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Psych Nsg Rvw


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Psych Nsg Rvw

  1. 1. PSYCHIATRIC NURSING Royal Pentagon Rvw Ctr Mr. Mike Jimenez Beliefs—Feelings—Behavior Sigmund Freud – Father of Psychoanalysis -structure of personality Id- impulsive part, pleasure principle -eat, urinate, have sex -it’s all “I” Superego – small voice of God -conscience -should not eat yet, should not eat yet Ego- arbiter, decision maker -in touch with reality Id___________________Superego EGO ID DOMINANT – needs a superego-needs a conscience M- manic A- antisocial – serial killer N- narcissistic SUPEREGO DOMINANT –needs an Id O- Obsessive Compulsive A- Anorexia nervosa EGO – impaired reality perception (RN will present reality) S- schizophrenia- cant distinguish fact from reality Libido- sexual energy FREUD - PSYCHOSEXUAL THEORY ORAL – 0-18 months Cry, suck – mouth- survival Id dominant Maternal deprivation if not feed, not given milk/water, not kept warm. Narcissistic – seeks the Id – I love myself Regression – return to an earlier stage or earlier level Fixation – stopped in a stage ANAL- 18 mos-3yrs Toilet training Mom is superego. Superego is being formed Child is caught in ambivalence – pulled in 2 opposing factors Too much toilet training with punishment will result to a child who is: Obedient, organized, clean Rebel, dirty, disobedient = OC =Anti-social =anal retentive =anal expulsive 1
  2. 2. PHALLIC – 3-6 yrs old -penis & vagina -love of parent of opposite sex Oedipal-boy loves mom Electra-girl loves dad Identification- boy imitates dad Castration fears- fear that dad is angry at him and will cut off penis Penis envy- girls envy little boys Dr. Karen Horney- detractor of Freud, didn’t believe in penis envy. Freud said that it is maybe in her unconscious mind. Or repressed. Conscious- highest level of awareness Pre-conscious- at tip of tongue Unconscious – forgotten Repression-kept in unconscious. Unconscious forgotten. Suppression – conscious forgetting LATENT- 6-12 years old Latent- Logtu = sexual energy asleep School age – School phobia- 1st time to go to school – Separation anxiety Child is busy with Reading, writing, arithmetic. Sublimation –putting anger into something more productive putting all energies into schooling Ex. Angry at life, pour anger in singing. GENITAL –12 years old Genital-Gising sexual energy Sexual intercourse most important in this stage!! PHARMA MOMENTS Anti-anxiety Drugs (used also for alcohol withdrawal) Valium Librium Ativan Serax Tranxene Miltown Equanil Vistaril Atarax Inderal Buspar ERIK ERIKSON STAGE (+) (-) FACTOR 0-18 months (Oral) Trust vs Mistrust Feeding 18 mos- 3yrs old (Anal) Autonomy vs Au-(anal) To-ilet training No-No! Favorite word. My Shame/doubt Toilet training 3-6 yrs old (Phallic) Initiative vs (Initiate 1st steps) Phallic-oedipal,electra Guilt –anger turned inward Independence 6-12 yrs old (Latent) Industry vs Inferiority Industry Induskul 12-20 (Genital) Identity vs Role confusion Peers 20-25 Intimacy vs Isolation Love 25-45 Generativity vs Stagnation Parenting 45 up Ego Integrity vs Despair Reflection Newly admitted pt- develop trust 1st -pts are dependent=self care deficit -develop/teach autonomy -then pt will develop initiative 2
  3. 3. -etc Frontal lobe- personality, learning, judgment, language Occipital- vision Temporal- hearing, smell Parietal-taste, touch Sensory Integration Motor Somatic nervous system- voluntary movements Acetylcholine- responsible for voluntary movements - on switch of movement Autonomic nervous system- involuntary movements -Sympathetic(Anti cholinergic) and parasympathetic (cholinergic) SYMPATHETIC (alert) PARASYMPATHETIC (relax) Heart tachycardia bradycardia Respiratory tachypnea bradypnea GI (opposite effect) Slow, constipation diarrhea GU (opposite effect) Slow, oliguria, retention Polyuria, frequency Dry mouth Moist mouth Neurotransmitter Epinephrine, Norepinephrine Acetylcholine (AcH) Pupils Dilated (dilat when alert) (Midriasis) Constricted (Myotic) Blood vessels vasoconstriction vasodilated BP increased decreased Anti-cholinergic / anti-parasympathetic =effect is sympathetic! Sympathetic drug classifications: A- anxiety P- psychotic Anti C- cholinergic D- depressants MONO AMINE OXIDASE INHIBITORS: mARplan nARdil pARnate 3
  4. 4. DEFENSE MECHANISMS: coping mechanism from stress: DISPLACEMENT- -------------Your boss shouts at you, you shout at your subordinate. SUBLIMATION - ---------------putting anger into something more productive or + putting all energies into schooling Ex. Angry at life, pour anger in singing. DENIAL- ----------------------“I am not” an alcoholic! DISSOCIATION – --------------psychological flight from self. Amnesia. Ex. Rape, trauma REGRESSION – ----------------RETURN to an earlier developmental stage FIXATION – ---------------------stuck in a stage of development REPRESSION – -----------------unconscious forgetting SUPPRESSION – ---------------conscious forgetting. Avoidance. “I don’t want to talk about it. I don’t want to remember it.” RATIONALIZATION – -------uses “because”. Has illogical reasoning. “I drink because I don’t want to waste the beer in the ref.” REACTION FORMATION----plastic. Doing opposite of intention. UNDOING- ----------------------show true feeling/color then feels guilty after. IDENTIFICATION – -----------models a certain behavior from a certain role model. PROJECTION – -----------------blame other people, pass load to others. Looks for a scapegoat. “Not me, but them.” INTROJECTION – --------------assume another persons trait as your own. “Not just you, me too.” “Ako din, gusto ko yan.” CONVERSION – repression. Anger turned inward to herself. Converted to physical symptoms. Sensory-numbness. Motor-paralyzed, tremors. COMPENSATION – -----------defects of the person, overachieve to cover a defective part. SUBSTITUTION – -----------when you replace a difficult role with a more accessible one. Ex.Wants to go to Disneyland but can’t afford it. Went to Enchanted Kingdom instead. Defense mechanism: Affects/interferes with ADL Harm to self or others Behavior Model – Ivan Pavlov Classical Conditioning -behavior learned-repeated (+) BF Skinner – operant conditioning-reinforcement Confront (-) behavior to make it extinct. MASLOW’S HEIRARCHY OF NEEDS: 5. Self-actualization 4. Self-esteem 3. Love and belonging 2. Safety and security 1. Air, food, water, shelter, clothing, sex –Basic physiologic needs LEVELS OF PREVENTION PRIMARY SECONDARY TERTIARY Healthy ill Relapse avoidance Community teaching Crisis intervention Rehab centers Community demographics Treatment and diagnosis Al anon STAGES OF INTERACTION ORIENTATION WORKING TERMINATION Assessment Problem solving Evaluation Establishment of trust Discussion Summarize Tell patient about termination Patient is most cooperative Say goodbye Set contract Grief-ANGER-focus of RN Patient is resistant Pt might become violent/suicidal 4
  5. 5. ANTI-PARKINSON DRUGS (Capables) –used with anti-psychotics Anti-cholinergic Dopaminergic ABC PLSE C- Cogentin A- Artane P- Parlodel A- Akineton B- Benadryl L- Larodopa E- Eldepryl S- Symmetrel THERAPEUTIC COMMUNICATION NON- THERAPEUTIC 1. Offer self- “I’ll stay/sit with you.” “Don’t worry, be happy.” 2. Explores –use what, when, where, how Why? – Puts pt in defensive position. 3. Silence Change the subject. 4. Active listening-nodding, eye contact, leaning forward-show active participation. “Everything’s going to be alright.” – giving False reassurance. 5. Make observations. “You see/ I have observed/ I have noticed…” Ignore the patient. 6. Broad opening- “How are you?” “You have combed your hair today.” Prejudicial. “Nice weather today.” –value based judgment. 7. Clarification-“What do you mean by ploopplank?” Flattery – don’t use too much adjectives. “You have the most beautiful hair in the ward.” 8. Restating-“I don’t want to eat.” (Word per word repetition!) “You don’t want to eat?” Arguing with the patient Don’t impose your opinion. 9. General leads- “And then/What else/Go on…” 10. Refocusing-“We were talking abt the exam…” 11. Focusing-“Tell me more abt this.” ABG ANALYSIS Ph & PCO2-Respiratory-opposite signs Ph & HC02-Metabolic – same signs Compensation: Ph is normal=Fully compensated. C02 & HC03 –same signs = Partially compensated ANXIETY -vague sense of impending doom. Sympathetic activation. Assessment: Level of anxiety MILD-------------------sit restlessly, widened perceptual field, enhanced learning experience. “You seem anxious.” MODERATE----------patient is pacing, selective inattention. Give PRN meds-Anti-anxiety drugs-valium… SEVERE----------------patient can’t make decisions. “I don’t know what to do or say.” RN directs patient. “Sit down on the chair.” – Directive. PANIC- highest level of anxiety. Suicidal. Priority: safety. Stay with patient. Don’t touch pt. Sympathetic activation. “I think I’m having a heart attack!” Nrs Dx: -----------------Ineffective Individual Coping P/I: Decrease anxiety, decrease stimuli HT: relaxation technique E: Effective Individual Coping 5
  6. 6. GENERALIZED ANXIETY DISORDER – 6 months excessive worrying. Patient knows what the problem is. Cant sleep, concentrate, seat Fatigue and palpitations PANIC ATTACK – ------------------------------15-30 minutes, happens without warning. SNS activation. -with or without agoraphobia -------------------- fear of open space -social phobia –------------------------------------- fear of public -provide safety -alkalosis-brown bag -stay with patient -be directive POST TRAUMATIC STRESS DISORDER Victims – rape, accident, war zone, disaster, trauma 1. Survivor 2. Flashback > 1 month 3. Memory – nightmares MALINGERING------------------------------------- no organic basis (no tissue change) -pretending to be sick, conscious -decrease anxiety – for primary gain -increase attention from RN– secondary gain SOMATOFORM DISORDER –------------------unconscious, not pretending, no organic basis - goes doctor hopping Nervous system Minor discomfort BODY DYSMORPHIC DISORDER CONVERSION -Feels like illness -illusion of structural defect -loss of sensory/motor fx -HYPOCHONDRIASIS -S/sx not real -s/sx real (biglang nabulag) PSYCHOSOMATIC DISORDER (Psychophysiologic)– real illness, real s/sx, real pain, with organic basis (with change in tissue) - stress ulcers, migraine, HPN PHOBIA---------------------------------------------------------- irrational fear Etiology – knowledge, experience Immediate nsg intervention: Remove object of fear (Increase stimuli=increase level of anxiety) (Decrease stimuli=decrease anxiety) Belief Feeling Behavior Object will hurt patient Scared Avoidant=interferes with ADL Gradual exposure to feared object- SYSTEMATIC DESENSYTHEZATION Individual Therapy 1. Hypnosis – --------------relaxed state 2. Free association –------ ideas shared to psychoanalyst 3. Catharsis – --------------free to express feeling 4. Transterence- -----------patient feels something for psychoanalyst 5. Countertransterence –--RN feels something for patient 6
  7. 7. Green light-Go – Epi & Norepinephrine Red light – Stop – G-gamma A-amino B-butyric A- acid Anxiety Increase GABA Anti- cholinergic S/E GI-constipation GU-retention Effect of GABA: Drowsy, drink, don’t drive, orthostatic hypotension Anti-anxiety drug Withdrawal from drug – abrupt – REBOUND PHENOMENA – leads to seizures. 1 week effect. Gradual withdrawal – tapered dose Dependence- Can’t live without valium ANTI-PSYCHOTIC AGENTS – Sympathetic effect. Effect – 2-4 weeks STELAZINE CLOZARIL SERENTIL MELLARIL THORAZINE HALDOL TRILAFON PROLIXIN SCHIZOPHRENIA-------------------------------impaired reality perception. Ego disintegration. Genetic vulnerability. Stress. -Chose fantasy over reality. Increase dopamine theory. Cause: unknown. Increase dopamine, increase schizophrenia. 4 A’s: 1. Affect---------------------------------------------feelings & emotions (smiles, laughs). External, readily observable. Mood, internal, does not match affect. (sad inside) 2. Ambivalence-------------------------------------pulled between 2 opposing forces 3. Autism --------------------------------------------self absorbed. Trapped in his own world.Attached to odd objects.Poor eye contact. 4. Associative looseness---------------------------talk about so many things but unrelated ideas. Disturbed thought process-------------------------Nsg dx Content of thought---------------Hallucinations/Illusions------------ADL----------------------------Harm Disturbed thought process Disturbed sensory Self care deficit Self Other Perception Directed Violence P/I: Reality/Orient/Safety Eval: Improved thought process S & Sx of Schizophrenia: (-)neg sx (+) positive sx hypoactive hyperactive flight of ideas withdrawn restless hallucinations quiet, flat affect talkative delusions many ideas poverty of words queen of the world illusions 7
  8. 8. Types of schizophrenia: 1. Disorganized schizo---------------------------------sad inside, happy outside – inappropriate affect (+) flat affect – no affect (-) disorganized manner/speech –flight of ideas (+) Hebephrenic- giggling (+) Sx: both (+) and (-). 2. Catatonic ---------------------------------------------ambivalence –anal stage (-) No! Negativisim-rebel-anal (-) Waxy flexibility--------------raise arm of patient. Patients arm remains up for a long time. (-) (-) > (+) 3. Paranoid ----------------------------------------------uses projection. Mistrust Scared/withdrawn/violent Based on history Develop trust: orientation -Leave door open -1:1 interaction -Distance from pt: 1 arms length -consistent approach -stay near door not window -short/frequent interaction -have visibility:stand halfway in & out -food: sealed container to be able to call for reinforcement. -meds: wrapped in tamper resistant foil -calm and firm 4. Unclassified/ Undifferentiated-----------------------can’t be classified anymore. 5. Residual-------------------------------------------------no more (+), (-). Social withdrawal THOUGHT PROCESS DISTURBANCE 1. LOOSENESS OF ASSOCIATION----------------topics have connection but no thought. “I am going to the mall. The mall is in town. The town flies. Flies are here.” 2. FLIGHT OF IDEAS ---------------------------------New unrelated topics. “I am going to the mall. Where is the light? I treasure this chalk. Hurray!” 3. AMBIVALENCE-------------------------------------Pulled by 2 opposing forces. 4. MAGICAL THINKING----------------------------- believes he has magical powers. “I can turn you into a frog.” 5. ECHOLALIA------------------------------------------repeat what is said. Parrots. 6. ECHOPRAXIA----------------------------------------repeats what you do. Repeats what is seen. 7. WORD SALAD----------------------------------------mixes words that don’t rhyme. 8. CLANG ASSOCIATION----------------------------uses words that rhyme. “Flank, blank, prank.” 9. NEOLOGISM------------------------------------------invents new words not in the dictionary. “Ploopplank, pisnok.” 10. DELUSIONS-----------------------------------------false belief Grandeur--------------I am a queen/ king/millionaire! Persecution------------NBI out to get me! Ideas of reference-----They talk and write about me! 11. CONCRETE ASSOCIATION-----------------------pilosopo. “What will you wear tomorrow?” “Clothes!” 12. HALLUCINATIONS----------------------ILLUSIONS (with stimuli) Stimuli N Y Visual N Y Auditory N Y Tactile N Y Present reality!!! H A R D-Directive. “Let’s go in the garden.” Acknowledge: “I know the voices are real to you. Present reality. “But I can’t hear them.” =Assess what voices are saying to know if patient will harm himself. 8
  9. 9. Increase Dopamine = increase schizo Decrease dopamine = decrease schizo Extra Pyramidal Side Effects (EPSE) (Happens when acetylcholine is up and dopamine is down) 1. AKATHISIA-------------------------- restless, inability to sit still. 2. AKINISIA ---------------------------- rigidity 3. DYSTONIA--------------------------- affects neck TORTICOLLIS -------------wry neck OCULOGYRIC CRISIS – fixed stare OPISTHOTONUS ---------arched back, contracted 4. TARDIVE DYSKINESIA------------lip smacking, tongue is protruding, puffy cheeks. Irreversible! 5. NEUROLEPTIC MALIGNANT SYNDROME- hyperthermia, unstable BP, increase CPK, diaphoresis, pallor -discontinue meds, medical emergency. 6. PHOTOSENSITIVITY------------------wear shades, sunscreen 7. WBC- Agranulocytosis---------------sore throat, fever, malaise, leukopenia AUTISM- boys > girls. 1:100 kids gift-autistic savants -echolalis, poor eye contact, can’t express verbally. Assess: A- appearance- neat, OC, wants constancy B- behavior- ritualistic behavior, flat affect, repetitive C- communication – difficulty communicating Nsg Dx: Impaired social interaction – cant form IPR (Interpersonal relationship) Impaired verbal communication Self mutilation – cant express anger. Express it inward. Risk for injury P/I: constancy, promote safety Expressive therapy – uses art, music, poetry, decreasing risk for injury, improved social interaction, be able to express feelings. E: -Safety ADHD- ATTENTION DEFICIT HYPERACTIVITY DISORDER (can progress to conduct disorder to anti-social behavior) Cant focus on anything. Onset 7 yrs old and below Duration >6 months Setting: House & school ID dominant: Mom or RN will act as superego Assessment: A- appearance: dirty B- behavior: clumsy, impatient, easily distracted C- talkative Nsg Dx: High risk for injury Safety Structure- provide place to study, eat, play,bath,etc. Schedule – time for everything Set limits Residual ADHD grows up not anti-social Meds: Ritalin, Dexedrine,Pemoline, Adderal Best time to give meds: If once a day give AFTER MEALS- to prevent loss of appetite. Don’t give at bedtime-it’s a stimulant-will cause insomia. Can be given 6hours before bedtime (if q2d) 9
  10. 10. ANOREXIA NERVOSA – diet, underweight < 85% of expected fat, 3 months amenorrhea, failure to recognize problem. BULIMIA NERVOSA – induce vomiting, takes laxative, normal weight, irregular menstruation, dental carries, diarrhea - knows problem but ashamed and embarrassed, Priority: Fluid volume balance Weight gain – monitor weight, eating pattern, stay 1 hour after eating, accompany in toilet Problem: Body image Disturbance NI: 1. Establish nutrition pattern 2. Teach stress management, journal keeping 3. Monitor eating pattern and weight. 4. Anti-depressant MANIA – needs mood stabilizing agents- Lithium. Group therapy L- 0.5-1.5 mEq/L (If level is near 2.5-3 mEq/L –will cause ataxia and mental confusion) I- increase urination T- tremors H- H20- 3L/d I- increase T- uu M- mouth dry N- Na- 135-145 mEq/L – to hold water Check kidney(blood level) before administration of Lithium – BUN, CREA, electrolyte Lithium toxicity – n/v, diarrhea = Diamox BIPOLAR DISORDER – 2 poles, happy (more dominant) & sad -female, >20 yrs old, stress, obese Self actualization Task to decrease self esteem Family therapy Risk for injury, risk for other directed violence Decrease eat, decreased sleep, hyperactive, increase sex – masturbate in front of others Nsg Dx: High risk for self or other directed violence Risk for injury Give task, no group games, any competition will increase anxiety, water the plants, activities using gross motor skills, escorted walk, punching bag-displacement. 3 or more signs confirms disorder: G – grandiose, increase risk activities F – flt of ideas S - sleeplessness P – pressured speech E – exaggerated SE E – extraneous stimuli (easily distracted) D – distractability PERSONALITY DISORDER 1. Schizoid – --------doesn’t care about people, believes that he can stand on his own, never had a best friend avoid groups & activities – no enjoyment cares more about computers, pets 2. Avoidant ----------avoid group – fear criticism, have talent but no confidence. 3. Anti-social– ------as child steal, lie, always get reprimanded Adult – grand robbery, illegal activities against the law. drug addiction, drives fast, unsafe sex, thrill seeker. Good talker, charmer, witty, manipulator. Motto – “I will break the law” 10
  11. 11. 4. Borderline -------Favorite line – “ life is an empty glass.” Splitting, suicidal, superficial relationship, labile- sudden change of Mood, self mutilation. (+) (-) fill glass with friends suicide have happy moments LABILE AFFECT sad moment labile- change from good to bad in a split moment 5. Dependent ---------Decrease self esteem, dependent Poor decision making skills “I cant live if living is without you” 6. Histrionics ----------excited, dramatic, manipulative - CENTER OR ATTENTION - 7. Narcissistic----------“I love myself” – insensitive, arrogant, self absorbed - exaggerated Self esteem, ambitious “I am the best” - 8. OC ------------------ perfectionist, organized, constancy in environment. Provide time to do rituals. 9. Paranoid ----------- always jealous, suspicious, violent 10. Passive aggressive ------always say “yes”, but resistance is hidden. Nsg Intervention: Improve IPR, build trust A-LCOHOL ABUSE ----------------------happy – socializing Narcotic oversode-give Narcan -escape from problem Narcotic detox- Methadone -peer pressure Aversion therapy-Antabuse B-blackout ---------------- awake but unaware C-confabulation ---------- invent stories to increase Self-Esteem D-denial -------------------“ I am at not an alcoholic.” D-dependence ------------“ I cant live without alcohol.” a. physical – tremors, tachycardia, restless b.psychological – craving E-enabling/codependency (significant others tolerate abusers) DISULFIRAM voids alcohol beer version therapy ntabuse (DISULFIRAM) lcoholics anonymous n/v hypotension interval of alcohol & antabuse: 12h interval after alcohol intake B1 – Thiamine Complications wernickes Encephalopathy Korsakoff psychosis Wernickes – VROOM – Motor sx effect Korsakoff – memory- confabulation 24 – 72h after alcohol intake 11
  12. 12. Delirium tremors – happens due SNS activation Tremors, hallucinations, illusions. Well lit room – to avoid hallucinations ANTI DEPRESSANTS – decrease serotonin problem Anti depressants – full stomach All meds take on a full stomach, except anti anxiety. ASENDIN TCA NORPRAMIN TCA TOFRANIL TCA SINEQUAN TCA ANAPRANIL TCA - OC AVENTYL TCA VIVACTIL TCA ELAVIL TCA PROZAC SSRI PAXIL SSRI ZOLOFF SSRI LUVOX SSRI Serotonin ---------makes us happy Decrease serotonin – pt becomes sad – depression Increase serotonin – antidepressant SSRI: Selective S Serotonin S – (decrease S/E) Reuptake R – Inhibitors I – (1 – 4 weeks) If SSRI don’t work, give TCA Tri Cyclic Antidepressants –( TCA) ----------2 – 4 wks has increased S/E increased Serotonin & Norephinephrine MAOI-------------------------- effect 2 – 6wks Increase E, NE, serotonin kills serotonin - MAOI increase MAO = decrease serotonin * decrease MAO = increase serotonin give MAOI Most dangerous, most S/E Diet – avoid tyramine food – eat SARIWA, fresh foods HPN crisis – dangerous! Increase CR, diaphoresis Tyramine rich food: Avocado Pickles Alcohol Fermented foods Beer Eggplant Chocolate preservatives – tocino, bologna,canned meat etc. Cheese – mozerella, swiss cheese W – ine S – soysauce Anticholinergic = antidepressants – antiparasympathetic Dry, constipation, retention, tachycardia Male erectile dysfunction MAOI mARplan 12
  13. 13. NARdil PARnate DEPRESSION – decrease serotonin. If unresponsive to drugs, ECT-electroconvulsive therapy Assess: 1. Denial – this cant be happening. This cant be real. 2. Anger – Why me, why now, why God?! 3. Bargaining – If returned, I will give reward. 4. Depression – 2 wks or more of sx = clinical depression 5. Acceptance – client acts according to situation. Pt prepares living will. Increase risk for self directed violence. Maslows: 5 – 4 – decrease Self-esteem – give TASK 3 – Pt is withdrawn 2 – Risk for self directed violence suicide 1 – eat (wt gain) or not eat(wt loss), sleep or not sleep, hypoactive, decrease sex SUICIDE CUES: “I wont be a problem any longer” “Remember me when I’m gone” “This is my last day” “This is my wedding ring. Give it to my son” - Sudden change in mood. Pt is suicidal, RN should: D –d irect question – “Are you going to commit suicide? I – irregular interval of visit to pt room E – early am & endorsement period - time pt’s commit suicide. Who will commit suicide? S – sex – male (more successful)/female (hesitant) A – age – 15 – 24yo or above 45 D – depression P – pt with previous attempts will try again E – ETOH – (Ethanol) alcoholics R – irrational S – lacks social support O – organized plan – greater risk N – no family S – sickness, terminal Suicide Triad: - Loss of spouse - Loss of job - Aloneness Best approach for suicide: Direct approach Nursing Mgt: close surveillance Hospital area majority suicide happens at: weekends 1 – 3 am Sunday Weekend – less staff personnel Early am – every one is asleep Give simple task. Don’t give complex task – no jigsaw puzzle Water the plants Wash the dishes except sharp objects 13
  14. 14. SUBSTANCE ABUSE Type of Addict: 1. Nervous -----tremors Give downers Sx of overdose 1. Identify if drug is upper or downer 2. Check effect 3. Sx of withdrawal If patient takes a downer, all vital signs are down! If he stops taking it (during withdrawal), patient will experience the opposite effect of a downer. All his vital signs will shoot up! Same with uppers. Ex: Pt had cocaine intoxication. Pt will manifest hyperactivity, tachypnea, seizure. During withdrawal, pt will manifest bradypnea or coma. Substance Abuse Moments (downer) A – alcohol B – barbiturates O – opiates Antidote N – narcotics - Narcan (narcotic antagonist) M – marijuana Morph CODE HERO (uppers) C – cocaine H – Hallucinogens A – amphetamines Uppers Downers Seizure decrease RR, decrease HR Tachypnea Para constricted pupil Moist mouth Dilated Blood Vessels Coma Asleep Decreased GI constriction Decrease GU retention Decrease BP State of euphoria Sx of withdrawal – reverse of effect 1. Know if upper or downer 2. Opposite of effect Overdose Withdrawal (opposite of withdrawal is overdose) Alcohol – coma seizure Morphine – bradypnea tachypnea Detox – withdrawal with MD supervision Methadone 14
  15. 15. 2. Depressed - Sits down on chair Uppers Codeine increased heart increase - BP increase, awake Hallucinogen sympathetic HR increase seizure Amphetamine pupils- dilate GI - diarrhea Mouth – dry Decrease appetite - thin Stop uppers Tremors crash syndrome Depressed Suicide Fatigue LEVELS OF MENTAL RETARDATION Profound severe moderate mild borderline normal IQ 20 35 50 70 90 110 Profound Mental retardation IQ <20 =thinks like an INFANT. Cant be trained. Stay with patient. Severe MR 20-35 Moderate 35-50 = Can be trained. Mental age is 2-7yo. Pre-operational stage. Mild 50-70 = (mild 7) Mental age is 7-12. Educable. Can go to school. Borderline- 70-90 Normal- 90-110 JOHN PIAGET COGNITIVE THEORY 0-2 yrs old – S-ensory motor. Baby can sense, see, perceive and hear. Object permanence 2-4 yo- P-reconceptual- language. 4-7 yo- I-ntuitive stage. Unidimentional classification or unidimentional characteristic. Child can fix toys according to size, color, height=one at a time only. 7-12 yo- C-conservation/concrete association. Multidemensional 12yo- F-ormal operation – good in abstract thinking. Can interpret proverbs. CHILD ABUSE B=burns, bruises, bone fractures, bungi Don’t bathe child. Don’t brush teeth. Body of evidence will be lost. Bantay Bata 163 ALZHEIMER Anomia- don’t know name of object Agnosia – problem with senses (smell, taste, hear, touch) Aphasia – can’t say it Apraxia – can’t do it Dissociative Fugue- takes a new personality from a tar away place. New place new identity. Dissociative Identity Disorder – multiple personality Dissociative Amnesia – don’t know who/where I am. 15
  16. 16. DEPERSONALIZATION- believe that they are not persons anymore PERSEVERATION- kulit. “I want to talk about something because this is something that I want to do. It is something that I need to talk about. This is something that I want to do.” ELECTROCONVULSIVE THERAPY- sign informed consent. For depressed pt. If meds don’t work, use ECT. Pre-ECT N-npo 6 hours A-atropine sulfate – dry mouth B-barbiturate S- succinylcholine chloride – to relax muscles Post-ECT Side-lying- lateral S/E headache, dizziness, temporary memory loss (distinct sx)=RN-orient pt. EXAMS: Nsg intervention: Look for words like: S=safety, support, stay, set limits, assist Provide safety. Mobilize support system. I will stay with you. Assist in activity. Set limit- don’t allow patient to misbehave. Look for words like: Orient=orient pt post delirium, ECT, pt with dementia Accept “Seem, observed, noticed, comment, feelings…” Group therapy- facilitator is RN. Rape, battered pt ALTRUISM – Victim becomes a counselor, shares experience to new victim. Self-help group=facilitator is the pt themselves. AL ANON groups –Alcoholics Anonymous 16