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BULIMIA NERVOSA
• Metabolic alkalosis (vomiting results to decrease hydrochloric acid)
• Metabolic acidosis (diarrhea results to decrease bicarbonate)
• Dental caries
• Wound in knuckles
MANAGEMENT
• Fluid and electrolyte imbalance
• Meal contract
• Weight gain for client
• After eating stay with client for 1 hour and accompany when going to the comfort room
PHARMA NOTES:
ANTI – PSYCHOTIC DRUG
• Stelazine
• Serentil
• Thorazine
• Trilafon
• Clozaril
• Mellaril
• Haldol
• Prolixin
SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
• Biological theory – increase dopamine level
• Exact cause unknown
ASSESSMENT
• Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
• Ambivalence: pulled into 2 opposing forces
Autism
• Looseness, no idea, not related to one another
ASSESSMENT
NEGATIVE ------------------------POSITIVE
Hypoactive ------------------------ Hyperactive
Withdrawn ------------------------- Sociable
Thought Blocking ------------------Flight of ideas
Apathy
I. ASSESS
• Content of thought
NURSING DIAGNOSIS
• Disturbed thought process
PLANNING/IMPLEMENTATION
• Present reality
• Provide safety
EVALUATION
• Improved thought process
II. ASSESS
• Hallucinations/Illusions
NURSING DIAGNOSIS
• Disturbed sensory perception
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Improved sensory perception
III. ASSESS
• Suspicious
NURSING DIAGNOSIS
• Risk for other directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for other directed violence
IV. ASSESS
• Suicidal
NURSING DIAGNOSIS
• Risk for self directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for self directed violence
LOOSENESS OF ASSOCIATION
• Thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between
one thought and the next
FLIGHT OF IDEAS
• Jumping from on topic to another
AMBIVALENCE
• Pulled between 2 strong opposing forces
MAGICAL THINKING
• acting like magician
ECHOLALIA
• Client repeats what you say
ECHOPRAXIA
• Client repeats what you do
WORD SALAD
• Just words no rhyme
CLANG ASSOCIATION
• Words that rhyme
NEOLOGISM
• Formation of new words (needs clarification)
DELUSION: PERSECUTORY
• “The NBI is out to get me”
DELUSION: RELIGIOUS
• “I am Jesus Christ the savior”
DELUSION: GRANDEUR
• “ I am the queen of the world”
CONCRETE ASSOCIATION
• Also known as “pilosopo”
THOUGHT BLOCKING
• Unable to think
-----------------------HALLUCINATIONS------ ILLUSIONS
STIMULUS ------------ ABSENT------------ PRESENT
VISUAL ----------------ABSENT------------ PRESENT
AUDITORY ----------- ABSENT------------ PRESENT
TACTILE ABSENT --- ABSENT------------ PRESENT
PARKINSON’S DISEASE
• If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in
dopamine (off switch)
ANTI-PSYCHOTIC
Decrease dopamine level
Parkinson like effect
Extra pyramidal side effect
With akathesia
Restless, inability to rest
AKINESIA
• Muscle rigidity
DYSTONIA
• Torticollis (wryneck)
OCULOGYRIC CRISIS
• Fixed stare
OPISTHOTONUS
• Arched back
• Lips – smacking
• Tongue – protruding
• Cheeks – puffing
• The 3 are irreversible and called tardive dyskinesia
• Neuroleptic malignant syndrome – hyperthermia
ANTI – PARKINSON
Anticholinergics Dopaminergics
(Decrease Ach) (Increase Dopa)
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel
TYPES OF SCHIZOPHRENIA
DISORGANIZED SCHIZOPHRENIA
- Sad but smiles (inappropriate affect)
- No reaction (flat affect)
- Flight of ideas (disorganized speech)
- Giggling (hebephrenic giggle)
- Combination of positive and negative signs and symptoms
CATATONIC SCHIZOPHRENIA
- Ambivalence
- Waxy flexibility
- Favorite word is “No”
- Negativism (client do not follow what you tell them to do)
Nursing management: meet needs
PARANOID SCHIZOPHRENIA
- Suspicious
- Mistrust, scared, withdrawn
Nursing management:
- Gain trust by 1 to 1 short interaction but frequent
- Foods should be in a sealed container
- Medications should be in tamper resistant foil.
Violent:
- Keep door open
- Position near door
- Don’t touch client
- Call for reinforcement
- One arms length away from the client.
PARANOID SCHIZOPHRENIA
- No more positive symptoms just withdrawn
UNDIFFIRENTIATED SCHIZOPHRENIA
- Mixed classification, cant be classified
PHAMRA NOTES:
BI-POLAR, MANIC
• Lithium: undergo first kidney test and check for blood levels
• Level: .6 – 1.2 meq/L
• Increase urination
• Tremors, fine hand
• Hydration of 3L/day
• Increase
• Uu (diarrhea)
• Mouth dry
ASSESSMENT
• Decrease appetite (give finger foods)
• Decrease sleep (place in a private room)
• Hyperactive
• Increase sexual activity – only means of addressing anxiety so decrease level of anxiety
• Risk for injury/other directed violence
• Impaired social interaction (care giver role: strain and stay with client)
• Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)
• Because there is decrease self esteem there will be increase compensation resulting to
increase interference with ADL’s and harm to others
• Compensation is the culprit
• Management: increase self esteem to decrease compensation and decrease interference
with ADL’s and harm to others
PHARMA NOTES:
ANTI – DEPRESSANTS
• Asendin
• Norpralamin
• Tofranil
• Sinequan
• Anafranil
• Aventyl
• Vivactil
• Elavil
• Prozac
• Paxil
• Zoloft
MANAGEMENT
• Detoxification: withdrawal with medical doctor supervision
• Avoid alcohol therapy
• Aversion therapy a more technical term for avoid alcohol therapy
• Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting
• Alcoholics anonymous
• Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and
hypotension
• Alcoholism may result to Vitamin B1 (Thiamine) deficiency
WERNICKE’S ENCEPHALOPATHY
• Problem with motor
KORSAKOFF’S PSYCHOSIS
• Problem with memory
• 24 – 72 hours after last dose of alcohol expect:
• Delirium Tremens: sympathetic nervous system
• Prevent hallucinations/Illusions by placing client in a well lit room
• Formication: feeling of bugs crawling under the skin
ALZHEIMERS DISEASE
• Axon (away) and Dendrites (toward) nerve
• Neurofibrillary tangles
• Neurotic plaques
5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
- expressive: cant say/express
- frontal lobe is affected particularly broca’s area
- receptive: cant hear
- temporal lobe is affected particularly wernicke’s area
5. Apraxia – cant do simple things
* Reminiscing Therapy – talk about past
• Patients with alzheimer’s may experience hallucinations, illusions thus becomes restless and
may wander
• As sun goes down client becomes restless, agitated, disoriented called sundowning
• Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases Ach causing
delay in disease progression
SEROTONIN
• Responsible for happiness
• Decrease serotonin clients becomes sad give anti-depressants
PERSONALITY DISORDERS
1. Schizophrenia
- They avoid people because there is no enjoyment
2. Avoidant
- They avoid people because they are afraid of criticisms
- They have talent but has no confidence
3. Anti-Social
- Constantly breaks law
- Project charm
- They are witty and articulate
- Manipulative
4. Borderline
- They perceive life as an empty glass
- They like splitting friends
- Sudden change in mood “labile affect”
- Prone to suicide
5. Dependent
- “Cant live if living is without you”
6. Histrioinic
- Constantly wants to be the center of attention
- Excited, dramatic, manipulative
7. Narcissistic
- “I love myself”
- They get jealous even with achievement of family members
8. Obsessive – Compulsive
- “I am so organized”
9. Paranoid
- Suspicious
- May lead to domestic violence
ANTI – DEPRESSANT SIDE EFFECTS:
Male – erectile dysfunction, prone to impotence
GRIEF PROCESS
1. Denial – shock/disbelief
2. Anger – question “why me?”
3. Bargaining – if, then
4. Depression – 2 weeks or more sign and symptoms becomes major clinical depression
5. Acceptance – client acts according to situation
ASSESSMENT
• Decrease self actualization
• Decrease self esteem
• Withdrawn: stay with client
• Suicidal: risk for self directed violence
• Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
• Be sensitive to clients needs
DOWNERS
Alcohol
Barbiturate
Opiates
Narcotics
Marijuana
Morphine
Codeine
Heroine
Resulting to:
• Bradycardia
• Bradypnea
• Moist mouth
• Pupils constrict
• Constipation
• Urinary retention
• Hypotension
• Coma
• Weight gain
• Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride)
UPPERS
Cocaine
Hallucinogens
Amphetamines
Resulting to:
• Tachycardia
• Awake
• Tachypnea
• Dry mouth
• Pupils dilate
• Hypertension
• Seizures
• Weight loss
DRUGS WITH ANTICHOLINERGIC EFFECTS
• Anti – Anxiety
• Anti – Psychotic
• Anti – Cholinergic
• Anti – Depressants
PHARMA NOTES:
DEFENSE MECHANISMS
1. Displacement – transfer of feelings to a less threatening object rather than the one who
provoked it.
2. Denial – failure to acknowledge an unacceptable trait or situation.
3. DISOCIATION – psychological flight from the self.
4. REGRESSION – return to an earlier development state.
5. repression – unconscious forgetting.
6. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation.
7. REACTION FORMATION – doing the opposite of what you have done.
8. UNDOING – doing the opposite of what you have done.
9. IDENTIFICATION – assuming trait for personal, social, occupational role.
10. PROJECTION – attribute to others one’s unacceptable trait.
11. INTROJECTION – assume another person’s trait as your own.
12. SUPPRESSION – conscious forgetting.
13. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive
endeavors.
14. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms.
15. COMPENSATION – over achievement in one area to cover a defective part.
16. SUBSTITUTION – replace difficult goal with more accessible one.
PHARMA NOTES:
THERAPEUTIC
1. Offer Self
2. Silence – provide time to think
3. Making observation – what you see you say
4. Active Listening – nodding, eye contact
5. Broad Opening – how are you today?
6. General Leads – Go on, I’m listening
7. Restating – I’m sad “You’re sad?” 1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion
NONTHERAPEUTIC
ANXIETY
• Vague sense of impending doom.
• Triggers the sympathetic nervous system.
• Assess level of anxiety of client.
TYPES OF ANXIETY
MILD ANXIETY
• + 1 level of anxiety.
• Widened perceptual field.
• Restless (say you seem restless).
• Enhanced learning capacity.
MODERATE ANXIETY
• + 2 level of anxiety.
• Client pace.
• Give PRN meds.
SEVERE ANXIETY
• + 3 level of anxiety.
• Don’t know what to do/say.
• Directive orders (please sit down).
PANIC
• + 4 level of anxiety.
• May commit suicide.
• Promote safety.
• Never touch patient.
• Hyperventilation (Respiratory Alkalosis)
• Breathe into paper bag.
NURSING DIAGNOSIS:
• ineffective individual coping.
• Powerlessness.
• Impaired skin integrity
PLANNING/IMPLEMENTATION:
• decrease level of anxiety.
• Decrease environmental stimuli.
• Relaxation techniques.
EVALUATION
• effective individual coping.
PANIC ATTACKS/DISORDER
• 15 – 30 minutes sympathetic nervous system escalation.
• Example is AGORAPHOBIA fear of open spaces.
MALINGERING
• pretending to be sick (conscious).
• Primary Gain anxiety decreases, able to escape source of anxiety.
• Secondary Gain able to get attention.
SOMATOFORM
• no protection
• unconscious
• no organic basis of being sick
HYPOCHONDRIASIS
• has minor discomfort and interprets it as major illness.
• Focus on clients feelings.
PSYCHOSOMATIC
• Real pains/illness
• Real symptoms because of anxiety
PSYCHOSOMATIC
Increase Anxiety
SNS
Increase BP & HR
Hypertension
Fat Deposits
Atherosclerosis
Calcium
Arteriosclerosis
Decrease Oxygen
Angina Pectoris
MI
Necrosis
CHF
Coma
PHOBIA
• Irrational fear
• Etiology: Knowledge of certain object
• Bad experience
• Immediate nursing objective: Removal of stimulus will remove anxiety
• Systemic Desensitization gradually expose client to stimuli/feared object
• Employ relaxation techniques
SNS
• GABA (Gamma Amino Butyric Acid) – stop
• Epinephrine and Norepinephrine – Go
ANTI-ANXIETY
• Increase GABA and client becomes drowsy (no alcohol and coffee)
• May develop orthostatic hypotension
• Let patient sit then dangle feet and then stand
• Develop anti cholinergic effects
• If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead
to seizures
• Do it in gradual and in tapered dose
• Anti anxiety leads to dependence
AUTISM
• Unresponsive and does not want to be touched
• Autistic Savant: high intelligence and has a ratio of 1:100
• Assessment
• Appearance – flat affect and loves constancy and ritualistic
• Behavior – withdrawn
• Communication – echolalia
NURSING DIANOSIS
• Impaired verbal communication
• Impaired social interaction
• Self mutilation
• Risk for injury
PLANNING/IMPLEMENTATION
• Maslow’s hierarchy of needs
• Expressive Therapy – use of art as mode if communication
EVALUATION
• Enhanced communication
• Improved social interaction
• Safety
NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction
PLANNING/IMPLEMENTATION
• Structure: place to play, sleep, eat and study
• Schedule: there is always a time for everything that you do
• Set limits
• Safety
EVALUATION
• Minimize risk for injury
• Improved social interaction
1. FRONTAL LOBE
- Language
- Learning
- Personality
- Judgment
2. TEMPORAL LOBE
- Hearing
- Smell
3. PAREITAL LOBE
- Touch
- Taste
4. OCCIPITAL LOBE
- Visual
STRUCTURE OF PERSONALITY
ID
SUPEREGO
• should not
• small voice of God
• to stop
EGO
• executive decision maker.
• In touch with reality principle.
ID DOMINANT PERSONALITIES
Manic
Anti – Social – experienced by serial killers
Narcissistic
LIBIDO
• Sexual energy responsible for survival.
Oral Stage
• 0 – 18 months evident.
• ID is developed.
Anal Stage
• 18 months – 3 years old.
• Able to control bladder, bowel.
• Best time for toilet training.
• SUPEREGO is developed.
TOILET TRAINING
PHALLIC STAGE
• 3 – 6 years old.
• Experience pleasure by manipulating genitals.
• Love – hate relationship.
• Oedipus Complex boy loves parent of the opposite sex.
• Imitates daddy called identification.
• Castration fears.
• Electra Complex girl loves parent of the opposite sex.
• Imitates mommy called identification.
• Penis envy.
*Conscious – upper level of thinking.
*Preconscious – tip of tongue.
*Unconscious – protects us from traumatic experiences.
LATENCY STAGE
• 6 – 12 years old.
• School age.
• Separation anxiety.
• Reading , Writing, Arithmetic.
• Lasts for 6 years.
GENITAL STAGE
• 12 years old and above
• Sexual reawakening.
• Very important stage.
PHARMA NOTES:
ANTI - ANXIETY DRUGS
• Valium
• Librium
• Ativan
• Serax
• Tanxene
• Miltown
• Equanil
• Vistaril
• Atarax
• Ideral
• Buspar
ERIC ERIKSON
• There is more to life than just sex.
• Psychosocial Theory of development.
• You can develop a positive side or a negative side.
• Developmental task begins at 0 – 18 months.