Psychia Review Notes

8/20/2019 Psychia Review Notes

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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'e

ps!c"osocial (ell bein%+

• Core , interpersonal process

Related 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 our

en'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:sPSYCH=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*


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6/46

• H=PE

T=//LER

• 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


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• MI/LI2E CRISIS

• 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=ND.A4=6E, 2=RMAL =PERATI=NAL TH=UGHT

• Abstract t"in3in%

• Separation o antas! and act

• Realit! oriented

• /educti'e reasonin%


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• Appl! scientiic #et"od

Ha'i%"urst:s

/E6EL=PMENTAL TASS

• 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%:s

M=RAL /E6EL=PMENT7 THINING7 8U/GEMENT


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• PRE.C=N6ENTI=NAL )>.?*

– 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 =2

HUMAN 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 =2

5ISH 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/

PAINSCH==L AGE


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• 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@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 =THERSSENESCENCE

•/E6EL=PS AN ACCEPTANCE =2 RESP=NSI4ILITY 2=R 5HAT LI2E ISAN/ 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 NEUTRAL

T=PICS

• STEPS ,

cli#ate o acceptance

creatin% brid%e to realit!

s"arin% t"e (orld (e li'e in

appreciation o (or3s o t"e (orldcli#ate o appreciation

MUSIC THERAPY

• In'ol'es use o #usic to acilitate e0pression o eelin%s& rela0ation and outlet o

tension

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:ssituation 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


11/46

• 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

• 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 done

2AMILY 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"e

patients 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 instructions4EHA6I=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


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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

=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


13/46

– Met"o"e0ital Sodiu# ) 4re'ital *, ser'es as an anest"etic a%ent

• co##on co#plications,

– loss o #e#or!

– "eadac"e

–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


14/46

– 4uli#ia

– =bsessi'e.co#pulsi'e d7o

• Possibl!

– Attention deicit7H!peracti'it! d7o

–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 NardilTran!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


15/46

• Pic3led or s#o3ed is"

• 4eer& red (ine& s"err!9 li-uor F co%nac

• Yeast

• 2a'a or broad beans

• 4ee or c"ic3en li'er

• Spoiled7 o'erripe ruits9 banana peel

• !o%urt

H!pertensi'e Crisis

• Si%ns

– Sudden ele'ation o 4P

– E0plosi'e "eadac"e& occipital #a! radiate rontall!

– Head F ace lus"ed

– Palpitations& c"est pain

– S(eatin%& e'er

– Nausea& 'o#itin%

– /ilated pupils& p"otop"obia

– Intracranial bleedin%

• Treat#ent

– Hold ne0t MA= dose

– /on:t let pt+ lie do(n

– IM c"lorpro#a$ine >> #%

– 2e'er, #ana%e b! e0ternal coolin% tec"ni-uesSerotonin Reupta3e In"ibitors

Generic Trade na#e

2luo0etine Pro$acSertraline Kolot

Paro0etine Pa0il

6enlaa0ine Ee0or Side eects

• Nausea

• /iarr"ea

•Inso#nia

• /r! #out"

• Ner'ousness

• Headac"e

• Male se0ual d!sunction


16/46

• /ro(siness

• /i$$iness

• S(eatin%

Mood stabili$in% dru%s• 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


17/46

– Let"ar%!

• Late

– 5ei%"t %ain

– acne

Contraindications

• 4rain da#a%e7 C6 disease

• Epileps!

• Elderl!7 debilitated

• T"!roid and renal disease

• Se'ere de"!dration

• Pre%nanc! )st tri#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/S


• /iet, ade-uate Na and luid


18/46

– % NaCl7 da!

– ?.B %lasses o HD=

• No caeine

• No dri'in%, (ait or clinical eect

Mana%e#ent• Moderatel! se'ere to0icit!

– =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


• 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*


19/46

– Side eects

• Nausea

• Hepato0icit!

• Neuroto0icit!

• He#atolo%ical to0icit!

• Pancreatitis– Prep, tab& cap& sprin3les

• M=A, inc+ le'els o GA4A9 in"ibits t"e kindling process or snoball.li3e eect

seen in #ania F sei$ures Nursin% 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*


20/46

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*

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&


21/46


22/46


23/46

– Nausea or abd+ Pain

– 2eelin% di$$!& unstead!& li%"t"eaded or aint

– /ereali$ation or depersonali$ation

– 2ear o losin% control or %oin% cra$!

– 2ear o d!in%

– Parest"esias

– C"ills or "ot las"es

SPECI2ICQ PH=4IA S=CIAL

• 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


24/46

• 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 o

t"e s0,– sense o detac"#ent&

– reduced a(areness o one:s surroundin%s&

– dereali$ation&

– depersonali$ation&

– dissociated a#nesia

• E0cessi'e an0iet! or (orr!& occurrin% in #ore da!s t"an not or at least ? #os&

about a nu#ber o e'ents or acti'ities

• 2inds it diicult to control t"e (orr!

M==/7 A22ECTI6E /IS=R/ERS• 4IP=LAR /7=

– 4IP=LAR I, current or past e0perience o #anic episode& lastin% at least a (ee3&

t"at is se'ere enou%" to cause e0tre#e i#pair#ent in social or occupational unctionin%+• MANIA, "!peracti'it!

• /EPRESSE/, e0tre#e sadness or (it"dra(al

• MI@E/

– 4IP=LAR II, "0 o or #ore #1 depressi'e episodes F at least "!po#anic

episode9 no #ania

• MA8=R /EPRESSI6E /7=

– least s0 o sa#e D. (3 period (it" one bein% eit"er depressed #ood or loss

o interest or pleasure+

– Sin%le episode or recurrent

– =t"er s0, (t loss& inso#nia& ati%ue& recurrent t"ou%"ts o deat"& di#inis"ed

abilit! to t"in3& ps!c"o#otor a%itation or retardation& eelin%s o (ort"lessness+

• CYCL=THYMIC /7=

– H0 o D !rs o "!po#ania (it" nu#erous periods o abnor#all! ele'ated&

e0pansi'e or irritable #oods+

– /oes not #eet t"e criteria o #ania or depression+

• /YSTHYMIC /7=

– least D !rs o usuall! depressed #ood and at least o t"e s0 o #1 depression

(it"out #eetin% t"e criteria or it

• SEAS=NAL A22ECTI6E /7=


25/46

– /epression t"at co#es (it" s"ortened da!li%"t in all and (inter t"at disappears

durin% sprin% and su##er+

/ealin% (it" Inappropriate 4e"a'iors

AGGRESSI6E 4EHA6I=R

• Assist t"e client in identi!in% eelin%s o rustration and a%%ression

• Encoura%e t"e client to tal3 out instead o actin% out eelin%s o rustration

• Assist t"e client in identi!in% precipitatin% e'ents or situations t"at lead to

a%%ressi'e be"a'ior

• /escribe t"e conse-uences o t"e be"a'ior on sel and ot"ers

• Assist in identi!in% pre'ious copin% #ec"anis#s

• Assist t"e client in t"e proble#.sol'in% tec"ni-ues to cope (it" rustration or

a%%ression

/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


26/46

• 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

• 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!

• Undifferentiated 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#sAccordin% 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%arded

as #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


27/46

– 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

• Hallucinations• Inco"erence )#ar3ed looseness o association*

• Zero7 lac3 o interest& ener%! and initiati'e

• O b'ious ailure to attain e0pected le'el o de':t

• Peculiar be"a'ior

• H!%iene and %roo#in% i#paired

• R ecurrent illusions and unusual perception e0periences

• E0acerbations and re#issions are co##on

• No or%anic actors accounts or t"e s!#pto#s

• Inabilit! to return to baseline unctionin% ater relapse

• Aect is inappropriate

Ns% /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"e

indi'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


28/46

• 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!

– 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/


29/46

– 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#

• 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


30/46

• 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!

– 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


31/46

• /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"!&

• 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=


32/46

• 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

• 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

Oter se!ual pro"le#s

• Se0ual dissatisaction )non.speciic*


33/46

• 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

• 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+ Partialism reers 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%+


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• 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 at

all+

• 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*

– coprop"ilia )eces*– 3lis#ap"ilia )ene#as*

– urop"ilia )urine*

S=MAT=2=RM /7=

• S=MATIKATI=N /7=, "0 o #an! p"!sical co#plaints be%innin% beore t"e a%e

o > occurrin% o'er a pd o se'eral !rs resultin% in ttt bein% sou%"t or si%niicant

occupational or social 0nin%+

• C=N6ERSI=N /7=, or #ore s0 o deicits aectin% 'oluntar! #otor or

sensor! unction su%%estin% a neurolo%ical or %eneral #edical condition9 preceded b!conlicts or stressors9 can:t be e0plained and sanctioned b! cultural be"a'ior+

– Most co##on, blindness& deaness& paral!sis& inabilit! to tal3

– La belle indierence

• HYP=CH=N/RIASIS, preoccupation (it" ears o "a'in%& or ideas t"at one "as&

a serious dse based on t"e person:s #isinterpretation o bodil! s0 and persist despiteappropriate #edical e'al and reassurance and "as e0isted or least ? #os+

)e+%+,e0tensi'e use o "o#e re#edies*

• PAIN /7=, pain in or #ore anato#ical sites se'ere enou%" to (arrant clinical

attention and causes clinicall! si%niicant distress or i#pair#ent in 0nin%+

Inter'entions

• /o not reinorce t"e sic3 role

• /iscoura%e 'erbali$ation about p"!sical s!#pto#s b! not respondin% (it"

positi'e reinorce#ent

• E0plore (it" t"e client t"e needs bein% #et b! t"e p"!sical s!#pto#s


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• Con'e! understandin% t"at t"e p"!sical s!#pto#s are real to t"e client

• Report and assess an! ne( p"!sical co#plaint

» ne0t

EATING /IS=R/ER 4EHA6I=RS

• 4INGE, rapid consu#ption o lar%e -uantities o ood in a discrete period o ti#e+

)A, "undrends o Cal9 4, t"ousands o Cal at a sittin%*

• PURGE, Maladapti'e eatin% re%ulation response t"at includes e0cessi'e e0ercise&

orced 'o#itin%& =C/ R0 diuretics& diet pills& la0ati'es and steroids+

• 2AST7 RESTRICT, Includes 'e%etarian diet eli#inatin% all #eat (it"out

substitutin% nonani#al sources o protein& =C about ood c"oices& and eatin% "abits+

AN=RE@IA 4ULIMIA• Rare 'o#itin% or diuretic7la0ati'e abuse

• More se'ere (t loss

• Sli%"tl! !oun%er

• More intro'erted• 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#otor

acti'it! and sleep.(a3e c!cle+

• C=GNITI6E, t"e #ental process c"aracteri$ed b! 3no(in%& t"in3in%& and

1ud%in%+


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• 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

• Insi%"t #a! be present in lucid #o#ent

• Poor but 'ariable in MSE

» ne0t

• /isor%ani$ed& ric" in content& delusional& paranoid

• No c"an%e in perception

• Poor 1ud%#ent

• No insi%"t

• Consistentl! poor F pro%ressi'el! (orsens in MSE

ALKHEIMER:S /EMENTIA

• Most co##on t!pe o de#entia

• Sta%es,

– MIL/, i#paired #e#or!& insidious loses in A/L& subtle personalit! c"an%es&

sociall! nor#al

– M=/ERATE, ob'ious #e#or! loss& o'ert A/L i#pair#ent& pro#inent

be"a'ioral diiculties& 'ariable social s3ills& super'ision needed

– SE6ERE, ra%#ented #e#or!& no reco%nition o a#iliar people& assistance

needed (it" basic A/L& e(er troubleso#e be"a'iors& reduced #obilit! ) A:s*

S!#pto#s

• AGN=SIA, /iicult! reco%ni$in% (ell.3no(n ob1ects

• APHASIA, /iicult! in indin% t"e ri%"t (ord

• APRA@IA, Inabilit! or diicult! in peror#in% a purposeul or%ani$ed tas3 or

si#ilar s3illed acti'ities


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• AMNESIA, Si%niicant #e#or! i#pair#ent in t"e absence o clouded

consciousness or ot"er co%niti'e s!#pto#s

PSYCHIATRIC /7= IN CHIL/REN

• MENTAL RETAR/ATI=N

• PER6ASI6E /E6:TAL /7=

– AUTISM

– RETT:S /7=

– CHIL/H==/ /ISINTEGRATI6E /7=

– ASPERGER:S /7=

– P// N=S

• LEARNING /7=

– REA/ING

– MATHEMATICS

–

5RITTEN E@PRESSI=N– ACA/EMIC PR=4LEM

– LEARNING /7= N=S

• 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


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– =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=

• 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"eli#itations beca#e apparent in beore B !+o+

• T"e ollo(in% ran%es& based on t"e 5ec"sler Adult Intelli%ence Scale )5AIS*& are

in standard use toda!,• Class I$ %er#s

Proound 4elo( D> IdiotSe'ere D>– I#becile

Moderate –V Moron

Mild >–?V

4orderline J>–JVRETT: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*

http://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scalehttp://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! losin% ite#s re-uired to acilitate tas3s or acti'ities& suc" as sc"ool

supplies

• E0cessi'e distractibilit!• 2or%etulness

• Procrastination& inabilit! to be%in an acti'it!

•

/iiculties (it" "ouse"old acti'ities )cleanin%& pa!in% bills& etc+*• /iicult! allin% asleep& #a! be due to too #an! t"ou%"ts at ni%"t

• 2re-uent e#otional outbursts

• Easil! rustrated• Easil! distracted

Hyperacti'ity(i#pulsi'e "ea'iour

• 2id%etin% (it" "ands or eet or s-uir#in% in seat

• Lea'in% seat oten& e'en ("en inappropriate• Runnin% or cli#bin% at inappropriate ti#es

• /iicult! in -uiet pla!

• 2re-uentl! eelin% restless•

E0cessi'e speec"• Ans(erin% a -uestion beore t"e spea3er "as inis"ed

• 2ailure to a(ait oneWs turn

• Interruptin% t"e acti'ities o ot"ers at inappropriate ti#es

• I#pulsi'e spendin%& leadin% to inancial diiculties

• 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'iorto(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


42/46

– 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 ("en

t"e bod! beco#es adapted to "a'in% an addicti'e dru% in t"e s!ste#9 occurs ("en seru#

le'els decreaseA//ICTI=N

• ALC=H=L, blood alco"ol le'els o >+ )>>#% alco"ol7dl o blood* or "i%"er

– 5ITH/RA5AL

• 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!


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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

– 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 sel

ro# 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


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• 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

– 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"anical

de'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 ore-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+


45/46

– 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

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 response

to t"e#9 can be used ater an! stressul e'ent

» ne0t

THERAPEUTIC 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+


46/46

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 nurse

as 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

• 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

Psychia Review Notes

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