* NLE * NCLEX * CGFNS * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY *

PSYCHIATRIC NURSING INHOUSE 2023

Prof. Kenneth Arzadon, RN, UKRN

Mental Disorder
Alteration in…… That affects ones:
>
perception self -
awareness
>
Personality Interpersonal Relationships
>
Mood
> Reality Orientation
Behavior
>
Thought
Activities of Daily living ( ADCs)
>
Logic
cognition
>

medications are ∅ a
therapeutic tool
p

THERAPEUTIC USE OF0

SELF ↳ most important !

Active Listening with a heart . . .

-
check
Of PX
for congruence
's words / actions

Principles:
S sit :
facing the client
0 :
open posture
↳ inhibitions !
no

L :
Lean forward
F
Eye contact
:

↳ most
important principle
R : relaxed

reliable form
p more of communication

NON-VERBAL communication
Paralanguage – Tone Volume Intonation ,
,

Proxemics – study of distance

Intimate ( 1.5ft )
Professional ( 4ft) ④ →
distance to respect the
patient 's personal space

Social ( 12ft)
Public ( 15ft)

VERBAL Communication
Sympathy vs. Empathy
Nurse 1: “I feel sorry for you.” Focuses on

→
the nurse

Nurse 2: “I see you are sad.” →

focuses
the
on

patient

Nurse 1: “It must have been very difficult for you to lose you sister when you needed her most.”

Nurse 2: “I know what it felt like to lose a sister, I lost mine when I was six.”

OFFERING SELF
make them feel that
→
someone is willing
to listen / be

[
there .

“I’ll sit with for a while”

SILENCE
↳ am , µ
, , www..my , ,,
•

maintain eye contact ; px

's
peripheral vision
check non -
verbal cues

BROAD OPENING
↳ allows the
patient to direct the conversation

“How are you feeling today?”

“Is there something you’d like to talk about?”
encourages the patient to talk more about the topic
p
EXPLORING
“Tell me more….” " "

↳ alternative for WHY

a
good .
. .

( demands an

explanation ]

1 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
 GENRAL LEAD
“Go on.”
“And then?”
conveys understanding

⑧ RESTATING
of patient 's statement ;
→ ↑ confidence to express /
communicate effectively

CLIENT: “I can’t sleep. I stay awake all night.”

NURSE: “You have difficulty sleeping.”

SEEKING CLARIFICATION ∅ Assume !

1.
→

Client: “I’m-
feeling sick inside.” ↳ could mean a lot of things

Nurse: “What do you mean by ‘feeling sick inside?”

±¥Ff%%i TRANSLATING INTO FEELINGS -

Client: “I’m way out in the ocean.”

Nurse: “You seem to feel lonely.”

>"Pfnnt9VeÑonsiP÷
suicidal

VERBALIZING THE IMPLIED >

statements are a call for help

CLIENT: “Life is hard. I want it to be done. There is no rest. I just want to sleep and never wake up.”
NURSE: “I hear you saying things seem hopeless. I wonder if you are planning to kill yourself.”

alternative
PLACING EVENTS IN SEQUENCE → also an
for YYHY ?

“Describe where you were and what you were doing when you collapsed.”
Cognitive Behavioral Therapy
Patterns of patient 's thoughts (thoughts → Behaviors )

[
IDENTIFYING THEMES
@ “What comes into your mind each time you….?”
“What do you do each time you argue with your wife?”

FORMULATING A PLAN →
for px w/ anger
management issues

“What could you do to let your anger out harmlessly?”

""" "
" " " "" " " " " "
°

[p allows Px to organize their own

thoughts
REFLECTING
p@
nurses are ∅ :

CLIENT: “Do you think I should tell my dad?”

]
>
agree
>
disagree nurses should promotes
>
argue independent decision making
NURSE: “What do you think would work best?” >
>
challenge
give ideas /
opinions

p acknowledge first then motivate

SUPPORTIVE CONFRONTATION
''I know this isn't easy to do, but I believe you can do it.“
“It would be difficult at first, but you’ll get through it.”

ENCOURAGING COMPARISON → EVALUATION .

.
.

“What is different about your feelings today?”

Non – therapeutic communication [ SBRR ]

Stereotyping: “Just have a positive attitude.”
Belittling: “Everybody gets down in the dump”
Reassuring: “Everything will be alright.”
Requesting an explanation: “Why”

µµµµµm,
"
"

I can see
•

. . .

" "

You seem
•

. . .

''

You sound
"
•
. . .

"

It seems
"
•
. . .

2 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
?⃝
NURSE-PATIENT RELATIONSHIP
Most Important Element: _________________
Acceptance → nurses can
refuse endorsement !

Purpose: ____________________________________________
To facilitate helping relationship a

Professional Relationship
Elements of a contract:
>
Time Duration Venue , ,

>
Termination
> Patient / Nurses responsibilities
Importance :

Phases of Nurse Patient Relationship (POWT)

PRE – ORIENTATION ⑧ Resp .
Goal Problem

Nurse’s Responsibility: Read the px 's charts

( cover - to -
cover ]
PR Orientation
-
read chart
introspection pentane ,
nurse

Goal: hurting DX peristome of

/ Introspection
orientation RAPPORT µ
self - awareness
↳ ways to ↑ : good whir mat .

assertive Comm .
attachment
① Resolve issues

Working
Your Past conflict
autobiography /
◦
T C Farmer
@ Determine your own thoughts / beliefs
③ Determine your pre -

conceptions

errand intern
determine feelin sepang
.
.

termination

Problem: Hesitance of the nurse

P 1st face to face contact w/ patient

ORIENTATION
-
-

Nurse’s Responsibility: Formulate your nursing diagnosis

Goal: Establish rapport l trusting relationship )
↳
ways :

◦
set the contract w/ the patient
Involve the patient in
planning
°

÷*""*i÷i
%

A-:$
: ÷ :÷ ;€*
Problem: Resistance of the Patient

* *
¥
:
•

WORKING
Nurse’s Responsibility: set good working relationship
→
longest phase of
nurse -

patient
relationship

a
.

×
¢ .

⑧oB⑤¥§

$
Goal: Assertive communication Encourage
verbalization of feeling
#
Problem:
↳
"" " " "" " " "" " "
M" %¥¥¥¥8¥8¥⑧⑧ "

Transference ( RN ) PF> µ
>
A*i%¥{
can
/
Countertransference (
be (t) t)

"
) RN → PT ,
↳ nurses are the ones on the counter "

Intervention:
>
Remind the
px about the contract
>
redirect the emotions
of the px
> Let the verbalize
px to

TERMINATION
Nursing responsibility: Determine the px 's feelings about the termination of relationship
Goal: Evaluate the effectiveness of interventions
Problem: separation Anxiety lsepanx)
↳ this is normal !
↳ could be ( t ) or C- )

contract
Prevention: constantly remind the px about the
Intervention: the power of verbalization

3 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
FREUD’s STRUCTURAL THEORY OF PERSONALITY
3 components of the mind
Failure of
ego to balance
ID Id vs
superego results
in :

•
pleasure seeking component of the mind >
Anti -
social

•
Seeks immediate gratification > Borderline personality Disorder

EGO >
schizophrenia ( splitting of the mind /soul )
•
Balancer ; Real you °

Ambivalence

SUPEREGO >
Anorexia nervosa

Disorder
>
Obsessive Compulsive
•
Conscience ; Guilt feeling

EGO DEFENSE MECHANISMS feeling of helplessness

µgyg
Protect the ego from the

D
Denial Alcoholism
Refusal to accept the truth
-

Regression Alzheimer 's

-
return to early stage of der 't
schizophrenia

Identification
-

Becoming the person you admire

Introjection
-

Blaming self major depressive disorder

dislike Bully
Becoming
-

the person you

bi bintang
"
"

Projection
hang

Paranoid
Blaming others
-

Displacement
↳ can be (t) or
f)
"
Kick the cat

hang b abating
phenomenon
"

are being displaced to an object Phobia

-
Emotions ↳ irrational
fear

less
threatening person
acrophobia ( neighs )
or a eg .

Reaction Formation main problem

main SX :
:
Depression
mania to conceal
j
g.
"
mask of Depression
"

Actions are not parallel w/ your emotions ↳ Bipolar Disorder

-

( 2 opposing emotions
]
-

Undoing
OCD
Doing something to relieve guilt feelings
-

0Suppression
↳
"

sinasadyang / Pil it kinakalimutan

"

pilot of appetite
-
Conscious forgetting An nervosa suppressing hunger
c)

Repression
-
Unconscious forgetting Amnesia

Dissociation
Multiple Personality Disorder
-

Forgetting w/ change in
identity
Dissociative Fuge

Rationalization
-

making excuses that are unjustifiable Anti social Disorder

-

Intellectualization [
High functioning
levels of :

↳ "
acknowledges
"
the situation but not the emotions Anxiety
It is God 's will .

Substitution
Unattainable to something that is achievable
easily
-

big to small

0
Compensation
↳ C pacquiao
manny
" "

in other areas
overachieving
-

-
small to big

Sublimation
-

bad to good

ng lalaki ,
"

Pare pareho
"
Lahat

Splitting
-

Borderline personality
-

seeing people
as either good or bad Disorder

4 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
 SYMPTOMATOLOGIES OF MENTAL DISORDER
Disturbances in PERCEPTION
• Illusion misinterpretation of
external stimulus

• Hallucination misinterpretation of
sensory stimulus Management:
▪ Visual (psychedelics) >
marijuana
,%%ation H all
not ↳
uci nation must be recognized
patient m⑤"n9 may be ;
"
It seems
"
first
Do "
.

▪ Tactile (formication)
. .

> alcohol
↳
"

as
withdrawal

if bugs are crawling

under the skin
" onto A
↳ check
content of hallucination
egg
for
the
safety issues ;
"

what are the voices telling you ?

"

▪ Olfactory (Phantosmia) f.
closely associated w/ emotions
> PTSD
/ Posttraumatic stress Disorder
) R ity presentation
eat
↳" I know the voices seem real but I don't hear them ,
let's take a look at the Flowers !
"

▪ Gustatory (aura of seizure)

Reorient Distract !

D patient
Acknowledge
-

, ,

taste
> metallic
istract the

▪ Auditory (command auditory) ↳

> Schizophrenia

type of hallucination
most dangerous

• ↳Synesthesia 's senses

mixing of one

the colors
>
hearing
the sound
>
seeing

Disturbances in THOUGHT
reflection

• DELUSION
Could be a

↳
false belief
of past experiences
Management:
▪ Grandiose [ px believes he / she
superior / invulnerable
is
] C larify the content of the delusion "

i identify where the delusion comes from

delusion
↳ "
when
what do you mean

▪ Persecutory [
.
.

A knowledge the emotions but not the

.

px
will
believes that someone
them
] c. ,
kill / harm
↳ validate ! "
I can see
"

∅ᵈisⁿ
▪ Somatic [
. . .

]
believes that
V ice doubt
PX
→
helps the px have second / reorganized thoughts
he in ill / sick 0
∅ agree
"

↳ "

but I don't see j ∅ disagree to avoid conflict

▪ Nihilistic [
.
. .

believes that
. . .

missing ]
px
Engage in reality based activities
a
-

body part is
↳ ∅ play along
painting gardening
▪ Erotomanic [ px believes that someone
]
.

is in love w/ them

Ideas of Reference )
"

( Referential
"
Delusion
↳
giving meaning to the action
of others .

px eventually answers ]
Circumstantiality [ the
question
provides
unnecessary
details →

Tangentiality [ px didn't
the
answer

question
]

P fragmented thoughts (Walang connection

Yung mga vinasa

Looseness of Association (derailment)

Flight of Ideas
↳
speech jumping from one topic to another that could be related
rapid

UNUSUAL SPEECH PATTERNS

Neologisms [ coining of meaning ] new words

B
"¥¥¥i¥*;↑¥
hx : ask the

Schizophasia [
Clang associations
"
word salad
orange Sky Dirt
, ,
"
]
[ Rhyming of
"

mother has a
words
feather ]
*:
"
due to weather

Echolalia [ repeating ]
words
of others

Palilalia [ ] Repeating
own
one 's

words

Verbigeration [repeating own phrases

]

Stilted language [ Flowery

Perseveration [ Adherence to
single topic
]
words

a
]
§
1
external emotions
P mood -
internal emotions

Disturbance in Affect
Flat [ ] no emotions
withdrawn Minimal disorder

Blunt iii. depressive ] major

"
disorder

Rest single
Inappropriate [ 7ie%i¥aIFY]
.
em

schizophrenia
Restrictive [ ] single emotion
paranoid
shift in emotions
La bile [ bipolar
sudden
] disorder

Disturbances in Memory
p inability to recall / remember

Amnesia
%

|
" " " " "" " "
Retrograde a traumatic event

Anterograde [ ∅
a
recall events
traumatic
after
event
]
↳
inability to form new memories

Confabulation true to
making
are
↳ stories that not
losses
fill the gap between memory

5 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
?⃝
 ANXIETY
Neurotransmitter: Gamma aminobutyric acid [ GABA ) ↳ neurotransmitter
inhibitory
( ↑GABA )
Characteristic: Contagious )
' " ↳s ↳
Pregabalin : Anticonvulsant
'

↳
↓ GABA =
KABA

Initial Nursing Action: self awareness -

↳
Determine your
own level of anxiety

• Priority: safety ( stay w/ the px ) Suicide

severe level →
◦

Anxiety →

Drug of choice: Benzodiazepines C- 1am ,

-
pam )
>
Diazepam >
Alprazolam

↳
>
lorazepam >
Clonazepam

anxiolytic Respiratory depressants

= <

+ alcohol Resp A-
Benzodiazepines
= .

Avoidakoho@Flumazeni1LRomazicorDmWhx.mgt
Nursing education:
Antidote:

LEVELS OF ANXIETY .

" "" " "" "

" "

acknowledgement
MILD effective
more

normal level of anxiety verbalization

←
↑
alertness

Pacing
Paulit -
Wit ( Circumstantiality)
Parasympathetic response redirect the patient
MODERATE ↳ Para : Tae [ Diarrhea
) (t ) Diaphoresis
tinier urination
Dura [ ↑
]
Salivation ]
→ misses few
Coral
anxiety tics
Narrowed perception details

Physical manifestations Psychological ,

causes

somatic manifestations ↳
Blindness ,
Paralysis

SEVERE ¢ complete a
task
1M
anxiolytic
∅ be redirected

∅ solve a problem

violence , hallucinations
PANIC delusions
,
restrain PRN

g,pg,na,,µ
↓
DSM -5
basis of diagnosis

ANXIETY RELATED DISORDERS

OBSESSIVE COMPULSIVE DISORDER
Obsession Repetitive thoughts
i. ••oaaga•%•
Bahamian

*ⁿ;*ÑBg%
Compulsion Repetitive actions -

¥ x ¥E↑E¥ ¥É*µ¥ ¥
•¥;?o:%¥¥Q
0E•:• •
.

÷÷÷ !gg¥:B¥!☒
Defense Mechanism: Ritualistic
Purpose ↓ anxiety :
Behaviors
:*:* .
}

Management:
1. Allow px to perform the ritual
2. Adjust the schedule of px
3. Gy limit the rituals
P Displacement !

PHOBIC DISORDER '

.
Irrational Fear

Social Phobia Fear of interacting w/ strangers :

[
3 main open spaces !

types of Agoraphobia Fear of inescapable places '

.
→

Phobia
Specific phobias: all other types of phobias
Claustrophobia Fear of closed spaces i

Nosocomephobia Fear of hospitals :

Thanatophobia Fear of death i.

Necrophobia Fear of dead people ^

Defense Mechanism: Displacement

Management:
1. Flooding Sudden Exposure '

. to maximum stimulus

2. Systematic Desensitization
↳ spiders
'

.
Gradual exposure
↳ Gradually
to feared object
Arachnophobia : Fear of
place the feared object
1.) Place spider in a bottle to familiar places . .

2) Place spider on a table

3) _ . - and so on

6 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
 EATING DISORDERS ] a lack of love / attention
Desire to seek

[ affection / validation ]

Psychodynamics: Parental Antagonism / Harassment

↳
causes !
overprotective Parents
-
Enmeshment ( lack of Boundaries]
[ Desire to be
in ↳ HM ]
Sociocultural factor: Dev 't Press u

Age group: Adolescent ( 18-24 y to)

Neurotransmitter: ↓ Serotonin/ norepinephrine

↳
same in major Depressive Disorder

Anorexia Nervosa → LIFE THREATENING -

Bulimia Nervosa
I *

Perfectionist
↓ food intake ; ↑
> can also
purge activity
Anger Cycle
)
( ma,

sa
ammonia
Bulimia nervosa)
,
Hunger _
psm.is :

>
Self Restricted Diet * '× / week for 3- 4m " !

↓ purge syndrome
>
tatsBinge
-

Compulsive Exercising
> too
many/fast induced
_
"
'
vomiting
↳ Rigorous
Complications : ) Russ /es sign _
scarring 4-

www.agepnmemJ
nx : Distract the client the Knuckles
;
Invite them to
engage in other activites ( walk )
Alopecia [ ↓ "" N ) >
Aware
Encourage client to verbalize during me walk
>
Of the problem
Ritualistic Food Behaviors
>
Anemia (↓ Fe Vit Ba B
9) ( Guilt
feelings → undoing )
,
.
,

)
> mechanism
compensatory
↳ cuts food into small pieces
>
Lanugo ( as

in
an alternative for

thermoregulation
Fat

>
knowledgeable abt . Food
>
∅ refuse to talk abt .
food Complications :

> Tooth
Decay
>
Hypokalemia (¥:¥¥e:)
>
preoccupied w/ eating behaviors
Bleeding "÷÷÷÷÷
>
> Gastric Ulcer Rectal when food has reached

> unaware ,,

NURSING DIAGNOSIS:
- Electrolyte imbalance ☆
↳
nursing priority Easily manageable ;
-

- Altered Nutrition ↳
Long -
term management

_____ BODY IMAGE DISTURBANCE *

↳ how the px perceives his body

_____ ALTERED BODY IMAGE ↳ actual

deformity in the body of px
↳
amputation mastectomy bums, , ,

colostomy

INTERVENTIONS:
] Plan meals w/ the client
meals
>
Time limit during
⑧ the client after meals
Supervise
>

the bathroom
↳ px
when going to
accompany

PSYCHOTHERAPY:
Self monitoring [ diary
]
> -
Instruct px to keep a
of food intake
emotions / Reflections
& a
journal for
↳ other →
allows the client to associate their food intake & emotion w/ each

1
>
Cognitive Behavioral Therapy

)"""""
EVALUATION: ( 9) BM /
normal

18.5 -
:

24 .

Happy hormones
q
MEDICAL TREATMENT: SSRIs ( selective
↳
snReuptake Inhibitors
safest / best antidepressant

qpaHemof0
PERSONALITY DISORDERS: ↳ personality affects interpersonal relationships
•Bai*

Cluster A
• Paranoid Absence of trust :

odd / Eccentric mad

/
[
• Schizoid Aloof / Alone Asocial
• Schizotypal Superstitious Magical Thinking
:

:
,

,
/ anting anting / Charms
"

accessories
"

ing
-

↳ Characteristics : Maram

Cluster B
• Borderline Unpredictable mood [ ]
has unstable

: relationships

§
• Antisocial Law Breakers :

their

• Histrionic Attention Seekers [ ]

uses
Baa , erratic
& actions
appearance
:

• Narcissistic Self entitled [

Denies any form of
] :
-
weakness / failure

↳ common in : politicians / Famous personalities

Cluster C
• Avoidant ∅ Responsibilities :

[• Dependent ∅ ☒ de their
"

" " °" °" "

""
" " " """ "
""

Obsessive compulsive Perfectionist/ Detail : -

oriented

• Passive aggressive ∅ Refuse Plastic

" "

: ,
↳
tanggaplangnangtanggap

Management: Behavioral Therapy @ roleplaying ) g.

back to community
Goal of Management: to help px to go
Establish meaningful relationships

7 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
 Eugene Bleuler

p
:ñm%iiia%ñix
"

[ sohizen splitting
-

SCHIZOPHRENIA ↳ no cure , manageable ①

Phren -
diaphragm

DSM
CRITERIA IN THE DIAGNOSIS OF SCHIZOPHRENIA
←

•
2 or more of the following for at least 1 month.
> Hallucinations > Catatonia
↳ lack of movement
>
Delusion >
neg . S / SX
Disturbed
>

thought processes

BIOLOGIC THEORY chance

① Genetics: Hereditary [ k%i÷iÉ% ] zp 's

Predisposing / :)
All mental disorders

Neuroanatomy: ↓ CSF ↓ Brain tissue

l "
¥:S:
are

but
hereditary
no± us '
,
Precipitating [ life
>
-

exp
Threshold
.

=
↑ risk ]
l
protective [ coping
mechanisms ]
↑ serotonin ↑ Dopamine
Neurochemistry: ________________________________________ ,
neumim
Social Causation Hypothesis: ↓ socioeconomic status = ↑ risk
unhealthy foods
°

inaccessible
•

healthcare

4As of Schizophrenia (Prof. Eugene Bleuler)

Autism [ longer
reality
contact
]
no
w/
in _

Ambivalence [ feelings
opposing
]
2

Associative looseness [∅ ∅
communicate
connect ]
Abnormal affect [ FBIRL ]

SIGN AND SYMPTOMS OF SCHIZOPHRENIA

POSITIVE Signs of Schizophrenia i. ↑ Dopamine

↳ Disturbances
in thought / perception

@
NEGATIVE Signs of Schizophrenia
↳
:

↳
↑ Serotonin
Disturbances in emotions
Lacks
something

Asociality :X social life

Avolition :X motivation
Anhedonia :$ pleasure
Alogia :O speech ; mute
Abnormal affect FB④L i

↳ most common in :

↓ Catatonia purposive schizophrenia

i
"

flexibility
"

waxy movement
∅

TREATMENT MODALITY (Schizophrenia)

1st generation P
ends in
"
-
zine
"
2rd generation
*

ends in "

Chlorpromazine
"

TYPICAL / CONVENTIONAL ATYPICAL

pine
" "
◦ -

-
done
,

thioñdazine
°
◦

Olanzapine ◦
risperidone
◦
flu phenazine ↓ °
Quetriapine °
brazed one

High end meds Clozapine zisprasidone

-

Ha Idol ( Haloperidol
° ° °

)
{
•
↑
potency
torpx that
1st gentle
exception
:[%"a%% ] 1st generation
are

hallucinating .
'

MOA : ↓ Dopamine
of ( t )
ism]
SX
Mgt .

SE : Pseudo parkinson ↓ serotonin & ↓

Parkinson 's caused by ↓ Dopamine
MOA :
Dopamine
CI : ∅ Elderly ( 65710) > most of f)
-

SX

④ for elderly

3rd generation ÷
Long Term Injection eg .
Haloperidol
decanoc⊕z
DOPAMINE SYSTEM STABILIZERS " "
DEPOT THERAPY µ µ
,, , mm, ,

↳ ends in -

Zola
◦
Aripiprazole
Brexpiprazole Factors that could affect
◦

non-compliance
MOA : ↑ ↓
/ sensitivity of dopamine receptors
°
Side
effects
↓ balance in dopamine
Inaccessibility
SE
due to
: °

Memory loss
°

8 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
 SIDE EFFECTS OF ↓ ANTIPSYCHOTICS
parasympathetic ] Anticholinergic [ opposite of
Physio >
Psycho
sounder 's 8th edition
Constipation [ fiber]→
"

↑ oral Residue diet

"

High "

High Roughage diet

"

↑
19000
Agranulocytosis [ ]→ normal 15000
: -

↓ WBC A risk for infection

◦
report fever/ sore throat

Tooth decay [ candy ] suck on

hard
sugarless ↓
cavity

,
stimulates salivation
l

Dry mouth
[ ]
gradually
Orthostatic hypotension reposition
client
the

in breasts

Galactorrhea [ ] presence of milk

wear cotton clothing

SPF 15 ↑

Photosensitivity [%dE.fi?gEFF-
umbrella
☆

Arrhythmias [%EEF.be ] at

Weight gain [∅ sugary food intake ]

machineries ]
Sedation [ ∅ driving / operating

Extra Pyramidal Syndrome

cause : ↓
Dopamine
components i Dysphagia / Drooling diff swallowing
[ ]
- .

crisis
◦ • ↳
%
"'
spasm of eye muscles
-

Dystonia -

uncontrollable muscle contraction torticollis -

contraction
of neck muscles
Akathisia -

restlessness ∅ sit still

Drugs to my
,
> Eps :

)J
Pseudo parkinsonism
{ :}
parkinson - like manifestations
tremors A Kineton -

biperidin
=
hx Mgt : Altered gait
Benadryl -

diphenhydramine
cogent n
'

notify physician / ∅ discontinue to ∅ relapse benz tropine

-

mx Mgt :

shifting of medication ( 1st → 2nd / 3rd )

Neuroleptic Malignant Syndrome ⑧ Most fatal SE of anticholinergic

Fever → Muscle spasms →

laryngeal Spasms
( also , seizures ) ( airway obstruction = Do B)

hxmgt : Discontinue medications !

Relapse > seizure / Death
muscle
MX
Mgt :
Baclofen →

relaxant

⑧ Prevention ↑ !
:
Hydration

Tardive Dyskinesia
$1
↳ late
difficulty moving

gµ9ue
Protrusion
'
last possible SE of anticholinergic drugs
↳
only appears after 6 months
of treatment Ong ul twisting
↳ the
of drugs in
body
grinding
accumulation
eeth
> Permanent / Irreversible
ip smacking
notify physician
>

>
mx Mgt : Val ben azine ( Ing re 229)
↳ start w/ the lowest dose

9 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer