Psychiatric Nursing Notes • Psych focuses in feelings or self awareness. • Beliefs determine feelings which w hich affects behavior (manifestation (manifestation of feelings) • Sigmund Freud is the father of PSY!"#N#$YS%S. • &hat ha''ens to childhood will affect adulthood.
S**+ "F P+S"N#$%Y %, • im'ulsive- want to- wants 'leasure. • P$+#S*+ P%N%P$+. • uiding 'rinci'le is P#%N #/"%,#N+. S*P++" • should not • small voice of od • to sto' +" • e0ecutive decision ma1er. • %n touch with w ith reality 'rinci'le. %, ,"2%N#N P+S"N#$%%+S P+S"N#$%%+S 2anic #nti 3 Social 3 e0'erienced by serial 1illers Narcissistic S*P++" ,"2%N#N P+S"N#$%%+S "bsessive om'ulsive #nore0ia Nervosa +" 3 if destroyed result in im'aired reality 'erce'tion. Schi4o'hrenia $%B%," • Se0ual energy res'onsible for survival. "ral Stage • 5 3 67 months m onths evident. evident. • %, is develo'ed. 8F%9#%"N 3 Person is stuc1 in certain develo'mental sha'e. 8++SS%"N 3 eturn to an earlier develo'mental stage. +" 3 ,evelo'ed on the :th month. #nal Stage • 67 months 3 ; years old.
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• #ble to control bladder- bowel. • Best time for toilet training. • S*P++" is develo'ed. "%$+ #%N%N Good Mother------------------------ Bad Mother Successful <<<<<<<<<<<<<<<<<,irty <<<<<<<<<<<<<<<<<<<<<< lean <<<<<<<<<<<<<<<<<<<<<<<<
$#+NY S#+ • : 3 6= years old. • School age. • Se'aration an0iety. • eading- &riting- #rithmetic. • $asts for : years.
+N%#$ S#+ • 6= years old and above • Se0ual reawa1ening. • /ery im'ortant stage.
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P!#2# N"+S> #N% < #N9%+Y ,*S • /alium • $ibrium • #tivan • Sera0 • an0ene • 2iltown • +?uanil • /istaril • #tara0 • %deral • Bus'ar +% +%@S"N • here is more to life than Aust se0. • Psychosocial heory of develo'ment. • You can develo' a 'ositive side or a negative side. • ,evelo'mental tas1 begins at 5 3 67 months. <<<<<<<<<<<<<<<<<<<< P"S%%/+ <<<<<
$"B+S "F B#%N 6. F"N#$ $"B+ < $anguage < $earning < Personality < Eudgment =. +2P"#$ $"B+ < !earing < Smell ;. P#+%#$ $"B+ < ouch < aste D. "%P%#$ $"B+ < /isual
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; S+PS " %N+# &%! +N/%"N2+N 6. Sensory 3 eyes- ears- tongue =. %ntegration ;. 2otor 3 voluntary or involuntary /"$*N#Y N+/"*S SYS+2 • also called as somatic Brain S'inal ord 2otor Nerve Syna'se 2uscle Fiber • 2otor nerve to muscle fiber you need #cethylcholine which is an "n switchG. %N/"$*N#Y N+/"*S SYS+2 • also called autonomic nervous system. #*"N"2% N+/"*S SYS+2 <<<<<<<<<<<<<<<<<<<<<<
,*S &%! #N%!"$%N+% +FF+S • #nti 3 #n0iety • #nti 3 Psychotic • #nti 3 holinergic • #nti 3 ,e'ressants P!#2# N"+S> 2"N"#2%N+ "9%,#S+ %N!%B%"S (2#"% ,*S) • 2ar'lan • Nardil • Parnate ,+F+NS+ 2+!#N%S2S 6. ,is'lacement 3 transfer of feelings to a less threatening obAect rather than the one who 'rovo1ed it. =. ,enial 3 failure to ac1nowledge an unacce'table trait or situation. ;. ,%S"%#%"N 3 'sychological flight from the self. D. ++SS%"N 3 return to an earlier develo'ment state. C. re'ression 3 unconscious forgetting.
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:. #%"N#$%H#%"N 3 illogical reasoning for an unacce'table trait and situation. I. +#%"N F"2#%"N 3 doing the o''osite of what you have done. 7. *N,"%N 3 doing the o''osite of what you have done. J. %,+N%F%#%"N 3 assuming trait for 'ersonal- social- occu'ational role. 65. P"E+%"N 3 attribute to others oneKs unacce'table trait. 66. %N"E+%"N 3 assume another 'ersonKs trait as your own. 6=. S*PP+SS%"N 3 conscious forgetting. 6;. S*B$%2#%"N 3 'utting destructive energies or hostile feelings towards a more 'roductive endeavors. 6D. "N/+S%"N 3 une0'ressed or re'ressed feelings are converted to 'hysical sym'toms. 6C. "2P+NS#%"N 3 over achievement in one area to cover a defective 'art. 6:. S*BS%*%"N 3 re'lace difficult goal with more accessible one. P!#2# N"+S> #N% 3 P#@%NS"N ,* < #P#B$+S • ogentin • #rtane • Parlodel • #1ineton • Benadryl • $arodo'a • +lde'ryl • Symmetrel
#*"N"2% N+/"*S SYS+2 <<<<<<<<<<<<<<<<< SY2P#!+% <<<<<<<< P##SY2P#!+% Pu'ils <<<<<<<<<<<<<<<<,ilate <<<<<<<<<<<<<<<<onstrict Blood /essels <<<<<<<<onstrict <<<<<<<<<<<<< ,ilate Blood Pressure <<<<<<<<%ncrease <<<<<<<<<<<< ,ecrease !+#P+*% "22*N%#%"N +!N%L*+S !+#P+*% 6. "ffer Self =. Silence 3 'rovide time to thin1 ;. 2a1ing observation 3 what you see you say D. #ctive $istening 3 nodding- eye contact C. Broad "'ening 3 how are you todayM :. eneral $eads 3 o on- %Km listening I. estating 3 %Km sad YouKre sadMG 6. ,onKt worry be ha''y =. hanging the to'icsubAect ;. %gnore the client D. /alue based Audgment 3 never assume C. Flattery :. #dvising I. iving "'inion
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N"N!+#P+*% 6. ,onKt worry be ha''y =. hanging the to'icsubAect ;. %gnore the client D. /alue based Audgment 3 never assume C. Flattery :. #dvising I. iving "'inion F+# 3 'rotects us from something bad. #N9%+Y • /ague sense of im'ending doom. • riggers the sym'athetic nervous system. • #ssess level of an0iety of client. YP+S "F #N9%+Y MILD ANXIETY • O 6 level of an0iety. • &idened 'erce'tual field. • estless (say you seem restless). • +nhanced learning ca'acity. MODERATE ANXIETY • O = level of an0iety. • lient 'ace. • ive PN meds. SEVERE ANXIETY • O ; level of an0iety. • ,onKt 1now what to dosay. • ,irective orders ('lease sit down). PANIC • O D level of an0iety. • 2ay commit suicide. • Promote safety. • Never touch 'atient. • !y'erventilation (es'iratory #l1alosis) • Breathe into 'a'er bag. NURSING DIAGNOSIS: • ineffective individual co'ing. • Powerlessness. • %m'aired s1in integrity PLANNING/IMPLEMENTATION: • decrease level of an0iety.
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• ,ecrease environmental stimuli. • ela0ation techni?ues. EVALUATION • effective individual co'ing. GENERALIZED ANXIETY DISORDER • : month e0cessive worrying. • estless- difficulty concentration- slee' disorders- 'al'itations- edge of the seateasy fatigability. PANIC ATTACS/DISORDER • 6C 3 ;5 minutes sym'athetic nervous system escalation. • +0am'le is #"#P!"B%# fear of o'en s'aces. P"S #*2#% S+SS ,%S",+ • victims becomes survivors and e0'erience flashbac1s or nightmares. 2#$%N+%N • 'retending to be sic1 (conscious). • Primary ain an0iety decreases- able to esca'e source of an0iety. • Secondary ain able to get attention. S"2#"F"2 • no 'rotection • unconscious • no organic basis of being sic1 ,%FF++N YP+ "F S"2#"F"2 6. onversion ,isorder • cannot s'ea1- see- hear. • Nervous system affected. =. $a Belle %ndifference • do not care what ha''ens to them. !YP"!"N,%#S%S • has minor discomfort and inter'rets it as maAor illness. • Focus on clients feelings. B",Y ,%S2"P!% ,%S",+ • %llusion of structural defect. • Favorite 'ast time is doctor ho''ing. • Focus on clients feelings. PSY!"S"2#% • eal 'ainsillness • eal sym'toms because of an0iety PSYC!OSOMATIC %ncrease #n0iety
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SNS %ncrease BP ! !y'ertension Fat ,e'osits #therosclerosis alcium #rteriosclerosis ,ecrease "0ygen #ngina Pectoris 2% Necrosis !F oma P!"B%# • %rrational fear • +tiology> @nowledge of certain obAect • Bad e0'erience • %mmediate nursing obAective> emoval of stimulus will remove an0iety • Systemic ,esensiti4ation gradually e0'ose client to stimulifeared obAect • +m'loy rela0ation techni?ues SNS • #B# (amma #mino Butyric #cid) 3 sto' • +'ine'hrine and Nore'ine'hrine 3 o #N%<#N9%+Y • %ncrease #B# and client becomes drowsy (no alcohol and coffee) • 2ay develo' orthostatic hy'otension • $et 'atient sit then dangle feet and then stand • ,evelo' anti cholinergic effects • %f abru'tly withdrawn to anti an0iety it may result to rebound 'henomenon (6 wee1) may lead to sei4ures • ,o it in gradual and in ta'ered dose • #nti an0iety leads to de'endence #*%S2 • *nres'onsive and does not want to be touched • #utistic Savant> high intelligence and has a ratio of 6>655 • #ssessment • #''earance 3 flat affect and loves constancy and ritualistic • Behavior 3 withdrawn • ommunication 3 echolalia NURSING DIANOSIS • %m'aired verbal communication • %m'aired social interaction • Self mutilation • is1 for inAury PLANNING/IMPLEMENTATION
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• 2aslowKs hierarchy of needs • +0'ressive hera'y 3 use of art as mode if communication EVALUATION • +nhanced communication • %m'roved social interaction • Safety #+N%"N ,+F%% !YP+#%/%Y ,%S",+ • I years and below onset • ,uration> : months and above • Settings> house and school • #ssessment • #''earance> dirty- clumsy- hy'eractive- im'atient- easily distracted and has no focus • Behavior • ommunication> tal1ative NURSING DIAGNOSIS • is1 for inAury • %m'aired social interaction PLANNING/IMPLEMENTATION • Structure> 'lace to 'lay- slee'- eat and study • Schedule> there is always a time for everything that you do • Set limits • Safety EVALUATION • 2inimi4e ris1 for inAury • %m'roved social interaction F"N#$ $"B+ "F #,!, ,ecrease glucose ,ecrease Audgment %ncrease im'ulsiveness #,!, !y'eractivity • Need a drug that brings glucose level u'. • ive italin a stimulant • 2ay result in loss of a''etite • iven after meals • iven : hours before bedtime
+#%N ,%S",+S #N"+9%# N+/"S# <<<<<<<<<<<<<<
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< ; months amenorrhea <<<<<<<<<<<<<<< %rregular menstruation
B*$%2%# N+/"S# • 2etabolic al1alosis (vomiting results to decrease hydrochloric acid) • 2etabolic acidosis (diarrhea results to decrease bicarbonate) • ,ental caries • &ound in 1nuc1les MANAGEMENT • Fluid and electrolyte imbalance • 2eal contract • &eight gain for client • #fter eating stay with client for 6 hour and accom'any when going to the comfort room P!#2# N"+S> #N% 3 PSY!"% ,* • Stela4ine • Serentil • hora4ine • rilafon • lo4aril • 2ellaril • !aldol • Proli0in S!%H"P!+N%# • +go disintegration • %m'aired reality 'erce'tion • enetic vulnerability • Stress 3 ,iathesis 2odel • Biological theory 3 increase do'amine level • +0act cause un1nown ASSESSMENT • #ffect> #''ro'riate- %na''ro'riate- Flat- Blunt (incom'lete) • #mbivalence> 'ulled into = o''osing forces #utism • $ooseness- no idea- not related to one another #SS+SS2+N N+#%/+ <<<<<<<<<<<<<<<<<<<<<<<
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NURSING DIAGNOSIS • ,isturbed thought 'rocess PLANNING/IMPLEMENTATION • Present reality • Provide safety EVALUATION • %m'roved thought 'rocess %%. #SS+SS • !allucinations%llusions NURSING DIAGNOSIS • ,isturbed sensory 'erce'tion PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • %m'roved sensory 'erce'tion %%%. #SS+SS • Sus'icious NURSING DIAGNOSIS • is1 for other directed violence PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • +liminateminimi4e ris1 for other directed violence %/. #SS+SS • Suicidal NURSING DIAGNOSIS • is1 for self directed violence PLANNING/IMPLEMENTATION • Present reality • Safety EVALUATION • +liminateminimi4e ris1 for self directed violence $""S+N+SS "F #SS"%#%"N • here is connection with statements F$%! "F %,+#S • Eum'ing from on to'ic to another #2B%/#$+N+ • Pulled between = strong o''osing forces
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2#%#$ !%N@%N • acting li1e magician +!"$#$%# • lient re'eats what you say +!"P#9%# • lient re'eats what you do &", S#$#, • Eust words no rhyme $#N #SS"%#%"N • &ords that rhyme N+"$"%S2 • Formation of new words (needs clarification) ,+$*S%"N> P+S+*"Y • he NB% is out to get meG ,+$*S%"N> +$%%"*S • % am Eesus hrist the saviorG ,+$*S%"N> #N,+* • % am the ?ueen of the worldG ,+$*S%"N> %,+#S "F +F++N+ • he nurses are tal1ing about meG "N++ #SS"%#%"N • #lso 1nown as 'iloso'oG !"*! B$"@%N • *nable to thin1 <<<<<<<<<<<<<<<<<<<<<<
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P#@%NS"NKS ,%S+#S+ • %f acethylcholine (on switch) is increased there is e0cessive movement resulting to decrease in do'amine (off switch) #N%
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< ombination of 'ositive and negative signs and sym'toms CATATONIC SC!IZOP!RENIA < #mbivalence < &a0y fle0ibility < Favorite word is NoG < Negativism (client do not follow what you tell them to do) Nursing management> meet needs PARANOID SC!IZOP!RENIA < Sus'icious < 2istrust- scared- withdrawn Nursing management> < ain trust by 6 to 6 short interaction but fre?uent < Foods should be in a sealed container < 2edications should be in tam'er resistant foil. /iolent> < @ee' door o'en < Position near door < ,onKt touch client < all for reinforcement < "ne arms length away from the client. PARANOID SC!IZOP!RENIA < No more 'ositive sym'toms Aust withdrawn UNDI""IRENTIATED SC!IZOP!RENIA < 2i0ed classification- cant be classified
P!#2# N"+S> B%
undergo first 1idney test and chec1 for blood levels • $evel> .: 3 6.= me?$ • %ncrease urination • remors- fine hand • !ydration of ;$day • %ncrease • *u (diarrhea) • 2outh dry S#$%& o' L#th#() to*#+#t, • Nausea- vomiting- diarrhea • %ncrease sodium 8 &ait for = 3 D wee1s before lithium thera'y ta1es effects B%P"$# ,%S",+2#N% P"F%$+ • =5 years old • Female
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• Stress • "bese ASSESSMENT • ,ecrease a''etite (give finger foods) • ,ecrease slee' ('lace in a 'rivate room) • !y'eractive • %ncrease se0ual activity 3 only means of addressing an0iety so decrease level of an0iety • is1 for inAuryother directed violence • %m'aired social interaction (care giver role> strain and stay with client) • Self esteem decrease (to cover u' their sadness there is com'ensation to cover defective doing) • Because there is decrease self esteem there will be increase com'ensation resulting to increase interference with #,$Ks and harm to others • om'ensation is the cul'rit • 2anagement> increase self esteem to decrease com'ensation and decrease interference with #,$Ks and harm to others !"& " %N+#S+ S+$F +S++2 "F 2#N% P#%+NS < no s'orts (bas1etball- volleyball)- no fine motor s1ills only gross motor s1ills # lot energies toward more 'roductive endeavors (sublimation) S < escorted wal1 outdoors @ 3 'unching bag (dis'lacement)
P!#2# N"+S> #N% 3 ,+P+SS#NS • #sendin • Nor'ralamin • ofranil • Sine?uan • #nafranil • #ventyl • /ivactil • +lavil • Pro4ac • Pa0il • Holoft #$"!"$ $+#,S "> • Blac1out> awa1e but unaware • onfabulation> inventing stories to increase self esteem • ,enial> % am not an alcoholicG • ,e'endence> cant leave with out leading to enabling where in the significant other tolerates the abuser co de'endence is another term • olerance> gradual increase in amount of stimuli to e0'erience the same eu'horia
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2#N#+2+N • ,eto0ification> withdrawal with medical doctor su'ervision • #void alcohol thera'y • #version thera'y a more technical term for avoid alcohol thera'y • #ntabuse> ,isulfiram ma1es the client never drin1 alcohol because it causes vomiting • #lcoholics anonymous • %nterval of 6= hours after last dose of alcohol or e0'erience nausea and vomiting and hy'otension • #lcoholism may result to /itamin B6 (hiamine) deficiency &+N%@+KS +N+P!#$"P#!Y • Problem with motor @"S#@"FFKS PSY!"S%S • Problem with memory • =D 3 I= hours after last dose of alcohol e0'ect> • ,elirium remens> sym'athetic nervous system • Prevent hallucinations%llusions by 'lacing client in a well lit room • Formication> feeling of bugs crawling under the s1in #$H!+%2+S ,%S+#S+ • #0on (away) and ,endrites (toward) nerve • Neurofibrillary tangles • Neurotic 'la?ues <<<<<<<<<<<<<<<<<<<<<<<<<<#$"!"$ <<< #$H!+%2+S "NS+ <<<<<<<<<<<<<<<<<<<< #bru't <<<<<<<< radual $+/+$ "F "NS%"*SN+SS << Fluctuating <<<<*naffected ,*#%"N <<<<<<<<<<< !ours to days <<< Progressive 2+2"Y <<<<<<<<<<<<<< Short term << cant saye0'ress < frontal lobe is affected 'articularly brocaKs area < rece'tive> cant hear < tem'oral lobe is affected 'articularly wernic1eKs area C. #'ra0ia 3 cant do sim'le things 8 eminiscing hera'y 3 tal1 about 'ast • Patients with al4heimerKs may e0'erience hallucinations- illusions thus becomes restless and may wander • #s sun goes down client becomes restless- agitated- disoriented called sundowning • ,rug of choice is ogne0 and #rice't a cholinesterase inhibitor that increases #ch causing delay in disease 'rogression
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S+""N%N • es'onsible for ha''iness • ,ecrease serotonin clients becomes sad give anti
2"N" #2%N+ "9%,#S+ %N!%B%"S • 2#" 1ills serotonin • %ncreased 2#" results to decreased serotonin the more de'ressed the client becomes • 2#"% 1ills 2#" and increases all neurotransmitters (serotonin- e'ine'hrinenore'ine'hrine- do'amine but client becomes 'rone to hy'ertensive crisis • #void tyramine rich foods • #vocado- #lcohol • Beer • hocolates- heese (aged) • Fermented foods • Pic1les • Preserved foods • Soy sauce • here is increase incidence of side effects after = 3 : wee1s • 2ar'lan- Nardil- Parnate
P+S"N#$%Y ,%S",+S 6. Schi4o'hrenia < hey avoid 'eo'le because there is no enAoyment =. #voidant < hey avoid 'eo'le because they are afraid of criticisms < hey have talent but has no confidence ;. #nti
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D. Borderline < hey 'erceive life as an em'ty glass < hey li1e s'litting friends < Sudden change in mood labile affectG < Prone to suicide C. ,e'endent < ant live if living is without youG :. !istrioinic < onstantly wants to be the center of attention < +0cited- dramatic- mani'ulative I. Narcissistic < % love myselfG < hey get Aealous even with achievement of family members 7. "bsessive 3 om'ulsive < % am so organi4edG J. Paranoid < Sus'icious < 2ay lead to domestic violence
#N% 3 ,+P+SS#N S%,+ +FF+S> 2ale 3 erectile dysfunction- 'rone to im'otence
%+F P"+SS 6. ,enial 3 shoc1disbelief =. #nger 3 ?uestion why meMG ;. Bargaining 3 if- then D. ,e'ression 3 = wee1s or more sign and sym'toms becomes maAor clinical de'ression C. #cce'tance 3 client acts according to situation
#SS+SS2+N • ,ecrease self actuali4ation • ,ecrease self esteem • &ithdrawn> stay with client • Suicidal> ris1 for self directed violence • %ncreasedecrease eat- increasedecrease slee'- hy'oactive- decrease se0ual urge • Be sensitive to clients needs
F" S*%%,#$ "BS+/+ F" /erbal • % wont be a 'roblemG • his is my last day on earthG • %Kll soon be goneG Non verbal • iving away of valuables • Sudden change in mood
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&!+N !+ $%+N %S S*%%,#$ &!# &%$$ !+ N*S+ ," ,irect> ,o you 'lan to commit suicideMG %rregularinterval visits +ndorsement 'eriod- early morning clients are most li1ely to commit suicide
,"&N+S #lcohol Barbiturate "'iates Narcotics 2ariAuana 2or'hine odeine !eroine
esulting to> • Bradycardia • Brady'nea • 2oist mouth • Pu'ils constrict • onsti'ation • *rinary retention • !y'otension • oma • &eight gain • Narcotics overdose> give narcotic antagonist (Narcan- Nalo0one hydrochloride)
*PP+S ocaine !allucinogens #m'hetamines esulting to> • achycardia • #wa1e • achy'nea • ,ry mouth • Pu'ils dilate • !y'ertension • Sei4ures • &eight loss
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