Beliefs Feelings Behavior

Therapeutic Communication Techniques

What you see, you say
What you hear, you say restating
Sigmund Freud
Father of Psychoanalysis
Structure of Personality (Id, Ego, Superego)
Dominant ID
Mania
D
mpulsive
want to
want PLEASURE

eat
drink
urinate
defecate

Antisocial
Narcissistic

PLEASURABLE PRINCIPLE
Pain Avoidance
Its all I

UPER EGO
hould not
mall voice of God

DOMINANT SUPER EGO

Obsessive - compulsive
Anorexia Nervosa
I

CONSCIENCE PRINCIPLE

GO
Xecutive Secretary

Impaired Reality
Schizophrenia

REALITY PRINCIPLE
LIBIDO sexual energy responsible for survival
PSYCHOSEXUAL THEORY
ORAL STAGE
0 18 Months old
Survival
I want to eat, sleep, urinate, defecate
ID formation
Cry & Suck mouth
Child Cries
Feed the Infant

Ignore the Infant

Successful

Unsuccessful

Narcissistic

Defense Mechanism:
FIXATION when a person is stuck in a certain developmental stage
REGRESSION return to an earlier developmental stage
EGO is develop in the 6th month
ANAL STAGE
Ateen 3 years old (18 mos 3 y.o.)
Toilet training
Super Ego develop
Toilet Training

Successful

Good Mother

Unsuccessful

Bad Mother

SE
Too Rigid Training

Dirty

Disorganized
Clean
Disobedient
Organized

Obedient
ANTISOCIAL
BIG

(Anal Expulsive)
SE
OBSESSIVE COMPULSSIVE
(Anal Retentive)
PHALLIC
3 6 y.o.
Penis/ Vagina
Parents is the significant person
Called as Preschooler

Small
S
E

Oedipus Complex little boy loves mommy

Electra Complex little girl loves daddy
Identification boy associates with daddy, girl assoc. with mommy
Castration fear of the little boy to daddy
Penis Envy envy of little girl towards daddy
Dr. Karen Horney opposition to penis envy
Level of Awareness
Conscious highest level of awareness
Preconscious Tip of the tongue
Unconscious deepest level of awareness
Birth Trauma First traumatic experience of child
REPRESSION unconscious forgetting of an anxiety provoking concept
SUPRESSION conscious forgetting of an anxiety provoking concept
LATENCY STAGE
6 12 years old
SCHOOlatency
Sexual energy is dormant
Reading, Riting, Rithmetic
SUBLIMATION placing sexual energies toward a more productive endeavors
GENITAL STAGE
12 y. o. above
Gising
Genital
PHARMA MOMENTS

ANTIANXIETY
VLAST ME VAIB
Valium ate V
Miltown - Meal
Vistaril - largavista
Libreum - L
Equanil Aqua KneelAttarax Mga bato (rocks)
Ativan - Ate Guy
Inderal hindi ralph
Seraks Sera Ulo
Busfar sasakay ng bus
Tranxene - Transit
ERIK ERIKSON
PSYCHOSOCIAL THEORY OF DEVELOPMENT
Age
+
0-18 mos.
18 mos. 3 y.o.

Trust
Autonomy

Mistrust
Shame/ doubt

Affecting Major
Factor
Feeding
Toilet Training

3 6 y.o.
6 12 y.o.
12 20 y.o.
20 25 y.o.
25 45 y.o.
45 y.o. and above

AU nal
TO ilet training
NO favorite word
MY
Initiative
Industry
Identity
Intimacy
Generativity
Ego Integrity

Guilt
Inferiority
Role confusion
Isolation
Stagnation
Despair

Independence
In da-school
Peer
Love
Parenting
Reflection

MASLOWS HEIRARCHY OF NEEDS

Physiologic Needs
Air, food, water, shelter, rest, sleep, activity and temperature maintenance that are crucial
for survival
Safety and Security Needs
Safe in physical and psychological aspects
Love and Belonging Needs
Giving and receiving affection, attaining a place in a group, maintaining the feeling of
belonging
Self esteem Needs
Self esteem feelings of independence, competence and self respect
Esteem from others recognition, respect, appreciation
Self Actualization
Ones maximum potential and realize ones abilities and qualities
BEHAVIORAL MODELS
Ivan Pavlov
Classical Conditioning Model
All behavior are learned
Food dog Salivation
Bell Food Dog Salivation
Bell Salivation
B.F. Skinner
Operant Conditioning
All behaviors are unlearned
Reward (+ reinforcement) and Punishment (- Reinforcement)
BRAIN LOBES ACTION
Frontal Language, Learning, Personality, Judgment
Temporal hearing, smelling
Parietal Taste, touch
Occipital Vision
Sensory

Integration

Voluntary
Motor
Involuntary

VOLUNTARY NERVOUS SYSTEM

Somatic Nervous System
AcetylCholine

Brain Spinal Cord Motor Nerve Muscle Fiber

INVOLUNTARY NERVOUS SYSTEM
Autonomic Nervous System
Sympathetic
HR

RR

GI

Constipation
GU

Urinary
retention
Neuro
Epi/ Nor

Parasympathetic

Diarrhea

Urinary
Frequency
Acetyl Choline

PHARMA MOMENTS

MONOAMINE OXIDASE INHIBITORS

AR

M
N
P

PLAN
DIL
NATE

ANTIPARKINSON
CAPABLES

Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetryl
THERAPEUTIC COMMUNICATION
Therapeutic
Offer your self Ill stay with you

Non-Therapeutic
Dont worry be happy

Silence
Everythings gonna be alright
Making observations
Ignoring the client
You seem sad
Changing the subject
Active listening
Nice weather were having
Nodding
Adjectives value based perception,
Eye contact
should not be use
Lean forward
You are the most beautiful client
Who, what, when, where
Why
General leads
Arguing
Go on, Im listening, what else?
Flattery
Broad opening - best Opening line
You should do this now
How are you today?
In my opinion
How are you?
Restating
Clarrification
Refocusing we are talking about the
exam
Focusing tell me about
DEFENSE MECHANISMS Fight for stress
DISPLACEMENT
Transfer of feelings to a less
Boss shouts at you,
threatening object rather than the one
you shout at your
who provoke it
subordinate
DENIAL
Failure to acknowledge an
Im not an alcoholic
unacceptable trait or situation
DISSOCIATION
Psychological flight from self
Sino ka, Sino ako?
A type of amnesia
REGRESSION
Return to an earlier developmental
Return to
stage
thumbsucking
REPRESSION
Unconscious forgetting of an anxiety
Hindi ko maalala
provoking concept
RATIONALIZATION Illogical reasoning for a socially
I drink because I dont
unacceptable trait
want to waste the beer
sayang ang beer sa ref, kaya ko
in the ref
ininum
REACTION
doing the opposite of your intention
sasabunutan kita. . . ay
FORMATION
plastic
kuklulutin lang kita
UNDOING
Doing the opposite of what you have
ay pinatid kita, halika
done due to guilt
punta kita sa clinic
orocan, plastic, Tupperware
IDENTIFICATION
Assume trait for personal, social,
Tulad niya
occupational role
PROJECTION
Attributing to others ones acceptable
hindi ako alcoholic,
trait
sila yon
Pasa load
INTROJECTION
Assume another persons trait as your
ako din
own
Not just you, me too
SUPPRESSION

Conscious forgetting of an anxiety

provoking concept

Hindi ko alam yan

SUBLIMATION

Placing sexual energies toward a more

productive endeavors
Repressed angers put towards physical
symptoms affecting nervous system
leading to sensory numbness and motor
paralysis
Overachievement in one area to cover a
defective part
Replacing a difficult goal with a more
accessible one

CONVERSION

COMPENSATION
SUBSTITUTION

Angry at life, put

anger in singing
Biglang mangingig

Pilay pero magaling

kumanta
Gusto ko Disneyland.
Enchanted nalang.

STOP GABA Inhibitory

Gamma Amino Butyric Acid
GO Epinephrine/ Norepinephrine
Exitatory

SNS
ANXIETY

Anticholinergic side effect

Constipation
Urinary Retention
Dry Mouth
Blurred Vision

Within 1 week
Rebound
phenomenon
Seizure
Abrupt

Anti-Anxiety

Dependence
Withdrawal
Drowsy
No Alcohol
No Coffee
Develop Orthostatic
Hypotension
Prevetion of O.H.
1. Sit Down
2. Dangle feet
3. Stand Up Gradually

Gradually
Tapered Dose

RELAXED

ANXIETY
Vague sense of impending doom

Mild
+1
Widened
Perceptual

Moderate
+2
acing

Severe

Panic

+3
+4
ont know what uicide
to say/do
afety

Dont touch client

Field
RN Meds
Restless
Enhanced Learning
Capacity
You Seem Restless

IRECTIVE

Respi Alkalosis
Bown Bag

Assess : Level of Anxiety

Nx Dx
: Ineffective Individual Coping
Powerlessness
Impaired Skin Integrity
Planning/ Implementation:
level of anxiety
environmental Stimuli
Relaxation Technique
Showing pictures of flower, waterfalls
Hearing sounds of chirping birds
Evaluation
: Effective individual coping

ENERALIZED ANXIETY DISORDER

months excessive worrying
Might be mild, moderate and severe anxiety
S/Sx
Restless
Difficulty of concentration
Sleep Disorders
Palpitations
Edge of the seat
Easy fatigability

PANIC DISORDER
15 30 Minutes escalation of SNS
AGORAPHOBIA fear of open space/ public places
SOCIAL PHOBIA fear of public

POST TRAUMATIC STRESS DISORDER

Trauma
Disaster
Accident
War

Flashbacks
VICTIMS Survivors

Rape
Earthquake
Soldier

Nightmares

6 years old

Assignments/
Homeworks

No Assignments/
Homeworks

You Think
Teacher may
get angry

Anxiety

I am sick

MALINGERING
pretending to be sick
(Conscious)

Absent

Escape from
Teacher
PRIMARY GAIN
(Behavior anxiety)

SOMATOFORM
> no pretension
> no organic
basis
> unconscious

PSYCHOSOMATIC
> Real pains/ illness
> Real symptoms
> 4 major types
* Hypertension
* Migraine
Mama Care
* Stress Ulcer

* Asthma
Attention
SECONDARY GAIN

SOMATOFORM DISORDERS
SOMATOFORM
Nervous System
CONVERSION DISORDER
La Belle Indifference
emotional disattachment
from disability
Minor Discomfort
Interpreted as major illness
HYPOCHONDRIASIS
Maliit na butas, pinalalaki
Favorite Past Time: Doctor Hopping
Nursing Focus: Feelings

PSYCHOSOMATIC DISORDERS

Illusion of structural defect

BODY DYSMHORPIC DISORDER

 Anxiety
SNS

PNS

BP

Hypertension

Vasoconstriction
Cerebral Artery

Migraine

Left Gastric Artery

Stress Ulcer

Bronchoconstriction

Asthma

OBSESSIVE COMPULSIVE
Belief/ thought
Door Open
Burglar may go inside

Feelings
Anxiety

anxiety

Returns to house
(Action)
Anxiety Compulsion
Obsession
(thought)

PHOBIA
Irrational fears
Etiology
Knowledge
Experience
Immediate Nursing Intervention remove the stimuli
SYSTEMATIC DESENSITIZATION
Gradual exposure to feared object

PHARMA MOMENTS
ANTIPSYCHOTIC AGENT
SSTTCMHP
Stelazine - sexy star
Serentil serena
Thorazine babaeng Tora
Trilafon - tri-band phone

Clozaril closed reel

Mellaril maraming reel
Haldol hahaha
Prolixin pero lick scene

ALCOHOLISM
Etiology:
Intergenerational Transmission
From one generation to another generation

Alcohol

Blackout awake but unaware

Confabulation inventing stories to self-esteem

Denial I am not an alcoholic

Dependence I cant live without it

Enabling significant other tolerates abusers

Another term CO DEPENDENCY
TOLERANCE Substance to achieve a previous effect
DETOXIFICATION
Withdrawal with MD supervision
Check Alcohol, Mouthwash, Elixer
void alcohol
version therapy
lcoholics Anonymous self help group
ntabuse DISULFIRAM Never drink alcohol

12 hour interval/ 12 h last alcohol intake

B1 Vitamin Deficiency

Complications

or else: nausea, vomiting and hypotension

Wernickes Encephalopathy motor
Korsakoffs Psychosis memory

Delirium Tremens 24 72 h after last dose of alcohol

untreated withdrawal syndrome

ormocation bugs crawling under the skin
amily Therapy mother, father, brother

AUTISM
Autistic Savant autistic with a special talent
Assess
Appearance flat affect, consistent movement
Behavior repetitive, ritualistic
Communication echolalia, incomprehensible
Nx Dx

Impaired verbal communication

Impaired social interaction
Self mutilation
Risk for injury
Planning/ Implementation
Maslows hierarchy of needs
Constancy, promote safety
Evaluation
Expressive therapy drawing, muscic etc
Enhanced communication
Improved social interaction
Safety

ATTENTION DEFICIT HYPERACTIVE DISORDER

Onset
Duration
Settings
Id Dominant

: 7 y.o. and below

: 6 months and above
: 2 House and school
: Mom or RN will act as superego

ADHD Glucose Frontal Lobe impaired judgement ADHD S/Sx

Ritalin Frontal Lobe Judgement ADHD S/Sx
(stimulant)
Assess
Appearance dirty
Behavior clumsy, impatient, easily distracted, hyperactive
Communication talkative, blurts out in class
Nx Dx
Risk for injury
Impaired social interaction
Planning/ Implementation
tructure separate room for eating, playing, sleeping and etc
chedule time for everything
et limits
afety
Evaluation
Minimize Risk for Injury
Improved social interaction
Safety
Residual ADHD grows up not antisocial
Meds: Ritalin, dexedrin, pemoline, adderal
Best time to give: once a day: AFTER MEALS: prevent lost of appetite
Dont give at bedtime STIMULANT causes insomnia
Give 6 hours prior bedtime if bid

EATING DISORDERS
18 mos. 3 y.o.

Toilet Training

Clean
Obedient
Organized

6 y.o. class valedictorian/ model student

social inactive/ no BF

weighing

Thought
I Am Fat

Feeling
Behavior
Self Esteem Diet, Diet, Diet

Anorexia Nervosa
Diet, diet, diet
<85% of expected body
3 mos. ammenorhea
Karen Carpenter

Eating Disorders
Eating Pattern
Weight
Menstruation

Bulimia
Eat, eat, vomit
Normal weight
Irregular menstruation
Dao Ming Xi
Da Ming Sugat/ suka
Vomiting
Dental caries
Wounded knuckles
Metabolic alkalosis
Metabolic acidosis

Vomiting
Fluid Volume Deficit ARRHYTHMIA (fatal complication)
Diarrhea
Interventions
Restore fluid and electrolyte balance
Collaborative regarding menu contract
Target weight gain
After meals: stay 30 mins 1 hour

PHARMA MOMENT

LITHIUM
L evel 0.6 1.2 mEq/L
Increase urination
Tremors, fine hand
Hydration 3 L/day
Increase

ausea, vomiting, diarrhea

Lithium Toxicity
a+

Kidney

Uu diarhea
Mouth, dry

ANTIPARKINSON
ANTICHOLINERGIC
ABC
Artane
Akineton
Benadryl
Cogentin

DOPAMINERGIC
PLSE
Parlodel
Larodopa
Symmetyl
Eldepryl

SCHIZOPHRENIA
Ego disintegration
Impaired reality perception
Genetic vulnerability
Stress Diathesis Model
Too much stress in the reality will lead client to escape it and go to the fantasy world
Biological Theory
Dopamine level is High
The exact cause is unknown
ffect appropriate, inappropriate, flat, blunt (incomplete emotion)
mbivalence torn between 2 opposing forces
utism
ssociative Looseness
Symptoms
Negative
Hypoactive
Withdrawn
Apathy
Assess : Content of Thought
Nx Dx
: Disturbed thought process
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve thought process
Assess : Hallucination/ Illusions
Nx Dx
: Disturbed sensory perception
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve sensory perception

Positive
Hyperactive
Sociable
Flight of Ideas
Talkative

Assess : Suspicious
Nx Dx
: Risk for other directive behavior
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Eliminate/ minimize risk for other-directed violence
Assess : Suicidal
Nx Dx
: Risk for self directive behavior
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Eliminate/ minimize risk for self-directed violence
Flight or Looseness
I am going to the mall.
Where is the light?
Go here.
Mineral Water.

I am going to the mall.

The mall is big.
Big is the tree.
The tree is tall.

Magical Thinking
Believes to have a magical power
I can turn you into a frog
Echolalia I repeat what you say Parrots
Echopraxia I repeat what you do
Word Salad words, no rhyme
Clang Association words with rhyme : Dunk, plank, sunk
Neologism creation of new words Plinking, hustash
Clarification done in case of neologism
Delusion:
Persecutory NBI is out to get me/ someone will harm the client
Religious I am Jesus Christ
Grandeur I am the queen of the world.
Ideas of reference Nurses are talking about me.
Concrete Association pilosopo what will you wear? clothes
Thought Blocking

Stimulus
Visual
Auditory
Tactile

Halucinations
Absent
X
X
X

Illusion
Present

In case of hallucinations do:

Hallucinations
Acknowledgment
I know you the voices are real to you
Reality orientation
But I dont hear them
Diversion
Lets go to the garden
But if nothing in the preceeding intervention are seen
Assess what the voices are saying
SCHIZOPRENIA

Disorganized
Sad but smiles
o Inappropriate affect
No reaction
o Flat affect
Flight of ideas
o HEBEPHRENIC
Giggling
Positive
and Negative
classified
S/Sx differentiated

Residual Mixed classification

Cant be classified
1st paranoid, then
No more positive s/sx,
disorganized then
just withdrawn
catatonic, etc etc

Catatonic

Ambivalence
Waxy Flexibility
o Iniwan na posture,
ganun forever
No favorite word
Negativism

Paranoid

Suspicious
Tendency to be violent
MistrustScaredWithdraw
n
Nrsg. Int:
Develop trust
1 to 1
short interaction
frequent visit
foods in sealed
container
meds wrapped
for violent pt.
Doors open
Near the door
Dont touch the pt.
Eye contact
1 arms length away
call reinforcement

Normally
Acetylcholine = ON

Dopamine = OFF

Your always ON
With parkinsON

High Dopamine= Schizophrenia

Antipsychotics = makes Dopamine goes down

ON
Extrapyramidal Side Effects
AKATHISIA
Restless, inability to sit
Makati siya, ahh kati siya
AKINESIA
Muscle rigidity
Ahh kiniss siya
DYSTONIA
3 features
TORTICOLLIS
Wry neck
Anticholinergic
OCULOGYRIC
CRISIS
Drugs that will make the
Fixedstare
AcH down
OPISTHOTUNOS
Arched backo Artane
TARDIVE DYSKINESIA
o Akineton
Irreversible side
effects of antipsychotics
o Benadryl
Lip smackingo Cogentin
Tongue protruding
Cheeks
puffing
Dopaminergic
NEUROLEPTIC
MALIGNANT
SYNDROME
Dopamine
goes up
Hyperthermiao among
client
taking
antipsychotic
Parlodel
Hyperthermia with muscle rigidity
o Larodopa
o Symmetryl
Other Side Effects
o Eldepryl
Photosensitivity
Sunscreen

Wide brimmed hat

Agranulocytosis
Report immediately Sore throat
1st sign to appear

PHARMAMOMENTS

ANTIDEPRESSANTS
ANTSAAVE PPZ

Asendin ascending
Norpramin sabaw ng knorr
Tofranil Tofu
Sinequan nood ng Sine Quan ang title
Anafranil kina Ana Praning
Aventyl kina Aven Til Midnight tayo
Vivactil Bye Back till next week
Elavil Eh love mo ba ako
Prozac Pero saka na
Paxil - Taksil
Zoloft mag Solo ka
BIPOLAR DISORDER Mania more common
Female
20 years old and above
Stressful life
Obese
Self Actualization

TASK

Caregiver Role Strain

Safety
Impaired social interaction
Safety
Self Esteem

Risk for injury/ other directed violence

Eating
finger food

Sleep
Private room

Lithium 2 4 weeks before effect

Hyperactive

Sex
Anxiety

SE Compensation interfere ADLs, harm others

SE Compensation interfere ADLs, harm others
TASK increases clients self esteem
Gross motor skills via sublimation
Escorted walk outdoors
Punching bag
No group games compition will increase anxiety
3 or more signs confirms disorder
G
F
S
P
E
E
D

randiose
light of ideas
leeplessness
ressured speech
xagerated SE
xtraneous stimuli (easily distracted)
istractibility

PERSONALITY DISORDERS
SCHIZOID
I dont want people
Believes he can stand on his own
Never had a best friend
Avoid groups and social activities no enjoyment
Cares more about computers and pets
AVOIDANT
I avoid people, I fear criticism
Have talent but no confidence
ANTISOCIAL
I break the law as motto
As a child,: steal, lie, always get reprimanded
Adult grand robbery, illegal activitist against the law, drug addiction, drives fast, unsafe
sex, thrill seeker
Good talker, charmer, witty manipulator

BORDERLINE my life is an emptyglass

Dependent
I cant live without you
self esteem
poor decision making skills
Histrionic
excited, dramatic but manipulative
center of attention
Narcissistic
I love myself
Insensitive, arrogant
I am the best
Obsessive Compulsive
I am organized
Perfectionist
Provide time to do rituals
Paranoid
Suspicious
Passive Aggressive
Always say yes but resistance is hidden
Serotonin
MAO kills Serotonin

MAO Serotonin
MAO Serotonin

 Serotonin

1st Line of Drug Prescribed

ANTIDEPRESSANTS

wo 4 weeks
wo neurotransmitter
RI

ONO

ide effects low

EROTONIN

CYCLIC

MINE

EUPTAKE

NTIDEPRESSANT

XIDASE

afest
ELECTIVE

to 4 weeks
NHIBITOR
PPZ

Higher incidence of Side effects

Serotonin/ Epi affected
NHIBITOR
ANTSAVE

MNP

All neurotransmitter affected

Highest Side effects
Avoid tyramine rich food
may lead to
HYPERTENSIVE CRISES
TYRAMINE RICH FOODS
vocado
ged Cheese
eer
hocolate
ermented Foods
ickles
reserved Foods
oy Sauce

SSRI

TCA

MAOI

Antidepressant

Anticholinergic Side Effects

(Syphathetic)

Male Erectile Dysfunction

Antidepressant no effect ECT

ELECROCONVULSIVE THERAPY
Pre
Informed consent
NPO 6 8 hours prior
Meds
Atropine dry mouth

Barbituate Sedative
Succinylcholine muscle relaxant, prevent seizure
Post
Side-lying lateral
S/E
headache, dizziness,
TEMPORARY MEMORY LOSS distinct sign
70 110 volts
20 30 seconds
hour asleep post

PHARMAMOMENTS

SUBSTANCE ABUSE
Downers (ABONM INE)
Alcohol
Barbituates
Opiates
Narcotics
Marijuana

Morph
Code
Hero

NARCAN antidote

Uppers (CHA)
Cocaine
Hallucinogen
Amphetamines
OVERDOSE
Alcohol
HR
RR
BP
Coma

Cocaine

LOC

Bradycardia
Bradypnea
Pupil constriction

Moist mouth
Constipation
Hypotension
Coma
Asleep
Weight gain

EUPHORIA

Seizure

 Psych well being

NARCAN Narcotic Antagonist narcotic overdose
Tachycardia
Tachypnea
Pupil Dilation
Dry mouth
Hypertension
Seizure
Awake
Weight Loss

DETOXIFICATION withdrawal with MD Supervision

METHADONE

Withdrawal reverse of effect or opposite of overdose

DEPRESSION Serotonin, if unresponsive to drugs, ECT

The Grief Process
Denial no! this cant be true
Anger why me, why me, why now
Bargaining if something happens, then Ill give something back
Depression Im down 2 weeks or more s/sx major depression
Acceptance client acts according to situation
Self Actualization
Self Esteem
withdrawn

C TASK
Stay

Risk for self directed violence

Eating

Sleep

Hypoactive

Sex

Sensitivity to client needs

SUICIDE
Verbal
I wont be a problem anymore
This is my last day on earth
Ill soon be gone

Non Verbal
Take this ring, its yours (giving of valuable)
Sudden change in mood

Who will commit Suicide?

Sex Male (more successful)/ female (hesitant)
Age 15 24 y/o or above 45
Depression
Patient with previous attempt
ETOH ethanol - alcoholics
Rirrational
Social support lacking

Organized plan greater risk

No family
Sickness, terminal
SUICIDE TRIAD
Loss of spouse
Loss of job
Aloneness
Is Patient is SUICIDAL; nurse should: DIE
Direct question Are you going to commit suicide?
Irregular interval of visit to pt. room
Early AM and period of endorsement the time pts commit suicide
Best approach for suicidal pt. :
Direct approach
Nursing Management:
Close surveillance
Hospital area majority sucide will happens at:
weekends 1- 3 am Sunday
Weekend less staff personnel
Early AM every one is asleep
Give simple task. Dont give complex may cause depression ex. Jigsaw
Water plants
Wash the dishes except sharps
CHILD ABUSE (think B)
Burns, bruise, bone fractures, BUNGI!
Dont bathe the child, dont brush teet. Body of evidence will be lost
Bantay Bata 163
LEVELS OF MENTAL RETARDATION
Profound
< 20
thinks like an infants
ero 2 y/o
cant be trained
ensorimotor
stay with the patient
evere
Severe
20 35
Modera e
Moderate
hirtyfive 50
35 50
rainable
can be train
wo 7 y/o
mental age is 2 7 y/o
pre-operational stage
Mild
50 70
meantal age is 7 12
educable
can go to school
Borderline

70 - 90
Normal
90 100
JOHN PIAGETS COGNITIVE THEORY
02
Sensorimotor Baby can sense, see, perceive and hear. Object permanence
24
Preconceptual Language
47
Intuitive
Unidimentional classification characteristic. Child can fix toys
according to size, color, height = one at a time
7 12
Conservation Multidimensional
Concrete
Association
Formal
Good abstract thinking. Can interpret words
12
Operation
ALZHEIMER
NOMIA dont know name of objects
GNOSIA problem with senses
PHASIA cant say it
PRAXIA cant do it
Cocaine Nasal Septum perforation
Marijuana impaired Lung Structure
eroine withdrawal
ikab
atsing
u hu hu

CRITICAL REVIEW
TEST TAKING TECHNIQUES
Assess the answer, use circle
Initial priority
TRUST

Air food, water

ABC
Good Word/ Bad Word
S Technique
eek support
it
tay
upervised
ee = observed

ASSESS
air

eem = notice
assi t
feeling
2 same answer/ 2 same mistake
Words to watch out for
Inappropriate
Most
Not included
Except
All but one
Umbrella
RELATIONSHIP
Preorientation

Orientation

Working

Termination

Self awareness

Trust
Discussion Evaluation
Setting Contract
Resistance

PRACTICE OF NURSING
Level of Prevention
1

Healthy
Ill
Community Demog. Crisis Intervention

Relapse
AA

SELF HELP GROUPS

nique
niversality
r not alone
RESTATE exact words
REFLECT use other words
DEPRESSION
Endogenous
Internal
Chemical

Reactive
external

Barbituate withdrawal LIBRIUM (Chloridiazepoxide)

TOFRANIL Antidepressant/ Anticholinergic pupil dilation midriasis
Catharsis Feelings
Free Association Ideas

ATTITUDE THERAPIES
Active friendliness ask permission
assive Friendliness
aranoid
anipulative
nic
atter of Fact
No Demand Depressed
Kind Firmness Anorexic
Crisis 4 6 weeks
Goal Return the client to the pre-crisis level of functioning
PSC
Perception what do you think about it?
Coping what will you do about it?
Support who will be there for you?
Kulit kulit kulit kulit Perseveration stick to 1 topic
Ulit Ulit Ulit Verbigeration
DISSOCIATION
Dissociative Amnesia dont know themselves
Fugue Far
Dissociative Identity Disorder Multiple Personality D.O.