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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
Structured social situations
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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
Structured social situations
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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
Thank you
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