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PHARMA NOTES:
DEFENSE MECHANISMS
1. 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 one’s unacceptable trait.
11. INTROJECTION – assume another person’s 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.
PHARMA NOTES:
NONTHERAPEUTIC
ANXIETY
• Vague sense of impending doom.
• Triggers the sympathetic nervous system.
• Assess level of anxiety of client.
TYPES OF ANXIETY
MILD 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.
• Don’t 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.
PANIC ATTACKS/DISORDER
• 15 – 30 minutes sympathetic nervous system escalation.
• Example is AGORAPHOBIA fear of open spaces.
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
HYPOCHONDRIASIS
• has minor discomfort and interprets it as major illness.
• Focus on clients feelings.
PSYCHOSOMATIC
• Real pains/illness
• Real symptoms because of anxiety
PSYCHOSOMATIC
Increase Anxiety
SNS
Increase BP & HR
Hypertension
Fat Deposits
Atherosclerosis
Calcium
Arteriosclerosis
Decrease Oxygen
Angina Pectoris
MI
Necrosis
CHF
Coma
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 techniques
SNS
• 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
• Maslow’s hierarchy of needs
• Expressive Therapy – use of art as mode if communication
EVALUATION
• Enhanced communication
• Improved social interaction
• Safety
ATTENTION DEFICIT HYPERACTIVITY DISORDER
• 7 years and below onset
• Duration: 6 months and above
• Settings: house and school
• Assessment
• Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no
focus
• Behavior
• Communication: talkative
NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction
PLANNING/IMPLEMENTATION
• Structure: place to play, sleep, eat and study
• Schedule: there is always a time for everything that you do
• Set limits
• Safety
EVALUATION
• Minimize risk for injury
• Improved social interaction