Psychiatric Nursing

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PSYCHIATRIC NURSING
Course Outline:
I.
II.
III.
IV.

Foundations of Mental Health Development: Theories
Defense Mechanism
Therapeutic Modalities
Maladaptive Patterns of Behavior
a. Anxiety Response and Related Disorders
b. Emotional Responses and Mood disorders
c. Schizoprenia and other psychotic and mood disorders
d. Social responses and personality disorders
e. Substance Related Disorders
f. Psychophysiologic responses, somatoform and sleep disorders
g. Abuse and Violence
h. Eating disorders
i. Sexual Disorders
j. Emotional Disorders of infants, children and adolescents

V.

Psychiatric Medications

I.

FOUNDATIONS OF MENTAL HEALTH DEVELOPMENT: THEORIES

A. ERICK ERICKSON: Psychosocial
Age

STAGE

0 -18 mos

INFANT

18 mos -3 yrs

Developmental Tasks

TODDLER

Needs that should be Met

Trust vs. Mistrust

Attention specially when hungry;
important factor is feeding

Autonomy vs. Shame &
Doubt.

Complement and Appreciation for
things done; Toilet-training should
be completed

Initiative vs. Guilt

Options and alternatives given
from which the child can choose on
their own but with adult
supervision(example : which toy to
play, what food to eat);
Opportunities for exploration of self
and reality

3-5 years

PRE-SCHOOL/
EARLY
CHILDHOOD

6-12 years

SHOOL AGE

Industry vs Inferiority

Involvement in competitive
activities like academic/ school
competencies and games

13-18 years

ADOLESCENCE

Identity vs Confusion

Establishment of friends,
Belongingness to peers

19-25 years

YOUNG
ADULTHOOD

Intimacy vs. Isolation

Intimate Relationships; Love

26-45 years

MIDDLE
ADULTHOOD

Generativity vs.
Stagnation

Being a worthy and productive
member of the society, being a
responsible parent

LATE
ADULTHOOD

Integrity vs. Despair

Recollection of life in the past,
Sense of Accomplishment

Id

Needs
Implication
46- death

C. SIGMEUND FREUD: Psychosexual
Stage
ORAL– 0 to 18 months

Sexual development


Sucking – mouth – survival: feeding

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ANAL – 18 months to 3
years




Toilet training
sense of control (autonomy)

PHALLIC – 3 to 6 years
old





penis and vagina
starts to masturbate
love of parent of opposite sex
> Oedipal complex – boy loves mother
> Electra complex - girl loves dad

LATENT – 6 to 12 years
old

GENITAL – 12 years to
18 years old

 School age – school phobia – 1st time to go to school –
separation anxiety
 sublimation – putting anger into something more productive
- putting all energies into schooling
 Important figures – teacher, peers (same sex)
 (sexual energy sleep)


increased sexual energy

Childhood Trauma and Unexpressed Feelings
can cause conflicts in succeeding stages in life

D. ABRAHAM MASLOW: Hierarchy of Needs
I.

Physiologic Needs – needs such as air, food, water, shelter, rest, sleep, sex,
activity and temperature maintenance are crucial for survival

II. Safety and Security Needs – the need for safety has both physical and physiologic
aspects
III. Love and Belonging Needs – the third level of needs includes giving and receiving
affection, attaining a place in a group and maintaining the
feeling of belonging
IV. Self-Esteem Needs – the individual needs both self-esteem and esteem from
others
V. Self-Actualization – when the need for self-esteem is satisfied, the individual strives for selfactualization, the innate need to develop one’s maximum potential and
realize one’s abilities and qualities

Needs must be fulfilled in order. One
cannot progress to the next level if the
previous level has not been
successfully satisfied.

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II . DEFENSE MECHANISMS - coping mechanisms to stress.
Compensation

“making up” for a real or imagined inability or deficiency to
maintain self-esteem

Conversion

.transfer of mental conflict to physical symptom to release
tension or anxiety

Denial

Unconcious refusal to face reality - “I am not an addict”

Displacement

Transfer of feelings such as anger from one person to
another– Father shouted and got angry with the first child then
shouts also to the other child after.

Dissociation

Detaching or separating strong conflict from one’s
conciousness– Ex. Traumatic amnesia- forgetting the
vehicular accident which killed significant other.

Fixation

Stucked in a certain stage of development.

Identification

The “imitator” - identify a certain behavior from a certain role
model.

Introjection

Attributing to oneself the good qualities of another; Taking in
the character of one person by ingesting the attitudes, ideas,
philosophy of other person. – Ex. Patient claiming that he is
Jesus.

Projection

Rejection of unwanted characteristic of oneself and assigns
them to others. Blames others for wroing doing .Looks for a
scapegoat. Ex. A student was late and blames the alarm clock
for failing to alarm.

Rationalization

Unconciously justifying ideas, actions, feelings with good or
acceptable reasons. Used to maintain self-respect, prevent
guilt.

Reaction formation

Exaggeration of certain actions by displaying exactly the
opposite behavior, feeling and attitude of what he normally
would show.

Regression

Going back to past level of behavior to feel more comfortable
and reduce anxiety, fear and permits dependency. – Ex. 12
years old wets bed like an infant.

Repression

“Burrying alive mechanism” – unable to recall painful or
unpleasant thoughts.

Sublimation

Conciously re-channeling of unacceptable behavior into activities
that is socially acceptable.

Substitution

Replacement of consciously unacceptable emotions, attitudes,
drives by those that are more acceptable.- Ex. Student who
receives low grades dropped from school and worked as
busboy.

Suppression

Voluntarily forgetting unacceptable thought but able to recall at
will.

Undoing

Feeling guilty for doing something.- Showing true feelings but
regrets after.
III. THERAPEUTIC MODALITIES

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Therapeutic communication

Family Therapy

Behavior Modification

Crisis Intervention

Milieu Therapy

Expressive Therapy

Group Therapy

Self-Help Groups

1. Therapeutic Communication
THERAPEUTIC

NON-THERAPEUTIC

1.Offer self – “I’ll stay/sit with you”

“Don’t worry, be happy”

2. Explore – use what, when, where, how

Do not ask “WHY” ; puts patient in defensive position.

3. Silence

Change the subject

4. Active listening – nodding, eye contact,
leaning, forward, active participation

“Everything’s going to be alright” – giving false
reassurance

5. Make observations. “You see/I have
observed/I have noticed…”

Ignore the patient

6. Broad opening – “How are you?” “You

Prejudgmental. “Nice weather today”- value based
judgment

7. Clarification – “What do you mean when you
say dwakledoo?”

Avoid too much flattery. “You have the most beautiful
hair in the ward”.

8. Restating – “I don’t want to eat” (Word per
word repetition) “You don’t want to
eat?”

Arguing with the patient. Do not impose your opinion

9. General leads – “And then…/what else/go
on…”
10. Refocusing – “We were talking about the
exam…”
11. Focusing – “Tell me more about this”
2. Behavior Modification


Reconditioning
maladaptive behavior

-taking out maladaptive behavior; unlearning the



Desensitization
-frequent exposure to undesirable stimulus to make
individual get used
to it and decrease anxiety despite of exposure. – Ex. treatment to phobias



Punishment



Reinforcement

3. Milieu Therapy
 An environment that is organized to assist patients to control behavior and give opportunity to
utilize psychosocial skills in coping with self, others and environment.


The environment is as close as to the “real world”

4. Group Therapy

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

Accdg. to Nudelman: Group therapy is “an identifiable group of at least three people who share
common goal.”

Three Phases of Group therapy:
a. Beginning or Orientation Phase - Period to resolve initial feelings and achieve a sense of
the group identification and definition of purpose
b. Middle or Working Phase

– Exploration of relationships and conflicts

c. Ending or Termination Phase

- shares feedback with one another as they prepare to
leave the group.
 Share feelings and reflections about the group.
 Person is expected to leave the group with the

5. Family Therapy
- Treating family members in a modified group therapy.
- Establishes open communication an healthy interactions within the family.
6. Crisis Intervention
- An attempt to resolve an immediate crisis when a person’s life goals are obstructed and
usual problem-solving methods fails.
Four Methods:
a. Assessment
b. Planning therapeutic interventions
c. Implementing Techniques of intervention and Resolution of the Crisis
d. Anticipatory Planning
7. Expressive Therapy
- Additional therapeutic modalities used to aid in assessment where expression of feelings can be
relayed through dancing, singing, drawing, etc.

IV.

MALADAPTIVE PATTERNS OF
BEHAVIOR
ANXIETY
–A Feeling of uncertainty, uneasiness, apprehension or tension that a person experiences in
response to an unknowm object or situation.
Levels of
Anxiety

Description

Nursing Interventions

MILD

Increased alertness, client is not able to
relax.

Listen to patient
Remain calm

Moderate

Narrowed ability to perceive occurs and
concentrates on only one thing

Listen to patient
Remain calm
Reassurance and support

Pacing, voice tremors, speed in speaking,
physiologic changes, verbalization of
danger
Severe

Patient cannot make decisions; Ability to
perceive is reduced

Stay with the client
Encourage deep breaths or

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breathe into paper bag
Remove stimuli

Cannot communicate clearly
Panic

Total ability to perceive is lost; Personality
is disintegrated, unable to focus on reality
Suicidal. Priority: safety. Stay with the
patient. Do not do anything to the patient

Stay with the client, prevent from
injury
Encourage deep breaths or
breathe into paper bag
Remove stimuli

.
Generalized anxiety disorder

6 months excessive worrying

Client having difficulty sleeping, concentrating, eating

Fatigue and palpitations experienced
Panic attack



occurs for only 15-20 minutes, happens without warning.
Sympathetic nervous system activation.

Post traumatic stress disorder
- victims of rape, unpleasant circumstances, war zones, disaster, trauma.
OBSSESSIVE COMPULSIVE DISORDER

-A condition of recurrent and persistent urge to repeat an act purposefully to prevent some future event or
situation.
Examples: Rituals, Frequent rearranging, washing of hands, opening / closing, rigidity
Defense Mechanisms present: Displacement, undoing, reaction formation
Nursing Interventions:
a.
b.
c.
d.

Do not interrupt with rituals
Allow time to complete rituals and gradually decrease time allotment for such act
Avoid injury
Increase self-esteem and encourage expression of self

PHOBIA
-

Irrational fear of an object, activity or situation

Types of Phobia:
1.
or situation
2.
exposure
3.
fear of being alone in the crowd where there is no escape
Examples of phobias:
Acrophobia- fear of heights
Androphobia – fear of men
Astraphobia – fear of storms, thunder, lightning
Ceraunophobia –fear of thunder
Claustrophobia- fear of enclosed places
Hematophobia- fear of blood
Nursing Intervention:
a.
b.
c.

Simple Phovia – fear of object
Social Phobias – fear of
Agoraphobia- most common,

Hydrophobia – fear of water
Iatrophobia- fear of doctors
Nyctophobia – fear of night
Ochlophobia – fear of crowds
Pyrophobia- fear of fire
Zoophobia- fear of animals

Behavior modifications
Relaxation
Desensitization

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d.
e.

Expression of feelings
Anti-depressant
DEPRESSION

- decrease serotonin. If unresponsive to medications, ECT is administered.
1.
2.
3.
4.
5.

Denial – getting away from reality, “This cant be happening, this cant be real”
Anger – blaming. “Why me?”
Bargaining – closing a deal to the cheapest possible price, “If only… I will”
Depression – silence
Acceptance – client acts according to situation. Patient prepares living will.

Suicide cues:
 “I wont be a problem any longer”
 “Remember me when I’m gone”
 “This is my last day”
 “This is my wedding ring give it to my son”
 there is a sudden change in mood
Intervention:
 direct question – “Are you going to commit suicide?”
 irregular interval of visit to patient’s room
 early in the morning and during endorsement period – time the patient commits suicide
 give simple task, do not give complex one’s
Risk factors:
 sex – male (more successful) female (hesitant)
 age – 15 to 25 years old or above 45
 depression
 patient with previous attempts will try again
 alcoholics
 irrational
 lacks social support
 organized plan – greater risk
 no family
 with terminal sickness

SCHIZOPRENIA
- A serious psychiatric disorder characterized by impaired communication with loss of contact to reality
4 A’s of Schizoprenia (Bleuler)
1. Autism - retreat from reality
2. Affect
- inappropriate, flat or blunt ed emotional response
3. Ambivalence – contradictory or opposing emotions, attitudes, ideas or desires
4. Associative Disturbance – unable to think logically, shifts from one subject to another
Other manifestations beside’s 4 A’s
1.
2.
3.
4.

Delusions
Illusions
Hallucinations
Loss of ego

5. Inability to complete a task
6. Impaired reaction to the environment
7. Mood swings: getting angry, depressed, joyous
without any reason

Types of Schizoprenia

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1. Disorganized

Incoherent; thought
disturbance;

regression, hallucinations, hypochondriasis, social
withdrawal

2. Catatonic

Psychomotor
symptoms

a. Waxy flexibility – bizarre positioning
b. Expressionless
c. Catatonic rigidity- assume position and
does not move
d.
Negativism-resistant to all
instructions
e.
Unexpected shifts of behavior

3. Paranoid

Suspiciousness

a.
Hallucinations –persecutory or
grandeur
b.
Delusions
c.
Angry, Suspicious, mistrust of
others,
overly religious

4. Undifferentiated

Mixture of behaviors

5. Residual

State of partial
remission

THOUGHT PROCESS DISTURBANCE
1. Looseness of association – topics have connection but no thought.
2. Ambivalence – pulled by two opposing forces.
3. Magical thinking – believes he has magical powers.
4. Echolalia – repeat what is said by the nurse.
5. Echopraxia – repeats what the nurse’s do.
6. Word salad – mixes word that don’t rhyme.
7. Clang association – uses word that rhyme.
8. Neologism – invents new words not in the dictionary.
9. Neologism – invents new words not in the dictionary.
10. Delusions – false belief.
 grandeur – thinks he’s somebody
 persecution – thinks that there is somebody after him
 ideas of reference – thinks he’s being talk about
11. Concrete association
12. Hallucination – may be stimuli, visual, auditory, tactile
Extra Pyramidal Side Effects (EPS)
Cause: increase in acetylcholine and decrease in dopamine
Symptoms of EPS:
1. Akathisia – restless and with inability to sit still
2. Akinisia – rigidity of the body
3. Dystonia – affects neck
 Torticollis – wry neck
 Oculogyric crisis – fixed stare
 Opisthotonus – arched back, contracted
4. Tardive dyskenisia – lip smacking tongue is protruding, puffy cheeks. Irreversible.
5. Neuroleptic malignant syndrome – hyperthermia, unstable BP, increase CPK, diaphoresis,
pallor
6. Photosensitivity – wear shades or put on sunscreen
7. Agranulocytosis – sore throat, fever, malaise, leucopenia
Nursing Management:
1. Use of Therapeutic communication
2. Prevent injury
3. Orient to reality
4. Medications: anti-psychotic

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AUTISM
- echolalias, poor eye contact, can’t express verbally
Manifestations:
 appearance – neat, obsessive compulsive, wants constancy
 behavior – ritualistic behavior, flat affect, repetitive
 communication – difficulty communicating
Nursing Intervention:
 constancy
 promote safety
 expressive therapy – uses art, poetry, decreasing risk for injury, improve social interaction, be
able to express feelings.
ATTENTION DEFICIT HYPERACTIVITY DISORDER
- can progress to conduct disorder to anti-social behavior
 short attention span
 impulsive ; shifts from one activity to the other
 Destructive and hyperactive: unable to sit still, keeps on running and climbing
 May occur at age 3 and lasts for at least 6 months but often diagnosed upon entrance to school
 Id dominant: mother or the nurse will act as superego
Manifestations:
 appearance – dirty
 behavior – clumsy, impatient, easily distracted
 talkative
Nursing Intervention:
 safety
 provide place to study, eat play, bath
 schedule time for all activities
 set limits

ANOREXIA NERVOSA
-

diet, underweight <85% of expected fat, 3 months amenorrhea, failure to recognize problem
Most common in women (90-95%), usually
teenagers
Starvation- an attention-getting device; a psychotic disorder, early manifestation of schizophrenia.
Contributing Factors:
1.
2.
3.
resulting to feeling
of dependency & helplessness

Disturbed self-image
Parent-child conflicts
Past and present experiences

Warning Signs of Possibility of Anorexia Nervosa:
1. Drastic weight loss in the presence of unusual eating habits
2. Obsession with neatness including frequency in mirror-gazing
3. Hostility and desire to control others
4. Calorie counting, dieting, excessive exercise
5. Depressed mood
6. Amenorrhea or irregular menses
7. Wearing loose-fitting to mask physical appearance as it changes
8. Denying hunger
Symptoms:




Dry, flaky or cracked skin
Brittle hair and nails, hair
beginning to fall out
Amenorrhea or menstrual




Skeletal-like appearance
Presence of lanugo



Intense fear of becoming

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




irregularity
Constipation
Hypothermia



Decreased BP, PR, basal
metabolic rate
DHN, malnutrition,
electrolyte imbalance





obese
Distorted body image as
continues to
see self as fat
Loss of appetite
Total lack of concern about
symptoms

BULEMIA NERVOSA
-Binge eating and purging , normal weight, irregular menstruation, dental carries, diarrhea, knows the
problem but ashamed and embarrassed.
PICA – eating non-nutritive foods like ice, starch
Priority:
 fluid volume balance
 weight gain – monitor weight, eating pattern, stay 1 hour after eating, accompany in toilet
Complications:
1. Chronic inflammation of the lining of the esophagus
2. Rupture of the esophagus
3. Dilatation of the esophagus
4. Rupture of the stomach
5. Electrolyte imbalance or abnormalities, leading to arrhythmias of the heart and metabollic
alkalosis
6. Heart problems, irreversible Cong. Heart failure
7. Chronic enlargement of the parotid gland
8. Dehydration
9. Irritable bowel syndrome or abnormal dilatation of the colon
10. Rectal prolapse or abcess
11. Rupture of the diaphragm
12. Dental erosion
13. Chronic edema
14. Fungal infections of the vagina or rectum
Nursing intervention for ANOREXIA NERVOSA AND BULEMIA
1. Establish nutrition pattern
2. Setting limits
3. State that three meals a day is necessary to maintain a healthy body
4. Allow some control in decision making
5. Teach stress management, journal keeping
6. Monitor eating pattern and weight
7. Anti-depressant
BIPOLAR DISORDER
- Depression and Mania
- 2 poles, happy (more dominant) and sad, affects more female than male >20 years of age,
stress and obese
Depression – a mood state characterized by a feeling of sadness, dejection, despair,
discouragement or hopelessness
Mania

– a mood disorder characterized by psychomotor over-activity or excitement, insomnia
without fatigue, euphoria or a state of elation, distractibility, and pressured speech.

Mixed – experiences both manic and depressive phases
Symptoms of Manic Phase:
6. Overactivity or excitement
7. Insomnia without fatigue

6.
Flight of ideas
7.
Manipulative or
demanding behavior
8.
Destructive / Combative
9.
Delusions of grandeur
10. Impaired judgment

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8. Euphoria or elated mood
9. Distractibility
10. Pressured speech
Nursing Intervention:
1.
2.
3.
4.

Divert attention - give task
Avoid giving group games – any competition will increase anxiety
Give activities that uses gross motor skills to provide
outlet of energy
Displacement like punching bag
PERSONALITY DISORDER

Characteristics of a Personality Disorder
1.
2.
3.
4.
5.
6.

Denial of the maladaptive behavior being exhibited.
Maladaptive behaviors are inflexible.
Minor stress is poorly tolerated which furthers the increase in the ability to cope.
Defective ego functioning
Difficulty dealing with reality
Disturbance of mood, such as anxiety or depression

Clinical Types of Personality Disorder
1.

Schizoid – doesn’t care about people, believes that he can stand on his own, never had a
best friend, avoid groups and activities – no enjoyment

2.

Avoidant – avoid group – fear criticism, have talent but with no confidence

3.

Anti-social – law breaker, do not follow rules from childhood until adulthood

4.

Borderline – suicidal, superficial relationship, sudden change of mood, self mutilation

5.

Dependent – decrease self esteem, dependent, poor decision making skills

6.

Histrionics – excited, dramatic, manipulative, center of attention

7.

Narcissistic – insensitive, arrogant, self absorbed, exaggerated self esteem, ambitious,
grandiosity

8.

Obsessive-compulsive – perfectionist, organized, constancy in environment, provide time to
do rituals

9.

Paranoid – always jealous, suspicious, violent

10. Passive/aggressive – with hidden resistance, but always on the go

ALCOHOL ABUSE
- socializing, escape from problem, peer pressure
Manifestations of Individual under Abuse of alcohol:
1. Chronic absenteeism from work
2. Repeated job-related accidents
3. Overuse of rationalization, or excuses for drinking
4. Disruption of home, marital and family relationships
5. Frequent job changes
6. Poor job performance
7. Deterioration of health
Intervention:
1. Gradually avoid alcohol
2. Aversion therapy
3. Anti-abuse (DISULFIRAM)
4. May refer to group therapy
Complications:
1. Wernickes – motor side effects

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2.
3.

Korsakoff – memory – confabulation
Delirium tremors – 24 72 hours after alcohol intake due to sympathetic nervous system
activation (with tremors, hallucinations, illusions)

SUBSTANCE ABUSE

1. Nervous – tremors, give downers
Signs of overdose:

identify if drug is upper or downer

check effect

signs of widrawal


2.

If patients take a downer, all vital signs are down. If he stops taking it (during
withdrawal), patient will experience the opposite effect of a downer. All of the
patients vital signs will shoot up just the same with uppers (e.g., patient had
cocaine intoxication, patient will manifest hyperactivity, tachypnea, seizure.
During withdrawal, patient will manifest bradypnea or coma).

Substance abuse moments:
DOWNER:
 alcohol
 barbiturates
 opiates
 narcotics
 marijuana
Toxic effects:
 decrease respiratory rate, decrease heart rate
 constricted pupil
 moist mouth
 dilated blood vessel
 coma
 asleep
 decreased gastro-intestinal constriction
 decrease genitor-urethral retention
 decrease blood pressure
 state of euphoria

Depressed – sits down on chair
UPPERS:
 cocaine
 hallucinogen
 amphetamines
Toxic effects:
 seizure
 tachypnea
 increase heart rate
 pupils dilate
 dry mouth
 decrease in appetite
 diarrhea








profound mental retardation – IQ <20 – thinks like an infant, cant be trained
severe mental retardation – 20-35
moderate – 35-50 – can be trained, mental age is 2-7 years old, pre-operational stage
mild – 50-70 – (mild 7) mental age is 7 -12, educable, can go to school
borderline – 70-90
normal 90 – 110

CHILD ABUSE

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- A result of a potentially abusive or neglectful parents resulting to maltreatment of children
Characteristics of potentially abusive or neglectful parents :
a.
b.
c.
d.
e.
f.
g.
h.
i.

Denial of pregnancy
Depression during pregnancy
Unwanted child
Fear of delivery
Lack of support form husband or family
Undue concern about the unborn child’s sex and how
Fear that the child will be one of too many children
Resentment towards the child
Inability to tolerate the child’s crying, viewing child as being too demanding

Areas of Child Abuse:
1. Physical Abuse
2. Neglect
3. Emotional Maltreatment
4. Sexual Abuse
Area
Physical Abuse

Physical
Multiple injuries in various stages
of healing
Unexplained bruises, fractures,
lacerations

Behavioral
Fear of strangers
Labile behavior
Rigid, distant

Explanation and injury mismatch
Neglect

Poor hygiene and dress
Needs unattended

Fatigue
Withdrawal
Engaged in substance abuse

Emotional Maltreatment
Decreased self-esteem,
hypochondriasis
Developmental lag
Sleep disorders, behavioral
problems
Sexual Abuse

Venereal disease
Pregnancy

Unusual sexual behavior
Poor peer relations
Sexual assaults

Itching in genitals, difficulty
ealking or sitting
ALZHEIMER

1.
2.
3.
4.
5.
6.
7.

Anomia – don’t know name of object
Agnosia – problem with senses (smell, taste, hear, touch)
Aphasia – can’t say what he wanted to say
Apraxia – can’t do what he wanted to do
Dissociative fugue – takes a new personality from a far away place. New place, new
identity
Dissociative identity disorder – multiple personality
Dissociative amnesia – he don’t know who he is and where he is

Anti-cholinergic/Anti-parasympathetic
 mono amine oxidase inhibitors
 marplan
 nardil
 parnate

Anti-parkinson drugs
 cogentin
 artane
 parlodel
 akineton
 benadryl
 larodopa
 eldepryl
 symmetrel

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Alcoholics
 disulfiram
 anti depressants
Electro-convulsive therapy (ECT) –
-if the medication the patient was taking did not take effect ECT is administered.
Pre-ECT:
 sign informed consent
 NPO 6 hours
 give atropine sulfate
 give barbiturate
 succinylcholine chloride – to relax muscles
Post-ECT
 side lying lateral
 side effects: headache, dizziness, temporary, memory loss (distinct symptoms)

PSYCHIATRIC MEDICATIONS

Anti-mania

Anti-depressant
MAO Inhibitors – Isocarboxacid, Phenelzine

Drug:

LITHIUM
Tricyclic Anti-depressant – Imipramine,
Amitryptilne
Tetracyclic Anti-depressant
- Maprotiline

Drug Interaction

Diuretics increases level of
toxicity
ACT may cause neurotoxicity

Side Effects

Initial Dosage:
Fine tremor, nausea, drowsiness,
lethargy, polyuria, thirst, fatigue,
weight gain
Toxic Level:
Vomiting, diarrhea, lethargy,
muscle twitching, ataxia, slurred
speech, coma, seizure

Concommittant use with:
Anti-HPN –causes hypo/hypertension
Antacids- inhibit absorption
Anti-psychotc- potentiate anti-cholinergic
effects
CNS depressant-potentiate effectsn
Anti-cholinergic Effect:
a.
Dry mouth
b.
Constipation
c.
Urinary retention
d.
Blurred vision
e.
Glaucoma
Cardio Effects:
a. Postural Hypotension
b. Arrhythmias
Rashes, photosensitivity, tremors, seizures,
perspiration, anxiety, restlessness

Nursing Intervention

Careful observations for signs
and symptoms of toxicity

WOF Hypertensive crisis- elevated BP,
palpitations, diaphoresis, chest pain, headache
w/c can lead to intracranial hemorrhage and
bleed-> death

Morally and ethically acceptable behavior
Conscience
- is it good or bad?
Superego
-conscious
- what is more beneficial
in touch with reality
- think before deciding
Ego

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Far Eastern University-Institute of Nursing
In-House Nursing Review Hand-out

eat, drink, smoke, urinate, have sex
pleasure principle
- do what you want

If a specific developmental tasks are not met within the
stage, person may manifest psychologic problem related
to the missed task in the past.

B. SIGMEUND FREUD: Psychoanalytic Stage
2. conscious – easy recall of events ; highest level of awareness
3. pre-conscious –about to to recall certain events
4. unconscious –cannot recall
 repression – involuntary forgetting of something unpleasant experience
 ex. forgot the name of ex-boyfriend’s present girlfriend (thirdparty)
 suppression – voluntarily or conscious forgetting of unpleasant experience



 Mind-Setting

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