PSYCHIATRIC NURSING

By: Joshua James L. Diao, BSN-RN, BSMT, AMT, ASCPT, MAN(On-Going)

 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

STRUCTURE OF PERSONALITY
ID
 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 PERSONALITIES
Manic
Anti - Social  experienced by serial killers
Narcissistic

SUPEREGO DOMINANT PERSONALITIES

Obsessive Compulsive
Anorexia Nervosa

EGO – if destroyed result in impaired reality perception.

Schizophrenia

LIBIDO
 Sexual energy responsible for survival.
PSYCHOSEXUAL STAGES OF DEVELOPMENT ACCDNG TO FREUD [O.A.P.L.G.]

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.

TOILET TRAINING

Good Mother Bad Mother

Successful
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.

PHARMACOLOGY NOTES
ANTI ANXIETY DRUGS [S.A.T.L.V.M. – E.V.A.B.I.]
 Serax  Equanil
 Ativan  Vistaril
 Tanxene  Atarax
 Librium  Buspar
 Valium  Inderal
 Miltown

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 FACTOR
0 – 18 mos. Trust Mistrust Feeding
18 mos. – 3 yrs. Autonomy Shame & Doubt Toilet Training
3 yrs. – 6 yrs. Initiative Guilt Independence
6 yrs. – 12 yrs. Industry Inferiority School
12 yrs. – 20 yrs. Identity Role Confusion Peers
20 yrs. – 25 yrs. Intimacy Isolation Love
25 yrs. – 45 yrs. Generativity Stagnation Parenting
45 yrs. - above Ego Integrity Despair Reflection

BEHAVIORAL MODELS
Ivan Pavlov
 Classical Conditioning
 All behaviors are learned.

BF Skinner
 Behavior can be learned and unlearned.
 Operant conditioning.
 If given reward there is repetition.
 If punished behavior becomes extinct.

LOBES OF BRAIN
1. FRONTAL LOBE 3. PARIETAL LOBE
 Language  Touch
 Learning  Taste
 Personality
 Judgment 4. OCCIPITAL LOBE
2. TEMPORAL LOBE  Visual
 Hearing
 Smell
3 STEPS TO INTERACT WITH ENVIRONMENT
1. Sensory – eyes, ears, tongue
2. Integration
3. Motor – voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM

 Also called as SOMATIC
 Motor nerve to muscle fiber you need ACETYLCHOLINE which is an “On switch”.
Brain
 Spinal Cord

Motor Nerve

Synapse

Muscle Fiber

INVOLUNTARY NERVOUS SYSTEM

 Also called AUTONOMIC nervous system.

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC PARASYMPATHETIC
(Awake, ADRENERGIC) (Relax, CHOLINERGIC)
Heart Rate Increase Decrease
Respiratory Rate Increase Decrease
GI Decrease (Dry mouth, Constipation) Increase (Moist mouth, Diarrhea)
GU Decrease (Urinary Retention) Increase (Urinary Frequency)
Neurotransmitter Epinephrine, Norepinephrine Acetylcholine

DRUGS WITH ANTICHOLINERGIC EFFECTS

 Anti – Anxiety
 Anti – Psychotic
 Anti – Cholinergic
 Anti – Depressants
PHARMACOLOGY NOTES
MONOAMINE OXIDASE INHIBITORS
 Marplan
 Nardil
 Parnate
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. DISSOCIATION – 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.
PHARMACOLOGY NOTES
ANTI – PARKINSON DRUG [C.A.P.A.B.L.E.S]
 Cogentin
 Artane
 Parlodel
 Akineton
 Benadryl
 Larodopa
 Eldepryl
 Symmetrel
AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC PARASYMPATHETIC
Pupils Dilate Constrict
Blood Vessels Constrict Dilate
Blood Pressure Increase Decrease

THERAPEUTIC COMMUNICATION TECHNIQUES

THERAPEUTIC NONTHERAPEUTIC
1. Offer Self 1. Don’t worry be happy
2. Silence – provide time to think 2. Changing the topic/subject
3. Making observation – what you see 3. Ignore the client
you say 4. Value based judgment – never assume
4. Active Listening – nodding, eye contact 5. Flattery
5. Broad Opening – how are you today? 6. Advising
6. General Leads – Go on, I’m listening 7. Giving Opinion
7. Restating – I’m sad “You’re sad?”

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 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 PLANNING/IMPLEMENTATION

 Ineffective individual coping.  Decrease level of anxiety.
 Powerlessness.  Decrease environmental stimuli.
 Impaired skin integrity  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 become 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 DISORDER
 No protection
 Unconscious
 No organic basis of being sick

DIFFERENT TYPES OF SOMATOFORM

1. 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 DYSMORPHIC DISORDER
 Illusion of structural defect.
 Favorite past time is doctor hopping.
 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

SYMPATHETIC NERVOUS SYSTEM

 GABA (Gamma Amino Butyric Acid) – stop
 Epinephrine and Norepinephrine – Go
ANTI- ANXIETY MEDICATIONS
 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 of 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
FRONTAL LOBE OF ADHD
Decreased glucose
↓
Decreased judgment
↓
Increase impulsiveness
ADHD/ Hyperactivity
 Need a drug that brings glucose level up.
 Give RITALIN as stimulant
 May result in loss of appetite
 Given after meals
 Given 6 hours before bedtime
EATING DISORDERS
ANOREXIA NERVOSA BULIMIA NERVOSA
 Eat, eat, eat  Eat, eat, vomit
 Less 85% expected body weight  Normal weight
 3 months Amenorrhea  Irregular menstruation

BULIMIA NERVOSA
 Metabolic alkalosis (vomiting results to decreased hydrochloric acid)
 Metabolic acidosis (diarrhea results to decreased bicarbonate)
 Dental caries
 Wound in knuckles
MANAGEMENT
 Fluid and electrolyte imbalance
 Meal contract
 Weight gain for client
 After eating stay with client for 1 hour and accompany when going to the comfort room
PHARMACOLOGY NOTES
ANTI – PSYCHOTIC DRUG
 Stelazine
 Serentil
 Thorazine
 Trilafon
 Clozaril
 Mellaril
 Haldol
 Prolixin

SCHIZOPHRENIA
 Ego disintegration
 Impaired reality perception
 Genetic vulnerability
 Stress – Diathesis Model
 Biological theory – increase dopamine level
 Exact cause unknown
ASSESSMENT
 Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
 Ambivalence: pulled into 2 opposing forces
 AUTISM: Looseness, no idea, not related to one another

ASSESSMENT

NEGATIVE POSITIVE
Hypoactive Hyperactive
Withdrawn Sociable
Thought Blocking Flight of ideas
Apathy
I. ASSESS
 Content of thought
NURSING DIAGNOSIS
 Disturbed thought process
PLANNING/IMPLEMENTATION
 Present reality
 Provide safety
EVALUATION
  Improved thought process

II. ASSESS
 Hallucinations/ Illusions
NURSING DIAGNOSIS
 Disturbed sensory perception
PLANNING/IMPLEMENTATION
 Present reality
 Safety
EVALUATION
 Improved sensory perception

III. ASSESS
 Suspicious
NURSING DIAGNOSIS
 Risk for other directed violence
PLANNING/IMPLEMENTATION
 Present reality
 Safety
EVALUATION
 Eliminate/minimize risk for other directed violence

IV. ASSESS
 Suicidal
NURSING DIAGNOSIS
 Risk for self directed violence
PLANNING/IMPLEMENTATION
 Present reality
 Safety
EVALUATION
 Eliminate/minimize risk for self directed violence

LOOSENESS OF ASSOCIATION
 There is connection with statements
FLIGHT OF IDEAS
 Jumping from on topic to another
AMBIVALENCE
 Pulled between 2 strong opposing forces
MAGICAL THINKING
 acting like magician
ECHOLALIA
 Client repeats what you say
ECHOPRAXIA
 Client repeats what you do
WORD SALAD
 Just words no rhyme
CLANG ASSOCIATION
 Words that rhyme
NEOLOGISM
 Formation of new words (needs clarification)
DELUSION: PERSECUTORY
 “The NBI is out to get me”
DELUSION: RELIGIOUS
 “I am Jesus Christ the savior”
DELUSION: GRANDEUR
 “ I am the queen of the world”
DELUSION: IDEAS OF REFERENCE
 “The nurses are talking about me”
CONCRETE ASSOCIATION
 Also known as “pilosopo”
THOUGHT BLOCKING
 Unable to think

HALLUCINATIONS ILLUSIONS
STIMULUS ABSENT PRESENT
VISUAL ABSENT PRESENT
AUDITORY ABSENT PRESENT
TACTILE ABSENT PRESENT

 Present reality to clients experiencing hallucinations

 Technique in handling clients with hallucinations
 Hallucinations
 Acknowledgement “I know the voices are real to you”
  Reality orientation “I know the voices are real but I don’t hear them”
 Diversion “Lets go to the garden”
 10% of schizophrenic clients hear voices

PARKINSON’S DISEASE
 If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in
dopamine (off switch)
ANTI-PSYCHOTIC
↓
Decrease dopamine level
↓
Parkinson like effect
↓
Extra pyramidal side effect
↓
With akathesia
↓
Restless, inability to rest
AKINESIA
 Muscle rigidity
DYSTONIA
 Torticollis (wry-neck)
OCULOGYRIC CRISIS
 Fixed stare
OPISTHOTONUS
 Arched back
 Lips – smacking
 Tongue – protruding
 Cheeks – puffing
 The 3 are irreversible and called TARDIVE DYSKINESIA
 NEUROLEPTIC MALIGNANT SYNDROME  Hyperthermia

ANTI – PARKINSON DRUGS

ANTICHOLINERGICS DOPAMINERGICS
(Decrease ACh) (Increase Dopamine)
 ↓ ↓
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel
OTHER SIDE EFFECTS OF DECREASE DOPAMINE
 Photosensitivity
 AGRANULOCYTOSIS – decrease WBC
 Clients prone to infection due to decrease WBC
 First sign for infection is sore throat
TYPES OF SCHIZOPHRENIA
DISORGANIZED CATATONIC PARANOID RESIDUAL UNDIFFIRENTIATED
UNCLASSIFIED
- Sad but smiles - Ambivalence - Suspicious - No more - Mixed classification,
(Inappropriate affect) - Waxy flexibility - Mistrust, positive cant be classified
- No reaction (flat - Favorite word is “No” scared, symptoms
affect) - Negativism (client do withdrawn just
- Flight of ideas not follow what you tell Nursing withdrawn
(disorganized speech) them to do) management:
- Giggling Nursing - Gain TRUST
(hebephrenic giggle) management: by 1 to 1 short
- Combination of Meet needs interaction but
positive and negative frequent
signs and symptoms - Foods should
be in a sealed
container
- Medications
should be in
tamper resistant
foil.
Violent:
- Keep door open
- Position near
door
- Don’t touch
client
- Call for
reinforcement
- One arms
length away from
the client.

PHARMACOLOGY NOTES
BI-POLAR, MANIC
 Lithium: undergo first kidney test and check for blood levels
 Level: .6 – 1.2 meq/L
 Increase urination
  Tremors, fine hand
 Hydration of 3L/day
 Increase
 Uu (diarrhea)
 Mouth dry
Signs of Lithium toxicity
 Nausea, vomiting, diarrhea
 Increase sodium
**** WAIT FOR 2 – 4 WEEKS BEFORE LITHIUM THERAPY TAKES EFFECTS
BIPOLAR DISORDER/ MANIC PROFILE
 20 years old
 Female
 Stress
 Obese
ASSESSMENT
 Decrease appetite (give finger foods)
 Decrease sleep (place in a private room)
 Hyperactive
 Increase sexual activity – only means of addressing anxiety so decrease level of anxiety
 Risk for injury/other directed violence
 Impaired social interaction (care giver role: strain and stay with client)
 Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)
 Because there is decrease self esteem there will be increase compensation resulting to
increase interference with ADL’s and harm to others
 Compensation is the culprit
 Management: increase self esteem to decrease compensation and decrease interference
with ADL’s and harm to others

HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS?

T - no sports (basketball, volleyball), no fine motor skills only gross motor skills
A -llot energies toward more productive endeavors (sublimation)
S - escorted walk outdoors
K - punching bag (displacement)

PHARMACOLOGY NOTES
ANTI – DEPRESSANTS
 Asendin  Sinequan
 Norpralamin  Anafranil
 Tofranil  Aventyl
  Vivactil  Paxil
 Elavil  Zoloft
 Prozac

ALCOHOL LEADS TO:

 Blackout: awake but unaware
 Confabulation: inventing stories to increase self esteem
 Denial: “I am not an alcoholic”
 Dependence: cant leave with out leading to enabling where in the significant other tolerates the
abuser co dependence is another term
 Tolerance: gradual increase in amount of stimuli to experience the same euphoria
MANAGEMENT
 Detoxification: withdrawal with medical doctor supervision
 Avoid alcohol therapy
 Aversion therapy a more technical term for avoid alcohol therapy
 Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting
 Alcoholics anonymous
 Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension
 Alcoholism may result to Vitamin B1 (Thiamine) deficiency

WERNICKE’S ENCEPHALOPATHY
 Problem with motor
KORSAKOFF’S PSYCHOSIS
 Problem with memory
 24 – 72 hours after last dose of alcohol expect:
 Delirium Tremens: sympathetic nervous system
 Prevent hallucinations/Illusions by placing client in a well lit room
 Formication: feeling of bugs crawling under the skin

ALZHEIMERS DISEASE
- Axon (away) and Dendrites (toward) nerve
- Neurofibrillary tangles
- Neurotic plaques
ALCOHOL/ DELIRIUM ALZHEIMERS
ONSET Abrupt Gradual
LEVEL OF CONSCIOUSNESS Fluctuating Unaffected
DURATION Hours to days Progressive
MEMORY Short term memory loss Short term and long term
(orient patient)

5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
 EXPRESSIVE: cant say/express
 Frontal lobe is affected particularly broca’s area
 RECEPTIVE: cant hear
 Temporal lobe is affected particularly wernicke’s area
5. Apraxia – can’t do simple things
 Reminiscing Therapy – talk about past
 Patients with Alzheimer’s may experience hallucinations, illusions thus becomes restless and may
wander
 As sun goes down client becomes restless, agitated, disoriented called “sundowning”
 Drug of choice is COGNEX and ARICEPT a cholinesterase inhibitor that increases Ach causing delay in
disease progression

SEROTONIN
 Responsible for happiness
 Decrease serotonin clients becomes sad give anti-depressants

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

Safest drug
Side effects low
R
I to 4 weeks
 Increases serotonin and affects only serotonin
 PROZAC, PAXIL, ZOLOFT
TRICYCLIC ANTI DEPRESSANT
Two – four weeks
C
A
 Has higher incidence of side effects
 Also increases norepinephrine
  ASENDIN, NORPRALAMIN, TOFRANIL, SINEQUAN, ANAFRANIL, AVENTYL, VIVACTIL, ELAVIL

MONO AMINE OXIDASE INHIBITORS

 MAO kills serotonin
 Increased MAO results to decreased serotonin the more depressed the client becomes
 MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine
but client becomes prone to hypertensive crisis
 Avoid tyramine rich foods
 Avocado, Alcohol
 Beer
 Chocolates, Cheese (aged)
 Fermented foods
 Pickles
 Preserved foods
 Soy sauce
 There is increase incidence of side effects after 2 – 6 weeks
 MARPLAN, NARDIL, PARNATE
PERSONALITY DISORDERS
1. Schizophrenia
 They avoid people because there is no enjoyment
2. Avoidant
 They avoid people because they are afraid of criticisms
 They have talent but has no confidence
3. Anti-Social
 Constantly breaks law
 Project charm
 They are witty and articulate
 Manipulative
4. Borderline
 They perceive life as an empty glass
 They like splitting friends
 Sudden change in mood “labile affect”
 Prone to suicide
5. Dependent
 “Cant live if living is without you”
6. Histrionic
 Constantly wants to be the center of attention
 Excited, dramatic, manipulative
7. Narcissistic
  “I love myself”
 They get jealous even with achievement of family members
8. Obsessive – Compulsive
 “I am so organized”
9. Paranoid
 Suspicious
 May lead to domestic violence

ANTI – DEPRESSANT SIDE EFFECTS

 MALE – Erectile dysfunction, prone to impotence

GRIEF PROCESS [D.A.B.D.A]

1. Denial – shock/disbelief
2. Anger – question “why me?”
3. Bargaining – if, then
4. Depression – 2 weeks or more sign and symptoms becomes major clinical depression
5. Acceptance – client acts according to situation

ASSESSMENT
 Decrease self actualization
 Decrease self esteem
 Withdrawn: stay with client
 Suicidal: risk for self directed violence
 Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
 Be sensitive to clients needs

FOR SUICIDAL OBSERVE FOR

Verbal communication
 “I wont be a problem”
 “This is my last day on earth”
 “I’ll soon be gone”
Non-verbal communication
 Giving away of valuables
 Sudden change in mood

WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO

Direct: “Do you plan to commit suicide?”
Irregular/interval visits
Endorsement period, EARLY MORNING clients are most likely to commit suicide
DOWNERS [A.B.O.N.-M.M.C.H.]
Alcohol Marijuana
Barbiturate Morphine
Opiates Codeine
Narcotics Heroine
Resulting to:
 Bradycardia
 Bradypnea
 Moist mouth
 Pupils constrict
 Constipation
 Urinary retention
 Hypotension
 Coma
 Weight gain
 Narcotics overdose: give narcotic antagonist (NARCAN, NALOXONE HYDROCHLORIDE)

UPPERS [C.H.A.R.]
Cocaine
Hallucinogens
Amphetamines
Resulting to:
 Tachycardia
 Awake
 Tachypnea
 Dry mouth
 Pupils dilate
 Hypertension
 Seizures
 Weight loss