Quick Review Psychiatric Nursing 2

8/6/2019 Quick Review Psychiatric Nursing 2

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QUICK REVIEW PSYCHIATRICNURSING


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Ego Defense Mechanisms

Denial

Displacement

Projection Undoing

Compensation

Symbolization


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Substitution

Introjection

Repression Reaction formation

Regression

Dissociation

Suppression


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STAGES OF GRIEVING (Dying

patient) Denial

Anger Bargaining

Depression

Acceptance


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Bipolar Disorder

Assessments Disoriented, flight

of ideas

Lacks inhibitions,

agitated

Easily stimulated

by environment

Sexually indiscreet Affective disorder

Maintain contact

with reality

Elation is defense

against underlying

depression

Manipulative

behavior resultsfrom poor self-

esteem


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Bipolar Disorder

Implementations Meet physical

needs first

Simplify

environment

Distract and

redirect energy

Provide externalcontrols

Set limits:

escalating

hyperactivity

Use consistent

approach

Administer Lithium

(help Manic Phase

of Bipolar, keep

hydrated)

Increaseawareness of

feelings through

reflection


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Schizophrenia

Assessments Withdrawal fromrelationships and

world

Inappropriate

display of feelings

Hypochondriasis

Suspiciousness Inability to test

reality, regression

Hallucinations

Delusions

Loose associations

Short attention

span

Inability to meet

basic needs:nutrition, hygiene


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Schizophrenia Types

Disorganizedinappropriate behavior,

transient hallucinations

Catatonicsudden onset mutism,stereotyped position, periods of

agitation

Paranoidlate onset in life,

suspiciousness, ideas of persecution

and delusions


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Schizophrenia

Implementations Maintain safetyprotect from erraticbehavior

With hallucinationdo not argue, validate

reality, respond to feeling tone, never

further discuss voices (dont ask to tell more

about voices)

With delusionsdo not argue, point outfeeling tone, provide diversional activities

Meet physical needs

Establish therapeutic relationship


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Schizophrenia

Implementations Institute measures to promote trust

Engage in individual, group, or family

therapy Encourage clients affect

Accept nonverbal behavior

Accept regression Provide simple activities or tasks


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ParanoidAssessments

Suspiciousness

Cold, blunted affect Quick response with anger or rage

Paranoid Implementations

Establish trust

Low doses phenothiazines for anxiety

Structured social situations


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SchizoidAssessments

Shy and introverted

Little verbal interaction

Few friends

Uses intellectualization


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Schizoid Implementations

Establish trust

Low doses phenothiazines for

anxiety



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SchizotypalAssessments

Eccentric

Suspicious of others

Blunted affect Problems with perceiving,

communicating


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Schizotypal Interventions

Establish trust

Low doses neuroleptics to

decrease psychotic symptoms



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Antisocial Assessments

Disregards rights of others

Lying, cheating, stealing, promiscuous

Lack of guilt Immature

Irresponsible

Associated with substance abuse


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Antisocial Implementations

Firm limit-setting

Confront behaviors consistently

Enforce consequences Group therapy


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Borderline Assessments

Brief and intense relationships

Blames others for own problems

Impulsive, manipulative Self-mutilation

Women who have been sexually

abused Suicidal when frustrated, stressed


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Borderline implementations

Identify and verbalize feelings

Use empathy

Behavioral contract Journaling

Consistent limit-setting

Group therapy


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Narcissistic Assessments

Arrogant lack of feelings andempathy for others

Sense of entitlement Uses others to meet own

needs

Shallow relationships

Views self as superior to

others


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Narcissistic

Implementations Mirror what client sounds like Limit-setting

Consistency Teach that mistakes are acceptable


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Histrionic Assessments

Draws attention to self

Somatic complaints

Temper tantrums, outbursts Shallow, shifting emotions

Cannot deal with feelings

Easily influenced by others


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Histrionic Implementations

Positive reinforcement for other

centered behaviors

Clarify feelings Facilitate expression of feelings


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Dependent Assessments

Passive Problem working

independently

Helpless when alone

Dependent on others for

decisions Fears loss of support and

approval


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Dependent

Implementations Emphasize decision-making Teach assertiveness

Assist to clarify feelings and needs


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Avoidant Assessments

Socially uncomfortable

Hypersensitive to criticism,

Lacks self-confidence

Fears intimate relationships


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Avoidant Implementations

Gradually confront fears

Discuss feelings

Teach assertiveness

Increase exposure to small

groups


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Obssessive-compulsive

Assessments

High personal standards for

self and others

Preoccupied with rules, lists,organized

Perfectionists Intellectualize


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Obssessive-compulsive

Implementations

Explore feelings

Help with decision-making

Confront procrastination Teach that mistakes are acceptable


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Manipulative behavior

Assessments Unreasonable requests for

time, attention, favors

Divides staff against eachother

Intimidates others Use seductive or disingenuous

approach


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Manipulative Behavior

Implementations

Use consistent undivided staff

approach

Set limits

Be alert for manipulation

Check for destructive behavior Help client to see

consequences of behavior


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Acute Alcohol Intoxication

Drowsiness

Slurred speech

Tremors Impaired thinking

Belligerence

Loss of inhibitions


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Acute Alcohol

Implementations Protect airway

Assess for injuries

Withdrawal assess

IV glucose

Counsel about alcohol use


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Alcohol Withdrawal

Assessments Tremors

insomnia

anxiety

hallucinations


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After WithdrawalDelirium

Tremens Assessments

Disorientation

Paranoia

Ideas of reference

Suicide attempts

Grand mal convulsions


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Alcohol Withdrawal

Implementations Monitor vital signs, especially pulse Administer sedation, anticonvulsants,

thiamine (IM or IV), glucose (IV) Seizure precautions

Quiet, well-lighted environment

Stay with patient


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Chronic Alcohol Dependence

Assessments

Persistent incapacitation

Cyclic drinking or binges

Others in family take over

clients role

Family violence


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Chronic Alcohol Dependence

Implementations

Identify problems related to drinking

Help client see problem

Establish control of problem Alcoholics anonymous

Antabuse

Counsel spouse and children


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Wernickes Syndrome

Assessments Confusion

Diplopia, nystagmus

Ataxia

Apathy


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Wernickes Syndrome

Implementations

Thiamine (IM or IV)

Abstinence from alcohol


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Korsakoffs Psychosis

Assessments Memory disturbances withconfabulation

Learning problems Altered taste and smell

Loss of reality testing


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Korsakoffs Psychosis

Implementations

Balanced diet

Thiamine

Abstinence from alcohol


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MEDICATIONS

PYSCHIATRIC


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ANTIPSYCHOTICMEDICATIONS

C

O R

C

H F


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Also called major tranquilizers/neurolepticmedications

Improve the thought processes and the

behavior of the client with psychoticsymptoms.

Typical antipsychotic (C-H-F) are good forPOSITIVE symptoms (hallucination,

delusion, aggression) Atypical antipsychotic medications (C-O-R) are good for NEGATIVE symptoms(withdrawal, apathy, alogia)


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ANTIPSYCHOTIC

ME

DIC

AT

IONS

Liquid form (mixed with fruit juice) is

preferred than tablets (some clients

hide the tablets)

Full therapeutic effect occurs at 3-6

weeks. Observable response may

occur at 7-10 days.

May change the color of the urine to

pinkish/red brown


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ANTIPSYCHOTIC

ME

DIC

AT

IONS

The antipsychotic

medications have

ANTICHOLINERGIC andEXTR-PYRAMIDAL side

effects.


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ANTICHOLINERGICSIDEEFFECTS

are usually ALL down EXCEPT for

PULSE RATE! (Effect is

TACHYCARDIA)


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EXTRA-PYRAMIDALsigns (EPS)are PD-ANT

P

D

A

N

T


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TO REVERSE P-D-A, give

ABC! (ABC mo lang yan!)

Pseudo-parkinsonism

Dystonia

Akathisia


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DEPRESSION

3MAJORGROUP of DRUGS for

DEPRESSION are:

Tricyclic anti-depressant (TCAs); Selective serotonin inhibitors (SSRIs)

Monoamine oxidase inhibitors

(MAOIs)


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MOSTCOMMONTricyclic anti-depressant (TCAs) are

TAE-ICA

T A

E

I

C

A


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TCA

Therapeutic effect occurs at 2-4

weeks (observe patient for suicidal

attempt at this period)

Cardiac problems (dysrhythmias) are

adverse reactions to the drug. ECG,

cardiac monitor may be used.


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TCA

Anticholinergic side effects should be

addressed (D BUSS). Avoid alcohol

and OTC

Seizure threshold decreases, prone

to seizures


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SELECTIVESEROTONIN

INHIBITORS (SSRIs)

Inhibits serotonin reuptake and elicits

antidepressant effect

Avoid taking St. Johns Wort/MAOIs

while taking SSRI (leads to serotonin

syndrome; muscle rigidity, elevated

CPK and temperature)


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Most common SSRIs are S-P-F.

Sertraline (Zoloft)

Paroxetine (Paxil) Fluoxetine (Prozac) and bupropion

(Wellbutrin) taken in AMto prevent

insomnia


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SSRI

Serotonin syndrome occurs when St.Johns wort/MAOIs are concurrentlytaken

Should take the drug in AM if it causesinsomnia

Report PRIAPISM. Withhold the drug

Instruct the client not to drive, changeposition gradually, and taper the dosegradually


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MONOAMINEOXIDASE

INHIBITORS (MAOIs)

Inhibits monoamine oxidize to

increase the levels of norepinephrine

and serotonin. These eventually

improves the mood of depressed

client

The drug is ONLYgiven if TCAs,

SRIs and even ECT were noteffective.


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MONOAMINEOXIDASE

INHIBITORS (MAOIs)

1. AVOID amphetamines, TCA/SSRI,

epinephrine, dopamine

THYRAMINE-RICH foods, and

vasoconstriction medications (may

lead to hypertensive crisis)


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Most common MAOIs are the Pa-

Na-Ma


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Monitor BP regularly. Withhold if withheadache, neck stiffness/soreness andpalpitations. (Hypertensive crisis is anadverse reaction, prepare to administerphentolamine; Regitine)

Avoid thyramine-rich foods (ABC), TCA,SSRI, narcotics, Flexeril (muscle relaxant)

Observable therapeutic effect occurs at 3weeks (observe for suicidal attempt at thistime)


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Avoid thyramine-rich foods (ABC),

TCA, SSRI, narcotics, Flexeril

(muscle relaxant)

Observable therapeutic effect occurs

at 3 weeks (observe for suicidal

attempt at this time)


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Instruct patient to avoid caffeine and

OTCs, and sudden change of position

Should ALWAYS wear medic alert

bracelet that MAOI is being taken


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COMMONFOODSHIGH in

THYRAMINE (Should be avoided

when taking MAIOs)

ABCs MOST of them and those

preserved foods or foods THAT

REQUIRE BACTERIA/MOLD for their

PREAPRATION/PRESERVATION


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Alcohol/red wine/beer/sherry

Avocado

Banana, papaya or over ripe fruits

Beef/chicken liver Brewers yeast

Broad beans

Caffeine-containing products

Cheese (aged cheese NOT the cottagecheese)


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And those PRESERVED FOODS

Pickled herring

Raisins

Sausage, bologna, pepperoni, salami(Think of pizza)

Sour cream

Soy sauce Yogurt


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END

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Quick Review Psychiatric Nursing 2

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