PSYCHIATRIC NURSING

TOPRANK COMPREHENSIVE PHASE

PNLE NOVEMBER 2024
Lecturer: Mr. Kevin Fajardo

PSYCHIATRIC NURSING 18 mos. - 3 years old 1-3 years old

Anal Stage Autonomy vs. Shame
Mental Health Gratification: Control of and doubt
●​ According to the World Health Organization elimination Autonomy develops when
(WHO, 2020), mental health is a state of the child's toilet needs are
wellbeing in which an individual realizes his or met consistently
her own abilities, can cope with the normal
stresses of life, can work productively, and is 3-5 years old 3-6 years old
able to make a contribution to his or her Phallic/Oedipal Initiative vs. Guilt
community. Stage Initiative develops when the
Curious of opposite sex child's efforts at learning are
Three Personality Component by Freud Oedipal Complex: boy supported
ID: starts at birth loves mom more Talents
“I want principle” “Devil Principle” Electra complex: girl
●​ Pleasure principle loves dad more
●​ Unconscious Masturbation
●​ Sense of right or wrong (diminished)
●​ Innate desire 5-13 years old 6-12 years old
Latency stage Industry vs. Inferiority
SUPEREGO: 3-6 years old Sexual energy is Industry is achieved if the
●​ Conscience diverted to play activity child learns how to make
●​ Unconscious Competition things through working with
●​ Morality principle (right or wrong) others
○​ Affected Superego: Anorexia, OCD,
Paranoid 12-21 years old 12-18 years old
Genital Stage Identity vs. Role
EGO: starts 1-3 years old Increase sexual activity Confusion
“Self” “I” and sexual identity Vocational choices are
●​ Partly unconscious and conscious Sexual release supported
●​ Reality principle Sex addiction: “What do you want to be
●​ Integrator of personality
●​ D balancer of id and superego
Complication
Sex education ⭐️ when you grow up?”

18-25 years old

●​ Enables adaptive behavior
○​ Affected Ego: Schizophrenia Intimacy vs. Isolation
Intimacy is achieved if the
person is able to establish
Freud’s Erikson’s Psychosocial satisfying relationships
Psychosexual Theory Theory “Love”

25-65 years old

Libido: driving force of Social Factor Generativity vs.
human behavior Stagnation
The person is interested in
guiding next generation
0-18 months 0-12 months “Parenthood”
Oral Stage Trust vs. Mistrust
Gratification: placing Trust/mistrust is developed 65 years old and above
things in the mouth with mom Integrity vs. Despair
The person evaluates
Regression: return to his/her life
previous developmental “Reflection”
stages.

1
Four Phases of Nurse Client Relationship
Pre-interaction/Pre-orientation (For the Nurse)
●​ Stage of Self-Awareness: To prevent
Countertransference
○​ Awareness of yourself and your past and
how it relates to the future.
○​ To avoid biases
●​ #1 Virtue in Psych: Self-awareness

Orientation (Initiation)
●​ T- rust and rapport
●​ R- eflect on words
●​ U- se of contract, boundaries and schedules Two types of Communication: Verbal and
S-trength and weakness Nonverbal
●​ T-herapeutic environment
*The start of the termination phase: "Good morning, full Elements of Non-verbal Communication
name, RN, shift, session, date start & end." 1. Kinetics
●​ Body language
Working Phase ●​ Facial expressions, poise, posture, gait,
●​ S- elf concept movement
●​ O- rganize support system ●​ Reflects mood
●​ L- ead to a plan of action
●​ V- erbalization of feelings 2. Proxemics
●​ E- ncourage independence ●​ Space/ distance between sender and receiver
●​ R- ealistic goal setting ○​ Intimate Distance - up to 18 inches
○​ Most difficult phase ■​ Maintain professionalism
○​ Longest phase ○​ Personal Space- 18 inches to 4 ft.
■​ Health teaching
Termination Phase ○​ Social Space- 9-12 ft
●​ R-einforce and reward change and strength of ■​ Group therapy
●​ patient ○​ Public Space: beyond 12 feet
●​ E- ncourage expression of feelings about ■​ Seminar
termination of the relationship
●​ S- ummarize the progress 3. Paralanguage
●​ T- erminate the relationship without giving ●​ Vocal cue/vocal delivery/ voice quality
promises
○​ S/s: Regression: Temper tantrums, 4. Touch
thumb sucking, apathy, fetal position ●​ Shows an attempt to connect and relate
when cry
5. Silence
Communication ●​ Encourages verbalization of feelings

⭐️
Exchange of information between 2 or more person
Most important in Communication: Feedback Therapeutic Communication Techniques
CLARIFYING I'm not sure I understand
Elements of Communication: what you are trying to say.
1. Sender / Encoder: source of the message
2. Message: Information being transmitted GIVING BROAD Is there something you'd like
3. Receiver / Decoder: Recipient of the message OPENINGS or to do?
4. Feedback – Receiver’ s response ASKING
(Note: Barriers – factors that inhibits the communication OPEN-ENDED
process) QUESTIONS

ACCEPTING Yes, that must have been

difficult for you.

ACKNOWLEDGING I noticed that you've fixed

or GIVING your bed.

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 Anxiety Disorders
RECOGNITION
●​ “Fear of unknown”
OFFERING SELF I’ll sit with you in a while. ●​ A normal response to stress
(Presence, ●​ A subjective experience that includes feelings of
Comfort) apprehension, uneasiness, uncertainty, or dread.

PRESENTING Hallucination: I see no one General Anxiety Disorder

REALITY else in the room. ●​ Anxiety of day to day activities
Voice doubt
I find that hard to believe. Hildegard Peplau: Levels of Anxiety
INFORMING I'll be your nurse for today, Mild +1 (Good) Widened Perceptual Field
from 7:00 until Increase concentration
3:00 this afternoon. Restless (stationary)
Health Teaching Enhanced Learning
Capacity
MAKING "You appear tense" "You Seem Restless"
OBSERVATIONS No Management
REFLECTING Client: I do not want those Moderate +2 Pacing back and forth
(Feelings, medicines! pout Nausea
Thoughts, Ideas) Nurse: You are unhappy about Anorexia
taking the medication? Vomiting
Diarrhea and Increased
RESTATING Client: I can't sleep, I stay Urination
awake all night. Abdominal butterflies
Nurse: You can't sleep at
night. Management:
Safety
SUPPORTIVE "I know it isn't easy, but you
Oral Medications
CONFRONTATION can do it."
Problem Solving
(Acknowledge "It would be difficult at first,
client’s feeling) but you'll get through it." Severe +3 Increase RR, HR,
Dyspnea
Non-Therapeutic Communication Techniques Confusion/Alogia
●​ Don’t know what
FALSE Don't worry, everything will to do/ Don’t
REASSURANCE be alright. know what to say
JUDGING It's your own mistake. Management:
Directives/Direct
DEFENDING All doctors here are simply
Questions
great.
IV Meds
Safety
BELITTLING Don't be concerned,
Panic +4 Hallucination
everyone feels like that.
Harming others/self

❌
Chest pain/Syncope

❌
❌
Why
Lecturing Management:

❌ Advising Stay with client but do

❌ Moralizing/ Immoralizing not touch

❌ Agree/Disagree Environmental Safety

❌ Ignore patient Restraint (Last Resort)

❌Blame the patient

Avoid passing the back (refer)

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Psychotropic Medications: 2. Situational/Accidental
●​ Antianxiety or Anxiolytic Medications ●​ Often unanticipated
○​ Potentiations GABA ○​ Loss of spouse, loss of job, divorce, loss
○​ Minor tranquilizer of loved one
○​ Can cause sedation 3. Adventitious/Social
○​ Decrease anxiety symptoms ●​ Relates to unplanned/ accidental crisis
●​ Kakaiba/abnormal
○​ Disaster
Benzodiazepines Nonbenzodiazepines
○​ Earthquake, fire, murder suicide,
(Short Term) (Long Term)
tsunami, rape
Valium (Diazepam) Buspirone (Buspar)
Xanax (Alprazolam) ●​ no sedation Duration of Crisis: 4 - 6 weeks (self-limiting)
Klonopin ●​ 3-4 weeks to Goal: To help patient return to pre-crisis level
(Clonazepam) reach full Focus: Here and Now (GESTALT THERAPY)
Serax (Oxazepam) effect - immediate problem, feelings, and solutions
Ativan (Lorazepam) ●​ no
withdrawal
Approach:
effect
Meprobamate Directive - promote problem solving,
(Miltown, Equanil) Supportive - encourage expression of feelings

Phobias
SE: Anticholinergic
5 Can’ts: See, Spit, Sweat, Pee, Shit ●​ Fear the known
●​ An illogical, intense and persistent fear of a
●​ Blurry Vision specific object or social situation
●​ Dry Mouth ●​ Symptoms of a phobia are generally similar
●​ Dry skin signs and symptoms to a panic attack
●​ Urinary retention
●​ Constipation
3 Categories of Phobias
Precautions: 1. Agoraphobia - fear or anxiety of places from which
●​ Best to take at bedtime/ before meals escape is difficult
●​ Avoid Alcohol 2. Specific - fear or anxiety caused by an object
●​ Avoid cigarettes/coffee
●​ Monitor kidney/liver Acrophobia Fear of heights
Agoraphobia Fear of open spaces
Anxiety Astraphobia Fear of electrical storms
Drug of Choice: Benzodiazepines Azapirones Claustrophobia Fear of closed spaces
Nursing Education: Avoid alcohol Hematophobia Fear of blood
●​ Midazolam Hydrophobia Fear of water
●​ Alprazolam Monophobia Fear of being alone
●​ Diazepam Mysophobia Fear of dirt or germs
●​ Clonazepam Nyctophobia Fear of darkness
●​ Buspirone Pyrophobia Fear of fires
●​ Ipsapirone Social phobia Fear situations in which one
might be embarrassed or
Antidote: Flumazenil (Romazicon) criticized; fear of making a fool of
Therapeutic Effect in 5 mins Xenophobia oneself
Zoophobia Fear of strangers
Crisis Arachnophobia Fear of animals
Ophidiophobia Fear of spiders
●​ When coping mechanisms are ineffective that
Fear of snakes
results in disequilibrium.

Types of Crisis: 3. Social Phobia - fear or anxiety cause by social or

1. Maturational/Developmental performance situations
●​ Expected/predictable;
●​ Social Anxiety Disorder
○​ Menarche, Marriage, Birth of child

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 Guided imagery
●​ Defense Mechanism: Displacement and ●​ a mind-body intervention where clients
avoidance concentrate on (mental images) to help reduce
stress, anxiety, & improve concentration.
Management: Group Therapy
●​ Cognitive Behavioral Therapy ●​ 3-5 members
●​ Flooding - sudden exposure to maximum ●​ 3-10 members
stimulus ●​ Reduce isolation & communicate acceptance
●​ Systematic Desensitization - gradual
exposure to the feared object Therapeutic Milieu
●​ This provides a safe & secure environment for
●​ 1st step: Let the client think and talk about the
clients that are in therapy.
feared object

TOC: Anxiolytic/SSRI (Prozac & Zoloft) PERSONALITY DISORDER

●​ A personality disorder is a way of thinking,

PTSD and Acute Stress Disorder feeling, and acting that goes against what
●​ ASD- Acute stress disorder is a mental people in the culture expect, causes distress or
disorder that can occur within the first month makes it hard to function, and lasts for a long
following a traumatic event. time.
●​ PTSD - Post Traumatic Stress Disorder if ●​ Unaware
symptoms persist for over 1 month.

Signs and symptoms:

●​ Same as panic/severe anxiety
●​ Guilt/ anger
●​ Insomnia
●​ Loss of appetite
●​ Nightmares
●​ Flashbacks

Management:
●​ Grounded Techniques
●​ Safety
●​ Psychotherapy
⬆️
Narcissistic Personality Disorder
●​ Needs admiration = self-esteem
Psychotherapy: ●​ Arrogant, & grandiose
●​ Talk therapy ●​ Really believes they're perfect
●​ To help eliminate and control symptoms ●​ Constant need for praise
●​ Guided by mental health professional ●​ Superiority complex
Defusing – providing education on stress and stress Paranoid Personality Disorder
management
●​ Suspicious
Debriefing – client is asked about their emotional
●​ Intense and controlling
reaction to an incident
●​ Lonely and Isolated
Exposure therapy – confronting trauma associated
●​ Over-jealous
thoughts rather than avoiding
●​ Sensitive
Adaptive disclosure therapy (empty chair technique)
Catharsis – releasing repressed emotions thru art and
Histrionic Personality Disorder
music
●​ Ua - attention-seeker seductive
CBT ●​ Gratification always needed
●​ It helps clients reframe their thought processes ●​ Hysterical and dramatic
in order to slowly cope with stress and anxiety. ●​ Hyper-emotions
●​ Change the mindset to change behavior

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Dependent Personality Disorder TOC: Anxiolytic/SSRI (Prozac & Zoloft)
●​ Wife battered syndrome
○​ Martyr Dissociative Identity Disorder
●​ Indecisive and a good-follower ●​ Dissociative identity disorder occurs when 2 or
●​ Fears separation more identities (alters) rotate control over the
○​ Loss of function
client's behavior.
●​ Enabler and codependent
●​ Multiple Personality Disorder
○​ To their alcoholic husbands
●​ Caused: Trauma
Antisocial Personality Disorder
●​ Good-talker and charming (bad boy effect) Types:
●​ Manipulates others for personal gain Dissociative Amnesia: unable to recall personal info
●​ Aggressive (sexually) [Sadism and masochism] Dissociative Fugue: New identity, new environment
●​ Impulsive Depersonalization Disorder: An altered
●​ Law/Rule breakers/criminal
self-perception in which one's own reality is temporarily
Borderline Personality Disorder lost or changed.
●​ Will use manipulation
●​ Abandonment issues/fear of separation Nursing Management:
●​ Gaslighting and suicidal ●​ Stay with patient
●​ Gather data about the patient
Avoidant Personality Disorder ●​ Do not present all data, avoid flooding
●​ Avoids people ●​ Explore stressors
●​ Timid/Shy
●​ Ask the patient to relate the event
●​ Inferiority complex
●​ Sensitive to rejection and criticism ●​ Look for effective coping
○​ Prone to abuse TOC: SSRI (Prozac & Zoloft)

Schizoid Personality Disorder

●​ No best friend - avoid people SOMATIC DISORDERS
●​ Long-term relationship SDD is a psychological disorder where clients have
●​ Attach to computer and pets unexplained physical symptoms like abdominal pain,
●​ I don't like people weakness, chest pain, shortness of breath, & others.
●​ Loner
●​ Stands on his own Conversion Disorder
●​ Loss of body function/disability
Schizotypal Personality Disorder ●​ La belle indifference
●​ Alone ●​ Unconcerned symptoms
●​ Has special powers
●​ Withdrawn Hypochondriasis (Illness Anxiety Disorder)
●​ Often tells magical stories/horror stories ●​ Preoccupation with illness
●​ Overly detached ●​ Doctor hopping/shopping

Obsessive Compulsive Disorder Body Dysmorphic Disorder

Obsession: Intrusive thoughts ●​ Loss of organ/ defect
Compulsion: Ritual
With physical symptoms, no organic cause
OCPD: People are unaware of the problem ●​ Malingering: faking an illness/fabrication
OCD: Aware but keeps on doing it ●​ Factitious: cause an illness to self
●​ Factitious Disease by Proxy
Nursing Management:
●​ Divert/ redirect the ritual to a productive activity (Munchausen’s Syndrome): cause an illness
●​ Initially, allow patient to continue the rituals to others
●​ Engage patient in social activities
●​ Set limits to patient's ritual, but do not Nursing Management:
stop/interrupt a ritual ●​ Rule out any possible organic of physiologic
cause

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 ●​ Real for the patient ●​ I-nclude dietician psychiatrist
●​ Recognize manipulation ●​ N-o signs of malnutrition
●​ Attend to physical complaints ●​ G-oal
●​ Consistent caregiver must be provided
●​ Encourage verbalization of feeling
Anorexia Bulimia
○​ Do not give placebo
Diet Diet Diet Eating Eat, Eat, Vomit
Treatment: Behavior
1. Antidepressants - SSRI
2. Chronic pain therapy - avoid narcotic analgesics <85% of Body Weight Normal Weight
expected body
(morphine, codeine)
weight
3. Cognitive behavioral therapy
3 months Menstruation Irregular
amenorrhea menstruation
EATING DISORDERS
Anorexia Nervosa Stay with the Nurse Stay with the
client during client 1-2 hrs
●​ Fear of obesity
meals after meals
●​ Problem with hypothalamus (thirst, hunger)
●​ Common to female Family Therapy

Assessment: Antidepressant: Tofranil and Amitriptyline (Elavil)

●​ Refusal to eat/drink Olanzapine (Zyprexa)
SSRI: (Fluoxetine) Prozac and Zoloft
●​ Excessive exercise
●​ Perfectionist = superego Weight gain Side Effects Decrease urge
●​ Underweight/ 15% or less than IBW. to purging
●​ Signs of malnutrition
●​ Bony prominence Neurotransmitters:
●​ Amenorrhea for 3 periods ●​ Dopamine/ Epinephrine /Norepinephrine:
●​ Dry hair ○​ Excitatory
●​ Lanugo ●​ Serotonin:
●​ Imbalance ○​ Excitatory in synapse
○​ Inhibitory in cells
●​ Poor skin turgor
●​ GABA (Gamma-Aminobutyric acid):
●​ Ensure Safety (suicidal) ○​ Balancer

Bulimia Nervosa/ Binge and Purge Syndrome

●​ Binge eating, followed by self-induced vomiting NEURODEVELOPMENTAL DISORDERS
Autism Spectrum Disorder
Assessment: ●​ ASD is a developmental disorder that impairs a
●​ Hoarseness of voice child's ability to communicate and interact.
●​ Enlarged parotid glands ●​ The cause of autism is unknown.
●​ Average weight
Signs and symptoms:
●​ Russel's sign: calluses on knuckles ●​ Does not maintain eye contact
●​ Toothache: dental caries, halitosis ●​ Does not interact with gestures
●​ Metabolic acidosis and alkalosis ●​ Like being cuddled & plays alone
●​ Enema's, diuretics and diet pills ●​ Delay in language development
●​ Echolalia and rituals
Nursing Management: ●​ Respond to questions
●​ E-ncourage expression of feelings
●​ A-lways use the same scale
●​ T-o promote the feelings of control

7
Management: both biologic parents have
●​ Safety- stay with the client schizophrenia.
●​ Structure- provide a place to study, eat, play, ○​ Identical twins: 50%
bath, etc. ○​ Fraternal twins: 15%
●​ Schedule - time for everything
●​ Set limits according to scheduled Positive Symptoms: clear symptoms, visibly displayed
●​ Give a written schedule of daily activities ●​ Hallucinations
●​ Aggressive behavior:
●​ Echopraxia
○​ distract the child & ask them to blow up
a balloon ●​ Associative Looseness
●​ Increased risk for injury ●​ Delusions
●​ Perseveration
TOC: Haloperidol (Haldol): Major Tranquilizer ●​ Ideas of Reference
●​ Group of Disorganized Speech and Thoughts
ADHD
●​ Attention Deficit Hyperactivity Disorder Negative Symptoms: non-active symptoms, not ussy
●​ Former term ADD - Attention Deficit Disorder
displayed
●​ Decrease in attention span
●​ A - Affect Flat (expressionless, blank look)
Signs and symptoms: ●​ A - Anhedonia (inability to experience pleasure)
●​ Impulsiveness "excessive talking” client's mood turned of like
●​ Hyperactivity "restless" ●​ A - Apathy & Avolition (lack of interest or
●​ Inattention "reduced ability to focus" motivation
●​ Low self-esteem & impaired social skills
●​ A - Alogia (poor speech)
●​ A - Anxiety & avoids social interaction
Drugs:
●​ Methylphenidate Amphetamine mixture (brand:
Ritalin) Psychomotor disturbances:
●​ Dextroamphetamine Stimulants (brand: Adrenal) ●​ Posturing - behavior that is intended to
impress or mislead. (+)
Residual ADHD grows up not antisocial ●​ Apraxia - no movement (-)
Meds: Ritalin, dexedrine, pemoline, adderall ●​ Automatism- repeated purposeless behavior
(+)
20-30 mg
Best time to give: once a day ○​ Twisting locks of hair ⭐️
After meals to prevent loss of appetite ○​ Leg shaking
●​ Waxy flexibility- maintenance of awkward

⬆️HR,●​ ⬆️Antidote:
RR
Alprazolam
posture (-)
●​ Echopraxia - repetition of someone else's
actions (+)
●​ Rigidity - stiffness or inflexibility (-)
Don't give at bedtime: stimulant
Causes insomnia
●​ Give 6 hours prior bedtime if bid Mood/affect disturbances:
●​ Apathy- lack of interest or emotions
●​ Blunt affect - decreased ability to express
PSYCHOTIC DISORDERS
emotion
Schizophrenia ●​ Ambivalence - two opposing emotions
●​ A long-term mental disorder involving a ●​ Flat speech - don't express outwardly vocally
deteriorating breakdown in the relation between ●​ Inappropriate affect - emotional responses
thought, emotion, and behavior.
that are not compatible
●​ The earlier the onset, the worse the prognosis.
●​ Melancholia - deep sadness
Causes: ●​ Alexithymia - inability to recognize or describe
●​ Genetics one's own emotions.
○​ One biologic parent with schizophrenia ●​ Labile - changeable mood
have a 15% risk; the risk rises to 35% if ●​ Euphoria - extreme happiness

8
 ●​ Capgras' syndrome
Disorganized Speech & Thought: ○​ The central theme is that a significant
●​ Loose associations: rapid shift of thought with other (usually a family member) has
no logical connection been replaced by an identical impostor.
●​ Flight of ideas: rapid shift of thought with ●​ Dorian Gray
logical connection ○​ The central theme is that others are
●​ Neologisms: making up imaginary words aging while the client appears to remain
●​ Clang associations: listing rhyming words the same age.
together that make no sense ●​ Jealous delusions
●​ Word Salad: mixing words together that have ○​ unfaithfulness of a spouse or lover.
no meaning except to the client ●​ Erotomanic delusions
●​ Concrete thinking: taking a statement literally. ○​ belief that the patient is loved intensely
●​ Echolalia: repetition of words they hear from by the "loved object," who is usually
someone else married, of a higher socio-economic
●​ Verbigeration: repeating phrases status, or otherwise unattainable.
●​ Stilted language: use of flowery words
●​ Perseveration: adherence to a single topic Management of Schizophrenia:
●​ Illusion: false perception of actual external ●​ Hallucination must be recognized
stimuli ●​ Assess the content
●​ Hallucination: false sensory perception in the ●​ Reality presentation
absence of external stimuli ●​ Divert the attention
●​ Engage in reality-based activity
Note: Illusions and hallucinations can be visual tactile,
●​ Reintegrate with the milieu
auditory, gustatory, or olfactory
●​ TALK BACK to the voices
Visual: Psychedelics
Tactile: Formication: alcohol withdrawal
Delusion - false belief
Olfactory: Phantosmia: PTSD
Management:
Gustatory: Dysgeusia
●​ Clarification the meaning
Auditory: Commands
●​ Acknowledge the feelings
Synesthesia: Mixing of senses
●​ Voice doubt
●​ Engage in reality based activities here to search
Delusion: the false belief that is inconsistent with one's
knowledge and cultures Classification of Schizophrenia
●​ Delusion of reference DISORGANIZED: aka Hebephrenic (Taong grasa)
○​ This song has a secret message just for ●​ Essential features:
me. ○​ Characterized with inappropriate
behavior: Silly crying, laughing,
●​ Delusion of control regression, transient hallucinations
○​ I do not go online, that’s how the NBI (Auditory)
controls you. ○​ Management: Assist in ADL’s
●​ Delusions of Grandeur:
○​ "I have a very important meeting with PARANOID: (Hallucination, Illusion, Delusion)
the President today" ●​ Presenting signs are SUSPICIOUSNESS, ideas of
●​ Persecutory (paranoid) delusions: persecution and delusions.
○​ "The hospital food is trying to poison ○​ 4Ps:
me" ■​ Projection
●​ Religious Delusions ■​ Proxemics: social space
○​ The central theme often center to the ■​ Passive friendliness
second coming of Christ or another ■​ Persecutory delusion
significant religious figure or a prophet. Nursing Diagnosis: Alteration in nutrition: Less than
body requirement

9
Nursing Goal: to meet the patient's daily nutritional
Usage: Positive Symptoms
requirements Increase risk for EPS
Nursing Interventions:
a. Do not force patient to eat foods that he refuses MOA: Block the receptor of dopamine
b. You may do any of the following:
1.​ Allow client to buy foods ATYPICAL ANTIPSYCHOTICS: 2nd Generation
“Done” “Pine”
2.​ Allow client to prepare his own food
●​ Clozapine (Clozaril)
3.​ Offer packaged foods except canned foods: ●​ Risperidone (Risperdal)
gustatory hallucination ●​ Olanzapine (Zyprexa)
●​ Quetiapine (Seroquel)
Nursing Diagnosis: Non-compliance with therapy ●​ Ziprasidone (Geodon)
Nursing Interventions:
a. Reinforce drug teaching Usage: Negative Symptoms
b. Administer drugs in the same form always
c. Do not hide tablets
⬇️
Decrease risk for EPS
(+) Agranulocytosis ( WBC)
Risk for Infection

CATATONIC MOA: Block the receptor of dopamine and inhibit

●​ Essential features: psychomotor disturbances reuptake of serotonin which treats the depressivel
○​ waxy flexibility(cerea flexibilitas) rigidity, aspect of serotonin.
posturing, negativism,mutism
New Generation
●​ Defense Mechanism: Autism and mutism “Zole”
●​ Aripiprazole (Abilify): New Generation
UNDIFFERENTIATED or MIXED: ●​ Brexpiprazole (Rexulti)
●​ Symptoms of more than one type of ●​ Cariprazine (Vraylar)
schizophrenia
●​ The #1 drug of choice is Fluphenazine (Prolixin SE: Sedation, Weight Gain, Akathisia, Headache,
Anxiety, Nausea
decanoate)

RESIDUAL: Extra Pyramidal Syndrome

●​ No longer exhibits overt symptoms, no more ●​ Acute Dystonia: facial grimace, dysphagia
○​ Torticollis (twisted head and neck)
delusions but, still has negative symptoms
○​ Opisthotonus (tightness in the entire
body with the head back and an arched
SCHIZOAFFECTIVE: neck)
●​ Schizophrenia (+) mood disorders (e.g. ○​ Oculogyric crisis (eyes rolled back in a
depression) locked position).
●​ Akathisia: restless, agitated
Antipsychotics ●​ Pseudoparkinsonism: shuffling gait, mask like
●​ These are medications, also known as face, pill rolling
neuroleptics, which are used to treat the
Nursing Action:
symptoms of psychosis such as the delusions ●​ Notify the physician; decrease dose
and hallucinations seen in schizophrenia,
schizoaffective disorder, and the manic phase of Management:
bipolar disorder. ●​ Shift to another generation of drug

TYPICAL ANTIPSYCHOTICS: 1st Generation Neuroleptic Malignant Syndrome

Conventional: “Zine” “Dol” ●​ Hyperthermia
●​ Chlorpromazine (Thorazine) ●​ Hypertension
●​ Fluphenazine decanoate ●​ Muscle spasms
●​ (Prolixin Decanoate)
●​ Haloperidol (Haldol) Nursing Action:
●​ Thioridazine (Mellaril) ●​ Stop medication

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 DEFENSE MECHANISM
Medical Management: ●​ Protects ego and decrease anxiety
●​ Baclofen (muscle spasm) ●​ Sigmund Freud
●​ Supportive Management

Prevention:
Displacement Transfer of feelings to a less
●​ Increase fluid intake
threatening object rather than
the one who provoke it
Tardive Dyskinesia
●​ Tongue protrusion Denial Failure to acknowledge an
●​ Teeth grinding (Alcoholic) unacceptable trait or
●​ Lip Smacking situation.

Nursing Action: Regression Return to an earlier

●​ Notify physician developmental stage

Medical Management: Repression Unconscious forgetting of an

●​ Valbenazine (Ingrezza) anxiety provoking concept.

Prevention: Suppression Conscious forgetting of an

●​ Start with a lower dose anxiety provoking concept it
happens because the person
Other Symptoms: is protecting his/her ego
●​ CATDOG
●​ Constipation: increase fluid and fiver Sublimation Placing sexual energies
●​ Agranulocytosis: monitor WBC toward a more productive
●​ Tooth decay: sugarless gum endeavor.
●​ Dry mouth: sugarless gum
●​ Orthostatic hypotension: slow position Rationalization Illogical reasoning for a
change socially unacceptable trait
●​ Galactorrhea: wear cotton clothes
Reaction formation Doing the opposite of your
PAWS intention. (Plastic)
●​ Photosensitivity: avoid direct sunlight, use
umbrella and Undoing Doing the opposite of what
●​ sunglasses, apply SPF 25 lotion. you have done due to guilt.
●​ Arrhythmias : immediately report abnormal
Identification Assume traits for personal,
heartbeat.
social, occupational role.
●​ Weight gain: lessen intake of sugary food and
beverages.
Introjection Assume another person's trait
●​ Sedation: avoid driving and operating
as your own.
machineries.
●​ 5 Cant’s Projection Attributing to others one's
acceptable trial.
If the client forgets a dose of antipsychotic
medication, he or she can take the missed dose if it is Conversion Repressed anger put toward
only 3 or 4 hours late. If the dose is more than 4 physical symptoms affecting
hours overdue or the next dose is due, the client can nervous system leading to
omit the forgotten dose. sensory numbness and motor
paralysis.
→When emotions turn to
physical symptoms.

Compensation Overachievement in one area

to cover a defective part.

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 5. Insomnia or hyper-insomnia (sleeping too
Intellectualization Acknowledging the facts not
much)
the emotion. Do not make
6. Fatigue (anergia)
everything emotional.
7. Feeling worthlessness or guilt
8. Difficult in concentration
Substitution Replacing a difficult goal with
9. Suicidal thoughts (recurrent)
a more accessible one.

Splitting Seeing things black and Depressed Client

white. ●​ 24 hour/7 days constant supervision
●​ Kind firmness.
Idealization The action of regarding or ○​ S - silence means you are offering
representing something as yourself and will listen attentively.
perfect or better than reality. ○​ 0 - Offering self - offer yourself and let
\
the patient share their problem.
○​ M - motivate - remind client of time
MOOD DISORDER when she or he felt better and was
successful
Bipolar Bipolar Manic Major Cyclothym Dysthymi ○​ E - engage in social activities. Just talk
1 2 d/o d/o ia a
with the people with depression, ensure
Mania
✔️ ❌ ✔️ ❌ ❌ ❌ that remove them on that state of
having problem which causes the
Hypomani
a ✔️ ✔️ ✔️ ❌ ✔️ ❌ depression
■​ Management: MOTIVATE them
Hypo
Depressio
n
✔️ ✔️ ❌ ✔️ ✔️ ✔️ through praising.
●​ Continuous one-on-one observation
Major
Depressio
n
✔️ ✔️ ❌ ✔️ ❌ ❌ ●​ Semi-private room (near nurses' station)
○​ Remove harmful objects form the room
since the patient is depressed and
possible for suicidal thoughts → kill
Mania: hypomania, hallucination , illusion, and delusion themselves using the harmful objects.
Hypomania: Euphoria, hyperactivity, restlessness, ○​ Observe changes in behavior once there
increased sex drive, is change in behavior it can mean that
Hypo Depression: Excessive loneliness, hopeless, the patient has a plan how to do their
empty, anergia (lack of energy) suicide attempt.
Major depression: Hypo dep + suicidal thoughts ○​ Doors should be lockable outside.
○​ Supervise during meals.
Cyclothymia: Bipolar like disorder ■​ Small frequent meals
Dysthymia: 2-3 years Minor depression ■​ High calorie foods and fluid
■​ Stay with client during meals
Depression ■​ Determinant if the patient has a
●​ Experiences severe depression → thus result to good diet: Weekly weighing.
loss of enjoyment in life, low energy, and few ●​ Reassess: changes in suicidal thoughts clear
other critical signs and symptoms. plans of the future involving personal goals,
●​ Everything is low and slow → due to low levels family, and friends.
of neurotransmitters within the brain.
●​ Also known as clinical depression Antidepressant: 4 Rules
●​ Main problem: it is the low levels of ●​ Increased risk of suicide it is because of the
neurotransmitters. excitatory effect of the antidepressant (from low
○​ Low serotonin levels of neurotransmitter → with antidepressant
○​ Low dopamine → increased level of neurotransmitter or
○​ Low norepinephrine excitatory effects) because remember
antidepressant does not cure the depression
Signs and symptoms: therefore, the suicidal thoughts and depression
Diagnosis: 5 or more symptoms → there is DEPRESSION is still there.
1. Depressed mood (hopeless, empty) ●​ Slow onset and slowly taper off for 2-4 weeks
2. Anhedonia (loss of joy/interest in life) ○​ To avoid withdrawal symptoms
3. Weight loss (anorexia) or wt. gain
4. Psychomotor retardation or agitation

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 ●​ Never mix: mixing can cause serotonin ●​ 1 to 4 weeks only
syndrome which is a dangerous and deadly ○​ Onset and Taper Off
side effect of this drug
○​ Serotonin Syndrome: ⬆️ HR, BP, RR,
Temp, Anxiety, Tremors, Seizure →
Monoamine Oxidase Inhibitor (MAOI)
PaMaNA
Death ●​ Phenelzine (Nardil)
●​ All antidepressant drugs: ●​ Tranylcypromine (Parnate)
○​ Decrease BP (slow position changes) ●​ Isocarboxazid (Marplan)
→ orthostatic hypotension
○​ Cause weight changes: ●​ Action: Increase availability of
■​ Short Term: Weight loss norepinephrine, serotonin, and dopamine
■​ Long Term: Weight gain in the brain.
●​ most noticeable ●​ Avoid tyramine because it causes massive HTN.
●​ Massive hypertensive crisis risk due to tyramine
Tricyclic Antidepressant (TCA) ●​ Avoid tyramine rich foods
ToSiEI ○​ Alcohol, chocolates, preserved and
●​ Imipramine (Tofranil) processed food, avocado, cheese
●​ Doxepin (Sinequan) ●​ OTC Drugs
●​ Amitriptyline (Elavil) ○​ No calcium, antacids, acetaminophen,
NSAIDs
Other drugs: ●​ Other Antidepressants
●​ Asendin ○​ Can lead to serotonin syndrome
●​ Norpramin ●​ Increased suicide risk.
●​ Anafranil
●​ Aventyl
If the client forgets a dose of an SSRI, he or she can
●​ Vivactil
take it up to 8 hours after the missed dose. To
minimize side effects, clients generally should take
●​ Action: Prevent reuptake of norepinephrine
cyclic compounds at night in a single daily dose when
and serotonin increasing these
possible. If the client forgets a dose of a cyclic
neurotransmitters in the body.
compound, he or she should take it within 3 hours of
●​ 2 - 4 weeks
the missed dose or omit the dose for that day.
●​ Check for the higher incidence of side effects
(anticholinergic).
●​ Assess for suicide. Electroconvulsive Therapy
●​ Monitor for anticholinergic effect. ●​ an effective treatment for depression that
○​ 5 Cant’s consists of inducing a grand mal (tonic-clonic)
■​ See - blurry vision seizure by passing an electrical current through
■​ Spit - dry mouth electrodes attached to the temples
■​ Sweat - decreased perspiration ●​ Process: through electrical chargers'
■​ Pee - urinary neurotransmitters it has rebalancing
■​ Shit - constipation ●​ Indication:
○​ Treatment resistant disorder
Selective Serotonin Reuptake Inhibitors (SSRI) ●​ Life-threatening priority: monitor for aspiration
CeProZo and respiratory status.
●​ Fluoxetine (Prozac)
●​ Sertraline (Zoloft) Pre-procedure:
●​ Citalopram (Celexa) ●​ X ray
○​ Due to risk of fracture
●​ Action: Prevent reuptake of serotonin ●​ Informed consent
increasing the availability of serotonin in the ○​ Voluntary: patient must be in lucid state
body. ○​ Involuntary: next of kin
●​ Sexual Dysfunction ●​ NPO 6 - 8 hours
●​ Serotonin syndrome - increased HR, BP, ○​ Risk for aspiration
confusion, anxiety, and tremors → seizure → ●​ Medications
death ○​ Atropine:
●​ Side effect but suicide risk. ■​ dry mouth, decreased oral
●​ Rigid muscle and restless - it is still part of secretions
serotonin syndrome.

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 ○​ Barbiturate: ●​ Age (18-25 and >40), Alcoholism
■​ Sedative it is not for seizure ●​ Lethality of previous attempts/losses
rather for sedative purposes ●​ Plan - Most Outstanding
○​ Succinylcholine:
■​ muscle relaxant, prevents Best approach for suicidal patient: Direct
seizure. approach
Post-procedure:
●​ Side-lying - lateral best position after seizure Nursing Management and Intervention:
due to risk for aspiration. ●​ Close surveillance 24/7
●​ S/E: ●​ Assess directly and monitor for signs/plans
○​ Most common: confusion due to ○​ Suicidal clues: verbal or non-verbal
headache and dizziness. ●​ Safety, security and supervision
○​ Distinct sign: Temporary memory loss ●​ Provide family therapy/support group and
counseling
Nursing Intervention:
• 5’s in Seizure Hospital area majority suicide will happens at:
●​ Safety ●​ Weekend, 1 - 3 am Sunday
●​ Side-lying ●​ Weekend less staff personnel
●​ Side rails up ●​ Early AM, endorsement, everyone is asleep
●​ Stimulus (no noise and bright lights)
●​ Support the head with a pillow after the seizure. Bipolar Disorder
○​ To make the patient comfortable. ●​ Mania:
Do not touch: Fracture ○​ "A mood disorder marked by hyperactive
wildly optimistic state"
POINTS TO REMEMBER: ○​ Mood that is elevated, expansive, or
irritable to mask depression
Electric current: 70 to 150 volts ●​ Depression:
○​ "The feeling of severe despondency and
Duration of administration: 0.5 to 2 seconds dejection"

Frequency of treatment: 2 – 3 treatments Assessment:

weekly MANIC
●​ Mood, elevated
Total number of 6 – 12 ECT therapy ●​ Agrandiose delusion
treatments: ●​ No need for sleep, eat
●​ Inappropriate behavior
Side effect: 30 seconds to 1 ●​ Clanging vulgar
Seizure (tonic-clonic) or minute or slightly DOWN
grand mal longer ●​ Depressed
●​ 0ut for suicide
●​ Won't sleep,eat
Suicide
●​ Negativistic
Verbal Non-verbal
Nursing Diagnosis:
●​ I won't be a ●​ Take this ring, it's ●​ Risk/ Potential for Injury directed to others for to
problem anymore yours (giving of self
●​ This is my last valuable) ●​ Fluid & Electrolytes Imbalances
day on earth ●​ Sudden change in ●​ Fluid Volume Deficit
●​ l'Il soon be gone mood
Nursing Interventions:
●​ Accept client; reject behavior
Risk Factors:
●​ Provide consistent care
●​ Sex: (Male: Successful) (Female: High Attempts)
●​ Set limits of behavior/external controls
●​ Unsuccessful previous attempt
●​ Distract and redirect energy: (dancing, walking
●​ Identification with someone who committed
with staff)
suicide
●​ Meet nutritional needs: High-calorie FINGER
●​ Chronic illness
FOODS and fluids to be carried while moving.
●​ Depression/Dependent personality
(potato chips, bread, raisin, and sandwich)

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 ●​ Monitoring: one-on-one monitoring on the first
●​ Shortcut: all high caloric & high carbohydrate hour
diet or all bakery products! ●​ Environment: less simulated environment (no
visitors and phone calls allowed)
Signs and Symptoms:
●​ More energy & mood swings Restraint
●​ Agitation ●​ Used only for client who are violent, harming
●​ Non-stop talking & flight of ideas (refocus) others/self, and berserk.
●​ Insomnia ●​ Doctors order (Application): to follow within 1
●​ Attention span hour to 24 hours.
●​ Informed consent: Involuntary
Antimanic and Mood Stabilizing Agents
●​ Improves productivity by decreasing Proper Application
psychomotor activity or response to 1.​ 6 to 8 staff members are required.
environmental stimuli 2.​ Adequate circulation must be ensured every
10-15 minutes.
Lithium Preparation 3.​ Anchor on a stable part of the bed which is the
●​ Lithium carbonate (Eskalith, Lithobid) bed frame.
●​ Lithium citrate (Cibalith-s)
○​ Long lasting, increased risk of toxicity Removal
Doctor’s order (removal): Necessary
Lithium: undergo the first kidney
●​ Check: Creatinine and Bun Proper Removal
●​ Test and check for blood levels ●​ Temporary – alternately one at a time, for 10
○​ Sodium minutes every 2 hours
●​ Level: 0.6 - 1.2 meq/L ●​ Permanent – alternately one at a time
○​ 3 Cant’s: See, Spit, Sweat
○​ 2 Can: Pee, Shit
●​ Increase urination SUBSTANCE ABUSE
●​ Toxicity watch/out tremors, fine hand Alcoholism
●​ Hydration should be within normal Etiology: Intergenerational Transmission
○​ Water=2-3L/ day ●​ From one to generation to another generation
○​ Na 2-3g/day Process:
●​ Hypothyroidism - inhibits thyroidal Iodine uptake ●​ Alcohol
●​ Increase ●​ Blackout
●​ Uu (diarrhea) ○​ Awake but unaware
●​ Mouth dry ●​ Confabulation
○​ 2-4 weeks for full therapeutic effects ○​ Inventing stories to increase
self-esteem.
Aggressive Client (Verbally Abusive) ●​ Denial
●​ Decrease stimulation: ○​ “I am not alcoholic.”
○​ turn of television, let other clients leave ●​ Dependence
the room. ○​ “I can’t live without it.”
●​ Deescalate: ●​ Enabling – significant other tolerates abuser.
○​ encourage expression of feelings ○​ Another term CO-DEPENDENCY
promote assertive communication. ●​ Increased tolerance
●​ Directive approach: ○​ Increase substance to achieve a
○​ calm, non-threatening previous effect.
●​ Show of force:
○​ visibility of 4 – 6 staff members Thiamin Deficiency: Decrease in Vitamin B1

Seclusion Wernicke’s (Acute) Korsakoff (Chronic)

●​ Indication: Inappropriate behavior, continuous
thought of suicide Ataxia Confabulation
●​ Informed consent: voluntary/involuntary Confusion Hallucination
●​ Room: lockable and observable from the outside Ophthalmoplegia Amnezia
●​ Purpose: restorative, not punitive
●​ Goal: to help client regain self-control

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Management: ○​ Signs of withdrawal: Bipolar Cycling
●​ Thiamine Rich Diet
○​ Pork ●​ Shabu (Methamphetamine): Rotten or
○​ Nuts stained teeth
○​ Beans ●​ Sign of withdrawal: Hallucination
○​ Milk
○​ Peas Medical Management:
○​ Meat ●​ Bromocriptine (Parlodel)
○​ Green Veggies ○​ To decrease cravings

Alcohol Withdrawal Narcotics (Downers)

●​ Abrupt stop ●​ Purpose: to escape reality
●​ Increase BP, HR, Temperature, LOC, Anxiety, ●​ Commonly abused narcotics: Codeine,
Tremors Tramadol, Oxycodone, Morphine,
●​ Seizure Meperidine, Fentanyl
○​ Delirium Tremens (48-72 hours) ●​ Route: IV
●​ Medication: ●​ Worst Complication: HIV/Hepa B
○​ Anxiolytics ●​ V/S: Hypo Brady Brady, pupil constriction
■​ Lorazepam ○​ WOF: Decrease in respiratory rate
■​ Diazepam ●​ Morphine Intoxication: Overdose
■​ Librium ○​ Antidote: Naloxone (Narcan)
●​ Morphine Withdrawal:
Alcohol Intoxication ○​ Methadone: weak opioid
●​ Overdose
●​ Decrease in BP, HR, Temperature, LOC, Anxiety, Barbiturates (Sedative Hypnotics)
Tremors ●​ Purpose: to cause sedation
●​ Coma ●​ Barbitals (phenobarbital, methohexital,
and thiopental)
Detoxification ●​ V/S: Hypo Brady Brady, pupil constriction
●​ Process of assisting an individual to go through ●​ Management: activated charcoals
withdrawal safely and successfully.
●​ It does not cure the alcoholism, but it helps the Hallucinogens
patient to stop drinking because it avert the ●​ Purpose: to cause hallucinations.
alcohol. (Aversion Therapy) ●​ Most commonly abused hallucinogens:
●​ DOC: Disulfiram (Antabuse) ●​ Cannabis Sativa (marijuana) – bloodshot
●​ Side effects: if taken with Alcohol eyes increased blood flow to eyeballs.
○​ Disulfiram Reaction ○​ Appetite stimulants make the patient
■​ Diarrhea hungry and gain weight.
■​ Intense headache ○​ Both an upper and downer.
■​ Nausea and vomiting ■​ Can cause hallucination and
■​ Abdominal pain sedation.
●​ Avoid the following: ○​ Abuse: Schizophrenia
○​ Vanilla
○​ Vinegar Other hallucinogens:
○​ After shave lotion ●​ Lysergic acid diethylamide:
○​ Mouthwash ○​ Causes Synesthesia
○​ Polish remover ●​ Phencyclidine (PCP):
○​ Backrub ointment ○​ Violence
○​ Cologne ●​ Ecstasy:
○​ Isopropyl alcohol ○​ Aggression

Stimulants (Uppers)
●​ Purpose: to cause euphoria
●​ Signs of abuse: Hypertension, tachycardia,
tachypnea, pupil dilatation, appetite loss,
insomnia
●​ Route: Nasal
●​ Cocaine: Excoriated nostrils

16