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.

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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 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
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*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.
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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
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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 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, I’m listening 7. Restating – I’m sad “You’re sad?” FEAR – protects us
from something bad. ANXIETY

NONTHERAPEUTIC 1. Don’t 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.
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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. Don’t 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.
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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 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
↓
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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 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

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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 Maslow’s 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
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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
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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
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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 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)
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↓
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
on’t 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
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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 ADL’s and harm to othe
rs Compensation is the culprit Management: increase self esteem to decrease comp
ensation and decrease interference with ADL’s 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

Asendin Norpralamin Tofranil

Sinequan Anafranil Aventyl
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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
WERNICKE’S ENCEPHALOPATHY

Problem with motor Problem with memory 24 – 72 hours after last dose of alcohol
expect:
KORSAKOFF’S 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
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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/e
xpress Frontal lobe is affected particularly broca’s area RECEPTIVE: cant hear T
emporal lobe is affected particularly wernicke’s area 5. Apraxia – can’t do simp
le things Reminiscing Therapy – talk about past

Patients with Alzheimer’s 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” “I’ll 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
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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
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