Professional Documents
Culture Documents
B. During emergency situations, if there is potential danger, the client can be forcibly
medicated
C. Right to refuse medication is upheld if client is involuntary and competent
IV.
TEMPORAL
OCCIPITAL
PARIETAL
III.
NORMAL FXN
execution of voluntary motor fxn
thought processes ex. Planning, abstract thought, decision making, critical
thinking
Intellectual insight, judgment
Expression emotion
Sensory and motor
Interprets sensory information
Right and left orientation
Hearing, connects with limbic system, allows connection of emotions,
responsible for language comprehension
vision
ANTIPSYCHOTIC MEDICATIONS:
A. Also called NEUROLEPTICS used for tx psychosis, behavioural problems in
children, schizophrenia etc. Controls symptoms like delusions, hallucinations and
thought disorders Two types:
i. CONVENTIONAL or TYPICAL - block dopamine, acetylcholine and
epinephrine Phenothiazines (first generation) and non-phenothiazines ex.
Haldol, Thorazine, Stelazine
a. Side effects: extrapyramidal symptoms, dry mouth, orthostatic
hypotension
ii. UNCONVENTIONAL or ATYPICAL blocks action of dopamine and serotonin.
Ex. Clozaril, Zyprexa, Risperdal, Abilify
1. Less side effects, few or no EPS
2. Work on negative and positive symptoms of schizophrenia
ANTIDEPRESSANTS:
V.
VI.
VII.
VIII.
iv. Culture
v. Developmental level
vi. Health status
c. Define DISTRESS: Subjective response to stimuli that are threatening or perceived
as threatening. Includes fatigue, pain, fear, or acute/chronic dx
d. Define EUTRESS: Stress response (nonspecific) assoc. with desirable events ex.
Wedding, job promotion, birth of child.
e. Define PSYCHOLOGIC STRESS: All processes of the person that require cognitive
appraisal of the event before a response
f. What is GIS? Activated automatically as response to survival; POSSOM
RESPONSE.
Results overstimulation of PNS, activated by life threatening situations
g. Stages of GAS:
ALARM REACTION
fight or flight
RESISTENCE
your body attempts to adapt to the stressor
I.
Holistic/alternative care beliefs strengthen individuals inner resistance to dx, healing from
within, or enhance bodys innate healing powers
I.
ii.
iii.
iv.
v.
vi.
vii.
Mind-body interventions
Pharmacologic and biologic based therapies
Herbal medicines
Diet, nutrition, supplements and lifestyle changes
Manipulative and body-based methods
Energy therapies<<Box 25-1 p. 573>>
ANXIETY DISORDERS:
I.
X.
DEFENSE MECHANISMS:
EGO DEFENSE
MECHANISMS
Conversion
Denial
Dissociation
Identification
Projection
Rationalization
Reaction-formation
Suppression
Symbolization
DEFINITION
Unconscious expression of a mental conflict as a
physical symptom to relieve anxiety
Unconscious refusal to face reality.
EXAMPLE
Woman experiences blindness after
witnessing a robbery.
Woman denies that her marriage is
failing
Separation and detachment of a strong, emotionallyMale victim of car-jacking exhibits
charged conflict from one's consciousness
symptoms of traumatic amnesia the
next day.
Unconscious attempt to identify with personality Teenager dresses, walks, and talks
traits or actions of another to preserve one's self- like his favourite basketball player.
esteem
Unconscious assignment of unacceptable thoughts Man who was late for work blames
or characteristics of self to others
wife for not setting the alarm clock.
Justification of one's ideas, actions, or feelings to Student states he didn't make the
maintain self-respect, prevent guilt feelings, or
golf team because he was sick.
obtain social approval
Demonstration of the opposite behaviour, attitude, Man who dislikes his mother-in-law
or feeling of what one would normally show in a is very polite and courteous toward
given situation
her.
Voluntary rejection of unacceptable thoughts or
Student who failed a test states she
feelings from conscious awareness
isn't ready to talk about her grade.
Use of external objects to become an outward
An engagement ring symbolizes
representation of an internal idea, attitude, or
love and a commitment to another
feeling
person.
XII.
Nursing Interventions
Reducing Symptoms of Anxiety:
1. Maintain safety for the client and the environment
2. Assess own level of anxiety
3. Recognize the clients use of relief behaviours
4. Inform client limiting caffeine, nicotine, and other CNS stimulants
5. Teach client to distinguish anxiety that is connected to identifiable sources
6. Instruct client to practice stress reduction techniques
7. Help client build on coping methods
8. Activate the client to identify support persons
9. Assist client gain control of overwhelming feelings and impulses
10.
Help client structure quiet environment
11.
Assess the presence and degree of depression and suicide ideation
12.Administer anxiolytics
Types of ANXIETY:
i. Panic Anxiety: Recurrent unexpected anxiety attacks with thoughts of
dread, impending doom, death and fear of being trapped.
ii. Phobias: Client experiences panic attack in response to particular situations
Types: Agoraphobia fear of being alone in public places, without escape,
Social Phobia - fear of social or performance situations. Eg. Speaking, eating
in public
iii. Posttraumatic Stress Disorder (PTSD): Describes and individuals reaction
to traumatic events eg. Combat, sexual abuse, physical abuse, disasters, and
grieving
a. Efforts to avoid thoughts, feeling, or conversation about the
trauma
b. Efforts to avoid persons or places that evoke memories of
trauma
c. Inability to remember important aspects of trauma
d. Diminished interest in significant activities
e. Restricted range of effect
f. A sense of impending doom.
1. Must have two of the following present:
a. Sleep disturbances, irritability or angry outbursts, difficulty
concentrating, Hypervigilance and exaggerated startle response.
iv. Acute Stress Disorder: Symptoms occur during or immediately after
trauma
a. Develops three or more dissociative symptoms:
i. Subjective sense of numbing or detachment
ii. Absence of emotional responsiveness
XIII.
XIV.
XVI.
Anti-anxiety
A. Benzodiazapines
a. How it works: by enhancing the inhibitory action of GABA thus causing
generalized CNS depression
b. Therapeutic effect: relief of anxiety
c. Interactions: DO not use with MAOIs, additive effect when taken with
alcohol, antihistamines
i. Diazapam (Valium)- 2-10mg 2-4xs /dy
ii. Alprozolam (Xanax)- .25-.5mg 3xs/dy
d. SE: dizziness, drowsiness lethargy, mouth dryness
o Treat overdose of benzos by:
a. Administering an antiemetic in conscious pt. and
gastric lavage in unconscious patient
B. Non-Benzodiazapine
a.
How it works: decrease reputake of dopamine and increase serotonin in
the CNS
b.
Therapeutic effect: decrease depression
c.
Interactions: grapefruit juice can cause toxicity, use with MAOI may
cause HTN
1. Buspirone HCL (BusPAR) -5mg 2-3x/dy
d.
SE: dry mouth, nausea, vomiting, agitation, headache, blurred vision,
constipation
Antidepressant: 4 groups:
B. Tricyclics
a.
How it works: blocks reputake of norepinephrine and serotonin
b.
Interactions: do not use with MAOI and avoid concurrent use with
SSRIs
1. Amitriptyline (Elavil)-25mg 3xs up to 200mg/dy
2. Imipramin (Tofranil)-25-50mg 3-4 up to 300mg/dy
c.
SE: orthostatic hypotension, sedation, suicidal thoughts, blurred vision,
dry mouth
C. SRRIs:
a.
How it works: blocks reputake of serotonin
b.
Interactions: St. Johns wart causes central serotonin syndrome
1. Fluoxetine (Prozac)
2. Sertraline (Zoloft)
3. Paraxentine (Paxil)
c.
SE: nervousness, sexual dysfunction, headache, insomnia
D. MAOI:
a.
How it works: inhibiting monoamine oxidase causing a rise in
neurotransmitters
b.
tyramines
E. Atypical antidepressant:
a.
How it works: effects serotonin, dopamine, and norepinephrine
b.
Interactions: do not use w/ MAOI, should not be taken within 14dys of
MAOI use
1. BuPropion (Wellbutrint)
2. Venlafaxine (Effecor)
3. Doloxetine (Cymbalta)
c.
SE: headache, dry mouth, seizures, appetite suppression
F. Mood Stabilizers:
a.
How it works: alters electrical conductivity of cell
b.
Interactions: make sure have adequate Na intake for Lithium
1. Lithium
c.
Monitor: therapeutic levels
G. Anti-epileptics:
a.
How it works: increases inhibitory action of GABA
b.
Interactions: increased CNS depression with consumption of alcohol
1. Divalproex sodium (Depakote)
2. Carbamazepine (Tegretol)
c.
SE: agranulocytosisso check WBC, sedation
d.
Monitor: I/O
H. Beta-Blockers: Anti-anginals
a.
How it works: blocks beta 1 receptors thus decreasing BP and HR
b.
SHOULD NOT 50mg daily, Ccr=15-35mL/min
1. Atenolol (tenormin)- 50-200mg/dy
2. Propranolol (Inderal)- 40-100mg/dy
c.
SE: fatigue, weakness, bradycardia, CHF, pulmonary edema
d.
Monitor: vitals, I/O, daily weight, assess CHF. Take apical pulse before
admin, if ,50bpm do not administer
I. Antihistamines:
a.
How it works: blocks effects histamine @ H1 receptor, creating CNS
depression
b.
Interactions: additive CNS depression with alcohol and antidepressants
1. Diphenhydramin (Benadryl)
2. Hydroxyzine HCL (Atarax)
3. Hydroxyzine Pamoate (Vistaril)
c.
SE: dry eyes, constipation, dry mouth, and blurred vision, can decrease
anxiety so asses mood, mental status and behaviour.
J. Herbal Therapy:
a.
Kava-Kava: used for anxiety
1. How it works: alters limbic system modulation of emotional
processes
2. SE: dizziness, headache, drowsiness, extrapyramidal effects,
HEPATIC TOXICITY. When taken with Benzos additive CNS
depression
b.
Valerian: for anxiety
1. How it works: may increase concentrations of GABA
2. SE: drowsiness, headache
SLEEP DISORDERS:
I.
II.
Types:
a. Dyssomnias- abnormalities in amt, quality or timing of sleep
i. Insomnia- most common, difficulty initiating and maintaining sleep
ii. Hypersomniaiii. Narcolepsy- excessive daytime sleepiness, sudden onset sleep attacks. Can
have cataplexy (sudden loss muscle tone and involuntary muscle movement)
or sleep paralysis
iv. Breathing-related sleep disorder-e.g sleep apnea
v. Circadian rhythm sleep disorder- e.g jet lag, shift work type and delayed
sleep phase
b. Parasomnias- abnormal behaviour during sleep
i. Nightmare disorder- occurs during REM
ii. Sleep terror- occurs during non-REM
iii. Sleepwalking- typically ages 4-8, occurs during non-REM
NSG PROCESS:
a. Assessment: subjective and objective data sources and sleep hx
b. NSG DX:
i. Sleep deprivation
ii. Insomnia
iii. Ineffective bx
iv. Anxiety
v. Fatigue
vi. Ineffective coping
c. Outcome I.D
i. I.d primary causes sleep alteration
ii. Communicate interventions and implement them
iii. Demonstrate reduction sleep disturbance
iv. Participate discharge planning
d. Planning: participation multidisciplinary team
e. Implementation/Interventions:
i. Monitor sleep patter and id risks
ii. Have client keep sleep diary
iii. Develop hygiene plane
iv. Teach symptom management
v. Make environment quiet
vi. Help client i.d stressors
vii. Promote development coping skills
viii. i.d clients support system
ix. promote compliance medications
x. teach limit substances cause sleep disturbances
xi. educate about circadian rhythms
xii. refer sleep specialist
GRIEF:
I.
II.
Types:
a. Anticipatory grief- pre-mourning- grief assoc. With anticipation predicted death or
developing loss
b. Acute Grief- painful exper. After a loss
c. Dysfunctional grief- ex. PTSD. Lasts longer than other types and has greater
disability ex. Traumatic loss, complicated grief, chronic grief
d. Chronic sorrow- response to ongoing loss ex. Parents w/ disabled children.
Interventions:
a. Assess risk kill or harm self and others
b. Promote ns-relationship
c. Facilitate expression feelings related to loss
d. Help client understand relationship between self and lost person
e. Facilitate full expression grief
f. Promote interactions with others
COGNITIVE DISORDERS:
I.
Types:
1. Dementia- It is the gradual and progressive deterioration of intellectual
functioning.
2. Delirium- an acute state of confusion, disorientation to person and place, rapid
onset and short duration
SYMPTOMS
DEMENTIA
Judgment
Impaired
Mood
Fluctuates
Apathetic
Memory
Impaired
Cognition
Disordered reasoning
Orientation
Disoriented
Thoughts
Confused
Suspicious
Paranoid
Perception
No change
Consciousness
Speech
Behavior
Normal
Sparse
Repetitive
Agitation
Wanders
Insomnia
DELIRIUM
May be impaired
Fluctuates (fluctuating consciousness)
Reduced ability sustain attention
Impaired
Disordered reasoning
Disorientation
Confused
Suspicious
Incoherent
Misinterpretations, Visual hallucinations and
delusions
Clouded
Sparse or fluent
Incoherent
Agitation
May wander
Insomnia
Mental status
Poor testing
Progressively worsens
Inappropriate answers
Activities of daily Deteriorate as dementia progresses
living
PROGNOSIS
No return to pre-morbid function, chronic,
depends on cause as is generally insidious
in onset
II.
III.
IV.
V.
Poor testing
Improves when medically stable
Improves with treatment
Usually remain stable unless medically unstable
Return to pre-morbid function if cause is
correctable and is corrected in time. Generally
acute onset
STAGES OF ALZHEIMERS:
1. Stage1: Mild (2-4yrs)
i. Recent memory loss, neologisms
ii. Cognitive loss in:
1. Communicating
2. Calculating
3. Recognition
iii. Anxiety and confusion
iv. Mild behavioural problems
2. Stage2: Moderate
i. Stage1 symptoms increase
ii. Behavioural probs increase and include:
1. Catastrophic rxs
2. Sundowning- behavioural disturbance in the morning or evening
3. Preservation-excessive repetition
4. Aimless pacing
5. Wandering
6. Incontinence
7. Hypertonia
3. Stage3: Severe:
i. Stage2 symptoms increase
ii. Total incontinence
iii. Choking
iv. Emaciation
v. Total care needed
vi. Progressive gait disturbance leading to non-ambulatory status
NSG DX:
1. Risk aspiration
2. Imbalanced body temp
3. Infection
4. Injury
5. Physical mobility
6. Anxiety
7. Impaired verbal communication
8. Chronic confusion
9. Grieving
OUTCOME IDENTIFICATION:
1. Maintain health and safety with caregiver help
2. Reach and maintain highest fxn level possible within capacity
3. Maintain best possible physical status
4. Participate therapeutic activity program
5. Participate planning for care
INTERVENTION:
1. Inform all caregivers nsg plan
CRISIS INTERVENTIONS/RAPE-TRAUMA:
I.
II.
III.
Types crisis:
a. External (situational)- external stressor which is apparent to another observer.
Centres on real events threaten health, shelter, loss loved one.
b. Internal (subjective) crisis- internal stressor threatens well being ex. Aging, loss
independence
c. Phase-of-life (maturational) crisisd. Disaster (adventitious crisis)- man-made and natural disasters ex. Terrorism,
tornados
5 steps Crisis interventions:
a. Assess the individual and the problem:
i. Assess the individual and the problem- in the field and in office (physical
safety principles, medical hx, introduction and boundaries, chief complaint,
hx present illness, family/social hx, mental status, past medical & psychiatric
hx, drug & alcohol hx, cultural and spiritual issues, strengths and support,
coping skills, GAF etc
b. Plan therapeutic intervention:
i. Express caring and consolation
ii. Assess reality of situation
iii. Develop and begin to utilize an immediate plan for intervention
iv. Coordinate w/ other agencies
v. Anticipate future needs related to crisis
c. Intervention
d. Resolution of the crisis
e. Anticipatory planning
10 stages acute traumatic stress
i. Assess for danger/safety
ii. Consider mechanism of injury
iii. Address medical needs
iv. Evaluate level of responsiveness
v. Observe and identify who exposed
vi. Ground the individual
vii. Normalize the response
viii. Prepare for the future
DOMESTIC VIOLENCE:
I.
II.
III.
IV.
V.
d. Intergenerational transmission
e. Legal marriage or pregnancy
f. An attempt to leave the relationship
Interview questions: ask in private only: ask SAFE Questions
a. Have you ever been emotionally or physically hurt by your partner or someone
important to you?
b. Within the last year, have you been hit, slapped, kicked, or physically hurt by
someone? By whom? How many times?
c. Within the last year, has anyone forced you to have sexual activity? Who? How
many times?
d. Are you afraid of your partner or anyone else?
Rape-trauma syndrome:
a. Acute Phase:
i. Occurs immediately after the assault
ii. May lst for a few weeks
iii. Lifestyle disorganized
iv. Somatic symptoms are common
v. Reaction in cognitive, affective and behavioural functions
b. Long-term reorganization phase:
i. Intrusive thoughts
ii. Increased motor activity
iii. Increased emotional lability
iv. Fears and phobias
Violence Interventions:
a. Follow your institutions protocol for sexual assault
b. Do not leave the person alone
c. Maintain a non-judgemental attitude
d. Ensure confidentiality
e. Encourage the person to talk, listen empathetically
f. Emphasize that the person did the right thing to save his/her life
g. Keep accurate records:
i. Physical trauma
ii. Ask permission to take photos
iii. Take verbatim statements as to clients reaction to rape
iv. Document emotional status
h. Explain everything that you are going to do before hand
i. Obtain medicolegal specimens with clients written permission
j. Alert client as to what he/she may experience during the long-term reorganization
phase
k. Arrange for support follow-up, for ex.:
i. Support groups
ii. Group therapy
iii. Individual therapy
iv. Crisis counselling
Long-term effects rape:
a. Depression
b. Suicide
c. Anxiety
d. Fear
e. Difficulties with daily functioning
f. Low self-esteem
g. Sexual dysfunction
h. Somatic complaints
MOOD DISORDERS:
A. Leading cause of disease burden
i. Types:
1. Major depression
2. Dysrhythmic disorder- chronic low-level depression
3. Bipolar disorder-pattern of manic, hypomania and depressed episodes
4. Cyclothymic disorders- chronic mood disturbance
b. Nsg process:
i. Assessment- mood, affect and temperament
1. Mental status criteria
a. Mood
b. Affect
c. Temperament
d. Emotion
e. Emotional reactivity
f. Emotional regulation
g. Range of affect
ii. Nsg DX:
1. Activity intolerance
2. Anxiety
3. Constipation etc. Box 11-5
iii. Interventions:
1. Conduct a suicide assessment
2. Maintain a safe environ
3. Establish a rapport and demonstrate respect
4. Assist client verbalize feelings
5. Identify clients social support system and encourage client
6. Praise the client for attempt
7. Promote self-care
8. Assist s at alternate activities and interactions with others
9. Gently refuse to be part of secrecy agreements with the client
10.Monitor and implement strategies to ensure adequate fluid intake and
output, food intake and weight
11.Refer p.235
c. Pharmacology:
i. SSRIs- citalopram (celexa), fluoxetine (Prozac), paroxetine (paxil), sertraline
(Zoloft), venlafaxine (Effexor)
ii. Atypical antidepressants
SUICIDE:
I.
II.
Assessment:
a. The observable behaviour of client e.g increased irritation, increase in energy
b. Hx from the client- gathering self-defeating coping patterns
c. Information from friends and familyd. Hx suicidal gestures or attempts
e. MSE-disturbance concentration, memory, orientation
f. Physical exam-signs substance abuse, irritability, euphoria, slurred speech
g. Nurses intuition
Interventions:
a. Provide safety and prevent violence: ex. Safe environment, remove all weapons
b. Assist with improvement of coping skills
c. Enhance family and support system
EATING DISORDERS:
Sign/Symptoms:
1. Anorexia:
a. Self-starvation
b. Rituals/compulsive behaviours
regarding food
c. Self-induced vomiting, laxatives,
diuretics, or excessive exercise
d. Weight loss 15% below ideal
e. Amenorrhea
f. Slow pulse
g. Cachexia-muscle wasting
h. Lanugo
i. Constipation
j. Cold sensitivity
k. Denial seriousness
l. Irrational fear gaining weight
m. Preoccupation food
n. Delayed psychosexual
development
Bulimia Nervosa:
1. Recurrent episodes binge eating
2. Purging behaviours: self-induced
vomiting, use laxatives, diuretics, diet
pills, ipecac, enemas, exercise, periods
fasting
3. Purging
4. Hypokalemia
5. Alkalosis
6. Dehydration
7. Idiopathic edema
8. Hypotension
9. Cardiac arrhythmias
10.
Cardiomyopathy
11.
Hypogycemia
12.
Constipation
13.
Esophageal reflux
14.
Mallory-weiss syndrome
15.
16.
17.
Outcomes anorexia:
1. participate therapeutic contact staff
2. consume adequate calories
3. achieve normal weight
4. maintain normal fluid and electrolyte
balance
5. resume normal menstrual cycle
6. demonstrate improvement body image
7. demonstrate effective coping skills
8. manage family conflicts
III.
IV.
Outcomes Bulimia:
1. participate therapeutic contact staff
2. maintain normal fluid and electrolyte
levels
3. consume adequate calories
4. cease binge/purge episodes
5. demonstrate effective coping skills
6. Demonstrate age-approp. Boundaries
7. Verbalize improved body awareness
8. Normal perception of body weight and
shape
Complications:
a. Electrolyte imbalance
b. Cardiac arrhythmias
c. Cardiac arrest
d. Diabetes mellitus
e. hypertension
Interventions:
a. Provide safety
b. Assess suicide
c. Engage therapeutic relationship
d. Restore min. Body weight and nutritional balance
e. Create structured, supportive environment, with limits
f. Coordinate with dietician
g. Encourage client express thought, feelings, concerns body image
h. Cont help client recall positive eating exper.
i. Assume caring matter of fact approach
j. P.400 for rest
SCHIZOPHRENIA:
I.
II.
Neurobiologic brain disorder, results impaired thoughts, perceptions, cog. Fxn, mood and
motivation
Signs/symptoms and course:
a. Premorbid: contributing factors
b. Prodromal: one mth to 1yr before diagnosis:
i. Mood-Anxiety, irritability, dysphoria
ii. Cognitive- distractibility, concentration difficulties, disorganized think
iii. Obsessive behaviours and rituals
iv. Sleep disturbance
v. Weak positive symptoms
c. Psychotic phase:
i. Acute phase- pos. And neg. symptoms, unable to perform self-care
IV.
V.
VI.
VII.
VIII.
Types:
a. Paranoid
b. Disorganized
c. Catatonic
d. Residual
e. Undifferentiated
Positive symptoms:
a. Alterations perceiving: hallucinations (false perceptions), delusions (false
beliefs), loss ego boundaries
b. Alterations thinking: concrete thinking, loose associations, flight of ideas, ideas of
reference, ideas persecution, ideas grandiosity, ideas being controlled, though
broadcasting, thought insertion, thought withdrawal
c. Alterations speech: neologisms, echolalia, clang assoc, word salad,
circumstantiality, tangential (superficial speech)
d. Alterations behaviour: bizarre behaviour, agitation, waxy flexibility, stupor,
negativity, echopraxia, symbolism
Negative symptoms:
a. Cognitive: Poverty of speech (alogia), Poverty of thought. Thought blocking,
Problems with attention, memory, Impaired decision making/judgement, problem
solving, Disorganized think
b. Behavioural: anhedonia, anergia, avolition, depression, hopelessness, social
isolation, decreased spontaneity, anxiety, irritability, drug abuse. Medical
comorbidity
NSG DX: bassed on assessment pos and neg symptoms
NSG interventions:
a. for the agitated:
i. safety
ii. reduce stimulation
iii. brief, concise statements
iv. det. stressors
v. redirect
vi. prevent agitation
b. for those in acute crisis: crisis intervention, stabilization, safety and limit setting
c. for those in maintenance and stable phase: give small amts infor, i.d signs of
relapse
Psychopharmacology:
a. Typical antipsychotics, which block dopamine, phenothiazines: treat positive
symptoms
i. Ex. Thorazine, Mellaril, Navane, Stelazine, Haldol and Prolixin
ii. SE: anticholinergic- dry eyes, mouth, constipation, sedation, orthostatic
hypotension, lowered seizure thresholds, jaundice, ESP (use antiparkinson
drugs...cogentin, artane), dystonica, neuroleptic malignant syndrome, tardive
dyskineasia
b. Atypical antipsychotics- block serotonin and norepinephrine. Work on pos and neg
symptoms. Produce metabolic syndromes (so check weights)
SUBSTANCE ABUSE:
Support groups: AA, NA, CA Al-Anon, Al-a-teen, Adult children of alcoholics, inpatient,
outpatient, hospitalization, intensive outpatient, halfway houses.
IX.
Signs/symptoms:
CNS Depressants:
Decreased inhibitions
Impaired judgement,
attention, memory
CNS stimulants:
Euphoria
Feelings impending
doom
Hallucinogens:
Panic attack/anxiety
Psychosis
Delirium
X.
Drowsiness
Slurred speech
Unsteady gate
Hypotension
Bradycardia
Pinpoint pupils
Weak rapid pulse
Depressed respirations
Can lead com/death
XII.
Agitation or
combativeness
Hallucinations/paranoia
Seizures
Cardiovascular events,
palpitations,
tachycardia,
Hypertension, irregular
rhythms, can lead to
infarct
Altered moods
flashbacks
XI.
Tx acute overdose
alcohol:
ABCs
Thiamine
Nutritional
glucose
Clonidine
(catapress) for
GI symptoms
Benzos
Long-term tx:
Antabuse
Naltrexone
Zofran and
topamax
decrease
cravings as well
Tx CNS intoxication:
Treat cardiac
symptoms
Benzos for
agitation and
seizures
Antipsychotics for
hallucinations
e.
f.
g.
h.
i.
j.
PERSONALITY DISORDERS:
I.
II.
III.
IV.
V.
1.
2.
3.
4.
5.
6.
7.
8.
9.
In General PD:
a. Higher death rates
b. Higher rates suicide attempts
c. Increased rates separation, divorce and involvement legal proceedings
d. Increased rate criminal behaviour, alcoholism, and drug abuse
4 common characteristics:
a. Inflexibility, maladaptive response stress
b. Disability in working and loving
c. Ability cause interpersonal conflict in others
d. Capacity to irritate others
4 maladaptive patterns:
a. Faulty perceptions
b. Emotional lability
c. Poor impulse control
d. Difficult interpersonal functioning
Characteristics:
a. Repetitive maladaptive behaviour
b. Behaviour not recognized as abnormal so dont seek treatment
c. Ability achieve developmental tasks are limited
d. Seek help only in crisis
e. Starts in adolescence
f. Maladaptive behaviour used fulfill need and bring satisfaction
General interventions:
Asses suicide ideation
Implement suicide precautionsevery 15min
Establish contract for safety
Encourage attendance all group sessions
Assess for escalating anger or rage
Contract not to harm staff or others
Teach manage anger and impulsive feelings and behaviours
Discuss angry and aggressive feelings
Assess client for evidence self-mutilation.
s/s antisocial
personality:
1. Hx antisocial
behaviour
2. Deceitful, liar
3. Aggressive
towards
others
4. Lack remorse
hurting others
5. Presents as
charming,
Interventions:
1. Prevent/decrease
effects
manipulation
2. Guard against being
manipulated
3. Set clear and
realistic limits
behaviour
4. All limits must be
adhered to by all
staff
s/s borderline
personality;
1. Relationship with
others intense
and aunstable
2. Poor impulse
control
3. Recurrent
suidical/self
mutilation
4. Attention
seeking/manipul
Interventions:
1. Set limits
2. Provide
boundaries
and limits
that are clear
and
consistent
3. Consistent
staff: asses
for suicide
VI.
self-assured
5. Carefully document
and adept
objective physical
6. Interacts
signs of
others
manipulation/
through
aggression
manipulation,
aggressivene
ss and
exploitation
7. Lack empathy
or concern
Etiology/factors:
a. Lower socioeconomic status
b. Substance abuse
c. Genetics
ative
5. No boundaries
6. Outbursts odd
anger and
hostility
7. Intense and
primitive rage
8. Rapid
idealization and
devaluation
and self
mutilating
behaviour