Refusal to accept the reality of their problem Treatment Confront it by pointing out to the person the difference between what they say and what they do.

Antabuse/Revia (Aversion Therapy) Onset and duration of effectiveness - 2 weeks Avoid all forms of alcohol to avoid nausea, vomiting, death Alcohol avoidance Mouth wash, cologne, perfume, aftershave, elixir, most OTC liquid medicines, insect repellant, vanilla extract, vinaigrettes (red wine vinaigrettes acceptable), hand sanitizer

Types of Psychotics Functional Psychotics Schizophrenia, Schizoaffected, Major depression, Manic Teaching reality 1. Acknowledge feelings 2. Present reality 3. Positive - what is reality 4. Negative - what is not reality 5. Set a limit 6. Enforce the limit Psychosis of Dementia Brain damage Alzheimer's, Wernicke's, Organic Brain Syndrome, Dementia Can't learn reality Treatment 1. Acknowledge feelings 2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately Psychotic delirium Temporary episodic sudden onset loss of reality due to chemical imbalances UTI, thyroid imbalance, electrolyte imbalance, adrenal crisis Treatment 1. Acknowledge feelings 2. Reassure them of safety and temporariness

1st gen anti-psychotics (typical) All end in -zine (zines for the zany) Thorazine, compazine Reduces symptoms Actions large doses - antipsychotic small doses - antiemetic major tranquilizers S/E A = anticholinergic (dry mouth) B = blurred vision and bladder retention C = constipation D = drowsiness E = EPS (tremors, parkinsonisms) F = “f”otosensitivity (skin burns) G = aGranulocytosis (low WB count) Treat Side Effects Teaching Teach patient to report sore throat and symptoms of infection to PCP Never stop the zine #1 diagnosis is safety Deconate or … D Long-acting IM form given to non-compliant patients

Antianxiety meds (considered minor tranquilizers) Always have “pam/lam” in name Indications induction of anesthetic muscle relaxant alcohol withdrawal seizures (status) facilitates mechanical ventilation Work quickly Must not take for more than 6 weeks → 3 months Keep on valium until elavil kicks in #1 nursing diagnosis is safety S/E A = anticholinergic B = blurred vision C = constipation D = drowsiness

Used for bipolar disorder (decreases mania) S/E (3 Ps) Peeing Pooping Paresthesia Toxic S/Es Tremors Metallic taste Severe diarrhea #1 intervention → good fluid hydration If sweating, give sodium (or other electrolyte) as well as fluid Don't give water →give gatorade or other electrolyte drink Monitor Na+ levels high sodium will cause lithium to not work low sodium will make lithium toxic

Psych Flashcards by N J

1 problem in abuse is

denial

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Denial

Refusal to accept the reality of their problem
Treatment
- Confront it by pointing out to the person the difference between what they say and what they do.

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Wernicke’s (Korsakoff’s Syndrome

Psychosis induced by vitamin B1 (thiamine) deficiency
Symptoms
- Amnesia (memory loss)
- Confabulation (make-up stuff)
- Preventable (take vitamin)
- Irreversible (kills brain cells)

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Alcoholism treatment

Antabuse/Revia (Aversion Therapy)
- Onset and duration of effectiveness - 2 weeks
- Avoid all forms of alcohol to avoid nausea, vomiting, death
- Alcohol avoidance
  - Mouth wash, cologne, perfume, aftershave, elixir, most OTC liquid medicines, insect repellant, vanilla extract, vinaigrettes (red wine vinaigrettes acceptable), hand sanitizer

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Alcohol Withdrawal Syndrome vs. Delirium Tremens

AWS
- Every alcohol goes through this
- semiprivate room
- regular diet
- up ad lib
- Give anti-HTN meds
- Give tranquilizer
- Give multivitamin to prevent Wernicke’s
DT
- can kill you
- Danger to self and others
- Private room near nurse’s station
- Clear liquid or NPO
- bedrest w/o bathroom privileges
- vest or 2 point restraints
- Give anti-HTN meds
- Give tranquilizer
- Give multivitamin to prevent Wernicke’s

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Non-psychotic vs. psychotic

Non-psychotic
- has insight (reality based)
  - know they’re sick and that it’s affecting them
Psychotic
- no insight (non-reality based)
- therapeutic communication can’t be used
- Delusions
  - Paranoid/Persecutory Delusion - false, fixed belief that people are out to harm you
  - Grandiose - false, fixed belief that you are superior
  - Somatic - False, fixed belief about a body part
- Hallucinations
  - Auditory, Visual, Tactile, Gustatory, Olfactory
- Illusion
  - Misinterpretation of reality → sensory experience

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Types of Psychotics

Types of Psychotics
- Functional Psychotics
  - Schizophrenia, Schizoaffected, Major depression, Manic
  - Teaching reality
    1. Acknowledge feelings
    2. Present reality
    3. Positive - what is reality
    4. Negative - what is not reality
    5. Set a limit
    6. Enforce the limit
- Psychosis of Dementia
  - Brain damage
  - Alzheimer’s, Wernicke’s, Organic Brain Syndrome, Dementia
  - Can’t learn reality
  - Treatment
    1. Acknowledge feelings
    2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately
- Psychotic delirium
  - Temporary episodic sudden onset loss of reality due to chemical imbalances
  - UTI, thyroid imbalance, electrolyte imbalance, adrenal crisis
  - Treatment
    1. Acknowledge feelings
    2. Reassure them of safety and temporariness

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Loosening of association

Flight of ideas
- Stringing phases together (loosely associated phrases; tangentiality)
Word salad
- Throw words together
Neologisms
- Making up new words

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ABN - Abnormal Personality Disorders

Antisocial, Borderline, Narcissistic
- most severe personality disorders

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All psych drugs cause…

Hypotension
Weight changes (primarily weight gain)

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Phenothiazines

1st gen anti-psychotics (typical)
All end in -zine (“zines for the zany”)
- Thorazine, compazine
Reduces symptoms
Actions
- large doses - antipsychotic
- small doses - antiemetic
- major tranquilizers
S/E
- A = anticholinergic (dry mouth)
- B = blurred vision and bladder retention
- C = constipation
- D = drowsiness
- E = EPS (tremors, parkinsonisms)
- F = “f”otosensitivity (skin burns)
- G = aGranulocytosis (low WB count)
- Treat Side Effects
Teaching
- Teach patient to report sore throat and symptoms of infection to PCP
- Never stop the zine
# 1 diagnosis is safety
Deconate or … D
- Long-acting IM form given to non-compliant patients

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Tricyclic Antidepressants (NSSRI)

“Mood elevators” to treat depression
- Must take for 2-4 weeks before beneficial effects
Ex. Elavil, Trofranil, Aventyl, Desyrel
S/E
- A = Anticholinergic (dry mouth)
- B = blurred vision
- C = constipation
- D = drowsiness
- E = euphoria

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Benzodiazepines

Antianxiety meds (considered minor tranquilizers)
Always have “pam/lam” in name
Indications
- induction of anesthetic
- muscle relaxant
- alcohol withdrawal
- seizures (status)
- facilitates mechanical ventilation
Work quickly
Must not take for more than 6 weeks → 3 months
- Keep on valium until elavil kicks in
# 1 nursing diagnosis is safety
S/E
- A = anticholinergic
- B = blurred vision
- C = constipation
- D = drowsiness

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Monoamine Oxidase (MAO) Inhibitors

Antidepressants
Prevent breakdown of norepinephrine, dopamine, and serotonin
Ex. MARplan, NARdil, PARnate
S/E
- A = anticholinergic
- B = blurred vision
- C = constipation
- D = drowsiness
Teaching
- Must avoid foods containing tyramine to avoid hypertensive crisis
  - “BAR” - Bananas, Avocados, Raisins (any dried fried)
  - avoid things made from active yeast
  - No organ meats
  - no preserved meats (smoked, dried, cured, pickled, hot dogs)
  - No cheese except mozzarella and cottage cheese (no aged cheese)
  - No yogurt
  - No alcohol, elixirs, tinctures (iodine/betadine), caffeine, chocolate, licorice, soy sauce
- Avoid OTC meds

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Lithium

Used for bipolar disorder (decreases mania)
S/E (3 Ps)
- Peeing
- Pooping
- Paresthesia
Toxic S/Es
- Tremors
- Metallic taste
- Severe diarrhea
# 1 intervention → good fluid hydration
If sweating, give sodium (or other electrolyte) as well as fluid
Don’t give water
- →give gatorade or other electrolyte drink
Monitor Na+ levels
- high sodium will cause lithium to not work
- low sodium will make lithium toxic

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Prozac (SSRI)

Similar to Elavil
Antidepressant - mood elevator
S/E
- A = anticholinergic
- B = blurred vision
- C = constipation
- D = drowsiness
- I = Insomnia
  - give before noon
Watch for suicide in adolescents and young adults after a dose change

Haldol (Haloperidol)

Tranquilizer
Also has a deconate (D) form
- Long-acting IM form given to non-compliant patients
S/E
- A = anticholinergic
- B = blurred vision
- C = constipation
- D = drowsiness
- E = EPS
- F = fotosensitivity
- G = aGranulocytosis
- Safety concerns related to S/E
NMS (neuroleptic malignant syndrome)
- medical emergency
- develops in elderly patients from an overdose
- high fever (105+), tremors, anxiety
  - similar to EPS except for fever
- elderly patients should be on half usual dose
only antipsychotic that can be given to pregnant women

Clozaril (clozapine)

Atypical antipsychotic
Do not confuse with Klonopin (clonazepam)
Used to treat severe schizophrenia
S/E
- no A→F
- G = aGranulocytosis (worse than cancer drugs)
  - does not affect everyone
  - measure WBC Q4 weeks,, then once a month for 6 months, then every 6 month

Geodon

Should not be used in people with heart problems
can cause elongated Q-T intervals

Zoloft (Sertraline) (SSRI)

Antidepressant
S/E (“SAD Head”)
- Sweating
- Apprehensive
- Dizzy
- Headache
- Insomnia, but can be given in the evening
Watch for interaction w/ St. John’s wort (serotonin syndrome) and warfarin (bleeding)

Adulthood

Early adulthood (19-35 years)
- Intimacy vs. Isolation
Middle adulthood (35-64 years)
- Generativity vs. Stagnation
Late adulthood (65 - death)
- Ego integrity vs. Despair

Eating disorders

Anorexia
- females under 25
- Weight loss of 15% of body weight
  - Hospitalize if loss of 30%
- symptoms
  - Bradycardia
  - Amenorrhea
  - lanugo

Psych Protocol Overview

Nurse will examine their own feelings usually best choice
Establish a trust relationship

Psycho treatment protocol

Depression
- watch for suicide risk
- Activities with other people that doesn’t require interaction
Schizophrenia
- If pacing, reduce stimulation and offer presence
- Need reality based activities but not competitive
- Should be with other people
Bipolar
- Manias can’t go to work or maintain family order, whereas a hypomaniac can
- Finger foods best, especially high caloria
- 8 hours of sleep, encourage naps
- Gross motor exercise that is non-competitive
Anxiety disorder
- Phobia treatment
  - desensitization (gradually expose, ensure no anxiety before moving to next step)
    - talk about it
    - show pics
    - be around
    - interact
Violent clients
- takes 5 people to control a violent client (one for each limb and one for head)
- only one person talks

Defense Mechanisms

* Projection * Repression * person unconsciously choosing to disbelieve the truth * Psychosomatic illness * Rationalizing * patient makes an excuse about something bad that happened * Regression * Patient becomes demanding and self-centered and attention-seeking * Intellectualization * patient talking about very upsetting events but acts cool and calm * Displacement * Patient expresses their emotions toward another object