PSYCHIATRIC NURSING Psych focuses in feelings or self-awareness.

Beliefs determine feelings which af fects behavior (manifestation of feelings) Sigmund Freud is the father of PSYCHO ANALYSIS What happens to childhood will affect adulthood STRUCTURE OF PERSONALITY ID Impulsive, want to, wants pleasure. PLEASURE PRINCIPLE Guiding principle is PA IN AVOIDANCE SUPEREGO Should not Small voice of God To stop EGO Executive decisi on maker. In touch with REALITY principle. ID DOMINANT PERSONALITIES Manic Anti - Social experienced by serial killers Narcissistic SUPEREGO DOMINANT PERSONAL ITIES Obsessive Compulsive Anorexia Nervosa EGO if destroyed result in impaire d reality perception. Schizophrenia LIBIDO

Sexual energy responsible for survival. 1 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 6th month. ANAL STAG E 18 months 3 years old. Able to control bladder, bowel. Best time for toilet tr aining. SUPEREGO is developed. TOILET TRAINING Good Mother Successful Dirty - Disorganized - Disobedient - Anti-social Bad Mother Clean - organized - obedient - O.C - Anal retentive - Anal expulsive PHALLIC STAGE 3 6 years old. Experience pleasure by manipulating genitals. Love hate relat ionship. Oedipus Complex boy loves parent of the opposite sex. Imitates daddy ca lled IDENTIFICATION. Castration fears. Electra Complex girl loves parent of the opposite sex. Imitates mommy called identification. Penis envy. 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

*Conscious upper level of thinking. *Preconscious tip of tongue. *Unconsciou s 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 Ativan Tanxene Librium Valium Miltown Equanil Vistaril Atarax Buspar Inderal 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. 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

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 POSITIVE Trust Autonomy Initiative Industry Identity Intimacy Generativity Ego I ntegrity NEGATIVE Mistrust Shame & Doubt Guilt Inferiority Role Confusion Isolation Stagn ation Despair FACTOR Feeding Toilet Training Independence School Peers Love Parenting Reflecti on BEHAVIORAL MODELS Ivan Pavlov Classical Conditioning All behaviors are learned. BF Skinner Behavior can be learned and unlearned. Operant conditioning. If given reward the re is repetition. If punished behavior becomes extinct. LOBES OF BRAIN 1. FRONTAL LOBE 3. PARIETAL LOBE Language Learning Personality Judgment Hearing Smell Touch Taste 4. OCCIPITAL LOBE Visual 2. TEMPORAL LOBE 3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory eyes, ears, tongue 2. Integrat ion 3. Motor voluntary or involuntary VOLUNTARY NERVOUS SYSTEM 1 Also called as SOMATIC Motor nerve to muscle fiber you need ACETYLCHOLINE which is an On switch. Brain Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

Spinal Cord Motor Nerve Synapse Muscle Fiber INVOLUNTARY NERVOUS SYSTEM Also called AUTONOMIC nervous system. AUTONOMIC NERVOUS SYSTEM SYMPATHETIC (Awake, ADRENERGIC) Increase Increase Decre ase (Dry mouth, Constipation) Decrease (Urinary Retention) Epinephrine, Norepine phrine PARASYMPATHETIC (Relax, CHOLINERGIC) Decrease Decrease Increase (Moist mo uth, Diarrhea) Increase (Urinary Frequency) Acetylcholine Heart Rate Respiratory Rate GI GU Neurotransmitter 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 f ailure to acknowledge an unacceptable trait or situation. 3. DISSOCIATION psyc hological flight from the self. 4. REGRESSION return to an earlier development state. 5. REPRESSION unconscious forgetting. 6. RATIONALIZATION illogical r easoning 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. 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

10. PROJECTION attribute to others ones unacceptable trait. 11. INTROJECTION assume another persons trait as your own. 12. SUPPRESSION conscious forgett ing. 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 a rea to cover a defective part. 16. SUBSTITUTION replace difficult goal with mo re accessible one. PHARMACOLOGY NOTES ANTI PARKINSON DRUG [C.A.P.A.B.L.E.S] Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetrel SYMPATHET IC Dilate Constrict Increase PARASYMPATHETIC Constrict Dilate Decrease AUTONOMIC NERVOUS SYSTEM Pupils Blood Vessels Blood Pressure THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. Offer Self 2. Silence prov ide time to think 3. Making observation what you see you say 4. Active Listeni ng nodding, eye contact 5. Broad Opening how are you today? 6. General Leads Go on, Im listening 7. Restating Im sad Youre sad? FEAR protects us from something bad. ANXIETY NONTHERAPEUTIC 1. Dont worry be happy 2. Changing the topic/subject 3. Ignore t he client 4. Value based judgment never assume 5. Flattery 6. Advising 7. Givi ng Opinion Vague sense of impending doom. Triggers the sympathetic nervous system. Assess l evel of anxiety of client. 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

TYPES OF ANXIETY MILD ANXIETY + 1 level of anxiety. Widened perceptual field. Restless (say you seem restless) . Enhanced learning capacity. + 2 level of anxiety. Client pace. Give PRN meds. + 3 level of anxiety. Dont know what to do/say. Directive orders (please sit do wn). MODERATE ANXIETY SEVERE ANXIETY PANIC + 4 level of anxiety. May commit suicide. Promote safety. Never touch patient. H yperventilation (Respiratory Alkalosis) Breathe into paper bag. NURSING DIAGNOSI S PLANNING/IMPLEMENTATION

Ineffective individual coping. Powerlessness. Impaired skin integrity EVALUATION Decrease level of anxiety. Decrease environmental stimuli. Relaxation techniques 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 fe ar of open spaces. 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

POST TRAUMATIC STRESS DISORDER Victims become survivors and experience flashbacks or nightmares. MALINGERING Pretending to be sick (conscious). Primary Gain anxiety decreases, able to escap e 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. Conversion Disorder Cannot speak, see, hear. Nervous system affected. 2. La Belle Indifference Do not care what happens to them. HYPOCHONDRIASIS has minor discomfort and interprets it as major illness. Focus on clients feelin gs. Illusion of structural defect. Favorite past time is doctor hopping. Focus o n clients feelings. Real pains/illness Real symptoms because of anxiety BODY DYSMORPHIC DISORDER PSYCHOSOMATIC PSYCHOSOMATIC Increase Anxiety 1 SNS Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

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 n ursing objective: Removal of stimulus will remove anxiety Systemic Desensitizati on gradually expose client to stimuli/feared object Employ relaxation techniques SYMPATHETIC NERVOUS SYSTEM GABA (Gamma Amino Butyric Acid) stop Epinephrine and Norepinephrine Go 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

ANTI- ANXIETY MEDICATIONS Increase GABA and client becomes drowsy (no alcohol and coffee) May develop orth ostatic hypotension Let patient sit then dangle feet and then stand Develop anti cholinergic effects If abruptly withdrawn to anti anxiety it may result to rebo und phenomenon (1 week) may lead to seizures Do it in gradual and in tapered dos e Anti anxiety leads to dependence Unresponsive and does not want to be touched AUTISTIC SAVANT: high intelligence and has a ratio of 1:100 Assessment Appearanc e flat affect and loves constancy and ritualistic Behavior withdrawn Communi cation echolalia Impaired verbal communication Impaired social interaction Sel f mutilation Risk for injury Maslows hierarchy of needs Expressive Therapy us e of art as mode of communication Enhanced communication Improved social interac tion Safety

AUTISM NURSING DIANOSIS PLANNING/IMPLEMENTATION EVALUATION ATTENTION DEFICIT HYPERACTIVITY DISORDER 7 years and below onset Duration: 6 months and above Settings: house and school Assessment Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus Behavior Communication: talkative 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

NURSING DIAGNOSIS Risk for injury Impaired social interaction Structure: place to play, sleep, eat and study Schedule: there is always a time for everything that you do Set limit s Safety Minimize risk for injury Improved social interaction FRONTAL LOBE OF AD HD Decreased glucose PLANNING/IMPLEMENTATION EVALUATION Decreased judgment Increase impulsiveness ADHD/ Hyperactivity Need a drug that brings glucose level up. Give RITALIN as stimulant May result i n loss of appetite Given after meals Given 6 hours before bedtime EATING DISORDE RS BULIMIA NERVOSA Eat, eat, vomit Normal weight Irregular menstruation

ANOREXIA NERVOSA Eat, eat, eat Less 85% expected body weight 3 months Amenorrhea

BULIMIA NERVOSA Metabolic alkalosis (vomiting results to decreased hydrochloric acid) Metabolic acidosis (diarrhea results to decreased bicarbonate) Dental caries Wound in knuc kles 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 1 MANAGEMENT PHARMACOLOGY NOTES Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

ANTI PSYCHOTIC DRUG Stelazine Serentil Thorazine Trilafon Clozaril Mellaril Haldol Prolixin SCHIZOPHRENIA Ego disintegration Impaired reality perception Genetic vulnerability Stress Di athesis Model Biological theory increase dopamine level Exact cause unknown Af fect: Appropriate, Inappropriate, Flat, Blunt (incomplete) Ambivalence: pulled i nto 2 opposing forces AUTISM: Looseness, no idea, not related to one another ASS ESSMENT ASSESSMENT NEGATIVE Hypoactive Withdrawn Thought Blocking Apathy I. ASSESS POSITIVE Hyperactive Sociable Flight of ideas Content of thought Disturbed thought process Present reality Provide safety 1 NURSING DIAGNOSIS PLANNING/IMPLEMENTATION EVALUATION Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

Improved thought process II. ASSESS Hallucinations/ Illusions Disturbed sensory perception Present reality Safety Im proved sensory perception NURSING DIAGNOSIS PLANNING/IMPLEMENTATION EVALUATION III. ASSESS Suspicious Risk for other directed violence Present reality Safety Eliminate/min imize risk for other directed violence NURSING DIAGNOSIS PLANNING/IMPLEMENTATION EVALUATION IV. ASSESS Suicidal Risk for self directed violence Present reality Safety Eliminate/minimi ze risk for self directed violence NURSING DIAGNOSIS PLANNING/IMPLEMENTATION EVALUATION 1 LOOSENESS OF ASSOCIATION There is connection with statements Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

FLIGHT OF IDEAS Jumping from on topic to another Pulled between 2 strong opposing forces acting like magician Client repeats what you say Client repeats what you do Just words no rhyme Words that rhyme Formation of new words (needs clarification) The NBI is out to get me I am Jesus Christ the savior I am the queen of the world The nurses are talking about me Also known as pilosopo Unable to think AMBIVALENCE MAGICAL THINKING ECHOLALIA ECHOPRAXIA WORD SALAD CLANG ASSOCIATION NEOLOGISM DELUSION: PERSECUTORY DELUSION: RELIGIOUS DELUSION: GRANDEUR DELUSION: IDEAS OF REFERENCE CONCRETE ASSOCIATION THOUGHT BLOCKING STIMULUS VISUAL AUDITORY TACTILE HALLUCINATIONS ABSENT ABSENT ABSENT ABSENT Present reality to clients experienci ng hallucinations Technique in handling clients with hallucinations Hallucinatio ns Acknowledgement I know the voices are real to you ILLUSIONS PRESENT PRESENT PRESENT PRESENT 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

Reality orientation I know the voices are real but I dont hear them Diversion Lets go to the garden 10% of schizophrenic clients hear voices PARKINSONS 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 Torticollis (wry-neck) Fixed stare Arched back Lips smacking T ongue protruding Cheeks puffing The 3 are irreversible and called TARDIVE DY SKINESIA NEUROLEPTIC MALIGNANT SYNDROME Hyperthermia DYSTONIA OCULOGYRIC CRISIS OPISTHOTONUS ANTI PARKINSON DRUGS 1 ANTICHOLINERGICS (Decrease ACh) DOPAMINERGICS (Increase Dopamine) Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

 Artane, Akineton Benadryl Cogentin OTHER SIDE EFFECTS OF DECREASE DOPAMINE Parlodel Larodopa Eldepryl Symmetrel Photosensitivity AGRANULOCYTOSIS decrease WBC Clients prone to infection due t o decrease WBC First sign for infection is sore throat CATATONIC - Ambivalence Waxy flexibility - Favorite word is No - Negativism (client do not follow wha t you tell them to do) Nursing management: Meet needs PARANOID - Suspicious - Mi strust, scared, withdrawn Nursing management: - Gain TRUST by 1 to 1 short inter action but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: - Keep door open - Position near door - D ont touch client - Call for reinforcement - One arms length away from the clien t. RESIDUAL - No more positive symptoms just withdrawn UNDIFFIRENTIATED UNCLASSI FIED - Mixed classification, cant be classified TYPES OF SCHIZOPHRENIA DISORGANIZED - Sad but smiles (Inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech) - Giggling (hebe phrenic giggle) - Combination of positive and negative signs and symptoms PHARMACOLOGY NOTES BI-POLAR, MANIC Lithium: undergo first kidney test and check for blood levels Level: .6 1.2 me q/L Increase urination 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

Tremors, fine hand Hydration of 3L/day Increase Uu (diarrhea) Mouth dry Nausea, vomiting, diarrhea Increase sodium Signs of Lithium toxicity **** WAIT FOR 2 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS BIPOLAR DISORDER/ MANIC PROFILE 20 years old Female Stress Obese Decrease appetite (give finger foods) Decrease sleep (place in a private room) Hyperactive Increase sexual activity only mean s of addressing anxiety so decrease level of anxiety Risk for injury/other direc ted 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) Because there is decrease self esteem there will be incr ease compensation resulting to increase interference with ADLs and harm to othe rs Compensation is the culprit Management: increase self esteem to decrease comp ensation and decrease interference with ADLs and harm to others ASSESSMENT

HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS? T - no sports (basketball, volley ball), no fine motor skills only gross motor skills A -llot energies toward more productive endeavors (sublimation) S - escorted walk outdoors K - punching bag (displacement) PHARMACOLOGY NOTES ANTI DEPRESSANTS 1 Asendin Norpralamin Tofranil Sinequan Anafranil Aventyl Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

Vivactil Elavil Prozac

Paxil Zoloft ALCOHOL LEADS TO: Blackout: awake but unaware Confabulation: inventing stories to increase self es teem Denial: I am not an alcoholic Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is an other term Tolerance: gradual increase in amount of stimuli to experience the sa me euphoria Detoxification: withdrawal with medical doctor supervision Avoid alc ohol therapy Aversion therapy a more technical term for avoid alcohol therapy An tabuse: Disulfiram makes the client never drink alcohol because it causes vomiti ng Alcoholics anonymous

MANAGEMENT Interval of 12 hours after last dose of alcohol or experience nausea and vomit ing and hypotension Alcoholism may result to Vitamin B1 (Thiamine) deficiency WERNICKES ENCEPHALOPATHY Problem with motor Problem with memory 24 72 hours after last dose of alcohol expect: KORSAKOFFS PSYCHOSIS Delirium Tremens: sympathetic nervous system Prevent hallucinations/Illusion s by placing client in a well lit room Formication: feeling of bugs crawling u nder the skin ALZHEIMERS DISEASE Axon (away) and Dendrites (toward) nerve Neurofibrillary tang les Neurotic plaques ALCOHOL/ DELIRIUM ALZHEIMERS 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

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 As OF ALZHEIMERS 1. Amnesia memory loss 2. Anomia dont know the name 3. Agnosia sensory problems smell, taste, sight 4. Aphasia EXPRESSIVE: cant say/e xpress Frontal lobe is affected particularly brocas area RECEPTIVE: cant hear T emporal lobe is affected particularly wernickes area 5. Apraxia cant do simp le things Reminiscing Therapy talk about past Patients with Alzheimers may experience hallucinations, illusions thus becomes restless and may wander As sun goes down client becomes restless, agitated, diso riented called sundowning Drug of choice is COGNEX and ARICEPT a cholinesteras e inhibitor that increases Ach causing delay in disease progression

SEROTONIN Responsible for happiness Decrease serotonin clients becomes sad give anti-depre ssants SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I t o 4 weeks Increases serotonin and affects only serotonin PROZAC, PAXIL, ZOLOFT T RICYCLIC ANTI DEPRESSANT Two four weeks C A

1 Has higher incidence of side effects Also increases norepinephrine Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, ELAVIL MONO AMINE OXIDASE INHIBITORS MAO kills serotonin Increased MAO results to decreased serotonin the more depres sed the client becomes MAOI kills MAO and increases all neurotransmitters (serot onin, epinephrine, norepinephrine, dopamine but client becomes prone to hyperten sive crisis Avoid tyramine rich foods Avocado, Alcohol Beer Chocolates, Ch eese (aged) Fermented foods Pickles Preserved foods Soy sauce

There is increase incidence of side effects after 2 6 weeks MARPLAN, NARDIL, P ARNATE PERSONALITY DISORDERS 1. Schizophrenia They avoid people because there is no enjoyment 2. Avoidant They avoid people be cause they are afraid of criticisms They have talent but has no confidence 3. An ti-Social

Constantly breaks law Project charm They are witty and articulate Manipulative T hey perceive life as an empty glass They like splitting friends Sudden change in mood labile affect Prone to suicide Cant live if living is without you 4. Borderline 5. Dependent 6. Histrionic 1 Constantly wants to be the center of attention Excited, dramatic, manipulative 7. Narcissistic Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

I love myself They get jealous even with achievement of family members 8. Obsessive 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 questi on why me? Bargaining if, then Depression 2 weeks or more sign and symptom s becomes major clinical depression Acceptance client acts according to situat ion ASSESSMENT Decrease self actualization Decrease self esteem Withdrawn: stay with client Sui cidal: 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 Ill soon be gone Giving away of valuables Sudden change in mood Non-verbal communication WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: Do you plan to commi t suicide? Irregular/interval visits Endorsement period, EARLY MORNING clients are most likely to commit suicide 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010

DOWNERS [A.B.O.N.-M.M.C.H.] Alcohol Barbiturate Opiates Narcotics Resulting to: Marijuana Morphine Codeine Heroine Bradycardia Bradypnea Moist mouth Pupils constrict Constipation Urinary retentio n Hypotension Coma Weight gain Narcotics overdose: give narcotic antagonist (NAR CAN, NALOXONE HYDROCHLORIDE) UPPERS [C.H.A.R.] Cocaine Hallucinogens Amphetamines Resulting to: Tachycardia Awake Tachypnea Dry mouth Pupils dilate Hypertension Seizures Weight loss 1 Compilation of Psychiatric Nursing Notes Karl Gerald C. Manalili, UASN 2010