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10. Projection
o Throwing of/or attributing someone ones own Perception of
characteristics what one cannot accept as Event
his
o Blaming
o Used by suspicious people Not a stressor Stressor
Delusion of persecution
11. Undoing
o Repairing or negating something Coping,
o Negating the guilt in compulsion Resources,
o Reverse enactment Support
12. Reaction formation
o Showing the exact opposite of ones wishes or
Effective, Ineffective,
desires Adequate Inadequate
13. Compensation
o Exaggerating a trait to cover for ones
inadequacy
14. Conversion Crisis
o Expressing ones feelings/ conflicts through the
body
fractures, dislocations
o Behavior: doesnt want to go home, fear of
abuser
Abuser gives explanations not Honeymoon
consistent w/ childs injuries stage
Aggressive, withdrawn, apathetic,
scared of parent, prefers to overstay The best time to call for help is when it is just starting
in school Must have action plan when abuse starts
Physical Neglect Omission (needs are not provided) o Ask direct question
o Malnourished may engage in child labor Interview done in the comfort room
Begs for food The abuser must also be treated
o No adequate clothing unkempt/ dirty
o No adequate medical attention Nursing Diagnosis Physical first before psychological
o No place to stay - may be street children Impaired tissue integrity
o Assumes adult responsibility Pain
Emotional Abuse Risk for injury
o Berated, humiliated Altered nutrition
o Delays in physical devt, failure to thrive Sleep pattern disturbance
o Anxiety through thumb sucking, nail biting, Fear
enuresis Self-esteem disturbance
Symptomatic management
SUBSTANCE USE DISORDER May be diagnosed w/ urine test w/in 1 to 2 days to trace
Socially maladaptive behavior characterized by abuse substances
of substance or the regular use of such substance Urine should not be diluted
impairs the functioning of individual
CNS Depressants
Substance Abuse vs. Substance dependence Alcohol
Physical dependence vs. Psychological dependence o Most commonly abused substance
Substance intoxication vs. Substance withdrawal o Oldest anti-anxiety
Sedative/ Hypnotics
Definitions: o Valium same effect as alcohol
Substance Abuse o Dangerous to mix alcohol and sedative
o Using a drug in a way that is inconsistent with o If taken therapeutically, no alcohol
medical and social norms and despite
negative consequences Narcotics - Opioids
Substance Dependence more serious problem o Papaver somniferum derivatives of opiates
o Tolerance takes higher dose of substance to o Opium, heroine, codeine (cough syrup),
bring about the same effect morphine (Demerol)
o Withdrawal symptoms substance-specific o Can only bought w/ prescription
manifestations that occur upon reduction/ o Euphoria, sleepy, VS, RR
cessation of substance o Heroin - most common
Intoxication occurs when Tell-tale Sign: Pinpoint pupil non-
substance is within the body - effects reactive to light
on CNS Severe CNS depression Narcan
o Unsuccessful attempts to give up the (Naloxone)
substance Can be passed through the
o More time to get, more time to take the placenta shrill cry of neonates
substance Taken via IV push or main line w/
Physical Dependence with withdrawal symptoms needle marks
Psychological Dependence Risk for blood-borne infections
o Takes the substance to avoid undesirable o Effects of Heroin:
effects of withdrawal Euphoria w/ sleepiness
o Stimulants physical and psychological o Relieve physical and
o Depressants - physical emotional pain
Morphine
CNS Stimulants o Potent respiratory
Amphetamines depressant
o Methamphetamine HCl Shabu o RR < 12 overdose
o Dextrin, Ritalin, Benzedrine o Antidote: Narcan narcotic
Ritalin - ADHD agonist
Pupils constriction
o Brings about euphoria exaggerated form of VS
well-being o Withdrawal from Heroine
o Pupils dilate Early can be likened to beginning
o Cannot sleep, no appetite respiratory infection
o Does not get tired o Runny nose
o Dependent: remain energetic, wants to be o Teary eyes
slim o Sneezing
o Abdominal cramps
Cocaine o Muscle cramps
o Not used for therapeutic use Inhalants
o Almost the same effect as amphetamines o Gasoline, glue, solvents, thinner, nail polish
More potent that amphetamines remover, spray paint, rugby (used by street
o Euphoria, VS, bronchodilation, energetic boys)
o Taken through snorting or sniffing o Headache, LOC, dizziness, lack of
coordination, mirthfulness, mouth ulcers,
Ecstasy slurred speech, unsteady gait, tremors, muscle
o Rush then crash if next dose is not taken weakness, blurred vision, GI upset, nausea
o Takes next dose even if the first one does not and vomiting
lose its effect yet o Rugby - hunger
If they fail, they feel painful o DEATH severe CNS depression
depression - Crash
o Fatigability, painful depression w/c may cause Must only take for 2 weeks to avoid addiction
them to commit suicide
o Methylenedioxymethamphetamine (MDMA) Hallucinogens
o Snorting, sniffing red nose w/ lesion Mind altering drugs/ psychomimetics
Pharmacotherapy
Anticonvulsants
o Tegretol (Carbamazepine) blood dyscrasia
Assessment: o Epival (Divalproex Na) Valproic Acid
Elevated, expansive mood of at least 1 week and any 3 o Depakote (Divalproex Na)
of the following:
o Pleasurable activities Antimanic - NE and S
Loud colors, activities o Lithium Carbonate oral only
Heavy make-up Blocks release and fastens reuptake
o Increase in goal-directed activities of NE and S
o Psychomotor disturbance Fastens excretion of Na
o Delusion of grandeur manic = low esteem Transposition of IC Na
o Pressure of speech/ loquacious speech o Where lithium is, Na will go
Pressure of speech o Lithium will find NA and
o Fast, rapid spitfire removes Na intracellularly
o Cannot understand o Na EC/ IT/ IV
Loquacious speech o Secreted in the
o Very productive speech renal tubules
o Distractibility Thin line between therapeutic and
o Flight of ideas/ racing thoughts toxic level
o Somatic manifestations Toxic to renal tubules MD orders
o Sarcastic, manipulative, demanding BUN and Crea before lithium is given
Hides weakness the through Therapeutic Serum Level: 0.6 to 1.2
weakness of others mEq/ L
o Up to 1.5 mEq/ L
Nursing Diagnosis Commonly Identified Safeguard Level
Risk for violence safety first o > 1.5 mEq/L TOXICITY
Risk for injury safety first Serum lithium exam: Blood test
Altered nutrition: less than body requirement Does not cure stabilizes the mood
Ineffective individual coping Continue even if not hyper/ manic
Self-care deficit anymore
Self-esteem disturbance
Impaired social interaction
Ineffective role performance Side Effects of Lithium Adverse Effect of Lithium
Fine tremors Gross tremors
Interventions: Polyuria Oliguria
Provide for clients physical safety and safety of those Polydipsia (3L fluids/ day) Vomiting (earliest
around him/her (PRIORITY than physiologic) Nausea manifestation of toxicity)/
o Environmental stimuli Hyper Metallic taste diarrhea
o Provide quiet, non-stimulating environment Motor incoordination
o Low pitched voice, non-confrontational, arms Confusion
on side, palms out Ataxia
o Do not cross arms
o Do not place hands at the back or inside the
pocket
Moderate (3 to 4 years)
o Confusion and disorientation
o Wandering and sleep disturbance
Classification:
Description Mental
Degree Range
Age
Profound < 20 IQ
Abilities of 3 y/o
20 40
Severe Contribute to self- 0-3
IQ
care
Self-care
Until grade 2 only
Trainable:
unskilled and
40 55
Moderate skilled work 3-8
IQ
May need
support even in
just minimal
stressor
Until grade 6
Educable:
Vocational
55 70
Mild
IQ
Professional 8 - 12
Cannot move
around
neighborhood
70 to 85
Borderline Slow learning
IQ