Far Eastern University-Institute of Nursing

In-House Nursing Review Hand-out

PSYCHIATRIC NURSING

Course Outline:

I. Foundations of Mental Health Development: Theories

II. Defense Mechanism
III. Therapeutic Modalities
IV. Maladaptive Patterns of Behavior
a. Anxiety Response and Related Disorders
b. Emotional Responses and Mood disorders
c. Schizoprenia and other psychotic and mood disorders
d. Social responses and personality disorders
e. Substance Related Disorders
f. Psychophysiologic responses, somatoform and sleep disorders
g. Abuse and Violence
h. Eating disorders
i. Sexual Disorders
j. Emotional Disorders of infants, children and adolescents

V. Psychiatric Medications

I. FOUNDATIONS OF MENTAL HEALTH DEVELOPMENT: THEORIES

A. ERICK ERICKSON: Psychosocial

Age STAGE Developmental Tasks Needs that should be Met

0 -18 mos INFANT Trust vs. Mistrust Attention specially when hungry;
important factor is feeding

18 mos -3 yrs TODDLER Autonomy vs. Shame & Complement and Appreciation for
Doubt. things done; Toilet-training should
be completed

3-5 years PRE-SCHOOL/ Initiative vs. Guilt Options and alternatives given
EARLY from which the child can choose on
CHILDHOOD their own but with adult
supervision(example : which toy to
play, what food to eat);
Opportunities for exploration of self
and reality

6-12 years SHOOL AGE Industry vs Inferiority Involvement in competitive

activities like academic/ school
competencies and games

13-18 years ADOLESCENCE Identity vs Confusion Establishment of friends,

Belongingness to peers

19-25 years YOUNG Intimacy vs. Isolation Intimate Relationships; Love

ADULTHOOD

26-45 years MIDDLE Generativity vs. Being a worthy and productive

ADULTHOOD Stagnation member of the society, being a
responsible parent

Id LATE Integrity vs. Despair Recollection of life in the past,

Needs ADULTHOOD Sense of Accomplishment
Implication
46- death

C. SIGMEUND FREUD: Psychosexual

Stage Sexual development

ORAL– 0 to 18 months
 Sucking – mouth – survival: feeding

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ANAL – 18 months to 3  Toilet training

years  sense of control (autonomy)

PHALLIC – 3 to 6 years  penis and vagina

old  starts to masturbate
 love of parent of opposite sex
> Oedipal complex – boy loves mother
> Electra complex - girl loves dad

LATENT – 6 to 12 years  School age – school phobia – 1st time to go to school –

old separation anxiety
 sublimation – putting anger into something more productive
- putting all energies into schooling
 Important figures – teacher, peers (same sex)
 (sexual energy sleep)

GENITAL – 12 years to  increased sexual energy

18 years old

Childhood Trauma and Unexpressed Feelings

can cause conflicts in succeeding stages in life

D. ABRAHAM MASLOW: Hierarchy of Needs

I. Physiologic Needs – needs such as air, food, water, shelter, rest, sleep, sex,
activity and temperature maintenance are crucial for survival

II. Safety and Security Needs – the need for safety has both physical and physiologic
aspects

III. Love and Belonging Needs – the third level of needs includes giving and receiving
affection, attaining a place in a group and maintaining the
feeling of belonging

IV. Self-Esteem Needs – the individual needs both self-esteem and esteem from
others

V. Self-Actualization – when the need for self-esteem is satisfied, the individual strives for self-
actualization, the innate need to develop one’s maximum potential and
realize one’s abilities and qualities

Needs must be fulfilled in order. One

cannot progress to the next level if the
previous level has not been
successfully satisfied.

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II . DEFENSE MECHANISMS - coping mechanisms to stress.

Compensation “making up” for a real or imagined inability or deficiency to

maintain self-esteem

Conversion .transfer of mental conflict to physical symptom to release

tension or anxiety

Denial Unconcious refusal to face reality - “I am not an addict”

Displacement Transfer of feelings such as anger from one person to

another– Father shouted and got angry with the first child then
shouts also to the other child after.

Dissociation Detaching or separating strong conflict from one’s

conciousness– Ex. Traumatic amnesia- forgetting the
vehicular accident which killed significant other.

Fixation Stucked in a certain stage of development.

Identification The “imitator” - identify a certain behavior from a certain role

model.

Introjection Attributing to oneself the good qualities of another; Taking in

the character of one person by ingesting the attitudes, ideas,
philosophy of other person. – Ex. Patient claiming that he is
Jesus.

Projection Rejection of unwanted characteristic of oneself and assigns

them to others. Blames others for wroing doing .Looks for a
scapegoat. Ex. A student was late and blames the alarm clock
for failing to alarm.

Rationalization Unconciously justifying ideas, actions, feelings with good or

acceptable reasons. Used to maintain self-respect, prevent
guilt.

Reaction formation Exaggeration of certain actions by displaying exactly the

opposite behavior, feeling and attitude of what he normally
would show.

Regression Going back to past level of behavior to feel more comfortable

and reduce anxiety, fear and permits dependency. – Ex. 12
years old wets bed like an infant.

Repression “Burrying alive mechanism” – unable to recall painful or

unpleasant thoughts.

Sublimation Conciously re-channeling of unacceptable behavior into activities

that is socially acceptable.

Substitution Replacement of consciously unacceptable emotions, attitudes,

drives by those that are more acceptable.- Ex. Student who
receives low grades dropped from school and worked as
busboy.

Suppression Voluntarily forgetting unacceptable thought but able to recall at

will.

Undoing Feeling guilty for doing something.- Showing true feelings but
regrets after.

III. THERAPEUTIC MODALITIES

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Therapeutic communication Family Therapy

Behavior Modification Crisis Intervention

Milieu Therapy Expressive Therapy

Group Therapy Self-Help Groups

1. Therapeutic Communication

THERAPEUTIC NON-THERAPEUTIC

1.Offer self – “I’ll stay/sit with you” “Don’t worry, be happy”

2. Explore – use what, when, where, how Do not ask “WHY” ; puts patient in defensive position.

3. Silence Change the subject

4. Active listening – nodding, eye contact, “Everything’s going to be alright” – giving false
leaning, forward, active participation reassurance

5. Make observations. “You see/I have Ignore the patient

observed/I have noticed…”

6. Broad opening – “How are you?” “You Prejudgmental. “Nice weather today”- value based
judgment

7. Clarification – “What do you mean when you Avoid too much flattery. “You have the most beautiful
say dwakledoo?” hair in the ward”.

8. Restating – “I don’t want to eat” (Word per Arguing with the patient. Do not impose your opinion
word repetition) “You don’t want to
eat?”

9. General leads – “And then…/what else/go

on…”

10. Refocusing – “We were talking about the

exam…”

11. Focusing – “Tell me more about this”

2. Behavior Modification

 Reconditioning -taking out maladaptive behavior; unlearning the

maladaptive behavior

 Desensitization -frequent exposure to undesirable stimulus to make

individual get used
to it and decrease anxiety despite of exposure. – Ex. treatment to phobias

 Punishment

 Reinforcement

3. Milieu Therapy

 An environment that is organized to assist patients to control behavior and give opportunity to
utilize psychosocial skills in coping with self, others and environment.

 The environment is as close as to the “real world”

4. Group Therapy

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 Accdg. to Nudelman: Group therapy is “an identifiable group of at least three people who share
common goal.”

Three Phases of Group therapy:

a. Beginning or Orientation Phase - Period to resolve initial feelings and achieve a sense of
the group identification and definition of purpose

b. Middle or Working Phase – Exploration of relationships and conflicts

c. Ending or Termination Phase - shares feedback with one another as they prepare to
leave the group.
 Share feelings and reflections about the group.
 Person is expected to leave the group with the

5. Family Therapy
- Treating family members in a modified group therapy.
- Establishes open communication an healthy interactions within the family.

6. Crisis Intervention
- An attempt to resolve an immediate crisis when a person’s life goals are obstructed and
usual problem-solving methods fails.

Four Methods:
a. Assessment
b. Planning therapeutic interventions
c. Implementing Techniques of intervention and Resolution of the Crisis
d. Anticipatory Planning

7. Expressive Therapy
- Additional therapeutic modalities used to aid in assessment where expression of feelings can be
relayed through dancing, singing, drawing, etc.

IV. MALADAPTIVE PATTERNS OF

BEHAVIOR

ANXIETY
–A Feeling of uncertainty, uneasiness, apprehension or tension that a person experiences in
response to an unknowm object or situation.

Levels of Description Nursing Interventions

Anxiety

MILD Increased alertness, client is not able to Listen to patient

relax. Remain calm

Moderate Narrowed ability to perceive occurs and Listen to patient

concentrates on only one thing Remain calm
Reassurance and support
Pacing, voice tremors, speed in speaking,
physiologic changes, verbalization of
danger

Severe Patient cannot make decisions; Ability to Stay with the client
perceive is reduced Encourage deep breaths or
breathe into paper bag
Cannot communicate clearly Remove stimuli

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Panic Total ability to perceive is lost; Personality Stay with the client, prevent from
is disintegrated, unable to focus on reality injury
Encourage deep breaths or
Suicidal. Priority: safety. Stay with the breathe into paper bag
patient. Do not do anything to the patient Remove stimuli
.
Generalized anxiety disorder
 6 months excessive worrying
 Client having difficulty sleeping, concentrating, eating
 Fatigue and palpitations experienced

Panic attack
 occurs for only 15-20 minutes, happens without warning.
 Sympathetic nervous system activation.

Post traumatic stress disorder

- victims of rape, unpleasant circumstances, war zones, disaster, trauma.

OBSSESSIVE COMPULSIVE DISORDER

-A condition of recurrent and persistent urge to repeat an act purposefully to prevent some future event or
situation.

Examples: Rituals, Frequent rearranging, washing of hands, opening / closing, rigidity

Defense Mechanisms present: Displacement, undoing, reaction formation

Nursing Interventions:

a. Do not interrupt with rituals

b. Allow time to complete rituals and gradually decrease time allotment for such act
c. Avoid injury
d. Increase self-esteem and encourage expression of self

PHOBIA

- Irrational fear of an object, activity or situation

Types of Phobia:
1. Simple Phovia – fear of object
or situation
2. Social Phobias – fear of
exposure
3. Agoraphobia- most common,
fear of being alone in the crowd where there is no escape

Examples of phobias:
Acrophobia- fear of heights Hydrophobia – fear of water
Androphobia – fear of men Iatrophobia- fear of doctors
Astraphobia – fear of storms, thunder, lightning Nyctophobia – fear of night
Ceraunophobia –fear of thunder Ochlophobia – fear of crowds
Claustrophobia- fear of enclosed places Pyrophobia- fear of fire
Hematophobia- fear of blood Zoophobia- fear of animals

Nursing Intervention:
a. Behavior modifications
b. Relaxation
c. Desensitization
d. Expression of feelings
e. Anti-depressant

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DEPRESSION

- decrease serotonin. If unresponsive to medications, ECT is administered.

1. Denial – getting away from reality, “This cant be happening, this cant be real”
2. Anger – blaming. “Why me?”
3. Bargaining – closing a deal to the cheapest possible price, “If only… I will”
4. Depression – silence
5. Acceptance – client acts according to situation. Patient prepares living will.

Suicide cues:
 “I wont be a problem any longer”
 “Remember me when I’m gone”
 “This is my last day”
 “This is my wedding ring give it to my son”
 there is a sudden change in mood

Intervention:
 direct question – “Are you going to commit suicide?”
 irregular interval of visit to patient’s room
 early in the morning and during endorsement period – time the patient commits suicide
 give simple task, do not give complex one’s

Risk factors:
 sex – male (more successful) female (hesitant)
 age – 15 to 25 years old or above 45
 depression
 patient with previous attempts will try again
 alcoholics
 irrational
 lacks social support
 organized plan – greater risk
 no family
 with terminal sickness

SCHIZOPRENIA

- A serious psychiatric disorder characterized by impaired communication with loss of contact to reality

4 A’s of Schizoprenia (Bleuler)

1. Autism - retreat from reality

2. Affect - inappropriate, flat or blunt ed emotional response
3. Ambivalence – contradictory or opposing emotions, attitudes, ideas or desires
4. Associative Disturbance – unable to think logically, shifts from one subject to another

Other manifestations beside’s 4 A’s

1. Delusions 5. Inability to complete a task

2. Illusions 6. Impaired reaction to the environment
3. Hallucinations 7. Mood swings: getting angry, depressed, joyous
4. Loss of ego without any reason

Types of Schizoprenia

1. Disorganized Incoherent; thought regression, hallucinations, hypochondriasis,

disturbance; social withdrawal

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2. Catatonic Psychomotor a. Waxy flexibility – bizarre positioning

symptoms b. Expressionless
c. Catatonic rigidity- assume position and
does not move
d. Negativism-resistant to all
instructions
e. Unexpected shifts of behavior

3. Paranoid Suspiciousness a. Hallucinations –persecutory or

grandeur
b. Delusions
c. Angry, Suspicious, mistrust of
others,
overly religious

4. Undifferentiated Mixture of behaviors

5. Residual State of partial

remission

THOUGHT PROCESS DISTURBANCE

1. Looseness of association – topics have connection but no thought.
2. Ambivalence – pulled by two opposing forces.
3. Magical thinking – believes he has magical powers.
4. Echolalia – repeat what is said by the nurse.
5. Echopraxia – repeats what the nurse’s do.
6. Word salad – mixes word that don’t rhyme.
7. Clang association – uses word that rhyme.
8. Neologism – invents new words not in the dictionary.
9. Neologism – invents new words not in the dictionary.
10. Delusions – false belief.
 grandeur – thinks he’s somebody
 persecution – thinks that there is somebody after him
 ideas of reference – thinks he’s being talk about
11. Concrete association
12. Hallucination – may be stimuli, visual, auditory, tactile

Extra Pyramidal Side Effects (EPS)

Cause: increase in acetylcholine and decrease in dopamine

Symptoms of EPS:
1. Akathisia – restless and with inability to sit still
2. Akinisia – rigidity of the body
3. Dystonia – affects neck
 Torticollis – wry neck
 Oculogyric crisis – fixed stare
 Opisthotonus – arched back, contracted
4. Tardive dyskenisia – lip smacking tongue is protruding, puffy cheeks. Irreversible.
5. Neuroleptic malignant syndrome – hyperthermia, unstable BP, increase CPK, diaphoresis,
pallor
6. Photosensitivity – wear shades or put on sunscreen
7. Agranulocytosis – sore throat, fever, malaise, leucopenia
Nursing Management:
1. Use of Therapeutic communication
2. Prevent injury
3. Orient to reality
4. Medications: anti-psychotic

AUTISM

- echolalias, poor eye contact, can’t express verbally

Manifestations:
 appearance – neat, obsessive compulsive, wants constancy

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 behavior – ritualistic behavior, flat affect, repetitive

 communication – difficulty communicating

Nursing Intervention:
 constancy
 promote safety
 expressive therapy – uses art, poetry, decreasing risk for injury, improve social interaction, be
able to express feelings.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

- can progress to conduct disorder to anti-social behavior

 short attention span
 impulsive ; shifts from one activity to the other
 Destructive and hyperactive: unable to sit still, keeps on running and climbing
 May occur at age 3 and lasts for at least 6 months but often diagnosed upon entrance to school
 Id dominant: mother or the nurse will act as superego

Manifestations:
 appearance – dirty
 behavior – clumsy, impatient, easily distracted
 talkative

Nursing Intervention:
 safety
 provide place to study, eat play, bath
 schedule time for all activities
 set limits

ANOREXIA NERVOSA

- diet, underweight <85% of expected fat, 3 months amenorrhea, failure to recognize problem
- Most common in women (90-95%), usually
teenagers
Starvation- an attention-getting device; a psychotic disorder, early manifestation of schizophrenia.

Contributing Factors:
1. Disturbed self-image
2. Parent-child conflicts
3. Past and present experiences
resulting to feeling
of dependency & helplessness

Warning Signs of Possibility of Anorexia Nervosa:

1. Drastic weight loss in the presence of unusual eating habits
2. Obsession with neatness including frequency in mirror-gazing
3. Hostility and desire to control others
4. Calorie counting, dieting, excessive exercise
5. Depressed mood
6. Amenorrhea or irregular menses
7. Wearing loose-fitting to mask physical appearance as it changes
8. Denying hunger

Symptoms:
 Dry, flaky or cracked skin  Skeletal-like appearance
 Brittle hair and nails, hair  Presence of lanugo
beginning to fall out
 Amenorrhea or menstrual  Intense fear of becoming
irregularity obese
 Constipation  Distorted body image as
 Hypothermia continues to
 see self as fat
 Decreased BP, PR, basal  Loss of appetite
metabolic rate  Total lack of concern about
 DHN, malnutrition, symptoms

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electrolyte imbalance

BULEMIA NERVOSA

-Binge eating and purging , normal weight, irregular menstruation, dental carries, diarrhea, knows the
problem but ashamed and embarrassed.

PICA – eating non-nutritive foods like ice, starch

Priority:
 fluid volume balance
 weight gain – monitor weight, eating pattern, stay 1 hour after eating, accompany in toilet

Complications:
1. Chronic inflammation of the lining of the esophagus
2. Rupture of the esophagus
3. Dilatation of the esophagus
4. Rupture of the stomach
5. Electrolyte imbalance or abnormalities, leading to arrhythmias of the heart and metabollic
alkalosis
6. Heart problems, irreversible Cong. Heart failure
7. Chronic enlargement of the parotid gland
8. Dehydration
9. Irritable bowel syndrome or abnormal dilatation of the colon
10. Rectal prolapse or abcess
11. Rupture of the diaphragm
12. Dental erosion
13. Chronic edema
14. Fungal infections of the vagina or rectum

Nursing intervention for ANOREXIA NERVOSA AND BULEMIA

1. Establish nutrition pattern
2. Setting limits
3. State that three meals a day is necessary to maintain a healthy body
4. Allow some control in decision making
5. Teach stress management, journal keeping
6. Monitor eating pattern and weight
7. Anti-depressant

BIPOLAR DISORDER

- Depression and Mania

- 2 poles, happy (more dominant) and sad, affects more female than male >20 years of age,
stress and obese

Depression – a mood state characterized by a feeling of sadness, dejection, despair,

discouragement or hopelessness

Mania – a mood disorder characterized by psychomotor over-activity or excitement, insomnia

without fatigue, euphoria or a state of elation, distractibility, and pressured speech.

Mixed – experiences both manic and depressive phases

Symptoms of Manic Phase:

6. Overactivity or excitement 6. Flight of ideas

7. Insomnia without fatigue 7. Manipulative or
8. Euphoria or elated mood demanding behavior
9. Distractibility 8. Destructive / Combative
10. Pressured speech 9. Delusions of grandeur
10. Impaired judgment
Nursing Intervention:
1. Divert attention - give task
2. Avoid giving group games – any competition will increase anxiety
3. Give activities that uses gross motor skills to provide
outlet of energy

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4. Displacement like punching bag

PERSONALITY DISORDER

Characteristics of a Personality Disorder

1. Denial of the maladaptive behavior being exhibited.

2. Maladaptive behaviors are inflexible.
3. Minor stress is poorly tolerated which furthers the increase in the ability to cope.
4. Defective ego functioning
5. Difficulty dealing with reality
6. Disturbance of mood, such as anxiety or depression

Clinical Types of Personality Disorder

1. Schizoid – doesn’t care about people, believes that he can stand on his own, never had a
best friend, avoid groups and activities – no enjoyment

2. Avoidant – avoid group – fear criticism, have talent but with no confidence

3. Anti-social – law breaker, do not follow rules from childhood until adulthood

4. Borderline – suicidal, superficial relationship, sudden change of mood, self mutilation

5. Dependent – decrease self esteem, dependent, poor decision making skills

6. Histrionics – excited, dramatic, manipulative, center of attention

7. Narcissistic – insensitive, arrogant, self absorbed, exaggerated self esteem, ambitious,

grandiosity

8. Obsessive-compulsive – perfectionist, organized, constancy in environment, provide time to

do rituals

9. Paranoid – always jealous, suspicious, violent

10. Passive/aggressive – with hidden resistance, but always on the go

ALCOHOL ABUSE
- socializing, escape from problem, peer pressure

Manifestations of Individual under Abuse of alcohol:

1. Chronic absenteeism from work
2. Repeated job-related accidents
3. Overuse of rationalization, or excuses for drinking
4. Disruption of home, marital and family relationships
5. Frequent job changes
6. Poor job performance
7. Deterioration of health
Intervention:
1. Gradually avoid alcohol
2. Aversion therapy
3. Anti-abuse (DISULFIRAM)
4. May refer to group therapy

Complications:
1. Wernickes – motor side effects
2. Korsakoff – memory – confabulation
3. Delirium tremors – 24 72 hours after alcohol intake due to sympathetic nervous system
activation (with tremors, hallucinations, illusions)

SUBSTANCE ABUSE

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1. Nervous – tremors, give downers

Signs of overdose:
 identify if drug is upper or downer
 check effect
 signs of widrawal

 If patients take a downer, all vital signs are down. If he stops taking it (during
withdrawal), patient will experience the opposite effect of a downer. All of the
patients vital signs will shoot up just the same with uppers (e.g., patient had
cocaine intoxication, patient will manifest hyperactivity, tachypnea, seizure.
During withdrawal, patient will manifest bradypnea or coma).

Substance abuse moments:

DOWNER:
 alcohol
 barbiturates
 opiates
 narcotics
 marijuana
Toxic effects:
 decrease respiratory rate, decrease heart rate
 constricted pupil
 moist mouth
 dilated blood vessel
 coma
 asleep
 decreased gastro-intestinal constriction
 decrease genitor-urethral retention
 decrease blood pressure
 state of euphoria

2. Depressed – sits down on chair

UPPERS:
 cocaine
 hallucinogen
 amphetamines

Toxic effects:
 seizure
 tachypnea
 increase heart rate
 pupils dilate
 dry mouth
 decrease in appetite
 diarrhea

 profound mental retardation – IQ <20 – thinks like an infant, cant be trained

 severe mental retardation – 20-35
 moderate – 35-50 – can be trained, mental age is 2-7 years old, pre-operational stage
 mild – 50-70 – (mild 7) mental age is 7 -12, educable, can go to school
 borderline – 70-90
 normal 90 – 110

CHILD ABUSE

- A result of a potentially abusive or neglectful parents resulting to maltreatment of children

Characteristics of potentially abusive or neglectful parents :

a. Denial of pregnancy
b. Depression during pregnancy
c. Unwanted child

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d. Fear of delivery
e. Lack of support form husband or family
f. Undue concern about the unborn child’s sex and how
g. Fear that the child will be one of too many children
h. Resentment towards the child
i. Inability to tolerate the child’s crying, viewing child as being too demanding

Areas of Child Abuse:

1. Physical Abuse
2. Neglect
3. Emotional Maltreatment
4. Sexual Abuse

Area Physical Behavioral

Physical Abuse Multiple injuries in various stages Fear of strangers

of healing
Labile behavior
Unexplained bruises, fractures, Rigid, distant
lacerations

Explanation and injury mismatch

Neglect Poor hygiene and dress Fatigue

Withdrawal
Needs unattended Engaged in substance abuse
Emotional Maltreatment
Decreased self-esteem,
hypochondriasis
Developmental lag
Sleep disorders, behavioral
problems

Sexual Abuse Venereal disease Unusual sexual behavior

Poor peer relations
Pregnancy Sexual assaults

Itching in genitals, difficulty

ealking or sitting

ALZHEIMER

1. Anomia – don’t know name of object

2. Agnosia – problem with senses (smell, taste, hear, touch)
3. Aphasia – can’t say what he wanted to say
4. Apraxia – can’t do what he wanted to do
5. Dissociative fugue – takes a new personality from a far away place. New place, new
identity
6. Dissociative identity disorder – multiple personality
7. Dissociative amnesia – he don’t know who he is and where he is

Anti-cholinergic/Anti-parasympathetic Anti-parkinson drugs

 mono amine oxidase inhibitors  cogentin
 marplan  artane
 nardil  parlodel
 parnate  akineton
 benadryl
Alcoholics  larodopa
 disulfiram  eldepryl
 anti depressants  symmetrel

Electro-convulsive therapy (ECT) –

-if the medication the patient was taking did not take effect ECT is administered.

Pre-ECT:

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 sign informed consent

 NPO 6 hours
 give atropine sulfate
 give barbiturate
 succinylcholine chloride – to relax muscles
Post-ECT
 side lying lateral
 side effects: headache, dizziness, temporary, memory loss (distinct symptoms)

PSYCHIATRIC MEDICATIONS

Anti-mania Anti-depressant

MAO Inhibitors – Isocarboxacid, Phenelzine

Drug: LITHIUM
Tricyclic Anti-depressant – Imipramine,
Amitryptilne

Tetracyclic Anti-depressant
- Maprotiline

Drug Interaction Diuretics increases level of Concommittant use with:

toxicity Anti-HPN –causes hypo/hypertension
ACT may cause neurotoxicity Antacids- inhibit absorption
Anti-psychotc- potentiate anti-cholinergic
effects
CNS depressant-potentiate effectsn
Side Effects Initial Dosage:
Fine tremor, nausea, drowsiness, Anti-cholinergic Effect:
lethargy, polyuria, thirst, fatigue, a. Dry mouth
weight gain b. Constipation
c. Urinary retention
Toxic Level: d. Blurred vision
Vomiting, diarrhea, lethargy, e. Glaucoma
muscle twitching, ataxia, slurred Cardio Effects:
speech, coma, seizure a. Postural Hypotension
b. Arrhythmias

Rashes, photosensitivity, tremors, seizures,

perspiration, anxiety, restlessness

Nursing Intervention Careful observations for signs WOF Hypertensive crisis- elevated BP,
and symptoms of toxicity palpitations, diaphoresis, chest pain, headache
w/c can lead to intracranial hemorrhage and
bleed-> death

Morally and ethically acceptable behavior

Conscience
- is it good or bad?
Superego
-conscious
- what is more beneficial
in touch with reality
- think before deciding
Ego
eat, drink, smoke, urinate, have sex
pleasure principle
- do what you want

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In-House Nursing Review Hand-out

If a specific developmental tasks are not met within the

stage, person may manifest psychologic problem related
to the missed task in the past.

B. SIGMEUND FREUD: Psychoanalytic Stage

2. conscious – easy recall of events ; highest level of awareness

3. pre-conscious –about to to recall certain events
4. unconscious –cannot recall
 repression – involuntary forgetting of something unpleasant experience
 ex. forgot the name of ex-boyfriend’s present girlfriend (third-
party)
 suppression – voluntarily or conscious forgetting of unpleasant experience



 Mind-Setting

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