- ANTIANXIETY/ANXIOLYTICS http://nursinglectures.blogspot.com
- Description
- Depress the CNS, thereby increasing the effects of GABA, which produces relaxation and may depress the limbic system
- Side effects
- Daytime sedation
- Ataxia
- Dizziness
- Headaches
- Blurred or double vision
- Hypotension
- Dry mouth
- Nausea
- Tremor
- Amnesia
- Slurred speech
- Urinary incontinence and Urinary retention
- Constipation
- Paradoxical CNS excitement
- Acute Toxicity
- Confusion
- Diminished reflexes and coma
- Flumazenil (Romazicon), a benzodiazepine antagonist, administered IV, will reverse benzodiazepine intoxication in 5 minutes.
- Effect
- Immediate except for Buspar (2 weeks)
- Drug Prototype (-zolam, -zepam)
- Valium (Diazepam)
- Librium (Chlordiazepoxide)
- Ativan (Lorazepam)
- Serax (Oxazepam)
- Tranxene (Chlorazapate)
- Miltown (Meprobamate)
- Equanil (Meprobamate)
- Vistaril (Hydroxyzine Pamoate)
- Atarax (hydroxyzine HCl)
- Inderal( Propanolol)
- Buspar (Buspirone)
- Implementation
- SAFETY
- Avoid sudden changes in position to prevent Orthostatic Hypotension
- Side effects are related to Mental Alertness
- cautioned about driving
- operating machines
- Given at bedtime
- No alcohol, tranquilizers
- Don’t stop abruptly - withdrawal symptoms (insomnia, anorexia, vomiting)
- ANTIMANIA http://nursinglectures.blogspot.com
- Description
- Affect cellular transport mechanisms alter both the pre synaptic and postsynaptic events affecting serotonin, thus enhancing serotonin function.
- Concurrent use with diuretics, fluoxetine , methyl dopa , or non steroidal anti-inflammatory medications increases lithium reabsorption by the kidney , or inhibits lithium excretion , either of which increases the risk of lithium toxicity.
- Acetazolamide, aminophylline, phenothiazines, or sodium bicarbonate may increase renal excretion of lithium , reducing its effectiveness
- The therapeutic drug serum level of lithium
- 0.6 – 1.2 mEq/L (0.5 – 1.5 mEq/L)
- Side effects
- Polyuria
- Polydipsia
- Anorexia, nausea
- Dry mouth
- Mild thirst
- Weight gain/acne
- Abdominal bloating
- Soft stools or diarrhea
- Fine hand tremors
- Inability to concentrate
- Muscle weakness
- Lethargy
- Fatigue
- Headache
- Hair loss
- Implementation
- Monitor the suicidal client , especially during improved mood and increased energy levels
- Instruct the client to maintain a fluid intake of 6 to 8 glasses of water a day.
- Instruct the client to avoid excessive amounts of coffee, tea, or cola , which have a diuretic effect
- Instruct the client in the signs and symptoms of lithium toxicity.
- Do not administer diuretics while the client is taking lithium
- Instruct the client to avoid alcohol
- Instruct the client that he or she may take a missed dose within 2 hours of the scheduled time; otherwise the client should take the next dose at the scheduled time
- Instruct the client not to adjust the dosage without consulting the physician, because lithium should be tapered off and not discontinued abruptly.
- Instruct the client to notify the physician if polyuria, prolonged vomiting, diarrhea, or fever occurs or lack of coordination and confusion
- Effect
- Therapeutic response to the medication is 2 – 4 weeks
- Some textbook says 1-3 weeks
- Drug Prototype
- Lithium carbonate (Eskalith, Lithane, Lithobid)
- Lithium citrate (Cibalith-Si)
- LITHIUM
- L evel 0.6 - 1.2
- I ncrease urination
- T remors, fine hand
- H 2O (water) 3 L/day and 3 gms of salt
- I increase thirst
- U “uu” diarrhea
- M outh dry
- <>
- CNS: Lethargy, slurred speech, muscle weakness, fine hand tremor
- GI: Nausea, vomiting, diarrhea, thirst
- GU: Polyuria
- 1.5-2 mEq/L (mild to moderate toxic reactions)
- CNS: Coarse hand tremor, mental confusion, hyperirritability of muscles, drowsiness, incoordination
- CV: ECG changes
- GI: Persistent GI upset, gastritis, salivary gland swelling, abdominal pain, excessive salivation, flatulence, indigestion
- 2-2.5 mEq/L (moderate to severe toxic reactions)
- CNS: Ataxia, giddiness, fasciculations, tinnitus, blurred vision, clonic movements, seizures, stupor, coma
- CV: Serious ECG changes, severe hypotension
- GU: Large output of dilute urine
- Respiratory: Fatalities secondary to pulmonary complications
- > 2.5 mEq/L (life-threatening toxicity)
- General: Complex involvement of multiple organ systems
- Reactions unrelated to serum levels
- CNS: Headache, worsening of organic brain syndromes, fever, reversible short-term memory impairment, dyspraxia
- ANTIPSYCHOTIC http://nursinglectures.blogspot.com
- Description
- Sometimes referred to as “neuroleptics”
- Block dopamine receptors in the brain, thereby reducing the psychotic symptoms
- Side Effects
- Akathisia
- Parkinsonian-like symptoms of rigidity and tremor
- Constipation
- Urinary retention
- Photosensitivity
- Drowsiness
- Pruritus
- Dry mouth
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal Syndrome
- Parkinsonism
- Tremors/pill rolling
- Mask like facies
- Rigidity
- Shuffling gait
- Dystonia
- Facial grimacing
- Abnormal or involuntary eye movements
- Torticollis
- Opisthotonus
- Akathisia
- Restlessness
- Constant moving about
- Tardive dyskinesia
- Protrusion of the tongue
- Chewing motion
- Involuntary movement of the body and extremities
- Effect
- 2 – 4 weeks
- Antiparkinsons (CAPABLES)
- Anticholinergic: AABC
- Akineton
- Artane
- Benadryl
- Cogentin
- Dopaminergic: PLSE
- Parlodel
- Levodopa
- Symmetrel
- Eldepryl
- Monitor for extrapyramidal symptoms
- Monitor for symptoms of neuroleptic malignant syndrome
- For oral use, the liquid form might be preferred
- Avoid skin contact with the liquid concentrate to prevent contact dermatitis
- Protect the liquid concentrate from light
- Inform the client that phenothiazines may cause a harmless pinkish to red-brown urine color
- Instruct the client to use sunscreen, hats, and protective clothing when outdoors (photosensitivity)
- Instruct the client to change positions slowly to avoid orthostatic hypotension
- Instruct the client to report signs of Agranulocytosis , including sore throat , fever , and malaise
- Instruct the client to report sign of liver dysfunction , including jaundice, malaise, fever, and right upper abdominal pain
- Neuroleptic Malignant Syndrome
- A potentially fatal syndrome that may occur at any time during therapy with neuroleptic medications
- Although its rare, it is more commonly seen at the:
- initiation of therapy
- after the client is changed from one medication to another
- after a dosage increase
- or when a combination of medication is used
- Assessment
- Dyspnea or tachypnea
- Tachycardia or irregular pulse rate
- Fever
- High or low blood pressure
- Increased sweating
- Loss of bladder control
- Skeletal muscle rigidity
- Pale skin
- Excessive weakness or fatigue
- Altered level of consciousness
- Seizures
- Severe EPS side effects
- Difficulty swallowing
- Excessive salivation
- Implementation
- Monitor vital signs
- Initiate safety and seizure precautions
- Discontinue the neuroleptic medication
- Notify the physician
- Monitor level of consciousness
- Give antipyretic as prescribed
- Drug Prototype
- Stelazine (Triflourperazine)
- Serentil (mesoridazine)
- Thorazine (Chlorpromazine)
- Trilafon (Perphenazine)
- Clozaril (Clozapine)
- Mellaril (Thioridazine HCl)
- Haldol (Haloperidol)
- Prolixin (Fluphenazine)
- “ AZINE (phenothiazines)” “PERIDOL (butyrophenones)” “THIXENE (thioxanthene)” http://nursinglectures.blogspot.com
- “ ATYPICAL”
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Sertindole (Serlect)
- Ziprasidone (Zeldox)
- ANTIDEPRESSANTS http://nursinglectures.blogspot.com
- SELECTIVE SEROTININ REUPTAKE INHIBITORS (SSRIs) http://nursinglectures.blogspot.com
- Description
- Inhibit serotonin uptake
- Enhance the transmission of serotonin in the brain cells
- Produce an antidepressant response
- Side Effects
- Nausea and Diarrhea
- Dry mouth
- CNS stimulation
- Photosensitivity
- Insomnia
- Nervousness
- Headache
- Dizziness
- Weight loss
- Implementation
- Initiate safety precautions , particularly if dizziness occurs
- Instruct the client to take a single dose in the morning to prevent insomnia
- Administer with a snack or with meals to reduce the risk of dizziness and lightheadedness
- Monitor the suicidal client , especially during improved mood and increased energy levels
- For client on long term therapy, monitor liver and renal function tests
- Monitor WBC and neutrophil counts and discontinue the medication, as prescribed, if levels fall below normal
- Drug Prototype
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine hydrochloride (Paxil)
- Sertaline hydrochloride (Zoloft)
- Venlafaxine (Effexor)
- Effect
- 2 – 4 weeks
- TRICYCLIC ANTIDEPRESSANTS http://nursinglectures.blogspot.com
- Description
- Blocks the reuptake of norepinephrine and serotonin at the presynaptic neuron
- Concurrent use with MAOIs can cause hypertensive crisis
- Use to treat depression
- May reduce seizure threshold
- May reduce effectiveness of antihypertensives
- Side Effects
- Dry mouth
- Decreased GI motility and constipation
- Difficulty voiding
- Dilated pupils and blurred vision
- Photosensitivity
- Cardiovascular disturbances
- Tachycardia, dysrhythmias
- Orthostatic hypotension
- Sedation
- Weight gain
- Anxiety, restlessness and irritability
- Effect
- 2 – 4 weeks
- Drug Prototype
- Amitriptyline hydrochloride (Elavil)
- Amoxapine (Asendin)
- Bupropion (Wellbutrin, Zyban)
- Clomipramine (Anfranil)
- Desipramine hydrochloride (Norpramin)
- Doxepin hydrochloride (Sinequan)
- Imipramine hydrochloride (Tofranil)
- Maprotiline (Ludiomil)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Nortriptyline hydrochloride (Aventyl)
- Protriptyline hydrochloride (Vivactyl)
- Trazodone (Desyrel)
- MONOAMINE OXIDASE INHIBITORS (MAOIs) http://nursinglectures.blogspot.com
- Description
- Inhibit MAO enzyme , which is present in the brain, blood platelets, liver, spleen, and kidneys.
- Inhibition of the MAO enzyme metabolizes amines, norepinephrine, and serotonin , and the concentrations of these amines increase
- Description
- Used for depression in the client who has not responded to other anti depressant therapies, including ECT.
- Concurrent use with amphetamines, antidepressants, dopamine, epinephrine, guanetidine, levodopa, methyldopa, nasal decongestants, norepinephrine, reserpine , tyramine containg foods , or vasoconstrictors may cause HYPERTENSIVE CRISIS.
- Side Effects
- Orthostatic hypotension
- Restlessness
- Insomnia
- Dizziness
- Weakness, lethargy
- GI upset
- Dry mouth
- Weight gain
- Hypertensive Crisis
- Hypertension
- Occipital headache radiating frontally
- Neck stiffness and soreness
- Nausea and vomiting
- Sweating
- Fever and chills
- Clammy skin
- Dilated pupils
- Palpitations, tachycardia, or bradycardia
- Constricting chest pain
- Antidote for hypertensive crisis
- 5 to 10 mg PHENTOLAMINE (Regitine) by IV injection
- Implementation
- Monitor blood pressure frequently for hypertension
- Monitor signs for hypertensive crisis
- If palpitations or frequent headaches occur, discontinue the medication and notify the physician
- Administer with food if GI distress occurs
- Instruct the client to report headache, neck stiffness, or neck soreness immediately
- Instruct the client to change positions slowly to prevent orthostatic hypotension
- Instruct the client to avoid caffeine or over-the-counter preparations such as weight reducing pills or medications for hay fever and colds
- Monitor the client compliance with medication administration
- Avoid administering the medication in the evening because insomnia may result
- Instruct the client to avoid foods that require bacteria or molds for preparation or those that contain tyramine.
- Effect
- 2 – 4 weeks
- Drug Prototype
- “ PANAMA”
- Tranylcypromine (Parnate)
- Pheneizine sulfate (Nardil)
- Isocaboxazid (Marplan)
- Moclobemide (Manerix)
- TYRAMINE containing foods to AVOID!
- Cheese, especially aged, except cottage cheese
- Sour cream
- Pickled herring
- Avocados
- Bananas
- Papaya
- Broad beans
- Overripe fruit
- Red wine, beer
- Brewer’s yeast
- Meat extracts and tenderizers
- Yogurt Sausage, bologna, pepperoni, salami
- Soy sauce
- Raisins
- Beef, chicken, or liver
- Caffeine as coffee, tea, or chocolate
- Canned goods
- Children with ADHD may require medication to reduce hyperactive behavior and lengthen attention span
- Medications that are most effective in controlling this disorder are CNS stimulants
- CNS stimulants, which increase agitation and activity in adults , have a calming effect on children with ADHD and increase alertness and sensitivity to stimuli
- Drug Prototype
- Dextroamphetamine (Dexedrine)
- Methylphenidate (Ritalin)
- Pemoline (Cylert)
- Implementation
- Monitor for CNS side effects
- Instruct the client and the parents that over-the-counter medications need to be avoided
- Instruct the client and the parents that the last dose of the day should be taken at least 6 hours before bedtime to prevent insomnia
- Reinforce that several weeks of therapy may be necessary before the therapeutic effect can be evaluated
- Implementation
- Monitor height and weight (particularly in children)
- Instruct the client and the parents that a drug-free period may be prescribed to allow growth of the child if the medication has caused growth retardation
- Methylphenidate (Ritalin) should be taken on an empty stomach , 30 to 45 minutes before a meal or a snack
- Medications to treat ALZHEIMER’S DISEASE
- Acetylcholinesterase inhibitors may be used to treat AD to improve cognitive functions in the early stages
- Donepezil (Aricept)
- Used to treat mild to moderate dementia of AD
- Common side effects include nausea and diarrhea
- Can slow the heart rate through its vagotonic effect
- Tacrine (Cognex)
- Used to treat mild to moderate dementia of AD
- Side effects include ataxia, loss of appetite, nausea, vomiting, and diarrhea
- An adverse effect is hepatoxicity , liver function need to be monitored.
- Aim for success, not perfection. Never give up your right to be wrong, because then you will lose the ability to learn new things and move forward with your life.
- Dr. David M. Burns
- Break
- http://nursinglectures.blogspot.com
- FREE NURSING LECTURES in
- MS,OB,OR,Psych,Funda and a whole lot more!
- ANXIETY DISORDERS http://nursinglectures.blogspot.com
- Levels of Anxiety http://nursinglectures.blogspot.com
- Mild Anxiety
- Individual is ALERT
- Attention is possible
- Moderate Anxiety
- Decrease perceptual field
- Difficulty concentrating
- acing
- RN meds
- Severe Anxiety
- Has trouble thinking and reasoning.
- Muscle tightens and vital signs increase.
- Learning and Problem solving skills is not Possible.
- Individual needs direction to focus.
- Panic
- uicide
- afety
- tay
- ANXIETY DISORDERS
- Client’s suffering from anxiety disorders can demonstrate unusual behaviors
- Disorder significantly impairs their daily routine, social life and occupational functioning.
- Considered abnormal
- GENERAL ETIOLOGY OF ANXIETY http://nursinglectures.blogspot.com
- Psychoanalytical theory
- Psychic conflict
- Overuse of Defense mechanism
- inhibit emotional growth
- lead to poor PS skills
- difficulty with relationship.
- Interpersonal theory
- Values of their parents and family
- Problems in interpersonal relationship = ANXIETY
- Cognitive - Behavioral theory
- Learned through experiences
- Biological theory
- Genetic theory
- Brain abnormality
- Impaired glucose metabolism in the prefrontal cortex & basal ganglia
- Activation of the R frontal hemisphere
- Diminished volume of the hippocampus
- Neurochemical Theory
- GABA, 5Ht, NE
- TREATMENT
- Combination of medication & therapy
- Cognitive behavioral therapy
- “ ASSERTIVENESS TRAINING”
- “ POSITIVE REFRAMING”
- “ DECATASTROPHIZING”
- ANXIETY DISORDERS
- GAD
- PD
- OCD
- Phobic disorder
- ASD and PTSD
- GENERAL ANXIETY DISORDER
- “ free floating anxiety”
- APPREHENSIVE WORRYING
- UNCONTROLLABLE WORRYING = problems with ADL
- AD
- months
- Primary symptoms
- Nervousness
- Irritability
- Apprehension
- Agitation
- Tension
- Tachycardia
- Diaphoresis
- SOB
- Difficulty falling and staying asleep
- Overlaps those with Panic and depressive
- TNPR
- First , to reduce the level of anxiety
- ULTIMATE GOAL: to assist patient’s with developing adaptive coping responses.
- Initially, patient needs support and reassurance
- TRUST
- EMPATHY
- S AFETY
- V erbalization of feelings
- C alm Environment and Activities
- PANIC DISORDER
- Greek word “PANIKOS” meaning FEAR.
- Panic attacks that is 15 to 30 minutes (some for an hour) of rapid intense, escalating anxiety
- peak: 10 mins.
- NO precipitating factor
- DSM IV CRITERIA for PANIC DISORDER
- Recurrent, unexpected panic attacks
- Panic Attacks are followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavioral changes related to the attacks
- Can be accompanied by agoraphobia
- TNPR
- Key Nursing Intervention:
- To help patients to get through the panic attack safely with as little discomfort as possible.
- OBSESSIVE COMPULSIVE DISORDER
- O - recurrent thoughts, ideas, impulses or images that are experienced as intrusive and senseless.
- C - are repetitive behavior that are performed in a particular manner in response to an obsession
- Compulsion are performed to prevent discomfort and to bind or neutralize anxiety.
- Central feature: subjective experience of loss of voluntary control.
- Doubt – the common theme
- DM: Reaction formation, isolation and undoing
- 2 Forms:
- Washers
- Checkers
- Others
- counting, touching, hoarding, ordering
- TNPR
- Ensure that basic needs of food, rest and grooming are met
- Provide patients with time to perform rituals
- Explain expectataions, routines, and changes
- PHOBIC DISORDER
- Fears are more specific.
- Are intense irrational fear responses to an external object, activity or situation.
- DM: Displacement
- three types
- AGORAPHOBIA
- Greek for “fear of marketplace”
- SOCIAL PHOBIA
- SPECIFIC PHOBIA
- Natural environmental, Blood injections phobias, Situational, Animal and Others
- Management
- Assertiveness training
- Social skills groups
- Behavior therapy
- systematic desensitization
- Flooding
- Self exposure
- ASD and PTSD
- Develops after exposure to a clearly identifiable traumatic event that threatens the self, others, resources and or a sense of control or hope.
- Traumatic stressors:
- War
- Community violence
- torture
- natural and manmade disasters
- Accidents
- catastrophic illness
- major personal or business losses.
- Duration
- ASD
- Onset: within 4 weeks after the event
- Duration: 2 days to weeks
- PTSD
- Onset: Acute within 6 months after the event, Delayed: 6 months or more after the event
- Duration: A= 1 – 3 months. D: 3 or more
- http://nursinglectures.blogspot.com
- PERSONALITY DISORDER
- They suffer lifelong , inflexible and dysfunctional patterns of relating and behaving
- “ Ego Syntonic”
- PERSONALITY DISORDERS CLUSTERS
- CLUSTER A (ODD and ECCENTRIC)
- PSS
- CLUSTER B (DRAMATIC, EMOTIONAL, ERRATIC)
- BHAN
- CLUSTER C (ANXIOUS, FEARFUL)
- ADO
- “ PSS BHAN ADO”
- Paranoid personality disorder: SUSPECT
- S : Spouse fidelity, suspected
- U : Unforgiving (bears grudges)
- S : Suspicious of others
- P : Perceives attacks (and reacts quickly)
- E : "Enemy or friend" (suspects associates, friends)
- C : Confiding in others feared
- T : Threats perceived in benign events
- PSYCHOTHERAPEUTIC MANAGEMENT
- Trust
- Formal , business-like manner
- Schizoid personality disorder: DISTANT (4)
- D : Detached (or flattened) affect
- I : Indifferent to criticism and praise
- S : Sexual experiences of little interest
- T : Tasks (activities) done solitarily
- A : Absence of close friends
- N : Neither desires nor enjoys close relations
- T : Takes pleasure in few activities
- Schizotypal personality disorder: ME PECULIAR (5 criteria).
- M : Magical thinking or odd beliefs
- E : Experiences unusual perceptions
- P : Paranoid ideation
- E : Eccentric behavior or appearance
- C : Constricted (or inappropriate) affect
- U : Unusual (odd) thinking and speech
- L : Lacks close friends
- I : Ideas of reference
- A : Anxiety in social situations
- R : Rule out psychotic disorders and pervasive developmental disorder
- PSYCHOTHERAPEUTIC MANAGEMENT
- Focused on improving function in the community
- Referrals to local agencies assistance
- Assist client to find CASE MANAGER
- CLUSTER B (DRAMATIC, EMOTIONAL, ERRATIC)
- B
- H
- A
- N
- Antisocial personality disorder: CORRUPT (3).
- C : Conformity to law, lacking
- O : Obligations ignored
- R : Reckless disregard for safety of self or others
- R : Remorse lacking
- U : Underhanded (deceitful, lies, cons others)
- P : Planning insufficient (impulsive)
- T : Temper (irritable and aggressive)
- ANTI SOCIAL
- 50% 0f the population in prison have this personality. Peak is 20 years of age.
- Before age 15 this is diagnosed as conduct disorders.
- LIMIT SETTING
- 3 steps in Limit setting
- stating the behavioral limit (stating the unacceptable behavior)
- Identifying the consequences if the limit is exceeded
- Identifying the expected or desired behavior
- Example
- “ IT IS NOT ACCEPTABLE FOR YOU TO ASK PERSONAL QUESTIONS, IF YOU CONTINUE I WILL TERMINATE OUR DISCUSSION. WE NEED TO USE THIS TIME TO WORK ON SOLVING YOUR JOB RELATED PROBLEMS.
- Borderline personality disorder: AM SUICIDE (5).
- A : Abandonment
- M : Mood instability (marked reactivity of mood)
- S : Suicidal (or self-mutilating) behavior
- U : Unstable and intense relationships
- I : Impulsivity (in two potentially self-damaging areas)
- C : Control of anger
- I : Identity disturbance
- D : Dissociative (or paranoid) symptoms that are transient and stress-related
- E : Emptiness (chronic feelings of)
- INTERVENTIONS
- Long term psychotherapy to address issues of family dysfunction and abuse
- Short term : self harm and transient psychotic symptoms
- PROMOTING CLIENTS SAFETY
- Safety “ priority ”
- No self harm contract or no suicide contract
- HELPING CLIENT COPE AND TO CONTROL EMOTIONS
- Keeping a journal often helps the client gain awareness of feelings
- Decreasing impulsivity and delay gratification by using distraction techniques
- RESHAPING THINKING PATTERNS
- Cognitive restructuring
- Thought stopping- “ STOP !”
- Positive self talk – “I made a mistake but it’s not yet the end of the world next time I’ll know what to do”
- Decatastrophizing – assessing situation realistically rather than assuming a catastrophe
- STRUCTURING THE CLIENTS DAILY ACTIVITIES
- Planning activities
- PSYCHOPHARMACOLOGY
- Generally not used
- Low dose of neuroleptics for 3 to 12 weeks
- Lithium valproic acid and carbamazepine
- Benzodiazepines SSRI
- Histrionic personality disorder: PRAISE ME (5).
- P : Provocative (or sexually seductive) behavior
- R : Relationships (considered more intimate than they are)
- A : Attention (uncomfortable when not the center of attention)
- I : Influenced easily
- S : Style of speech (impressionistic, lacks detail)
- E : Emotions (rapidly shifting and shallow)
- M : Made up (physical appearance used to draw attention to self)
- E : Emotions exaggerated (theatrical)
- Narcissistic personality disorder: SPECIAL (5).
- S : Special (believes he or she is special and unique)
- P : Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love)
- E : Entitlement
- C : Conceited (grandiose sense of self-importance)
- I : Interpersonal exploitation
- A : Arrogant (haughty)
- L : Lacks empathy
- PSYCHOTHERAPEUTIC MANAGEMENT
- Decreasing the constant recitation of self importance and grandiosity
- “ Matter of fact”
- Help patient focus on identification and verbalization of feelings
- Supportive Confrontation
- Limit setting
- UNIFIED APPROACH
- CLUSTER C (ANXIOUS, FEARFUL)
- A
- D
- O
- Avoidant personalty disorder: CRINGES (4 criteria).
- C : Certainty (of being liked required before willing to get involved with others)
- R : Rejection (or criticism) preoccupies one's thoughts in social situations
- I : Intimate relationships (restraint in intimate relationships due to fear of being shamed)
- N : New interpersonal relationships (is inhibited in)
- G : Gets around occupational activity (involving significant interpersonal contact)
- E : Embarrassment (potential) prevents new activity or taking personal risks
- S : Self viewed as unappealing, inept, or inferior
- Dependent personality disorder: RELIANCE (5 criteria).
- R : Reassurance required for decisions
- E : Expressing disagreement difficult (due to fear of loss of support or approval)
- L : Life responsibilites (needs to have these assumed by others)
- I : Initiating projects difficult (due to lack of self-confidence)
- A : Alone (feels helpless & discomfort when alone)
- N : Nurturance (goes to excessive lengths to obtain nurturance & support)
- C : Companionship (another relationship) sought urgently when close relationship ends
- E : Exaggerated fears of being left to care for self
- Obsessive-compulsive personality disorder: LAW FIRMS (4).
- L : Loses point of activity (due to preoccupation with detail)
- A : Ability to complete tasks (compromised by perfectionism)
- W : Worthless objects (unable to discard)
- F : Friendships (and leisure activities)
- I : Inflexible, scrupulous
- R : Reluctant to delegate
- M : Miserly (toward self and others).
- S : Stubbornness (and rigidity)
- http://nursinglectures.blogspot.com
- SCHIZOPHRENIA
- It is characterized by disturbances in THOUGHT, SENSORY PERCEPTION, including the EMOTIONS, MOVEMENTS, BEHAVIOR.
- AGE OF ONSET:
- Late Adolescence or early adulthood
- GENDER:
- MEN: 15 – 25
- WOMEN: 25 – 35
- PREVALENCE:
- 1% of the total population
- E. BLEULER
- Coined the term “ schizophrenia”
- ffective disturbance
- utism
- ssociative looseness
- mbivalence
- http://nursinglectures.blogspot.com
- PARANOID
- one or more delusions or frequent auditory hallucinations
- Intervention
- Serve food sealed
- Don’t laugh or whisper
- Don’t touch, Distance at least 4 ft or Arms length
- Consistency
- DISORGANIZED
- All of the following are prominent
- disorganized speech, disorganized behavior
- flat or inappropriate affect
- Intervention
- Less stimulating area
- Provide information boards with schedules and refer to them often
- CATATONIC (2)
- Motor immobility – waxy, stupor
- Excessive motor activity (purposeless)
- Extreme negativism or mutism
- Peculiar movements stereotypy of movements
- Prominent mannerisms and grimacing
- Echolalia and echopraxia
- Intervention
- Immobility
- To minimize circulatory problems and loss of muscle tone
- Adequate diet, exercise and rest
- UNDIFFERENTIATED
- Characteristic symptoms are present
- But criteria for paranoid, catatonic, or disorganized subtypes are not met.
- RESIDUAL
- There is continuing evidence of disturbance such as presence of negative symptoms or criterion A symptoms, in an attenuated form (e.g odd beliefs, unusual perceptual experiences)
- http://nursinglectures.blogspot.com
- Positive or type I
- Abnormal thought form
- Agitation, tension
- Associational disturbances
- Bizaare behavior
- Conceptual disorganization
- Delusions
- Excitement
- Feeling of persecution
- Grandiosity
- Hallucinations
- Hostility
- Ideas of reference
- Illusions
- Insomnia
- Suspiciousness
- Negative or type II
- Alogia, Anergia,
- Anhedonia
- Asocial behavior
- Attention deficits
- Avolition
- Blunted affect
- Communication difficulties
- Difficulty with abstractions
- Passive social withdrawal
- Poor grooming and hygiene
- Poor rapport
- Poverty of speech
- ETIOLOGY
- BIOLOGICAL
- Brain Abnormality Theory
- Increased VBR (ventricular brain ratio)
- BRAIN atrophy, brain cell loss
- Decreased CBF in the prefrontal complex
- INCREASED DENSITY OF D2 RECEPTORS
- Neurotransmitter theory
- Genetic theory
- PSYCHOLOGICAL (psychodynamic)
- Developmental theories
- Psychoanalytical theory
- OTHER PSYCHOTIC DISORDERS
- SCHIZOAFFECTIVE DISORDER
- Characterized by both affective and schizophrenic symptoms
- DELUSIONAL DISORDER
- BRIEF PSYCHOTIC DISORDER
- SCHIZOPHRENIFORM
- http://nursinglectures.blogspot.com
- MAJOR DEPRESSIVE DISORDER
- 2 week period. At least 5 of the following symptoms must be present during the 2 week period one of which must be 1 or 2:
- (1)Depressed mood
- (2)Anhedonia
- Significant change in weight
- Insomnia or hyper insomnia
- Increased or decreased psychomotor activity
- Fatigue or energy loss
- Feeling of worthlessness and guilt
- Diminished concentration or indecisiveness
- Recurrent death or suicidal ideations
- Intervention
- Safety
- Increase the self esteem
- Boring task
- Give praises
- Punching bags / Foam bats
- http://nursinglectures.blogspot.com
- MANIC EPISODES
- 1 week
- At least 3 of the following symptoms
- Inflated self esteem or grandiosity
- Decreased need for sleep
- Very talkative
- Flight of ideas
- Distractibility
- Increase in goal directed activity or psychomotor agitation
- Excessive involvement in pleasurable activity that have a high potential for personal problems
- HYPOMANIC
- 4 days
- Not severe enough to result in significant impairment or to require hospitalization
- BIPOLAR DISORDER
- BIPOLAR I
- must have history of manic episodes
- BIPOLAR II
- The patient has experienced major depression and a hypomanic episodes.
- CYCLOTHYMIC DISORDER
- For a period of 2 years , the patient has had history of periods of hypomanic and depressed mood.
- The patient is never symptom free for more than 2 months at a time
- The patient has never experienced Major Depression
- Intervention
- SAFETY
- Reduce external stimuli
- Remove hazardous objects from the environment
- Avoid competitive games
- Set realistic limits of behavior
- Give attention to physical needs
- Provide high calorie and high protein diet with vitamin supplements
- Ensure adequate rest or sleep
- Administer hypnotic or sedative
- http://nursinglectures.blogspot.com
- COGNITION
- Is the brain’s ability to process, retain and use information.
- COGNITIVE ABILITIES
- P erception
- O rientation
- R easoning
- M emory
- A ttention
- COGNITIVE DISORDER
- Delirium
- Dementia
- DELIRIUM
- “ acute confusional state”
- DSM CRITERIA for DELIRIUM
- Disturbances of consciousness
- Change in cognition
- Development over a short period of time
- KEY SYMPTOMS OF DELIRIUM
- F EARFULNESS
- D ISORIENTATION
- A GITATION
- ETIOLOGY:
- UNKNOWN
- General Medical condition
- CHF, Pneumonia, Uremia, Malnutrition, dehydration, cancer, CVA and etc.
- Substance
- Prescription drug intoxication like anticholinergic drugs combination (elavil, antihistamines, antispasmodics, analgesics, steroids, sedatives, cardiovascular drugs (digoxin and diuretics) and cimetidine.)
- MANAGEMENT:
- Treatment of underlying disease and judicious use of medications and manipulation of the environment.
- Psychopharmacology
- Hypoactive delirium – no specific meds
- Hyperactive – sedation
- Haloperidol (.5 to 1mg)
- NO benzodiazepine
- Except if caused by alcohol – benzo
- Restraints
- DEMENTIA
- Is a complex and devastating problem that is a major cause of disability in the older adult population.
- It is not a normal aging process
- DSM CRITERIA for DEMENTIA
- Multiple Cognitive deficits:
- Memory impairment (amnesia)
- At least one of the following cognitive disturbances:
- Aphasia
- Apraxia
- Agnosia
- Disturbance In executive functioning (PLOC)
- Significant impairment in social or occupational functioning.
- Amnesia
- Early sign
- Initially RECENT memory and in later stages it affects REMOTE memory
- Aphasia
- Deterioration of language function.
- Can’t say or Can’t express
- E – F – B
- R – T - W
- Echolalia and Palilalia
- Apraxia
- Impaired ability to execute motor functions despite intact motor abilities.
- Inability to perform routine self care activities
- Agnosia
- Inability to recognize or name objects despite intact sensory abilities.
- Senses
- ONSET & CLINICAL COURSE
- MILD
- Forgetfulness – hallmark sign
- Difficulty finding words
- Frequently loses objects – anxiety
- Most people remain in the community
- MODERATE
- Confusion is apparent with progressive memory loss
- No longer perform complex task but remains oriented to PPT
- End stage
- Loses the ability to live independently
- Remains in the community but with caregiver
- SEVERE
- Personality and Emotional changes occur
- Delusional, wander at night, forget the names of his or her spouse and children.
- Requires assistance in ADL
- Lives in Nursing Facility
- http://nursinglectures.blogspot.com DELIRIUM DEMENTIA Onset Acute, often at night Insidious Course Fluctuating , with lucid intervals, during day: worse at night Stable over course of the day Duration Hours to week Months to years
- http://nursinglectures.blogspot.com Awareness Reduced Clear Alertness Abnormally LOW or HIGH Usually Normal Attention Lacks direction and selectivity; distractibility; fluctuates over course of the day Relatively unaffected Orientation Usually impaired for time; tendency to mistake unfamiliar to familiar place and persons Often impaired
- http://nursinglectures.blogspot.com Memory Immediate and recent memory impairments Recent and remote memory impairments – the most prominent symptom Thinking Disorganized Impoverished Perception Illusions and Hallucinations (usually visual) Often absent Sometimes: Hallucinations Delusions Illusions
- http://nursinglectures.blogspot.com Speech Incoherent, hesitant, slow or rapid Difficulty finding words Sleep wake cycle Always disrupted Fragmented sleep Physical Illness or Drug toxicity Either or both present Often absent, especially in Alzheimer’s type
- Reversible Dementia
- SLE (encephalopathy)
- Syphilis
- Hypo and Hyperthyroidism
- B12 and folate deficiency
- Non Reversible Dementia
- Alzheimer’s Disease
- Parkinson’s disease
- Pick’s disease
- Creutzfeldt Jakob Disease
- Vascular or multiinfarct dementia
- Alcoholic Dementia
- TIA
- ALZHEIMER’S DISEASE
- Commonly seen in the elderly ( 65 years old)
- Most prevalent of all non reversible dementia (50 – 75%)
- 4A’s
- mnesia
- gnosia
- praxia
- phasia
- ETIOLOGY:
- UNKNOWN
- Presence of senile plaques and NFT
- Dystrophic neuritis; thickened swollen neuronal process
- Abnormal amyloid deposits within the senile plaques and around the blood vessels
- Genetics
- Toxins
- Aluminum
- Infection
- Slow growing virus
- Cholinergic deficit
- Loss of cholinergic neurons in the brain(nucleus basalis of meynert)
- Reduction in Acetylcholine
- Impairment In ADL based on stages of AD http://nursinglectures.blogspot.com
- Mild
- Difficulty with
- Balancing checkbook
- Preparing complex meal
- Managing medication schedule
- Moderate
- Difficulty with
- Simple food preparation
- Household clean up
- Yardwork
- Some aspects of self care
- Severe
- Needs considerable assistance with
- Personal care
- Feeding
- Grooming
- Toileting
- Profound
- Oblivious to surrounding and totally dependent to the caregiver
- Terminal
- Bed bound, requiring constant care
- TREATMENT
- Donezepil (Aricept)
- Tacrine (Cognex)
- Rivastigmine
- Galantamine
- Ginkgo Biloba
- NSAID’s
- Vitamin E
- Estrogen
- Calcium Channel Blockers prevents influx
- PARKINSON’S DISEASE
- A hypokinetic disorder , is a progressive, chronic, degenerative disease involving an area in the brain called the EPS
- ETIOLOGY: deficiency of the DOPAMINE and a subsequent decrease in the DOPAMINE transmission to the basal ganglia.
- S/Sx: B T R
- DIFFUSE LEWY BODY DISEASE
- Similar to AD but typically occurs in earlier life and is associated more often with Hallucination and Extra Pyramidal Symptoms
- Evolves rapidly
- Pathological feature: Presence of multiple Lewy bodies (eosinophilic cytoplasmic inclusions) in cortical and subcortical neurons.
- HUNTINGTON’S DISEASE (huntington’s Chorea)
- Opposite of PD
- Characterized by uncontrollable quick, jerky and purposeless writhing movements.
- Disturbance in gait and slurred speech are noted in the beginning and progress into neurological and intellectual deterioration.
- Memory loss, paranoia, irritability, impaired impulse control and lack of tongue and breathing control.
- Usually begins between the ages 25 to 45 average duration of 15 to 20 years
- Hereditary
- PICKS’S DISEASE
- Clinical presentation is similar to AD and are usually treated in the same way.
- Associated with aging and is without race and gender basis
- Onset is slow with an average duration of 5 to 7 years.
- Characterized by shrinkage of the frontal lobe.
- CREUTZFELDT – JAKOB DISEASE
- Also known as “Prion disease”
- Is a non inflammatory dementia that accounts for fewer than 1% of all cases of dementia.
- Prion is an infectious particle, smaller than a virus.
- It is rapidly progressive disorder of the CNS involving severe neurological impairment with marked dysfunction.
- Affects the cerebral cortex
- Early symptoms are vision and hearing loss, impaired cognition, myoclonus, ataxia, muscle wasting, tremor, hallucinations and illusions.
- VASCULAR OR MULTI INFARCT DEMENTIA
- Multiple large and small cerebral infarcts.
- CV disease maybe the leading cause of acquired intellectual impairment in the age 85 and older population.
- ALCOHOLIC DEMENTIA
- Typically occurs 15 to 20 years of continues drinking.
- Alcoholic dementia has three primary symptoms:
- Alcohol is directly toxic to the neurons
- Alcoholism causes destructive nutritional deficit
- Alcoholism causes end organ failure which in turn affects the CNS.
- TRANSIENT ISCHEMIC ATTACKS
- The chief importance of TIA is a precursor of a major stroke, MI or death.
- The syndrome is caused by microembolism to the brain from atherosclerotic plaques in the aortocranial arteries in about 90% of TIA. 10 % for mural thrombi, valvular disease of the heart, vegetation of the heart valve, polycythemia, or some other blood clotting disorder.
- PSYCHOTHERAPEUTIC MANAGEMENT http://nursinglectures.blogspot.com
- TNPR
- Delirium HIGHEST PRIORITY : interventions to maintain life
- Dementia HIGHEST PRIORITY : Providing Nursing Care to maintain optimal level of functioning
- Must learn the background and lifestyle of the patient.
- One on One basis by using the title and last name.
- Use praise, touch and affection whenever possible.
- Should be dressed in his or her own clothing during the day with his or her hair combed. Make up, shaved.
- 3 milieu related issues
- STRESS
- The work of HALL “Progressively Lowered Stress Threshold” (PLST)
- Stressors includes:
- Fatigue
- Change of routine
- Excessive demands
- Overwhelming stimuli
- Physical stressors
- SAFETY
- WANDERING
- CBQ
- Nursing Management
- Never Change the environment
- Don’t educate new skills
- olor
- lock
- alendar
- 3 stages
- Forgetfulness
- Agnosia, amnesia
- Wandering
- Sundown syndrome – restless and anxiety
- Management:
- Avoid catnap, coffee, increase fluid, diuretics
- Medical bracelet
- Warm bath, warm milk
- DOC: Serax and Ativan
- Kleuver Bucy like syndrome
- Hyperorality - REGRESSION
- http://nursinglectures.blogspot.com
- Substance abuse
- Using a drug in a way that is inconsistent with medical or social norms and despite negative consequences.
- DM: DENIAL
- DETOXIFICATION is the initial priority
- ALCOHOL
- Is a primary drug problem
- Is a central nervous system depressant that is absorbed rapidly into the blood stream.
- Ethanol
- ETIOLOGY
- Psychoanalytical Theories
- Due to fixation in the oral stage of development
- Learning theories
- Due to learned behaviors
- Biological theories
- Due to inherited traits
- Socio cultural Theories
- Effects of mass media
- Physiologic effects
- Initially, RELAXATION and DISINHIBITIONS
- Anxiety is relief
- INTOXICATION
- Slurred speech
- Unsteady gait
- Lack of coordination
- Impaired attention, concentration, memory and judgment.
- Some becomes aggressive or display inappropriate sexual behavior
- Intoxication can lead to BLACKOUT
- OVERDOSE OR EXCESSIVE ALCOHOL
- People die of alcohol because it depresses the CNS
- Vital centers becomes anesthesized
- Vomiting
- unconsciousness
- respiratory depression
- Respiratory depression + vomiting = aspiration pneumonia
- Alcohol induced hypotension
- GI bleeding or hemorrhage
- Treatment
- Gastric lavage
- Dialysis
- Supportive care
- CBQ
- KORSAKOFF’S Psychosis
- Thiamine and Niacin deficiency
- Memory Disturbance – essential feature
- R etrograde amnesia
- A nterograde amnesia
- C onfabulation
- K orsakoff’s Psychosis
- WERNICKE’S Encephalopathy
- Thiamine Deficiency
- C onfusion
- O pthalmoplegia
- A taxia
- T hiamine deficiency
- WITHDRAWAL AND DETOXIFICATION
- Symptoms usually begins 4 – 12 hours
- Peaks on second day and is over by day 5
- Coarse hand tremors
- Sweating
- Elevated pulse and BP
- Insomnia
- Anxiety
- Nausea and vomiting
- Delirium Tremens
- PHARMACOLOGIC TREATMENT
- TWO main Purposes
- to permit safe withdrawal from alcohol, sedatives/hypnotics, benzodiazepines
- to prevent relapse
- BENZODIAZEPINES
- To suppress the withdrawal symptoms
- Lorazepam (ativan)
- Diazepam (valium)
- Vitamin B1 (thiamine)
- To prevent or to treat Wernicke’s syndrome and Korsakoff’s syndrome ; neurologic conditions that can result from heavy alcohol use.
- Vitamin B12 (cyanocobalamin) and Folic acid
- For nutritional deficiencies
- Disulfiram (ANTABUSE)
- To help deter clients from drinking
- Inhibits breakdown of acetaldehyde by the enzyme aldehyde dehydrogenase
- If taken with alcohol a severe adverse reaction occurs:
- Flushing
- A throbbing headache
- Sweating
- Nausea and vomiting
- Severe hypotension
- Confusion
- Coma
- Death
- AVOID! Products that contain alcohol
- Cough syrup
- Lotions
- Mouthwash
- Perfume
- Aftershaves
- Vinegar
- Odansetron (ZOFRAN)
- Used in young males at high risk for alcohol dependence or early onset alcohol dependence
- Treatment for methampetamine
- Acamprosate (CAMPRAL)
- Modulates transmission of GABA and NMDA,
- Decreases alcohol cravings and to maintain abstinence (UK)
- SEDATIVES, HYPNOTICS, AND ANXIOLYTICS
- Barbiturates
- Relieve anxiety or to produce sleep
- Thiopental (anesthesia)
- Phenobarbital (epilepsy)
- Non Barbiturates hypnotics
- Anxiolytics (benzodiazepines)
- INTOXICATION
- Slurred speech
- Lack of coordination
- Unsteady gait
- Labile mood
- Impaired attention
- Stupor or coma
- OVERDOSE
- Benzodiazepines (Rarely fatal)
- Lethargy and confusion
- Management
- Gastric lavage followed by ingestion of charcoal and a saline cathartic
- Dialysis if severe
- Barbiturates (Fatal)
- Coma
- Respiratory arrest
- Cardiac failure
- Death
- Management
- ICU
- Lavage or dialysis
- Support respiratory and cardiovascular function
- WITHDRAWAL SYNDROME
- Autonomic hyperactivity
- Increased PR, BP, RR and TEMP
- Hand tremors
- Insomnia
- Anxiety
- Nausea
- Psychomotor agitation
- Seizures and hallucination (severe withdrawal of benzodiazepine)
- DETOXIFICATION
- Tapering the amount of the drug.
- 10% each day
- STIMULANTS (Amphetamines, Cocaine, Others)
- Amphetamines
- “ uppers” “speed” or “Crank”
- for losing weight and staying awake,
- ADHD
- Cocaine
- EUPHORIA
- Snorting best way “ NASAL SEPTUM PERFORATION ”
- Methamphetamines
- dangerous, highly addictive and causes psychotic behavior. Brain damage.
- INTOXICATION (develops rapidly)
- High or euphoric feeling
- Hyperactivity
- Hypervigilance
- Talkativeness
- Anxiety
- Grandiosity
- Hallucinations
- Stereotypic or repetitive behavior
- Anger
- Fighting
- Impaired judgment
- Physiologic effects
- Increase HR, BP,
- Dilated pupils
- Perspiration or chills
- Nausea
- Chest pain
- Confusion
- Cardiac dysrhythmia
- OVERDOSE
- Arrhythmia and Respiratory Collapse
- Seizures
- Coma
- Death (rare)
- MANAGEMENT
- Induction of vomiting
- Forced diuresis
- Chlorpromazine
- Antagonize the amphetamine effect
- Odansetron (ZOFRAN)
- Used in young males at high risk for alcohol dependence or early onset alcohol dependence
- Treatment for methampetamine
- CANNABIS SATIVA
- Is an Indian hemp plant
- Hashish
- Most often smoked in cigarettes “joints”
- Known to decrease the IOP
- Relieving nausea & vomiting associated with cancer chemotherapy and the anorexia of weight loss of AIDS.
- Tetrahydrocannabinol
- Changed into metabolites and stored in fatty tissues
- Remains in the body upto 6 weeks
- Acts less than 1 minute after inhalation
- PEAK is 20 – 30 minutes and last at least 2 – 3 hours.
- Ingested – 12 hours
- Effects similar to your alcohol, lowered inhibition, relaxation, euphoria, increased appetite “munchies”, conjunctival injection ( bloodshot eyes ), dry mouth, hypotension and tachycardia.
- Excessive use: delirium, psychotic disorder (rare)
- 2 cannabinoids
- Dronabinol (marinol)
- Nabilone (Cesamet)
- INTOXICATION
- Impaired motor coordination
- Inappropriate laughter
- Impaired judgment
- Short term memory
- Distortions of time and perception
- Others: anxiety, dysphoria and social withdrawal
- OVERDOSES
- Do not occur
- WITHDRAWAL
- No clinically withdrawal syndrome
- OPIOIDS
- Popular drug abuse because they desensitize the user to both physiologic and psychological pain and induce a sense of euphoria and well being.
- Relieve pain by increasing the pain threshold and by reducing anxiety and fear
- Morphine
- Meperedine (Demerol)
- Codeine
- hydromorphone
- hydrocodone
- oxycodone
- methadone
- oxymorphone
- hydrocodone
- propoxyphene
- HEROIN
- NORMETHADONE
- Cocaine + heroin = speed balling
- INTOXICATION
- Apathy
- Lethargy
- Listlessness
- Impaired judgment
- Psychomotor agitation or retardation
- Constricted pupils
- Drowsiness
- Slurred speech
- Impaired attention and memory
- OVERDOSE
- Coma
- Respiratory depression – primary effect
- Unconsciousness
- Death
- MANAGEMENT
- Naloxone (NARCAN) – antagonists
- Given every few hours until the level drops to non toxic; may take for days
- Nalorphine (nalline)
- Clonidine (CATAPRES)
- For opiate dependence to suppress some effects of withdrawal or abstinence.
- WITHDRAWAL AND INTOXICATION “painful”
- Early
- Yawning
- Tearing
- Rhinorrhea
- Sweating
- Intermediate
- Flushing
- Piloerection
- Tachycardia
- Tremor
- Restlessness
- irritability
- Late
- Muscle spasm
- Fever
- Nausea and vomiting
- Repetetive sneezing
- Abdominal cramps
- backache
- METHADONE (Dolophine)
- A potent synthetic opiate
- To prevent withdrawal symptoms
- Which meets the physical needs for opiates but does not produce cravings for more.
- LEVOMETHADYL
- Treatment of opiate dependence
- HALLUCINOGENS “psychosis like reaction”
- “ Psychotomimetics” or “psychedelics”
- Distorts the user’s perception of reality and produces symptoms similar to psychosis including hallucinations (visual and depersonalization)
- 2 basic groups
- Natural
- Mescaline (peyote) from cactus
- Psilocybin from mushrooms
- Marijuana
- Synthetic
- Lysergic acid diethylamide (LSD)
- “ Designer drugs”
- ecstasy
- phencyclidine (PCP), anesthetic
- Increased PR, BP and TEMP, Dilated pupils , Hyperreflexia
- Physiologic symptoms: sweating, tachycardia, palpitations, blurred vision, tremors and lack coordination.
- INTOXICATION
- Anxiety
- Depression
- Paranoid ideation
- Ideas of reference
- Fear of losing one’s mind
- Jumping out of the window
- PCP: belligerence, aggression, impulsivity and unpredictable behavior.
- primarily psychological except PCP
- PCP TOXICITY
- seizures
- hypertension
- hyperthermia
- Respiratory depression
- OVERDOSE
- None
- MANAGEMENT
- psychotic reactions – isolation from external stimuli
- restraints
- WITHDRAWAL AND DETOXIFICATION
- None
- INHALANTS
- CNS depressants
- Most common substances in this category are ALIPATHIC and AROMATIC hydrocarbons
- Can cause significant brain damage , peripheral nervous system damage and liver disease.
- 3 Basic forms of Inhalants
- Solvents (gasoline, glues)
- Aerosol propellants (spray cans)
- Anesthetic (chloroform, nitrous oxide)
- INTOXICATION
- Dizziness
- Nystagmus
- Lack of coordination
- Slurred speech
- Unsteady gait
- Tremor
- Muscle weakness
- Blurred vision
- Stupor and coma
- Belligerence
- Aggression
- Apathy
- Impaired judgment
- Inability to function
- Acute toxicity: anoxia, respiratory depression, vagal stimulation, dysrhythmia, death from brochospasm, cardiac arrest, suffocation, aspiration of the compound or vomitus.
- NO MEDS
- WITHDRAWAL AND DETOX
- none
- CBQ
- Short term Goal for Alcoholism
- Cut off denial
- Long term
- Abstinence
- Number 1 sign of Cocaine withdrawal
- Goosebumps
- Heroine
- CAT’S eye phenomenon
- Hallucinogen cardinal sign
- BAD TRIP
- Nightmares and flashbacks
- Number sign of Marijuana user
- RED eyes
- Signs of withdrawal
- Opposite of the effects
- OVERDOSE
- UPPERS
- Tachypnea/cardia
- Dry mouth
- Dilated pupils
- Hypertension
- Euphoria
- Seizure
- Weight loss
- DOWNERS
- Brady
- Moist mouth
- Constriction of pupil
- Urinary retention
- Hypotension
- Sleep
- Coma
- Hungry – eats – weight gain
- http://nursinglectures.blogspot.com
- DSM CRITERIA for ANOREXIA
- Refusal to maintain body weight at or above a minimum normal weight for age and height
- Intense fear of gaining weight or becoming fat even through underweight
- Disturbance in the way in which one’s body weight or shape is experienced, overvaluing of shape or weight or denial of seriousness of low weight .
- In females, absence of at least three consecutive menstrual cycle.
- Objective signs
- Deliberate weight loss
- Amenorrhea , low levels of LH and FSH,
- Dry skin , cracking
- Lanugo
- Preoccupied to food and eating which involves all aspects of life.
- Engage in bizarre behavior
- norexia
- dolescent
- menorrhea
- nderweyt
- DSM CRITERIA for BULIMIA
- Recurrent episodes of binge eating
- A feeling of lack of control over eating behaviors during the eating binges.
- Binge eating and inappropriate compensatory behaviors both occur on average at least twice a week for 3 months .
- Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting, use of laxatives or diuretics, strict dieting or fasting, vigorous exercise, or taking dieter pills.
- Self evaluation is unduly influenced by body shape and weight
- OBJECTIVE SIGNS
- Mechanical irritation and injuries to the GIT
- Fluid and Electrolytes abnormalities
- dehydration
- hyponatremia
- hypokalemia
- Hypochloremia
- Esophagitis
- Esophageal stricture
- Aspiration Pneumonia
- Addiction
- Reflex constipation
- Rebound edema
- Enlarged salivary glands (painless)
- Erosion of the dental enamel
- KEY NURSING INTERVENTIONS for EATING DISORDER
- Observe patients for signs of purging
- Monitor activity level
- Weigh daily
- Plan for dietitian
- Regular monitor electrolyte status
- BINGE EATING DISORDER (BED)
- Eating disorder that do not fit clearly into the diagnostic criteria for Anorexia or Bulimia.
- DSM
- Recurrent binge eating at least 2 days per week for 6 months at least 3 of the following:
- Eating rapidly
- Eating until becoming uncomfortably full
- Eating large amounts when not hungry
- Eating alone because of embarrassment
- Disgust, depression, guilt because of eating episodes
- Primary Goal Therapy
- Establish a regular, healthful pattern.
- Eating Related Problems http://nursinglectures.blogspot.com
- PICA
- Persistent eating of non nutritious food
- Anorexia Athletica
- Obsessed exercised
- Muscle Dysmorphia (bigorexia)
- Worry excessively that they are small even if they have good muscle mass.
- Orthorexia Nervosa
- Pathologic fixation of eating proper, “pure” or “superior” foods
- Night Eating Disorder
- Lack of appetite for breakfast because of preoccupation on the amount of food eaten the night before.
- Nocturnal Sleep related Eating Disorder
- Persons who eats while asleep.
- Rumination Syndrome
- Bizarre eating pattern wherein the person eats, swallows and then regurgitate food back into the mouth again and then swallowed again.
- Gourmand’s Syndrome
- Obsession with fine foods
- Prader Nilli Syndrome
- Incessant eating (congenital problem)
- Chewing and Spitting
- Putting foods in the mouth, tasting, chewing then spitting.
- CBQ
- A menorrhea
- N o organic factor accounts for weight loss
- O bviously thin but feels fat
- R efusal to maintain normal body weight
- E pigastric discomfort
- X symptoms
- I intense fear of gaining weight
- A Always thinking foods
- B inge eating
- U nder strict dieting or vigorous exercise
- I nduced vomiting
- L acks control over eating binges
- M inimum of 2 binge eating episode a week for 3 months
- I ncrease persistent concern of body size/shape
- A buse of diuretics and laxatives
- http://nursinglectures.blogspot.com
- SEXUAL DYSFUNCTION
- Sexual Response Cycle
- “ EPOR”
- “ DEOR”
- Desire
- Excitement
- Orgasm
- Resolution
- Sexual Desire Disorder
- Individuals with these disorder have little or no sexual desire or have an aversion to sexual contact.
- Sexual Arousal Disorder
- Individuals cannot maintain the physiological requirements for sexual intercourse
- Orgasm Disorder
- Individuals cannot complete the sexual response cycle because of the inability to achieve orgasm.
- In Premature Ejaculation
- Sexual Pain Disorder
- Suffer genital pain “DYSPAREUNIA”, before, during, after sexual intercourse.
- Vaginismus - involuntary spasm of the outer third of the vagina.
- PARAPHILIA
- Is a condition in which the sexual instinct is expressed in ways that are socially prohibited or unacceptable or biologically undesirable.
- DSM CRITERIA for PARAPHILIAS http://nursinglectures.blogspot.com
- Exhibitionism
- Recurrent intense sexually arousing fantasies, sexual urges or behaviors involving exposing one’s genitals to unsuspecting strangers.
- Fetishism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors using non living objects
- Frotteurism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving touching and rubbing against a non consenting person.
- Pedophilia
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors that involve sexual activity with a child or children generally 13 years of age or younger. The person is at least 16 years of age and at least 5 years older than the child or children involved.
- Sexual masochism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving the act of being humiliated, beaten, restrained or otherwise made to suffer.
- Sexual sadism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving acts in which the psychological or physical suffering of the victim is sexually exciting to the person.
- Voyeurism
- Act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
- The paraphiliac activities last over a period of 6 months and cause distress or impairment in social, occupational, or other important areas of functioning.
- Other types
- Annillingus
- Cunnillingus
- Fellatio
- Partialism
- Urophilia
- Coprophilia
- Telephone scatologia
- Klismaphilia
- Hypoxyphilia
- Buggery
- Sodomy
Psychiatric Nursing Pharmacology Lecture
Psychiatric Nursing Pharmacology includes lectures on
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment
Spammers are NOT Allowed on this site. Please do not waste your time leaving a comment that is not relevant with Nursing lectures, it will just be DELETED. If you want to offer Guest Posting or you have a blog related to Nursing lectures, then send it to me at nursingniches(at)gmail(dot)com and I'll include your site in the blogroll. Thanks!