psychiatric nursing dsecseaniel

8/13/2019 Psychiatric Nursing Dsecseaniel

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Presented by: Dave Jay S. Manriquez, RN.

PSYCHIATRIC NURSING

Introduction

MENTAL HEALTH balance in a persons internal lie and adaptation to realit!

Mental ILL Healt" state o i#balance c"aracteri$ed b! a disturbance in a

persons t"ou%"ts& eelin%s and be"a'ior

Ps!c"iatric nursin%

interpersonal process ("ereb! t"e proessional nurse practitioner &t"rou%" t"e

t"erapeutic use o sel )art* and nursin% t"eories )science*& assist clients to ac"ie'eps!c"osocial (ell bein%+

Core , interpersonal processRelated Ter#s

Mental "!%iene

#easures to pro#ote #ental "ealt" & pre'ent #ental illness and suerin% and

acilitate re"abilitation

Main tool, t"erapeutic use o sel

It re-uires sel.a(areness

Met"ods to increase sel.a(areness,

Introspection

/iscussion

E0perience

Role pla!

Assess#ent )ps!c"osocial processes *

Appearance & be"a'ior or #ood

Speec" & t"ou%"t content and t"ou%"t process

Sensoriu#

Insi%"t and 1ud%#ent

2a#il! relations"ips and (or3 "abits Le'el o %ro(t" and de'elop#ent

Co##on 4e"a'ioral Si%ns and S!#pto#s/isturbances in perception

Illusion

#isinterpretation o an actual e0ternal sti#uli


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Hallucinations

alse sensor! perception in t"e absence o e0ternal sti#uli

/isturbances in t"in3in% and speec"

neolo%is# coinin% o (ords t"at people do not understand

Circu#stantialit! o'er inclusion o inappropriate t"ou%"ts and details

5ord salad inco"erent #i0ture o (ords and p"rases (it" no lo%ical se-uence

6erbi%eration #eanin%less repetition o (ords and p"rases

Perse'eration persistence o a response to a pre'ious -uestion

Ec"olalia pat"olo%ical repetition o (ords o ot"ers

Ap"asia speec" diicult! and disturbance

E0pressi'e & recepti'e or %lobal

2li%"t o ideas. s"itin% o one topic ro# one sub1ect to anot"er in a so#e("at

related (a! Looseness o association.inco"erent illo%ical lo( o t"ou%"ts )unrelated (a!*

Clan% association sound o (ord %i'es direction to t"e lo( o t"ou%"t

/elusion persistent alse belie& ri%idl! "eld

/elusions o %randeur, special 7i#portant in a (a!

Persecutor!, t"reatened

Ideas o reerence, situation7e'ents in'ol'e t"e#

So#atic, bod! reactin% in a particular (a!

8ealous, t"in3in% t"at t"eir partner is unait"ul

Eroto#anic, person& usuall! o "i%" status& is in lo'e (it" t"e client

Reli%ious, illo%ical ideas about God and reli%ion e0"ibited b! e0tre#e or

e0traneous be"a'ior


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Mi0ed, co#bination o abo'e (it"out a predo#inant t"e#e

Ma%ical t"in3in% pri#iti'e t"ou%"t process t"ou%"ts alone can c"an%e e'ents

Autistic t"in3in% re%ressi'e t"ou%"t process9 sub1ecti'e interpretations not

'alidated (it" ob1ecti'e realit!

/ereis# unor%ani$ed t"in3in%

/isturbances o aect

Inappropriate dis"ar#on! bet(een t"e sti#uli and t"e e#otional reaction

4lunted aect se'ere reduction in e#otional reaction

2lat aect absence or near absence o e#otional reaction

Apat"! dulled e#otional tone

/epersonali$ation eelin% o stran%eness ro# one:s sel

/ereali$ation eelin% o stran%eness to(ards en'iron#ent

A%nosia lac3 o sensor! sti#uli inte%ration

/isturbances in #otor acti'it!

Ec"opra0ia i#itation o posture o ot"ers

5a0! le0ibilit! #aintainin% position or a lon% period o ti#e

Ata0ia loss o balance

A3at"esia e0tre#e restlessness

/!stonia. uncoordinated spastic #o'e#ents o t"e bod!

Tardi'e d!s3inesia in'oluntar! t(itc"in% or #uscle #o'e#ents

Apra0ia in'oluntar! unpurposeul #o'e#ents

/isturbances in #e#or!

Conabulation illin% o #e#or! %aps

/;1< 'u so#et"in% una#iliar see#s a#iliar

8a#ais 'u. so#et"in% a#iliar see#s una#iliar

A#nesia #e#or! loss )inabilit! to recall past e'ents*

Retro%rade.distant past

Antero%rade i##ediate past

Ano#ia lac3 o #e#or! o ite#s


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/!na#ics o Hu#an 4e"a'ior

4e"a'ior t"e (a! an indi'idual reacts to a certain sti#ulus

Conlict situation arisin% ro# t"e presence o t(o opposin% dri'es

Need . or%anis#ic condition t"at re-uires a certain acti'it!

/!na#ics o Hu#an 4e"a'ior

Personalit!

totalit! o e#otional and be"a'ioral traits t"at c"aracteri$e t"e person in da! to

da! li'in% under ordinar! conditions9 it is relati'el! stable and predictable+2=RMATI=N =2 PERS=NALITY

TEMPERAMENT

biolo%ical.%enetic te#plate t"at interacts (it" our en'iron#ent+

a set o in.built dispositions (e are born (it"

#ostl! unalterable our nature+

CHARACTER

t"e outco#e o t"e process o sociali$ation& t"e acts and i#prints o ouren'iron#ent and nurture on our ps!c"e durin% t"e or#ati'e !ears )>.? !ears and in

adolescence*+

t"e set o all ac-uired c"aracteristics (e posses& oten 1ud%ed in a cultural.social

conte0t+

So#eti#es t"e interpla! o all t"ese actors results in an abnor#al personalit!

THE=RIES =2 PERS=NALITY /E6EL=PMENT

2reud:s

PSYCH=SE@UAL THE=RY

Libido inner dri'e

Parts o bod! ocus o %ratiication

Unsuccessul resolution . i0ation

Structures o personalit!

Id, pleasure principle.instinct

E%o, controls action and perception realit! principle

Supere%o, #oral be"a'ior . conscience

>.B #>s 9oral #out" trust and discri#inatin%

B #os+ !ears 9 anal bo(els "oldin% on or lettin% %o

Ne%ati'is# and toilet trainin% a%e

.? !ears p"allic 9 %enitals e0ploration and disco'er! ) inc+ se0ual tension*

Gender identiication and %enital a(areness


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=edipus and Electra co#ple0

Castration an0iet! and penis en'!

?.D !ears latenc! )-uiet sta%e* se0ual ener%! di'erted to pla!+ Institution o

supere%o, control o instinctual i#pulses

D !oun% adult %enital 9 rea(a3enin% o se0ual dri'es relations"ips

Se0ual #aturation

Se0ual identit! &abilit! to lo'e and (or3

Eric Eric3son:sPSYCH=S=CIAL THE=RY

>.D#os

.!

.?

?.D

D.B

B.D

D.?>

?> and abo'e

TRUST 's+ MISTRUST

AUT=N=MY 's+ SHAME F /=U4T

IN/USTRY 's+ IN2ERI=RITY

INITIATI6E 's+ GUILT

I/ENTITY 's+ I/ENTITY C=N2USI=N

INTIMACY 's+ IS=LATI=N

EG= INTEGRITY 's+ STAGNATI=N

GENERATI6ITY 's+ /ESPAIR

IN2ANCY

C=NSISTENT MATERNAL CHIL/ INTERACTI=N TRUST

INNER 2EELING =2 SEL2 5=RTH

H=PE

T=//LER


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ALL=5 E@PL=RATI=N

PR=6I/E 2=R SA2ETY

N=& N= NEGATI6ISM

=22ER CH=ICES 7 RE6ERSE PSYCH=L=GY

T=ILET TRAINING B M=S+.4=5EL

/AYTIME 4LA//ER, D !o

NIGHTIME 4LA//ER, !o

RE5AR/ 57 PRAISE AN/ A22ECTI=N

IN/EPEN/ENCE

PRE.SCH==L

PR=6I/E PLAY MATERIALS

SATIS2Y CURI=SITY

TEACH AN/ REIN2=RCE)HYGIENE&S=CIAL 4EHA6I=R*

SI4LING RI6ALRY

5ILLP=5ER

SCH==L AGE

H=5 T= /= THINGS 5ELL.SUPP=RT E22=RTS

CHUMS AN/ H=44IES

NEE/S T= E@CEL7ACC=MPLISH

NEE/ 2=R PRI6ACY AN/ PEER INTERACTI=N

C=MPETENCE

A/=LESCENCE

MAE /ECISI=N&EMANCIPATI=N 2R=M PARENTS

4=/Y IMAGE CHANGES

NEE/ T= C=N2=RM 4UT EEP IN/I6I/UALITY

SEL2 . A5ARENESS

Y=UNG A/ULT

C=MMITMENT AN/ 2I/ELITY

RESP=NSI4ILITY

ACHIE6EMENT =2 IN/EPEN/ENCE

MI//LE A/ULTH==/

SUPP=RT.PERI=/ =2 R=LE TRANSITI=NS

MI/LI2E CRISIS


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A/8USTMENT AN/ C=MPR=MISE

M=ST PR=/UCTI6E AN/ CREATI6E

ALTRUISM

LATE A/ULTH==/

SEL2 ACCEPTANCE

SEL2 5=RTH

5IS/=M

8ean Pia%et:s

C=GNITI6E THE=RY>.D SENS=RIM=T=R

RE2LE@ES

IMITATI6E REPETITI6E 4EHA6I=R

SENSE =2 =48ECT PERMANENCE AN/ SEL2 SEPARATE 2R=M EN6T+

TRIAL AN/ ERR=R RESULTS IN PR=4LEM S=L6ING

D.JY PRE.=PERATI=NAL

SEL2.CENTERE/&EG=CENTRIC

CANN=T C=NCEPTUALIKE =THER:S 6IE5

ANIMISTIC THINING

IMAGINARY PLAYMATE SYM4=LIC MENTAL REPRESENTATI=N

CREATI6ITY

D. PRE.C=NCEPTUAL )PRE.L=GICAL*

.J INTUITI6E )UN/ERSTAN/ING =2 R=LES*

J.DY C=NCRETE =PERATI=NAL

L=GICAL C=NCRETE TH=UGHT

IN/UCTI6E REAS=NING )SPECI2IC T= GENERAL*

CAN RELATE& PR=4LEM S=L6ING A4ILITY

REAS=NING AN/ SEL2.REGULATI=N

D.A4=6E, 2=RMAL =PERATI=NAL TH=UGHT

Abstract t"in3in%

Separation o antas! and act

Realit! oriented

/educti'e reasonin%

Appl! scientiic #et"od

Ha'i%"urst:s/E6EL=PMENTAL TASS


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4ab! to earl! c"ild"ood

Ri%"t ro# (ron% and Conscience

Late c"ild"ood

P"!sical s3ills& ("oleso#e attitude& social roles

Conscience #oralit! and 'alues

2unda#ental s3ills in acade#ics

Personal independence

Adolescence

Se0ual social roles

Relations"ips

Independence and ideolo%!

Earl! adult"ood

Career

Selectin% a #ate

2indin% Ci'ic or social responsibilit!

Middle a%e Ac"ie'in% Ci'ic or social responsibilit!

Ad1ustin% to c"an%es

Satisactor! career peror#ance

Ad1ustin% to a%in% parents

Ad1ustin% to parental roles

=ld a%e

Ad1ustin% to c"an%es

Establis"in% satisactor! li'in% arran%e#ents and ailiations

o"lber%:sM=RAL /E6EL=PMENT7 THINING7 8U/GEMENT

PRE.C=N6ENTI=NAL )>.?*


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PUNISHMENT AN/ =4E/IENCE

=4E/IENCE T= RULES T= A6=I/ PUNISHMENT

C=N6ENTI=NAL ) ?.D *

MUTUAL INTERPERS=NAL E@PECTATI=NS&RELATI=NSHIPS AN/

C=N2=RMITY

S=CIAL SYSTEM AN/ C=NSCIENCE MAINTENANCE

4EING G==/ IS IMP=RTANT SEL2 RESPECT =R C=NSCIENCE

P=ST C=N6ENTI=NAL )D B Y*

PRI=R RIGHT =R S=CIAL C=NTRACT

UNI6ERSAL ETHICAL PRINCIPLE

A4I/E 2=R C=MM=N G==/

RATI=NAL PERS=N.6ALI/ITY =2 PRINCIPLES.AN/ 4EC=ME

C=MMITTE/ T= THEM

INNER C=NTR=L =2 4EHA6I=R UN/ERSTAN/ING THE EUALITY =2HUMAN RIGHTS AN/ /IGNITY =2 HUMAN 4EINGS AS IN/I6I/UALS

Harr! Stac3 Sulli'an:s

INTERPERS=NAL THE=RY

IN2ANCY

NEE/ 2=R SECURITY.IN2ANT LEARNS T= RELY =N =THERS T=

GRATI2Y NEE/S AN/ SATIS2Y 5ISHES& /E6EL=PS A SENSE =2 4ASIC

TRUST& SECURITY AN/ SEL2 5=RTH 5HEN THIS =CCURS

T=//LERH==/ 7 EARLY CHIL/H==/

CHIL/ LEARNS T= C=MMUNICATE NEE/S THR=UGH USE =2 5=R/S

AN/ ACCEPTANCE =2 /ELAYE/ GRATI2ICATI=N AN/ INTER2ERENCE =25ISH 2UL2ILLMENT

PRE.SCH==L

/E6EL=PMENT =2 4=/Y IMAGE AN/ SEL2.PERCEPTI=N

=RGANIKES AN/ USES E@PERIENCES IN TERMS =2 APPR=6AL AN/

/ISAPPR=6AL RECEI6E/

4EGINS USING SELCTI6E INATTENTI=N AN/ /ISASS=CIATES TH=SE

E@PERIENCES THAT CAUSE PHYSICAL =R EM=TI=NAL /ISC=M2=RT AN/PAIN

SCH==L AGE

THE PERI=/ =2 LEARNING T= 2=RM SATIS2YING RELATI=NSHIPS

5ITH PEERS.USES C=MPETITI=N&C=MPR=MISE AN/ C==PERATI=N

THE PRE.A/=LESCENT LEARNS T= RELATE T= PEERS =2 THE SAME

SE@


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A/=LESCENCE

LEARNS IN/EPEN/ENCE AN/ H=5 T= ESTA4LISH SATIS2ACT=RY

RELATI=NSHIPS 5ITH MEM4ERS =2 THE =PP=SITE SE@

Y=UNG A/ULTH==/

4EC=MES EC=N=MICALLY& INTELLECTUALLY AN/ EM=TI=NALLY

SEL2 SU2ICIENT

LATER A/ULTH==/

LEARNS T= 4E INTER/EPEN/ENT AN/ ASSUMES RESP=NSI4ILITY

2=R =THERS

SENESCENCE

/E6EL=PS AN ACCEPTANCE =2 RESP=NSI4ILITY 2=R 5HAT LI2E IS

AN/ 5AS AN/ =2 ITS PLACE IN THE 2L=5 =2 HIST=RY

TREATMENT M=/ALITIESREM=TI6ATI=N THERAPY

TREATMENT M=/ALITY THAT PR=M=TES E@PRESSI=N =2 2EELINGS

THR=UGH INTERACTI=N 2ACILITATE/ 4Y /ISCUSSI=N =2 NEUTRALT=PICS

STEPS ,

cli#ate o acceptance

creatin% brid%e to realit!

s"arin% t"e (orld (e li'e inappreciation o (or3s o t"e (orld

cli#ate o appreciation

MUSIC THERAPY

In'ol'es use o #usic to acilitate e0pression o eelin%s& rela0ation and outlet otension

PLAY THERAPY

enables patient to e0perience intense e#otion in a sae en'iron#ent (it" t"e use

o pla!

c"ildren e0press t"e#sel'es #ore easil! in pla!+ re'ealin% as relection o c"ild:s

situation in t"e a#il!

pro'ide to!s and #aterials acilitate interaction obser'e and "elp c"ild resol'e

proble#s t"rou%" pla!

Group t"erap!

Treat#ent #odalit! in'ol'in% t"ree or #ore patients (it" a t"erapist to relie'e

e#otional diiculties& increase sel estee#& de'elop insi%"t & LEARN NE5

A/APTI6E 5AYS T= C=PE 5ITH STRESS and i#pro'e be"a'ior (it" ot"ers

I/EAL B > MEM4ERS

MILIEU THERAPY

Consists o treat#ent b! #eans o controlled #odiication o t"e patient:s

en'iron#ent to acilitate positi'e be"a'ioral c"an%e


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Increase patient:s

A(areness o eelin%s Sense o responsibilit! and

Help return to co##unit!

clients plan social and %roup interaction

to3en pro%ra#s & open (ards and sel #edication are done2AMILY THERAPY

A METH=/ =2 PSYCH=THERAPY 5HICH 2=CUSES =N THE T=TAL

2AMILY AS AN INTERACTI=NAL SYSTEM

PR=4LEM IS A 2AMILY PR=4LEM

ocus on sic3 #e#bers be"a'ior as source o trouble 7 s!#pto# ser'e a unction

or t"e a#il!

#e#bers de'elop sense o identit!

points out unction o t"e sic3 #e#ber or t"e rest o t"e a#il!

PSYCH=ANALYTIC

ocuses on t"e e0ploration o t"e unconscious& to acilitate identiication o t"epatients deenses

AN@IETY RESULTS 4ET5EEN C=N2LICTS =2 I/ AN/ EG=

4eco#es a(are o unconscious t"ou%"ts and eelin%s to understand an0iet! and

deenses

HYPN=THERAPY

6arious #et"ods and tec"ni-ues to induce a trance state ("ere patient beco#es

sub#issi'e to instructions

4EHA6I=R M=/I2ICATI=N

Application o learnin% principles in order to c"an%e #aladapti'e be"a'ior

4elie'es t"at ps!c"olo%ical proble#s are a result o learnin%

E'er!t"in% learned can be unlearned

4EHA6I=R M=/I2ICATI=N

=PERANT C=N/ITI=NING

Use o re(ards to reinorce positi'e be"a'ior

Percei'ed and sel.reinorce#ent beco#es #ore i#portant t"an e0ternal

reinorce#ent

/ESENSITIKATI=N Slo( ad1ust#ent or e0posure to eared ob1ects )p"obias*

Periodic e0posure until undesirable be"a'ior disappears or lessens

A6ERSI=N THERAPY

An e0a#ple o be"a'ior #odiication

Painul sti#ulus is introduced to brin% about an a'oidance o anot"er sti#ulus

End 'ie(, be"a'ioral c"an%e


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=THER THERAPIES

HUM=R THERAPY

To acilitate e0pression and en"ance interaction

ACTI6ITY THERAPY

Group interaction ("ile (or3in% on a tas3 to%et"er

4I=L=GICAL7 ME/ICAL THE=RY

EM=TI=NAL PR=4LEM IS AN ILLNESS

cause #a! be in"erited or c"e#ical in ori%in

2=CUS =2 TREATMENT IS ME/ICATI=NS AN/ ECT

4I=L=GICAL THERAPY

ELECTR=C=N6ULSI6E THERAPY

Artiicial induction o a %rand #al sei$ure b! passin% a controlled electrical

current t"rou%" electrodes applied to one or bot" te#ples

#ec"anis# o action unclear 'olta%e, J> > 'olts

/uration, >+ D+> seconds

? to D treat#ents

inter'als o B "ours

indicators o eecti'eness occurrence o %enerali$ed tonic clonic sei$ures

indications depression & #ania and catatonic sc"i$op"renia

s7e, conusion& disorientation& s"ort .ter# #e#or! loss& sei$ure )>.?> sec*

NP= prior

Contraindications

2e'er& pre%nanc!

Inc ICP& racture

retinal detac"#ent

T4 (it" "e#opt!sis

cardiac d7o

consent needed

Reorient ater& supporti'e care

#edications %i'en ,

Atropine sulate, decrease secretions

Succin!lc"oline )Anectine*, pro#ote #uscle rela0ation

Met"o"e0ital Sodiu# ) 4re'ital *, ser'es as an anest"etic a%ent

co##on co#plications,

loss o #e#or!

"eadac"e


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apnea

racture

respirator! depression

Ps!c"op"ar#acolo%ic T"erap!

4en$odia$epines

Indications

An0iet!

Sedation7sleep

Muscle spas#

Sei$ure disorder

Alco"ol (it"dra(al s!ndro#es

Anti.an0iet! dru%s

Generic Trade na#e

Alpra$ola# @ana0C"lordia$epo0ide Libriu#Clora$epate Tran0ene

/ia$epa# 6aliu#

Lora$epa# Ati'an=0a$epa# Sera0

4usipirone 4uSpar

Side eects

/ro(siness7 sedation

Ata0ia

2eelin%s o detac"#ent

Increase irritabilit! and "ostilit!

Antero%rade a#nesia

Increased appetite F (ei%"t %ain

Nausea

Headac"e& conusion

Anti.depressants

Indications

/epression

4ipolar depression

Panic disorder

4uli#ia

=bsessi'e.co#pulsi'e d7o

Possibl!

Attention deicit7H!peracti'it! d7o


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Post Trau#atic Stress /7o

Conduct d7o

Tric!clic )TCA*

Generic Trade na#e

A#itript!line Ela'il

I#ipra#ine ToranilTri#ipra#ine Sur#ontil

Nortript!line Pa#elor

Tra$odone /es!rel4upropion 5ellbutrin

Side eects

=rt"ostatic "!pertension

Antic"oliner%ic eect

/r! #out"& blurred 'ision& constipation& e0cessi'e s(eatin%& urinar! "esitanc!7

retention& tac"!cardia& a%itation& deliriu#& e0acerbation o %lauco#a

Neurolo%ic eects sedation& ps!c"o#otor slo(in%& poor concentration& ati%ue& ata0ia& tre#ors

/ecrease libido and se0ual peror#ance

Monoa#ine =0idase in"ibitors Generic Trade na#e

Isocarbo0a$id Marplan

P"enel$ine Nardil

Tran!lc!pro#ine Parnate Side eects

Postural li%"t"eadedness

Constipation

/ela! e1aculation or or%as#

Muscle t(itc"in%

/ro(siness

/r! #out"

/ietar! restrictions

C"eese& esp+ a%ed and #atured 2er#ented or a%ed protein

Pic3led or s#o3ed is"

4eer& red (ine& s"err!9 li-uor F co%nac

Yeast

2a'a or broad beans


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16/46

Indications

Acute #ania

4ipolar prop"!la0is

Possibl!

4uli#ia Alco"ol abuse

A%%ressi'e be"a'ior

sc"i$oaecti'e

Mode o action

Nor#ali$es t"e reupta3e o certain neurotrans#itters suc" as serotonin&

norepinep"rine& acet!lc"oline and dopa#ine

Reduces t"e release o norepinep"rine t"ru co#petition (it" calciu#

Eects intracellularl!

La% period, J.> to da!s

Lit"iu# carbonate

Trade na#es

Es3alit"

Lit"otabs

Lit"ane

Lit"onate

M=A, unclear9 interere (it" #etabolis# o neurotrans#itters9 alter Na transport

in ner'es and #uscle cells

Prelit"iu# (or3up Urinal!sis )4UN and creatinine*

ECG& 24C& C4C

Side eects

Earl!

Nausea and diarr"ea

Anore0ia

2ine "and tre#or )propranolol*

T"irst& Pol!dipsia )dec+ crea& inc+ albu#in*

Metallic taste

2ati%ue

Let"ar%!

Late

5ei%"t %ain

acne

Contraindications


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4rain da#a%e7 C6 disease

Epileps!

Elderl!7 debilitated

T"!roid and renal disease

Se'ere de"!dration

Pre%nanc! )sttri#ester*

Can au%#ent t"e eects o anti.depressants

Nursin% considerations

T"erapeutic seru# le'el, >+ +D #e-7L

Maintenance le'el, >+? .+D #e-7L

To0ic

Mild to #oderate, + to D #e-7L

Moderate to se'ere, D D+ #e-7L

Needs dial!sis, #e- and abo'e

Earl! si%ns o to0icit!

Let"ar%!& #ild nausea& 'o#itin%& ine "and tre#ors& anore0ia& pol!uria&

pol!dipsia& #etallic taste& ati%ue

Late si%ns o to0icit!

Ata0ia& %iddiness& tinnitus& blurred 'ision& pol!uria


Lit"iu# le'els s"ould be c"ec3ed - D. #os

Seru# dra(n in t"e AM& DH ater last dose Co##on causes o inc+ le'els

/ec+ Na inta3e

/iuretic t"erap!

/ec+ renal unctionin%

2FE loss

Medical illness ='erdose

NSAI/SNursin% considerations

/iet, ade-uate Na and luid

% NaCl7 da!

?.B %lasses o HD=

No caeine

No dri'in%, (ait or clinical eect

Mana%e#ent

Moderatel! se'ere to0icit!


18/46

=s#otic diuresis, urea7 #annitol

A#inop"!lline F PLR I6

Ade-uate NaCl

Peritoneal7 "e#odial!sis

Se'ere to0icit!

Assess "0 -uic3l! Hold ne0t lit"iu# dose

C"ec3 4P& rectal TO& RR& L=C& support =D

=btain labs

ECG

E#etic& NGT la'a%e

H!drate, .?L7da! c PLR9 24C.C/U

=t"er dru%s

Carba#a$epine )Te%retol*

Side eects

/i$$iness Ata0ia

Clu#siness

Sedation

/!sart"ria /iplopia

Nausea F GI upset

Preparation, li-& tab& c"e(able tab


Assess dru% le'els - . da!s

Monitor salt and luid inta3e

A'oid alco"ol and non.prescription dru%s

Reer dec+ in U=

/on:t stop abruptl!

C7I, pre%nanc!

Ta3e (it" #eals

=t"er dru%s

6alproic acid )/epa3ote& /epa3ene*

Side eects Nausea

Hepato0icit!

Neuroto0icit!

He#atolo%ical to0icit!

Pancreatitis

Prep, tab& cap& sprin3les


19/46

M=A, inc+ le'els o GA4A9 in"ibits t"e kindlingprocess or snoball.li3e eect

seen in #ania F sei$uresNursin% considerations

T"erapeutic le'el, > >> u%7#L

/ose, & >>> &>> #%7da!

Monitor seru# le'els DH ater last dose

To0ic eects

Se'ere diarr"ea& 'o#itin%& dro(siness& ##+ (ea3ness& lac3 o coordination

Renal ailure& co#a& deat"

Anti.ps!c"otic dru%s

Indications

Ps!c"otic s!#pto#s o sc"i$op"renia& acute #ania and depression

Gilles de Tourette disorder

Treat#ent.resistant bipolar disorder

Huntin%ton:s disease and ot"er #o'e#ent disorder

Possibl!

Paranoid

C"ild"ood ps!c"oses

M=A, bloc3 receptors o dopa#ine )/D& /& /*

I unresponsi'e ater ? (ee3s o t"erap!& anot"er class is tried

General considerations

Cal#s (it"out producin% i#pair#ent o sleep

Hi%" t"erapeutic inde0

Non addictin%& no tolerance

A'oided in pre%nanc!

TYPICAL, Hi%" Potenc!2lup"ena$ine )Proli0in*

Haloperidol )Haldol*

T"iot"e0ene )Na'ane*

Triluopera$ine )Stela$ine*

Moderate Potenc!Lo0apine )Lo0itane*

Molindone )Moban*Perp"ena$ine )Trilaon*

Lo( Potenc!

C"lopro#a$ine )T"ora$ine*C"lorprot"i0ene )Taractan*

Mesorida$ine )Serentil*


20/46

T"iorida$ine )Mellaril*

ATYPICAL

Clo$apine )Clo$aril*Resperidone )Risperdal*

=lan$apine )K!pre0a*

uetiapine )Sero-uel*Sertindole )Serlec:t*

Kiprasidone )Keldo0*

Contraindications

CNS depression, brain da#a%e& e0cess alco"ol7 narcotics

Par3inson:s disease

Aller%!

4lood d!scrasias

Acute narro( an%le %lauco#a

4PH

Side eects

H!potension

Sedation

/er#al and ocular s!ndro#e

Neuroleptic #ali%nant s!ndro#e

Antic"oliner%ic s!ndro#e

Mo'e#ent s!ndro#e )E0trap!ra#idal S!ndro#e*

Atropine ps!c"osis A%ranuloc!tosis

Sei$ures

Neuroleptic Mali%nant S!ndro#e

A potentiall! atal& idios!ncratic reaction to an antips!c"otic dru%

>.D> #ortalit! rate

S0,

ri%idit!&

"i%" e'er& autono#ic instabilit! )4P& diap"oresis& pallor& deliriu#& ele'+ CP*& conused or

#ute& luctuate ro# a%itation to stupor =ccurs in t"e irst D (ee3s o t"erap!

Ris3, "i%" dose o "i%".potenc! dru%s9 de"!dration& poor n0& concurrent #ed

illness

Mo'e#ent S!ndro#es

A3at"isia

/!stonia


21/46

Tardi'e d!s3inesia

4rad!3inesia

Par3insonis#

=t"er s7e Atropine ps!c"osis )%eriatrics*

H!peracti'it!& a%itation& conusion& lus"ed s3in& slu%%is" reacti'e pupils

TTT, IM p"!sosti%#ine

A%ranuloc!tosis )Clo$apine*

=ccurs .B (3s ater

Medical e#er%enc!

s7s, e'er& #alaise& sore t"roat& leu3openia

TTT, d7c& re'erse iso& antibiotics

Sei$ures )Clo$apine* =ccurs in o patients9 TTT, /7c dru%

Antic"oliner%ics4en$tropine )Co%entin*

Tri"e0!p"enid!l )Artane*

4iperiden )A3ineton*Proc!clidine )e#adrin*

Not (it"dra(n abruptl!

Pro'ide cool en'iron#ent

ANTIPARINS=NIAN ME/ICATI=NS

Ad1unct to anti.ps!c"otic a%ents to balance dopa#ine7 acet!lc"oline in t"e brain

s7e, %lauco#a& tac"!cardia& HPN& cardiac d0& ast"#a& duodenal ulcer

A7e, blurred 'ision& p"otosensiti'it!& dro(siness& ort"ostatic "!potension& CH2&

"allucinations

C=MM=N /RUGS,

Tri"e0!p"enid!l )Artane*

ben$tropine )Co%entin*

4iperiden )Co%entin*

Sele%iline )Eldepr!l*

Per%olide )Per#a0*

ANTIHISTAMINE

/ip"en"!dra#ine HCl )4ENA/RYL*


22/46


23/46

E0cessi'e and unreasonable cued b! t"e presence or anticipation o a speciic

ob1ect or situation

/eense #ec" co##onl! used include repression and displace#ent

2ear o social peror#ance situations in ("ic" t"e person is e0posed to una#iliar

people or to possible scrutin! b! ot"ers

=4SESSI=N C=MPULSI=N Recurrent and persistent t"ou%"ts& i#pulses& or i#a%es are e0perienced durin% t"e

disturbance as intrusi'e and inappropriate

Cause an0iet! or distress

P0 3no(s t"at t"ese are 1ust product o one:s o(n #ind+

P0 eels dri'en to peror# repetiti'e be"a'iors or #ental acts in response to

obsession or accordin% to t"e rules t"at one dee#s #ust be applied ri%idl!+

Ai#ed at reducin% an0iet!

=4SESSI=N C=MPULSI=N

2ear o dirt F %er#s

2ear o bur%lar! or robber! 5orries about discardin% so#et"in% i#portant

Concerns about contractin% a serious illness

5orries t"at t"in%s #ust be s!##etrical or #atc"in%

E0cessi'e "and (as"in%

Repeated c"ec3in% o door and (indo( loc3s

Countin% and recountin% o ob1ects in e'er!da! lie

Hoardin% o ob1ects

E0cessi'e strai%"tenin%& orderin%& or o arran%in% t"in%s

Repeatin% (ords or pra!ers silentl!

P=ST TRAUMATIC STRESS SYN/R=ME

Person "as e0perienced& (itnessed or been conronted (it" an e'ent t"at in'ol'ed

actual or t"reatened deat" or serious in1ur!& or a t"reat to p"!sical inte%rit!

Person ree0periences t"ese in t"e #ind

In'ol'es intense ear& "elplessness& or "orror and nu#bin% o %eneral

responsi'eness )PSYCHIC NUM4ING* ACUTE GENERALIKE/

STRESS AN@IETY

Meets t"e criteria or e0posure to a trau#atic e'ent and person e0periences ot"e s0,

sense o detac"#ent& reduced a(areness o one:s surroundin%s&

dereali$ation&

depersonali$ation&

dissociated a#nesia


24/46


25/46

/EESCALATI=N TECHNIUES

Maintain saet!

Maintain lar%e personal space and use nona%%ressi'e posture

Use cal# approac" and co##unicate (it" a cal#& clear tone o 'oice )be

asserti'e not a%%ressi'e /eter#ine ("at t"e client considers to be "is or "er need

A'oid 'erbal stru%%les

Pro'ide clear options t"at deal (it" be"a'ior

Assist (it" proble#.sol'in% and decision #a3in% re%ardin% t"e options

MANIPULATI6E 4EHA6I=RS

Set clear& consistent& realistic& and enorceable li#its and co##unicate e0pected

be"a'iors

4e clear about conse-uences associated (it" e0ceedin% set li#its

/iscuss be"a'ior in non1ud%#ental and nont"reatenin% #anner

A'oid po(er stru%%les

Assist in de'elopin% #eans o settin% li#its on o(n be"a'ior

SCHIK=PHRENIA

c"aracteri$ed b! i#pair#ents in t"e perception or e0pression o realit! and b!

si%niicant social or occupational d!sunction+

=nce considered as a deadl! disease

T"ere is lac3 o insi%"t in be"a'ior

/0, late adolescence and earl! adult"ood

.D !+o+ )#en*9 D. !+o+ )(o#en* =bsolete ter#, de#entia praeco0 co%niti'e deterioration earl! in lie

Eu%ene 4leuler, sc"i$ split9 p"ren #ind

Ris3 actors

Genetics, identical t(ins >& or raternal t(ins

4ioc"e#ical actors

/opa#ine "!pot"esis, o'eracti'e

Serotonin i#balance /ecreased brain 'olu#e& enlar%ed 'entricles& deeper issures& and loss or

underde'eloped brain tissue

Ps!c"oanal!tic

lac3 o trust durin% t"e earl! sta%es

5ea3 e%o /eenses, REPRESSI=N& REGRESSI=N& PR=8ECTI=N

En'iron#ent inluences, po'ert!& lac3 o social support& "ostile "o#e en'iron#ent&

isolation& unsatisactor! "ousin%& disruption in interpersonal relations"ips )di'orce

or deat"*& 1ob pressure or une#plo!#entSubt!pes


26/46

Catatonic type

pro#inent ps!c"o#otor disturbances are e'ident+ S!#pto#s can include catatonic

stupor and (a0! le0ibilit!

Disorganized type

("ere t"ou%"t disorder and lat aect are present to%et"er Paranoid type

("ere delusions and "allucinations are present but t"ou%"t disorder& disor%ani$ed

be"a'ior& and aecti'e lattenin% are absent

Residual type

("ere positi'e s!#pto#s are present at a lo( intensit! onl!

ndi!!erentiated type

ps!c"otic s!#pto#s are present but t"e criteria or paranoid& disor%ani$ed& or

catatonic t!pes "as not been #et

S!#pto#s

Accordin% to 4leuler, A:s

Aect is inappropriate

Associati'e looseness

Autistic t"in3in%

A#bi'alence

S!#pto#s

Positi'e s!#pto#s

delusions& auditor! "allucinations and t"ou%"t disorder and are t!picall! re%ardedas #aniestations o ps!c"osis+

Ne%ati'e s!#pto#s

considered to be t"e loss or absence o nor#al traits or abilities

E+G+ lat& blunted or constricted aect and e#otion& po'ert! o speec" and lac3 o

#oti'ation+

S!#pto#s Social isolation

Catatonic be"a'ior

"allucinations

#nco"erence )#ar3ed looseness o association*

$ero7 lac3 o interest& ener%! and initiati'e

%b'ious ailure to attain e0pected le'el o de':t

Peculiar be"a'ior

"!%iene and %roo#in% i#paired

Recurrent illusions and unusual perception e0periences

&0acerbations and re#issions are co##on

No or%anic actors accounts or t"e s!#pto#s


27/46

#nabilit! to return to baseline unctionin% ater relapse

'ect is inappropriateNs% /0, Abnor#al t"ou%"t process

4L=CING, sudden cessation o a t"ou%"t in t"e #iddle o a sentence& unable to

continue t"e train o t"ou%"t

CIRCUMSTANTIALITY, beore %ettin% to t"e point o ans(erin% a -uestion& t"eindi'idual %ets cau%"t up in countless details and e0planations

C=N2A4ULATI=N

L==SENESS =2 ASS=CIATI=N

NE=L=GISM

5=R/ SALA/

Inter'entions

Assess p"!sical needs

Set li#its

Maintain saet!

Initiate one.on.one interaction F pro%ress to s#all %roups

Spend ti#e (it" clients

Monitor or altered t"ou%"t process

Maintain e%o boundaries& a'oid touc"in%

Li#it ti#e o interaction

4e neutral

/o not #a3e pro#ises t"at can:t be 3ept

Establis" dail! routines

/o not %o alon% (it" t"e client:s delusions or "allucinations Pro'ide si#ple co#plete acti'ities

Reorient

Spea3 to t"e client in si#ple direct and concise #anner

Set realistic %oals

E0plain e'er!t"in% t"at is bein% done

/ecrease sti#uli

Monitor or suicide ris3

En'iron#ent

Pro'ide sae en'iron#ent

Li#it sti#uli

Ps!c"olo%ical Ttt

4e"a'ior t"erap!


28/46

Social s3ills trainin%

Sel.#onitorin%

Social ttt

Milieu t"erap!

2a#il! t"erap! Group t"erap! )lon%.ter# ttt*

Related ps!c"otic disorders

SCHIK=A22ECTI6E /IS=R/ER sc"i$ #ood disorder )#ania7 depression*

4RIE2 PSYCH=TIC /IS=R/ER sudden onset o ps!c"otic s!#pto#s& lasts less

t"an D #os and client returns to pre#orbid le'el o unctionin%

SCHIK=PHRENI2=RM /IS=R/ER sc"i$ s0 lastin% bet(een #ont" and

?#os

/ELUSI=NAL /IS=R/ER c"aracteri$ed b! pro#inent& nonbi$arre delusions

PERS=NALITY /IS=R/ERS

CLUSTER A )odd F eccentric*

paranoid& sc"i$oid& sc"i$ot!pal

CLUSTER 4 )bad& dra#atic F erratic*

antisocial& borderline& "istrionic& narcissistic

CLUSTER C )an0ious F earul*

a'oidant& dependent& =C/

CLUSTER A, =// F ECCENTRIC

PARAN=I/ c"ronic "ostilit! pro1ected to ot"ers9 suspicious and #istrusts people

Seen #ostl! in #en

SCHIK=I/

social detac"#ent loner F intro'ert

Restriction o e#otions

Attention i0ed on ob1ects rat"er t"an people

2unctions (ell in 'ocations

SCHIK=TYPAL, interpersonal deicits

Ma%ical t"in3in%& telepat"!

Apparent in c"ild"ood or adolescence

Inter'entions or PARAN=I/ /7=

Asses or suicide ris3

A'oid direct e!e contact

Establis" trustin% relations"ip

Pro#ote increased sel.estee#


29/46

Re#ain cal#& nont"reatenin% and non1ud%#ental

Pro'ide continuit! o care

Respond "onestl! to t"e client

2ollo( t"ru on co##it#ents

Pro'ide a dail! sc"edule o acti'ities

Graduall! introduce client to %roups

/o not ar%ue (it" delusions

Use concrete& speciic (ords

/o not be secreti'e (it" client

/o not ("isper in presence o client

Assure t"at t"e client (ill be sae

Pro'ide opportunit! to co#plete s#all tas3s

Monitor eatin%& drin3in%& sleepin% and eli#ination patterns

Li#it p"!sical contact

Monitor or a%itation and decrease sti#uli as needed

CLUSTER 4, ERRATIC& /RAMATIC& =R EM=TI=NAL

ANTIS=CIAL

S!n, sociopat"& ps!c"opat"ic F se#antic d7o

Etiolo%!,

Genetics interere in t"e de':t o positi'e interpersonal relations"ips

4rain da#a%e or trau#a

Lo( socioecono#ic status

2ault! a#il! relations"ips, ne%lect

Secondar! %ains

.> !+o+

Si%ns

Lac3 o re#orse or indierence to persons "urt

I##ediate %ratiication

2ailure to accept social nor#s

I#pulsi'it!

Consistent irresponsibilit!


30/46

A%%ressi'e be"a'ior

Rec3less be"a'ior t"at disre%ards t"e saet! o ot"ers

B>.V> o all cri#e is co##itted b! antisocials )NIHM& D>>>*

4=R/ERLINE

Latent& a#bulator! and aborti'e sc"i$op"renics

4et(een #oderate neurosis and ran3 ps!c"osis but -uite stable

T"eories

ault! separation ro# #ot"er9 parent and c"ild are bound b! %uilt

Trau#a at B #os )(ea3enin% o e%o*

Unulilled need or inti#ac!

Si%ns instabilit!

I#pulsi'it!, unpredictable %a#blin%& s"oplitin%& se0 F substance abuse

"!persensiti'it!& sel.destructi'e& proound #ood s"its

unstable F intense relations

/isturbance in sel concept

Co##on in (o#en

/eenses, denial& pro1ection& splittin%& pro1ecti'e identiication

HISTRI=NIC

Pattern o t"eatrical or o'ertl! dra#atic be"a'ior

Si%ns

/isco#ort ("en t"e client isn:t t"e center o attention

Sel.dra#ati$ation and e0a%%erated e#otions

uses p"!sical appearance& se0uall! seducti'e and pro'ocati'e be"a'ior E0cessi'el! i#pressionistic speec" lac3in% in detail )labile e#otions*

Proble#s in dependence F "elplessness

More re-uent in (o#en

NARCISSISTIC

E0a%%erated or %randiose sense o sel.i#portance

/e'elop earl! in c"ild"ood

Preoccupied (it" antasies o unli#ited success& po(er and beaut!

Si%ns

arro%ance& need or ad#iration&

lac3 o e#pat"!&


31/46

seducti'e& sociall! e0ploitati'e& #anipulati'e

=ccurs #ore in #en

CLUSTER C, AN@I=US =R 2EAR2UL

A6=I/ANT

Sensiti'e to re1ection& criticis#& "u#iliation& disappro'al& or s"a#e

Intereres (it" participation in occupational acti'ities& de':t o relations"ips& and

ta3e personal ris3s

social in"ibition& lon%s or relations"ips

An0iet!& an%er and depression are co##on

Social p"obia #a! occur

Seen in > o clients in #ental clinics

/EPEN/ENT

Lac3s conidence and unable to unction in an independent role Allo(s ot"er persons to be responsible o t"eir li'es

Most re-uent personalit! disorder in t"e #ental "ealt" clinic

sub#issi'e be"a'ior& lo( sel.estee#& inade-uate& "elpless

=4SESSI6E.C=MPULSI6E

Preoccupied (it" rules F re%ulations& o'erl! concerned about tri'ial detail&

e0cessi'el! de'oted to t"eir (or3

/epression is co##on

Men are #ore aected t"an (o#en

UN/ER STU/Y PERS=NALITY /7=

PASSI6E.AGGRESSI6E, sullen and ar%u#entati'e& resents ot"ers& resists

ulillin% responsibilities& co#plains o bein% unappreciated

/EPRESSI6E, %loo#!& broodin% pessi#istic& %uilt.prone& "i%"l! critical o sel

and ot"ers& c"eerless+

Inter'entions

Maintain saet! a%ainst sel.destructi'e be"a'iors

Allo( t"e client to #a3e c"oices and be as independent as possible

Encoura%e t"e client to discuss eelin%s rat"er t"an act t"e# out Pro'ide consistenc! in response to t"e client:s actin% out

/iscuss e0pectations and responsibilities (it" t"e client

Inor# t"e client t"at "ar# to sel& ot"ers& and propert! is unacceptable

Identi! splittin% be"a'ior


32/46

Assist t"e client to deal directl! (it" an%er

/e'elop a (ritten contract (it" t"e client

Encoura%e t"e client to participate in %roup acti'ities& and praise non#anipulati'e

be"a'ior

Set and #aintain li#its Re#o'e t"e client ro# %roup situations in ("ic" attention.see3in% be"a'iors

occur

Pro'ide realistic praise or positi'e be"a'iors in social situations

PSYCH=L=GICAL SE@UAL /7=

H!poacti'e se0ual disorder )ase0ualit!*

Se0ual a'ersion disorder )a'oidance o or lac3 o desire or se0ual intercourse*

2e#ale se0ual arousal d7o )ailure o nor#al lubricatin% arousal response*

Male erectile d7o

2e#ale or%as#ic disorder

Male or%as#ic disorder

Pre#ature e1aculation

6a%inis#us

Secondar! se0ual d!s0n

Parap"ilias

Gender identit! d7o

PTS/ due to %enital #utilation or c"ild"ood se0ual abuse

%t(er se)ual proble*s

Se0ual dissatisaction )non.speciic*

Lac3 o se0ual desire

anor%as#ia

I#potence

ST/

Inidelit!

/ela! or absence o e1aculation& despite ade-uate sti#ulation

Inabilit! to control ti#in% o e1aculation

Inabilit! to rela0 'a%inal #uscles enou%" to allo( intercourse

Inade-uate 'a%inal lubrication precedin% and durin% intercourse

4urnin% pain on t"e 'ul'a or in t"e 'a%ina (it" contact to t"ose areas


33/46

Un"appiness or conusion related to se0ual orientation

Persistent se0ual arousal s!ndro#e

Se0ual addict

"!perse0ualit! Post E1aculator! Guilt S!ndro#e& t"e eelin% o %uilt ater t"e #ale or%as#

SE@UAL E@PRESSI=N

HETER=SE@UALITY

H=M=SE@UALITY

4ISE@UALITY

TRANS6ESTISM

PARAPHILIAS E@HI4ITI=NISM, t"e recurrent ur%e or be"a'ior to e0pose oneWs %enitals to an

unsuspectin% person+

2ETISHISM, t"e use o non.se0ual or nonli'in% ob1ects or part o a personWs bod!

to %ain se0ual e0cite#ent+Partialismreers to etis"es speciicall! in'ol'in% nonse0ual

parts o t"e bod!+

2R=TTEURISM, t"e recurrent ur%es or be"a'ior o touc"in% or rubbin% a%ainst a

nonconsentin% person+

SE@UAL MAS=CHISM, t"e recurrent ur%e or be"a'ior o (antin% to be

"u#iliated& beaten& bound& or ot"er(ise #ade to suer+ SE@UAL SA/ISM, t"e recurrent ur%e or be"a'ior in'ol'in% acts in ("ic" t"e

pain or "u#iliation o t"e 'icti# is se0uall! e0citin%+

TRANS6ESTIC 2ETISHISM, a se0ual attraction to(ards t"e clot"in% o t"e

opposite %ender+

PE/=PHILIA, t"e se0ual attraction to prepubescent or peripubescent c"ildren+

6=YEURISM, t"e recurrent ur%e or be"a'ior to obser'e an unsuspectin% person

("o is na3ed& disrobin% or en%a%in% in se0ual acti'ities& or #a! not be se0ual in nature atall+

Other paraphilias not otherwise specified)XSe0ual /isorder N=SX*

telep"one scatalo%ia )obscene p"one calls*

necrop"ilia )corpses*

partialis# )e0clusi'e ocus on one part o t"e bod!*

$oop"ilia)ani#als*


34/46


35/46

Hun%er denied

Eatin% be"a'ior #a! be considered nor#al and a source o estee#

Se0uall! inacti'e

=bsessional and perectionist eatures do#inate

2re-uent

Less (t loss Sli%"tl! older

More e0tro'erted

Hun%er e0perienced

Eatin% be"a'ior considered orei%n and source o distress

More se0uall! acti'e A'oidant& dependent& or borderline eatures as (ell as obsessional eatures

AN=RE@IA 4ULIMIA

co#plications

/eat" ro# star'ation )or suicide& in c"ronicall! ill*

A#enorr"ea

2e(er be"a'ioral proble#s )t"ese increase (it" le'el o se'erit!*

/eat" ro# "!po3ale#ia or suicide

Menses irre%ular or absent

/ru% and alco"ol abuse& sel.#utilation& and ot"er be"a'ioral proble#s

/ELIRIUM

T"e #edical d0 ter# t"at describes an or%anic #ental disorder c"aracteri$ed b! a

cluster o co%niti'e i#pair#ents (it" an acute onset (it" a speciic precipitatin% actor+

S0, di#inis"ed a(areness o t"e en'iron#ent& disturbances in ps!c"o#otoracti'it! and sleep.(a3e c!cle+

C=GNITI6E, t"e #ental process c"aracteri$ed b! 3no(in%& t"in3in%& and1ud%in%+ C=GNITI6E /ISS=NANCE, arises ("en D opposin% belies e0ists at t"e sa#e

ti#e+

C=GNITI6E /IST=RTI=NS, )* or ).* distortions o realit! t"at #i%"t includeerrors o lo%ic& #ista3es in reasonin%& or indi'iduali$ed 'ie( o t"e (orld t"at do not

relect realit!+

Ter#, conusion co%niti'e i#pair#ent

See de#entia

/EMENTIA

T"e #edical d0 ter# t"at describes an or%anic #ental d7o c"aracteri$ed b! a

cluster o co%niti'e i#pair#ents o %enerall! %radual onset and irre'ersible (it"outidentiiable precipitatin% stressors+

T!pes,

6ASCULAR or MULTI.IN2ARCT

6ASCULAR 5ITH ALKHEIMER:S /SE

A/, #ost co##on

/EMENTIA 5ITH LE5Y 4=/IES, Dnd#ost co##on9 neuroila#ent #aterial

PARINS=NIAN /EMENTIA


36/46

AI/S /EMENTIA C=MPLE@

2R=NTAL L=4E /EMENTIA or PIC:S /SE, c!toplas#ic collections9 rd

#ost co##on9 loss o e0pressi'e lan%ua%e F co#pre"ension

CREUTK2EL/T.8A=4 /SE, prion )proteinaceous inectious particles*

spon%! brain9 related to TSE F 4SE in #ad co( dse C=RTIC=4ASAL /EGENERATI=N or HUNTINGT=N:S /SE7CH=REA,

1er3! #o':ts

SUPRANUCLEAR PALSY, clu#pin% o protein tau slo( #o':t& (ea3 e!e

#o':t )esp+ do(n(ard*& i#paired (al3in% Fbalance

Re'ersible Causes,

Subdural "e#ato#a

Tu#or )#enin%io#a*

Cerebral 'asculitis

H!drocep"alus

Ter#s, disorientation& #e#or! loss )sensor!& pri#ar!& secondar!& tertiar!&

(or3in% #e#or!*& conabulation& conusion

/isturbin% be"a'iors

A%%ressi'e ps!c"o#otor

Nona%%ressi'e ps!c"o#otor

6erball! a%%ressi'e

Passi'e 2unctionall! i#paired, loss o abilit! to do sel.care

/ELIRIUM 's+ /EMENTIA

Rapid onset (7 (ide luctuations H!peralert to diicult to arouse L=C

2luctuatin% aect

/isoriented& conused

Attention F sleep disturbed

Me#or! i#paired

/isordered reasonin%

Gradual& c"ronic (it" continuous decline

Nor#al L=C

Labile aect

/isoriented& conused Attention intact& sleep usuall! nor#al

Me#or! i#paired

/isordered reasonin% F calculation

/ELIRIUM 's+ /EMENTIA

Inco"erent& conused& delusional& stereot!ped

Illusions& "allucinations

Poor 1ud%#ent


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M=T=R SILLS /7=

C=MMUNICATI=N /7=

E@PRESSI6E LANGUAGE

MI@E/ RECEPTI6E7E@PRESSI6E PH=N=L=GICAL

STUTTERING

SELECTI6E MUTISM

C=MMUNICATI=N /7= N=S

M=6:T F TIC /7=

/E6:TAL C==R/INATI=N

TRANSIENT TIC

CHR=NIC M=T=RF6=CAL TIC

T=URETTE:S /7=

STERE=TYPIC M=6:T /7=

TIC /7= N=S

/IS=R/ERS =2 INTAE F ELIMINATI=N

PICA

RUMINATI=N

2EE/ING /7=

ENURESIS

ENC=PRESIS

=THER, 4ULIMIA& AN=RE@IA

A/H/ F /ISRUPTI6E 4EHA6I=R /7=

A/H/

A/H/ N=S

C=N/UCT /7=

=PP=SITI=NAL /E2IANT

CHIL/ ANTIS=CIAL

/ISRUPTI6E 4EHA6I=R N=S

M==/ /7=

M8 /EPRESSI6E /7=

4IP=LAR I =R II /YSTHYMIC

MI@E/ EPIS=/E

HYP=MANIC EPIS=/E

M==/ /7= /UE T= ME/ICAL C=N/ITI=N

SU4STANCE.IN/UCE/ M==/ /7=


39/46

AN@IETY /7=

/7= =2 RELATI=NSHIP

SEPARATI=N AN@IETY

REACTI6E ATTACHMENT =2 IN2ANCY =R EARLY CHIL/H==/

PARENT.CHIL/ RELATI=NAL PR=4LEM SI4LING RELATI=NAL PR=4LEM

PR=4LEMS RELATE/ T= A4USE =R NEGLECT

MENTAL RETAR/ATI=N

an I belo( J>& si%niicant li#itations in t(o or #ore areas o adapti'e be"a'ior)i+e+& abilit! to unction at a%e le'el in an ordinar! en'iron#ent*& and e'idence t"at t"e

li#itations beca#e apparent in beore B !+o+

T"e ollo(in% ran%es& based on t"e5ec"sler Adult Intelli%ence Scale)5AIS*&

are in standard use toda!,

Class #+ er*s

Proound 4elo( D> Idiot

Se'ere D> I#becileModerate V Moron

Mild >?V4orderline J>JV

RETT:S /7=

/e'elop#ent is nor#al until ?.B #ont"s& ("en lan%ua%e and #otor #ilestones

re%ress&

purposeul "and use is lost

Ac-uired deceleration in t"e rate o "ead %ro(t" )resultin% in #icrocep"al! in

so#e*

Hand stereot!pes are t!pical and breat"in% irre%ularities suc" as "!per'entilation&breat" "oldin%& or si%"in% are seen in #an!+

Earl! on& autistic.li3e be"a'ior #a! be seen

Co##on in e#ales

CHIL/H==/ /ISINTEGRATI6E /7= or HELLER:S SYN/R=ME

C// "as so#e si#ilarit! to autis#& but an apparent period o airl! nor#al

de'elop#ent is oten noted beore a re%ression in s3ills or a series o re%ressions in s3ills+

c"aracteri$ed b! late onset ) !ears o a%e* o de':tal dela!s in lan%ua%e& social

unction and #otor s3ills9 s3ills apparentl! attained are lost

ASPERGER:S /7=

c"aracteri$ed b! dierence in lan%ua%e and co##unication s3ills& as (ell asrepetiti'e or restricti'e patterns o t"ou%"t and be"a'ior+

Si%ns, unable to interpret or understand t"e desires or intentions o ot"ers andt"ereb! are unable to predict ("at to e0pect o ot"ers or ("at ot"ers #a! e0pect o t"e#

Narro( interests or preoccupation (it" a sub1ect to t"e e0clusion o ot"er

acti'ities Repetiti'e be"a'iors or rituals

Peculiarities in speec" and lan%ua%e
http://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scale


40/46


41/46

2re-uentl! prescribed sti#ulants are #et"!lp"enidate )Ritalin and Concerta*&

a#p"eta#ines )Adderall* and de0troa#p"eta#ines )/e0edrine*

2ein%old diet("ic" in'ol'es re#o'in% salic!lates& artiicial colors and la'ors&

and certain s!nt"etic preser'ati'es ro# c"ildrenWs diets+

C=N/UCT /7=

repetiti'e and persistent pattern o be"a'ior in ("ic" t"e basic ri%"ts o ot"ers or

#a1or a%e.appropriate societal nor#s or rules are 'iolated&

AGGRESSI=N T= PE=PLE F ANIMALS

/ESTRUCTI=N =2 PR=PERTY

/ECEIT2ULNESS =R THE2T

SERI=US 6I=LATI=NS =2 RULES

4e%innin% beore a%e

=PP=SITI=NAL /E2IANT c"aracteri$ed b! an on%oin% pattern o disobedient& "ostile& and deiant be"a'ior

to(ard aut"orit! i%ures t"at %oes be!ond t"e bounds o nor#al c"ild"ood be"a'ior Si%ns

Losin% te#per Ar%uin% (it" adults

Reusin% to ollo( t"e rules

/eliberatel! anno!in% people

4la#in% ot"ers

Easil! anno!ed

An%r! and resentul

Spiteul or e'en re'en%eul ne0t

SU4STANCE A4USE

E0cessi'e or un"ealt"! use o substances& suc" as alco"ol& tobacco or dru%s& or

use o products suc" as ood

Ter#s,

T=LERANCE, t"e declinin% eect o t"e sa#e dru% dose ("en it is ta3en

repeatedl! o'er ti#e

HA4ITUATI=N, a ps!c"olo%ical dependence o t"e use o a dru%

A//ICTI=N, t"e biolo%ical and7 or ps!c"olo%ical be"a'iors related to substance

dependence

5ITH/RA5AL SYMPT=MS, result ro# a biolo%ical need t"at de'elops ("ent"e bod! beco#es adapted to "a'in% an addicti'e dru% in t"e s!ste#9 occurs ("en seru#

le'els decrease

A//ICTI=N

ALC=H=L, blood alco"ol le'els o >+ )>>#% alco"ol7dl o blood* or "i%"er

5ITH/RA5AL


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Anore0ia

An0iet!

Easil! startled H!peralertness

HPN

Inso#nia Irritabilit!

8er3! #o':t

Possibl!, "allucinations& illusions or 'i'id ni%"t#ares Sei$ures )J.B "rs ater cessation*

Tac"!cardia

tre#ors

5ITH/RA5AL /ELIRIUM

A%itation Anore0ia

An0iet! /eliriu#

/iap"oresis

/isorientation (it" luctuatin% le'els o consciousness

2e'er )>> to > 2*

Hallucinations and delusions

Inso#nia

Tac"!cardia and HPN

/isulira# )Antabuse* t"erap!

Nursin% care

=btain ino about dru% t!pe and a#ount consu#ed

Assess '7s Re#o'e unnecssar! ob1 ro# en'iron#ent

Pro'ide one.on.one super'ision i necessar!

Pro'ide a -uiet& cal# en'iron#ent (it" #ini#al sti#uli

Maintain orientation

Ensure saet!

Use restraints

Pro'ide p"!sical needs

Pro'ide ood and luids as tolerated

Ad#inister #edications

Collect blood and urine sa#ples or dru% screenin%SP=USE A4USE

4atterin% precipitates , suicide atte#pts o all (o#en

5i'es e0plain t"e in1uries as bein% sel.inlicted or accidental

P"ases

Tension.buildin%, series o s#all incidents t"at leads to beatin% Acute beatin% p"ase, (ie beco#es ob1ect o assault be"a'ior


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Lo'in% p"ase, batterer is re#orseul and assures spouse t"at "e (ill not "ar# "er

a%ain+ T"is leads to reconciliation+

M!t"s

T"e! belie'e t"at i t"e! tr! not to anta%oni$e (it" t"eir "usband& "e (ill c"an%e+

Eorts to coerce t"e (ie out o t"e 'icti# role can be ruitul+ 2acts

5o#en sta! in relations"ips (it" #en ("o batter because t"e! eel %uilt! or

responsible o t"e "usband:s be"a'ior

5ie de'elops little sense o sel.(ort"& i##obili$ed and unable to re#o'e selro# t"e relations"ip+

Assess#ent, in1uries& ot"er e'idence

Inter'entions, (it" consent

CHIL/ A4USE

PHYSICAL 4ATTERING

EM=TI=NAL

SE@UAL

NEGLECT

EL/ERLY A4USE

A 'ariet! o be"a'iors t"at t"reaten t"e "ealt"& co#ort& and possibl! t"e li'es o

t"e elderl!& includin% p"!sical and e#otional ne%lect& e#otional abuse& 'iolation o

personal ri%"ts& inancial abuse& and direct p"!sical abuse+

Co##onl! co##itted b! care %i'ers+

SE@UAL A4USE

Co#ponents

Se0ual Misuse, inappropriate se0ual acti'it!

Rape, t"ere is actual penetration

Incest, reers to t"e relations"ip bet(een t"e 'icti# and abuser blood relati'e or

step parent role

Inter'entions

C"ildren, t"ru pla! or role pla!in% (it" puppets

Pre'ention o urt"er se0ual abuse

ne0t C=MPLETE/ SUICI/E

Sel.inlicted deat"

LE6ELS =2 SUICI/E

Ideation, t"ou%"t

Atte#pt, acted upon but ailed


44/46

Co#pleted

CHEMICAL RESTRAINT

CHEMICAL RESTRAINTS, Medications used to restrict t"e patient:s reedo# o

#o'e#ent or or e#er%enc! control o be"a'ior but are not a standard treat#ent or t"e

p0:s #edical or ps!c"iatric condition+

PHYSICAL RESTRAINTS, Are an! #anual #et"od or p"!sical or #ec"anicalde'ice attac"ed to or ad1acent to t"e p0:s bod! t"at "e or s"e cannot easil! re#o'e and

t"at restricts reedo# o #o'e#ent or nor#al access to one:s bod!& #aterial or

e-uip#ent+

SECLUTI=N AN/ RESTRAINTS

SECLUTI=N, t"e in'oluntar! conine#ent o a person alone in a roo# ro#

("ic" t"e person is p"!sicall! pre'ented ro# lea'in%+

No t"erapeutic e'idence ot"er t"an a last resort to ensure saet!+

E'idence su%%est t"at it adds to urt"er trau#a and p"!sical "ar#

GUI/ELINES

All "ospital sta ("o "a'e direct contact (it" t"e p0 s"ould "a'e on%oin%

education and trainin% in t"e proper use o seclusion and restraints and ot"er alternati'es

P"!sician or licensed practitioner s"ould e'aluate need (it"in "our ater t"e

initiation o t"is inter'ention+

Ma0 o "ours or adults& D "ours or a%es V.J& and "our or c"ildren under V!rs

=rders #a! be rene(ed or D "rs beore anot"er ace to ace e'aluation Continuous assess#ent& #onitorin% and e'aluation9 recorded

Good nursin% care 2or bot" restrained and secluded, constant #onitorin% ace to ace or b! bot"audio and 'ideo e-uip#ent+

P0 s"ould be released ASAP=THER GUI/ELINES

SECLUSI=N

Roo# s"ould allo( obser'ation and co##unication (it" p0

Re#o'e all ite#s t"at p0 #i%"t use to "ar# sel

/ocu#ent, rationale& response to inter'ention& p"!sical condition& ns% care& F

rationale or ter#ination

RESTRAINTS

Gi'e support F reassurance Position in anato#ical position

Pri'ac! is i#portant '7s F Circulation c"ec3

S"ould be released - D"rs A'oid t!in% to t"e side rails o bed

Assist in periodic c"an%e in bod! positions


45/46

TERMINATING THE INTER6ENTI=N

As soon as #et t"e criteria or release

Re'ie( (it" p0 t"e be"a'ior t"at precipitated t"e inter'ention F p0:s capacit! to

e0ercise control o'er be"a'ior

/E4RIE2ING, re'ie(in% t"e acts related to an e'ent F processin% t"e responseto t"e#9 can be used ater an! stressul e'ent

ne0tTHERAPEUTIC IMPASSES

Are bloc3s in t"e pro%ress o t"e nurse.pt relations"ip

Pro'o3es intense eelin%s in bot" t"e nurse and patient

RESISTANCE

TRANS2ERENCE

C=UNTERTRANS2ERENCE

4=UN/ARY 6I=LATI=NS

RESISTANCE Reluctance or a'oidance o 'erbali$in% or e0periencin% troublin% aspects o

onesel

E%, suppression or repression& intensiication o s0& sel.de'aluation or

"opelessness& intellectual in"ibitions& actin% out or irrational be"a'ior& supericial tal3&intellectual insi%"t7 intellectuali$ation& transerence reactions+

TRANS2ERENCE

Unconscious response in ("ic" t"e p0 e0periences eelin%s and attitudes to(ard

t"e nurse t"at (ere ori%inall! associatated (it" ot"er si%niicant i%ures in "is or "er lie+

H=STILE TRANS2ERENCE, an%er and "ostilit!& resistance

/EPEN/ENT TRANS2ERENCE, sub#issi'e& subordinate and re%ards t"e nurseas a %od.li3e i%ure9 'ie(s relations"ip as #a%ical

5"at do !ou doZ

LISTEN

CLARI2Y

RE2LECT

E@PL=RE7 ANALYKEC=UNTERTRANS2ERENCE

Created b! t"e nurse:s speciic e#otional response to t"e -ualities o t"e patient9

inappropriate in t"e conte0t& content and intensit! o e#otion9 nurses identi! t"e p0 (it"

indi'iduals ro# t"eir past& and personal needs


46/46

T!pes, Reactions o INTENSE

lo'e or carin%

/is%ust or "ostilit!

An0iet!& oten in response to resistance b! t"e p0

E%+

/iicult! e#pat"i$in% 2eelin%s o depression beore or ater t"e session

Carelessness about i#ple#entin% t"e contract /ro(siness durin% t"e sessions

Encoura%e#ent o t"e p0:s dependenc! Ar%u#ents (it" t"e p0

Personal or social in'ol'e#ent (it" t"e p0

Se0ual or a%%ressi'e antasies to(ard t"e p0

Tendenc! to ocus on onl! one aspect or (a! o loo3in% at inor#ation presented

b! t"e p0 Atte#pts to "elp t"e p0 (it" #atters not related to t"e identiied nursin% proble#s

2eelin%s o an%er or i#patience because o t"e p0:s un(illin%ness to c"an%e

/rea#s about or preoccupation (it" t"e p0

psychiatric nursing dsecseaniel

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