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Psychiatric Nursing

Beliefs Feelings Behavior Therapeutic Communication Techniques What you see, you say What you hear, you say restating Sigmund Freud Father of Psychoanalysis Structure of Personality (Id, Ego, Superego) Dominant ID Mania Antisocial Narcissistic

D mpulsive want to want PLEASURE

eat drink urinate defecate

PLEASURABLE PRINCIPLE Pain Avoidance Its all I

UPER EGO hould not mall voice of God CONSCIENCE PRINCIPLE

DOMINANT SUPER EGO Obsessive - compulsive Anorexia Nervosa I E

GO Xecutive Secretary

Impaired Reality Schizophrenia

REALITY PRINCIPLE LIBIDO sexual energy responsible for survival PSYCHOSEXUAL THEORY 1. ORAL STAGE 0 18 Months old Survival I want to eat, sleep, urinate, defecate

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Psychiatric Nursing

ID formation Cry & Suck mouth Child Cries Feed the Infant Successful Ignore the Infant Unsuccessful Narcissistic

Defense Mechanism: o FIXATION when a person is stuck in a certain developmental stage o REGRESSION return to an earlier developmental stage EGO is develop in the 6th month

2. ANAL STAGE Ateen 3 years old (18 mos 3 y.o.) Toilet training Super Ego develop Toilet Training Good Mother Successful SE Too Rigid Training Clean Organized Obedient OBSESSIVE COMPULSSIVE (Anal Retentive) Dirty Disorganized Disobedient ANTISOCIAL (Anal Expulsive) Bad Mother Unsuccessful

BIG SE

Small S E

3. PHALLIC 3 6 y.o. Penis/ Vagina Parents is the significant person

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Psychiatric Nursing

Called as Preschooler

Oedipus Complex little boy loves mommy Electra Complex little girl loves daddy Identification boy associates with daddy, girl assoc. with mommy Castration fear of the little boy to daddy Penis Envy envy of little girl towards daddy Dr. Karen Horney opposition to penis envy Level of Awareness o Conscious highest level of awareness o Preconscious Tip of the tongue o Unconscious deepest level of awareness Birth Trauma First traumatic experience of child REPRESSION unconscious forgetting of an anxiety provoking concept SUPRESSION conscious forgetting of an anxiety provoking concept

4. LATENCY STAGE 6 12 years old SCHOOlatency Sexual energy is dormant Reading, Riting, Rithmetic SUBLIMATION placing sexual energies toward a more productive endeavors

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Psychiatric Nursing

5. GENITAL STAGE 12 y. o. above Gising Genital PHARMA MOMENTS

ANTIANXIETY
VLAST ME VAIB Valium ate V Miltown - Meal Libreum - L Equanil Aqua Kneel Ativan - Ate Guy Seraks Sera Ulo Tranxene - Transit Vistaril - largavista Attarax Mga bato (rocks) Inderal hindi ralph Busfar sasakay ng bus

ERIK ERIKSON PSYCHOSOCIAL THEORY OF DEVELOPMENT + Age 0-18 mos. 18 mos. 3 y.o. Trust Autonomy AU nal TO ilet training NO favorite word MY Initiative Industry Identity Intimacy Generativity Ego Integrity Mistrust Shame/ doubt

Affecting Major Factor Feeding Toilet Training

3 6 y.o. 6 12 y.o. 12 20 y.o. 20 25 y.o. 25 45 y.o. 45 y.o. and above

Guilt Inferiority Role confusion Isolation Stagnation Despair

Independence In da-school Peer Love Parenting Reflection

MASLOWS HEIRARCHY OF NEEDS 1. Physiologic Needs o Air, food, water, shelter, rest, sleep, activity and temperature maintenance that are crucial for survival 2. Safety and Security Needs o Safe in physical and psychological aspects 3. Love and Belonging Needs o Giving and receiving affection, attaining a place in a group, maintaining the feeling of belonging

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Psychiatric Nursing

4. Self esteem Needs o Self esteem feelings of independence, competence and self respect o Esteem from others recognition, respect, appreciation 5. Self Actualization o Ones maximum potential and realize ones abilities and qualities BEHAVIORAL MODELS 1. Ivan Pavlov Classical Conditioning Model All behavior are learned Food dog Salivation Bell Food Dog Salivation Bell Salivation 2. B.F. Skinner Operant Conditioning All behaviors are unlearned Reward (+ reinforcement) and Punishment (Reinforcement) BRAIN LOBES ACTION Frontal Language, Learning, Personality, Judgment Temporal hearing, smelling Parietal Taste, touch Occipital Vision Sensory Integration Motor Involuntary VOLUNTARY NERVOUS SYSTEM Somatic Nervous System AcetylCholine Brain Spinal Cord Motor Nerve Muscle Fiber INVOLUNTARY NERVOUS SYSTEM Autonomic Nervous System Sympathetic HR RR GI Constipation GU Voluntary

Parasympathetic Diarrhea

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Psychiatric Nursing

Neuro

Urinary retention Epi/ Nor

Urinary Frequency Acetyl Choline

PHARMA MOMENTS

MONOAMINE OXIDASE INHIBITORS

AR

M N P

PLAN DIL NATE

ANTIPARKINSON
CAPABLES

Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetryl THERAPEUTIC COMMUNICATION
Therapeutic Offer your self Ill stay with you Silence Making observations o You seem sad Active listening o Nodding o Eye contact o Lean forward Who, what, when, where General leads o Go on, Im listening, what else? Broad opening - best Opening line Non-Therapeutic Dont worry be happy Everythings gonna be alright Ignoring the client Changing the subject Nice weather were having o Adjectives value based perception, should not be use You are the most beautiful client Why Arguing Flattery You should do this now In my opinion

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Psychiatric Nursing

o How are you today? o How are you? Restating Clarrification Refocusing we are talking about the exam Focusing tell me about DEFENSE MECHANISMS Fight for stress DISPLACEMENT Transfer of feelings to a less threatening object rather than the one who provoke it DENIAL Failure to acknowledge an unacceptable trait or situation DISSOCIATION Psychological flight from self A type of amnesia REGRESSION Return to an earlier developmental stage REPRESSION Unconscious forgetting of an anxiety provoking concept RATIONALIZATION Illogical reasoning for a socially unacceptable trait sayang ang beer sa ref, kaya ko ininum REACTION doing the opposite of your FORMATION intention plastic UNDOING Doing the opposite of what you have done due to guilt orocan, plastic, Tupperware IDENTIFICATION Assume trait for personal, social, occupational role PROJECTION Attributing to others ones acceptable trait Pasa load INTROJECTION Assume another persons trait as your own SUPPRESSION Conscious forgetting of an anxiety provoking concept SUBLIMATION Placing sexual energies toward a more productive endeavors CONVERSION Repressed angers put towards

Boss shouts at you, you shout at your subordinate Im not an alcoholic Sino ka, Sino ako? Return to thumbsucking Hindi ko maalala I drink because I dont want to waste the beer in the ref sasabunutan kita. . . ay kuklulutin lang kita ay pinatid kita, halika punta kita sa clinic Tulad niya hindi ako alcoholic, sila yon ako din Not just you, me too Hindi ko alam yan Angry at life, put anger in singing Biglang mangingig

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Psychiatric Nursing

COMPENSATION SUBSTITUTION

physical symptoms affecting nervous system leading to sensory numbness and motor paralysis Overachievement in one area to cover a defective part Replacing a difficult goal with a more accessible one

Pilay pero magaling kumanta Gusto ko Disneyland. Enchanted nalang.

STOP GABA Inhibitory Gamma Amino Butyric Acid

SNS
ANXIETY

GO Epinephrine/ Norepinephrine Exitatory Anticholinergic side effect Constipation Urinary Retention Dry Mouth Blurred Vision

Within 1 week Rebound phenomenon Seizure Abrupt Dependence

Anti-Anxiety

Withdrawal Drowsy No Alcohol No Coffee Develop Orthostatic Hypotension Prevetion of O.H. 1. Sit Down 2. Dangle feet Gradually 3. Stand Up Gradually Tapered Dose RELAXED

ANXIETY
Vague sense of impending doom

Mild +1

Moderate +2

Severe +3

Panic +4

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Psychiatric Nursing
uicide afety Dont touch client Respi Alkalosis Bown Bag

Assess Nx Dx

: Level of Anxiety : Ineffective Individual Coping Powerlessness Impaired Skin Integrity Planning/ Implementation: level of anxiety environmental Stimuli Relaxation Technique Showing pictures of flower, waterfalls Hearing sounds of chirping birds Evaluation : Effective individual coping

ENERALIZED ANXIETY DISORDER

months excessive worrying Might be mild, moderate and severe anxiety S/Sx Restless Difficulty of concentration Sleep Disorders Palpitations Edge of the seat Easy fatigability

PANIC DISORDER
15 30 Minutes escalation of SNS AGORAPHOBIA fear of open space/ public places SOCIAL PHOBIA fear of public

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Psychiatric Nursing

POST TRAUMATIC STRESS DISORDER

Trauma Disaster Accident War Rape Earthquake Soldier 6 years old Assignments/ Homeworks No Assignments/ Homeworks You Think Teacher may get angry

Flashbacks VICTIMS Survivors Nightmares

Anxiety I am sick MALINGERING pretending to be sick (Conscious) Absent

SOMATOFORM > no pretension > no organic basis > unconscious PSYCHOSOMATIC > Real pains/ illness > Real symptoms > 4 major types * Hypertension * Migraine * Stress Ulcer * Asthma

Escape from Teacher PRIMARY GAIN (Behavior anxiety)

Mama Care Attention SECONDARY GAIN

SOMATOFORM DISORDERS SOMATOFORM

Nervous System CONVERSION DISORDER La Belle Indifference emotional disattachment from disability Illusion of structural defect BODY DYSMHORPIC DISORDER

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Psychiatric Nursing

Minor Discomfort Interpreted as major illness HYPOCHONDRIASIS Maliit na butas, pinalalaki Favorite Past Time: Doctor Hopping Nursing Focus: Feelings

PSYCHOSOMATIC DISORDERS
Anxiety SNS BP Hypertension PNS Vasoconstriction Bronchoconstriction Cerebral Artery Left Gastric Artery Asthma Migraine Stress Ulcer

OBSESSIVE COMPULSIVE
Belief/ thought Door Open Burglar may go inside Feelings Anxiety

Obsession anxiety (thought) Returns to house (Action) Anxiety Compulsion

PHOBIA
Irrational fears Etiology o Knowledge o Experience Immediate Nursing Intervention remove the stimuli SYSTEMATIC DESENSITIZATION o Gradual exposure to feared object

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Psychiatric Nursing

PHARMA MOMENTS

ANTIPSYCHOTIC AGENT
SSTTCMHP Stelazine - sexy star Serentil serena Thorazine babaeng Tora Trilafon - tri-band phone Clozaril closed reel Mellaril maraming reel Haldol hahaha Prolixin pero lick scene

ALCOHOLISM
Etiology: Intergenerational Transmission From one generation to another generation

Alcohol

Blackout awake but unaware

Confabulation inventing stories to self-esteem

Denial I am not an alcoholic Dependence I cant live without it

Enabling significant other tolerates abusers

Another term CO DEPENDENCY TOLERANCE Substance to achieve a previous effect DETOXIFICATION Withdrawal with MD supervision Check Alcohol, Mouthwash, Elixer void alcohol version therapy lcoholics Anonymous self help group ntabuse DISULFIRAM Never drink alcohol 12 hour interval/ 12 h last alcohol intake

B1 Vitamin Deficiency

or else: nausea, vomiting and hypotension Wernickes Encephalopathy motor

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Psychiatric Nursing

Complications
Korsakoffs Psychosis memory

Delirium Tremens 24 72 h after last dose of alcohol

untreated withdrawal syndrome ormocation bugs crawling under the skin amily Therapy mother, father, brother

AUTISM
Autistic Savant autistic with a special talent Assess Appearance flat affect, consistent movement Behavior repetitive, ritualistic Communication echolalia, incomprehensible Nx Dx Impaired verbal communication Impaired social interaction Self mutilation Risk for injury Planning/ Implementation Maslows hierarchy of needs Constancy, promote safety Evaluation Expressive therapy drawing, muscic etc Enhanced communication Improved social interaction Safety

ATTENTION DEFICIT HYPERACTIVE DISORDER

Onset Duration Settings Id Dominant : 7 y.o. and below : 6 months and above : 2 House and school : Mom or RN will act as superego

ADHD Glucose Frontal Lobe impaired judgement ADHD S/Sx Ritalin Frontal Lobe Judgement ADHD S/Sx (stimulant) Assess Appearance dirty

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Psychiatric Nursing

Behavior clumsy, impatient, easily distracted, hyperactive Communication talkative, blurts out in class

Nx Dx Risk for injury Impaired social interaction Planning/ Implementation tructure separate room for eating, playing, sleeping and etc chedule time for everything et limits afety Evaluation Minimize Risk for Injury Improved social interaction Safety Residual ADHD grows up not antisocial Meds: Ritalin, dexedrin, pemoline, adderal Best time to give: once a day: AFTER MEALS: prevent lost of appetite Dont give at bedtime STIMULANT causes insomnia Give 6 hours prior bedtime if bid

EATING DISORDERS
18 mos. 3 y.o. Toilet Training Clean Obedient Organized Thought I Am Fat 6 y.o. class valedictorian/ model student social inactive/ no BF weighing

Feeling Behavior Self Esteem Diet, Diet, Diet Eating Disorders Eating Pattern Weight Menstruation Bulimia Eat, eat, vomit Normal weight Irregular menstruation Dao Ming Xi

Anorexia Nervosa Diet, diet, diet <85% of expected body 3 mos. ammenorhea Karen Carpenter

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Psychiatric Nursing Da Ming Sugat/ suka Vomiting Dental caries Wounded knuckles Metabolic alkalosis Metabolic acidosis

Vomiting Fluid Volume Deficit ARRHYTHMIA (fatal complication) Diarrhea Interventions Restore fluid and electrolyte balance Collaborative regarding menu contract Target weight gain After meals: stay 30 mins 1 hour

PHARMA MOMENT

LITHIUM
L evel 0.6 1.2 mEq/L Increase urination Tremors, fine hand Hydration 3 L/day Increase Uu diarhea Mouth, dry ausea, vomiting, diarrhea Lithium Toxicity a+

Kidney

ANTIPARKINSON
ANTICHOLINERGIC ABC Artane Akineton Benadryl Cogentin DOPAMINERGIC PLSE Parlodel Larodopa Symmetyl Eldepryl

SCHIZOPHRENIA
Ego disintegration Impaired reality perception Genetic vulnerability

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Psychiatric Nursing

Stress Diathesis Model o Too much stress in the reality will lead client to escape it and go to the fantasy world Biological Theory o Dopamine level is High The exact cause is unknown

ffect appropriate, inappropriate, flat, blunt (incomplete emotion) mbivalence torn between 2 opposing forces utism ssociative Looseness Symptoms Negative Hypoactive Withdrawn Apathy Assess : Content of Thought Nx Dx : Disturbed thought process Planning/ Implementation: Present reality Provide safety Evaluation : Improve thought process Assess : Hallucination/ Illusions Nx Dx : Disturbed sensory perception Planning/ Implementation: Present reality Provide safety Evaluation : Improve sensory perception Assess : Suspicious Nx Dx : Risk for other directive behavior Planning/ Implementation: Present reality Provide safety Evaluation : Eliminate/ minimize risk for other-directed violence Assess : Suicidal Positive Hyperactive Sociable Flight of Ideas Talkative

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Psychiatric Nursing

Nx Dx : Risk for self directive behavior Planning/ Implementation: Present reality Provide safety Evaluation : Eliminate/ minimize risk for self-directed violence Flight or Looseness I am going to the mall. Where is the light? Go here. Mineral Water. I am going to the mall. The mall is big. Big is the tree. The tree is tall.

Magical Thinking Believes to have a magical power I can turn you into a frog Echolalia I repeat what you say Parrots Echopraxia I repeat what you do Word Salad words, no rhyme Clang Association words with rhyme : Dunk, plank, sunk Neologism creation of new words Plinking, hustash Clarification done in case of neologism Delusion: Persecutory NBI is out to get me/ someone will harm the client Religious I am Jesus Christ Grandeur I am the queen of the world. Ideas of reference Nurses are talking about me. Concrete Association pilosopo what will you wear? clothes Thought Blocking Halucination s Absent X X Illusion Present

Stimulus Visual Auditory

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Psychiatric Nursing

Tactile

In case of hallucinations do:

Hallucinations Acknowledgment
I know you the voices are real to you But I dont hear them Lets go to the garden

Reality orientation Diversion

But if nothing in the preceeding intervention are seen Assess what the voices are saying SCHIZOPRENIA

Disorganized
Sad but smiles o Inappropriate affect No reaction o Flat affect Flight of ideas o HEBEPHRENIC Giggling Positive and Negative classified S/Sx differentiated Cant be classified 1st paranoid, then No more positive s/sx, disorganized then just withdrawn catatonic, etc etc

Catatonic
Ambivalence Waxy Flexibility o Iniwan na posture, ganun forever No favorite word Negativism

Paranoid
Suspicious Tendency to be violent MistrustScaredWithdraw n Nrsg. Int: Develop trust 1 to 1 short interaction frequent visit foods in sealed container meds wrapped for violent pt. Doors open Near the door Dont touch the pt. Eye contact 1 arms length away call reinforcement

Residual Mixed classification

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Psychiatric Nursing

Normally Acetylcholine = ON

Dopamine = OFF

Your always ON With parkinsON

High Dopamine= Schizophrenia

Antipsychotics = makes Dopamine goes down Extrapyramidal Side Effects AKATHISIA o Restless, inability to sit o Makati siya, ahh kati siya AKINESIA o Muscle rigidity o Ahh kiniss siya DYSTONIA o 3 features TORTICOLLIS Wry neck Anticholinergic OCULOGYRIC CRISIS Drugs that will make the Fixed stare AcH down OPISTHOTUNOS o Artane Arched back o Akineton TARDIVE DYSKINESIA o Benadryl o Irreversible side effects of o Cogentin antipsychotics o Lip smacking Dopaminergic o Tongue protruding Dopamine goes up o Cheeks puffing o Parlodel NEUROLEPTIC MALIGNANT o Larodopa SYNDROME o Symmetryl o Eldepryl ON

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Psychiatric Nursing o Hyperthermia among client taking antipsychotic o Hyperthermia with muscle rigidity

Other Side Effects Photosensitivity o Sunscreen o Wide brimmed hat Agranulocytosis o Report immediately Sore throat 1st sign to appear

PHARMAMOMENTS

ANTIDEPRESSANTS
ANTSAAVE PPZ

Asendin ascending Norpramin sabaw ng knorr Tofranil Tofu Sinequan nood ng Sine Quan ang title Anafranil kina Ana Praning Aventyl kina Aven Til Midnight tayo Vivactil Bye Back till next week Elavil Eh love mo ba ako Prozac Pero saka na Paxil - Taksil Zoloft mag Solo ka
BIPOLAR DISORDER Mania more common Female 20 years old and above Stressful life Obese
Self Actualization Self Esteem

TASK Caregiver Role Strain

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Impaired social interaction Risk for injury/ other directed violence Eating finger food Sleep Private room Hyperactive

Psychiatric Nursing Safety Safety

Sex Anxiety

Lithium 2 4 weeks before effect

SE Compensation interfere ADLs, harm others SE Compensation interfere ADLs, harm others TASK increases clients self esteem Gross motor skills via sublimation Escorted walk outdoors Punching bag

No group games compition will increase anxiety 3 or more signs confirms disorder G F S P E E D randiose light of ideas leeplessness ressured speech xagerated SE xtraneous stimuli (easily distracted) istractibility

PERSONALITY DISORDERS SCHIZOID

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Psychiatric Nursing

I dont want people Believes he can stand on his own Never had a best friend Avoid groups and social activities no enjoyment Cares more about computers and pets

AVOIDANT I avoid people, I fear criticism Have talent but no confidence ANTISOCIAL I break the law as motto As a child,: steal, lie, always get reprimanded Adult grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe sex, thrill seeker Good talker, charmer, witty manipulator

BORDERLINE my life is an emptyglass

Dependent I cant live without you self esteem poor decision making skills Histrionic excited, dramatic but manipulative center of attention Narcissistic I love myself Insensitive, arrogant I am the best

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Psychiatric Nursing

Obsessive Compulsive I am organized Perfectionist Provide time to do rituals Paranoid Suspicious Passive Aggressive Always say yes but resistance is hidden

Serotonin
MAO kills Serotonin

MAO Serotonin MAO Serotonin

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Psychiatric Nursing

Serotonin

ANTIDEPRESSANTS wo 4 weeks wo neurotransmitter RI CYCLIC

1st Line of Drug Prescribed afest ELECTIVE ide effects low EROTONIN EUPTAKE to 4 weeks NHIBITOR
PPZ

ONO MINE

NTIDEPRESSANT Higher incidence of Side effects Serotonin/ Epi affected

XIDASE

NHIBITOR
ANTSAVE MNP

All neurotransmitter affected Highest Side effects Avoid tyramine rich food may lead to HYPERTENSIVE CRISES TYRAMINE RICH FOODS vocado ged Cheese eer hocolate ermented Foods ickles reserved Foods oy Sauce

SSRI

TCA

MAOI

Antidepressant Anticholinergic Side Effects (Syphathetic) Male Erectile Dysfunction

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Psychiatric Nursing

Antidepressant no effect ECT

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Psychiatric Nursing

ELECROCONVULSIVE THERAPY Pre o Informed consent o NPO 6 8 hours prior Meds o Atropine dry mouth o Barbituate Sedative o Succinylcholine muscle relaxant, prevent seizure Post o Side-lying lateral o S/E headache, dizziness, TEMPORARY MEMORY LOSS distinct sign 70 110 volts 20 30 seconds hour asleep post

PHARMAMOMENTS

SUBSTANCE ABUSE
Downers (ABONM INE) Alcohol Barbituates Opiates Narcotics Marijuana Uppers (CHA) Cocaine Hallucinogen Amphetamines OVERDOSE Alcohol HR RR BP LOC Cocaine Morph Code Hero NARCAN antidote

Bradycardia Coma Bradypnea

Pupil constriction

Seizure

Moist mouth Constipation Hypotension Coma Asleep Weight gain

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Psychiatric Nursing

EUPHORIA

Psych well being NARCAN Narcotic Antagonist narcotic overdose

Tachycardia Tachypnea Pupil Dilation Dry mouth Hypertension Seizure Awake Weight Loss

DETOXIFICATION withdrawal with MD Supervision METHADONE

Withdrawal reverse of effect or opposite of overdose

DEPRESSION Serotonin, if unresponsive to drugs, ECT

The Grief Process Denial no! this cant be true Anger why me, why me, why now Bargaining if something happens, then Ill give something back Depression Im down 2 weeks or more s/sx major depression Acceptance client acts according to situation
Self Actualization Self Esteem withdrawn

C TASK Stay

Risk for self directed violence Eating Sleep Hypoactive Sex

Sensitivity to client needs

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Psychiatric Nursing

SUICIDE
Verbal I wont be a problem anymore This is my last day on earth Ill soon be gone Non Verbal Take this ring, its yours (giving of valuable) Sudden change in mood

Who will commit Suicide? Sex Male (more successful)/ female (hesitant) Age 15 24 y/o or above 45 Depression Patient with previous attempt ETOH ethanol - alcoholics Rirrational Social support lacking Organized plan greater risk No family Sickness, terminal SUICIDE TRIAD Loss of spouse Loss of job Aloneness Is Patient is SUICIDAL; nurse should: DIE Direct question Are you going to commit suicide? Irregular interval of visit to pt. room Early AM and period of endorsement the time pts commit suicide Best approach for suicidal pt. : Direct approach Nursing Management: Close surveillance Hospital area majority sucide will happens at: weekends 1- 3 am Sunday Weekend less staff personnel Early AM every one is asleep Give simple task. Dont give complex may cause depression ex. Jigsaw Water plants Wash the dishes except sharps CHILD ABUSE (think B) Burns, bruise, bone fractures, BUNGI! Dont bathe the child, dont brush teet. Body of evidence will be lost

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Psychiatric Nursing

Bantay Bata 163 LEVELS OF MENTAL RETARDATION Profound o < 20 o thinks like an infants o cant be trained ero 2 y/o o stay with the patient ensorimotor Severe evere o 20 35 Moderate Modera e o 35 50 hirtyfive 50 rainable o can be train wo 7 y/o o mental age is 2 7 y/o o pre-operational stage Mild o 50 70 o meantal age is 7 12 o educable o can go to school Borderline o 70 - 90 Normal o 90 100 JOHN PIAGETS COGNITIVE THEORY 02 Sensorimotor Baby can sense, see, perceive and hear. Object permanence 24 Preconceptual Language 47 Intuitive Unidimentional classification characteristic. Child can fix toys according to size, color, height = one at a time 7 12 Conservation Multidimensional Concrete Association Formal Good abstract thinking. Can interpret words 12 Operation ALZHEIMER NOMIA dont know name of objects GNOSIA problem with senses PHASIA cant say it PRAXIA cant do it Cocaine Nasal Septum perforation Marijuana impaired Lung Structure eroine withdrawal ikab

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Psychiatric Nursing

atsing u hu hu

CRITICAL REVIEW
TEST TAKING TECHNIQUES 1. Assess the answer, use circle 2. Initial priority TRUST

Air food, water ABC Good Word/ Bad Word air S Technique eek support it tay upervised ee = observed eem = notice assi t feeling 2 same answer/ 2 same mistake Words to watch out for Inappropriate Most Not included Except All but one Umbrella ASSESS

3. 4.

5. 6.

7.

RELATIONSHIP Preorientation Self awareness Orientation Trust Setting Contract Resistance Working Discussion Termination Evaluation

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Psychiatric Nursing

PRACTICE OF NURSING Level of Prevention 1 2 3 Relapse AA

Healthy Ill Community Demog. Crisis Intervention SELF HELP GROUPS nique niversality r not alone RESTATE exact words REFLECT use other words DEPRESSION Endogenous Internal Chemical Reactive external

Barbituate withdrawal LIBRIUM (Chloridiazepoxide) TOFRANIL Antidepressant/ Anticholinergic pupil dilation midriasis Catharsis Feelings Free Association Ideas ATTITUDE THERAPIES Active friendliness ask permission assive Friendliness aranoid anipulative nic atter of Fact No Demand Depressed Kind Firmness Anorexic Crisis 4 6 weeks Goal Return the client to the pre-crisis level of functioning PSC Perception what do you think about it? Coping what will you do about it? Support who will be there for you?

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Psychiatric Nursing

Kulit kulit kulit kulit Perseveration stick to 1 topic Ulit Ulit Ulit Verbigeration DISSOCIATION Dissociative Amnesia dont know themselves Fugue Far Dissociative Identity Disorder Multiple Personality D.O.