Lecture Notes in Psychiatric Nursing

Topics: Schizophrenia, Antidepressant, Bipolar disorder Pages: 14 (3448 words) Published: February 26, 2013
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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