The Royal Pentagon Review Specialist, Inc .
Beliefs
Feelings
Psychiatric Nursing
Behavior
Therapeutic Communication Techniques • What you see, you say • What you hear, you say restating Sigmund Freud • Father of Psychoanalysis • Structure of Personality (Id, ( Id, Ego, Superego) Superego )
D mpulsive want to want PLEASURE
eat drink urinate defecate
I
Dominant ID Mania Antisocial Narcissistic S
PLEASURABLE PRINCIPLE Pain Avoidance It’s all “I”
UPER EGO hould not mall voice of God
DOMINANT SUPER EGO Obsessive - compulsive Anorexia Nervosa I
CONSCIENCE PRINCIPLE
GO Xecutive Secretary
Impaired Reality Schizophrenia
REALITY PRINCIPLE LIBIDO
sexual energy responsible for survival
PSYCHOSEXUAL THEORY 1. ORAL RAL STA STAGE • 0 – 18 Months old • Survival • I want to eat, sleep, urinate, defecate
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
S
The Royal Pentagon Review Specialist, Inc .
• •
Psychiatric Nursing
ID formation Cry & Suck mouth Child Cries Feed the Infant ↓ Successful
Ignore the Infant ↓ Unsuccessful ↓ Narcissistic
Defense Mechanism: o FIXATION when a person is stuck in a certain developmental stage o REGRESSION return to an earlier developmental stage •
EGO is develop in the 6 th month
2. ANAL NAL ST STAGE • Ateen – 3 years old (18 mos – 3 y.o.) • Toilet training • Super Ego develop Toilet Training Good Mother ↓ Successful
Bad Mother ↓ Unsuccessful
SE
BIG SE
Too Rigid Training ↓ Clean Organized Obedient ↓ OBSESSIVE – COMPULSSIVE (Anal Retentive)
Dirty Disorganized Disobedient ↓ ANTISOCIAL (Anal Expulsive)
Small SE
3. PHALLIC • 3 – 6 y.o. • Penis/ Vagina • Parents is the significant person
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
•
Called as Preschooler
• • •
Oedipus Complex little boy loves mommy Electra Complex little girl loves daddy Identification boy associates with daddy, girl assoc. with mommy Castration fear of the little boy to daddy Penis Envy envy of little girl towards daddy
• •
Dr. Karen Horney
opposition to penis envy
•
Level of Awareness Conscious highest level of awareness o Preconscious Tip of the tongue o Unconscious deepest level of awareness o
• •
Birth Trauma First traumatic experience of child REPRESSION unconscious forgetting of an anxiety provoking concept SUPRESSION conscious forgetting of an anxiety provoking concept
•
4. LATEN LATENCY CY STA STAGE • 6 – 12 years old • SCHOOlatency • Sexual energy is dormant • Reading, Riting, Rithmetic •
SUBLIMATION placing sexual energies toward a more productive endeavors
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
5. GENIT GENITA AL STA STAGE • 12 y. o. – above • Gising • Genital PHARMA MOMENTS
ANTIANXIETY VLAST ME VAIB Valium – ate V Miltown - Meal Libreum - L Equanil – Aqua Kneel Ativan tivan - Ate Ate Guy Seraks – Sera Ulo Tranxene - Transit
Vistaril - largavista Attarax – Mga bato (rocks) Inderal – hindi ralph Busfar – sasakay ng bus
ERIK ERIKSON • PSYCHOSOCIAL THEORY OF DEVELOPMENT + Age 0-18 mos. 18 mos. – 3 y.o.
3 – 6 y.o. 6 – 12 y.o. 12 – 20 y.o. 20 – 25 y.o. 25 – 45 y.o. 45 y.o. and above
Trust Autonomy AU nal TO ilet training NO favorite word MY Initiative Industry Identity Intimacy Generativity Ego Integrity
Mistrust Shame/ doubt
Guilt Inferiority Role confusion Isolation Stagnation Despair
Affecting Major Factor Feeding Toilet Training
Independence In da-school Peer Love Parenting Reflection
MASLOW’S HEIRARCHY OF NEEDS
1. Phys Physio iolo log gic Nee Needs ds o Air, Air, food, food, water water,, shelt shelter er,, rest, rest, sleep sleep,, activ activity ity and and temp tempera eratur ture e maintenance that are crucial for survival 2. Safet Safety y and and Secur Security ity Nee Needs ds Safe in physical and psychological aspects o 3. Love Love and and Belon Belongi ging ng Nee Needs ds o Givi Giving ng and and rece receiv ivin ing g affe affect ctio ion, n, atta attain inin ing g a plac place e in a grou group, p, maintaining the feeling of belonging
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
4. Self Self – est estee eem m Need Needs s o Self Self estee esteem m – feelin feelings gs of indepe independ nden ence, ce, comp compete etenc nce e and self self respect Esteem from others – recognition, respect, appreciation o 5. Self Self Actu Actual aliz izat atio ion n One’s maximum potential and realize one’s abilities and qualities o BEHAVIORAL MODELS 1. Iva Ivan Pa Pavlo vlov • Classical Conditioning Model • All behavior are learned Food dog Salivation Bell Food Dog Salivation Bell Salivation 2. B.F B.F. Skin Skinne ner r • Operant Conditioning • All behaviors are unlearned • Reward (+ reinforcement) and Punishment (Reinforcement) BRAIN LOBES ACTION Frontal Language, Learning, Personality, Judgment Temporal hearing, smelling Parietal Taste, touch Occipital Vision Sensory Integration
Voluntary Motor Involuntary
VOLUNTARY NERVOUS SYSTEM • Somatic Nervous System AcetylCholine ↓ Brain Spinal Cord Motor Nerve Muscle Fiber INVOLUNTARY NERVOUS SYSTEM • Autonomic Nervous System Symp Sympat athe heti tic c HR ↑ RR ↑ GI ↓ Constipation GU ↓
Jomar Anthony D. Maxion, BSN, RN
Para Parasy symp mpat athe heti tic c ↓ ↓ ↑ Diarrhea ↑
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Urinary retention Epi/ Nor
Neuro
Psychiatric Nursing
Urinary Frequency Acetyl Choline
PHARMA MOMENTS
MONOAMINE OXIDASE INHIBITORS AR
M N P
PLAN DIL NATE
ANTIPARKINSON CAPABLES
Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetryl THERAPEUTIC COMMUNICATION • • • •
• •
•
Therapeutic Offer your self I’ll stay with you Silence Making observations o You seem sad Active listening Nodding o Eye contact o Lean forward o Who, what, when, where General leads o Go on, I’m listening, what else? Broad opening - best Opening line
Jomar Anthony D. Maxion, BSN, RN
• • • • •
• • • • • •
Non-Therapeutic Don’t worry be happy Everything’s gonna be alright Ignoring the client Changing the subject Nice weather we’re having Adjectives – value o based perception, should not be use You are the most beautiful client Why Arguing Flattery You should do this now In my opinion
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
How are you today? o How are you? • Restating • Clarrification • Refocusing we are talking about the exam • Focusing tell me about DEFENSE MECHANISMS Fight for stress DISPLACEMENT • Transfer of feelings to a less threatening object rather than the one who provoke it o
DENIAL
•
DISSOCIATION REGRESSION
• • •
REPRESSION
•
RATIONALIZATION
• •
REACTION FORMATION
• •
UNDOING
•
IDENTIFICATION
• •
PROJECTION
•
INTROJECTION
• •
SUPPRESSION
• •
SUBLIMATION
•
•
Failure to acknowledge an unacceptable trait or situation Psychological flight from self A type of amnesia Return to an earlier developmental stage Unconscious forgetting of an anxiety provoking concept Illogical reasoning for a socially unacceptable trait “sayang ang beer sa ref, kaya ko ininum” doing the opposite of your intention plastic
•
Doing the opposite of what you have done due to guilt orocan, plastic, Tupperware Assume trait for personal, social, occupational role Attributing to others one’s acceptable trait Pasa load Assume another person’s trait as your own
•
Conscious forgetting of an anxiety provoking concept Placing sexual energies toward a more productive endeavors
Jomar Anthony D. Maxion, BSN, RN
• • • •
•
• •
Boss shouts at you, you shout at your subordinate “I’m not an alcoholic” “Sino ka, Sino ako?” Return to thumbsucking Hindi ko maalala I drink because I don’t want to waste the beer in the ref sasabunutan kita. . . ay kuklulutin lang kita “ay pinatid kita, halika punta kita sa clinic” Tulad niya “hindi ako alcoholic, sila yon”
• •
“ako din” Not just you, me too • Hindi ko alam yan • Angry at life, put anger in singing
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
CONVERSION
•
COMPENSATION
•
SUBSTITUTION
•
Psychiatric Nursing
Repressed angers put towards physical symptoms affecting nervous system leading to sensory numbness and motor paralysis Overachievement in one area to cover a defective part
•
Biglang mangingig
•
Replacing a difficult goal with a more accessible one
•
Pilay pero magaling kumanta Gusto ko Disneyland. Enchanted nalang.
STOP GABA Inhibitory Gamma Amino Butyric Acid GO Epinephrine/ Norepinephrine Exitatory
SNS ANXI NXIETY
Anti nticholi holine nerrgic gic side effe ffect Constipation Urinary Retention Dry Mouth Blurred Vision
Within 1 week Rebound phenomenon Seizure Abrupt
Anti-Anxiety
Dependence Withdrawal Drowsy No Alcohol No Coffee Develop Orthostatic Hypotension Prevetion of O.H. 1. Sit Down 2. Dangle feet 3. Stand Up Gradually
Gradually Tapered Dose
RELAXED
ANXIETY •
Vague sense of impending doom
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Mild Moderate +1 +2 Widened acing Perceptual Field RN Meds Restless Enhanced Learning Capacity “You Seem Restless “
Severe +3 ont know what to say/do IRECTIVE
Psychiatric Nursing
Panic +4 uicide afety Don’t touch client Respi Alkalosis Bown Bag
Assess Nx Dx
: Level of Anxiety : Ineffective Individual Coping Powerlessness Impaired Skin Integrity Planning/ Implementation: ↓ level of anxiety ↓ environmental Stimuli Relaxation Technique • Showing pictures of flower, waterfalls • Hearing sounds of chirping birds Evaluation : Effective individual coping
ENERALIZED ANXIETY DISORDER months excessive worrying • Might be mild, moderate and severe anxiety S/Sx • Restless • Difficulty of concentration • Sleep Disorders • Palpitations • Edge of the seat • Easy fatigability
PANIC DISORDER • •
15 – 30 Minutes escalation of SNS AGORAPHOBIA fear of open space/ public places
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
•
SOCIAL PHOBIA
Psychiatric Nursing
fear of public
POST TRAUMA TR AUMATIC TIC STRESS DISORDER Trauma Disaster Accident War Rape Earthquake Soldier
Flashbacks VICTIMS
Survivors Nightmares
↑ Anxiety ↓ “I am sick” ↓
6 years old ↓ Assignments/ Homeworks ↓ No Assi Assign gnme ment nts/ s/ Homeworks ↓ You Think “Teacher may get angry”
SOMATOFORM > no pretension > no organic basis
MALINGERING pret preten endi ding ng to be sick sick (Conscious) ↓ Absent
Escape from Teacher PRIMARY GAIN (Behavior ↓ (Behavior ↓ anxiety)
> unconscious PSYCHOSOMATIC > Real pains/ illness > Real symptoms > 4 major types * Hypertension * Migraine * Stress Ulcer * Asthma
Mama Care ↓ ↑ Attention SECONDARY GAIN
SOMATOFORM DISORDERS SOMATOFORM Nervous System
Jomar Anthony D. Maxion, BSN, RN
Illusion of structural defect
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
CONVERSION DISORDER La Belle Indifference emotional disattachment from disability
Psychiatric Nursing BODY DYSMHORPIC DISORDER
Minor Discomfort Interpreted as major illness HYPOCHONDRIASIS “Maliit na butas, pinalalaki” Favorite Past Time: Doctor Hopping Nursing Focus: Feelings
PSYCHOSOMATIC DISORDERS ↑ Anxiety SNS ↑BP ↓ Hypertension
PNS ↓ Vasoconstriction Bronchoconstriction ↓ Cerebral Artery Left Gastric Artery Asthma ↓ ↓ Migraine Stress Ulcer
OBSESSIVE – COMPULSIVE Belief/ thought Door Open Burglar may go inside
→
Feelings ↑ Anxiety
Obsession → ↑ anxiety (thought) ↓ Returns to house (Action) ↓ Anxiety ← Compulsion
PHOBIA • •
Irrational fears Etiology Knowledge o
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
Experience Immediate Nursing Intervention remove the stimuli SYSTEMATIC SYSTEMATIC DESENSITIZATION DESENSITIZATION Gradual exposure to feared object o o
• •
PHARMA MOMENTS
ANTIPSYCHOTIC AGENT SSTTCMHP Stelazine - sexy star Serentil – serena Thorazine – babaeng Tora Trilafon - tri-band phone
Clozaril – closed reel Mellaril – maraming reel Haldol – hahaha Prolixin – pero lick scene
ALCOHOLISM Etiology: Intergenerational Transmission • From one generation to another generation
Alcohol ↓
Blackout awake but unaware ↓
Confabulation inventing stories to ↑ self-esteem ↓
Denial “I am not an alcoholic” Dependence “I can’t live without it” ↓
Enabling significant other tolerates abusers Another term CO – DEPENDENCY TOLERANCE
↑ Substance to achieve a previous effect
DETOXIFICATION • Withdrawal with MD supervision • Check Alcohol, Mouthwash, Elixer void alcohol version therapy lcoholics Anonymous
self help group
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
ntabuse
DISULFIRAM
B1 Vitamin Deficiency
Psychiatric Nursing
Never drink alcohol 12 hour interval/ 12 h last alcohol intake
or else: nausea, vomiting and hypotension Wernicke’s Encephalopathy → motor
Complications Korsakoff’s Psychosis → memory
Delirium Tremens 24 – 72 h after last dose of alcohol untreated withdrawal syndrome ormocation bugs crawling under the skin amily Therapy mother, father, brother
AUTISM Autistic Savant
autistic with a special talent
Assess • Appearance flat affect, consistent movement • Behavior repetitive, ritualistic • Communication echolalia, incomprehensible Nx Dx • Impaired verbal communication • Impaired social interaction • Self mutilation • Risk for injury Planning/ Implementation • Maslow’s hierarchy of needs • Constancy, promote safety Evaluation • Expressive therapy drawing, muscic etc • Enhanced communication • Improved social interaction • Safety
ATTENTION DEFICIT HYPERACTIVE DISORDER • • • •
Onset Duration Settings Id Domin Dominant ant
: 7 y.o. and below : 6 months and above : 2 House and school : Mom or RN RN will will act as super superego ego
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
ADHD → ↓ Glucose → Frontal Lobe → impaired judgement → ↑ ADHD S/Sx → Ritalin Frontal Lobe → ↑ Judgement → ↓ ADHD S/Sx (stimulant) Assess • Appearance dirty • Behavior clumsy, impatient, easily distracted, hyperactive • Communication talkative, blurts out in class
Nx Dx • Risk for injury • Impaired social interaction Planning/ Implementation tructure separate room for eating, playing, sleeping and etc chedule time for everything et limits afety Evaluation • Minimize Risk for Injury • Improved social interaction • Safety Residual ADHD grows up not antisocial Meds: Ritalin, dexedrin, pemoline, adderal Best time to give: once a day: AFTER MEALS: prevent lost of appetite Don’t give at bedtime STIMULANT causes insomnia Give 6 hours prior bedtime if bid
EATING DISORDERS 18 mos. – 3 y.o. ↓ Toilet Training ↓ Clean Obedient Organized Thought I Am Fat
6 y.o.
class valedictorian/ model student
↓ social inactive/ no BF ↓ weighing
Feeling ↓ Self Esteem
Jomar Anthony D. Maxion, BSN, RN
Behavior Diet, Diet, Diet
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Anorexia Nervosa Diet, diet, diet <85% of expected body 3 mos. ammenorhea Karen Carpenter
Psychiatric Nursing
Eating Disorders Eating Pattern Weight Menstruation
Bulimia Eat, eat, vomit Normal weight Irregular menstruation Dao Ming Xi Da Ming Sugat/ suka Vomiting Dental caries Wounded knuckles Metabolic alkalosis Metabolic acidosis
Vomiting Fluid Volume Deficit
ARRHYTHMIA (fatal complication)
Diarrhea Interventions • Restore fluid and electrolyte balance • Collaborative regarding menu contract • Target weight weig ht gain • After meals: stay 30 mins – 1 hour
PHARMA MOMENT
LITHIUM
Kidney
L evel 0.6 – 1.2 mEq/L Increase urination Tremors, fine hand Hydration 3 L/day Increase Uu diarhea Mouth, dry
ausea, vomiting, diarrhea Lithium Toxicity a+
ANTIPARKINSON ANTICHOLINERGIC ABC Artane Akineton Benadryl Cogentin
Jomar Anthony D. Maxion, BSN, RN
DOPAMINERGIC PLSE Parlodel Larodopa Symmetyl Eldepryl
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
SCHIZOPHRENIA • • • •
• •
Ego disintegration Impaired reality perception Genetic vulnerability Stress – Diathesis Model o Too much stress in the reality will lead client to escape it and go to the fantasy world Biological Theory Dopamine level is High o The exact cause is unknown
ffect appropriate, inappropriate, flat, blunt (incomplete emotion) mbivalence torn between 2 opposing forces utism ssociative Looseness Symptoms Negative Hypoactive Withdrawn Apathy
Positive Hyperactive Sociable Flight of Ideas Talkative
Assess : Content of Thought Nx Dx : Disturbed thought process Planning/ Implementation: • Present reality • Provide safety Evaluation : Improve thought process
Assess : Hallucination/ Illusions Nx Dx : Disturbed sensory perception Planning/ Implementation: • Present reality • Provide safety Evaluation : Improve sensory perception
Assess Nx Dx
: Suspicious : Risk for other directive behavior
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
Planning/ Implementation: • Present reality • Provide safety Evaluation : Eliminate/ minimize risk for other-directed violence
Assess : Suicidal Nx Dx : Risk for self directive behavior Planning/ Implementation: • Present reality • Provide safety Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness I am going to the mall.
I am going to the mall.
Where is the light? Go here. Mineral Water.
The mall is big. Big is the tree. The tree is tall.
Magical Thinking • Believes to have a magical power • I can turn you into a frog Echolalia I repeat what you say Parrots Echopraxia I repeat what you do Word Salad words, no rhyme Clang Association words with rhyme : Dunk, plank, sunk Neologism creation of new words Plinking, hustash • Clarification done in case of neologism Delusion: Persecutory NBI is out to get me/ someone will harm the client Religious I am Jesus Christ Grandeur I am the queen of the world. Ideas of reference Nurses are talking about me. Concrete Association pilosopo “what will you wear?” “clothes” Thought Blocking
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Stimulus Visual Auditory Tactile
Halucination s Absent X X X
Psychiatric Nursing
Illusion Present √ √ √
In case of hallucinations do:
Hallucinations Acknowledgment •
I know you the voices are real to you
Reality orientation •
But I don’t hear them
Diversion •
Lets go to the garden
But if nothing in the preceeding intervention are seen Assess what the voices are saying SCHIZOPRENIA
Disorganized •
• •
Sad but smiles o Inappropriate affect No reaction o Flat affect Flight of ideas o
• •
Catatonic • •
•
HEBEPHRENIC
Giggling Positive and
Jomar Anthony D. Maxion, BSN, RN
Ambivalence Waxy Flexibility o Iniwan na posture, ganun forever No – favorite word
Paranoid • •
Suspicious Tendency to be violent Mistrust→ Mistrust→Scared→ Scared→ Withdrawn Nrsg. Int: Develop trust • 1 to 1 • short interaction • frequent visit • foods in sealed container meds wrapped • for violent pt. • Doors open • Near the door • Don’t touch the pt. • Eye contact • 1 arms length away
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Normally Acetylch Acetylcholin oline e = ON
Psychiatric Nursing
Dopami Dopamine ne = OFF
classified differentiated Residual • •
•
Mixed classification Can’t be classified • 1st paranoid, then No more positive s/sx, just withdrawndisorganized then catatonic, etc etc
Your always ON Schizophrenia With parkinsON
High Dopamine=
Antipsychotics = makes Dopamine goes down
ON
Extrapyramidal Side Effects • AKATHISIA Restless, inability to sit o Makati siya, ahh kati siya o • AKINESIA Muscle rigidity o Ahh kiniss siya o • DYSTONIA o 3 features Anticholinergic TORTICOLLIS • Drugs that will make the • Wry neck AcH down OCULOGYRIC CRISIS o Artane • Fixed stare Akineton o OPISTHOTUNOS o Benadryl • Arched back o Cogentin • TARDIVE TARDIVE DYSKINESIA D YSKINESIA Irreversible side effects of o Dopaminergic antipsychotics • Dopamine goes up Parlodel o o Larodopa Jomar Anthony D. Maxion, BSN, RN College of Nursing Batch 2009 o Symmetryl o Eldepryl
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
Lip smacking Tongue protruding o o Cheeks puffing NEUROLEPTIC MALIGNANT SYNDROME Hyperthermia among client o taking antipsychotic Hyperthermia with muscle o rigidity o
•
Other Side Effects • Photosensitivity Sunscreen o o Wide brimmed hat • Agranulocytosis Report immediately Sore throat o st 1 sign to appear
PHARMAMOMENTS
ANTIDEPRESSANTS ANTSAAVE PPZ
Asendin – ascending Norpramin – sabaw ng knorr Tofranil – Tofu Sinequan – nood ng Sine Quan ang title Anafranil – kina Ana Praning Aventyl – kina Aven Til Midnight tayo Vivactil – Bye Back till next week Elavil – Eh love mo ba ako Prozac – Pero saka na Paxil - Taksil Zoloft – mag Solo ka BIPOLAR DISORDER – Mania more common • Female • 20 years old and above Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
• •
Psychiatric Nursing
Stressful life Obese ↓Self Actualization
TASK Caregiver Role Strain ↓Self Esteem Safety Impaired social interaction Safety
Risk for injury/ other directed violence ↓ Eating finger food
↓ Sleep Pr Private room
Hyperactive
↑ Sex Anxiety
Lithium – 2 – 4 weeks before effect
↓SE → ↑Compensation → ↑interfere ADLs, ↑ harm others ↑SE → ↓Compensation → ↓interfere ADLs, ↓ harm others TASK → increases client’s self esteem • • •
Gross motor skills via sublimation Escorted walk outdoors Punching bag
No group games
compition will increase anxiety
3 or more signs confirms disorder G F S P E E D
randiose light of ideas leeplessness ressured speech xagerated SE xtraneous stimuli (easily distracted) istractibility
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
PERSONALITY DISORDERS SCHIZOID • I don’t want people • Believes he can stand on his own • Never had a best friend • Avoid groups and social activities no enjoyment • Cares more about computers and pets AVOIDANT • I avoid people, I fear criticism • Have talent but no confidence ANTISOCIAL • I break the law as motto • As a child,: steal, lie, always get reprimanded • Adult – grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe sex, thrill seeker • Good talker, charmer, witty manipulator
BORDERLINE – my life is an emptyglass
Dependent • I can’t live without you • ↓ self esteem • poor decision making skills Histrionic • excited, dramatic but manipulative • center of attention
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
Narcissistic • I love myself • Insensitive, arrogant • I am the best Obsessive – Compulsive • I am organized • Perfectionist • Provide time to do rituals Paranoid • Suspicious Passive Aggressive • Always say yes but resistance is hidden
Serotonin MAO kills Serotonin
↑MAO ↓ Serotonin ↓MAO ↑ Serotonin
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
↓ Serotonin
Psychiatric Nursing
ANTIDEPRESSANTS
1st Line of Drug Prescribed
wo – 4 weeks wo neurotransmitter RI
ONO
ide effects low EROTONIN
CYCLIC
MINE
EUPTAKE
NTIDEPRESSANT
XIDASE
afest ELECTIVE
to 4 weeks NHIBITOR PPZ
Higher incidence of Side effects Serotonin/ Epi affected NHIBITOR ANTSAVE
MNP
All neurotransmitter affected Highest Side effects Avoid tyramine rich food ↓ may lead to
TYRAMINE RICH FOODS vocado ged Cheese
SSRI
TCA MAOI
eer
hocolate
ermented Foods
Antidepressant ↓ Anticholinergic Side Effects (Syphathetic) ↓
ickles reserved Foods oy Sauce
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Antidepressant
no effect
Psychiatric Nursing
ECT
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
ELECROCONVULSIVE THERAPY • Pre o Informed consent NPO 6 – 8 hours prior o • Meds Atropine dry mouth o Barbituate Sedative o Succinylcholine muscle relaxant, prevent seizure o • Post o Side-lying – lateral S/E o headache, dizziness, TEMPORARY MEMORY LOSS distinct sign • 70 – 110 volts • 20 – 30 seconds • ½ hour asleep post
PHARMAMOMENTS
SUBSTANCE SUBSTANCE ABUSE ABUS E Downers (ABONM INE) Alcohol Barbituates Opiates Narcotics Marijuana
Morph Code Hero
NARCAN
antidote
Uppers (CHA) Cocaine Hallucinogen Amphetamines OVERDOSE Alcohol
Coma Bradycardia Bradypnea
Cocaine HR RR BP LOC
Seizure
Pupil constriction
Moist mouth Constipation Hypotension Coma Asleep Jomar AnthWeight ony D. Mgain axion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
EUPHORIA
Tachycardia Tachypnea Pupil Dilation Dry mouth Hypertension Seizure Awake Weight Loss
Withdrawal
Psychiatric Nursing
Psych well being NARCAN Narcotic Antagonist
narcotic overdose
DETOXIFICATION withdrawal with MD Supervision METHADONE
reverse of effect or opposite of overdose
DEPRESSION
↓ Serotonin, if unresponsive to drugs, ECT
The Grief Process • Denial no! this can’t be true • Anger why me, why me, why now • Bargaining if something happens, then I’ll give something back • Depression I’m down 2 weeks or more s/sx major depression • Acceptance client acts according to situation ↓Self Actualization
C TASK Stay
↓Self Esteem withdrawn
Risk for self directed violence Eating
Sleep
Hypoactive
↓Sex
Sensitivity to client needs
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
SUICIDE • • •
Verbal I wont be a problem anymore This is my last day on earth I’ll soon be gone
• •
Non Verbal Take this ring, its yours (giving of valuable) Sudden change in mood
Who will commit Suicide? Sex – Male (more successful)/ female (hesitant) Age – 15 –24 y/o or above 45 Depression Patient with previous attempt ETOH – ethanol - alcoholics Rirrational Social support lacking Organized plan greater risk No family Sickness, terminal SUICIDE TRIAD • Loss of spouse • Loss of job • Aloneness Is Patient is SUICIDAL; SUICIDAL; nurse should: DIE • Direct question – “Are you going to commit suicide?” • Irregular interval of visit to pt. room • Early AM and period of endorsement – the time pt’s commit suicide Best approach for suicidal pt. : Direct approach Nursing Management: Close surveillance Hospital area majority sucide will happens at: • weekends 1- 3 am Sunday • Weekend less staff personnel • Early AM every one is asleep Give simple task. Don’t give complex may cause depression ex. Jigsaw • Water plants • Wash the dishes except sharps CHILD ABUSE (think B) • Burns, bruise, bone fractures, BUNGI! • Don’t bathe the child, don’t brush teet. Body of evidence will be lost
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
• Bantay Bata 163 LEVELS OF MENTAL RETARDATION • Profound < 20 o thinks like an infants o can’t be trained o ero – 2 y/o stay with the patient o ensorimotor • Severe evere 20 – 35 o • Moderate Modera e o 35 – 50 hirtyfive – 50 rainable o can be train wo – 7 y/o o mental age is 2 – 7 y/o pre-operational stage o • Mild 50 – 70 o meantal age is 7 – 12 o educable o can go to school o • Borderline 70 - 90 o • Normal o 90 – 100 JOHN PIAGET’S COGNITIVE THEORY 0 –2 Sensorim orimot oto or Baby can se sense, se see, pe percei rceiv ve an and he hear. Ob Object permanence 2–4 Preconceptual Language 4–7 Intui Intuitiv tive e Unidi Unidime ment ntion ional al clas classif sifica icatio tion n charac characte teris ristic tic.. Child Child can can fix toys according to size, color, height = one at a time 7 – 12 Conservation Multidimensional Concrete Association Formal Good abstract thinking. Can interpret words 12 ↑ Operation ALZHEIMER NOMIA don’t know name of objects GNOSIA problem with senses PHASIA can’t say it PRAXIA can’t do it Cocaine Nasal Septum perforation Marijuana impaired Lung Structure eroine withdrawal ikab Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
atsing u hu hu
CRITICAL REVIEW
TEST TAKING TECHNIQUES 1. Assess Assess the answer answer,, use use circle circle 2. Initial priority TRUST
Air food, water
3. 4.
5. 6.
7.
ABC Good Good Word Word// Bad Bad Word Word S Tec Techn hniq ique ue eek support it tay upervised ee = observed eem = notice assi t feeling 2 same same ans answe wer/ r/ 2 same same mist mistak ake e Word Words s to to wat watch ch out for Inappropriate Most Not included Except All but one Umbrella
ASSESS
RELATIONSHIP Preorientation Self awareness
Orientation Trust Setting Contract Resistance
Jomar Anthony D. Maxion, BSN, RN
Working
Termination
Discussion
Evaluation
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Psychiatric Nursing
PRACTICE OF NURSING Level of Prevention 1
2
3
Healthy Ill Community Demog. Crisis Intervention
Relapse AA
SELF HELP GROUPS nique niversality r not alone RESTATE exact words REFLECT use other words DEPRESSION Endogenous Internal Chemical
Reactive external
Barbituate withdrawal LIBRIUM (Chloridiazepoxide) TOFRANIL Antidepressant/ Anticholinergic pupil dilation Catharsis Feelings Free Association Ideas
midriasis
ATTITUDE THERAPIES Active friendliness ask permission assive Friendliness aranoid anipulative nic atter of Fact No Demand Depressed Kind Firmness Anorexic Crisis 4 – 6 weeks Goal Return the client to the pre-crisis level of functioning PSC Perception what do you think about it? Coping what will you do about it? Support who will be there for you? Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009
The Royal Pentagon Review Specialist, Inc .
Kulit kulit kulit kulit Perseveration Ulit Ulit Ulit Verbigeration DISSOCIATION
Psychiatric Nursing
stick to 1 topic
Dissociative Amnesia don’t know themselves Fugue Far Dissociative Identity Disorder Multiple Personality D.O.
Jomar Anthony D. Maxion, BSN, RN
College of Nursing Batch 2009