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Psychiatric Nursing

PSYCHIATRIC NURSING
BeliefsFeelingsBehavior
Sigmund Freud Father of Psychoanalysis
-structure of personality
Id- impulsive part, pleasure principle
-eat, urinate, have sex
-its all I
Superego small voice of God
-conscience
-should not eat yet, should not eat yet
Ego- arbiter, decision maker
-in touch with reality
Id___________________Superego
EGO
ID DOMINANT needs a superego-needs a conscience
M- manic
A- antisocial serial killer
N- narcissistic
SUPEREGO DOMINANT needs an Id
O- Obsessive Compulsive
A- Anorexia nervosa
EGO impaired reality perception (RN will present reality)
S- schizophrenia- cant distinguish fact from reality
Libido- sexual energy
FREUD - PSYCHOSEXUAL THEORY
ORAL 0-18 months
Cry, suck mouth- survival
Id dominant
Maternal deprivation if not feed, not given milk/water, not kept warm.
Narcissistic seeks the Id I love myself
Regression return to an earlier stage or earlier level
Fixation stopped in a stage
ANAL- 18 mos-3yrs
Toilet training
Mom is superego.
Superego is being formed
Child is caught in ambivalence pulled in 2 opposing factors
Too much toilet training with punishment will result to a child who is:
Obedient, organized, clean Rebel, dirty, disobedient
= OC =Anti-social
=anal retentive =anal expulsive
PHALLIC 3-6 yrs old
-penis & vagina
-love of parent of opposite sex
Oedipal-boy loves mom
Electra-girl loves dad
Identification- boy imitates dad
Castration fears- fear that dad is angry at him and will cut off penis
Penis envy- girls envy little boys
Dr. Karen Horney- detractor of Freud, didnt believe in penis envy. Freud said
that it is maybe in her unconscious mind.
Or repressed.
Conscious- highest level of awareness
Pre-conscious- at tip of tongue
Unconscious forgotten
Repression-kept in unconscious. Unconscious forgotten.
Suppression conscious forgetting
LATENT- 6-12 years old Latent- Logtu = sexual energy asleep
School age School phobia- 1st time to go to school Separation anxiety
Child is busy with Reading, writing, arithmetic.
Sublimation putting anger into something more productive
putting all energies into schooling
Ex. Angry at life, pour anger in singing.
GENITAL 12 years old Genital-Gising sexual energy
Sexual intercourse most important in this stage!!
PHARMA MOMENTS
Anti-anxiety Drugs (used also for alcohol withdrawal)
Valium Librium Ativan Serax Tranxene
Miltown Equanil Vistaril Atarax Inderal Buspar
ERIK ERIKSON
STAGE (+) (-) FACTOR
0-18 months (Oral) Trust vs Mistrust Feeding
18 mos- 3yrs old (Anal) Autonomy vs
Au-(anal)
To-ilet training
No-No! Favorite word.
My Shame/doubt Toilet training
3-6 yrs old (Phallic) Initiative vs
(Initiate 1st steps)
Phallic-oedipal,electra Guilt anger turned inward
Independence
6-12 yrs old (Latent) Industry vs Inferiority Industry
Induskul
12-20 (Genital) Identity vs Role confusion Peers
20-25 Intimacy vs Isolation Love
25-45 Generativity vs Stagnation Parenting
45 up Ego Integrity vs Despair Reflection
Newly admitted pt- develop trust 1st
-pts are dependent=self care deficit
-develop/teach autonomy
-then pt will develop initiative
-etc
Frontal lobe- personality, learning, judgment, language
Occipital- vision
Temporal- hearing, smell
Parietal-taste, touch
Sensory Integration Motor
Somatic nervous system- voluntary movements
Acetylcholine- responsible for voluntary movements
- on switch of movement
Autonomic nervous system- involuntary movements
-Sympathetic(Anti cholinergic) and parasympathetic (cholinergic)
SYMPATHETIC (alert) PARASYMPATHETIC (relax)
Heart tachycardia bradycardia
Respiratory tachypnea bradypnea
GI (opposite effect) Slow, constipation diarrhea
GU (opposite effect) Slow, oliguria, retention Polyuria, frequency
Dry mouth Moist mouth
Neurotransmitter Epinephrine, Norepinephrine Acetylcholine (AcH)
Pupils Dilated (dilat when alert) (Midriasis) Constricted (Myotic)
Blood vessels vasoconstriction vasodilated
BP increased decreased
Anti-cholinergic / anti-parasympathetic =effect is sympathetic!
Sympathetic drug classifications:
A- anxiety
P- psychotic
Anti C- cholinergic
D- depressants
MONO AMINE OXIDASE INHIBITORS:
mARplan
nARdil
pARnate
DEFENSE MECHANISMS: coping mechanism from stress:
DISPLACEMENT- -------------Your boss shouts at you, you shout at your
subordinate.
SUBLIMATION - ---------------putting anger into something more productive or +
putting all energies into schooling
Ex. Angry at life, pour anger in singing.
DENIAL- ----------------------I am not an alcoholic!
DISSOCIATION --------------psychological flight from self. Amnesia. Ex. Rape,
trauma
REGRESSION ----------------RETURN to an earlier developmental stage
FIXATION ---------------------stuck in a stage of development
REPRESSION -----------------unconscious forgetting
SUPPRESSION ---------------conscious forgetting. Avoidance. I dont want to
talk about it. I dont want to remember it.
RATIONALIZATION -------uses because. Has illogical reasoning. I drink
because I dont want to waste the beer in the ref.
REACTION FORMATION----plastic. Doing opposite of intention.
UNDOING- ----------------------show true feeling/color then feels guilty after.
IDENTIFICATION -----------models a certain behavior from a certain role model.
PROJECTION -----------------blame other people, pass load to others. Looks for
a scapegoat. Not me, but them.
INTROJECTION --------------assume another persons trait as your own. Not
just you, me too. Ako din, gusto ko yan.
CONVERSION repression. Anger turned inward to herself. Converted to
physical symptoms.
Sensory-numbness. Motor-paralyzed, tremors.
COMPENSATION -----------defects of the person, overachieve to cover a
defective part.
SUBSTITUTION -----------when you replace a difficult role with a more
accessible one.
Ex.Wants to go to Disneyland but cant afford it. Went to Enchanted Kingdom
instead.
Defense mechanism: Affects/interferes with ADL
Harm to self or others
Behavior Model Ivan Pavlov
Classical Conditioning -behavior learned-repeated (+)
BF Skinner operant conditioning-reinforcement
Confront (-) behavior to make it extinct.
MASLOWS HEIRARCHY OF NEEDS:
5. Self-actualization
4. Self-esteem
3. Love and belonging
2. Safety and security
1. Air, food, water, shelter, clothing, sex Basic physiologic needs
LEVELS OF PREVENTION
PRIMARY SECONDARY TERTIARY
Healthy ill Relapse avoidance
Community teaching Crisis intervention Rehab centers
Community demographics Treatment and diagnosis Al anon
STAGES OF INTERACTION
ORIENTATION WORKING TERMINATION
Assessment Problem solving Evaluation
Establishment of trust Discussion Summarize
Tell patient about termination Patient is most cooperative Say goodbye
Set contract Grief-ANGER-focus of RN
Patient is resistant Pt might become violent/suicidal
ANTI-PARKINSON DRUGS (Capables) used with anti-psychotics
Anti-cholinergic Dopaminergic ABC PLSE
C- Cogentin
A- Artane
P- Parlodel
A- Akineton
B- Benadryl
L- Larodopa
E- Eldepryl
S- Symmetrel
THERAPEUTIC COMMUNICATION NON- THERAPEUTIC
1. Offer self- Ill stay/sit with you. Dont worry, be happy.
2. Explores use what, when, where, how Why? Puts pt in defensive position.
3. Silence Change the subject.
4. Active listening-nodding, eye contact, leaning
forward-show active participation. Everythings going to be alright. giving
False reassurance.
5. Make observations. You see/ I have observed/
I have noticed Ignore the patient.
6. Broad opening- How are you?
You have combed your hair today. Prejudicial. Nice weather today. value
based judgment.
7. Clarification-What do you mean by
ploopplank? Flattery dont use too much adjectives. You have the most
beautiful hair in the ward.
8. Restating-I dont want to eat. (Word per word repetition!) You dont want to
eat? Arguing with the patient
Dont impose your opinion.
9. General leads- And then/What else/Go on
10. Refocusing-We were talking abt the exam
11. Focusing-Tell me more abt this.
ABG ANALYSIS
Ph & PCO2-Respiratory-opposite signs
Ph & HC02-Metabolic same signs
Compensation: Ph is normal=Fully compensated.
C02 & HC03 same signs = Partially compensated
ANXIETY
-vague sense of impending doom. Sympathetic activation.
Assessment: Level of anxiety
MILD-------------------sit restlessly, widened perceptual field, enhanced learning
experience. You seem anxious.
MODERATE----------patient is pacing, selective inattention. Give PRN meds-Anti-
anxiety drugs-valium
SEVERE----------------patient cant make decisions. I dont know what to do or
say. RN directs patient. Sit down on the
chair. Directive.
PANIC- highest level of anxiety. Suicidal. Priority: safety. Stay with patient. Dont
touch pt. Sympathetic activation.
I think Im having a heart attack!
Nrs Dx: -----------------Ineffective Individual Coping
P/I: Decrease anxiety, decrease stimuli
HT: relaxation technique
E: Effective Individual Coping
GENERALIZED ANXIETY DISORDER 6 months excessive worrying. Patient
knows what the problem is.
Cant sleep, concentrate, seat
Fatigue and palpitations
PANIC ATTACK ------------------------------15-30 minutes, happens without
warning. SNS activation.
-with or without agoraphobia -------------------- fear of open space
-social phobia ------------------------------------- fear of public
-provide safety
-Alkalosis-brown bag
-stay with patient
-be directive
POST TRAUMATIC STRESS DISORDER
Victims rape, accident, war zone, disaster, trauma
1. Survivor
2. Flashback > 1 month
3. Memory nightmares
MALINGERING------------------------------------- no organic basis (no tissue change)
-pretending to be sick, conscious
-decrease anxiety for primary gain
-increase attention from RN secondary gain
SOMATOFORM DISORDER ------------------unconscious, not pretending, no
organic basis
- goes doctor hopping
Nervous system Minor discomfort BODY DYSMORPHIC DISORDER
CONVERSION -Feels like illness -illusion of structural defect
-loss of sensory/motor fx -HYPOCHONDRIASIS -S/sx not real
-s/sx real (biglang nabulag)
PSYCHOSOMATIC DISORDER (Psychophysiologic) real illness, real s/sx, real
pain, with organic basis (with change in tissue)
- stress ulcers, migraine, HPN
PHOBIA---------------------------------------------------------- irrational fear
Etiology knowledge, experience
Immediate nsg intervention: Remove object of fear
(Increase stimuli=increase level of anxiety)
(Decrease stimuli=decrease anxiety)
Belief Feeling Behavior
Object will hurt patient Scared Avoidant=interferes with ADL
Gradual exposure to feared object- SYSTEMATIC DESENSYTHEZATION
Individual Therapy
1. Hypnosis --------------relaxed state
2. Free association ------ ideas shared to psychoanalyst
3. Catharsis --------------free to express feeling
4. Transterence- -----------patient feels something for psychoanalyst
5. Countertransterence --RN feels something for patient
Green light-Go Epi & Norepinephrine
Red light Stop G-gamma
A-amino
B-butyric
A- acid
Anxiety
Increase GABA Anti-cholinergic S/E
GI-constipation
GU-retention
Effect of GABA:
Drowsy, drink, dont drive, orthostatic hypotension
Anti-anxiety drug
Withdrawal from drug abrupt REBOUND PHENOMENA leads to seizures.
1 week effect.
Gradual withdrawal tapered dose
Dependence- Cant live without valium
ANTI-PSYCHOTIC AGENTS Sympathetic effect.
Effect 2-4 weeks
STELAZINE CLOZARIL
SERENTIL MELLARIL
THORAZINE HALDOL
TRILAFON PROLIXIN
SCHIZOPHRENIA-------------------------------impaired reality perception. Ego
disintegration. Genetic vulnerability. Stress.
-Chose fantasy over reality. Increase dopamine theory. Cause: unknown.
Increase dopamine, increase schizophrenia.
4 As:
1. Affect---------------------------------------------feelings & emotions (smiles, laughs).
External, readily observable.
Mood, internal, does not match affect. (sad inside)
2. Ambivalence-------------------------------------pulled between 2 opposing forces
3. Autism --------------------------------------------self absorbed. Trapped in his own
world.Attached to odd objects.Poor eye contact.
4. Associative looseness---------------------------talk about so many things but
unrelated ideas.
Disturbed thought process-------------------------Nsg dx
Content of thought---------------Hallucinations/Illusions------------
ADL----------------------------Harm
Disturbed thought process
Disturbed sensory Self care deficit Self Other
Perception Directed Violence
P/I: Reality/Orient/Safety
Eval: Improved thought process
S & Sx of Schizophrenia:
(-)neg sx (+) positive sx
hypoactive hyperactive flight of ideas
withdrawn restless hallucinations
quiet, flat affect talkative delusions many ideas
poverty of words queen of the world illusions
Types of schizophrenia:
1. Disorganized schizo---------------------------------sad inside, happy outside
inappropriate affect (+)
flat affect no affect (-)
disorganized manner/speech flight of ideas (+)
Hebephrenic- giggling (+)
Sx: both (+) and (-).
2. Catatonic ---------------------------------------------ambivalence anal stage (-)
No! Negativisim-rebel-anal (-)
Waxy flexibility--------------raise arm of patient. Patients arm remains up for a long
time. (-)
(-) > (+)
3. Paranoid ----------------------------------------------uses projection.
Mistrust Scared/withdrawn/violent Based on history
Develop trust: orientation -Leave door open
-1:1 interaction -Distance from pt: 1 arms length
-consistent approach -stay near door not window
-short/frequent interaction -have visibility:stand halfway in & out
-food: sealed container to be able to call for reinforcement.
-meds: wrapped in tamper resistant foil -calm and firm
4. Unclassified/ Undifferentiated-----------------------cant be classified anymore.
5. Residual-------------------------------------------------no more (+), (-). Social
withdrawal
THOUGHT PROCESS DISTURBANCE
1. LOOSENESS OF ASSOCIATION----------------topics have connection but no
thought. I am going to the mall. The mall is in
town. The town flies. Flies are here.
2. FLIGHT OF IDEAS ---------------------------------New unrelated topics. I am going
to the mall. Where is the light? I treasure this
chalk. Hurray!
3. AMBIVALENCE-------------------------------------Pulled by 2 opposing forces.
4. MAGICAL THINKING----------------------------- believes he has magical powers. I
can turn you into a frog.
5. ECHOLALIA------------------------------------------repeat what is said. Parrots.
6. ECHOPRAXIA----------------------------------------repeats what you do. Repeats
what is seen.
7. WORD SALAD----------------------------------------mixes words that dont rhyme.
8. CLANG ASSOCIATION----------------------------uses words that rhyme. Flank,
blank, prank.
9. NEOLOGISM------------------------------------------invents new words not in the
dictionary. Ploopplank, pisnok.
10. DELUSIONS-----------------------------------------false belief
Grandeur--------------I am a queen/ king/millionaire!
Persecution------------NBI out to get me!
Ideas of reference-----They talk and write about me!
11. CONCRETE ASSOCIATION-----------------------pilosopo. What will you wear
tomorrow? Clothes!
12. HALLUCINATIONS----------------------ILLUSIONS (with stimuli)
Stimuli N Y
Visual N Y
Auditory N Y
Tactile N Y
Present reality!!! H A R D-Directive. Lets go in the garden.
Acknowledge: I know the voices are real to you. Present reality. But I cant hear
them.
=Assess what voices are saying to know if patient will harm himself.
Increase Dopamine = increase schizo
Decrease dopamine = decrease schizo
Extra Pyramidal Side Effects (EPSE) (Happens when acetylcholine is up and
dopamine is down)
1. AKATHISIA-------------------------- restless, inability to sit still.
2. AKINISIA ---------------------------- rigidity
3. DYSTONIA--------------------------- affects neck
TORTICOLLIS -------------wry neck
OCULOGYRIC CRISIS fixed stare
OPISTHOTONUS ---------arched back, contracted
4. TARDIVE DYSKINESIA------------lip smacking, tongue is protruding, puffy
cheeks. Irreversible!
5. NEUROLEPTIC MALIGNANT SYNDROME- hyperthermia, unstable BP,
increase CPK, diaphoresis, pallor
-discontinue meds, medical emergency.
6. PHOTOSENSITIVITY------------------wear shades, sunscreen
7. WBC- Agranulocytosis---------------sore throat, fever, malaise, leukopenia
AUTISM- boys > girls. 1:100 kids gift-autistic savants
-echolalis, poor eye contact, cant express verbally.
Assess:
A- appearance- neat, OC, wants constancy
B- behavior- ritualistic behavior, flat affect, repetitive
C- communication difficulty communicating
Nsg Dx: Impaired social interaction cant form IPR (Interpersonal relationship)
Impaired verbal communication
Self mutilation cant express anger. Express it inward.
Risk for injury
P/I: constancy, promote safety
Expressive therapy uses art, music, poetry, decreasing risk for injury, improved
social interaction, be able to express feelings.
E: -Safety
ADHD- ATTENTION DEFICIT HYPERACTIVITY DISORDER (can progress to
conduct disorder to anti-social behavior)
Cant focus on anything.
Onset 7 yrs old and below
Duration >6 months
Setting: House & school
ID dominant: Mom or RN will act as superego
Assessment:
A- appearance: dirty
B- behavior: clumsy, impatient, easily distracted
C- talkative
Nsg Dx: High risk for injury
Safety
Structure- provide place to study, eat, play,bath,etc.
Schedule time for everything
Set limits
Residual ADHD grows up not anti-social
Meds: Ritalin, Dexedrine,Pemoline, Adderal
Best time to give meds: If once a day give AFTER MEALS- to prevent loss of
appetite.
Dont give at bedtime-its a stimulant-will cause insomia. Can be given 6hours
before bedtime (if q2d)
ANOREXIA NERVOSA diet, underweight < 85% of expected fat, 3 months
amenorrhea, failure to recognize problem.
BULIMIA NERVOSA induce vomiting, takes laxative, normal weight, irregular
menstruation, dental carries, diarrhea
- knows problem but ashamed and embarrassed,
Priority: Fluid volume balance
Weight gain monitor weight, eating pattern, stay 1 hour after eating,
accompany in toilet
Problem: Body image Disturbance
NI: 1. Establish nutrition pattern
2. Teach stress management, journal keeping
3. Monitor eating pattern and weight.
4. Anti-depressant
MANIA needs mood stabilizing agents- Lithium. Group therapy
L- 0.5-1.5 mEq/L (If level is near 2.5-3 mEq/L will cause ataxia and mental
confusion)
I- increase urination
T- tremors
H- H20- 3L/d
I- increase
T- uu
M- mouth dry
N- Na- 135-145 mEq/L to hold water
Check kidney(blood level) before administration of Lithium BUN, CREA,
electrolyte
Lithium toxicity n/v, diarrhea = Diamox
BIPOLAR DISORDER 2 poles, happy (more dominant) & sad
-female, >20 yrs old, stress, obese
Self actualization
Task to decrease self esteem
Family therapy
Risk for injury, risk for other directed violence
Decrease eat, decreased sleep, hyperactive, increase sex masturbate in front
of others
Nsg Dx: High risk for self or other directed violence
Risk for injury
Give task, no group games, any competition will increase anxiety, water the
plants, activities using gross motor skills, escorted walk, punching bag-
displacement.
3 or more signs confirms disorder:
G grandiose, increase risk activities
F flt of ideas
S - sleeplessness
P pressured speech
E exaggerated SE
E extraneous stimuli (easily distracted)
D distractability
PERSONALITY DISORDER
1. Schizoid --------doesnt care about people, believes that he can stand on his
own, never had a best friend
avoid groups & activities no enjoyment
cares more about computers, pets
2. Avoidant ----------avoid group fear criticism, have talent but no confidence.
3. Anti-social ------as child steal, lie, always get reprimanded
Adult grand robbery, illegal activities against the law.
drug addiction, drives fast, unsafe sex, thrill seeker.
Good talker, charmer, witty, manipulator. Motto I will break the law
4. Borderline -------Favorite line life is an empty glass. Splitting, suicidal,
superficial relationship, labile-sudden change of
Mood, self mutilation.
(+) (-)
fill glass with friends suicide
have happy moments LABILE AFFECT sad moment
labile- change from good to bad in a split moment
5. Dependent ---------Decrease self esteem, dependent
Poor decision making skills
I cant live if living is without you
6. Histrionics ----------excited, dramatic, manipulative
- CENTER OR ATTENTION
-
7. Narcissistic----------I love myself insensitive, arrogant, self absorbed
- exaggerated Self esteem, ambitious I am the best
-
8. OC ------------------ perfectionist, organized, constancy in environment. Provide
time to do rituals.
9. Paranoid ----------- always jealous, suspicious, violent
10. Passive aggressive ------always say yes, but resistance is hidden.
Nsg Intervention: Improve IPR, build trust
A-LCOHOL ABUSE ----------------------happy socializing Narcotic oversode-give
Narcan
-escape from problem Narcotic detox- Methadone
-peer pressure Aversion therapy-Antabuse
B-blackout ---------------- awake but unaware
C-confabulation ---------- invent stories to increase Self-Esteem
D-denial ------------------- I am at not an alcoholic.
D-dependence ------------ I cant live without alcohol.
a. physical tremors, tachycardia, restless
b. psychological craving
E-enabling/codependency (significant others tolerate abusers)
DISULFIRAM
voids alcohol beer
version therapy
ntabuse (DISULFIRAM)
lcoholics anonymous n/v
hypotension
interval of alcohol & antabuse:
12h interval after alcohol intake
B1 Thiamine
Complications wernickes
Encephalopathy
Korsakoff psychosis
Wernickes VROOM Motor sx effect
Korsakoff memory- confabulation
24 72h after alcohol intake
Delirium tremors happens due SNS activation
Tremors, hallucinations, illusions. Well lit room to avoid hallucinations
ANTI DEPRESSANTS decrease serotonin problem
Anti depressants full stomach
All meds take on a full stomach, except anti anxiety.
ASENDIN TCA
NORPRAMIN TCA
TOFRANIL TCA
SINEQUAN TCA
ANAPRANIL TCA - OC
AVENTYL TCA
VIVACTIL TCA
ELAVIL TCA
PROZAC SSRI
PAXIL SSRI
ZOLOFF SSRI
LUVOX SSRI
Serotonin ---------makes us happy
Decrease serotonin pt becomes sad depression
Increase serotonin antidepressant
SSRI:
Selective S
Serotonin S (decrease S/E)
Reuptake R
Inhibitors I (1 4 weeks)
If SSRI dont work, give TCA
Tri Cyclic Antidepressants ( TCA) ----------2 4 wks has increased S/E
increased Serotonin & Norephinephrine
MAOI-------------------------- effect 2 6wks
Increase E, NE, serotonin kills serotonin - MAOI
increase MAO = decrease serotonin
* decrease MAO = increase serotonin
give MAOI
Most dangerous, most S/E
Diet avoid tyramine food eat SARIWA, fresh foods
HPN crisis dangerous! Increase CR, diaphoresis
Tyramine rich food:
Avocado Pickles
Alcohol Fermented foods
Beer Eggplant
Chocolate preservatives tocino, bologna,canned meat etc.
Cheese mozerella, swiss cheese
W ine
S soysauce
Anticholinergic = antidepressants antiparasympathetic
Dry, constipation, retention, tachycardia
Male erectile dysfunction
MAOI
mARplan
NARdil
PARnate
DEPRESSION decrease serotonin. If unresponsive to drugs, ECT-
electroconvulsive therapy
Assess:
1. Denial this cant be happening. This cant be real.
2. Anger Why me, why now, why God?!
3. Bargaining If returned, I will give reward.
4. Depression 2 wks or more of sx = clinical depression
5. Acceptance client acts according to situation. Pt prepares living will.
Increase risk for self directed violence.
Maslows:
5
4 decrease Self-esteem give TASK
3 Pt is withdrawn
2 Risk for self directed violence suicide
1 eat (wt gain) or not eat(wt loss), sleep or not sleep, hypoactive, decrease sex
SUICIDE CUES:
I wont be a problem any longer
Remember me when Im gone
This is my last day
This is my wedding ring. Give it to my son
- Sudden change in mood.
Pt is suicidal, RN should: D d irect question Are you going to commit suicide?
I irregular interval of visit to pt room
E early am & endorsement period - time pts commit suicide.
Who will commit suicide?
S sex male (more successful)/female (hesitant)
A age 15 24yo or above 45
D depression
P pt with previous attempts will try again
E ETOH (Ethanol) alcoholics
R irrational
S lacks social support
O organized plan greater risk
N no family
S sickness, terminal
Suicide Triad:
- Loss of spouse
- Loss of job
- Aloneness
Best approach for suicide: Direct approach
Nursing Mgt: close surveillance
Hospital area majority suicide happens at: weekends 1 3 am Sunday
Weekend less staff personnel
Early am every one is asleep
Give simple task. Dont give complex task no jigsaw puzzle
Water the plants
Wash the dishes except sharp objects
SUBSTANCE ABUSE
Type of Addict:
1. Nervous -----tremors
Give downers
Sx of overdose
1. Identify if drug is upper or downer
2. Check effect
3. Sx of withdrawal
If patient takes a downer, all vital signs are down! If he stops taking it (during
withdrawal), patient will experience the opposite effect of a downer. All his vital
signs will shoot up! Same with uppers.
Ex: Pt had cocaine intoxication. Pt will manifest hyperactivity, tachypnea, seizure.
During withdrawal, pt will manifest bradypnea or coma.
Substance Abuse Moments
(downer)
A alcohol
B barbiturates
O opiates Antidote
N narcotics - Narcan (narcotic antagonist)
M marijuana
Morph
CODE
HERO
(uppers)
C cocaine
H Hallucinogens
A amphetamines
Uppers Downers
Seizure decrease RR, decrease HR
Tachypnea Para constricted pupil
Moist mouth
Dilated Blood Vessels
Coma
Asleep
Decreased GI constriction
Decrease GU retention
Decrease BP
State of euphoria
Sx of withdrawal reverse of effect
1. Know if upper or downer
2. Opposite of effect
Overdose Withdrawal (opposite of withdrawal is overdose)
Alcohol coma seizure
Morphine bradypnea tachypnea
Detox withdrawal with MD supervision
Methadone
2. Depressed - Sits down on chair
Uppers
Codeine increased heart increase - BP increase, awake
Hallucinogen sympathetic HR increase seizure
Amphetamine pupils- dilate GI - diarrhea
Mouth dry
Decrease appetite - thin
Stop uppers
Tremors crash syndrome Depressed Suicide
Fatigue
LEVELS OF MENTAL RETARDATION
Profound severe moderate mild borderline normal
IQ 20 35 50 70 90 110
Profound Mental retardation IQ <20 =thinks like an INFANT. Cant be trained.
Stay with patient.
Severe MR 20-35
Moderate 35-50 = Can be trained. Mental age is 2-7yo. Pre-operational stage.
Mild 50-70 = (mild 7) Mental age is 7-12. Educable. Can go to school.
Borderline- 70-90
Normal- 90-110
JOHN PIAGET COGNITIVE THEORY
0-2 yrs old S-ensory motor. Baby can sense, see, perceive and hear. Object
permanence
2-4 yo- P-reconceptual- language.
4-7 yo- I-ntuitive stage. Unidimentional classification or unidimentional
characteristic.
Child can fix toys according to size, color, height=one at a time only.
7-12 yo- C-conservation/concrete association. Multidemensional
12yo- F-ormal operation good in abstract thinking. Can interpret proverbs.
CHILD ABUSE
B=burns, bruises, bone fractures, bungi
Dont bathe child. Dont brush teeth. Body of evidence will be lost.
Bantay Bata 163
ALZHEIMER
Anomia- dont know name of object
Agnosia problem with senses (smell, taste, hear, touch)
Aphasia cant say it
Apraxia cant do it
Dissociative Fugue- takes a new personality from a tar away place. New place
new identity.
Dissociative Identity Disorder multiple personality
Dissociative Amnesia dont know who/where I am.
DEPERSONALIZATION- believe that they are not persons anymore
PERSEVERATION- kulit. I want to talk about something because this is
something that I want to do. It is something that I need to talk about. This is
something that I want to do.
ELECTROCONVULSIVE THERAPY- sign informed consent. For depressed pt. If
meds dont work, use ECT.
Pre-ECT
N-npo 6 hours
A-atropine sulfate dry mouth
B-barbiturate
S- succinylcholine chloride to relax muscles
Post-ECT
Side-lying- lateral
S/E headache, dizziness, temporary memory loss (distinct sx)=RN-orient pt.
EXAMS:
Nsg intervention:
Look for words like:
S=safety, support, stay, set limits, assist
Provide safety. Mobilize support system. I will stay with you. Assist in activity.
Set limit- dont allow patient to misbehave.
Look for words like:
Orient=orient pt post delirium, ECT, pt with dementia
Accept
Seem, observed, noticed, comment, feelings
Group therapy- facilitator is RN.
Rape, battered pt
ALTRUISM Victim becomes a counselor, shares experience to new victim.
Self-help group=facilitator is the pt themselves. AL ANON groups Alcoholics
Anonymous

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