SCHIZOPHRENIA Ego disintegration Impaired reality perception Genetic vulnerability Stress Diathesis Model o Too much stress in the

n the reality will lead client to escape it and go to the fantasy world Biological Theory o 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(incomplete emotion) mbivalence torn between 2 opposing forces utism ssociative Looseness Symptoms Negative Hypoactive Withdrawn Apathy Positive Hyperactive Sociable Flight of Ideas Talkative

Residual
No more positive s/sx, just withdrawn

classified differentiated Mixed classification Cant be classified 1st paranoid, then disorganized then catatonic, etc etc

DOPAMINE - SCHIZO

we need to give

Anti-psychotic

drugs
DOPAMINE - SCHIZO lead to EPSE EXTRA PYRAMIDAL SIDE EFFECTS (EPSE) Happens when acetylcholine is up and dopamine is down AKATHESI A AKINESIA DYSTONIA Restless, unable to sit still Generalized muscle rigidity Affects neck

TORTICOLLIS- wry neck OCULOGYRIC CRISIS fixed stare

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 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

TARDIVE DYSKINES IA NEUROLE PTIC MALIGNA NT SYNDROM E

OPISTHOTONUSarched back Lip smacking, tongue protruding, puffy cheeks, irreversible Hyperthermia among client taking antipsychotic Hyperthermia with muscle rigidity

ADDITIONAL NOTES: SCHIZOPHRENIA At least 6 months psychotic symptoms BRIEF PSYCHOTIC DISORDER 1 day to 1 month SCHIZOPHENIFORM 1 month 6 months SCHIZOAFFECTIVE Psychosis + mood disorder (depression/ mania)

Catatonic
Ambivalence Waxy Flexibility o Iniwan na posture, ganun forever No favorite word Negativism Disorganized Sad but smiles o Inappropriate affect No reaction o Flat affect Flight of ideas o HEBEPHRENIC Giggling Positive and Negative S/Sx

Paranoid Suspicious Tendency to be violent MistrustScaredWithdra wn 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.

AUTISM
BIPOLAR DISORDER o o
o o Female, 20 y/o, Stress, Obese Bipolar because there is happy pole (more dominant) and sad pole (more on mania and less depression) Bipolar (depression+mania) Bipolar II (depression+hypomania)

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

ASSESSMENT o Via Maslows eat, sleep, hyperactive, sex/ masturbates 2. risk for other directed violence 3. Risk for injury 4. bad words 5. Flamboyant dress, heavy make-up, loud talking because patient has selfesteem and therefore compensates to be LOUD (def.mech. Compensation) NURSING DIAGNOSIS:

1.

o
o

Risk for other directed violence Risk for injury

NURSING ACTION: o o o finger foods (to eating) low stimuli environment (to sleep) set limits (hyper sexed/masturbation) The lower the self esteem, the higher the compensation; therefore the compensation by self-esteem thru simple tasks. Self Actualization Task to decrease self-esteem Family therapy Give task, no group game, any competition will increase anxiety.
Dos 1. Gross motor (sweeping the floor will act as sublimation ) escorted walk outdoor punching bag (displacemen t) water the plants Donts 1. Competition (basketball, one on one games like ping pong) 2. fine motor (cross stitching)

ATTENTION DEFICIT HYPERACTIVE DISORDER Onset : 7 y.o. and below

o
o o o o

Duration : 6 months and above Settings : 2 House and school Id Dominant: 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

2.

3.
4.

3 or more signs confirm this disorder: G F S P E E D Grandiose, increase risk activities Flight of ideas Sleeplessness Pressured speech Exaggerated SE Extraneous stimuli (easily distracted) Distractibility

Dont give at bedtime STIMULANT causes insomnia Give 6 hours prior bedtime if bid

3.

reminyl

EATING DISORDERS
18 mos. 3 y.o. 6 y.o. class valedictorian/ model student Toilet Training social inactive/ no BF Clean weighing Obedient Organized Thought Behavior I Am Fat Diet Feeling Self Esteem Diet, Diet,

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

Eating Disorders
Eating Pattern Weight Menstruatio n

Bulimia
Eat, eat, vomit Normal weight Irregular menstruation Vomiting Dental caries Wounded knuckles Metabolic alkalosis Metabolic acidosis

NOMIA dont know name of objects GNOSIA problem with senses PHASIA cant say it PRAXIA cant do it

THERAPEUTIC COMMUNICATION
Therapeutic Offer your self Ill stay with you Silence Making observations You seem sad Active listening Nodding Eye contact Lean forward Who, what, when, where General leads Go on, Im listening, what else? Broad opening - best Opening line How are you today? How are you? Restating Clarrification Refocusing we are talking about the exam Focusing tell me about Non-Therapeutic Dont worry be happy Everythings gonna be alright Ignoring the client Changing the subject Nice weather were having Adjectives value based perception , should not be use You are the most beautiful client Why Arguing Flattery You should do this now In my opinion

ALZHEIMERS DISEASE
o o Starts 45 y/o; full blown s/s at 60 y/o Dementia (short term memory), prominent formation of neurotic plaque neuro fibrillary tangles neuro fibers difficult them to onset the data Stages of Dementia:

1. 2. 3.

Mild forgetfulness, confabulation (invents stories to fill memory gaps) Moderate confusion

o
o o o

Severe personality changes, temper tantrums Nursing Action: focus on what is left (long term) = reminiscing therapy (50 yrs. Ago make use of memory in the past) Focus on Patient & Care giver May go to regression Nursing Tips: 1. Orient the patient 2. Provide with Schedule and Structure 3. straight step by step task Treatment: - Cholinesterase inhibitor delays progression but not definite treatment. 1. cognex 2. Aricept

DEFENSE MECHANISMS Fight for stress DISPLACEMENT Transfer of Boss shouts feelings to a less at you, you threatening shout at object rather than your the one who subordinate provoke it

DENIAL

DISSOCIATION

REGRESSION

REPRESSION

RATIONALIZATI ON

REACTION FORMATION

UNDOING

IDENTIFICATION PROJECTION

INTROJECTION

SUPPRESSION

SUBLIMATION

CONVERSION

COMPENSATION

SUBSTITUTION

Failure to acknowledge an unacceptable trait or situation Psychological flight from self A type of amnesia Return to an earlier developmental stage Unconscious forgetting of an anxiety provoking concept Illogical reasoning for a socially unacceptable trait sayang ang beer sa ref, kaya ko ininum doing the opposite of your intention plastic Doing the opposite of what you have done due to guilt orocan, plastic, Tupperware Assume trait for personal, social, occupational role Attributing to others ones acceptable trait Pasa load Assume another persons trait as your own Conscious forgetting of an anxiety provoking concept 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

Im not an alcoholic Sino ka, Sino ako? Return to thumbsucki ng Hindi ko maalala I drink because I dont want to waste the beer in the ref sasabunuta n kita. . . ay kuklulutin lang kita ay pinatid kita, halika punta kita sa clinic

A.k.a C.A.

H. Fever Dandy Fever Breakbone Arbovirus Onyong-nyong virus Chikungunya West Nille Flavivirus- Philippines

Mode of Transmission

Mosquito bite AEDES AEGYPTI -most common -day biting -low flying -low extremity biting -clear stagnant S/Sx GRADE I Fever, Vomiting, Abdominal Pain fever 3-5 days pain- body pain + petechiae + Hermans sign GRADE II Grade I + Bleeding bleeding, nose, U.G.I,L.G.I GRADE III Grade II + Shock Hypotension Cold/Clammy Extermities Slow Capillary Refill circulatory collapse GRADE IV Profound Shock Death Dx TOURNIQUET/RUMPEL LEEDS test capillary fragility > 20 petechaie/m2 BLOOD Exam -platelet count: 150,000-400,000 - Ins. Hematocrit -hemoconcentration Preventive: Fogging Clean Program C-hemically treated mosquitos net (K-othrine) - 6mons effect L-arvicides/Larvivovour fish

Tulad niya hindi ako alcoholic, sila yon ako din Not just you, me too Hindi ko alam yan Angry at life, put anger in singing Biglang mangingig

Pilay pero magaling kumanta Gusto ko Disneyland. Enchanted nalang.

Environment Control Anti Mosquitos Neem Tree (Eukalyptus, Oreganu)

Dengue Hemorrhagic Fever

Mgt: promote bleeding control and gum bleeding keep on NPO if vomiting ice pack on the epigastric area If gastric lavage, use ice cold NSS avoid dark colored foods Fluid Replacement give Vit.K give Vit.C Do not give Aspirin MALARIA A.k.a KING of TROPICAL Diseases/AGUE C.A. Plasmodium ovale P. malariae P. vivax P. falcifarum most fatal Mode of Transmission Mosquito bite ANOPHELES Mosquito night biting slow flowing H2O, rural, lands on surface angle of 45 D S/Sx COLD stage 10-15 mins chilling sensation shaking, chattering of lips HOT satge 4-6 hours fever, headache, abd.pain, vomiting WET stage profuse sweating, feeling of weakness Dx BSMP- Blood Smear for Malarial parasite Instant Test ( Strips Test ) Preventive: Zooprophylaxis (Chloroquine) Protect for the exposure only CLEAN Mgt: 1st Line - AL- Artemether Lumefantrine(Co-artem) 2nd Line - Sulfadoxine Pyremethamine(Fansdar) - Chloroquine - Primaquine

PTB/Pulmonary Tuberculosis (Kochs Disease) Infection of lung tissue caused by invasion of mycobacterium tuberculosis or tubercle bacilli An acid fast, gram negative, aerobic and easily destroyed by heat or sunlight

A. Precipitating Factors 1. 2. 3. 4. 5. Malnutrition Overcrowded places Alcoholism Over fatigue Ingestion of infected cattle with mycobacterium bovis 6. Virulence (degree of pathogenecity) of microorganism B. Mode of Transmission 1. Airborne transmission via droplet nuclei C. Signs and Symptoms 1. 2. 3. 4. 5. 6. 7. Low grade afternoon fever, night sweats Productive cough (yellowish sputum) Anorexia, generalized body malaise Weight loss Dyspnea Chest pain Hemoptysis (chronic)

D. Diagnostic Procedure

1. Mantoux Test (skin test) -Purified protein derivative

DOH 8 10 mm induration, 48 72 hours WHO 10 14 mm induration, 48 72 hours -Positive Mantoux test (previous exposure to tubercle bacilli but without active TB)

2. Sputum Acid Fast Bacillus -Positive to 3. 4.

cultured microorganism Chest X-ray -Reveals pulmonary infiltrates (chalk thorax) CBC -Reveals increase WBC

E. Nursing Management 1. 2. 3. 4. 5. Enforce CBR Institute strict respiratory isolation Administer oxygen inhalation Force fluids to liquefy secretions Place client on semi fowlers position to promote expansion of lungs 6. Encourage deep breathing and coughing exercise 7. Nebulize and suction when needed 8. Comfortable and humid environment 9. Institute short course chemotherapy Intensive phase

-INH (Isonicotinic Acid Hydrazide) -Rifampicin (Rifampin) -PZA (Pyrazinamide) -Given everyday simultaneously to prevent resistance -INH and Rifampicin is given for 4 months, taken before meals to facilitate absorption -PZA is given for 2 months, taken after meals to facilitate absorption -Side Effect INH: peripheral neuritis/neuropathy (increase intake of Vitamin B6/Pyridoxine) -Side Effect Rifampicin: all bodily secretions turn to red orange color -Side Effect PZA: allergic reaction, hepatotoxicity, nephrotoxicity -PZA can be replaced by Ethambutol -Side Effect Ethambutol: optic neuritis

Standard phase -Injection of streptomycin (aminoglycoside) -Kanamycin -Amikacin -Neomycin -Gentamycin

Side Effect: -Ototoxicity damage to the 8th cranial nerve resulting to tinnitus leading to hearing loss -Nephrotoxicity check for BUN and Creatinine -Give aspirin if there is fever -Side Effect: tinnitus, dyspepsia, heartburn

10. Provide increase carbohydrates, protein, vitamin C and calories 11. Provide client health teaching and discharge planning a. Avoidance of precipitating factors b. Prevent complications (Atelectasis, military tuberculosis) c. Strict compliance to medications d. Importance of follow up care

9. When mixing 2 types of insulin aspirate first the clear insulin before cloudy to prevent contaminating the clear insulin and promote proper calibration.

10. Monitor for signs of local complications such as Allergic reactions Lipodystrophy

INSULIN THERAPY B. Types of Insulin 1. Rapid Acting Insulin (clear) -Regular acting insulin (IV only) -Peak action is 2 4 hours 2. Intermediate Acting Insulin (cloudy) -Non Protamine Hagedorn Insulin (NPH) -Peak action is 8 16 hours 3. Long Acting Insulin (cloudy) -Ultra Lente -Peak action is 16 24 hours

Somogyi Phenomenon rebound effect of

Nursing Management for Insulin Injections 1. Administer at room temperature to prevent development of lipodystrophy (atrophy, hypertrophy of subcutaneous tissues) 2. Place in refrigerator once opened 3. Avoid shaking insulin vial vigorously instead gently roll vial between palms to prevent formation of bubbles 4. Use gauge 25 26 needle 5. Administer insulin either 45o 90o depending on amount of clients tissue deposit 6. No need to aspirate upon injection 7. Rotate insulin injection sites to prevent development of lipodystrophy 8. Most accessible route is abdomen 2. Second Generation Sulfonylureas a. Glipzide (Glucotrol) insulin characterized by hypoglycemia to hyperglycemia ORAL HYPOGLYCEMIC AGENTS -OHA -Stimulates the pancreas to secrete insulin A. Classsification 1. First Generation Sulfonylureas a. Chlorpropamide (Diabenase) b. Tolbutamide (Orinase) c. Tolamazide (Tolinase)

b. Diabeta (Micronase)

11. Assist in surgical procedure

Glaucoma
Nursing Management when giving OHA 1. Instruct the client to take it with meals to lessen GIT irritation and prevent hypoglycemia 2. Instruct the client to avoid taking alcohol because it can lead to severe hypoglycemia reaction or Disulfiram (Antabuse) toxicity symptoms
increase normal

IOP but not curable

IOP is 12 21 mmHg

preventable

A. Predisposing Factors
Common

among 40 years old and above

Hereditary Hypertension Obesity

B. Signs and Symptoms 1. Loss of peripheral vision

pathognomonic

sign is tunnel vision

2. Headache, nausea, vomiting, eye pain (halos around light)

steamy may

cornea

lead to blindness

C. Diagnostic Procedures 1. Tonometry Nursing Management 1. Monitor for peak action of insulin and OHA and notify physician 2. Administer insulin and OHA therapy as ordered 3. Monitor strictly vital signs, intake and output and blood sugar levels 4. Monitor for signs of hypoglycemia and hyperglycemia -administer simple sugars -for hypoglycemia (cold and clammy skin) give simple sugars -for hyperglycemia (dry and warm skin) 5. Provide nutritional intake of diabetic diet that includes: carbohydrates 50%, protein 30% and fats 20% or offer alternative food substitutes 6. Instruct client to exercise best after meals when blood glucose is rising 7. Monitor signs for complications Atherosclerosis (HPN, MI, CVA) Microangiopathy (affects small minute blood vessels of eyes and kidneys) HPN and DM major cause of renal failure Gangrene formation Shock due to dehydration -peripheral neuropathy diarrhea/constipation -sexual impotence 8. Institute foot care management instruct client to avoid walking barefooted instruct client to cut toenails straight instruct client to avoid wearing constrictive garments encourage client to apply lanolin lotion to prevent skin breakdown assist in surgical wound debriment (give analgesics 15 30 mins prior) 9. Instruct client to have an annual eye and kidney exam 10. Monitor for signs of DKA and HONKC 1. CATARACT 2. Perimetry 3. Gonioscopy D. Treatment 1. Miotics constricts pupil a. Pilocarpine Sodium, Carbachol 2. Epinephrine eyedrops decrease formation of aqueous humor 3. Carbonic Anhydrase Inhibitors Acetazolamide (Diamox) promotes increase outflow of aqueous humor or drainage 4. Timoptics (Timolol Maleate) E. Surgical Procedures

1. TRABECULECTOMY (Peripheral Indectomy)

drain aqueous humor

Decrease

opacity of lens

A. Predisposing Factor 1. Aging 65 years and above 2. Related to congenital 3. Diabetes Mellitus 4. Prolonged exposure to UV rays B. Signs and Symptoms 1. Loss of central vision C. Pathognomonic Signs 1 Blurring or hazy vision

2 Milky white appearance at center of pupils

3 Decrease perception to colors is blindness
Complication

D. Diagnostic Procedure Macular Degeneration 1. Opthalmoscopic exam

Treatment 1. Mydriatics (Mydriacyl) dilating pupils 2. Cyclopegics (Cyclogyl) paralyses cilliary muscle Surgical Procedure Extra Intra Capsular Capsular Cataract Cataract Lens Lens Extraction Extraction - Partial removal - Total removal of cataract with its surrounding capsules