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The Royal Pentagon Review Specialist, Inc.

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, Ego, Superego)

D
mpulsive
want to
want PLEASURE

eat
drink
urinate
defecate

PLEASURABLE PRINCIPLE
Pain Avoidance
Its all I

UPER EGO
hould not
mall voice of God

Dominant ID
Mania
Antisocial
Narcissistic

DOMINANT SUPER EGO


Obsessive - compulsive
Anorexia Nervosa

CONSCIENCE PRINCIPLE

GO
Xecutive Secretary

I
E

Impaired Reality
Schizophrenia

REALITY PRINCIPLE
LIBIDO sexual energy responsible for survival
PSYCHOSEXUAL THEORY
1. ORAL STAGE
0 18 Months old
Survival
I want to eat, sleep, urinate, defecate

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

ID formation
Cry & Suck mouth
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 6th month

2. ANAL STAGE
Ateen 3 years old (18 mos 3 y.o.)
Toilet training
Super Ego develop
3. PHALLIC
3 6 y.o.
Penis/ Vagina
Parents is the significant person
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
o Conscious highest level of awareness
o Preconscious Tip of the tongue
o Unconscious deepest level of awareness

Birth Trauma First traumatic experience of child


REPRESSION unconscious forgetting of an anxiety provoking
concept
SUPRESSION conscious forgetting of an anxiety provoking
concept

4. LATENCY STAGE

6 12 years old

SCHOOlatency

Sexual energy is dormant

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Reading, Riting, Rithmetic


SUBLIMATION placing sexual energies toward a more
productive endeavors

5. GENITAL STAGE

12 y. o. above

Gising

Genital
PHARMA MOMENTS

ANTIANXIETY
VLAST ME VAIB
Valium ate V
Miltown - Meal
Libreum - L
Equanil Aqua Kneel
Ativan - 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

Affecting Major
Factor
Feeding
Toilet Training

Guilt
Inferiority
Role confusion
Isolation
Stagnation
Despair

Independence
In da-school
Peer
Love
Parenting
Reflection

BEHAVIORAL MODELS
1. Ivan Pavlov
Classical Conditioning Model
All behavior are learned
Food dog Salivation
Bell Food Dog Salivation
Bell Salivation
2. B.F. Skinner

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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

PHARMA MOMENTS

MONOAMINE OXIDASE INHIBITORS


AR

M
N
P

PLAN
DIL
NATE

ANTIPARKINSON
CAPABLES

Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetryl
DEFENSE MECHANISMS Fight for stress
DISPLACEMENT
Transfer of feelings to a less
threatening object rather than the
one who provoke it
DENIAL
Failure to acknowledge an
unacceptable trait or situation
DISSOCIATION
Psychological flight from self
A type of amnesia
REGRESSION
Return to an earlier developmental
stage
REPRESSION
Unconscious forgetting of an
anxiety provoking concept

Jomar Anthony D. Maxion, BSN, RN

Boss shouts at
you, you shout at
your subordinate
Im not an
alcoholic
Sino ka, Sino
ako?
Return to
thumbsucking
Hindi ko maalala

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

RATIONALIZATION

REACTION
FORMATION
UNDOING

IDENTIFICATION
PROJECTION

INTROJECTION

SUPPRESSION
SUBLIMATION
CONVERSION

COMPENSATION
SUBSTITUTION

Psychiatric Nursing

Illogical reasoning for a socially


I drink because I
unacceptable trait
dont want to
waste the beer in
sayang ang beer sa ref, kaya ko
the ref
ininum
doing the opposite of your
sasabunutan
intention
kita. . . ay
kuklulutin lang kita
plastic
Doing the opposite of what you
ay pinatid kita,
have done due to guilt
halika punta kita
sa clinic
orocan, plastic, Tupperware
Assume trait for personal, social,
Tulad niya
occupational role
Attributing to others ones
hindi ako
acceptable trait
alcoholic, sila yon
Pasa load
Assume another persons trait as
ako din
your own
Not just you, me

too
Conscious forgetting of an anxiety Hindi ko alam yan
provoking concept
Placing sexual energies toward a
Angry at life, put
more productive endeavors
anger in singing
Repressed angers put towards
Biglang mangingig
physical symptoms affecting
nervous system leading to sensory
numbness and motor paralysis
Overachievement in one area to
Pilay pero
cover a defective part
magaling kumanta
Replacing a difficult goal with a
Gusto ko
more accessible one
Disneyland.
Enchanted
nalang.
STOP GABA Inhibitory
Gamma Amino Butyric Acid
GO Epinephrine/ Norepinephrine
Exitatory

SNS
ANXIETY

Anticholinergic side effect


Constipation
Urinary Retention
Dry Mouth

Jomar Anthony D. Maxion, BSN, RN

Within 1 week
Rebound
College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Blurred Vision

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

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

Panic
+4
uicide
afety Dont 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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
SOCIAL PHOBIA fear of public

POST TRAUMATIC STRESS DISORDER


Trauma
Disaster
Accident
War
Rape
Earthquake
Soldier
6 years old

Assignments/
Homeworks

Flashbacks
VICTIMS Survivors
Nightmares

Anxiety

I am sick

Jomar Anthony D. Maxion, BSN, RN

SOMATOFORM
> no pretension
> no organic
basis

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

No Assignments/
Homeworks

You Think
Teacher may
get angry

Psychiatric Nursing

MALINGERING
pretending to be sick
(Conscious)

Absent

Escape from
Teacher
PRIMARY GAIN
(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
CONVERSION DISORDER
La Belle Indifference
emotional disattachment
from disability

Illusion of structural defect


BODY DYSMHORPIC DISORDER

Minor Discomfort
Interpreted as major illness
HYPOCHONDRIASIS
Maliit na butas, pinalalaki
Favorite Past Time: Doctor Hopping
Nursing Focus: Feelings

OBSESSIVE COMPULSIVE
Belief/ thought
Door Open
Burglar may go inside

Feelings
Anxiety

Obsession anxiety
(thought)

Returns to house
(Action)
Anxiety Compulsion

PHOBIA

Irrational fears

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Etiology
o Knowledge
o Experience
Immediate Nursing Intervention remove the stimuli
SYSTEMATIC DESENSITIZATION
o Gradual exposure to feared object

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 cant 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
Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

version therapy
lcoholics Anonymous self help group
ntabuse DISULFIRAM Never drink alcohol

12 hour interval/ 12 h last alcohol intake

B1 Vitamin Deficiency

or else: nausea, vomiting and hypotension


Wernickes Encephalopathy motor

Complications

Korsakoffs 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
Maslows 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

: 7 y.o. and below


: 6 months and above
: 2 House and school

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Id Dominant : Mom or RN will act as superego

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
Dont 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

6 y.o. class valedictorian/ model student

social inactive/ no BF

weighing

Feeling

Jomar Anthony D. Maxion, BSN, RN

Behavior

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

I Am Fat

Psychiatric Nursing

Self Esteem Diet, Diet, Diet

Anorexia Nervosa
Diet, diet, diet
<85% of expected body
3 mos. ammenorhea
Karen Carpenter

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 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
Jomar Anthony D. Maxion, BSN, RN

DOPAMINERGIC
PLSE
Parlodel
Larodopa
College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Benadryl
Cogentin

Psychiatric Nursing
Symmetyl
Eldepryl

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
o Dopamine level is High
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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Assess
: Suspicious
Nx Dx
: Risk for other directive behavior
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.

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Concrete Association pilosopo what will you wear? clothes


Thought Blocking

Stimulus
Visual
Auditory
Tactile

Halucinations
Absent
X
X
X

Illusion
Present

In case of hallucinations do:

Hallucinations
Acknowledgment

I know you the voices are real to you

Reality orientation

But I dont 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 HEBEPHRENIC
Giggling
Positive and Negative
S/Sx

Catatonic

Ambivalence
Waxy Flexibility
o Iniwan na posture,
ganun forever
No favorite word
Negativism

Jomar Anthony D. Maxion, BSN, RN

Paranoid

Suspicious
Tendency to be violent

MistrustScaredWithdraw
n
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
Dont touch the pt.
Eye contact
1 arms length away
College of Nursing
Batch
2009
call
reinforcement

The Royal Pentagon Review Specialist, Inc.

Normally
Acetylcholine = ON

Psychiatric Nursing

Dopamine = OFF

classified
differentiated
Residual Mixed classification

Cant be classified
1st paranoid, then
No more positive s/sx,
disorganized then
just withdrawn
catatonic, etc etc

Your always ON
Schizophrenia
With parkinsON

High Dopamine=

Antipsychotics = makes Dopamine goes down


ON

Extrapyramidal Side Effects


AKATHISIA
o Restless, inability to sit
o Makati siya, ahh kati siya
AKINESIA
o Muscle rigidity
o Ahh kiniss siya
DYSTONIA
o 3 features
Anticholinergic
TORTICOLLIS
Drugs that will make the
Wry neck
AcH down
OCULOGYRIC CRISIS
o Artane
Fixed stare
o Akineton
OPISTHOTUNOS
o Benadryl
Arched back
o Cogentin
TARDIVE DYSKINESIA
o Irreversible side effects of
Dopaminergic
antipsychotics
Dopamine goes up
o Parlodel
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

o Lip smacking
o Tongue protruding
o Cheeks puffing
NEUROLEPTIC MALIGNANT
SYNDROME
o Hyperthermia among client
taking antipsychotic
o Hyperthermia with muscle
rigidity
Other Side Effects
Photosensitivity
o Sunscreen
o Wide brimmed hat
Agranulocytosis
o Report immediately Sore throat
1st 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
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
Private room

Jomar Anthony D. Maxion, BSN, RN

Hyperactive

Sex
Anxiety

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Lithium 2 4 weeks before effect

SE Compensation interfere ADLs, harm others


SE Compensation interfere ADLs, harm others
TASK increases clients 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

PERSONALITY DISORDERS
SCHIZOID
I dont 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

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 cant live without you
self esteem
poor decision making skills
Histrionic
excited, dramatic but manipulative
center of attention
Narcissistic
I love myself
Insensitive, arrogant
I am the best
Obsessive Compulsive
I am organized
Perfectionist

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Provide time to do rituals

Paranoid
Suspicious
Passive Aggressive
Always say yes but resistance is hidden

Serotonin
MAO kills Serotonin

MAO Serotonin
MAO Serotonin
Serotonin

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
HYPERTENSIVE CRISES

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

TYRAMINE RICH FOODS


vocado
ged Cheese
eer
hocolate
ermented Foods

SSRI

Psychiatric Nursing

TCA

MAOI

Antidepressant

Anticholinergic Side Effects


(Syphathetic)

Male Erectile Dysfunction

ickles
reserved Foods
oy Sauce

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Antidepressant no effect ECT


ELECROCONVULSIVE THERAPY
Pre
o Informed consent
o NPO 6 8 hours prior
Meds
o Atropine dry mouth
o Barbituate Sedative
o Succinylcholine muscle relaxant, prevent seizure
Post
o Side-lying lateral
o S/E
headache, dizziness,
TEMPORARY MEMORY LOSS distinct sign
70 110 volts
20 30 seconds
hour asleep post

PHARMAMOMENTS

SUBSTANCE ABUSE
Downers (ABONM INE)
Alcohol
Barbituates
Opiates

Morph
Code
Hero

Jomar Anthony D. Maxion, BSN, RN

NARCAN antidote

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Narcotics
Marijuana
Uppers (CHA)
Cocaine
Hallucinogen
Amphetamines
OVERDOSE
Alcohol

Cocaine
HR
RR
BP
LOC

Coma

Seizure

Bradycardia
Bradypnea
Pupil constriction

Moist mouth
Constipation
Hypotension
Coma
Asleep
Weight gain

EUPHORIA

Tachycardia
Tachypnea
Pupil Dilation
Dry mouth
Hypertension
Seizure
Awake
Weight Loss

Psych well being


NARCAN Narcotic Antagonist narcotic overdose

DETOXIFICATION withdrawal with MD Supervision


METHADONE

Withdrawal reverse of effect or opposite of overdose

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

DEPRESSION Serotonin, if unresponsive to drugs, ECT


The Grief Process
Denial no! this cant be true
Anger why me, why me, why now
Bargaining if something happens, then Ill give something back
Depression Im 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

SUICIDE
Verbal
I wont be a problem anymore
This is my last day on earth
Ill 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; nurse should: DIE
Direct question Are you going to commit suicide?
Irregular interval of visit to pt. room
Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Early AM and period of endorsement the time pts 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. Dont give complex may cause depression ex. Jigsaw
Water plants
Wash the dishes except sharps
CHILD ABUSE (think B)
Burns, bruise, bone fractures, BUNGI!
Dont bathe the child, dont brush teet. Body of evidence will be lost
Bantay Bata 163
LEVELS OF MENTAL RETARDATION
Profound
o < 20
o thinks like an infants
o cant be trained
ero 2 y/o
o stay with the patient
ensorimotor
Severe
evere
o 20 35
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
o pre-operational stage
Mild
o 50 70
o meantal age is 7 12
o educable
o can go to school
Borderline
o 70 - 90
Normal
o 90 100
JOHN PIAGETS COGNITIVE THEORY
02
Sensorimotor Baby can sense, see, perceive and hear. Object
permanence

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

24
47

Psychiatric Nursing

Preconceptual Language
Intuitive
Unidimentional classification characteristic. Child can
fix toys according to size, color, height = one at a time
Conservation Multidimensional
Concrete
Association
Formal
Good abstract thinking. Can interpret words
Operation

7 12
12

ALZHEIMER
NOMIA dont know name of objects
GNOSIA problem with senses
PHASIA cant say it
PRAXIA cant do it
Cocaine Nasal Septum perforation
Marijuana impaired Lung Structure
eroine withdrawal
ikab
atsing
u hu hu

CRITICAL REVIEW

RELATIONSHIP
Preorientation
Self awareness

Orientation
Trust
Setting Contract
Resistance

Working

Termination

Discussion

Evaluation

PRACTICE OF NURSING
Level of Prevention
1

Healthy
Ill
Community Demog. Crisis Intervention

Jomar Anthony D. Maxion, BSN, RN

3
Relapse
AA

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

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 midriasis
Catharsis Feelings
Free Association Ideas

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?
Kulit kulit kulit kulit Perseveration stick to 1 topic
Ulit Ulit Ulit Verbigeration
DISSOCIATION
Dissociative Amnesia dont know themselves
Fugue Far

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009

The Royal Pentagon Review Specialist, Inc.

Psychiatric Nursing

Dissociative Identity Disorder Multiple Personality D.O.

Jomar Anthony D. Maxion, BSN, RN

College of Nursing Batch 2009