ReD Mapalo – BSN Psychiatric Nursing
Beliefs Feelings Behavior
Therapeutic Communication Techniques What you see, you say What you hear, you say restating
Sigmund Freud Father of Psychoanalysis Structure of Personality (Id, Ego, Superego)
Dominant ID Mania
D eat Antisocialmpulsive drink Narcissistic want to urinate want PLEASURE defecate
PLEASURABLE PRINCIPLEPain AvoidanceIt’s all “I”
DOMINANT SUPER EGOObsessive - compulsive
UPER EGO Anorexia Nervosahould notmall voice of God
CONSCIENCE PRINCIPLE
GOXecutive Secretary Impaired Reality
Schizophrenia
REALITY PRINCIPLE
LIBIDO sexual energy responsible for survival
PSYCHOSEXUAL THEORY1. ORAL STAGE
0 – 18 Months old Survival I want to eat, sleep, urinate, defecate ID formation Cry & Suck mouth
I
S
E
I
S
E
ReD Mapalo – BSN Psychiatric Nursing
Child Cries
Feed the Infant Ignore the Infant
Successful Unsuccessful
Narcissistic
Defense Mechanism:o FIXATION when a person is stuck in a certain developmental
stageo REGRESSION return to an earlier developmental stage
EGO is develop in the 6th month
2. ANAL STAGE A teen – 3 years old (18 mos – 3 y.o.) Toilet training Super Ego develop
Toilet Training
Good Mother Bad Mother
Successful Unsuccessful
Too Rigid Training Dirty DisorganizedClean DisobedientOrganized Obedient ANTISOCIAL (Anal Expulsive)
OBSESSIVE – COMPULSSIVE(Anal Retentive)
3. PHALLIC 3 – 6 y.o. Penis/ Vagina Parents is the significant person Called as Preschooler
SE
BIG SE
Small SE
ReD Mapalo – BSN Psychiatric Nursing
Oedipus Complex little boy loves mommy Electra Complex little girl loves daddy Identification boy associates with daddy, girl assoc. with mommy Castration fear of the little boy to daddy Penis Envy envy of little girl towards daddy
Dr. Karen Horney opposition to penis envy
Level of Awarenesso Conscious highest level of awarenesso Preconscious Tip of the tongueo Unconscious deepest level of awareness
Birth Trauma First traumatic experience of child REPRESSION unconscious forgetting of an anxiety provoking
concept SUPRESSION conscious forgetting of an anxiety provoking
concept
4. LATENCY STAGE 6 – 12 years old SCHOOlatency Sexual energy is dormant Reading, Riting, Rithmetic
SUBLIMATION placing sexual energies toward a more productive endeavors
5. GENITAL STAGE 12 y. o. – above Gising Genital
ReD Mapalo – BSN Psychiatric Nursing
PHARMA MOMENTS
ANTIANXIETY VLAST ME VAIBValium – ate V Miltown - Meal Vistaril - largavistaLibreum - L Equanil – Aqua Kneel Attarax – Mga bato (rocks)Ativan - Ate Guy Inderal – hindi ralphSeraks – Sera Ulo Busfar – sasakay ng busTranxene - Transit
ERIK ERIKSON PSYCHOSOCIAL THEORY OF DEVELOPMENT
Age + - Affecting Major Factor
0-18 mos. Trust Mistrust Feeding18 mos. – 3 y.o. Autonomy
AU nalTO ilet trainingNO favorite wordMY
Shame/ doubt Toilet Training
3 – 6 y.o. Initiative Guilt Independence6 – 12 y.o. Industry Inferiority In da-school
12 – 18 y.o. Identity Role confusion Peer18- 35 y.o. Intimacy Isolation Love35 – 65 y.o. Generativity Stagnation Parenting
65 y.o. and above Ego Integrity Despair Reflection
MASLOW’S HEIRARCHY OF NEEDS
1. Physiologic Needso Air, food, water, shelter, rest, sleep, activity and temperature
maintenance that are crucial for survival2. Safety and Security Needs
o Safe in physical and psychological aspects3. Love and Belonging Needs
o Giving and receiving affection, attaining a place in a group, maintaining the feeling of belonging
4. Self – esteem Needso Self esteem – feelings of independence, competence and self
respecto Esteem from others – recognition, respect, appreciation
5. Self Actualization
ReD Mapalo – BSN Psychiatric Nursing
o One’s maximum potential and realize one’s abilities and qualitiesBEHAVIORAL MODELS
1. Ivan Pavlov Classical Conditioning Model All behavior are learned
Food dog Salivation Bell Food Dog Salivation Bell Salivation
2. B.F. Skinner Operant Conditioning All behaviors are unlearned Reward (+ reinforcement) and Punishment (-
Reinforcement)
BRAIN LOBES ACTIONFrontal Language, Learning, Personality, JudgmentTemporal hearing, smellingParietal Taste, touchOccipital Vision
SensoryIntegration Voluntary
MotorInvoluntary
VOLUNTARY NERVOUS SYSTEM Somatic Nervous System
AcetylCholine
Brain Spinal Cord Motor Nerve Muscle Fiber
INVOLUNTARY NERVOUS SYSTEM Autonomic Nervous System
Sympathetic ParasympatheticHR RR GI
Constipation
DiarrheaGU
Urinary retention
Urinary
FrequencyNeuro Epi/ Nor Acetyl Choline
ReD Mapalo – BSN Psychiatric Nursing
PHARMA MOMENTS MONOAMINE OXIDASE INHIBITORS (PANAMA) AR
M PLANN DILP NATE
ANTIPARKINSON CAPABLES
CogentinArtaneParlodelAkinetonBenadrylLarodopaEldeprylSymmetryl
THERAPEUTIC COMMUNICATIONTherapeutic Non-Therapeutic
Offer your self I’ll stay with you
Silence Making observations
o You seem sad Active listening
o Noddingo Eye contacto Lean forward
Who, what, when, where General leads
o Go on, I’m listening, what else?
Broad opening - best Opening line
o How are you today?o How are you?
Restating Clarrification Refocusing we are talking
about the exam Focusing tell me about
Don’t worry be happy Everything’s gonna be alright Ignoring the client Changing the subject Nice weather we’re having
o Adjectives – value based perception, should not be use
You are the most beautiful client
Why Arguing Flattery You should do this now In my opinion
ReD Mapalo – BSN Psychiatric Nursing
DEFENSE MECHANISMS Fight for stressDISPLACEMENT Transfer of feelings to a less
threatening object rather than the one who provoke it
Boss shouts at you, you shout at your subordinate
DENIAL Failure to acknowledge an unacceptable trait or situation
“I’m not an alcoholic”
DISSOCIATION Psychological flight from self A type of amnesia
“Sino ka, Sino ako?”
REGRESSION Return to an earlier developmental stage
Return to thumbsucking
REPRESSION Unconscious forgetting of an anxiety provoking concept
Hindi ko maalala
RATIONALIZATION Illogical reasoning for a socially unacceptable trait
“sayang ang beer sa ref, kaya ko ininum”
I drink because I don’t want to waste the beer in the ref
REACTION FORMATION
doing the opposite of your intention
plastic
sasabunutan kita. . . ay kuklulutin lang kita
UNDOING Doing the opposite of what you have done due to guilt
orocan, plastic, Tupperware
“ay pinatid kita, halika punta kita sa clinic”
IDENTIFICATION Assume trait for personal, social, occupational role
Tulad niya
PROJECTION Attributing to others one’s acceptable trait
Pasa load
“hindi ako alcoholic, sila yon”
INTROJECTION Assume another person’s trait as your own
“ako din” Not just you, me
tooSUPPRESSION Conscious forgetting of an anxiety
provoking concept Hindi ko alam yan
SUBLIMATION Placing sexual energies toward a more productive endeavors
Angry at life, put anger in singing
CONVERSION Repressed angers put towards physical symptoms affecting nervous system leading to sensory numbness and motor paralysis
Biglang mangingig
COMPENSATION Overachievement in one area to cover a defective part
Pilay pero magaling kumanta
SUBSTITUTION Replacing a difficult goal with a more accessible one
Gusto ko Disneyland. Enchanted nalang.
ReD Mapalo – BSN Psychiatric Nursing
STOP GABA Inhibitory Gamma Amino Butyric Acid
GO Epinephrine/ Norepinephrine
SNS Exitatory
ANXIETY Anticholinergic side effectConstipationUrinary Retention Within 1 weekDry Mouth Rebound Blurred Vision phenomenon
SeizureAbrupt
Anti-Anxiety DependenceWithdrawal
DrowsyNo AlcoholNo CoffeeDevelop OrthostaticHypotension
Prevetion of O.H.1. Sit Down2. Dangle feet Gradually3. Stand Up Gradually Tapered Dose
RELAXED
ANXIETY Vague sense of impending doom
Mild Moderate Severe Panic +1 +2 +3 +4Widened acing ont know what uicidePerceptual to say/do afety Don’t touch clientField RN Meds IRECTIVE Respi AlkalosisRestless Bown BagEnhanced LearningCapacity“You Seem Restless “
Assess : Level of Anxiety
ReD Mapalo – BSN Psychiatric Nursing
Nx Dx : Ineffective Individual Coping Powerlessness Impaired Skin Integrity
Planning/ Implementation: level of anxiety environmental Stimuli Relaxation Technique
Showing pictures of flower, waterfalls Hearing sounds of chirping birds
Evaluation : Effective individual coping
ENERALIZED ANXIETY DISORDER months excessive worrying
Might be mild, moderate and severe anxietyS/Sx
Restless Difficulty of concentration Sleep Disorders Palpitations Edge of the seat Easy fatigability
PANIC DISORDER 15 – 30 Minutes escalation of SNS AGORAPHOBIA fear of open space/ public places SOCIAL PHOBIA fear of public
POST TRAUMATIC STRESS DISORDER
TraumaDisasterAccident FlashbacksWar VICTIMS Survivors Rape NightmaresEarthquakeSoldier
6 years old Anxiety SOMATOFORM > no pretension
ReD Mapalo – BSN Psychiatric Nursing
Assignments/ “I am sick” > no organic Homeworks basis
MALINGERING > unconsciousNo Assignments/ pretending to be sickHomeworks (Conscious) PSYCHOSOMATIC > Real pains/ illnessYou Think Absent > Real symptoms“Teacher may > 4 major typesget angry” * Hypertension
* MigraineEscape from Mama Care * Stress UlcerTeacher * Asthma
PRIMARY GAIN Attention (Behavior anxiety) SECONDARY GAIN
SOMATOFORM DISORDERS
SOMATOFORM
Nervous System Illusion of structural defectCONVERSION DISORDER BODY DYSMHORPIC DISORDERLa Belle Indifference emotional disattachment from disability
Minor DiscomfortInterpreted as major illness
HYPOCHONDRIASIS“Maliit na butas, pinalalaki”
Favorite Past Time: Doctor Hopping Nursing Focus: Feelings
PSYCHOSOMATIC DISORDERS
Anxiety
ReD Mapalo – BSN Psychiatric Nursing
SNS PNS
BP Vasoconstriction Bronchoconstriction Hypertension Cerebral Artery Left Gastric Artery Asthma
Migraine Stress Ulcer
OBSESSIVE – COMPULSIVE
Belief/ thought FeelingsDoor Open AnxietyBurglar may go inside
Obsession anxiety(thought)
Returns to house (Action)
Anxiety Compulsion
PHOBIA Irrational fears Etiology
o Knowledgeo Experience
Immediate Nursing Intervention remove the stimuli SYSTEMATIC DESENSITIZATION
o Gradual exposure to feared object
PHARMA MOMENTS ANTIPSYCHOTIC AGENT
SSTTCMHP
Stelazine - sexy star Clozaril – closed reelSerentil – serena Mellaril – maraming reelThorazine – babaeng Tora Haldol – hahaha Trilafon - tri-band phone Prolixin – pero lick scene
ALCOHOLISM
Etiology:Intergenerational Transmission
From one generation to another generation
ReD Mapalo – BSN Psychiatric Nursing
Alcohol Blackout awake but unaware Confabulation inventing stories to self-esteem Denial “I am not an alcoholic”
Dependence “I can’t live without it” Enabling significant other tolerates abusers
Another term CO – DEPENDENCY
TOLERANCE Substance to achieve a previous effect
DETOXIFICATION Withdrawal with MD supervision Check Alcohol, Mouthwash, Elixer
void alcohol version therapy lcoholics Anonymous self help group ntabuse DISULFIRAM Never drink alcohol
12 hour interval/ 12 h last alcohol intake
B1 Vitamin Deficiency or else: nausea, vomiting and hypotension Wernicke’s Encephalopathy motor
Complications Korsakoff’s Psychosis memory
Delirium Tremens 24 – 72 h after last dose of alcohol untreated withdrawal syndrome
ormocation bugs crawling under the skin amily Therapy mother, father, brother
AUTISMAutistic Savant autistic with a special talent
Assess Appearance flat affect, consistent movement Behavior repetitive, ritualistic Communication echolalia, incomprehensible
ReD Mapalo – BSN Psychiatric Nursing
Nx Dx Impaired verbal communication Impaired social interaction Self mutilation Risk for injury
Planning/ Implementation Maslow’s hierarchy of needs Constancy, promote safety
Evaluation Expressive therapy drawing, muscic etc Enhanced communication Improved social interaction Safety
ATTENTION DEFICIT HYPERACTIVE DISORDER Onset : 7 y.o. and below Duration : 6 months and above Settings : 2 House and school Id Dominant : Mom or RN will act as superego
ADHD Glucose Frontal Lobe impaired judgement ADHD S/Sx Ritalin Frontal Lobe Judgement ADHD S/Sx (stimulant)
Assess Appearance dirty Behavior clumsy, impatient, easily distracted, hyperactive Communication talkative, blurts out in class
Nx Dx Risk for injury Impaired social interaction
Planning/ Implementation tructure separate room for eating, playing, sleeping and etc
chedule time for everythinget limits afety
Evaluation Minimize Risk for Injury Improved social interaction Safety
Residual ADHD grows up not antisocial
Meds: Ritalin, dexedrin, pemoline, adderalBest time to give: once a day: AFTER MEALS: prevent lost of appetite
Don’t give at bedtime STIMULANT causes insomnia
ReD Mapalo – BSN Psychiatric Nursing
Give 6 hours prior bedtime if bid
EATING DISORDERS
18 mos. – 3 y.o. 6 y.o. class valedictorian/ model student
Toilet Training social inactive/ no BF
Clean weighing Obedient Organized
Thought Feeling BehaviorI Am Fat Self Esteem Diet, Diet, Diet
Anorexia Nervosa Eating Disorders BulimiaDiet, diet, diet Eating Pattern Eat, eat, vomit
<85% of expected body Weight Normal weight3 mos. ammenorhea Menstruation Irregular menstruation
Karen Carpenter Dao Ming XiDa Ming Sugat/ suka
VomitingDental caries
Wounded knucklesMetabolic alkalosisMetabolic acidosis
Vomiting
Fluid Volume Deficit ARRHYTHMIA (fatal complication)
Diarrhea
Interventions Restore fluid and electrolyte balance Collaborative regarding menu contract Target weight gain After meals: stay 30 mins – 1 hour
PHARMA MOMENTLITHIUM
L evel 0.6 – 1.2 mEq/L ausea, vomiting, diarrhea
ReD Mapalo – BSN Psychiatric Nursing
Increase urination Lithium Toxicity Tremors, fine hand a+
Hydration 3 L/day IncreaseKidney Uu diarhea Mouth, dry
ANTIPARKINSONANTICHOLINERGIC
ABCDOPAMINERGIC
PLSEArtane ParlodelAkineton LarodopaBenadryl SymmetylCogentin Eldepryl
SCHIZOPHRENIA Ego disintegration Impaired reality perception Genetic vulnerability Stress – Diathesis Model
o Too much stress in the reality will lead client to escape it and go to the fantasy world
Biological Theoryo Dopamine level is High
The exact cause is unknown
ffect appropriate, inappropriate, flat, blunt (incomplete emotion)mbivalence torn between 2 opposing forcesutismssociative Looseness
SymptomsNegative Positive
Hypoactive HyperactiveWithdrawn SociableApathy Flight of Ideas
Talkative
Assess : Content of ThoughtNx Dx : Disturbed thought processPlanning/ Implementation:
Present reality Provide safety
Evaluation : Improve thought process
ReD Mapalo – BSN Psychiatric Nursing
Assess : Hallucination/ IllusionsNx Dx : Disturbed sensory perceptionPlanning/ Implementation:
Present reality Provide safety
Evaluation : Improve sensory perception
Assess : SuspiciousNx Dx : Risk for other directive behaviorPlanning/ Implementation:
Present reality Provide safety
Evaluation : Eliminate/ minimize risk for other-directed violence
Assess : SuicidalNx Dx : Risk for self directive behaviorPlanning/ Implementation:
Present reality Provide safety
Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness
I am going to the mall. I am going to the mall.
Where is the light? The mall is big.Go here. Big is the tree.Mineral Water. The tree is tall.
Magical Thinking Believes to have a magical power I can turn you into a frog
Echolalia I repeat what you say ParrotsEchopraxia I repeat what you doWord Salad words, no rhymeClang Association words with rhyme : Dunk, plank, sunk
ReD Mapalo – BSN Psychiatric Nursing
Neologism creation of new words Plinking, hustash Clarification done in case of neologism
Delusion:Persecutory NBI is out to get me/ someone will harm the clientReligious I am Jesus ChristGrandeur I am the queen of the world.Ideas of reference Nurses are talking about me.
Concrete Association pilosopo “what will you wear?” “clothes”Thought Blocking
Halucinations IllusionStimulus Absent PresentVisual X Auditory X Tactile X
In case of hallucinations do:
Hallucinations
Acknowledgment I know you the voices are real to you
Reality orientation But I don’t hear them
Diversion Lets go to the garden
But if nothing in the preceeding intervention are seenAssess what the voices are sayingSCHIZOPRENIA
Disorganized
Sad but smileso Inappropriate affect
No reactiono Flat affect
Flight of ideaso HEBEPHRENIC
Giggling Positive and Negative
S/Sx
Catatonic Ambivalence Waxy Flexibility
o Iniwan na posture, ganun forever
No – favorite word Negativism
Paranoid Suspicious Tendency to be violentMistrustScaredWithdrawnNrsg. Int:Develop trust
1 to 1 short interaction frequent visit foods in sealed
container meds wrapped
for violent pt. Doors open Near the door Don’t touch the pt. Eye contact 1 arms length away call reinforcement
ReD Mapalo – BSN Psychiatric Nursing
Normally Acetylcholine = ON Dopamine = OFF
Your always ON High Dopamine= Schizophrenia
With parkinsON
Antipsychotics = makes Dopamine goes down
ON Extrapyramidal Side Effects AKATHISIA
o Restless, inability to sito Makati siya, ahh kati siya
AKINESIAo Muscle rigidityo Ahh kiniss siya
DYSTONIAo 3 features
TORTICOLLIS Wry neck
OCULOGYRIC CRISIS Fixed stare
OPISTHOTUNOS Arched back
TARDIVE DYSKINESIAo Irreversible side effects of
antipsychoticso Lip smacking
Residual
No more positive s/sx, just withdrawn
classifieddifferentiated
Mixed classification Can’t be classified 1st paranoid, then
disorganized then catatonic, etc etc
Anticholinergic Drugs that will make the
AcH downo Artaneo Akinetono Benadrylo Cogentin
Dopaminergic Dopamine goes up
o Parlodelo Larodopao Symmetrylo Eldepryl
ReD Mapalo – BSN Psychiatric Nursing
o Tongue protrudingo Cheeks puffing
NEUROLEPTIC MALIGNANT SYNDROME
o Hyperthermia among client taking antipsychotic
o Hyperthermia with muscle rigidity
Other Side Effects Photosensitivity
o Sunscreeno Wide brimmed hat
Agranulocytosiso Report immediately Sore throat
1st sign to appear
PHARMAMOMENTS
ANTIDEPRESSANTSANTSAAVE PPZ
Asendin – ascending Norpramin – sabaw ng knorrTofranil – Tofu Sinequan – nood ng Sine Quan ang titleAnafranil – kina Ana PraningAventyl – kina Aven Til Midnight tayoVivactil – Bye Back till next weekElavil – Eh love mo ba akoProzac – Pero saka naPaxil - TaksilZoloft – mag Solo ka
BIPOLAR DISORDER – Mania more common Female 20 years old and above Stressful life
ReD Mapalo – BSN Psychiatric Nursing
Obese
TASK Caregiver Role Strain
Safety Safety
Lithium – 2 – 4 weeks before effect
SE Compensation interfere ADLs, harm othersSE Compensation interfere ADLs, harm others
TASK increases client’s self esteem
Gross motor skills via sublimation Escorted walk outdoors Punching bag
No group games compition will increae anxiety
3 or more signs confirms disorder
GFSPEED
randioselight of ideasleeplessnessressured speechxagerated SExtraneous stimuli (easily distracted)istractibility
Self Actualization
Self Esteem
Impaired social interaction
Risk for injury/ other directed violence
Eating Sleep Hyperactive Sexfinger food Private room Anxiety
ReD Mapalo – BSN Psychiatric Nursing
PERSONALITY DISORDERS
SCHIZOID I don’t want people Believes he can stand on his own Never had a best friend Avoid groups and social activities no enjoyment Cares more about computers and pets
AVOIDANT I avoid people, I fear criticism Have talent but no confidence
ANTISOCIAL I break the law as motto As a child,: steal, lie, always get reprimanded Adult – grand robbery, illegal activitist against the law, drug addiction,
drives fast, unsafe sex, thrill seeker Good talker, charmer, witty manipulator
BORDERLINE – my life is an emptyglass
Dependent I can’t live without you self esteem poor decision making skills
Histrionic excited, dramatic but manipulative center of attention
Narcissistic I love myself Insensitive, arrogant I am the best
ReD Mapalo – BSN Psychiatric Nursing
Obsessive – Compulsive I am organized Perfectionist Provide time to do rituals
Paranoid Suspicious
Passive Aggressive Always say yes but resistance is hidden
Serotonin
MAO kills Serotonin
MAO Serotonin MAO Serotonin
ReD Mapalo – BSN Psychiatric Nursing
TYRAMINE RICH FOODSvocadoged Cheese
eer
hocolate
ermented Foods
icklesreserved Foods
oy Sauce
SSRI TCAMAOI
Antidepressant
Anticholinergic Side Effects(Syphathetic)
Male Erectile Dysfunction
Serotonin ANTIDEPRESSANTS
1st Line of Drug Prescribed wo – 4 weekswo neurotransmitter
afest RI ONO ELECTIVE
ide effects low CYCLIC MINE EROTONIN
EUPTAKE NTIDEPRESSANT XIDASE
Higher incidence of Side effects to 4 weeks Serotonin/ Epi affected NHIBITOR NHIBITOR
PPZ ANTSAVE MNP
All neurotransmitter affectedHighest Side effectsAvoid tyramine rich food may lead to HYPERTENSIVE CRISES
ReD Mapalo – BSN Psychiatric Nursing
Antidepressant no effect ECT
ReD Mapalo – BSN Psychiatric Nursing
ELECROCONVULSIVE THERAPY Pre
o Informed consento NPO 6 – 8 hours prior
Medso Atropine dry mouth
o Barbituate Sedative
o Succinylcholine muscle relaxant, prevent seizure Post
o Side-lying – lateralo S/E
headache, dizziness, TEMPORARY MEMORY LOSS distinct sign
70 – 110 volts 20 – 30 seconds ½ hour asleep post
PHARMAMOMENTS
SUBSTANCE ABUSE
Downers (ABONM INE)Alcohol MorphBarbituates Code NARCAN antidoteOpiates HeroNarcoticsMarijuana
Uppers (CHA)CocaineHallucinogenAmphetamines
OVERDOSEAlcohol Cocaine
HRRRBP
Coma LOC SeizureBradycardiaBradypnea
Pupil constrictionMoist mouthConstipationHypotension
ComaAsleep
Weight gain
ReD Mapalo – BSN Psychiatric Nursing
Psych well being NARCAN Narcotic Antagonist narcotic overdose
DETOXIFICATION withdrawal with MD SupervisionMETHADONE
Withdrawal reverse of effect or opposite of overdose
DEPRESSION Serotonin, if unresponsive to drugs, ECTThe Grief Process
Denial no! this can’t be true Anger why me, why me, why now Bargaining if something happens, then I’ll give something back Depression I’m down 2 weeks or more s/sx major depression Acceptance client acts according to situation
C TASK Stay
Sensitivity to client needsSUICIDE
Verbal Non Verbal
TachycardiaTachypnea
Pupil DilationDry mouth
HypertensionSeizureAwake
Weight Loss
EUPHORIA
Self Actualization
Self Esteem
withdrawn
Risk for self directed violence
Eating Sleep Hypoactive Sex
ReD Mapalo – BSN Psychiatric Nursing
I wont be a problem anymore This is my last day on earth I’ll soon be gone
Take this ring, its yours (giving of valuable)
Sudden change in mood
Who will commit Suicide?Sex – Male (more successful)/ female (hesitant)Age – 15 –24 y/o or above 45DepressionPatient with previous attemptETOH – ethanol - alcoholicsRirrationalSocial support lackingOrganized plan greater riskNo familySickness, terminal
SUICIDE TRIAD Loss of spouse Loss of job Aloneness
Is Patient is SUICIDAL; nurse should: DIE Direct question – “Are you going to commit suicide?” Irregular interval of visit to pt. room Early AM and period of endorsement – the time pt’s commit suicide
Best approach for suicidal pt. : Direct approachNursing Management: Close surveillance
Hospital area majority sucide will happens at: weekends 1- 3 am Sunday Weekend less staff personnel Early AM every one is asleep
Give simple task. Don’t give complex may cause depression ex. Jigsaw Water plants Wash the dishes except sharps
CHILD ABUSE (think B) Burns, bruise, bone fractures, BUNGI! Don’t bathe the child, don’t brush teet. Body of evidence will be lost Bantay Bata 163
LEVELS OF MENTAL RETARDATION Profound
o < 20o thinks like an infants
ReD Mapalo – BSN Psychiatric Nursing
o can’t be trainedo stay with the patient
Severeo 20 – 35
Moderateo 35 – 50o can be traino mental age is 2 – 7 y/oo pre-operational stage
Mildo 50 – 70o meantal age is 7 – 12o educableo can go to school
Borderlineo 70 - 90
Normalo 90 – 100
JOHN PIAGET’S COGNITIVE THEORY0 – 2 Sensorimotor Baby can sense, see, perceive and hear. Object
permanence2 – 4 Preconceptual Language4 – 7 Intuitive Unidimentional classification characteristic. Child can
fix toys according to size, color, height = one at a time7 – 12 Conservation
Concrete Association
Multidimensional
12 Formal Operation
Good abstract thinking. Can interpret words
ALZHEIMERNOMIA don’t know name of objectsGNOSIA problem with sensesPHASIA can’t say itPRAXIA can’t do it
Cocaine Nasal Septum perforationMarijuana impaired Lung Structure
eroine withdrawalikabatsingu hu hu
CRITICAL REVIEW
ero – 2 y/o ensorimotor evere
Modera e hirtyfive – 50
rainable wo – 7 y/o
ReD Mapalo – BSN Psychiatric Nursing
TEST TAKING TECHNIQUES1. Assess the answer, use circle2. Initial priority TRUST
ABC ASSESS3. Good Word/ Bad Word4. S Technique
eek supportittayupervisedee = observedeem = notice
assi t feeling
5. 2 same answer/ 2 same mistake6. Words to watch out for
InappropriateMostNot includedExceptAll but one
7. Umbrella
RELATIONSHIP Preorientation Orientation Working Termination
Self awareness Trust Discussion Evaluation Setting Contract Resistance
PRACTICE OF NURSINGLevel of Prevention
1 2 3
Air food, water
air
ReD Mapalo – BSN Psychiatric Nursing
Healthy Ill RelapseCommunity Demog. Crisis Intervention AA
SELF HELP GROUPS nique
niversality r not alone
RESTATE exact wordsREFLECT use other words
DEPRESSION
Endogenous ReactiveInternal externalChemical
Barbituate withdrawal LIBRIUM (Chloridiazepoxide)TOFRANIL Antidepressant/ Anticholinergic pupil dilation midriasis Catharsis FeelingsFree Association Ideas
ATTITUDE THERAPIESActive friendliness ask permission
assive Friendlinessaranoid anipulative anic atter of Fact
No Demand DepressedKind Firmness Anorexic
Crisis 4 – 6 weeksGoal Return the client to the pre-crisis level of functioningPSCPerception what do you think about it?Coping what will you do about it?Support who will be there for you?
Kulit kulit kulit kulit Perseveration stick to 1 topicUlit Ulit Ulit VerbigerationDISSOCIATION Dissociative Amnesia don’t know themselvesFugue FarDissociative Identity Disorder Multiple Personality D.O.