ifc psyche
TRANSCRIPT
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PSYCHIATRIC
NURSING
IFC
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HOW TO ANSWER QUESTIONS
B Be consistent
E - Encourage verbalization
H Have a sound knowledge on
cultural diversityA Acknowledge feelings
V Voluntarily/ involuntarily
admitted px do not lose their rightto consent
E Empathize
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NURSING DIAGNOSIS
In the local board, oneof five questions
pertains to nursingdiagnosis
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INEFFECTIVE INDIVIDUAL COPINGANXIETYSUBSTANCE ABUSE
CRISIS
RAPE
BATTERED WIFE
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ALTERED THOUGHT PROCESSSCHIZOPHRENIAALZHEIMERS
DEMENTIA
AMNESIA
MENTALRETARDATION
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SELF-ESTEEM DISTURBANCEBATTERED WIFEANXIETY
DISORDERSDEPRESSION
B-A-D shape
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RISK FOR INJURYSUICIDALALZHEIMERS
MANIC
ADHD
MENTALRETARDATION
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INEFFECTIVE INDIVIDUAL COPINGANXIETYSUBSTANCE ABUSE
CRISIS
RAPE
BATTERED WIFE
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PSYCHOPHARMACOLOGY
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OBSESSIVE-COMPULSIVE
TOFRANIL
DEPRESSION ANTI-DEPRESSANT (NARDIL)
MANIC LITHIUM CARBONATE;THORAZINE (acute mania)
ADHD RITALIN
SCHIZOPHRENIA HALDOL/ THORAZINE
ANXIETY DIAZEPAM
AVERSION THERAPY ANTABUSE (DISULFIRAM)
COCAINEWITHDRAWAL
DIAZEPAM; TOFRANIL
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C- antipsychotics,
neuroleptics, majortranquilizers
H- decreased overt orpositive manifestations
of psychosisE- p.c.
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C- rise slowly, avoidsunlight
Report
sorethroat,fever,muscularrigidity
disorder takes 6-8 weeksfor full therapeutic effect
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K monitorBP and temperature
Blood levels
Adverse effect
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Neuroleptic malignant syndrome
F feverE encephalopathy
V v/s unstable
E elevated enzymes
(CPK)
R rigidity of muscles
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LITHIUM
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LITHIUM
C mood stabilizer anti manic H decrease hyperactivity/manic
episodes
Initial effect 10-14 days
Full therapeutic effect 3-4 weeks
E after meals with milk or food
LITHIUM
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LITHIUM
C antipsychotics given withlithium for immediate management
Diet Na 6-10 grams a day;fluids- 3 liters per day
Avoid caffeine, diuretics and
activities that increaseperspiration
LITHIUM
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LITHIUM
K Monitor serum level at least oncea month(A.M. 12 hours after the lastdose)
maintenance dose 0.5 1.2 mEq / L acute level 1.5 mEq / L
the elderly 0.4 1.0 mEq / L
LITHIUM
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LITHIUM
Antidote for toxicity Mannitol (Osmitrol)
Acetazolamide (Diamox)
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ANTIDEPRESSANTS
C anti-depressants H decreased signs and
symptoms ofdepression(increased appetiteand sleep
E p.c.
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TRICYCLIC ANTIDEPRESSANTS
C TCA; prevents reuptake ofnorepinephrine
Hincreased appetite andadequate sleep
E p.c.
C therapeutic effect after 2-3weeks
K hypotention, tachycardia
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TRICYCLIC ANTIDEPRESSANTS
IMIPRAMINE(TOFRANIL)
AMITRIPTYLINE(ELAVIL)
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MONOAMINE OXIDASE INHIBITOR
C MAOI; ANTIDEPRESSANTS Hincreased appetite and
adequate sleep
E p.c.
C report headache; 2-3 weeks
effect
K hypertensive crisis
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MONOAMINE OXIDASE INHIBITOR
Avoid TYRAMINEA avocado
B banana
C cheddar, aged cheese
S soysauce, preserved foods
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MONOAMINE OXIDASE INHIBITOR
TRANYLCYPROMINE(PARNATE)
PHENELZINE (NARDIL)ISOCARBOXAZID
(MARPLAN)
SELECTIVE SEROTONIN REUPTAKE
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SELECTIVE SEROTONIN REUPTAKE
INHIBITOR (SSRI)
C anti-depressants; increaselevel of serotonin
H decreased signs andsymptoms of depression
E p.c.
2-3 weeks initial effect
3-4 weeks full effect
ANTIDEPRESSANTS
SELECTIVE SEROTONIN REUPTAKE
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ANTIDEPRESSANTS
C/K side effectsTremors,
decreased libido,NAVDA,
insomnia
SELECTIVE SEROTONIN REUPTAKE
INHIBITOR (SSRI)
ANTIDEPRESSANTS
SELECTIVE SEROTONIN REUPTAKE
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ANTIDEPRESSANTS
FLUOXETINE (PROZAC)SERTRALINE (ZOLOFT)
PAROXETINE (PAXIL)
SELECTIVE SEROTONIN REUPTAKE
INHIBITOR (SSRI)
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p
ANTIANXIETY
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ANTIANXIETY
C anxiolytic; muscle relaxant H decreased anxiety, adequate
sleep
E before meals
C avoid driving (drowsiness),
avoid alcohol, caffeine (altereffects of drugs)
K administer separately,
incompatible with other drugs
ANTIANXIETY
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ANTIANXIETY
(benzodiazepines) DIAZEPAM (VALIUM)
OXAZEPAM (SERAX) CHLORDIAZEPOXIDE
(LIBRIUM)
CHLORAZEPATE DIPOTASSIUM(TRANXENE)
ALPRAZOLAM (XANAX)
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ANTABUSE (DISULFIRAM)
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ANTABUSE (DISULFIRAM)
C anticholinergic; unpleasnt rxnwith alcohol
H patient avoids alcohol
E after abstaining from alcoholfor 12 hours
C
avoid alcohol-based substances K monitor disulfiram reaction;
miver function tests
ANTABUSE (DISULFIRAM)
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ANTABUSE (DISULFIRAM)
M mouthwash O OTC remedies
F fruit flavored extracts
F food sauce made of wine
A aftershave lotion
V vinegar S skin products
tin
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tin
ALCOHOL WITHDRAWAL
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ALCOHOL WITHDRAWAL
H hallucinations (visual, tactile) I increased vital signs
T tremors
S sweating, seizuresOutcomes of alcoholism
B brain damage
A alcoholic hallucinosis
D death
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PRIORITIES
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SAFETY
SUICIDAL
PATIENT IN CRISIS
ALZHEIMERS
ADHD
MANIA
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NUTRITION
MANIC
ADHD
CATATONIC
DEPRESSED
ALCOHOLIC
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CIRCULATION
CATATONIC
PATIENT IN
RESTRAINTS
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DETOXIFICATION
ALCOHOLISM
SUBSTANCE ABUSE
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SOCIALIZATION
WITHDRAWN
CATATONIC
DEPRESSED
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CRISIS INTERVENTION
RAPE
CHILD ABUSE
BATTERED WIFE
MULTIPLE CRISIS
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REALITY ORIENTATION
SCHIZOPHRENIA
ALZHEIMERS
DEMENTIA
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ADL ASSISTANCE
PX WT REGRESSEDBEHAVIOR
ALZHEIMERS
DISORGANIZED
SCHIZOPHRENIA
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THERAPEUTICCOMMUNICATIONCORE CONCEPTS
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To initiate conversationGIVING BROAD-OPENING
GIVINGRECOGNITION
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To build trust/ rapportGIVINGINFORMATION
USE OF SILENCE
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To gather informationFOCUSINGVALIDATING
REFLECTINGRESTATING
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To close a conversation
SUMMARIZING
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DEFENSE
MECHANISM
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DISORDER DEFENSE MECHANISM
CATATONICSCHIZOPHRENIA
REPRESSION
DISORGANIZED
SCHIZOPHRENIA
REGRESSION
MANIC REACTION
FORMATIONDEPRESSION INTROJECTION
ANOREXIA SUPRRESSION
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DISORDER DEFENSE MECHANISM
OBSESSIVECOMPULSIVE
UNDOING
PHOBIA DISPLACEMENT
ALCOHOLISM D.R.I.P.
SCHIZOPHRENIA REGRESSION
PARANOID SCHI. PROJECTION
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ALZHEIMERS DISEAE
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ALZHEIMER S DISEAE
M.P. : Degeneration, atrophy of thebrain cortex leading to impaired brainfunctioning
VeI M: progressive memory
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VeI.M: progressive memoryloss
Lab : no specific
NDx: altered thoughtprocess
N.I.: 5Cs (calendar, clock.Colors, consistency,COGNEX/TACTRINE)
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SCHIZOPHRENIA
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SCHIZOPHRENIA
Split MindBleuler
ASSOCIATIVE LOOSENESS
AUTISM
APATHYAMBIVALENCE
ics
CATATONIC DISORGANIZED PARANOID
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ics
ACUTE INSIDUOUS ABRUPT
ABNORMALMOTORBEHAVIOR
BIZARREBEHAVIOR
SUSPICIOUS,IDEAS OFREFERENCE
REPRESSION REGRESSION PROJECTION
IMPAIREDMOTORACTIVITY
IMPAIREDSOCIALFUNCTIONING
POTENTIAL FORINJURY
CIRCULATIONNUTRITION
ASSISTANCEWITH ADL
NUTRITIONSAFETY
GOOD
PROGNOSIS
POOR GOOD
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PERSONALITY
DISORDERS
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Borderline
fears separations
Splitting
Suicidal attempst
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Anti-social habitually
breaks the law
low self-esteem;
No guilt
http://images.google.com/imgres?imgurl=http://www.cerebromente.org.br/n07/doencas/withoutconscience.jpg&imgrefurl=http://www.cerebromente.org.br/n07/doencas/biblio.htm&h=343&w=386&sz=15&hl=en&start=4&um=1&tbnid=peo-1p5pTMpInM:&tbnh=109&tbnw=123&prev=/images?q=antisocial+personality&um=1&hl=en&sa=Ghttp://images.google.com/imgres?imgurl=http://www.cerebromente.org.br/n07/doencas/withoutconscience.jpg&imgrefurl=http://www.cerebromente.org.br/n07/doencas/biblio.htm&h=343&w=386&sz=15&hl=en&start=4&um=1&tbnid=peo-1p5pTMpInM:&tbnh=109&tbnw=123&prev=/images?q=antisocial+personality&um=1&hl=en&sa=G -
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Dependent incessant
demands
forattention
from others
http://images.google.com/imgres?imgurl=http://ec1.images-amazon.com/images/I/416E477WMML.jpg&imgrefurl=http://www.bookrags.com/research/personal-dependency-eos-03/&h=475&w=337&sz=28&hl=en&start=11&um=1&tbnid=cacfnaxDI-LgmM:&tbnh=129&tbnw=92&prev=/images?q=dependent+personality&um=1&hl=en&sa=G -
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Schizoid withdrawn,
last to catch
up infashion,
introvert, aloof
http://images.google.com/imgres?imgurl=http://webpages.charter.net/micah/hb.jpg&imgrefurl=http://www.metafilter.com/36098/schizoid-personality-disorder-bipolar-disorder-and-sociopathic-tendencies-oh-my&h=195&w=200&sz=8&hl=en&start=6&um=1&tbnid=SF-ezX9BTTLl4M:&tbnh=101&tbnw=104&prev=/images?q=schizoid+personality&um=1&hl=en&sa=G -
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Shizotypal bizarre
behaviour,
silly laughter
http://images.google.com/imgres?imgurl=http://images.quizilla.com/M/MO/MOO/moonflower246/1129477492_Gothic_Art.jpg&imgrefurl=http://guinnesswench.spaces.live.com/blog/cns!2ED2BB1AC0E108D!3807.entry&h=400&w=300&sz=19&hl=en&start=1&um=1&tbnid=cmaoVCzeP4DIbM:&tbnh=124&tbnw=93&prev=/images?q=schizotypal+personality&um=1&hl=en&sa=G -
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Histrionicwants to
be the
center of
attention
http://images.google.com/imgres?imgurl=http://img238.imageshack.us/img238/4883/jane16to.jpg&imgrefurl=http://writhesafely.wordpress.com/2006/06/27/my-personality-disorder-could-use-some-attention/&h=400&w=263&sz=43&hl=en&start=7&um=1&tbnid=UzJMWnWv0cS6AM:&tbnh=124&tbnw=82&prev=/images?q=histrionic+personality&um=1&hl=en&sa=G -
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Avoidant fears
rejection
andcriticism
http://images.google.com/imgres?imgurl=http://www.qactive.co.uk/personality/images/avoidant.jpg&imgrefurl=http://meryine.blogspot.com/2007/07/apd.html&h=237&w=250&sz=18&hl=en&start=7&um=1&tbnid=k9uje6j63vxHpM:&tbnh=105&tbnw=111&prev=/images?q=avoidant+personality&um=1&hl=en&sa=G -
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Paranoid extreme
mistrust and
suspiciousness
http://images.google.com/imgres?imgurl=http://www1.istockphoto.com/file_thumbview_approve/2268126/2/istockphoto_2268126_paranoid_man.jpg&imgrefurl=http://www.1ravanpezeshk.blogfa.com/post-41.aspx&h=380&w=377&sz=42&hl=en&start=6&um=1&tbnid=IhZY3iG0A2VZGM:&tbnh=123&tbnw=122&prev=/images?q=paranoid+personality&um=1&hl=en&sa=G -
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Passive-Aggressive
Expresses
anger
throughpassivity or
aggression
E h ti N i i ti
http://images.google.com/imgres?imgurl=http://www.steadyhealth.com/articles/user_files/4542/Image/passive_aggressive.jpg&imgrefurl=http://www.steadyhealth.com/articles/Passive_Aggressive_Personality_Disorder_a289_f137.html&h=201&w=155&sz=7&hl=en&start=8&um=1&tbnid=48hcHeJpQZcdKM:&tbnh=104&tbnw=80&prev=/images?q=passive-aggressive+personality&um=1&hl=en&sa=G -
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Emphatic Narcissistic
believe that
they are
special andthey demand
special
attention
http://images.google.com/imgres?imgurl=http://static.sxc.hu/l/lu/lucianotb/544769_85700317.jpg&imgrefurl=http://shellyivey.blogspot.com/2007/05/were-all-narcissistic.html&h=1680&w=1680&sz=875&hl=en&start=15&um=1&tbnid=8tRwjT-QsIwMRM:&tbnh=150&tbnw=150&prev=/images?q=narcissistic+personality&um=1&hl=en&sa=G -
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OBSESSIVE-COMPULSIVE DISORDER
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M.P. : intrusive thoughts and repetitiveactions performed under strong senseof pressure
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I.M: ritualistic behaviorLab : no specific
NDx: AnxietyN.I.: provide time for the
rituals; assess level ofanxiety
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ANOREXIA NERVOSA
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M.P. : FEAR OF GAINING WEIGHT
VeI.M: AMENORRHEA
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Lab : decreased K,hypoglycemia
NDx: body imagedisturbance
N.I.: monitor weight;family therapy
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A amenorrhea
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N no organic factor for wt loss
O obviously thin but feels fat
R refusal to maintain ideal weight
E epigastric discomfortsX sx/ symptoms like hiding food
I intense fear of wt gain
A always thinking about food
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ELECTROCONVULSIVE THERAPY
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mechanism of actionunclear
70 150 volts
0.5 2 seconds 6 12 treatments
intervals of 48 hours
ELECTROCONVULSIVE THERAPY
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indicators of effectivenessoccurence of generalized tonicclonic seizures
indications depression , maniaand catatonic schizophrenia
contraindications:fever , IICP,
fracture,retinal det., cardiac d/o consent
ELECTROCONVULSIVE THERAPY
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AT SO4-decrease secretionsAnectine (Succinylcholine)-
muscle relaxationMethohexital Sodium
(Brevital )- anesthetic agent
ELECTROCONVULSIVE THERAPY
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mechanism of actionunclear
70 150 volts
0.5 2 seconds 6 12 treatments
intervals of 48 hours
ELECTROCONVULSIVE THERAPY
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indicators of effectivenessoccurence of generalized tonicclonic seizures
indications depression , maniaand catatonic schizophrenia
contraindications:fever , IICP,
fracture,retinal det., cardiac d/o consent
ELECTROCONVULSIVE THERAPY
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AT SO4-decrease secretionsAnectine (Succinylcholine)-
muscle relaxationMethohexital Sodium
(Brevital )- anesthetic agent
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NCM 5
Characteristics of a Profession
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ALTRUISMAUTONOMY
AUTHORITY
ACCOUNTABILITY
DISTINCT IDENTITY
CODE OF ETHICS
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SULLIVANS STAGES OFPERSONALITYDEVELOPMENT
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Birth 18 Months Infancy18 months 6 years Childhood6 9 years Juvenile9 12 years Preadolescence12 14 years Early Adolescence14 21 years Late Adolescence
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FreudsPsychosexualTheory
0 18 mos
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0 18 mos.(ORAL STAGE)
Area of gratification: Mouth18 mos. 3 years(ANAL STAGE)
Area of gratification: Bowelelimination
3 6 years
(PHALLIC STAGE)
Area of gratification:
Reproductive organs
6 12 years(LATENCY, quiet
stage)
Area of gratification: None(energy is diverted to play
activity)
Area of gratification: Organs12 21 yearsGENITAL STAGE
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AUTISM
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AUTISM
Treatable but not curableMore common among boys
Usually diagnosed at age 2Main Problem: Interpersonal
functioning
i M l k
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i.M.: lacks eye
contact; loves tospin objects
Lab: no specificNDx: Impaired
social interaction
Nursing interventions
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Tantrum involves
headbanging = place a helmeton the head
Communication all vowels =speak in clear, simple, shortterms
Perceptive disturbancesensory integration exercises
Routines consistency
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Acute stress disorder
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Acute stress disorder
Exposure to traumatic eventLack of emotions
Psychic numbingDetachment, derealization
AMNESIADuration: 2 days 4 weeks
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ADHD
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ADHD
Main Problem: decreasedattention span
I.M.:
I impulsivity
H hyperactivity
I inattention
e D Difficulty in remaining
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D - Difficulty in remainingseated
E Easily distracted
F Fidgets
I Interrupts others
C Child exhibits hyperactivity
I Indulges in dangerousactivities
T - Talkative
Nursing interventions
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Give foods that can beeaten on the run
RITALIN(methylphenidate)
Safety
Limit caffeine
RITALIN (METHYLPHENYDATE)
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C stimulant
H decreased hyperactivity
E after meals (anorexia);
morning/ 6 hours before bedtime(insomnia)
C may cause growth retardation
K monitor growth & development
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SOMATIZATION DISORDER
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Recurrent and multiplesomatic complaints ofseveral years duration and
seemingly withoutphysiologic causes
MALINGERING
http://images.google.com/imgres?imgurl=http://psychological.com/images/somatoform-2.jpg&imgrefurl=http://www.syrianmeds.net/forum/showthread.php?t=6761&h=123&w=104&sz=6&hl=en&start=3&um=1&tbnid=FGRPeYQmbFiyYM:&tbnh=89&tbnw=75&prev=/images?q=Somatization&svnum=10&um=1&hl=en&sa=N -
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fabricating or exaggeratingthe symptoms ofmental orphysical disorders for a
variety of motives
BODY DYSMORPHIC DISORDER
http://en.wikipedia.org/wiki/Mental_disorderhttp://en.wikipedia.org/wiki/Mental_disorder -
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Imagined defect onappearance which is out ofproportion to any organic
problem.
CONVERSION DISORDER
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Loss or alteration of physicalfunction that suggest aphysical disorder related to
expression of apsychological conflict.
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Post-traumatic Stress Disorder
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Reexperiencing of reactionsto a past traumatic event viarecurrent Nightmares,
flashbacks and psychicnumbing
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SCHIZOPHRENIA
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Split MindBleuler
ASSOCIATIVE LOOSENESSAUTISM
APATHY
AMBIVALENCE
ics
CATATONIC DISORGANIZED PARANOID
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ACUTE INSIDUOUS ABRUPT
ABNORMALMOTORBEHAVIOR
BIZARREBEHAVIOR
SUSPICIOUS,IDEAS OFREFERENCE
REPRESSION REGRESSION PROJECTION
IMPAIREDMOTORACTIVITY
IMPAIREDSOCIALFUNCTIONING
POTENTIAL FORINJURY
CIRCULATIONNUTRITION
ASSISTANCEWITH ADL
NUTRITIONSAFETY
GOODPROGNOSIS
POOR GOOD
C- antipsychotics,l ti j
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neuroleptics, majortranquilizers
H- decreased overt orpositive manifestations
of psychosisE- p.c.
C- rise slowly, avoid
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C rise slowly, avoid
sunlight Report
sorethroat,fever,muscularrigidity
disorder takes 6-8 weeksfor full therapeutic effect
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K monitor
BP and temperature
Blood levelsAdverse effect
Neuroleptic malignant syndrome
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F feverE encephalopathy
V v/s unstableE elevated enzymes
(CPK)R rigidity of muscles
ADVERSE EFFECT MANAGEMENT
NMS Bromocriptine or Amantadine(d i i )
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(dopamine agonist)Dantrolene (Dantrium) muscular
relaxant
Dystonia Diphenhydramine,Benztropine,
Diazepam, LorazepamPseudoparkin-sonism
Antiparkinsonian,Anticholinergic
Akathisia Anticholinergic,
Benzodiazepines,Beta- blockers
Tardive dyskinesia early referral-dose reduction,no anticholinergics
C d i i
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C- dopaminergic oranti-cholinergic
H- decrease tremorsand rigidity in 2-3 days
E- p.c.
C- avoid sudden position
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changeAvoid Vit. B6 and CHON rich foods
Avoid alcohol-increases
sedative effectsK-check BP- orthostatic
hypotensiondrugs not withdrawn abruptly
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NCM 5 SERIES - 1
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ANXIETY
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BEC ALM
A DMINISTER MEDICATIONS
L ISTEN
M INIMIZE ENVIRONMENTAL
STIMULI
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ELECTROCONVULSIVE THERAPY
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mechanism of actionunclear
70 150 volts
0.5 2 seconds 6 12 treatments
intervals of 48 hours
ELECTROCONVULSIVE THERAPY
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indicators of effectivenessoccurence of generalized tonicclonic seizures
indications depression , maniaand catatonic schizophrenia
contraindications:fever , IICP,
fracture,retinal det., cardiac d/o consent
ELECTROCONVULSIVE THERAPY
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AT SO4-decrease secretionsAnectine (Succinylcholine)-
muscle relaxation
Methohexital Sodium(Brevital )- anesthetic agent
CAGE questionnare
H f lt d d t Cut
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Have you ever felt you needed to Cut
down on your drinking? Have peopleAnnoyed you by
criticizing your drinking?
Have you ever felt Guilty aboutdrinking?
Have you ever felt you needed a drink
first thing in the morning (Eye-opener) to steady your nerves or to
get rid of a hangover?
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CRISIS INTERVENTION
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A way of entering into the lifesituation of the clients to helpthem mobilize their resources
and to decrease the effect of acrisis inducing stress.
Phases of Crisis
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DenialIncreased tension
DisorganizationAttempts to reorganize
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NCM 5 SERIES - 2
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NCM 5 SERIES 2
NEUROLEPTICS (PHENOTHIAZINE)
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antagonizes dopamine inthe CNS
blocks Cholinergic,Histaminic, Adrenergicneurotransmitters
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LITHIUM
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C mood stabilizer anti manic
H decrease hyperactivity/manicepisodes
Initial effect 10-14 days Full therapeutic effect 3-4 weeks
E after meals with milk or food
LITHIUM
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C
antipsychotics given withlithium for immediate management
Diet Na 6-10 grams a day;
fluids- 3 liters per dayAvoid caffeine, diuretics and
activities that increase
perspiration
LITHIUM
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K Monitor serum level at least once
a month(A.M. 12 hours after the lastdose)
maintenance dose 0.5 1.2 mEq / L
acute level 1.5 mEq / L
the elderly 0.4 1.0 mEq / L
LITHIUM
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Antidote for toxicity Mannitol (Osmitrol)
Acetazolamide (Diamox)
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ANTIDEPRESSANTS
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C anti-depressants
H decreased signs andsymptoms of
depression(increased appetiteand sleep
E p.c.
TRICYCLIC ANTIDEPRESSANTS
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C TCA; prevents reuptake ofnorepinephrine
Hincreased appetite and
adequate sleep E p.c.
C therapeutic effect after 2-3weeks
K hypotention, tachycardia
TRICYCLIC ANTIDEPRESSANTS
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IMIPRAMINE(TOFRANIL)
AMITRIPTYLINE(ELAVIL)
MONOAMINE OXIDASE INHIBITOR
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C MAOI; ANTIDEPRESSANTS
Hincreased appetite andadequate sleep
E p.c.
C report headache; 2-3 weeks
effect K hypertensive crisis
MONOAMINE OXIDASE INHIBITOR
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Avoid TYRAMINE
A avocado
B banana
C cheddar, aged cheeseS soysauce, preserved foods
MONOAMINE OXIDASE INHIBITOR
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TRANYLCYPROMINE(PARNATE)
PHENELZINE (NARDIL)ISOCARBOXAZID
(MARPLAN)
SELECTIVE SEROTONIN REUPTAKEINHIBITOR (SSRI)
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C anti-depressants; increaselevel of serotonin
H decreased signs and
symptoms of depression E p.c.
2-3 weeks initial effect3-4 weeks full effect
ANTIDEPRESSANTS
SELECTIVE SEROTONIN REUPTAKEINHIBITOR (SSRI)
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C/K side effectsTremors,
decreased libido,NAVDA,
insomnia
ANTIDEPRESSANTS
SELECTIVE SEROTONIN REUPTAKEINHIBITOR (SSRI)
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FLUOXETINE (PROZAC)SERTRALINE (ZOLOFT)
PAROXETINE (PAXIL)
p
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ANTIANXIETY
C i l ti l l t
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C anxiolytic; muscle relaxant
H decreased anxiety, adequatesleep
E before meals C avoid driving (drowsiness),
avoid alcohol, caffeine (alter
effects of drugs) K administer separately,
incompatible with other drugs
ANTIANXIETY
(b di i )
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(benzodiazepines)
DIAZEPAM (VALIUM)
OXAZEPAM (SERAX)
CHLORDIAZEPOXIDE(LIBRIUM)
CHLORAZEPATE DIPOTASSIUM(TRANXENE)
ALPRAZOLAM (XANAX)
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ANTABUSE (DISULFIRAM)
C ti h li i l t
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C anticholinergic; unpleasnt rxn
with alcohol
H patient avoids alcohol
E after abstaining from alcoholfor 12 hours
C avoid alcohol-based substances
K monitor disulfiram reaction;miver function tests
ANTABUSE (DISULFIRAM)
M th h
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M mouthwash
O OTC remedies
F fruit flavored extracts
F food sauce made of wineA aftershave lotion
V vinegar
S skin products
tin
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ALCOHOL WITHDRAWAL
H hallucinations (visual tactile)
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H hallucinations (visual, tactile)
I increased vital signs
T tremors
S sweating, seizures
Outcomes of alcoholism
B brain damage
A alcoholic hallucinosis D death
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NCM 5 SERIES - 3
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BORDERLINE PERSONALITY DISODER
M P : Instability of mood interpersonal
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M. P.: Instability of mood, interpersonal
relationships and self-image
s/sx
P persistent identity disorder
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p y
E efforts to avoid real/ imaginedabandonement
C chronic feelings of emptiness
U unstable relationship L lack of control of anger
I IMPULSIVENESS
A affective instability
R recurring suicidal threats
ND i i d i l
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NDx : impaired socialfunctioning
N.I:
Consistent, firm
Structured quiet environment
Limit setting
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NCM 5 SERIES - 4
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ti
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NCM 5 SERIES - 5
MILD ANXIETY
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Increase RR, PR, sweatingAttentive, alert
Minimal use of defensemechanism
MODERATE ANXIETY
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NAVD, restlessnessNarrowed perceptual field
Use of any defensemechanism available
SEVERE ANXIETY
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S/SX become the focus ofattention
Perceptual field greatlynarrowed
Amnesia, dissociation
PANIC
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S/SX of exhaustionignored
Personalitydisorganization
Defense mechanisms fail
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OBSESSIVE-COMPULSIVE DISORDER
M P : intrusive thoughts and repetitive
-
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M.P. : intrusive thoughts and repetitive
actions performed under strong senseof pressure
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I.M: ritualistic behaviorLab : no specific
NDx: AnxietyN.I.: provide time for the
rituals; assess level ofanxiety
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BIPOLAR DISORDER
M.P. : Hyperactivity alternating with
-
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M.P. : Hyperactivity alternating with
depression
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I.M: hyperactivity, rapid
-
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speechLab : norepinephrine,
serotoninNDx: risk for injury
N.I.: safety, finger foods,lithium carbonate
es
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ALZHEIMERS DISEAE
M.P. : Degeneration, atrophy of the
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M.P. : Degeneration, atrophy of the
brain cortex leading to impaired brainfunctioning
VeI.M: progressive memoryloss
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Lab : no specificNDx: altered thought
processN.I.: 5Cs (calendar, clock.
Colors, consistency,COGNEX/TACTRINE)
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ANOREXIA NERVOSA
M.P. : FEAR OF GAINING WEIGHT
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O G G G
VeI.M: AMENORRHEALab : decreased K,
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hypoglycemiaNDx: body image
disturbanceN.I.: monitor weight;
family therapy
-
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A amenorrhea
N no organic factor for wt loss
-
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O obviously thing but feels fat R refusal to maintain ideal weight
E epigastric discomforts
X sx/ symptoms like hiding food
I intense fear of wt gain
A always thinking about food
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