1

PSYCHIATRIC NURSING

Psych focuses in feelings or self-awareness. Beliefs determine feelings which affects behavior (manifestation of feelings) Sigmund Freud is the father of PSYCHOANALYSIS What ha ens to childhood will affect adulthood

STRUCTURE OF PERSONALITY ID

!m ulsive" #want to$" wants leasure. PLEASURE PRINCIPLE %uiding rinci le is PAIN AVOIDANCE Should not Small voice of %od &o sto '(ecutive decision ma)er. !n touch with REALITY principle.

SUPEREGO

EGO

ID DOMINANT PERSONALITIES Manic Anti - Social e( erienced by serial )illers Narcissistic SUPEREGO DOMINANT PERSONALITIES Obsessive *om ulsive Anore(ia +ervosa EGO , if destroyed result in im aired reality erce tion. Schi-o hrenia LIBIDO

Se(ual energy res onsible for survival.

PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.] ORAL STAGE

. , 1/ months evident. ID i !e"el#pe!.

$FIXATION % Person is stuc) in certain develo mental sha e. $REGRESSION % 0eturn to an earlier develo mental stage. $EGO % Developed on the 6th month.

1 ANAL STAGE

1/ months , 2 years old. 3ble to control bladder" bowel. Best time for toilet training. SUPEREGO i !e"el#pe!. TOILET TRAINING

%ood 4other Successful 5irty - 5isorgani-ed - 5isobedient - 3nti-social

Bad 4other

*lean - organi-ed - obedient - 6.* ) An&l re*en*i"e

- An&l e'p(l i"e PHALLIC STAGE

2 , 7 years old. '( erience leasure by mani ulating genitals. 8ove , hate relationshi . Oe!ip( C#+ple' boy loves arent of the o !mitates daddy called IDENTIFICATION. C& *r&*i#n ,e&r . Elec*r& C#+ple' girl loves arent of the o !mitates mommy called i!en*i,ic&*i#n. Peni en"-. er level of thin)ing. osite se(. osite se(.

$C#n ci#( , u

$Prec#n ci#( , ti of tongue. $Unc#n ci#( , rotects us from traumatic e( eriences. LATENCY STAGE

7 , 11 years old. School age. Se aration an(iety. 0eading" Writing" 3rithmetic. 8asts for 7 years.

GENITAL STAGE

11 years old and above Se(ual reawa)ening. 9ery im ortant stage.

PHARMACOLOGY NOTES ANTI ANXIETY DRUGS [S.A.T.L.V.M. % E.V.A...I.]

Ser&' A*i"&n T&n'ene Li/ri(+ V&li(+ Mil*#0n E1(&nil Vi *&ril A*&r&' .( p&r In!er&l

ERIC ERI2SON

&here is more to life than :ust se(. P -c3# #ci&l T3e#r- of develo ment. ;ou can develo a ositive side or a negative side. 5evelo mental tas) begins at . , 1/ months.

. , 1/ mos. 1/ mos. , 2 yrs. 2 yrs. , 7 yrs. 7 yrs. , 11 yrs. 11 yrs. , 1. yrs. 1. yrs. , 1= yrs. 1= yrs. , >= yrs. >= yrs. - above

POSITIVE &rust 3utonomy !nitiative !ndustry !dentity !ntimacy %enerativity 'go !ntegrity

NEGATIVE 4istrust Shame < 5oubt %uilt !nferiority 0ole *onfusion !solation Stagnation 5es air

FACTOR Feeding &oilet &raining !nde endence School Peers 8ove Parenting 0eflection

.EHAVIORAL MODELS I"&n P&"l#"

*lassical *onditioning 3ll behaviors are learned.

.F S4inner

Behavior can be learned and unlearned. 6 erant conditioning. !f given reward there is re etition. !f unished behavior becomes e(tinct.

LO.ES OF .RAIN 5. FRONTAL LO.E

8earning Personality

8anguage

>

?udgment @earing Smell &ouch

&aste

6. TEMPORAL LO.E

8. OCCIPITAL LO.E

9isual

7. PARIETAL LO.E

7 STEPS TO INTERACT 9ITH ENVIRONMENT 1. Sensory , eyes" ears" tongue 1. !ntegration 2. 4otor , voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM

3lso called as SOMATIC 4otor nerve to muscle fiber you need ACETYLCHOLINE which is an #6n switch$. Brain S inal *ord 4otor +erve Syna se 4uscle Fiber

INVOLUNTARY NERVOUS SYSTEM

3lso called AUTONOMIC nervous system.

AUTONOMIC NERVOUS SYSTEM SYMPATHETIC (3wa)e" ADRENERGIC: !ncrease !ncrease 5ecrease (5ry mouth" *onsti ation) 5ecrease (Arinary 0etention) ' ine hrine" +ore ine hrine PARASYMPATHETIC (0ela(" CHOLINERGIC: 5ecrease 5ecrease !ncrease (4oist mouth" 5iarrhea) !ncrease (Arinary FreBuency) 3cetylcholine

He&r* R&*e Re pir&*#r- R&*e GI GU Ne(r#*r&n +i**er

DRUGS 9ITH ANTICHOLINERGIC EFFECTS

3nti , 3n(iety 3nti , Psychotic 3nti , *holinergic 3nti , 5e ressants

PHARMACOLOGY NOTES MONOAMINE OXIDASE INHI.ITORS

M&rpl&n N&r!il P&rn&*e

DEFENSE MECHANISMS 5. DISPLACEMENT % transfer of feelings to a less threatening ob:ect rather than the one who rovo)ed it. 6. DENIAL % failure to ac)nowledge an unacce table trait or situation. 7. DISSOCIATION % sychological flight from the self. 8. REGRESSION % return to an earlier develo ment state. ;. REPRESSION % unconscious forgetting. <. RATIONALI=ATION % illogical reasoning for an unacce table trait and situation. >. REACTION FORMATION % doing the o ?. UNDOING % doing the o osite of what you have done. osite of what you have done.

@. IDENTIFICATION % assuming trait for ersonal" social" occu ational role. 5A. PROBECTION % attribute to others oneCs unacce table trait. 55. INTROBECTION % assume another ersonCs trait as your own. 56. SUPPRESSION % conscious forgetting. 57. SU.LIMATION % utting destructive energies or hostile feelings towards a more roductive endeavors. 58. CONVERSION % une( ressed or re ressed feelings are converted to hysical sym toms. 5;. COMPENSATION % over achievement in one area to cover a defective art. 5<. SU.STITUTION % re lace difficult goal with more accessible one.

PHARMACOLOGY NOTES ANTI % PAR2INSON DRUG [C.A.P.A...L.E.S]

C#Cen*in Ar*&ne P&rl#!el A4ine*#n .en&!r-l L&r#!#p& El!epr-l S-++e*rel

AUTONOMIC NERVOUS SYSTEM Pu ils Blood 9essels Blood Pressure SYMPATHETIC 5ilate *onstrict !ncrease PARASYMPATHETIC *onstrict 5ilate 5ecrease

THERAPEUTIC COMMUNICATION TECHNIDUES THERAPEUTIC 1. 6ffer Self 1. Silence , rovide time to thin) 2. 4a)ing observation , what you see you say >. 3ctive 8istening , nodding" eye contact =. Broad 6 ening , how are you todayD NONTHERAPEUTIC 1. 5onCt worry be ha y 1. *hanging the to icEsub:ect 2. !gnore the client >. 9alue based :udgment , never assume =. Flattery 7. 3dvising

7 7. %eneral 8eads , %o on" !Cm listening F. 0estating , !Cm sad #;ouCre sadD$ FEAR % rotects us from something bad. ANXIETY

F.

%iving 6 inion

9ague sense of im ending doom. &riggers the sym athetic nervous system. 3ssess level of an(iety of client.

TYPES OF ANXIETY MILD ANXIETY

G 1 level of an(iety. Widened erce tual field. 0estless (say you seem restless). 'nhanced learning ca acity. G 1 level of an(iety. *lient ace. %ive P0+ meds. G 2 level of an(iety. 5onCt )now what to doEsay. 5irective orders ( lease sit down). G > level of an(iety. 4ay commit suicide. Promote safety. +ever touch atient. @y erventilation (0es iratory 3l)alosis) Breathe into a er bag. PLANNINGEIMPLEMENTATION

MODERATE ANXIETY

SEVERE ANXIETY

PANIC

NURSING DIAGNOSIS

!neffective individual co ing. Powerlessness. !m aired s)in integrity

5ecrease level of an(iety. 5ecrease environmental stimuli. 0ela(ation techniBues

EVALUATION

'ffective individual co ing.

GENERALI=ED ANXIETY DISORDER

7 month e(cessive worrying. 0estless" difficulty concentration" slee disorders" al itations" edge of the seat" easy fatigability.

PANIC ATTAC2SE DISORDER

1= , 2. minutes sym athetic nervous system escalation. '(am le is AGORAPHO.IA fear of o en s aces.

F POST TRAUMATIC STRESS DISORDER

9ictims become survivors and e( erience flashbac)s or nightmares.

MALINGERING

Pretending to be sic) (conscious). Pri+&r- G&in an(iety decreases" able to esca e source of an(iety. Sec#n!&r- G&in able to get attention.

SOMATOFORM DISORDER

+o rotection Anconscious +o organic basis of being sic)

DIFFERENT TYPES OF SOMATOFORM 1. Conversion Disorder

*annot s ea)" see" hear. +ervous system affected. 5o not care what ha ens to them.

2. La Belle Indi eren!e

HYPOCHONDRIASIS

has minor discomfort and inter rets it as ma:or illness. Focus on clients feelings. !llusion of structural defect. Favorite ast time is doctor ho Focus on clients feelings. 0eal ainsEillness 0eal sym toms because of an(iety ing.

.ODY DYSMORPHIC DISORDER

PSYCHOSOMATIC

PSYCHOSOMATIC

F
Incre& e An'ie*-

F
SNS

F
Incre& e .P G HR

F
H-per*en i#n

/
F&* Dep# i*

F
A*3er# cler# i

F
C&lci(+

F
Ar*eri# cler# i

F
Decre& e O'-Cen

F
AnCin& Pec*#ri

F
MI

F
Necr# i

F
CHF

F
C#+&

PHO.IA

!rrational fear 'tiologyH Inowledge of certain ob:ect Bad e( erience !mmediate nursing ob:ectiveH 0emoval of stimulus will remove an(iety S- *e+ic De en i*iH&*i#n gradually e( ose client to stimuliEfeared ob:ect 'm loy rela(ation techniBues

SYMPATHETIC NERVOUS SYSTEM

%3B3 (%amma 3mino Butyric 3cid) , sto ' ine hrine and +ore ine hrine , %o

ANTI) ANXIETY MEDICATIONS

!ncrease %3B3 and client becomes drowsy (no alcohol and coffee) 4ay develo orthostatic hy otension 8et atient sit then dangle feet and then stand 5evelo anti cholinergic effects !f abru tly withdrawn to anti an(iety it may result to rebound henomenon (1 wee)) may lead to sei-ures 5o it in gradual and in ta ered dose 3nti an(iety leads to de endence

AUTISM

Anres onsive and does not want to be touched AUTISTIC SAVANT H high intelligence and has a ratio of 1H1.. A 3 e +en* earance , flat affect and loves constancy and ritualistic

Behavior , withdrawn *ommunication , echolalia

NURSING DIANOSIS

!m aired verbal communication !m aired social interaction Self mutilation 0is) for in:ury

PLANNINGEIMPLEMENTATION

4aslowCs hierarchy of needs E'pre i"e T3er&p- , use of art as mode of communication

EVALUATION

'nhanced communication !m roved social interaction Safety

ATTENTION DEFICIT HYPERACTIVITY DISORDER

F years and below onset D(r&*i#nH 7 months and above Se**inC H house and school A 3 e +en* earanceH dirty" clumsy" hy eractive" im atient" easily distracted and has no focus

Behavior *ommunicationH tal)ative 0is) for in:ury !m aired social interaction S*r(c*(reH lace to lay" slee " eat and study Sc3e!(leH there is always a time for everything that you do Se* li+i* S&,e*4inimi-e ris) for in:ury !m roved social interaction FRONTAL LO.E OF ADHD 5ecreased glucose

NURSING DIAGNOSIS

PLANNINGEIMPLEMENTATION

EVALUATION

K
5ecreased :udgment

K
!ncrease im ulsiveness ADHDE H-per&c*i"i*

+eed a drug that brings glucose level u . %ive RITALIN as stimulant 4ay result in loss of a %iven after meals %iven 7 hours before bedtime etite

1. EATING DISORDERS

ANOREXIA NERVOSA 'at" eat" eat 8ess /=L e( ected body weight 2 months 3menorrhea

.ULIMIA NERVOSA 'at" eat" vomit +ormal weight !rregular menstruation

.ULIMIA NERVOSA

4etabolic al)alosis (vomiting results to decreased hydrochloric acid) 4etabolic acidosis (diarrhea results to decreased bicarbonate) 5ental caries Wound in )nuc)les Fluid and electrolyte imbalance 4eal contract Weight gain for client 3fter eating stay with client for 1 hour and accom any when going to the comfort room

MANAGEMENT

PHARMACOLOGY NOTES ANTI % PSYCHOTIC DRUG

S*el&Hine Seren*il T3#r&Hine Tril&,#n Cl#H&ril Mell&ril H&l!#l Pr#li'in

SCHI=OPHRENIA

'go disintegration !m aired reality erce tion %enetic vulnerability Stress , Di&*3e i M#!el Biological theory , incre& e !#p&+ine le"el '(act cause un)nown 3ffectH 3 ro riate" !na ro riate" Flat" Blunt (incom lete) osing forces

ASSESSMENT

3mbivalenceH ulled into 1 o

AUTISMH 8ooseness" no idea" not related to one another ASSESSMENT

NEGATIVE @y oactive Withdrawn &hought Bloc)ing 3 athy

POSITIVE @y eractive Sociable Flight of ideas

11 I. ASSESS

*ontent of thought 5isturbed thought rocess Present reality Provide safety !m roved thought rocess

NURSING DIAGNOSIS

PLANNINGEIMPLEMENTATION

EVALUATION

II. ASSESS

@allucinationsE !llusions 5isturbed sensory erce tion Present reality Safety !m roved sensory erce tion

NURSING DIAGNOSIS

PLANNINGEIMPLEMENTATION

EVALUATION

III. ASSESS

Sus icious 0is) for other directed violence Present reality Safety 'liminateEminimi-e ris) for other directed violence

NURSING DIAGNOSIS

PLANNINGEIMPLEMENTATION

EVALUATION

IV. ASSESS

Suicidal 0is) for self directed violence Present reality Safety 'liminateEminimi-e ris) for self directed violence

NURSING DIAGNOSIS

PLANNINGEIMPLEMENTATION

EVALUATION

LOOSENESS OF ASSOCIATION

&here is connection with statements

11 FLIGHT OF IDEAS

?um ing from on to ic to another Pulled between 1 strong o acting li)e magician *lient re eats what you say *lient re eats what you do ?ust words no rhyme Words that rhyme Formation of new words (needs clarification) #&he +B! is out to get me$ #! am ?esus *hrist the savior$ # ! am the Bueen of the world$ #&he nurses are tal)ing about me$ 3lso )nown as # iloso o$ Anable to thin) osing forces

AM.IVALENCE

MAGICAL THIN2ING

ECHOLALIA

ECHOPRAXIA

9ORD SALAD

CLANG ASSOCIATION

NEOLOGISM

DELUSIONI PERSECUTORY

DELUSIONI RELIGIOUS

DELUSIONI GRANDEUR

DELUSIONI IDEAS OF REFERENCE

CONCRETE ASSOCIATION

THOUGHT .LOC2ING

S&!4A8AS 9!SA38 3A5!&60; &3*&!8'

HALLUCINATIONS 3BS'+& 3BS'+& 3BS'+& 3BS'+& Present reality to clients e( eriencing hallucinations &echniBue in handling clients with hallucinations Hallucinations Ac)nowledgement #! )now the voices are real to you$

ILLUSIONS P0'S'+& P0'S'+& P0'S'+& P0'S'+&

Reality orientation #! )now the voices are real but ! donCt hear them$ Diversion #8ets go to the garden$ 5AJ #, c3iH#p3renic clien* 3e&r "#ice

PAR2INSONKS DISEASE

!f acethylcholine (on switch) is increased there is e(cessive movement resulting to decrease in do amine (off switch) ANTI)PSYCHOTIC

12

F
5ecrease do amine level

F
Par)inson li)e effect

F
'(tra yramidal side effect

F
With a)athesia

F
0estless" inability to rest A2INESIA

4uscle rigidity &orticollis (wry-nec)) Fi(ed stare 3rched bac) Lip , smac)ing T#nC(e , rotruding C3ee4 , uffing &he 2 are irreversible and called TARDIVE DYS2INESIA NEUROLEPTIC MALIGNANT SYNDROME H-per*3er+i& ANTI % PAR2INSON DRUGS

DYSTONIA

OCULOGYRIC CRISIS

OPISTHOTONUS

3+&!*@68!+'0%!*S (Decre& e AC3 )

56P34!+'0%!*S (Incre& e D#p&+ine)

F
Artane" A)ineton .enadryl Cogentin OT"E# $IDE E%%ECT$ O% DEC#EA$E DO&A'INE

F
Parlodel Larodo a Elde ryl Symmetrel

Photosensitivity 3%03+A86*;&6S!S , decrease WB* *lients rone to infection due to decrease WB* First sign for infection is #re *3r#&* CATATONIC - 3mbivalence - Wa(y fle(ibility - Favorite word is #+o$ - +egativism (client do not follow what you tell them to do) N(r inC PARANOID - Sus icious - 4istrust" scared" withdrawn N(r inC +&n&Ce+en*I - %ain &0AS& RESIDUAL - +o more ositive sym toms :ust withdrawn UNDIFFIRENTIATED UNCLASSIFIED - 4i(ed classification" cant be classified

TYPES OF SCHI=OPHRENIA DISORGANI=ED - Sad but smiles (!na ro riate affect) - +o reaction (flat affect) - Flight of ideas (disorgani-ed s eech) - %iggling

1> (hebe hrenic giggle) - *ombination of ositive and negative signs and sym toms +&n&Ce+en*I 4eet needs by 1 to 1 short interaction but freBuent - Foods should be in a sealed container - 4edications should be in tam er resistant foil. Vi#len*H - Iee door o en - Position near door - 5onCt touch client - *all for reinforcement - 6ne arms length away from the client.

PHARMACOLOGY NOTES .I)POLARL MANIC

Li*3i(+I (n!erC# ,ir * 4i!ne- *e * &n! c3ec4 ,#r /l##! le"el LevelH .7 , 1.1 meBE8 Increase urination Tremors" fine hand Hydration of 28Eday Increase Uu (diarrhea) Mouth dry +ausea" vomiting" diarrhea !ncrease sodium

$i(ns o Lithi)m to*i!it+

$$$$ 9AIT FOR 6 % 8 9EE2S .EFORE LITHIUM THERAPY TA2ES EFFECTS

.IPOLAR DISORDERE MANIC PROFILE

1. years old Female Stress 6bese 5ecrease a @y eractive !ncrease se(ual activity , only means of addressing an(iety so decrease level of an(iety 0is) for in:uryEother directed violence !m aired social interaction (care giver roleH strain and stay with client) Self esteem decrease (to cover u their sadness there is com ensation to cover defective doing) Because there is !ecre& e C#+pen &*i#n i *3e c(lpri* M&n&Ce+en*I incre& e el, e *ee+ *# !ecre& e c#+pen &*i#n &n! !ecre& e in*er,erence 0i*3 ADLK &n! 3&r+ *# #*3er el, e *ee+ there will be incre& e c#+pen &*i#n resulting to incre& e in*er,erence 0i*3 ADLK &n! 3&r+ *# #*3er etite (give finger foods)

ASSESSMENT

5ecrease slee ( lace in a rivate room)

1=

HO9 TO INCREASE SELF ESTEEM OF MANIC PATIENTSM T - no s orts (bas)etball" volleyball)" no fine motor s)ills only gross motor s)ills A -llot energies toward more roductive endeavors ( (/li+&*i#n) S ) escorted wal) outdoors 2 - unching bag (dis lacement) PHARMACOLOGY NOTES ANTI % DEPRESSANTS

A en!in N#rpr&l&+in T#,r&nil Sine1(&n An&,r&nil A"en*-l

Vi"&c*il El&"il Pr#H&c P&'il =#l#,*

ALCO"OL LEAD$ TO,

.l&c4#(*I awa)e but unaware C#n,&/(l&*i#nI inventing stories to increase self esteem Deni&lI #! am not an alcoholic$ Depen!enceI cant leave with out leading to en&/linC where in the significant other tolerates the abuser c# !epen!ence is another term T#ler&nceI gradual increase in amount of stimuli to e( erience the same eu horia De*#'i,ic&*i#nI withdrawal with medical doctor su ervision Avoid alcohol thera y Aversion thera y a more technical term for avoid alcohol thera y AntabuseH 5isulfiram ma)es the client never drin) alcohol because it causes vomiting Alcoholics anonymous

MANAGEMENT

!nterval of 11 hours after last dose of alcohol or e( erience nausea and vomiting and hy otension 3lcoholism may result to 9itamin B1 (&hiamine) deficiency

-E#NIC.E/$ ENCE&"ALO&AT"Y

Problem with motor Problem with memory 1> , F1 hours after last dose of alcohol e( ectH

.O#$A.O%%/$ &$YC"O$I$

Deliri(+ Tre+en H sym athetic nervous system Prevent hallucinationsE!llusions by lacing client in a well lit room F#r+ic&*i#nH feeling of bugs crawling under the s)in

AL=HEIMERS DISEASE 3(on (away) and 5endrites (toward) nerve +eurofibrillary tangles

17 +eurotic laBues ALCOHOLE DELIRIUM 3bru t Fluctuating @ours to days Short term memory loss AL=HEIMERS %radual Anaffected Progressive Short term and long term (orient atient) ; AK OF AL=HEIMERS 1. Amnesia , memory loss 1. Anomia , donCt )now the name 2. Agnosia , sensory roblems smell" taste" sight >. A hasia

ONSET LEVEL OF CONSCIOUSNESS DURATION MEMORY

EXPRESSIVEI cant sayEe( ress Frontal lobe is affected articularly /r#c&K &re& RECEPTIVEI cant hear &em oral lobe is affected articularly 0ernic4eK &re& Re+ini cinC T3er&p- % *&l4 &/#(* p& * Patients with 3l-heimerCs may e( erience hallucinations" illusions thus becomes restless and may wander 3s sun goes down client becomes restless" agitated" disoriented called # (n!#0ninCN 5rug of choice is COGNEX and ARICEPT a cholinesterase inhibitor that increases 3ch causing delay in disease rogression

=. A ra(ia , canCt do sim le things

SEROTONIN

0es onsible for ha

iness

5ecrease serotonin clients becomes sad give anti-de ressants

SELECTIVE SEROTONIN REUPTA2E INHI.ITOR Safest drug Side effects low R I to > wee)s

!ncreases serotonin and affects only serotonin PRO=ACL PAXILL =OLOFT

TRICYCLIC ANTI DEPRESSANT Two , four wee)s C A

@as higher incidence of side effects 3lso increases nore ine hrine ASENDINL NORPRALAMINL TOFRANILL SINEDUANL ANAFRANILL AVENTYLL VIVACTILL ELAVIL

1F MONO AMINE OXIDASE INHI.ITORS

436 )ills serotonin !ncreased 436 results to decreased serotonin the more de ressed the client becomes 436! )ills 436 and increases all neurotransmitters (serotonin" e ine hrine" nore ine hrine" do amine but client becomes rone to hy ertensive crisis 3void tyramine rich foods Avocado" 3lcohol .eer Chocolates" *heese (aged) Fermented foods Pic)les Preserved foods Soy sauce

&here is increase incidence of side effects after 1 , 7 wee)s MARPLANL NARDILL PARNATE

PERSONALITY DISORDERS 1. Sc3iH#p3reni&

&hey avoid eo le because there is no en:oyment &hey avoid eo le because they are afraid of criticisms &hey have talent but has no confidence *onstantly brea)s law Pro:ect charm &hey are witty and articulate 4ani ulative &hey erceive life as an em ty glass &hey li)e s litting friends Sudden change in mood #labile affect$ Prone to suicide #*ant live if living is without you$ *onstantly wants to be the center of attention '(cited" dramatic" mani ulative i *ic #! love myself$ &hey get :ealous even with achievement of family members i"e % C#+p(l i"e #! am so organi-ed$ Sus icious

1. A"#i!&n*

2. An*i)S#ci&l

>. .#r!erline

=. Depen!en*

7. Hi *ri#nic

F. N&rci

/. O/ e

J. P&r&n#i!

1/

4ay lead to domestic violence

ANTI 0 DE&#E$$ANT $IDE E%%ECT$

438' , 'rectile dysfunction" rone to im otence

GRIEF PROCESS [D.A...D.A] 1. 1. 2. >. =. Deni&l , shoc)Edisbelief AnCer , Buestion #why meD$ .&rC&ininC , if" then Depre i#n , 1 wee)s or more sign and sym toms becomes ma:or clinical de ression Accep*&nce , client acts according to situation

ASSESSMENT

5ecrease self actuali-ation 5ecrease self esteem WithdrawnH stay with client SuicidalH ris) for self directed violence !ncreaseEdecrease eat" increaseEdecrease slee " hy oactive" decrease se(ual urge Be sensitive to clients needs

FOR SUICIDAL O.SERVE FOR Ver/&l c#++(nic&*i#n

#! wont be a roblem$ #&his is my last day on earth$ #!Cll soon be gone$ %iving away of valuables Sudden change in mood

N#n)"er/&l c#++(nic&*i#n

9HEN THE CLIENT IS SUICIDAL 9HAT 9ILL THE NURSE DO DirectH #5o you lan to commit suicideD$ IrregularEinterval visits Endorsement eriod" '308; 460+!+% clients are most li)ely to commit suicide DO9NERS [A...O.N.)M.M.C.H.] Alcohol .arbiturate O iates Narcotics #es)ltin( to,

Mari:uana Mor hine Codeine Heroine

Bradycardia Brady nea 4oist mouth Pu ils constrict *onsti ation

1J

Arinary retention @y otension *oma Weight gain N&rc#*ic #"er!# eI give narcotic antagonist (+30*3+" +386M6+' @;506*@860!5')

UPPERS [C.H.A.R.] Cocaine Hallucinogens Am hetamines Re (l*inC *#I

&achycardia 3wa)e &achy nea 5ry mouth Pu ils dilate @y ertension Sei-ures Weight loss