Kubler Ross Stages of Grief

Denial, Anger, Bargaining, Depression, Acceptance

Engle Model of Normal Grief response:

Shock and disbelief, developing awareness, restitutions, resolving the loss, idealization,
outcome

Wardens 4 task of mourning

Accepting the loss, coping with the loss, altered, modifying, and changing environment to cope
with & accommodate absence of lost entity, resuming ones life having healthy connection to
loved one

Atypical psychotics have fewer eps symptoms than typical - Benadryl for EPS symptoms-
involving muscle movement, shuffled gait

AIMS- abnormal involuntary movement scale CIWA- assess risk of severity of alcohol
withdrawal

Dementia- slow progression over years- Decline in cognitive ability in the presence of clear
consciousness

Delirium-Difficulty sustaining and shifting attention, Instant sudden change, confused

aggressive- UTI? MEDS ( migraine. Uncontrolled pain, febrile illness, hypoxia, metabolic
disorders, seizures, hepatic/renal failure)

Stage 1: No Impairment. During this stage, Alzheimer's is not detectable and

no memory problems or other symptoms of dementia are evident.

Stage 2: Very Mild Decline. … Stage 3: Mild Decline. … Stage 4: Moderate Decline. … Stage 5: Moderately Severe Decline. ...

Stage 6: Severe Decline. … Stages 7: Very Severe Decline. ***——Sundown- aggressiveness after dust p372

https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_194823.pdf

With older patient be aware of poly pharmacy, Smoking is bad for everyone, With an Alzeheimer PT its is always good to provide comfort, safety, and

Borderline Personality disorder- All good or all bad , love attention! Staff splitting (sexually abused, don’t attach to parent in childhood), self harm, very needy, impulsive -DBT

Antisocial Personality – focus on themselves, devalue others, strong idea of self

Narcissistic- all about them selves “ted Bundy”, negative relationship with mom

Depression – Compassion , consideration

Schizotypal- ideas of reference , paranoid, odd thinking and speech, eccentric, inappropriate affect

a person having a belief or perception that irrelevant, unrelated or innocuous things in the world are referring to them directly or have special personal significance

Schizoid- isolation , not involved , not intimacy, flat affect, cold aloft, indifferent to others, don’t desire/enjoy close relationships

Paranoid – very suspicious, lack of trust in others, preoccupied with unjustified thoughts. 5mg zyprexa..

Histrionic Personal disorder- colorful, dramatic, extroverted behavior – very sexual, manipulative

Dependent – ask questions for permission, difficult to express disagreement

OCD- overly disciplined, perfectionistic, preoccupied with rules

Aphasia- loss of ability to understand or express speech.uses pictures to express self Apraxia- inability to perform particular purposive actions/autism unable to tie shoes

Extrapyramidal Side Effects

(See Table 4–13 for differences between typical and atypical antipsychotics.) To conduct a thorough assessment, the nurse must be familiar with the several distinct types of extrapyramidal side effects:

   Pseudoparkinsonism: Symptoms of pseudoparkinsonism—tremor, shuffling gait, drooling, rigidity—may appear 1 to 5 days following initiation of antipsychotic medication. This side effect occurs most often in
women, the elderly, and dehydrated clients.

   Akinesia: Absence or impairment in voluntary movement.

   Akathisia: Continuous restlessness and fidgeting, or akathisia, occurs most often in women and may manifest 50 to 60 days after therapy begins. Combining second generation antipsychotics has demonstrated a
three-fold risk for developing akathisia as compared to monotherapy with a single second generation antipsychotic (Berna et al., 2015)

   Dystonia: This side effect—involuntary muscle spasms in the face, arms, legs, and neck—occurs most often in men and those younger than age 25. Dystonia should be treated as an emergency situation because
laryngospasm follows these symptoms and can be fatal. The physician should be contacted, and intravenous or intramuscular benztropine mesylate (Cogentin) is commonly administered (see Table 4–13 for a list of
antiparkinsonian agents used to treat extrapyramidal symptoms). Stay with the client and offer reassurance and support during this frightening time.

   Oculogyric crisis: Uncontrolled rolling back of the eyes, or oculogyric crisis, is a symptom of acute dystonia and can be mistaken for seizure activity. As with other symptoms of acute dystonia, this side effect should
be treated as a medical emergency.

   Tardive dyskinesia: This extrapyramidal side effect involves bizarre face and tongue movements, stiff neck, and difficulty swallowing. It may occur with all classifications but most commonly takes place with typical
antipsychotics. All clients receiving antipsychotic therapy for months or years are at risk. Symptoms are potentially irreversible. Nurses should immediately report to the prescribing physician or nurse practitioner
earliest signs of tardive dyskinesia (usually vermiform movements of the tongue) as the drug is often discontinued, changed to a different antipsychotic, or the dosage is altered.
SSRI- Antidepressants , anxiety, ocd

Block reabsorption of serotonin/increase

serotonin

Zoloft- improve concentration social function

(Celexa, lexapro, Luvox, Paxil, Prozac, Zoloft)

Typical antipsychotic – blocks dopamine, more

eps

(Haldol, prolixin, Thorazine )

Atypical antipsychotics-blocks serotonin

dopamine noradrenaline, less eps

(Abilify, geodon, clozaril, risperal, seroquel,

zyprexa) mesolimbic, cortical

Benzodiazepines- AntiAnixiety/tranquilizers

Sedativexslow down body function by increasing

gaba

Librium &Dilantin- long lasting

(Ativan, Valium, Xanax, klonopin)

CNS depressant- Valium

Bipolar-Vraylar

Unruly pt-Haldol

Sleep assistance, abating aggression -seroquel

Antabuse used with ciwa pt,