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Psychiatric Nursing
D
mpulsive
want to
want PLEASURE
eat
drink
urinate
defecate
PLEASURABLE PRINCIPLE
Pain Avoidance
Its all I
UPER EGO
hould not
mall voice of God
Dominant ID
Mania
Antisocial
Narcissistic
CONSCIENCE PRINCIPLE
GO
Xecutive Secretary
I
E
Impaired Reality
Schizophrenia
REALITY PRINCIPLE
LIBIDO sexual energy responsible for survival
PSYCHOSEXUAL THEORY
1. ORAL STAGE
0 18 Months old
Survival
I want to eat, sleep, urinate, defecate
Psychiatric Nursing
ID formation
Cry & Suck mouth
Defense Mechanism:
o FIXATION when a person is stuck in a certain developmental
stage
o REGRESSION return to an earlier developmental stage
2. ANAL STAGE
Ateen 3 years old (18 mos 3 y.o.)
Toilet training
Super Ego develop
3. PHALLIC
3 6 y.o.
Penis/ Vagina
Parents is the significant person
Called as Preschooler
Oedipus Complex little boy loves mommy
Electra Complex little girl loves daddy
Identification boy associates with daddy, girl assoc. with
mommy
Castration fear of the little boy to daddy
Penis Envy envy of little girl towards daddy
Dr. Karen Horney opposition to penis envy
Level of Awareness
o Conscious highest level of awareness
o Preconscious Tip of the tongue
o Unconscious deepest level of awareness
4. LATENCY STAGE
6 12 years old
SCHOOlatency
Psychiatric Nursing
5. GENITAL STAGE
12 y. o. above
Gising
Genital
PHARMA MOMENTS
ANTIANXIETY
VLAST ME VAIB
Valium ate V
Miltown - Meal
Libreum - L
Equanil Aqua Kneel
Ativan - Ate Guy
Seraks Sera Ulo
Tranxene - Transit
Vistaril - largavista
Attarax Mga bato (rocks)
Inderal hindi ralph
Busfar sasakay ng bus
ERIK ERIKSON
PSYCHOSOCIAL THEORY OF DEVELOPMENT
+
Age
0-18 mos.
18 mos. 3 y.o.
3 6 y.o.
6 12 y.o.
12 20 y.o.
20 25 y.o.
25 45 y.o.
45 y.o. and above
Trust
Autonomy
AU nal
TO ilet training
NO favorite word
MY
Initiative
Industry
Identity
Intimacy
Generativity
Ego Integrity
Mistrust
Shame/ doubt
Affecting Major
Factor
Feeding
Toilet Training
Guilt
Inferiority
Role confusion
Isolation
Stagnation
Despair
Independence
In da-school
Peer
Love
Parenting
Reflection
BEHAVIORAL MODELS
1. Ivan Pavlov
Classical Conditioning Model
All behavior are learned
Food dog Salivation
Bell Food Dog Salivation
Bell Salivation
2. B.F. Skinner
Psychiatric Nursing
Operant Conditioning
All behaviors are unlearned
Reward (+ reinforcement) and Punishment (Reinforcement)
PHARMA MOMENTS
M
N
P
PLAN
DIL
NATE
ANTIPARKINSON
CAPABLES
Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetryl
DEFENSE MECHANISMS Fight for stress
DISPLACEMENT
Transfer of feelings to a less
threatening object rather than the
one who provoke it
DENIAL
Failure to acknowledge an
unacceptable trait or situation
DISSOCIATION
Psychological flight from self
A type of amnesia
REGRESSION
Return to an earlier developmental
stage
REPRESSION
Unconscious forgetting of an
anxiety provoking concept
Boss shouts at
you, you shout at
your subordinate
Im not an
alcoholic
Sino ka, Sino
ako?
Return to
thumbsucking
Hindi ko maalala
RATIONALIZATION
REACTION
FORMATION
UNDOING
IDENTIFICATION
PROJECTION
INTROJECTION
SUPPRESSION
SUBLIMATION
CONVERSION
COMPENSATION
SUBSTITUTION
Psychiatric Nursing
too
Conscious forgetting of an anxiety Hindi ko alam yan
provoking concept
Placing sexual energies toward a
Angry at life, put
more productive endeavors
anger in singing
Repressed angers put towards
Biglang mangingig
physical symptoms affecting
nervous system leading to sensory
numbness and motor paralysis
Overachievement in one area to
Pilay pero
cover a defective part
magaling kumanta
Replacing a difficult goal with a
Gusto ko
more accessible one
Disneyland.
Enchanted
nalang.
STOP GABA Inhibitory
Gamma Amino Butyric Acid
GO Epinephrine/ Norepinephrine
Exitatory
SNS
ANXIETY
Within 1 week
Rebound
College of Nursing Batch 2009
Psychiatric Nursing
Blurred Vision
phenomenon
Seizure
Abrupt
Anti-Anxiety
Dependence
Withdrawal
Drowsy
No Alcohol
No Coffee
Develop Orthostatic
Hypotension
Prevetion of O.H.
1. Sit Down
2. Dangle feet
3. Stand Up Gradually
Gradually
Tapered Dose
RELAXED
ANXIETY
Mild
Moderate
+1
+2
Widened
acing
Perceptual
Field
RN Meds
Restless
Enhanced Learning
Capacity
You Seem Restless
Severe
+3
ont know what
to say/do
IRECTIVE
Panic
+4
uicide
afety Dont touch client
Respi Alkalosis
Bown Bag
Assess
Nx Dx
: Level of Anxiety
: Ineffective Individual Coping
Powerlessness
Impaired Skin Integrity
Planning/ Implementation:
level of anxiety
environmental Stimuli
Relaxation Technique
Showing pictures of flower, waterfalls
Hearing sounds of chirping birds
Psychiatric Nursing
PANIC DISORDER
Assignments/
Homeworks
Flashbacks
VICTIMS Survivors
Nightmares
Anxiety
I am sick
SOMATOFORM
> no pretension
> no organic
basis
No Assignments/
Homeworks
You Think
Teacher may
get angry
Psychiatric Nursing
MALINGERING
pretending to be sick
(Conscious)
Absent
Escape from
Teacher
PRIMARY GAIN
(Behavior anxiety)
> unconscious
PSYCHOSOMATIC
> Real pains/ illness
> Real symptoms
> 4 major types
* Hypertension
* Migraine
* Stress Ulcer
* Asthma
Mama Care
Attention
SECONDARY GAIN
SOMATOFORM DISORDERS
SOMATOFORM
Nervous System
CONVERSION DISORDER
La Belle Indifference
emotional disattachment
from disability
Minor Discomfort
Interpreted as major illness
HYPOCHONDRIASIS
Maliit na butas, pinalalaki
Favorite Past Time: Doctor Hopping
Nursing Focus: Feelings
OBSESSIVE COMPULSIVE
Belief/ thought
Door Open
Burglar may go inside
Feelings
Anxiety
Obsession anxiety
(thought)
Returns to house
(Action)
Anxiety Compulsion
PHOBIA
Irrational fears
Psychiatric Nursing
Etiology
o Knowledge
o Experience
Immediate Nursing Intervention remove the stimuli
SYSTEMATIC DESENSITIZATION
o Gradual exposure to feared object
PHARMA MOMENTS
ANTIPSYCHOTIC AGENT
SSTTCMHP
Stelazine - sexy star
Serentil serena
Thorazine babaeng Tora
Trilafon - tri-band phone
ALCOHOLISM
Etiology:
Intergenerational Transmission
From one generation to another generation
Alcohol
Psychiatric Nursing
version therapy
lcoholics Anonymous self help group
ntabuse DISULFIRAM Never drink alcohol
B1 Vitamin Deficiency
Complications
AUTISM
Autistic Savant autistic with a special talent
Assess
Appearance flat affect, consistent movement
Behavior repetitive, ritualistic
Communication echolalia, incomprehensible
Nx Dx
Impaired verbal communication
Impaired social interaction
Self mutilation
Risk for injury
Planning/ Implementation
Maslows hierarchy of needs
Constancy, promote safety
Evaluation
Expressive therapy drawing, muscic etc
Enhanced communication
Improved social interaction
Safety
Onset
Duration
Settings
Psychiatric Nursing
EATING DISORDERS
18 mos. 3 y.o.
Toilet Training
Clean
Obedient
Organized
Thought
social inactive/ no BF
weighing
Feeling
Behavior
I Am Fat
Psychiatric Nursing
Anorexia Nervosa
Diet, diet, diet
<85% of expected body
3 mos. ammenorhea
Karen Carpenter
Eating Disorders
Eating Pattern
Weight
Menstruation
Bulimia
Eat, eat, vomit
Normal weight
Irregular menstruation
Dao Ming Xi
Da Ming Sugat/ suka
Vomiting
Dental caries
Wounded knuckles
Metabolic alkalosis
Metabolic acidosis
Vomiting
Fluid Volume Deficit ARRHYTHMIA (fatal complication)
Diarrhea
Interventions
Restore fluid and electrolyte balance
Collaborative regarding menu contract
Target weight gain
After meals: stay 30 mins 1 hour
PHARMA MOMENT
LITHIUM
Kidney
ANTIPARKINSON
ANTICHOLINERGIC
ABC
Artane
Akineton
Jomar Anthony D. Maxion, BSN, RN
DOPAMINERGIC
PLSE
Parlodel
Larodopa
College of Nursing Batch 2009
Benadryl
Cogentin
Psychiatric Nursing
Symmetyl
Eldepryl
SCHIZOPHRENIA
Ego disintegration
Impaired reality perception
Genetic vulnerability
Stress Diathesis Model
o Too much stress in the reality will lead client to escape it and go to
the fantasy world
Biological Theory
o Dopamine level is High
The exact cause is unknown
ffect appropriate, inappropriate, flat, blunt (incomplete emotion)
mbivalence torn between 2 opposing forces
utism
ssociative Looseness
Symptoms
Negative
Hypoactive
Withdrawn
Apathy
Positive
Hyperactive
Sociable
Flight of Ideas
Talkative
Assess
: Content of Thought
Nx Dx
: Disturbed thought process
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve thought process
Assess
: Hallucination/ Illusions
Nx Dx
: Disturbed sensory perception
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve sensory perception
Psychiatric Nursing
Assess
: Suspicious
Nx Dx
: Risk for other directive behavior
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Eliminate/ minimize risk for other-directed violence
Assess
: Suicidal
Nx Dx
: Risk for self directive behavior
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness
I am going to the mall.
Magical Thinking
Believes to have a magical power
I can turn you into a frog
Echolalia I repeat what you say Parrots
Echopraxia I repeat what you do
Word Salad words, no rhyme
Clang Association words with rhyme : Dunk, plank, sunk
Neologism creation of new words Plinking, hustash
Clarification done in case of neologism
Delusion:
Persecutory NBI is out to get me/ someone will harm the client
Religious I am Jesus Christ
Grandeur I am the queen of the world.
Ideas of reference Nurses are talking about me.
Psychiatric Nursing
Stimulus
Visual
Auditory
Tactile
Halucinations
Absent
X
X
X
Illusion
Present
Hallucinations
Acknowledgment
Reality orientation
Diversion
Disorganized
Sad but smiles
o Inappropriate affect
No reaction
o Flat affect
Flight of ideas
o HEBEPHRENIC
Giggling
Positive and Negative
S/Sx
Catatonic
Ambivalence
Waxy Flexibility
o Iniwan na posture,
ganun forever
No favorite word
Negativism
Paranoid
Suspicious
Tendency to be violent
MistrustScaredWithdraw
n
Nrsg. Int:
Develop trust
1 to 1
short interaction
frequent visit
foods in sealed
container
meds wrapped
for violent pt.
Doors open
Near the door
Dont touch the pt.
Eye contact
1 arms length away
College of Nursing
Batch
2009
call
reinforcement
Normally
Acetylcholine = ON
Psychiatric Nursing
Dopamine = OFF
classified
differentiated
Residual Mixed classification
Cant be classified
1st paranoid, then
No more positive s/sx,
disorganized then
just withdrawn
catatonic, etc etc
Your always ON
Schizophrenia
With parkinsON
High Dopamine=
Psychiatric Nursing
o Lip smacking
o Tongue protruding
o Cheeks puffing
NEUROLEPTIC MALIGNANT
SYNDROME
o Hyperthermia among client
taking antipsychotic
o Hyperthermia with muscle
rigidity
Other Side Effects
Photosensitivity
o Sunscreen
o Wide brimmed hat
Agranulocytosis
o Report immediately Sore throat
1st sign to appear
PHARMAMOMENTS
ANTIDEPRESSANTS
ANTSAAVE PPZ
Asendin ascending
Norpramin sabaw ng knorr
Tofranil Tofu
Sinequan nood ng Sine Quan ang title
Anafranil kina Ana Praning
Aventyl kina Aven Til Midnight tayo
Vivactil Bye Back till next week
Elavil Eh love mo ba ako
Prozac Pero saka na
Paxil - Taksil
Zoloft mag Solo ka
BIPOLAR DISORDER Mania more common
Female
20 years old and above
Stressful life
Obese
Self Actualization
TASK
Caregiver Role Strain
Self Esteem
Safety
Impaired social interaction
Safety
Sleep
Private room
Hyperactive
Sex
Anxiety
Psychiatric Nursing
randiose
light of ideas
leeplessness
ressured speech
xagerated SE
xtraneous stimuli (easily distracted)
istractibility
PERSONALITY DISORDERS
SCHIZOID
I dont want people
Believes he can stand on his own
Never had a best friend
Avoid groups and social activities no enjoyment
Cares more about computers and pets
Psychiatric Nursing
AVOIDANT
I avoid people, I fear criticism
Have talent but no confidence
ANTISOCIAL
I break the law as motto
As a child,: steal, lie, always get reprimanded
Adult grand robbery, illegal activitist against the law, drug addiction,
drives fast, unsafe sex, thrill seeker
Good talker, charmer, witty manipulator
Dependent
I cant live without you
self esteem
poor decision making skills
Histrionic
excited, dramatic but manipulative
center of attention
Narcissistic
I love myself
Insensitive, arrogant
I am the best
Obsessive Compulsive
I am organized
Perfectionist
Psychiatric Nursing
Paranoid
Suspicious
Passive Aggressive
Always say yes but resistance is hidden
Serotonin
MAO kills Serotonin
MAO Serotonin
MAO Serotonin
Serotonin
ANTIDEPRESSANTS
wo 4 weeks
wo neurotransmitter
RI
ONO
CYCLIC
MINE
EUPTAKE
NTIDEPRESSANT
XIDASE
afest
ELECTIVE
to 4 weeks
NHIBITOR
PPZ
MNP
SSRI
Psychiatric Nursing
TCA
MAOI
Antidepressant
ickles
reserved Foods
oy Sauce
Psychiatric Nursing
PHARMAMOMENTS
SUBSTANCE ABUSE
Downers (ABONM INE)
Alcohol
Barbituates
Opiates
Morph
Code
Hero
NARCAN antidote
Psychiatric Nursing
Narcotics
Marijuana
Uppers (CHA)
Cocaine
Hallucinogen
Amphetamines
OVERDOSE
Alcohol
Cocaine
HR
RR
BP
LOC
Coma
Seizure
Bradycardia
Bradypnea
Pupil constriction
Moist mouth
Constipation
Hypotension
Coma
Asleep
Weight gain
EUPHORIA
Tachycardia
Tachypnea
Pupil Dilation
Dry mouth
Hypertension
Seizure
Awake
Weight Loss
Psychiatric Nursing
C TASK
Stay
Self Esteem
withdrawn
Sleep
Hypoactive
Sex
SUICIDE
Verbal
I wont be a problem anymore
This is my last day on earth
Ill soon be gone
Non Verbal
Take this ring, its yours (giving of
valuable)
Sudden change in mood
Psychiatric Nursing
24
47
Psychiatric Nursing
Preconceptual Language
Intuitive
Unidimentional classification characteristic. Child can
fix toys according to size, color, height = one at a time
Conservation Multidimensional
Concrete
Association
Formal
Good abstract thinking. Can interpret words
Operation
7 12
12
ALZHEIMER
NOMIA dont know name of objects
GNOSIA problem with senses
PHASIA cant say it
PRAXIA cant do it
Cocaine Nasal Septum perforation
Marijuana impaired Lung Structure
eroine withdrawal
ikab
atsing
u hu hu
CRITICAL REVIEW
RELATIONSHIP
Preorientation
Self awareness
Orientation
Trust
Setting Contract
Resistance
Working
Termination
Discussion
Evaluation
PRACTICE OF NURSING
Level of Prevention
1
Healthy
Ill
Community Demog. Crisis Intervention
3
Relapse
AA
Psychiatric Nursing
Reactive
external
ATTITUDE THERAPIES
Active friendliness ask permission
assive Friendliness
aranoid
anipulative
nic
atter of Fact
No Demand Depressed
Kind Firmness Anorexic
Crisis 4 6 weeks
Goal Return the client to the pre-crisis level of functioning
PSC
Perception what do you think about it?
Coping what will you do about it?
Support who will be there for you?
Kulit kulit kulit kulit Perseveration stick to 1 topic
Ulit Ulit Ulit Verbigeration
DISSOCIATION
Dissociative Amnesia dont know themselves
Fugue Far
Psychiatric Nursing