Professional Documents
Culture Documents
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Withdrawn ------------------------- Sociable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”
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
PARKINSON’S 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
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
- Don’t 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
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 ADL’s and harm to others
• Compensation is the culprit
• Management: increase self esteem to decrease compensation and
decrease interference with ADL’s and harm to others
PHARMA NOTES:
ANTI – DEPRESSANTS
• Asendin
• Norpralamin
• Tofranil
• Sinequan
• Anafranil
• Aventyl
• Vivactil
• Elavil
• Prozac
• Paxil
• Zoloft
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
WERNICKE’S ENCEPHALOPATHY
• Problem with motor
KORSAKOFF’S 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
5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
- expressive: cant say/express
- frontal lobe is affected particularly broca’s area
- receptive: cant hear
- temporal lobe is affected particularly wernicke’s area
5. Apraxia – cant do simple things
* Reminiscing Therapy – talk about past
• Patients with alzheimer’s 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
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
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”
• “I’ll soon be gone”
Non verbal
• Giving away of valuables
• Sudden change in mood
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