur. □ Provide appropriate environment where environmental stress & stimulation are low (First nursing action): • Structured, NON-STIMULATING, uncluttered • SAFE from physical exhaustion and harm. □ STAY. Do not leave client alone. Recognize if additional help is needed. Provide physical care if necessary. □ Establish PERSON-TO-PERSON relationship and maintain an accepting attitude: • ACCEPT client. Show willingness to LISTEN. • Encourage, allow EXPRESION OF FEELINGS at clients OWN PACE avoid forcing verbalization. □ Administer medication as directed and needed. The pharmacology therapy of choice is the ANXIOLYTICS-reduces anxiety so client can participate in psychotherapy. □Assist to cope with anxiety more effectively. Assist to recognize individual strengths realistically • Encourage measures to reduce anxiety: activities: relaxation techniques, exercises (DANCING, WALKING, JOGGING), hobbies, talking with support groups, desensitization treatment program • Provide individual or group therapy to identify anxiety and new ways of dealing with it and develop more effective coping interpersonal skills.
• If patient can be redirected back to the topic after he gets anxious while the RN gives discharge teaching, it is an indication that discharge teaching can be resumed.

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TYPES OF ANXIETY DISORDER 1. Phobia 2. Obsessive Compulsive 3. Post Traumatic Stress Disorder (PTSD) 4. Generalized Anxiety Disorder (GAD) 5. Panic Disorder PHOBIA AND PANIC DISORDER A. Extreme anxiety and apprehension experienced by an individual when confronted with feared object/ situation; commonly begins in early twenty’s (young adult) as a result of childhood environmental factors characterized by ORDER & RIGIDITY; use compensatory mechanism of the psychoneurotic pattern of behavior and development of symptoms permits some measure of social adjustment. B. PRECIPITATING FACTOR: Pressures of decision-making regarding life-style in early adult period C. TYPES OF PHOBIA • Agoraphobia: Ffear of being alone, fear of open spaces or PUBLIC places where help would not be immediately available (trains, tunnels, crowds, buses)
A client with agoraphobia who is already able to go outside the house indicates a positive response to therapy.

Expected outcome for agoraphobia includes going out to see the mailbox

• •

Social phobia: Ffear of public speaking or situations in which public scrutiny may occur Simple phobia: Ffear of specific objects, animals or situations

D. NURSING IMPLEMENTATION • Recognize the client’s feelings about phobic object/ situation
Specific precipitants are present with phobia

• • • •

Avoid confrontation and humiliation; Provide constant support (Stay with client during an attack) if exposure to phobic object or situation cannot be avoided Do not focus on getting patient to stop being afraid Provide relaxation techniques Implement behavioral therapy: SYSTEMIC DESENSITIZATION (the #1 treatment for PHOBIA) . Administer antidepressants as ordered

OBSESSIVE-COMPULSIVE DISORDER

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A. A psychiatric disorder characterized by persistent, recurring anxiety-provoking thoughts and repetitive acts; Unconscious control of anxiety by the use of rituals and thoughts 1. OBSESSION: Ppersistent, repetitive, uncontrollable thoughts 2. COMPULSION: Rrepetitive, uncontrollable acts of irrational behavior that serve NO rational purpose → rigidity, rituals, inflexibility; the development of rituals permits some measure of social adjustment B. ASSESSMENT FINDINGS: Rritualistic, rigid, inflexible; with difficulty making decisions and demonstrates striving at perfection; use verbal and intellectual defenses C. NURSING IMPLEMENTATION:  Provide for physical safety (1st); meet physical needs  Accept, allow ritualistic activity; DO NOT INTERFERE with it; (The best time to interfere with ritual is after client has completed it.) Accept behavior but set limits on length and frequency of the ritual. Offer alternative activities; support attempts to reduce dependency on the ritual; guide decisions  Provide structured environment, minimize choices  Provide socialization, group therapy  Administer CLOMIPRAMINE (ANAFRANIL) as ordered  A Tricyclic antidepressant used in phobias, anxiety and obsessive-compulsive disorder; SIDE-EFFECTS/ ADVERSE REACTIONS: Ttachycardia, cardiac arrest, dizziness, tremors, seizures, CONTRAINDICATIONS: Ppregnancy, hypersensitivity; Interactions/Incompatibilities: Hypertensive crisis, convulsions, with MAOIs POST-TRAUMATIC STRESS SYNDROME A. A disorder following exposure to extreme traumatic event (wars, rape, natural catastrophes) causing intense fear, recurring distressing recollections and nightmares B. ASSESSMENT: 2 Cardinal Sign: FLASHBACK & NIGHTMARES. Images, thoughts, feelings → intense fear and horror, sleep disturbances.  Depression, or irritability or outburst of anger  Exaggerated startle response; Poor impulsive control  Avoidance; Inability to maintain intimacy; Hypervigilance C. PRIORITY NURSING DIGNOSIS: Altered Sleeping Patterns Altered Skin Integrity Ineffective Individual Coping D. NURSING INTERVENTATION  Encourage VERBALIZATION about painful experience. Show empathy; be nonjudgmental; Help feel safe.  Rational emotive-therapy; Allow to grieve  Help client identify, label and express feelings safely  Enhance support systems: Sself-help groups, family psychoeducation, and socialization.

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In a rape victim, a statement like, “If I should not have worn that red panty, it wont happen to me”, shows denial Statement of a rape patient who is beginning to resolve trauma includes, “I’m able to tell my friends about being raped.” An RN needs further teaching about caring for a post-traumatic client when she keeps on asking the client to describe the trauma that caused patient’s distress after recovering from a PTSD.

GENERALIZED ANXIETY DISORDER A. Description 1. Generalized anxiety disorder is an unrealistic anxiety in which the cause can be identified.
The two major types of precipitating factors for anxiety are: treats to one biologic integrity and treats to one’s self-esteem. Anxiety is one of the defining characteristics of ineffective individual coping. A patient with anxiety disorder may exhibit difficulty in coping.

2. Physical symptoms occur B. Assessment 1. Restlessness and inability to relax 2. Episodes of trembling and shakiness 3. Chronic muscular tension 4. Dizziness 5. Inability to concentrate 6. Chronic fatigue and sleep problems 7. Inability to recognize the connection between the anxiety and the physical symptoms 8. Focus on the physical discomfort PANIC DISORDER 1. Description a. The cause usually can not be identified. b. Panic disorder produces a sudden onset with feeling of intense apprehension and dread. c. Severe, recurrent, intermittent anxiety attacks lasting 5 to 30 minutes occur. 2. Assessment a. Choking sensation b. Labored breathing c. Pounding heart d. Chest pain e. Dizziness f. Nausea g. Blurred vision h. Numbness or tingling of the extremities i. A sense of unreality and helplessness j. A fear of being trapped k. A fear of dying 27

DO NOT modify psychotic behavior. e. Most commonly prescribed drugs in medicine Greatest harm: Wwhen combined with ALCOHOL I. Therapeutic communication appropriate to patient showing signs of panic disorder includes providing a concrete direction ANXIOLYTICS/ANTI-ANXIETY Another word: Sedatives/Hypnotics/Minor Tranquilizer For: Delirium. Ffeelings of impending doom 3. Assist the client to identify the thoughts that aroused the anxiety and identify the basis for these thoughts. Attend to physical symptoms b. Assist the client to change unrealistic thoughts to more realistic thoughts. trembling & says. c. d.” Should be accompanied in her room & RN should stay w/ her for a while The goal of intervention in the care of the anxious patient is to enable him to develop his capacity to tolerate mild anxiety. also induce sedation. Benzodiazepine Code: -ZEPAM/ZOLAM Action: Aanticonvulsant. functional psychiatric disorders. Uuse cognitive restructuring. inhibit convulsion. psychosomatic disorders. Interventions a. the best for delirium tremens (alcohol & cocaine withdrawal) Estazolam (Prosom) Alprazolam (Xanax) Chlorazepate (Tranxene) Oxazepam (Serax)* the best in sundown syndrome (seen in Alzheimers) Advantage: Nnot hepatotoxic Lorazepam (Ativan)* 2nd drug for sundown syndrome Triazolam (Halcion)* Anti-insomnia Temazepam (Restoril)* Anti-insomnia Flurazepam (Dalmane)* Anti-insomnia. Used in neuroses. insomnia ACTION: Increases GABA (gamma amino butyric acid) USES: Major use to reduce anxiety. A combination of behavioral and somatic approaches is effective in the management of anxiety. anti-anxiety.L. do not stop abruptly  because of rebound grand mal seizure Midazolam (Dormicum) Prazepam (Centrax) Chlordiazepoxide (Librium)* 2nd drug of choice for delirium tremens Clonazepam (Klonopin) 28 . muscle relaxant & anxiolytic Diazepam (Valium)* best for: Sstatus epilepticus . “I can no longer go further. Administer anti-anxiety medications as prescribed A client in panic disorder showing dilated eyes. relax muscles.

assistance w/ walking. Stillnox) sleeping aid 1. Milltown) Chloral Hydrate (Noctec) Hydroxyzine (Atarax. affect) Habituation and increased tolerance Withdrawal symptoms: high doses & prolonged use (>6mo) PSYCHOTIC DISORDER: SCHIZOPHRENIA 29 . Vistaril)* anti emetic & antihistamine Diphenhydramine (Benadryl)* Antiparkinsons. Anxiolytic (addictive) Zolpidem (Ambien.Halazepam (Paxipam) Side Effects: #1 Vital sign to be monitored: Respiratory Rate due to its Lethal Side Effect. an anxiolytic antagonist II.     SIDE EFFECTS DROWSINESS (Do not drive. Iterax. Respiratory Depression 1. Barbiturates Action: Uused as an anticonvulsant besides being a sedative Code: TAL / AL Secobarbital (seconal) Phenobarbital (luminal)* commonly used anticonvulsant barbiturate Methohexital (Brevital) Amobarbital (Amital) III Atypical Anxiolytics Meprobamate (Equanil. sensorium. NO alcohol) Mental confusion (Evaluate mood. Antihistamine. Early  decrease LOC  Lethargic Late/Fatal  decrease RR  Respiratory Depression  RR below 12 Avoid strenuous activities Antidote for Benzodiazepine intoxication: FLUMAZENIL (ROMAZICON).

Drug addicts and alcoholics: Hhigh probability for schizophrenia due to increase Delusions & hallucination DSM V Criteria for Schizophrenia: Characterized by both (-) & (+) symptoms & social / occupational dysfunction for at least SIX (6) months. sensory perception and with deterioration & regression of psychosocial functioning. Delusion. (+) POSITIVE SIGNS OF SCHIZOPHRENIA: Ddue to EXCESS DOPAMINE Do you know HILDDA PI? Hallucination. “Pretty red dress. Genetics 65% chances. neologism. Illusion. Looseness of Association. aloofness) AFFECT. Disorientation & Agitation Paranoia & Insomnia Schizophrenic patient says. Ddouble-bind theory  2 kinds of information/communication 4.Definition: Ssevere impairment of mental & social functioning with grossly impaired reality testing. Patient with 5 admissions in 2 yrs is considered a chronic schizo. FLAT (Inappropriate or no display of feelings) #1 HALLUCINATION of Schizophrenia is Auditory. Iincreased dopamine –coming from the substancia nigra 2. ASSESSMENT FINDINGS (GENERAL SIGNS) THE FOUR A’s of SCHIZOPHRENIA ACCORDING TO BLEULER A ASSOCIATIONS.if two parents are diagnose with schizophrenia 32. LOOSE: Jjumping to different topics WITHOUT association or relevance AMBIVALENCE (Two opposing feelings toward others at the same time) AUTISM (withdrawal from environment and others) → magical thinking. Trauma  PTSD 3. A. tomatoes are red…” is showing looseness of association 30 . THEORIES: 1.5% chances.if 1 parent is diagnosed with schizophrenia 5.

(-) NEGATIVE SIGNS OF SCHIZOPHRENIA: Ddue to LACK OF DOPAMINE Remember your POOR A’s? Poor judgment. Poor self care Alogia. Clang association (use of rhymes in sentences) vs. no whispering & laughing) . Self-care deficit 3. REMEMBER the 4 P’s: Projection (#1 defense mechanism). 2. Social isolation C. Risk for violence: Ddirected toward self or other (priority!!!) 2.g. ideas of persecution and delusions. delusion of Persecution (#1 delusion of Paranoid Schizophrenia) . Perseveration e. PRIORITIZED NURSING DIAGNOSES FOR ALL TYPES OF SCHIZOPHRENIA: 1. Echolalia/Parroting & Echopraxia (Commonly seen in AUTISM) B. Alzheimer’s & Manic) 1. Tangentiality (did not answer the stimulus/ question) 5. Word Salad (incoherent mixture of words) 2. 3. Passive Friendliness (#1 attitude therapy: Nno touching. 1st stimulus  correct response 2nd & following stimulus  still responding to the 1st stimuli 4. 31 . sees environment as hostile and threatening. Flight of Ideas (jumping from one RELATED topic to another): Ccommonly seen in MANIC patients. Alteration in Content of Thought OTHER NEGATIVE SYMPTOMS: All this signs & symptoms can also be seen in SAM (Schizophrenia. Neologism (creating NEW WORDS) vs. . Proxemics( 7 feet away from the patient). Poor insight. altered 4. delusion & hallucination) 5. Thought process. Anergia. Sensory/perceptual alterations ( related to illusion. Anhedonia NURSING DIAGNOSIS FOR NEGATIVE SYMPTOMS OF SCHIZOPHRENIA: 1. Alteration in Thought Process. 5 (FIVE) TYPES OF SCHIZOPHRENIA: 1. Verbigeration (meaningless repetition of action words (Verb)) vs. Circumstantiality (beating around the bush. PARANOID: Presenting sign is SUSPICIOUSNESS. also in Schizophrenia. answers but delayed) vs.

Catatonic posturing. Consistency to build trust 2. laughing. CATATONIC: With stereotyped position (catatonia) with waxy flexibility. Altered Nutrition less than body requirement 3.” shows a paranoid delusion of schizophrenia. DISORGANIZED: Another word is Hebephrenic. transient hallucinations (Auditory). 2. Food: PACKED OR SEALED foods except canned goods: Nno metal 3. Characterized with inappropriate behavior: Ssilly crying. Self Care Deficit 3. Developmental Stage FIXATION: Anal Fixation #1 Defense Mechanism: Regression & Fixation 4. All behaviors are similar with toddlers since they are anal fixated.Catatonic hyperactivity or excitability: PRIORITIZED NURSING DIAGNOSIS: 1. UNDIFFERENTIATED or MIXED : Symptoms of more than one type of schizophrenia 32 . Social Isolation – no group session when schizophrenic Paranoid who is suspicious saying.A patient who says. “Someone has placed a transistor in my brain. #1 Defense mechanism: Autism & mutism #1 Cardinal Sign of Catatonia – waxy flexibility (cerea flexibilitas) -Ssimilar in children with autism . “I don’t like to eat meat because animal produced foods are Poisonous”. Schizophrenic says. “This place is meant for bugs & prison.Catatonic stupor – markedly slowed movement. . regression. MISTRUST) NURSING CONSIDERATION: 1. shows suspicious paranoid type schizophrenia.bizarre or weird positions . the patient should be involved in the plan of care.Most dangerous/serious type of schizophrenia– may die from dehydration CATATONIC CHARACTERISTICS: . mutism. Fluid & Electrolyte Imbalance 2.Catatonic negativism – resistance towards flexion & extension .” correct interpretation shows paranoid delusion Statement like.” In order to encourage trust. bizarre mannerism.Catatonic rigidity – cementation/stone-like position .” The other staff members are laughing at my back. Developmental Stage FIXATION: ORAL PHASE (TRUST vs.

no more delusions but still has negative symptoms or odd beliefs or unusual perceptions. and drinking more than 6 L of water daily for past weeks. 2. PRINCIPLES OF CARE 1. who yells. Desired efficacy of treatment in schizophrenic patient who is mute & immobilized includes standing up when RN enters the room. and not to delusions. “Everyone. the action of an RN that shows a need for further teaching is when shegoes to the room of a pt. so solitary activities are preferred over team activities.” Appropriate action of RN to a Schizophrenic who yells loudly. The #1 drug of choice is Fluphenazine (Prolixin decanoate) 5. Do not argue. remove from areas of tension Suspiciousness & paranoid patient is threatening to the staff. Promote trust. RESIDUAL: No longer exhibits overt symptoms. social or diversional therapies Patients with schizophrenia need activities that do not require interaction. Maintenance of safety: Protect from altered thought processes. priority focus should be hyponatremia.” includes walking towards the pt & ask him who he is talking to. Encourage expression by verbalizing the observed. Implementation of appropriate family. Validate reality.- has delusions & disorganized behavior but DOES NOT meet the critieria for the above sub types alone. Respond to feelings. Establishment and maintenance of therapeutic relationship: Engage in individual therapy. ANTIPSYCHOTICS Another word: Neuroleptic / Major Tranquilizers 33 . Undifferentiated type chronic schizophrenia must be referred to a program promoting social skills due to functional loss deficit. talks to wall and saying “Don’t talk to me. Admission assessment of a Schizophrenic client reveals auditory hallucination. Offer presence-Tolerate long silences 4. bastard. D. Meeting of physical needs: May have to be fed / bathe initially 3. group. out of here.

100 ml juice (prone or tomato). Serenase)* #1 drug used for extreme violent behavior Instruct patient taking Haldol to wear sunscreen Droperidol (Inapsine) III. Butyrophenones Code: PERIDOL Haloperidol (Haldol. Atypical Antipsychotics Olanzapine (Zyprexia) Code: DONE / ZAPINE or APINE 34 . Non-psychiatric cases: Nausea and vomiting. taken with straw (bite straw & sip) Mesoridazine (Serentil) Thioridazine (Mellaril)* ceiling dose/day: 800 mg  Adverse Effect: Rretinitis pigmentosa Prochlorperazine (Compazine)* #1 commonly used anti emetic Compazine causes anticholinergic side effects Trifluoperazine (Stelazine) II.USES: Schizophrenia. to prevent constipation & contact dermatitis. but not the negative symptom such as ambivalence. pre-anesthesia. Side effects: Ccauses also red orange urine In liquid form is usually put in a chaser  Chaser: 60. looseness of association to decrease levels of dopamine in the substantia nigra I. intractable hiccups. Phenothiazine Code: AZINE Fluphenazine (Prolixin)* Acetophenazine (Tindal) Pherphenazine (Trilafon) Promazine (Sparine) Chlorpromazine (Thorazine)*#1 that causes photosensitivity/photophobia. Thioxanthenes Code: THIXENE Chlorprothixene (Taractan Thiothixene (Navane) IV. Antipsychotics can only decrease the positive symptoms of schizophrenia. acute mania. Action: ↓ delusion. depression and organic conditions. hallucinations.

Mydriatic – pupil dilate  sympa  ↑ IOP  don’t use in glaucoma 2. Loxapine (Loxitane) Risperidone (Risperidone) #1 drug for Korsakoff’s psychosis Molindone (Moban) Aripiprazole (Abilify) newest antipsychotic drug SIX COMMON ANTICHOLINERGIC SIDE EFFECTS OF ANTIPSYCHOTICS (Anticholinergic effects are drug actions of antipsychotic drugs because they BLOCK MUSCARINIC CHOLINERGIC RECEPTORS) CODE: BUCO PanDan – anticholinergic S/Es 1. paraplegia) Nursing Interventions: 1. Constipation Nursing Interventions: 1.take BP in supine. Fowler’s & standing position. Sounds of dripping water – faucet 3. Urinary Retention – (Post Partum. Autonomic Dysreflexia. Blurring of Vision . ↑exercise 4. Prevent constipation ↑ fiber (residue) AG or roughage. Difference of BP 15-20 mm Hg below S/Sx: Ppallor. Pan Photosensitivity (photophobia) Nursing Intervention: 35 . Intermittent cold & warm compress 3.Clozapine (Clozaril) #1 that causes Agranulocytosis & Blood Dyscrascia “I will need to monitor my blood level to continue my medication. Provide Privacy – give bed pan 2. Orthostatic Hypotension/Postural Hypotension . prune/pineapple/papaya juice/ fruits 2.” shows a correct understanding of a patient while taking Clozaril. dizziness Nursing consideration: Slowly change position Told patient to dangle feet first before standing 5.↑ sympathetic reaction (don’t operate machinery). ↑ OFI 3.

1. long sleeves or/and umbrella Patients taking antipsychotic should be instructed to wear wide brimmed hat when going outside 6. flat affect. Dan Dry mouth/ Xerostomia Prioritized Nursing Intervention: Give (1) ice chips. Dystonia – #1 cardinal Sign: Ooculogyric crisis = involuntary rolling of eyeballs. finger fidgeting. (2) chewing gum.another word: Ddrug-induced Parkinsonism – #1 sign: Ppill-rolling tremors. Akathisia –another word: Mmotor restlessness  1-6 wks Signs of motor restless: Foot tapping. Patients taking with prolonged antipsychotic medications should always be assessed for symptoms of extrapyramidal symptoms. jaw and throat spasm (dysphagia)  2-5 days Drug of Choice: CODE: CBA #1 Cogentin (Benztropine Mesylate) #2 Benadryl (Diphenhydramine Hcl) #3 Akineton (Biperiden Hcl) 3. which is a result of neurological dysfunction of the Extrapyramidal System. sun block. can’t sit down for more than 15 minutes and pacing back & forth. shuffling gait or festinating gait. neck shoulder.1. Use sun glasses. cogwheel rigidity. Patient is unable to remain still Drug of Choice: CODE: CBA #1 Cogentin (Benztropine Mesylate) #2 Benadryl (Diphenhydramine Hcl) #3 Akineton (Biperiden Hcl) 2. (3) sips of water ACUTE/COMMON SIDE-EFFECTS FOR PROLONGED USED OF ANTIPSYCOTICS Extrapyramidal Symptoms (EPS) Common Signs & Symptoms: Definition of EPS: Rreversible side effect (except TARDIVE DYSKINESIA). Pseudoparkinsonism . Other signs: Mmask-like face. 36 .

tongue thrusting. Benadryl. tachycardia. renal dialysis. Cogentin. --administer Artane. also an ANTI VIRAL 4.EPS MEDICATION CODE: PACABBA .DRUG OF CHOICE: #1 Artane (trihexyphenydyl) #2 Amantadine ( Symmetrel) can also be used in Chicken pox. This is an EMERGENCY!!! Symptoms of tardive dyskinesia include fly catcher’s mouth. which is a medical emergency. protrusion of the tongue. nutrition. Antiparkinsonian drug 5. ANTIDOTE: Dantrolene (Dantrium) or Bromocriptine (Parlodel) Bromocriptine is both an Antiparkinsons & Anti prolactin AFFECTIVE / MOOD DISORDERS 37 . ventilation. renal failure. hydrotherapeutic measures). hydration. Akinesia – absence of kinetic movements ANTI. tongue rolling. incontinence.Usually they are anticholinergic & antiparkinsonian drugs Procyclidine (kemadryl. Elevated blood pressure and diaphoresis are indicative of Neuroleptic malignant syndrome. LIFE-THREATENING : (EXTREME EMERGENCY): #1 Cardinal Sign is High fever. Tardive Dyskinesia – Starts with T: TONGUE (tongue rolling & tongue protrusion) lip smacking. puckering of cheeks. facial grimacing. sweating. vermicular or vermiform tongue rolling  irreversible. tremors. hyperkalemia. muscle rigidity (Discontinue all drugs STAT. kemadrin) Artane ( trihexyphenydyl) Cogentin (Benztropine mesylate) Akineton (biperiden Hcl) Bromocriptine (Parlodel) Benadryl (Diphenhydramine) Amantadine (Symmetrel) ADVERSE EFFECT OF ANTIPSYCHOTIC DRUGS: Neuroleptic Malignant Syndrome RARE. stupor. and drooling of saliva. tachypnea.

behavioral variables DEPRESSION: An abnormal extension or over elaboration of sadness and grief. poor hygiene. psychomotor retardation. DEPRESSIVE DISORDERS: Depressive episode with no manic episodes 1. Major depression. Suicidal Behavior A. bitterness. sense of worthlessness. recurrent: Rrepeated episodes of major sadness or depression separated by long intervals. hopelessness. Manic-Depressive (Bipolar) Disorders. low self-esteem. Physiological: Ffatigue. tearfulness Depression in children results to anhedonia (energy loss & fatigue. loss of interest. Aggression turned inward. Life stressors. severe.MODELS OF CAUSATION: Genetic. 38 . oldest and most frequently described psychiatric illness. with (uncommon) or without psychotic features I. occurring in clusters or increasing with age* 3. weight change. dizziness. depression less than 2weeks *Major Depression – Severe depression for more than 2 weeks * . Behavioral: Altered activity level. experiential. and Integrative: chemical. Affective: Anger. indecisiveness. helplessness. over-dependency. Objects loss. vomiting. a pathologic grief reaction experienced by an individual who does not mourn • The term depression is used in varied ways: a sign. withdrawal. Biological: Ddecreased serotonin and norepinephrine *. backache. Dysthymia: Cchronic depressive mood problems occurring in the absence of a major depressive or organic or psychotic diagnosis. hostility is turned towards the environment.Dysthymia – painful depression for 2 years *Severe Depression – Crying at early morning. Cognitive: Hhopelessness. In a depressed patient. abdominal pains* c. headache. Personality disorganization. moderate. hostility is turned towards the self. pessimism. emotional state. • May be mild. insomnia. agitation. constipation. reaction. while in manic patient. syndrome. symptom. Behavioral: Lloss of positive reinforcement. anorexia. anxiety. apathy. denial of feelings b. TYPES: Depressive Disorders. inability to concentrate. Cognitive: Confusion. DIFFERENTIATION/CATEGORY: Moderate Depression – crying at night . ambivalence. irritability. self-blame d. chest pain. Learned helplessnesshopelessness. Major depression. decreased interest in previously enjoyed activities) like playing alone during recess.both of them have the same characteristics • BEHAVIORS COMMONLY ASSOCIATED WITH DEPRESSION a. single episode 2. disease or clinical entity.

o. Insomnia* 8.• DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSION: At least five of the following. or relationship. no hobby. This produces high intensity color like broad day light. Elderly (ego-despair) 3. Adolescent (identity crisis) 2. Annulled & Divorced 2. no money & has history of alcohol abuse is at risk for suicide 6. most of the day. nearly daily. 39 . Middle age men (45 y. avoiding being a burden to others. Fatigue or loss of energy (anemia) 10. for 2 weeks: 1.-Feb. fear living) * (ANHEDONIA)* 7. Constipation* PREDISPOSING FACTORS: 1. Feelings of worthlessness & 2. Flat affect* 11. Protestants 7. difficulty. retired 6 yrs ago. Weight loss or gain 5. Caucasians/Afro-Americans/Asians* 5. above) 4. Loss of loved one (situational crisis) 3.. crisis. Psychomotor retardation (slow mov’t) 9. resolving an untenable family situation.) or intimate months Seasonal depression occurs during winter and fall this is due to abnormal melatonin metabolism. to get away or end an intolerable situation. escaping a terminal illness. Early morning depression 6. e. Intervention for pt with seasonal affective disorder (SAD) during a depressed mood includes the use of broad spectrum light in high activity area. History of suicide* 4. Post partum depression (7 days/2-4 weeks) Suicide and Self-destructive Behavior Suicide is never a random act. Alcoholics/Drug addicts* A 66 y/o American men. In general the purpose or reason for suicide is to escape. SAD – Seasonal Affective Disorder – common on winter season (Nov. Self care deficit* 3. no friend. Post partum depression 9. Whether committed impulsively or after painstaking consideration the act has both a message and a purpose. Also instruct the pt that the light source must be 3 ft away from the eye 4. Schizophrenia* Prone: Mmale Age bracket prone for suicide #1. Loss of interest or pleasure ambivalence (fear of death vs.g. or to avoid punishment or exposure of socially or personally unacceptable behavior. Single. Incurable Illness* 8.

g. form of communication. people cannot express their needs or feelings to others. Those with physical illness. socially and physically damage or end their lives. Suicidal threat – a threat more serious than a casual statement of suicidal intent and accompanied by behavioral changes. 2. People who have experienced the loss of an important person at some time in the past or the loss of both parents early in life. A complete suicide is the most violent self-destructive behavior. Some. Chronic self-destructive behavior – e. Cognitive styles of suicidal patients: 1. Single people Divorced.g. or the loss of or threat of their spouse. Demographic Variables – suicide rates are higher among the following: 1. 3. smoking. For them. People who have attempted suicide before 2. they do not obtain the results they hope for. particularly when the illness involves an alteration of body images or lifestyle 5. if violent. 4. gambling. loss of job. Ambivalence. Ambivalence accounts for the fact that a suicidal person often takes lethal or near-lethal action but leaves open the possibility for rescue. money or social position 3. e. decline in school or work performance 3. 2. or when they do. Typical behavior are biting one’s nails. job. pulling one’s hair scratching or cutting one’s wrist. Communication. Eskimos and Native Americans 6. Caucasians.. separated or widowed People who are confused about their sexual orientation People who have experienced a recent loss: divorce. suicide becomes a clear and direct. mood swings. They have 2 conflicting desires at the same time: T to live and to die. temper outbursts. Levels of self-destructive behavior: 1. Suicidal gesture – more serious warning signal than a threat that maybe followed a suicidal act that is carefully planned to attract attention without seriously injuring the subject 4. self-mutilation 2. Protestants or those who profess no religious affiliation Clinical variables: 1. loss of prestige. Those who abuse alcohol or drugs 40 . Suicidal attempt – a strong and desperate call for help involving a definite risk.Self-destructive behavior is action by which people emotionally. People who are depressed or recovering from depression or a psychotic episode 4. loss of social status or who are facing the threat of criminal exposure 5.

Those who are recovering from a thought disorder combined with depressed mood and / or suicidal ideation ( hallucinations that tell them to kill or harm themselves) Management – people bent on suicide almost always give either verbal or nonverbal clues of their intent. Table 2: Lethality Assessment Scale Key to Scale 1 Danger to Self No predictable risk of immediate suicide Typical Indicators Has no notion of suicide or history of attempts. 1. basically wants to live 2 Low risk of immediate suicide 3 Moderate risk of immediate suicide Has considered suicide with high lethal method but no specific plan or threats. They actually make a powerful attempt to communicate to others their hurt ad desperation. no history of attempts or recent serious loss. A lethality assessment scale (Table 2) is an attempt to predict the likelihood of suicide. is weighing the odds between life and 41 . and is in close contact with significant others Person has considered suicide with low lethal method. or has plan with low lethal method . with dysfunctional family history and reliance on Valium or other drugs for stress relief. no alcohol problems. has satisfactorily support network. They are crying out for help. history of low lethal attempts.6. has satisfactorily social support network.

and is threatened with a serious loss.death 4 High risk of immediate suicide Has current high lethal plan. obtainable means. history of previous attempts. Talk about suicide openly and directly c. is depressed and uses alcohol to excess. Take only threat seriously b. has a close friend but is unable to communicate with him or her a drinking problem. is cut off from resources. history of high lethal suicide attempts. Implement basic suicide precautions: • • Check on the client at least every 15 minutes or require the client to remain in public places Stay with the client while all medications are taken 42 . is depressed and wants to die Has current high lethal plan with available means. such as unemployment or divorce or failure in school age more in elderly and adolescents 5 Very high risk of immediate suicide General guidelines – the general task of the nurse is to work with the client to stop the constricted processing of suicidal thinking long enough to allow the client and the family to consider alternatives to suicide. a.

Evaluate the client’s need for medication q. 43 . Assume a nonjudgmental. the most pressing need is h. pantyhose. Decide with the client which family members and friends are to be contact and by whom o. robe belts. Ask why the client chose to attempt suicide at this particular moment. Relieve the client’s obvious immediate distress g. Recognize that people can and have hanged or strangled themselves with shoelaces. Work with other team members to evaluate the issues fully t. Do a body examination u. no suicide contract will be used k. Monitor your personal feelings about the client and decide how they may be influencing your clinical work s. Do not make unrealistic promises m. Find out what.acceptance f. Make the search in the client’s presence and ask for the client’s assistance while doing so Check articles brought in by visitors Allow the client to have regular food tray but check whether the glass or any utensils are missing when collecting the tray Allow visitors and telephone calls unless the client wishes otherwise Check that visitors do not potentially dangerous objects in the room d. Be prepared to deal with family members who may be confused. The nurse must be in the room with the client at all times Maintain the client’s safety in the least restrictive manner possible Do not allow the client to leave the unit for test or procedures Serve the client’s meals in an isolation tray that contains no glass or metal silverware e. etc. Evaluate the plan developed in collaboration with the client and arrange for appropriate follow-up r. Encouraged the client to continue daily activities and self-care as much as possible n. The answer will shed light on the meaning suicide has for this patient and may provide information that can lead to other helpful interventions j. Be careful not to encourage staff behaviors that give clients or staff members a false sense of security l. maximum suicide precautions mean: • • • • Provide one-to-one nursing supervision. and work to assists the client toward self.• • • • • Search the client’s belongings for potentially harmful objects. angry or uninterested p. caring attitude that does not engender self-pity in the client i. In addition to the above. brassiere straps. in the client’s view. Expect that the client will be experiencing shame. Decide if a no-harm.

it means that the patient is from depression and is in danger of committing suicide. Giving away of prized possessions* 3. b) SUICIDAL THREAT: Ooccurs before the overt suicidal activity takes place: “Will you remember me when I am gone. 2. Best question to be asked after a patient who recovers from an overdose of pills includes asking “Do you still want to end your life?” IMPENDING SIGNS OF SUICIDE: 1. (No suicide contract)* 3. gun shot. and has the means readily available. usually 10-14 days after start of medication. jumping from a very high place/building. A most suicidal person has made a specific plan.” “Take care of my children”. In between nursing shifts RATIONALE: Nnurses at this time are very busy NURSING DIAGNOSIS: (common) Risk/Potential for Injury Directed to Self STEP BY STEP PRIORITIZE NURSING INTERVENTIONS: 1. c) SUICIDAL ATTEMPTS: Aany self-directed actions taken by the individual that will lead to death if not interrupted. Low-risk = slashing of the radial pulse (more o females) 2. and after ECT USUAL TIME FOR SUICIDE: 1. Sudden elevation of mood/sudden mood swings* recovering When a depressed patient suddenly becomes cheerful.2 LETHAL METHODS OF SUICIDE: 1. Schizophrenia) 4. Early in the morning RATIONALE: Tthe depression at this time is HIGH 2. No metallic objects 44 . hanging. High-risk = drowning. less than 2-4 wks ( telling a lie) • Suicidal attempts are common when client is strong enough to carry out a suicidal plan. overdose of tranquilizer (Midazolam & Dormicum) SUICIDAL BEHAVIORS: SUICIDAL GESTURE: Ddirected toward the goal of receiving attention rather than actual self-destruction. One-on-one nursing monitoring/intervention (never leave the client)* 2. Do not leave the patient for the 1st 24 hrs. When the patient verbalizes that the 2nd Gen TCA is working. Delusion of Omnipotence (divine powers) Used by SS (Suicidal. Offering of self (best therapeutic communication)* 4.

Meet physical needs: Promote eating. 11.” Depressed patients usually turn their hostile feelings towards themselves. No sharp objects 6. Providing an activity that serves as an outlet for these aggressive feelings will make the patient feel less guilty. rest. a mother asks. #1 Attitude Therapy: Kind Firmness 14. Join group therapy During family therapy. Decrease social withdrawal: Ssit with client during quiet times. between shift & during endorsement 13. which increases the risk for suicide. #1 – sudden mood swings A female patient who becomes euphoric for no apparent reason shows a behavior that indicates recovery from depression. “How long will my daughters have suicidal thoughts?” appropriate response of the RN. Activities focus on self-care 10. Monitor in giving medication – do not leave patient after giving medication for 30 minutes. Monitor patient in CR. elimination Promote self-care whenever appropriate / possible 16. TCA 3rd MAOI 4th ECT (last resort) 15. Check under the tongue & pillow 12.” My life is ruined now. Step by step Tx: ANTIDEPRESSANT another word is THYMOLEPTICS 1st SSRI (Selective Serotonin Reuptake Inhibitor) A 2nd Second Gen. Needs stimulus – bright room Rationale: to see suicidal acts 7. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) 45 . 9. introduce to others when ready The priority focus for a suicidal patient in the ER with a slash in her wrist is her physiologic homeostasis. Rationale: Depressed patients have fatigue. Avoid religious music (increases guilt) and love songs = non-suggestive song is needed 8. 17.” ANTIDEPRESSANTS or THYMOLEPTICS I. Check for impending signs of suicide = sudden elevation of mood. Assess attempt for suicide in a 16 y/o girl who is eating & sleeping poorly since break-up and saying.‘’ Your daughter will go on to view suicide as a way of coping. Support self-esteem: Warm and consistent care Being patient with client’s slowness Simple tasks that increase success and self-esteem and imply confidence in capabilities Example: Self care activities that will not easily tire the patient.5.

Warm milk/banana (active substance: tryptophan) 3. Aventyl) Trimipramine ( Surmontil) Buproprion (Wellbutrin) 400 mg/day*(ceiling dose) EXCESS INTAKE: Ggrand mal seizure Doxepine (Sinequan) 46 . Weight Loss 2. Insomnia (single am dose) Nursing Considerations: 1. SECOND GENERATION TRICYCLIC ANTI DEPRESSANT Action: Increases norepinephrine and/or serotonin levels in CNS by blocking their uptake by presynaptic neurons or it balances Serotonin & Epinephrine levels. Code: XETINE/ODONE Fluoxetine HCl (Prozac) – dry mouth (xerostomia) Paroxetine HCl (Paxil) Trazodone (Desyrel)) – adverse effect: Ppriapism (prolonged use) Nefazodone (Serzone) Fluvoxamine (Luvox) Sertraline (Zoloft) – causes GI upset (diarrhea. insomnia): always with meals Venlafaxine (Effexor) Citalopram (Celexia) Common Side Effects: 1.Usually the FIRST LINE of drug. Massage b. Wwarm bath (systemic effect) 2. Induce sleep thru: 1. Effect: 2-4 wks. RATIONALE: FEWER SIDE EFFECTS Action: Balance Serotonin – gradual effect (usually 2 weeks) Effect: 2 wks. RATIONALE: Ffewer anticholinergic S/E Nortryptilline (Pamelor. Give meds in single AM dose Antidepressants are best taken after meals II. Code: PRAMINE/TRYPTILLINE Clomipramine HCl (Anaframil) #1 for OCD* Imipramine (Tofranil)* the best drug for enuresis Amitryptilline (Elavil) Protryphilline (Vivactil) Maprotilline (Ludiomil) Norpramine (Desipramine) #1 antidepressant for elderly depression. Ffor insomnia: a.

sauerkrauts. block oxidative deamination of naturally occurring monoamines (epinephrine. bologna. . soy sauce & catsup 3. sausage. sour cream. Italian green beans. the nurse must anticipate the physician to discontinue TCA after two weeks and start on Parnate. Canned foods such as sardines. Sedation (at night) 2. Cream. raisins (all over ripe fruits except apricot) 7. Cheese burger 6. MAOI – MONO AMINE OXIDESE INHIBITOR ACTION: Psychomotor stimulator or psychic energizers. Weight gain 1. OTC decongestants 10. Yogurt. Nursing intervention before giving the drug includes checking the BP. Tyramine rich-food. Give meds at night # 1 adverse effect – cardiac dysrhythmias #1 screening test before taking TCA – ECG When a depressed client taking TCA shows no improvement in the symptoms. Chocolate . serotonin) → CNS stimulation Effect: 2 weeks CODE: PAMMANA Parnate (tranylcypromine) Marplan (Isocarboxacid) Mannerix (Moclobemide) *the newest MAOI Nardil (Phenelzine SO4) CONTAINDICATIONS: TYRAMINE + MAOI = HYPERTENSIVE CRISIS 1. Coffee. Organ meats (chicken gizzard & liver) & Process foods (salami/bacon) ↑ Na 3. NOREPINEPHRINE. Food safe to give includes fresh fish. Aged cheese (except cottage cheese. Mayonnaise 9. III.Amoxapine (Asendin) Common Side Effects: Nursing Consideration: 1. 47 . chicken liver. margarine. Cheddar cheese and Swiss cheese are high in tyramine and should be avoided. Soy sauce 5. meat tenderizer. high in Na & cholesterol  Hypertensive Crisis 1. Pickled herring Foods contraindicated in MAOI therapy includes figs. yeast. Yogurt. licorice. yeast. Pickled foods. cream cheese). Red wine (alcohol) 4. 8. papaya. Banana. 2. avocado. sausage. chocolate.

Invasive . . Post CVA. confusion/disorientation – (usually 24 hours) 3. ECT (last resort) Side Effects: 1. ELECTROCONVULSIVE THERAPY (ECT) ECT is passing of an electric current through electrodes applied to one or both temples to artificially induce a grand mal seizure for the safe and effective treatment of depression.Best therapy for major depression (last resort) . Phentolamine (Regitine)  also the #1drug for Pheochromocytoma (tumor in the medulla) IV. degenerative disorder 3.Antidote: CALCIUM CHANNEL BLOCKERS (-DIPINE) 1. gain (stimulate thalamic/limbic  appetite) Contraindicated: 1. Safer for elderly. Temporary RECENT Memory Loss – ANTEROGRADE amnesia Intervention: Rre-orient client to 3 spheres 2. Headache  ↑ 02 demand.Induction of 70-150 volts of electricity in).6-12 treatments. PPPP – Post MI. 80 % improvement rate of major depressive episode with vegetative aspects . Neurologic problem  Alzheimer’s. pacemaker.Before ECT a major depressed client undergo the ff meds: 1. it is followed by a grand-mal seizure lasting 30-60 secs. Wt. Brain tumor. weakness of lumbosacral spine 48 . MAOi – 2 wks 4. Antidepressants  TCA 2nd Generation – 2-4 wks 3. Muscle spasm 5. SSRi (Selective Serotonin Reuptake Inhibitor inhibitor) –2 wks 2. Verapamil (Calan) 2.5-2secs. “every other day” . ECT’s mechanism of action is unclear at present Advantages: Quicker effects than antidepressants. pregnant women 2. ↑ cerebral hypoxia 4. Then.

Phenobarbital (Luminal). Safety (#1 objective) 2. if not a guardian may sign the consent forms. Risk for Airway Obstruction/aspiration 2. REORIENT: Ttime. Legal/Pre-Nursing Responsibilities: Preparation: Similar to preparing a client for surgery: 1. Methohexital (barbiturate Na) minor tranquilizer also an anticonvulsant c. Side rails up 4. place (unit). Before ECT  supine position. Risk for Injury 3. Reassure regarding confusion and memory loss. Support the head with a pillow AFTER the seizure -    FIRST & TOP priority: Ensure a patent airway. person (nurse). No nail polish to check peripheral circulation 4. Stimulus ↓ (no noise & bright lights) 5. VS q 5 min until stable. 49 . No contact lenses it may adhere to the cornea 5. 2. Priority vs. Wash & dry hair 6. Informed Consent – if client is coherent. Succinylcholine (Anectine) – muscle relaxant 7. Same RN before & after. Impaired/Altered Cognition/LOC Nursing Intervention 5 S in Seizure 1. Side-lying (#1 Position) 3. Have patient VOID before giving ECT Nursing Diagnosis: 1. check RR 12 less. LOC 8. Atropine sulfate – anticholinergic PRIMARY purpose – to dry secretions and prevent aspiration SECONDARY purpose – to prevent bradycardia (vagolytic) b. Observe for respiratory problems Remain with client until alert.A. after ECT  side-lying 9. to focus ABC. Side-lying after removal of airway. Give following medications BEFORE ECT: a. No metallic objects 3.

B. irritability. Easily Agitated 9. inflated self-esteem* b. Insomnia 3. Excessive involvement in pleasurable activities without regard for negative consequences 5. lack of judgment. humorous. with or without a major depressive episode 1. argumentative* DIAGNOSTIC CRITERIA FOR A MANIC EPISODE: At least 3 of the following for at least 1 week: 1. provocativeness. Manipulative 50 . Bipolar. weight loss* c. Bipolar. intolerance of criticism. Tell manic pt to speak more slowly to make a sense if he keeps on moving one subject to 6. Flight of ideas – talkative/pressured speech/pressure to keep talking another. depressive: Mmost recent or current behavior displaying major depression 2. inadequate nutrition. manic: Mmost recent or current behavior displaying overactive. • MANIA: Mood that is elevated. poor grooming. flight of ideas. hyperactivity. excessive spending. expansiveness. Norepinephrine 2. inflated self-esteem RATIONALE: Aa defense to mask feelings of depression & inadequacies 2. or irritable Manic behavior is a defense against depression since the individual attempts to deny feelings of unworthiness and helplessness. Cyclothymania: Nnumerous occurrences of abnormally depressed moods over a period of at least 2 years 5. BIPOLAR DISORDERS: With one or more manic episodes. agitated behavior 3. distractibility. * d. needs little sleep. Behavioral: Aggressiveness. Hyperactive & Distractibility 8. lack of guilt. Serotonin BEHAVIORS COMMONLY ASSOCIATED WITH MANIA a. Cognitive: Ambitiousness. denial of realistic danger. expansive. Physiological: Dehydration. Delusion of Grandeur – over self-worth. mixed: Rrapid intermingling of depressed and manic behavior 4. Flight of ideas 4. MANIC EPISODE: Neurotransmitter imbalance: * 1. Bipolar. grandiosity. Affective: Eelation/ euphoria. lack of shame.

raking leaves. Check Lithium intoxication 51 . “My wife hasn’t eaten or slept for days. gym. so. constructive. Risk/ Potential for Injury directed to others /or to self 2. Violent/aggressive/hypersexual 13. Prone to become fatigue. give finger foods: potato chips. Fluid Volume Deficit NURSING INTERVENTIONS: 1. Set limits of behavior/external controls *One staff to provide controls *Do not leave alone in room when hyperactivity is escalating *Explain restrictions on behavior *Do not encourage performance/jokes *Approach in a calm. reject behavior 2. 8.” The RN should place a priority focus on physical condition. scrabble. Encourage OFI: Bbecause of Lithium and increased metabolism 12. Poor impulse control – impulsive 12. bread. Avoid CONTACT SPORTS: Bbasketball. Less environmental stimulus: Nno bright lights. punching bag. competitive is not safe. Encourage rest: Ssedation PRN. raisin. productive) to increase self-esteem. bingo. finger painting. Distract and redirect energy: Cchoose physical activities using large movements until acute mania subsides (dancing. non-argumentative manner 4.10. household chores. and sandwich. SHORTCUT: ALL HIGH CALORIC & HIGH CARBOHYDRATE DIET or ALL BAKERY PRODUCTS!!! Tuna sandwich & apple are appropriate food for bipolar manic A Husband of 36 y/o bipolar manic type says. walking with staff) Meet nutritional needs: Hhigh-calorie FINGER FOODS and fluids to be carried while moving. tearing newspaper. Activity for Manic Bipolar includes raking leaves (quiet physical. strenuous activities & Increase perspiration!! ACCEPTABLE ACTIVITIES: Bbrisk walking. do not touch 11. 10.. short PM naps 7.. Avoid ACTIVITIES that increases attention span such as chess. Provide consistent care 3. Increased Metabolism 11. 9 Productive activities: Ggardening. collected. Pressured speech NURSING DIAGNOSIS: 1. Accept client. Fluid & Electrolytes Imbalances 3.

2. ACTS by reducing adrenergic neurotransmitter levels in cerebral tissue through alteration of sodium transport → affects a shift in intraneural metabolism of NOREPINEPHRINE Action: ↓ hyperactivity and balance or stabilize the mood Effect: 1 wk. Move to the door fast and call the crisis management team D. appropriate nursing action includes removing patient from group meeting & accompany him to his room B. Aggressive Reaction 1. Violent Patients 1. Give avenues for verbalization/expression vs. Swearing 1. “Staff 1 st used a lesser means of control for less success.SELECTED SITUATIONS AND INTERVENTIONS: A. CODE: LITH Lithium CO3 – Eskalith. used in acute manic. C. Physical violence MOOD STABILIZERS (ANTIMANIC DRUGS): LITHIUM For: (Mood disorder specifically Mania (Bipolar Disorder) USES: Elevate mood when client is depressed. immediate action is to place pt in seclusion. Setting of limits – “matter of fact” (#1 Attitude therapy for manipulative patients) Patient in acute manic phase begins to disrobe.S Therapeutic Serum Level: = 0.5 mEq (local/CGFNS) = 0. Lithane. Separate the patient from the group. Disturbing the Group Session 1.5-1. Lithobid Lithium Citrate – Cibalith .6 – 1.” Shows a documentation that indicates a pt’s right is being safeguarded during aggressive reactions. bipolar prophylaxis. REMEMBER don’t touch the patient Touching the patient may increase AGITATION. Setting of Limits 2. Decrease environmental stimulation A pt who is pt watching TV suddenly throws the pillows & chair.2 mEq (NCLEX) 52 . dampen mood when client is in manic.

Avoid taking soda and/or soda drinks 8. skip the dose and take the next dose. CARDIAC. Increase Na = ↓ Lithium effect For hypernatremia  AVOID Na CO3 Avoid taking soda and/or soda drinks mania. if longer than 2 hours. Avoid caffeine  because it is a diuretic 6. Long-term: q 2-3 months. For hypernatremia  AVOID Na CO3 7. Before extracting Lithium serum level  Lithium fasting 12 hrs  check vital signs 2. MNGT. Avoid strenuous exercise/activities  gym works 4. A patient who is talking lithium must be placed in a normal sodium (3 gms. he may take it if he missed dosing time by 2 hours. ↑ OFI – 3 L /day. Avoid sauna baths 5. Early/Initial/Mild: 1. Before lithium is begun baseline RENAL. If patient forgets a dose.5 mEq 53 .a. high fluid diet (3 L of water).5. Avoid diuretics to prevent hyponatremia 3. ↓ cerebral edema 3. This is done to facilitate excretion of lithium from the body.) . Early in therapy: Serum levels measured q 2-3 times per week. ↑ Na – 3mg/day A. Antidote: 1. When the lithium level falls below 0. the patient will manifest signs and symptoms of B. . 12 hours after the last dose. DIAMOX (ACETAZOLAMIDE) carbonic anhydrase inhibitor (for open angle glaucoma) 2. Decrease Na = ↑ Lithium intoxication  MORE dangerous!!!! AVOID the 2 dangerous “D”: diuretics & dehydration Avoid diuretics to prevent hyponatremia Avoid strenuous exercise/activities  gym works Avoid sauna baths (EXCESSIVE PERSPIRATION) Avoid caffeine  because it is a diuretic Stages in Lithium Intoxication I. MANNITOL (Osmitrol) osmotic diuretics  Action to ↑ urine output. NEVER DOUBLE A DOSE!!! Nursing Considerations: 1. OF OVERDOSE: Induce emesis / lavage. airway. and THYROID status obtained. dialysis for severe intoxication 4.

Nausea.4 mEq Symptoms are 2x the initial signs III. Dermatitis Nervous: Chronic fatigue. • The way an individual reacts to stress depends on his physiological and psychological make-up. Oliguria. Severe: ↑ 2. Exhaustion 54 . PSYCHOSOMATIC DISORDERS: Wwithout any organic or REAL physiological “OBJECTIVE” symptoms. Moderate: 1.. • Somatoform disorders result in impaired social. Hyperventilation.Diarrhea . • Structural changes may take place and pose threat to life. olfactory & visual hallucination 2. • Emotional stress may exacerbate or precipitate an illness. • Synergistic relationship exists between repressed feelings and overexcited organs. tactile. ulcerative colitis. Nnystagmus.Abdominal cramps  hypocalcemia  metabolic alkalosis (Prolong vomiting  metabolic acidosis) II. CONVERSION and INTROJECTION.5 mEq 1.6 – 2. vomiting & anorexia . Tachycardia Gastrointestinal: Peptic Ulcer. Colic Respiratory: Asthma. • Defense mechanisms include REPRESSION. Hay fever Skin: Blushing. • • • • • Cardiovascular: Hypertension. Flushing. Anuria)  ARF (Kidney problem) Lithium is nephrotoxic & teratogenic 3. Perspiring. occupational and other areas of functioning. PSYCHOPHYSIOLOGIC DISORDER: with real symptoms! Physical symptoms whose etiologies are in part precipitated by psychological factors and may involve any organ system. Common colds.Gross hand tremors . Migraine headaches. Grand Mal Seizure  Cerebral hypoxia  ↓LOC  COMA  death PSYCHOSOMATIC / SOMATOFORM DISORDERS A. POA (Polyuria. PROJECTION.

NURSING INTERVENTION: Do’s: Divert attention from symptom. Feed into secondary gains through anticipating client needs. Hyperthyroidism Musculoskeletal: Cramps Others: Obesity. Can take the form of blindness. ASSESS FOR • Preoccupation with body functions or fear of serious disease misinterpretation and exaggeration of physical symptoms • Adoption of sick role and invalid life-style. attention. ASSESS FOR: TWO GAINS IN CONVERSION DISORDER Primary gain. b. Help to work through problems and learn new coping mechanism.• • • Endocrine: Dysmenorrhea. hyperemesis gravidarum NURSING CARE: Holistic or TOTAL – physical and emotional Understand that PHYSICAL SYMPTOMS ARE REAL and that the client is not faking and the TREATMENT OF PHYSICAL PROBLEMS DOES NOT RELIEVE EMOTIONAL PROBLEMS Develop nurse-client relationship: • Respect the client and his problems. Control environment Don’ts: Confront client with his illness. paralysis or any other physical conditions but with no organic basis. REPRESSION: Keeps internal need or conflict out of awareness. 2. Reinforces maladjusted behavior. TYPES OF SOMATOFORM DISORDERS / PSYCHOSOMATIC DISORDERS 1. Reduce pressure on client. • Help to express feelings. Client derives primary and secondary gains from the physical symptoms. HYPOCHONDRIASIS Preoccupation with an imagined illness with no observable symptoms and no organic changes. Secondary gain. 2. Provide social and recreational activities. CONVERSION DISORDER: Presence of physical symptoms with NO identified physical etiology. signs of severe regression 55 . SYMBOLISM: Symptom has symbolic value to client. deafness. Allow client to feel in control • Let client meet dependency needs. avoidance. CHARACERISTICS: #1 Sign “ Labelle Indifference” a. (Not connected to the primary gain) Additional advantages: Ssympathy. #1 Sign is “DOCTOR SHOPPING”: Inability to accept reassurance even after exhaustive testing activities as going from doctor to doctor to find cure.

Client attempts to deal with anxiety by BLOCKING certain areas out of the mind or deeply REPRESSING traumatic events. sense of detachment from self. as if self is NOT REAL • DISSOCIATIVE IDENTITY DISORDER ( MULTIPLE PERSONALITY): Donated by two or more personalities. lifestyle. and interpersonal relations • Reduce anxiety-producing stimuli 56 . o Provide diversionary activities that build self-esteem. family therapy and group therapy: A combination of somatic and behavioral treatment modalities facilities treatment of the disorder. o Help client refocus on topics other than the illness. identity. each of which controls the behavior while in the consciousness C. or by PSYCHOLOGICAL RETREAT from reality. o Meet physical needs giving accurate information and correcting misconception. supportive approach but NOT focusing on the illness. and Introjection DISSOCIATIVE DISORDERS A. memory.) • DEPERSONALIZATION: Aalteration in perception or experience of self. Projection. ‘faking illness’ Nursing Intervention: • Show acceptance of the client. Conversion.• Lack of interest in environment history of repeated absences from work • If the client is MALINGERING: Ddeliberately making up illness to prolong hospitalization. o Demonstrate friendly. DEFENSE MECHANISMS IN SOMOTOFORM DISORDERS: Denial. or perception of the environment. ASSESSMENT FINDINGS: • AMNESIA: Sselective or generalized and continuous loss of memory • FUGUE: Sstate of dissociation involving amnesia and actual PHYSICAL FLIGHT – transient disorientation where client is unaware that he has traveled to another location (Client does not remember period of fugue. A condition NOT of organic origin and usually occurs as a result of some very painful experience B. o Assist client understand how he uses illness to avoid dealing with his problems. NURSING IMPLEMENTATION: • Assess what form the dissociative disorder is manifesting and degree of interference in ADL. assist in complete medical workup to reassure client and rule and medical problems • Psychotherapy. • Prepare for. DEFINITION: Psychiatric disorder involving disruption in the usually integrated functions of consciousness.

PERSONALITY DISORDERS A. Freudian fixation GENERAL CHARACTERISTICS: 1. Denial 2. DEFINITION: Borderline state of personality characterized by defects in its development or by pathologic trends in its structure. Avoidant c. Cluster B Disorders: Dramatic / Erratic a. neurologic defects & congenital predisposition 2. Not caused by physiological pattern . Obsessive Compulsive CLUSTER A: ODD / ECCENTRIC A. Paranoid b. PREDISPOSING FACTORS & CAUSATION 1. B. premorbid personality of individuals resembling the compensatory mechanisms associated with the pathologic counterpart. in reality 5. Cluster A Disorders: Odd / Eccentric a. Minor stress poor tolerance  mood disturbance 4.Attitude  can be changed . Biological predisposition  malnutrition. Borderline 3. Narcissistic c. Cluster C Disorders: Anxious/ Fearful a. Development of maladaptive behavior 3. Maladaptive behavior  inflexible 3. Histrionic b.• • Redirect client’s attention away from self. Schizotypal 2. painful experiences o Hypnosis.do not adjust to environment 3 CLUSTERS OF PERSONALITY DISORDERS 1.Immature . Passive Aggressive d. Antisocial d. cognitive restructuring o Behavioral therapy o Psychopharmacology: Anti-anxiety. Paranoid Personality Disorder 57 . increase socialization / diversional activities Support modalities of treatment: o Abreaction: aAsssisting in the recall of past. antidepressant Most appropriate intervention for Dissociative Personality Behavior includes encouraging to chart alternative personality. Schizoid c. Dependent b.

.Ideas of reference or delusion of reference .avoids close relationships with family.Functional when works alone. no laughing/giggling. aloof. e.Withdrawn. cold and detached #1 NURSING DIAGNOSIS: Social Isolation\ C.Peculiarity in speech but no looseness of association . peers . vague. hypersensitive #1 DEFENSE MECHANISM: Projection #1 NURSING DIAGNOSIS: Social Isolation #1NURSING CONSIDERATION/INTERVENTIONS: 1.History of conduct disorder (6-11 yo) 58 . Passive Friendliness  no eye contact. Schizotypal Personality Disorder . unattached.Loneliness  suspicious/mistrust  pathologic jealousy.introvert.CHARACTERISTICS: Code (MOST OF THEM STARTS WITH LETTER “P”) . distrustful  oral fixation .Flat affect  indifferent to praise .o. more interested on objects Shy. detached. eccentric. lowest IQ .Socially distant. Schizoid Personality Disorder CHARACTERISTICS: . mostly in males .Odd.Frequent part of vagabond or transient groups of society #1 NURSING DIAGNOSIS: Social Isolation CLUSTER B: DRAMATIC/ ERRATIC A.Cold/aloof  limit social contact=social anxiety . . loner.Magical thinking. Proxemics: 7 feet away from the patient B.g. mo touch. emotional detachment. superstitiousness. telepathy . humorless . odd and eccentric.Diminished affective (blunted/inappropriate affect) and intellectual skills. low IQ . non whispering 2. over elaborate speech .suspicious.15-40 y. avoidance of meaningful interpersonal relationships.Similar with schizophrenia CHARACTERISTICS: . friends.may develop into schizophrenia or other psychotic disorders . dreaming. Consistency 3. introverted since childhood but with fair contact with reality Autistic thinking. Antisocial Personality Disorder .

coprolalia (bad words) . manipulative . disregard for right of others.lack remorse .Impulsive. self-destructive. cheats. irresponsible . Setting of limits prevent the patient from manipulating the nurse. 59 .hates rule/regulations.Underdeveloped superego.#1 Defense Mechanism: Rrationalization . . SETTING OF LIMITS – “matter of fact.Appears charming. NURSING INTERVENTION/CONSIDERATION: 1.Randomly acting out aggressive egocentric impulses on society.” voice not high nor low. rapes. smooth talker Antisocial patients have low tolerance to frustration. does not say please. immature. destroys . steals.Impulsive. unit privilege Positive outcome for antisocial personality disorder includes adherence to rule of hospital Interventions that can be appreciated by antisocial include exchanging tokens for any B. lies . conscience and remorse. physical/sexual abuse (18 months)  low ego Unfulfilled need of intimacy CHARACTERISTICS: . reckless. aggressive.Self-mutilation & suicidal Therapeutic measure to prevent self-mutilation in borderline includes behavioral contract. intellectual. Efficacy of treatment is achieved for an antisocial if the patient is able to respect nurse’s & other patients boundaries.THEORIES: Ggenetic/hereditary Physical/Sexual abuse Low socioeconomic status  maladaptive behaviors CHARACTERISTICS: . unstable . Consistency is a must regarding rules & regulation. authority figures .Kills. Borderline Personality Disorder . unlawful. cheats. dysfunctional family Trauma. unable to learn from experience or punishment .Low self-esteem .Mostly in females THEORIES: Ffaulty parent-child relationship.Life-long disturbances that conflict with laws and customs . lack of guilt.Steals.Unable to postpone gratification. 2.

vain with behavior directed toward gaining attention to self. substance abuse) .” Best response of the nurse will be. Borderline personality with a history of cutting her wrist shows an intense & a changeable affect during the middle phase of nurse-pt relationship. “The policy of the unit is that.Usually Men . You don’t know what happened to me. "You’re a smart nurse.Emotionally unstable. manipulative.The purpose of behavioral contract in borderline is to limit use of unhealthy defense mechanisms . manipulation.Emotional. Style of speech is excessively impressionistic .Identity disturbance with chronic feelings of emptiness (Anhedonia) .Manipulative. “You’re a phony.Intense.Marked mood swings and impulsive unpredictable behavior with potential for self-destruction.” This statement shows Transference A patient borderline state. The patient says. dramatic. uses somatic complaints to avoid responsibility D. . .Disturbance in self-concept: Iidentity .Unpredictable behavior (gambling. unstable interpersonal relationships with impulsiveness.’” C. theatrical . “I’ll ensure what is necessary will be done to you Intervention for borderline d/o includes setting of limits through saying. imaginative . brief. physical fights and temper tantrums A borderline patient indicates an improvement when she state. “I ran around the block rather than cutting myself”. Narcissistic Personality Disorder .Labile emotion.wants to be the center of attention . ‘You can’t leave in the unit in 1st 24 hrs.#1 DEFENSE MECHANISM: Ssplitting “You’re the only nurse who understands me. I want to be just like you. .Exaggeration of emotion.Extroverted. shopping. Histrionic Personality Disorder . 2-3 % of the population THEORY: Llacks Electra complex (no father figure) Papa’s girl CHARACTERISTICS: . Sexually seductive or provocative .” This statement is shown in a patient with borderline behavior.Another: Mmetrosexual 60 . Positive: Ccreative.More common in women. sex.

beauty . rules and organization STEP TO STEP PRIORITY NURSING DIAGNOSIS: Altered Sleeping Patterns Altered Skin Integrity Ineffective Individual Coping PRIORITY NURSING INTERVENTIONS: 1. inflexible. egotistical. perfectionist. lack of empathy -Overblown sense of importance.Vanity in personal appearance . Compulsion – irresistible action THEORIES: Genetic: Serotonin imbalance Anal fixation  strict toilet training Overpowering mother CHARACTERISTICS: Cardinal Signs: RITUALISTIC #1 DEFENSE MECHANISM: Undoing. grandiosity.CHARACTERISTICS: .Boastful. envies other. Symbolization # 1 Ritual: handwashing Other Ritualistic behaviors: 4 C’s: Controlling  perfectionism Collects or hoarding Cleaning Checking • • • • Rigid. cold affect Driven by obsessive concerns Sets high standards for self and others Preoccupied with details.Exaggerated or grandiose sense of self-importance .Obsession – irresistible thought. Repression. over-conscientious.preoccupied with fantasies: Ppower. arrogant. success. with strong need for attention and admiration from others CLUSTER C: ANXIOUS / FEARFUL A. Give appropriate time to do rituals to decrease anxiety 61 . superiority complex .Excessive admirations. Obsessive –Compulsive Personality Disorder .More in women .

Do not abruptly stop rituals 3. good follower . Setting of limits  avoid manipulative and controlling behaviors 4. helpless. I love you & I’ll never do it again.Co-dependency  enabling Statement of pt that indicates ability to care for self after being victim of domestic violence includes a statement like. C. clinging . inferiority complex .” Battered wife should be referred to shelter Batterers are violent. TX: Tricyclics – antidepressants  balance serotonin and norepinephrine Effects: 2-4 wks.lacks self-confidence. pls.Over sensitive to rejection/criticism 62 .Fails to make decisions and accept responsibility→ induces others to take responsibility A pt with Dependent personality who shows ineffective decision making should have setting of limits & make behavioral contract on its daily activities. loving & remorseful (dual personality) Wife batterer has low-self esteem Honeymoon episodes in acute wife battering syndrome showing statement of reconciliation includes.In OCD. timid. Question most likely to elicit response for treatment of compulsive hand washing includes asking “how much has the symptom interfered with your daily activities?” 2.avoid open forum . low self-esteem. Clomipramine (Anaframil) #1 drug of choice for OC Imipramine (Toframil) 2nd drug of choice An oriented group therapy is indicated for OCD B. “I have a car key & money hidden outside the house.Most common personality disorder for Acute wife battering syndrome . helpless when alone. “Mama.Submissive. Avoidant Personality Disorder CHARACTERISTICS: . get these red flowers. preoccupied with fear of being alone . intervention includes giving an extra ½ hr to the pt to do the ritual before starting the task.” CHARACTERISTICS: .Lacks self-confidence.Shy. Dependent Personality Disorder .

anxiety. anger are common . COGNITIVE/PSYCHIATRIC DISORDERS • With organic etiology • With deficits in COGNITION and MEMORY • Effects: Cchanges in levels of functioning and disturbed behavior • MOST COMMON AREAS OF DIFFICULTY (JOCAM) J – Judgment (impaired) O – Orientation (confused/disoriented.loves to procrastinate. lacks self-confidence.Depression. cant finish a task Patients with passive-aggressive personality expresses anger through passivity.Memory (Impaired especially for names and recent events – compensated by confabulation and circumstantiality) DELIRIUM VERSUS DEMENTIA Delirium Acute in onset Dementia Chronic / Gradual in onset 63 . illusion/hallucination) C – Confabulation (filling in memory gaps) A – Affect (mood changes. COGNITIVE / ORGANIC MENTAL DISORDERS I. loner. withdrawn) M. Passive Aggressive Personality Disorder CHARACTERISTICS: . rejection and failure are a possibility C. with feelings of discomfort/timidity when with others -Unwilling to get involved with others and in situations where negative evaluation. depression. tearful.Withdrawn.insecure  backbiter  plastic .. #1 Defense Mechanism: Rreaction formation . Goal of nurse in Passive Aggressive Personality includes verbalization of anger when needed Goal of Care for Passive Aggressive includes verbalization of feelings of anger when the need arises.Social withdrawal = inept .

meningitis. Misinterpretations or hallucinations * Can have sleep – wake cycle disturbances * Changes in psychomotor activity * May experience anxiety. fear. sepsis such as (idiopathic) Encephalitis. drug induced Withdrawal (alcohol & cocaine withdrawal) SYMPTOMS OF DELIRIUM * Difficulty with attention * Easily distractible * Disoriented * May have sensory disturbances such as illusions.Reversible #1 sign: Clouding of consciousness Or grand mal / tonic-clonic seizure Causes: Hyperthermia. irreversible #1 Sign: Progressive memory Loss Causes: Uunknown TYPES OF DEMENTIA Pick’s Disease: Similar picture to DAT. Vascular/Multi-infarct Dementia: Ppatchy cognitive deterioration (dependent on infarct site) appearing within 1 years of vascular injury. slurred speech) & cognitive changes (dementia) 64 . but with frontal lobe symptoms (personality changes) and reactive gliosis. common in men and earlier in onset. euphoria. Huntington’s Disease: Autosomal dominant (chromosome 4) disorder with both motor (chorea. irritability. gait disturbance.

4 CARDINAL SIGNS OF ALZHEIMER’S 1.traumatic cause of dementia is Alzheimer’s disease at 65. Amnesia – 1st amnesia to appear: Aanterograde amnesia –recent memory 2nd amnesia to appear: Retrograde – past Tx: Reminiscing Group Therapy 4. rapidly progressive from vague somatic complaints to ataxia. mask-like fascies. cogwheel rigidity. Agnosia – sensory–inability to recognize objects/subjects Patient with agnosia is unable to recognize persons. Place an alarm signal to know that the pt is attempting to exit in a dementia client who used to wander away from acute facility. 10% of the population has Alzheimer’s. progressive.Creutzfeldt-Jacob Disease: Dementia due to prions (infectious particle without DNA or RNA). ex. by 85. Tremors 3. may begin at 40-65.  The etiology of Alzheimer’s disease is unknown  The most common non. Degenerative disorder of the cerebral cortex.  Progresses to depression & dementia. the percentage increases to half. treated with L-dopa Nursing care for the patient with dementia is geared towards maintaining existing functions by minimizing regression. Onset: Usually after 65 (2-4%). Apraxia – sensory-inability for purposeful mov’t. bradykinesia. shuffling gait. Aphasia – sensory-inability for speech and communication Predisposing/Contributing Factors: Psychiatric Mental Health Nursing 3rd edition by Mary C.  NATURE: Gradual.  The primary need of a patient with Alzheimer’s is Reorientation. Multi-infarct dementia is the second most common cause of non – traumatic dementia. Parkinson’s Disease:  Dopamine in the basal ganglia & extra-pyramidal system causes tremors (pill-rolling & resting). dementia then death. may die within 2 yrs or 8-10 yrs if with total care. (pg 342-343) 65 . The main pathology is the of presence of senile plaques that destroys neurons leading to decreased acetylcholine. ALZHEIMER’S DISEASE  Degenerative disease of the central nervous system characterized by premature senile retardation. 1st to forget: Tthe name of an object 2nd to forget is the function of an object 2. Townsend Exact cause unknown but several hypothesis were introduced.

short-term memory loss. Middle stage (Wandering Stage/Sundown syndrome) The patient is increasingly disoriented and completely unable to learn and recall new information. He’s unable to speak intelligibly. season. Individual may be unable to recall major life events even the name of spouse. individual may deny memory loss.1) Acetylcholine Alteration: Ddecrease in acetylcholine reduces the amount of neurotransmitter which results in disruption of cognitive process. forget names. Findings that are observed in the early stages of Alzheimer’s disease are inappropriate affect. 2) Accumulation of Aluminum: Sstudies show that aluminum accumulates in damaged areas of the brain. and year. He’s totally incontinent of bowel and bladder. 3) Alterations in the Immune System: Aantibodies are being produced in the brain which causes a reaction against self it is called autoimmune. Late stage (Kluver Bucy like Syndrome) The patient may be unable to walk and is completely dependent on caregivers. Early Confusion: Symptoms of confusion begins and concentration may be interrupted. Recent memory is affected including the ability to learn new information. He may have bladder incontinence and may require assistance with activities of daily living. Managing daily living activities becomes progressively more difficult. disorientation to time. personality changes. In the late stages of Alzheimer’s disease it is better to go along with the patient’s reality rather than confront him with logical reasoning. The patient may notice difficulty balancing his checkbook and may forget where he put things. Disorientation in the surroundings is common and the person may be unable to recall the day. Forgetfulness: loose things. and an impaired judgment. The individual may not recognize family members. He may wander or become agitated or physically aggressive. The patient can compensate for the memory loss but the family may notice personality changes and mood swing. 4) Head Trauma: Head injuries 5) Genetic Factor: Pattern of inheritance THREE STAGES OF ALZHEIMERS Early stage (Forgetfulness Stage: Mild) The first symptom of Alzheimer’s disease is Progressive memory loss. Individual may forget major event in personal history such as birthday of his/her child: experience declining activity to perform task. * Response of nursing assistant to an Alzheimer’s patient that Needs Further Teaching includes a statement like. This is followed by disorientation. Symptoms worsen in the evening known as “SUNDOWNING. Asking close ended simple questions that relate to his reality is non-threatening and calming. and other symptoms & dementia. paranoia. “How many glasses of water did you drink today?” - Anterograde amnesia. memory loss. and the individual is aware of the intellectual decline. He may even be unable to swallow and is at risk for aspiration. There may be problems of immobility. language difficulty. Sleeping becomes a problem. Note that the nurse’s response in a way that is congruent is the main concern. 66 .

Address. 5) Assist patient with ambulation. Tel #. repeating. structured environment. Family counseling about Alzheimer’s disease includes checking that pt is wearing ID bracelet when going out at all times 11. 10. frequent contacts. Bed of confused Alzheimer’s patient must always have its side rails up. Clock 67 . ↓ choices Consistency and ROUTINE in care to increase security. Brief. Calendar. environment that can influence In milieu therapy. Wear the Medical Alert Bracelet – (name. Medication) 14. Provision of simple. 8) Frequently orient patient to time. Diagnosis. 9) If patient is prone to wander. provided with A confused Alzheimer’s patient who gets out of bed several times must be a safe environment like placing a hand rails for the patient to hold. 6) Keep dim light on at night. Reminiscing helps lessen the patient’s loneliness. 12. reinforce reality-oriented comments Ample time and patience to allow client to talk / complete tasks using associative patterns to improve recall: simplicity. 7) If patient is a smoker. patients plan and lead activities rather than the staff. place and situation. Allow REMINISCING of past life / exploits / achievements. Millieu therapy involves scientific manipulation of the improvement patient’s behavior 2) Store frequently used items within reach. stay with him/her at all times. 4) Assign room near nurses’ station. Avoid afternoon naps. Soft restrain may be required if the client is disoriented and hyperactive as ordered by the physician. provide an area in which the client is safe to wander. Decrease environmental stimulus. summarizing. focusing.Nursing Diagnosis: Risk for trauma Nursing Intervention: 1) Milieu Therapy is needed: a CONSISTENT UNCHANGING & FAMILIAR ENVIRONMENT IS NEEDED to decrease chances of disorientation & confusion. 3) Keep bed in unelevated position with soft padding if client has history of seizure and keep the rails up. TV & radio remote 15. 13. avoid caffeine. REMEMBER THE 3 C’s for Alzheimer’s to DECREASE DISORIENTATION: Color.

6) Provide client’s nutritional needs. Talk about real people and real events. . Sensory stimulation for elders helps to increase pt’s arousal 2) Keep explanation simple and use face-to-face interaction. 68 . Nursing Diagnosis: Self-care deficit Nursing Intervention: 1) Identify self-care deficit and provide assistance. which will make the patient feel stressed. the nurse tells the student that the reason why pt’s do not take a bath is that they cant remember anymore if they have taken the bath already. Don’t a hurried tone.Nursing Diagnosis: Altered thought process Nursing intervention: 1) Frequently orient the patient to reality. 5) ADLs should follow home routine as closely as possible. repeat yourself using the same words. 5) Use soft tone. Urinary incontinence in patient with Alzheimer’s can be controlled by decreasing fluid intake at night time 2) Allow plenty of time for the patient to perform task. 4) Provide structure schedule of activities that does not change from day to day. Your nonverbal communication is more important than your actual spoken message. and a slow. Move slowly and maintain eye contact. simple sentences. 4) Monitor for medication side effects. 3) Discourage rumination of delusional thinking. 3) Provide guidance and support for independent actions by talking the patient through the task. If he doesn’t understand you. In caring for elderly w/ Alzheimer’s use short & simple words & face him while you are talking. Give foods high in carbohydrates to an Alzheimer’s who refuses to eat his meal In an Alzheimer’s caregiver class. 7. calm manner when speaking to a person with Alzheimer’s disease. safety and security. Speak slowly and do not shout.

three drugs. thus maintaining memory skills for a period of time. have been approved by the Food and Drug Administration to improve cognitive function in patients with mild to moderate Alzheimer’s disease. Tacrine hydrochloride (Cognex)-monitor patient for liver toxicity Tacrine hydrochloride (Cognex)-enhances acetylcholine uptake in the brain.Screening Test: MS Brunner and Suddarth (pg 160) 1) Electroencephalography 2) Computed tomography 3) Magnetic Resonance Imaging Confirmative Test: MS Brunner and Suddarth (pg 160) Cerebral biopsy after death. Tacrine (Cognex) 69 . However. SUMMARIZED DRUGS USED TO TREAT DEMENTIA NAME DOSAGE RANGE AND ROUTE 40 – 160 mg orally per day divided into 4 doses NURSING CONSIIDERATION Monitor liver enzymes for hepatotoxic effects. Monitor for flu – like symptoms. Complication: MS Brunner and Suddarth (pg 158) 1) Infection 2) Malnutrition Best Drug: Anticholinesterase:I increases ACH (acetylcholine) levels MS Brunner and Suddarth (pg 160) Tacrine hydrochloride (Cognex) Donezepil (Aricept) Rivastigmine (Exelon) DRUG STUDY: No cure or definitive treatment exists for Alzheimer’s disease. tacrine (Cognex). rivastigmine (Exelon). and donepizel (Aricept).

and syncope. Test stools periodically for GI bleeding. Monitor for nausea. Behavioral: Aattention-seeking by rejecting foods. manipulation to gratify needs 2. It is believed that symptoms are caused by stressor that the adolescent perceives as a loss of control in some aspect of her life. dizziness. abdominal pain. diarrhea. Adverse effects are uncommon but may include GI upset or using anticoagulants. Psychoanalytic: Rregression to oral and anal developmental stage to avoid adolescent sexuality and independence 4. lack of personal boundaries and independence. overprotection. increased catecholamines. hypothalamus dysfunction 70 . Controlling intake and weight gain is a way the client establishes a sense of control over her life. leading to improved tissue perfusion and blood flow. vomiting. Medical: Ggenetic predisposition. BEST HERBAL DRUG FOR ALZHEIMERS: Enhancing memory with ginkgo biloba Ginkgo biloba. vomiting. Research has shown that ginkgo produces arterial. Rivastigmine (Exelon) 3 – 12 mg orally per day divided into 2 doses Galantamine (Reminyl) 16 – 32 mg orally per day divided into 2 doses Monitor for nausea. and insomnia.Donepezil (Aricept) 5 – 10 mg orally per day Monitor for nausea. loss of appetite. contains several ingredients that many believe can slow memory loss in people with Alzheimer’s disease. and loss of appetite. a plant extract. 3. use of anorexia to avoid interpersonal conflicts. rigidity. Family interaction: Aambivalent feelings towards mother. and capillary dilation. The issue of CONTROL is a central one for the client with anorexia nervosa. EATING DISORDERS #1 CAUSE: Unknown #1 Personality Disorder of Eating Disorders: Obsessive Compulsive Personality THEORIES OF CAUSATION: 1. venous.

hypoglycemia.ANOREXIA .esophageal varices .loves to cook -abuses laxatives/enema . bradycardia.4 % are Boys .hoards/collects food .extrovert .vegetarian .fluctuation of body weight There is ACCEPTANCE . OTHERS: Refusal to take meals → dramatic weight loss Anorexic patients usually suppress their appetite. difficulty accepting nurturance & caring Feelings of loneliness and isolation Hypotension. electrolyte imbalance Hyperactivity. ↑ caloric fast foods . amenorrhea Reduced metabolism.Adolescent 11-17 yo . CHARACTERISTICS .dental carries . Resistance to treatment. -2 binge-eating episodes or more per week for 3 months . Hypokalemia  ECG  ST segment depression 71 .↓ 15-20% ideal weight Defective defense mechanism: Denial Poor to fair prognosis CHARACTERISTICS .introvert . Leukopenia Skin problem: Hyperkeratosis (overgrowth of Complications: horny layer of epidermis) .young adults .chipmunk face #1 Cause of death: cardiac dysrrhythmia --.Binge/purge syndrome Binge eating: Eating increased amounts of high calorie food in a short period of time. which makes it difficult for the nurse to convince them to eat.Patient’s with eating disorders are usually high achievers.Bulimic patients are usually aware of their abnormal behavior. Constipation.carbohydrate.Amenorrhea  lanugo BULIMIA .good prognosis  acceptance . perfectionist and preoccupied with food. reduced hormonal functioning.All are females .strenuous exercise .callous finger Complications: . hypothermia Secondary sexual organ atrophy.

STEP BY STEP NURSING DIAGNOSIS: 1. grant or restrict privileges. ASSESS AND EVALUATE: • Weight and % of normal body weight loss. Provide surveillance 30 min. amenorrhea • Interpersonal relationships PROVIDE A STRUCTURED ENVIRONMENT that offers safety and comfort and helps DEVELOP INTERNAL CONTROL→ reduces need to control by self-starvation. Provide education 1) on growth & development and normal nutrition 2) Limit setting: Bbased on weight gain or loss. • Presence of anemia. monitor hydration and electrolytes An anorexic patient with high urine specific gravity must be encouraged to have an increase fluid intake b. IV or tubes. 3. clothing and weighing scale. time and place of eating. 5. F/E imbalance 2.Altered Nutrition less than body requirement NURSING INTERVENTION FOR EATING DISORDERS 1. calories restriction to effect WEIGHT GAIN (1-2 pound per week) 72 . Help client accept eating problem and set realistic. 4. gain less than 100 g. attainable short-term goals Provide support is developing better outlets for emotional expression. type of foods. Fluid volume deficit – hypovolemic shock 3.& Prominent U wave STEP BY STEP NURSING DIAGNOSIS: 1. hypotension. Encourage outside interests not related to food Provide teaching on therapeutic diet: Bbalanced.with bathroom privileges. Altered Body Image Change of body image causes difficulty in self-esteem. Altered Nutrition less than body requirement 4. whether food is forced or followed by vomiting. to 1 hr after meals • Preventing the patient from using the bathroom for 2 hours after eating. prevents the patient from inducing vomiting. DIETARY THERAPY → restoration and stabilization of nutritional and fluid balance a. F/E imbalance 2. 6. Fluid volume deficit – hypovolemic shock 3. Loss – complete bed rest. Long term treatment for anorexia/bulimia includes outpatient family therapy sense of control over herself is a positive outcome in eating disorder. Feedings: Ooral. more than 200 gmay ambulate in the hospital • Eating patterns: Aamount. Limit activity based on weight gain: For wt. use behavioral contract to enforce limits 2. Caring and nurturance when possible c. bradycardia. weighing 3x a week: Ssame time.

psychological.7. Instruct and support in behavioral modification program: 1) Control speed of eating – chewing food well. accept lapses (behavior modification) 8. social. Offer PRAISE for progress. ignoring serious substance-related problems The body’s physical adaptation to a drug. behavioral. whereby withdrawal symptoms occur if the drug is not used Substance abuse Substance dependence Physiologic dependence 73 . and cognitive symptoms indicating that a person persists in using the substance. or occupational problems A range of physiologic. 2) Self monitoring w/ food diary. & 3) Praise/reinforce compliance Best discharge plan for anorexic teen includes attending a support group DRUG ADDICTION/NONALCOHOLIC SUBSTANCE ABUSE SUBSTANCE ABUSE TERMS AND DEFINITTIONS TERMS Psychoactive substance DEFINITIONS A substance that affects a person’s mood or behavior Continued use of a psychoactive substance despite the occurrence of physical.

obsession with the drug. It also refers to the decreasing effect of the drug. neglect of personal needs.Psychological dependence The emotional need or craving for a drug either for its effect or to prevent the occurrence of withdrawal symptoms A compulsion. and progressive pattern of drug use. resulting in a serious toxic reaction or death Tolerance is the need for the increasing amount of a substance to produce its desired effect. impaired thinking. A state whereby the effect of a drug is decreased and greater amounts are required to achieve the desired effect because the person has become tolerant to a similar drug Overdose Tolerance Cross-tolerance 74 . decreased tolerance. loss of control. and physiologic deterioration Addiction Polysubstance abuse Concurrent use of multiple drugs Intoxication An altered physiologic state resulting from the use of a psychoactive drug Accidental or deliberate consumption of a drug in a dose larger than is ordinarily used. unkept promises to stop usage. characterized by behavioral changes.

Predisposition Any factor that increases the likelihood of an event occurring The ability of one drug to increase the activity of another drug when taken at the same time Any use of a drug that deviates from medical or socially acceptable use Potentiation Drug misuse Dual diagnosis The coexistence of a major psychiatric illness and a psychoactive substance abuse disorder An acute situation in which a person experiences a period of memory loss for actions as a direct result of using drugs or alcohol Discontinuation of a substance by a person who is dependent on it The process of withdrawing a person from an addictive substance in a safe manner The amount of a drug that produces a poisonous effect The tendency to relapse into a former pattern of substance use and associated behaviors Blackout Withdrawal Detoxification Toxic dose Recidivism 75 .

misinterpretation of stimuli ● Defensive Coping related to denial of problem. Academic or job failures. needle marks on arms along path of a vein (wearing of long. and spiritual arenas of a person’s life Sobriety Abstinence A. abdominal cramps.sleeves). stealing to support habit. NURSING DIAGNOSES. psychological. projection of responsibility or blame. POTENTIAL: ● Altered health maintenance/nutrition related to chemical dependence. ASSESSMENT FINDINGS ● History. intake of mind-altering substances. lack of interest in food ● High Risk for Violence: Ddirected toward self or others related to feelings of suspicion or distrust.Recovery The return to a normal state of health. violent acting out ● Physical Examination: Mmalnutrition. personality change. rhinorrhea 10 hours after the last opiate injection. lacrimation. intellectual. diaphoresis. nasal discharge with nasal septum perforation (cocaine) ● Social: Inability to maintain ADL and fulfill role responsibilities and obligations B. whereby the person does not engage in problematic behavior and continues to meet life’s challenges and personal goals Complete abstinence from drugs while developing a satisfactory lifestyle Voluntarily refraining from activities or the use of substances that cause problems in the physiologic. rationalization of failures NON-ALCOHOLIC ABUSED SUBSTANCES DRUG OPIATE or SX OF ABUSE/ INTOXICATION Euphoria → SX OF WITHDRAWAL Chills and TREATMENT Naloxone (NARCAN) 76 . yawning. marital failures. social.

muscle spasm (legs). weakness. Grandiosity Hypervigilance. use gastric lavage 77 . Anxiety → Sadness → Insomnia PERSPIRATION Tremors Narcotic Withdrawal causes muscle ache. diarrhea. VS changes. 3. decreased selfesteem. depression the #1 antidote for Opioids or Narcotic intoxication METHADONE for Heroin Withdrawal : 1. Coma ↓ Memory Euphoria Agitation ↑ BP.Horse and Fine China) Marked respiratory depression PinpointPupils . Uppers. Activated charcoal. diaphoresis. dilated pupils. piloerection. anxiety 1st 12-72 hrs: -sleep disturbances. abdominal pain. Temp Hyperactivity. RP. Hyperpyrexia Ventricular dysrhythmia Lacrimation (Watery eyes) RUNNY NOSE YAWNING ↑ BP Dilated pupils Cramps Muscle SPASM Nausea. pulse. pills. PR. irritability.NARCOTICS: A CNS depressant can cause decreased blood pressure. pep. VOMITING Panic. rhinorrhea. speed. Demerol Morphine Codeine Nalbuphine HEROIN. 4.(Horse. and weight loss/anorexia Fatigue Anxiety Depression ↑ BP and PR Tachycardia Tremors Convulsions Delirium Hallucinations Anxiety Insomnia Depression Fatigue Apathy Disorientation Irritability Altered sleep Sodium bicarbonate → excretion Activated charcoal. 2. Crank Amphetamines Dexedrine Slurred speech Respiratory depression ↓ BP and PR Ataxia/ impaired coordination Drowsiness Seizures. meth. smack. pink ladies) Phenobarbital Nembutal STIMULANTS (Upper. respiration. junk. and temperature. . Ice. rainbows. tremors. crystal. gastric lavage ANXIOLYTICS: Minor tranquilizers Valium Librium Barbiturates(Downes. Smack.

Inhaled) Angel dust. weed. Mania. vivid dreams and hypersomnia or insomnia and psychomotor agitation. grass. Temp Delirium. Injected. Conjunctival Hash. Inhaled) “Coke” “Crack” “Snow” “Blow” “Lady” “Powder” Nasal septum perforation Irritability. Weed) Congestion ↑ appetite Euphoria Relaxed inhibition Dilated pupils Psychosis Small doses of Valium Hyperactivity Insomnia Dry mouth Sexual arousal Visual hallucinations Most effects wear off in 58 hr ‘ talk down’ client Another word for alcohol is “Booze” “Brew” GENERAL PRINCIPLES OF CARE: ALCOHOL DETOXIFICATION 3 A’s = Alcohol Withdrawal  Aversion Therapy (Punishment) 78 . Hog. Amino acid therapy is utilized to facilitate restoration of depleted neurotransmitters. Appetite suppression. Pot. Psychosis similar to paranoid schizophrenia None Cocaine use leads to dopamine deficiency. Hallucinogens: LSD (acid) (PCP :Oral. Seizure Coma. Agitation Convulsions Coma Cannabis #1 sign RED EYES Derivatives: (irritated conjunctiva) Marijuana (mary jane. Fatigue joint. Injected. Personality changes. Insomnia. Antisocial behavior Cocaine (Oral.Methamphetamine Euphoria. Dilated pupils Cocaine is characterized by. rocket fuel) Hallucination Incoherence ↑ confusion Dilated pupils ↑ BP.

Nausea & Vomiting 2. astringent. vinegar. shaving cream.“ The group activity may not seem helpful to you but you can help them. How much alcohol have you taken for the last 24-48 hrs? In a detoxification unit. fruitcake. “I can quit whenever I want. When was the last time you have taken alcohol? 2. Diarrhea 3. Statement of a pt who is alcoholic and undergoing detoxification saying. cough syrup/elixir. acetone/nail polish Cough medicines and other over-the-counter medicines are alcohol-based and may cause antabuse reaction when it is combined with antabuse. Maintenance Phase = 250 mg & ↓ >Prohibited Household items with alcohol: mouthwash.Antabuse (Disulfiram) = no effect unless mixed with alcohol Action: Iinhibit Antabuse effect Acetaldehyde dehydrogenase > Dosage: Acute phase = 500 mg in 1st 2 wks. Goal in alcohol detoxification includes maintaining maximum physical integrity during withdrawal period. Effect of Antabuse with Alcohol 1. “I don’t want to attend group meeting. Abdominal cramps > Short term objective for an alcoholic: Tto stop/cut denial Long term objective: Abstinence (similar with STD/HIV/AIDS) > # 1 group therapy for Alcoholics (12 step recovery program – AA (Alcoholic Anonymous) for victims of alcoholics: AL-ANON for alcoholic teens: ALATEEN Correct response of an RN to alcoholic patient who says.” Is a statement like. the nurse asks the pt when was the last time he drink alcohol to determine the onset of alcohol withdrawal syndrome. and toner.” shows denial CAGE SCREENING QUESTION FOR AN ALCOHOLIC C cut down alcohol (Do you need to cut down alcohol?) A annoyed (Are you annoyed when someone will ask you “Are you an alcoholic?) G guilty (Are you guilty of taking too much alcohol?) 79 . Intense headache 4. I don’t need their alcoholic advice.” > Screening Questions for alcohol abuse: 1. Antabuse may worsen renal damage thus it is contraindicated for patients with renal problems.

Alcohol Serum Level = 0. Hallucination – #1 hallucination of Alcohol withdrawal is TACTILE Nursing diagnosis for patient with delirium tremens who says. Liver Cirrhosis 2.1 or 100 mg/dl > slurring of speech > Fruity odor  similar to ketoacidosis > Legal intoxication III. ASL = 0. Early/Initial – Fine tremors. Wernicke’s Korsakoff’s  peripheral neuritis  lack of Vit. hyperventilation & nervousness Symptoms of alcohol withdrawal is observed when the cup rattles to the side when the patient stirs his coffee II. restlessness. diaphoresis. Gastritis  inflammation 3.04 -0. Pancreatitis 4.05% > unsteady gait > ↓ social & sexual inhibition II. Wernicke’s Aphasia / Receptive Aphasia: Pproblems in interpretation (temporal lobe) B. Korsakoff’s Psychosis – irreversible (the best drug is Risperidone (Risperdal): Iit has Decrease extrapyramidal symptoms (EPS) 4 Stages of Alcohol Withdrawal I. Wernicke’s’ psychosis is due to thiamine deficiency. tachycardia. “There are bugs in my bed crawling over me” is Altered Thought Process 2.E eye opener (stimulant) Do you use an eye opener early in the morning to decrease the after effects of alcohol? 3 Stages of Alcohol Intoxication I. Confabulation or making up of stories is one of the initial manifestations of Korsakoff’s Two categories of Wernicke’s Korsakoff’s: A. B1 (thiamine) (Sx: Ttingling sensation/numbness of extremities: Aavoid electric blankets!) syndrome.15-0. Visual hallucination Intervention: > Use lampshade to ↓ shadow (illusions) 80 . ASL = 0.2 – severe alcohol intoxication > 4 Common Complications with History of Alcoholism 1.08-0.

Restlessness  cerebral hypoxia = ↓ 02 & glucose IV.  Shadow stimulates hallucination  don’t leave the patient (Offering of self) episodes. Delirium Tremens Active Seizure = Grand mal/Tonic-Clonic Delirium tremens is initially manifested by anxiety.Leaving a light on the patient’s room will decrease visual hallucinations. Headache & Aura. illusions. Epigastric pain (early sign in eclampsia) 2. Pre-seizure/RUM FITS Impending signs of Seizure 1. restlessness. Eye pain/periorbital pain (scotomas) usually in eclampsia 4.↑ ICP 5. Assigning a staff to the patient promotes safety especially during withdrawal III. High pitch cry/projectile 3. which frequently occur in alcohol withdrawal syndromes. Observation indicating a need to be included during endorsement to next shift in an alcoholic patient in the ER include observations of becoming fearful (delirium tremens) DRUGS CAUSING DELIRIUM Anticonvulsants Anticholinergics Antidepressants Antihistamines Antipsychotics Aspirin Barbiturates Benzodiazepines Cardiac glycosides Cimetidine (Tagamet) Hypoglycemic agents Insulin Narcotics Propranolol (Inderal) Reserpine Thiazide diuretics MOST COMMON CAUSES OF DELERIUM 81 . hallucinations and elevated vital signs.

thiamine or vitamin B12 deficiency.000-400. Carbamazepine (Tegretol): Anticonvulsant  trigeminal neuralgia (tic douloureux) A/E: Agranulocytosis/neutropenia – S/Sx: Ssore throat Neutrophils 54-56 % 82 . dehydration. renal or hepatic failure. prescription medication or illicit (street) drugs Infection Drug-related COMMONLY USED ANTICONVULSANTS 1. brain tumor. head injury.or hyperglycemia. sedatives. thyroid or glucocorticoid disturbances. syphilis Intoxication: Aanticholinergics. hypo. Valium (Diazepam)  best drug for delirium tremens 2. HIV. or protein deficiency.Physiologic or metabolic Hypoxemia. Solution for Phenytoin (dilantin) is NSS (Normal Saline Solution) 5. sedatives. Phenytoin (Dilantin)  best anticonvulsant for children SE: Ggingival hyperplasia & red orange urine Intervention: Mmassage the gums & use soft bristle toothbrush Adverse Effect: Blood dyscrasia. cardiovascular shock. electrolytes disturbances. and exposure to gasoline. encephalitis. pneumonia Cerebral: Mmeningitis. alcohol. and related substances Systemic: Ssepsis.000active bleeding Special Considerations: The only COMPATIBLE I. urinary tract infection.V. Klonopin (Clonazepam)  4. vitamin C. if ↓100.thrombocytopenia S/SX: Bbleeding of the gums Lab test: Pplatelet count = 150. and hypnotics Reactions to anesthesia. lithium. insecticides. Librium (Clordiazepoxide) Positive) outcome of Librium in alcoholic depressed woman includes an observation that client can pick an object on floor w/ smooth coordination 3. and hypnotics Withdrawal: Aalcohol. paint solvents. sleep deprivation.000. niacin.

thiamine and folic acid help decrease withdrawal symptoms.6. multivitamins. suction B. Administer ordered drugs. LOC D. Start IV line C. MASOCHISM: Sexual gratification from self-suffering used as an accompaniment of the sexual act or substitute for it 83 . public transportation) 4. pulse. Adverse Reaction: Hepatotoxic (assess SGPT or ALT) 7. Prevent and control seizures.  Antidepressants block the ‘high’ from stimulant abuse G. will ↑ respiratory depression if barbiturates have also been used  METHADONE – drug substitute used for acute withdrawal and long-term maintenance. FETISHISM: Sexual gratification from an inanimate object (usually clothing material) substituted for the genitals 3. Ethosuccimide (zarontin) Chlordiazepoxide (Librium). Detoxify / treat overdose NALOXONE (NARCAN) – Pure antagonist to narcotics-induces withdrawal and stimulates respiration. protect from injury A pt taking phencyclidine (PCP). temperature. Check for trauma. DRUG OF CHOICE when in doubt the substance used because NALOPHINE (NALLIN). high-protein. quiet environment E. GENERAL PRINCIPLES OF CARE: DETOXIFICATION/OVERDOSE A. the pain to self or partner. EXHIBITIONISM: Sexual gratification from exposing genitalia 2. Maintain airway: Iintubation (keep airway on hand). or children and other nonconsenting individuals. SEXUAL DISORDER: Ddeviations in sexual behavior. high-vitamin SEXUAL DISORDERS / DYSFUNCTION A. Nutrition: Hhigh-calorie. Monitoring: BP. respiration. and decreasing stimuli. 1. shouts & walks back & forth. FROTTEURISM: Sexual gratification from toughing or rubbing against a nonconsenting person (usually in crowds. sexual behaviors that are directed toward anything other than consenting adults or are performed under unusual circumstances and are considered abnormal B. Keep in calm. a partial antagonist to narcotics. appropriate nursing intervention includes seclusion. which is administered under supervision. changes an illegal to a legal drug. F. PARAPHILIA: Sexual fantasies or urges that are directed toward nonhuman objects. Valproic Acid (Depakene/Depakote) therapeutic serum level: 40-100 mcg. staying w/ the pt.

talented in music or math . 3. A type of developmental disorder for an unknown. CHARACTERISTICS: 1. Sexual dysfunction related to actual or perceived sexual limitations 4. SADISM: Sexual gratification from inflicting pain or cruelty to others used as an accompaniment of the sexual act or a substitute for it 7. Potential for infection related to frequent changes in sexual partners or sadistic or masochistic acts 6.Autism is usually diagnosed during the toddler stage. Rrepetitive movement: head banging  padded room/helmet 3. TRANSVESTISM: Sexual gratification from wearing clothes of the opposite sex 8. 1. 2. Blank stare 2.mostly males . Anxiety related to threat to security and fear of discovery 2.# 1 screening test – DDST (Denver Developmental Screening Test) . GENERAL PRINCIPLES OF CARE Acceptance NOT of the behavior but of the client who is in emotional pain Protection of the client from others Setting limits on the sexual acting out Supporting of self-esteem: Aavoidance of punitive remarks or responses Provision of diversional activities PERVASIVE DEVELOPMENTAL DISORDERS CODE: ACA Autism.5. VOYEURISM: Sexual gratification from watching the sexual play / act of others 9. NURSING DIAGNOSES 1. 4. probable underlying problem: failure to develop satisfactory relationships with significant adults . Sexual dysfunction related to inability to achieve sexual satisfaction without the use of paraphilic behaviors 5. 5. Conduct Disorder. Anxiety related to conflict between sexual desires social norms 3. Llikes to follow bright moving objects 4. Attention Deficit Hyperactive Disorder (ADHD). D. Potential for injury / violence related to sexual behavior and retaliation for sexual behaviors E. acquired or lifelong inhibition or interference with any of the phases of the sexual responses which may be due to psychogenic factors alone or psychogenic and biologic combined. PEDOPHILIA: Sexual gratification from children 6. Ccatatonic 84 . AUSTITIC DISORDER A. SEXUAL DYSFUNCTION: Generalized or situational. ZOOPHILIA: Sexual gratification from animals C.

Cclings to inanimate objects B. never leave alone. ↑ Serotonin . Prevent acts of self-destructive behavior 5. Provide appropriate therapy: ● Removal from home. Poor intellectual functioning C.5.#1 Screening Test  DDST CHARACTERISTICS: 1. steering mechanisms due to profound interference in intellect 5. if necessary. ASSESSMENT FINDINGS: 1. Hyperactive  could not sit and stay in 15 minutes 2. Poor interpersonal relations. group. ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) A. Association looseness. Personality alteration – adaptive. Disturbance in sense of self-identity. Withdrawal from reality. individual therapy Primary treatment goal to facilitate the recovery of an autistic child should include playing with blocks not with balls . SEVERE AUTISM – Severe apathy. Make physical contact on a regular basis. ● Psychotherapy: Pplay. Disruptive behavioral disorder evident before 7 years old and lasting at least 6 months and characterized by hyperactivity and inattentiveness THEORIES: ↑ Norepinephrine. turns to inanimate objects and self-centered activities for security 4. NURSING DIAGNOSIS: Potential for Injury D. Lacks meaningful relationship with outside world. in ego system formation: Iinability to distinguish between self and reality / environment → speaks of self in the third person 2. Easily agitated by noise & color (orange/yellow) B. Set consistent and firm limits for his behavior 3. 3. ASSESSMENT 85 . and always provide safety. inhibitory. Accept the client’s need to push but still maintain regular contact. ↑metabolism  fatigue 3. consistent loving home care is still favored over hospitalization. Poor communication skills. NURSING IMPLEMENTATION: 1. Behavior modification in an autistic child enables the nurse to modify the child’s maladaptive behavior. Occupational Therapy #1  behavior modification #2 ● Pharmacology: Tranquilizers and amphetamines to reduce symptoms Caring autistic children requires specialized skills. Ttemper tantrums 6. Autistic thinking. Ambivalence. routine ADL in familiar environment 2. consistent care giver. handwriting not legible 4. Provide consistent. 4. Poor grasp of reality.

Tx: 1.5. 1.” indicates efficacy of the drug. 2. Psychostimulant – to increase attention span 2. insomnia and suppression of appetite. 1. attainable goals Provide firm. C. Short attention span 3. “My son is able to accomplish his task better. #1 Therapy: Occupational Therapy using behavior modification 2. CHILD ABUSE A. the drug of choice for ADHD causes growth suppression. a drug for ADD/ADHD enhances catecholamine effect. Easily agitated by noise & color (orange/yellow) NURISNG IMPLEMENTATION: Set realistic. Vitamin B Complex ↑ appetite 4. ↑metabolism  fatigue 3. Dextroamphetamine (Dexedrine) 3. Statement like. consistent discipline with opportunities to experience satisfaction and success Provide a structured environment● With a balance of energy expenditure and quiet time ● With learning experience utilizing child’s ability ● With exercise in perceptual-motor coordination ● With LESS STIMULATION The priority needs of the child with ADHD are safety and provision of inadequate nutrition. ASSESSMENT: 86 . handwriting not legible 4. Catching attention of a child with ADD includes getting him to look at his mom & give him simple directions. Do not mix Caffeinated food/drinks with ACA/alcohol 5. 3. Severe inattentiveness with or without hyperactivity 2. Squirming and fidgeting Hyperactive  could not sit and stay in 15 minutes 2. RITALIN (Methylphenidate: BEST GIVEN AFTER BREAKFAST) Always with meals Ritalin. Pemoline (Cylert) very hepatotoxic!!! 4. DEFINITION: Physical abuse and emotional neglect. may include sexual abuse B. CAUSE: Exact-unknown. Stratera ( Atomoxetine) newest psychostimulant!! Contraindication: Ddo not give below 6 yo  hepatotoxic  SGPT Stratera. DIET: ↑caloric content – finger foods 3. 4. Administer drugs as ordered: RITALIN (methylphenidate) or dextroamphetamine sulfate 5. Excessive impulsiveness 4. Present in all socioeconomic levels C.

) ● Inconsistency of declaration of the type. POTENTIAL NURSING DIAGNOSES 1) Impaired Skin Integrity 2) Infective Family Coping E. treat injuries • MANDATORY: REPORTING of suspected cases to appropriate agency (SAVE EVIDENCES. lacerations. immature. disturbance on parent-child interaction (Absence of PROTEST on admission of a toddler is a sign of abuse. TAKE PICTURES) • • • EMOTIONAL SUPPORT to child: PLAY THERAPY to express feelings. Notify the legal authorities about reports of a battered 7 y/o girl is part of the responsibilities of an RN D. cause of injury. discovery of undeclared / unreported fractures ● Malnutrition / failure to thrive / emotional neglect ● Sexual abuse signs: Ggenital bruises. therapeutic use of self requires self awareness initially.esteem 3) Lacks identity 4) Expect child to provide them with love and care (PERSONAL ROLE THEORY of causation) 5) With incorrect concept of what the child is. In working with the mother of abused child. NONJUDGMENTAL ATTITUDE toward parents ROLE MODELING for parents who are encouraged to care for child DOCUMENTATION of ACTUAL FINDIGNS not interpretation nor opinion 87 . Attendance to a parenting class is a step towards learning parenting skills. therefore the nurse has to deal with her feelings first. STDs • History: Parents who were abused as kids ○ Other characteristics of abusive parents: 1) Tend to be young. NURSING IMPLEMENTATION • FIRST: Meet physical needs. The interaction between the abuse child and a mother provides a clue to the kind of relationship that this child has with his mother. 20 Low in self. dependent. which are lacking in abusive parents. and can do 6) With inadequate resources and support system Abusive parents usually have low-self-esteem and has little social involvement. location.● Obvious physical injuries. Child abuse is common in the lower socio-economic class.

or personal items that are easily affordable Unusual concern by the caregiver over the expense of the elder’s treatment when it is not the caregiver’s money being spent Neglect indicators • • • Dirt.• POSSIBLE INDICATORS OF ELDER ABUSE Physical abuse indicators • • • • Frequent. unexplained injuries accompanied by a habit of seeking medical assistance from various locations Reluctance to seek medical treatment for injuries. fecal or urine smell. or lice on the elder Elder has an untreated medical condition is malnourished or dehydrated not related to a known illness 88 . or denial of their existence Disorientation or grogginess indicating misuse of medications Fear or edginess in the presence of family member or caregiver Psychological or Emotional abuse indicators • • • • Helplessness Hesitance to talk openly Anger or agitation Withdrawal or depression Financial abuse indicators • • • • • • Unusual or inappropriate activity in bank accounts Signatures on checks that differ from the elder’s Recent changes in will or power of attorney when elder is not capable of making those decisions Missing valuable belongings that are no just misplaced Lack of television. sores. clothes. or other health hazards in the elder’s living environment Rashes.

• Inadequate clothing Indicators of self-neglect • • • • • • Inability to manage personal finances. memory loss. such as hoarding. housework Wandering. problems. squandering. to have visitors. unresponsive Lack of toilet facilities. or giving away money while not paying bills Inability to manage activities of daily living such as personal care. isolation. living quarters infested with animals or vermin Warning indicators from caregiver • • • • • • Elder is not given opportunity to speak for self. shopping. 89 . and so forth Previous history of abuse or problems with alcohol or drugs. refusing needed medical attention . substance use Failure to keep needed medical appointments Confusion. or to see anyone without the presence of the caregiver Attitudes of indifference or anger toward the elder Blaming the elder for his or her illness or limitations Defensiveness Conflicting accounts of elder’s abilities.