Psychiatric Nursing Notes
Content
Psychiatric Nursing Notes
• Psych focuses in feelings or self awareness.
• Beliefs determine feelings which affects behavior (manifestation of feelings)
• Sigmund Freud is the father of PSYCHOANALYSIS.
• What happens to childhood will affect adulthood.
STRUCTURE OF PERSONALITY
ID
• impulsive, want to, wants pleasure.
• PLEASURE PRINCIPLE.
• Guiding principle is PAIN AVOIDANCE.
SUPEREGO
• should not
• small voice of God
• to stop
EGO
• executive decision maker.
• In touch with reality principle.
ID DOMINANT PERSONALITIES
Manic
Anti – Social – experienced by serial killers
Narcissistic
SUPEREGO DOMINANT PERSONALITIES
Obsessive Compulsive
Anorexia Nervosa
EGO – if destroyed result in impaired reality perception.
Schizophrenia
LIBIDO
• Sexual energy responsible for survival.
Oral Stage
• 0 – 18 months evident.
• ID is developed.
*FIXATION – Person is stuck in certain developmental shape.
*REGRESSION – Return to an earlier developmental stage.
EGO – Developed on the 6th month.
Anal Stage
• 18 months – 3 years old.
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• Able to control bladder, bowel.
• Best time for toilet training.
• SUPEREGO is developed.
TOILET TRAINING
Good Mother------------------------ Bad Mother
Successful -----------------Dirty ---------------------- Clean
-------------------------disorganized --------------- organized
------------------------- disobedient ---------------- obedient
------------------------- Anti-social ------------------- O.C
----------------------- Anal expulsive ----------- Anal retentive
PHALLIC STAGE
• 3 – 6 years old.
• Experience pleasure by manipulating genitals.
• Love – hate relationship.
• Oedipus Complex boy loves parent of the opposite sex.
• Imitates daddy called identification.
• Castration fears.
• Electra Complex girl loves parent of the opposite sex.
• Imitates mommy called identification.
• Penis envy.
*Conscious – upper level of thinking.
*Preconscious – tip of tongue.
*Unconscious – protects us from traumatic experiences.
LATENCY STAGE
• 6 – 12 years old.
• School age.
• Separation anxiety.
• Reading, Writing, Arithmetic.
• Lasts for 6 years.
GENITAL STAGE
• 12 years old and above
• Sexual reawakening.
• Very important stage.
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PHARMA NOTES:
ANTI - ANXIETY DRUGS
• Valium
• Librium
• Ativan
• Serax
• Tanxene
• Miltown
• Equanil
• Vistaril
• Atarax
• Ideral
• Buspar
ERIC ERIKSON
• There is more to life than just sex.
• Psychosocial Theory of development.
• You can develop a positive side or a negative side.
• Developmental task begins at 0 – 18 months.
-------------------- POSITIVE ------NEGATIVE -------- FACTOR
0 – 18 mos. ----------Trust ------------ Mistrust ------------ Feeding
18 mos. – 3 yrs. ----Autonomy -------Shame & Doubt ---- Toilet Training
3 yrs. – 6 yrs. -------Initiative ---------- Guilt --------------Independence
6 yrs. – 12 yrs. -----Industry ---------Inferiority ------------ School
12 yrs. – 20 yrs. ----Identity ---------Role Confusion --------- Peers
20 yrs. – 25 yrs. ----Intimacy -----------Isolation --------------Love
25 yrs. – 45 yrs. ---Generativity --------Stagnation -----------Parenting
45 yrs. - above ----Ego Integrity --------- Despair ------------Reflection
LOBES OF BRAIN
1. FRONTAL LOBE
- Language
- Learning
- Personality
- Judgment
2. TEMPORAL LOBE
- Hearing
- Smell
3. PAREITAL LOBE
- Touch
- Taste
4. OCCIPITAL LOBE
- Visual
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3 STEPS TO INTERACT WITH ENVIRONMENT
1. Sensory – eyes, ears, tongue
2. Integration
3. Motor – voluntary or involuntary
VOLUNTARY NERVOUS SYSTEM
• also called as somatic
Brain
Spinal Cord
Motor Nerve
Synapse
Muscle Fiber
• Motor nerve to muscle fiber you need Acethylcholine which is an “On switch”.
INVOLUNTARY NERVOUS SYSTEM
• also called autonomic nervous system.
AUTONOMIC NERVOUS SYSTEM
-----------------------SYMPATHETIC ------------PARASYMPATHETIC
-------------------(Awake, ADRINERGIC) --------(Relax, CHOLINERGIC)
Heart Rate ------------ Increase -------------------- Decrease
Respiratory Rate ------ Increase -------------------- Decrease
GI ---------------------Decrease ------Increase (Moist mouth, Diarrhea)
GU -------------------- Decrease ---- Increase (Urinary Frequency)
Neurotransmitter---- Epinephrine, Norepinephrine ----Acethylcholine
DRUGS WITH ANTICHOLINERGIC EFFECTS
• Anti – Anxiety
• Anti – Psychotic
• Anti – Cholinergic
• Anti – Depressants
PHARMA NOTES:
MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS)
• Marplan
• Nardil
• Parnate
DEFENSE MECHANISMS
1. Displacement – transfer of feelings to a less threatening object rather than the
one who provoked it.
2. Denial – failure to acknowledge an unacceptable trait or situation.
3. DISOCIATION – psychological flight from the self.
4. REGRESSION – return to an earlier development state.
5. repression – unconscious forgetting.
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6. RATIONALIZATION – illogical reasoning for an unacceptable trait and
situation.
7. REACTION FORMATION – doing the opposite of what you have done.
8. UNDOING – doing the opposite of what you have done.
9. IDENTIFICATION – assuming trait for personal, social, occupational role.
10. PROJECTION – attribute to others one’s unacceptable trait.
11. INTROJECTION – assume another person’s trait as your own.
12. SUPPRESSION – conscious forgetting.
13. SUBLIMATION – putting destructive energies or hostile feelings towards a
more productive endeavors.
14. CONVERSION – unexpressed or repressed feelings are converted to physical
symptoms.
15. COMPENSATION – over achievement in one area to cover a defective part.
16. SUBSTITUTION – replace difficult goal with more accessible one.
PHARMA NOTES:
ANTI – PARKINSON DRUG - CAPABLES
• Cogentin
• Artane
• Parlodel
• Akineton
• Benadryl
• Larodopa
• Eldepryl
• Symmetrel
AUTONOMIC NERVOUS SYSTEM
----------------- SYMPATHETIC -------- PARASYMPATHETIC
Pupils ----------------Dilate ----------------Constrict
Blood Vessels --------Constrict ------------- Dilate
Blood Pressure --------Increase ------------ Decrease
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC
1. Offer Self
2. Silence – provide time to think
3. Making observation – what you see you say
4. Active Listening – nodding, eye contact
5. Broad Opening – how are you today?
6. General Leads – Go on, I’m listening
7. Restating – I’m sad “You’re sad?” 1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion
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NONTHERAPEUTIC
1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion
FEAR – protects us from something bad.
ANXIETY
• Vague sense of impending doom.
• Triggers the sympathetic nervous system.
• Assess level of anxiety of client.
TYPES OF ANXIETY
MILD ANXIETY
• + 1 level of anxiety.
• Widened perceptual field.
• Restless (say you seem restless).
• Enhanced learning capacity.
MODERATE ANXIETY
• + 2 level of anxiety.
• Client pace.
• Give PRN meds.
SEVERE ANXIETY
• + 3 level of anxiety.
• Don’t know what to do/say.
• Directive orders (please sit down).
PANIC
• + 4 level of anxiety.
• May commit suicide.
• Promote safety.
• Never touch patient.
• Hyperventilation (Respiratory Alkalosis)
• Breathe into paper bag.
NURSING DIAGNOSIS:
• ineffective individual coping.
• Powerlessness.
• Impaired skin integrity
PLANNING/IMPLEMENTATION:
• decrease level of anxiety.
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• Decrease environmental stimuli.
• Relaxation techniques.
EVALUATION
• effective individual coping.
GENERALIZED ANXIETY DISORDER
• 6 month excessive worrying.
• Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat,
easy fatigability.
PANIC ATTACKS/DISORDER
• 15 – 30 minutes sympathetic nervous system escalation.
• Example is AGORAPHOBIA fear of open spaces.
POST TRAUMATIC STRESS DISORDER
• victims becomes survivors and experience flashbacks or nightmares.
MALINGERING
• pretending to be sick (conscious).
• Primary Gain anxiety decreases, able to escape source of anxiety.
• Secondary Gain able to get attention.
SOMATOFORM
• no protection
• unconscious
• no organic basis of being sick
DIFFERENT TYPE OF SOMATOFORM
1. Conversion Disorder
• cannot speak, see, hear.
• Nervous system affected.
2. La Belle Indifference
• do not care what happens to them.
HYPOCHONDRIASIS
• has minor discomfort and interprets it as major illness.
• Focus on clients feelings.
BODY DISMORPHIC DISORDER
• Illusion of structural defect.
• Favorite past time is doctor hopping.
• Focus on clients feelings.
PSYCHOSOMATIC
• Real pains/illness
• Real symptoms because of anxiety
PSYCHOSOMATIC
Increase Anxiety
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SNS
Increase BP & HR
Hypertension
Fat Deposits
Atherosclerosis
Calcium
Arteriosclerosis
Decrease Oxygen
Angina Pectoris
MI
Necrosis
CHF
Coma
PHOBIA
• Irrational fear
• Etiology: Knowledge of certain object
• Bad experience
• Immediate nursing objective: Removal of stimulus will remove anxiety
• Systemic Desensitization gradually expose client to stimuli/feared object
• Employ relaxation techniques
SNS
• GABA (Gamma Amino Butyric Acid) – stop
• Epinephrine and Norepinephrine – Go
ANTI-ANXIETY
• Increase GABA and client becomes drowsy (no alcohol and coffee)
• May develop orthostatic hypotension
• Let patient sit then dangle feet and then stand
• Develop anti cholinergic effects
• If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1
week) may lead to seizures
• Do it in gradual and in tapered dose
• Anti anxiety leads to dependence
AUTISM
• Unresponsive and does not want to be touched
• Autistic Savant: high intelligence and has a ratio of 1:100
• Assessment
• Appearance – flat affect and loves constancy and ritualistic
• Behavior – withdrawn
• Communication – echolalia
NURSING DIANOSIS
• Impaired verbal communication
• Impaired social interaction
• Self mutilation
• Risk for injury
PLANNING/IMPLEMENTATION
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• Maslow’s hierarchy of needs
• Expressive Therapy – use of art as mode if communication
EVALUATION
• Enhanced communication
• Improved social interaction
• Safety
ATTENTION DEFICIT HYPERACTIVITY DISORDER
• 7 years and below onset
• Duration: 6 months and above
• Settings: house and school
• Assessment
• Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no
focus
• Behavior
• Communication: talkative
NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction
PLANNING/IMPLEMENTATION
• Structure: place to play, sleep, eat and study
• Schedule: there is always a time for everything that you do
• Set limits
• Safety
EVALUATION
• Minimize risk for injury
• Improved social interaction
FRONTAL LOBE OF ADHD
Decrease glucose
Decrease judgment
Increase impulsiveness
ADHD
Hyperactivity
• Need a drug that brings glucose level up.
• Give Ritalin a stimulant
• May result in loss of appetite
• Given after meals
• Given 6 hours before bedtime
EATING DISORDERS
ANOREXIA NERVOSA ---------------BULIMIA NERVOSA
- Eat, eat, eat --------------------------- Eat, eat, vomit
- Less 85% expected body weight ------- Normal weight
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- 3 months amenorrhea --------------- Irregular menstruation
BULIMIA NERVOSA
• Metabolic alkalosis (vomiting results to decrease hydrochloric acid)
• Metabolic acidosis (diarrhea results to decrease bicarbonate)
• Dental caries
• Wound in knuckles
MANAGEMENT
• Fluid and electrolyte imbalance
• Meal contract
• Weight gain for client
• After eating stay with client for 1 hour and accompany when going to the
comfort room
PHARMA NOTES:
ANTI – PSYCHOTIC DRUG
• Stelazine
• Serentil
• Thorazine
• Trilafon
• Clozaril
• Mellaril
• Haldol
• Prolixin
SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
• Biological theory – increase dopamine level
• Exact cause unknown
ASSESSMENT
• Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
• Ambivalence: pulled into 2 opposing forces
Autism
• Looseness, no idea, not related to one another
ASSESSMENT
NEGATIVE ------------------------POSITIVE
Hypoactive ------------------------ Hyperactive
Withdrawn ------------------------- Sociable
Thought Blocking ------------------Flight of ideas
Apathy
I. ASSESS
• Content of thought
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NURSING DIAGNOSIS
• Disturbed thought process
PLANNING/IMPLEMENTATION
• Present reality
• Provide safety
EVALUATION
• Improved thought process
II. ASSESS
• Hallucinations/Illusions
NURSING DIAGNOSIS
• Disturbed sensory perception
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Improved sensory perception
III. ASSESS
• Suspicious
NURSING DIAGNOSIS
• Risk for other directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for other directed violence
IV. ASSESS
• Suicidal
NURSING DIAGNOSIS
• Risk for self directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for self directed violence
LOOSENESS OF ASSOCIATION
• There is connection with statements
FLIGHT OF IDEAS
• Jumping from on topic to another
AMBIVALENCE
• Pulled between 2 strong opposing forces
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MAGICAL THINKING
• acting like magician
ECHOLALIA
• Client repeats what you say
ECHOPRAXIA
• Client repeats what you do
WORD SALAD
• Just words no rhyme
CLANG ASSOCIATION
• Words that rhyme
NEOLOGISM
• Formation of new words (needs clarification)
DELUSION: PERSECUTORY
• “The NBI is out to get me”
DELUSION: RELIGIOUS
• “I am Jesus Christ the savior”
DELUSION: GRANDEUR
• “ I am the queen of the world”
DELUSION: IDEAS OF REFERENCE
• “The nurses are talking about me”
CONCRETE ASSOCIATION
• Also known as “pilosopo”
THOUGHT BLOCKING
• Unable to think
-----------------------HALLUCINATIONS------ ILLUSIONS
STIMULUS ------------ ABSENT------------ PRESENT
VISUAL ----------------ABSENT------------ PRESENT
AUDITORY ----------- ABSENT------------ PRESENT
TACTILE ABSENT --- ABSENT------------ PRESENT
• Present reality to clients experiencing hallucinations
• Technique in handling clients with hallucinations
• Hallucinations
• Acknowledgement “I know the voices are real to you”
• Reality orientation “I know the voices are real but I don’t hear them”
• Diversion “Lets go to the garden”
• 10% of schizophrenic clients hear voices
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PARKINSON’S DISEASE
• If acethylcholine (on switch) is increased there is excessive movement resulting
to decrease in dopamine (off switch)
ANTI-PSYCHOTIC
Decrease dopamine level
Parkinson like effect
Extra pyramidal side effect
With akathesia
Restless, inability to rest
AKINESIA
• Muscle rigidity
DYSTONIA
• Torticollis (wryneck)
OCULOGYRIC CRISIS
• Fixed stare
OPISTHOTONUS
• Arched back
• Lips – smacking
• Tongue – protruding
• Cheeks – puffing
• The 3 are irreversible and called tardive dyskinesia
• Neuroleptic malignant syndrome – hyperthermia
ANTI – PARKINSON
Anticholinergics Dopaminergics
(Decrease Ach) (Increase Dopa)
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel
OTHER SIDE EFFECTS OF DECREASE DOPAMINE
• Photosensitivity
• Agranulocytosis – decrease WBC
• Clients prone to infection due to decrease WBC
• First sign for infection is sore throat
TYPES OF SCHIZOPHRENIA
DISORGANIZED SCHIZOPHRENIA
- Sad but smiles (inappropriate affect)
- No reaction (flat affect)
- Flight of ideas (disorganized speech)
- Giggling (hebephrenic giggle)
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- Combination of positive and negative signs and symptoms
CATATONIC SCHIZOPHRENIA
- Ambivalence
- Waxy flexibility
- Favorite word is “No”
- Negativism (client do not follow what you tell them to do)
Nursing management: meet needs
PARANOID SCHIZOPHRENIA
- Suspicious
- Mistrust, scared, withdrawn
Nursing management:
- Gain trust by 1 to 1 short interaction but frequent
- Foods should be in a sealed container
- Medications should be in tamper resistant foil.
Violent:
- Keep door open
- Position near door
- Don’t touch client
- Call for reinforcement
- One arms length away from the client.
PARANOID SCHIZOPHRENIA
- No more positive symptoms just withdrawn
UNDIFFIRENTIATED SCHIZOPHRENIA
- Mixed classification, cant be classified
PHAMRA NOTES:
BI-POLAR, MANIC
• Lithium: undergo first kidney test and check for blood levels
• Level: .6 – 1.2 meq/L
• Increase urination
• Tremors, fine hand
• Hydration of 3L/day
• Increase
• Uu (diarrhea)
• Mouth dry
Signs of Lithium toxicity
• Nausea, vomiting, diarrhea
• Increase sodium
* Wait for 2 – 4 weeks before lithium therapy takes effects
BIPOLAR DISORDER/MANIC PROFILE
• 20 years old
• Female
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• Stress
• Obese
ASSESSMENT
• Decrease appetite (give finger foods)
• Decrease sleep (place in a private room)
• Hyperactive
• Increase sexual activity – only means of addressing anxiety so decrease level of
anxiety
• Risk for injury/other directed violence
• Impaired social interaction (care giver role: strain and stay with client)
• Self esteem decrease (to cover up their sadness there is compensation to cover
defective doing)
• Because there is decrease self esteem there will be increase compensation
resulting to increase interference with ADL’s and harm to others
• Compensation is the culprit
• Management: increase self esteem to decrease compensation and decrease
interference with ADL’s and harm to others
HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS
T- no sports (basketball, volleyball), no fine motor skills only gross motor skills
A lot energies toward more productive endeavors (sublimation)
S - escorted walk outdoors
K – punching bag (displacement)
PHARMA NOTES:
ANTI – DEPRESSANTS
• Asendin
• Norpralamin
• Tofranil
• Sinequan
• Anafranil
• Aventyl
• Vivactil
• Elavil
• Prozac
• Paxil
• Zoloft
ALCOHOL LEADS TO:
• Blackout: awake but unaware
• Confabulation: inventing stories to increase self esteem
• Denial: “I am not an alcoholic”
• Dependence: cant leave with out leading to enabling where in the significant
other tolerates the abuser co dependence is another term
• Tolerance: gradual increase in amount of stimuli to experience the same
euphoria
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MANAGEMENT
• Detoxification: withdrawal with medical doctor supervision
• Avoid alcohol therapy
• Aversion therapy a more technical term for avoid alcohol therapy
• Antabuse: Disulfiram makes the client never drink alcohol because it causes
vomiting
• Alcoholics anonymous
• Interval of 12 hours after last dose of alcohol or experience nausea and
vomiting and hypotension
• Alcoholism may result to Vitamin B1 (Thiamine) deficiency
WERNICKE’S ENCEPHALOPATHY
• Problem with motor
KORSAKOFF’S PSYCHOSIS
• Problem with memory
• 24 – 72 hours after last dose of alcohol expect:
• Delirium Tremens: sympathetic nervous system
• Prevent hallucinations/Illusions by placing client in a well lit room
• Formication: feeling of bugs crawling under the skin
ALZHEIMERS DISEASE
• Axon (away) and Dendrites (toward) nerve
• Neurofibrillary tangles
• Neurotic plaques
--------------------------ALCOHOL --- ALZHEIMERS
ONSET -------------------- Abrupt -------- Gradual
LEVEL OF CONSCIOUSNESS -- Fluctuating ----Unaffected
DURATION ----------- Hours to days --- Progressive
MEMORY -------------- Short term ---Short and long term
5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
- expressive: cant say/express
- frontal lobe is affected particularly broca’s area
- receptive: cant hear
- temporal lobe is affected particularly wernicke’s area
5. Apraxia – cant do simple things
* Reminiscing Therapy – talk about past
• Patients with alzheimer’s may experience hallucinations, illusions thus becomes
restless and may wander
• As sun goes down client becomes restless, agitated, disoriented called
sundowning
• Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases
Ach causing delay in disease progression
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SEROTONIN
• Responsible for happiness
• Decrease serotonin clients becomes sad give anti-depressants
SELECTIVE SEROTONIN REUPTAKE INHIBITOR
Safest drug
Side effects low
R
I to 4 weeks
- Increases serotonin and affects only serotonin
- Prozac, Paxil, Zoloft
TRICYCLIC ANTI DEPRESSANT
Two – four weeks
C
A
- Has higher incidence of side effects
- Also increases norepinephrine
- Asendin, Norpralamin, Tofranil, Sinequan, Anafranil, Aventyl, Vivactil, Elavil
MONO AMINE OXIDASE INHIBITORS
• MAO kills serotonin
• Increased MAO results to decreased serotonin the more depressed the client
becomes
• MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine,
norepinephrine, dopamine but client becomes prone to hypertensive crisis
• Avoid tyramine rich foods
• Avocado, Alcohol
• Beer
• Chocolates, Cheese (aged)
• Fermented foods
• Pickles
• Preserved foods
• Soy sauce
• There is increase incidence of side effects after 2 – 6 weeks
• Marplan, Nardil, Parnate
PERSONALITY DISORDERS
1. Schizophrenia
- They avoid people because there is no enjoyment
2. Avoidant
- They avoid people because they are afraid of criticisms
- They have talent but has no confidence
3. Anti-Social
- Constantly breaks law
- Project charm
- They are witty and articulate
- Manipulative
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4. Borderline
- They perceive life as an empty glass
- They like splitting friends
- Sudden change in mood “labile affect”
- Prone to suicide
5. Dependent
- “Cant live if living is without you”
6. Histrioinic
- Constantly wants to be the center of attention
- Excited, dramatic, manipulative
7. Narcissistic
- “I love myself”
- They get jealous even with achievement of family members
8. Obsessive – Compulsive
- “I am so organized”
9. Paranoid
- Suspicious
- May lead to domestic violence
ANTI – DEPRESSANT SIDE EFFECTS:
Male – erectile dysfunction, prone to impotence
GRIEF PROCESS
1. Denial – shock/disbelief
2. Anger – question “why me?”
3. Bargaining – if, then
4. Depression – 2 weeks or more sign and symptoms becomes major clinical
depression
5. Acceptance – client acts according to situation
ASSESSMENT
• Decrease self actualization
• Decrease self esteem
• Withdrawn: stay with client
• Suicidal: risk for self directed violence
• Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
• Be sensitive to clients needs
FOR SUICIDAL OBSERVE FOR
Verbal
• “I wont be a problem”
• “This is my last day on earth”
• “I’ll soon be gone”
Non verbal
• Giving away of valuables
• Sudden change in mood
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WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO
Direct: “Do you plan to commit suicide?”
Irregular/interval visits
Endorsement period, early morning clients are most likely to commit suicide
DOWNERS
Alcohol
Barbiturate
Opiates
Narcotics
Marijuana
Morphine
Codeine
Heroine
Resulting to:
• Bradycardia
• Bradypnea
• Moist mouth
• Pupils constrict
• Constipation
• Urinary retention
• Hypotension
• Coma
• Weight gain
• Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride)
UPPERS
Cocaine
Hallucinogens
Amphetamines
Resulting to:
• Tachycardia
• Awake
• Tachypnea
• Dry mouth
• Pupils dilate
• Hypertension
• Seizures
• Weight loss
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• Psych focuses in feelings or self awareness.
• Beliefs determine feelings which affects behavior (manifestation of feelings)
• Sigmund Freud is the father of PSYCHOANALYSIS.
• What happens to childhood will affect adulthood.
STRUCTURE OF PERSONALITY
ID
• impulsive, want to, wants pleasure.
• PLEASURE PRINCIPLE.
• Guiding principle is PAIN AVOIDANCE.
SUPEREGO
• should not
• small voice of God
• to stop
EGO
• executive decision maker.
• In touch with reality principle.
ID DOMINANT PERSONALITIES
Manic
Anti – Social – experienced by serial killers
Narcissistic
SUPEREGO DOMINANT PERSONALITIES
Obsessive Compulsive
Anorexia Nervosa
EGO – if destroyed result in impaired reality perception.
Schizophrenia
LIBIDO
• Sexual energy responsible for survival.
Oral Stage
• 0 – 18 months evident.
• ID is developed.
*FIXATION – Person is stuck in certain developmental shape.
*REGRESSION – Return to an earlier developmental stage.
EGO – Developed on the 6th month.
Anal Stage
• 18 months – 3 years old.
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• Able to control bladder, bowel.
• Best time for toilet training.
• SUPEREGO is developed.
TOILET TRAINING
Good Mother------------------------ Bad Mother
Successful -----------------Dirty ---------------------- Clean
-------------------------disorganized --------------- organized
------------------------- disobedient ---------------- obedient
------------------------- Anti-social ------------------- O.C
----------------------- Anal expulsive ----------- Anal retentive
PHALLIC STAGE
• 3 – 6 years old.
• Experience pleasure by manipulating genitals.
• Love – hate relationship.
• Oedipus Complex boy loves parent of the opposite sex.
• Imitates daddy called identification.
• Castration fears.
• Electra Complex girl loves parent of the opposite sex.
• Imitates mommy called identification.
• Penis envy.
*Conscious – upper level of thinking.
*Preconscious – tip of tongue.
*Unconscious – protects us from traumatic experiences.
LATENCY STAGE
• 6 – 12 years old.
• School age.
• Separation anxiety.
• Reading, Writing, Arithmetic.
• Lasts for 6 years.
GENITAL STAGE
• 12 years old and above
• Sexual reawakening.
• Very important stage.
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PHARMA NOTES:
ANTI - ANXIETY DRUGS
• Valium
• Librium
• Ativan
• Serax
• Tanxene
• Miltown
• Equanil
• Vistaril
• Atarax
• Ideral
• Buspar
ERIC ERIKSON
• There is more to life than just sex.
• Psychosocial Theory of development.
• You can develop a positive side or a negative side.
• Developmental task begins at 0 – 18 months.
-------------------- POSITIVE ------NEGATIVE -------- FACTOR
0 – 18 mos. ----------Trust ------------ Mistrust ------------ Feeding
18 mos. – 3 yrs. ----Autonomy -------Shame & Doubt ---- Toilet Training
3 yrs. – 6 yrs. -------Initiative ---------- Guilt --------------Independence
6 yrs. – 12 yrs. -----Industry ---------Inferiority ------------ School
12 yrs. – 20 yrs. ----Identity ---------Role Confusion --------- Peers
20 yrs. – 25 yrs. ----Intimacy -----------Isolation --------------Love
25 yrs. – 45 yrs. ---Generativity --------Stagnation -----------Parenting
45 yrs. - above ----Ego Integrity --------- Despair ------------Reflection
LOBES OF BRAIN
1. FRONTAL LOBE
- Language
- Learning
- Personality
- Judgment
2. TEMPORAL LOBE
- Hearing
- Smell
3. PAREITAL LOBE
- Touch
- Taste
4. OCCIPITAL LOBE
- Visual
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3 STEPS TO INTERACT WITH ENVIRONMENT
1. Sensory – eyes, ears, tongue
2. Integration
3. Motor – voluntary or involuntary
VOLUNTARY NERVOUS SYSTEM
• also called as somatic
Brain
Spinal Cord
Motor Nerve
Synapse
Muscle Fiber
• Motor nerve to muscle fiber you need Acethylcholine which is an “On switch”.
INVOLUNTARY NERVOUS SYSTEM
• also called autonomic nervous system.
AUTONOMIC NERVOUS SYSTEM
-----------------------SYMPATHETIC ------------PARASYMPATHETIC
-------------------(Awake, ADRINERGIC) --------(Relax, CHOLINERGIC)
Heart Rate ------------ Increase -------------------- Decrease
Respiratory Rate ------ Increase -------------------- Decrease
GI ---------------------Decrease ------Increase (Moist mouth, Diarrhea)
GU -------------------- Decrease ---- Increase (Urinary Frequency)
Neurotransmitter---- Epinephrine, Norepinephrine ----Acethylcholine
DRUGS WITH ANTICHOLINERGIC EFFECTS
• Anti – Anxiety
• Anti – Psychotic
• Anti – Cholinergic
• Anti – Depressants
PHARMA NOTES:
MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS)
• Marplan
• Nardil
• Parnate
DEFENSE MECHANISMS
1. Displacement – transfer of feelings to a less threatening object rather than the
one who provoked it.
2. Denial – failure to acknowledge an unacceptable trait or situation.
3. DISOCIATION – psychological flight from the self.
4. REGRESSION – return to an earlier development state.
5. repression – unconscious forgetting.
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6. RATIONALIZATION – illogical reasoning for an unacceptable trait and
situation.
7. REACTION FORMATION – doing the opposite of what you have done.
8. UNDOING – doing the opposite of what you have done.
9. IDENTIFICATION – assuming trait for personal, social, occupational role.
10. PROJECTION – attribute to others one’s unacceptable trait.
11. INTROJECTION – assume another person’s trait as your own.
12. SUPPRESSION – conscious forgetting.
13. SUBLIMATION – putting destructive energies or hostile feelings towards a
more productive endeavors.
14. CONVERSION – unexpressed or repressed feelings are converted to physical
symptoms.
15. COMPENSATION – over achievement in one area to cover a defective part.
16. SUBSTITUTION – replace difficult goal with more accessible one.
PHARMA NOTES:
ANTI – PARKINSON DRUG - CAPABLES
• Cogentin
• Artane
• Parlodel
• Akineton
• Benadryl
• Larodopa
• Eldepryl
• Symmetrel
AUTONOMIC NERVOUS SYSTEM
----------------- SYMPATHETIC -------- PARASYMPATHETIC
Pupils ----------------Dilate ----------------Constrict
Blood Vessels --------Constrict ------------- Dilate
Blood Pressure --------Increase ------------ Decrease
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC
1. Offer Self
2. Silence – provide time to think
3. Making observation – what you see you say
4. Active Listening – nodding, eye contact
5. Broad Opening – how are you today?
6. General Leads – Go on, I’m listening
7. Restating – I’m sad “You’re sad?” 1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion
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NONTHERAPEUTIC
1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion
FEAR – protects us from something bad.
ANXIETY
• Vague sense of impending doom.
• Triggers the sympathetic nervous system.
• Assess level of anxiety of client.
TYPES OF ANXIETY
MILD ANXIETY
• + 1 level of anxiety.
• Widened perceptual field.
• Restless (say you seem restless).
• Enhanced learning capacity.
MODERATE ANXIETY
• + 2 level of anxiety.
• Client pace.
• Give PRN meds.
SEVERE ANXIETY
• + 3 level of anxiety.
• Don’t know what to do/say.
• Directive orders (please sit down).
PANIC
• + 4 level of anxiety.
• May commit suicide.
• Promote safety.
• Never touch patient.
• Hyperventilation (Respiratory Alkalosis)
• Breathe into paper bag.
NURSING DIAGNOSIS:
• ineffective individual coping.
• Powerlessness.
• Impaired skin integrity
PLANNING/IMPLEMENTATION:
• decrease level of anxiety.
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• Decrease environmental stimuli.
• Relaxation techniques.
EVALUATION
• effective individual coping.
GENERALIZED ANXIETY DISORDER
• 6 month excessive worrying.
• Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat,
easy fatigability.
PANIC ATTACKS/DISORDER
• 15 – 30 minutes sympathetic nervous system escalation.
• Example is AGORAPHOBIA fear of open spaces.
POST TRAUMATIC STRESS DISORDER
• victims becomes survivors and experience flashbacks or nightmares.
MALINGERING
• pretending to be sick (conscious).
• Primary Gain anxiety decreases, able to escape source of anxiety.
• Secondary Gain able to get attention.
SOMATOFORM
• no protection
• unconscious
• no organic basis of being sick
DIFFERENT TYPE OF SOMATOFORM
1. Conversion Disorder
• cannot speak, see, hear.
• Nervous system affected.
2. La Belle Indifference
• do not care what happens to them.
HYPOCHONDRIASIS
• has minor discomfort and interprets it as major illness.
• Focus on clients feelings.
BODY DISMORPHIC DISORDER
• Illusion of structural defect.
• Favorite past time is doctor hopping.
• Focus on clients feelings.
PSYCHOSOMATIC
• Real pains/illness
• Real symptoms because of anxiety
PSYCHOSOMATIC
Increase Anxiety
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SNS
Increase BP & HR
Hypertension
Fat Deposits
Atherosclerosis
Calcium
Arteriosclerosis
Decrease Oxygen
Angina Pectoris
MI
Necrosis
CHF
Coma
PHOBIA
• Irrational fear
• Etiology: Knowledge of certain object
• Bad experience
• Immediate nursing objective: Removal of stimulus will remove anxiety
• Systemic Desensitization gradually expose client to stimuli/feared object
• Employ relaxation techniques
SNS
• GABA (Gamma Amino Butyric Acid) – stop
• Epinephrine and Norepinephrine – Go
ANTI-ANXIETY
• Increase GABA and client becomes drowsy (no alcohol and coffee)
• May develop orthostatic hypotension
• Let patient sit then dangle feet and then stand
• Develop anti cholinergic effects
• If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1
week) may lead to seizures
• Do it in gradual and in tapered dose
• Anti anxiety leads to dependence
AUTISM
• Unresponsive and does not want to be touched
• Autistic Savant: high intelligence and has a ratio of 1:100
• Assessment
• Appearance – flat affect and loves constancy and ritualistic
• Behavior – withdrawn
• Communication – echolalia
NURSING DIANOSIS
• Impaired verbal communication
• Impaired social interaction
• Self mutilation
• Risk for injury
PLANNING/IMPLEMENTATION
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• Maslow’s hierarchy of needs
• Expressive Therapy – use of art as mode if communication
EVALUATION
• Enhanced communication
• Improved social interaction
• Safety
ATTENTION DEFICIT HYPERACTIVITY DISORDER
• 7 years and below onset
• Duration: 6 months and above
• Settings: house and school
• Assessment
• Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no
focus
• Behavior
• Communication: talkative
NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction
PLANNING/IMPLEMENTATION
• Structure: place to play, sleep, eat and study
• Schedule: there is always a time for everything that you do
• Set limits
• Safety
EVALUATION
• Minimize risk for injury
• Improved social interaction
FRONTAL LOBE OF ADHD
Decrease glucose
Decrease judgment
Increase impulsiveness
ADHD
Hyperactivity
• Need a drug that brings glucose level up.
• Give Ritalin a stimulant
• May result in loss of appetite
• Given after meals
• Given 6 hours before bedtime
EATING DISORDERS
ANOREXIA NERVOSA ---------------BULIMIA NERVOSA
- Eat, eat, eat --------------------------- Eat, eat, vomit
- Less 85% expected body weight ------- Normal weight
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- 3 months amenorrhea --------------- Irregular menstruation
BULIMIA NERVOSA
• Metabolic alkalosis (vomiting results to decrease hydrochloric acid)
• Metabolic acidosis (diarrhea results to decrease bicarbonate)
• Dental caries
• Wound in knuckles
MANAGEMENT
• Fluid and electrolyte imbalance
• Meal contract
• Weight gain for client
• After eating stay with client for 1 hour and accompany when going to the
comfort room
PHARMA NOTES:
ANTI – PSYCHOTIC DRUG
• Stelazine
• Serentil
• Thorazine
• Trilafon
• Clozaril
• Mellaril
• Haldol
• Prolixin
SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
• Biological theory – increase dopamine level
• Exact cause unknown
ASSESSMENT
• Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
• Ambivalence: pulled into 2 opposing forces
Autism
• Looseness, no idea, not related to one another
ASSESSMENT
NEGATIVE ------------------------POSITIVE
Hypoactive ------------------------ Hyperactive
Withdrawn ------------------------- Sociable
Thought Blocking ------------------Flight of ideas
Apathy
I. ASSESS
• Content of thought
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NURSING DIAGNOSIS
• Disturbed thought process
PLANNING/IMPLEMENTATION
• Present reality
• Provide safety
EVALUATION
• Improved thought process
II. ASSESS
• Hallucinations/Illusions
NURSING DIAGNOSIS
• Disturbed sensory perception
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Improved sensory perception
III. ASSESS
• Suspicious
NURSING DIAGNOSIS
• Risk for other directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for other directed violence
IV. ASSESS
• Suicidal
NURSING DIAGNOSIS
• Risk for self directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for self directed violence
LOOSENESS OF ASSOCIATION
• There is connection with statements
FLIGHT OF IDEAS
• Jumping from on topic to another
AMBIVALENCE
• Pulled between 2 strong opposing forces
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MAGICAL THINKING
• acting like magician
ECHOLALIA
• Client repeats what you say
ECHOPRAXIA
• Client repeats what you do
WORD SALAD
• Just words no rhyme
CLANG ASSOCIATION
• Words that rhyme
NEOLOGISM
• Formation of new words (needs clarification)
DELUSION: PERSECUTORY
• “The NBI is out to get me”
DELUSION: RELIGIOUS
• “I am Jesus Christ the savior”
DELUSION: GRANDEUR
• “ I am the queen of the world”
DELUSION: IDEAS OF REFERENCE
• “The nurses are talking about me”
CONCRETE ASSOCIATION
• Also known as “pilosopo”
THOUGHT BLOCKING
• Unable to think
-----------------------HALLUCINATIONS------ ILLUSIONS
STIMULUS ------------ ABSENT------------ PRESENT
VISUAL ----------------ABSENT------------ PRESENT
AUDITORY ----------- ABSENT------------ PRESENT
TACTILE ABSENT --- ABSENT------------ PRESENT
• Present reality to clients experiencing hallucinations
• Technique in handling clients with hallucinations
• Hallucinations
• Acknowledgement “I know the voices are real to you”
• Reality orientation “I know the voices are real but I don’t hear them”
• Diversion “Lets go to the garden”
• 10% of schizophrenic clients hear voices
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PARKINSON’S DISEASE
• If acethylcholine (on switch) is increased there is excessive movement resulting
to decrease in dopamine (off switch)
ANTI-PSYCHOTIC
Decrease dopamine level
Parkinson like effect
Extra pyramidal side effect
With akathesia
Restless, inability to rest
AKINESIA
• Muscle rigidity
DYSTONIA
• Torticollis (wryneck)
OCULOGYRIC CRISIS
• Fixed stare
OPISTHOTONUS
• Arched back
• Lips – smacking
• Tongue – protruding
• Cheeks – puffing
• The 3 are irreversible and called tardive dyskinesia
• Neuroleptic malignant syndrome – hyperthermia
ANTI – PARKINSON
Anticholinergics Dopaminergics
(Decrease Ach) (Increase Dopa)
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel
OTHER SIDE EFFECTS OF DECREASE DOPAMINE
• Photosensitivity
• Agranulocytosis – decrease WBC
• Clients prone to infection due to decrease WBC
• First sign for infection is sore throat
TYPES OF SCHIZOPHRENIA
DISORGANIZED SCHIZOPHRENIA
- Sad but smiles (inappropriate affect)
- No reaction (flat affect)
- Flight of ideas (disorganized speech)
- Giggling (hebephrenic giggle)
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- Combination of positive and negative signs and symptoms
CATATONIC SCHIZOPHRENIA
- Ambivalence
- Waxy flexibility
- Favorite word is “No”
- Negativism (client do not follow what you tell them to do)
Nursing management: meet needs
PARANOID SCHIZOPHRENIA
- Suspicious
- Mistrust, scared, withdrawn
Nursing management:
- Gain trust by 1 to 1 short interaction but frequent
- Foods should be in a sealed container
- Medications should be in tamper resistant foil.
Violent:
- Keep door open
- Position near door
- Don’t touch client
- Call for reinforcement
- One arms length away from the client.
PARANOID SCHIZOPHRENIA
- No more positive symptoms just withdrawn
UNDIFFIRENTIATED SCHIZOPHRENIA
- Mixed classification, cant be classified
PHAMRA NOTES:
BI-POLAR, MANIC
• Lithium: undergo first kidney test and check for blood levels
• Level: .6 – 1.2 meq/L
• Increase urination
• Tremors, fine hand
• Hydration of 3L/day
• Increase
• Uu (diarrhea)
• Mouth dry
Signs of Lithium toxicity
• Nausea, vomiting, diarrhea
• Increase sodium
* Wait for 2 – 4 weeks before lithium therapy takes effects
BIPOLAR DISORDER/MANIC PROFILE
• 20 years old
• Female
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• Stress
• Obese
ASSESSMENT
• Decrease appetite (give finger foods)
• Decrease sleep (place in a private room)
• Hyperactive
• Increase sexual activity – only means of addressing anxiety so decrease level of
anxiety
• Risk for injury/other directed violence
• Impaired social interaction (care giver role: strain and stay with client)
• Self esteem decrease (to cover up their sadness there is compensation to cover
defective doing)
• Because there is decrease self esteem there will be increase compensation
resulting to increase interference with ADL’s and harm to others
• Compensation is the culprit
• Management: increase self esteem to decrease compensation and decrease
interference with ADL’s and harm to others
HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS
T- no sports (basketball, volleyball), no fine motor skills only gross motor skills
A lot energies toward more productive endeavors (sublimation)
S - escorted walk outdoors
K – punching bag (displacement)
PHARMA NOTES:
ANTI – DEPRESSANTS
• Asendin
• Norpralamin
• Tofranil
• Sinequan
• Anafranil
• Aventyl
• Vivactil
• Elavil
• Prozac
• Paxil
• Zoloft
ALCOHOL LEADS TO:
• Blackout: awake but unaware
• Confabulation: inventing stories to increase self esteem
• Denial: “I am not an alcoholic”
• Dependence: cant leave with out leading to enabling where in the significant
other tolerates the abuser co dependence is another term
• Tolerance: gradual increase in amount of stimuli to experience the same
euphoria
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MANAGEMENT
• Detoxification: withdrawal with medical doctor supervision
• Avoid alcohol therapy
• Aversion therapy a more technical term for avoid alcohol therapy
• Antabuse: Disulfiram makes the client never drink alcohol because it causes
vomiting
• Alcoholics anonymous
• Interval of 12 hours after last dose of alcohol or experience nausea and
vomiting and hypotension
• Alcoholism may result to Vitamin B1 (Thiamine) deficiency
WERNICKE’S ENCEPHALOPATHY
• Problem with motor
KORSAKOFF’S PSYCHOSIS
• Problem with memory
• 24 – 72 hours after last dose of alcohol expect:
• Delirium Tremens: sympathetic nervous system
• Prevent hallucinations/Illusions by placing client in a well lit room
• Formication: feeling of bugs crawling under the skin
ALZHEIMERS DISEASE
• Axon (away) and Dendrites (toward) nerve
• Neurofibrillary tangles
• Neurotic plaques
--------------------------ALCOHOL --- ALZHEIMERS
ONSET -------------------- Abrupt -------- Gradual
LEVEL OF CONSCIOUSNESS -- Fluctuating ----Unaffected
DURATION ----------- Hours to days --- Progressive
MEMORY -------------- Short term ---Short and long term
5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
- expressive: cant say/express
- frontal lobe is affected particularly broca’s area
- receptive: cant hear
- temporal lobe is affected particularly wernicke’s area
5. Apraxia – cant do simple things
* Reminiscing Therapy – talk about past
• Patients with alzheimer’s may experience hallucinations, illusions thus becomes
restless and may wander
• As sun goes down client becomes restless, agitated, disoriented called
sundowning
• Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases
Ach causing delay in disease progression
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SEROTONIN
• Responsible for happiness
• Decrease serotonin clients becomes sad give anti-depressants
SELECTIVE SEROTONIN REUPTAKE INHIBITOR
Safest drug
Side effects low
R
I to 4 weeks
- Increases serotonin and affects only serotonin
- Prozac, Paxil, Zoloft
TRICYCLIC ANTI DEPRESSANT
Two – four weeks
C
A
- Has higher incidence of side effects
- Also increases norepinephrine
- Asendin, Norpralamin, Tofranil, Sinequan, Anafranil, Aventyl, Vivactil, Elavil
MONO AMINE OXIDASE INHIBITORS
• MAO kills serotonin
• Increased MAO results to decreased serotonin the more depressed the client
becomes
• MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine,
norepinephrine, dopamine but client becomes prone to hypertensive crisis
• Avoid tyramine rich foods
• Avocado, Alcohol
• Beer
• Chocolates, Cheese (aged)
• Fermented foods
• Pickles
• Preserved foods
• Soy sauce
• There is increase incidence of side effects after 2 – 6 weeks
• Marplan, Nardil, Parnate
PERSONALITY DISORDERS
1. Schizophrenia
- They avoid people because there is no enjoyment
2. Avoidant
- They avoid people because they are afraid of criticisms
- They have talent but has no confidence
3. Anti-Social
- Constantly breaks law
- Project charm
- They are witty and articulate
- Manipulative
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4. Borderline
- They perceive life as an empty glass
- They like splitting friends
- Sudden change in mood “labile affect”
- Prone to suicide
5. Dependent
- “Cant live if living is without you”
6. Histrioinic
- Constantly wants to be the center of attention
- Excited, dramatic, manipulative
7. Narcissistic
- “I love myself”
- They get jealous even with achievement of family members
8. Obsessive – Compulsive
- “I am so organized”
9. Paranoid
- Suspicious
- May lead to domestic violence
ANTI – DEPRESSANT SIDE EFFECTS:
Male – erectile dysfunction, prone to impotence
GRIEF PROCESS
1. Denial – shock/disbelief
2. Anger – question “why me?”
3. Bargaining – if, then
4. Depression – 2 weeks or more sign and symptoms becomes major clinical
depression
5. Acceptance – client acts according to situation
ASSESSMENT
• Decrease self actualization
• Decrease self esteem
• Withdrawn: stay with client
• Suicidal: risk for self directed violence
• Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
• Be sensitive to clients needs
FOR SUICIDAL OBSERVE FOR
Verbal
• “I wont be a problem”
• “This is my last day on earth”
• “I’ll soon be gone”
Non verbal
• Giving away of valuables
• Sudden change in mood
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WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO
Direct: “Do you plan to commit suicide?”
Irregular/interval visits
Endorsement period, early morning clients are most likely to commit suicide
DOWNERS
Alcohol
Barbiturate
Opiates
Narcotics
Marijuana
Morphine
Codeine
Heroine
Resulting to:
• Bradycardia
• Bradypnea
• Moist mouth
• Pupils constrict
• Constipation
• Urinary retention
• Hypotension
• Coma
• Weight gain
• Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride)
UPPERS
Cocaine
Hallucinogens
Amphetamines
Resulting to:
• Tachycardia
• Awake
• Tachypnea
• Dry mouth
• Pupils dilate
• Hypertension
• Seizures
• Weight loss
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