You are on page 1of 31

ReD Mapalo – BSN Psychiatric Nursing

Beliefs  Feelings  Behavior

Therapeutic Communication Techniques


• What you see, you say
• What you hear, you say  restating

Sigmund Freud
• Father of Psychoanalysis
• Structure of Personality (Id, Ego, Superego)

Dominant ID
I Mania
D eat Antisocial
mpulsive drink Narcissistic
want to urinate
want PLEASURE defecate

PLEASURABLE PRINCIPLE E
Pain Avoidance
It’s all “I”

DOMINANT SUPER EGO


Obsessive - compulsive
UPER EGO Anorexia Nervosa
hould not
mall voice of God I

CONSCIENCE PRINCIPLE E

GO
Xecutive Secretary Impaired Reality
Schizophrenia

REALITY PRINCIPLE

LIBIDO  sexual energy responsible for survival

PSYCHOSEXUAL THEORY
1. ORAL STAGE
• 0 – 18 Months old
• Survival
• I want to eat, sleep, urinate, defecate
• ID formation
ReD Mapalo – BSN Psychiatric Nursing

• Cry & Suck  mouth


Child Cries

Feed the Infant Ignore the Infant


↓ ↓
Successful Unsuccessful

Narcissistic

Defense Mechanism:
o FIXATION  when a person is stuck in a certain developmental
stage
o REGRESSION  return to an earlier developmental stage

• EGO is develop in the 6th month

2. ANAL STAGE
• A teen – 3 years old (18 mos – 3 y.o.)
• Toilet training
• Super Ego develop

Toilet Training

Good Mother Bad Mother


↓ ↓
Successful Unsuccessful

SE
Too Rigid Training Dirty
↓ Disorganized
Clean Disobedient
Organized ↓ Small
Obedient ANTISOCIAL S
BIG E
↓ (Anal Expulsive)
SE
OBSESSIVE – COMPULSSIVE
(Anal Retentive)

3. PHALLIC
• 3 – 6 y.o.
• Penis/ Vagina
• Parents is the significant person
• Called as Preschooler
ReD Mapalo – BSN Psychiatric Nursing

• Oedipus Complex  little boy loves mommy


• Electra Complex  little girl loves daddy
• Identification  boy associates with daddy, girl assoc. with mommy
• Castration  fear of the little boy to daddy
• Penis Envy  envy of little girl towards daddy

Dr. Karen Horney  opposition to penis envy

• Level of Awareness
o Conscious  highest level of awareness
o Preconscious  Tip of the tongue
o Unconscious  deepest level of awareness

• Birth Trauma  First traumatic experience of child


• REPRESSION  unconscious forgetting of an anxiety provoking
concept
• SUPRESSION  conscious forgetting of an anxiety provoking
concept

4. LATENCY STAGE
• 6 – 12 years old
• SCHOOlatency
• Sexual energy is dormant
• Reading, Riting, Rithmetic

• SUBLIMATION  placing sexual energies toward a more


productive endeavors

5. GENITAL STAGE
• 12 y. o. – above
• Gising
• Genital
ReD Mapalo – BSN Psychiatric Nursing

PHARMA MOMENTS
ANTIANXIETY
VLAST ME VAIB
Valium – ate V Miltown - Meal Vistaril - largavista
Libreum - L Equanil – Aqua Kneel Attarax – Mga bato (rocks)
Ativan - Ate Guy Inderal – hindi ralph
Seraks – Sera Ulo Busfar – sasakay ng bus
Tranxene - Transit

ERIK ERIKSON
• PSYCHOSOCIAL THEORY OF DEVELOPMENT
Age + - Affecting Major
Factor
0-18 mos. Trust Mistrust Feeding
18 mos. – 3 y.o. Autonomy Shame/ doubt Toilet Training
AU nal
TO ilet training
NO favorite word
MY
3 – 6 y.o. Initiative Guilt Independence
6 – 12 y.o. Industry Inferiority In da-school
12 – 18 y.o. Identity Role confusion Peer
18- 35 y.o. Intimacy Isolation Love
35 – 65 y.o. Generativity Stagnation Parenting
65 y.o. and above Ego Integrity Despair Reflection

MASLOW’S HEIRARCHY OF NEEDS

1. Physiologic Needs
o Air, food, water, shelter, rest, sleep, activity and temperature
maintenance that are crucial for survival
2. Safety and Security Needs
o Safe in physical and psychological aspects
3. Love and Belonging Needs
o Giving and receiving affection, attaining a place in a group,
maintaining the feeling of belonging
4. Self – esteem Needs
o Self esteem – feelings of independence, competence and self
respect
o Esteem from others – recognition, respect, appreciation
ReD Mapalo – BSN Psychiatric Nursing

5. Self Actualization
o One’s maximum potential and realize one’s abilities and qualities
BEHAVIORAL MODELS
1. Ivan Pavlov
• Classical Conditioning Model
• All behavior are learned
 Food  dog  Salivation
 Bell  Food  Dog  Salivation
 Bell  Salivation
2. B.F. Skinner
• Operant Conditioning
• All behaviors are unlearned
• Reward (+ reinforcement) and Punishment (-
Reinforcement)

BRAIN LOBES ACTION


Frontal  Language, Learning, Personality, Judgment
Temporal  hearing, smelling
Parietal  Taste, touch
Occipital  Vision

Sensory
Integration Voluntary
Motor
Involuntary

VOLUNTARY NERVOUS SYSTEM


• Somatic Nervous System
AcetylCholine

Brain  Spinal Cord  Motor Nerve  Muscle Fiber

INVOLUNTARY NERVOUS SYSTEM


• Autonomic Nervous System
Sympathetic Parasympathetic
HR ↑ ↓
RR ↑ ↓
GI ↓ ↑
Constipation Diarrhea
GU ↓ ↑
Urinary Urinary
retention Frequency
Neuro Epi/ Nor Acetyl Choline
ReD Mapalo – BSN Psychiatric Nursing

PHARMA MOMENTS
MONOAMINE OXIDASE INHIBITORS (PANAMA)
AR
M PLAN
N DIL
P NATE

ANTIPARKINSON
CAPABLES

Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetryl

THERAPEUTIC COMMUNICATION
Therapeutic Non-Therapeutic
• Offer your self  I’ll stay with • Don’t worry be happy
you • Everything’s gonna be alright
• Silence • Ignoring the client
• Making observations • Changing the subject
o You seem sad • Nice weather we’re having
• Active listening o Adjectives – value
o Nodding based perception,
o Eye contact should not be use
o Lean forward • You are the most beautiful
• Who, what, when, where client
• General leads • Why
o Go on, I’m listening, • Arguing
what else? • Flattery
• Broad opening - best Opening • You should do this now
line • In my opinion
o How are you today?
o How are you?
• Restating
• Clarrification
• Refocusing  we are talking
ReD Mapalo – BSN Psychiatric Nursing

about the exam


• Focusing  tell me about
DEFENSE MECHANISMS  Fight for stress
DISPLACEMENT • Transfer of feelings to a less • Boss shouts at
threatening object rather than the you, you shout at
one who provoke it your subordinate
DENIAL • Failure to acknowledge an • “I’m not an
unacceptable trait or situation alcoholic”
DISSOCIATION • Psychological flight from self • “Sino ka, Sino
• A type of amnesia ako?”
REGRESSION • Return to an earlier developmental • Return to
stage thumbsucking
REPRESSION • Unconscious forgetting of an • Hindi ko maalala
anxiety provoking concept
RATIONALIZATION • Illogical reasoning for a socially • I drink because I
unacceptable trait don’t want to
• “sayang ang beer sa ref, kaya ko waste the beer in
ininum” the ref
REACTION • doing the opposite of your • sasabunutan
FORMATION intention kita. . . ay
• plastic kuklulutin lang kita
UNDOING • Doing the opposite of what you • “ay pinatid kita,
have done due to guilt halika punta kita
• orocan, plastic, Tupperware sa clinic”
IDENTIFICATION • Assume trait for personal, social, • Tulad niya
occupational role
PROJECTION • Attributing to others one’s • “hindi ako
acceptable trait alcoholic, sila yon”
• Pasa load
INTROJECTION • Assume another person’s trait as • “ako din”
your own • Not just you, me
• too
SUPPRESSION • Conscious forgetting of an anxiety • Hindi ko alam yan
provoking concept
SUBLIMATION • Placing sexual energies toward a • Angry at life, put
more productive endeavors anger in singing
CONVERSION • Repressed angers put towards • Biglang mangingig
physical symptoms affecting
nervous system leading to sensory
numbness and motor paralysis
COMPENSATION • Overachievement in one area to • Pilay pero
cover a defective part magaling kumanta
SUBSTITUTION • Replacing a difficult goal with a • Gusto ko
more accessible one Disneyland.
ReD Mapalo – BSN Psychiatric Nursing

Enchanted
nalang.

STOP  GABA  Inhibitory


Gamma Amino Butyric Acid

GO  Epinephrine/ Norepinephrine
SNS Exitatory

ANXIETY Anticholinergic side effect


Constipation
Urinary Retention Within 1 week
Dry Mouth Rebound
Blurred Vision phenomenon
Seizure
Abrupt

Anti-Anxiety Dependence
Withdrawal
Drowsy
No Alcohol
No Coffee
Develop Orthostatic
Hypotension
Prevetion of O.H.
1. Sit Down
2. Dangle feet Gradually
3. Stand Up Gradually Tapered Dose

RELAXED

ANXIETY
• Vague sense of impending doom

Mild Moderate Severe Panic


+1 +2 +3 +4
Widened acing ont know what uicide
Perceptual to say/do afety Don’t touch client
Field RN Meds IRECTIVE Respi Alkalosis
Restless Bown Bag
Enhanced Learning
Capacity
“You Seem Restless “
ReD Mapalo – BSN Psychiatric Nursing

Assess : Level of Anxiety


Nx Dx : Ineffective Individual Coping
Powerlessness
Impaired Skin Integrity
Planning/ Implementation:
 ↓ level of anxiety
 ↓ environmental Stimuli
 Relaxation Technique
• Showing pictures of flower, waterfalls
• Hearing sounds of chirping birds
Evaluation : Effective individual coping

ENERALIZED ANXIETY DISORDER


months excessive worrying
• Might be mild, moderate and severe anxiety
S/Sx
• Restless
• Difficulty of concentration
• Sleep Disorders
• Palpitations
• Edge of the seat
• Easy fatigability

PANIC DISORDER
• 15 – 30 Minutes escalation of SNS
• AGORAPHOBIA  fear of open space/ public places
• SOCIAL PHOBIA  fear of public

POST TRAUMATIC STRESS DISORDER

Trauma
Disaster
Accident Flashbacks
War VICTIMS  Survivors
Rape Nightmares
ReD Mapalo – BSN Psychiatric Nursing

Earthquake
Soldier

6 years old ↑ Anxiety SOMATOFORM


↓ ↓ > no pretension
Assignments/ “I am sick” > no organic
Homeworks ↓ basis

↓ MALINGERING > unconscious


No Assignments/ pretending to be sick
Homeworks (Conscious) PSYCHOSOMATIC
↓ ↓ > Real pains/ illness
You Think Absent > Real symptoms
“Teacher may > 4 major types
get angry” * Hypertension
* Migraine
Escape from Mama Care * Stress Ulcer
Teacher ↓ * Asthma
PRIMARY GAIN ↑ Attention
(Behavior ↓ anxiety) SECONDARY GAIN

SOMATOFORM DISORDERS

SOMATOFORM

Nervous System Illusion of structural defect


CONVERSION DISORDER BODY DYSMHORPIC DISORDER
La Belle Indifference
 emotional disattachment
from disability
Minor Discomfort
Interpreted as major illness
HYPOCHONDRIASIS
“Maliit na butas, pinalalaki”

Favorite Past Time: Doctor Hopping


Nursing Focus: Feelings
ReD Mapalo – BSN Psychiatric Nursing

PSYCHOSOMATIC DISORDERS

↑ Anxiety

SNS PNS

↑BP Vasoconstriction Bronchoconstriction
↓ ↓
Hypertension Cerebral Artery Left Gastric Artery Asthma
↓ ↓
Migraine Stress Ulcer

OBSESSIVE – COMPULSIVE

Belief/ thought → Feelings


Door Open → ↑ Anxiety
Burglar may go inside

Obsession → ↑ anxiety
(thought) ↓
Returns to house
(Action)
↓ Anxiety ← Compulsion

PHOBIA
• Irrational fears
• Etiology
o Knowledge
o Experience
• Immediate Nursing Intervention  remove the stimuli
• SYSTEMATIC DESENSITIZATION
o Gradual exposure to feared object

PHARMA MOMENTS
ANTIPSYCHOTIC AGENT
SSTTCMHP

Stelazine - sexy star Clozaril – closed reel


Serentil – serena Mellaril – maraming reel
Thorazine – babaeng Tora Haldol – hahaha
Trilafon - tri-band phone Prolixin – pero lick scene
ReD Mapalo – BSN Psychiatric Nursing

ALCOHOLISM

Etiology:
Intergenerational Transmission
• From one generation to another generation

Alcohol

Blackout  awake but unaware

Confabulation  inventing stories to ↑ self-esteem

Denial  “I am not an alcoholic”
Dependence  “I can’t live without it”

Enabling  significant other tolerates abusers
Another term CO – DEPENDENCY

TOLERANCE  ↑ Substance to achieve a previous effect

DETOXIFICATION
• Withdrawal with MD supervision
• Check Alcohol, Mouthwash, Elixer

void alcohol
version therapy
lcoholics Anonymous  self help group
ntabuse  DISULFIRAM  Never drink alcohol
↓ 12 hour interval/ 12 h last alcohol intake
B1 Vitamin Deficiency or else: nausea, vomiting and hypotension
↓ Wernicke’s Encephalopathy → motor
Complications
↓ Korsakoff’s Psychosis → memory
Delirium Tremens  24 – 72 h after last dose of alcohol
↓ untreated withdrawal syndrome
ormocation  bugs crawling under the skin
amily Therapy  mother, father, brother
ReD Mapalo – BSN Psychiatric Nursing

AUTISM
Autistic Savant  autistic with a special talent

Assess
• Appearance  flat affect, consistent movement
• Behavior  repetitive, ritualistic
• Communication  echolalia, incomprehensible
Nx Dx
• Impaired verbal communication
• Impaired social interaction
• Self mutilation
• Risk for injury
Planning/ Implementation
• Maslow’s hierarchy of needs
• Constancy, promote safety
Evaluation
• Expressive therapy  drawing, muscic etc
• Enhanced communication
• Improved social interaction
• Safety

ATTENTION DEFICIT HYPERACTIVE DISORDER


• Onset : 7 y.o. and below
• Duration : 6 months and above
• Settings : 2  House and school
• Id Dominant : Mom or RN will act as superego

ADHD → ↓ Glucose → Frontal Lobe → impaired judgement → ↑ ADHD S/Sx


→ Ritalin  Frontal Lobe → ↑ Judgement → ↓ ADHD S/Sx
(stimulant)
Assess
• Appearance  dirty
• Behavior  clumsy, impatient, easily distracted, hyperactive
• Communication  talkative, blurts out in class

Nx Dx
• Risk for injury
• Impaired social interaction
Planning/ Implementation
tructure  separate room for eating, playing, sleeping and etc
chedule  time for everything
et limits 
ReD Mapalo – BSN Psychiatric Nursing

afety
Evaluation
• Minimize Risk for Injury
• Improved social interaction
• Safety

Residual ADHD grows up not antisocial

Meds: Ritalin, dexedrin, pemoline, adderal


Best time to give: once a day: AFTER MEALS: prevent lost of appetite
Don’t give at bedtime  STIMULANT  causes insomnia
Give 6 hours prior bedtime if bid

EATING DISORDERS

18 mos. – 3 y.o. 6 y.o.  class valedictorian/ model student


↓ ↓
Toilet Training social inactive/ no BF
↓ ↓
Clean weighing
Obedient
Organized

Thought Feeling Behavior


I Am Fat  ↓ Self Esteem  Diet, Diet, Diet

Anorexia Nervosa Eating Disorders Bulimia


Diet, diet, diet Eating Pattern Eat, eat, vomit
<85% of expected body Weight Normal weight
3 mos. ammenorhea Menstruation Irregular menstruation
Karen Carpenter Dao Ming Xi
Da Ming Sugat/ suka
Vomiting
Dental caries
Wounded knuckles
Metabolic alkalosis
Metabolic acidosis

Vomiting

Fluid Volume Deficit  ARRHYTHMIA (fatal complication)

Diarrhea
ReD Mapalo – BSN Psychiatric Nursing

Interventions
• Restore fluid and electrolyte balance
• Collaborative regarding menu contract
• Target weight gain
• After meals: stay 30 mins – 1 hour

PHARMA MOMENT
LITHIUM

L evel 0.6 – 1.2 mEq/L ausea, vomiting, diarrhea


Increase urination Lithium Toxicity
Tremors, fine hand a+
Hydration 3 L/day
Increase
Kidney Uu  diarhea
Mouth, dry

ANTIPARKINSON
ANTICHOLINERGIC DOPAMINERGIC
ABC PLSE
Artane Parlodel
Akineton Larodopa
Benadryl Symmetyl
Cogentin Eldepryl

SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
o Too much stress in the reality will lead client to escape it and go to
the fantasy world
• Biological Theory
o Dopamine level is High
• The exact cause is unknown

ffect  appropriate, inappropriate, flat, blunt (incomplete emotion)


mbivalence  torn between 2 opposing forces
utism
ssociative Looseness
ReD Mapalo – BSN Psychiatric Nursing

Symptoms
Negative Positive
Hypoactive Hyperactive
Withdrawn Sociable
Apathy Flight of Ideas
Talkative

Assess : Content of Thought


Nx Dx : Disturbed thought process
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Improve thought process

Assess : Hallucination/ Illusions


Nx Dx : Disturbed sensory perception
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Improve sensory perception

Assess : Suspicious
Nx Dx : Risk for other directive behavior
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Eliminate/ minimize risk for other-directed violence

Assess : Suicidal
Nx Dx : Risk for self directive behavior
Planning/ Implementation:
• Present reality
• Provide safety
Evaluation : Eliminate/ minimize risk for self-directed violence

Flight or Looseness

I am going to the mall. I am going to the mall.

Where is the light? The mall is big.


Go here. Big is the tree.
ReD Mapalo – BSN Psychiatric Nursing

Mineral Water. The tree is tall.

Magical Thinking
• Believes to have a magical power
• I can turn you into a frog
Echolalia  I repeat what you say  Parrots
Echopraxia  I repeat what you do
Word Salad  words, no rhyme
Clang Association  words with rhyme : Dunk, plank, sunk
Neologism  creation of new words Plinking, hustash
• Clarification  done in case of neologism
Delusion:
Persecutory  NBI is out to get me/ someone will harm the client
Religious  I am Jesus Christ
Grandeur  I am the queen of the world.
Ideas of reference  Nurses are talking about me.
Concrete Association  pilosopo “what will you wear?” “clothes”
Thought Blocking 

Halucination Illusion
s
Stimulus Absent Present
Visual X √
Auditory X √
Tactile X √

In case of hallucinations do:

Hallucinations
Acknowledgment
• I know you the voices are real to you
Reality orientation
• But I don’t hear them
Diversion
• Lets go to the garden
ReD Mapalo – BSN Psychiatric Nursing

But if nothing in the preceeding intervention are seen


Assess what the voices are saying
SCHIZOPRENIA

Disorganized Catatonic Paranoid


• Ambivalence • Suspicious
• Sad but smiles • Waxy Flexibility • Tendency to be violent
o Inappropriate affect o Iniwan na posture, Mistrust→Scared→Withdrawn
ganun forever Nrsg. Int:
• No reaction
Develop trust
o Flat affect • No – favorite word • 1 to 1
• Flight of ideas • Negativism • short interaction
o HEBEPHRENIC • frequent visit
• Giggling • foods in sealed
• Positive and Negative
classified
container
S/Sx • meds wrapped
differentiated for violent pt.
• Doors open
Residual • Mixed classification • Near the door
• Can’t be classified • Don’t touch the pt.
• Eye contact
• No more positive •s/sx,
1st paranoid, then
disorganized then • 1 arms length away
just withdrawn
catatonic, etc etc • call reinforcement

Normally
Acetylcholine = ON Dopamine = OFF

Your always ON High Dopamine= Schizophrenia


With parkinsON
ReD Mapalo – BSN Psychiatric Nursing

Antipsychotics = makes Dopamine goes down

ON Extrapyramidal Side Effects


• AKATHISIA
o Restless, inability to sit
o Makati siya, ahh kati siya
• AKINESIA
o Muscle rigidity
o Ahh kiniss siya
• DYSTONIA
o 3 features
 TORTICOLLIS
• Wry neck
Anticholinergic  OCULOGYRIC CRISIS
• Drugs that will make the • Fixed stare
AcH down
 OPISTHOTUNOS
o Artane
• Arched back
o Akineton
• TARDIVE DYSKINESIA
o Benadryl
o Irreversible side effects of
o Cogentin
antipsychotics
o Lip smacking
Dopaminergic
o Tongue protruding
• Dopamine goes up
o Cheeks puffing
o Parlodel
o Larodopa • NEUROLEPTIC MALIGNANT
SYNDROME
o Symmetryl
o Hyperthermia among client
o Eldepryl
taking antipsychotic
o Hyperthermia with muscle
rigidity

Other Side Effects


• Photosensitivity
o Sunscreen
o Wide brimmed hat
• Agranulocytosis
o Report immediately Sore throat
 1st sign to appear
ReD Mapalo – BSN Psychiatric Nursing

PHARMAMOMENTS
ANTIDEPRESSANTS
ANTSAAVE PPZ

Asendin – ascending
Norpramin – sabaw ng knorr
Tofranil – Tofu
Sinequan – nood ng Sine Quan ang title
Anafranil – kina Ana Praning
Aventyl – kina Aven Til Midnight tayo
Vivactil – Bye Back till next week
Elavil – Eh love mo ba ako
Prozac – Pero saka na
Paxil - Taksil
Zoloft – mag Solo ka

BIPOLAR DISORDER – Mania more common


• Female
• 20 years old and above
• Stressful life
• Obese

↓Self Actualization TASK


↓Self Esteem Caregiver Role Strain
Impaired social interaction Safety
Safety
Risk for injury/ other directed violence
↓ Eating ↓ Sleep Hyperactive ↑ Sex
finger food Private room Anxiety

Lithium – 2 – 4 weeks before effect


ReD Mapalo – BSN Psychiatric Nursing

↓SE → ↑Compensation → ↑interfere ADLs, ↑ harm others


↑SE → ↓Compensation → ↓interfere ADLs, ↓ harm others

TASK → increases client’s self esteem

• Gross motor skills via sublimation


• Escorted walk outdoors
• Punching bag

No group games  compition will increae anxiety

3 or more signs confirms disorder

G randiose
F light of ideas
S leeplessness
P ressured speech
E xagerated SE
E xtraneous stimuli (easily distracted)
D istractibility

PERSONALITY DISORDERS

SCHIZOID
• I don’t want people
• Believes he can stand on his own
• Never had a best friend
• Avoid groups and social activities  no enjoyment
• Cares more about computers and pets

AVOIDANT
• I avoid people, I fear criticism
• Have talent but no confidence

ANTISOCIAL
• I break the law as motto
• As a child,: steal, lie, always get reprimanded
ReD Mapalo – BSN Psychiatric Nursing

• Adult – grand robbery, illegal activitist against the law, drug addiction,
drives fast, unsafe sex, thrill seeker
• Good talker, charmer, witty manipulator

BORDERLINE – my life is an emptyglass

Dependent
• I can’t live without you
• ↓ self esteem
• poor decision making skills

Histrionic
• excited, dramatic but manipulative
• center of attention

Narcissistic
• I love myself
• Insensitive, arrogant
• I am the best

Obsessive – Compulsive
• I am organized
• Perfectionist
• Provide time to do rituals

Paranoid
• Suspicious

Passive Aggressive
• Always say yes but resistance is hidden

Serotonin  
ReD Mapalo – BSN Psychiatric Nursing

MAO kills Serotonin

↑MAO  ↓ Serotonin  
↓MAO  ↑ Serotonin  

↓ Serotonin    ANTIDEPRESSANTS

1st Line of Drug Prescribed wo – 4 weeks


wo neurotransmitter
afest RI ONO
ELECTIVE

ide effects low CYCLIC MINE


EROTONIN

EUPTAKE NTIDEPRESSANT XIDASE

Higher incidence of Side effects


to 4 weeks Serotonin/ Epi affected
NHIBITOR NHIBITOR

PPZ ANTSAVE MNP

All neurotransmitter affected


Highest Side effects
Avoid tyramine rich food
↓ may lead to
HYPERTENSIVE CRISES

TYRAMINE RICH FOODS


vocado
ged Cheese
SSRI TCA MAOI

eer
Antidepressant

hocolate Anticholinergic Side Effects
(Syphathetic)

ermented Foods Male Erectile Dysfunction
ReD Mapalo – BSN Psychiatric Nursing

ickles
reserved Foods

oy Sauce
ReD Mapalo – BSN Psychiatric Nursing

Antidepressant  no effect  ECT

ELECROCONVULSIVE THERAPY
• Pre
o Informed consent
o NPO 6 – 8 hours prior
• Meds
o Atropine  dry mouth
o Barbituate  Sedative
o Succinylcholine  muscle relaxant, prevent seizure
• Post
o Side-lying – lateral
o S/E
 headache, dizziness,
 TEMPORARY MEMORY LOSS  distinct sign
• 70 – 110 volts
• 20 – 30 seconds
• ½ hour asleep post

PHARMAMOMENTS
SUBSTANCE ABUSE
Downers (ABONM INE)
Alcohol Morph
Barbituates Code NARCAN  antidote
Opiates Hero
Narcotics
Marijuana

Uppers (CHA)
Cocaine
Hallucinogen
Amphetamines

OVERDOSE
Alcohol Cocaine
HR
RR
ReD Mapalo – BSN Psychiatric Nursing

BP
Coma LOC Seizure

Bradycardia
Bradypnea
Pupil constriction
Moist mouth
Constipation
Hypotension
Coma
Asleep
Weight gain

EUPHORIA  Psych well being


NARCAN  Narcotic Antagonist  narcotic overdose

Tachycardia
Tachypnea
Pupil Dilation
DETOXIFICATION  withdrawal with MD Supervision
Dry mouth
METHADONE
Hypertension
Seizure
Awake
Weight Loss

Withdrawal  reverse of effect or opposite of overdose

DEPRESSION  ↓ Serotonin, if unresponsive to drugs, ECT


The Grief Process
• Denial  no! this can’t be true
• Anger  why me, why me, why now
• Bargaining  if something happens, then I’ll give something back
• Depression  I’m down 2 weeks or more s/sx  major depression
• Acceptance  client acts according to situation

↓Self Actualization
↓Self Esteem C TASK
withdrawn Stay
ReD Mapalo – BSN Psychiatric Nursing

Risk for self directed violence

Eating Sleep Hypoactive ↓Sex

Sensitivity to client needs


SUICIDE

Verbal Non Verbal


• I wont be a problem anymore • Take this ring, its yours (giving of
• This is my last day on earth valuable)
• I’ll soon be gone • Sudden change in mood

Who will commit Suicide?


Sex – Male (more successful)/ female (hesitant)
Age – 15 –24 y/o or above 45
Depression
Patient with previous attempt
ETOH – ethanol - alcoholics
Rirrational
Social support lacking
Organized plan  greater risk
No family
Sickness, terminal

SUICIDE TRIAD
• Loss of spouse
• Loss of job
• Aloneness

Is Patient is SUICIDAL; nurse should: DIE


• Direct question – “Are you going to commit suicide?”
• Irregular interval of visit to pt. room
• Early AM and period of endorsement – the time pt’s commit suicide

Best approach for suicidal pt. : Direct approach


Nursing Management: Close surveillance

Hospital area majority sucide will happens at:


• weekends 1- 3 am Sunday
• Weekend  less staff personnel
• Early AM  every one is asleep

Give simple task. Don’t give complex  may cause depression ex. Jigsaw
• Water plants
ReD Mapalo – BSN Psychiatric Nursing

• Wash the dishes except sharps

CHILD ABUSE (think B)


• Burns, bruise, bone fractures, BUNGI!
• Don’t bathe the child, don’t brush teet. Body of evidence will be lost
• Bantay Bata 163
LEVELS OF MENTAL RETARDATION
• Profound
o < 20
o thinks like an infants
o can’t be trained
ero – 2 y/o
o stay with the patient ensorimotor
• Severe evere
o 20 – 35
• Moderate Modera e
o 35 – 50 hirtyfive – 50
o can be train rainable
o mental age is 2 – 7 y/o wo – 7 y/o
o pre-operational stage
• Mild
o 50 – 70
o meantal age is 7 – 12
o educable
o can go to school
• Borderline
o 70 - 90
• Normal
o 90 – 100
JOHN PIAGET’S COGNITIVE THEORY
0–2 Sensorimotor Baby can sense, see, perceive and hear. Object
permanence
2–4 Preconceptual Language
4–7 Intuitive Unidimentional classification characteristic. Child can
fix toys according to size, color, height = one at a time
7 – 12 Conservation Multidimensional
Concrete
Association
12 ↑ Formal Good abstract thinking. Can interpret words
Operation

ALZHEIMER
NOMIA  don’t know name of objects
GNOSIA  problem with senses
PHASIA  can’t say it
ReD Mapalo – BSN Psychiatric Nursing

PRAXIA  can’t do it
Cocaine  Nasal Septum perforation
Marijuana  impaired Lung Structure
eroine withdrawal
ikab
atsing
u hu hu

CRITICAL REVIEW

TEST TAKING TECHNIQUES


1. Assess the answer, use circle
2. Initial priority TRUST

Air food, water

air
ABC ASSESS
3. Good Word/ Bad Word
4. S Technique
eek support
it
tay
upervised
ee = observed
eem = notice
assi t
feeling
5. 2 same answer/ 2 same mistake
6. Words to watch out for
Inappropriate
Most
Not included
Except
All but one
7. Umbrella

RELATIONSHIP

Preorientation Orientation Working Termination


ReD Mapalo – BSN Psychiatric Nursing

Self awareness Trust Discussion Evaluation


Setting Contract
Resistance

PRACTICE OF NURSING
Level of Prevention

1 2 3

Healthy Ill Relapse


Community Demog. Crisis Intervention AA

SELF HELP GROUPS


nique
niversality
r not alone

RESTATE  exact words


REFLECT  use other words
DEPRESSION

Endogenous Reactive
Internal external
Chemical

Barbituate withdrawal  LIBRIUM (Chloridiazepoxide)


TOFRANIL  Antidepressant/ Anticholinergic  pupil dilation  midriasis
Catharsis  Feelings
Free Association  Ideas

ATTITUDE THERAPIES
Active friendliness  ask permission
assive Friendliness
aranoid
anipulative
anic
atter of Fact
No Demand  Depressed
Kind Firmness  Anorexic

Crisis  4 – 6 weeks
Goal  Return the client to the pre-crisis level of functioning
ReD Mapalo – BSN Psychiatric Nursing

PSC
Perception  what do you think about it?
Coping  what will you do about it?
Support  who will be there for you?

Kulit kulit kulit kulit  Perseveration  stick to 1 topic


Ulit Ulit Ulit  Verbigeration
DISSOCIATION

Dissociative Amnesia  don’t know themselves


Fugue  Far
Dissociative Identity Disorder Multiple Personality D.O.