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PSYCHIATRIC NURSING

BeliefsFeelingsBehavior Sigmund Freud Fa!her of Ps"#hoanal"sis $s!ru#!ure of %ersonali!" Id$ im%ulsive %ar!& %leasure %rin#i%le $ea!& urina!e& have se' $i!(s all )I* Su%erego small voi#e of God $#ons#ien#e $should no! ea! "e!& should no! ea! "e! +go$ ar,i!er& de#ision ma-er $in !ou#h .i!h reali!" Id///////////////////Su%erego +G0 I1 102INANT needs a su%erego$needs a #ons#ien#e 2$ mani# A$ an!iso#ial serial -iller N$ nar#issis!i# SUP+R+G0 102INANT needs an Id 0$ 0,sessive Com%ulsive A$ Anore'ia nervosa +G0 im%aired reali!" %er#e%!ion 3RN .ill %resen! reali!"4 S$ s#hi5o%hrenia$ #an! dis!inguish fa#! from reali!" 6i,ido$ se'ual energ" FR+U1 $ PSYCH0S+7UA6 TH+0RY 0RA6 8$9: mon!hs Cr"& su#- mou!h$ survival Id dominan! 2a!ernal de%riva!ion if no! feed& no! given mil-;.a!er& no! -e%! .arm< Nar#issis!i# see-s !he Id I love m"self Regression re!urn !o an earlier s!age or earlier level Fi'a!ion s!o%%ed in a s!age ANA6$ 9: mos$="rs Toile! !raining 2om is su%erego< Su%erego is ,eing formed Child is #augh! in am,ivalen#e

%ulled in > o%%osing fa#!ors

Too mu#h !oile! !raining .i!h %unishmen! .ill resul! !o a #hild .ho is?

0,edien!& organi5ed& #lean @ 0C @anal re!en!ive PHA66IC =$A "rs old $%enis B vagina

Re,el& dir!"& diso,edien! @An!i$so#ial @anal e'%ulsive

$love of %aren! of o%%osi!e se' 0edi%al$,o" loves mom +le#!ra$girl loves dad Iden!ifi#a!ion$ ,o" imi!a!es dad Cas!ra!ion fears$ fear !ha! dad is angr" a! him and .ill #u! off %enis Penis env"$ girls env" li!!le ,o"s 1r< Caren Horne"$ de!ra#!or of Freud& didn(! ,elieve in %enis env"< Freud said !ha! i! is ma",e in her un#ons#ious mind< 0r re%ressed< Cons#ious$ highes! level of a.areness Pre$#ons#ious$ a! !i% of !ongue Un#ons#ious forgo!!en Re%ression$-e%! in un#ons#ious< Un#ons#ious forgo!!en< Su%%ression #ons#ious forge!!ing 6AT+NT$ A$9> "ears old 6a!en!$ 6og!u @ se'ual energ" aslee% S#hool age S#hool %ho,ia$ 9s! !ime !o go !o s#hool Se%ara!ion an'ie!" Child is ,us" .i!h Reading& .ri!ing& ari!hme!i#< Su,lima!ion %u!!ing anger in!o some!hing more %rodu#!ive %u!!ing all energies in!o s#hooling +'< Angr" a! life& %our anger in singing< G+NITA6 9> "ears old Geni!al$Gising se'ual energ" Se'ual in!er#ourse mos! im%or!an! in !his s!ageDD PHAR2A 202+NTS An!i$an'ie!" 1rugs 3used also for al#ohol .i!hdra.al4 Ealium 6i,rium A!ivan Sera' 2il!o.n +Fuanil Eis!aril A!ara' +RIC +RICS0N STAG+ 3G4 8$9: mon!hs 30ral4 Trus! vs 9: mos$ ="rs old 3Anal4 Au!onom" vs Au$3anal4 To$ile! !raining No$NoD Favori!e .ord< 2" =$A "rs old 3Phalli#4 Ini!ia!ive vs 3Ini!ia!e 9s! s!e%s4 Phalli#$oedi%al&ele#!ra A$9> "rs old 36a!en!4 Indus!r" vs 9>$>8 >8$>H >H$IH IH u% 3Geni!al4 Iden!i!" vs In!ima#" vs Genera!ivi!" vs +go In!egri!" vs 3$4 2is!rus! Shame;dou,! FACT0R Feeding Toile! !raining

Tran'ene Inderal

Bus%ar

Guil! anger !urned in.ard Inferiori!" Role #onfusion Isola!ion S!agna!ion 1es%air

Inde%enden#e Indus!r" Indus-ul Peers 6ove Paren!ing Refle#!ion

Ne.l" admi!!ed %!$ develo% !rus! 9s! $%!s are de%enden!@self #are defi#i! $develo%;!ea#h au!onom" $!hen %! .ill develo% ini!ia!ive $e!#

Fron!al lo,e$ %ersonali!"& learning& Judgmen!& language 0##i%i!al$ vision Tem%oral$ hearing& smell Parie!al$!as!e& !ou#h Sensor" In!egra!ion 2o!or Soma!i# nervous s"s!em$ volun!ar" movemen!s A#e!"l#holine$ res%onsi,le for volun!ar" movemen!s $ on s.i!#h of movemen! Au!onomi# nervous s"s!em$ involun!ar" movemen!s $S"m%a!he!i#3An!i #holinergi#4 and %aras"m%a!he!i# 3#holinergi#4 Hear! Res%ira!or" GI 3o%%osi!e effe#!4 GU 3o%%osi!e effe#!4 Neuro!ransmi!!er Pu%ils Blood vessels BP SY2PATH+TIC 3aler!4 !a#h"#ardia !a#h"%nea Slo.& #ons!i%a!ion Slo.& oliguria& re!en!ion 1r" mou!h +%ine%hrine& Nore%ine%hrine 1ila!ed 3dila! .hen aler!4 32idriasis4 vaso#ons!ri#!ion in#reased PARASY2PATH+TIC 3rela'4 ,rad"#ardia ,rad"%nea diarrhea Pol"uria& freFuen#" 2ois! mou!h A#e!"l#holine 3A#H4 Cons!ri#!ed 32"o!i#4 vasodila!ed de#reased

An!i$#holinergi# ; an!i$%aras"m%a!he!i# @effe#! is s"m%a!he!i#D S"m%a!he!i# drug #lassifi#a!ions? A$ an'ie!" P$ %s"#ho!i#

An!i
mAR %lan nAR dil %AR na!e

C$ #holinergi# 1$ de%ressan!s

20N0 A2IN+ 07I1AS+ INHIBIT0RS?

DEFENSE MECHANISMS? #o%ing me#hanism from s!ress? 1ISP6AC+2+NT$ $$$$$$$$$$$$$Your ,oss shou!s a! "ou& "ou shou! a! "our su,ordina!e<

SUB6I2ATI0N $ $$$$$$$$$$$$$$$%u!!ing anger in!o some!hing more %rodu#!ive or G %u!!ing all energies in!o s#hooling +'< Angr" a! life& %our anger in singing< 1+NIA6$ $$$$$$$$$$$$$$$$$$$$$$)I am no!* an al#oholi#D 1ISS0CIATI0N $$$$$$$$$$$$$$%s"#hologi#al fligh! from self< Amnesia< +'< Ra%e& !rauma R+GR+SSI0N $$$$$$$$$$$$$$$$R+TURN !o an earlier develo%men!al s!age FI7ATI0N $$$$$$$$$$$$$$$$$$$$$s!u#- in a s!age of develo%men! R+PR+SSI0N $$$$$$$$$$$$$$$$$un#ons#ious forge!!ing SUPPR+SSI0N $$$$$$$$$$$$$$$#ons#ious forge!!ing< Avoidan#e< )I don(! .an! !o !al- a,ou! i!< I don(! .an! !o remem,er i!<* RATI0NA6IKATI0N $$$$$$$uses ),e#ause*< Has illogi#al reasoning< )I drin- ,e#ause I don(! .an! !o .as!e !he ,eer in !he ref<* R+ACTI0N F0R2ATI0N$$$$%las!i#< 1oing o%%osi!e of in!en!ion< UN10ING$ $$$$$$$$$$$$$$$$$$$$$$sho. !rue feeling;#olor !hen feels guil!" af!er< I1+NTIFICATI0N $$$$$$$$$$$models a #er!ain ,ehavior from a #er!ain role model< PR0L+CTI0N $$$$$$$$$$$$$$$$$,lame o!her %eo%le& %ass load !o o!hers< 6oo-s for a s#a%egoa!< )No! me& ,u! !hem<* INTR0L+CTI0N $$$$$$$$$$$$$$assume ano!her %ersons !rai! as "our o.n< )No! Jus! "ou& me !oo<* )A-o din& gus!o -o "an<* C0NE+RSI0N re%ression< Anger !urned in.ard !o herself< Conver!ed !o %h"si#al s"m%!oms< Sensor"$num,ness< 2o!or$%aral"5ed& !remors< C02P+NSATI0N $$$$$$$$$$$defe#!s of !he %erson& overa#hieve !o #over a defe#!ive %ar!< SUBSTITUTI0N $$$$$$$$$$$.hen "ou re%la#e a diffi#ul! role .i!h a more a##essi,le one< +'<Man!s !o go !o 1isne"land ,u! #an(! afford i!< Men! !o +n#han!ed Cingdom ins!ead< 1efense me#hanism? Harm !o self or o!hers Behavior 2odel Affe#!s;in!erferes .i!h A16

Ivan Pavlov

Classi#al Condi!ioning $,ehavior learned$re%ea!ed 3G4 BF S-inner o%eran! #ondi!ioning$reinfor#emen! Confron! 3$4 ,ehavior !o ma-e i! e'!in#!< 2AS60M(S H+IRARCHY 0F N++1S? H< Self$a#!uali5a!ion I< Self$es!eem =< 6ove and ,elonging >< Safe!" and se#uri!" 9< Air& food& .a!er& shel!er& #lo!hing& se' Basi# %h"siologi# needs LEVELS OF PREVENTION PRI2ARY Heal!h" Communi!" !ea#hing Communi!" demogra%hi#s S+C0N1ARY ill Crisis in!erven!ion Trea!men! and diagnosis T+RTIARY Rela%se avoidan#e Reha, #en!ers Al anon

STAGES OF INTERACTION 0RI+NTATI0N Assessmen! +s!a,lishmen! of !rus! Tell %a!ien! a,ou! !ermina!ion Se! #on!ra#! Pa!ien! is resis!an!

M0RCING Pro,lem solving 1is#ussion Pa!ien! is mos! #oo%era!ive

T+R2INATI0N +valua!ion Summari5e Sa" good,"e Grief$ANG+R$fo#us of RN P! migh! ,e#ome violen!;sui#idal

ANTI$PARCINS0N 1RUGS 3Ca%a,les4 used .i!h an!i$%s"#ho!i#s

An!i$#holinergi# ABC C$ A$ P$ A$ B$ 6$ +$ +lde%r"l S$ S"mme!rel TH+RAP+UTIC C022UNICATI0N 9< 0ffer self$ )I(ll s!a";si! .i!h "ou<* >< +'%lores use .ha!& .hen& .here& ho. =< Silen#e I< A#!ive lis!ening$nodding& e"e #on!a#!& leaning for.ard$sho. a#!ive %ar!i#i%a!ion< H< 2a-e o,serva!ions< )You see; I have o,served; I have no!i#edO* A< Broad o%ening$ )Ho. are "ouN* )You have #om,ed "our hair !oda"<* P< Clarifi#a!ion$)Mha! do "ou mean ," %loo%%lan-N* :< Res!a!ing$)I don(! .an! !o ea!<* 3Mord %er .ord re%e!i!ionD4 )You don(! .an! !o ea!N* Q< General leads$ )And !hen;Mha! else;Go onO* 98< Refo#using$)Me .ere !al-ing a,! !he e'amO* 99< Fo#using$)Tell me more a,! !his<* ABG ANA6YSIS Ph B PC0>$Res%ira!or"$o%%osi!e signs Ph B HC8>$2e!a,oli# same signs Cogen!in Ar!ane Parlodel A-ine!on Benadr"l 6arodo%a

1o%aminergi# P6S+

N0N$ TH+RAP+UTIC )1on(! .orr"& ,e ha%%"<* Mh"N Pu!s %! in defensive %osi!ion< Change !he su,Je#!< )+ver"!hing(s going !o ,e alrigh!<* giving False reassuran#e< Ignore !he %a!ien!< PreJudi#ial< )Ni#e .ea!her !oda"<* value ,ased Judgmen!< Fla!!er" don(! use !oo mu#h adJe#!ives< )You have !he mos! ,eau!iful hair in !he .ard<* Arguing .i!h !he %a!ien! 1on(! im%ose "our o%inion<

Com%ensa!ion? Ph is normal@Full" #om%ensa!ed< C8> B HC8= same signs @ Par!iall" #om%ensa!ed

ANXIETY $vague sense of im%ending doom< S"m%a!he!i# a#!iva!ion< Assessmen!? 6evel of an'ie!" 2I61$$$$$$$$$$$$$$$$$$$si! res!lessl"& .idened %er#e%!ual field& enhan#ed learning e'%erien#e< )You seem an'ious<* 201+RAT+$$$$$$$$$$%a!ien! is %a#ing& sele#!ive ina!!en!ion< Give PRN meds$An!i$an'ie!" drugs$valiumO S+E+R+$$$$$$$$$$$$$$$$%a!ien! #an(! ma-e de#isions< )I don(! -no. .ha! !o do or sa"<* RN dire#!s %a!ien!< )Si! do.n on !he #hair<* 1ire#!ive<

PANIC$ highes! level of an'ie!"< Sui#idal< Priori!"? safe!"< S!a" .i!h %a!ien!< 1on(! !ou#h %!< S"m%a!he!i# a#!iva!ion< )I !hin- I(m having a hear! a!!a#-D* Nrs 1'? $$$$$$$$$$$$$$$$$Ineffe#!ive Individual Co%ing P;I? 1e#rease an'ie!"& de#rease s!imuli HT? rela'a!ion !e#hniFue +? +ffe#!ive Individual Co%ing GENERALIZED ANXIETY DISORDER Can! slee%& #on#en!ra!e& sea! A mon!hs e'#essive .orr"ing< Pa!ien! -no.s .ha! !he %ro,lem is< Fa!igue and %al%i!a!ions PANIC ATTACK $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$9H$=8 minu!es& ha%%ens .i!hou! .arning< SNS a#!iva!ion< $.i!h or .i!hou! agora%ho,ia $$$$$$$$$$$$$$$$$$$$ fear of o%en s%a#e $so#ial %ho,ia $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ fear of %u,li# $%rovide safe!" $al-alosis$,ro.n ,ag $s!a" .i!h %a!ien! $,e dire#!ive POST TRAUMATIC STRESS DISORDER Ei#!ims ra%e& a##iden!& .ar 5one& disas!er& !rauma 9< Survivor >< Flash,a#- R 9 mon!h =< 2emor" nigh!mares 2A6ING+RING$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ no organi# ,asis 3no !issue #hange4 $%re!ending !o ,e si#-& #ons#ious $de#rease an'ie!" for %rimar" gain $in#rease a!!en!ion from RN se#ondar" gain SOMATOFORM DISORDER $$$$$$$$$$$$$$$$$$un#ons#ious& no! %re!ending& no organi# ,asis - goes do#!or ho%%ing

Nervous s"s!em 1IS0R1+R C0NE+RSI0N $loss of sensor";mo!or f' $s;s' real 3,iglang na,ulag4

2inor dis#omfor! $Feels li-e illness $HYP0CH0N1RIASIS

B01Y 1YS20RPHIC $illusion of s!ru#!ural defe#! $S;s' no! real

PSYCHOSOMATIC DISORDER 3Ps"#ho%h"siologi#4 real illness& real s;s'& real %ain& .i!h organi# ,asis 3.i!h #hange in !issue4 $ s!ress ul#ers& migraine& HPN PHOBIA$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ irra!ional fear +!iolog" -no.ledge& e'%erien#e Immedia!e nsg in!erven!ion? Remove o,Je#! of fear 3In#rease s!imuli@in#rease level of an'ie!"4 31e#rease s!imuli@de#rease an'ie!"4 Belief 0,Je#! .ill hur! %a!ien! Feeling S#ared Behavior Avoidan!@in!erferes .i!h A16

Gradual e'%osure !o feared o,Je#!$ SYST+2ATIC 1+S+NSYTH+KATI0N Individual Thera%" 9< H"%nosis $$$$$$$$$$$$$$rela'ed s!a!e >< Free asso#ia!ion $$$$$$ ideas shared !o %s"#hoanal"s! =< Ca!harsis $$$$$$$$$$$$$$free !o e'%ress feeling I< Trans!eren#e$ $$$$$$$$$$$%a!ien! feels some!hing for %s"#hoanal"s! H< Coun!er!rans!eren#e $$RN feels some!hing for %a!ien!

Green ligh!$Go +%i B Nore%ine%hrine Red ligh! S!o% G$gamma A$amino B$,u!"ri# A$ a#id An'ie!" In#rease GABA GI$#ons!i%a!ion GU$re!en!ion An!i$ #holinergi# S;+

+ffe#! of GABA? 1ro.s"& drin-& don(! An!i$an'ie!" drug drive& or!hos!a!i# h"%o!ension

Mi!hdra.al from drug a,ru%! R+B0UN1 PH+N02+NA Gradual .i!hdra.al !a%ered dose 1e%enden#e$ Can(! live .i!hou! valium ANTI$PSYCH0TIC AG+NTS ST+6AKIN+ S+R+NTI6 TH0RAKIN+ TRI6AF0N S"m%a!he!i# effe#!< +ffe#! >$I .ee-s

leads !o sei5ures< 9 .ee- effe#!<

C60KARI6 2+66ARI6 HA6106 PR06I7IN

SCHIZOPHRENIA$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$im%aired reali!" %er#e%!ion< +go disin!egra!ion< Gene!i# vulnera,ili!"< S!ress< $Chose fan!as" over reali!"< In#rease do%amine !heor"< Cause? un-no.n< In#rease do%amine& in#rease s#hi5o%hrenia< I A(s? 9< Affe#!$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$feelings B emo!ions 3smiles& laughs4< +'!ernal& readil" o,serva,le< 2ood& in!ernal& does no! ma!#h affe#!< 3sad inside4 >< Am,ivalen#e$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%ulled ,e!.een > o%%osing for#es =< Au!ism $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$self a,sor,ed< Tra%%ed in his o.n .orld<A!!a#hed !o odd o,Je#!s<Poor e"e #on!a#!< I< Asso#ia!ive looseness$$$$$$$$$$$$$$$$$$$$$$$$$$$!al- a,ou! so man" !hings ,u! unrela!ed ideas< 1is!ur,ed !hough! %ro#ess$$$$$$$$$$$$$$$$$$$$$$$$$Nsg d' Con!en! of !hough!$$$$$$$$$$$$$$$Hallu#ina!ions;Illusions$$$$$$$$$$$$A16$$$$$$$$$$$$$$$$$$$$$$$$$$$$Harm

1is!ur,ed !hough! %ro#ess 1is!ur,ed sensor" Per#e%!ion Self #are defi#i! Self 0!her 1ire#!ed Eiolen#e

P;I? Reali!";0rien!;Safe!" +val? Im%roved !hough! %ro#ess S B S' of S#hi5o%hrenia? 3$4neg s' h"%oa#!ive .i!hdra.n Fuie!& fla! affe#! %over!" of .ords T"%es of s#hi5o%hrenia?

3G4 %osi!ive s' h"%era#!ive fligh! of ideas res!less hallu#ina!ions !al-a!ive Fueen of !he .orld illusions

delusions man" ideas

9< 1isorgani5ed s#hi5o$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$sad inside& ha%%" ou!side fla! affe#! no affe#! 3$4 disorgani5ed manner;s%ee#h fligh! of ideas 3G4 He,e%hreni#$ giggling 3G4 S'? ,o!h 3G4 and 3$4<

ina%%ro%ria!e affe#! 3G4

>< Ca!a!oni# $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$am,ivalen#e anal s!age 3$4 NoD Nega!ivisim$re,el$anal 3$4 Ma'" fle'i,ili!"$$$$$$$$$$$$$$raise arm of %a!ien!< Pa!ien!s arm remains u% for a long !ime< 3$4 3$4 R 3G4 =< Paranoid $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$uses %roJe#!ion< 2is!rus! S#ared;.i!hdra.n;violen! Based on his!or"

1evelo% !rus!? orien!a!ion o%en $9?9 in!era#!ion $#onsis!en! a%%roa#h $shor!;freFuen! in!era#!ion ou! $food? sealed #on!ainer $meds? .ra%%ed in !am%er resis!an! foil I< Un#lassified; Undifferen!ia!ed$$$$$$$$$$$$$$$$$$$$$$$#an(! ,e #lassified an"more< H< Residual$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$no more 3G4& 3$4< So#ial .i!hdra.al

$6eave door $1is!an#e from %!? 9 arms leng!h $s!a" near door no! .indo. $have visi,ili!"?s!and half.a" in B !o ,e a,le !o #all for reinfor#emen!< $#alm and firm

THOUGHT PROCESS DISTURBANCE 9< 600S+N+SS 0F ASS0CIATI0N$$$$$$$$$$$$$$$$!o%i#s have #onne#!ion ,u! no !hough!< )I am going !o !he mall< The mall is in !o.n< The !o.n flies< Flies are here<* >< F6IGHT 0F I1+AS $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Ne. unrela!ed !o%i#s< )I am going !o !he mall< Mhere is !he ligh!N I !reasure !his #hal-< Hurra"D* =< A2BIEA6+NC+$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Pulled ," > o%%osing for#es< I< 2AGICA6 THINCING$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ ,elieves he has magi#al %o.ers< )I #an !urn "ou in!o a frog<* H< +CH06A6IA$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$re%ea! .ha! is said< Parro!s< A< +CH0PRA7IA$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$re%ea!s .ha! "ou do< Re%ea!s .ha! is seen< P< M0R1 SA6A1$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$mi'es .ords !ha! don(! rh"me< :< C6ANG ASS0CIATI0N$$$$$$$$$$$$$$$$$$$$$$$$$$$$uses .ords !ha! rh"me< )Flan-& ,lan-& %ran-<* Q< N+060GIS2$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$inven!s ne. .ords no! in !he di#!ionar"< )Ploo%%lan-& %isno-<* 98< 1+6USI0NS$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$false ,elief Grandeur$$$$$$$$$$$$$$I am a Fueen; -ing;millionaireD Perse#u!ion$$$$$$$$$$$$NBI ou! !o ge! meD Ideas of referen#e$$$$$The" !al- and .ri!e a,ou! meD 99< C0NCR+T+ ASS0CIATI0N$$$$$$$$$$$$$$$$$$$$$$$%iloso%o< )Mha! .ill "ou .ear !omorro.N* )Clo!hesD*

9><

HA66UCINATI0NS$$$$$$$$$$$$$$$$$$$$$$I66USI0NS 3.i!h s!imuli4 S!imuli N Y Eisual N Y Audi!or" N Y Ta#!ile N Y H A R 1$1ire#!ive< )6e!(s go in !he garden<*

Presen! reali!"DDD

A#-no.ledge? )I -no. !he voi#es are real !o "ou< Presen! reali!"< )Bu! I #an(! hear !hem<* @Assess .ha! voi#es are sa"ing !o -no. if %a!ien! .ill harm himself< In#rease 1o%amine @ in#rease s#hi5o 1e#rease do%amine @ de#rease s#hi5o +'!ra P"ramidal Side +ffe#!s 3+PS+4 3Ha%%ens .hen a#e!"l#holine is u% and do%amine is do.n4 9< ACATHISIA$$$$$$$$$$$$$$$$$$$$$$$$$$ res!less& ina,ili!" !o si! s!ill< >< ACINISIA $$$$$$$$$$$$$$$$$$$$$$$$$$$$ rigidi!" =< 1YST0NIA$$$$$$$$$$$$$$$$$$$$$$$$$$$ affe#!s ne#T0RTIC066IS $$$$$$$$$$$$$.r" ne#0CU60GYRIC CRISIS fi'ed s!are 0PISTH0T0NUS $$$$$$$$$ar#hed ,a#-& #on!ra#!ed I< TAR1IE+ 1YSCIN+SIA$$$$$$$$$$$$li% sma#-ing& !ongue is %ro!ruding& %uff" #hee-s< Irreversi,leD H< N+UR06+PTIC 2A6IGNANT SYN1R02+$ h"%er!hermia& uns!a,le BP& in#rease CPC& dia%horesis& %allor $dis#on!inue meds& medi#al emergen#"< A< PH0T0S+NSITIEITY$$$$$$$$$$$$$$$$$$.ear shades& suns#reen P< MBC$ Agranulo#"!osis$$$$$$$$$$$$$$$sore !hroa!& fever& malaise& leu-o%enia AUTISM$ ,o"s R girls< 9?988 -ids gif!$au!is!i# savan!s $e#holalis& %oor e"e #on!a#!& #an(! e'%ress ver,all"< Assess? A$ a%%earan#e$ nea!& 0C& .an!s #ons!an#" B$ ,ehavior$ ri!ualis!i# ,ehavior& fla! affe#!& re%e!i!ive C$ #ommuni#a!ion diffi#ul!" #ommuni#a!ing Nsg 1'? Im%aired so#ial in!era#!ion #an! form IPR 3In!er%ersonal rela!ionshi%4 Im%aired ver,al #ommuni#a!ion Self mu!ila!ion #an! e'%ress anger< +'%ress i! in.ard< Ris- for inJur" #ons!an#"& %romo!e safe!" +'%ressive !hera%" uses ar!& musi#& %oe!r"& de#reasing ris- for inJur"& im%roved so#ial in!era#!ion& ,e a,le !o e'%ress feelings< $Safe!"

P;I? +?

ADHD- ATTENTION DEFICIT HYPERACTIVITY DISORDER 3#an %rogress !o #ondu#! disorder !o an!i$so#ial ,ehavior4 Can! fo#us on an"!hing< 0nse! P "rs old and ,elo. 1ura!ion RA mon!hs Se!!ing? House B s#hool I1 dominan!? 2om or RN .ill a#! as su%erego Assessmen!? A$ a%%earan#e? dir!" B$ ,ehavior? #lums"& im%a!ien!& easil" dis!ra#!ed C$ !al-a!ive

Nsg 1'? High ris- for inJur" Safe!" S!ru#!ure$ %rovide %la#e !o s!ud"& ea!& %la"&,a!h&e!#< S#hedule !ime for ever"!hing Se! limi!s Residual A1H1 gro.s u% no! an!i$so#ial 2eds? Ri!alin& 1e'edrine&Pemoline& Adderal Bes! !ime !o give meds? If on#e a da" give AFT+R 2+A6S$ !o %reven! loss of a%%e!i!e< 1on(! give a! ,ed!ime$i!(s a s!imulan!$.ill #ause insomia< Can ,e given Ahours ,efore ,ed!ime 3if F>d4

ANOREXIA NERVOSA die!& under.eigh! S :HT of e'%e#!ed fa!& = mon!hs amenorrhea& failure !o re#ogni5e %ro,lem< BULIMIA NERVOSA indu#e vomi!ing& !a-es la'a!ive& normal .eigh!& irregular mens!rua!ion& den!al #arries& diarrhea $ -no.s %ro,lem ,u! ashamed and em,arrassed& Priori!"? Pro,lem? NI? Fluid volume ,alan#e Meigh! gain moni!or .eigh!& ea!ing %a!!ern& s!a" 9 hour af!er ea!ing& a##om%an" in !oile! Bod" image 1is!ur,an#e 9< +s!a,lish nu!ri!ion %a!!ern >< Tea#h s!ress managemen!& Journal -ee%ing =< 2oni!or ea!ing %a!!ern and .eigh!< I< An!i$de%ressan! needs mood s!a,ili5ing agen!s$ 6i!hium< Grou% !hera%"

MANIA

6$ 8<H$9<H m+F;6 3If level is near ><H$= m+F;6 .ill #ause a!a'ia and men!al #onfusion4 I$ in#rease urina!ion T$ !remors H$ H>8$ =6;d I$ in#rease T$ uu 2$ mou!h dr" N$ Na$ 9=H$9IH m+F;6 !o hold .a!er Che#- -idne"3,lood level4 ,efore adminis!ra!ion of 6i!hium 6i!hium !o'i#i!" n;v& diarrhea @ 1iamo' BIPOLAR DISORDER BUN& CR+A& ele#!rol"!e

> %oles& ha%%" 3more dominan!4 B sad $female& R>8 "rs old& s!ress& o,ese

Self a#!uali5a!ion Tas- !o de#rease self es!eem Famil" !hera%" Ris- for inJur"& ris- for o!her dire#!ed violen#e 1e#rease ea!& de#reased slee%& h"%era#!ive& in#rease se' Nsg 1'? High ris- for self or o!her dire#!ed violen#e Ris- for inJur"

mas!ur,a!e in fron! of o!hers

Give !as-& no grou% games& an" #om%e!i!ion .ill in#rease an'ie!"& .a!er !he %lan!s& a#!ivi!ies using gross mo!or s-ills& es#or!ed .al-& %un#hing ,ag$dis%la#emen!< = or more signs #onfirms disorder? G grandiose& in#rease ris- a#!ivi!ies F fl! of ideas S $ slee%lessness P %ressured s%ee#h + e'aggera!ed S+

10

+ 1

e'!raneous s!imuli 3easil" dis!ra#!ed4 dis!ra#!a,ili!"

PERSONALITY DISORDER 9< ,es! friend >< =< Schizoid $$$$$$$$doesn(! #are a,ou! %eo%le& ,elieves !ha! he #an s!and on his o.n& never had a

avoid grou%s B a#!ivi!ies no enJo"men! #ares more a,ou! #om%u!ers& %e!s A oid!"# $$$$$$$$$$avoid grou% fear #ri!i#ism& have !alen! ,u! no #onfiden#e< A"#i-$oci!% $$$$$$as #hild s!eal& lie& al.a"s ge! re%rimanded Adul! grand ro,,er"& illegal a#!ivi!ies agains! !he la.< drug addi#!ion& drives fas!& unsafe se'& !hrill see-er< Good !al-er& #harmer& .i!!"& mani%ula!or< 2o!!o )I .ill ,rea- !he la.* ) life is an em%!" glass<* S%li!!ing& sui#idal& su%erfi#ial rela!ionshi%& 3$4 sui#ide sad momen!

I< Bo&d'&%i"' -------Favori!e line la,ile$sudden #hange of 2ood& self mu!ila!ion< 3G4 fill glass .i!h friends have ha%%" momen!s

6ABI6+ AFF+CT

la,ile$ #hange from good !o ,ad in a s%li! momen! H< D'('"d'"# $$$$$$$$$1e#rease self es!eem& de%enden! Poor de#ision ma-ing s-ills )I #an! live if living is .i!hou! "ou* Hi$#&io"ic$ $$$$$$$$$$e'#i!ed& drama!i#& mani%ula!ive - C+NT+R 0R ATT+NTI0N N!&ci$$i$#ic----------)I love m"self* insensi!ive& arrogan!& self a,sor,ed - e'aggera!ed Self es!eem& am,i!ious )I am !he ,es!* OC $$$$$$$$$$$$$$$$$$ %erfe#!ionis!& organi5ed& #ons!an#" in environmen!< Provide !ime !o do P!&!"oid $$$$$$$$$$$ al.a"s Jealous& sus%i#ious& violen! P!$$i ' !))&'$$i ' $$$$$$al.a"s sa" )"es*& ,u! resis!an#e is hidden< Nsg In!erven!ion? Im%rove IPR& ,uild !rus! A-LCOHOL ABUSE $$$$$$$$$$$$$$$$$$$$$$ha%%" so#iali5ing $es#a%e from %ro,lem $%eer %ressure Nar#o!i# oversode$give Nar#an Nar#o!i# de!o'$ 2e!hadone Aversion !hera%"$An!a,use

A< P< :< ri!uals< Q< 98<

B$,la#-ou! $$$$$$$$$$$$$$$$ a.a-e ,u! una.are C$#onfa,ula!ion $$$$$$$$$$ inven! s!ories !o in#rease Self$+s!eem 1$denial $$$$$$$$$$$$$$$$$$$) I am a! no! an al#oholi#<* 1$de%enden#e $$$$$$$$$$$$) I #an! live .i!hou! al#ohol<* a<%h"si#al !remors& !a#h"#ardia& res!less ,<%s"#hologi#al #raving +$ena,ling;#ode%enden#" 3signifi#an! o!hers !olera!e a,users4 1ISU6FIRA2 voids al#ohol ,eer

11

version !hera%" n!a,use 31ISU6FIRA24 l#oholi#s anon"mous

n;v h"%o!ension in!erval of al#ohol B an!a,use? 9>h in!erval af!er al#ohol in!a-e

B9 Thiamine Com%li#a!ions

.erni#-es +n#e%halo%a!h" Corsa-off %s"#hosis

Merni#-es ER002 2o!or s' effe#! Corsa-off memor"$ #onfa,ula!ion >I P>h af!er al#ohol in!a-e 1elirium !remors ha%%ens due SNS a#!iva!ion Tremors& hallu#ina!ions& illusions< Mell li! room ANTI 1+PR+SSANTS

!o avoid hallu#ina!ions

de#rease sero!onin %ro,lem An!i de%ressan!s full s!oma#h All meds !a-e on a full s!oma#h& e'#e%! an!i an'ie!"<

AS+N1IN N0RPRA2IN T0FRANI6 SIN+UUAN ANAPRANI6 AE+NTY6 EIEACTI6 +6AEI6 PR0KAC PA7I6 K060FF 6UE07

TCA TCA TCA TCA TCA $ 0C TCA TCA TCA SSRI SSRI SSRI SSRI de%ression

Sero!onin $$$$$$$$$ma-es us ha%%" 1e#rease sero!onin %! ,e#omes sad In#rease sero!onin an!ide%ressan! SSRI* Sele#!ive Sero!onin Reu%!a-e Inhi,i!ors S S 3de#rease S;+4 R I 39 I .ee-s4

If SSRI don(! .or-& give TCA T&i C+c%ic A"#id'(&'$$!"#$ 3 TCA4 MAOI-------------------------- effe#! > In#rease +& N+& sero!onin V $$$$$$$$$$> I .-s has in#reased S;+ in#reased Sero!onin B Nore%hine%hrine -ills sero!onin $ 2A0I in#rease 2A0 @ de#rease sero!onin de#rease 2A0 @ in#rease sero!onin give 2A0I

A.-s

2os! dangerous& mos! S;+ 1ie! avoid #+&!,i"' food ea! SARIMA& fresh foods HPN c&i$i$ dangerousD In#rease CR& dia%horesis T"ramine ri#h food?

12

Avo#ado Pi#-les Al#ohol Fermen!ed foods Beer +gg%lan! Cho#ola!e %reserva!ives !o#ino& ,ologna&#anned mea! e!#< Cheese mo5erella& s.iss #heese M ine S so"sau#e An!i#holinergi# @ an!ide%ressan!s an!i%aras"m%a!he!i# 1r"& #ons!i%a!ion& re!en!ion& !a#h"#ardia 2ale ere#!ile d"sfun#!ion 2A0I

mAR %lan NAR dil PAR na!e


DEPRESSION de#rease sero!onin< If unres%onsive !o drugs& +CT$ele#!ro#onvulsive !hera%" Assess? 9< 1enial !his #an! ,e ha%%ening< This #an! ,e real< >< Anger Mh" me& .h" no.& .h" GodND =< Bargaining If re!urned& I .ill give re.ard< I< 1e%ression > .-s or more of s' @ #lini#al de%ression H< A##e%!an#e #lien! a#!s a##ording !o si!ua!ion< P! %re%ares living .ill< In#rease ris- for self dire#!ed violen#e< 2aslo.s? H I de#rease Self$es!eem give TASC = P! is .i!hdra.n > Ris- for self dire#!ed violen#e sui#ide 9 ea! 3.! gain4 or no! ea!3.! loss4& slee% or no! slee%& h"%oa#!ive& de#rease se' SUICI1+ CU+S? )I .on! ,e a %ro,lem an" longer* )Remem,er me .hen I(m gone* )This is m" las! da"* )This is m" .edding ring< Give i! !o m" son* - Sudden #hange in mood< P! is sui#idal& RN should? 1 d ire#! Fues!ion )Are "ou going !o #ommi! sui#ideN I irregular in!erval of visi! !o %! room + earl" am B endorsemen! %eriod $ !ime %!(s #ommi! sui#ide<

Mho .ill #ommi! sui#ideN S A 1 P + R S 0 N S se' male 3more su##essful4;female 3hesi!an!4 age 9H >I"o or a,ove IH de%ression %! .i!h %revious a!!em%!s .ill !r" again +T0H 3+!hanol4 al#oholi#s irra!ional la#-s so#ial su%%or! organi5ed %lan grea!er risno famil" si#-ness& !erminal

Sui#ide Triad?

13

6oss of s%ouse 6oss of Jo, Aloneness

Bes! a%%roa#h for sui#ide? 1ire#! a%%roa#h Nursing 2g!? #lose surveillan#e Hos%i!al area maJori!" sui#ide ha%%ens a!? .ee-ends 9 Mee-end less s!aff %ersonnel +arl" am ever" one is aslee% Give sim%le !as-< 1on(! give #om%le' !asMa!er !he %lan!s Mash !he dishes e'#e%! shar% o,Je#!s SUBSTANCE ABUSE T"%e of Addi#!? 9< Nervous $$$$$!remors Give do.ners S' of overdose 9< Iden!if" if drug is u%%er or do.ner >< Che#- effe#! =< S' of .i!hdra.al If %a!ien! !a-es a do.ner& all vi!al signs are do.nD If he s!o%s !a-ing i! 3during .i!hdra.al4& %a!ien! .ill e'%erien#e !he o%%osi!e effe#! of a do.ner< All his vi!al signs .ill shoo! u%D Same .i!h u%%ers< +'? P! had #o#aine in!o'i#a!ion< P! .ill manifes! h"%era#!ivi!"& !a#h"%nea& sei5ure< 1uring .i!hdra.al& %! .ill manifes! ,rad"%nea or #oma< S-.$#!"c' A.-$' Mo,'"#$ 3do.ner4 A al#ohol B ,ar,i!ura!es 0 o%ia!es N nar#o!i#s 2 mariJuana 2or%h C01+ H+R0 = am Sunda"

no Jigsa. %u55le

An!ido!e $ Nar#an 3nar#o!i# an!agonis!4

3u%%ers4
C H A #o#aine Hallu#inogens am%he!amines Do/"'&$ de#rease RR& de#rease HR #ons!ri#!ed %u%il 2ois! mou!h 1ila!ed Blood Eessels Coma Aslee% 1e#reased GI #ons!ri#!ion 1e#rease GU re!en!ion 1e#rease BP

U(('&$ Sei5ure Ta#h"%nea

Para

14

S!a!e of eu%horia S' of .i!hdra.al reverse of effe#! 9< Cno. if u%%er or do.ner >< 0%%osi!e of effe#! 0verdose Al#ohol #oma 2or%hine ,rad"%nea 1e!o' Mi!hdra.al 3o%%osi!e of .i!hdra.al is overdose4 sei5ure !a#h"%nea

.i!hdra.al .i!h 21 su%ervision 2e!hadone

>< 1e%ressed $ Si!s do.n on #hair U%%ers Codeine a.a-e Hallu#inogen Am%he!amine

in#reased hear! in#rease s"m%a!he!i# HR in#rease %u%ils$ dila!e 2ou!h dr" 1e#rease a%%e!i!e $ !hin s"ndrome sei5ure GI $ diarrhea

$ BP in#rease&

S!o% u%%ers Tremors Fa!igue

#rash

1e%ressed Sui#ide

6+E+6S 0F 2+NTA6 R+TAR1ATI0N Profound severe modera!e IU >8 =H H8

mild P8

,orderline Q8

normal 998

Profound 2en!al re!arda!ion IU S>8 @!hin-s li-e an INFANT< Can! ,e !rained< S!a" .i!h %a!ien!< Severe 2R >8$=H 2odera!e =H$H8 @ Can ,e !rained< 2en!al age is >$P"o< Pre$o%era!ional s!age< 2ild H8$P8 @ 3mild 04 2en!al age is 0$9>< +du#a,le< Can go !o s#hool< Borderline$ P8$Q8 Normal$ Q8$998 L0HN PIAG+T C0GNITIE+ TH+0RY 8$> "rs old S$ensor" mo!or< Ba," #an sense& see& %er#eive and hear< 0,Je#! %ermanen#e >$I "o$ P$re#on#e%!ual$ language< I$P "o$ I$n!ui!ive s!age< Unidimen!ional #lassifi#a!ion or unidimen!ional #hara#!eris!i#< Child #an fi' !o"s a##ording !o si5e& #olor& heigh!@one a! a !ime onl"< P$9> "o$ C$#onserva!ion;#on#re!e asso#ia!ion< 2ul!idemensional 9>"o$ F$ormal o%era!ion good in a,s!ra#! !hin-ing< Can in!er%re! %rover,s< CHI61 ABUS+

15

@,urns& ,ruises& ,one fra#!ures& ,ungi 1on(! ,a!he #hild< 1on(! ,rush !ee!h< Bod" of eviden#e .ill ,e los!< Ban!a" Ba!a 9A=

A6KH+I2+R
Anomia$ don(! -no. name of o,Je#! Agnosia %ro,lem .i!h senses 3smell& !as!e& hear& !ou#h4 A%hasia #an(! sa" i! A%ra'ia #an(! do i! 1isso#ia!ive Fugue$ !a-es a ne. %ersonali!" from a !ar a.a" %la#e< Ne. %la#e ne. iden!i!"< 1isso#ia!ive Iden!i!" 1isorder mul!i%le %ersonali!" 1isso#ia!ive Amnesia don(! -no. .ho;.here I am< 1+P+RS0NA6IKATI0N$ ,elieve !ha! !he" are no! %ersons an"more P+RS+E+RATI0N$ -uli!< )I .an! !o !al- a,ou! some!hing ,e#ause !his is some!hing !ha! I .an! !o do< I! is some!hing !ha! I need !o !al- a,ou!< This is some!hing !ha! I .an! !o do<* +6+CTR0C0NEU6SIE+ TH+RAPY$ sign informed #onsen!< For de%ressed %!< If meds don(! .or-& use +CT< Pre$+CT N$n%o A hours A$a!ro%ine sulfa!e dr" mou!h B$,ar,i!ura!e S$ su##in"l#holine #hloride !o rela' mus#les Pos!$+CT Side$l"ing$ la!eral S;+ heada#he& di55iness& !em%orar" memor" loss 3dis!in#! s'4@RN$orien! %!<

+7A2S? Nsg in!erven!ion? 6oo- for .ords li-e?

@safe!"& su%%or!& s!a"& se! limi!s& assis! Provide safe!"< 2o,ili5e su%%or! s"s!em< I .ill s!a" .i!h "ou< Assis! in a#!ivi!"< Se! limi!$ don(! allo. %a!ien! !o mis,ehave< 6oo- for .ords li-e? 0rien!@orien! %! %os! delirium& +CT& %! .i!h demen!ia A##e%! )Seem& o,served& no!i#ed& #ommen!& feelingsO* Grou% !hera%"$ fa#ili!a!or is RN< Ra%e& ,a!!ered %! A6TRUIS2 Ei#!im ,e#omes a #ounselor& shares e'%erien#e !o ne. vi#!im<

Self$hel% grou%@fa#ili!a!or is !he %! !hemselves< A6 AN0N grou%s Al#oholi#s Anon"mous

16

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