psychiatric nursing notes

Download Psychiatric Nursing Notes

Post on 12-Dec-2015




3 download

Embed Size (px)


Psychiatric Nursing Notes


Psychiatric Nursing Notes

Psychiatric Nursing Notes Psych focuses in feelings or self awareness. Beliefs determine feelings which affects behavior (manifestation of feelings) Sigmund Freud is the father of PSYCHOANALYSIS. What happens to childhood will affect adulthood.



impulsive, want to, wants pleasure. PLEASURE PRINCIPLE. Guiding principle is PAIN AVOIDANCE.

SUPEREGO should not small voice of God to stop

EGO executive decision maker. In touch with reality principle.

ID DOMINANT PERSONALITIESManicAnti Social experienced by serial killersNarcissistic

SUPEREGO DOMINANT PERSONALITIES Obsessive CompulsiveAnorexia Nervosa

EGO if destroyed result in impaired reality perception.Schizophrenia

LIBIDO Sexual energy responsible for survival.

Oral Stage 0 18 months evident. ID is developed.

*FIXATION Person is stuck in certain developmental shape.*REGRESSION Return to an earlier developmental stage.EGO Developed on the 6th month.

Anal Stage 18 months 3 years old. Able to control bladder, bowel. Best time for toilet training. SUPEREGO is developed.


Good Mother------------------------ Bad MotherSuccessful -----------------Dirty ---------------------- Clean-------------------------disorganized --------------- organized------------------------- disobedient ---------------- obedient------------------------- Anti-social ------------------- O.C----------------------- Anal expulsive ----------- Anal retentive

PHALLIC STAGE 3 6 years old. Experience pleasure by manipulating genitals. Love hate relationship. Oedipus Complex boy loves parent of the opposite sex. Imitates daddy called identification. Castration fears. Electra Complex girl loves parent of the opposite sex. Imitates mommy called identification. Penis envy.*Conscious upper level of thinking.*Preconscious tip of tongue.*Unconscious protects us from traumatic experiences.

LATENCY STAGE 6 12 years old. School age. Separation anxiety. Reading, Writing, Arithmetic. Lasts for 6 years.

GENITAL STAGE 12 years old and above Sexual reawakening. Very important stage.

PHARMA NOTES:ANTI - ANXIETY DRUGS Valium Librium Ativan Serax Tanxene Miltown Equanil Vistaril Atarax Ideral Buspar

ERIC ERIKSON There is more to life than just sex. Psychosocial Theory of development. You can develop a positive side or a negative side. Developmental task begins at 0 18 months.

-------------------- POSITIVE ------NEGATIVE -------- FACTOR0 18 mos. ----------Trust ------------ Mistrust ------------ Feeding18 mos. 3 yrs. ----Autonomy -------Shame & Doubt ---- Toilet Training3 yrs. 6 yrs. -------Initiative ---------- Guilt --------------Independence6 yrs. 12 yrs. -----Industry ---------Inferiority ------------ School12 yrs. 20 yrs. ----Identity ---------Role Confusion --------- Peers20 yrs. 25 yrs. ----Intimacy -----------Isolation --------------Love25 yrs. 45 yrs. ---Generativity --------Stagnation -----------Parenting45 yrs. - above ----Ego Integrity --------- Despair ------------Reflection


1. FRONTAL LOBE- Language- Learning- Personality- Judgment

2. TEMPORAL LOBE- Hearing- Smell

3. PAREITAL LOBE- Touch- Taste


3 STEPS TO INTERACT WITH ENVIRONMENT1. Sensory eyes, ears, tongue2. Integration3. Motor voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM also called as somaticBrainSpinal CordMotor NerveSynapseMuscle Fiber Motor nerve to muscle fiber you need Acethylcholine which is an On switch.

INVOLUNTARY NERVOUS SYSTEM also called autonomic nervous system.

AUTONOMIC NERVOUS SYSTEM-----------------------SYMPATHETIC ------------PARASYMPATHETIC-------------------(Awake, ADRINERGIC) --------(Relax, CHOLINERGIC)Heart Rate ------------ Increase -------------------- DecreaseRespiratory Rate ------ Increase -------------------- DecreaseGI ---------------------Decrease ------Increase (Moist mouth, Diarrhea)GU -------------------- Decrease ---- Increase (Urinary Frequency)Neurotransmitter---- Epinephrine, Norepinephrine ----Acethylcholine

DRUGS WITH ANTICHOLINERGIC EFFECTS Anti Anxiety Anti Psychotic Anti Cholinergic Anti Depressants



DEFENSE MECHANISMS1. Displacement transfer of feelings to a less threatening object rather than the one who provoked it.2. Denial failure to acknowledge an unacceptable trait or situation.3. DISOCIATION psychological flight from the self.4. REGRESSION return to an earlier development state.5. repression unconscious forgetting.6. RATIONALIZATION illogical reasoning for an unacceptable trait and situation.7. REACTION FORMATION doing the opposite of what you have done.8. UNDOING doing the opposite of what you have done.9. IDENTIFICATION assuming trait for personal, social, occupational role.10. PROJECTION attribute to others ones unacceptable trait.11. INTROJECTION assume another persons trait as your own.12. SUPPRESSION conscious forgetting.13. SUBLIMATION putting destructive energies or hostile feelings towards a more productive endeavors.14. CONVERSION unexpressed or repressed feelings are converted to physical symptoms.15. COMPENSATION over achievement in one area to cover a defective part.16. SUBSTITUTION replace difficult goal with more accessible one.


ANTI PARKINSON DRUG - CAPABLES Cogentin Artane Parlodel Akineton Benadryl Larodopa Eldepryl Symmetrel

AUTONOMIC NERVOUS SYSTEM----------------- SYMPATHETIC -------- PARASYMPATHETICPupils ----------------Dilate ----------------ConstrictBlood Vessels --------Constrict ------------- DilateBlood Pressure --------Increase ------------ Decrease


THERAPEUTIC1. Offer Self2. Silence provide time to think3. Making observation what you see you say4. Active Listening nodding, eye contact5. Broad Opening how are you today?6. General Leads Go on, Im listening7. Restating Im sad Youre sad? 1. Dont worry be happy2. Changing the topic/subject3. Ignore the client4. Value based judgment never assume5. Flattery6. Advising7. Giving Opinion


1. Dont worry be happy2. Changing the topic/subject3. Ignore the client4. Value based judgment never assume5. Flattery6. Advising7. Giving Opinion

FEAR protects us from something bad.

ANXIETY Vague sense of impending doom. Triggers the sympathetic nervous system. Assess level of anxiety of client.

TYPES OF ANXIETYMILD ANXIETY + 1 level of anxiety. Widened perceptual field. Restless (say you seem restless). Enhanced learning capacity.

MODERATE ANXIETY + 2 level of anxiety. Client pace. Give PRN meds.

SEVERE ANXIETY + 3 level of anxiety. Dont know what to do/say. Directive orders (please sit down).

PANIC + 4 level of anxiety. May commit suicide. Promote safety. Never touch patient. Hyperventilation (Respiratory Alkalosis) Breathe into paper bag.

NURSING DIAGNOSIS: ineffective individual coping. Powerlessness. Impaired skin integrity

PLANNING/IMPLEMENTATION: decrease level of anxiety. Decrease environmental stimuli. Relaxation techniques.

EVALUATION effective individual coping.

GENERALIZED ANXIETY DISORDER 6 month excessive worrying. Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability.

PANIC ATTACKS/DISORDER 15 30 minutes sympathetic nervous system escalation. Example is AGORAPHOBIA fear of open spaces.

POST TRAUMATIC STRESS DISORDER victims becomes survivors and experience flashbacks or nightmares.

MALINGERING pretending to be sick (conscious). Primary Gain anxiety decreases, able to escape source of anxiety. Secondary Gain able to get attention.

SOMATOFORM no protection unconscious no organic basis of being sick

DIFFERENT TYPE OF SOMATOFORM1. Conversion Disorder cannot speak, see, hear. Nervous system affected.2. La Belle Indifference do not care what happens to them.

HYPOCHONDRIASIS has minor discomfort and interprets it as major illness. Focus on clients feelings.

BODY DISMORPHIC DISORDER Illusion of structural defect. Favorite past time is doctor hopping. Focus on clients feelings.

PSYCHOSOMATIC Real pains/illness Real symptoms because of anxiety

PSYCHOSOMATICIncrease AnxietySNSIncrease BP & HRHypertensionFat DepositsAtherosclerosisCalciumArteriosclerosisDecrease OxygenAngina PectorisMINecrosisCHFComa

PHOBIA Irrational fear Etiology: Knowledge of certain object Bad experience Immediate nursing objective: Removal of stimulus will remove anxiety Systemic Desensitization gradually expose client to stimuli/feared object Employ relaxation techniquesSNS GABA (Gamma Amino Butyric Acid) stop Epinephrine and Norepinephrine Go

ANTI-ANXIETY Increase GABA and client becomes drowsy (no alcohol and coffee) May develop orthostatic hypotension Let patient sit then dangle feet and then stand Develop anti cholinergic effects If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures Do it in gradual and in tapered dose Anti anxiety leads to dependence

AUTISM Unresponsive and does not want to be touched Autistic Savant: high intelligence and has a ratio of 1:100 Assessment Appearance flat affect and loves constancy and ritualistic Behavior withdrawn Communication echolalia

NURSING DIANOSIS Impaired verbal communication Impaired social interaction Self mutilation Risk for injury

PLANNING/IMPLEMENTATION Maslows hierarchy of needs Expressive Therapy use of art as mode if communication

EVALUATION Enhanced communication Improved soc