Compilation of Psych Notes

PSYCHIATRIC NURSING 

Psych focuses in feelings or self-awareness.



Beliefs determine feelings which affects behavior (manifestation of feelings)



Sigmund Freud is the father of PSYCHOANALYSIS of PSYCHOANALYSIS



What happens to childhood will affect adulthood

STRUCTURE OF PERSONALITY ID 

Impulsive, “want to”, wants pleasure.



PLEASURE PRINCIPLE



Guiding principle is PAIN AVOIDANCE SUPEREGO



Should not



Small voice of God



To stop EGO



Executive decision maker.



In touch with REALITY principle. principle .

ID DOMINANT PERSONALITIES Manic Anti - Social  experienced by serial killers Narcissistic

SUPEREGO DOMINANT PERSONALITIES Obsessive Compulsive Anorexia Nervosa

EGO – if destroyed result in impaired reality perception. Schizophrenia

LIBIDO 

Sexual energy responsible for survival.

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Compilation of Psychiatric Nursing Notes | Karl Gerald C. Manalili, UASN 2010 |

PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.] ORAL STAGE 

0 – 18 months evident.



ID is developed.

*FIXATION – Person is stuck in certain developmental shape. *REGRESSION – Return to an earlier developmental stage. *EGO – Developed on the 6 th month. month.

ANAL STAGE 

18 months – 3 years old.



Able to control bladder, bowel.



Best time for toilet training.



SUPEREGO is developed.

TOILET TRAINING

Good Mother

Bad Mother

Successful Dirty

Clean

- Disorganized

- organized

- Disobedient

- obedient

- Anti-social

- O.C

- Anal expulsive

- Anal retentive

PHALLIC STAGE 

3 – 6 years old.



Experience pleasure by manipulating genitals.



Love – hate relationship.



Oedipus Complex boy loves parent of the opposite sex.



Imitates daddy called IDENTIFICATION.



Castration fears.



Electra Complex girl loves parent of the opposite sex.



Imitates mommy called identification.



Penis envy.


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*Conscious – *Conscious – upper level of thinking. *Preconscious – *Preconscious – tip of tongue. *Unconscious – *Unconscious – protects us from traumatic experiences.

LATENCY STAGE 

6 – 12 years old.



School age.



Separation anxiety.



Reading, Writing, Arithmetic.



Lasts for 6 years.

GENITAL STAGE 

12 years old and above



Sexual reawakening.



Very important stage.

PHARMACOLOGY NOTES ANTI ANXIETY DRUGS

[S.A.T.L.V.M. – E.V.A.B.I.]



Serax



Equanil



Ativan



Vistaril



Tanxene



Atarax



Librium



Buspar



Valium



Inderal



Miltown

ERIC ERIKSON 

There is more to life than just sex.



Psychosocial Theory of development.



You can develop a positive side or a negative side.



Developmental task begins at 0 – 18 months.

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POSITIVE 0 – 18 mos. 18 mos. – 3 yrs. 3 yrs. – 6 yrs. 6 yrs. – 12 yrs. 12 yrs. – 20 yrs. 20 yrs. – 25 yrs. 25 yrs. – 45 yrs. 45 yrs. - above

Trust Autonomy Initiative Industry Identity Intimacy Generativity Ego Integrity

NEGATIVE Mistrust Shame & Doubt Guilt Inferiority Role Confusion Isolation Stagnation Despair

FACTOR Feeding Toilet Training Independence School Peers Love Parenting Reflection

BEHAVIORAL MODELS Ivan Pavlov 

Classical Conditioning



All behaviors are learned.

BF Skinner 

Behavior can be learned and unlearned.



Operant conditioning.



If given reward there is repetition.



If punished behavior becomes extinct.

LOBES OF BRAIN 1. FRONTAL LOBE

3. PARIETAL LOBE



Language



Touch



Learning



Taste



Personality



Judgment

4. OCCIPITAL LOBE

2. TEMPORAL LOBE 

Hearing



Smell

Visual

3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory – eyes, ears, tongue 2. Integration 3. Motor – voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM 

Also called as SOMATIC



Motor nerve to muscle fiber you need ACETYLCHOLINE which is an “On switch”. Brain


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Spinal Cord

Motor Nerve

Synapse

Muscle Fiber

INVOLUNTARY NERVOUS SYSTEM 

Also called AUTONOMIC nervous system.

AUTONOMIC NERVOUS SYSTEM SYMPATHETIC (Awake, ADRENERGIC) Heart Rate Increase Respiratory Rate Increase GI Decrea Decrease se (Dry (Dry mouth mouth,, Consti Constipat pation ion)) GU Decrease ase (Urinary Retenti ntion) Neurotransmitter Epinephrine, Norepinephrine

PARASYMPATHETIC (Relax, CHOLINERGIC) Decrease Decrease Increa Increase se (Mois (Moistt mouth, mouth, Diar Diarrhe rhea) a) Increas ease (Urinary Frequ equenc ency) Acetylcholine

DRUGS WITH ANTICHOLINERGIC EFFECTS 

Anti – Anxiety



Anti – Psychotic



Anti – Cholinergic



Anti – Depressants

PHARMACOLOGY NOTES MONOAMINE OXIDASE INHIBITORS 

Marplan



Nardil



Parnate DEFENSE MECHANISMS 1.

DISPLACEMENT – transfer of feelings to a less threatening object rather than the one who provoked it.

2.

DENIAL – failure to acknowledge an unacceptable trait o r situation.

3.

DISSOCIATION – psychological flight from the self.

4.

REGRESSION – return to an earlier development state.

5.

REPRESSION – unconscious forgetting.

6.

RATIONALIZATION – illogical reasoning for an unacceptable trait and situation.

7.

REACTION FORMATION – doing the opposite of what you have done.

8.

UNDOING – doing the opposite of what you have done.

9.

IDENTIFICATION – assuming trait for personal, social, occupational role.


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10.

PROJECTION – attribute to others one’s unacceptable trait.

11.

INTROJECTION – assume another person’s trait as your own.

12.

SUPPRESSION – conscious forgetting.

13.

SUBLIMATION – putting destructive energies or hostile feelings towards a more productive endeavors.

14.

CONVERSION – unexpressed or repressed feelings are converted to physical symptoms.

15.

COMPENSATION – over achievement in one area to cover a defective part.

16.

SUBSTITUTION – replace difficult goal with more accessible one.

PHARMACOLOGY NOTES ANTI – PARKINSON DRUG [C.A.P.A.B.L.E.S] 

Cogentin



Artane



Parlodel



Akineton



Benadryl



Larodopa



Eldepryl



Symmetrel

AUTONOMIC NERVOUS SYSTEM SYMPATHETIC Dilate Constrict Increase

Pupils Blood Vessels Blood Pressure

PARASYMPATHETIC Constrict Dilate Decrease

THERAPEUTIC COMMUNICATION TECHNIQUES 1.

THERAPEUTIC Offer Se Self

NONTHERAPEUTIC 1. Don’ Don’tt wor worry ry be happ happy y

2. Silen Silence ce – provi provide de time time to think think

2. Chan Changi ging ng the the topic topic/s /sub ubje ject ct

3. Maki aking obs observ ervatio ation n – wha what you see see

3. Igno Ignore re the the clie client nt

you say

4. Value Value base based d judg judgmen mentt – never never assu assume me

4. Activ Active e Listen Listening ing – noddin nodding, g, eye eye contac contactt

5.

Flattery

5. Broad Broad Openin Opening g – how how are you today? today?

6.

Advising

6. Genera Generall Leads Leads – Go on, on, I’m I’m list listeni ening ng

7.

Givi iving Opini pinio on

7. Restat Restatin ing g – I’m I’m sad “You’r “You’re e sad?” sad?” FEAR – protects us from something bad.

ANXIETY 

Vague sense of impending doom.



Triggers the sympathetic nervous system.



Assess level of anxiety of client.


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TYPES OF ANXIETY MILD ANXIETY 

+ 1 level of anxiety.



Widened perceptual field.



Restless (say you seem restless).



Enhanced learning capacity.

MODERATE ANXIETY 




Client pace.



Give PRN meds.

SEVERE ANXIETY 




Don’t know what to do/say.



Directive orders (please sit down). PANIC






May commit suicide.



Promote safety.



Never touch patient.



Hyperventilation (Respiratory Alkalosis)



Breathe into paper bag.

NURSING DIAGNOSIS

PLANNING/IMPLEMENTATION



Ineffective individual coping.



Decrease level of anxiety.



Powerlessness.



Decrease environmental stimuli.



Impaired skin integrity



Relaxation techniques

EVALUATION 

Effective individual coping.

GENERALIZED ANXIETY DISORDER 

6 month excessive worrying.



Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability.

PANIC ATTACKS/ DISORDER 

15 – 30 minutes sympathetic nervous system escalation.



Example is AGORAPHOBIA fear of open spaces.


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POST TRAUMATIC STRESS DISORDER 

Victims become survivors and experience flashbacks or nightmares.

MALINGERING 

Pretending to be sick (conscious).



Primary Gain anxiety decreases, able to escape source of anxiety.



Secondary Gain able to get attention.

SOMATOFORM DISORDER 

No protection



Unconscious



No organic basis of being sick

DIFFERENT TYPES OF SOMATOFORM 1. Co Conv nver ersi sion on Di Diso sord rder er 

Cannot speak, see, hear.



Nervous system affected. 2. La Be Bell lle e Ind Indif iffe fere renc nce e 

Do not care what happens to them.

HYPOCHONDRIASIS 

has minor discomfort and interprets it as major illness.



Focus on clients feelings.

BODY DYSMORPHIC DISORDER 

Illusion of structural defect.



Favorite past time is doctor hopping.



Focus on clients feelings.

PSYCHOSOMATIC 

Real pains/illness



Real symptoms because of anxiety

PSYCHOSOMATIC

↓ Increase Anxiety

↓ SNS

↓


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Increase BP & HR

↓ Hypertension

↓ Fat Deposits

↓ Atherosclerosis

↓ Calcium

↓ Arteriosclerosis

↓ Decrease Oxygen

↓ Angina Pectoris

↓ MI

↓ Necrosis

↓ CHF

↓ Coma

PHOBIA 

Irrational fear



Etiology: Knowledge of certain object



Bad experience



Immediate nursing objective: Removal of stimulus will remove anxiety



Systemic Desensitization Desensitization gradually expose client to stimuli/feared object



Employ relaxation techniques

SYMPATHETIC NERVOUS SYSTEM 

GABA (Gamma Amino Butyric Acid) – stop



Epinephrine and Norepinephrine – Go


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ANTI- ANXIETY MEDICATIONS 

Increase GABA and client becomes drowsy (no alcohol and coffee)



May develop orthostatic hypotension



Let patient sit then dangle feet and then stand



Develop anti cholinergic effects



If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures



Do it in gradual and in tapered dose



Anti anxiety leads to dependence

AUTISM 

Unresponsive and does not want to be touched



AUTISTIC SAVANT: SAVANT : high intelligence and has a ratio of 1:100



Assessment



Appearance – flat affect and loves constancy and ritualistic



Behavior – withdrawn



Communication – echolalia

NURSING DIANOSIS 

Impaired verbal communication



Impaired social interaction



Self mutilation



Risk for injury

PLANNING/IMPLEMENTATION 

Maslow’s hierarchy of needs



Expressive Therapy – use of art as mode of communication

EVALUATION 

Enhanced communication



Improved social interaction



Safety

ATTENTION DEFICIT HYPERACTIVITY DISORDER 

7 years and below onset



Duration: Duration : 6 months and above



Settings: Settings : house and school



Assessment



Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus



Behavior



Communication: talkative


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NURSING DIAGNOSIS 

Risk for injury



Impaired social interaction


Structure: Structure : place to play, sleep, eat and study



Schedule: Schedule : there is always a time for everything that you do



Set limits



Safety

EVALUATION 

Minimize risk for injury



Improved social interaction FRONTAL LOBE OF ADHD Decreased glucose

↓ Decreased judgment

↓ Increase impulsiveness ADHD/ Hyperactivity 

Need a drug that brings glucose level up.



Give RITALIN as stimulant



May result in loss of appetite



Given after meals



Given 6 hours before bedtime EATING DISORDERS



ANOREXIA NERVOSA Eat, eat, eat



BULIMIA NERVOSA Eat, eat, vomit



Less 85% expected body weight



Normal weight



3 months Amenorrhea



Irregular menstruation

BULIMIA NERVOSA 

Metabolic alkalosis (vomiting results to decreased hydrochloric acid)



Metabolic acidosis (diarrhea results to decreased bicarbonate)



Dental caries



Wound in knuckles

MANAGEMENT 

Fluid and electrolyte imbalance



Meal contract



Weight gain for client



After eating stay with client for 1 hour and accompany when going to the comfort room

PHARMACOLOGY NOTES


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ANTI – PSYCHOTIC DRUG 

Stelazine



Serentil



Thorazine



Trilafon



Clozaril



Mellaril



Haldol



Prolixin

SCHIZOPHRENIA 

Ego disintegration



Impaired reality perception



Genetic vulnerability



Stress – Diathesis Model



Biological theory – increase dopamine level



Exact cause unknown

ASSESSMENT 

Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)



Ambivalence: pulled into 2 opposing forces AUTISM: AUTISM : Looseness, no idea, not related to one another



ASSESSMENT

NEGATIVE

POSITIVE

Hypoactive

Hyperactive

Withdrawn

Sociable

Thought Blocking

Flight of ideas

Apathy I. ASSESS 

Content of thought


Disturbed thought process


Present reality



Provide safety

EVALUATION


1



Improved thought process

II. ASSESS 

Hallucinations/ Illusions


Disturbed sensory perception


Present reality



Safety

EVALUATION 

Improved sensory perception

III. ASSESS 

Suspicious


Risk for other directed violence


Present reality



Safety

EVALUATION 

Eliminate/minimize Eliminate/minimize risk for other directed violence

IV. ASSESS 

Suicidal


Risk for self directed violence


Present reality



Safety

EVALUATION 

Eliminate/minimize Eliminate/minimize risk for self directed violence

1 LOOSENESS OF ASSOCIATION 

There is connection with statements


FLIGHT OF IDEAS 

Jumping from on topic to another

AMBIVALENCE 

Pulled between 2 strong opposing forces

MAGICAL THINKING 

acting like magician

ECHOLALIA 

Client repeats what you say

ECHOPRAXIA 

Client repeats what you do

WORD SALAD 

Just words no rhyme

CLANG ASSOCIATION 

Words that rhyme

NEOLOGISM 

Formation of new words (needs clarification)

DELUSION: PERSECUTORY 

“The NBI is out to get me”

DELUSION: RELIGIOUS 

“I am Jesus Christ the savior”

DELUSION: GRANDEUR 

“ I am the queen of the world”

DELUSION: IDEAS OF REFERENCE 

“The nurses are talking about me”

CONCRETE ASSOCIATION 

Also known as “pilosopo”

THOUGHT BLOCKING 

Unable to think

STIMULUS

HALLUCINATIONS ABSENT

ILLUSIONS PRESENT

VISUAL

ABSENT

PRESENT

AUDITORY

ABSENT

PRESENT

TACTILE

ABSENT

PRESENT



Present reality to clients experiencing hallucinations



Technique in handling clients with hallucinations



Hallucinations



Acknowledgement “I know the voices are real to you”


1



Reality orientation “I know the voices are real but I don’t hear them”



Diversion “Lets go to the garden”



10% of schizophrenic clients hear voices

PARKINSON’S DISEASE 

If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch) ANTI-PSYCHOTIC

↓ Decrease dopamine level

↓ Parkinson like effect

↓ Extra pyramidal side effect

↓ With akathesia

↓ Restless, inability to rest AKINESIA 

Muscle rigidity

DYSTONIA 

Torticollis (wry-neck)

OCULOGYRIC CRISIS 

Fixed stare

OPISTHOTONUS 

Arched back



Lips – smacking



Tongue – protruding



Cheeks – puffing



The 3 are irreversible and called TARDIVE DYSKINESIA



NEUROLEPTIC MALIGNANT SYNDROME

Hyperthermia

ANTI – PARKINSON DRUGS

1 ANTICHOLINERGICS (Decrease ACh) ACh)

DOPAMINERGICS (Increase Dopamine) Dopamine)


↓

↓

Artane, Akineton

Parlodel

Benadryl

Larodopa

Cogentin

Eldepryl Symmetrel

OTHER SIDE EFFECTS OF DECREASE DOPAMINE 

Photosensitivity



AGRANULOCYTOSIS AGRANULOCYTOSIS – decrease WBC



Clients prone to infection due to decrease WBC



First sign for infection is sore throat

TYPES OF SCHIZOPHRENIA DISORGANIZED

CATATONIC

- Sad but smiles (Inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech) - Giggling (hebephrenic giggle) - Combination of positive and negative signs and symptoms

- Ambivalence - Waxy flexibility - Favorite word is “No” - Negativism (client do not follow what you tell them to do) Nursing management: Meet needs

PARANOID - Suspicious - Mistrust, scared, withdrawn Nursing management: - Gain TRUST by 1 to 1 short interaction but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: Violent : - Keep door open - Position near door - Don’t touch client - Call for reinforcement - One arms length away from the client.

RESIDUAL - No more positive symptoms just withdrawn

UNDIFFIRENTIATED UNCLASSIFIED - Mixed classification, cant be classified

PHARMACOLOGY NOTES BI-POLAR, MANIC 

Lithium: undergo undergo first kidney test and check for blood levels



Level: .6 – 1.2 meq/L



Increase urination


1



Tremors, fine hand



Hydration of 3L/day



Increase



Uu (diarrhea)



Mouth dry

Signs of Lithium toxicity 

Nausea, vomiting, diarrhea



Increase sodium

**** WAIT FOR 2 – 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS BIPOLAR DISORDER/ MANIC PROFILE 

20 years old



Female



Stress



Obese

ASSESSMENT 

Decrease appetite (give finger foods)



Decrease sleep (place in a private room)



Hyperactive



Increase sexual activity – only means of addressing anxiety so decrease level of anxiety



Risk for injury/other directed violence



Impaired social interaction (care giver role: strain and stay with client)



Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)



Becaus Because e there there is decrease decrease self esteem esteem there there will will be increase compensation resulting resulting to increase interference with ADL’s and harm to others



Compensation is the culprit



Management: increase self esteem to decrease compensation and decrease interference with ADL’s and harm to others

HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS? T - no sports (basketball, volleyball), no fine motor skills only gross motor skills A -llot energies toward more productive endeavors (sublimation (sublimation)) S - escorted walk outdoors K - punching bag (displacement)

PHARMACOLOGY NOTES ANTI – DEPRESSANTS

1



Asendin



Sinequan



Norpralamin



Anafranil



Tofranil



Aventyl




Vivactil



Paxil



Elavil



Zoloft



Prozac

ALCOHOL LEADS TO: 

Blackout: awake but unaware



Confabulation: inventing stories to increase self esteem



Denial: “I am not an alcoholic”



Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co abuser co dependence is another term



Tolerance: gradual increase in amount of stimuli to experience the same euphoria

MANAGEMENT 

Detoxification: withdrawal with medical doctor supervision



Avoid alcohol therapy



Aversion therapy a more technical term for avoid alcohol therapy



Antabuse: Disulfiram makes the client never drink a lcohol because it causes vomiting



Alcoholics anonymous



Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension



Alcoholism may result to Vitamin B1 (Thiamine) deficiency

WERNICKE’S ENCEPHALOPATHY 

Problem with motor

KORSAKOFF’S PSYCHOSIS 

Problem with memory 24 – 72 hours after last dose of alcohol expect:



Delirium Tremens: Tremens: sympathetic nervous system



Prevent hallucinations/Illusions hallucinations/Illusions by placing client in a well lit room



Formication: Formication : feeling of bugs crawling under the skin

ALZHEIMERS DISEASE

-

Axon (away) and Dendrites (toward) nerve

-

Neurofibrillary Neurofibrillary tangles

-

Neurotic plaques

1 ALCOHOL/ DELIRIUM

ALZHEIMERS


ONSET LEVEL OF CONSCIOUSNESS DURATION MEMORY

Abrupt Fluctuating Hours to days Short term memory loss

Gradual Unaffected Progressive Short term and

long term

(orient patient) 5 A’s OF ALZHEIMERS 1. Amnesia – memory loss 2. Anomia – don’t know the name 3. Agnosia – sensory problems smell, taste, sight 4. Aphasia EXPRESSIVE: cant say/express Frontal lobe is affected particularly broca’s area RECEPTIVE: cant hear Temporal lobe is affected particularly wernicke’s area 5. Apraxia – can’t do simple things Reminiscing Therapy Therapy – talk about past 

Patients Patients with Alzheimer’s Alzheimer’s may experience experience hallucinatio hallucinations, ns, illusions illusions thus becomes becomes restless restless and may wander



As sun goes down client becomes restless, agitated, disoriented called “sundowning” “sundowning”



Drug of choice is COGNEX and ARICEPT a cholinesterase inhibitor that increases Ach causing delay in disease progression

SEROTONIN 

Responsible for happiness



Decrease serotonin clients becomes sad give anti-depressants

SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks 

Increases serotonin and affects only serotonin



PROZAC, PAXIL, ZOLOFT TRICYCLIC ANTI DEPRESSANT Two – four weeks C

1

A 

Has higher incidence of side effects



Also increases norepinephrine




ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, ELAVIL

MONO AMINE OXIDASE INHIBITORS 

MAO kills serotonin



Increased MAO results to decreased serotonin the more depressed the client becomes



MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis



Avoid tyramine rich foods 

Avocado, Alcohol



Beer



Chocolates, Cheese (aged)



Fermented foods



Pickles



Preserved foods



Soy sauce



There is increase incidence of side effects after 2 – 6 weeks



MARPLAN, NARDIL, PARNATE

PERSONALITY DISORDERS 1. Schizophrenia They avoid people because there is no e njoyment



2. Avoidant 

They avoid people because they are afraid of criticisms



They have talent but has no confidence 3. Anti-Social 

Constantly breaks law



Project charm



They are witty and articulate



Manipulative

4. Borderline 

They perceive life as an empty glass



They like splitting friends



Sudden change in mood “labile affect”



Prone to suicide

5. Dependent “Cant live if living is without you”



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6. Histrionic 

Constantly wants to be the center of attention



Excited, dramatic, manipulative 7. Narcissistic




“I love myself”



They get jealous even with achievement of family members

8. Obsessive – Compulsive Compulsive 

“I am so organized” 9. Paranoid



Suspicious



May lead to domestic violence

ANTI – DEPRESSANT SIDE EFFECTS 

MALE – Erectile dysfunction, prone to impotence

GRIEF PROCESS [D.A.B.D.A]

1. 2. 3. 4. 5.

Denial – shock/disbelief Anger – – question “why me?” Bargaining – argaining – if, then Depression – epression – 2 weeks or more sign and a nd symptoms becomes major clinical depression Acceptance – cceptance – client acts according to situation

ASSESSMENT 

Decrease self actualization



Decrease self esteem



Withdrawn: stay with client



Suicidal: risk for self directed violence



Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge



Be sensitive to clients needs

FOR SUICIDAL OBSERVE FOR Verbal communication 

“I wont be a problem”



“This is my last day on earth”



“I’ll soon be gone”

Non-verbal communicatio communication n 

Giving away of valuables



Sudden change in mood

WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: “Do you plan to commit suicide?” Irregular/interval visits Endorsement period, EARLY MORNING clients are most likely to commit suicide


1

DOWNERS [A.B.O.N.-M.M.C.H.] Alcohol

Marijuana

Barbiturate

Morphine

Opiates

Codeine

Narcotics

Heroine

Resulting to: 

Bradycardia



Bradypnea



Moist mouth



Pupils constrict



Constipation



Urinary retention



Hypotension



Coma



Weight gain



Narcotic Narc otics s overdose overd ose : give narcotic antagonist (NARCAN, NALOXONE HYDROCHLORIDE) HYDROCHLORIDE)

UPPERS [C.H.A.R.] Cocaine Hallucinogens Amphetamines Resulting to: 

Tachycardia



Awake



Tachypnea



Dry mouth



Pupils dilate



Hypertension



Seizures



Weight loss

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Compilation of Psych Notes

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