Psychiatric Nursing
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Psychiatric Nursing

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Psychiatric Nursing , PSYCHIATRIC DISORDER

Psychiatric Nursing , PSYCHIATRIC DISORDER

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Psychiatric Nursing Document Transcript

  • 1. Presented by: Dave Jay S. Manriquez, RN. PSYCHIATRIC NURSING Introduction 0. MENTAL HEALTH – balance in a persons internal life and adaptation to reality 1. Mental ILL Health – state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior Psychiatric nursing 0. interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self (art) and nursing theories (science), assist clients to achieve psychosocial well being. 1. Core : interpersonal process Related Terms 2. Mental hygiene 0. measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation 1. Main tool: therapeutic use of self 2. It requires self-awareness 3. Methods to increase self-awareness: 3. Introspection 4. Discussion 5. Experience 6. Role play 4. Assessment (psychosocial processes ) 7. Appearance , behavior or mood 8. Speech , thought content and thought process 9. Sensorium 10. Insight and judgment 11. Family relationships and work habits 12. Level of growth and development Common Behavioral Signs and Symptoms Disturbances in perception 5. Illusion 13. misinterpretation of an actual external stimuli 6. Hallucinations 14. false sensory perception in the absence of external stimuli
  • 2. Disturbances in thinking and speech 7. neologism – coining of words that people do not understand 8. Circumstantiality – over inclusion of inappropriate thoughts and details 9. Word salad – incoherent mixture of words and phrases with no logical sequence 10. Verbigeration – meaningless repetition of words and phrases 11. Perseveration – persistence of a response to a previous question 12. Echolalia – pathological repetition of words of others 13. Aphasia – speech difficulty and disturbance 15. Expressive , receptive or global 14. Flight of ideas- shifting of one topic from one subject to another in a somewhat related way 15. Looseness of association-incoherent illogical flow of thoughts (unrelated way) 16. Clang association – sound of word gives direction to the flow of thought 17. Delusion – persistent false belief, rigidly held 16. Delusions of grandeur: special /important in a way 17. Persecutory: threatened 18. Ideas of reference: situation/events involve them 19. Somatic: body reacting in a particular way 20. Jealous: thinking that their partner is unfaithful 21. Erotomanic: person, usually of high status, is in love with the client 22. Religious: illogical ideas about God and religion exhibited by extreme or extraneous behavior 23. Mixed: combination of above without a predominant theme 18. Magical thinking – primitive thought process thoughts alone can change events 19. Autistic thinking – regressive thought process; subjective interpretations not validated with objective reality 20. Dereism – unorganized thinking
  • 3. Disturbances of affect 21. Inappropriate – disharmony between the stimuli and the emotional reaction 22. Blunted affect – severe reduction in emotional reaction 23. Flat affect – absence or near absence of emotional reaction 24. Apathy – dulled emotional tone 25. Depersonalization – feeling of strangeness from one’s self 26. Derealization – feeling of strangeness towards environment 27. Agnosia – lack of sensory stimuli integration Disturbances in motor activity 28. Echopraxia – imitation of posture of others 29. Waxy flexibility – maintaining position for a long period of time 30. Ataxia – loss of balance 31. Akathesia – extreme restlessness 32. Dystonia- uncoordinated spastic movements of the body 33. Tardive dyskinesia – involuntary twitching or muscle movements 34. Apraxia – involuntary unpurposeful movements Disturbances in memory 35. Confabulation – filling of memory gaps 36. Déjà vu – something unfamiliar seems familiar 37. Jamais vu- something familiar seems unfamiliar 38. Amnesia – memory loss (inability to recall past events) 24. Retrograde-distant past 25. Anterograde – immediate past 26. Anomia – lack of memory of items Dynamics of Human Behavior 2. Behavior – the way an individual reacts to a certain stimulus 3. Conflict – situation arising from the presence of two opposing drives 4. Need - organismic condition that requires a certain activity Dynamics of Human Behavior 39. Personality 27. totality of emotional and behavioral traits that characterize the person in day to day living under ordinary conditions; it is relatively stable and predictable. FORMATION OF PERSONALITY 0. TEMPERAMENT 0. biological-genetic template that interacts with our environment.
  • 4. 1. a set of in-built dispositions we are born with 2. mostly unalterable 3. our nature. 1. CHARACTER 4. the outcome of the process of socialization, the acts and imprints of our environment and nurture on our psyche during the formative years (0-6 years and in adolescence). 5. the set of all acquired characteristics we posses, often judged in a cultural-social context. 2. Sometimes the interplay of all these factors results in an abnormal personality THEORIES OF PERSONALITY DEVELOPMENT Freud’s PSYCHOSEXUAL THEORY 40. Libido – inner drive 41. Parts of body –focus of gratification 42. Unsuccessful resolution - fixation 43. Structures of personality 28. Id: pleasure principle-instinct 29. Ego: controls action and perception –reality principle 30. Superego: moral behavior - conscience 44. 0-18 m0s ;oral – mouth – trust and discriminating 45. 18 mos. – 3 years ; anal – bowels – holding on or letting go 0. Negativism and toilet training age 46. 3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension) 1. Gender identification and genital awareness 2. Oedipus and Electra complex 3. Castration anxiety and penis envy 47. 6-12 years – latency (quiet stage) sexual energy diverted to play. Institution of superego: control of instinctual impulses 48. 12 – young adult – genital ; reawakening of sexual drives –relationships 31. Sexual maturation 32. Sexual identity ,ability to love and work Eric Erickson’s PSYCHOSOCIAL THEORY 3. 0-12mos 4. 1-3y
  • 5. 5. 3-6 6. 6-12 7. 12-18 8. 18-25 9. 25-60 10. 60 and above 11. TRUST vs. MISTRUST 12. AUTONOMY vs. SHAME & DOUBT 13. INDUSTRY vs. INFERIORITY 14. INITIATIVE vs. GUILT 15. IDENTITY vs. IDENTITY CONFUSION 16. INTIMACY vs. ISOLATION 17. EGO INTEGRITY vs. STAGNATION 18. GENERATIVITY vs. DESPAIR INFANCY 49. CONSISTENT MATERNAL –CHILD INTERACTION – TRUST 50. INNER FEELING OF SELF WORTH 51. HOPE TODDLER 19. ALLOW EXPLORATION 20. PROVIDE FOR SAFETY 21. “NO, NO” – NEGATIVISM 22. OFFER CHOICES / REVERSE PSYCHOLOGY 23. TOILET TRAINING – 18 MOS.-BOWEL 33. DAYTIME BLADDER: 2 yo 34. NIGHTIME BLADDER: 3 yo 24. REWARD W/ PRAISE AND AFFECTION 25. INDEPENDENCE PRE-SCHOOL 52. PROVIDE PLAY MATERIALS 53. SATISFY CURIOSITY 54. TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) 55. SIBLING RIVALRY 56. WILLPOWER SCHOOL AGE 57. HOW TO DO THINGS WELL-SUPPORT EFFORTS 58. CHUMS AND HOBBIES 59. NEEDS TO EXCEL/ACCOMPLISH 60. NEED FOR PRIVACY AND PEER INTERACTION 61. COMPETENCE
  • 6. ADOLESCENCE 62. MAKE DECISION,EMANCIPATION FROM PARENTS 63. BODY IMAGE CHANGES 64. NEED TO CONFORM BUT KEEP INDIVIDUALITY 65. SELF - AWARENESS YOUNG ADULT 66. COMMITMENT AND FIDELITY 67. RESPONSIBILITY 68. ACHIEVEMENT OF INDEPENDENCE MIDDLE ADULTHOOD 26. SUPPORT-PERIOD OF ROLE TRANSITIONS 27. MIDLIFE CRISIS 28. ADJUSTMENT AND COMPROMISE 29. MOST PRODUCTIVE AND CREATIVE 30. ALTRUISM LATE ADULTHOOD 69. SELF ACCEPTANCE 70. SELF WORTH 71. WISDOM Jean Piaget’s COGNITIVE THEORY 0-2 SENSORIMOTOR 72. REFLEXES 73. IMITATIVE REPETITIVE BEHAVIOR 74. SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. 75. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING 2-7Y PRE-OPERATIONAL 31. SELF-CENTERED,EGOCENTRIC 32. CANNOT CONCEPTUALIZE OTHER’S VIEW 33. ANIMISTIC THINKING 34. IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY 35. 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 36. 4-7 INTUITIVE (UNDERSTANDING OF ROLES) 7-12Y CONCRETE OPERATIONAL 76. LOGICAL CONCRETE THOUGHT
  • 7. 77. INDUCTIVE REASONING (SPECIFIC TO GENERAL) 78. CAN RELATE, PROBLEM SOLVING ABILITY 79. REASONING AND SELF-REGULATION 12-ABOVE: FORMAL OPERATIONAL THOUGHT 80. Abstract thinking 81. Separation of fantasy and fact 82. Reality oriented 83. Deductive reasoning 84. Apply scientific method Havighurst’s DEVELOPMENTAL TASKS 85. Baby to early childhood 35. Right from wrong and Conscience 86. Late childhood 36. Physical skills, wholesome attitude, social roles 37. Conscience morality and values 38. Fundamental skills in academics 39. Personal independence 87. Adolescence 40. Sexual social roles 41. Relationships 42. Independence and ideology 88. Early adulthood 43. Career 44. Selecting a mate 45. Finding Civic or social responsibility 89. Middle age 46. Achieving Civic or social responsibility 47. Adjusting to changes 48. Satisfactory career performance 49. Adjusting to aging parents 50. Adjusting to parental roles 90. Old age 51. Adjusting to changes 52. Establishing satisfactory living arrangements and affiliations
  • 8. Kohlberg’s MORAL DEVELOPMENT/ THINKING/ JUDGEMENT 91. PRE-CONVENTIONAL (0-6) 53. PUNISHMENT AND OBEDIENCE 54. OBEDIENCE TO RULES TO AVOID PUNISHMENT 92. CONVENTIONAL ( 6-12 ) 55. MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY 56. SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE 57. BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE 93. POST –CONVENTIONAL (12 – 18 Y) 58. PRIOR RIGHT OR SOCIAL CONTRACT 59. UNIVERSAL ETHICAL PRINCIPLE 60. ABIDE FOR COMMON GOOD 61. RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM 62. INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS Harry Stack Sullivan’s INTERPERSONAL THEORY INFANCY 94. NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS TODDLERHOOD / EARLY CHILDHOOD 95. CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT PRE-SCHOOL 37. DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION 38. ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED
  • 9. 39. BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN SCHOOL AGE 96. THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION 97. THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX ADOLESCENCE 98. LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX YOUNG ADULTHOOD 99. BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT LATER ADULTHOOD 100. LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS SENESCENCE 101. DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY TREATMENT MODALITIES REMOTIVATION THERAPY 102. TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS 103. STEPS : climate of acceptance creating bridge to reality sharing the world we live in appreciation of works of the world climate of appreciation MUSIC THERAPY 104. Involves use of music to facilitate expression of feelings, relaxation and outlet of tension PLAY THERAPY 40. enables patient to experience intense emotion in a safe environment with the use of play 41. children express themselves more easily in play. revealing as reflection of child’s situation in the family 42. provide toys and materials – facilitate interaction – observe and help child resolve problems through play Group therapy
  • 10. 43. Treatment modality involving three or more patients with a therapist to relieve emotional difficulties, increase self – esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with others 44. IDEAL 8 – 10 MEMBERS MILIEU THERAPY 45. Consists of treatment by means of controlled modification of the patient’s environment to facilitate positive behavioral change 46. Increase patient’s 6. Awareness of feelings 7. Sense of responsibility and 8. Help return to community 47. clients plan social and group interaction 48. token programs , open wards and self medication are done FAMILY THERAPY 49. A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL FAMILY AS AN INTERACTIONAL SYSTEM 50. PROBLEM IS A FAMILY PROBLEM 51. focus on sick members behavior as source of trouble / symptom serve a function for the family 52. members develop sense of identity 53. points out function of the sick member for the rest of the family PSYCHOANALYTIC 54. focuses on the exploration of the unconscious, to facilitate identification of the patients defenses 55. ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO 56. Becomes aware of unconscious thoughts and feelings to understand anxiety and defenses HYPNOTHERAPY 105. Various methods and techniques to induce a trance state where patient becomes submissive to instructions BEHAVIOR MODIFICATION 106. Application of learning principles in order to change maladaptive behavior 107. Believes that psychological problems are a result of learning 108. Everything learned can be unlearned BEHAVIOR MODIFICATION 109. OPERANT CONDITIONING 63. Use of rewards to reinforce positive behavior 64. Perceived and self-reinforcement becomes more important than external reinforcement 110. DESENSITIZATION 65. Slow adjustment or exposure to feared objects (phobias) 66. Periodic exposure until undesirable behavior disappears or lessens AVERSION THERAPY
  • 11. 111. An example of behavior modification 112. Painful stimulus is introduced to bring about an avoidance of another stimulus 113. End view: behavioral change OTHER THERAPIES 114. HUMOR THERAPY 67. To facilitate expression and enhance interaction 115. ACTIVITY THERAPY 68. Group interaction while working on a task together BIOLOGICAL/ MEDICAL THEORY 116. EMOTIONAL PROBLEM IS AN ILLNESS 117. cause may be inherited or chemical in origin 118. FOCUS OF TREATMENT IS MEDICATIONS AND ECT BIOLOGICAL THERAPY 57. ELECTROCONVULSIVE THERAPY 9. Artificial induction of a grand mal seizure by passing a controlled electrical current through electrodes applied to one or both temples 10. mechanism of action – unclear 11. voltage: 70 – 150 volts 12. Duration: 0.5 – 2.0 seconds 13. 6 to 12 treatments 14. intervals of 48 hours 58. indicators of effectiveness – occurrence of generalized tonic – clonic seizures 59. indications – depression , mania and catatonic schizophrenia 60. s/e: confusion, disorientation, short -term memory loss, seizure (30-60 sec) 61. NPO prior 62. Contraindications 15. Fever, pregnancy 16. Inc ICP, fracture 17. retinal detachment 18. TB with hemoptysis 19. cardiac d/o 63. consent needed 64. Reorient after, supportive care 119. medications given : 69. Atropine sulfate: decrease secretions 70. Succinylcholine (Anectine): promote muscle relaxation 71. Methohexital Sodium ( Brevital ): serves as an anesthetic agent 120. common complications: 72. loss of memory 73. headache
  • 12. 74. apnea 75. fracture 76. respiratory depression Psychopharmacologic Therapy Benzodiazepines 121. Indications 77. Anxiety 78. Sedation/sleep 79. Muscle spasm 80. Seizure disorder 81. Alcohol withdrawal syndromes Anti-anxiety drugs Generic Trade name Alprazolam Xanax Chlordiazepoxide Librium Clorazepate Tranxene Diazepam Valium Lorazepam Ativan Oxazepam Serax Busipirone BuSpar Side effects 122. Drowsiness/ sedation 123. Ataxia 124. Feelings of detachment 125. Increase irritability and hostility 126. Anterograde amnesia 127. Increased appetite & weight gain 128. Nausea 129. Headache, confusion Anti-depressants 130. Indications 82. Depression 83. Bipolar depression 84. Panic disorder 85. Bulimia 86. Obsessive-compulsive d/o 131. Possibly 87. Attention deficit/Hyperactivity d/o 88. Post Traumatic Stress D/o 89. Conduct d/o Tricyclic (TCA) Generic Trade name Amitriptyline Elavil Imipramine Tofranil
  • 13. Trimipramine Surmontil Nortriptyline Pamelor Trazodone Desyrel Bupropion Wellbutrin Side effects 132. Orthostatic hypertension 133. Anticholinergic effect 90. Dry mouth, blurred vision, constipation, excessive sweating, urinary hesitancy/ retention, tachycardia, agitation, delirium, exacerbation of glaucoma 134. Neurologic effects 91. sedation, psychomotor slowing, poor concentration, fatigue, ataxia, tremors 135. Decrease libido and sexual performance Monoamine Oxidase inhibitors Generic Trade name Isocarboxazid Marplan Phenelzine Nardil Tranylcypromine Parnate Side effects 136. Postural lightheadedness 137. Constipation 138. Delay ejaculation or orgasm 139. Muscle twitching 140. Drowsiness 141. Dry mouth Dietary restrictions 142. Cheese, esp. aged and matured 143. Fermented or aged protein 144. Pickled or smoked fish 145. Beer, red wine, sherry; liquor & cognac 146. Yeast 147. Fava or broad beans 148. Beef or chicken liver 149. Spoiled/ overripe fruits; banana peel 150. yogurt Hypertensive Crisis 151. Signs 92. Sudden elevation of BP 93. Explosive headache, occipital may radiate frontally 94. Head & face flushed 95. Palpitations, chest pain 96. Sweating, fever
  • 14. 97. Nausea, vomiting 98. Dilated pupils, photophobia 99. Intracranial bleeding 152. Treatment 100. Hold next MAO dose 101. Don’t let pt. lie down 102. IM chlorpromazine 100 mg 103. Fever: manage by external cooling techniques Serotonin Reuptake Inhibitors Generic Trade name Fluoxetine Prozac Sertraline Zoloft Paroxetine Paxil Venlafaxine Effexor Side effects 153. Nausea 154. Diarrhea 155. Insomnia 156. Dry mouth 157. Nervousness 158. Headache 159. Male sexual dysfunction 160. Drowsiness 161. Dizziness 162. Sweating Mood stabilizing drugs 163. Indications 104. Acute mania 105. Bipolar prophylaxis 164. Possibly 106. Bulimia 107. Alcohol abuse 108. Aggressive behavior 109. schizoaffective 165. Mode of action 110. Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine and dopamine 111. Reduces the release of norepinephrine thru competition with calcium 112. Effects intracellularly 166. Lag period: 7-10 to 14 days Lithium carbonate
  • 15. 167. Trade names 113. Eskalith 114. Lithotabs 115. Lithane 116. Lithonate 65. MOA: unclear; interfere with metabolism of neurotransmitters; alter Na transport in nerves and muscle cells 168. Prelithium workup 117. Urinalysis (BUN and creatinine) 118. ECG, FBC, CBC Side effects 169. Early 119. Nausea and diarrhea 120. Anorexia 121. Fine hand tremor (propranolol) 122. Thirst, Polydipsia (dec. crea, inc. albumin) 123. Metallic taste 124. Fatigue 125. Lethargy 170. Late 126. Weight gain 127. acne Contraindications 171. Brain damage/ CV disease 172. Epilepsy 173. Elderly/ debilitated 174. Thyroid and renal disease 175. Severe dehydration 176. Pregnancy (1st trimester) 177. Can augment the effects of anti-depressants Nursing considerations 66. Therapeutic serum level: 0.5 – 1.2 meq/L 67. Maintenance level: 0.6 -1.2 meq/L 68. Toxic 20. Mild to moderate: 1.5 to 2 meq/L 21. Moderate to severe: 2 – 2.5 meq/L 22. Needs dialysis: 3 meq and above 69. Early signs of toxicity 23. Lethargy, mild nausea, vomiting, fine hand tremors, anorexia, polyuria, polydipsia, metallic taste, fatigue 70. Late signs of toxicity 24. Ataxia, giddiness, tinnitus, blurred vision, polyuria
  • 16. Nursing considerations 71. Lithium levels should be checked q 2-3 mos 72. Serum drawn in the AM, 12H after last dose 73. Common causes of inc. levels 25. Dec. Na intake 26. Diuretic therapy 27. Dec. renal functioning 28. F&E loss 29. Medical illness 30. Overdose 31. NSAIDS Nursing considerations 178. Diet: adequate Na+ and fluid 128. 3g NaCl/ day 129. 6-8 glasses of H2O 179. No caffeine 180. No driving: wait for clinical effect Management 74. Moderately severe toxicity 32. Osmotic diuresis: urea/ mannitol 33. Aminophylline & PLR IV 34. Adequate NaCl 35. Peritoneal/ hemodialysis 75. Severe toxicity 36. Assess hx quickly 37. Hold next lithium dose 38. Check BP, rectal T°, RR, LOC, support O2 39. Obtain labs 40. ECG 41. Emetic, NGT lavage 42. Hydrate: 5-6L/day c PLR; FBC-CDU Other drugs 181. Carbamazepine (Tegretol) 130. Side effects 0. Dizziness 1. Ataxia 2. Clumsiness 3. Sedation 4. Dysarthria 5. Diplopia 6. Nausea & GI upset 131. Preparation: liq, tab, chewable tab Nursing considerations 182. Assess drug levels q 3-4 days
  • 17. 183. Monitor salt and fluid intake 184. Avoid alcohol and non-prescription drugs 185. Refer dec. in UO 186. Don’t stop abruptly 187. C/I: pregnancy 188. Take with meals Other drugs 189. Valproic acid (Depakote, Depakene) 132. Side effects 7. Nausea 8. Hepatoxicity 9. Neurotoxicity 10. Hematological toxicity 11. Pancreatitis 133. Prep: tab, cap, sprinkles 190. MOA: inc. levels of GABA; inhibits the kindling process or “snoball”-like effect seen in mania & seizures Nursing considerations 191. Therapeutic level: 50 – 100 ug/mL 192. Dose: 1, 000 – 1,500 mg/day 193. Monitor serum levels 12H after last dose 194. Toxic effects 134. Severe diarrhea, vomiting, drowsiness, mm. weakness, lack of coordination 135. Renal failure, coma, death Anti-psychotic drugs 195. Indications 136. Psychotic symptoms of schizophrenia, acute mania and depression 137. Gilles de Tourette disorder 138. Treatment-resistant bipolar disorder 139. Huntington’s disease and other movement disorder 196. Possibly 140. Paranoid 141. Childhood psychoses 197. MOA: block receptors of dopamine (D2, D3, D4) 198. If unresponsive after 6 weeks of therapy, another class is tried 199. General considerations 142. Calms without producing impairment of sleep 143. High therapeutic index 144. Non addicting, no tolerance 145. Avoided in pregnancy TYPICAL: High Potency Fluphenazine (Prolixin)
  • 18. Haloperidol (Haldol) Thiothexene (Navane) Trifluoperazine (Stelazine) Moderate Potency Loxapine (Loxitane) Molindone (Moban) Perphenazine (Trilafon) Low Potency Chlopromazine (Thorazine) Chlorprothixene (Taractan) Mesoridazine (Serentil) Thioridazine (Mellaril) ATYPICAL Clozapine (Clozaril) Resperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Sertindole (Serlec’t) Ziprasidone (Zeldox) Contraindications 200. CNS depression: brain damage, excess alcohol/ narcotics 201. Parkinson’s disease 202. Allergy 203. Blood dyscrasias 204. Acute narrow angle glaucoma 205. BPH Side effects 206. Hypotension 207. Sedation 208. Dermal and ocular syndrome 209. Neuroleptic malignant syndrome 210. Anticholinergic syndrome 211. Movement syndrome (Extrapyramidal Syndrome) 212. Atropine psychosis 213. Agranulocytosis 214. Seizures Neuroleptic Malignant Syndrome 76. A potentially fatal, idiosyncratic reaction to an antipsychotic drug 77. 10-20% mortality rate 78. Sx: 43. rigidity, 44. high fever, 45. autonomic instability (BP, diaphoresis, pallor, delirium, elev. CPK), confused or mute, fluctuate from agitation to stupor 79. Occurs in the first 2 weeks of therapy
  • 19. 80. Risk: high dose of high-potency drugs; dehydration, poor nx, concurrent med illness Movement Syndromes 215. Akathisia 216. Dystonia 217. Tardive dyskinesia 218. Bradykinesia 219. Parkinsonism Other s/e 220. Atropine psychosis (geriatrics) 146. Hyperactivity, agitation, confusion, flushed skin, sluggish reactive pupils 147. TTT: IM physostigmine 221. Agranulocytosis (Clozapine) 148. Occurs 3-8 wks after 149. Medical emergency 150. s/s: fever, malaise, sore throat, leukopenia 151. TTT: d/c, reverse iso, antibiotics 222. Seizures (Clozapine) 152. Occurs in 5% of patients; TTT: D/c drug Anticholinergics Benztropine (Cogentin) Trihexyphenidyl (Artane) Biperiden (Akineton) Procyclidine (Kemadrin) 223. Not withdrawn abruptly 224. Provide cool environment ANTIPARKINSONIAN MEDICATIONS 81. Adjunct to anti-psychotic agents to balance dopamine/ acetylcholine in the brain 82. s/e: glaucoma, tachycardia, HPN, cardiac dx, asthma, duodenal ulcer 83. A/e: blurred vision, photosensitivity, drowsiness, orthostatic hypotension, CHF, hallucinations 225. COMMON DRUGS: 153. Trihexyphenidyl (Artane) 154. benztropine (Cogentin) 155. Biperiden (Cogentin) 156. Selegiline (Eldepryl) 157. Pergolide (Permax) 226. ANTIHISTAMINE
  • 20. 158. Diphenhydramine HCl (BENADRYL) 227. DOPAMINE RELEASING AGENT 159. Amantadine (SYMMETREL) 228. Nursing considerations 160. Best taken after meals 161. Avoid driving 162. Check BP 163. Alcohol increases sedative effects 164. Avoid sudden position change 165. Drug is not withdrawn abruptly PSYCHIATRIC DISORDERS ANXIETY DISORDERS 5. PANIC DISORDERS 6. SPECIFIC PHOBIA 7. SOCIAL PHOBIA 8. OCD 9. PTSD 10. ACUTE STRESS DISORDER 11. GENERALIZED ANXIETY DISORDER PANIC ATTACKS 229. Discrete period of intense fear or discomfort in which at least 4 if the ff sx develop abruptly and peak within 10 mins: 166. Palpitations, pounding heart, or accelerated HR 167. Sweating 168. Trembling or shaking 169. Sensations of SOB and smothering 170. Feeling of choking 171. Chest pain or discomfort 172. Nausea or abd. Pain 173. Feeling dizzy, unsteady, lightheaded or faint 174. Derealization or depersonalization 175. Fear of losing control or going crazy 176. Fear of dying 177. Paresthesias 178. Chills or hot flashes SPECIFICS ¨ PHOBIA ¨ © SOCIAL 84. Excessive and unreasonable cued by the presence or anticipation of a specific object or situation 85. Defense mech commonly used include repression and displacement 86. Fear of social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others OBSESSION COMPULSION
  • 21. 87. Recurrent and persistent thoughts, impulses, or images are experienced during the disturbance as intrusive and inappropriate 88. Cause anxiety or distress 89.Px knows that these are just product of one’s own mind. 90. Px feels driven to perform repetitive behaviors or mental acts in response to obsession or according to the rules that one deems must be applied rigidly. 91. Aimed at reducing anxiety OBSESSION COMPULSION 12. Fear of dirt & germs 13. Fear of burglary or robbery 14. Worries about discarding something important 15. Concerns about contracting a serious illness 16. Worries that things must be symmetrical or matching 17. Excessive hand washing 18. Repeated checking of door and window locks 19. Counting and recounting of objects in everyday life 20. Hoarding of objects 21. Excessive straightening, ordering, or of arranging things 22. Repeating words or prayers silently POST TRAUMATIC STRESS SYNDROME 230. Person has experienced, witnessed or been confronted with an event that involved actual or threatened death or serious injury, or a threat to physical integrity 231. Person reexperiences these in the mind 232. Involves intense fear, helplessness, or horror and numbing of general responsiveness (PSYCHIC NUMBING) ACUTE GENERALIZED STRESS ANXIETY 92. Meets the criteria for exposure to a traumatic event and person experiences 3 of the ff sx: 46. sense of detachment, 47. reduced awareness of one’s surroundings, 48. derealization, 49. depersonalization, 50. dissociated amnesia 93. Excessive anxiety or worry, occurring in more days than not for at least 6 mos, about a number of events or activities 94. Finds it difficult to control the worry MOOD/ AFFECTIVE DISORDERS 95. BIPOLAR D/O
  • 22. 179. BIPOLAR I: current or past experience of manic episode, lasting at least a week, that is severe enough to cause extreme impairment in social or occupational functioning. 23. MANIA: hyperactivity 24. DEPRESSED: extreme sadness or withdrawal 25. MIXED 180. BIPOLAR II: hx of 1 or more mj depressive episodes & at least 1 hypomanic episode; no mania 233. MAJOR DEPRESSIVE D/O 181. @ least 5 sx of same 2- wk period with one being either depressed mood or loss of interest or pleasure. 182. Single episode or recurrent 183. Other sx: wt loss, insomnia, fatigue, recurrent thoughts of death, diminished ability to think, psychomotor agitation or retardation, feelings of worthlessness. 234. CYCLOTHYMIC D/O 184. Hx of 2 yrs of hypomania with numerous periods of abnormally elevated, expansive or irritable moods. 185. Does not meet the criteria of mania or depression. 235. DYSTHYMIC D/O 186. @ least 2 yrs of usually depressed mood and at least 1 of the sx of mj depression without meeting the criteria for it 236. SEASONAL AFFECTIVE D/O 187. Depression that comes with shortened daylight in fall and winter that disappears during spring and summer. Dealing with Inappropriate Behaviors AGGRESSIVE BEHAVIOR 96. Assist the client in identifying feelings of frustration and aggression 97. Encourage the client to talk out instead of acting out feelings of frustration 98. Assist the client in identifying precipitating events or situations that lead to aggressive behavior 99. Describe the consequences of the behavior on self and others 100. Assist in identifying previous coping mechanisms 101. Assist the client in the problem-solving techniques to cope with frustration or aggression DEESCALATION TECHNIQUES 102. Maintain safety 103. Maintain large personal space and use nonaggressive posture 104. Use calm approach and communicate with a calm, clear tone of voice (be assertive not aggressive 105. Determine what the client considers to be his or her need 106. Avoid verbal struggles
  • 23. 107. Provide clear options that deal with behavior 108. Assist with problem-solving and decision making regarding the options MANIPULATIVE BEHAVIORS 237. Set clear, consistent, realistic, and enforceable limits and communicate expected behaviors 238. Be clear about consequences associated with exceeding set limits 239. Discuss behavior in nonjudgmental and nonthreatening manner 240. Avoid power struggles 241. Assist in developing means of setting limits on own behavior SCHIZOPHRENIA 109. characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. 110. Once considered as a deadly disease 111. There is lack of insight in behavior 112. Dx: late adolescence and early adulthood 51. 15-25 y.o. (men); 25-35 y.o. (women) 113. Obsolete term: dementia praecox = “cognitive deterioration early in life” 114. Eugene Bleuler: schiz “split”; phren “mind” Risk factors 26. Genetics: identical twins 50%, 15% for fraternal twins 27. Biochemical factors 0. Dopamine hypothesis: overactive 1. Serotonin imbalance 2. Decreased brain volume, enlarged ventricles, deeper fissures, and loss or underdeveloped brain tissue 28. Psychoanalytic 3. lack of trust during the early stages 4. Weak ego 5. Defenses: REPRESSION, REGRESSION, PROJECTION 29. Environment influences: poverty, lack of social support, hostile home environment, isolation, unsatisfactory housing, disruption in interpersonal relationships (divorce or death), job pressure or unemployment Subtypes 242. Catatonic type 188. prominent psychomotor disturbances are evident. Symptoms can include catatonic stupor and waxy flexibility 243. Disorganized type 189. where thought disorder and flat affect are present together 244. Paranoid type 190. where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent 12.Residual type
  • 24. 4. where positive symptoms are present at a low intensity only 13.Undifferentiated type 5. psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types has not been met Symptoms According to Bleuler: 4 A’s 191. Affect is inappropriate 192. Associative looseness 193. Autistic thinking 194. Ambivalence Symptoms 245. Positive symptoms 195. delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. 246. Negative symptoms 196. considered to be the loss or absence of normal traits or abilities 197. E.G. flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Symptoms 30.Social isolation 31.Catatonic behavior 32.Hallucinations 33.Incoherence (marked looseness of association) 34.Zero/ lack of interest, energy and initiative 35.Obvious failure to attain expected level of dev’t 36.Peculiar behavior 37.Hygiene and grooming impaired 38.Recurrent illusions and unusual perception experiences 39.Exacerbations and remissions are common 40.No organic factors accounts for the symptoms 41.Inability to return to baseline functioning after relapse 42.Affect is inappropriate Nsg Dx: Abnormal thought process 115. BLOCKING: sudden cessation of a thought in the middle of a sentence, unable to continue the train of thought
  • 25. 116. CIRCUMSTANTIALITY: before getting to the point of answering a question, the individual gets caught up in countless details and explanations 117. CONFABULATION 118. LOOSENESS OF ASSOCIATION 119. NEOLOGISM 120. WORD SALAD Interventions 121. Assess physical needs 122. Set limits 123. Maintain safety 124. Initiate one-on-one interaction & progress to small groups 125. Spend time with clients 126. Monitor for altered thought process 127. Maintain ego boundaries, avoid touching 128. Limit time of interaction 129. Be neutral 130. Do not make promises that can’t be kept 247. Establish daily routines 248. Do not “go along” with the client’s delusions or hallucinations 249. Provide simple complete activities 250. Reorient 251. Speak to the client in simple direct and concise manner 252. Set realistic goals 253. Explain everything that is being done 254. Decrease stimuli 255. Monitor for suicide risk 256. Environment 198. Provide safe environment 199. Limit stimuli 257. Psychological Ttt 200. Behavior therapy 201. Social skills training 202. Self-monitoring 258. Social ttt 203. Milieu therapy 204. Family therapy 205. Group therapy (long-term ttt) Related psychotic disorders 259. SCHIZOAFFECTIVE DISORDER schiz + mood disorder (mania/ depression) 260. BRIEF PSYCHOTIC DISORDER sudden onset of psychotic symptoms, lasts less than 2 mos and client returns to premorbid level of functioning
  • 26. 261. SCHIZOPHRENIFORM DISORDER schiz sx lasting between 1 month and <6mos 262. DELUSIONAL DISORDER characterized by prominent, nonbizarre delusions PERSONALITY DISORDERS 0. CLUSTER A (odd & eccentric) 0. paranoid, schizoid, schizotypal 1. CLUSTER B (bad, dramatic & erratic) 1. antisocial, borderline, histrionic, narcissistic 2. CLUSTER C (anxious & fearful) 2. avoidant, dependent, OCD CLUSTER A: ODD & ECCENTRIC 131. PARANOID 52. chronic hostility projected to others; suspicious and mistrusts people 53. Seen mostly in men 132. SCHIZOID 54. social detachment = “loner” & “introvert” 55. Restriction of emotions 56. Attention fixed on objects rather than people 57. Functions well in vocations 133. SCHIZOTYPAL: interpersonal deficits 58. Magical thinking, telepathy 59. Apparent in childhood or adolescence Interventions for PARANOID D/O 14. Asses for suicide risk 15. Avoid direct eye contact 16. Establish trusting relationship 17. Promote increased self-esteem 18. Remain calm, nonthreatening and nonjudgmental 19. Provide continuity of care 20. Respond honestly to the client 21. Follow thru on commitments 22. Provide a daily schedule of activities 23. Gradually introduce client to groups 24. Do not argue with delusions 25. Use concrete, specific words 263. Do not be secretive with client 264. Do not whisper in presence of client 265. Assure that the client will be safe 266. Provide opportunity to complete small tasks 267. Monitor eating, drinking, sleeping and elimination patterns 268. Limit physical contact 269. Monitor for agitation and decrease stimuli as needed
  • 27. CLUSTER B: ERRATIC, DRAMATIC, OR EMOTIONAL 270. ANTISOCIAL 206. Syn: sociopath, psychopathic & semantic d/o 207. Etiology: 43. Genetics interfere in the dev’t of positive interpersonal relationships 44. Brain damage or trauma 45. Low socioeconomic status 46. Faulty family relationships: neglect 47. Secondary gains 208. 15-40 y.o. 271. Signs 209. Lack of remorse or indifference to persons hurt 210. Immediate gratification 211. Failure to accept social norms 212. Impulsivity 213. Consistent irresponsibility 214. Aggressive behavior 215. Reckless behavior that disregards the safety of others 272. 80-90% of all crime is committed by antisocials (NIHM, 2000) 26. BORDERLINE 6. Latent, ambulatory and abortive schizophrenics 7. Between moderate neurosis and frank psychosis but quite stable 8. Theories 134. faulty separation from mother; parent and child are bound by guilt 135. Trauma at 18 mos (weakening of ego) 136. Unfulfilled need for intimacy 273. Signs 216. instability 217. Impulsivity: unpredictable gambling, shoplifting, sex & substance abuse 218. hypersensitivity, self-destructive, profound mood shifts 219. unstable & intense relations 220. Disturbance in self concept 274. Common in women 275. Defenses: denial, projection, splitting, projective identification
  • 28. 276. HISTRIONIC 221. Pattern of theatrical or overtly dramatic behavior 222. Signs 48. Discomfort when the client isn’t the center of attention 49. Self-dramatization and exaggerated emotions 50. uses physical appearance, sexually seductive and provocative behavior 51. Excessively impressionistic speech lacking in detail (labile emotions) 223. Problems in dependence & helplessness 224. More frequent in women 277. NARCISSISTIC 225. Exaggerated or grandiose sense of self-importance 226. Develop early in childhood 227. Preoccupied with fantasies of unlimited success, power and beauty 228. Signs 52. arrogance, need for admiration, 53. lack of empathy, 54. seductive, socially exploitative, manipulative 229. Occurs more in men CLUSTER C: ANXIOUS OR FEARFUL 278. AVOIDANT 230. Sensitive to rejection, criticism, humiliation, disapproval, or shame 231. Interferes with participation in occupational activities, dev’t of relationships, and take personal risks 232. social inhibition, longs for relationships 233. Anxiety, anger and depression are common 234. Social phobia may occur 235. Seen in 10% of clients in mental clinics 279. DEPENDENT 236. Lacks confidence and unable to function in an independent role 237. Allows other persons to be responsible of their lives 238. Most frequent personality disorder in the mental health clinic 239. submissive behavior, low self-esteem, inadequate, helpless 280. OBSESSIVE-COMPULSIVE 240. Preoccupied with rules & regulations, overly concerned about trivial detail, excessively devoted to their work 241. Depression is common 242. Men are more affected than women UNDER STUDY PERSONALITY D/O
  • 29. 281. PASSIVE-AGGRESSIVE: sullen and argumentative, resents others, resists fulfilling responsibilities, complains of being unappreciated 282. DEPRESSIVE: gloomy, brooding pessimistic, guilt-prone, highly critical of self and others, cheerless. Interventions 137. Maintain safety against self-destructive behaviors 138. Allow the client to make choices and be as independent as possible 139. Encourage the client to discuss feelings rather than act them out 140. Provide consistency in response to the client’s acting out 141. Discuss expectations and responsibilities with the client 142. Inform the client that harm to self, others, and property is unacceptable 283. Identify splitting behavior 284. Assist the client to deal directly with anger 285. Develop a written contract with the client 286. Encourage the client to participate in group activities, and praise nonmanipulative behavior 287. Set and maintain limits 288. Remove the client from group situations in which attention-seeking behaviors occur 289. Provide realistic praise for positive behaviors in social situations PSYCHOLOGICAL SEXUAL D/O 290. Hypoactive sexual disorder (asexuality) 291. Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse) 292. Female sexual arousal d/o (failure of normal lubricating arousal response) 293. Male erectile d/o 294. Female orgasmic disorder 295. Male orgasmic disorder 296. Premature ejaculation 143. Vaginismus 144. Secondary sexual dysfxn 145. Paraphilias 146. Gender identity d/o 147. PTSD due to genital mutilation or childhood sexual abuse Other sexual problems 148. Sexual dissatisfaction (non-specific) 149. Lack of sexual desire 150. anorgasmia 151. Impotence 152. STD
  • 30. 297. Infidelity 298. Delay or absence of ejaculation, despite adequate stimulation 299. Inability to control timing of ejaculation 300. Inability to relax vaginal muscles enough to allow intercourse 301. Inadequate vaginal lubrication preceding and during intercourse 302. Burning pain on the vulva or in the vagina with contact to those areas 303. Unhappiness or confusion related to sexual orientation 304. Persistent sexual arousal syndrome 305. Sexual addict 306. hypersexuality 307. Post Ejaculatory Guilt Syndrome, the feeling of guilt after the male orgasm SEXUAL EXPRESSION 308. HETEROSEXUALITY 309. HOMOSEXUALITY 310. BISEXUALITY 311. TRANSVESTISM PARAPHILIAS 312. EXHIBITIONISM: the recurrent urge or behavior to expose one's genitals to an unsuspecting person. 313. FETISHISM: the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body. 314. FROTTEURISM: the recurrent urges or behavior of touching or rubbing against a nonconsenting person. 315. SEXUAL MASOCHISM: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer. 316. SEXUAL SADISM: the recurrent urge or behavior involving acts in which the pain or humiliation of the victim is sexually exciting. 317. TRANSVESTIC FETISHISM: a sexual attraction towards the clothing of the opposite gender. 318. PEDOPHILIA: the sexual attraction to prepubescent or peripubescent children. 319. VOYEURISM: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.
  • 31. 320. Other paraphilias not otherwise specified (quot;Sexual Disorder NOSquot;) 243. telephone scatalogia (obscene phone calls) 244. necrophilia (corpses) 245. partialism (exclusive focus on one part of the body) 246. zoophilia(animals) 247. coprophilia (feces) 248. klismaphilia (enemas) 249. urophilia (urine) SOMATOFORM D/O 153. SOMATIZATION D/O: hx of many physical complaints beginning before the age of 30 occurring over a pd of several yrs resulting in ttt being sought or significant occupational or social fxning. 154. CONVERSION D/O: 1 or more sx of deficits affecting voluntary motor or sensory function suggesting a neurological or general medical condition; preceded by conflicts or stressors; can’t be explained and sanctioned by cultural behavior. 60. Most common: blindness, deafness, paralysis, inability to talk 61. “La belle indifference” 321. HYPOCHONDRIASIS: preoccupation with fears of having, or ideas that one has, a serious dse based on the person’s misinterpretation of bodily sx and persist despite appropriate medical eval and reassurance and has existed for @ least 6 mos. (e.g.:extensive use of home remedies) 322. PAIN D/O: pain in 1 or more anatomical sites severe enough to warrant clinical attention and causes clinically significant distress or impairment in fxning. Interventions 323. Do not reinforce the sick role 324. Discourage verbalization about physical symptoms by not responding with positive reinforcement 325. Explore with the client the needs being met by the physical symptoms 326. Convey understanding that the physical symptoms are real to the client 327. Report and assess any new physical complaint 0. next EATING DISORDER BEHAVIORS 155. BINGE: rapid consumption of large quantities of food in a discrete period of time. (A: hundrends of Cal; B: thousands of Cal at a sitting) 156. PURGE: Maladaptive eating regulation response that includes excessive exercise, forced vomiting, OCD Rx diuretics, diet pills, laxatives and steroids.
  • 32. 157. FAST/ RESTRICT: Includes vegetarian diet eliminating all meat without substituting nonanimal sources of protein, OC about food choices, and eating habits. ANOREXIA BULIMIA 55. Rare vomiting or diuretic/laxative abuse 56. More severe wt loss 57. Slightly younger 58. More introverted 59. Hunger denied 60. Eating behavior may be considered normal and a source of esteem 61. Sexually inactive 62. Obsessional and perfectionist features dominate 63. Frequent 64. Less wt loss 65. Slightly older 66. More extroverted 67. Hunger experienced 68. Eating behavior considered foreign and source of distress 69. More sexually active 70. Avoidant, dependent, or borderline features as well as obsessional features ANOREXIA BULIMIA complications 158. Death from starvation (or suicide, in chronically ill) 159. Amenorrhea 160. Fewer behavioral problems (these increase with level of severity) 161. Death from hypokalemia or suicide 162. Menses irregular or absent 163. Drug and alcohol abuse, self-mutilation, and other behavioral problems DELIRIUM 71. The medical dx term that describes an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset with a specific precipitating factor. 72. Sx: diminished awareness of the environment, disturbances in psychomotor activity and sleep-wake cycle. 73. COGNITIVE: the mental process characterized by knowing, thinking, and judging. 6. COGNITIVE DISSONANCE: arises when 2 opposing beliefs exists at the same time. 7. COGNITIVE DISTORTIONS: (+) or (-) distortions of reality that might include errors of logic, mistakes in reasoning, or individualized view of the world that do not reflect reality. 8. Term: confusion = cognitive impairment 0. See dementia DEMENTIA
  • 33. 164. The medical dx term that describes an organic mental d/o characterized by a cluster of cognitive impairments of generally gradual onset and irreversible without identifiable precipitating stressors. 165. Types: 62. VASCULAR or MULTI-INFARCT 63. VASCULAR WITH ALZHEIMER’S DSE 64. AD: most common 65. DEMENTIA WITH LEWY BODIES: 2nd most common; neurofilament material 66. PARKINSONIAN DEMENTIA 67. AIDS DEMENTIA COMPLEX 250. FRONTAL LOBE DEMENTIA or PICK’S DSE: cytoplasmic collections; 3rd most common; loss of expressive language & comprehension 251. CREUTZFELDT-JAKOB DSE: prion (proteinaceous infectious particles) = spongy brain; related to TSE & BSE in mad cow dse 252. CORTICOBASAL DEGENERATION or HUNTINGTON’S DSE/ CHOREA: jerky mov’ts 253. SUPRANUCLEAR PALSY: clumping of protein tau = slow mov’t, weak eye mov’t (esp. downward), impaired walking &balance 166. Reversible Causes: 68. Subdural hematoma 69. Tumor (meningioma) 70. Cerebral vasculitis 71. Hydrocephalus 167. Terms: disorientation, memory loss (sensory, primary, secondary, tertiary, working memory), confabulation, confusion 168. Disturbing behaviors 72. Aggressive psychomotor 73. Nonaggressive psychomotor 74. Verbally aggressive 75. Passive 76. Functionally impaired: loss of ability to do self-care DELIRIUM vs. DEMENTIA 169. Rapid onset w/ wide fluctuations 170. Hyperalert to difficult to arouse LOC 171. Fluctuating affect 172. Disoriented, confused 173. Attention & sleep disturbed 174. Memory impaired
  • 34. 175. Disordered reasoning 176. Gradual, chronic with continuous decline 177. Normal LOC 178. Labile affect 179. Disoriented, confused Attention intact, sleep usually normal 180. Memory impaired 181. Disordered reasoning & calculation DELIRIUM vs. DEMENTIA 182. Incoherent, confused, delusional, stereotyped 183. Illusions, hallucinations 184. Poor judgment 185. Insight may be present in lucid moment 186. Poor but variable in MSE 0. next 187. Disorganized, rich in content, delusional, paranoid 188. No change in perception 189. Poor judgment 190. No insight 191. Consistently poor & progressively worsens in MSE ALZHEIMER’S DEMENTIA 27. Most common type of dementia 28. Stages: 0. MILD: impaired memory, insidious loses in ADL, subtle personality changes, socially normal 1. MODERATE: obvious memory loss, overt ADL impairment, prominent behavioral difficulties, variable social skills, supervision needed 2. SEVERE: fragmented memory, no recognition of familiar people, assistance needed with basic ADL, fewer troublesome behaviors, reduced mobility (4 A’s) Symptoms 328. AGNOSIA: Difficulty recognizing well-known objects 329. APHASIA: Difficulty in finding the right word 330. APRAXIA: Inability or difficulty in performing a purposeful organized task or similar skilled activities 331. AMNESIA: Significant memory impairment in the absence of clouded consciousness or other cognitive symptoms PSYCHIATRIC D/O IN CHILDREN 192. MENTAL RETARDATION 193. PERVASIVE DEV’TAL D/O 77. AUTISM 78. RETT’S D/O
  • 35. 79. CHILDHOOD DISINTEGRATIVE D/O 80. ASPERGER’S D/O 81. PDD NOS 194. LEARNING D/O 82. READING 83. MATHEMATICS 84. WRITTEN EXPRESSION 85. ACADEMIC PROBLEM 86. LEARNING D/O NOS 332. MOTOR SKILLS D/O 333. COMMUNICATION D/O 254. EXPRESSIVE LANGUAGE 255. MIXED RECEPTIVE/EXPRESSIVE 256. PHONOLOGICAL 257. STUTTERING 258. SELECTIVE MUTISM 259. COMMUNICATION D/O NOS 334. MOV’T & TIC D/O 260. DEV’TAL COORDINATION 261. TRANSIENT TIC 262. CHRONIC MOTOR&VOCAL TIC 263. TOURETTE’S D/O 264. STEREOTYPIC MOV’T D/O 265. TIC D/O NOS 335. DISORDERS OF INTAKE & ELIMINATION 266. PICA 267. RUMINATION 268. FEEDING D/O 269. ENURESIS 270. ENCOPRESIS 271. OTHER: BULIMIA, ANOREXIA 195. ADHD & DISRUPTIVE BEHAVIOR D/O 87. ADHD 88. ADHD NOS 89. CONDUCT D/O 90. OPPOSITIONAL DEFIANT 91. CHILD ANTISOCIAL 92. DISRUPTIVE BEHAVIOR NOS 196. MOOD D/O 93. MJ DEPRESSIVE D/O 94. BIPOLAR I OR II 95. DYSTHYMIC 96. MIXED EPISODE
  • 36. 97. HYPOMANIC EPISODE 98. MOOD D/O DUE TO MEDICAL CONDITION 99. SUBSTANCE-INDUCED MOOD D/O 336. ANXIETY D/O 337. D/O OF RELATIONSHIP 272. SEPARATION ANXIETY 273. REACTIVE ATTACHMENT OF INFANCY OR EARLY CHILDHOOD 274. PARENT-CHILD RELATIONAL PROBLEM 275. SIBLING RELATIONAL PROBLEM 276. PROBLEMS RELATED TO ABUSE OR NEGLECT MENTAL RETARDATION 74. an IQ below 70, significant limitations in two or more areas of adaptive behavior (i.e., ability to function at age level in an ordinary environment), and evidence that the limitations became apparent in before 18 y.o. 75.The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use today: 76. Class IQ Terms Profound Below 20 Idiot Severe 20–34 Imbecile Moderate 35–49 Moron Mild 50–69 Borderline 70–79 RETT’S D/O 197. Development is normal until 6-18 months, when language and motor milestones regress, 198. purposeful hand use is lost 199. Acquired deceleration in the rate of head growth (resulting in microcephaly in some) 200. Hand stereotypes are typical and breathing irregularities such as hyperventilation, breath holding, or sighing are seen in many. 201. Early on, autistic-like behavior may be seen 202. Common in females CHILDHOOD DISINTEGRATIVE D/O or HELLER’S SYNDROME 338. CDD has some similarity to autism, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills. 339. characterized by late onset (>3 years of age) of dev’tal delays in language, social function and motor skills; skills apparently attained are lost ASPERGER’S D/O 77. characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. 78. Signs: unable to interpret or understand the desires or intentions of others and thereby are unable to predict what to expect of others or what others may expect of them
  • 37. 9. Narrow interests or preoccupation with a subject to the exclusion of other activities 10. Repetitive behaviors or rituals 11. Peculiarities in speech and language 12. Extensive logical/technical patterns of thought 13. Socially and emotionally inappropriate behavior and interpersonal interaction 14. Problems with nonverbal communication 15. Clumsy and uncoordinated motor mov’ts CHRONIC MOTOR/ VOCAL TIC 340. TIC is a sudden, repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic) that involves discrete groups of muscles. 341. can be invisible to the observer (e.g. abdominal tensing or toe crunching) TOURETTE’S D/O 342. characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane 343. TTT: Neuroleptic medications 277. haloperidol (Haldol) 278. pimozide (Orap) ADHD Inattention: 0. Failure to pay close attention to details or making careless mistakes when doing schoolwork or other activities 1. Trouble keeping attention focused during play or tasks 2. Appearing not to listen when spoken to 3. Failure to follow instructions or finish tasks 4. Avoiding tasks that require a high amount of mental effort and organization, such as school projects 5. Frequently losing items required to facilitate tasks or activities, such as school supplies 6. Excessive distractibility 7. Forgetfulness 8. Procrastination, inability to begin an activity 9. Difficulties with household activities (cleaning, paying bills, etc.) 10. Difficulty falling asleep, may be due to too many thoughts at night 11. Frequent emotional outbursts 12. Easily frustrated 13. Easily distracted Hyperactivity-impulsive behaviour 0. Fidgeting with hands or feet or squirming in seat 1. Leaving seat often, even when inappropriate 2. Running or climbing at inappropriate times 3. Difficulty in quiet play 4. Frequently feeling restless
  • 38. 5. Excessive speech 6. Answering a question before the speaker has finished 7. Failure to await one's turn 8. Interrupting the activities of others at inappropriate times 9. Impulsive spending, leading to financial difficulties 344. Frequently prescribed stimulants are methylphenidate (Ritalin and Concerta), amphetamines (Adderall) and dextroamphetamines (Dexedrine) 345. Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets. CONDUCT D/O 346. repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, 279. AGGRESSION TO PEOPLE & ANIMALS 280. DESTRUCTION OF PROPERTY 281. DECEITFULNESS OR THEFT 282. SERIOUS VIOLATIONS OF RULES 79. Beginning before age 13 OPPOSITIONAL DEFIANT 80. characterized by an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior 81. Signs 100. Losing temper 101. Arguing with adults 102. Refusing to follow the rules 103. Deliberately annoying people 104. Blaming others 105. Easily annoyed 106. Angry and resentful 107. Spiteful or even revengeful 1. next SUBSTANCE ABUSE 203. Excessive or unhealthy use of substances, such as alcohol, tobacco or drugs, or use of products such as food 204. Terms: 108. TOLERANCE: the declining effect of the same drug dose when it is taken repeatedly over time 109. HABITUATION: a psychological dependence of the use of a drug 110. ADDICTION: the biological and/ or psychological behaviors related to substance dependence
  • 39. 111. WITHDRAWAL SYMPTOMS: result from a biological need that develops when the body becomes adapted to having an addictive drug in the system; occurs when serum levels decrease ADDICTION 205. ALCOHOL: blood alcohol levels of 0.1% (100mg alcohol/dl of blood) or higher 112. WITHDRAWAL 0. Anorexia 1. Anxiety 2. Easily startled 3. Hyperalertness 4. HPN 5. Insomnia 6. Irritability 7. Jerky mov’t 8. Possibly: hallucinations, illusions or vivid nightmares 9. Seizures (7-48 hrs after cessation) 10. Tachycardia 11. tremors 283. WITHDRAWAL DELIRIUM 82. Agitation 83. Anorexia 84. Anxiety 85. Delirium 86. Diaphoresis 87. Disorientation with fluctuating levels of consciousness 88. Fever (100 to 103 F) 89. Hallucinations and delusions 90. Insomnia 91. Tachycardia and HPN 284. Disulfiram (Antabuse) therapy Nursing care 0. Obtain info about drug type and amount consumed 1. Assess v/s 2. Remove unnecssary obj from environment 3. Provide one-on-one supervision if necessary 4. Provide a quiet, calm environment with minimal stimuli 5. Maintain orientation 6. Ensure safety 7. Use restraints 8. Provide physical needs 9. Provide food and fluids as tolerated 10. Administer medications 11. Collect blood and urine samples for drug screening SPOUSE ABUSE
  • 40. 206. Battering precipitates 1:4 suicide attempts of all women 207. Wives explain the injuries as being self-inflicted or accidental 208. Phases 113. Tension-building: series of small incidents that leads to beating 114. Acute beating phase: wife becomes object of assault behavior 115. Loving phase: batterer is remorseful and assures spouse that he will not harm her again. This leads to reconciliation. 209. Myths 116. They believe that if they try not to antagonize with their husband, he will change. 117. Efforts to coerce the wife out of the victim role can be fruitful. 210. Facts 118. Women stay in relationships with men who batter because they feel guilty or responsible of the husband’s behavior 119. Wife develops little sense of self-worth, immobilized and unable to remove self from the relationship. 211. Assessment: injuries, other evidence 212. Interventions: with consent CHILD ABUSE 0. PHYSICAL BATTERING 1. EMOTIONAL 2. SEXUAL 3. NEGLECT ELDERLY ABUSE 347. A variety of behaviors that threaten the health, comfort, and possibly the lives of the elderly, including physical and emotional neglect, emotional abuse, violation of personal rights, financial abuse, and direct physical abuse. 348. Commonly committed by care givers. SEXUAL ABUSE 349. Components 285. Sexual Misuse: inappropriate sexual activity 286. Rape: there is actual penetration 287. Incest: refers to the relationship between the victim and abuser blood relative or step parent role 350. Interventions 288. Children: thru play or role playing with puppets 289. Prevention of further sexual abuse 1. next COMPLETED SUICIDE 351. Self-inflicted death 352. LEVELS OF SUICIDE 290. Ideation: thought 291. Attempt: acted upon but failed
  • 41. 292. Completed CHEMICAL RESTRAINT 213. CHEMICAL RESTRAINTS: Medications used to restrict the patient’s freedom of movement or for emergency control of behavior but are not a standard treatment for the px’s medical or psychiatric condition. 214. PHYSICAL RESTRAINTS: Are any manual method or physical or mechanical device attached to or adjacent to the px’s body that he or she cannot easily remove and that restricts freedom of movement or normal access to one’s body, material or equipment. SECLUTION AND RESTRAINTS 353. SECLUTION: the involuntary confinement of a person alone in a room from which the person is physically prevented from leaving. 293. No therapeutic evidence other than a last resort to ensure safety. 294. Evidence suggest that it adds to further trauma and physical harm 215. GUIDELINES 120. All hospital staff who have direct contact with the px should have ongoing education and training in the proper use of seclusion and restraints and other alternatives 121. Physician or licensed practitioner should evaluate need within 1 hour after the initiation of this intervention. 122. Max of 4 hours for adults, 2 hours for ages 9-17, and 1 hour for children under 9 yrs 123. Orders may be renewed for 24 hrs before another face to face evaluation 124. Continuous assessment, monitoring and evaluation; recorded 125. Good nursing care 126. For both restrained and secluded: constant monitoring face to face or by both audio and video equipment. 127. Px should be released ASAP OTHER GUIDELINES 216. SECLUSION 128. Room should allow observation and communication with px 129. Remove all items that px might use to harm self 130. Document: rationale, response to intervention, physical condition, nsg care, & rationale for termination 217. RESTRAINTS 131. Give support & reassurance 132. Position in anatomical position 133. Privacy is important 134. v/s & Circulation check 135. Should be released q 2hrs 136. Avoid tying to the side rails of bed 137. Assist in periodic change in body positions
  • 42. TERMINATING THE INTERVENTION 354. As soon as met the criteria for release 355. Review with px the behavior that precipitated the intervention & px’s capacity to exercise control over behavior 356. DEBRIEFING: reviewing the facts related to an event & processing the response to them; can be used after any stressful event 2. next THERAPEUTIC IMPASSES 357. Are blocks in the progress of the nurse-pt relationship 358. Provokes intense feelings in both the nurse and patient 295. RESISTANCE 296. TRANSFERENCE 297. COUNTERTRANSFERENCE 298. BOUNDARY VIOLATIONS RESISTANCE 359. Reluctance or avoidance of verbalizing or experiencing troubling aspects of oneself 360. Eg: suppression or repression, intensification of sx, self-devaluation or hopelessness, intellectual inhibitions, acting out or irrational behavior, superficial talk, intellectual insight/ intellectualization, transference reactions. TRANSFERENCE 361. Unconscious response in which the px experiences feelings and attitudes toward the nurse that were originally associatated with other significant figures in his or her life. 299. HOSTILE TRANSFERENCE: anger and hostility, resistance 300. DEPENDENT TRANSFERENCE: submissive, subordinate and regards the nurse as a god-like figure; views relationship as magical What do you do? 0. LISTEN 1. CLARIFY 2. REFLECT 3. EXPLORE/ ANALYZE COUNTERTRANSFERENCE 218. Created by the nurse’s specific emotional response to the qualities of the patient; inappropriate in the context, content and intensity of emotion; nurses identify the px with individuals from their past, and personal needs 219. Types: Reactions of INTENSE 301. love or caring 302. Disgust or hostility 303. Anxiety, often in response to resistance by the px 220. Eg.
  • 43. 138. Difficulty empathizing 139. Feelings of depression before or after the session 140. Carelessness about implementing the contract 141. Drowsiness during the sessions 142. Encouragement of the px’s dependency 143. Arguments with the px 144. Personal or social involvement with the px 145. Sexual or aggressive fantasies toward the px 146. Tendency to focus on only one aspect or way of looking at information presented by the px 147. Attempts to help the px with matters not related to the identified nursing problems 148. Feelings of anger or impatience because of the px’s unwillingness to change 149. Dreams about or preoccupation with the px