ST.

LOUIS REVIEW CENTER Nursing Review and Tutorials

PSYCHI TRIC NURSIN! REVIEW NOTES Compiled by Gianina Marie Borja, RN CMT ST. LOUIS REVIEW CENTER "PSYCHI TRIC NURSIN! # $ENT L HE LTH% PSYCHI TRIC NURSIN! - a specialized area of nursing; SC !NC!" #$eories of $uman be$a%ior &RT" #$erapeu#ic or purposeful use of self - includes" promo#ion and main#enance of men#al $eal#$ pre%en#ion of men#al illness managemen# of men#al and p$ysical problems diagnosis and #rea#men# of men#al disorders referral and re$abili#a#ion ' Basic (rinciples of (syc$Nsg" )* &ccep# and respec# #$e clien# regardless of $is be$a%ior +* ,imi# #$e be$a%ior, no# #$e clien# -* &l.ays main#ain a safe and non/judgmen#al en%ironmen# 0* !ncourage e1pression of #$oug$#s and feelings 2* Remember #$a# all be$a%ior is learned 3* &ll be$a%ior $as meaning ' - ,e%els of (syc$Nsg" * (rimary /////////////////// 4bjec#i%e" (romo#ion 5 (re%en#ion * Secondary //////////////////////////4bj" Screening, 6iagnosis, 5 mmedia#e Trea#men# * Ter#iary ////////////////////////////4bj" Re$abili#a#ion 7.$ic$ s#ar#s upon admission8 & $ENT L HE LTH 'o(us) *revention - i# is rela#i%e and dynamic - 6efini#ion" 9s#a#e of emo#ional, psyc$ological, and social .ellness as e%idenced by sa#isfying in#erpersonal rela#ions$ips, effec#i%e be$a%ior and coping, a posi#i%e self/concep#, and emo#ional s#abili#y* - Men#al $eal#$ is influenced by ndi%idual fac#ors 7biologic ma:e/up, emo#ional resilience, self concep#8, n#erpersonal ;ac#ors 7communica#ion, in#imacy, rela#ions$ips8, and Social<Cul#ural ;ac#ors 7sense of communi#y<family, access #o resources, %iolence, di%ersi#y8* M!NT&, ,,N!SS - +ental disorder is a clinically significan#, psyc$ological syndrome or pa##ern #$a# occurs in an indi%idual and is associa#ed by a presen# dis#ress, disabili#y, or an increase in #$e ris: of dea#$, pain, disabili#y, or a loss of freedom* & SSESS$ENT O, $ENT L HE LTH ' Componen#s of #$e &ssessmen# of Men#al S#a#us" )* S!NS4R =M" Consciousness, 4rien#a#ion, &##en#ion, Concen#ra#ion, Compre$ension +* &((!&R&NC!" &ppropria#eness, Grooming, Rigidi#y, Mannerisms -* &;;!CT< M446" &ppropria#eness of affec#, Mood s.ing, 6ura#ion, n#ensi#y 0* T>4=G>T C4NT!NT" Self/concep#, &reas of concern, T$emes of #$oug$#, 6elusions, llusions, >allucina#ions, 4bsessions )* T>4=G>T (R4C!SS" abili#y #o unders#and symbols; abs#rac# reasoning

+* S(!!C>" Co$erency, Rele%ance, Meaning, ?uali#y, ?uan#i#y ' M!NT&, ST&T=S &SS!SSM!NT" a* General &ssessmen#" facial e1pression, grooming and dress, body language,
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

b* M446, ;!!, NGS, and &;;!CT" mood, affec#i%e e1pression, and appropria#eness of affec# #o #$oug$# con#en# c* (ercep#ion and T$in:ing" i* (ercep#ual 6is#urbances @ >allucina#ions, illusions, depersonaliza#ion ii* T$oug$# (rocess @ (roduc#i%i#y of ideas, Con#inui#y of #$oug$#, language impairmen#s iii* Con#en# of T$oug$# @ (reoccupa#ions, #$oug$# dis#urbances i%* n#ellec#ual ;unc#ioning @ memory, abs#rac# abili#y d* =se of !go 6efense Mec$anisms e* ,e%el of Self/es#eem "- C. TO - SICS% THER PEUTIC REL TIONSHIP / #$erapeu#ic, no# social in na#ure; i# is no# a Afriends$ipB; al.ays pa#ien#/cen#ered and goal direc#ed; i# is limi#ed in na#ure ' ST&G!S<(>&S!S of a Nurse/(a#ien# Rela#ions$ip" )* (re/orien#a#ion ($ase" objec#i%e is #o pre%en# coun#er/#ransference +* 4rien#a#ion< ni#ia#ion ($ase" obj" es#ablis$ #rus# 5 rappor#; se# goals / #$e p$ase .$ere #$e #ermina#ion p$ase is begun / assessmen# of problems, needs, 5 e1pec#a#ions of pa#ien# / define #$e responsibili#ies of nurse, sc$edules, con#rac#s,, limi#a#ions, goals -* Cor:ing ($ase" / 4bj" iden#ifica#ion of problems, employmen# of problem/sol%ing #ec$niDues, $elp clien# de%elop<res#ore coping mec$anisms 0* Termina#ion < !%alua#ion ($ase" 4bj" !%alua#e if goals se# .ere me# / s#age of separa#ion an1ie#y and o#$er problems of #ermina#ion THER PEUTIC CO$$UNIC TION /t0era(o+1 - an in#erpersonal in#erac#ion be#.een a nurse and clien#; i# is pa#ien#/cen#ered and goal/direc#ed* ' Co+*onents of T$eraCom" )* Confiden#iali#y +* Self/6isclosure -* (ri%acy and Respec#ing Boundaries 0* Touc$ 2* &c#i%e ,is#ening and &c#i%e 4bser%a#ion T>!R&C4M TECHNI2UES) O''ering o' Sel' @ 9 am $ere*E ((e*ting @ 9Fes, follo. .$a# you saidE -road O*enings @ 9C$a# are you #$in:ing abou#GE; o*en3ended 4uestions; no# ans.erable by yes or no Clari'i(ation @ 9C$a# do you mean byHGE En(ourage des(ri*tion o' *er(e*tions 5 9Tell me .$a# you feel .$en you feel an1ious*E E6*loration7Ela8oration @ 9Tell me moreHE ,o(using @ 9C$a# is one #$ing #$a# is bad<good abou#HE; concen#ra#ing on a single poin# !eneral Leads @ 9>mmHand #$enGE; encourages con#inua#ion of e1pression !iving Re(ognition @ 9>ello*E, 9 no#iced you combed your $air #oday*E
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

$a9ing O8servations @ 9 no#iced #$a# you are bi#ing your nails*E ; %erbalizing .$a# #$e nurse $as obser%ed* Para*0rasing7 Restating7 Re*eating @ 9Fou donB# #$in: #$a# #$is is rig$#GE; repea#ing #$e issue e1pressed* Realit: Orientation7Testing @ 9 donB# see lizards on your bac:*E Re'le(tion 5 9Fou seem upse#* # mus# be difficul# for you*E, 9Could you li:e #$a#GE; mirroring feelings; direc#ing clien#Bs ac#ions, #$oug$#s, and feelings bac: #o $im* Silen(e @ absence of %erbal communica#ion Su++ari;ing @ 96uring #$e las# $alf/$our, .e $a%e discussedHE; recap Validating @ 7clien#" 9 Bm deadE8 nurse" 9Fou feel lifelessGE; #ransla#ing in#o feelings .ords #$e clien# e1pressed* Voi(ing <ou8t @ 9T$a#Bs unusualHE; gen#ly Dues#ioning #$e reali#y of #$e percep#ion = NON3 THER CO$" s9ing WHY dvising greeing and <isagreeing **roval and <isa**roval -elittling #$e feelings e1pressed C0allenging <e'ending ,alse ssuran(es Introdu(ing an Unrelated to*i( @ c$anging #$e subjec# >udging Non/#$erapeu#ic Tou(0 Non/#$erapeu#ic Silen(e Re?e(ting Stereot:*ing / generaliza#ion =sing <enial @ 9Fou donB# mean #o say #$ose #$ingsHE B!>&I 4R @ #$e .ay an organism responds #o a s#imulus; i# is a response #o a c$anged condi#ion - all be$a%ior $as meaning and purpose - #$e perception is more impor#an# #$an .$a# is ac#ually $appening N!!6 @ a reDuiremen# for sur%i%al C4N;, CT @ #$e resul# of #$e presence of + or more opposing or in(o+*ati8le dri%es .$erein #$e person is reDuired #o ma:e a (0oi(e. STR!SS @ #$e .ear and #ear on #$e body / pressure broug$# on by a stressor; i# is recurring, normal, and canno# be a%oided* ' S#ress &dap#a#ion Syndrome S#age " lar+ Rea(tion / fig$# or flig$# mec$anism; increased &ler#ness and an1ie#y; #as:/orien#ed; defense/orien#ed S#age " Resistan(e @ op#imal adap#a#ion #o s#ress; increased use of coping mec$anisms; defense/orien#ed be$a%ior S#age " E60austion @ loss of abili#y #o resis# s#ress; reali#y con#ac# reduced

;R=STR&T 4N @ a s#a#e .$ere #$e s#ress surpasses #$e personBs #$res$old* ' Major Be$a%ioral responses #o frus#ra#ion" a* ;i1a#ion @ a s#rong and persis#en# response b* &ggression @ a response in some form of a##ac: and is generally des#ruc#i%e J + Types of &ggression" i* (assi%e aggression ii* &c#i%e aggression
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

c* Regression @ a response .$erein #$e person re%er#s bac: #o a pre%ious period in life .$ere $e fel# safe and able #o cope d* Resigna#ion @ ac# of gi%ing up or .i#$dra.ing from reali#y &NK !TF @ a %ague feeling of dread or uneasiness; $as no iden#ifiable s#imulus for an1ie#y; subjec#i%e; painful appre$ension; fear of #$e un:no.n ' ;!&R @fear is a response #o a specific, iden#ifiable #$rea#ening objec#* ' ,!I!,S 4; &NK !TF $IL< @A " person is fully aler#, senses are $eig$#ened, and percep#ual field is .idened, increased a##en#i%eness $O<ER TE @B) selec#i%e ina##en#ion; percep#ual field is narro.ed; $is focus needs #o be direc#ed #o a poin#; can %erbalize feelings of an1ie#y; increased %i#al signs SEVERE @C) percep#ual field is grea#ly reduced; #$ere is a##en#ion #o de#ail bu# no# necessarily on .$a# is impor#an#; inabili#y #o sol%e problems; #$is is #$e s#ar# of #$e s:+*at0eti( s:+*to+s; pacing, .ringing of $ands P NIC @D) focus is sur%i%al; percep#ual field is se%erely reduced; tunnel vision; no problem sol%ing, no focused a##en#ion; = G!N!R&, NT!RI!NT 4NS ;4R &NK !TF" den#ify an1ious be$a%ior and de#ermine le%el of an1ie#y* Con#rol en%ironmen# S#ay .i#$ clien# !s#ablis$ a suppor#i%e and #rus#ing rela#ions$ip S$o. accep#ance and be non/judgmen#al 6o no# confron# pa#ien#; !ncourage e1pression and %erbaliza#ion (ro%ide p$ysical care and rela1a#ion #ec$niDues &s direc#ed, adminis#er medica#ion !ncourage indi%idual or group #$erapy #o iden#ify ne. .ays of coping

' N4/N4s in &NK !TF" - pressuring pa#ien# #o c$ange e%en if $e is no# ready - Confron#a#ion - 6isappro%ing %erbally - Ci#$dra.ing from #$e pa#ien# - Cri#ically focusing on #$e an1ious feelings of #$e clien# - Being non/#$erapeu#ic CRISIS @ an upse# in a s#eady s#a#e; .$en faced .i#$ a si#ua#ion #$a# canno# be readily sol%ed by #$e usual coping #ec$niDues; i# is self/limi#ing 70/3 .ee:s8 ' Types of Crisis" )* 6e%elopmen#al<Ma#ura#ional Crisis @ de%elopmen#al s#ages of life +* Si#ua#ional<&cciden#al Crisis / acciden#s, miscarriages, rape, sudden dea#$ -* &d%en#i#ious / calami#ies, disas#ers, .ar CRISIS INTERVENTION @ o8?e(tive) to return to nor+al level o' 'un(tioning - alle%ia#e #$e impac# of #$e crisis and $elp mobilize resources* ' General (rinciples in Crisis n#er%en#ion" - ensure safe#y of all #$ose in%ol%ed - $elp #$e clien# #o %erbalize - e1plain #o clien# #$e fac#s; fan#asies are more dangerous and frig$#ening - ne%er gi%e false assurances - $elp $im #o see: $elp - assis# $im .i#$ e%eryday #as:s
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

!RIE, # LOSS GR !; @ #$e normal emo#ional response #o #$e e1perience of loss GR !I NG @ is #$e process of grief M4=RN NG<B!R!&I!M!NT @ #$e ou#.ard e1pression of grief ' L=B,!R/R4SS ST&G!S 4; GR !I NG" 76&B6&8 <enial nger -argaining <e*ression ((e*tan(e ' NT!RI!NT 4NS / assess $o. #$e clien# is coping .i#$ #$e loss / encourage clien# #o reac$ ou# / encourage clien# #o re%ie. personal s#reng#$ / encourage clien# #o care for $erself / use #$erapeu#ic communica#ion / main#ain in#erpersonal s:ills E!O <E,ENSE $ECH NIS$S - defense mec$anisms ser%e a useful pro#ec#i%e func#ion CTIN! OUT) an unconscious desire #urned in#o reali#y CO$PENS TION) ma:ing up for a percei%ed insufficiency #$roug$ a specific be$a%ior CONVERSION) #ransla#ion of emo#ions #o p$ysical symp#oms; psyc$osoma#ic; <ENI L) fig$#ing .i#$ reali#y by s#a#ing #$a# i# doesnB# e1is# !1* 9T$is is no# $appening #o me*E <ISPL CE$ENT) #ransfer feelings of frus#ra#ion 5 anger #o a less #$rea#ening objec#<person <ISSOCI TION) de#ac$men# or separa#ion from oneBs consciousness during an emo#ionally e1#reme si#ua#ion ,IE TION) persis#ence of a #$oug$# or be$a%ior pa##ern beyond i#s appropria#e s#age I<ENTI,IC TION) #$e unconscious be$a%ior of associa#ing .i#$ ano#$er person or #$e en%ironmen# #o preser%e #$e ego; usually found in presc$oolers INTELLECTU LIF TION) a%oiding emo#ional in%ol%emen# by focusing on #$e in#ellec#ual aspec#s; smo#$ering emo#ions .i#$ fac#s* INTRO>ECTION) incorpora#ing in one self #$e %alues and #rai#s of ano#$er PRO>ECTION) placing unaccep#able impulses of yourself on#o someone else; blaming; scapegoa# R TION LIF TION) Asour/grapingB; gi%ing ano#$er logical reason as opposed #o #$e real reason RE CTION ,OR$ TION) #a:ing #$e opposi#e belief<be$a%ior because #$e #rue belief<be$a%ior is unaccep#able; Aplas#icB RE!RESSION) #emporary re#rea# #o a safer s#age of de%elopmen# or #o a be$a%ior during s#ress REPRESSION) mainly unconscious; unin#en#ional forge#fulness SPLITTIN! 7 STEREOTYPIN! 7 !ENER LIFIN!) 9all good, all badE SU-LI$ TION) socially unaccep#able be$a%ior in#o personally or socially accep#able be$a%ior SUPPRESSION) unconscious %olun#ary or in#en#ional pus$ing of conscious #$oug$#s or feelings in#o #$e

SY$-OLIF TION) unconscious; an objec# or ac# unconsciously $olds a $idden meaning and carries an emo#ional feeling
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

UN<OIN! 7 RESTITUTION) a .ay of compensa#ing or apologizing for .rong doing SUICI<E - T$e in#en#ional ac# of :illing oneself Types of Suicide" a* <ire(t Sui(ide @ conscious 5 %olun#ary b* Indire(t Sui(ide @ unconscious 5 $idden desires #o die (opula#ion a# Ris: for Suicide - males; di%orced spouses, Caucasians, adolescen#s, adul#s -M/0M yrs old, elders abo%e 32 yrs old; .i#$ painful or debili#a#ing diseases, psyc$osis, #$ose .i#$ no social suppor# group; lac: spiri#uali#y or religion, #$ose .i#$ a $is#ory of suicidal a##emp#s NT!RI!NT 4NS" - ne%er ignore any suicidal idea#ionN - (romo#e clien#Bs safe#y by con#rolling $is en%ironmen#; suicide precau#ion, may need res#rain#s - Crisis in#er%en#ion, problem/sol%ing - No/suicide con#rac# - >elp clien# iden#ify suppor# sys#ems - 4ne/#o/one super%ision a# all #imes "PERSON L N% & PERSON LITY 5 #$e cumula#i%e of all #$e aspec#s of an indi%idual; i# is e1pressed #$roug$ be$a%ior ' ;ac#ors #$a# influence (ersonali#y" a* >eredi#y b* !n%ironmen# c* Training ' T$eories on (ersonali#y" )* !ri: !ri:sonBs (syc$osocial T$eory +* Sigmund ;reudBs (syc$ose1ual< (syc$oanaly#ical T$eory ERI.SONGS PSYCHOSOCI L THEORY @ O s#ages of man TRUST vs. $ISTRUST 7M/)O mon#$s8 #$e regular and cons#an# in#erac#ion be#.een mo#$er and infan# lay #$e founda#ions of #rus# for #$e infan# if posi#i%e P realis#ic #rus# and confidence in o#$ers, op#imism 5 $ope mis#rus# P .i#$dra.al; suspiciousness, projec#ion; o%erly #rus#ing in o#$ers UTONO$Y vs. SH $E # <OU-T 7)O mon#$s @ - years8 a##emp#s #o gain con#rol o%er $imself and $is en%ironmen# 7au#onomy8 s$ame 5 doub# P affec# $is abili#y #o ac$ie%e P compulsi%eness, fear of cri#icism 9$olding on or le##ing goE s#age social s:ill" parallel play INITI TIVE vs. !UILT 7-/2 yrs8 period of de%elopmen# of #$e conscience ini#ia#i%es in #a:ing on $ig$er le%els of mo#or and in#ellec#ual s:ills if posi#i%e P ini#ia#i%e is reinforced P adeDua#e conscience if nega#i%e P e1cessi%e guil# P passi%i#y, apa#$y; labile emo#ions, s$o.ing off social s:ill" coopera#i%e play IN<USTRY vs. IN,ERIORITY 72/)) yrs*8 effor#s #o in#erac# .i#$in a broader social con#e1#; $e crea#es $is o.n #oys, games encouragemen# 5 praise P indus#ry and compe#ence; comple#ion of ac#i%i#ies cri#icism 5 e1cessi%e discipline P sense of inferiori#y, inadeDua#e problem sol%ing s:ills; perfec#ionis#, in#ense fear of failing I<ENTITY vs. ROLE <I,,USION # CON,USION 7)) @ )O yrs8 cons#ruc#s personali#y #$eories abou# $imself and #$ose around $im if iden#i#y is formed P sense of self, confidence, emo#ional s#abili#y, role diffusion P $is a##emp# of being 9#oo many peopleE
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

role confusion P no# :no.ing .$ere $e belongs #o P may see: a 9nega#i%e iden#i#yE INTI$ CY vs. ISOL TION 7young adul#$ood8 abili#y #o be in#ima#e .i#$ o#$ers on le%els of friends$ip and se1uali#y if in#imacy is no# es#ablis$ed P isola#ion, emo#ional dis#ance, casual se1 encoun#ers; possessi%eness and jealousy, dependence, abusi%eness if posi#i%e P abili#y #o gi%e and recei%e lo%e, responsible se1ual be$a%iors !ENER TIVITY vs. ST !N TION 7middle adul#$ood8 focuses on $is con#ribu#ion #o #$e ne1# genera#ion Qc$ildren, nieces, nep$e.s, e#c*R if posi#i%e P produc#i%e, cons#ruc#i%e, crea#i%e; paren#al 5 socie#al responsibili#ies no sense of genera#i%i#y P s#a#e of self/absorp#ion; self/cen#eredness INTE!RITY vs. <ESP IR 7la#e adul#$ood8 $e assesses $imself based on #$e cumula#i%e e1periences of a life#ime; accep#s responsibili#y for .$a# $is life $as been and finds i#s .or#$ sa#isfac#ion .i#$ $is life P sense of in#egra#ion, digni#y, .or#$, and impor#ance; many regre#s P sense of despair, $elplessness, .or#$lessness; .i#$dra.al, loneliness

,REU<GS PSYCHO N LYTIC L 7 PSYCHOSEEU L THEORY 39icebergE #$eory, componen#s of personali#y, and role of early c$ild$ood e1periences in s$aping #$e personali#y ' ,!I!,S 4; C4NSC 4=SN!SS" 9icebergE )* Conscious @ func#ions .$en a.a:e; #$e #$in:ing being; !G4 / pas# e1perience, recen# e%en#s are recalled easily +* (reconscious < Subconscious @ par# .$ere ideas and reac#ions are s#ored and par#ially forgo##en; i# pre%en#s unaccep#able memories from surfacing in #$e conscious / #$oug$#s and e1periences are recalled bu# .i#$ effor# -* =nconscious @ #$e larges# par# of #$e mind / s#orage of all memories, feelings, reac#ions, e#c* / memories canB# be recalled a# .ill; bu# #$roug$ dreams, 9;reudian slipsE, une1plained be$a%ior, jo:es, lapses of memories ' C4M(4N!NTS 4; (!RS4N&, TF" )* 6 @ #$e unconscious par# of #$e person; con#ain #$e primi#i%e dri%es and urges / 9pleasure principleE / de%eloped during infancy +* !G4 @ #$e self 9 E; #$e in#egra#or of #$e personali#y / de%eloped during #oddler s#age / 9reali#y principleE -* S=(!R!G4 @ #$e conscience / de%eloped during presc$ool age ' ST !ES O, PSYCHOSEEU L <EVELOP$ENT) OR L PH SE 7M/)O mon#$s8 Mou#$ is #$e pleasure area; sa#isfac#ion #$roug$ feeding, suc:ing, and s.allo.ing N L PH SE 7)O mon#$s @ - years8 - &nus is pleasure area; sa#isfac#ion #$roug$ elimina#ion and re#en#ion - Cri#ical period of #oile# #raining; firs# e1periences .i#$ discipline and au#$ori#y - Reali#y principle is in#roduced - !G4 de%elopmen# and s#ar# of Superego de%elopmen# PH LLIC PH SE 7-/2 years8 / Geni#als is pleasure area; sa#isfac#ion #$roug$ mas#urba#ion, fan#asy, and play / Girls" 9penis en%yE and !le:#ra comple1 / Boys" 4edipus comple1 / Resolu#ion of #$ese comple1es occurs #$roug$ iden#ifica#ion .i#$ same se1
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

paren# / S=(!R!G4 is de%eloped L TENCY 73/)+ years8 / #$is s#age is mar:ed by e1panding social ne#.or:, more peer rela#ions$ips / increased in#ellec#ual ac#i%i#y !ENIT L PH SE 7)+ @ on.ards8 / mar:ed by se1ual ma#uri#y #$a# s#ar#s .i#$ puber#y / Geni#als are again #$e pleasure area; es#ablis$men#s of rela#ions$ips .i#$ opposi#e se1 PERSON LITY <ISOR<ERS 3 are diagnosed .$en oneBs personali#y becomes infle1ible and maladap#i%e and in#erferes .i#$ $o. $e func#ions in socie#y or causes emo#ional dis#ress ' C&T!G4R !S < C,=ST!RS 4; (!RS4N&, TF 6 S4R6!RS" Cluster ) Odd 7 E((entri( A. Paranoid Personalit: <isorder / suspicious, dis#rus#ful / suspicions P pa#$ological jealousy, $ypersensi#i%i#y / delusions of persecu#ion / 6efme1" (R4S!CT 4N / T$eracom" (&SS I! ;R !N6, N!SS B. S(0i;oid Personalit: <isorder - aloof, socially dis#an#, in#ro%er#, loner, $umorless - fla# affec#; fair con#ac# .i#$ reali#y - a%oids meaningful in#erpersonal rela#ions$ips - inabili#y #o e1perience pleasure - T$eracom" respec# #$eir space and pri%acy of #$eir #$oug$#s - T$erapy" (syc$o#$erapy 5 Group #$erapy #o de%elop in#erpersonal 5 social s:ills C. S(0i;ot:*al Personalit: <isorder 3 S1 of Sc$izoid T magical #$in:ing, ideas<delusions of reference, peculiari#y of speec$ bu# no looseness of associa#ion; .i#$dra.n, de#ac$ed; inappropria#e or blun# affec# / #eac$ self/care and assis# in de%eloping social s:ills Cluster -) <ra+ati( 7 Errati( A. ntiso(ial Personalit: <isorder / usually males .i#$ $is#ory of conduc# disorder during c$ild$ood / may $a%e $is#ory of se1ual or p$ysical abuse or %iolence / may appeal as s.ee# #al:ing, c$arming, in#ellec#ual / impulsi%e, aggressi%e, manipula#i%e, lo. self/es#eem, lac: remorse, $a#es rules and au#$ori#y figures / 6efme1" R&T 4N&, U&T 4N, 6 S(,&C!M!NT / T$eracom" Li+it Setting; 9ma##er/of/fac#E approac$ Consisten(: / $elp clien# learn $o. #o sol%e problems and manage emo#ions of anger

B. -orderline Personalit: <isorder / mos#ly females / unfulfilled need for in#imacy; c$ronic feeling of emp#iness and an$edonia / dis#urbance in !G4 and self/concep# / impulsi%e, self/des#ruc#i%e, emo#ionally uns#able / .i#$ mar:ed mood s.ings and unpredic#able be$a%ior / 6efme1" S(, TT NG / promo#e safe#y, $elp clien# cope and con#rol emo#ions / T$eracom" ,imi# se##ing, Confron#a#ion, No Self/>arm Con#rac# C. Histrioni( Personalit: <isorder / common in .omen; .an#s #o be #$e cen#er of a##en#ion; usually pro%oca#i%e / emo#ional, drama#ic, manipula#i%e, seduc#i%e, impressionis#ic speec$,
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

e1#ro%er#, crea#i%e, emo#ionally uns#able, %ain / T$eracom" pro%ide fac#ual feedbac: on be$a%ior D. Nar(issisti( Personalit: <isorder / mos#ly in males; 9me#rose1ualE / boas#ful, ego#is#ical, superiori#y comple1, arrogan#, lac: of empa#$y / superficial rela#ions$ips / T$eracom" 9ma##er/of/fac#E Cluster C) A. n6ious 7 ,ear'ul voidant Personalit: <isorder - fear of rejec#ion - inferiori#y comple1, s$y, #imid; social .i#$dra.al, loner - $ypersensi#i%e #o nega#i%e e%alua#ion<cri#icism - T$eracom" promo#e self/es#eem, suppor#

B. <e*endent Personalit: <isorder / submissi%e, clinging, emo#ionally needy, %ery lo. self/es#eem, $elpless / mos#ly .omen / lac: self/confidence; unable #o ma:e decisions for $erself; fear of being alone / (riori#y" Safe#y, refer #o s$el#er / T$eracom" fos#er self/reliance, au#onomy, problem/sol%ing s:ills, decision/ ma:ing, and self/es#eem C. Passive 5 ggressive Personalit: <isorder /*lasti(1 - per%asi%e pa##ern of passi%e resis#ance #o #$e demands for social performance .i#$ a nega#i%e a##i#ude; lo%es #o procras#ina#e and Aforge#B; moods fluc#ua#e rapidly - clien# may s$if# from blaming o#$ers #o e1aggera#ed remorse and guil# D. O8sessive3Co+*ulsive Personalit: <isorder / 4bsession" persis#en# and repe#i#i%e #$oug$# or emo#ion / Compulsion" irresis#ible desire #o perform an ac#ion, uncon#rollable irra#ional ac#s / &nal ;i1a#ion @ s#ric# #oile# #raining Cardinal Sign" Ri#ualis#ic be$a%ior 7main P $and.as$ing8 / need #o be perfec# and precise; self and en%ironmen#al con#rol / T$eracom" gi%e appropria#e #ime #o do #$e ri#uals #o relie%e an1ie#y; do no# in#erfere; Se# limi#s on #ime leng#$ and freDuency of ri#ual; offer al#erna#i%e ac#i%i#ies; con#rol #$e en%ironmen# and minimize c$oices a%oid manipula#i%e and con#rolling be$a%iors / Meds" TC&s P firs# c$oice is Clomipramine Q&naframilR second c$oice is mipramine QTofranilR "NER-YOSO% & NEIETY REL TE< <ISOR<ERS - all $a%e insomnia due #o decrease in gamma aminobu#yric acid 7G&B&8 - gi%en an1ioly#ics #o con#rol symp#oms = Pani( <isorder 5 recurren#, une1pec#ed panic a##ac:s follo.ed by ) mon#$ of persis#en# concern or .orry abou# $a%ing fu#ure a##ac:s / Meds" SSR s, TC&s, M&4 s, benzodiazepine an1ioly#ics 7an#ian1ie#y8 / decrease en%ironmen#al s#imuli, s#ruc#ured en%ironmen#, slo. 5 deep brea#$ing, engage in rela1ing p$ysical ac#i%i#y, performing repe#i#i%e ac#i%i#ies / $elp clien# produce a posi#i%e 9self/#al:E ' P0o8ia <isorder 5 an illogical, in#ense, persis#en# fear of a specific objec# or a social si#ua#ion #$a# causes e1#reme dis#ress and in#erferes .i#$ normal func#ioning / Types" agorap$obia, social p$obia, algop$obia, 1enop$obia, zoop$obia / (syc$o#$erapy, Be$a%ioral T$erapy, s:ste+ati( desensiti;ation 3 rela1a#ion #ec$niDues, pro%ide cons#an# suppor#, a%oid confron#a#ion 5 $umilia#ion ' O8sessive3Co+*ulsive <isorder @ also a personali#y disorder 7discussed abo%e8
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

' Post Trau+ati( Stress S:ndro+e /PTS<1 @ a disorder follo.ing #$e e1posure #o an e1#remely #rauma#ic e%en# causing in#ense fear and recurring recollec#ions and nig$#mares .$erein #$e e1perience is reli%ed / Cardinal signs" ;,&S>B&CLS 5 N G>TM&R!S / Symp#oms" sleep dis#urbance, irri#abili#y, depression, anger ou#burs#s, $yper%igilance, inabili#y #o main#ain in#imacy, poor impulse con#rol, e1aggera#ed s#ar#le response - T$eracom" encourage %erbaliza#ion; s$o. empa#$y; be non/judgmen#al; $elp clien# find .ays of e1pressing feelings safely, encourage #o reac$ ou# #o suppor# sys#ems ' !enerali;ed n6iet: <isorder /! <1 5 free/floa#ing an1ie#y - Cardinal sign" c$ronic .orrier ' <isso(iative <isorder 5 o%eruse of #$e 6efMe1 6issocia#ion - disrup#ion in #$e usually in#egra#ed func#ions of consciousness Types of 6issocia#i%e disorders" )* <isso(iative +nesia @ clien# canB# remember personal informa#ion +* <isso(iative ,ugue @ clien# $as episodes of suddenly lea%ing #$e $ouse or .or: .i#$ou# any e1plaina#ion; C. <isso(iative Identit: <isorder /$ulti*le Personalit: <isorder1 / clien# displays + or more iden#i#ies or personali#ies #$a# #a:e o%er $is be$a%ior; 0* <e*ersonali;ation <isorder @ clien# $as a persis#en# feeling of being de#ac$ed NEIOLYTICS 7 NTI3 NEIETY $E<IC TION - Sedative 7 H:*noti( 7 $inor Tran4uili;er - (rescribed for an1ie#y, insomnia, 5 6elirium; 4C6, (TS6, alco$ol .i#$dra.al =se" reduce an1ie#y; induces rela1a#ion, seda#ion, in$ibi# con%ulsions >arm" ne%er mi1 .i#$ alco$ol -ENFO<I FIPINES 7/zepam < /zolam8 3 an#icon%ulsan#, an1ioly#ic, muscle rela1an# 6iazepam QIaliumR C$lordiazapro1ide Q,ibriumR &lprazolam QKana1R !s#azolam Q(rosomR 41azepam QSera1R ,orazepam Q&#i%anR Clonazepam QLlonopinR >alazepam Q(a1ipamR Midrazolam Q6ormicumR (razepam QCen#ra1R Triazolam Q>alcionR Temazepam QRes#rorilR ;lurazepam Q6almaneR Side !ffec#s" #end #o cause p$ysical 5 psyc$ological dependence; dro.siness, seda#ion, poor coordina#ion >eal#$ Teac$ing" do no# s#op abrup#ly; donB# #a:e more #$an #$e prescribed dose; do no# drin: alco$ol; do no# dri%e a car or opera#e mac$inery; in elderly, fall precau#ions* Carning" moni#or Res*irator: Rate H sign of Respira#ory 6epression &n#ido#e" ;lumazenil QRomaziconR @ an1ioly#ic an#agonis# - R-ITUR TES 5 NTICONVULS NTS / 3tal 7 3al 1 / more used as an an#icon%ulsan# #$an a seda#i%e Secobarbi#al QSeconalR ($enobarbi#al Q,uminalR @ commonly used Me#$o$e1i#al QBre%i#alR &mobarbi#al Q&mi#alR (upillary cons#ric#ion P sign of o%erdose
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

TYPIC L NEIOLYTICS 6ip$en$ydramine QBenadrylR >ydro1yzine Q&#ara1, #era1, Iis#arilR Meprobama#e QMill#o.n, !DuanilR C$loral >ydra#e QNoc#ecR Uolpidem Q&mbien, S#illno1R Side !ffec#s" dro.siness, men#al confusion, $abi#ua#ion 5 increased #olerance, .i#$dra.al symp#oms >eal#$ Teac$ing" no dri%ing or opera#e mac$inery; no alco$ol; e%alua#e mood, affec#, and sensorium for indica#ions of men#al confusion "SI. TI%

& SO$ TO,OR$ 7 PSYCHOSO$ TIC <ISOR<ERS - .i#$ou# any organic or real p$ysiological or objec#i%ely obser%able symp#oms - Soma#iza#ion" #ransference of men#al e1periences in#o bodily symp#oms - 6efmez" Repression, (rojec#ion, Con%ersion, and n#rojec#ion - General n#er%en#ions" unders#and #$a# #$e symp#oms are real #o #$e pa#ien#; be #$erapeu#ic; $elp clien# de%elop problem sol%ing s:ills and coping mec$anisms; pro%ide di%ersionary ac#i%i#ies #o dis#rac# clien# from #$e symp#om; &n#idepressan#s as ordered* TF(!S 4; S4M&T4;4RM 6 S4R6!RS" A. CONVERSION <ISOR<ER @ #$e presence of p$ysical symp#oms .i#$ no iden#ifiable p$ysical e#iology 3 S1" ,a Belle ndifference @ seemingly lac: of concern of manifes#a#ion / 6efme1" 6enial, (rojec#ion, Con%ersion, 5 n#ro%ersion n#er%en#ions" di%er# a##en#ion from symp#om; pro%ide social and recrea#ional ac#i%i#ies, con#rol en%ironmen# B. HYPOCHON<RI SIS @ preoccupa#ion .i#$ an imagined illness .i#$ no obser%able symp#oms and no organic c$anges / Cardinal sign" 96oc#or S$oppingE; condi#ions are mos#ly #erminal or debili#a#ing / 6iagnos#ic Tes#" using (lacebo S(andalII & SEEU L <YS,UNTION - de%ia#ions in se1ual be$a%ior - Prin(i*les o' Care) ,imi# be$a%ior bu# accep# #$a# #$e pa#ien# is in emo#ional pain; (ro#ec# #$e clien# from o#$ers; Se# limi#s on $im ac#ing ou# se1ually; 6e%elop and suppor# self/es#eem; pro%ide di%ersional ac#i%i#ies* P R PHILI @ se1ual fan#asies or urges #$a# direc#ed #o.ards non/$uman objec#s, pain #o self or par#ner, and #o non/consen#ing adul#s Qc$ildrenR* E60i8itionis+ ,etis0is+ ,rotteuris+ $aso(0is+ Pedo*0ilia Sadis+ Transvestis+ Vo:euris+ Foo*0ilia

Hi:a9I & E TIN! <ISOR<ERS General n#er%en#ions" 6ie#ary T$erapy @ oral or #ube feedings, moni#or $ydra#ion and elec#roly#es, pro%ide $eal#$ #eac$ings, se# limi#s based on .eig$# loss or gain, res#ric# or gran# pri%ileges; use be$a%ioral con#rac#s; posi#i%e and nega#i%e reinforcemen#; .eig$ - #imes a .ee:; assess ea#ing pa##erns; ne%er lea%e pa#ien# un#il + $ours af#er meal Q.a#c$ for purgingR*
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

NOREEI NERVOS @ignoring #$eir feelings of $unger 5 signs of p$ysical .ea:ness, / $as an in#ense fear of gaining .eig$# or becoming fa# J S6) in#ense fear of becoming fa# or gaining .eig$# !macia#ion &menorr$ea for a# leas# - consecu#i%e cycles 6epressi%e symp#oms suc$ as .i#$dra.al, irri#abili#y, 5 insomnia Cold in#olerance 5 le#$argy !lec#roly#e imbalance, cons#ipa#ion, and abdominal pain nfle1ible #$in:ing >ypo#ension, $ypo#$ermia, bradycardia, reduced BMR J Criteria o' treat+ent) Ceig$# gain 5 adeDua#e food in#a:e Q)/+ pounds<.:R JCO<) cardiac dysr$y#$mias due #o $ypo:alemia

-ULI$I NERVOS 5 recurren# episodes of binge ea#ing follo.ed by inappropria#e compensa#ory be$a%iors suc$ as a%oid .eig$# gain, suc$ as purging, fas#ing, or e1cessi%e e1ercise JS6) may be of normal .eig$#, o%er.eig$#, or under.eig$# Iery cri#ical of body image 6epressi%e or an1ie#y symp#oms (ossible subs#ance abuse in%ol%ing alco$ol or s#imulan#s ,oss of den#al enamel, increase in den#al carries, mo#$/ea#en #ee#$ Mens#rual irregulari#ies !sop$ageal #ears and %arices Callous finger C$ipmun: face "W L S $OO<%

& $OO< 7 ,,ECTIVE <ISOR<ERS - per%asi%e al#era#ions in a personBs emo#ions, manifes#ed by depression or mania; #$ey in#erfere .i#$ #$e personBs life<func#ioning - are neurobiologic dysfunc#ions #$a# cause al#ered emo#ional responses* JC&T!G4R !S 4; M446 6 S4R6!RS" UNIPOL R <ISOR<ER @ includes Major 6epresson J<e*ression 5 an abnormal e1#ension or elabora#ion of sadness 5 grief / S1" anger, an1ie#y, bi##erness, $opelessness, lo. self/es#eem, fa#igue, bac:ac$e, anore1ia, %omi#ing, insomnia, c$es# pain, confusion, indecisi%eness, pessimism, o%er/dependency, psyc$omo#or re#arda#ion, poor $ygiene, agi#a#ion, crying, irri#abili#y J $ >OR <EPRESSION) se%ere depression of more #$an + .ee:s / 6iagnos#ic Cri#eria" / a# leas# 2 occurring mos# of #$e day, daily for + .ee:s !arly morning depression &n$edonia nsomnia (syc$omo#or re#arda#ion ;a#igue, anergia ;eelings of .or#$lessness 5 ambi%alence Self @care defici# >is#ory of suicidal a##emp#s Ceig$# loss or gain; cons#ipa#ion ;la# affec# -IPOL R <ISOR<ER 7 $ NIC3<EPRESSIVE <ISOR<ER J <e*ression J $ NI @ abnormally ele%a#ed mood in .$ic$ #$e person is e1#raordinarily energe#ic;
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

needs li##le res#, sleep or food; / S1" ela#ion<eup$oria, lac: of s$ame 5 guil#, in#oleran# #o cri#icism, de$ydra#ion, inadeDua#e nu#ri#ion, insomnia, .eig$# loss, flig$# of ideas, lac: of judgmen#, aggressi%eness, pro%oca#i%eness, $yperac#i%i#y, poor grooming / 6iagnos#ic Cri#eria for Mania" 6elusion of grandeur nsomnia ;lig$# of ideas 5 pressured speec$ >yperac#i%e 5 dis#rac#ed !asily agi#a#ed, res#less Manipula#i%e ncreased me#abolism (oor impulse con#rol Iiolen#, aggressi%e, $yperse1ual / n#er%en#ions" accep# clien# bu# rejec# be$a%ior, consis#en# care, se# limi#s, ne%er lea%e pa#ien# .$en $yperac#i%e, donB# encourage performances, dis#rac# and redirec# energy , use p$ysical ac#i%i#ies un#il mania .ears ou#, mee# nu#ri#ional needs Q$ig$/calorie finger foods 5 fluids #$a# can be carried aroundR, encourage res#, lessen en%ironmen#al s#imuli, c$ec: for li#$ium in#o1ica#ion* NTI<EPRESS NTS SELECTIVE SEROTONIN REUPT .E INHI-ITORS /SSRI1 firs# line in major depressi%e disorders, panic disorders, an1ie#y disorders, 5 bipolar disorders #a:e in #$e morning Side !ffec#s" agi#a#ion, res#lessness, an1ie#y, a:a#$isia Qmo#or res#lessnessR, nausea, insomnia, se1ual dysfunc#ion, .eig$# loss / 36entine 7 3 ;odone 1 (aro1en#ine >Cl Q (a1ilR ;luo1en#ine >Cl Q(rozacR ;lu%o1amine Q,u%o1R Ienlafa1ine Q!ffe1orR Trazodone Q6esyrelR Nefazodone QSerzoneR Ser#aline QUolof#R Ci#alopram QCele1iaR TRICYCLIC NTI<EPRESS NTS /TC 1 are po#en#ially fa#al if o%erdosed; an#ic$olinergic effec# #a:e a# nig$# al.ays #a:e an !CG before gi%ing TC&s; ad%erse effec# of cardiac dysr$y#$mias / 3*ra+ine 7 3tr:*tilline 1 Clomipramine >Cl Q&naframilR Norpramine Q6esipramineR mipramine QTofranilR Trimipramine QSurmon#ilR &mi#ryp#illine Q!la%ilR (ro#ryp#illine QIi%ac#ilR Mapro#illine Q,udiomilR Nor#ryp#illine Q(amelor, &%en#ylR &mo1apine Q&sendinR 6o1epine QSineDuanR Buproprion QCellbu#rinR $ONO $INE OEI< SE INHI-ITOR /$ OI1 lo. seda#ion and an#ic$olinergic effec#s; use .i#$ e1#reme cau#ion ne%er gi%e food .i#$ TFR&M N! P fa#al side effec# , $yper#ensi%e crisis Qoccipi#al $eadac$eR Tyramine food" &ged c$eeses Qincluding lasagna or pizzaR &ged mea#s Qsalami, sausage, pepperoniR No #ap beers; only + cans or bo##les of beer No soy sauce, c$eese$burgers, canned food Q$ig$ sal#R / P $$ N 1
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

(arna#e Q#rancyclopromineR Marplan Q socarbo1acidR Manneri1 QMoclobemide Nardil Q($enelzine S40R $OO< ST -ILIFERS 7 NTI$ NIC $E<IC TION / LITHIU$ 1 - used for mood disorders especially Mania in bipolar disorder ,i#$ium Carbona#e Q!s:ali#$, ,i#$ane, ,i#$boidR ,i#$ium Ci#ra#e QCibali#$ SR Carbamazepine QTegre#olR T$erapeu#ic Serum ,e%el @ M*2 @ )*+ m!D Qaf#er )+ $our li#$ium fas#ingR &n#ido#es" 6iamo1 Q&ce#azolamideR Manni#ol Q4smi#rolR / H:*onatre+ia P increased li#$ium le%el / n#er%en#ions" Moni#or ,i#$ium serum le%el, a%oid diure#ics 5 caffeine, a%oid e1cessi%e s.ea#ing JLit0iu+ Into6i(ation) Stages !&R,F<M ,6 @ Nausea 5 %omi#ing, anore1ia, diarr$ea, gross $and #remors, abdominal cramps M46!R&T! @ symp#oms are #.ice #$e ini#ial signs S!I!R!<,&T! @ nys#agmus; #ac#ile, olfac#ory, 5 %isual $allucina#ions, (olyuria, 4liguria, &nuria; &cu#e renal failure; Grand mal seizure "-E UTI,UL $IN<% PSYCHOTIC <ISOR<ERS & SCHIFOPHRENIC <ISOR<ERS - & se%ere impairmen# of men#al 5 social func#ioning .i#$ grossly impaired reali#y #es#ing, sensory percep#ion, 5 .i#$ de#eriora#ion 5 regression of psyc$osocial func#ioning* D s o' S(0i;o*0renia) &u#ism" .i#$dra.al from #$e en%ironmen#, magical #$in:ing, neologisms, aloofness &mbi%alence" #.o opposing feelings #o.ard #$e same #$ing &ssocia#i%e ,ooseness" jumping from #opic #o ano#$er .i#$ou# any rele%ance &ffec#, ;la#" inappropria#e or no display of e1pression<feelings Categories o' S(0i;o S:+*to+s) )* POSITIVE 3 delusions, $allucina#ions, illusions, associa#i%e looseness, delusions, disorien#a#ion, agi#a#ion, paranoia, 5 insomnia B. NE! TIVE / poor judgmen#, insig$#, 5 self/care; alogia, anergia, an$edonia, neologism, .ord salad, flig$# of ideas, %erbigira#ion, circums#an#iali#y, Tangen#iali#y, Clang associa#ion, !c$olalia 5 !c$opra1ia Prin(i*les o' Care) Main#ain safe#y; do no# argue .i#$ #$e pa#ien#; %alida#e 5 reinforce reali#y; priori#ize p$ysical needs; #$erapeu#ic rela#ions$ip; indi%idual #$erapy; proper di%ersional ac#i%i#ies TYPES O, SCHIFOPHRENI A. P R NOI< SCHIFOPHRENI Cardinal Sign" S=S( C 4=SN!SS
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

S1" 6elusions of persecu#ion 6efme1" (rojec#ion n#er%en#ions" Leep dis#ance, (assi%e ;riendliness, :eep isola#ed B. C T TONIC SCHIFOPHRENI Cardinal Sign" Ca#a#onia Q.a1y fle1ibili#yR S1" mu#ism, bizarre mannerisms, similar .i#$ au#ism 6efme1" &u#ism 5 Mu#ism Ca#a#onic c$arac#eris#ics" Ca#a#onic S#upor @ mar:edly slo. mo%emen# Ca#a#onic (os#uring @ .eird 5 a.:.ard posi#ions Ca#a#onic Rigidi#y @ s#one/li:e posi#ions Ca#a#onic Nega#i%ism @ resis#ance #o.ard fle1ion<e1#ension Ca#a#onic >yperac#i%i#y or e1i#abili#y @ occasional periods of agi#a#ion 5 e1ci#emen# -* <ISOR! NIFE< SCHIFOPHRENI 5 >ebep$renic Cardinal Sign" e1#remely disorganized be$a%ior S1" inappropria#e be$a%ior, silly crying 5 laug$ing, #ransien# audi#ory $allucina#ions, fla# or inappropria#e affec#, inco$erence, loose associa#ions D. UN<I,,ERENTI TE< SCHIFOPHRENI 7 $IEE< Mi1ed sc$izop$renic symp#oms .i#$ dis#urbances in affec#, #$oug$#, or be$a%ior 6rug of C$oice" ;lup$enazine Q(ro1ilin decanoa#eR K. RESI<U L SCHIFOPHRENI C$arac#erized by a $is#ory of a psyc$o#ic symp#oms, .i#$dra.al, fla# affec#, or looseness of associa#ion bu# #$ere are no more delusions or o%er# symp#oms NTIPSYCHOTIC $E<IC TIONS 7 NEUROLEPTICS 7 $ >OR TR N2UILIFERS - decreases $allucina#ions, delusions, 5 associa#i%e looseness - cause an#ic$olinergic effec#s - cause !(S Qe1#rapyramidal symp#omsR .i#$ prolonged use PHENOTHI FINES / 3a;ine 1 C$lorpromazine QT$orazineR T$ioridazine QMellarilR @ &!" re#ini#is pigmen#osa ;lup$enazine Q(roli1inR &ce#op$enazine QTindalR ($erp$enazine QTrilafonR (romazine QSparineR Mesoridazine QSeren#ilR -UTYROPHENONES / 3*eridol 1 >aloperidol Q>aldol, SerenaseR 6roperidol Q napsineR THIOE NTHINES / 3 t0i6ene 1 C$lorpro#$i1ene QTarac#anR T$io#$i1ene QNa%aneR TYPIC L NTIPSYCHOTICS Clozapine QClozarilR Risperidone QRisperidalR &rpiprazole Q&blifyR 4lanzapine QUypre1iaR ,o1azipine Q,o1i#aneR / 3doneL 3;a*ineL 3a*ine 1

EETR PYR $I< L SY$PTO$S @ re%ersible side effec#s of prolonged use of an#ipsyc$o#ic drugs as a resul# of neurologic dysfunc#ion of #$e e1#rapyramidal sys#em
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

A.

9at0isia @ mo#or res#lessness S1" foo# #apping, finger fidge#ing, pacing, canB# si# s#ill 64C" Cogen#in QBenz#ropine mesyla#eR Benadryl Q6ip$en$ydramineR &:ine#on QBiperiden >ClR

B. <:stonia @ cardinal sign" 4cculogyric Crisis Qrolling of eyeballsR S1" spasm of #$e nec:, s$oulder, ja. 5 #$roa# 64C" same .i#$ a:a#$isia C. Pseudo*ar9insonis+ @ a:a drug/induced par:insonism Cardinal Sign" (in/rolling #remors S1" mas:/li:e e1pression, fla# affec#, s$uffling gai#, cog.$eel rigidi#y 64C" &r#ane Q#ri$e1yp$enydylR &man#idine QSymme#relR @ an#i%iral D. Tardive <:s9inesia @ permanen#, medical emergency Cardinal sign" #ongue rolling 5 pro#rusion K. 9inesia @ absence of :ine#ic mo%emen# " <I. " SU-ST NCE # LCOHOL -USE & LCOHOLIS$ 7 LCOHOL -USE in#er%ened #$roug$ C$emical &%ersion Q&n#abuseR CNS depressan# #$a# is rapidly absorbed in#o #$e bloods#ream l(o0ol Into6i(ation) ni#ial" rela1a#ion, loss of in$ibi#ions n#o1ica#ion" slurred speec$, uns#eady gai#, lac: of coordina#ion; impaired a##en#ion, concen#ra#ion; may s$o. aggressi%eness or inappropria#e se1ual be$a%iors; may blac: ou# 4%erdose in a s$or# period of #ime P %omi#ing, unconsciousness, respira#ory depression P aspira#ion pneumonia, pulmonary obs#ruc#ion Trea#men# of 4%erdose" gas#ric la%age or dialysis, cardio 5 respira#ory suppor# Q C=R Stages o' l(o0ol Wit0drawal) 3/ pea:s on #$e +nd day and is o%er in 2 days; some may #a:e )/+ .ee:s A. Earl: 7 Initial Mstarts D 5 AB 0ours a'ter last inta9eN S1" ;ine Tremors, res#lessness, #ac$ycardia, diap$oresis, 5 $yper%en#ila#ion, $yper#ension, insomnia, N5I B. Hallu(ination stage S1" T&CT ,! $allucina#ion @ main $allucina#ion in alco$ol .i#$dra.al Iisual $allucina#ions T$eraCom" s#ay .i#$ pa#ien#, offer self, reorien#a#ion, elimina#e s$ado.s from $is en%ironmen# C. Pre3Sei;ure 7 Ru+ ,its D. <eliriu+ Tre+ens / ac#i%e seizure, grand mal seizure 64C" Benzodiazepines QIalium, ,ibriumR @ grand mal ($eny#oin Q6ilan#inR Co++on Co+*li(ations wit0 Histor: o' l(o0olis+) A. ,i%er Cirr$osis B. Gas#ri#is C. (ancrea#i#is D. Cernic:eBs &p$asia @ recep#i%e ap$asia; problems in in#erpre#a#ion K. Lorsa:offBs (syc$osis @ irre%ersible;
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

S1" (erip$eral neuri#is Qdue #o lac: of T$iamine or Ii# B)R Blac: ou#s P confabula#ion <isul'ira+ M nta8useN used in c$emical a%ersion #$erapy Qnega#i%e reinforcemen#R causes nausea, %omi#ing, in#ense $eadac$e, abdominal cramps i# $as no effec# unless mi1ed .i#$ alco$ol Teac$ clien# #o a%oid $ouse$old i#ems .i#$ alco$ol li:e mou#$.as$, coug$ syrup, %inegar, .ine, frui#ca:e, as#ringen#s, #oners, ace#one, nail polis$, s$a%ing cream -USE 7 NON3 LCOHOL SU-ST NCE -USE

<RU! -

N RCOTICS 7 OPIOI<S Q6emerol, Morp$ine, Codeine, Nalbup$ine, >eroinR Signs of &buse" !up$oria, an1ie#y, insomnia; mar:ed respira#ory depression .i#$ $eroin, $yperpyre1ia; use of long/slee%ed s$ir#s; apa#$y, le#$argy, agi#a#ion, dila#ed pupils 4%erdose" coma, respira#ory depression, unconsciousness P dea#$ Signs of Ci#$dra.al" c$ills, perspira#ion, #remors, bac: ac$e, opoid cra%ings, ya.ning, res#lessness, insomnia, N5I, r$inorr$ea >eroin" lacrima#ion, runny nose, ya.ning, muscle spasm, N5I, panic Trea#men#" Nalo1one QNarcanR >eroin @ Me#$adone 7as subs#i#u#e #$en #apered8 NEIOLYTICS 7 $INOR TR N2UILIFERS CNS depressan# barbi#ura#es are fa#al if o%erdosed P coma, respira#ory arres#, cardiac failure P dea#$ signs of abuse" slurred speec$, respira#ory depression, a#a1ia, uns#eady gai#, impairmen# in memory 5 a##en#ion P s#upor P coma signs of .i#$dra.al" fa#igue, an1ie#y, depression, #remors, $allucina#ions, delusions, insomnia Trea#men#" gas#ric la%age T Sodium Bicarbona#e, ac#i%a#ed c$arcoal T #apering of #$e drug dose Qpre%en#s comaR STI$UL NTS /UPPERS1 crys#al me#$, speed, cocaine, amp$e#amines signs of abuse" rapid effec#s of eup$oria, agi#a#ion, $yperac#i%i#y, irri#abili#y, seizures, dila#ed pupils, perspira#ion, c$ills, c$es# pain, confusion, cardiac dysr$y#$mias P seizures, coma cocaine @ nasal sep#um perfora#ion signs of .i#$dra.al" 9cras$ingE; depression< mar:ed dysp$oria, fa#igue, apa#$y, disorien#a#ion, #ac#ile $allucina#ion, delirium #remens, suicidal idea#ion #rea#men#" ac#i%a#ed c$arcoal, gas#ric la%age TT$orazine #o con#rol $allucina#ion 5 nausea H LLUCINO!ENS ,S6, (C( Q($encyclidineR, ecs#asy, 9designer drugsE &buse" $allucina#ions Q%isualR,depersonaliza#ion, paranoia, inco$erence, confusion, delirium, mania, agi#a#ion, con%ulsion, $yper#$ermia; (C( P seizures, respira#ory depression Qmay be fa#alR No signs of .i#$dra.al nor p$ysiologic o%erdose Trea#men#" small doses of %alium T cooling measures Q$yper#$ermiaR *C NN -IS <ERIV TIVES /cannabis sativa1 marijuana abuse" similar #o alco$olism; R!6 !F!S, fa#igue, increased appe#i#e, eup$oria, psyc$osis, inappropria#e laug$#er, s$or#/#erm memory, dis#or#ions in percep#ion; e1cess P delirium no o%erdoses occur .i#$dra.al" no clinically significan# .i#$dra.al syndrome is iden#ified

INH L NTS n#o1ica#ion" apa#$y, dizziness, nys#agmus, lac: of coordina#ion, slurred speec$, uns#eady gai#, #remors, muscle .ea:ness, blurred %ision, s#upor, coma - &cu#e To1ici#y" ano1ia, respira#ory depression, arr$y#$mias - 6ea#$" caused by bronc$ospasm, aspira#ion, cardiac arres#, suffoca#ion - Trea#men#" no an#ido#e; respira#ory 5 cardiac suppor# "CR C.E< E!!S% PERVERSIVE <EVELOP$ENT L <ISOR<ERS UTISTIC <ISOR<ER - c$arac#erized by #$e inabili#y #o form significan# rela#ions$ips .i#$ adul#s
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

S1" doesnB# recognize #$e self<ego; spea:s in #$e #$ird person; .i#$dra.al from reali#y; %alues inanima#e objec#s 5 self/cen#ered ac#i%i#ies; personali#y al#era#ion S!I!R! &=T SM @ apa#$y, associa#i%e looseness, au#is#ic #$in:ing, ambi%alence

TTENTION3<E,ICIT HYPER CTIVITY <ISOR<ER disrup#i%e be$a%ioral disorder e%iden# before age V; c$arac#erized by $yperac#i%i#y and ina##en#i%eness T$eraCom" pro%ide firm 5 consis#en# discipline .i#$ oppor#uni#ies for success 5 sa#isfac#ion; pro%ide a s#ruc#ured en%ironmen# .i#$ less s#imula#ion - pro%ide a balance of energy e1pendi#ure 5 Duie# #ime - Meds" me#$ylp$enida#e QRi#alinR or de1#roamp$e#amine sulfa#e -

CON<UCT <ISOR<ER - a persis#en# an#isocial be$a%ior of c$ildren and adolescen#s - $a%e li##le empa#$y for o#$ers; lo. self/es#eem; lo. frus#ra#ion #olerance; #emper ou#burs#s & $ENT L RET R< TION - c$arac#erized by belo. a%erage in#ellec#ual func#ioning Q ? belo. VMR #$a# is accompanied by significan# limi#a#ions in adap#i%e func#ioning areas - degree of re#arda#ion $as a grea# impac# on #$e c$ildBs abili#y #o func#ion - <egree o' Retardation Qbased on ? le%elR a* Mild ? P 2M @ VM b* Modera#e ? P -2 @ 2M c* Se%ere ? P +M @ -2 d* (rofound ? P belo. +M "W N! .I% & CO!NITIVE <ISOR<ERS C4GN T 4N @ #$e brainBs abili#y #o process, re#ain, 5 use informa#ion - include reasoning, judgmen#, percep#ion, a##en#ion, compre$ension, 5 memory C4GN T I! 6 S4R6!RS @ a disrup#ion in #$e $ig$er/le%el func#ioning of #$e brain causing de%as#a#ing effec#s on #$eir abili#y #o func#ion in life <ELIRIU$ - a syndrome #$a# in%ol%es a dis#urbance of consciousness .i#$ a c$ange in cogni#ion - usually de%elops in a s$or# period of #ime - S1" difficul#y .i#$ a##en#ion 5 concen#ra#ion; easily dis#rac#ed; disorien#ed, sensory dis#urbances Q$allucina#ions, illusions, misin#erpre#a#ionsR; c$anges in psyc$omo#or ac#i%i#y, may $a%e an1ie#y, fear, irri#abili#y, eup$oria, or apa#$y - Medica#ion" an#ipsyc$o#ics Q>aloperidolR n#er%en#ions" (romo#e clien#Bs safe#y Qclose super%ision, ready assis#ance, con#rol en%ironmen#R; use calm %oice 5 simple sen#ences #o communica#e; gi%e clien# #ime #o ma:e decisions, Duie# 5 non/s#imula#ing en%ironmen#, moni#or clien#Bs %isi#ors; promo#e sleep 5 nu#ri#ion; moni#or elimina#ion pa##erns <E$ENTI - a men#al disorder #$a# in%ol%es mul#iple cogni#i%e defici#s; primarily memory impairmen# 5 a# leas# one of #$e cogni#i%e dis#urbances - is gradual - (rominen# !arly Sign" memory impairmen# Qs$or# #$en long #erm, e%en#ually des#royedR - S1" difficul#y learning ne. ma#erial, de#eriora#ion of language func#ion Cogni#i%e 6is#urbances" )* &p$asia @ de#eriora#ion of language func#ion +* &pra1ia @ inabili#y #o e1ecu#e mo#or func#ions -* &gnosia @ inabili#y #o recognize or name objec#s 0* 6is#urbance in !1ecu#i%e func#ioning @ inabili#y #o #$in: abs#rac#ly 5 #o plan, ini#ia#e, seDuence, moni#or, 5 s#op comple1 be$a%ior S#ages of 6emen#ia" )* Mild @ $allmar:" ;4RG!T;=,N!SS; difficul#y finding .ords, freDuen#ly losses objec#s, may begin social .i#$dra.al +* Modera#e @ Confusion is apparen#, progressi%e memory loss, s#ill orien#ed #o person 5 place; inabili#y #o perform comple1 #as:s; may lose #$e abili#y #o li%e independen#ly
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ST. LOUIS REVIEW CENTER Nursing Review and Tutorials

-* Se%ere @ (ersonali#y 5 emo#ional c$anges; may be delusional; C&N6!R NG; forge#s names of spouse, c$ildren, o.n name; need assis#ance in &6,s n#er%en#ions" (romo#e safe#y 5 pre%en# injury; super%ision of &6,s; promo#e adeDua#e sleep, nu#ri#ion, $ygiene, 5 ac#i%i#y; s#ruc#ure en%ironmen# 5 rou#ine ; pro%ide emo#ional suppor#; promo#e in#erac#ion 5 in%ol%emen# " -US RI% , $ILY VIOLENCE - includes p$ysical, emo#ional, 5 se1ual abuse of c$ildren, c$ild neglec#, spouse ba##ering, mari#al rape, 5 elder abuse SPOUSE 7 P RTNER M8o:'riend7sa+e se6 relations0i*sN -USE - #$e mis#rea#men# of one person by ano#$er in #$e con#e1# of an in#ima#e rela#ions$ip - may include one or a combina#ion of p$ysical, emo#ional, psyc$ological, or se1ual abuse CHIL< -USE - in#en#ional injury of a c$ild - includes p$ysical, se1ual, psyc$ological, emo#ional abuse 5 neglec# Types of C$ild &buse" a* ($ysical &buse @ of#en #$e resul# of unreasonably se%ere corporal punis$men# b* Se1ual &buse @ se1ual ac#s performed by an adul# on a c$ild belo. )O yrs of age c* Neglec# @ #$e malicious or ignoran# .i#$$olding of #$e p$ysical, emo#ional, or educa#ional necessi#ies of #$e c$ild; #$e mos# pre%alen# #ype of mal#rea#men# d* (syc$ological &buse<!mo#ional &buse @ %erbal assaul#s Qblaming, screaming, name/calling, sarcasmR EL<ERLY -USE - mal#rea#men# of older adul#s by family members or care#a:ers - may include p$ysical, emo#ional, or se1ual abuse; neglec#, self/neglec#, financial e1ploi#a#ion, denial of adeDua#e medical #rea#men# R PE - a crime of %iolence 5 $umilia#ion #$roug$ se1ual means - #$e pene#ra#ion of an ac# of se1ual in#ercourse agains# $er .ill or consen# - mos#ly unrepor#ed due #o %ic#imBs feelings of s$ame 5 guil# or fear of fur#$er injury - Rapis#s are usually +2/00 yrs of age, 5 $a%e $is#ory of o#$er crimes n#er%en#ion" immedia#e suppor# and %erbaliza#ion of feelings, allo.ing $er #o ma:e decisions Q#o $elp $er regain con#rolR, prop$ylac#ic #rea#men# for ST6s and > I #es#ing - T$erapy INTERVENTIONS ,OR -USE) - (riori#y" promo#e clien#Bs safe#y Qfrom $arming o#$ers or selfR - >elp clien# de%elop an 9escape<emergencyE plan .$en #$rea#s arise - Reorien# #o reali#y Qflas$bac:s, dissocia#ionR - 6onB# grab, force, or #ouc$ clien# .i#$ou# permission - Teac$ deep brea#$ing, rela1a#ion #ec$niDues, 5 dis#rac#ion #ec$niDues - (romo#e self/es#eem Q9sur%i%orE ra#$er #$an 9%ic#imER - !s#ablis$ a social suppor# sys#em - Refer .$en needed Q(olice, social .elfare, psyc$ologis#, e#c*R

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