Download - Psychiatric Nursing Dsecseaniel
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Presented by: Dave Jay S. Manriquez, RN.
PSYCHIATRIC NURSING
Introduction
MENTAL HEALTH balance in a persons internal lie and adaptation to realit!
Mental ILL Healt" state o i#balance c"aracteri$ed b! a disturbance in a
persons t"ou%"ts& eelin%s and be"a'ior
Ps!c"iatric nursin%
interpersonal process ("ereb! t"e proessional nurse practitioner &t"rou%" t"e
t"erapeutic use o sel )art* and nursin% t"eories )science*& assist clients to ac"ie'eps!c"osocial (ell bein%+
Core , interpersonal processRelated Ter#s
Mental "!%iene
#easures to pro#ote #ental "ealt" & pre'ent #ental illness and suerin% and
acilitate re"abilitation
Main tool, t"erapeutic use o sel
It re-uires sel.a(areness
Met"ods to increase sel.a(areness,
Introspection
/iscussion
E0perience
Role pla!
Assess#ent )ps!c"osocial processes *
Appearance & be"a'ior or #ood
Speec" & t"ou%"t content and t"ou%"t process
Sensoriu#
Insi%"t and 1ud%#ent
2a#il! relations"ips and (or3 "abits Le'el o %ro(t" and de'elop#ent
Co##on 4e"a'ioral Si%ns and S!#pto#s/isturbances in perception
Illusion
#isinterpretation o an actual e0ternal sti#uli
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Hallucinations
alse sensor! perception in t"e absence o e0ternal sti#uli
/isturbances in t"in3in% and speec"
neolo%is# coinin% o (ords t"at people do not understand
Circu#stantialit! o'er inclusion o inappropriate t"ou%"ts and details
5ord salad inco"erent #i0ture o (ords and p"rases (it" no lo%ical se-uence
6erbi%eration #eanin%less repetition o (ords and p"rases
Perse'eration persistence o a response to a pre'ious -uestion
Ec"olalia pat"olo%ical repetition o (ords o ot"ers
Ap"asia speec" diicult! and disturbance
E0pressi'e & recepti'e or %lobal
2li%"t o ideas. s"itin% o one topic ro# one sub1ect to anot"er in a so#e("at
related (a! Looseness o association.inco"erent illo%ical lo( o t"ou%"ts )unrelated (a!*
Clan% association sound o (ord %i'es direction to t"e lo( o t"ou%"t
/elusion persistent alse belie& ri%idl! "eld
/elusions o %randeur, special 7i#portant in a (a!
Persecutor!, t"reatened
Ideas o reerence, situation7e'ents in'ol'e t"e#
So#atic, bod! reactin% in a particular (a!
8ealous, t"in3in% t"at t"eir partner is unait"ul
Eroto#anic, person& usuall! o "i%" status& is in lo'e (it" t"e client
Reli%ious, illo%ical ideas about God and reli%ion e0"ibited b! e0tre#e or
e0traneous be"a'ior
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Mi0ed, co#bination o abo'e (it"out a predo#inant t"e#e
Ma%ical t"in3in% pri#iti'e t"ou%"t process t"ou%"ts alone can c"an%e e'ents
Autistic t"in3in% re%ressi'e t"ou%"t process9 sub1ecti'e interpretations not
'alidated (it" ob1ecti'e realit!
/ereis# unor%ani$ed t"in3in%
/isturbances o aect
Inappropriate dis"ar#on! bet(een t"e sti#uli and t"e e#otional reaction
4lunted aect se'ere reduction in e#otional reaction
2lat aect absence or near absence o e#otional reaction
Apat"! dulled e#otional tone
/epersonali$ation eelin% o stran%eness ro# one:s sel
/ereali$ation eelin% o stran%eness to(ards en'iron#ent
A%nosia lac3 o sensor! sti#uli inte%ration
/isturbances in #otor acti'it!
Ec"opra0ia i#itation o posture o ot"ers
5a0! le0ibilit! #aintainin% position or a lon% period o ti#e
Ata0ia loss o balance
A3at"esia e0tre#e restlessness
/!stonia. uncoordinated spastic #o'e#ents o t"e bod!
Tardi'e d!s3inesia in'oluntar! t(itc"in% or #uscle #o'e#ents
Apra0ia in'oluntar! unpurposeul #o'e#ents
/isturbances in #e#or!
Conabulation illin% o #e#or! %aps
/;1< 'u so#et"in% una#iliar see#s a#iliar
8a#ais 'u. so#et"in% a#iliar see#s una#iliar
A#nesia #e#or! loss )inabilit! to recall past e'ents*
Retro%rade.distant past
Antero%rade i##ediate past
Ano#ia lac3 o #e#or! o ite#s
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/!na#ics o Hu#an 4e"a'ior
4e"a'ior t"e (a! an indi'idual reacts to a certain sti#ulus
Conlict situation arisin% ro# t"e presence o t(o opposin% dri'es
Need . or%anis#ic condition t"at re-uires a certain acti'it!
/!na#ics o Hu#an 4e"a'ior
Personalit!
totalit! o e#otional and be"a'ioral traits t"at c"aracteri$e t"e person in da! to
da! li'in% under ordinar! conditions9 it is relati'el! stable and predictable+2=RMATI=N =2 PERS=NALITY
TEMPERAMENT
biolo%ical.%enetic te#plate t"at interacts (it" our en'iron#ent+
a set o in.built dispositions (e are born (it"
#ostl! unalterable our nature+
CHARACTER
t"e outco#e o t"e process o sociali$ation& t"e acts and i#prints o ouren'iron#ent and nurture on our ps!c"e durin% t"e or#ati'e !ears )>.? !ears and in
adolescence*+
t"e set o all ac-uired c"aracteristics (e posses& oten 1ud%ed in a cultural.social
conte0t+
So#eti#es t"e interpla! o all t"ese actors results in an abnor#al personalit!
THE=RIES =2 PERS=NALITY /E6EL=PMENT
2reud:s
PSYCH=SE@UAL THE=RY
Libido inner dri'e
Parts o bod! ocus o %ratiication
Unsuccessul resolution . i0ation
Structures o personalit!
Id, pleasure principle.instinct
E%o, controls action and perception realit! principle
Supere%o, #oral be"a'ior . conscience
>.B #>s 9oral #out" trust and discri#inatin%
B #os+ !ears 9 anal bo(els "oldin% on or lettin% %o
Ne%ati'is# and toilet trainin% a%e
.? !ears p"allic 9 %enitals e0ploration and disco'er! ) inc+ se0ual tension*
Gender identiication and %enital a(areness
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=edipus and Electra co#ple0
Castration an0iet! and penis en'!
?.D !ears latenc! )-uiet sta%e* se0ual ener%! di'erted to pla!+ Institution o
supere%o, control o instinctual i#pulses
D !oun% adult %enital 9 rea(a3enin% o se0ual dri'es relations"ips
Se0ual #aturation
Se0ual identit! &abilit! to lo'e and (or3
Eric Eric3son:sPSYCH=S=CIAL THE=RY
>.D#os
.!
.?
?.D
D.B
B.D
D.?>
?> and abo'e
TRUST 's+ MISTRUST
AUT=N=MY 's+ SHAME F /=U4T
IN/USTRY 's+ IN2ERI=RITY
INITIATI6E 's+ GUILT
I/ENTITY 's+ I/ENTITY C=N2USI=N
INTIMACY 's+ IS=LATI=N
EG= INTEGRITY 's+ STAGNATI=N
GENERATI6ITY 's+ /ESPAIR
IN2ANCY
C=NSISTENT MATERNAL CHIL/ INTERACTI=N TRUST
INNER 2EELING =2 SEL2 5=RTH
H=PE
T=//LER
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ALL=5 E@PL=RATI=N
PR=6I/E 2=R SA2ETY
N=& N= NEGATI6ISM
=22ER CH=ICES 7 RE6ERSE PSYCH=L=GY
T=ILET TRAINING B M=S+.4=5EL
/AYTIME 4LA//ER, D !o
NIGHTIME 4LA//ER, !o
RE5AR/ 57 PRAISE AN/ A22ECTI=N
IN/EPEN/ENCE
PRE.SCH==L
PR=6I/E PLAY MATERIALS
SATIS2Y CURI=SITY
TEACH AN/ REIN2=RCE)HYGIENE&S=CIAL 4EHA6I=R*
SI4LING RI6ALRY
5ILLP=5ER
SCH==L AGE
H=5 T= /= THINGS 5ELL.SUPP=RT E22=RTS
CHUMS AN/ H=44IES
NEE/S T= E@CEL7ACC=MPLISH
NEE/ 2=R PRI6ACY AN/ PEER INTERACTI=N
C=MPETENCE
A/=LESCENCE
MAE /ECISI=N&EMANCIPATI=N 2R=M PARENTS
4=/Y IMAGE CHANGES
NEE/ T= C=N2=RM 4UT EEP IN/I6I/UALITY
SEL2 . A5ARENESS
Y=UNG A/ULT
C=MMITMENT AN/ 2I/ELITY
RESP=NSI4ILITY
ACHIE6EMENT =2 IN/EPEN/ENCE
MI//LE A/ULTH==/
SUPP=RT.PERI=/ =2 R=LE TRANSITI=NS
MI/LI2E CRISIS
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A/8USTMENT AN/ C=MPR=MISE
M=ST PR=/UCTI6E AN/ CREATI6E
ALTRUISM
LATE A/ULTH==/
SEL2 ACCEPTANCE
SEL2 5=RTH
5IS/=M
8ean Pia%et:s
C=GNITI6E THE=RY>.D SENS=RIM=T=R
RE2LE@ES
IMITATI6E REPETITI6E 4EHA6I=R
SENSE =2 =48ECT PERMANENCE AN/ SEL2 SEPARATE 2R=M EN6T+
TRIAL AN/ ERR=R RESULTS IN PR=4LEM S=L6ING
D.JY PRE.=PERATI=NAL
SEL2.CENTERE/&EG=CENTRIC
CANN=T C=NCEPTUALIKE =THER:S 6IE5
ANIMISTIC THINING
IMAGINARY PLAYMATE SYM4=LIC MENTAL REPRESENTATI=N
CREATI6ITY
D. PRE.C=NCEPTUAL )PRE.L=GICAL*
.J INTUITI6E )UN/ERSTAN/ING =2 R=LES*
J.DY C=NCRETE =PERATI=NAL
L=GICAL C=NCRETE TH=UGHT
IN/UCTI6E REAS=NING )SPECI2IC T= GENERAL*
CAN RELATE& PR=4LEM S=L6ING A4ILITY
REAS=NING AN/ SEL2.REGULATI=N
D.A4=6E, 2=RMAL =PERATI=NAL TH=UGHT
Abstract t"in3in%
Separation o antas! and act
Realit! oriented
/educti'e reasonin%
Appl! scientiic #et"od
Ha'i%"urst:s/E6EL=PMENTAL TASS
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4ab! to earl! c"ild"ood
Ri%"t ro# (ron% and Conscience
Late c"ild"ood
P"!sical s3ills& ("oleso#e attitude& social roles
Conscience #oralit! and 'alues
2unda#ental s3ills in acade#ics
Personal independence
Adolescence
Se0ual social roles
Relations"ips
Independence and ideolo%!
Earl! adult"ood
Career
Selectin% a #ate
2indin% Ci'ic or social responsibilit!
Middle a%e Ac"ie'in% Ci'ic or social responsibilit!
Ad1ustin% to c"an%es
Satisactor! career peror#ance
Ad1ustin% to a%in% parents
Ad1ustin% to parental roles
=ld a%e
Ad1ustin% to c"an%es
Establis"in% satisactor! li'in% arran%e#ents and ailiations
o"lber%:sM=RAL /E6EL=PMENT7 THINING7 8U/GEMENT
PRE.C=N6ENTI=NAL )>.?*
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PUNISHMENT AN/ =4E/IENCE
=4E/IENCE T= RULES T= A6=I/ PUNISHMENT
C=N6ENTI=NAL ) ?.D *
MUTUAL INTERPERS=NAL E@PECTATI=NS&RELATI=NSHIPS AN/
C=N2=RMITY
S=CIAL SYSTEM AN/ C=NSCIENCE MAINTENANCE
4EING G==/ IS IMP=RTANT SEL2 RESPECT =R C=NSCIENCE
P=ST C=N6ENTI=NAL )D B Y*
PRI=R RIGHT =R S=CIAL C=NTRACT
UNI6ERSAL ETHICAL PRINCIPLE
A4I/E 2=R C=MM=N G==/
RATI=NAL PERS=N.6ALI/ITY =2 PRINCIPLES.AN/ 4EC=ME
C=MMITTE/ T= THEM
INNER C=NTR=L =2 4EHA6I=R UN/ERSTAN/ING THE EUALITY =2HUMAN RIGHTS AN/ /IGNITY =2 HUMAN 4EINGS AS IN/I6I/UALS
Harr! Stac3 Sulli'an:s
INTERPERS=NAL THE=RY
IN2ANCY
NEE/ 2=R SECURITY.IN2ANT LEARNS T= RELY =N =THERS T=
GRATI2Y NEE/S AN/ SATIS2Y 5ISHES& /E6EL=PS A SENSE =2 4ASIC
TRUST& SECURITY AN/ SEL2 5=RTH 5HEN THIS =CCURS
T=//LERH==/ 7 EARLY CHIL/H==/
CHIL/ LEARNS T= C=MMUNICATE NEE/S THR=UGH USE =2 5=R/S
AN/ ACCEPTANCE =2 /ELAYE/ GRATI2ICATI=N AN/ INTER2ERENCE =25ISH 2UL2ILLMENT
PRE.SCH==L
/E6EL=PMENT =2 4=/Y IMAGE AN/ SEL2.PERCEPTI=N
=RGANIKES AN/ USES E@PERIENCES IN TERMS =2 APPR=6AL AN/
/ISAPPR=6AL RECEI6E/
4EGINS USING SELCTI6E INATTENTI=N AN/ /ISASS=CIATES TH=SE
E@PERIENCES THAT CAUSE PHYSICAL =R EM=TI=NAL /ISC=M2=RT AN/PAIN
SCH==L AGE
THE PERI=/ =2 LEARNING T= 2=RM SATIS2YING RELATI=NSHIPS
5ITH PEERS.USES C=MPETITI=N&C=MPR=MISE AN/ C==PERATI=N
THE PRE.A/=LESCENT LEARNS T= RELATE T= PEERS =2 THE SAME
SE@
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A/=LESCENCE
LEARNS IN/EPEN/ENCE AN/ H=5 T= ESTA4LISH SATIS2ACT=RY
RELATI=NSHIPS 5ITH MEM4ERS =2 THE =PP=SITE SE@
Y=UNG A/ULTH==/
4EC=MES EC=N=MICALLY& INTELLECTUALLY AN/ EM=TI=NALLY
SEL2 SU2ICIENT
LATER A/ULTH==/
LEARNS T= 4E INTER/EPEN/ENT AN/ ASSUMES RESP=NSI4ILITY
2=R =THERS
SENESCENCE
/E6EL=PS AN ACCEPTANCE =2 RESP=NSI4ILITY 2=R 5HAT LI2E IS
AN/ 5AS AN/ =2 ITS PLACE IN THE 2L=5 =2 HIST=RY
TREATMENT M=/ALITIESREM=TI6ATI=N THERAPY
TREATMENT M=/ALITY THAT PR=M=TES E@PRESSI=N =2 2EELINGS
THR=UGH INTERACTI=N 2ACILITATE/ 4Y /ISCUSSI=N =2 NEUTRALT=PICS
STEPS ,
cli#ate o acceptance
creatin% brid%e to realit!
s"arin% t"e (orld (e li'e inappreciation o (or3s o t"e (orld
cli#ate o appreciation
MUSIC THERAPY
In'ol'es use o #usic to acilitate e0pression o eelin%s& rela0ation and outlet otension
PLAY THERAPY
enables patient to e0perience intense e#otion in a sae en'iron#ent (it" t"e use
o pla!
c"ildren e0press t"e#sel'es #ore easil! in pla!+ re'ealin% as relection o c"ild:s
situation in t"e a#il!
pro'ide to!s and #aterials acilitate interaction obser'e and "elp c"ild resol'e
proble#s t"rou%" pla!
Group t"erap!
Treat#ent #odalit! in'ol'in% t"ree or #ore patients (it" a t"erapist to relie'e
e#otional diiculties& increase sel estee#& de'elop insi%"t & LEARN NE5
A/APTI6E 5AYS T= C=PE 5ITH STRESS and i#pro'e be"a'ior (it" ot"ers
I/EAL B > MEM4ERS
MILIEU THERAPY
Consists o treat#ent b! #eans o controlled #odiication o t"e patient:s
en'iron#ent to acilitate positi'e be"a'ioral c"an%e
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Increase patient:s
A(areness o eelin%s Sense o responsibilit! and
Help return to co##unit!
clients plan social and %roup interaction
to3en pro%ra#s & open (ards and sel #edication are done2AMILY THERAPY
A METH=/ =2 PSYCH=THERAPY 5HICH 2=CUSES =N THE T=TAL
2AMILY AS AN INTERACTI=NAL SYSTEM
PR=4LEM IS A 2AMILY PR=4LEM
ocus on sic3 #e#bers be"a'ior as source o trouble 7 s!#pto# ser'e a unction
or t"e a#il!
#e#bers de'elop sense o identit!
points out unction o t"e sic3 #e#ber or t"e rest o t"e a#il!
PSYCH=ANALYTIC
ocuses on t"e e0ploration o t"e unconscious& to acilitate identiication o t"epatients deenses
AN@IETY RESULTS 4ET5EEN C=N2LICTS =2 I/ AN/ EG=
4eco#es a(are o unconscious t"ou%"ts and eelin%s to understand an0iet! and
deenses
HYPN=THERAPY
6arious #et"ods and tec"ni-ues to induce a trance state ("ere patient beco#es
sub#issi'e to instructions
4EHA6I=R M=/I2ICATI=N
Application o learnin% principles in order to c"an%e #aladapti'e be"a'ior
4elie'es t"at ps!c"olo%ical proble#s are a result o learnin%
E'er!t"in% learned can be unlearned
4EHA6I=R M=/I2ICATI=N
=PERANT C=N/ITI=NING
Use o re(ards to reinorce positi'e be"a'ior
Percei'ed and sel.reinorce#ent beco#es #ore i#portant t"an e0ternal
reinorce#ent
/ESENSITIKATI=N Slo( ad1ust#ent or e0posure to eared ob1ects )p"obias*
Periodic e0posure until undesirable be"a'ior disappears or lessens
A6ERSI=N THERAPY
An e0a#ple o be"a'ior #odiication
Painul sti#ulus is introduced to brin% about an a'oidance o anot"er sti#ulus
End 'ie(, be"a'ioral c"an%e
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=THER THERAPIES
HUM=R THERAPY
To acilitate e0pression and en"ance interaction
ACTI6ITY THERAPY
Group interaction ("ile (or3in% on a tas3 to%et"er
4I=L=GICAL7 ME/ICAL THE=RY
EM=TI=NAL PR=4LEM IS AN ILLNESS
cause #a! be in"erited or c"e#ical in ori%in
2=CUS =2 TREATMENT IS ME/ICATI=NS AN/ ECT
4I=L=GICAL THERAPY
ELECTR=C=N6ULSI6E THERAPY
Artiicial induction o a %rand #al sei$ure b! passin% a controlled electrical
current t"rou%" electrodes applied to one or bot" te#ples
#ec"anis# o action unclear 'olta%e, J> > 'olts
/uration, >+ D+> seconds
? to D treat#ents
inter'als o B "ours
indicators o eecti'eness occurrence o %enerali$ed tonic clonic sei$ures
indications depression & #ania and catatonic sc"i$op"renia
s7e, conusion& disorientation& s"ort .ter# #e#or! loss& sei$ure )>.?> sec*
NP= prior
Contraindications
2e'er& pre%nanc!
Inc ICP& racture
retinal detac"#ent
T4 (it" "e#opt!sis
cardiac d7o
consent needed
Reorient ater& supporti'e care
#edications %i'en ,
Atropine sulate, decrease secretions
Succin!lc"oline )Anectine*, pro#ote #uscle rela0ation
Met"o"e0ital Sodiu# ) 4re'ital *, ser'es as an anest"etic a%ent
co##on co#plications,
loss o #e#or!
"eadac"e
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apnea
racture
respirator! depression
Ps!c"op"ar#acolo%ic T"erap!
4en$odia$epines
Indications
An0iet!
Sedation7sleep
Muscle spas#
Sei$ure disorder
Alco"ol (it"dra(al s!ndro#es
Anti.an0iet! dru%s
Generic Trade na#e
Alpra$ola# @ana0C"lordia$epo0ide Libriu#Clora$epate Tran0ene
/ia$epa# 6aliu#
Lora$epa# Ati'an=0a$epa# Sera0
4usipirone 4uSpar
Side eects
/ro(siness7 sedation
Ata0ia
2eelin%s o detac"#ent
Increase irritabilit! and "ostilit!
Antero%rade a#nesia
Increased appetite F (ei%"t %ain
Nausea
Headac"e& conusion
Anti.depressants
Indications
/epression
4ipolar depression
Panic disorder
4uli#ia
=bsessi'e.co#pulsi'e d7o
Possibl!
Attention deicit7H!peracti'it! d7o
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Post Trau#atic Stress /7o
Conduct d7o
Tric!clic )TCA*
Generic Trade na#e
A#itript!line Ela'il
I#ipra#ine ToranilTri#ipra#ine Sur#ontil
Nortript!line Pa#elor
Tra$odone /es!rel4upropion 5ellbutrin
Side eects
=rt"ostatic "!pertension
Antic"oliner%ic eect
/r! #out"& blurred 'ision& constipation& e0cessi'e s(eatin%& urinar! "esitanc!7
retention& tac"!cardia& a%itation& deliriu#& e0acerbation o %lauco#a
Neurolo%ic eects sedation& ps!c"o#otor slo(in%& poor concentration& ati%ue& ata0ia& tre#ors
/ecrease libido and se0ual peror#ance
Monoa#ine =0idase in"ibitors Generic Trade na#e
Isocarbo0a$id Marplan
P"enel$ine Nardil
Tran!lc!pro#ine Parnate Side eects
Postural li%"t"eadedness
Constipation
/ela! e1aculation or or%as#
Muscle t(itc"in%
/ro(siness
/r! #out"
/ietar! restrictions
C"eese& esp+ a%ed and #atured 2er#ented or a%ed protein
Pic3led or s#o3ed is"
4eer& red (ine& s"err!9 li-uor F co%nac
Yeast
2a'a or broad beans
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Indications
Acute #ania
4ipolar prop"!la0is
Possibl!
4uli#ia Alco"ol abuse
A%%ressi'e be"a'ior
sc"i$oaecti'e
Mode o action
Nor#ali$es t"e reupta3e o certain neurotrans#itters suc" as serotonin&
norepinep"rine& acet!lc"oline and dopa#ine
Reduces t"e release o norepinep"rine t"ru co#petition (it" calciu#
Eects intracellularl!
La% period, J.> to da!s
Lit"iu# carbonate
Trade na#es
Es3alit"
Lit"otabs
Lit"ane
Lit"onate
M=A, unclear9 interere (it" #etabolis# o neurotrans#itters9 alter Na transport
in ner'es and #uscle cells
Prelit"iu# (or3up Urinal!sis )4UN and creatinine*
ECG& 24C& C4C
Side eects
Earl!
Nausea and diarr"ea
Anore0ia
2ine "and tre#or )propranolol*
T"irst& Pol!dipsia )dec+ crea& inc+ albu#in*
Metallic taste
2ati%ue
Let"ar%!
Late
5ei%"t %ain
acne
Contraindications
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4rain da#a%e7 C6 disease
Epileps!
Elderl!7 debilitated
T"!roid and renal disease
Se'ere de"!dration
Pre%nanc! )sttri#ester*
Can au%#ent t"e eects o anti.depressants
Nursin% considerations
T"erapeutic seru# le'el, >+ +D #e-7L
Maintenance le'el, >+? .+D #e-7L
To0ic
Mild to #oderate, + to D #e-7L
Moderate to se'ere, D D+ #e-7L
Needs dial!sis, #e- and abo'e
Earl! si%ns o to0icit!
Let"ar%!& #ild nausea& 'o#itin%& ine "and tre#ors& anore0ia& pol!uria&
pol!dipsia& #etallic taste& ati%ue
Late si%ns o to0icit!
Ata0ia& %iddiness& tinnitus& blurred 'ision& pol!uria
Nursin% considerations
Lit"iu# le'els s"ould be c"ec3ed - D. #os
Seru# dra(n in t"e AM& DH ater last dose Co##on causes o inc+ le'els
/ec+ Na inta3e
/iuretic t"erap!
/ec+ renal unctionin%
2FE loss
Medical illness ='erdose
NSAI/SNursin% considerations
/iet, ade-uate Na and luid
% NaCl7 da!
?.B %lasses o HD=
No caeine
No dri'in%, (ait or clinical eect
Mana%e#ent
Moderatel! se'ere to0icit!
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=s#otic diuresis, urea7 #annitol
A#inop"!lline F PLR I6
Ade-uate NaCl
Peritoneal7 "e#odial!sis
Se'ere to0icit!
Assess "0 -uic3l! Hold ne0t lit"iu# dose
C"ec3 4P& rectal TO& RR& L=C& support =D
=btain labs
ECG
E#etic& NGT la'a%e
H!drate, .?L7da! c PLR9 24C.C/U
=t"er dru%s
Carba#a$epine )Te%retol*
Side eects
/i$$iness Ata0ia
Clu#siness
Sedation
/!sart"ria /iplopia
Nausea F GI upset
Preparation, li-& tab& c"e(able tab
Nursin% considerations
Assess dru% le'els - . da!s
Monitor salt and luid inta3e
A'oid alco"ol and non.prescription dru%s
Reer dec+ in U=
/on:t stop abruptl!
C7I, pre%nanc!
Ta3e (it" #eals
=t"er dru%s
6alproic acid )/epa3ote& /epa3ene*
Side eects Nausea
Hepato0icit!
Neuroto0icit!
He#atolo%ical to0icit!
Pancreatitis
Prep, tab& cap& sprin3les
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M=A, inc+ le'els o GA4A9 in"ibits t"e kindlingprocess or snoball.li3e eect
seen in #ania F sei$uresNursin% considerations
T"erapeutic le'el, > >> u%7#L
/ose, & >>> &>> #%7da!
Monitor seru# le'els DH ater last dose
To0ic eects
Se'ere diarr"ea& 'o#itin%& dro(siness& ##+ (ea3ness& lac3 o coordination
Renal ailure& co#a& deat"
Anti.ps!c"otic dru%s
Indications
Ps!c"otic s!#pto#s o sc"i$op"renia& acute #ania and depression
Gilles de Tourette disorder
Treat#ent.resistant bipolar disorder
Huntin%ton:s disease and ot"er #o'e#ent disorder
Possibl!
Paranoid
C"ild"ood ps!c"oses
M=A, bloc3 receptors o dopa#ine )/D& /& /*
I unresponsi'e ater ? (ee3s o t"erap!& anot"er class is tried
General considerations
Cal#s (it"out producin% i#pair#ent o sleep
Hi%" t"erapeutic inde0
Non addictin%& no tolerance
A'oided in pre%nanc!
TYPICAL, Hi%" Potenc!2lup"ena$ine )Proli0in*
Haloperidol )Haldol*
T"iot"e0ene )Na'ane*
Triluopera$ine )Stela$ine*
Moderate Potenc!Lo0apine )Lo0itane*
Molindone )Moban*Perp"ena$ine )Trilaon*
Lo( Potenc!
C"lopro#a$ine )T"ora$ine*C"lorprot"i0ene )Taractan*
Mesorida$ine )Serentil*
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T"iorida$ine )Mellaril*
ATYPICAL
Clo$apine )Clo$aril*Resperidone )Risperdal*
=lan$apine )K!pre0a*
uetiapine )Sero-uel*Sertindole )Serlec:t*
Kiprasidone )Keldo0*
Contraindications
CNS depression, brain da#a%e& e0cess alco"ol7 narcotics
Par3inson:s disease
Aller%!
4lood d!scrasias
Acute narro( an%le %lauco#a
4PH
Side eects
H!potension
Sedation
/er#al and ocular s!ndro#e
Neuroleptic #ali%nant s!ndro#e
Antic"oliner%ic s!ndro#e
Mo'e#ent s!ndro#e )E0trap!ra#idal S!ndro#e*
Atropine ps!c"osis A%ranuloc!tosis
Sei$ures
Neuroleptic Mali%nant S!ndro#e
A potentiall! atal& idios!ncratic reaction to an antips!c"otic dru%
>.D> #ortalit! rate
S0,
ri%idit!&
"i%" e'er& autono#ic instabilit! )4P& diap"oresis& pallor& deliriu#& ele'+ CP*& conused or
#ute& luctuate ro# a%itation to stupor =ccurs in t"e irst D (ee3s o t"erap!
Ris3, "i%" dose o "i%".potenc! dru%s9 de"!dration& poor n0& concurrent #ed
illness
Mo'e#ent S!ndro#es
A3at"isia
/!stonia
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Tardi'e d!s3inesia
4rad!3inesia
Par3insonis#
=t"er s7e Atropine ps!c"osis )%eriatrics*
H!peracti'it!& a%itation& conusion& lus"ed s3in& slu%%is" reacti'e pupils
TTT, IM p"!sosti%#ine
A%ranuloc!tosis )Clo$apine*
=ccurs .B (3s ater
Medical e#er%enc!
s7s, e'er& #alaise& sore t"roat& leu3openia
TTT, d7c& re'erse iso& antibiotics
Sei$ures )Clo$apine* =ccurs in o patients9 TTT, /7c dru%
Antic"oliner%ics4en$tropine )Co%entin*
Tri"e0!p"enid!l )Artane*
4iperiden )A3ineton*Proc!clidine )e#adrin*
Not (it"dra(n abruptl!
Pro'ide cool en'iron#ent
ANTIPARINS=NIAN ME/ICATI=NS
Ad1unct to anti.ps!c"otic a%ents to balance dopa#ine7 acet!lc"oline in t"e brain
s7e, %lauco#a& tac"!cardia& HPN& cardiac d0& ast"#a& duodenal ulcer
A7e, blurred 'ision& p"otosensiti'it!& dro(siness& ort"ostatic "!potension& CH2&
"allucinations
C=MM=N /RUGS,
Tri"e0!p"enid!l )Artane*
ben$tropine )Co%entin*
4iperiden )Co%entin*
Sele%iline )Eldepr!l*
Per%olide )Per#a0*
ANTIHISTAMINE
/ip"en"!dra#ine HCl )4ENA/RYL*
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E0cessi'e and unreasonable cued b! t"e presence or anticipation o a speciic
ob1ect or situation
/eense #ec" co##onl! used include repression and displace#ent
2ear o social peror#ance situations in ("ic" t"e person is e0posed to una#iliar
people or to possible scrutin! b! ot"ers
=4SESSI=N C=MPULSI=N Recurrent and persistent t"ou%"ts& i#pulses& or i#a%es are e0perienced durin% t"e
disturbance as intrusi'e and inappropriate
Cause an0iet! or distress
P0 3no(s t"at t"ese are 1ust product o one:s o(n #ind+
P0 eels dri'en to peror# repetiti'e be"a'iors or #ental acts in response to
obsession or accordin% to t"e rules t"at one dee#s #ust be applied ri%idl!+
Ai#ed at reducin% an0iet!
=4SESSI=N C=MPULSI=N
2ear o dirt F %er#s
2ear o bur%lar! or robber! 5orries about discardin% so#et"in% i#portant
Concerns about contractin% a serious illness
5orries t"at t"in%s #ust be s!##etrical or #atc"in%
E0cessi'e "and (as"in%
Repeated c"ec3in% o door and (indo( loc3s
Countin% and recountin% o ob1ects in e'er!da! lie
Hoardin% o ob1ects
E0cessi'e strai%"tenin%& orderin%& or o arran%in% t"in%s
Repeatin% (ords or pra!ers silentl!
P=ST TRAUMATIC STRESS SYN/R=ME
Person "as e0perienced& (itnessed or been conronted (it" an e'ent t"at in'ol'ed
actual or t"reatened deat" or serious in1ur!& or a t"reat to p"!sical inte%rit!
Person ree0periences t"ese in t"e #ind
In'ol'es intense ear& "elplessness& or "orror and nu#bin% o %eneral
responsi'eness )PSYCHIC NUM4ING* ACUTE GENERALIKE/
STRESS AN@IETY
Meets t"e criteria or e0posure to a trau#atic e'ent and person e0periences ot"e s0,
sense o detac"#ent& reduced a(areness o one:s surroundin%s&
dereali$ation&
depersonali$ation&
dissociated a#nesia
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/EESCALATI=N TECHNIUES
Maintain saet!
Maintain lar%e personal space and use nona%%ressi'e posture
Use cal# approac" and co##unicate (it" a cal#& clear tone o 'oice )be
asserti'e not a%%ressi'e /eter#ine ("at t"e client considers to be "is or "er need
A'oid 'erbal stru%%les
Pro'ide clear options t"at deal (it" be"a'ior
Assist (it" proble#.sol'in% and decision #a3in% re%ardin% t"e options
MANIPULATI6E 4EHA6I=RS
Set clear& consistent& realistic& and enorceable li#its and co##unicate e0pected
be"a'iors
4e clear about conse-uences associated (it" e0ceedin% set li#its
/iscuss be"a'ior in non1ud%#ental and nont"reatenin% #anner
A'oid po(er stru%%les
Assist in de'elopin% #eans o settin% li#its on o(n be"a'ior
SCHIK=PHRENIA
c"aracteri$ed b! i#pair#ents in t"e perception or e0pression o realit! and b!
si%niicant social or occupational d!sunction+
=nce considered as a deadl! disease
T"ere is lac3 o insi%"t in be"a'ior
/0, late adolescence and earl! adult"ood
.D !+o+ )#en*9 D. !+o+ )(o#en* =bsolete ter#, de#entia praeco0 co%niti'e deterioration earl! in lie
Eu%ene 4leuler, sc"i$ split9 p"ren #ind
Ris3 actors
Genetics, identical t(ins >& or raternal t(ins
4ioc"e#ical actors
/opa#ine "!pot"esis, o'eracti'e
Serotonin i#balance /ecreased brain 'olu#e& enlar%ed 'entricles& deeper issures& and loss or
underde'eloped brain tissue
Ps!c"oanal!tic
lac3 o trust durin% t"e earl! sta%es
5ea3 e%o /eenses, REPRESSI=N& REGRESSI=N& PR=8ECTI=N
En'iron#ent inluences, po'ert!& lac3 o social support& "ostile "o#e en'iron#ent&
isolation& unsatisactor! "ousin%& disruption in interpersonal relations"ips )di'orce
or deat"*& 1ob pressure or une#plo!#entSubt!pes
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Catatonic type
pro#inent ps!c"o#otor disturbances are e'ident+ S!#pto#s can include catatonic
stupor and (a0! le0ibilit!
Disorganized type
("ere t"ou%"t disorder and lat aect are present to%et"er Paranoid type
("ere delusions and "allucinations are present but t"ou%"t disorder& disor%ani$ed
be"a'ior& and aecti'e lattenin% are absent
Residual type
("ere positi'e s!#pto#s are present at a lo( intensit! onl!
ndi!!erentiated type
ps!c"otic s!#pto#s are present but t"e criteria or paranoid& disor%ani$ed& or
catatonic t!pes "as not been #et
S!#pto#s
Accordin% to 4leuler, A:s
Aect is inappropriate
Associati'e looseness
Autistic t"in3in%
A#bi'alence
S!#pto#s
Positi'e s!#pto#s
delusions& auditor! "allucinations and t"ou%"t disorder and are t!picall! re%ardedas #aniestations o ps!c"osis+
Ne%ati'e s!#pto#s
considered to be t"e loss or absence o nor#al traits or abilities
E+G+ lat& blunted or constricted aect and e#otion& po'ert! o speec" and lac3 o
#oti'ation+
S!#pto#s Social isolation
Catatonic be"a'ior
"allucinations
#nco"erence )#ar3ed looseness o association*
$ero7 lac3 o interest& ener%! and initiati'e
%b'ious ailure to attain e0pected le'el o de':t
Peculiar be"a'ior
"!%iene and %roo#in% i#paired
Recurrent illusions and unusual perception e0periences
&0acerbations and re#issions are co##on
No or%anic actors accounts or t"e s!#pto#s
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#nabilit! to return to baseline unctionin% ater relapse
'ect is inappropriateNs% /0, Abnor#al t"ou%"t process
4L=CING, sudden cessation o a t"ou%"t in t"e #iddle o a sentence& unable to
continue t"e train o t"ou%"t
CIRCUMSTANTIALITY, beore %ettin% to t"e point o ans(erin% a -uestion& t"eindi'idual %ets cau%"t up in countless details and e0planations
C=N2A4ULATI=N
L==SENESS =2 ASS=CIATI=N
NE=L=GISM
5=R/ SALA/
Inter'entions
Assess p"!sical needs
Set li#its
Maintain saet!
Initiate one.on.one interaction F pro%ress to s#all %roups
Spend ti#e (it" clients
Monitor or altered t"ou%"t process
Maintain e%o boundaries& a'oid touc"in%
Li#it ti#e o interaction
4e neutral
/o not #a3e pro#ises t"at can:t be 3ept
Establis" dail! routines
/o not %o alon% (it" t"e client:s delusions or "allucinations Pro'ide si#ple co#plete acti'ities
Reorient
Spea3 to t"e client in si#ple direct and concise #anner
Set realistic %oals
E0plain e'er!t"in% t"at is bein% done
/ecrease sti#uli
Monitor or suicide ris3
En'iron#ent
Pro'ide sae en'iron#ent
Li#it sti#uli
Ps!c"olo%ical Ttt
4e"a'ior t"erap!
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Social s3ills trainin%
Sel.#onitorin%
Social ttt
Milieu t"erap!
2a#il! t"erap! Group t"erap! )lon%.ter# ttt*
Related ps!c"otic disorders
SCHIK=A22ECTI6E /IS=R/ER sc"i$ #ood disorder )#ania7 depression*
4RIE2 PSYCH=TIC /IS=R/ER sudden onset o ps!c"otic s!#pto#s& lasts less
t"an D #os and client returns to pre#orbid le'el o unctionin%
SCHIK=PHRENI2=RM /IS=R/ER sc"i$ s0 lastin% bet(een #ont" and
?#os
/ELUSI=NAL /IS=R/ER c"aracteri$ed b! pro#inent& nonbi$arre delusions
PERS=NALITY /IS=R/ERS
CLUSTER A )odd F eccentric*
paranoid& sc"i$oid& sc"i$ot!pal
CLUSTER 4 )bad& dra#atic F erratic*
antisocial& borderline& "istrionic& narcissistic
CLUSTER C )an0ious F earul*
a'oidant& dependent& =C/
CLUSTER A, =// F ECCENTRIC
PARAN=I/ c"ronic "ostilit! pro1ected to ot"ers9 suspicious and #istrusts people
Seen #ostl! in #en
SCHIK=I/
social detac"#ent loner F intro'ert
Restriction o e#otions
Attention i0ed on ob1ects rat"er t"an people
2unctions (ell in 'ocations
SCHIK=TYPAL, interpersonal deicits
Ma%ical t"in3in%& telepat"!
Apparent in c"ild"ood or adolescence
Inter'entions or PARAN=I/ /7=
Asses or suicide ris3
A'oid direct e!e contact
Establis" trustin% relations"ip
Pro#ote increased sel.estee#
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Re#ain cal#& nont"reatenin% and non1ud%#ental
Pro'ide continuit! o care
Respond "onestl! to t"e client
2ollo( t"ru on co##it#ents
Pro'ide a dail! sc"edule o acti'ities
Graduall! introduce client to %roups
/o not ar%ue (it" delusions
Use concrete& speciic (ords
/o not be secreti'e (it" client
/o not ("isper in presence o client
Assure t"at t"e client (ill be sae
Pro'ide opportunit! to co#plete s#all tas3s
Monitor eatin%& drin3in%& sleepin% and eli#ination patterns
Li#it p"!sical contact
Monitor or a%itation and decrease sti#uli as needed
CLUSTER 4, ERRATIC& /RAMATIC& =R EM=TI=NAL
ANTIS=CIAL
S!n, sociopat"& ps!c"opat"ic F se#antic d7o
Etiolo%!,
Genetics interere in t"e de':t o positi'e interpersonal relations"ips
4rain da#a%e or trau#a
Lo( socioecono#ic status
2ault! a#il! relations"ips, ne%lect
Secondar! %ains
.> !+o+
Si%ns
Lac3 o re#orse or indierence to persons "urt
I##ediate %ratiication
2ailure to accept social nor#s
I#pulsi'it!
Consistent irresponsibilit!
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A%%ressi'e be"a'ior
Rec3less be"a'ior t"at disre%ards t"e saet! o ot"ers
B>.V> o all cri#e is co##itted b! antisocials )NIHM& D>>>*
4=R/ERLINE
Latent& a#bulator! and aborti'e sc"i$op"renics
4et(een #oderate neurosis and ran3 ps!c"osis but -uite stable
T"eories
ault! separation ro# #ot"er9 parent and c"ild are bound b! %uilt
Trau#a at B #os )(ea3enin% o e%o*
Unulilled need or inti#ac!
Si%ns instabilit!
I#pulsi'it!, unpredictable %a#blin%& s"oplitin%& se0 F substance abuse
"!persensiti'it!& sel.destructi'e& proound #ood s"its
unstable F intense relations
/isturbance in sel concept
Co##on in (o#en
/eenses, denial& pro1ection& splittin%& pro1ecti'e identiication
HISTRI=NIC
Pattern o t"eatrical or o'ertl! dra#atic be"a'ior
Si%ns
/isco#ort ("en t"e client isn:t t"e center o attention
Sel.dra#ati$ation and e0a%%erated e#otions
uses p"!sical appearance& se0uall! seducti'e and pro'ocati'e be"a'ior E0cessi'el! i#pressionistic speec" lac3in% in detail )labile e#otions*
Proble#s in dependence F "elplessness
More re-uent in (o#en
NARCISSISTIC
E0a%%erated or %randiose sense o sel.i#portance
/e'elop earl! in c"ild"ood
Preoccupied (it" antasies o unli#ited success& po(er and beaut!
Si%ns
arro%ance& need or ad#iration&
lac3 o e#pat"!&
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seducti'e& sociall! e0ploitati'e& #anipulati'e
=ccurs #ore in #en
CLUSTER C, AN@I=US =R 2EAR2UL
A6=I/ANT
Sensiti'e to re1ection& criticis#& "u#iliation& disappro'al& or s"a#e
Intereres (it" participation in occupational acti'ities& de':t o relations"ips& and
ta3e personal ris3s
social in"ibition& lon%s or relations"ips
An0iet!& an%er and depression are co##on
Social p"obia #a! occur
Seen in > o clients in #ental clinics
/EPEN/ENT
Lac3s conidence and unable to unction in an independent role Allo(s ot"er persons to be responsible o t"eir li'es
Most re-uent personalit! disorder in t"e #ental "ealt" clinic
sub#issi'e be"a'ior& lo( sel.estee#& inade-uate& "elpless
=4SESSI6E.C=MPULSI6E
Preoccupied (it" rules F re%ulations& o'erl! concerned about tri'ial detail&
e0cessi'el! de'oted to t"eir (or3
/epression is co##on
Men are #ore aected t"an (o#en
UN/ER STU/Y PERS=NALITY /7=
PASSI6E.AGGRESSI6E, sullen and ar%u#entati'e& resents ot"ers& resists
ulillin% responsibilities& co#plains o bein% unappreciated
/EPRESSI6E, %loo#!& broodin% pessi#istic& %uilt.prone& "i%"l! critical o sel
and ot"ers& c"eerless+
Inter'entions
Maintain saet! a%ainst sel.destructi'e be"a'iors
Allo( t"e client to #a3e c"oices and be as independent as possible
Encoura%e t"e client to discuss eelin%s rat"er t"an act t"e# out Pro'ide consistenc! in response to t"e client:s actin% out
/iscuss e0pectations and responsibilities (it" t"e client
Inor# t"e client t"at "ar# to sel& ot"ers& and propert! is unacceptable
Identi! splittin% be"a'ior
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Assist t"e client to deal directl! (it" an%er
/e'elop a (ritten contract (it" t"e client
Encoura%e t"e client to participate in %roup acti'ities& and praise non#anipulati'e
be"a'ior
Set and #aintain li#its Re#o'e t"e client ro# %roup situations in ("ic" attention.see3in% be"a'iors
occur
Pro'ide realistic praise or positi'e be"a'iors in social situations
PSYCH=L=GICAL SE@UAL /7=
H!poacti'e se0ual disorder )ase0ualit!*
Se0ual a'ersion disorder )a'oidance o or lac3 o desire or se0ual intercourse*
2e#ale se0ual arousal d7o )ailure o nor#al lubricatin% arousal response*
Male erectile d7o
2e#ale or%as#ic disorder
Male or%as#ic disorder
Pre#ature e1aculation
6a%inis#us
Secondar! se0ual d!s0n
Parap"ilias
Gender identit! d7o
PTS/ due to %enital #utilation or c"ild"ood se0ual abuse
%t(er se)ual proble*s
Se0ual dissatisaction )non.speciic*
Lac3 o se0ual desire
anor%as#ia
I#potence
ST/
Inidelit!
/ela! or absence o e1aculation& despite ade-uate sti#ulation
Inabilit! to control ti#in% o e1aculation
Inabilit! to rela0 'a%inal #uscles enou%" to allo( intercourse
Inade-uate 'a%inal lubrication precedin% and durin% intercourse
4urnin% pain on t"e 'ul'a or in t"e 'a%ina (it" contact to t"ose areas
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Un"appiness or conusion related to se0ual orientation
Persistent se0ual arousal s!ndro#e
Se0ual addict
"!perse0ualit! Post E1aculator! Guilt S!ndro#e& t"e eelin% o %uilt ater t"e #ale or%as#
SE@UAL E@PRESSI=N
HETER=SE@UALITY
H=M=SE@UALITY
4ISE@UALITY
TRANS6ESTISM
PARAPHILIAS E@HI4ITI=NISM, t"e recurrent ur%e or be"a'ior to e0pose oneWs %enitals to an
unsuspectin% person+
2ETISHISM, t"e use o non.se0ual or nonli'in% ob1ects or part o a personWs bod!
to %ain se0ual e0cite#ent+Partialismreers to etis"es speciicall! in'ol'in% nonse0ual
parts o t"e bod!+
2R=TTEURISM, t"e recurrent ur%es or be"a'ior o touc"in% or rubbin% a%ainst a
nonconsentin% person+
SE@UAL MAS=CHISM, t"e recurrent ur%e or be"a'ior o (antin% to be
"u#iliated& beaten& bound& or ot"er(ise #ade to suer+ SE@UAL SA/ISM, t"e recurrent ur%e or be"a'ior in'ol'in% acts in ("ic" t"e
pain or "u#iliation o t"e 'icti# is se0uall! e0citin%+
TRANS6ESTIC 2ETISHISM, a se0ual attraction to(ards t"e clot"in% o t"e
opposite %ender+
PE/=PHILIA, t"e se0ual attraction to prepubescent or peripubescent c"ildren+
6=YEURISM, t"e recurrent ur%e or be"a'ior to obser'e an unsuspectin% person
("o is na3ed& disrobin% or en%a%in% in se0ual acti'ities& or #a! not be se0ual in nature atall+
Other paraphilias not otherwise specified)XSe0ual /isorder N=SX*
telep"one scatalo%ia )obscene p"one calls*
necrop"ilia )corpses*
partialis# )e0clusi'e ocus on one part o t"e bod!*
$oop"ilia)ani#als*
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Hun%er denied
Eatin% be"a'ior #a! be considered nor#al and a source o estee#
Se0uall! inacti'e
=bsessional and perectionist eatures do#inate
2re-uent
Less (t loss Sli%"tl! older
More e0tro'erted
Hun%er e0perienced
Eatin% be"a'ior considered orei%n and source o distress
More se0uall! acti'e A'oidant& dependent& or borderline eatures as (ell as obsessional eatures
AN=RE@IA 4ULIMIA
co#plications
/eat" ro# star'ation )or suicide& in c"ronicall! ill*
A#enorr"ea
2e(er be"a'ioral proble#s )t"ese increase (it" le'el o se'erit!*
/eat" ro# "!po3ale#ia or suicide
Menses irre%ular or absent
/ru% and alco"ol abuse& sel.#utilation& and ot"er be"a'ioral proble#s
/ELIRIUM
T"e #edical d0 ter# t"at describes an or%anic #ental disorder c"aracteri$ed b! a
cluster o co%niti'e i#pair#ents (it" an acute onset (it" a speciic precipitatin% actor+
S0, di#inis"ed a(areness o t"e en'iron#ent& disturbances in ps!c"o#otoracti'it! and sleep.(a3e c!cle+
C=GNITI6E, t"e #ental process c"aracteri$ed b! 3no(in%& t"in3in%& and1ud%in%+ C=GNITI6E /ISS=NANCE, arises ("en D opposin% belies e0ists at t"e sa#e
ti#e+
C=GNITI6E /IST=RTI=NS, )* or ).* distortions o realit! t"at #i%"t includeerrors o lo%ic& #ista3es in reasonin%& or indi'iduali$ed 'ie( o t"e (orld t"at do not
relect realit!+
Ter#, conusion co%niti'e i#pair#ent
See de#entia
/EMENTIA
T"e #edical d0 ter# t"at describes an or%anic #ental d7o c"aracteri$ed b! a
cluster o co%niti'e i#pair#ents o %enerall! %radual onset and irre'ersible (it"outidentiiable precipitatin% stressors+
T!pes,
6ASCULAR or MULTI.IN2ARCT
6ASCULAR 5ITH ALKHEIMER:S /SE
A/, #ost co##on
/EMENTIA 5ITH LE5Y 4=/IES, Dnd#ost co##on9 neuroila#ent #aterial
PARINS=NIAN /EMENTIA
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AI/S /EMENTIA C=MPLE@
2R=NTAL L=4E /EMENTIA or PIC:S /SE, c!toplas#ic collections9 rd
#ost co##on9 loss o e0pressi'e lan%ua%e F co#pre"ension
CREUTK2EL/T.8A=4 /SE, prion )proteinaceous inectious particles*
spon%! brain9 related to TSE F 4SE in #ad co( dse C=RTIC=4ASAL /EGENERATI=N or HUNTINGT=N:S /SE7CH=REA,
1er3! #o':ts
SUPRANUCLEAR PALSY, clu#pin% o protein tau slo( #o':t& (ea3 e!e
#o':t )esp+ do(n(ard*& i#paired (al3in% Fbalance
Re'ersible Causes,
Subdural "e#ato#a
Tu#or )#enin%io#a*
Cerebral 'asculitis
H!drocep"alus
Ter#s, disorientation& #e#or! loss )sensor!& pri#ar!& secondar!& tertiar!&
(or3in% #e#or!*& conabulation& conusion
/isturbin% be"a'iors
A%%ressi'e ps!c"o#otor
Nona%%ressi'e ps!c"o#otor
6erball! a%%ressi'e
Passi'e 2unctionall! i#paired, loss o abilit! to do sel.care
/ELIRIUM 's+ /EMENTIA
Rapid onset (7 (ide luctuations H!peralert to diicult to arouse L=C
2luctuatin% aect
/isoriented& conused
Attention F sleep disturbed
Me#or! i#paired
/isordered reasonin%
Gradual& c"ronic (it" continuous decline
Nor#al L=C
Labile aect
/isoriented& conused Attention intact& sleep usuall! nor#al
Me#or! i#paired
/isordered reasonin% F calculation
/ELIRIUM 's+ /EMENTIA
Inco"erent& conused& delusional& stereot!ped
Illusions& "allucinations
Poor 1ud%#ent
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M=T=R SILLS /7=
C=MMUNICATI=N /7=
E@PRESSI6E LANGUAGE
MI@E/ RECEPTI6E7E@PRESSI6E PH=N=L=GICAL
STUTTERING
SELECTI6E MUTISM
C=MMUNICATI=N /7= N=S
M=6:T F TIC /7=
/E6:TAL C==R/INATI=N
TRANSIENT TIC
CHR=NIC M=T=RF6=CAL TIC
T=URETTE:S /7=
STERE=TYPIC M=6:T /7=
TIC /7= N=S
/IS=R/ERS =2 INTAE F ELIMINATI=N
PICA
RUMINATI=N
2EE/ING /7=
ENURESIS
ENC=PRESIS
=THER, 4ULIMIA& AN=RE@IA
A/H/ F /ISRUPTI6E 4EHA6I=R /7=
A/H/
A/H/ N=S
C=N/UCT /7=
=PP=SITI=NAL /E2IANT
CHIL/ ANTIS=CIAL
/ISRUPTI6E 4EHA6I=R N=S
M==/ /7=
M8 /EPRESSI6E /7=
4IP=LAR I =R II /YSTHYMIC
MI@E/ EPIS=/E
HYP=MANIC EPIS=/E
M==/ /7= /UE T= ME/ICAL C=N/ITI=N
SU4STANCE.IN/UCE/ M==/ /7=
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AN@IETY /7=
/7= =2 RELATI=NSHIP
SEPARATI=N AN@IETY
REACTI6E ATTACHMENT =2 IN2ANCY =R EARLY CHIL/H==/
PARENT.CHIL/ RELATI=NAL PR=4LEM SI4LING RELATI=NAL PR=4LEM
PR=4LEMS RELATE/ T= A4USE =R NEGLECT
MENTAL RETAR/ATI=N
an I belo( J>& si%niicant li#itations in t(o or #ore areas o adapti'e be"a'ior)i+e+& abilit! to unction at a%e le'el in an ordinar! en'iron#ent*& and e'idence t"at t"e
li#itations beca#e apparent in beore B !+o+
T"e ollo(in% ran%es& based on t"e5ec"sler Adult Intelli%ence Scale)5AIS*&
are in standard use toda!,
Class #+ er*s
Proound 4elo( D> Idiot
Se'ere D> I#becileModerate V Moron
Mild >?V4orderline J>JV
RETT:S /7=
/e'elop#ent is nor#al until ?.B #ont"s& ("en lan%ua%e and #otor #ilestones
re%ress&
purposeul "and use is lost
Ac-uired deceleration in t"e rate o "ead %ro(t" )resultin% in #icrocep"al! in
so#e*
Hand stereot!pes are t!pical and breat"in% irre%ularities suc" as "!per'entilation&breat" "oldin%& or si%"in% are seen in #an!+
Earl! on& autistic.li3e be"a'ior #a! be seen
Co##on in e#ales
CHIL/H==/ /ISINTEGRATI6E /7= or HELLER:S SYN/R=ME
C// "as so#e si#ilarit! to autis#& but an apparent period o airl! nor#al
de'elop#ent is oten noted beore a re%ression in s3ills or a series o re%ressions in s3ills+
c"aracteri$ed b! late onset ) !ears o a%e* o de':tal dela!s in lan%ua%e& social
unction and #otor s3ills9 s3ills apparentl! attained are lost
ASPERGER:S /7=
c"aracteri$ed b! dierence in lan%ua%e and co##unication s3ills& as (ell asrepetiti'e or restricti'e patterns o t"ou%"t and be"a'ior+
Si%ns, unable to interpret or understand t"e desires or intentions o ot"ers andt"ereb! are unable to predict ("at to e0pect o ot"ers or ("at ot"ers #a! e0pect o t"e#
Narro( interests or preoccupation (it" a sub1ect to t"e e0clusion o ot"er
acti'ities Repetiti'e be"a'iors or rituals
Peculiarities in speec" and lan%ua%e
http://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scale -
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2re-uentl! prescribed sti#ulants are #et"!lp"enidate )Ritalin and Concerta*&
a#p"eta#ines )Adderall* and de0troa#p"eta#ines )/e0edrine*
2ein%old diet("ic" in'ol'es re#o'in% salic!lates& artiicial colors and la'ors&
and certain s!nt"etic preser'ati'es ro# c"ildrenWs diets+
C=N/UCT /7=
repetiti'e and persistent pattern o be"a'ior in ("ic" t"e basic ri%"ts o ot"ers or
#a1or a%e.appropriate societal nor#s or rules are 'iolated&
AGGRESSI=N T= PE=PLE F ANIMALS
/ESTRUCTI=N =2 PR=PERTY
/ECEIT2ULNESS =R THE2T
SERI=US 6I=LATI=NS =2 RULES
4e%innin% beore a%e
=PP=SITI=NAL /E2IANT c"aracteri$ed b! an on%oin% pattern o disobedient& "ostile& and deiant be"a'ior
to(ard aut"orit! i%ures t"at %oes be!ond t"e bounds o nor#al c"ild"ood be"a'ior Si%ns
Losin% te#per Ar%uin% (it" adults
Reusin% to ollo( t"e rules
/eliberatel! anno!in% people
4la#in% ot"ers
Easil! anno!ed
An%r! and resentul
Spiteul or e'en re'en%eul ne0t
SU4STANCE A4USE
E0cessi'e or un"ealt"! use o substances& suc" as alco"ol& tobacco or dru%s& or
use o products suc" as ood
Ter#s,
T=LERANCE, t"e declinin% eect o t"e sa#e dru% dose ("en it is ta3en
repeatedl! o'er ti#e
HA4ITUATI=N, a ps!c"olo%ical dependence o t"e use o a dru%
A//ICTI=N, t"e biolo%ical and7 or ps!c"olo%ical be"a'iors related to substance
dependence
5ITH/RA5AL SYMPT=MS, result ro# a biolo%ical need t"at de'elops ("ent"e bod! beco#es adapted to "a'in% an addicti'e dru% in t"e s!ste#9 occurs ("en seru#
le'els decrease
A//ICTI=N
ALC=H=L, blood alco"ol le'els o >+ )>>#% alco"ol7dl o blood* or "i%"er
5ITH/RA5AL
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Anore0ia
An0iet!
Easil! startled H!peralertness
HPN
Inso#nia Irritabilit!
8er3! #o':t
Possibl!, "allucinations& illusions or 'i'id ni%"t#ares Sei$ures )J.B "rs ater cessation*
Tac"!cardia
tre#ors
5ITH/RA5AL /ELIRIUM
A%itation Anore0ia
An0iet! /eliriu#
/iap"oresis
/isorientation (it" luctuatin% le'els o consciousness
2e'er )>> to > 2*
Hallucinations and delusions
Inso#nia
Tac"!cardia and HPN
/isulira# )Antabuse* t"erap!
Nursin% care
=btain ino about dru% t!pe and a#ount consu#ed
Assess '7s Re#o'e unnecssar! ob1 ro# en'iron#ent
Pro'ide one.on.one super'ision i necessar!
Pro'ide a -uiet& cal# en'iron#ent (it" #ini#al sti#uli
Maintain orientation
Ensure saet!
Use restraints
Pro'ide p"!sical needs
Pro'ide ood and luids as tolerated
Ad#inister #edications
Collect blood and urine sa#ples or dru% screenin%SP=USE A4USE
4atterin% precipitates , suicide atte#pts o all (o#en
5i'es e0plain t"e in1uries as bein% sel.inlicted or accidental
P"ases
Tension.buildin%, series o s#all incidents t"at leads to beatin% Acute beatin% p"ase, (ie beco#es ob1ect o assault be"a'ior
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Lo'in% p"ase, batterer is re#orseul and assures spouse t"at "e (ill not "ar# "er
a%ain+ T"is leads to reconciliation+
M!t"s
T"e! belie'e t"at i t"e! tr! not to anta%oni$e (it" t"eir "usband& "e (ill c"an%e+
Eorts to coerce t"e (ie out o t"e 'icti# role can be ruitul+ 2acts
5o#en sta! in relations"ips (it" #en ("o batter because t"e! eel %uilt! or
responsible o t"e "usband:s be"a'ior
5ie de'elops little sense o sel.(ort"& i##obili$ed and unable to re#o'e selro# t"e relations"ip+
Assess#ent, in1uries& ot"er e'idence
Inter'entions, (it" consent
CHIL/ A4USE
PHYSICAL 4ATTERING
EM=TI=NAL
SE@UAL
NEGLECT
EL/ERLY A4USE
A 'ariet! o be"a'iors t"at t"reaten t"e "ealt"& co#ort& and possibl! t"e li'es o
t"e elderl!& includin% p"!sical and e#otional ne%lect& e#otional abuse& 'iolation o
personal ri%"ts& inancial abuse& and direct p"!sical abuse+
Co##onl! co##itted b! care %i'ers+
SE@UAL A4USE
Co#ponents
Se0ual Misuse, inappropriate se0ual acti'it!
Rape, t"ere is actual penetration
Incest, reers to t"e relations"ip bet(een t"e 'icti# and abuser blood relati'e or
step parent role
Inter'entions
C"ildren, t"ru pla! or role pla!in% (it" puppets
Pre'ention o urt"er se0ual abuse
ne0t C=MPLETE/ SUICI/E
Sel.inlicted deat"
LE6ELS =2 SUICI/E
Ideation, t"ou%"t
Atte#pt, acted upon but ailed
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Co#pleted
CHEMICAL RESTRAINT
CHEMICAL RESTRAINTS, Medications used to restrict t"e patient:s reedo# o
#o'e#ent or or e#er%enc! control o be"a'ior but are not a standard treat#ent or t"e
p0:s #edical or ps!c"iatric condition+
PHYSICAL RESTRAINTS, Are an! #anual #et"od or p"!sical or #ec"anicalde'ice attac"ed to or ad1acent to t"e p0:s bod! t"at "e or s"e cannot easil! re#o'e and
t"at restricts reedo# o #o'e#ent or nor#al access to one:s bod!& #aterial or
e-uip#ent+
SECLUTI=N AN/ RESTRAINTS
SECLUTI=N, t"e in'oluntar! conine#ent o a person alone in a roo# ro#
("ic" t"e person is p"!sicall! pre'ented ro# lea'in%+
No t"erapeutic e'idence ot"er t"an a last resort to ensure saet!+
E'idence su%%est t"at it adds to urt"er trau#a and p"!sical "ar#
GUI/ELINES
All "ospital sta ("o "a'e direct contact (it" t"e p0 s"ould "a'e on%oin%
education and trainin% in t"e proper use o seclusion and restraints and ot"er alternati'es
P"!sician or licensed practitioner s"ould e'aluate need (it"in "our ater t"e
initiation o t"is inter'ention+
Ma0 o "ours or adults& D "ours or a%es V.J& and "our or c"ildren under V!rs
=rders #a! be rene(ed or D "rs beore anot"er ace to ace e'aluation Continuous assess#ent& #onitorin% and e'aluation9 recorded
Good nursin% care 2or bot" restrained and secluded, constant #onitorin% ace to ace or b! bot"audio and 'ideo e-uip#ent+
P0 s"ould be released ASAP=THER GUI/ELINES
SECLUSI=N
Roo# s"ould allo( obser'ation and co##unication (it" p0
Re#o'e all ite#s t"at p0 #i%"t use to "ar# sel
/ocu#ent, rationale& response to inter'ention& p"!sical condition& ns% care& F
rationale or ter#ination
RESTRAINTS
Gi'e support F reassurance Position in anato#ical position
Pri'ac! is i#portant '7s F Circulation c"ec3
S"ould be released - D"rs A'oid t!in% to t"e side rails o bed
Assist in periodic c"an%e in bod! positions
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TERMINATING THE INTER6ENTI=N
As soon as #et t"e criteria or release
Re'ie( (it" p0 t"e be"a'ior t"at precipitated t"e inter'ention F p0:s capacit! to
e0ercise control o'er be"a'ior
/E4RIE2ING, re'ie(in% t"e acts related to an e'ent F processin% t"e responseto t"e#9 can be used ater an! stressul e'ent
ne0tTHERAPEUTIC IMPASSES
Are bloc3s in t"e pro%ress o t"e nurse.pt relations"ip
Pro'o3es intense eelin%s in bot" t"e nurse and patient
RESISTANCE
TRANS2ERENCE
C=UNTERTRANS2ERENCE
4=UN/ARY 6I=LATI=NS
RESISTANCE Reluctance or a'oidance o 'erbali$in% or e0periencin% troublin% aspects o
onesel
E%, suppression or repression& intensiication o s0& sel.de'aluation or
"opelessness& intellectual in"ibitions& actin% out or irrational be"a'ior& supericial tal3&intellectual insi%"t7 intellectuali$ation& transerence reactions+
TRANS2ERENCE
Unconscious response in ("ic" t"e p0 e0periences eelin%s and attitudes to(ard
t"e nurse t"at (ere ori%inall! associatated (it" ot"er si%niicant i%ures in "is or "er lie+
H=STILE TRANS2ERENCE, an%er and "ostilit!& resistance
/EPEN/ENT TRANS2ERENCE, sub#issi'e& subordinate and re%ards t"e nurseas a %od.li3e i%ure9 'ie(s relations"ip as #a%ical
5"at do !ou doZ
LISTEN
CLARI2Y
RE2LECT
E@PL=RE7 ANALYKEC=UNTERTRANS2ERENCE
Created b! t"e nurse:s speciic e#otional response to t"e -ualities o t"e patient9
inappropriate in t"e conte0t& content and intensit! o e#otion9 nurses identi! t"e p0 (it"
indi'iduals ro# t"eir past& and personal needs
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T!pes, Reactions o INTENSE
lo'e or carin%
/is%ust or "ostilit!
An0iet!& oten in response to resistance b! t"e p0
E%+
/iicult! e#pat"i$in% 2eelin%s o depression beore or ater t"e session
Carelessness about i#ple#entin% t"e contract /ro(siness durin% t"e sessions
Encoura%e#ent o t"e p0:s dependenc! Ar%u#ents (it" t"e p0
Personal or social in'ol'e#ent (it" t"e p0
Se0ual or a%%ressi'e antasies to(ard t"e p0
Tendenc! to ocus on onl! one aspect or (a! o loo3in% at inor#ation presented
b! t"e p0 Atte#pts to "elp t"e p0 (it" #atters not related to t"e identiied nursin% proble#s
2eelin%s o an%er or i#patience because o t"e p0:s un(illin%ness to c"an%e
/rea#s about or preoccupation (it" t"e p0