Nle Notes Psych

8/13/2019 Nle Notes Psych

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PSYCHIATRIC NURSING

Psych focuses in feelings or self-awareness.

Beliefs determine feelings which affects behavior (manifestation of feelings)

Sigmund Freud is the father of PSYCHOANALYSIS

What happens to childhood will affect adulthood

STRUCTURE OF PERSONALITY

ID

mpulsive! "want to#! wants pleasure.

PLEASURE PRINCIPLE

$uiding principle is PAIN AVOIDANCE

SUPEREGO

Should not

Small voice of $od

%o stop

EGO

&'ecutive decision maer.

n touch with REALITY principle.

ID DOMINANT PERSONALITIES

Manic

Anti - Sociale'perienced by serial illers

Narcissistic

SUPEREGO DOMINANT PERSONALITIES

Obsessive ompulsive

Anore'ia *ervosa

EGO+ if destroyed result in impaired reality perception.

Schi,ophrenia

LIBIDO

Se'ual energy responsible for survival.


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PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD[O.A.P.L.G.]

ORAL STAGE

+ / months evident.

ID i !e"el#pe!.

$FIXATION % Person is stuc in certain developmental shape.

$REGRESSION % 0eturn to an earlier developmental stage.

$EGO % Developed on the 6thmonth.

ANAL STAGE

/ months + 1 years old.

2ble to control bladder! bowel.

Best time for toilet training.

SUPEREGO i !e"el#pe!.

TOILET TRAINING

$ood 3other Bad 3other

Successful

4irty lean

- 4isorgani,ed - organi,ed- 4isobedient - obedient

- 2nti-social - 5.

- An&l e'p(li"e ) An&l re*en*i"e

PHALLIC STAGE

1 + 6 years old.

&'perience pleasure by manipulating genitals.

7ove + hate relationship.

Oe!ip( C#+ple' boy loves parent of the opposite se'.

mitates daddy called IDENTIFICATION.

C&*r&*i#n ,e&r.

Elec*r& C#+ple' girl loves parent of the opposite se'.

mitates mommy called i!en*i,ic&*i#n.

Peni en"-.


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$C#nci#(+ upper level of thining.

$Prec#nci#(+ tip of tongue.

$Unc#nci#(+ protects us from traumatic e'periences.

LATENCY STAGE

6 + 8 years old. School age.

Separation an'iety.

0eading! Writing! 2rithmetic.

7asts for 6 years.

GENITAL STAGE

8 years old and above

Se'ual reawaening.

9ery important stage.

PHARMACOLOGY NOTES

ANTI ANXIETY DRUGS [S.A.T.L.V.M. % E.V.A..I.]

Ser&'

A*i"&n

T&n'ene

Li/ri(+

V&li(+

Mil*#0n

E1(&nil

Vi*&ril

A*&r&'

(p&r

In!er&l

ERIC ERI2SON

%here is more to life than :ust se'.

P-c3##ci&l T3e#r- of development.

;ou can develop a positive side or a negative side.

4evelopmental tas begins at + / months.


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POSITIVE NEGATIVE FACTOR

+ / mos. %rust 3istrust Feeding

/ mos. + 1 yrs. 2utonomy Shame < 4oubt %oilet %raining

1 yrs. + 6 yrs. nitiative $uilt ndependence

6 yrs. + 8 yrs. ndustry nferiority School

8 yrs. + 8 yrs. dentity 0ole onfusion Peers

8 yrs. + 8= yrs. ntimacy solation 7ove8= yrs. + >= yrs. $enerativity Stagnation Parenting

>= yrs. - above &go ntegrity 4espair 0eflection

EHAVIORAL MODELS

I"&n P&"l#"

lassical onditioning

2ll behaviors are learned.

F S4inner

Behavior can be learned and unlearned.

5perant conditioning.

f given reward there is repetition.

f punished behavior becomes e'tinct.

LOES OF RAIN

5. FRONTAL LOE

7anguage

7earning

Personality

?udgment

6. TEMPORAL LOE

@earing

Smell

7. PARIETAL LOE

%ouch

%aste

8. OCCIPITAL LOE

9isual

7 STEPS TO INTERACT 9ITH ENVIRONMENT

. Sensory + eyes! ears! tongue

8. ntegration

1. 3otor + voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM

2lso called as SOMATIC

3otor nerve to muscle fiber you need ACETYLCHOLINE which is an "5n switch#.

Brain


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Spinal ord

3otor *erve

Synapse

3uscle Fiber

INVOLUNTARY NERVOUS SYSTEM

2lso called AUTONOMICnervous system.

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC(2wae! ADRENERGIC:

PARASYMPATHETIC(0ela'! CHOLINERGIC:

He&r* R&*e ncrease 4ecrease

Repir&*#r- R&*e ncrease 4ecrease

GI 4ecrease (4ry mouth! onstipation) ncrease (3oist mouth! 4iarrhea)

GU 4ecrease (Arinary 0etention) ncrease (Arinary Freuency)

Ne(r#*r&n+i**er &pinephrine! *orepinephrine 2cetylcholine

DRUGS 9ITH ANTICHOLINERGIC EFFECTS

2nti + 2n'iety

2nti + Psychotic

2nti + holinergic

2nti + 4epressants

PHARMACOLOGY NOTES

MONOAMINE OXIDASE INHIITORS

M&rpl&n

N&r!il

P&rn&*e

DEFENSE MECHANISMS

1. DISPLACEMENT% transfer of feelings to a less threatening ob:ect rather than the one who provoed it.

2. DENIAL% failure to acnowledge an unacceptable trait or situation.

3. DISSOCIATION%psychological flight from the self.

4. REGRESSION%return to an earlier development state.

5. REPRESSION%unconscious forgetting.

6. RATIONALI;ATION%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.


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10. PRO


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POST TRAUMATIC STRESS DISORDER

9ictims become survivors and e'perience flashbacs or nightmares.

MALINGERING

Pretending to be sic (conscious).

Pri+&r- G&in an'iety decreases! able to escape source of an'iety. Sec#n!&r- G&inable to get attention.

SOMATOFORM DISORDER

*o protection

Anconscious

*o organic basis of being sic

DIFFERENT TYPES OF SOMATOFORM

1. Conversion Disorder

annot spea! see! hear.

*ervous system affected.

2. La Belle Indieren!e

4o not care what happens to them.

HYPOCHONDRIASIS

has minor discomfort and interprets it as ma:or illness.

Focus on clients feelings.

ODY DYSMORPHIC DISORDER

llusion of structural defect.

Favorite past time is doctor hopping.

Focus on clients feelings.

PSYCHOSOMATIC

0eal painsillness

0eal symptoms because of an'iety

PSYCHOSOMATIC

@

Incre&e An'ie*-

@

SNS

@


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ANTI) ANXIETY MEDICATIONS

ncrease $2B2 and client becomes drowsy (no alcohol and coffee)

3ay develop orthostatic hypotension

7et patient sit then dangle feet and then stand

4evelop anti cholinergic effects f abruptly withdrawn to anti an'iety it may result to rebound phenomenon ( wee) may lead to

sei,ures

4o it in gradual and in tapered dose

2nti an'iety leads to dependence

AUTISM

Anresponsive and does not want to be touched

AUTISTIC SAVANTH high intelligence and has a ratio of H

Ae+en*

2ppearance + flat affect and loves constancy and ritualistic

Behavior + withdrawn

ommunication + echolalia

NURSING DIANOSIS

mpaired verbal communication

mpaired social interaction

Self mutilation

0is for in:ury

PLANNING?IMPLEMENTATION

3aslowCs hierarchy of needs

E'prei"e T3er&p-+ use of art as mode of communication

EVALUATION

&nhanced communication

mproved social interaction

Safety

ATTENTION DEFICIT HYPERACTIVITY DISORDER

E years and below onset

D(r&*i#nH 6 months and above

Se**in=H house and school

Ae+en*

2ppearanceH dirty! clumsy! hyperactive! impatient! easily distracted and has no focus

Behavior

ommunicationH talative


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NURSING DIAGNOSIS

0is for in:ury

mpaired social interaction


S*r(c*(reH place to play! sleep! eat and study

Sc3e!(leH there is always a time for everything that you do Se* li+i*

S&,e*-

EVALUATION

3inimi,e ris for in:ury

mproved social interaction

FRONTAL LOE OF ADHD4ecreased glucose

J4ecreased :udgment

Jncrease impulsivenessADHD? H-per&c*i"i*-

*eed a drug that brings glucose level up.

$ive RITALIN as stimulant

3ay result in loss of appetite

$iven after meals

$iven 6 hours before bedtime

EATING DISORDERS

ANOREXIA NERVOSA ULIMIA NERVOSA

&at! eat! eat

7ess /=K e'pected body weight

1 months 2menorrhea

&at! eat! vomit

*ormal weight

rregular menstruation

ULIMIA NERVOSA

3etabolic alalosis (vomiting results to decreased hydrochloric acid)

3etabolic acidosis (diarrhea results to decreased bicarbonate)

4ental caries

Wound in nucles

MANAGEMENT

Fluid and electrolyte imbalance

3eal contract

Weight gain for client

2fter eating stay with client for hour and accompany when going to the comfort room

PHARMACOLOGY NOTES


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ANTI % PSYCHOTIC DRUG

S*el&Bine

Seren*il

T3#r&Bine

Tril&,#n

Cl#B&ril Mell&ril

H&l!#l

Pr#li'in

SCHI;OPHRENIA

&go disintegration

mpaired reality perception

$enetic vulnerability

Stress + Di&*3ei M#!el

Biological theory + incre&e !#p&+ine le"el

&'act cause unnown

ASSESSMENT

2ffectH 2ppropriate! nappropriate! Flat! Blunt (incomplete)

Ambivalence: pulled into 2 opposing forces

AUTISMH 7ooseness! no idea! not related to one another

ASSESSMENT

NEGATIVE POSITIVE

@ypoactive @yperactive

Withdrawn Sociable

%hought Blocing Flight of ideas

2pathy

I. ASSESS

ontent of thought

NURSING DIAGNOSIS

4isturbed thought process


Present reality

Provide safety

EVALUATION


13/22

mproved thought process

II. ASSESS

@allucinations llusions

NURSING DIAGNOSIS

4isturbed sensory perceptionPLANNING?IMPLEMENTATION

Present reality

Safety

EVALUATION

mproved sensory perception

III. ASSESS

Suspicious

NURSING DIAGNOSIS

0is for other directed violence


Present reality

Safety

EVALUATION

&liminateminimi,e ris for other directed violence

IV. ASSESS

Suicidal

NURSING DIAGNOSIS

0is for self directed violence


Present reality

Safety

EVALUATION

&liminateminimi,e ris for self directed violence

LOOSENESS OF ASSOCIATION

%here is connection with statements


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FLIGHT OF IDEAS

?umping from on topic to another

AMIVALENCE

Pulled between 8 strong opposing forces

MAGICAL THIN2ING

acting lie magicianECHOLALIA

lient repeats what you say

ECHOPRAXIA

lient repeats what you do

9ORD SALAD

?ust words no rhyme

CLANG ASSOCIATION

Words that rhyme

NEOLOGISM

Formation of new words (needs clarification)

DELUSION PERSECUTORY

"%he *B is out to get me#

DELUSION RELIGIOUS

" am ?esus hrist the savior#

DELUSION GRANDEUR

" am the ueen of the world#

DELUSION IDEAS OF REFERENCE

"%he nurses are taling about me#

CONCRETE ASSOCIATION

2lso nown as "pilosopo#

THOUGHT LOC2ING

Anable to thin

HALLUCINATIONS ILLUSIONS

S%3A7AS

9SA27

2A4%50;

%2%7&

2BS&*%

2BS&*%

2BS&*%

2BS&*%

P0&S&*%

P0&S&*%

P0&S&*%

P0&S&*%

Present reality to clients e'periencing hallucinations

%echniue in handling clients with hallucinations

Hallucinations

Acnowledgement " now the voices are real to you#


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Reality orientation " now the voices are real but donCt hear them#

Diversion "7ets go to the garden#

5 #, c3iB#p3renic clien* 3e&r "#ice

PAR2INSONS DISEASE

f acethylcholine (on switch) is increased there is e'cessive movement resulting to decrease indopamine (off switch)

ANTI)PSYCHOTIC

@

4ecrease dopamine level

@

Parinson lie effect

@

&'tra pyramidal side effect

@

With aathesia

@

0estless! inability to rest

A2INESIA

3uscle rigidity

DYSTONIA

%orticollis (wry-nec)

OCULOGYRIC CRISIS

Fi'ed stare

OPISTHOTONUS

2rched bac

Lip+ smacing

T#n=(e+ protruding

C3ee4+ puffing

%he 1 are irreversible and called TARDIVE DYS2INESIA

NEUROLEPTIC MALIGNANT SYNDROME H-per*3er+i&

ANTI % PAR2INSON DRUGS

2*%@57*&0$S 45P23*&0$S

(Decre&e AC3) (Incre&e D#p&+ine)


16/22

@ @

Artane! Aineton Parlodel

enadryl Larodopa

Cogentin Eldepryl

Symmetrel

OT"E# $IDE E%%ECT$ O% DEC#EA$E DO&A'INE

Photosensitivity

2$02*A75;%5SS + decrease WB

lients prone to infection due to decrease WB

First sign for infection is #re *3r#&*

TYPES OF SCHI;OPHRENIA

DISORGANI;ED CATATONIC PARANOID RESIDUAL UNDIFFIRENTIATED

UNCLASSIFIED

- Sad but smiles(nappropriate affect)- *o reaction (flataffect)- Flight of ideas(disorgani,ed speech)- $iggling(hebephrenic giggle)- ombination ofpositive and negativesigns and symptoms

- 2mbivalence- Wa'y fle'ibility- Favorite word is "*o#- *egativism (client donot follow what you tellthem to do)N(rin=+&n&=e+en*3eet needs

- Suspicious- 3istrust!scared!withdrawnN(rin=+&n&=e+en*- $ain %0AS%by to shortinteraction butfreuent- Foods shouldbe in a sealedcontainer- 3edicationsshould be in

tamper resistantfoil.Vi#len*H- Ieep door open- Position neardoor- 4onCt touchclient- all forreinforcement- 5ne armslength away fromthe client.

- *o morepositivesymptoms

:ustwithdrawn

- 3i'ed classification!cant be classified

PHARMACOLOGY NOTES

I)POLAR MANIC

Li*3i(+ (n!er=# ,ir* 4i!ne- *e* &n! c3ec4 ,#r /l##! le"el

LevelH .6 + .8 me7

Increase urination


17/22

Tremors! fine hand

Hydration of 17day

Increase

Uu (diarrhea)

Mouth dry

$i(ns o Lithi)m to*i!it+ *ausea! vomiting! diarrhea

ncrease sodium

$$$$9AIT FOR 6 % 8 9EE2S EFORE LITHIUM THERAPY TA2ES EFFECTS

IPOLAR DISORDER? MANIC PROFILE

8 years old

Female

Stress

5bese

ASSESSMENT

4ecrease appetite (give finger foods)

4ecrease sleep (place in a private room)

@yperactive

ncrease se'ual activity + only means of addressing an'iety so decrease level of an'iety

0is for in:uryother directed violence

mpaired social interaction (care giver roleH strain and stay with client)

Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)

Because there is !ecre&e el, e*ee+ there will be incre&e c#+pen&*i#n resulting to

incre&e in*er,erence 0i*3 ADL &n! 3&r+ *# #*3er

C#+pen&*i#n i *3e c(lpri*

M&n&=e+en* incre&e el, e*ee+ *# !ecre&e c#+pen&*i#n &n! !ecre&e in*er,erence

0i*3 ADL &n! 3&r+ *# #*3er

HO9 TO INCREASE SELF ESTEEM OF MANIC PATIENTS

T - no sports (basetball! volleyball)! no fine motor sills only gross motor sills

A-llot energies toward more productive endeavors ((/li+&*i#n)

S) escorted wal outdoors

2- punching bag (displacement)

PHARMACOLOGY NOTES

ANTI % DEPRESSANTS

Aen!in

N#rpr&l&+in

T#,r&nil

Sine1(&n

An&,r&nil

A"en*-l


18/22

Vi"&c*il

El&"il

Pr#B&c

P&'il

;#l#,*

ALCO"OL LEAD$ TO,

l&c4#(* awae but unaware C#n,&/(l&*i#n inventing stories to increase self esteem

Deni&l " am not an alcoholic#

Depen!ence cant leave with out leading to en&/lin= where in the significant other tolerates the

abuser c# !epen!ence is another term

T#ler&nce gradual increase in amount of stimuli to e'perience the same euphoria

MANAGEMENT

De*#'i,ic&*i#n withdrawal with medical doctor supervision

Avoid alcohol therapy

Aversion therapy a more technical term for avoid alcohol therapy

AntabuseH 4isulfiram maes the client never drin alcohol because it causes vomiting

Alcoholics anonymous

nterval of 8 hours after last dose of alcohol or e'perience nausea and vomiting and hypotension

2lcoholism may result to 9itamin B (%hiamine) deficiency

-E#NICE/$ ENCE&"ALO&AT"Y

Problem with motor

O#$AO%%/$ &$YC"O$I$ Problem with memory

8> + E8 hours after last dose of alcohol e'pectH

Deliri(+ Tre+enH sympathetic nervous system

Prevent hallucinationsllusions by placing client in a well lit room

F#r+ic&*i#nH feeling of bugs crawling under the sin

AL;HEIMERS DISEASE

- 2'on (away) and 4endrites (toward) nerve

- *eurofibrillary tangles

- *eurotic plaues

ALCOHOL? DELIRIUM AL;HEIMERS


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ONSET 2brupt $radualLEVEL OF CONSCIOUSNESS Fluctuating AnaffectedDURATION @ours to days ProgressiveMEMORY Short term memory loss Short term and long term

(orient patient)

A OF AL;HEIMERS. Amnesia + memory loss

8. Anomia + donCt now the name

1. Agnosia + sensory problems smell! taste! sight

>. Aphasia

EXPRESSIVEcant saye'press

Frontal lobe is affected particularly /r#c& &re&

RECEPTIVE cant hear

%emporal lobe is affected particularly 0ernic4e &re&

=. Apra'ia + canCt do simple things Re+inicin= T3er&p- % *&l4 &/#(* p&*

Patients with 2l,heimerCs may e'perience hallucinations! illusions thus becomes restless and may

wander

2s sun goes down client becomes restless! agitated! disoriented called "(n!#0nin=J

4rug of choice is COGNEX and ARICEPTa cholinesterase inhibitor that increases 2ch causing delay in

disease progression

SEROTONIN

0esponsible for happiness

4ecrease serotonin clients becomes sad give anti-depressants

SELECTIVE SEROTONIN REUPTA2E INHIITOR

Safest drug

Side effects low

R

Ito > wees

ncreases serotonin and affects only serotonin

PRO;AC PAXIL ;OLOFT

TRICYCLIC ANTI DEPRESSANT

Two + four wees

C

A

@as higher incidence of side effects

2lso increases norepinephrine


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21/22

" love myself#

%hey get :ealous even with achievement of family members

/. O/ei"e % C#+p(li"e

" am so organi,ed#

L. P&r&n#i!

Suspicious 3ay lead to domestic violence

GRIEF PROCESS [D.A..D.A]

1. Deni&l+ shocdisbelief

2. An=er+ uestion "why meD#3. &r=&inin=+ if! then

4. Deprei#n+ 8 wees or more sign and symptoms becomes ma:or clinical depression

5. Accep*&nce+ client acts according to situation

ASSESSMENT

4ecrease self actuali,ation

4ecrease self esteem

WithdrawnH stay with client

SuicidalH ris for self directed violence

ncreasedecrease eat! increasedecrease sleep! hypoactive! decrease se'ual urge

Be sensitive to clients needs

FOR SUICIDAL OSERVE FOR

Ver/&l c#++(nic&*i#n

" wont be a problem#

"%his is my last day on earth#

"Cll soon be gone#

N#n)"er/&l c#++(nic&*i#n

$iving away of valuables Sudden change in mood

ANTI 0 DEE$$ANT $IDE E%%ECT$

327& + &rectile dysfunction! prone to impotence

9HEN THE CLIENT IS SUICIDAL 9HAT 9ILL THE NURSE DO

DirectH "4o you plan to commit suicideD#

Irregularinterval visits

Endorsement period! &207; 350**$ clients are most liely to commit suicide


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DO9NERS [A..O.N.)M.M.C.H.]

Alcohol

arbiturate

Opiates

Narcotics

Mari:uana

Morphine

Codeine

Heroine

#es)ltin( to, Bradycardia

Bradypnea

3oist mouth

Pupils constrict

onstipation

Arinary retention

@ypotension

oma

Weight gain

N&rc#*ic #"er!#e give narcotic antagonist (*202*! *275M5*& @;405@7504&)

UPPERS [C.H.A.R.]

Cocaine

Hallucinogens

Amphetamines

Re(l*in= *#

%achycardia

2wae

%achypnea

4ry mouth

Pupils dilate

@ypertension

Sei,ures

Weight loss

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Nle Notes Psych