LOBES OF BRAIN 1. FRONTAL LOBE - Language - Learning - Personality - Judgment 2. TEMPORAL LOBE - Hearing - Smell 3.

PAREITAL LOBE - Touch - Taste 4. OCCIPITAL LOBE - Visual 3 STEPS TO INTERACT WITH ENVIRONMENT 1. Sensory eyes, ears, tongue 2. Integration 3. Motor voluntary or involuntary VOLUNTARY NERVOUS SYSTEM also called as somatic Brain Spinal Cord Motor Nerve Synapse Muscle Fiber Motor nerve to muscle fiber you need Acethylcholine which is an On switch. INVOLUNTARY NERVOUS SYSTEM also called autonomic nervous system. AUTONOMIC NERVOUS SYSTEM SYMPATHETIC PARASYMPATHETIC -(Awake, ADRINERGIC) (Relax, CHOLINERGIC) Heart Rate Increase Decrease Respiratory Rate Increase Decrease GI Decrease Increase (Moist mouth, Diarrhea) GU Decrease - Increase (Urinary Frequency) Neurotransmitter- Epinephrine, Norepinephrine -Acethylcholine Psych focuses in feelings or self awareness. Beliefs determine feelings which affects behavior (manifestation of feelings) Sigmund Freud is the father of PSYCHOANALYSIS. What happens to childhood will affect adulthood. STRUCTURE OF PERSONALITY ID impulsive, want to, wants pleasure. PLEASURE PRINCIPLE. Guiding principle is PAIN AVOIDANCE. SUPEREGO should not small voice of God to stop EGO executive decision maker. In touch with reality principle.

ID DOMINANT PERSONALITIES Manic Anti Social experienced by serial killers Narcissistic SUPEREGO DOMINANT PERSONALITIES Obsessive Compulsive Anorexia Nervosa EGO if destroyed result in impaired reality perception. Schizophrenia LIBIDO Sexual energy responsible for survival. Oral Stage 0 18 months evident. ID is developed. *FIXATION Person is stuck in certain developmental shape. *REGRESSION Return to an earlier developmental stage. EGO Developed on the 6th month. Anal Stage 18 months 3 years old. Able to control bladder, bowel. Best time for toilet training. SUPEREGO is developed. TOILET TRAINING Good Mother Bad Mother Successful Dirty - Clean -disorganized organized - disobedient - obedient - Anti-social - O.C Anal expulsive Anal retentive PHALLIC STAGE 3 6 years old. Experience pleasure by manipulating genitals. Love hate relationship. Oedipus Complex boy loves parent of the opposite . Imitates daddy called identification. Castration fears. Electra Complex girl loves parent of the opposite . Imitates mommy called identification. Penis envy. *Conscious upper level of thinking. *Preconscious tip of tongue. *Unconscious protects us from traumatic experiences. LATENCY STAGE 6 12 years old. School age. Separation anxiety. Reading, Writing, Arithmetic. Lasts for 6 years. GENITAL STAGE 12 years old and above Sexual reawakening. Very important stage.

PHARMA NOTES: ANTI ANXIETY DRUGS Valium Librium Ativan Serax Tanxene Miltown Equanil Vistaril Atarax Ideral Buspar ERIC ERIKSON There is more to life than just . Psychosocial Theory of development. You can develop a positive side or a negative side. Developmental task begins at 0 18 months. POSITIVE NEGATIVE FACTOR 0 18 mos. -Trust Mistrust Feeding 18 mos. 3 yrs. -Autonomy -Shame & Doubt - Toilet Training 3 yrs. 6 yrs. -Initiative - Guilt Independence 6 yrs. 12 yrs. Industry Inferiority School 12 yrs. 20 yrs. -Identity Role Confusion Peers 20 yrs. 25 yrs. -Intimacy Isolation Love 25 yrs. 45 yrs. Generativity Stagnation Parenting 45 yrs. above -Ego Integrity Despair Reflection DRUGS WITH ANTICHOLINERGIC EFFECTS Anti Anxiety Anti Psychotic Anti Cholinergic Anti Depressants PHARMA NOTES: MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS) Marplan Nardil Parnate DEFENSE MECHANISMS 1. Displacement transfer of feelings to a less threatening object rather than the one who provoked it. 2. Denial failure to acknowledge an unacceptable trait or situation. 3. DISOCIATION psychological flight from the self. 4. REGRESSION return to an earlier development state. 5. repression unconscious forgetting. 6. RATIONALIZATION illogical reasoning for an unacceptable trait and situation. 7. REACTION FORMATION doing the opposite of what you have done. 8. UNDOING doing the opposite of what you have done. 9. IDENTIFICATION assuming trait for personal, social, occupational role. 10. PROJECTION attribute to others ones unacceptable trait. 11. INTROJECTION assume another persons trait as your own. 12. SUPPRESSION conscious forgetting. 13. SUBLIMATION putting destructive energies or hostile feelings towards a more productive

endeavors. 14. CONVERSION unexpressed or repressed feelings are converted to physical symptoms. 15. COMPENSATION over achievement in one area to cover a defective part. 16. SUBSTITUTION replace difficult goal with more accessible one. PHARMA NOTES: ANTI PARKINSON DRUG - CAPABLES Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetrel AUTONOMIC NERVOUS SYSTEM SYMPATHETIC PARASYMPATHETIC Pupils -Dilate -Constrict Blood Vessels Constrict - Dilate Blood Pressure Increase Decrease THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC 1. Offer Self 2. Silence provide time to think 3. Making observation what you see you say 4. Active Listening nodding, eye contact 5. Broad Opening how are you today? 6. General Leads Go on, Im listening 7. Restating Im sad Youre sad? 1. Dont worry be happy 2. Changing the topic/subject 3. Ignore the client 4. Value based judgment never assume 5. Flattery 6. Advising 7. Giving Opinion NONTHERAPEUTIC 1. Dont worry be happy 2. Changing the topic/subject 3. Ignore the client 4. Value based judgment never assume 5. Flattery 6. Advising 7. Giving Opinion FEAR protects us from something bad. ANXIETY Vague sense of impending doom. Triggers the sympathetic nervous system. Assess level of anxiety of client. TYPES OF ANXIETY MILD ANXIETY + 1 level of anxiety. Widened perceptual field.

 Restless (say you seem restless). Enhanced learning capacity. MODERATE ANXIETY + 2 level of anxiety. Client pace. Give PRN meds. SEVERE ANXIETY + 3 level of anxiety. Dont know what to do/say. Directive orders (please sit down). PANIC + 4 level of anxiety. May commit suicide. Promote safety. Never touch patient. Hyperventilation (Respiratory Alkalosis) Breathe into paper bag. NURSING DIAGNOSIS: ineffective individual coping. Powerlessness. Impaired skin integrity PLANNING/IMPLEMENTATION: decrease level of anxiety. Decrease environmental stimuli. Relaxation techniques. EVALUATION effective individual coping. GENERALIZED ANXIETY DISORDER 6 month excessive worrying. Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability. PANIC ATTACKS/DISORDER 15 30 minutes sympathetic nervous system escalation. Example is AGORAPHOBIA fear of open spaces. POST TRAUMATIC STRESS DISORDER victims becomes survivors and experience flashbacks or nightmares. MALINGERING pretending to be sick (conscious). Primary Gain anxiety decreases, able to escape source of anxiety. Secondary Gain able to get attention. SOMATOFORM no protection unconscious no organic basis of being sick DIFFERENT TYPE OF SOMATOFORM 1. Conversion Disorder cannot speak, see, hear. Nervous system affected. 2. La Belle Indifference do not care what happens to them.

HYPOCHONDRIASIS has minor discomfort and interprets it as major illness. Focus on clients feelings. BODY DISMORPHIC DISORDER Illusion of structural defect. Favorite past time is doctor hopping. Focus on clients feelings. PSYCHOSOMATIC Real pains/illness Real symptoms because of anxiety PSYCHOSOMATIC Increase Anxiety SNS Increase BP & HR Hypertension Fat Deposits Atherosclerosis Calcium Arteriosclerosis Decrease Oxygen Angina Pectoris MI Necrosis CHF Coma PHOBIA Irrational fear Etiology: Knowledge of certain object Bad experience Immediate nursing objective: Removal of stimulus will remove anxiety Systemic Desensitization gradually expose client to stimuli/feared object Employ relaxation techniques SNS GABA (Gamma Amino Butyric Acid) stop Epinephrine and Norepinephrine Go ANTI-ANXIETY Increase GABA and client becomes drowsy (no alcohol and coffee) May develop orthostatic hypotension Let patient sit then dangle feet and then stand Develop anti cholinergic effects If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures Do it in gradual and in tapered dose Anti anxiety leads to dependence AUTISM Unresponsive and does not want to be touched Autistic Savant: high intelligence and has a ratio of 1:100 Assessment Appearance flat affect and loves constancy and ritualistic Behavior withdrawn Communication echolalia

NURSING DIANOSIS Impaired verbal communication Impaired social interaction Self mutilation Risk for injury PLANNING/IMPLEMENTATION Maslows hierarchy of needs Expressive Therapy use of art as mode if communication EVALUATION Enhanced communication Improved social interaction Safety ATTENTION DEFICIT HYPERACTIVITY DISORDER 7 years and below onset Duration: 6 months and above Settings: house and school Assessment Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus Behavior Communication: talkative NURSING DIAGNOSIS Risk for injury Impaired social interaction PLANNING/IMPLEMENTATION Structure: place to play, sleep, eat and study Schedule: there is always a time for everything that you do Set limits Safety EVALUATION Minimize risk for injury Improved social interaction FRONTAL LOBE OF ADHD Decrease glucose Decrease judgment Increase impulsiveness ADHD Hyperactivity Need a drug that brings glucose level up. Give Ritalin a stimulant May result in loss of appetite Given after meals Given 6 hours before bedtime EATING DISORDERS ANOREXIA NERVOSA BULIMIA NERVOSA - Eat, eat, eat Eat, eat, vomit - Less 85% expected body weight - Normal weight - 3 months amenorrhea Irregular menstruation BULIMIA NERVOSA Metabolic alkalosis (vomiting results to decrease hydrochloric acid) Metabolic acidosis (diarrhea results to decrease bicarbonate)

 Dental caries Wound in knuckles MANAGEMENT Fluid and electrolyte imbalance Meal contract Weight gain for client After eating stay with client for 1 hour and accompany when going to the comfort room PHARMA NOTES: ANTI PSYCHOTIC DRUG Stelazine Serentil Thorazine Trilafon Clozaril Mellaril Haldol Prolixin SCHIZOPHRENIA Ego disintegration Impaired reality perception Genetic vulnerability Stress Diathesis Model Biological theory increase dopamine level Exact cause unknown ASSESSMENT Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete) Ambivalence: pulled into 2 opposing forces Autism Looseness, no idea, not related to one another ASSESSMENT NEGATIVE POSITIVE Hypoactive Hyperactive Withdrawn - Sociable Thought Blocking Flight of ideas Apathy I. ASSESS Content of thought NURSING DIAGNOSIS Disturbed thought process PLANNING/IMPLEMENTATION Present reality Provide safety EVALUATION Improved thought process II. ASSESS Hallucinations/Illusions NURSING DIAGNOSIS Disturbed sensory perception PLANNING/IMPLEMENTATION Present reality Safety

EVALUATION Improved sensory perception III. ASSESS Suspicious NURSING DIAGNOSIS Risk for other directed violence PLANNING/IMPLEMENTATION Present reality Safety EVALUATION Eliminate/minimize risk for other directed violence IV. ASSESS Suicidal NURSING DIAGNOSIS Risk for self directed violence PLANNING/IMPLEMENTATION Present reality Safety EVALUATION Eliminate/minimize risk for self directed violence LOOSENESS OF ASSOCIATION Thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between one thought and the next FLIGHT OF IDEAS Jumping from on topic to another AMBIVALENCE Pulled between 2 strong opposing forces MAGICAL THINKING acting like magician ECHOLALIA Client repeats what you say ECHOPRAXIA Client repeats what you do WORD SALAD Just words no rhyme CLANG ASSOCIATION Words that rhyme NEOLOGISM Formation of new words (needs clarification) DELUSION: PERSECUTORY The NBI is out to get me DELUSION: RELIGIOUS I am Jesus Christ the savior DELUSION: GRANDEUR I am the queen of the world DELUSION: IDEAS OF REFERENCE The nurses are talking about me CONCRETE ASSOCIATION Also known as pilosopo THOUGHT BLOCKING Unable to think

HALLUCINATIONS ILLUSIONS
STIMULUS ABSENT PRESENT VISUAL -ABSENT PRESENT AUDITORY ABSENT PRESENT TACTILE ABSENT ABSENT PRESENT Present reality to clients experiencing hallucinations Technique in handling clients with hallucinations Hallucinations Acknowledgement I know the voices are real to you Reality orientation I know the voices are real but I dont hear them Diversion Lets go to the garden 10% of schizophrenic clients hear voices PARKINSONS DISEASE If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch) ANTI-PSYCHOTIC Decrease dopamine level Parkinson like effect Extra pyramidal side effect With akathesia Restless, inability to rest AKINESIA Muscle rigidity DYSTONIA Torticollis (wryneck) OCULOGYRIC CRISIS Fixed stare OPISTHOTONUS Arched back Lips smacking Tongue protruding Cheeks puffing The 3 are irreversible and called tardive dyskinesia Neuroleptic malignant syndrome hyperthermia ANTI PARKINSON Anticholinergics Dopaminergics (Decrease Ach) (Increase Dopa) Artane, Akineton Parlodel Benadryl Larodopa Cogentin Eldepryl Symmetrel OTHER SIDE EFFECTS OF DECREASE DOPAMINE Photosensitivity Agranulocytosis decrease WBC Clients prone to infection due to decrease WBC First sign for infection is sore throat TYPES OF SCHIZOPHRENIA DISORGANIZED SCHIZOPHRENIA - Sad but smiles (inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech)

- Giggling (hebephrenic giggle) - Combination of positive and negative signs and symptoms CATATONIC SCHIZOPHRENIA - Ambivalence - Waxy flexibility - Favorite word is No - Negativism (client do not follow what you tell them to do) Nursing management: meet needs PARANOID SCHIZOPHRENIA - Suspicious - Mistrust, scared, withdrawn Nursing management: - Gain trust by 1 to 1 short interaction but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: - Keep door open - Position near door - Dont touch client - Call for reinforcement - One arms length away from the client. PARANOID SCHIZOPHRENIA - No more positive symptoms just withdrawn UNDIFFIRENTIATED SCHIZOPHRENIA - Mixed classification, cant be classified PHAMRA NOTES: BI-POLAR, MANIC Lithium: undergo first kidney test and check for blood levels Level: .6 1.2 meq/L Increase urination Tremors, fine hand Hydration of 3L/day Increase Uu (diarrhea) Mouth dry Signs of Lithium toxicity Nausea, vomiting, diarrhea Increase sodium * Wait for 2 4 weeks before lithium therapy takes effects BIPOLAR DISORDER/MANIC PROFILE 20 years old Female Stress Obese ASSESSMENT Decrease appetite (give finger foods) Decrease sleep (place in a private room) Hyperactive Increase sexual activity only means of addressing anxiety so decrease level of anxiety Risk for injury/other directed violence Impaired social interaction (care giver role: strain and stay with client) Self esteem decrease (to cover up their sadness there is compensation to cover defective

doing) Because there is decrease self esteem there will be increase compensation resulting to increase interference with ADLs and harm to others Compensation is the culprit Management: increase self esteem to decrease compensation and decrease interference with ADLs and harm to others HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS T- no sports (basketball, volleyball), no fine motor skills only gross motor skills A lot energies toward more productive endeavors (sublimation) S - escorted walk outdoors K punching bag (displacement) PHARMA NOTES: ANTI DEPRESSANTS Asendin Norpralamin Tofranil Sinequan Anafranil Aventyl Vivactil Elavil Prozac Paxil Zoloft ALCOHOL LEADS TO: Blackout: awake but unaware Confabulation: inventing stories to increase self esteem Denial: I am not an alcoholic Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is another term Tolerance: gradual increase in amount of stimuli to experience the same euphoria MANAGEMENT Detoxification: withdrawal with medical doctor supervision Avoid alcohol therapy Aversion therapy a more technical term for avoid alcohol therapy Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting Alcoholics anonymous Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension Alcoholism may result to Vitamin B1 (Thiamine) deficiency WERNICKES ENCEPHALOPATHY Problem with motor KORSAKOFFS PSYCHOSIS Problem with memory 24 72 hours after last dose of alcohol expect: Delirium Tremens: sympathetic nervous system Prevent hallucinations/Illusions by placing client in a well lit room Formication: feeling of bugs crawling under the skin ALZHEIMERS DISEASE Axon (away) and Dendrites (toward) nerve Neurofibrillary tangles Neurotic plaques

ALCOHOL ALZHEIMERS
ONSET Abrupt Gradual LEVEL OF CONSCIOUSNESS Fluctuating -Unaffected DURATION Hours to days Progressive MEMORY Short term Short and long term 5 As OF ALZHEIMERS 1. Amnesia memory loss 2. Anomia dont know the name 3. Agnosia sensory problems smell, taste, sight 4. Aphasia - expressive: cant say/express - frontal lobe is affected particularly brocas area - receptive: cant hear - temporal lobe is affected particularly wernickes area 5. Apraxia cant do simple things * Reminiscing Therapy talk about past Patients with alzheimers may experience hallucinations, illusions thus becomes restless and may wander As sun goes down client becomes restless, agitated, disoriented called sundowning Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases Ach causing delay in disease progression SEROTONIN Responsible for happiness Decrease serotonin clients becomes sad give anti-depressants SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks - Increases serotonin and affects only serotonin - Prozac, Paxil, Zoloft TRICYCLIC ANTI DEPRESSANT Two four weeks C A - Has higher incidence of side effects - Also increases norepinephrine - Asendin, Norpralamin, Tofranil, Sinequan, Anafranil, Aventyl, Vivactil, Elavil MONO AMINE OXIDASE INHIBITORS MAO kills serotonin Increased MAO results to decreased serotonin the more depressed the client becomes MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis Avoid tyramine rich foods Avocado, Alcohol Beer Chocolates, Cheese (aged) Fermented foods Pickles Preserved foods Soy sauce

 There is increase incidence of side effects after 2 6 weeks Marplan, Nardil, Parnate PERSONALITY DISORDERS 1. Schizophrenia - They avoid people because there is no enjoyment 2. Avoidant - They avoid people because they are afraid of criticisms - They have talent but has no confidence 3. Anti-Social - Constantly breaks law - Project charm - They are witty and articulate - Manipulative 4. Borderline - They perceive life as an empty glass - They like splitting friends - Sudden change in mood labile affect - Prone to suicide 5. Dependent - Cant live if living is without you 6. Histrioinic - Constantly wants to be the center of attention - Excited, dramatic, manipulative 7. Narcissistic - I love myself - They get jealous even with achievement of family members 8. Obsessive Compulsive - I am so organized 9. Paranoid - Suspicious - May lead to domestic violence ANTI DEPRESSANT SIDE EFFECTS: Male erectile dysfunction, prone to impotence GRIEF PROCESS 1. Denial shock/disbelief 2. Anger question why me? 3. Bargaining if, then 4. Depression 2 weeks or more sign and symptoms becomes major clinical depression 5. Acceptance client acts according to situation ASSESSMENT Decrease self actualization Decrease self esteem Withdrawn: stay with client Suicidal: risk for self directed violence Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge Be sensitive to clients needs FOR SUICIDAL OBSERVE FOR Verbal I wont be a problem This is my last day on earth Ill soon be gone Non verbal

 Giving away of valuables Sudden change in mood WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: Do you plan to commit suicide? Irregular/interval visits Endorsement period, early morning clients are most likely to commit suicide DOWNERS Alcohol Barbiturate Opiates Narcotics Marijuana Morphine Codeine Heroine Resulting to: Bradycardia Bradypnea Moist mouth Pupils constrict Constipation Urinary retention Hypotension Coma Weight gain Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride) UPPERS Cocaine Hallucinogens Amphetamines Resulting to: Tachycardia Awake Tachypnea Dry mouth Pupils dilate Hypertension Seizures Weight loss