Predisposing factors: Age (30y/o) Precipitating factors: environmental and daily stressors Pschosexual Phases: Oral Phase Subjective/Objective

cues: hindi naman daw ako napapabayaan ng nanay ko nung baby ako, as verbalized by the client. Oral stimulation needs of the client were satisfied.

Anal Phase

Lagi akong pinapaihi ng nanay ko bago matulog, at Had effective toilet training may arinola sa cr namin. Ginigising niya akos a gabi para umihi dinas verbalized by the client. Mas close ako sa nanay ko kasi maalagain.. kasi yung tatay ko laging nasa trabaho, as verbalized by the client. Madalas mag-away ang nanay at tatay ko, nagbabatuhan nagsasakitan, as verbalized by the client. The client says that she has no close friend but her eldest sister which she thought as her best friend. There was no electra complex developed

Phallic Phase

Latent Phase

The incident made the client nervous

Noted to exclude herself; screams inside her room Has no ability to cooperate and compromise No joy of involvement in the world and with others. No balance of work and play.

Unable to redirect feelings and to manage conflict and anxiety

The client was not able to gain social relationship at school and her neighbors. The client was not able to gain confident sense of self. The client was not able to establish commitment to career -planning and realistic long-term goals. Establish relationship with opposite sex. The incident serves as a shock. This experience made the client got home-sick (longing for her family)

Inadequate problem-solving skills. Lack of friends Reluctance to try new things for fear of failing Feeling unable to gain love/affection unless totally successful. Lack of / giving up of productive -roles. Vacillation bet. dependence & independence. Short-term relationship w/ opposite sex.

Genital Phase

Studied until her 4th year (college) but was not able to graduate.

The client had only one boyfriend. (Clients husband) One of the victims of Glorietta bombing. The client worked in Taiwan as factory worker in garments Became pregnant with her 3rd child

Noted with blank-stares and was withdrawn. Then was noted with occasional blank stares and yells but functional.

Socially detached for awhile but functional at home Unresponsive for awhile still functional at home

Noted w/ irritability, talking to self and shouting spells Mood disturbances happened after pregnancy Post partum blues Postpartal psychosis

Due to hormonal imbalance related to pregnancy Anger

She discovered that her husband was having an affair with another woman.

Jealousy Frustration Possessiveness

Lack of harmony of emotions

Do not have the confidence to cope with rejection/hurt

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Increase irritability Post partum blues Stress/ hormonal changes + history of depression Post-partum depression Postpartal psychosis Noted with behavioral oddities Lost contact with the reality talking to self irrelevantly Shouting spells

Sensory input is too disturbed

Biological Factor:
Hallucination Elicit (+) symptoms Insomnia Impulsivity Hostility Aggression UNDIFFERENTIATED SCHIZOPHRENIA Vulnerability Stress Model

Unknown mechanism

Increase dopamine

References: Psychiatric Nursing, Keltner Psychiatric Mental Health Nursing, Videbeck Maternal and Child Health Nursing, Pilliteri Feb 7 2010, emedhealth http://www.emedicinehealth.com/postpartum_depression/article_em. htm

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VI. PSYCHOPHARMACOLOGY Name of Drug Haloperidol Generic Name: Haldol 50 mg/cc x1, 20 mg/tab tab BID Uses in Psychiatry Psychotic Disorders Chronic psychosis requiring prolonged therapy Nonpsychotic behavior disorders Tourette Syndrome Delirium Mechanism of Action A butyrophenone that probably exerts antipsychotic effects by blocking postsynaptic dopamine receptors in the brain. Side Effect Parkinsonism; epilepsy, allergy, angle-closure glaucoma, benign prostatic hyperplasia; severe cardiac or hepatic disease; extremes in temp (hot and cold weather); presence of acute infections or leucopenia; hyperthyroidism; pregnancy, elderly, children. Patients receiving anticoagulants. Discontinue upon signs of neurological toxicity in patients taking haloperidol and lithium. Adverse Effect CNS: severe extrapyramidal reactions, tardive dyskinesia, sedation, drowsiness, lethargy, headache, insomnia, confusion, vertigo, seizures, neuroleptic malignant syndrome CV: tachycardia, hypotension, hypertension, ECG changes, torasades de pointes, with I.V. use EENT: Blurred Vision GI: Dry mouth, anorexia, constipation, diarrhea, nausea, vomiting, dyspepsia GU: urine retention, menstrual irregularity, priapism Nursing Responsibility Protect drug from light. Slight yellowing of injection or concentrate is common and doesnt affect potency. Discard markedly discolored solution. When switching from tablets to decanoate injection, give 10 to 15 times the oral dose once a month (maximum 100mg) Dilute oral dose with water or a beverage, such as orange juice, apple juice, tomato juice, or cola, immediately before administration. ALERT: Dont give decanoate form I.V. Monitor patient for tardive dyskinesia, which may occur after prolonged use. It may not appear until months or years later and may disappear spontaneously or persist for life, despite ending therapy. ALERT: Watch for signs and symptoms of

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Hematologic: leukopenia, leukocytosis Hepatic: jaundice Skin: rash, other skin reactions, diaphoresis Other: gynecomastia

neuroleptic malignant symdrome (extrapyramidal effects, hyperthermia, autonomic disturbance), which is rare but commonly fatal. It may not be related to length of drug use or type of neuroleptic; more than 60% of affected patients are men. Dont withdraw drug abruptly unless required by severe adverse reactions ALERT: Haldol may contain tartrazine. Look alike-sound alike: Dont confuse Haldol with Halcion or Halog

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Name of Drug Chlorpromazine Generic Name: Thorazine 100 mg tab hs

Uses in Psychiatry Psychosis, mania

Mechanism of Action A piperidine phenothiazine that may block postsynaptic dopamine receptors in the brain.

Side Effect Parkinson's disease; CV disease; renal or hepatic impairment; cerebrovascular and respiratoty disease; jaundice; DM; hypothyroidism; paralytic ileus; prostatic hyperplasia or urinary retention; epilepsy or history of seizures; myasthenia gravis; pregnancy; elderly (especially with dementia), and debilitated patients. Avoid direct sunlight.

Adverse Effect

Nursing Responsibility CNS: extrapyramidal Obtain baseline reactions, drowsiness, blood pressure sedation, seizures, measurements tardive dyskinesia, before starting pseudoparkinsonism, therapy, and dizziness, neuroleptic , monitor malignant syndrome regularly. Watch for CV: orthostatic orthostatic hypotension, hypotension, tachycardia, quinidineespecially with like ECG effects parenteral administration. EENT: ocular changes, Monitor blood blurred vision, nasal pressure before congestion and after I.M. administration; GI: dry mouth, keep patient constipation, nausea supine for 1 hour afterward GU: urinary retention, and have him menstrual irregularities, get up slowly. inhibited ejaculation, Wear gloves priapism when preparing solutions and Hematologic: avoid contact leukopenia, with skin and agranulocytosis, clothing. Oral eosinophilia, hemolytic liquid and anemia, aplastic parenteral forms anemia, can cause thrombocytopenia contact dermatitis. Hepatic: jaundice Slight yellowing of injection or

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Skin: mild photosensitivity reactions, allergic reactions, pain at I.M. injection site, sterile abscess, skin pigmentation changes Other: gynecomastia, lactation, galactorrhea

concentrate is common and doesnt affect potency. Discard markedly discolored solutions. Give deep I.M.only in upper outer quadrant of buttocks. Consider giving injection by Ztrack method. Massage slowly afterward to prevent sterile abscess. Injection stings. Rotate injection sites. ALERT: watch for evidence of neuroleptic malignant syndrome (extrapyramidal effects, hyperthermia, autonomic disturbance) which is rare but usually fatal. It may not be related to length of drug use or

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type of neuroleptic; more than 60% of affected patients are men. Look alikesound alike: Dont confuse chlorpromazine with clomipramine or with chlorpropamide, a hypoglycemic

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