Professional Documents
Culture Documents
Psychiatric Nursing
Psychiatric Nursing
privileged
communication;
confidentiality circle: attending MD, RN, patient, guardian
o Privacy least intrusion should be done to the client; least
restrictive environment for client with freedom; dont guard
client one on one except if suicidal watcher pwede na
When to admit:
He hurts himself/. Others
Acutely ill needs hospitalization
o Free from unnecessary restraint to contain angry behavior
Assault cycle:
Verbalization
Time out client is told to go back to room and
remain there until he can control himself
Isolation room restraint application
Medicate the client
Self awareness is a must self understanding; know who you are; you can
control only what you know
Joharis window
You know and others know open window public self; introspection
Other know, you dont know closed window semi public self : listen
what others say about you ; sensitivity session positive and
constructive criticisms
You know, other dont know secret- hidden self private self; with
threat of being not accepted
Inner consciousness that you dont want to acknowledge inner self
psychoanalysis
Why self awareness? There is similarity among people; if the nurse
understand herself, she can understand others
When to develop? Start with pre-orientation. If client intrudes your
privacy do self awareness. What did I feel, why did I feel and what
can I do about this feeling.
Social VS Therapeutic relationship
o Social
Mutual approval
Mutual gratification of need
No structure no boundary and limit
Goal is for pleasure
o Therapeutic relationship
No need for approval
Client centered
Structured
Goal directed follow the contract
Phases of N-C relationship
o Pre orientation
Self awareness
Gather Initial info about the client how to approach client
o Orientation
Establish rapport, begin to build trust be consistent
Set a contract with the client expectations and parameters
Do the initial assessment of the client very crucial
Gives you cues and clues as basis for care plan
Routine assessment mental status exams
Appearance, reactions towards you, though content and process,
speech, judgment, sensorium
o Insight- why and what of condition ano pang ang dahilan bakit
kayo nandito?
Wala akong sakit, di ko alam No insight
Introduce yourself, call patient by name
o Working phases
Encourage verbalization of feelings client trusts you already
Assist patient to learn more socially acceptable behavior
Assist patient to learn more effective coping patterns - alternatives
Assist the client to develop insight
On going assessment of the client
Learning and corrective experience
Longest phase
Broad opening- let the client choose what topic to discuss what are you
thinking? What is in your mind? Let client talk about what he wants to talk
about
Accepting technique interested, convey to the client that you are following;
does not follow that you are agreeing; it should not be an agreement
General leads more prompting
Go on, and then..
Giving information needs by the client to know; giving info what he wants to
know
Clarifying- making clear what is not understood
Ganon nga ba ang pagkakaintindi ko?
Exploring delve into a topic;
Tell me more about that.
Questioning open ended; avoid why questions- explanation; explore
>> resolution
Validating determine mutual understanding
Yung sinabi ng patient, same as what you understood?
Did I get you right when you said these?
Is that so?
Presenting reality present fact as it exist in external reality
Confronting cite discrepancy in clients behavior
Giving feedback or facilitative self disclosure role modeling you exemplify
desirable behavior that the client can imitate
Focusing- directing the client back to the topic to be pursued
Reflecting and Restating repeat what client said
Reflecting you direct back to the client what he said
Repeating to the client the feeling implied** >> empathize >>
verbalize the feeling
Restating saying at again
Exactly as he used them
Paraphrasing - repeat the idea, different set of words
Summarizing you give the summary gist of what you transpired during the
conversation; para mafeel niyo na may naaccomplish kayong dalawa sense
of accomplishment
Encouraging description
Placing events in time sequence chronological order to determine
relationships
Collaborating you work with the client; Let us
Non therapeutic
False reassurance re assure client not to worry
Do not worry you take it for granted
Belittling feelings you take the situation for granted
Approval you concede; disapprove you denounce the client
Moralizing or judging the client
Agreeing same thing what client is saying- no second thoughts ;
disagreeing- you oppose the client, you challenge the client
Giving advice impose what client need to do
Probing- explore beyond the clients desire what to explore
Defending protect another
Requesting explanation-WHY?
Giving literal response making the abstract concrete and literal
o
o
o
Conscious awareness
What he is thinking now
Subconscious partly remembered, partly forgotten
Partly forgotten can be easily recalled
Unconscious cannot be easily remembered because they are painful and traumatic
FREUD
- Id- pleasure immediate gratification cannot wait
- Ego I/ Me emerged only if the infant knows that he is separated to the mother
o Infant >> I >> I baby has separation anxiety 8 months
o Balances the superego and id
o Defense mechanisms
- Superego sensor?
DEFENSE MECHANISMS blurs the problem for the tension to be relieved; if healthy, he should
solve the problem
- Suppression VS Repression
o Both forget
o S: purposely forget what is threatening
o R: unconscious forgetting
- Dissociation form of repression; aspects about the identity or the sense of self
- Isolation
o Behavior
o Defense mechanism separation of feeling from the thought of the event
- Regression VS fixation
o Both manifest behavior expected at an earlier stage of life
o R: goes back to the behavior expected at an earlier stage of development
o F: carries the behavior up to present stage; unable to outgrow behavior
alcoholism
- Identification vs introjection
o Both attempt to imitate- who we admire
o Identification: he integrates; dinadagdag lang niya sa kanya ung iba
o Introjections- he incorporates; he make a part of you; swallowing the person into
you
Used by suicidal client anger taking in
- Undoing negating, repairing something- obsessive compulsive disorder
- Reaction formation showing the exact opposite of what one feels, wishes or desires
- Compensation exaggerating a trait to cover for an inadequacy
- Conversion expressing ones feeling or conflicts through the body
- Symbolization attributing a meaning to an object to represent the unacceptable
- Substitution taking a more attainable goal because the original goal is not attainable
- Sublimation rechanneling socially unaccepted drives to something that is acceptable
- Rationalization Using a reason which is not the real reason to justify
- Denial refusal to acknowledge painful reality as if reality is not there
o Primary DM for alcoholics
- Displacement transfer of feeling to a less threatening object- ibinaling
- Projection throwing off; attributing to someone what one cannot acknowledge as his;
blaming
o Suspicious clients delusion of persecution papatayin niyo ako a!
CRISIS
- State of disequilibrium resulting from a stressful event or a perceived threat where the
individuals usual coping mechanisms become ineffective in dealing with it.
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Highly individualized.
Types
o Development transition; part of development; anticipated to happen
o Situational: External events; not part of development; cannot be anticipated; death
of someone- not traumatic
o Adventitious- man made or natural disaster; extraordinary
Rape, murder, hostage taking
3 balancing factors that will determine if a person will go into a crisis or not:
o Individuals perception of the event
o Situational support
o Coping mechanisms
EVENT >> assess the event>> perception of event >>
o Stressor >> coping, resources, support >> effective and adequate
o Not a stressor
Characteristics of crisis state
o Highly individualized
o Self limiting- 4-6 weeks; grief 6 months
o Short time management
o Rarely affects the individual without also affecting the significant others
o The person is amenable to suggestions
o Has a growth potential
Phases
o Pre crisis state of equilibrium >> stressful event >> ineffective coping / support
system lacking >> denial , ^ tension , feeling of fallen apart / state of
disorganization >> real crisis state >> attempt of reorganization ,trial and error >>
resolution
CRISIS INTERVENTION
- Active and directive approach
- Problem soling
- RN assist clients support system
- Steps
o Assess the situation - physical impact sa patient
o Assist the client to develop cognitive awareness of the event ano ang ibig sabihin
ng problema sa kanya?
o Assist the client in managing feelings
o Explore with the client the resources available
o Assist the client in action planning- we dont solve, we just assist
- Techniques
o Abreaction verbalization
o Clarification make client connect problem to his life
o Suggestion- influence client to take alternative
o Manipulation you use the positive point of the client to his advantage
o Reinforcement of behavior positive behavior should be recognized
o Support of defenses
o Raising self esteem
o Exploration of solution explore the advantages and disadvantages of values
RAPE and SEXUAL ASSAULT
- Rape- sexual act with penile penetration or any blunt object; without consent and against
the will
o Main motivation: strong feeling of inadequacy and helplessness
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CHILD ABUSE
- Maltreatment of a child that ranges from violent physical attacks to passive neglect
- Types sexual, physical and emotional abuse
- Why abuse occurs?
o Individual factors he may use abusive act to feel adequate
- Dynamics underlying child abuse
o Individual factors
o Societal factors powerless end up helpless >> child and elderly; chronic poverty,
neglect
o Familial factors multi generational problem; generation to generation abused
happen in the family; how to assess: do a genogram to assess every generation
- Elements
o Abused
o Abuser
o Crisis
- Assessment we are mandated by RA 7610 anti child abuse law
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Altered nutrition
Sleep pattern disturbance
Fear
Self esteem disturbance
Risk for violence
Ineffective individual or family coping
Nursing interventions
Intervention for the victim of abuse
Focus on preventing violent behavior
Interventions for the abuser
Interventions for the family
SUBSTANCE ABUSE
- 2 clinical subtypes
o Substance abuse
o Substance dependence
More serious
o Similarities of substance abuse/dependence
Regular use of the substance impairs function (cognitive. Physical etc) even
though pt knows nkakasama sa pt ang substance tinetake pa din nya; more
time to take and more time to get substance; takes the substance longer
than intended to; may have withdrawal symptoms substance specific
manifestations that occur upon the reduction or cessation of the substance
o Substance intoxication effect on the body CNS
CNS depressant decreased CNS
o Substance withdrawal
CNS depressant increased CNS
o Tolerance pt needs higher dose to bring about same effect
o Physical dependence patient nagwwithdrawal symptoms kapag wala na yung
substance
o Psychological dependency takes substance to avoid the unpleasant effects of
substance
- CNS stimulant
o Amphetamines
ADHD Ritaline
Narcolepsy decrease NREM
Shabu metamphetamine HCl
Obese clients
Benzadrine
Rizadrine
CI: thyroid problems, cardiac problems
Same effects as cocaine
o Cocaine
More expensive
Status symbol
Sniffing - nose
o Ecstasy
o Signs
Euphoria
Increase VS
Cardiorespiratory arrest
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Dilated pupils
Delusion and hallucinations
o Urine test asap after last day of taking drugs; up to 2-4 days; 5 days excreted; do
no dilute- false negative
o Momentary ecstasy RUSH wag lubayan ang pagtake
Shabu 8-12 hours; if not taken, Crashing >> psychological dependence
o Decrease appetite
o Decrease sleep insomnia
o Ecstacy MDMA methylene dioxymetamphetamine
With feeling of closeness or empathy among users
Club drug
Heightened sexuality > indiscriminate sexual acts
Withdrawal
Fatigability
Increase appetite
Increased tulog
o Given: antipsychotics
CNS depressant
o Alcohol
o Sedative or hypnotics
o Narcotics- opiods
Plant source: papaver somniferum
Derivative:
o Opium
o Heroine- mostly abused
o Codeine- cough syrup
o Morphine - analgesics
o Synthetic: Demerol analgesics
o Methadone
Effects
Causes euphoria
Can bring about sleepy languor masrap na tulog
Easy sensitivity to pain
Thought too slow need help in judgment
Pin point pupil life threatening
Decreased RR
Depressed DTR
Early manifestation of withdrawal
Runny nose
Teary eyes
Sneezing
Yawning
Piloerection
Muscle and abdominal cramps diarrhea; take warm showers
Dose should be tapered of
Narcotic opiate receptor blocker- to relieve craving Revia
Narcotic antagonist- narcan Naloxone
When withdrawing heroine- take methadone; does not make client sleepy
Hallucinogens or Psychotomimetics mind altering drugs
o Mescaline- natural
o LSD
o PCP anesthetic for animals
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Ketamine or Ketalar
Similar effect with ecstacy heightens sociality
Seeing self separating from body
Memory impairment
KHOLE experience
o Cannabinols
Plant cannabis sativa
Dagta potent form hashish
Increased appetite
If smoked red eyes
Prolonged use loss of motivation and poor judgement
Decrease in testosterone
o Can induce psychosis
o Effects
Distort sense of space- psychedelic
Warped appearance
Synesthesia blending of senses he smell color; could see odor
Bad trip frightening perception
Flash back experience hallucinations
Inhalants
o Nail polish removers
o Rugby
o Gasoline
o Solvents
o Generally cns depressants
o Mirthfulness- masayahin
o Hilarious
o Ulceration in the mouth
o
Alcoholism
- Etiology
o Biologic with genetic predisposition
o Psychodynamic fixation in oral stage
o Behavioral a learned behavior
o Social peer pressure
- Rehabilitation give up alcohol drinking friends
- Active ingredient: ethanol
- Blood alcohol concentrations/ level to behavioral manifestations of intoxications
o BAL behaviors
o Up to .1% - anxiety, euphoria, loud speech
o .05% loss of inhibition
o .1%-.15 slurred speech, motor in coordination, moodiness (LEGAL INTOXICATION)
o .2-.3 irritability, black out- memory impairment (cannot remember what he did
when he was drunk), tremor, ataxia, stupor
o .3 and up unconsciousness
- Liver metabolize 10ml per 90 minutes of whisky 1 glass of beer
- Stomach starts absorption of alcohol- small intestines
- Complications
o Gi
Malnutrition
Inflammations
o CNS
Due to deficiency in Vitamin B this should be supplemented
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Neuritis
Wenickes ataxia, ophthalmoplegia
Korsakoffs syndrome- confabulation falsifying to fill in the gap in
memory
o Reproductive
Impotence ; decrease testosterone
o CVS cardiomyopathy >> congestive heart failure
o FAS- pregnant
Nursing diagnosis
o Ineffective denial
o Ineffective individual coping
o Altered family process
o Anxiety
o Altered sensory perception- hallucinations and delusions
o Altered thought process
o Impaired verbal communication
o Sleep patterns disturbance
o Altered nutrition
o Self- esteem disturbance- low self esteem
o Alteration in social interaction
o Risk for violence
Enabling behavior and co-dependence behavior of relatives of alcoholics; kunsintidor
o Family therapy
Understanding the psychodynamics of substance dependence may be a basis for the
nurse client relationship
o Unresolved needs of early attachments
^ID
Strong oral tendencies
Demanding or manipulative
Decrease ego
Uses denial, rationalization and projection
o Denial - confront
Uses escape behavior provided by alcohol
Inferior feeling
We treat the behavior, not the diagnosis
Management
o Short term detoxification remove toxic effects of alcohol in the body
Do not let client to take alcohol done in a controlled environment
Admitted to the ward confiscate potential sources of alcohol mouthwash,
cologne, aftershave lotions, hand sanitizers, rubbing alcohol, elixir type of
cough syrup not allowed if taking disulfiram or antabuse
What to expect: withdrawal symptoms
Stage 1 6-8 hours after last drink
Stage 2 8-12 hours
Stage 3- 2 to 3 days late
Stage 4 2-5 days after Delirium tremens
How much alcohol have you taken in the last 48 hours? More alcohol,
more intense withdrawal manifestations will be; if with denial >>
underestimate the amount
Earliest- tremors, anxious, perspiration, hang over manifestations HA, nausea, vomiting, retching
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o
o
Group therapy- collection of people with common goal and working to the
attainment of the common goal
Membership
o Size 8 to 10
o Nature homogenous or heterogenous
Stages of group development
o Initial phase orientation phase getting to know you;
clarification of goals
o Middle working phase; more coordinated; able to achieve goal
because of cohesiveness and unity
o Termination termination phase- summary of what have been
learned
Types
o Support group or maintenance group- maintain existing
strengths and behaviors rather than confront or change
behaviors
o Activity groups use a variety of techniques to facilitate self
expression, interaction and acceptance
Remotivation therapy discuss about a certain topic
o Psychoeducation groups to offer content and skills (medication,
stress/ anger management, problem solving, social skills)
o Self help groups = a homogenous group organized and led by
group members
Alcohol anonymous group
Yaloms therapeutic factors of GT
o Instillation of hope
o Universality hindi ako nagiisa
o Imparting information
o Altruism able to help
o Corrective recapitulation of primarily family group
o Development of socializing techniques
o Imitative techniques
o Catharsis - expression
o Cohesiveness
o Interpersonal learning
Manifestations
o Psychomotor or physical
o Emotional
o Cognitive manifestations
o MILD - +1
Psychomotor
slight muscle tension
Slight fidgeting
Energetic
Good eye contact
Emotional
Occasional slight irritability
Confident
Cognitive
Alertness
Awareness of the surroundings
Concentration
Accurate perceptions
Attentiveness
Logical reasoning and problem solving
Client is at its best
o MODERATE +2
Psychomotor
Moderate muscle tension
Increased BP, PR, RR
Startle reflex
Slight perspiration
Difficulty sitting still for long
Periodic slow pacing
Increased rate of speech
Sporadic eye contact
Emotional
On edge keyed up
Increased irritability
Decreased confidence
Cognitive
Difficulty in concentrating
Easily distracted, can focuses with assistance
Narrowed perceptions
Decreased span of attention
Problem solving and reasoning with effort or assistance
Selective inattention- security operation
o SEVERE preparation for flight and fight response
Psychomotor
Preparation of body for F and F response
Extreme muscle tension
Increased perspiration
Continuous and rapid pacing, trembling
Loud and rapid speech
Poor eye contact
Somatic cymptoms
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Emotional
Feeling of dread
Cognitive
Difficulty focusing even with assistance
Ineffective reasoning and problem solving
Disorientation
PANIC
Psychomotor
Actual flight, fight or immobilization
Suicide attempts or violence
Eyes fixed
Hysterical or mute
Incoherent
Emotional
Feeling overwhelmed
Cognitive
Disorganized perceptions
Disorganized or irrational reasoning and problem solving
Out of contact with reality
Personality disorganization
1. Music therapy
2. Recreation therapy
3. Compulsive rigid and precise >> BAKING
measurement
4. Recognize well done activities to reinforce activities
5. Recognize positive behaviors
6. Assist client to have verbal outlet outlet that will
not use compulsion
3. Anxiolytics
4. Skin integrity impairment repetitive handwashing
a. Mild soap and emollient
b. Phobia irrational fear
i. Displacement, repression and symbolization, avoidance
ii. Real reason repressed- you do not know why
iii. Different types
1. Dog specific object specific phobia- simple phobia
2. Animals- zoophobia
3. Height- acrophobia ?
4. Disease- pathophobia
5. Thanatophobia- death
6. Social phobia- fear of being in situation that one can be embarrassed
or humiliated
a. Not attend parties, public speaking
7. Agoraphobia most resistant of all forms of phobia
a. Fear of open space cannot tolerate open parking area, open
highway
b. Fear of being alone
c. Fear of being in a situation where escape can be difficult
iv. Management
1. Accept the clients fear as real to him.
2. Do not denounce the client.
3. Let client get used to it. Involvement into the situation
4. Avoidance >> generates relief anxiety that rewards the voidance.
5. Systematic Desensitization gradual exposure to current situation;
least to most provoking
a. Imagine the situation
b. Make client see a picture.
c. See the real fearing situation very far
d. Nearer..
6. Implosive therapy flooding the client of the fearing situation; if client
can tolerate for sometime recognize behavior
c. GAD persistent worrying- 6 months
i. Anxiety is free flowing and diffuse; hindi nakaattach
ii. Can be moderate but continuous >> unplesant
d. Panic acute anxiety attack; sudden onset and short duration
i. 5-10 minutes; at most 1 hour; recurrent
ii. Variations
1. With agoraphobia fear of being alone
a. Why? When he is alone, he can have an attack no one can help
him
2. Without agoraphobia
a. With intense manifestations, hyperventilating dont let client to
be alone
b. Safe environment
c. Let client breathe to a brown bag
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d. Parenteral anxiolytics
Thorough medical exam to rule out medical condition
after trauma
Person had not let go of the event
Living the life as a victim; not a survivor
Manifestations for atleast one month
1. Flash back relives the experience; nightmares
a. Nakaupo with far- away look; facial expression is in distress
2. Emotional numbness manhid; avoidance
3. Cannot eat, sleep, concentrate, feels guilty
iv. Management
1. Empathy and acceptance
2. Process the event progressive and intense
a. Parang desensitization progressive kung kaya ng client
b. Intense every detail
3. Grounding siya nakaground s past, iground mo siya sa present
a. When client is having flashbacks, call her name to ground her in
present
b. To realize that you are now in the present, not in the past
Nursing diagnosis
a. Risk for injury
b. Anxiety
c. Ineffective individual coping
i. Perception
ii. Coping
iii. Support
d. Powerlessness feels no power or control over the event; whatever that he does, he
cannot change the outcome anymore
e. Altered role performance - expectations
f. Sleep pattern disturbance
g. Self esteem disturbance
h. Fatigue for OCD
i. Decisional conflict
j. Skin integrity risk for impaired for OCD
Interventions
a. Assist in minimizing the clients anxiety
b. Provide for safety of the client
c. Assist in developing a more effective coping- psychotherapy
i. Awareness on the problem for the client to cope
ii. Problem solving very adaptive; for the problem to be resolve
1. Awareness and understanding of the problem
2. Assist the client to have alternatives
iii. Humor
iv. Diversional activities
v. Stress reduction techniques
d. Pharmacotherapy
i. Minor tranquilizers anxiolytics
1. Benzodiazepines
a. Valium Diazepam
b. Tranxene
c. Librium
d. Xanax - SA acute anxiety attack
e. Serax- SA
f. Ativan Lorazepam -SA
g. Dormicum Midazolam
iii.
e. PTSD
i.
ii.
iii.
V.
VI.
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III.
IV.
V.
VI.
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
c. Psychodynamic
i. Faulty parent child relationship
ii. Faulty communication
iii. Dysfunctional relationship
d. Assessment
i. 4As Bleulers 4A
1. Affect- apathy, inappropriate
a. External manifestation of emotion; temporary
b. Apathy walang affective response
c. Affect adequacy
i. Restricted affect- less than normal
ii. Less than restricted blunt affect
iii. Less than blunt- flat (apathy)
2. Ambivalence two opposing feelings at the same time
3. Associative looseness though process disturbance how a person
connect his thoughts; no logical sequence; incoherent speec
4. Autism- self absorption; client who pays attention to external
stimulation may sariling mundo
5. Auditory hallucinations- client hears when there is nothing to be heard;
common among schizophrenic clients
ii. DSM criteria at least 2 of the ff for at least 6 months
1. Positive symptoms
a. Delusions false beliefs projection as a defense mechanism;
altered thought process
i. Fixed and false belief
ii. Delusion of grandeur one is an exalted person ;
motivation or underlying need: feelings of inadequacy and
low self esteem listen to the content, enhancing esteem
of the client
iii. Persecution or paranoia others are plotting against him;
at risk for violence; do not leave client stand by
1. Verbal content sarcastic, obscene words
intensifying emotions
iv. Religious delusion- religion content
v. Reference things are referring to him- talk loud enough
to be heard by the client
vi. Control external force is controlling him God made me
do it.
vii. Thought insertion- others can put thoughts in his minds
viii. Thought withdrawal others can remove thought in his
mind
ix. Thought Broadcast- client believes others know what he is
thinking off
x. Somatic delusion- body is changing in some way
xi. Nihilistic - Body or parts does not exist
b. Hallucination false sensory perception
i. Altered sensory perception
c. Disorganized speech
i. Word salad jumble of words put together kapatid puti
inis tatay
ii. Clang association rhyming words are put together
broom boom
iii. Neologism coining of new words
iv. Perseveration same response to different stimuli
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25
v.
vi.
vii.
viii.
1.
2.
vii. EPS
1.
2.
3.
4.
h. AE
j.
III.
b. Anger
c. Bargaining trade off or exchange; attempt to delay the loss
d. Depression - sad
e. Acceptance
Engel:
a. Shock and disbelief >> awareness of the pain >> acceptance
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
a.
b.
c.
d.
e.
f.
Tofranil***
Elavil
Norpramine
Anafranil
Dozepin
Disadvantage: have delayed effect- 2-4 weeks; 3-4 weeksinform client to continue medications
3. SSRI specific serotonin reuptake inhibitor
a. S- stimulate tachycardia, irritable, hypomanic episode > report
b. Prozac
c. Zoloft
d. Luvox
e. Paxil
4. MAOI
a. Parnate
b. Nardil
c. Marplan
d. SE- same as TCA
e. OH except taken with tyramine rich fopods >> HPN crisis
i. Tyramine can only be metabolized by MAO
ii. ^Amine ephedrine like effect vasopressor effect
iii. Check BP, HA, tachycardia >> validate again
iv. Tyramine rich foods: processed foods, age cheese
1. ROT: fresh foods are not tyramine rich except
banana, avocado, chicken liver, beef liver
5. Atypical anti depressants
a. Effexor
b. Depresil
c. Remeron mirtazipine
d. Lexapro
ii. ECT
1. 70-150 volts to bring about seizures
2. Neurochemical and neurophysiologic >> similar to the effect of
antidepressants
3. Indications
a. Severe depression- did not respond to medications
b. Acutely suicidal client delayed effects of medications
c. Schizophrenic but did not respond to antipsychotic- catatonic
and paranoid
d. Maniac did not respond to meds
4. CI
a. Cardiac problems ECG to be done first
b. Organic mental disorders- tumor, aneurysms- do EEG
c. With fracture
d. High BP
e. Pregnancy
f. Active bleeding tendency CBC agranulocytosis and
leucopenia
5. Psychological and physical preparations
a. NPO 6-8 hours; 4-6 hours
b. Hospital gown-loose clothing
c. Remove good conductors of electricity
d. Nothing to shave off
e. Void to prevent accidental voiding during the ECT
f. Mouth gag to prevent biting the tongue during ECT
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6. Types
a. Without sedative- unmodified ECT
b. Modified ECT with pre medications
i. IV pentothal or brevital Na to sedate
ii. Atropine sulfate prevent aspiration
iii. Anectine or succinylcholine HCl- muscle relaxant
1. Too much relax >> respiration muscles >>
aspiration
7. Who applies the electrodes in temple: MD
8. Nurse assistant during the procedure and observe reaction
9. Desired outcome
a. Tonic clonic phases of convulsion same as with epilepsy
10.Right after seizure turn to sides prevent aspiration >> check RR
rerspiration depression
11.Client will be asleep- check VS every 15 minutes until stable
12.Re orient client
13.Check for gag reflex
BIPOLAR DISORDER
I.
With manic episodes
II.
If depressed all manifestations of MDD
III.
Manic episode
IV.
Etiology
a. Biologic genetic
i. Manic - ^S,NE; intracellular Na is increased very excitable cells
b. Psychodynamics
i. Manic as defense against depression >> do not acknowledge that he is
depressed
ii. ^ID >> denial of depression >> reaction formation >> anger >>
externalized >> manic
V.
Manifestations manic
a. Elevated expansive mood/ irritable mood of at least 1 week and at least 3 of the ff:
i. Pleasurable activities laughs a lot, buying spree, hypersexual
ii. ^ in goal directed activities
iii. ^ psychomotor agitation lakad ng lakad >> exhaustion poor prognosis
iv. Inflated self esteem or grandiosity feeling of inadequacy
v. Pressure of speech - nagkakapatong ang sinasabi / loquacious speech
productive and speech di nauubusan ng sinasabi
vi. Flight of ideas or feeling that thoughts are racing
vii. Distractability attention span is very short
viii. Somatic manifestations- nutrition and sleep less no time to eat
ix. Sarcastic they want to hide their own vulnerability; manipulative and
demanding
VI.
Nursing diagnosis
a. Risk for violence
b. Risk for injury
c. Altered nutrition less than body requirements
d. Ineffective individual coping
e. Self care deficit
f. Self esteem disturbance
g. Sleep pattern disturbance
h. Impaired social interaction
i. Altered role performance
VII.
Interventions
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2. Avoid diuretics
vii. Client should not skimp with lithium wag magtitipid; kapag sobra excrete;
kasama ang lithium
COGNITIVE DISORDERS
1.
Organic mental disorders
2.
Affect consciousness, memory, orientation, attention, perception and landuage
disturbance
3.
Delirium acute confusional state
a. Causes
i. Physical illness
1. CHF, uremia, PNM, metabolic disorders, CVA, DHN, infection
ii. Prescription drugs
1. Polypharmacy with drugs with anticholinergic effects
a. Antipsychotic, antihistamine, anti HPN, cardiovascular drugs like
digoxin and diuretics, cimetidine, parkinsonism
4.
Dementia progressive cognitive deterioration
a. Causes
i. Reversible like:
1. Encephalopathy
2. Infections like syphilis
3. Toxic conditions due to substances like alcohol and metal
ii. Non reversible
1. Multi infarct dementia
2. AD
3. PD
4. Picks D
5. Huntingtons chorea - genetic
5.
Delirium
a. Disturbances in LOC with reduced ability to focus, sustain or shift attention
b. Changes in cognition
c. Develops over a short period of time and with a tendency to fluctuate during the
course of the day
i. More intense at bedtime sun downing
6.
Dementia
a. Memory impairment- amnesia may progressively deteriorate
b. 1 or more of the ff disturbances
i. Aphasia, apraxia, agnosia,
ii. Disturbances in executive functions (planning, organizing, sequencing,
abstracting),
iii. Cognitive deficits can cause significant impairment in social and occupational
function
7.
Alzheimers disease
a. Etiology
i. Genetic predisposition
ii. Unknown but with various theories like genetic, toxin, infection, cholinergic
deficit, structural
b. Biologic- acetylcholine- cholinesterase blockers- to minimize deterioration more
quality life
i. Tacrine cognex
ii. Exelon
iii. Aricept
c. Viral
d. Toxic substances aluminum
e. Structural changes
33
34
iv.
v.
vi.
vii.
viii.
ix.
EATING DISORDERS
1. Anorexia nervosa starvation client will not eat because of self imposed starvation
a. Poor insight with her eating behavior
b. Causes
i. Biologic decreased S give anti depressants
ii. Psychodynamic
1. With dysfunctional family relationship >> unmeshed type of family
parents are domineering and controlling; protective >> he has
lost control over life >> helpless >> control something >> mouth
>> control over life
2. Manipulation control others
3. She thinks she is fat >> disturbed body image >> wants to lose
weight >> afraid of gaining weight >> client will not eat /
strenuous exercise / diuretics and laxatives / loves to cook
4. Conflicts when growing up too much stressors if you did not eat,
you will not develop the stressors at that age
iii. Social theory
1. Thin is in
c. Assessment
i. Starvation loss weight 15 to 85% of ideal weight >> cachexia
ii. Decrease VS decrease BMR
iii. Decrease FSH and LH amenorrhea for 3 consecutive menses
iv. DHN
v. Fluid and electrolyte imbalance hypoK- cardiac function, hypoNa
vi. Lanugo
d. Stressor >> anxious >> starvation to relieve anxiety >> decrease anxiety:
ineffective coping
e. Achievers, good girl in the family, perfectionist
f. ND
i. Altered NTN less than body requirements
ii. Disturbed body image
iii. Low self esteem
iv. Anxiety
v. Ineffective coping
vi. Disturbed parent child relationship
g. Goal:
i. client will regain her nutritional state best parameter- weight taking OD
1. Early morning, before breakfast, same amount of clothing
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VIII.
IX.
d. Narcissistic self loving; exaggerated sense of self; she is the best; needs to be
admired; envious type; she wants to be praised
Cluster C anxious and fearful type
a. Dependent depends on others for DM and problem solving, cannot make decision
for himself; follow the flow of tide; low self esteem; lack of confidence, stupid
b. Avoidant avoids relationship, afraid rejection
c. OC personality disorder person is very meticulous, organized, devoted to work in
the expense of pressure; wants things to happen the way he wants, very rigid
Management
a. Withdrawn AF
b. Passive Friendliness- paranoid
c. Manipulative MOF
d. No medications
CHILDHOOD DISORDERS
I.
Autistic pervasive disorders
a. Biologic
i. Genetic
ii. PKU
b. Manifestations
i. Impairment in social interactions
ii. Want inanimate objects- security objects
iii. Not capable of establishing eye contact
iv. Disturbed personal identity
v. Unable to distinguish self and non self uses third person
vi. Repetitive activities head banging, spin around without feeling dizzy, flapping
vii. May have peculiar response to the environment client does not want change;
no reaction to environment
viii. With fantasy world
ix. Does not pay attention to NTN
c. Management
i. Optimize function
ii. Consistent
iii. Accepting
iv. Safe
v. Reality based
vi. Haldol
II.
Separation anxiety disorder
a. SA- normal during first stage of development
b. Separation individuation phase
c. Child has been overprotected; not given experience to be independent
d. Play therapy
e. If with school phobia gradually expose systematic desensitization
III.
ADHD
a. Etiology
i. Genetic
ii. Biochemical Ritalin use; improves attention span of child paradoxic effect
1. Used of foods with preservatives use fresh foods
iii. Minimal brain disorder
iv. Psychosocial factors very loving parents before, then ngayon laging
magkaaway na >> upset client
b. Manifestation
i. Inattention distractibility
ii. Impulsivity
iii. Hyperactivity
37
IV.
V.
abutin
mental
age
or
SEXUAL DYSFUNCTIONS
I.
Self awareness
II.
Knowledge
III.
Ability to communicate
IV.
Behaviors to attain the physiologic requirements in sex acts
V.
Sexual appetite or sexual desire seeking out and responding to the sex act
VI.
Persistent and recurrent lack of desire for the sex act sexual desire disorder
VII.
Have sexual desire, but have dislike in sex- sexual aversion disorder
VIII. Arousal initial physiologic response to the sex act
a. Male erection erectile dysfunction
b. Female frigidity sexual arousal disorder
IX.
Orgasm
a. Failure >> orgasmic disorder
X.
Premature ejaculation early ejaculation
XI.
Management
a. Any medical or biological cause for this disorder
b. Psychological >> psychotherapy
XII.
Paraphilias or sexual de- sexual behaviors person engages in certain sexual behaviors
satisfies her instinct in a way that is socially unacceptable or biologically unacceptable
a. Cyber sex- voyeurism
b. Transvestism susuotin yung damit ng opposite sex- cross dressing
i. This brings arousal and satisfaction
c. Fetishism - Personal effects on opposite sex - symbols
d. Pedophilia Preferences children
i. Below age 13
ii. Age gap of 5 years
e. Zoophilia- animal partner
f. Incest- relatives
g. Pyromania fire
h. Klismaphilia- Enema
i. Necrophilia- dead
j. Anal intercourse 2 adult males sodomy
k. Male and boy- pederasty
l. Rubbing frotteurism
m. Sex phone or obscene words Scatologia
n. Satyriasis- excessive coitus for male
o. Nymphomia- excessive coitus for female
p. Fellacio oral stimulation of males
q. Cunnilingus oral stimulation of females
r. Voids on the partner urophilia
s. Defecates on partner - coprophilia
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