NOTES VI - PSYCHIATRIC NURSING PART 1

Dereism unorganized thinking

Introduction
MENTAL HEALTH balance in a persons internal life and
adaptation to reality

c)Disturbances of affect
Inappropriate disharmony between the stimuli and the emotional
reaction
Blunted affect severe reduction in emotional reaction
Flat affect absence or near absence of emotional reaction
Apathy dulled emotional tone
Depersonalization feeling of strangeness from ones self
Derealization feeling of strangeness towards environment
Agnosia lack of sensory stimuli integration

Mental ILL Health state of imbalance characterized by a

disturbance in a persons thoughts, feelings and behavior
Psychiatric nursing
interpersonal process whereby the professional nurse practitioner
,through the therapeutic use of self (art) and nursing theories
(science), assist clients to achieve psychosocial well being.
Core : interpersonal process
Related Terms
Mental hygiene
measures to promote mental health , prevent mental illness and
suffering and facilitate rehabilitation
Main tool: therapeutic use of self
It requires self-awareness
Methods to increase self-awareness:
Introspection
Discussion
Experience
Role play
Assessment (psychosocial processes )
Appearance , behavior or mood
Speech , thought content and thought process
Sensorium
Insight and judgment
Family relationships and work habits
Level of growth and development
Common Behavioral Signs and Symptoms
a)Disturbances in perception
Illusion
misinterpretation of an actual external stimuli
Hallucinations
false sensory perception in the absence of external stimuli
b)Disturbances in thinking and speech
neologism coining of words that people do not understand
Circumstantiality over inclusion of inappropriate thoughts and
details
Word salad incoherent mixture of words and phrases with no
logical sequence
Verbigeration meaningless repetition of words and phrases
Perseveration persistence of a response to a previous question
Echolalia pathological repetition of words of others
Aphasia speech difficulty and disturbance
Expressive , receptive or global
Flight of ideas- shifting of one topic from one subject to another in a
somewhat related way
Looseness of association-incoherent illogical flow of thoughts
(unrelated way)
Clang association sound of word gives direction to the flow of
thought
Delusion persistent false belief, rigidly held
Delusions of grandeur: special /important in a way
Persecutory: threatened
Ideas of reference: situation/events involve them
Somatic: body reacting in a particular way
Jealous: thinking that their partner is unfaithful
Erotomanic: person, usually of high status, is in love with the client
Religious: illogical ideas about God and religion exhibited by
extreme or extraneous behavior
Mixed: combination of above without a predominant theme
Magical thinking primitive thought process thoughts alone can
change events
Autistic thinking regressive thought process; subjective
interpretations not validated with objective reality

d)Disturbances in motor activity

Echopraxia imitation of posture of others
Waxy flexibility maintaining position for a long period of time
Ataxia loss of balance
Akathesia extreme restlessness
Dystonia- uncoordinated spastic movements of the body
Tardive dyskinesia involuntary twitching or muscle movements
Apraxia involuntary unpurposeful movements
e)Disturbances in memory
Confabulation filling of memory gaps
Dj vu something unfamiliar seems familiar
Jamais vu- something familiar seems unfamiliar
Amnesia memory loss (inability to recall past events)
Retrograde-distant past
Anterograde immediate past
Anomia lack of memory of items
f)Dynamics of Human Behavior
Behavior the way an individual reacts to a certain stimulus
Conflict situation arising from the presence of two opposing drives
Need - organismic condition that requires a certain activity
Dynamics of Human Behavior
Personality
totality of emotional and behavioral traits that characterize the
person in day to day living under ordinary conditions; it is relatively
stable and predictable.
FORMATION OF PERSONALITY
TEMPERAMENT
biological-genetic template that interacts with our
environment.
a set of in-built dispositions we are born with
mostly unalterable
our nature.
CHARACTER
the outcome of the process of socialization, the acts and
imprints of our environment and nurture on our psyche during the
formative years (0-6 years and in adolescence).
the set of all acquired characteristics we posses, often
judged in a cultural-social context.
Sometimes the interplay of all these factors results in an abnormal
personality
THEORIES OF PERSONALITY DEVELOPMENT
Freuds
PSYCHOSEXUAL THEORY
Libido inner drive
Parts of body focus of gratification
Unsuccessful resolution - fixation
Structures of personality
Id: pleasure principle-instinct
Ego: controls action and perception reality principle
Superego: moral behavior - conscience
0-18 m0s ;oral mouth trust and discriminating
18 mos. 3 years ; anal bowels holding on or letting go
Negativism and toilet training age
3 -6 years phallic ; genitals exploration and discovery ( inc. sexual
tension)

Gender identification and genital awareness

Oedipus and Electra complex
Castration anxiety and penis envy
6-12 years latency (quiet stage) sexual energy diverted to play.
Institution of superego: control of instinctual impulses
12 young adult genital ; reawakening of sexual drives
relationships
Sexual maturation
Sexual identity ,ability to love and work
Eric Ericksons
PSYCHOSOCIAL THEORY
0-12mos TRUST vs. MISTRUST
1-3y
AUTONOMY vs. SHAME & DOUBT
3-6
INDUSTRY vs. INFERIORITY
6-12
INITIATIVE vs. GUILT
12-18 IDENTITY vs. IDENTITY CONFUSION
18-25 INTIMACY vs. ISOLATION
25-60 EGO INTEGRITY vs. STAGNATION
60 and above GENERATIVITY vs. DESPAIR
INFANCY
CONSISTENT MATERNAL CHILD INTERACTION
TRUST
INNER FEELING OF SELF WORTH
HOPE
TODDLER
ALLOW EXPLORATION
PROVIDE FOR SAFETY
NO, NO NEGATIVISM
OFFER CHOICES / REVERSE PSYCHOLOGY
TOILET TRAINING 18 MOS.-BOWEL
DAYTIME BLADDER: 2 yo
NIGHTIME BLADDER: 3 yo
REWARD W/ PRAISE AND AFFECTION
INDEPENDENCE
PRE-SCHOOL
PROVIDE PLAY MATERIALS
SATISFY CURIOSITY
TEACH AND REINFORCE(HYGIENE,SOCIAL
BEHAVIOR)
SIBLING RIVALRY
WILLPOWER
SCHOOL AGE
HOW TO DO THINGS WELL-SUPPORT EFFORTS
CHUMS AND HOBBIES
NEEDS TO EXCEL/ACCOMPLISH
NEED FOR PRIVACY AND PEER INTERACTION
COMPETENCE
ADOLESCENCE
MAKE DECISION,EMANCIPATION FROM PARENTS
BODY IMAGE CHANGES
NEED TO CONFORM BUT KEEP INDIVIDUALITY
SELF - AWARENESS
YOUNG ADULT
COMMITMENT AND FIDELITY
RESPONSIBILITY
ACHIEVEMENT OF INDEPENDENCE
MIDDLE ADULTHOOD
SUPPORT-PERIOD OF ROLE TRANSITIONS
MIDLIFE CRISIS
ADJUSTMENT AND COMPROMISE
MOST PRODUCTIVE AND CREATIVE
ALTRUISM
LATE ADULTHOOD
SELF ACCEPTANCE
SELF WORTH
WISDOM
Jean Piagets
COGNITIVE THEORY
0-2 SENSORIMOTOR
REFLEXES

IMITATIVE REPETITIVE BEHAVIOR

SENSE OF OBJECT PERMANENCE AND SELF
SEPARATE FROM ENVT.
TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
2-7Y PRE-OPERATIONAL
SELF-CENTERED,EGOCENTRIC
CANNOT CONCEPTUALIZE OTHERS VIEW
ANIMISTIC THINKING
IMAGINARY PLAYMATE SYMBOLIC MENTAL
REPRESENTATION CREATIVITY
2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
4-7 INTUITIVE (UNDERSTANDING OF ROLES)
7-12Y CONCRETE OPERATIONAL
LOGICAL CONCRETE THOUGHT
INDUCTIVE REASONING (SPECIFIC TO GENERAL)
CAN RELATE, PROBLEM SOLVING ABILITY
REASONING AND SELF-REGULATION
12-ABOVE: FORMAL OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality oriented
Deductive reasoning
Apply scientific method
Havighursts
DEVELOPMENTAL TASKS
Baby to early childhood
Right from wrong and Conscience
Late childhood
Physical skills, wholesome attitude, social roles
Conscience morality and values
Fundamental skills in academics
Personal independence
Adolescence
Sexual social roles
Relationships
Independence and ideology
Early adulthood
Career
Selecting a mate
Finding Civic or social responsibility
Middle age
Achieving Civic or social responsibility
Adjusting to changes
Satisfactory career performance
Adjusting to aging parents
Adjusting to parental roles
Old age
Adjusting to changes
Establishing satisfactory living arrangements and
affiliations
Kohlbergs
MORAL DEVELOPMENT/ THINKING/ JUDGEMENT
PRE-CONVENTIONAL (0-6)
PUNISHMENT AND OBEDIENCE
OBEDIENCE TO RULES TO AVOID PUNISHMENT
CONVENTIONAL ( 6-12 )
MUTUAL INTERPERSONAL EXPECTATIONS,
RELATIONSHIPS AND CONFORMITY
SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE
BEING GOOD IS IMPORTANT SELF RESPECT OR
CONSCIENCE
POST CONVENTIONAL (12 18 Y)
PRIOR RIGHT OR SOCIAL CONTRACT
UNIVERSAL ETHICAL PRINCIPLE
ABIDE FOR COMMON GOOD
RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND
BECOME COMMITTED TO THEM
INNER CONTROL OF BEHAVIOR UNDERSTANDING
THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF
HUMAN BEINGS AS INDIVIDUALS

Harry Stack Sullivans

INTERPERSONAL THEORY
INFANCY
NEED FOR SECURITY-INFANT LEARNS TO RELY ON
OTHERS TO GRATIFY NEEDS AND SATISFY WISHES,
DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF
WORTH WHEN THIS OCCURS
TODDLERHOOD / EARLY CHILDHOOD
CHILD LEARNS TO COMMUNICATE NEEDS THROUGH
USE OF WORDS AND ACCEPTANCE OF DELAYED
GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT
PRE-SCHOOL
DEVELOPMENT OF BODY IMAGE AND SELFPERCEPTION
ORGANIZES AND USES EXPERIENCES IN TERMS OF
APPROVAL AND DISAPPROVAL RECEIVED
BEGINS USING SELCTIVE INATTENTION AND
DISASSOCIATES THOSE EXPERIENCES THAT CAUSE
PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN
SCHOOL AGE
THE PERIOD OF LEARNING TO FORM SATISFYING
RELATIONSHIPS WITH PEERS-USES
COMPETITION,COMPROMISE AND COOPERATION
THE PRE-ADOLESCENT LEARNS TO RELATE TO
PEERS OF THE SAME SEX
ADOLESCENCE
LEARNS INDEPENDENCE AND HOW TO ESTABLISH
SATISFACTORY RELATIONSHIPS WITH MEMBERS OF
THE OPPOSITE SEX
YOUNG ADULTHOOD
BECOMES ECONOMICALLY, INTELLECTUALLY AND
EMOTIONALLY SELF SUFICIENT
LATER ADULTHOOD
LEARNS TO BE INTERDEPENDENT AND ASSUMES
RESPONSIBILITY FOR OTHERS
SENESCENCE
DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY
FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN
THE FLOW OF HISTORY
TREATMENT MODALITIES
REMOTIVATION THERAPY
TREATMENT MODALITY THAT PROMOTES
EXPRESSION OF FEELINGS THROUGH INTERACTION
FACILITATED BY DISCUSSION OF NEUTRAL TOPICS
STEPS :
climate of acceptance
creating bridge to reality
sharing the world we live in
appreciation of works of the world
climate of appreciation
MUSIC THERAPY
Involves use of music to facilitate expression of feelings,
relaxation and outlet of tension
PLAY THERAPY
enables patient to experience intense emotion in a safe
environment with the use of play
children express themselves more easily in play. revealing
as reflection of childs situation in the family
provide toys and materials facilitate interaction
observe and help child resolve problems through play
Group therapy
Treatment modality involving three or more patients with a
therapist to relieve emotional difficulties, increase self
esteem, develop insight , LEARN NEW ADAPTIVE WAYS
TO COPE WITH STRESS and improve behavior with
others
IDEAL 8 10 MEMBERS
MILIEU THERAPY

Consists of treatment by means of controlled modification

of the patients environment to facilitate positive behavioral
change
Increase patients
Awareness of feelings
Sense of responsibility and
Help return to community
clients plan social and group interaction
token programs , open wards and self medication are
done
FAMILY THERAPY
A METHOD OF PSYCHOTHERAPY WHICH FOCUSES
ON THE TOTAL FAMILY AS AN INTERACTIONAL
SYSTEM
PROBLEM IS A FAMILY PROBLEM
focus on sick members behavior as source of trouble /
symptom serve a function for the family
members develop sense of identity
points out function of the sick member for the rest of the
family
PSYCHOANALYTIC
focuses on the exploration of the unconscious, to facilitate
identification of the patients defenses
ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND
EGO
Becomes aware of unconscious thoughts and feelings to
understand anxiety and defenses
HYPNOTHERAPY
Various methods and techniques to induce a trance state
where patient becomes submissive to instructions
BEHAVIOR MODIFICATION
Application of learning principles in order to change
maladaptive behavior
Believes that psychological problems are a result of
learning
Everything learned can be unlearned
BEHAVIOR MODIFICATION
OPERANT CONDITIONING
Use of rewards to reinforce positive behavior
Perceived and self-reinforcement becomes
more important than external reinforcement
DESENSITIZATION
Slow adjustment or exposure to feared objects
(phobias)
Periodic exposure until undesirable behavior
disappears or lessens
AVERSION THERAPY
An example of behavior modification
Painful stimulus is introduced to bring about an avoidance
of another stimulus
End view: behavioral change
OTHER THERAPIES
HUMOR THERAPY
To facilitate expression and enhance interaction
ACTIVITY THERAPY
Group interaction while working on a task together
BIOLOGICAL/ MEDICAL THEORY
EMOTIONAL PROBLEM IS AN ILLNESS
cause may be inherited or chemical in origin
FOCUS OF TREATMENT IS MEDICATIONS AND ECT
BIOLOGICAL THERAPY
ELECTROCONVULSIVE THERAPY
Artificial induction of a grand mal seizure by
passing a controlled electrical current through
electrodes applied to one or both temples
mechanism of action unclear
voltage: 70 150 volts
Duration: 0.5 2.0 seconds
6 to 12 treatments
intervals of 48 hours
indicators of effectiveness occurrence of generalized
tonic clonic seizures

indications depression , mania and catatonic

schizophrenia
s/e: confusion, disorientation, short -term memory loss,
seizure (30-60 sec)
NPO prior
Contraindications
Fever, pregnancy
Inc ICP, fracture
retinal detachment
TB with hemoptysis
cardiac d/o
consent needed
Reorient after, supportive care
medications given :
Atropine sulfate: decrease secretions
Succinylcholine (Anectine): promote muscle
relaxation
Methohexital Sodium ( Brevital ): serves as an
anesthetic agent
common complications:
loss of memory
headache
apnea
fracture
-respiratory depression
NOTES VI - PSYCHIATRIC NURSING PART 2
Psychopharmacologic Therapy
Benzodiazepines
Indications
Anxiety
Sedation/sleep
Muscle spasm
Seizure disorder
Alcohol withdrawal syndromes
Anti-anxiety drugs
Generic
Trade name
Alprazolam
Xanax
Chlordiazepoxide
Librium
Clorazepate
Tranxene
Diazepam
Valium
Lorazepam
Ativan
Oxazepam
Serax
Busipirone
BuSpar
Side effects
Drowsiness/ sedation
Ataxia
Feelings of detachment
Increase irritability and hostility
Anterograde amnesia
Increased appetite & weight gain
Nausea
Headache, confusion
Anti-depressants
Indications
Depression
Bipolar depression
Panic disorder
Bulimia
Obsessive-compulsive d/o
Possibly
Attention deficit/Hyperactivity d/o
Post Traumatic Stress D/o
Conduct d/o
Tricyclic (TCA)
Generic
Trade name
Amitriptyline
Elavil
Imipramine
Tofranil
Trimipramine
Surmontil
Nortriptyline
Pamelor

Trazodone
Bupropion

Desyrel
Wellbutrin

Side effects
Orthostatic hypertension
Anticholinergic effect
Dry mouth, blurred vision, constipation, excessive
sweating, urinary hesitancy/ retention, tachycardia,
agitation, delirium, exacerbation of glaucoma
Neurologic effects
sedation, psychomotor slowing, poor concentration,
fatigue, ataxia, tremors
Decrease libido and sexual performance
Monoamine Oxidase inhibitors
Generic
Isocarboxazid
Phenelzine
Tranylcypromine

Trade name
Marplan
Nardil
Parnate

Side effects
Postural lightheadedness
Constipation
Delay ejaculation or orgasm
Muscle twitching
Drowsiness
Dry mouth
Dietary restrictions
Cheese, esp. aged and matured
Fermented or aged protein
Pickled or smoked fish
Beer, red wine, sherry; liquor & cognac
Yeast
Fava or broad beans
Beef or chicken liver
Spoiled/ overripe fruits; banana peel
yogurt
Hypertensive Crisis
Signs
Sudden elevation of BP
Explosive headache, occipital may radiate frontally
Head & face flushed
Palpitations, chest pain
Sweating, fever
Nausea, vomiting
Dilated pupils, photophobia
Intracranial bleeding
Treatment
Hold next MAO dose
Dont let pt. lie down
IM chlorpromazine 100 mg
Fever: manage by external cooling techniques
Serotonin Reuptake Inhibitors
Generic
Trade name
Fluoxetine
Prozac
Sertraline
Zoloft
Paroxetine
Paxil
Venlafaxine
Effexor
Side effects
Nausea
Insomnia
Nervousness
Male sexual dysfunction
Dizziness

Diarrhea
Dry mouth
Headache
Drowsiness
Sweating

Mood stabilizing drugs

Indications
Acute mania
Bipolar prophylaxis
Possibly

Bulimia
Alcohol abuse
Aggressive behavior
schizoaffective
Mode of action
Normalizes the reuptake of certain neurotransmitters such
as serotonin, norepinephrine, acetylcholine and dopamine
Reduces the release of norepinephrine thru competition
with calcium
Effects intracellularly
Lag period: 7-10 to 14 days
Lithium carbonate
Trade names
Eskalith
Lithotabs
Lithane
Lithonate
MOA: unclear; interfere with metabolism of neurotransmitters; alter
Na transport in nerves and muscle cells
Prelithium workup
Urinalysis (BUN and creatinine)
ECG, FBC, CBC
Side effects
Early
Nausea and diarrhea
Anorexia
Fine hand tremor (propranolol)
Thirst, Polydipsia (dec. crea, inc. albumin)
Metallic taste
Fatigue
Lethargy
Late
Weight gain
acne
Contraindications
Brain damage/ CV disease
Epilepsy
Elderly/ debilitated
Thyroid and renal disease
Severe dehydration
Pregnancy (1st trimester)
Can augment the effects of anti-depressants
Nursing considerations
Therapeutic serum level: 0.5 1.2 meq/L
Maintenance level: 0.6 -1.2 meq/L
Toxic
Mild to moderate: 1.5 to 2 meq/L
Moderate to severe: 2 2.5 meq/L
Needs dialysis: 3 meq and above
Early signs of toxicity
Lethargy, mild nausea, vomiting, fine hand tremors,
anorexia, polyuria, polydipsia, metallic taste, fatigue
Late signs of toxicity
Ataxia, giddiness, tinnitus, blurred vision, polyuria
Nursing considerations
Lithium levels should be checked q 2-3 mos
Serum drawn in the AM, 12H after last dose
Common causes of inc. levels
Dec. Na intake
Diuretic therapy
Dec. renal functioning
F&E loss
Medical illness
Overdose
NSAIDS
Nursing considerations
Diet: adequate Na+ and fluid
3g NaCl/ day
6-8 glasses of H2O

No caffeine
No driving: wait for clinical effect
Management
Moderately severe toxicity
Osmotic diuresis: urea/ mannitol
Aminophylline & PLR IV
Adequate NaCl
Peritoneal/ hemodialysis
Severe toxicity
Assess hx quickly
Hold next lithium dose
Check BP, rectal T, RR, LOC, support O2
Obtain labs
ECG
Emetic, NGT lavage
Hydrate: 5-6L/day c PLR; FBC-CDU
Other drugs
Carbamazepine (Tegretol)
Side effects
Dizzines
Ataxia
Clumsiness
Sedation
Dysarthria
Diplopia
Nausea & GI upset
Preparation: liq, tab, chewable tab
Nursing considerations
Assess drug levels q 3-4 days
Monitor salt and fluid intake
Avoid alcohol and non-prescription drugs
Refer dec. in UO
Dont stop abruptly
C/I: pregnancy
Take with meals
Other drugs
Valproic acid (Depakote, Depakene)
Side effects
Nausea
Hepatoxicity
Neurotoxicity
Hematological toxicity
Pancreatitis
Prep: tab, cap, sprinkles
MOA: inc. levels of GABA; inhibits the kindling process or snoballlike effect seen in mania & seizures
Nursing considerations
Therapeutic level: 50 100 ug/mL
Dose: 1, 000 1,500 mg/day
Monitor serum levels 12H after last dose
Toxic effects
Severe diarrhea, vomiting, drowsiness, mm. weakness,
lack of coordination
Renal failure, coma, death
Anti-psychotic drugs
Indications
Psychotic symptoms of schizophrenia, acute mania and
depression
Gilles de Tourette disorder
Treatment-resistant bipolar disorder
Huntingtons disease and other movement disorder
Possibly
Paranoid
Childhood psychoses
MOA: block receptors of dopamine (D2, D3, D4)
If unresponsive after 6 weeks of therapy, another class is tried
General considerations
Calms without producing impairment of sleep
High therapeutic index
Non addicting, no tolerance
Avoided in pregnancy
TYPICAL: High Potency
Fluphenazine (Prolixin)
Haloperidol (Haldol)

Thiothexene (Navane)
Trifluoperazine (Stelazine)
Moderate Potency
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon)
Low Potency
Chlopromazine (Thorazine)
Chlorprothixene (Taractan)
Mesoridazine (Serentil)
Thioridazine (Mellaril)
ATYPICAL
Clozapine (Clozaril)
Resperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Sertindole (Serlect)
Ziprasidone (Zeldox)
Contraindications
CNS depression: brain damage, excess alcohol/ narcotics
Parkinsons disease
Allergy
Blood dyscrasias
Acute narrow angle glaucoma
BPH
Side effects
Hypotension
Sedation
Dermal and ocular syndrome
Neuroleptic malignant syndrome
Anticholinergic syndrome
Movement syndrome (Extrapyramidal Syndrome)
Atropine psychosis
Agranulocytosis
Seizures
Neuroleptic Malignant Syndrome
A potentially fatal, idiosyncratic reaction to an antipsychotic drug
10-20% mortality rate
Sx:
rigidity,
high fever,
autonomic instability (BP, diaphoresis, pallor, delirium,
elev. CPK), confused or mute, fluctuate from agitation to
stupor
Occurs in the first 2 weeks of therapy
Risk: high dose of high-potency drugs; dehydration, poor nx,
concurrent med illness
Movement Syndromes
Akathisia
Dystonia
Tardive dyskinesia
Bradykinesia
Parkinsonism
Other s/e
Atropine psychosis (geriatrics)
Hyperactivity, agitation, confusion, flushed skin, sluggish
reactive pupils
TTT: IM physostigmine
Agranulocytosis (Clozapine)
Occurs 3-8 wks after
Medical emergency
s/s: fever, malaise, sore throat, leukopenia
TTT: d/c, reverse iso, antibiotics
Seizures (Clozapine)
Occurs in 5% of patients; TTT: D/c drug
Anticholinergics
Benztropine (Cogentin)

Trihexyphenidyl (Artane)
Biperiden (Akineton)
Procyclidine (Kemadrin)
Not withdrawn abruptly
Provide cool environment
ANTIPARKINSONIAN MEDICATIONS
Adjunct to anti-psychotic agents to balance dopamine/ acetylcholine
in the brain
s/e: glaucoma, tachycardia, HPN, cardiac dx, asthma, duodenal
ulcer
A/e: blurred vision, photosensitivity, drowsiness, orthostatic
hypotension, CHF, hallucinations
COMMON DRUGS:
Trihexyphenidyl (Artane)
benztropine (Cogentin)
Biperiden (Cogentin)
Selegiline (Eldepryl)
Pergolide (Permax)
ANTIHISTAMINE
Diphenhydramine HCl (BENADRYL)
DOPAMINE RELEASING AGENT
Amantadine (SYMMETREL)
Nursing considerations
Best taken after meals
Avoid driving
Check BP
Alcohol increases sedative effects
Avoid sudden position change
Drug is not withdrawn abruptly

NOTES VI - PSYCHIATRIC NURSING PART 3

PSYCHIATRIC DISORDERS
ANXIETY DISORDERS

PANIC DISORDERS
SPECIFIC PHOBIA
SOCIAL PHOBIA
OCD
PTSD
ACUTE STRESS DISORDER
GENERALIZED ANXIETY DISORDER

PANIC ATTACKS
DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT IN
WHICH AT LEAST 4 IF THE FF SX DEVELOP ABRUPTLY AND
PEAK WITHIN 10 MINS:
Palpitations, pounding heart, or accelerated HR
Sweating
Trembling or shaking
Sensations of SOB and smothering
Feeling of choking
Chest pain or discomfort
Nausea or abd. Pain
Feeling dizzy, unsteady, lightheaded or faint
Derealization or depersonalization

 Fear of losing control or going crazy

Fear of dying
Paresthesias
Chills or hot flashes

POST TRAUMATIC STRESS SYNDROME

PERSON HAS EXPERIENCED, WITNESSED OR BEEN
CONFRONTED WITH AN EVENT THAT INVOLVED ACTUAL OR
THREATENED DEATH OR SERIOUS INJURY, OR A THREAT TO
PHYSICAL INTEGRITY
PERSON REEXPERIENCES THESE IN THE MIND

SPECIFIC PHOBIA SOCIAL

EXCESSIVE AND UNREASONABLE CUED BY
THE PRESENCE OR ANTICIPATION OF A
SPECIFIC OBJECT OR SITUATION
DEFENSE MECH COMMONLY USED
INCLUDE REPRESSION AND DISPLACEMENT
FEAR OF SOCIAL PERFORMANCE
SITUATIONS IN WHICH THE PERSON IS
EXPOSED TO UNFAMILIAR PEOPLE OR TO
POSSIBLE SCRUTINY BY OTHERS
OBSESSION
COMPULSION
RECURRENT AND PERSISTENT THOUGHTS,
IMPULSES, OR IMAGES ARE EXPERIENCED
DURING THE DISTURBANCE AS INTRUSIVE
AND INAPPROPRIATE
CAUSE ANXIETY OR DISTRESS
PX KNOWS THAT THESE ARE JUST
PRODUCT OF ONES OWN MIND.
PX FEELS DRIVEN TO PERFORM
REPETITIVE BEHAVIORS OR MENTAL ACTS IN
RESPONSE TO OBSESSION OR ACCORDING
TO THE RULES THAT ONE DEEMS MUST BE
APPLIED RIGIDLY.
AIMED AT REDUCING ANXIETY
OBSESSION
COMPULSION
FEAR OF DIRT & GERMS
FEAR OF BURGLARY OR ROBBERY
WORRIES ABOUT DISCARDING
SOMETHING IMPORTANT
CONCERNS ABOUT CONTRACTING A
SERIOUS ILLNESS
WORRIES THAT THINGS MUST BE
SYMMETRICAL OR MATCHING
EXCESSIVE HAND WASHING
REPEATED CHECKING OF DOOR AND
WINDOW LOCKS
COUNTING AND RECOUNTING OF
OBJECTS IN EVERYDAY LIFE
HOARDING OF OBJECTS
EXCESSIVE STRAIGHTENING, ORDERING,
OR OF ARRANGING THINGS
REPEATING WORDS OR PRAYERS
SILENTLY

INVOLVES INTENSE FEAR, HELPLESSNESS, OR HORROR

AND NUMBING OF GENERAL RESPONSIVENESS (PSYCHIC
NUMBING)
ACUTE
STRESS

GENERALIZED
ANXIETY

MEETS THE CRITERIA FOR EXPOSURE TO A TRAUMATIC

EVENT AND PERSON EXPERIENCES 3 OF THE FF SX:
sense of detachment,
reduced awareness of ones surroundings,
derealization,
depersonalization,
dissociated amnesia
EXCESSIVE ANXIETY OR WORRY, OCCURRING IN MORE
DAYS THAN NOT FOR AT LEAST 6 MOS, ABOUT A NUMBER OF
EVENTS OR ACTIVITIES
FINDS IT DIFFICULT TO CONTROL THE WORRY

MOOD/ AFFECTIVE DISORDERS

BIPOLAR D/O
BIPOLAR I: current or past experience of manic episode, lasting
at least a week, that is severe enough to cause extreme impairment
in social or occupational functioning.
MANIA: hyperactivity
DEPRESSED: extreme sadness or withdrawal
MIXED
BIPOLAR II: hx of 1 or more mj depressive episodes & at least 1
hypomanic episode; no mania
MAJOR DEPRESSIVE D/O
@ least 5 sx of same 2- wk period with one being either
depressed mood or loss of interest or pleasure.
Single episode or recurrent
Other sx: wt loss, insomnia, fatigue, recurrent thoughts of death,
diminished ability to think, psychomotor agitation or retardation,
feelings of worthlessness.
CYCLOTHYMIC D/O
Hx of 2 yrs of hypomania with numerous periods of abnormally
elevated, expansive or irritable moods.
Does not meet the criteria of mania or depression.

 DYSTHYMIC D/O
@ least 2 yrs of usually depressed mood and at least 1 of the sx
of mj depression without meeting the criteria for it
SEASONAL AFFECTIVE D/O
Depression that comes with shortened daylight in fall and winter
that disappears during spring and summer.

Dealing with Inappropriate Behaviors

AGGRESSIVE BEHAVIOR
ASSIST THE CLIENT IN IDENTIFYING FEELINGS OF
FRUSTRATION AND AGGRESSION

ASSIST IN DEVELOPING MEANS OF SETTING LIMITS ON

OWN BEHAVIOR
SCHIZOPHRENIA
CHARACTERIZED BY IMPAIRMENTS IN THE PERCEPTION OR
EXPRESSION OF REALITY AND BY SIGNIFICANT SOCIAL OR
OCCUPATIONAL DYSFUNCTION.
ONCE CONSIDERED AS A DEADLY DISEASE
THERE IS LACK OF INSIGHT IN BEHAVIOR
DX: LATE ADOLESCENCE AND EARLY ADULTHOOD
15-25 y.o. (men); 25-35 y.o. (women)
OBSOLETE TERM: DEMENTIA PRAECOX = COGNITIVE
DETERIORATION EARLY IN LIFE
EUGENE BLEULER: SCHIZ SPLIT; PHREN MIND
Risk factors
GENETICS: IDENTICAL TWINS 50%, 15% FOR FRATERNAL
TWINS
BIOCHEMICAL FACTORS

ENCOURAGE THE CLIENT TO TALK OUT INSTEAD OF ACTING

OUT FEELINGS OF FRUSTRATION
ASSIST THE CLIENT IN IDENTIFYING PRECIPITATING
EVENTS OR SITUATIONS THAT LEAD TO AGGRESSIVE
BEHAVIOR
DESCRIBE THE CONSEQUENCES OF THE BEHAVIOR ON
SELF AND OTHERS
ASSIST IN IDENTIFYING PREVIOUS COPING MECHANISMS

Dopamine hypothesis: overactive

Serotonin imbalance

Decreased brain volume, enlarged ventricles, deeper

fissures, and loss or underdeveloped brain tissue

PSYCHOANALYTIC

lack of trust during the early stages

Weak ego
Defenses: REPRESSION, REGRESSION, PROJECTION

ASSIST THE CLIENT IN THE PROBLEM-SOLVING

TECHNIQUES TO COPE WITH FRUSTRATION OR AGGRESSION

ENVIRONMENT INFLUENCES: POVERTY, LACK OF SOCIAL

SUPPORT, HOSTILE HOME ENVIRONMENT, ISOLATION,
UNSATISFACTORY HOUSING, DISRUPTION IN
INTERPERSONAL RELATIONSHIPS (DIVORCE OR DEATH),
JOB PRESSURE OR UNEMPLOYMENT

DEESCALATION TECHNIQUES

Subtypes

MAINTAIN SAFETY

CATATONIC TYPE prominent psychomotor disturbances are

evident. Symptoms can include catatonic stupor and waxy flexibility

MAINTAIN LARGE PERSONAL SPACE AND USE

NONAGGRESSIVE POSTURE

DISORGANIZED TYPE
where thought disorder and flat affect are present together

USE CALM APPROACH AND COMMUNICATE WITH A CALM,

CLEAR TONE OF VOICE (BE ASSERTIVE NOT AGGRESSIVE

PARANOID TYPE

DETERMINE WHAT THE CLIENT CONSIDERS TO BE HIS OR

HER NEED

where delusions and hallucinations are present but thought

disorder, disorganized behavior, and affective flattening are absent

AVOID VERBAL STRUGGLES

PROVIDE CLEAR OPTIONS THAT DEAL WITH BEHAVIOR
ASSIST WITH PROBLEM-SOLVING AND DECISION MAKING
REGARDING THE OPTIONS

MANIPULATIVE BEHAVIORS
SET CLEAR, CONSISTENT, REALISTIC, AND ENFORCEABLE
LIMITS AND COMMUNICATE EXPECTED BEHAVIORS
BE CLEAR ABOUT CONSEQUENCES ASSOCIATED WITH
EXCEEDING SET LIMITS
DISCUSS BEHAVIOR IN NONJUDGMENTAL AND
NONTHREATENING MANNER
AVOID POWER STRUGGLES

RESIDUAL TYPE
where positive symptoms are present at a low intensity only
UNDIFFERENTIATED TYPE
psychotic symptoms are present but the criteria for paranoid,
disorganized, or catatonic types has not been met

Symptoms
ACCORDING TO BLEULER: 4 AS
Affect is inappropriate

 Associative looseness
Autistic thinking
Ambivalence
Symptoms
POSITIVE SYMPTOMS
delusions, auditory hallucinations and thought disorder and are
typically regarded as manifestations of psychosis.
NEGATIVE SYMPTOMS

REORIENT
SPEAK TO THE CLIENT IN SIMPLE DIRECT AND CONCISE
MANNER
SET REALISTIC GOALS
EXPLAIN EVERYTHING THAT IS BEING DONE
DECREASE STIMULI
MONITOR FOR SUICIDE RISK
ENVIRONMENT
Provide safe environment
Limit stimuli
PSYCHOLOGICAL TTT

considered to be the loss or absence of normal traits or abilities

Behavior therapy

E.G. flat, blunted or constricted affect and emotion, poverty of

speech and lack of motivation

Social skills training

Self-monitoring
SOCIAL TTT

Symptoms
SOCIAL ISOLATION
CATATONIC BEHAVIOR
HALLUCINATIONS
INCOHERENCE (MARKED LOOSENESS OF ASSOCIATION)
ZERO/ LACK OF INTEREST, ENERGY AND INITIATIVE
OBVIOUS FAILURE TO ATTAIN EXPECTED LEVEL OF DEVT
PECULIAR BEHAVIOR
HYGIENE AND GROOMING IMPAIRED
RECURRENT ILLUSIONS AND UNUSUAL PERCEPTION
EXPERIENCES
EXACERBATIONS AND REMISSIONS ARE COMMON
NO ORGANIC FACTORS ACCOUNTS FOR THE SYMPTOMS
INABILITY TO RETURN TO BASELINE FUNCTIONING AFTER
RELAPSE
AFFECT IS INAPPROPRIATE
Nsg Dx: Abnormal thought process
BLOCKING: SUDDEN CESSATION OF A THOUGHT IN THE
MIDDLE OF A SENTENCE, UNABLE TO CONTINUE THE TRAIN
OF THOUGHT
CIRCUMSTANTIALITY: BEFORE GETTING TO THE POINT OF
ANSWERING A QUESTION, THE INDIVIDUAL GETS CAUGHT UP
IN COUNTLESS DETAILS AND EXPLANATIONS
CONFABULATION
LOOSENESS OF ASSOCIATION
NEOLOGISM
WORD SALAD
Interventions
ASSESS PHYSICAL NEEDS
SET LIMITS
MAINTAIN SAFETY
INITIATE ONE-ON-ONE INTERACTION & PROGRESS TO
SMALL GROUPS
SPEND TIME WITH CLIENTS
MONITOR FOR ALTERED THOUGHT PROCESS
MAINTAIN EGO BOUNDARIES, AVOID TOUCHING
LIMIT TIME OF INTERACTION
BE NEUTRAL
DO NOT MAKE PROMISES THAT CANT BE KEPT
ESTABLISH DAILY ROUTINES
DO NOT GO ALONG WITH THE CLIENTS DELUSIONS OR
HALLUCINATIONS
PROVIDE SIMPLE COMPLETE ACTIVITIES

Milieu therapy
Family therapy
Group therapy (long-term ttt)

Related psychotic disorders

SCHIZOAFFECTIVE DISORDER SCHIZ + MOOD DISORDER
(MANIA/ DEPRESSION)
BRIEF PSYCHOTIC DISORDER SUDDEN ONSET OF
PSYCHOTIC SYMPTOMS, LASTS LESS THAN 2 MOS AND
CLIENT RETURNS TO PREMORBID LEVEL OF FUNCTIONING
SCHIZOPHRENIFORM DISORDER SCHIZ SX LASTING
BETWEEN 1 MONTH AND <6MOS
DELUSIONAL DISORDER CHARACTERIZED BY PROMINENT,
NONBIZARRE DELUSIONS
PERSONALITY DISORDERS
CLUSTER A (ODD & ECCENTRIC)
paranoid, schizoid, schizotypal
CLUSTER B (BAD, DRAMATIC & ERRATIC)
antisocial, borderline, histrionic, narcissistic
CLUSTER C (ANXIOUS & FEARFUL)
avoidant, dependent, OCD
CLUSTER A: ODD & ECCENTRIC
PARANOID
chronic hostility projected to others; suspicious and
mistrusts people
Seen mostly in men
SCHIZOID
social detachment = loner & introvert
Restriction of emotions
Attention fixed on objects rather than people
Functions well in vocations

 SCHIZOTYPAL: INTERPERSONAL DEFICITS

Magical thinking, telepathy
Apparent in childhood or adolescence
Interventions for PARANOID D/O
ASSES FOR SUICIDE RISK
AVOID DIRECT EYE CONTACT
ESTABLISH TRUSTING RELATIONSHIP
PROMOTE INCREASED SELF-ESTEEM
REMAIN CALM, NONTHREATENING AND NONJUDGMENTAL
PROVIDE CONTINUITY OF CARE
RESPOND HONESTLY TO THE CLIENT
FOLLOW THRU ON COMMITMENTS
PROVIDE A DAILY SCHEDULE OF ACTIVITIES
GRADUALLY INTRODUCE CLIENT TO GROUPS
DO NOT ARGUE WITH DELUSIONS
USE CONCRETE, SPECIFIC WORDS
Do not be secretive with client
DO NOT WHISPER IN PRESENCE OF CLIENT
ASSURE THAT THE CLIENT WILL BE SAFE
PROVIDE OPPORTUNITY TO COMPLETE SMALL TASKS
MONITOR EATING, DRINKING, SLEEPING AND ELIMINATION
PATTERNS
LIMIT PHYSICAL CONTACT
MONITOR FOR AGITATION AND DECREASE STIMULI AS
NEEDED
CLUSTER B: ERRATIC, DRAMATIC, OR EMOTIONAL
ANTISOCIAL
Syn: sociopath, psychopathic & semantic d/o
Etiology:
Genetics interfere in the devt of positive interpersonal relationships
Brain damage or trauma
Low socioeconomic status
Faulty family relationships: neglect
Secondary gains
15-40 y.o.

SIGNS
Lack of remorse or indifference to persons hurt
Immediate gratification
Failure to accept social norms
Impulsivity

Theories
faulty separation from mother; parent and child are bound by guilt
Trauma at 18 mos (weakening of ego)
Unfulfilled need for intimacy
SIGNS
instability
Impulsivity: unpredictable gambling, shoplifting, sex & substance
abuse
hypersensitivity, self-destructive, profound mood shifts
unstable & intense relations
Disturbance in self concept
COMMON IN WOMEN
DEFENSES: DENIAL, PROJECTION, SPLITTING, PROJECTIVE
IDENTIFICATION
HISTRIONIC
Pattern of theatrical or overtly dramatic behavior
Signs
Discomfort when the client isnt the center of attention
Self-dramatization and exaggerated emotions
uses physical appearance, sexually seductive and provocative
behavior
Excessively impressionistic speech lacking in detail (labile
emotions)
Problems in dependence & helplessness
More frequent in women
NARCISSISTIC
Exaggerated or grandiose sense of self-importance
Develop early in childhood
Preoccupied with fantasies of unlimited success, power and
beauty
Signs
arrogance, need for admiration,
lack of empathy,
seductive, socially exploitative, manipulative
Occurs more in men
CLUSTER C: ANXIOUS OR FEARFUL
AVOIDANT
Sensitive to rejection, criticism, humiliation, disapproval, or shame
Interferes with participation in occupational activities, devt of
relationships, and take personal risks
social inhibition, longs for relationships
Anxiety, anger and depression are common
Social phobia may occur
Seen in 10% of clients in mental clinics

Aggressive behavior

Reckless behavior that disregards the safety of others

OBSESSIVE-COMPULSIVE

Consistent irresponsibility

DEPENDENT
Lacks confidence and unable to function in an independent role
Allows other persons to be responsible of their lives
Most frequent personality disorder in the mental health clinic
submissive behavior, low self-esteem, inadequate, helpless

Preoccupied with rules & regulations, overly concerned about

trivial detail, excessively devoted to their work
80-90% OF ALL CRIME IS COMMITTED BY ANTISOCIALS
(NIHM, 2000)

Depression is common
Men are more affected than women

BORDERLINE
Latent, ambulatory and abortive schizophrenics
Between moderate neurosis and frank psychosis but
quite stable

UNDER STUDY PERSONALITY D/O

PASSIVE-AGGRESSIVE: SULLEN AND ARGUMENTATIVE,
RESENTS OTHERS, RESISTS FULFILLING RESPONSIBILITIES,
COMPLAINS OF BEING UNAPPRECIATED

 DEPRESSIVE: GLOOMY, BROODING PESSIMISTIC, GUILTPRONE, HIGHLY CRITICAL OF SELF AND OTHERS, CHEERLESS.

TRANSVESTISM
PARAPHILIAS

Interventions
MAINTAIN SAFETY AGAINST SELF-DESTRUCTIVE
BEHAVIORS
ALLOW THE CLIENT TO MAKE CHOICES AND BE AS
INDEPENDENT AS POSSIBLE
ENCOURAGE THE CLIENT TO DISCUSS FEELINGS RATHER
THAN ACT THEM OUT
PROVIDE CONSISTENCY IN RESPONSE TO THE CLIENTS
ACTING OUT
DISCUSS EXPECTATIONS AND RESPONSIBILITIES WITH THE
CLIENT
INFORM THE CLIENT THAT HARM TO SELF, OTHERS, AND
PROPERTY IS UNACCEPTABLE
IDENTIFY SPLITTING BEHAVIOR
ASSIST THE CLIENT TO DEAL DIRECTLY WITH ANGER
DEVELOP A WRITTEN CONTRACT WITH THE CLIENT
ENCOURAGE THE CLIENT TO PARTICIPATE IN GROUP
ACTIVITIES, AND PRAISE NONMANIPULATIVE BEHAVIOR
SET AND MAINTAIN LIMITS
REMOVE THE CLIENT FROM GROUP SITUATIONS IN WHICH
ATTENTION-SEEKING BEHAVIORS OCCUR
PROVIDE REALISTIC PRAISE FOR POSITIVE BEHAVIORS IN
SOCIAL SITUATIONS
PSYCHOLOGICAL SEXUAL D/O
HYPOACTIVE SEXUAL DISORDER (ASEXUALITY)
SEXUAL AVERSION DISORDER (AVOIDANCE OF OR LACK OF
DESIRE FOR SEXUAL INTERCOURSE)
FEMALE SEXUAL AROUSAL D/O (FAILURE OF NORMAL
LUBRICATING AROUSAL RESPONSE)
MALE ERECTILE D/O
FEMALE ORGASMIC DISORDER
MALE ORGASMIC DISORDER
PREMATURE EJACULATION
VAGINISMUS
SECONDARY SEXUAL DYSFXN
PARAPHILIAS
GENDER IDENTITY D/O
PTSD DUE TO GENITAL MUTILATION OR CHILDHOOD
SEXUAL ABUSE
OTHER SEXUAL PROBLEMS
SEXUAL DISSATISFACTION (NON-SPECIFIC)
LACK OF SEXUAL DESIRE
ANORGASMIA
IMPOTENCE
STD
INFIDELITY
DELAY OR ABSENCE OF EJACULATION, DESPITE ADEQUATE
STIMULATION
INABILITY TO CONTROL TIMING OF EJACULATION
INABILITY TO RELAX VAGINAL MUSCLES ENOUGH TO ALLOW
INTERCOURSE
INADEQUATE VAGINAL LUBRICATION PRECEDING AND
DURING INTERCOURSE
BURNING PAIN ON THE VULVA OR IN THE VAGINA WITH
CONTACT TO THOSE AREAS
UNHAPPINESS OR CONFUSION RELATED TO SEXUAL
ORIENTATION
PERSISTENT SEXUAL AROUSAL SYNDROME
SEXUAL ADDICT
HYPERSEXUALITY
POST EJACULATORY GUILT SYNDROME, THE FEELING OF
GUILT AFTER THE MALE ORGASM
SEXUAL EXPRESSION
HETEROSEXUALITY
HOMOSEXUALITY
BISEXUALITY

EXHIBITIONISM: THE RECURRENT URGE OR BEHAVIOR TO

EXPOSE ONE'S GENITALS TO AN UNSUSPECTING PERSON.
FETISHISM: THE USE OF NON-SEXUAL OR NONLIVING
OBJECTS OR PART OF A PERSON'S BODY TO GAIN SEXUAL
EXCITEMENT. PARTIALISM REFERS TO FETISHES
SPECIFICALLY INVOLVING NONSEXUAL PARTS OF THE BODY.
FROTTEURISM: THE RECURRENT URGES OR BEHAVIOR OF
TOUCHING OR RUBBING AGAINST A NONCONSENTING
PERSON.
SEXUAL MASOCHISM: THE RECURRENT URGE OR
BEHAVIOR OF WANTING TO BE HUMILIATED, BEATEN, BOUND,
OR OTHERWISE MADE TO SUFFER.
SEXUAL SADISM: THE RECURRENT URGE OR BEHAVIOR
INVOLVING ACTS IN WHICH THE PAIN OR HUMILIATION OF THE
VICTIM IS SEXUALLY EXCITING.
TRANSVESTIC FETISHISM: A SEXUAL ATTRACTION
TOWARDS THE CLOTHING OF THE OPPOSITE GENDER.
PEDOPHILIA: THE SEXUAL ATTRACTION TO PREPUBESCENT
OR PERIPUBESCENT CHILDREN.
VOYEURISM: THE RECURRENT URGE OR BEHAVIOR TO
OBSERVE AN UNSUSPECTING PERSON WHO IS NAKED,
DISROBING OR ENGAGING IN SEXUAL ACTIVITIES, OR MAY
NOT BE SEXUAL IN NATURE AT ALL.
OTHER PARAPHILIAS NOT OTHERWISE SPECIFIED ("SEXUAL
DISORDER NOS")
telephone scatalogia (obscene phone calls)
necrophilia (corpses)
partialism (exclusive focus on one part of the body)
zoophilia(animals)
coprophilia (feces)
klismaphilia (enemas)
urophilia (urine)

SOMATOFORM D/O
SOMATIZATION D/O: HX OF MANY PHYSICAL COMPLAINTS
BEGINNING BEFORE THE AGE OF 30 OCCURRING OVER A PD
OF SEVERAL YRS RESULTING IN TTT BEING SOUGHT OR
SIGNIFICANT OCCUPATIONAL OR SOCIAL FXNING.
CONVERSION D/O: 1 OR MORE SX OF DEFICITS AFFECTING
VOLUNTARY MOTOR OR SENSORY FUNCTION SUGGESTING A
NEUROLOGICAL OR GENERAL MEDICAL CONDITION;
PRECEDED BY CONFLICTS OR STRESSORS; CANT BE
EXPLAINED AND SANCTIONED BY CULTURAL BEHAVIOR.
Most common: blindness, deafness, paralysis, inability to talk
La belle indifference

 HYPOCHONDRIASIS: PREOCCUPATION WITH FEARS OF

HAVING, OR IDEAS THAT ONE HAS, A SERIOUS DSE BASED ON
THE PERSONS MISINTERPRETATION OF BODILY SX AND
PERSIST DESPITE APPROPRIATE MEDICAL EVAL AND
REASSURANCE AND HAS EXISTED FOR @ LEAST 6 MOS.
(E.G.:EXTENSIVE USE OF HOME REMEDIES)
PAIN D/O: PAIN IN 1 OR MORE ANATOMICAL SITES SEVERE
ENOUGH TO WARRANT CLINICAL ATTENTION AND CAUSES
CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN
FXNING.
INTERVENTIONS
DO NOT REINFORCE THE SICK ROLE
DISCOURAGE VERBALIZATION ABOUT PHYSICAL
SYMPTOMS BY NOT RESPONDING WITH POSITIVE
REINFORCEMENT
EXPLORE WITH THE CLIENT THE NEEDS BEING MET BY THE
PHYSICAL SYMPTOMS
CONVEY UNDERSTANDING THAT THE PHYSICAL SYMPTOMS
ARE REAL TO THE CLIENT
REPORT AND ASSESS ANY NEW PHYSICAL COMPLAINT
EATING DISORDER BEHAVIORS
BINGE: RAPID CONSUMPTION OF LARGE QUANTITIES OF
FOOD IN A DISCRETE PERIOD OF TIME. (A: HUNDRENDS
OF CAL; B: THOUSANDS OF CAL AT A SITTING)
PURGE: MALADAPTIVE EATING REGULATION RESPONSE
THAT INCLUDES EXCESSIVE EXERCISE, FORCED VOMITING,
OCD RX DIURETICS, DIET PILLS, LAXATIVES AND STEROIDS.
FAST/ RESTRICT: INCLUDES VEGETARIAN DIET ELIMINATING
ALL MEAT WITHOUT SUBSTITUTING NONANIMAL SOURCES OF
PROTEIN, OC ABOUT FOOD CHOICES, AND EATING HABITS.

ANOREXIA

BULIMIA

RARE VOMITING OR DIURETIC/LAXATIVE ABUSE

MORE SEVERE WT LOSS
SLIGHTLY YOUNGER
MORE INTROVERTED
HUNGER DENIED
EATING BEHAVIOR MAY BE CONSIDERED NORMAL AND A
SOURCE OF ESTEEM
SEXUALLY INACTIVE
OBSESSIONAL AND PERFECTIONIST FEATURES DOMINATE
FREQUENT
LESS WT LOSS
SLIGHTLY OLDER
MORE EXTROVERTED
HUNGER EXPERIENCED
EATING BEHAVIOR CONSIDERED FOREIGN AND SOURCE
OF DISTRESS
MORE SEXUALLY ACTIVE
AVOIDANT, DEPENDENT, OR BORDERLINE FEATURES AS
WELL AS OBSESSIONAL FEATURES
ANOREXIA
BULIMIA
complications
DEATH FROM STARVATION (OR SUICIDE, IN CHRONICALLY
ILL)
AMENORRHEA
FEWER BEHAVIORAL PROBLEMS (THESE INCREASE WITH
LEVEL OF SEVERITY)
DEATH FROM HYPOKALEMIA OR SUICIDE
MENSES IRREGULAR OR ABSENT
DRUG AND ALCOHOL ABUSE, SELF-MUTILATION, AND
OTHER BEHAVIORAL PROBLEMS
DELIRIUM

THE MEDICAL DX TERM THAT DESCRIBES AN ORGANIC

MENTAL DISORDER CHARACTERIZED BY A CLUSTER OF
COGNITIVE IMPAIRMENTS WITH AN ACUTE ONSET WITH A
SPECIFIC PRECIPITATING FACTOR.
SX: DIMINISHED AWARENESS OF THE ENVIRONMENT,
DISTURBANCES IN PSYCHOMOTOR ACTIVITY AND SLEEPWAKE CYCLE.
COGNITIVE: THE MENTAL PROCESS CHARACTERIZED BY
KNOWING, THINKING, AND JUDGING.
COGNITIVE DISSONANCE: arises when 2 opposing
beliefs exists at the same time.
COGNITIVE DISTORTIONS: (+) or (-) distortions of
reality that might include errors of logic, mistakes in reasoning, or
individualized view of the world that do not reflect reality.
Term: confusion = cognitive impairment
DEMENTIA
THE MEDICAL DX TERM THAT DESCRIBES AN ORGANIC
MENTAL D/O CHARACTERIZED BY A CLUSTER OF COGNITIVE
IMPAIRMENTS OF GENERALLY GRADUAL ONSET AND
IRREVERSIBLE WITHOUT IDENTIFIABLE PRECIPITATING
STRESSORS.
TYPES:
VASCULAR or MULTI-INFARCT
VASCULAR WITH ALZHEIMERS DSE
AD: most common
DEMENTIA WITH LEWY BODIES: 2nd most common;
neurofilament material
PARKINSONIAN DEMENTIA
AIDS DEMENTIA COMPLEX
FRONTAL LOBE DEMENTIA or PICKS DSE: cytoplasmic

collections; 3rd most common; loss of

expressive language & comprehension

CREUTZFELDT-JAKOB DSE: prion (proteinaceous infectious

particles) = spongy brain; related to TSE & BSE in mad cow dse
CORTICOBASAL DEGENERATION or HUNTINGTONS
DSE/CHOREA: jerky movts
SUPRANUCLEAR PALSY: clumping of protein tau = slow movt,
weak eye movt (esp. downward), impaired walking &balance
REVERSIBLE CAUSES:
Subdural hematoma
Tumor (meningioma)
Cerebral vasculitis
Hydrocephalus
TERMS: DISORIENTATION, MEMORY LOSS (SENSORY,
PRIMARY, SECONDARY, TERTIARY, WORKING MEMORY),
CONFABULATION, CONFUSION
DISTURBING BEHAVIORS
Aggressive psychomotor
Nonaggressive psychomotor
Verbally aggressive
Passive
Functionally impaired: loss of ability to do self-care

 PDD NOS
DELIRIUM
vs. DEMENTIA
RAPID ONSET W/ WIDE FLUCTUATIONS
HYPERALERT TO DIFFICULT TO AROUSE LOC
FLUCTUATING AFFECT
DISORIENTED, CONFUSED
ATTENTION & SLEEP DISTURBED
MEMORY IMPAIRED
DISORDERED REASONING
GRADUAL, CHRONIC WITH CONTINUOUS DECLINE
NORMAL LOC
LABILE AFFECT
DISORIENTED, CONFUSED ATTENTION INTACT, SLEEP
USUALLY NORMAL
MEMORY IMPAIRED
DISORDERED REASONING & CALCULATION
DELIRIUM
vs. DEMENTIA
INCOHERENT, CONFUSED, DELUSIONAL, STEREOTYPED
ILLUSIONS, HALLUCINATIONS
POOR JUDGMENT
INSIGHT MAY BE PRESENT IN LUCID MOMENT
POOR BUT VARIABLE IN MSE
DISORGANIZED, RICH IN CONTENT, DELUSIONAL,
PARANOID
NO CHANGE IN PERCEPTION
POOR JUDGMENT
NO INSIGHT
CONSISTENTLY POOR & PROGRESSIVELY WORSENS IN
MSE
ALZHEIMERS DEMENTIA
MOST COMMON TYPE OF DEMENTIA
STAGES:
MILD: impaired memory, insidious loses in ADL, subtle
personality changes, socially normal
MODERATE: obvious memory loss, overt ADL impairment,
prominent behavioral difficulties, variable social skills,
supervision needed
SEVERE: fragmented memory, no recognition of familiar
people, assistance needed with basic ADL, fewer troublesome
behaviors, reduced mobility (4 As)

LEARNING D/O
READING
MATHEMATICS
WRITTEN EXPRESSION
ACADEMIC PROBLEM
LEARNING D/O NOS

MOTOR SKILLS D/O

COMMUNICATION D/O
EXPRESSIVE LANGUAGE
MIXED RECEPTIVE/EXPRESSIVE
PHONOLOGICAL
STUTTERING
SELECTIVE MUTISM
COMMUNICATION D/O NOS
MOVT & TIC D/O
DEVTAL COORDINATION
TRANSIENT TIC

Symptoms
AGNOSIA: DIFFICULTY RECOGNIZING WELL-KNOWN
OBJECTS
APHASIA: DIFFICULTY IN FINDING THE RIGHT WORD
APRAXIA: INABILITY OR DIFFICULTY IN PERFORMING A
PURPOSEFUL ORGANIZED TASK OR SIMILAR SKILLED
ACTIVITIES
AMNESIA: SIGNIFICANT MEMORY IMPAIRMENT IN THE
ABSENCE OF CLOUDED CONSCIOUSNESS OR OTHER
COGNITIVE SYMPTOMS

CHRONIC MOTOR&VOCAL TIC

TOURETTES D/O
STEREOTYPIC MOVT D/O
TIC D/O NOS
DISORDERS OF INTAKE & ELIMINATION
PICA

PSYCHIATRIC D/O IN CHILDREN

RUMINATION

MENTAL RETARDATION

FEEDING D/O

PERVASIVE DEVTAL D/O

AUTISM
RETTS D/O
CHILDHOOD DISINTEGRATIVE D/O
ASPERGERS D/O

ENURESIS
ENCOPRESIS
OTHER: BULIMIA, ANOREXIA

RETTS D/O
ADHD & DISRUPTIVE BEHAVIOR D/O

DEVELOPMENT IS NORMAL UNTIL 6-18 MONTHS, WHEN

LANGUAGE AND MOTOR MILESTONES REGRESS,
PURPOSEFUL HAND USE IS LOST
ACQUIRED DECELERATION IN THE RATE OF HEAD GROWTH
(RESULTING IN MICROCEPHALY IN SOME)
HAND STEREOTYPES ARE TYPICAL AND BREATHING
IRREGULARITIES SUCH AS HYPERVENTILATION, BREATH
HOLDING, OR SIGHING ARE SEEN IN MANY.
EARLY ON, AUTISTIC-LIKE BEHAVIOR MAY BE SEEN
COMMON IN FEMALES
CHILDHOOD DISINTEGRATIVE D/O or HELLERS SYNDROME

ADHD
ADHD NOS
CONDUCT D/O
OPPOSITIONAL DEFIANT
CHILD ANTISOCIAL

CDD HAS SOME SIMILARITY TO AUTISM, BUT AN APPARENT

PERIOD OF FAIRLY NORMAL DEVELOPMENT IS OFTEN NOTED
BEFORE A REGRESSION IN SKILLS OR A SERIES OF
REGRESSIONS IN SKILLS.

DISRUPTIVE BEHAVIOR NOS

MOOD D/O
MJ DEPRESSIVE D/O

CHARACTERIZED BY LATE ONSET (>3 YEARS OF AGE) OF

DEVTAL DELAYS IN LANGUAGE, SOCIAL FUNCTION AND
MOTOR SKILLS; SKILLS APPARENTLY ATTAINED ARE LOST

BIPOLAR I OR II

ASPERGERS D/O

DYSTHYMIC

CHARACTERIZED BY DIFFERENCE IN LANGUAGE AND

COMMUNICATION SKILLS, AS WELL AS REPETITIVE OR
RESTRICTIVE PATTERNS OF THOUGHT AND BEHAVIOR.

MIXED EPISODE
HYPOMANIC EPISODE
MOOD D/O DUE TO MEDICAL CONDITION

SIGNS: UNABLE TO INTERPRET OR UNDERSTAND THE

DESIRES OR INTENTIONS OF OTHERS AND THEREBY ARE
UNABLE TO PREDICT WHAT TO EXPECT OF OTHERS OR WHAT
OTHERS MAY EXPECT OF THEM
Narrow interests or preoccupation with a subject to the exclusion
of other activities

SUBSTANCE-INDUCED MOOD D/O

Repetitive behaviors or rituals

ANXIETY D/O
Peculiarities in speech and language

D/O OF RELATIONSHIP

Extensive logical/technical patterns of thought

SEPARATION ANXIETY
REACTIVE ATTACHMENT OF INFANCY OR EARLY
CHILDHOOD

Socially and emotionally inappropriate behavior and interpersonal

interaction
Problems with nonverbal communication

PARENT-CHILD RELATIONAL PROBLEM

Clumsy and uncoordinated motor movts

SIBLING RELATIONAL PROBLEM

PROBLEMS RELATED TO ABUSE OR NEGLECT

CHRONIC MOTOR/ VOCAL TIC

MENTAL RETARDATION
AN IQ BELOW 70, SIGNIFICANT LIMITATIONS IN TWO OR
MORE AREAS OF ADAPTIVE BEHAVIOR (I.E., ABILITY TO
FUNCTION AT AGE LEVEL IN AN ORDINARY ENVIRONMENT),
AND EVIDENCE THAT THE LIMITATIONS BECAME APPARENT IN
BEFORE 18 Y.O.
THE FOLLOWING RANGES, BASED ON THE WECHSLER
ADULT INTELLIGENCE SCALE (WAIS), ARE IN STANDARD USE
TODAY:
CLASS
PROFOUND
SEVERE
MODERATE
MILD
BORDERLINE

IQ
BELOW 20
2034
3549
5069
7079

TERMS
IDIOT
IMBECILE
MORON

TIC IS A SUDDEN, REPETITIVE, STEREOTYPED,

NONRHYTHMIC, INVOLUNTARY MOVEMENT (MOTOR TIC) OR
SOUND (PHONIC TIC) THAT INVOLVES DISCRETE GROUPS OF
MUSCLES.
CAN BE INVISIBLE TO THE OBSERVER (E.G. ABDOMINAL
TENSING OR TOE CRUNCHING)
TOURETTES D/O
CHARACTERIZED BY THE PRESENCE OF MULTIPLE
PHYSICAL (MOTOR) TICS AND AT LEAST ONE VOCAL (PHONIC)
TIC; THESE TICS CHARACTERISTICALLY WAX AND WANE
TTT: NEUROLEPTIC MEDICATIONS
haloperidol (Haldol)
pimozide (Orap)

ADHD
INATTENTION:
FAILURE TO PAY CLOSE ATTENTION TO DETAILS OR
MAKING CARELESS MISTAKES WHEN DOING SCHOOLWORK
OR OTHER ACTIVITIES
TROUBLE KEEPING ATTENTION FOCUSED DURING PLAY
OR TASKS
APPEARING NOT TO LISTEN WHEN SPOKEN TO
FAILURE TO FOLLOW INSTRUCTIONS OR FINISH TASKS
AVOIDING TASKS THAT REQUIRE A HIGH AMOUNT OF
MENTAL EFFORT AND ORGANIZATION, SUCH AS SCHOOL
PROJECTS
FREQUENTLY LOSING ITEMS REQUIRED TO FACILITATE
TASKS OR ACTIVITIES, SUCH AS SCHOOL SUPPLIES
EXCESSIVE DISTRACTIBILITY
FORGETFULNESS
PROCRASTINATION, INABILITY TO BEGIN AN ACTIVITY
DIFFICULTIES WITH HOUSEHOLD ACTIVITIES (CLEANING,
PAYING BILLS, ETC.)
DIFFICULTY FALLING ASLEEP, MAY BE DUE TO TOO MANY
THOUGHTS AT NIGHT
FREQUENT EMOTIONAL OUTBURSTS
EASILY FRUSTRATED
EASILY DISTRACTED
HYPERACTIVITY-IMPULSIVE BEHAVIOUR
FIDGETING WITH HANDS OR FEET OR SQUIRMING IN SEAT
LEAVING SEAT OFTEN, EVEN WHEN INAPPROPRIATE
RUNNING OR CLIMBING AT INAPPROPRIATE TIMES
DIFFICULTY IN QUIET PLAY
FREQUENTLY FEELING RESTLESS
EXCESSIVE SPEECH
ANSWERING A QUESTION BEFORE THE SPEAKER HAS
FINISHED
FAILURE TO AWAIT ONE'S TURN
INTERRUPTING THE ACTIVITIES OF OTHERS AT
INAPPROPRIATE TIMES
IMPULSIVE SPENDING, LEADING TO FINANCIAL
DIFFICULTIES
FREQUENTLY PRESCRIBED STIMULANTS
ARE METHYLPHENIDATE (RITALIN AND CONCERTA),
AMPHETAMINES (ADDERALL) AND DEXTROAMPHETAMINES
(DEXEDRINE)
FEINGOLD DIET WHICH INVOLVES REMOVING SALICYLATES,
ARTIFICIAL COLORS AND FLAVORS, AND CERTAIN SYNTHETIC
PRESERVATIVES FROM CHILDREN'S DIETS.
CONDUCT D/O
REPETITIVE AND PERSISTENT PATTERN OF BEHAVIOR IN
WHICH THE BASIC RIGHTS OF OTHERS OR MAJOR AGEAPPROPRIATE SOCIETAL NORMS OR RULES ARE VIOLATED,

Beginning before age 13

OPPOSITIONAL DEFIANT
CHARACTERIZED BY AN ONGOING PATTERN OF
DISOBEDIENT, HOSTILE, AND DEFIANT BEHAVIOR TOWARD
AUTHORITY FIGURES THAT GOES BEYOND THE BOUNDS OF
NORMAL CHILDHOOD BEHAVIOR
SIGNS
Losing temper
Arguing with adults
Refusing to follow the rules
Deliberately annoying people
Blaming others
Easily annoyed
Angry and resentful
Spiteful or even revengeful

SUBSTANCE ABUSE
EXCESSIVE OR UNHEALTHY USE OF SUBSTANCES, SUCH
AS ALCOHOL, TOBACCO OR DRUGS, OR USE OF PRODUCTS
SUCH AS FOOD
TERMS:
TOLERANCE: the declining effect of the same drug dose when it
is taken repeatedly over time
HABITUATION: a psychological dependence of the use of a drug
ADDICTION: the biological and/ or psychological behaviors
related to substance dependence
WITHDRAWAL SYMPTOMS: result from a biological need that
develops when the body becomes adapted to having an addictive
drug in the system; occurs when serum levels decrease
ADDICTION
ALCOHOL: BLOOD ALCOHOL LEVELS OF 0.1% (100MG
ALCOHOL/DL OF BLOOD) OR HIGHER

AGGRESSION TO PEOPLE & ANIMALS

WITHDRAWAL
DESTRUCTION OF PROPERTY
DECEITFULNESS OR THEFT
SERIOUS VIOLATIONS OF RULES

Anorexia

Anxiety

Easily startled

Hyperalertness

HPN

Insomnia

Irritability

Jerky movt

Possibly: hallucinations, illusions or vivid nightmares

Seizures (7-48 hrs after cessation)
Tachycardia

tremors

WITHDRAWAL DELIRIUM

 Agitation

Anorexia

ELDERLY ABUSE

Anxiety

Delirium

Fever (100 to 103 F)

A VARIETY OF BEHAVIORS THAT THREATEN THE HEALTH,

COMFORT, AND POSSIBLY THE LIVES OF THE ELDERLY,
INCLUDING PHYSICAL AND EMOTIONAL NEGLECT, EMOTIONAL
ABUSE, VIOLATION OF PERSONAL RIGHTS, FINANCIAL ABUSE,
AND DIRECT PHYSICAL ABUSE.

Hallucinations and delusions

COMMONLY COMMITTED BY CARE GIVERS.

Diaphoresis
Disorientation with fluctuating levels of consciousness

Insomnia

Tachycardia and HPN

SEXUAL ABUSE
COMPONENTS

Disulfiram (Antabuse) therapy

Sexual Misuse: inappropriate sexual activity

Nursing care
OBTAIN INFO ABOUT DRUG TYPE AND AMOUNT CONSUMED
ASSESS V/S
REMOVE UNNECSSARY OBJ FROM ENVIRONMENT
PROVIDE ONE-ON-ONE SUPERVISION IF NECESSARY
PROVIDE A QUIET, CALM ENVIRONMENT WITH MINIMAL
STIMULI
MAINTAIN ORIENTATION
ENSURE SAFETY
USE RESTRAINTS
PROVIDE PHYSICAL NEEDS
PROVIDE FOOD AND FLUIDS AS TOLERATED
ADMINISTER MEDICATIONS
COLLECT BLOOD AND URINE SAMPLES FOR DRUG
SCREENING

Rape: there is actual penetration

SPOUSE ABUSE
BATTERING PRECIPITATES 1:4 SUICIDE ATTEMPTS OF ALL
WOMEN
WIVES EXPLAIN THE INJURIES AS BEING SELF-INFLICTED
OR ACCIDENTAL
PHASES
Tension-building: series of small incidents that leads to beating

Incest: refers to the relationship between the victim and abuser

blood relative or step parent role
INTERVENTIONS
Children: thru play or role playing with puppets
Prevention of further sexual abuse

COMPLETED SUICIDE
SELF-INFLICTED DEATH
LEVELS OF SUICIDE
Ideation: thought
Attempt: acted upon but failed
Completed

Acute beating phase: wife becomes object of assault behavior

CHEMICAL RESTRAINT
Loving phase: batterer is remorseful and assures spouse that he
will not harm her again. This leads to reconciliation.
MYTHS
They believe that if they try not to antagonize with their husband,
he will change.
Efforts to coerce the wife out of the victim role can be fruitful.
FACTS
Women stay in relationships with men who batter because they
feel guilty or responsible of the husbands behavior
Wife develops little sense of self-worth, immobilized and unable
to remove self from the relationship.
ASSESSMENT: INJURIES, OTHER EVIDENCE
INTERVENTIONS: WITH CONSENT
CHILD ABUSE
PHYSICAL BATTERING
EMOTIONAL
SEXUAL
NEGLECT

CHEMICAL RESTRAINTS: MEDICATIONS USED TO RESTRICT

THE PATIENTS FREEDOM OF MOVEMENT OR FOR
EMERGENCY CONTROL OF BEHAVIOR BUT ARE NOT A
STANDARD TREATMENT FOR THE PXS MEDICAL OR
PSYCHIATRIC CONDITION.
PHYSICAL RESTRAINTS: ARE ANY MANUAL METHOD OR
PHYSICAL OR MECHANICAL DEVICE ATTACHED TO OR
ADJACENT TO THE PXS BODY THAT HE OR SHE CANNOT
EASILY REMOVE AND THAT RESTRICTS FREEDOM OF
MOVEMENT OR NORMAL ACCESS TO ONES BODY, MATERIAL
OR EQUIPMENT.
SECLUTION AND RESTRAINTS
SECLUTION: THE INVOLUNTARY CONFINEMENT OF A
PERSON ALONE IN A ROOM FROM WHICH THE PERSON IS
PHYSICALLY PREVENTED FROM LEAVING.
No therapeutic evidence other than a last resort to ensure safety.
Evidence suggest that it adds to further trauma and physical harm
GUIDELINES
All hospital staff who have direct contact with the px should have
ongoing education and training in the proper use of seclusion and
restraints and other alternatives

 Physician or licensed practitioner should evaluate need within 1

hour after the initiation of this intervention.

TRANSFERENCE
COUNTERTRANSFERENCE

Max of 4 hours for adults, 2 hours for ages 9-17, and 1 hour for
children under 9 yrs

BOUNDARY VIOLATIONS

Orders may be renewed for 24 hrs before another face to face

evaluation

RESISTANCE

Continuous assessment, monitoring and evaluation; recorded

Good nursing care
For both restrained and secluded: constant monitoring face to
face or by both audio and video equipment.

RELUCTANCE OR AVOIDANCE OF VERBALIZING OR

EXPERIENCING TROUBLING ASPECTS OF ONESELF
EG: SUPPRESSION OR REPRESSION, INTENSIFICATION OF
SX, SELF-DEVALUATION OR HOPELESSNESS, INTELLECTUAL
INHIBITIONS, ACTING OUT OR IRRATIONAL BEHAVIOR,
SUPERFICIAL TALK, INTELLECTUAL INSIGHT/
INTELLECTUALIZATION, TRANSFERENCE REACTIONS.

Px should be released ASAP

TRANSFERENCE

OTHER GUIDELINES
SECLUSION

UNCONSCIOUS RESPONSE IN WHICH THE PX EXPERIENCES

FEELINGS AND ATTITUDES TOWARD THE NURSE THAT WERE
ORIGINALLY ASSOCIATATED WITH OTHER SIGNIFICANT
FIGURES IN HIS OR HER LIFE.

Room should allow observation and communication with px

HOSTILE TRANSFERENCE: anger and hostility, resistance

Remove all items that px might use to harm self

DEPENDENT TRANSFERENCE: submissive, subordinate and

regards the nurse as a god-like figure; views relationship as magical

Document: rationale, response to intervention, physical condition,

nsg care, & rationale for termination
RESTRAINTS
Give support & reassurance
Position in anatomical position
Privacy is important
v/s & Circulation check

What do you do?

LISTEN
CLARIFY
REFLECT
EXPLORE/ ANALYZE
COUNTERTRANSFERENCE
CREATED BY THE NURSES SPECIFIC EMOTIONAL
RESPONSE TO THE QUALITIES OF THE PATIENT;
INAPPROPRIATE IN THE CONTEXT, CONTENT AND INTENSITY
OF EMOTION; NURSES IDENTIFY THE PX WITH INDIVIDUALS
FROM THEIR PAST, AND PERSONAL NEEDS

Should be released q 2hrs

TYPES: REACTIONS OF INTENSE

Avoid tying to the side rails of bed

love or caring

Assist in periodic change in body positions

Disgust or hostility
Anxiety, often in response to resistance by the px

TERMINATING THE INTERVENTION

AS SOON AS MET THE CRITERIA FOR RELEASE
REVIEW WITH PX THE BEHAVIOR THAT PRECIPITATED THE
INTERVENTION & PXS CAPACITY TO EXERCISE CONTROL
OVER BEHAVIOR
DEBRIEFING: REVIEWING THE FACTS RELATED TO AN
EVENT & PROCESSING THE RESPONSE TO THEM; CAN BE
USED AFTER ANY STRESSFUL EVENT

EG.
Difficulty empathizing
Feelings of depression before or after the session
Carelessness about implementing the contract

THERAPEUTIC IMPASSES
ARE BLOCKS IN THE PROGRESS OF THE NURSE-PT
RELATIONSHIP
PROVOKES INTENSE FEELINGS IN BOTH THE NURSE AND
PATIENT
RESISTANCE

Drowsiness during the sessions

Encouragement of the pxs dependency
Arguments with the px
Personal or social involvement with the px

 Sexual or aggressive fantasies toward the px

Tendency to focus on only one aspect or way of looking at
information presented by the px
Attempts to help the px with matters not related to the identified
nursing problems

Feelings of anger or impatience because of the pxs

unwillingness to change
Dreams about or preoccupation with the px