Lecture Notes in Psychiatric Nursing

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*DSM4
1.Mental Illness (thought and mood disorders)
2. Developmental Disability (mental retardation and personality disorders) 3. Comorbid Medical Conditions (DM)
4. Stressors (psychosocial and environmental problems)
5. GAF (0-100)

Age| Freud-psychosexual| Erikson-psychosocial|
0-1 Infant| Oral| Trust v. Mistrust|
1-3 Toddler| Anal| Autonomy v. Shame and doubt|
3-6 Preschoool| Phallic/ Oedipal| Initiative v. Guilt|
6-12 Schoolage| Latency| Industry v. Inferiority|
12-21 Adolescence| Genital| Identity v. Role confusion|
Maslow- food, safety, belonging, self esteem, self actualization.

Developmental crisis- individual part of maturing, normal part of life, get married Situational crisis- individual, unanticipated
Adventitious- community tragedy, Katrina

Impulse control- Frontal lobe
Visual hallucination (<occipital lobe)
Auditory (Temporal lobe)
Short term memory (hippocampus)
Long term (Cortex- grey matter) asymmetrical ventricles

Id-impulsive (limbic system- flight, fight, feed, fornicate) Ego-negotiates (frontal lobe- impulse control) <anxiety * Superego- super cop “no”

*Schizophrenia- excess dopamine
Positive symptoms- hallucinations, delusions, illusions
Negative symptoms- (depression) anhedonia, avolition, flat affect, associative looseness

Drug, Dose, Route, and Frequency| Usual and maximum dose.| Drug Classification and Action| Nursing Implications andMajor Side Effects| Why is this client receiving this drug?| Chlorpromazine (Thorazine)| 200-1,600mg qd PO| Conventional AntipsychoticDopamine antagonists, only works on positive symptoms| Sedation, Hypotension, AnticholinergicErectile Dysfunction, tell patient to wear sunscreen| Schizophrenia, to decrease psychotic symptoms. Good for sexually preoccupied and aggressive males| Haloperidol (Haldol)| 2-20mg qd PO100mg q4weeks IM| Conventional Antipsychotic| EPS, women are at an increased risk of neuroleptic malignant syndrome| Psychotic symptom treatment|

Clozapine (Clozaril)| 150-500mg qd PO| Atypical Antipsychotics| Sedation, Agranulocytocis, need CBC with dif, not for immunosuppressed patiens (AIDs or Cancer). Teach patient to report cold or flu.| Treats positive and negative symptoms.| Risperidone (Risperdal)| 2-8mg qd POMax 50mg q2weeks IM| Atypical Antipsychotics| Sedation, increased prolactin, reduced menstruation, breast lactation, pituitary tumor risk.| Long acting | Olanzapine (Zyprexa)| 5-20mg qd POPrn breath stripsDissolve instantly| Atypical Antipsychotics| Sedation, Hypotension, increased appetite, weight gain, DM risk. May need a script for metformin.| Schizophrenia, to decrease psychotic symptoms. | Benadryl, cogentin, artane, symmetrel| IM| Anticholinergic, relaxes muscles| “No spit, piss or poop”| To releve adverse effects of antipsychotics includeing dystonia and akathisia.|

The patient with bipolar disorder may have mood swings that can vary widely on the mood chart: Euphoria-dancing on the ceiling
Mania-pyschomotor agitation increases
Hypomania-“spring fever”
Euthymic-stable mood. Patient is in an optimal reality based productive state. Dysthymia-“the blues” *chronic and constant
Major Depression-psychomotor retardation worsens, * periods of time free of depression Vegetative Depression-frozen

Interventions: Set Limits for Safety, Socialization and Sleep that are Timely, Consistent and Enforceable.

Bipolar 1- documented manic episode. Non-drug induced.
Bipolar 2- up to hypomanic, more time spent in dysthymia.
Cyclothymia- similar but with less intensity and duration. Common in the normal population. Depression- unipolar.
Endogenous- hypothyroid & high TSH***
Situational- stressors. Quality, frequency and duration.

Use three meds with manic patient- Antipsychotic, Anticonvulsant, Anxiolytic Drug, Dose, Route, and Frequency| Usual and maximum dose.| Drug Classification and Action| Nursing Implications Major...
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