Psychiatric Nursing
Beliefs Feelings Behavior
Therapeutic Communication Techniques
What you see, you say
What you hear, you say restating
Sigmund Freud
Father of Psychoanalysis
Structure of Personality (Id, go, Superego)
!ominant I!
"ania
! eat #ntisocial
mpulsive drink Narcissistic
want to urinate
want PL!S"# defecate
PL!S"#!BL P#$%&$PL
Pain !voidance
$t's all ($)
!$"IN#NT S%PR &$
$*sessive + compulsive
%PR &$ #nore,ia %ervosa
hould not
mall voice of -od
&.%S&$%& P#$%&$PL
&$
/ecutive Secretary Impaired Reality
Schi0ophrenia
#!L$12 P#$%&$PL
'I(I!$ se,ual energy responsi*le for survival
PS)C*$S+%#' T*$R)
,. $R#' ST#&
3 4 56 7onths old
Survival
$ want to eat, sleep, urinate, defecate
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
I
%arcissistic
Defense Mechanism:
o FI+#TI$N when a person is stuck in a certain developmental
stage
o R&RSSI$N return to an earlier developmental stage
EGO is develop in the 6
th
month
-. #N#' ST#&
!teen 4 > years old (56 mos 4 > y:o:)
1oilet training
Super go develop
1oilet 1raining
-ood 7other Bad 7other
Successful "nsuccessful
1oo #igid 1raining 9irty
9isorgani0ed
&lean 9iso*edient
.rgani0ed
.*edient #NTIS$CI#'
(!nal ,pulsive)
$(SSSI. / C$"P%'SSI.
(!nal #etentive)
0. P*#''IC
> 4 < y:o:
Penis? @agina
Parents is the significant person
&alled as Preschooler
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
S
(I&
S
Small
S
(ako din)
%ot Hust you, me
too
S"PP#SS$.% &onscious forgetting of an an,iety
provoking concept
Bindi ko alam yan
S"BL$7!1$.% Placing se,ual energies toward a
more productive endeavors
!ngry at life, put
anger in singing
&.%@#S$.% #epressed angers put towards
physical symptoms affecting
Biglang mangingig
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
nervous system leading to sensory
num*ness and motor paralysis
&.7P%S!1$.% .verachievement in one area to
cover a defective part
Pilay pero
magaling kumanta
S"BS1$1"1$.% #eplacing a difficult goal with a
more accessi*le one
-usto ko
9isneyland:
nchanted
nalang:
S1.P -!B! $nhi*itory
-amma !mino Butyric !cid
-. pinephrine? %orepinephrine
SNS ,itatory
#N+IT) #nticholinergic side e22ect
&onstipation
"rinary #etention Within 5 week
9ry 7outh #e*ound
Blurred @ision phenomenon
Sei0ure
!*rupt
!nti+!n,iety 9ependence
Withdrawal
9rowsy
%o !lcohol
%o &offee
9evelop .rthostatic
Bypotension
Prevetion of .:B:
5: Sit 9own
;: 9angle feet -radually
>: Stand "p -radually 1apered 9ose
R'#+!
#N+IT)
@ague sense of impending doom
"ild "oderate Severe Panic
F5 F; F> FE
Widened acing ont know what uicide
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
Perceptual to say?do afety 9on't touch client
Field #% 7eds $#&1$@ #espi !lkalosis
#estless Bown Bag
nhanced Learning
&apacity
(2ou Seem #estless (
#ssess ; Level of !n,iety
N1 !1 ; $neffective $ndividual &oping
Powerlessness
$mpaired Skin $ntegrity
Planning< Implementation;
level of an,iety
environmental Stimuli
#ela,ation 1echniCue
Showing pictures of flower, waterfalls
Bearing sounds of chirping *irds
valuation ; ffective individual coping
NR#'I=! #N+IT) !IS$R!R
months e,cessive worrying
7ight *e mild, moderate and severe an,iety
S<S1
#estless
9ifficulty of concentration
Sleep 9isorders
Palpitations
dge of the seat
asy fatiga*ility
P#NIC !IS$R!R
5D 4 >3 7inutes escalation of S%S
#&$R#P*$(I# fear of open space? pu*lic places
S$CI#' P*$(I# fear of pu*lic
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
P$ST TR#%"#TIC STRSS !IS$R!R
1rauma
9isaster
!ccident Flash*acks
War .ICTI"S Survivors
#ape %ightmares
arthCuake
Soldier
< years old !n,iety S$"#T$F$R"
J no pretension
!ssignments? ($ am sick) J no organic
Bomeworks *asis
"#'IN&RIN& J unconscious
%o !ssignments? pretending to *e sick
Bomeworks (&onscious) PS)C*$S$"#TIC
J #eal pains? illness
2ou 1hink !*sent J #eal symptoms
(1eacher may J E maHor types
get angry) K Bypertension
K 7igraine
scape from 7ama &are K Stress "lcer
1eacher K !sthma
PRI"#R) &#IN !ttention
(Behavior an,iety) SC$N!#R) &#IN
S$"#T$F$R" !IS$R!RS
S$"#T$F$R"
%ervous System $llusion of structural defect
C$N.RSI$N !IS$R!R ($!) !)S"*$RPIC !IS$R!R
La Belle $ndifference
emotional disattachment
from disa*ility
7inor 9iscomfort
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
$nterpreted as maHor illness
*)P$C*$N!RI#SIS
(7aliit na *utas, pinalalaki)
Favorite Past 1imeL 9octor Bopping
%ursing FocusL Feelings
PS)C*$S$"#TIC !IS$R!RS
!n,iety
S%S P%S
BP @asoconstriction Bronchoconstriction
*ypertension &ere*ral !rtery Left -astric !rtery #sthma
"igraine Stress %lcer
$(SSSI. / C$"P%'SI.
(elie2< thought Feelings
9oor .pen !n,iety
Burglar may go inside
$>session an,iety
(thought)
#eturns to house
(!ction)
!n,iety Compulsion
P*$(I#
$rrational fears
tiology
o Anowledge
o ,perience
$mmediate %ursing $ntervention remove the stimuli
S)ST"#TIC !SNSITI=#TI$N
o -radual e,posure to feared o*Hect
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
PHARMA MOMENTS
#NTIPS)C*$TIC #&NT
SSTTC"*P
Stela0ine + se,y star &lo0aril 4 closed reel
Serentil 4 serena 7ellaril 4 maraming reel
1hora0ine 4 *a*aeng 1ora Baldol 4 hahaha
1rilafon + tri+*and phone Proli,in 4 pero lick scene
#'C$*$'IS"
tiologyL
Intergenerational Transmission
From one generation to another generation
#lcohol
(lackout awake *ut unaware
Confa*ulation inventing stories to self+esteem
!enial ($ am not an alcoholic)
!ependence ($ can't live without it)
na*ling significant other tolerates a*users
!nother term C$ / !PN!NC)
T$'R#NC Su*stance to achieve a previous effect
!T$+IFIC#TI$N
Withdrawal with 79 supervision
&heck #lcohol, "outhwash, li1er
void alcohol
version therapy
lcoholics !nonymous self help group
nta*use !IS%'FIR#" %ever drink alcohol
5; hour interval? 5; h last alcohol intake
(5 @itamin 9eficiency or elseL nausea, vomiting and hypotension
9ernic?e:s ncephalopathy motor
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
Complications
5orsa?o22:s Psychosis memory
!elirium 1remens ;E 4 M; h after last dose of alcohol
untreated withdrawal syndrome
ormocation *ugs crawling under the skin
amily 1herapy mother, father, *rother
#%TIS"
!utistic Savant autistic with a special talent
#ssess
#ppearance flat affect, consistent movement
(ehavior repetitive, ritualistic
Communication echolalia, incomprehensi*le
N1 !1
$mpaired ver*al communication
$mpaired social interaction
Self mutilation
#isk for inHury
Planning< Implementation
7aslow's hierarchy of needs
&onstancy, promote safety
valuation
,pressive therapy drawing, muscic etc
nhanced communication
$mproved social interaction
Safety
#TTNTI$N !FICIT *)PR#CTI. !IS$R!R
.nset L M y:o: and *elow
9uration L < months and a*ove
Settings L ; Bouse and school
$d 9ominant L 7om or #% will act as superego
!9B9 -lucose Frontal Lo*e impaired Hudgement !9B9 S?S,
#italin Frontal Lo*e 8udgement !9B9 S?S,
(stimulant)
#ssess
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
#ppearance dirty
(ehavior clumsy, impatient, easily distracted, hyperactive
Communication talkative, *lurts out in class
N1 !1
#isk for inHury
$mpaired social interaction
Planning< Implementation
tructure separate room for eating, playing, sleeping and etc
chedule time for everything
et limits
afety
valuation
7inimi0e #isk for $nHury
$mproved social interaction
Safety
#esidual !9B9 grows up not antisocial
7edsL #italin, de,edrin, pemoline, adderal
Best time to giveL once a dayL !F1# 7!LSL prevent lost of appetite
9on't give at *edtime S1$7"L!%1 causes insomnia
-ive < hours prior *edtime if *id
#TIN& !IS$R!RS
56 mos: 4 > y:o: < y:o: class valedictorian? model student
1oilet 1raining social inactive? no BF
&lean weighing
.*edient
.rgani0ed
1hought Feeling Behavior
$ !m Fat Self steem 9iet, 9iet, 9iet
#nore1ia Nervosa ating !isorders (ulimia
9iet, diet, diet ating Pattern at, eat, vomit
N6DO of e,pected *ody 9eight %ormal weight
> mos: ammenorhea "enstruation $rregular menstruation
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
Aaren &arpenter 9ao 7ing /i
9a 7ing Sugat? suka
@omiting
9ental caries
Wounded knuckles
7eta*olic alkalosis
7eta*olic acidosis
@omiting
Fluid @olume 9eficit !##B21B7$! (fatal complication)
9iarrhea
Interventions
#estore fluid and electrolyte *alance
&olla*orative regarding menu contract
1arget weight gain
!fter mealsL stay >3 mins 4 5 hour
PHARMA MOMENT
'IT*I%"
' evel 3:< 4 5:; mC?L ausea, vomiting, diarrhea
Increase urination Lithium 1o,icity
Tremors, fine hand aF
*ydration > L?day
Increase
5idney %u diarhea
"outh, dry
#NTIP#R5INS$N
#NTIC*$'INR&IC
#(C
!$P#"INR&IC
P'S
#rtane Parlodel
#kineton 'arodopa
(enadryl Symmetyl
Cogentin ldepryl
SC*I=$P*RNI#
go disintegration
$mpaired reality perception
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
-enetic vulnera*ility
Stress 4 9iathesis 7odel
o 1oo much stress in the reality will lead client to escape it and go to
the fantasy world
Biological 1heory
o 9opamine level is Bigh
1he e,act cause is unknown
ffect appropriate, inappropriate, flat, *lunt (incomplete emotion)
m*ivalence torn *etween ; opposing forces
utism
ssociative Looseness
Symptoms
Negative Positive
Bypoactive Byperactive
Withdrawn Socia*le
!pathy Flight of $deas
1alkative
#ssess ; &ontent of 1hought
N1 !1 ; 9istur*ed thought process
Planning< Implementation;
Present reality
Provide safety
valuation ; $mprove thought process
#ssess ; Ballucination? $llusions
N1 !1 ; 9istur*ed sensory perception
Planning< Implementation;
Present reality
Provide safety
valuation ; $mprove sensory perception
#ssess ; Suspicious
N1 !1 ; #isk for other directive *ehavior
Planning< Implementation;
Present reality
Provide safety
valuation ; liminate? minimi0e risk for other+directed violence
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
#ssess ; Suicidal
N1 !1 ; #isk for self directive *ehavior
Planning< Implementation;
Present reality
Provide safety
valuation ; liminate? minimi0e risk for self+directed violence
Flight or 'ooseness
$ am going to the mall: $ am going to the mall:
Where is the lightG 1he mall is *ig:
-o here: Big is the tree:
7ineral Water: 1he tree is tall:
"agical Thin?ing
Believes to have a magical power
$ can turn you into a frog
cholalia $ repeat what you say Parrots
chopra1ia $ repeat what you do
9ord Salad words, no rhyme
Clang #ssociation words with rhyme L 9unk, plank, sunk
Neologism creation of new words Plinking, hustash
Clari2ication done in case of neologism
!elusion;
Persecutory %B$ is out to get me? someone will harm the client
Religious $ am 8esus &hrist
&randeur $ am the Cueen of the world:
Ideas o2 re2erence %urses are talking a*out me:
Concrete #ssociation pilosopo (what will you wearG) (clothes)
Thought (loc?ing
*alucinations Illusion
Stimulus !*sent Present
@isual /
!uditory /
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
1actile /
$n case of hallucinations doL
*allucinations
#cknowledgment
$ know you the voices are real to you
Reality orientation
But $ don't hear them
!iversion
Lets go to the garden
But if nothing in the preceeding intervention are seen
Assess what the voices are saying
SC*I=$PRNI#
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
!isorgani@ed
Sad *ut smiles
o $nappropriate affect
%o reaction
o Flat affect
Flight of ideas
o HEBEPHRENIC
-iggling
Positive and %egative
S?S,
Catatonic
!m*ivalence
Wa,y Fle,i*ility
o $niwan na posture,
ganun forever
%o 4 favorite word
%egativism
Paranoid
Suspicious
1endency to *e violent
7istrustScaredWithdraw
n
%rsg: $ntL
9evelop trust
5 to 5
short interaction
freCuent visit
foods in sealed
container
meds wrapped
for violent pt:
9oors open
%ear the door
9on't touch the pt:
ye contact
5 arms length away
call reinforcement
Residual
%o more positive s?s,,
Hust withdrawn
classi2ied
di22erentiated
7i,ed classification
&an't *e classified
5
st
paranoid, then
disorgani0ed then
catatonic, etc etc
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
Normally
!cetylcholine P .% 9opamine P .FF
2our always $N Bigh 9opamineP Schi0ophrenia
With par?ins$N
#ntipsychotics P makes 9opamine goes down
.% 1trapyramidal Side 22ects
#5#T*ISI#
o #estless, ina*ility to sit
o 7akati siya, ahh kati siya
#5INSI#
o 7uscle rigidity
o !hh kiniss siya
!)ST$NI#
o > features
1.#1$&.LL$S
Wry neck
.&"L.-2#$& &#$S$S
Fi,ed stare
.P$S1B.1"%.S
!rched *ack
T#R!I. !)S5INSI#
o $rreversi*le side effects of
antipsychotics
o Lip smacking
o 1ongue protruding
o &heeks puffing
N%R$'PTIC "#'I&N#NT
S)N!R$"
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
#nticholinergic
Drugs that will make the
Ac down
o !rtane
o !kineton
o Benadryl
o &ogentin
!opaminergic
Dopamine goes up
o Parlodel
o Larodopa
o Symmetryl
o ldepryl
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
o Byperthermia among client
taking antipsychotic
o Byperthermia with muscle
rigidity
$ther Side 22ects
Photosensitivity
o Sunscreen
o Wide *rimmed hat
!granulocytosis
o #eport immediately Sore throat
5
st
sign to appear
PHARMAMOMENTS
#NTI!PRSS#NTS
#NTS##. PP=
#sendin 4 ascending
Norpramin 4 sa*aw ng knorr
Tofranil 4 1ofu
SineCuan 4 nood ng Sine Quan ang title
#nafranil 4 kina !na Praning
#ventyl 4 kina !ven 1il 7idnight tayo
.ivactil 4 Bye Back till ne,t week
lavil 4 h love mo *a ako
Pro0ac 4 Pero saka na
Pa,il + 1aksil
=oloft 4 mag Solo ka
(IP$'#R !IS$R!R / "ania more common
Female
;3 years old and a*ove
Stressful life
.*ese
1!SA
&aregiver #ole Strain
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
Self !ctuali0ation
Self steem
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
Safety
Safety
Lithium 4 ; 4 E weeks *efore effect
S &ompensation interfere !9Ls, harm others
S &ompensation interfere !9Ls, harm others
T#S5 increases client's self esteem
-ross motor skills via su*limation
scorted walk outdoors
Punching *ag
%o group games compition will increase an,iety
> or more signs confirms disorder
&
F
S
P
!
randiose
light of ideas
leeplessness
ressured speech
,agerated S
,traneous stimuli (easily distracted)
istracti*ility
PRS$N#'IT) !IS$R!RS
SC*I=$I!
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
$mpaired social interaction
#isk for inHury? other directed violence
ating Sleep Byperactive Se,
finger food Private room !n,iety
The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
$ don't want people
Believes he can stand on his own
%ever had a *est friend
!void groups and social activities no enHoyment
&ares more a*out computers and pets
#.$I!#NT
$ avoid people, $ fear criticism
Bave talent *ut no confidence
#NTIS$CI#'
$ *reak the law as motto
!s a child,L steal, lie, always get reprimanded
!dult 4 grand ro**ery, illegal activitist against the law, drug addiction,
drives fast, unsafe se,, thrill seeker
-ood talker, charmer, witty manipulator
($R!R'IN 4 my life is an emptyglass
!ependent
$ can't live without you
self esteem
poor decision making skills
*istrionic
e,cited, dramatic *ut manipulative
center of attention
Narcissistic
$ love myself
$nsensitive, arrogant
$ am the *est
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
$>sessive / Compulsive
$ am organi0ed
Perfectionist
Provide time to do rituals
Paranoid
Suspicious
Passive #ggressive
!lways say yes *ut resistance is hidden
Serotonin
7!. kills Serotonin
7!. Serotonin
7!. Serotonin
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The Royal Pentagon Review Specialist, Inc. Psychiatric Nursing
T)R#"IN RIC* F$$!S
vocado
ged &heese
eer
hocolate
ermented Foods
ickles
reserved Foods
oy Sauce
8omar !nthony 9: 7a,ion, BS%, #% PL7 &ollege of %ursing Batch ;33<
SSRI TC# "#$I
!ntidepressant