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Mental and Psychiatric Nursing PDF
Mental and Psychiatric Nursing PDF
Personality
- It is the integration of interests, abilities and habits
to create a unique quality of response by an
individual to internal and external environment.
2. ANAL
Cognitive Model
- Toilet training
Jean Piaget
- Too harsh
- Intellectual development is a result of constant
- Too lax
interaction between environmental influences
and genetically determined attributes.
Adult Sensorimotor Preverbal; Learning occurs
- Obsessiveness, 0-2 y/o) through use of senses and
simple motor activities
- tidiness, meanness; Preoperational Can now use language and
Pre-conceptual symbolic representations in
- untidiness, generosity (2-4 y/o) play
EGOCENTRIC
Preoperational Asks questions, begins to
3. PHALLIC Intuitive understand relationship
- Abnormal family set up leading to (4-6 y/o) INTUITIVE REASONING
Concrete Operations Increase conceptual
unusual relationship with mother father. (7-11 y/o) development: problem solving,
cause and effect, inductive
reasoning, logical thought
Adult Formal Operations Can reason logically and
(>12y/o) abstractly; can formulate and
- Vanity, self-obsession, sexual anxiety, test hypothesis
inadequacy, inferiority, envy.
Social
- The environment can affect the individual.
Balance Humanistic
- is the process of gradually allowing independent - Focuses on a person's positive qualities, his or
behaviors in a dependent situation. her capacity to change, and the promotion of self-
esteem.
Framework of Care and Treatment Modalities - Satisfaction of human needs
Biologic
- Psychological conditions are caused by (Maslow, 1954)
physiologic functions. (Rogers, 1961)
Existential Forms:
- Helps the person discover an authentic sense of ● Grandeur-belief that one is an exalted
self, which emphasizes personal responsibility for person; but in reality, there is
one's self, feelings, behaviors, and choices inadequacy.
● Persecutory/Paranoid-belief that one
Rational emotive therapy may harm him/her; prone to be violent to
- uses confrontation of irrational beliefs that protect himself/herself.
prevent the individual from accepting ● Reference-belief that all communication
responsibility for sell and behavior is all about him
● Control- strong belief that an external
Logotherapy force controls him/her
- helps individuals assume personal responsibility *Thought insertion - someone provides
in searching for meaning in life. him/her with ideas
*Thought withdrawal - someone removes
his/her ideas
Schizophrenia Spectrum Disorder *Thought broadcast- know what he is
At least 5 of the criteria for a minimum of 2 weeks Risk Factors for Suicide
● Depressive mood or sadness a. Recent loss
● Anhedonia b. Age- elderly
● Worthlessness / excessive or inappropriate guilt c. Sex- females usually attempt; males usually
● Psychomotor disturbance - (slow movement, succeed
agitation) d. Civil status- dingle and widowed
● Diminished ability to concentrate or e. Previous history of suicide
indecisiveness
● Somatic manifestations - (appetite disturbance, 2. Promote a therapeutic relationship.
sleep disturbance, fatigue or loss of energy) ● Accept the patient
● Recurrent thoughts of death ● Spend time with patient.
● Respond to the patient's anger therapeutically.
PSYCHOTHERAPEUTIC MANAGEMENT - Shout-set limits
1. provide for the client's safety- control the - Self-destructive - limit
environment.
● Assess for cues and clues of suicide 3. Focus on the patient's strength.
● Validate direct and indirect verbalization ● Be with the patient.
of suicide ● Provide music and art therapies.
● Provide repetitive, monotonous, non ● Avoid activities that entail detailed works and
gratifying activity- externalizes anger. decision making skills.
● Kind firmness ● Assist the patient in decision making.
● Establish a "NON SUICIDE" contract
4. Create a scheduled and structured but non-demanding
environment
● Start on one-one-one activity then progressive
● Insomnia
5. Promote independence by encouraging to perform ● Headache
ADL's. ● Weight loss
● Give enough time to finish performing ADL's. ● Sexual dysfunction (anorgasmia for women and
● Consider patient's preferences ejaculatory dysfunction for men)
● Provide small but frequent feedings.
3. Monoamine Oxidase Inhibitors (MAOI's) inhibit
PHARMACOLOGIC TREATMENT the MOA, which is responsible for breaking down
1. Tricyclic Antidepressants (TCA's) block the excess serotonin and norepinephrine at the
reuptake of neurotransmitters such as serotonin, synapse.
norepinephrine, acetylcholine and dopamine at (*Given @ Morning to prevent sleep disturbance)
the presynaptic neurons. (*If given with food: watch out for
- Delayed onset of effect for 3-4 weeks HYPERTENSIVE CRISIS especially those
- (**Norepi and Serotonin in between synapses of containing with Tyramine)
2 neurons--- they are excitatory which transmit
impulse---- increase amount of these 2 protein = Types
SEROTONIN SYNDROME) ● Phenelzine (Nardil)
● Isocarboxazid (Marplan) Tranylcypromine
Examples of Tricyclic Antidepressants: (Parnate)
● Imipramine (Tofranil) ● Moclobemide (Manerix)
● Amitriptyline (Elavil)
● Desipramine (Norpramin) Common Side Effects
● Trimipramine (Surmontil) ● Anticholinergic effects
● Nortriptyline (Aventyl) ● Cardiovascular effects
● Chlomipramine (Anafranil) ● CNS stimulation (anxiety, agitation, restlessness,
insomnia)
Side Effects
● Anticholinergic effects Serious Side Effects
● Cardiovascular effects ● Agranulocytosis
● Photosensitivity ● Hepatic toxicity
● GI effects (anorexia and nausea) ● Hypertensive crisis - (severe occipital headache,
● CNS effects (sedation and fatigue) nausea, vomiting, elevated BP, photophobia,
dilated pupils, arrhythmia)
Adverse Effects
● TCA overdose
● Serotonin syndrome - hypothermia,
hyperreflexia, tachycardia, diaphoresis and
decreased LOC
● Agranulocytosis (WBC <2000)
● Seizures
Outcomes of ECT
● Produces grand-mal seizures that last for 30 to
60 seconds
- Turn patient to the sides. (R: drainage of
secretions and tongue is relaxed which
can obstruct the airway)
- Check for respiratory depression.
- Evaluate return of reflex. gag
● Brings about temporary memory impairment
- Orient the patient.
***Electric current @temporal area = reorganization of ● Increased willingness of patient to socialize with
neurons on brain others.
Indications:
- Literally depressed patients BIPOLAR DISORDERS
- Acutely suicidal patients
- Patients who do not respond to medications and ETIOLOGY
other neurochemical and physiologic therapies 1. Biologic
- genetics
Contraindications - increased norepinephrine and serotonin
● Heart conditions (ECG) - Increased intracellular sodium
● Organic mental disorders (EEG)
● Active bleeding tendencies 2. Psychodynamics
● Pregnant women - Extremes polar experience
● Hypertension and hyperthermia
● Fractures
● Pacemakers
Nursing Considerations
● Secure informed consent from a responsible
family member.
● Place the patient on NPO for at least 6-8 hours
prior to the procedure.
● Let the patient wear loose clothing
● Application of hair shampoo is not required; hair
should be dried
● Remove the patient's dentures
● Encourage the patient to void
● Monitor VS before and after the procedure MANIFESTATIONS
● Apply mouth gag to prevent aspiration
● In Modified ECT, pre-procedure medications are - Elevated, expansive and irritable mood with labile
administered: affect (happy then angry) for at least 1 week and
- Brevital Sodium (Pentothal) - short- at least 3 of the following:
acting sedative ----prevent severe
seizure ● Engaging in pleasurable activities
- Atropine Sulfate (Atropine) - prevents ● Increased participation in goal-directed activities
bradycardia but it dries the mouth. --- or psychomotor agitation
Anticholinergic med ● Inflated self-esteem or grandiosity (indicates
- Succinyl Hydrochloride (Anectine) - feeling of inadequacy)
relaxes the muscles ● Pressured speech (fast) and loquacious speech
(productive)
● Flight of ideas or feeling that thoughts are rising
● Distractibility Post crisis
● Somatic manifestations (nutrition and sleep - Recovery
deprivation)
● Sarcasm, manipulative behavior a d demanding Psychotherapeutic Management
behavior
1. Provide for client's physical safety and safety of
those around him or her.
ETIOLOGY
Contraindication
● Pregnant Women 1. Biologic Perspective
- Affects the ANS
- Decrease in GABA
- Affects Serotonin
2. Behavioral Perspective
- Learned response
3. Psychodynamic Perspective
- Id and Superego
- Repression (main defense mechanism)
4. Interpersonal Perspective
- Unsatisfying and inadequate
relationships
NURSING CONSIDERATIONS
1. Phobic Disorder
a. No diuretics
b. Toxicity- hemodialysis - Phobia is an irrational ffear. -Illogical, intense,
c. Oral form only persistent
d. For those who cannot tolerate Lithium Carbonate, - Extreme distress that interferes with functioning.
they are given Clonazepam (Rivotril)
e. Regular sodium diet (liberal but not excessive) Defense Mechanisms:
f. Lithium and Sodium has affinity - looks for sodium - Repression
intracellularly and kicks off sodium - Displacement
g. Dangerous - Symbolization
- Low sodium results to hyponatremia
- High sodium results to excretion of Types:
lithium
Specific Phobia
- Provoked by a specific feared object or situation
which causes an avoidant behavior Nursing considerations:
● Do not let avoidance to take place for too long.
● Systematic Desensitization-serial / gradual
exposure to the object feared.
● Flooding- tapis desensitization
● Patient is aware of the fear but cannot control his
reactions. Accept that the client's fear is real.
● Promotes patient's safety.
Manifestations:
- Blushes, sweats, trembles, palpitates, 3. Panic Disorder
feels nauseous ● Characterized by sudden periods of intense fear
- Looks and sounds very shy that peak within minutes
- Struggles to be with other people ● Occurs for a maximum of 10 hours with recurrent
- Very self-conscious and afraid of generalized symptoms
judgments - Palpitation, sweating
- Stays away from crowded places - Trembling or shaking
- Shortness of breath or chocking
- Feelings of impending doom
- Feelings of being out of control
Nursing Considerations:
- Ensure the client's safety.
- Remain with the client.
- Provide less stimulating environment.
- Help client focus on deep breathing.
- Talk in a calm and reassuring voice.
- Teach relaxation techniques.
- Conduct cognitive restructuring techniques.
- Assist in exploring how to decrease stressors and
anxiety-provoking situations.
LONG TERM
1. Demonstrate more effective methods of coping.
Dissociative Disorders
- Dissociative Amnesia with Fugue Somatic Symptom Illnesses
- Dissociative Identity Disorder ● Somatic Symptom Disorder
- Depersonalization Disorder ● Pain Disorder
● Illness Anxiety Disorder
● Conversion Disorder
ETIOLOGY
1. PSYCHOSOCIAL THEORIES
● Internalization - keeps stress, anxiety or
frustration inside rather than expressing them
outwardly
● Internalized feelings of stress through physical
symptoms
● Tremendous difficulty dealing with interpersonal
conflict
● Primary gains-direct external benefits (relief of
anxiety)
● Secondary gains - internal or personal benefits
(attention)
Factitious Disorder
- Intentionally produces or feigns physical or
psychologic symptoms solely to gain attention
- May inflict injury on themselves to receive
attention
- AKA Munchausen Syndrome
DEMENTIA
Causes:
REVERSIBLE
- Encephalopathy
- Infections like syphilis
- Toxic conditions due to substances like alcohol
and metals
NON REVERSIBLE
- Disorders like Alzheimer's Parkinson's Disease,
Picks D., Huntington's , Chorea disease
Manifestations:
- Memory impairment - Amnesia
- 1 or more of the following cognitive disturbances:
● Aphasia
● Apraxia Stages:
● Agnosia Mild Stage
- Disturbance in executive functions (planning, ● 2-3 years
organizing, sequencing, abstracting) ● Amnesia - forgetfulness is the hallmark
- Cognitive defects can cause significant No recent memory
impairment in social and occupational function Routine - consistent arrangement
● Other cognitive difficulties - decision- making,
Assessment judgment, reasoning
- History taking-family or friends (impaired recent ● Repetitive questioning
memory recall)
- Uninhibited behavior Anxiety and fear Moderate Stage
- Labile mood over time, may also shift rapidly and ● 3-4 years
drastically ● Confusion and disorientation apparent
- Emotional outbursts Withdrawal from the world - Intervention:
- Impaired to loss of ability to think abstractly a. Supply the information
- Delusions of persecution b. Orientation board - font size
- Poor judgement, limited insight c. They can easily see vivid hues -
- Chronically confused amenable
- Disoriented d. Every start of contact -
- Hallucinations orientation
- Profoundly impacts roles and relationships
- Disturbed sleep-wake cycles ● Wandering
- Ignore internal cues ● Safety - provide a place where he can do it
- Inability to do ADL's ● Sleep disturbance
● Risk for insomnia - name the causes
DEMENTIA
- Initially - recent memory is impaired, intact long- Interventions:
term - Activity towards the afternoon
- Later stages- affects remote memory and even - Warm milk and warm bath
their own name
- Echolalia (echo) Papilalia (repeat) Apraxia
- Forgets activities of daily living
ALZHEIMER'S DISEASE - Self-care deficit
- Be with the client
Etiology:
- Unknown AGNOSIA
- Genetic - Loss of ability to name things
- Toxin - Give instruction
- Infection - Supervise the client
- Cholinergic deficit
APHASIA
- Loss of language
- Expressive aphasia
- Receptive aphasia
- Do not lose their appetite but they ignore it
Confabulation - Absorbed in quest for weight loss and thinness
- Filling in memory gaps *Factor: Serotonin = Appetite
- To prevent loss of self- esteem
- May get frustrated or angry with themselves for ETIOLOGY:
forgetting 1. BIOLOGIC FACTOR
- Genetic predispositions
- Dysfunctional hypothalamus
Severe stage - Decreased serotonin
● 5-10 years
● Personality and emotional changes 2. SOCIAL FACTOR
● Deterioration in all areas of function - Thin is in
● May be delusional, require assistance in ADL's, - Rely on physique to get the approval of others
may wander
3. DEVELOPMENTAL FACTOR
● Overprotective / domineering enmeshed
NURSING CONSIDERATIONS: family→ decreased control and helplessness
- Promote client's safety and protection from injury ● Disturbed body image → Sees oneself as fat
- Structure environment and routine - Use diuretics and laxatives
- Promote adequate sleep, proper nutrition, - Locks herself in the room and does
hygiene and activity extraneous exercise
- Initial work - simple work ● Conflicts about growing up
- Provide interaction and involvement - Does not like to be adolescent
- Provide emotional support
- Family/Caregiver support
- Provide opportunities for recall of past events
- Encourage use of written cues
- Minimize environmental changes
- Short, simple instructions
- Integrate reminders of previous events into
current interactions
- Assist w tasks but do not rush
- Reframing
- Reminiscence therapy
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Reminyl)
- Memantine (Namenda) Assessment:
- Refusal to maintain body weight at or above
minimum normal weight
EATING DISORDERS - Intense fear of gaining weight 3. VS decreased
- Absence of at least 3 consecutive menstrual
Bulimia Nervosa cycles
- Binge eat- Purge behavior - Lanugo
- Hypoglycemia, fluid and electrolyte imbalance
Anorexia Nervosa
- Self-imposed starvation Management:
- Re-establish appropriate eating behaviors
A. Feed the patient
ANOREXIA - Be firm and consistent
- Characterized by self-imposed starvation
- Be with them to assess what the client had eaten ETIOLOGY
and set limits do not force the client → make 1. BIOLOGIC
agreement - Dysfunctional hypothalamus
- Behavior Modification Contract/Therapy → "You - Decreased serotonin
agreed that whatever is served you will eat. You
have 30 minutes to consume the food 2. PSYCHODYNAMIC
- Make part of the decisions → take over internal - Ambivalent feelings toward self-knows
locus of control increased self- esteem that eating is maladaptive
- Limit setting - Low self-esteem
● Stay with the client for 1 hour after meals - Depression
● Place in a public place after meal
Nursing Interventions:
Bulimia
- Set limit to binge eating- adhere to meal
- Characterized by binge- eating over a short
schedule
period of time followed by purging behavior.
- Assist feelings in binge eating and purging
- Recurrent episodes (at least twice a week for 3
- Improve self-esteem
months) of binge eating followed by purging,
- Use of treatment
fasting or excessively exercising.
- Antidepressants
- Binging and purging episodes are often
- Cognitive Behavioral Therapy
precipitated by strong emotions and followed by
guilt, remorse, shame or self-contempt
- Binge eating-consuming a large amount of food
in two hours of less SEXUAL DISORDERS
- Purging-compensatory behaviors to eliminate
food through self-induced vomiting or misuse of Categories of Sexual Disorders:
laxatives, enemas and diuretics 1. GENDER IDENTITY DISORDER
2. SEXUAL DYSFUNCTION
3. PARAPHILIAS
- Sexual gratification from the exposure of one's
1. Gender Identity/ Dysphoria genitalia
i. SADISM
Human Sexual Response Cycle - Sexual satisfaction obtained from inflicting pain to
partner
j. SODOMY
- Anal intercourse as the preferred sexual act
between adults
k. PEDARASTY
- Anal intercourse of a man and a boy
l. NYMPHOMANIA
- Female excessive desire for sexual act
m. SATYRIASIS
- Male excessive desire for sexual act
3. Sexual Perversions/ Paraphilias
- Sexual instincts that are expressed in ways that n. FELLATIO
are socially prohibited or unacceptable or are - Oral sex of the male genital
biologically undesirable
Types: o. CUNNILINGUS
a. PEDOPHILIA - Oral sex of the female genital
- Experience of sexual pleasure by an adult to a
child less than 13 y/o p. PERTIALISM
- Oral sex that does not proceed to genital sex
b. INCEST
- Sexual contact with a person belonging to the q. PYROMANIA
same blood line - Sexual arousal obtained from fire
c. EXHIBITIONISM r. KLISMAPHILIA
- Sexual gratification from using enema Conduct disorder
- Repetitive or persistent pattern of conduct in
s. UROPHILIA which either the basic rights of others or major
- Sexual satisfaction derived from urinating one's age-appropriate societal norms or rules are
partner violated
t. COPROPHILIA Etiology
- Sexual satisfaction derived from defecating one's - Genetics
partner - Environmental adversity
- Poor coping
u. NECROPHILIA - Risk factors:
- Sexual satisfaction obtained from a corpse - Poor parenting, Poor family functioning
- Low academic achievement
v. TELEPHONE SCATOLOGIA - Poor peer relationships
- Telephone sex - Low self-esteem
- Exchange of sexually provocative remarks - Lack of reactivity to ANS→ decreased normal
avoidance or social inhibitions
w. ZOOPHILIA
- Bestiality Classifications:
- Sexual arousal with animals
Mild: relatively minor harm to others Lying, staying out
late without permission
ADOLESCENT DISORDERS
Moderate: increased problems and harm to others
Separation Anxiety Disorder - Vandalism, theft
- Normal among infants (8-9 months) - notion as
separate entity to mother Severe: considerable harm
- Cries if mother would leave- thought it would be - Forced sex, cruelty to animals, use of weapon,
forever burglary, robbery
- Beyond age- excessive anxiety to separation
from mother Manifestations:
- Aggression to people and animals
Manifestations: - Destruction of property
- Follows mother around - Deceitfulness or theft
- If separated-forever, something would happen to - Serious violations of rules
mother - May be quiet or openly hostile
- School phobia-separation to mother because of - Disrespectful to authority figures
school - Irritable, temper outbursts
- Uncooperative
Management: - Capable of logical and rational thinking
- Accompany the child - Perceive world as aggressive and
- Desensitize the child-used to separate to mother threatening act similarly
(gradual experience of separations)
- Counterproductive-Home Study no Manifestations:
independence - Intellectual capacity is NOT impaired but with
poor grades
Childhood Depression - Behavioral problems
- Loss of parents through divorce, separation or - Failure to attend class and complete assignments
death - Self-esteem is low but appear tough and cool
- Death of other person close to the child; death of - Disruptive and violent
pet - Relationship with peers limited to those who
- Movement to another neighborhood display similar behaviors as them
- Academic problems or failure. - Perceive those who follow rules as dumb afraid
- Physical illness or injury
Management: - Nutrition
- Group and individual psychotherapy
- Cognitive treatment. problem-solving, skills Nursing Interventions:
training 1. Optimum functions
- Parent training Family therapy - Develop capabilities that he does not have
- Anger management - How?-accepting, reality-based, safe and
consistent
Pervasive Developmental Disorders - Delay touch
- Pervasive and usually severe impairment of - If establish contact → eye contact
● Reciprocal social interaction skills - Talk to the child-don't expect to answer
● Communication deviance
● Restricted stereotypical behavioral 2. Call the child by name
patterns - Face to the mirror > body parts
- AKA: Autism Spectrum Disorders 3. Safe environment-consistency
- Autistic disorder (classic autism), Rett's disorder, 4. Establish more relationship
childhood disintegrative disorder, and 5. Medication - Haloperidol
- Asperger's disorder
- 75% of children with Pervasive Developmental Asperger's Disorder
disorders also have Mental Retardation - Severely sustained impairment in social
interaction
Autistic Disorder - Restricted, repetitive patterns of behavior,
- Pervasive developmental disorder interests and activities
- No significant delays in language, Cognitive
Etiology: development or age- appropriate self-help skills
- Genetic - May benefit from Autistic treatment
- Biochemical
- Defect in metabolism Mental Retardation
- Identified 18 months - 3 years old - Sub-average intellectual capacity
- Ave. 10-90-110
Autistic Disorder - Deficit in adaptive ability
- Little eye contact with others - Some are passive and dependent, others
- Few facial expressions Limited gestures to aggressive and impulsive
communicate
- Limited capacity to relate with others Causes of MR
- Lack spontaneous enjoyment - Fetal Alcohol Syndrome (FAS)
- express no moods or emotional affect - Genetic
- Cannot engage in play - Exposure to measles during pregnancy
- Little intelligible speech - Perinatal (delayed birth,multiple birth, placenta
- Stereotyped motor behaviors (hand flapping. previa, traumatic pregnancy)
body twisting, head banging) - Postnatal (head injuries, malnutrition)
- Persist into adulthood - Environment (parent incapability)
- Remain dependent to some degree
- Social skills rarely improve enough to permit Classification of MR
marriage and child rearing a. Profound - Below 20-25
- Viewed as odd or reclusive. b. Severe -25-40
- Mental Age: 0-3 y/o
Social Impairment c. Moderate-40-55
- Does not want people; go with inanimate; - Mental Age: 3-8 y/o
- Impaired verbal communication - Trainable to unskilled-semiskilled work
- Cannot establish eye contact - Minimum stress → Assistance
- Disturbance in personal identity (pronouns) d. Mild-55-70, Mental Age: 8-12 y/o
- Repetitive act - Educable, Vocational skills
- Peculiar reaction to change-resist change, e. Slow Learners-70-89 (not mental retardation)
peculiar actions
Nursing Interventions: - Time out
- Therapeutic play
1. Optimize mental functioning-Mental age or ● Release energy
developmental age (Highest to attain regardless ● Expression of self
of chronological age) ● Promote communication
2. Planning with parents-Grieving process - Assist in focusing, redirect
3. Routine and repetition in teaching them - Improve role performance Gradually decrease
4. Down Syndrome reminders
Teach socially acceptable behavior
Speech Tantrums is communication Learning Disorders
Joints> Enhance - Deficits in acquiring expected skills compared
with other children of the same age and
Attention Deficit Hyperactivity Disorder (ADHD) intellectual capacity
- Disruptive Disorder - Categories
- Causes ● Reading disorder
● Genetic ● Mathematics disorder
● Biochemical-response to stimulants ● Language disorder
(Ritalin)-paradoxical effect-increase ● Disorder of written expression
attention ● Learning disorder not otherwise
● Preservatives specified
● In organic or developmental -
disequilibrium in the family-stressful for Motor Skills Disorder
the child - Low performance in daily activities that require
coordination below what is expected for age &
Manifestations: intellectual level
- Inattention or distractibility - Clumsy gross & fine motor skills, resulting in poor
- Impulsivity performance in sports & even poor handwriting
- Hyperactivity - Often coexists with a communication disorder
CNS Depressant
- Alcohol Effects of Alcohol
- Blood Alcohol Concentration Levels (BAC/BAL)
to Behavioral Manifestations of Intoxications GI
- Malnutrition
Etiology - Inflammations
- Biologic CNS
- Psychodynamic-very strong (fixation) - Due to deficiency in Vitamin B
- Behavioral-anxiety relief (rewarding). learned - Neuritis
behavior - Wernicke's syndrome-acute delirium and ataxia
- Social-peer pressure - Korsakoff's syndrome - acute amnesia memory
impairment- they do confabulation
Effects of Alcohol
- Rapidly absorbed in the bloodstream Reproductive system
● Initial effect of relaxation and loss of - Impotence (decreased testosterone)
inhibitions Intoxication
- Slurred speech, unsteady gait, lack of CVS
coordination, impaired attention, concentration, - Cardiomyopathy
memory and judgment - Fetal Alcohol Syndrome
- Aggressiveness or display inappropriate sexual
behavior Psychodynamics of substance dependence
- May experience a blackout - May be a basis for the nurse-client relationship
- Overdose - Unresolved needs of early attachments
● Short term - Increased Id
- Vomiting - Strong oral tendencies
- Unconsciousness - Demanding/manipulative - Matter of Fact - casual
- Respiratory depression but not indifferent; consistent, no bargaining; no
Eventually may lead to exemptions
● Aspiration pneumonia, pulmonary - Learn how to wait
obstruction - Rules and regulations
● Alcohol induced hypotension→
Cardiovascular shock → Death Management Goals: Detoxification
- Ensure the physiologic integrity and safety of the
Overview long term physiologic effects of alcohol use client.
- Limit visitors
● Cardiomyopathy - Check VS every 1-2 hours
● Wernicke's encephalopathy - Safety: Side rails up and ask someone to
● Korsakoff's psychosis accompany the client; Last resort: restraints,
● Pancreatitis adequate light, non-stimulating room, seizure
● Esophagitis (Dilantin Magnesium Sulfate → absorption of
● Hepatitis Vitamin B)
● Cirrhosis
● Warm shower
- Healthworkers have access to these drugs
- Antidote: Narcan
Inhalants
- Diverse group of drugs that are inhaled for their
effects
● Cause significant brain damage,
peripheral nervous system damage and
liver disease
***Mouth puffs: Mgt- gargle to prevent mouth ulcers
**Disulfam Therapy – blocking aldehyde dehydrogenase Effects
(=Sx- headache ; thereby: di na sila iinom because of sx) - GI Upset
- Mirthfulness
Management of Alcoholism: Rehabilitation - Ulcers in the mouth
- Support group for the family of the Alcoholics - CNS depression →→ Death
● Al Anon - for the wife
● Ala Teen-for the children Examples
- Activity therapy group - Solvents
- Remotivation therapy - Gasoline
- Withdrawn and regressed-to be interested again
in socializing, sharing stories. Intoxication and Overdose
- Dizziness, nystagmus, lack of coordination,
Nursing Interventions slurred speech, unsteady gait, tremors, muscle
- Providing for physical and nutritional needs weakness, blurred vision
- Confrontation - Stupor and coma can occur
- Tough love
- Group work Behavioral symptoms
- Education - Belligerence, aggression, apathy, impaired
judgment, inability to function
Effects
- Depressant but may have euphoria
- Psycho-motor retardation
- Sleepy languor
- Insensitivity to pain-physical and emotional
- Decreased LOC
- Respiratory rate- below 12 per minute
Withdrawal
- Initial: anxiety, restlessness, aching back and
legs, craving for more opioids
- Runny nose
- Teary eyes
- Goose flesh-Piloerection'
- Abdominal or leg cramps → diarrhea