Think Link Psychiatric Nursing Anxiety related disorders

issociati!e identity disorder Generali"ed anxiety disorder #$sessi!e co%&ulsi!e disorder Panic isorder Pho$ic disorder Post trau%atic disorder So%ato'or% disorder

PSYCHIATRIC NURSING Post 4 Trau%atic Stress isorder

Sy%&to%s e!elo&s a'ter ex&osure to a clearly identi'ia$le threat Acute PTS 5 #ccurs /ithin 6 %onths elayed PTS 5 #ccurs 6 %onths or %ore 7lunted e%otions 8eelings o' detach%ent 8lash$ack )oral Guilt Nu%$ing o' res&onsi!eness Sur!i!or Guilt e&ression Sel' destructi!e $eha!iours Suicidal atte%&ts Su$stance a$use PTS is co%%on /ho are sur!i!or o' co%$at. natural disasters . sexual assault or catastro&hic e!ents

Panic isorder
Sudden attacks o' intense 'ear o' disco%'ort that &eaks /ithin <= 4 <> %inutes Assess%ent( not $eing a$le to $reathe 8eeling o' heart attack Going cra"y 9hat3s the &ro$le%? Agora&ho$ia Agora&ho$ia 8ear o' o&en s&ace Restrict acti!ities outside the sa'ety o' their ho%e Panic attack can $e $rought on $y ca''eine. car$on dioxide and sodiu% lactate 8actors a''ect &anic disorder Genetic -n!iron%ental 8actors 7en"odia"e&ine rece&tor sites alteration

Cogniti!e $eha!ioral thera&y and desensiti"ation

PTS Pho$ic disorders I%&ortant nursing inter!entions( Ad%inistering antide&ressant %edication Hel&ing the client to $eco%e %ore a/are o' situations that increase anxiety Hel&ing the client to recogni"e the o!eruse o' certain de'ense %echanis%s Teaching cogniti!e $eha!ioral %ethods 'or reducing anxiety Personality isorder Reality $ased disorders They see nothing /rong /ith their $eha!ior It re'er to &er!asi!e %alada&ti!e &atterns o' $eha!ior that are e!ident in the &erce&tions. co%%unication. and thinking o' an indi!idual

Assess%ent( Le!el o' anxiety )IL *You see% anxious+, -nhanced learning. sit restlessly. /idened &erce&tual 'ield 0 Gi!e 0 Anti0anxiety drugs0!aliu% Patient is &acing. selecti!e inattention+ 1 *I don3t kno/ /hat to say or do+, Hard to %ake decisions+ Suicidal+ Highest le!el o' anxiety+ Priority( sa'ety+ Stay /ith &atient+ on3t touch &atient+

)# -RATS-2-RPANIC

9arning(

Clients /ith PTS /ho use cocaine or a%&heta%ines are %ore !ulnera$le to &aranoia and &sychosis than those /ho do not use sti%ulants

issociati!e Identity isorder : I ; : %ulti&le &ersonality disorder ;

T/o or %ore identity. alters &ersonalities that control indi!idual $eha!iour issociation 4 act as a de'ense against an o!er/hel%ing sense o' anxiety that is $oth &ain'ul and e%otionally trau%atic+ Trau%a( &hysical . e%otional or sexual a$use

Pho$ic isorders
-x&ressed as intense . irrational 'ears o' so%e o$@ect. situation . or acti!ity The &atient ex&erience anxiety /hen he co%es contact /ith the situation or 'eared o$@ect

Three cluster o' &ersonality disorder

Cluster A 4 Include #dd. eccentric 7eha!ior Paranoid Schi"oid Schi"oty&al Cluster 7 4 ra%atic . erratic. e%otional $eha!ior Histrionic Narcissistic Antisocial 7orderline

Generali"ed Anxiety isorder

Co%%on 'or% o' anxiety disorder e&ression So%ati"ation Pho$ias Genetics and alteration in neurotrans%itters Serotonin Nore&ine&hrine Ga%%a 4 A%ino$utyric acid It /orries excessi!ely o!er e!erything. a''ects e!ery as&ect o' li'e GA /ay o' relie!ing anxiety Retreating 'ro% anxiety 4 situation Sel' %edication /ith drugs or alcohol

Ti%e tra!el Sa%e &erson /ith di''erent &ersonality /ith each other+ Ha!ing its o/n na%e 9ays o' $eha!ing )e%ories -%otional characteristics Social relationshi& Unex&ected tra!el o' &ersonality+ Hehehe+ + 8or so%e it is nor%al

9hat3s the &ro$le%? Intense 'ear and restlessness Three %a@or categories o' &ho$ic disorders Agora&ho$ia Social Pho$ia S&eci'ic Pho$ia Thera&y Cogniti!e $eha!ior thera&y esensiti"ation

Cluster C 4 anxious and 'ear'ul $eha!ior A!oidant e&endent #$sessi!e 4 Co%&ulsi!e

#$sessi!e 4 Co%&ulsi!e isorder

Recurrent &ersistent thoughts. ideas. or i%&ulses Re&etiti!e rituals in res&onse to the o$session It is their de'ense to a!oid o!er/hel%ing anxiety

Cluster A Paranoid Personality isorder

Rigid Sus&icious Hy&ersensiti!e $eha!ior They s&end there great deal o' ti%e and energy !alidating their sus&icions o not ha!e delusions or hallucination

So%ato'or% disorder
A&&earance o' &hysical sy%&to%s 'or /hich there is no a&&arent organic or &hysiologic cause+ Seek %edical attention e!en though he has $een told that there is no e!idence o' &hysical illness( Con!ersion isorder Hy&ochondriasis Pain isorder So%ati"ation isorder

9hat3s the &ro$le%? Inter'eres /ith nor%al acti!ity and relationshi&s #thers !ie/ this as rigid. controlling and lacking s&ontaneity So%e e!ident sho/s( Genetic trans%issions or alterations in serotonin regulation

Antide&ressant %edication(
Panic disorder #$sessi!e 4 co%&ulsi!e

9hat3s the &ro$le%? -xtre%e stress ( transient &sychotic 'eatures Uncontrolla$le Anger to/ard others 9hat3s your nursing goal? Sa'ety o' $oth health &ersonnel and other &atient

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Think Link

PSYCHIATRIC NURSING Antisocial Personality disorder

Pattern o' disregard 'or the rights o' others 8ailure to learn 'ro% the &ast %istakes La/ !iolation at early age o' <> Hel&less

Schizoid Personality Disorder

Shy Aloo' 9ithdra/n 7eha!ior Her%it 4 &re'ers solitary acti!ities This &atient are reality oriented

e&endent Personality isorder

-xtre%e need to $e taken care o' $y so%eone else 8ear o' se&aration In'erior Inco%&etent In!ol!ed in a$usi!e relationshi&

Psychotic isorders
Alterations in &erce&tions in reality Hallucinations elusions i''iculty #rgani"ing taughts Schi"o&hrenia 7i&olar disorder e%entia rug intoxication 9ithdra/al

9hat3s the &ro$le%? The &atient o'ten 'antasi"es and daydrea% 9hatAs your nursing goal? Patient3s Health : nutrition ;

Schi"oty&al Personality isorder

8ound %ore o'ten in relati!es o' those /ith schi"o&hrenia Shy Aloo' 9ithdra/n 7i"aare /ay o' thinking

-arly childhood $eha!ior( Ani%al Cruelty Nor%ally Runs a/ay 'ro% ho%e Truancy In'lict &ain to others Starting 'ire #$!iously Intelligent Char%ing Ideally S%ooth talking A$use su$stances La/ 7reaking 9hat3s the &ro$le%? Take ad!antage o' others o not 'eel re%orse 'or /rong doings e'ense %echanis% use( enial and Rationali"ation

9hat3s the &ro$le%? 8ear o' $eing le't alone 4 Stays /ith a a$usi!e relationshi& 9hat is your nursing concern? Sa'ety

#$sessi!e 4 Co%&ulsi!e Personality isorder

Per'ectionist #!erly inhi$ited In'lexi$le Preoccu&ied /ith rules Tri!ial details Procedures Cold and rigid No ex&ression o' tenderness or /ar%th Sets standard too high 'or the%sel!es

Schi"o&hrenia
Schi"o&hrenia is a chronic illness. although %edication i%&ro!e client3s Cuality o' li'e. they do not cure the disease+ Late adolescence -arly Adulthood Theories o''ered 'or the cause o' schi"o&hrenia( Genetics -n!iron%ental 'actors 7iological Alterations in serotonin and do&a%ine

9hat is the &ro$le%? They are sensiti!e to the reactions o' and &ossi$le re@ection $y others A!oid social interaction

7orderline Personality isorder

)ost co%%on treated &ersonally disorder Co%%on in 'e%ale /ho ha!e $een !icti%s o' sexual a$use i''iculty identi'ying their 'eelings

Cluster 7 Histrionic &ersonality disorder

Southern $elle syndro%e iagnosed %ost o'ten in 'e%ale #!erly seducti!e -xcita$le I%%ature -%otional

9hat3s the &ro$le%? They are 'ear'ul o' %aking %istake 4 tend to &rocrastinate

e'ense )echanis%( S&litting 4 ina$ility to see sel' and others as ha!ing a good and $ad Cualities 9hat3s the &ro$le%? 8eeling o' a$andon%ent and de&ression 9hat3s your nursing &riority? Close %onitoring 'or suicidal ideation and %utilation Ad%inister antide&ressant %edication Counseling 'or PTS

Nursing Inter!entions
Pro!ide Cuiet. su&&orti!e en!iron%ent -sta$lishing a trusting relationshi& Anti&sychotic %edication Acti!ities o' daily li!ing Nutrition and hydration

)anaging client /ith &ersonality disorder

Phar%acological inter!entions are generally not a&&ro&riate 'or these clients Ho/e!er i' there is a coexisting diagnosis such as de&ression or anxiety Set Li%its Con!eying a sense o' acce&tance )aintain a &ro'essional rather 'riendly relationshi&

9hat3s the &ro$le%? )ani&ulati!e )any shallo/ relationshi& that are al/ays short li!ed

Co%%only askD
A!oid challenging acti!ities 4 con'usion and o!er/hel% the client o not argue or change the delusional thinking 4 redirect the client to a reality $ased su$@ect -xa%&le( Hearing 2oices 0 ackno/ledge the !oice 4 'ace /ith reality 4 %edication

Narcissistic Personality disorder

*It3s all a$out %e, Sel' a$sor&tion Grandiose ideas( /ealth &o/er intelligence They $elie!e that they are su&eriorB entitled to certain &ri!ileges and s&ecial treat%ent 9hat3s the &ro$le%? Co!er u& 'or dee& 'eelings o' resent%ent and rage Rationali"e or $la%e others 'or their sel'0 centered $eha!ior

Cluster C A!oidant &ersonality disorder

Ti%id 9ithdra/n Hy&ersensiti!e to criticis% Socially inadeCuate 8eeling o' re@ection

Your nursing Goal(

E A3s o' Schi"o&hrenia

A''ect 4 'lat. $lunted. or ina&&ro&riate Autis% 4 Preoccu&ation /ith sel' and retreat into 'antasy Association 4 loosely @oined unrelated to&ics A%$i!alence 4 Ha!ing si%ultaneous o&&osing 'eelings

9hat3s the &ro$le%? Lack o' con'idence

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Think Link

PSYCHIATRIC NURSING
Stage F ( K0 <F hours a'ter last use 4 con'usion hallucinations hy&eracti!ity and gross tre%or Stage I ( <F 4 EK hours a'ter last use 4 se!ere anxiety. increased 7P . &ro'use s/eating. se!ere hallucination and grand%al sei"ure Stage E ( I0 > day a'ter last use 4 deliriu% tre%ens including con'usion. inso%nia. agitation . hallucinations and uncontrolled tachycardia+ eath0 cardiac co%&lication/E/

Su$ty&es o' schi"o&hrenia

Catatonic 9ith stereoty&ed &osition :catatonia; /ith /axy 'lexi$ility. %utis%. $i"arre %anneris% isorgani"ed Another /ord is He$e&hrenic+ Characteri"ed /ith ina&&ro&riate $eha!ior( Silly crying. laughing. regression. transient hallucinations :Auditory;+ Paranoid Presenting sign is SUSPICI#USN-SS. ideas o' &ersecution and delusions Residual No longer exhi$its o!ert sy%&to%s. no %ore delusions $ut still has negati!e Undi''erentiated Sy%&to%s o' %ore than one ty&e o' schi"o&hrenia

7i&olar isorders
Acute %ania Pro'ound changes in %ood -le!ated -x&ansi!e Irrita$le Additional Sy%&to%s( elusion o' granduer 8lights o' ideas Increase %otor acti!ity Increase risk taking and &ro%iscuity Use o' &ro'anity Uncontrolled s&ending 8ailing to slee& or eat 'or a long &eriods o' ti%e 9hen li%itations are &laced on the client3s $eha!ior. he ty&ically reacts /ith sarcas% and $elligerence+ 9hat3s your nursing inter!ention? Huiet Nonsti%ulating en!iron%ent Protecting 'ro% &hysical exhaustion Nutrition( High calorie. high &rotein 'inger 'oods and snacks that can $e eaten /hile %o!ing a$out 9hat to gi!e? )ood sta$ili"ers 2al&roic Acid Car$a%e"i&ine Lithiu%

)a@or e&ression
e&ressed %ood lasting at least t/o /eeks+ -ating disorder ( Anorexia Patient 8eeling o' /orthlessness Recurrent thoughts o' death and suicide -arly assess%ent( i%inished a$ility to concentrate Slee& distur$ance 9hat3s the &ro$le%? Suicidal Ideation and suicidal &lan I%&ro!ing 4 Greater risk 9hat to gi!e? #rdered )edication( Anti 4de&ressants( serotonin reu&take inhi$itor )onoa%ine oxidase inhi$itor Tricyclic antide&ressant 9hat3s your nursing inter!ention? Nursing Inter!ention Har%'ul o$@ect should $e re%o!ed Constant o$ser!ation &ro!ide sa'e en!iron%ent &hysiologic needs Assists in -CT Selecti!e

Ty&es o' Crisis

<+ )aturation Crisis 0 Adolescence :identity crisis; 0 )id0li'e crisisB 0 Pregnancy 0 Parenthood F+ Situational crisis 0 )ost co%%on( eath o' a lo!ed one I%&ortant iagnosis NSG L( Ine''ecti!e Indi!idual Co&ingJ enial 0 A$ortion )urder.. ra&e and 'ire I+ Ad!entitious Crisis Cala%ity. disaster ex+ 9orld 9ar I M II. e&ide%ic. tsuna%i In a ISAST-R <st assessJsur!ey the scene G+

)edications(
Ne/ )edication Aty&ical anti&sychotics Ris&eridone 4 gi!en in s%all doses 8e/er side e''ects )anage negati!e sy%&to%s o' schi"o&hrenia #ld %edication Anti&sychotic Chloro&ro%a"ine0 )any side e''ects %ay ex&erience extra &yra%idal e''ect

Su$stance A$use
-xcessi!e use o' drugs that is di''erent 'ro% societal nor% Illegal 0 Heroin Legal 4 Alcohol or &rescri&tion drugs

Stages o' &sychosocial e!elo&%ent

AGIn'ancy Toddler :=0 <K %onths ; :<K%os+ 4 I years; Psychosocial Trust !s+ )istrust Autono%y !s+ Sha%e and dou$t Initiati!e !s+ Guilt Industry !s In'eriority Identity !s+ Role con'usion Inti%acy !s+ Isolation Generati!ity !s stagnation Integrity !s es&air

9atch out 'or Lithiu% Toxicity

This is not a drug. %ineral that sta$ili"es the %ood o' the client Start o' lithiu% 4 dra/n t/ice /eekly F0I %onths during long ter% thera&y

Nor%al Thera&eutic Le!el =+> 4 <+> %eCJ L

Sy%&to%s( %uscle /eakness. con'usion. ataxia . sei"ures. cardio &ul%onary change. organ 'ailure+ 9hat3s the only 'luid to gi!e? Plain NSS

9hat3s the history o' the &atient A$senteesi% ecline in school or /ork &er'or%ance 8reCuent accidents Increase isolation Slurred s&eech Tre%ors 9hat is the &ri%ary su$stance a$use? Alcohol

Preshool Age : I 4 6 yrs ; School Age : 6 4 <F yrs ; Adolescence : <F 4 F= yrs ; -arly Adulthood : F= 4 I> yrs; )iddle Adulthood :I> 4 6> yrs ; Later YearsJ #ld age : 6> yrs ;

-xa% AlertD Neurole&tic %alignant syndro%e

Antidote( Anti&arkinsonian drug Sy%&to%s( hy&erther%ia : <=G degree 8ahrenheit ;

Alcoholis%
Alcohol /ithdra/al 60 K hours a'ter the last drink #r /hen the a%ount consu%ed is less than usual 8our stages o' alcohol /ithdra/al Stage < ( 60 K hours a'ter last use 4 anxiety. anorexia. tre%ors. nausea and !o%iting. de&ression. headache. icrease $lood &ressure

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Think Link SIG)UN 8R-U Psychosexual Theory

In'ancy Toddler ( #ral PhaseB Id ( Anal PhaseB -go

PSYCHIATRIC NURSING Non0 Thera&eutic Res&onses

9HY? 7eing de'ensi!e Changing su$@ect Gi!ing ad!ice or a&&ro!al Pro!iding 'alse reassurance )aking Nudg%ent on3t 9orry I a% Undoing Negation o' &re!ious consciously intolera$le action or ex&erience to reduce or alle!iate 'eelings o' guilt+ 7orderline rug Addicts Alcoholic S&litting 2ie/ing &eo&le as all good. and others as all $ad Passi!e Aggressi!e &ersonality disorder Reaction 4 8or%ation #2-RC#)P-NSATI#N+ Conscious intent o'ten altruistic+ Procrastinate )olested Child Acting out Unconscious /ish turned into reality Alcoholics PTS Incura$le illness enial 7locking the a/areness o' reality+ Schi"oid 8antasy I%agined e!ents or %ental i%ages+ 9ish'ul thinkingB Te%&orary 'light 'ro% reality to O anxiety #thers 000 Intellectuali"ation The act o' trans'erring e%otional concerns into the intellectual s&here 8ixation Identi'ication I%itator. si%ilar to role &laying e&ression( Intro@ection Attri$uting to onesel' the good Cualities o' another+ Incor&orate 'eelings Anti 4 social Alcoholics Rationali"ation Is @usti'ying one3s actions /hich are $ased on other %oti!es . Paranoid Pro@ection Person re@ects un/anted characteristics o' sel' and assigns the% to others+ #$sessi!e Co%&ulsi!e Regression A te%&orary retreat to &ast le!els o' $eha!ior that reduce anxiety. allo/ one to 'eel %ore co%'orta$le+ Co%&ensation The act o' %aking u& 'or a real or i%agined de'iciency /ith a s&eci'ic $eha!ior+ Conscious or unconscious+ Su$li%ation Rechanneling o' consciously intolera$le or socially unacce&ta$le $eha!ior Per%anent or &ersistence into later li'e o' interests and $eha!ior &atterns a&&ro&riate to an early age.

Anti0anxiety rugs
2aliu% )ilto/n Li$riu% -Cuanil Ati!an 2istaril Serax Atarax Tranxene 7us&ar : ia"e&a%; :)e&ro$a%ate; :Chlordia"e&oxide; :)e&ro$a%ate; :Lora"e&an; :Hydroxy"ine &a%oate; :#xa"e&an; :Hydroxy"ine hydrochloride; :Chlora"a&ate; :7us&irone;

Preschooler( Phallic PhaseB Su&erego :Conscience; -lectra co%&lex( Attach%ent o' the girl to her 'ather and @ealousy to/ard the %other #edi&al Co%&lex( Attach%ent o' the son to his %other and @ealousy to/ard the 'ather+

9hat de'ense %echanis% are they using?

Sexually A$used( Re&ression In!oluntary recall or un&leasant thoughts )oderate Anxiety( Su&&ression 2oluntary 8orget'ulness So%ato'or%( Con!ersion Trans'erring o' %ental con'lict or anxiety into &hysical sy%&to%s )ulti&le Personality( issociation etaching o' strong e%otionally charged con'lict 'ro% one3s consciousness Pho$ia( Sy%$oli"ation #$@ect. idea. or act re&resents another through so%e co%%on as&ect Preschooler(

)onoa%ine #xide Inhi$itors

)ar&lan Nardil Parnate

Schooler ( Latency &hase Strict Su&erego Adolescent ( Genital &hase

Anti&arkinsonian rugs
Artane Akineton $enadryl Cogentin -lde&ryl Larodo&a Sy%%etrel

Thera&eutic res&onses
#''ering o' sel' 4 sa'ety. ser!ice. co%'ort *I a% here+ I /ill sit here $eside you+ I /ill lead you to the grou& thera&y session+, Re'lection( :%irror o' 'eelings; *It %ust $e di''icult 'or you+, *You see% angry+ You see% concerned+, -la$orationJ-x&loration *Tell %e %ore a$out your 'eelings, Clari'ication *9hat do you %ean $y1, *I could not 'ollo/ you+, Reality #rientationJReality Testing Client( *Hel&D Hel&D There are rats on %y $ackD, Nurse( *I don3t see rats $ut 'or you that are real+, 9hat is your Nursing iagnosis? Altered Sensory Perce&tion elusionB Hallucination. Illusion 2alidation 4 inter&ret Client( *I see a dead &eo&le+, Nurse( *You3re 'rightened+, #&en0ended Cuestion J $road o&enings *Ho/ are you?, *Ho/3s your day?, *9hat are your 'a!orite things?,

Anti&sychotic rugs
Haldol Tri'alon Prolixin Stela"ine Clo"aril Serentil )ellaril Thora"ine :Halo&eridol; :Per&hena"ine; :8lu&hena"ine :Tri'lour&era"ine; :Clo"a&ine; :)esorida"ine; :Thiorida"ine HCl; :Chlor&ro%a"ine;

Anti de&ressant drugs

-la!il Pro"ac Paxil Polo't Lu!ox Asendin Nor&ra% To'ranil SineCuan Ana'ranil A!entyl 2i!actile :A%itri&tyline; :8luoxetine; :Paroxetin; :Sertraline; :8lu!oxa%ine )aleate; :)a&rotiline; : esi&ra%ine; :I%i&ra%ine; : oxe&in; :Clo%i&ra%ine; :Nortri&tyline; :Protri&tyline Hydrochloride;

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