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Saturday, January 19, 2008

Myk Psychiatric Nursing Notes 3

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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 one’s unacceptable trait.
11. INTROJECTION – assume another person’s 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, I’m listening
7. Restating – I’m sad “You’re sad?” 1. Don’t 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. Don’t 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.
• Don’t 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
• Maslow’s 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



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