PSYCHIATRIC NURSING Psychiatric Nursing

Sir Jay Balicha  Interpersonal process (Core)

 Therapeutic self (Tool)
If your nurse supervisor instructed you to check the CBG of o Acknowledging the feelings of the pt.
your patient at 6 pm and you found out that the CBG is 45 o Self-awareness
mg/dl. What would be your initial nursing action?
Best answer: Report to your nurse supervisor. Mental Health
 Ability of a person to adjust to any type of stress
Best way to extinguish the fire on your patient’s clothes.  Criteria:
Best answer: Immerse the patient on the pool. o Self-Acceptance
You entered the room of a patient and noticed a small fire Mental Illness
inside the trash can. Which of the following is your initial  Disturbance of thoughts (beliefs), feelings, behavior.
nursing action?
Best answer: Extinguish except of cover. Risk Factors towards development of Mental Illness
1. Poverty
Best response when patient is seeing objects. 2. Abuse
Acknowledge patient by saying “I understand that you are 3. Hereditary
seeing things again”
Presenting reality – with acknowledgement Precipitating (Modifiable)
Predisposing (Non-modifiable) – Hereditary
Discount on Senior Citizen:
12% Vat
20% Discount Major Psychotic Signs and Symptoms
1. Altered Sensory Perception
“I think the cord of an iron is a snake” a. Hallucinations
Delusion  Without external stimuli.
Keyword: “think” b. Illusions
 With external stimuli.
“There are so many tiny people at the back of this building.”
Delusion 2. Altered Thought Process (Belief, Language)
Patient did not see. He was just telling the nurse his a. Delusions
thought.  False belief.
Examples:
“I saw many tiny people at the back of this building.”  Grandeur (VIP)
Hallucination  Persecution
 Control
“I saw many tiny people at the back of this building while  Religion
staring at the grass.”  Ideas of Reference
Illusion  Always relate self with the
environment.
Best way to lower progression of Alzheimer’s:  Anything one perceives
Enhance memory such as recall when asking for food relates to his own destiny.
preference. b. Echolalia
c. Word salad
Hallucinations and delusions  Mixing words without making sense
Best describes Schizophrenia d. Neologism
 Coining of new words
HIV e. Clang Association
PREP, PEP  Rhyming of words
Zidovudine – Taken by mother to prevent transplacental HIV f. Alogia
PCR Test – Test done to baby to detect if HIV  Lack words
g. Tangentiality
PCR Test – accurate test to determine TB Gene Expert  Digress from point of the question
h. Circumstantiality
Activated charcoal – charred bread  Add unnecessary details but they
reach the point of the question
Food for manic patient: MILKSHAKE or POTATO CHIPS i. Flight of Ideas
 Shift from one topic to another.
Basic salary – 18,000  Can relate.
j. Loose of Association
RA 7677 – Acts of Lasciviousness  Shift from one topic to another.
 Cannot relate.
ER Staff nurse receives a case of rape at 3 AM. To whom  Pt. presents series of unrelated
would you refer? ideas.
a) Medico Legal k. Dissociation
b) Police  Detached from normal function.
c) Supervisor  Dissociative fugue
d) Social Worker
Rationale: If supervisor is not among the choices, choose 3. Inappropriate Affect
“police” as the answer. a. Blunt Affect
 Delayed response with facial
BKA – Instead of elevating with pillows, elevate the foot of expression.
the bed. Pillows may cause contractures. b. Flat Affect
 More delayed response without
Pet of an asthmatic child. facial expression.
Gerbil (Hamster) c. Anhedonia
Canary (Bird)  Does not like to experience
Fish pleasure
Cat  First sign of depression
d. Apathy

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  No emotion
e. Ambivalence
 Opposing feelings Types:
 Suicidal 1. Schizophrenia
f. Labile o Paranoid
 Mood swing Priority
 Safety
4. Impaired Motor  Nutrition (Sealed)
a. Echopraxia o Catatonic
 Repeat movements (Catatonic –  Excitement (Hyper)
Excitement)  Stupor (Waxy)
b. Waxy Flexibility Priority
 Hold position long (Catatonic –  Circulation
Stupor)  Open communication
 Open-ended questions
5. Memory Disturbance  Nutrition
a. Amnesia o Disorganized
 Anterograde  Thought
o Recent/Immediate  Mumble when they talk
o Short-term  Behavior
o Alzheimer’s 2. Schizoaffective
 Retrograde  Schizophrenia + Mania
o Distant past
o Long-term Other types:
3. Delusional Disorders
SCHIZOPHRENIA  Paranormal experts
4. Shared Psychosis
 “Split of the mind”
 Belief of the delusion of others ( 1 month)
5. Postpartum Psychosis
Causes:
 After 1 month
 IDIOPATHIC
Management: SEE HANDOUTS
1. Biologic Cause:  Dopamine
1. Antipsychotics (Neuroleptics, Major Tranquilizers)
Population: 1%
a. Typical
2. Freud (Psychoanalytic)
o Old
o Weak Ego
o Can only manage POSITIVE signs
3. Social Factors
a. Single Parent Mothers o  EPS
4. Vitamin Deficiency o “-zines”
o B1, B6, B12, C b. Atypical
5. Organic Factors o New
a. Trauma to the brain o Can manage both POSITIVE and
b. Bacterial infection / Viral infections NEGATIVE
i. Typhoid Fever o  EPS
o “-pine, -done”
Criteria: Forms:
2 or more (Atleast 1 major)  Oral
Major o Tablet (Assess)
1. Hallucinations (1 month) o Liquid (Wear gloves)
2. Delusions (+)  Decanoates (IM)
3. Disorganized Speech o Every 2-4 weeks
Minor
4. Disorganized Behavior (Catatonia – hyper, waxy) 2. Anti-parkinsons
5. Negative Symptoms
o Minor Psychotropics (All psyche drugs) – Test taking
o Soft 1. Avoid alcohol
o Present to mentally healthy 2. Avoid caffeine
3. Avoid activities that require concentration.
a. Avolition 4. Hepatotoxic
b. Anergia 5. GI side effects (With meals or after meals) except
c. Asocial anxiolytics (should be given on empty stomach to
d. Apathy be absorbed)
e. Anhedonia
f. Alogia MOOD DISORDERS
g. Affect: Blunted, Flat  Affect
 Mood swings
Signs and Symptoms: o Sudden change of emotions
Positive Negative
Major 2 Types
Hard 1. Unipolar
Absent to a mentally healthy a. Depression
individual 2. Bipolar
Hallucinations Avolition a. Mania
Illusion Anergia b. Depression
Delusion Asocial
Bizarre behavior Apathy Causes:
Hyperactivity Anhedonia 1. Loss
Agitation Alogia 2. Biologic
Ambivalence Affect: Blunted, Flat a. Serotonin
Poor hygiene i. Banana
Insomnia ii. Chocolate
b. Norepinephrine
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 i. Stimulants o “No-harm” Contract
c. Dopamine (Minor) 2. Age group
3. Substance Abuse o 18-27 y/o
a. Alcohol o  40 y/o
b. Methamphetamine 3. Sex
4. Chronic Illness o  Attempt: Female
a. Cancer o  Complete: Male
4. Chronic Illness
Depression 5. Substance Abuse
 Most common cause of suicide in the Philippines:
IGNORANCE Signs:
 Best place to give health teaching on depression: 1. Sudden Mood Change
WORKPLACE 2. Giving of prized belongings
3. Will
Signs and symptoms: 4. Verbalization of ideation
 Classic Sign: 5.  Self-esteem
o Hopelessness
o Helplessness Prevention:
 Overwhelming: Address safety.
o Sadness 1. Staying with the patient.
o Loneliness 2. Unscheduled
o Isolation 3. Remove pointed objects inside the room.
  Appetite Fastest way to die
o Increase: More common Remove the following:
  Sleep Glass (Laceration)
Portable Electric fan (Strangulation)
 Slow movement
  Self-esteem
4. Verbalize – “Direct questions”
o Unworthy
o Suicide
Treatment:
1. MAOIs
Suicide Precautions: a. Parnate
o IDENTIFY WORTH b. Nardil
o Know present plans. c. Marplan
 Direct statements answerable by
yes or no. o Avoid foods rich in tyramine.
 What, where, when, how? o Can lead to hypertensive crisis.
o Foods:
Types:
 Preservatives
1. Major Depression
 Soya (Soy, yogurt)
 Sever
 Cheese
 Acute (2 weeks or more)
 Safe:
Management:
o Processed
 Anti-depressants
o Cottage
o Significant effect: 2 – 4 weeks
o Cream
o  Risk Suicide: <2 weeks of taking
 Unsafe:
o Onset: 2-3 days
o Cheddar
 Electroconvulsive Therapy
o Aged
o As long as pt. is highly suicidal,
o Swiss
recommended for ECT
o Did not respond with o Mozzarella
antidepressants
2. TCA (3 Girls love tofu)
2. Dysthymia a. Anafranil
 Less severe b. Pamelor
 Chronic (2 years or more) c. Elavil
Management: d. Tofranil
 Psychotherapy  Anticholinergic side effects
o Encourages pt. to ventilate his/her  Contraindicated in pts. with
glaucoma.
feelings.
o Examples:
3. Selective Serotonin Reuptake Inhibitors
 Art therapy
a. Prozac
 Music therapy
b. Zoloft
Suicide c. Paxil
 Self-destructive behavior d. Escitalopram
 Hostility towards self e. Citalopram
 “Cry for help”
 Ambivalence Bipolar
Types:
Types of Suicide:
1. Bipolar I
1. Threat
 With History of Mania
2. Gesture
 Sometimes depressed
3. Attempt
 More episodes of mania
4. Complete
2. Bipolar II
 Without History of Mania
Suicidal Ideation:
 Sometimes manic
 Plan
 More episodes of depression
3. Cyclothymic
Risk:
 Chronic – 2 yrs
1. Unsuccessful suicide
 Episodes of Mania ( 1 week)
o Contract
 Episodes of Depression
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  Episodes of Hypomania ( 1 week) o Atropine Sulfate
 Safety – Aspiration
Mania o Succinylcholine (Anectine)
 Manipulative  Muscle relaxant
 Threat, Danger, Impulsive o Methohexital Sodium (Brevital)
 Hyperactive, Insomnia  Anesthesia
 Talkative  Patient is asleep prior to ECT.
o Flight of ideas
o Pressured speech Side Effects:
 Colorful 1. Temporary memory loss
 Extravagant 2. Headache
 Sexually provocative 3. Asleep
4. Muscle weakness due to Succinylcholine
Defense Mechanism:
 Reaction Formation Management:
1. Airway
Management: 2. Safety (Side rails up, lower height of the bed)
1. Safety 3. Orient once patient awakens
a. Decrease stimuli 4. Continue to monitor the VS and LOC
i. Put pt. away from the things that
makes the patient angry.
b. Command (Authority) 1. Which of the following is an expected side effect after
c. Restraint ECT?
i. Protocol a. Pt. forget events prior to ECT
ii. Monitor circulation b. Anterograde amnesia
iii. Most restrictive – Sedative c. Can drive after ECT
iv. Least restrictive – Isolation d. Retrograde amnesia
2. Nutrition:  Calories 2. If the patient is scheduled for ECT tomorrow, what is
a. Finger foods that plan of care to be included by the nurse?
i. Burger a. Administer pre-ECT meds
3. Matter of Fact b. Instruct relatives to stay with the patient
4. Set limits c. Orient pt. after ECT
a. Firm d. N/A
b. Consistent
5. Group Therapy (Support group) ALZHEIMER’S
a. Minimum: 6-7  Senile plaque deposition in brain (Cerebral Cortex)
b. Maximum: 10  Neurofibrillary tangles
c. Should be of the same cases.   Acetylcholine
d. Some has recovered. (To inspire others)  Lifespan: 2 – 20 years (10 years)
e. Nurse not a part of the group.
6. Mood Stabilizer (Anti-manic) Diagnostic:
o Lithium Carbonate  Early detection: PET Scan
o Valproic Acid (Depakote)  Confirm presence:
o AUTOPSY
Electroconvulsive Therapy o Post-mortem biopsy
Indications:
 Depression not managed by antidepressants or highly Classic Signs:
suicidal  Aphasia
 Mania o Expressive
 Catatonic excitement  Pictures
 Bipolar o Receptive
 Low toned
 Consent: COURT waiver form if pt. or no relative is  Anomnia
not available o Difficulty in naming
o Should be on top of the patient’s chart  Agnosia
 70-150 volts o Difficulty recognizing
 6 – 12 times in order to have response  Apraxia
 Interval of every 48 hours o Difficulty in movement
 EFFECTIVE: o Give them time when performing a task.
o Seizure (Tonic-Clonic)
o Threshold: 0.5 – 2.0 secs Stages:
 Major Contraindications: I. Forgetfulness – “Poor judgment”
o Any case of increased ICP (Tumor, trauma) Examples:
 Other Contraindications: Hallmark – First sign of Alzheimer’s
o Fever, Hypertension, Fracture II. Moderate – Difficulty performing complex tasks
o Present respiratory or cardiac problems Examples:
o Organ transplant  Grocery shopping
 NOT Contraindicated: III. Active – Signs and symptoms are shown
o Pregnancy  Confabulation
 <100 volts  Recollection of the past
 No pregnancy complications o Best way to prevent depression
o Liver problems o Old pictures
o Kidney problems  Sundown’s Syndrome
o To promote safety: orient pt. to time
Preparation: place and person and divert them
 Same with pre-op or general anesthesia preparation. into watching the television or
o Consent listening to the radio
 Lucid Interval
o Remove jewelries, nail polish.
o Short consciousness or short
o NPO past midnight
awareness
 Pre-ECT meds:
 Disinhibition
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 IV. End Stage Management:
 Complications: 1. Preserve the evidences.
o Immobility  Not to bathe, not to change clothes.
o Pneumonia 2. Safety: Stay with the patient.
 Forgets how to: 3. Proper referral: supervisor
o Chew 4. Proper documentation
o Swallow 5. Remove clothes of the victim using scissors.
 Address Nutrition: NGT
CHILD ABUSE
 NEGLECT
Management: o Most common type of abuse in the
1. Safety Philippines
2. Nutrition  Emotional
3. Orient  Physical
4. Socialize  Sexual
5. Daily routine
6. Assist ADL RA 7610
7. Cholinergics (Retard, not cure)  Reporting cases of child abuse within 48 hours.
a. Tacrine (Cognex) o Social worker
b. Donepezil (Aricept) o Police
Side effect: o Barangay
 Dehydration
Signs of child abuse
1. Injuries at various stages.
SUBSTANCE ABUSE PLS RETYPE o Most common sites:
Abuse  Buttocks
 Use of substance other that its medical purpose.  Thighs
Tolerance 2. Aloof
 Need to increase dose of substance a. No eye contact.
Dependence b. Withdrawn
 Physical and psychological, withdrawal signs and 3. Unequal hair length
symptoms 4. Nightmares
5. Knowledge with sex
CNS Stimulants 6. Depression (Powerlessness)

1. Suicide attempt: 1st and 2nd day, patient is able to eat Management:
20% of the meal and is on isolation. On the 3rd day, 1. Safety
patient was able to eat 80% of meal and is starting to a. Call (Bantay Bata – 163)
socialize. b. Where to go? Nearest neighbor who can
a. Showing improvement protect the child.
b. Highly suicidal c. Shelter (Social worker)
c. Joyful mood 2. Family Therapy
d. Not applicable o Role of a nurse – OBSERVE the family
Rationale: Patient wants to survive. (Food) relationships
3. Play Therapy
DOMESTIC VIOLENCE
Questions:
RAPE 1. You witnessed a case of a child abuse, where are you
 RA 8353 going to report?
Definition a. Mother
 “Forcible insertion of penis or any object into the b. Relative
vagina, mouth and anus” c. Barangay Tanod
d. Bantay Bata 163
Types:
1. Acquaintance Rape
o The victim knows the rapist.
BATTERED WIFE SYNDROME
 Neglect
o Stepfather
 Emotional
2. Incest  Physical
3. Statutory Rape  Sexual
o Rape with consent
o Minor.  18 y/o Causes:
4. Blitz Characteristics of Abusive Husband or Parent
o Suspect is unknown to the victim. a. Low Self-esteem or High insecurity
5. Accessory Rape b. Belong to a violent family.
o Victim cannot give consent such as those c. Abused before.
with mental problems (mental retardation, d. Immaturity
schizophrenia) e. Poor parenting (Parent
6. Date Rape
o Starts in social media dating apps. Phases:
1. Tension Building
Rape Trauma Syndrome 2. Acute Battery
 Trauma experienced by the victim after the rape.  Physical Harm.
 Disorganized  Codependency.
o Shock o Ask help.
o Disbelief o Denial.
o Numbness  Dependence.
 Denial o Stays for the sake of the children.
o Does not want to talk  Low self-esteem.
o Talks about the rape WITHOUT emotions o Characteristic of a battered wife.
  Anxiety (Caused by fear of death) 3. Honeymoon
 Undoing
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 Autism
Management:  Boys
1. Safety  Diagnosed at 2-3 years old
a. Call (Bantay Bata – 163)
b. Where to go? Nearest neighbor who can Characteristics
protect the child.  Poor Social Interaction
c. Shelter (Social worker) o Unresponsive
2. Family Therapy o No eye contact
o Role of a nurse – OBSERVE the family o Act deaf
relationships o Love spin objects (Ritualistic Behavior)
DEVELOPMENTAL DISORDERS  Toy: Blocks
The following are pervasive developmental disorders, except: o Intimacy with inanimate objects
a) ADHP o Loves music
b) MR o Temper tantrums
c) Autism  Head banging
d) Retts  Helmet
Developmental Disorders: Management:
1. ADHD 1. Safety
2. Autism 2. Behavioral Modification Therapy
3. MR 3. Nutrition
4. Role Modeling
Causes: 5. Repetition
1. Pregnancy Complications 6. Refer with resources such as SPED
2. Heredity
3. Nutrition, Stress, Environmental Factors
Parallel Play – initiate social interaction
Characteristics:
ADHD, Autism, MR – Poor Social Interaction
Mental Retardation
What is the probability that the child can have a productive life?  Now called: Learning Disability
a) Early detection  Not a mental illness
b) Early diagnosis and treatment  Sub-average IQ (70)
c) Acceptance
d) Good nutrition Levels of Mental Retardation
Grade 5-6
Mild
1 Educable
Attention Deficit Hyperactivity Disorder (Moron)
No supervision
 Boys.
Grade 1-2
 Diagnosed at 6-7 years old.
Basic training
Moderate
2 (Handwashing, how to use
Characteristics: (Imbecile)
utensils)
 Impulsive – destructive
Less supervision
 Hyperactive – Fidget (Voluntary movements)
Severe Toddler (1-3)
 Inattention – Easily distracted 3
(Idiot) Supervision
o Check notebook – full of drawing/doodles
Infant
4 Profound Custodial care
Management:
Minimum verbal
1. Safety
2. Behavioral Modification Therapy
Management:
1) Trust and rapport
1. Safety
 Longest part
2. Behavioral Modification Therapy
2) Contract (+ Behavior)
3. Nutrition
 Set limits
4. Role Modeling
o Firm
5. Repetition
o Consistent
6. Refer with resources such as SPED
3) Token of Economy
a. Reward (Not materials)
b. Punish CRISIS
3. Nutrition:  Calories  Happens when coping mechanism of a person fails.
4. Structure Activities o Coping mechanism
Give schedule to give sense of accomplishment.  Reaction of a person to stress.
5. Allow to Play  Depends on person’s perception.
6. CNS Stimulants:  Highly individualized.
a. Methylphenidate (Ritalin) o Every person has a different reaction to
Short acting stress.
Given in the morning to prevent insomnia.  Lasts for 4-6 weeks (2 months – moved on)
Common S/E: Growth Retardation
Shift to… Types:
b. Cytert 1. Developmental or Maturational
c. Benzidine  Expected.
d. Dexedrine (Dextroamphethamine)  Part of growth and development.
 All people experience crisis.
Which system or organs should be monitored among patients  Pregnancy (If planned. But if unplanned, can
with ADHD? be situational.)
a. CNS 2. Situational
b. Renal  Not expected.
c. Cardiovascular  Accidents.
d. Musculoskeletal 3. Adventitious (Social)
Rationale: Growth retardation may be caused by the  Caused by:
medications. o Nature
o Act of man.
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  Any violence. o Death
 Any disaster.  Goal:
o Decrease level of anxiety to a
Outcomes or Effects of Crisis to a person: manageable level.
1. Lower level of function  Cannot cope.
 Negative outcome of crisis.  Signs and symptoms:
2. Same level of function o Same with severe.
 Go back to “Pre-crisis state” o Exhausted
 Goal: Realistic o Pupil dilation
3. High level of function
 Positive outcome of crisis. Patient experiences tunnel vision – Severe
Mang Jose is experiencing insomnia every since his son died 2
Crisis Intervention months ago.
 Assisting an individual, family or community a. Mild
 Performed by a TRAINED individual depending on the b. Moderate
type of crisis. c. Severe
d. Panic
Characteristics of a victim during crisis:
 Hopeless Management:
 Helpless 1. Safety
a.  Stimuli
Characteristics of a nurse during crisis: b. Command
 Active c. Restrain
 Directive 2. Relaxation – Deep breathing exercises
3. Verbalization
Phases of Crisis: a. Mild or moderate
1. D – Denial b. If severe/panic:
2. I – Increased Tension i. Direct
3. D – Disorganized ii. Simple
4. A – Attempt to escape – Blaming others iii. Specific
4. Beta-blockers (-lols) – Palpitation
Management: 5. Anxiolytics (Benzodiazepines)
1. Priority:  Short-term
a. Safety  Emergency
b. First aid  -zepams, -zolams
c. Resolves immediate problem  Buspar
2. Assess needs. o Wait for 2 weeks.
3. Referral to appropriate resources.
 Antidotes: Flumazenil
6. Anti-depressants
ANXIETY DISORDERS  Long-term management
 Fear of unknown  Prozac
 Subjective response to threat.  Zoloft
 Paxil
Causes:
1. GABA  Phobia
2. Heredity  Irrational fear of a specific object.
3. Social Factors
4. Familial Types:
5. Life experiences 1. Agoraphobia
o Public
Levels of Anxiety o Example:
1. Mild (Alertness)
 Library
 Power Perception
 Going out of the house
 Highest in learning.
2. Social Phobia
 Normal tensions of daily living.
o People
 Cope.
 Signs and symptoms: 3. Simple (Specific)
o Thanatophobia
o Pupil Dilation
 Fear of leaving the dying.
o  VS with headache
2. Moderate (Apprehension)
Management:
  Perception
Systematic Desensitization
 Selective Inattention
1. Imagery
 Cope
a. Drawing
 Signs and symptoms (GI)
2. Videos
o LBM
3. Expose
o Constipated
o Butterfly tummy  Deep breathe or relaxation while doing SD
3. Severe (Fight or Flight) (Free Floating Anxiety)
 Confused Post-traumatic Stress Disorder
 Diminished perception
 Caused by traumatic experiences.
 Impending doom
 3-6 months after the traumatic experience.
 Cannot cope.
 Flashback
 Signs and symptoms (Heart and Lungs)
o Re-experiencing, Relieving
o Palpitations
o Panic, Palpitations
o Hyperventilation/Dyspnea
o Triggered by stimuli
o Pupil constriction
 Nightmares
4. Panic (Disorganized)
 Conversion
 Thought, behavior
o Somatoform caused by trauma
 Danger:
o Blindness
o Self
o Paralysis
o Others
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 o “La belle indifference” 3. Perfectionist.
 Depression 4. Abdominal problems
a. Ulcer
Management: b. Heartburn
1. Flooding 5. Exercise
 Prank 6. Abuse laxatives and diuretics
 Not real a. Green tea
 Sudden exposure of the patient to a certain b. Biguerlai
FAKE scenario c. Biofit
2. Group Therapy (Min – 6, Max – 10-12) 7. Depression – Suicide
 Role of nurse: Create a therapeutic
environment.

Nursing Diagnoses: *** Anorexia Nervosa Bulimia Nervosa

1. Ineffective Coping Denial Aware
a. Mild anxiety Odd, bizarre, behavior. Binge-eating
b. Moderate anxiety  Slow eating  Most common
2. Anxiety, Severe Poor nutrition. cause is social
a. Severe anxiety  Hypothermia factors/social
b. Panic anxiety  Lanugo (Fine hair) insecurities.
 Amenorrhea Purging
Obsessive Compulsive Disorder  Brown and brittle  Dental enamel
 Obsession – persistent intrusive thought (increases  Skin (Dry & scaly) erosion.
anxiety) Purging  Stained teeth.
 Compulsion – uncontrolled ritual (decreases anxiety)  Not as frequent as  Dental carries.
o Goal bulimia  Rupture of the
 Limit esophagus.
 Control Weight is Near Normal
 Schedule  Slight weight loss
 Nursing Diagnosis: Anxiety, Severe More obsessed with
exercise
Management:
1. Cognitive Behavioral Therapy Nursing Diagnoses:
 To correct a wrong belief. 1. Altered Nutrition: Less than body requirements
2. Disturbed body image
2. Antidepressants 3. Self-esteem disturbance
a. Anafranil 4. Ineffective coping
b. Paxil
Management:
Generalized Anxiety Disorder 1. Cognitive behavioral therapy
 Excessive worrying. o Teach
 Last for 6 months. 2. Behavior modification therapy
o Set limits
Classic sign:  Firm
 Tension  Consistent
o Headache o Token
o Confusion  Reward
o  Vital Signs  Phone calls
o Tremors  Punishment
o Slurred speech 3. Involve the patient with meal planning.
o Irritable + Restless 4. Weigh the patient daily; same time, same clothes.
5. Monitor while eating.
6. Monitor 1-2 hours after eating.
Management:
7. Anti-depressants.
1. Safety
 Most effective management.
2. Relaxation
 SSRIs (PZP)
3. Verbalization
4. Beta-blockers
Questions:
5. Anxiolytics
1. Which of the following is the best way to promote
6. Antidepressants
eating to a patient with eating disorder?
a. Serve favorite foods.
A mother reports that her child performs 30x handwashing a
b. Involve with meal planning.
day. The nurse learns that the child has red, dry, cracked and
c. Monitor patient while eating.
scaly skin. What is the major goal of treatment
d. Continuous monitoring.
a. Limit handwashing.
Rationale:
b. Encourage to verbalize.
Letter C could be the answer but pt. could purge, but
c. Provide adequate skin care.
letter D is a global answer which also covers letter C.
d. Decrease handwashing a day.
2. Best way to manage hyperemesis gravidarum.
Rationale: Goal – time-bound.
a. IV line
b. F&E replacement
Eating Disorders c. Hospitalization
d. NPO
Causes:
1. Belongs to a strict family. 3. Most common fatal complication of an eating disorder.
2. Heredity a. Starvation
3. Social factors b. F&E Imbalance
4. Mass media c. Tissue wasting
d. Cardiac arrhythmia
Characteristics of Both:
1. Obsession with Body Weight.
2. Obsession with food.
DANA RIBUYACO | TUA-SLCN
 4. A pt. underwent insertion of a Harrington rod which of
the following is the most important assessment
immediately after the procedure?
a. Capillary refill, sensation and motion in
all extremities.
b. Pain
c. Ability to use the log-roll technique.
d. Ability to move the lower extremities.

EGO Defense Mechanisms

 Normal and automatic
 Defense = Protect
 Protects the self against anxiety experience

1. Denial
2. Displacement
 Shift emotion to less threatening
object/person.
 Hitting your pet after fighting with your
girlfriend.
3. Projection
 Assimilate self with other people.
 Blaming
4. Substitution
5. Sublimation
 Doing good instead of doing bad
 So angry at that time, saw a piano and just
played your favorite piano piece.
6. Symbolization
 Use object to represent another.
 Going to gym after someone says you’re
ugly.
o Symbolize masculinity.
7. Reaction formation
 Acting opposite to what you truly feel.
8. Undoing
 Erase a previous wrong act.
9. Repression
 Involuntary forgetting
 Keep yourself busy.
10. Suppression
 Voluntary forgetting.
11. Identification
 Conscious patterning of behavior.
12. Introjection
 Unconscious patterning of behavior.
 Not your intention
13. Rationalization
 Excuse
14. Intellectualization
 Explain so much in detail
 Base explanation on books, studies…
15. Compensation
 Compensate for perceived lack.
 You want to be a soccer player, but you
have polio. You compensate by succeeding
as a musician.
16. Regression
 Decrease anxiety
 Going back to previous growth and
development
 Most common:
o Fetal position

Questions:
1. Maria was abused by her father who recently died,
when asked how her father was. Her reply was, “My
father is the best father in the world” How do you
interpret the statement of Maria?
a. Projection
b. Denial
c. Suppression
d. Dishonesty
Rationale: Question is not asking about defense
mechanism.

DANA RIBUYACO | TUA-SLCN

Psychopharmacology

ANTIPSYCHOTICS ANXIOLYTICS –
 Decrease positive and negative symptoms
BENZODIAZEPINES
Typical Atypical  Decrease anxiety
Old New  Muscle relaxant
High EPS Low EPS  ZEPAMs, ZOLAMs
Treats (+) symptoms Treats (+) and ( – ) symp.
DONE 1. Diazepam (Valium)
ZINE
PINE 2. Lorazepam (Ativan)
Chlorpromazine (Thorazine) Risperidone (Resperdal) 3. Oxazepam (Serax)
Chlorperazine (Compazine) Molindone (Moban) 4. Flurazepam (Dalmane)
Thioridazine (Mellaril) Ziprasidone (Geodon) 5. Clonazepam (Rivotril)
Fluphenazine (Prolixin) Clozapine (Clozaril) -BEST 6. Temazepam (Restoril)
Perphenazine (Trilafon) Olanzapine (Zyprexia) 7. Alprazolam (Xanax)
Haloperidol (Haldol) Quetiapine (Seroquel) 8. Estazolam (Prosom)
9. Midazolam (Versed)
Side effects: 10. Chlorazepate dipotassium (Tranxene)
1. Dry Mouth 11. Buspirone (Buspar)
o Sugar free candy 12. Chlordiazepoxide (Librium)
2. Constipation
o  Fiber Antidote
3. Weight gain  FLUMAZENIL (Romazicon)
o  Appetite
4. Photosensitivity Side Effects
o Caution: Use sunscreen 1. Dizziness (Common)
5. Hypotension (Orthostatic) 2. Headache
6. EPS 3. Nausea and Vomiting
4. Clumsiness
Extrapyramidal Symptoms 5. Hang-over effect
1. Tardive Dyskinesia
o Lip smacking Danger
o Tongue twitching 1. Dependence/Addiction
2. Pseudo parkinsonism 2. CNS Depression
o Tremors (Reversible)
o Rigidity ANTIDEPRESSANTS
o Mask-face  Effective: After 2-3 weeks
o Bradykinesia  Onset: 3-5 days
o Akinesia
3. Dystonia MAOI
o Neck rigidity (Dysphagia) PANAMA
o Pupillary paralysis 1. Isocarboxazid (Marplan)
4. Akathisia 2. Phenelzine (Nardil)
o Feeling of ants under their pants 3. Trancylpromine (Parnate)
o Restless a. Selegiline (Emsam) – Patch
o Irritable
o Jitteriness Nursing Considerations:
o Agitation  Avoid Tyramine Rich foods which can cause
HYPERTENSIVE CRISIS
Adjunct Drugs o Preservatives (Canned, Sealed)
Anticholinergics (Muscle Relaxants) o Soy, Soya, Yogurt
1. Cogentin (BEST) o Salami
2. Benadryl o Avocado, Banana, Papaya
3. Akineton o Cheese (Swiss, Cheddar, Aged, Mozzarella)
4. Artane  Safe Cheese (Processed, Cottage,
Cream)
Antiparkinsons
1. Sinemet (Levodopa + Carbidopa)
2. Amantadine (Symmetrel)
TCA
 “-Pramine”, “-triptyline”
Toxic Side Effects   Norepinephrine
1. Neuroleptic Malignant Syndrome
o High fever (1st sign) 1. Imipramine (Tofranil)
2. Desipramine (Norpramin)
o Muscle rigidity
3. Trimipramine (Surmontil)
o Spasm 4. Clomiparamine (Anafranil) – OCD
o Decreased LOC 5. Amitriptyline (Elavil)
o Bromocriptine (Parlodel) 6. Protrityline (Aventyl)
o Dantrolene (Dantrium) 7. Nortriptyline (Vivactyl, Pamelor)
2. Agranulocytosis – Sore Throat 8. Trazodone (Desyrel)
3. Leukopenia
4. Hepatotoxicity ANTICHOLINERGIC Side Effects:
 Dry mouth
***DECANOATE – IM/IV Antipsychotics  Constipation
 Decreased BP
 Blurred vision
 Hallucination
 Increased appetite

DANA RIBUYACO | TUA-SLCN

Contraindicated in patients with GLAUCOMA!
SSRI
 “-INE”, “-PRAM”
  Serotonin

1. Fluoxetine (Prozac)
2. Paroxetine (Paxil, Pexeva)
3. Sertraline (Zoloft)
4. Fluvoxamine (Luvox) – OCD
5. Vilazodone (Viibryd)
6. Citalopram (Celexa)
7. Escitalopram (Lexapro)

Side effects:
 Sexual Dysfunction
 GI Symptoms
o Headache
o Nausea and vomiting
o Abdominal Pain

*** St. John’s Wort (Hypericum perforatum) – US Herbal

Antidepressant

ANTI-MANIC AGENTS – MOOD

STABILIZERS
1. Lithium Carbonate (Eskalith)
 Oral
 Therapeutic Level: 0.5 – 1.5 mEq/L
 Below 0.5: Manic
 Above 1.5: Toxic
2. Valproic Acid (Depakote)
3. Carbamazepine (Tegretol)
4. Antipsychotics

Toxic Side Effects:

 Diarrhea (1st sign)
 Muscle rigidity/spasm
 Decrease LOC (Lethargy, stupor, coma)

Antidote ( Sodium)
 Diuretics (Mannitol, Diamox)
 Theophylline

Side effects:
 GI Symptoms
o Headache
o Nausea and vomiting
o Abdominal pain
 Depression – Suicide risk

Nursing Considerations:
 Regular Sodium (2-3 g per day)
o  Na: Toxicity
o  Na: No effect
  OFI (2-3 L per day)
 Avoid activities that causes excessive perspiration
 When to extract?
o Morning before breakfast

DANA RIBUYACO | TUA-SLCN

SUBSTANCE ABUSE ALCOHOLISM
 Use of substance other than its medical purpose.  WHO
o Excessive intake of alcohol that alters a
Tolerance person’s health, career, family and financial
 Need to increase dose of substance status.
Dependence  Blood Alcohol Level – 0.1%
 Physical and psychological, withdrawal signs and  Alcohol withdrawal signs and symptoms if BAL is 
symptoms 0.1%
o Confusion – well-illuminated room
o Hallucination (Visual, Tactile)
CNS STIMULANTS o Increased vital signs
1. Methamphetamines o Tremors
Amphetamines o Sweating (1st sign)
Ketamines (ADHD meds) o Seizure (Last sign)
“Shabu”
Examples  Defense Mechanism: DENIAL
2. Cocaine
o Underestimate use
3. Ecstasy
Methyldeoxymethampetamine
(Liquid, colorless, odorless) ALCOHOL WITHDRAWAL SYNDROME (AWS)
1. Delirium Tremens
1. Dilated Pupil
 Alcohol in the brain
2. Palpitation – Arrest
 Signs and symptoms:
3. Weight Loss (Decreased appetite)
o C
4. Hyperactive
Side Hyper stimulation of senses o H
Effects 5. Increased VS o I
6. Euphoria ( Confidence) o T
7. Increased libido o S
(No erection, unless it has worn off) o S
8. Insomnia  Management:
1. Depression o Anxiolytics (Benzodiazepines)
Withdrawal 2. Hypersomnia  Diazepam
S&Sx 3. Increased appetite  Librium
4. schizophrenia  Tranxene
SEDATIVES 2. Korsakoff’s
Antidote “-ZEPAMS”  Deficiency in Thiamine and Niacin
“-ZOLAMS”  Signs and symptoms:
o MEMORY Disturbance
PSYCHOSTIMULANTS o Amnesia (Antero, retro)
o Confabulation
(Hallucinogens)  Treatment:
 AKA: Mind-Altering Substance o IM – 1 month
 Real Classification: Psycho stimulants  Schilling’s Test
 Layman’s Term: Hallucinogen 3. Wernicke’s
1. Cannabis Sativa (Marijuana)  Deficiency in Thiamine ONLY
Examples 2. LSD (Lysergic Acid Diethylamide)  Signs and symptoms:
3. PCP (Phencylidine) o EYE and BALANCE Problem
1. Dilated pupil o Ophthalmoplegia
Side o Ataxia
2. Blotchy, Red eye
Effects o Nystagmus
3. Increased Libido
NO KNOWN WITHDRAWAL SIDE EFFECTS.
Withdrawal AVERSION THERAPY
Danger: Acute Psychosis
S&Sx  Introduction of painful stimuli (Disulfiram) to prevent
Marijuana – Dangerous to a pregnant mom.
Antidote Vitamin C-rich JUICE another stimuli (Alcohol)
 Disulfiram (Antabuse)
o Avoid alcohol 12 hours prior to intake
NARCOTICS (Opiates)  Effects of alcohol:
1. Heroin o Severe GI symptoms
2. Morphine  Substances with alcohol:
Examples 3. Demerol o Read labels of mouthwash, cold remedies,
4. Paregoric Acid fruit extracts (wine, skin products, aftershave
5. Codeine lotion)
1. Constricted pupil  There must be acceptance prior to Aversion Therapy.
2. Piloerection (Goose bumps/flesh)  Epinephrine
Side
 Respiratory depression o S/E: Pupil dilation
Effects
3. Constipation
4. Euphoria Defense Mechanisms:
1. Sweating and yawning (1st Sign)  Alzheimers – Denial
2. GI Symptoms (H, N, V, Abd’l pain)  Manic – Reaction formation
Withdrawal 3. Coryza Symptoms (Teary eyes, o Classic sign: Manipulative
S&Sx runny nose)
4. Tremors
5. Irritability
Heroin – METHADONE
NALOXONE (Narcan)
NALTROXENE (Revia)
Antidote
In exchange to addiction when tapering
Morphine, Demerol, Paregoric Acid, Codeine:
NALBUPINE (Nalline, Nubain)

DANA RIBUYACO | TUA-SLCN

 THERAPEUTIC NURSE-PATIENT RELATIONSHIP

PHASE NURSE PATIENT

Explore personal feelings, values, attitudes.

Pre-Interaction:
Collect data about patient. Patient has no role in this phase.
Begins before contact with patient
Plan for first interaction.

Listen: be empathetic.
Identify boundaries of relationship. Recognize need for help.
Orientation (Introductory):
(Termination begins here) Commit to a therapeutic relationship.
Begins at first meeting of nurse/patient
Clarify expectations. Begin to test relationship.
Establish rapport.

Assist with exploration of issues. Develop trust in nurse.

Support healthy problem solving. Examine personal issues.
Working:
Assist with strategy development. Develop strategies to resolve issues.
Begins when patient identifies problems to be worked on
Identify own reactions to client based on own needs, conflicts, May superimpose feelings from another relationship onto
relationships. (Counter-transference) nurse/patient relationship. (Transference)

Review objectives/goals achieved.

Reinforce adaptive behaviors.
Share feelings about termination (anger, rejection, regression;
Resolution (Termination): Share feelings about termination.
negative feelings may be expressed to deal with loss)
Begins when problems are resolved; ends when relationship is Avoid discussing previous issues.
May attempt to discuss previous issues.
terminated Encourage independence: focus on future.
Assume responsibility for use of community resources.
Promote positive family interactions.
Refer to community resources.

DANA RIBUYACO | TUA-SLCN