COURSE OUTLINE:

SYMPATHY
1. Therapeutic Communication
2. Non-therapeutic Communication Nurse 2: “I know what it felt like to lose a sister, I lost
3. Nurse patient relationship mine when I was six”
4. Professional relationship
5. Phases of Nurse-Patient Relationship
6. Coping Mechanism OFFERING SELF
a. Crisis ● I”ll sit with you for awhile”
b. Crisis intervention
7. Freud’s structural theory of personality SILENCE
a. ID ● Always maintain eye contact
b. EGO
● PT: Organize his thought
c. SUPEREGO
8. Symptomatologies of Mental Disorder ● RN: Observe for non-verbal cues
a. Disturbances in Perception ● When initiating communication: Sit with the client
b. Disturbances in Thought and stay silent
c. Disturbances in Affect ● How are you going to initiate a conversation with a
d. Disturbances in Memory patient? Give a broad opening (How are you
9. Behavioral Management feeling today?)
a. Withdrawn Client [AAA]
b. Depressed Client [SOME]
c. Suicidal Client [GCASH] BROAD OPENING
d. Paranoid Client ● How are you feeling today
e. Manic Client ● Is there something you’d like to talk about?
f. Manipulative Client ● Patient: Choose the topic!
g. Aggressive Client
h. Assaultive Client EXPLORING
10. Neurosis
● Tell me more…
a. Anxiety
b. Generalized Anxiety Disorder ○ 99% will be the correct answer
c. Obsessive Compulsive Disorder ● Good replacement or alternative to the question
d. Phobic Disorder WHY
e. Somatic Symptom Illness ○ Why= non-therapeutic!
f. Factitious Disorder
g. Cyberchondria RESTATING
h. Post traumatic Stress Disorder
● Client: “I can’t sleep. I stay awake at night”
i. Dissociative Disorder
j. Depersonalization vs. Derealization ● Nurse: “You have difficulty sleeping”
k. Eating Disorder ● Conveys understanding = Increase confidence of
l. Personality Disorder the patient to express more
m. Substance Abuse Disorder
11. Psychosis VERBALIZING THE IMPLIED
a. Schizophrenia ● CLIENT: it’s a waste of time talking to anyone//”
b. Major Depressive Disorder
c. Bipolar Disorder ● Nurse: Do you feel that no one understands?
d. Dual Diagnosis ○ Assertiveness → to be able to express
something without getting too emotional
REFERENCE
Toprank – Kenneth Arzadon SEEKING CLARIFICATION
● Client: im feeling sick inside (Sick – can mean a
lot)
PSYCHIATRIC NURSING ● Nurse: What do you mean by feeling sick inside?
THERAPEUTIC COMMUNICATION ○ Never ASSUME
EMPATHY
● Always clarify and understand the feelings of the
● Better therecomm
patient
● Focus on the PATIENT’S FEELINGS

TRANSLATING INTO FEELINGS

Nurse 1: “I Feel sorry for you” = SYMPATHY [RN’s ● Client: “I’m way out in the ocean”
feelings] ● Nurse: “You seem to feel lonely”
● Client: i am in cloud 9
Nurse 2: “I see you are sad” = EMPATHY [Patient’s
● Nurse: Are you feeling happy today?
feelings]
○ Always perform reality check

Nurse 1: “It must have been very difficult for you to

lose your sister when you needed her the most” =

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

PLACING EVENTS IN SEQUENCE

patient?
● Good alternative in WHY – BECAUSE PT MAY a. “I dont’ think your parents would agree
FEEL OFFENDED WITH WHY to your decision of leaving the
● Describe where you were and what you were university” – DISAGREEING
doing when you collapsed b. “Tell me more about your discharge
● Cause & Effect plans.”
c. Let’s discuss something more
interesting
IDENTIFYING THEMES
d. “That seems to be a well-thought idea.”
● “What comes into your mind each time you….?” – AGREEING
● “What do you do each time you argue with your
wife?” 2. A client diagnosed with terminal cancer says to
○ Identifying patterns of thought of patient the nurse, “I’m going to die and I wish my family
○ Thoughts Will always influence behavior would stop hoping for a cure! I get so angry
● Cognitive behavioral therapy when they carry on like this. After all, I’m the
one who’s dying.” Thich response by the nurse
○ Manage and correcting first the thinking to
is therapeutic?
be able to correct the behavior of the a. “Have you shared your feelings with
patient your family?” – Follow up QUESTION
ONLY
REFLECTING b. “I think we should talk more about your
● Client: “Do you think I should tell my dad?” anger with your family.” –
● Nurse: what do you think would work best? REDIRECTING NA WE SHOULD TALK
● Nurses are not allowed to: Agree, disagree, argue, MORE
c. “You’re feeling angry that your
challenge, suggest, give your own opinion (DO family continues to hope for you to
NOT) be cured?”
○ Give the question back to the client!! d. “You are probably very depressed
● GOAL: Independent decision making opportunity which is understandable with such a
○ Should learn how to make decisions na diagnosis– ASSUMING “DEPRESSED”
hindi iniisip yung thoughts ng ibang tao 3. A depressed client discussing marital problems
with the nurse says, “What will I do if my
husband asks me for a divorce?” Which
FORMULATING A PLAN response by the nurse would be an example of
● “What could you do to let your anger out therapeutic communication?
harmlessly? a. “Why do you think that your husband
● Anger Management! will ask you for a divorce?” – WHY IS
ALWAYS NON THERA COM
SUPPORTIVE CONFRONTATION b. “You seem to be worrying over nothing.
I’m sure everything will be fine.” –
● “I know this isn’t easy to do, but I think you can do
“WORRYING OVER NOTHING” IS
it.” INVALIDATING FEELINGS OF PT
● “It would be difficult at first, but you’ll get through (ANG MAHIRAP SAYO, ANG
it” PUEDING IBA SA IBANG TAO)
● Both are toxic positivity! – acknowledge first the c. “What has happened to mkae you think
feelings, before motivating!!!! that your husband will ask for a
○ You sound lonely..” divorce.” – CORRECT! BETTER WAY
TO DET WHAT HAS HAPPENED
○ You seem to be frightened…”
(ASKING FOR REASON W/O SAYING
■ Acknowledge first!!!! “WHY”)
■ Never ever compliment!! d. “Talking about this will only make you
■ I can see that you comb your hair more anxious and increase your
today.. (not compliment, just depression.”
acknowledge) 4. The experienced nurse is orienting a new nurse
on a mental health unit. Which intervention
should the nurse suggest when attempting to
ENCOURAGING COMPARISON establish a therapeutic relationship with the
● What is different about your feelings today? newly admitted client diagnosed with major
● Evaluation! depressive disorder?
a. Sit with the client in silence – A! IT
NON-THERAPEUTIC COMMUNICATION WITH CLIENT IN SILENCE
STEREOTYPING b. Invite the client to attend an exercise
● Just have a positive attitude class
c. Ask the client to join others to watch a
2-hour movie
REASSURING
d. Ask the client how his or her day should
● Everything will be alright be scheduled
5. After the first psychotherapeutic session, a
REQUESTING AN EXPLANATION patient was found to be weeping bitterly,
● Why pounding the bed and shouting, “I can’t
● Say “Tell me more…” remember anything.” The nurse responds by:
a. Patting him reassuringly on the back
and saying “I know it’s hard to bear.”
1. Which of the following statements by a nurse b. Sitting in the room and listening
working in a psychiatric facility would promote attentively – YOU DO NOT HAVE TO
an effective exchange of information with a SAY ANYTHING, JUST LISTEN

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

ATTENTIVELY
c.Sitting beside him and saying “Your
memory will probably return soon.”
d. Stand in front of him and saying gently,
“Stop crying, how can I help?”
6. The patient says, “I’m less of a man since I’ve
been taking my Elavil.” Which of the following
responses by the nurse would be therapeutic?”
a. “Are you saying that the medication
interferes with sexual intimacy?” ALL
OTHER OPTIONS ARE CORRECT, UT
FIRST MAKE SURE NA YOU
UNDERSTOOD THE CLIENT'S
STATEMENT
b. “Compliance with the medication is the
most important issue here.”
c. “When was the last time you had sex.”
d. “Are you involved in an intimate
relationship now?”

NURSE-PATIENT RELATIONSHIP
● Most important element: ACCEPTANCE!
● Purpose: To help the client develop new &
effective coping mechanisms
7. After a few minutes of conversation, a client ● To facilitate a helping relationship
wearily asks the nurse, “Why pick me to talk to
you when there are so many other people PROFESSIONAL RELATIONSHIP
here.” Which reply by Elisa would be best?/ ● Elements of a contract:
a. “I’m assigned to care for you today if ○ Time, duration and venue of sessions
you’ll let me.” ○ Termination and criteria for termination
b. “You have a lot of potential, and I want ○ Nurse’s and patient’s responsibilities
to help you.” – COMPLIMENTING
○ Participants
c. “Why shouldn/t I talk to you and not the
others?” – WHY IS WRONG!
d. “You’re wondering why I’m PHASES OF THE NURSE-PATIENT RELATIONSHIP
interested in you, and not the [PEPLAU]
others.” BEST ANSWER – MAKING PRE-ORIENTATION
SURE YOU UNDERSTOOD THE PT ● Goal: Introspection = Process of self-awareness
8. The client teSS – EMPATHY → MORE ON ● Self-Awareness:
ACKNOWLEDGING FEELINGS OF PT! ○ Resolve past conflicts = Acknowledge
a. S own limitations
b. EMPATHY STATEMENT
○ Explore own feelings/thoughts
○ Determine preconceptions
○ These 3 will give us a
NON-JUDGEMENTAL ATTITUDE
○ Write an Autobiography [Binabalikan mo
yung mga nangyari before] = We all have
repressed feelings → We have to resolve
these first! = So we won’t be affected on
the events that has happened to the
patient
● The nurse needs to read the chart of the patient
9. DD
[cover-to-cover]
a. FOLLOW UP Q
b. – DO NOT INCLUDE YOURSELF ● Problem: Reluctance of the Nurse
c. – BETTER BECOS U ARE
ACKNOWLEDGING (W/O 1. The nurse is to care for a client who is
COMPLICATING)
d. – DO NOT INCLUDE YOURSELF homosexual, What is the most important thing
10. SS that the nurse should undergo first before
a. CONSENSUAL VALIDATION (TAMA initiating client interaction?
BA PAGKAKAINTINDI KO? TAMA BA a. NURSE SHOULD EXPLORE OWN
PAGKAKAKITA KO?” FEELINGS ON HOMOSEXUALITY
b. “DESCRIBE TO ME YOUR REL W/ 2. What should the nurse undergo first in
YOUR SON A FEW DAYS AGO
maintaining professionalism and ethical sound
c. SS
d. “GO ON…” judgement who is highly aggressive?

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○ in the 6 weeks i was with u, these are

a. SELF AWARENESS & EXPLORE
what we did...
OWN FEELINGS
● (TESTABLE) Power of Verbalization! → How do
you feel about the upcoming termination of our
ORIENTATION PHASE relationship? (Para malabas niya ang anxity niya
● First face-to-face contact with the client and thoughts)
● Formulation of nursing diagnosis
● Goal: Establish Trust
On the last day of the nurse client relationship, the
○ Rapport = More on a trusting relationship
client suddenly got mad, shouts and curses at the
[Magandang pagsasamahan]
nurse. What would be appropriate action
● Mutually set the contract = Regular meeting
a. Inform the physician
schedules that are set by the nurse & patient
b.
● Congruence = When the words of the nurse are
c. Normal Response to termination
congruent or parallel to his/her actions!
● Involve the client in planning
○ People will cooperate if they will benefit
on the activity
COPING MECHANISMS
CRISIS
● Problem: Resistance of the patient
● When coping mechanisms are ineffective that
results to disequilibrium
WORKING PHASE
● Longest phase
SITUATIONAL
● Most of the communication happens here
● D/t unexpected events
● Goal: RN [Explores] | Patient [Verbalize]
● Ex. loss of job, death of a loved one, illness
● Problem: Emotional Attachment
○ Transference → Patient to Nurse
ADVENTITIOUS
■ Kamuka mo yung girlfriend ko,
● AKA Social Crisis
Ang bait mo (+)
● D/t natural catastrophe
■ Ikaw nurse ko? Kamuka mo yung
● Ex. Earthquake, fire, tornado, war, pandemic,
babae na umagaw sa asawa ko
social crisis (rape, war, pandemic)
(-)
○ Social → It affects social relationships
○ Countertransference → Nurse to Patient
■ Sino ba nasa counter? → NURSE
MATURATIONAL
■ (+) Your patient looks like your
● “Developmental”
granfather “I will be with you from
● Caused by expected events
1-3pm pero super napalapit loob
● Ex: Menarche, marriage, pregnancy, retirement
kaya ginawa mong everyday
1-5pm”
CRISIS INTERVENTION
■ (-) Kamuka ng patient niya yung ● Helping the patient totally move forward
nanay niya na lasingera na iniwan ● Highly testable!
sila nung bata sila! ● Patient a & B both lost their husband → Not both
● How to manage these problems? of them will have CRISIS (different ppl, have
○ Remind the patient about the contract different effects)
■ Mr. Cruz, I am your nurse and
you are my pt, we need to PRIORITY ASSESSMENT
maintain a professional ● Priority (highly testable):
relationship. ○ Client perception/feeling regarding
○ Redirect the feelings of the patient situation → #1
■ …But Let's talk about how you ○ Support system (fewer ss may lead to
can make new friends at home crisis)
○ Establish boundaries! ○ Coping mechanism
● Duration of Crisis: 4-6 weeks [self-limiting]
TERMINATION PHASE ● Goal: To help patient return to pre-crisis level
● Goal: Evaluate effectiveness of interventions ● Focus: Here and now (highly testable)
● Problem: Separation Anxiety → NORMAL ○ Focus on immediate feelings (problems &
○ (+) Mukang babalik ako sir kasi di ko pa alternative): “how are you feeling now?”
kaya ng wala tulong mo → Hindi pa ○ Gestalt therapy → focus on the here and
handa maglet go now, rather than the past & future
○ (-) Sige! Umalis ka na! → Using ● Approach: Directive & Supportive
egocentrism, pinagtatakpan kalungkutan ○ Directive → Education: Stress
● Constantly remind pt about the contract management!
○ Mr. Cruz i will be your nurse for 6 weeks,
every 2pm
○ This will now be our 5th session, when i Situation: Latest death toll in the Philippines due to
come back next week, that will be the last corona virus after Easter 2021 was 13,425. It was so
time we meet scary that within a year this COVID 19 virus takes
● Remind patient about what was accomplished its toll. The nurse must understand the importance

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

i. Dahil iniisip niya na lagi pag nasa

of self awareness and competencies in helping
mataas na lugar, masaktan ulit siya
patients and families during bereavement.
○ Phobic disorder : Fears the idea that is
As a nurse which of the following are the critical factors
associated on the event or the object
for successful integration of loss during the grieving
6. REACTION FORMATION
process?
○ Expressing opposite of your true emotions
A. The patient's predictable and steady movement
○ Ex. hug someone you hate
from one step of the process to the next
i. Galit ka sa mother in law mo, pero
B. Accurate assessment and intervention by the
pinapakitaan mo pa rin ng mabuti
nursing or supporting person
○ Common in Bipolar disorder
C. The nurse's trustworthiness and healthy
i. Main problem: Depression
attribute about the grief
ii. Main Manifestation: Mania →
D. The patient's adequate perception, adequate
Hyperactivated
support, and adequate coping →
iii. Since yung patient sad talaga
PERCEPTION, ADEQUATE SUPPORT,
siya pero pinapakita niya na
ADEQUATE COPING
happy siya
*Mindset: Answer the questions based on the principle
7. UNDOING
based on crisis intervention. Use 3 assessments:
○ Doing something to relieve feelings of guilt
Perception; support system; coping mechanism
○ Bumabawi
*Crisis intervention → Always the here and now!
○ Obsessive compulsive disorder
(gestalt therapy)
i. He/she is checking the lock of the
door before leaving the house na
FREUD’S STRUCTURAL THEORY OF paulit ulit baka kasi manakawan
ulit sila
PERSONALITY 8. SUPPRESSION
● Intrapersonal Theory → Sarili ang kalaban ○ More on Sinasadyang/Conscious forgetting
○ Anorexia Nervosa: They suppress their
ID hunger
● Pleasure seeker ○ “I don’t want to talk about it”
○ Needs immediate gratification 9. REPRESSION
BORDERLINE ○ Unconscious forgetting
● Dapat lagi mapagbigyan, magagalit kung hindi ○ Dissociative Amnesia → Nagahasa ka
○ “I can’t remember”
ANTISOCIAL 10. DISSOCIATION
○ Disconnection of feelings
○ Post traumatic stress disorder
EGO ○ “I don’t care”
● Balancer
11. RATIONALIZATION
● Reality; the real you
○ Distortion of facts
● Ego defense mechanism: Protect self / Anxiety
○ Antisocial → Pasaway [Rapist, Magnanakaw
feeling
etc.] → Nagda-dahilan palagi
i. Unjustifiable excuse
SCHIZOPHRENIA
12. INTELLECTUALIZATION
● Ego can no longer balance
○ Disregarding the emotional aspect of a
● Splitting of soul
situaition
● Ambivalence → Opposing feelings
○ Stress & Anxiety
○ It is God’s will / It is destiny
DEFENSE MECHANISM
13. SPLITTING
1. DENIAL
○ Viewing people of events as either good or
○ Refusal to accept the truth [Alcoholism]
bad
2. REGRESSION
○ Pag pinagbigyan mo ko = friends tayo
○ Return to earlier stage of development
○ Pag di mo ko pinagbigyan = magkaaway tayo
[dementia & Schizophrenia]
○ Borderline personality disorder
3. INTROJECTION
14. SUBSTITUTION
○ Blaming self
○ Replacing unattained goals with by one that is
○ Major depressive disorders
more attainable
4. PROJECTION
○ Big to small / Hight to low
○ Blaming others
i. Dream → RN, pero di ka makapag
○ “Di ako naging cum laude kasi yung dean
aral, you are currently working as a
namin ayaw sakin” (Binintang mo sa iba)
BHW
○ Paranoid disorders
15. COMPENSATION
5. DISPLACEMENT
○ Babawi ka ng bongga sa ibang field
○ Redirection of emotion
○ Overachieve in another area to compensate
○ AKA kick the cat phenomenon → Kung galit
for failure
ka sa jowa mo, yung pusa ang sisipain mo”
○ Small to big
(Napagbalingan mo ang iba)
○ Pacquiao di nakapagtapos ng pag aaral kaya
○ Acrophobia: Fear of heights
nag-overachieve sa boxing

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

16. SUBLIMATION ● D → Divert the attention

○ Rechanneling of unacceptable impulse to ○ … let me accompany you at garden and
acceptable once lets look at the flowers
○ Bad to good ● E → Engage in reality-based activity
○ You dreamt of becoming a serial killer, but you ○ I can see you are afraid, but i do not see
know that it is bad. You are now currently a any headless being
director and directing a movie about ○ Playing cards, Gardening [part of reality]
violence/murder ● R → Reintegrate with the milieu
17. IDENTIFICATION ● TALK BACK TO THE VOICES
○ Adopting the behavior of a person that you ○ Let the client practice saying “GO AWAY”
like or dislike ○ A schizophrenia pt ca still live a normal
○ You’re mad at your friend na maarte, tas life given that they take their medications
naging maarte ka na
○ Stockholm Syndrome: Nangrape ka kasi SYNESTHESIA
nirape ka before ● Mixing of senses → Hear colors and see scents
i. Binugbog ng nanay ang mga
anak niya kasi binugbog din siya DELUSION
ng nanay niya ● False belief

SUPEREGO
GRANDIOSE Superiority or invulnerability
● Conscience; guilt
● Little voice of God PERSECUTORY To be harmed by others
● Guilt feelings
SOMATIC Bodily functions are abnormal
ANOREXIA NERVOSA
● Guilt feeling na mataba sila NIHILISTIC A part of body is missing

EROTOMANIC Loved by a person / entity

OBSESSIVE COMPULSIVE
● Guilt feeling na makahawa → Hugas ng hugas IDEAS OF Giving meaning to events or actions of
REFERENCE / other
SYMPTOMATOLOGIES OF MENTAL REFERENTIAL
DELUSION
DISORDER
DISTURBANCES IN PERCEPTION MANAGEMENT FOR DELUSIONS
ILLUSION ● C → Clarification of meaning
● Misinterpretation of External stimulus ○ Wag kang lalapit sakin, kasi mamatay ako
● Stethoscope = snake → Clarify!
● A → Acknowledge the feelings
HALLUCINATION ○ Validate (Used in boards)
● Misinterpretation of SENSORY stimulus ○ I can see that you are frightened but you
● Visual [Psychedelics]: Marijuana Use are safe here/but i don't see it that way
● Tactile [Formication]: Alcohol withdrawal ● V → Voice doubt
○ May gumagapang pero wala ○ The nurse did not directly disagree with
○ Testable – Saan common ang tactile edi the delusion, but voice doubt!
alcoholism ○ Use “I don’t see it that way or I find it
● Olfactory [Phantosmia]: PTSD hard to believe”
○ Our emotions are connected to our sense ● E → Engage in reality-based activities
of smell ● DEMENTIA: IGNORE & DISTRACT
● Gustatory [Aura of Seizure]: Metallic taste ○ Apo halika ka parating na ang hapon →
● Auditory [Command Auditory]: Paranoid Ignore and distract “lola tara na kakain na
Schizophrenia tayo”
○ Most dangerous because he/she hearing ○ Dementia is a clinical diagnosis
voices to commit suicide or murder
DISTURBANCES IN THOUGHT
MANAGEMENT FOR HALLUCINATIONS DISORGANIZED THINKING
● H → Hallucinations must be recognized 1. CIRCUMSTANTIALITY
○ If pt is mumbling: “are you hearing voices a. Fullness of detail
again? – Yes. b. Circular → Paikot ikot but Pt answered
● A → Assess the content the question
○ To know if there is a need for suicide or 2. TANGENTIALITY
safety precautions a. Nag Paligoy-ligoy di naman nasagot yung
○ “What are the voices tellig you?” – To tanong mo
know if the client will kill, or kill herself b. Lack of focus
○ Highly testable! 3. LOOSENESS OF ASSOCIATION
● R → Reality presentation [DERAILMENT]
○ I know the voices are real to you but i dont a. Fragmented ideas
hear them.. b. Walang connect/walang kuwenta sinasabi

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

c. Irrelevant CONFABULATION
d. “Kumain ako ng isda, tas ang traffic traffic ● Making stories that are not true to fill the gap
sa edsa then umulan ng malakas between memory loss
namatay mga isda”
4. FLIGHT OF IDEAS
a. Rapid speech, jumping from one topic to
another

UNUSUAL SPEECH PATTERNS

Neologism Coining of new words
→ Ask the meaning! ● Visual hallucination – nakita niya raw ang
Ex. Passimpable (Possible & nanay niya (multo)
Impossible)

Schizophasia World salad (Orange mother pen)

BEHAVIORAL MANAGEMENT
Clang World salad but RHYMING words ● TESTABLE! BULK OF THE MAY 2022 NLE
Associations
WITHDRAWN CLIENT [AAA]
Echolalia Repeating words of OTHERS ● Alone, Aloof & Catatonic d/t low self esteem

Palilalia Repeating OWN words ACTIVE FRIENDLINESS

● A – Activity
Stilted Use of FLOWERY words
Language ○ Give non-competitive but productive
activities to prevent client from loosing
Preservation Adherence to a single topic ○ Ex. fold linens, water plants → Tasks to
be completed = Self-worth
DISTURBANCES IN AFFECT ● A – Accompany
● Affect: Outward expression of your mood ● A – Appraise
[External] ○ NO TO Material rewards → So that
● Mood: Internal emotions! (What you feel INSIDE) whenever she finish task, her self worth
● Ex. Sad (Mood), Pouting face (Affect) increases, not material gain
○ Focus: Increase self worth
FLAT No emotional response
Common in pt with CATATONIA
DEPRESSED CLIENT [SOME]
(Waxy flexibility)
● Mothering role
BLUNT Minimal emotional response
Common in Major Depressive KIND FIRMNESS
Disorders ● S – SILENCE
● O – OFFERING SELF
INAPPROPRIATE Emotions are opposite to the ● M – MOTIVATE → Recall previous achievements
context of the situation
● E – ENGAGE IN
Ex. Sad story but pt is laughing
Common in Schizophrenia ○ Highly structured / Scheduled activities!
■ Ex. Baking [Step by step activity]
RESTRICTIVE Singe emotional response ○ Must always be SCHEDULED
Ex. Palaging galit the whole day ○ Provide distractions !
Common in Paranoia
SUICIDAL CLIENT [GCASH]
LA BILE Sudden shift of emotions ● G → Giving of valuables
Common in Bipolar Disorder
● C → Cancellation of appointments
*During the board exam, do not answer based on the ● A → Apologetic
disorder, always answer based on the actual ● S → Sudden cheerfulness & increase in energy /
MANIFESTATION. Seems satisfied & detached
○ When patient start saying that he’s okay
DISTURBANCES IN MEMORY and ready to go home → Close
AMNESIA monitoring (Most likely will forego suicide)
● Loss of Memory ○ Acute phase of depression: unlikely to
1. RETROGRADE suicide; pt has absence of energy
● Inability to recall memories formed BEFORE the ○ When antidepressant works brings
event that cause the amnesia increased energy: High likeliness to
● Reminiscence therapy → Give the client photos suicide
or listen to music to get back the memory ● H → Homicidal & suicidal thoughts
○ Music is the last to be forgotten ○ Suicidal person kills whole family first
before killing herself, because they think
2. ANTEROGRADE family is a part of them
● Unable to make new memories AFTER traumatic
event ● Most common time: Early morning, Monday,
● Reorient patient → Use clock & calendar During endorsement

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○ Wala pa gising ○ Let the patient open the food container by

○ Start of the week himself
○ RN are all busy! ○ Let the client open the medicine pack IN
● Gender FRONT of the nurse
○ Attempt: Female ● A → Avoid staring, whispering and giggling
○ Death: male ● R → Respect personal space (not < 4 feet)
● Age ● M → Maintain professional tone
○ Attempt: 18-25 yo → Age where ○ Giving food to paranoid client: i wont eat
developmental pressure is highest because may lason yan → RN: use
○ Death: 75 yo and above SIMPLE WORDS (direct, clear, concise)
● Civil status: Single → Absence of support system “walang lason ang pagkain, iwan ko dio
● Important factor to consider: Substance abuse! kumain ka kung magugutom ka na”
○ TIP: Basta behavioral management
DIRECT CONFRONTATIONAL APPROACH question → Always choose, simple,
● C → Confront the client directly direct, clear, concise answer
○ Clarify and then directly confront pt “What
do you mean when you say you want to MANIC CLIENT
die and finish everything? ● Hyperactive Impulsive, and destructive
● C → Consider the plan, method, lethality ● SET: FIRM LIMITS! → How to deal w/
○ “How, when, where are you planning to hyperactive, impulsive, destructive
kill yourself? ○ Point out unaccepted behavior
■ Most important: WHEN → To ○ Inform client of what is expected
know when you need to intervene ● Room: Private
/ closely monitor ○ Di puede may kasama, may show abuse
● C → Contract of safety to other patients
○ No suicide Contract: “I will not harm ● Activity: Non-competitive; Solitary; Gross Motor
myself intentionally or accidentally with Activities
the next 24 hours” ○ Baka if natalo, mambugbog
■ Effective → If pt informs the nurse ○ Mag-isa lang
of increasing anxiety ○ Cleaning the room → Redirect the energy:
■ “Hindi lahat ng namamatay, ay ■ Writing or drawing in a journal
gusto mamatay, consider demons (OUTLET OF EMOTIONS) →
telling them to die (Cannot fight Give crayons
urge) ○ Triggering factors:
○ Confiscate dangerous objects (Belt, bottle ■ Watching TV
of coke ■ Reading newspaper
● C → Constant Observation ■ Listening to radio
○ Irregular intervals → Pt will notice your ● Diet: High in calories; finger food
monitoring patter and try to suicide at ○ French fries, peanut butter sandwich!
intervals ● Pt removed all clothes in public – Approach client,
○ One on one supervision is the SAFEST and bring immediately to room
answer → Dahil di mo iiwan at andun ka ○ Embarrassing for pt if you put on clothes
lang babantayan mo siya = Should not be in the crowd
more than 1 METER away
■ Patient may run or jump MANIPULATIVE CLIENT
● C → Create a list of support system ● Demanding, Making a lot of request
○ Discharge planning for suicidal? = Give ○ 12MN asking for phone → SET LIMITS
suicide / crisis hotline ● Matter of fact approach
● C → Counsel the family ○ Consistently – SET FIRM LIMITS!
○ Educate suicidal cues! ● Calm, Non-threatening, directive tone
○ Tell patient what he should do next
○ Point out the unacceptable and
A client states that she hears God's voice telling her acceptable behavior
that she has sinned and needs to punish herself?
Which response by the nurse is most important?
a. "How do you think you will be punished?” AGGRESSIVE CLIENT
b. "Please tell staff when you think you need to ● Verbally abusive
punish yourself." → Always tell the nurse ● Decrease stimulation! → Turn off TV; let other pt
WHEN you feel suicidal leave room
c. "What exactly do you think you have done to be ● Deescalate: Verbalization
punished?" ● Directive approach: Calm, non threatening
d. "Let's talk about your strengths." ○ “Profanity and shouting is not tolerated
inside the building, if you have concerns,
PARANOID CLIENT [DISARM] you can talk to us nicely” (Sabihin mo na
PASSIVE FRIENDLINESS mali siya, and tell him what to do)
● D → Develop Trust ● Show of Force!
● I → Involve the client ○ Visibility of 4-6 staff members
● S → Sealed container (food & medicine) ■ Not allowed to talk and touch

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

■ Only the nurse assigned is ○ Adequate circulation must be ensured

allowed to talk to the client (Q2HRS)
● Principle in psych nursing: Ppl who are able to ○ Anchor on a stable part of the bed (BED
verbalize are less likely to be aggressive or FRAME)
assaulted ● According to AGENCY/PROTOCOL/HOPITAL
○ If client shows aggressiveness → Do not POLICY
show you are afraid but ready to talk,
Client is experiencing ventricular tachycardia. What is
maintain attention of pt – “Maria put the
the appropriate action of a nurse?
gun at the floor at magusap tayo
a. Administer lidocaine
makikinig ako”
b. Elevate foot of bed
c. Administer epinephrine
ASSAULTIVE PATIENT
d. Follow hospital protocol
● Physically abusive
● Goal of Management: To strengthen patient’s ● Doctor’s order [Removal]: REQUIRED
impulse control ● Proper removal
○ 2 RNs needed
○ Temporary – Alternately, one at a time for
ASSAULT CYCLE
10 minutes every 2 hours or according to
PHASE BEHAVIOR INTERVENTION agency’s protocols
■ Left arm → After 10 minutes
Triggering Non-Complia Encourage verbalization place it back
nce “I see that you are restless, ■ Right arm → After 10 mins place
do you want to share in the
it back
group?
■ Left leg → After 10 minutes place
Escalation Verbal Time out! it back
Aggression Quiet room ○ Permanent – Alternately one at a time
gardening

Crisis Physical Seclusion The nurse observes a client muttering to himself and
Violence Restraint → provide privacy pounding his fist in his other hand while pacing in the
don't let other patients see hallway. Which principle should guide the nurse's
him/her being restraint to action?
avoid embarrassing a. Only one nurse should approach an upset client
moments to avoid threatening the client.
b. Clients who can verbalize angry feelings are
Recovery Relaxation Asses for injury less likely to become physically aggressive.
c. Talking to a client with delusions is not helpful,
Post Crisis Reconciliatory Discuss alternatives because the client has no ability to reason.
Depression actions solutions d. Verbally aggressive clients often calm down on
their own if staff members don't bother them.
● Least to most restrictive form of control!!
When the nurse placed the patient in restraints before
SECLUSION using other methods of intervention, she/he violated the
● Pt has right to refuse treatment → Yes when patient's rights to.
stable/lucid, unless delusional (non stable) a. Receive confidential and respectful care
● Pt has right to confidentiality → Yes, unless they b. Provide informed consent
are a threat to self and others c. Receive treatment in the least restrictive
environment
● Informed Consent: REQUIRED! Even if verbal d. Refuse treatment
only
○ Implied consent → For non invasive /
simple procedures NEUROSIS
■ Ex. mam take ko BP mo, pag ● D/t Anxiety
inextend niya arm niya then thats
consent ANXIETY
● Room: Lockable and observable from the outside ● Neurotransmitter: Gamma Amino Butyric Acid
● Purpose: RESTORATIVE, NOT PUNITIVE (GABA)
● Goal: To help client regain self-control ○ “GABA nawala, lalabas ang kaba”
● Monitoring: One on one monitoring on the first ● Characteristics: Contagious
hour ● Initial nursing action: determine own level of
● Environment: Less stimulated environment [no anxiety → RN w/ panic attacks should avoid
visitors; phone calls] taking care of anxious pt
● Priority: SAFETY → Stay with patient
RESTRAINT ● DOC: Benzodiazepines (-lam / -pam)
● Doctor’s order [Application]: NOT REQUIRED ○ Diazepam, clonazepam, alprazolam
○ To follow / Must be obtained within 1 hour ● Nursing ED: AVOID ALCOHOL
○ “Standing Order” → Restraint as needed ○ Instruction to client receiving Clonazepam
● Informed consent: Required → Avoid alcohol (Respi depressant) +
● Proper Application: lam/pam drugs also depressant =
○ 6-8 staff members required respiratory arrest if combined

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

■ Necrophobia → fear of dead

MILD (Normal) Increase alertness
Learning is effective people
MANAGEMENT
MODERATE *Paikot-ikot (pacing) ● Flooding → Sudden exposure to max level
*Paikot-ikot *Paulit-ulit (Inc automatism = stimulus (Fear of heights - dalin mo sa eroplano)
(pacing) Echo/Palalia) ● Systematic Desensitization → Gradual exposure
*Paulit-ulit (Inc *Parasympathetic stimulation to feared object (fear of heights, 1st day 1st flr,
automatism = (Para-ihi;tae;dura)
2nd day,2nd floor)
Echo/Palalia)
*Parasympathe ○ 1st step: THINK & TALK about feared
tic stimulation object

SEVERE Cannot: SOMATIC SYMPTOM ILLNESS

● Solve problem ILLNESS ANXIETY DISORDER (IAD)
● Complete task ● AKA Hypochondriasis (last term used in 2013)
● Be redirected ● Disease conviction → fear that self has serious
SOMATIZATION
● Physical (Blindness, disease
Paralysis) ○ Ex. pt experiences REA headaches –
Thinks he has brain tumor
PANIC Delusion; hallucination; violence; ■ (+) Complaint
suicide ■ (-) medical finding
● Disease Phobia → fear that one will get a serious
INTERVENTIONS FOR ANXIETY disease
● R → Remove stimulus ○ Doctor shopping
● E → Env modification
● P → Protect client CONVERSION DISORDER (CD)
● E → Establish trust ● Anxiety converted to neurologic manifestation
● A → Accept coping mechanism ○ Blindness, paralysis (REAL in the
● T → Try other creative outlet absence of organic (physical) cause)
● Grounding technique → Do not lose control over ● New term (2022): Functional Neurological
self (Ground yourself) Symptom Disorder
○ Do not react to anxiety, tell yourself “Ken, ● La belle Indifference → Pt is not concerned w/
anxiety langyan, wag kang gumalaw, manifestation because they gain something from
mawawala an rin yan” s/sx
○ La belle → Beautiful
GENERALIZED ANXIETY DISORDER ○ Indifference → Ignore
● Anxiety > 6 mos ● Primary gain: Relief of anxiety or guilt
○ Swimming competition inc anxiety causing
OBSESSIVE COMPULSIVE DISORDER paralysis (happy so that he won't go with
● OBSESSIVE → Repetitive thoughts swimming)
● COMPULSION → repetitive actions ● Secondary gain: Attention
○ Allow px to perform “rituals”
● DEFENSE MECHANISM: Undoing NURSING DIAGNOSIS
● Ineffective coping → IAD
MANAGEMENT ● Ineffective denial → CD
● Allow px to perform ritual → Decrease anxiety & ● Ineffective role performance → Both
guilt
● Adjust schedule of px NURSING INTERVENTION
● gradually limit ritual ● Situation: Pt w/ SSI has abdominal pain at 4th
● Cognitive-Behavioral Therapy → Eliminate admission, all tests negative. What should you
obsession to eliminate compulsions (Mawala ang do? → Perform assessment because all
anxiety, mawala ang manifestation) manifestation of SSI are REAL so always assess
and r/o any organic cause!
PHOBIC DISORDER ○ Answer: Give medication for pain relief
● DSM 5 (3 Main Types) : Diagnostic & Statistical (Real and objective pain)
Manual ● R → Rule out any possible organic or physiologic
○ Social phobia cause
○ Agoraphobia → Fear of inescapable ● A → Attend to physical complaints
(OPEN) places (Soccer field) ○ Clients w/ anxiety do have palpitations.
○ Specific phobia What's your immediate action? →
■ Mysophobia → Fear of Administer beta blockers
contamination ● C → Consistent caregiver must be provided
■ Claustrophobia → fear of ○ Trust!
ENCLOSED spaces (MRI ● E → Encourage verbalization of feeling
machine) ○ In all anxiety disorders prioritize
■ Nosocomephobia → fear of verbalization UNLESS there is somatic
hospital symptoms (symptomatic attack)
■ Thanatophobia → fear of death

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

MEDICAL MANAGEMENT ● Ex. na rape sa PH, but nakarating sa Taiwan

● Selective Serotonin Reuptake Inhibitors (SSRIs) tapos wala na siya maalala (new identity, new
○ If question is about anxiety, trauma, eating country)
disorder then walang anxiolytic,
benzodiazepine automatic SSR sagot DISSOCIATIVE IDENTITY DISORDER
(anti-depressant) to inhibit reuptake of ● AKA multiple personality disorder
Serotonin (happy hormone) ● Host: Reality (Real you)
● Alter: other persona (not known by real you)
FACTITIOUS DISORDER ● Psychodynamics: Inconsistent Parenting Style!
● AKA Munchausen’s (Basta has to do with parenting!)
● Imposed on self/on others ● Resolution: Acknowledgement, Acceptance, and
● Intentional induction or FALSIFICATION of illness Verbalization (Mawawala lang ang theIr personas
○ Nagiinarte lang!!!! once magka-resolution)

MANAGEMENT DEPERSONALIZATION V DEREALIZATION

● SSRIs ● Brought by stress
● Verbalization! DEPERSONALIZATION DEREALIZATION

CYBERCHONDRIA Out of body experience Out of world experience

● Excess or repeated online searches for (parang nakaalis ka sa (para ka na lumulutang
health-related information katawan mo)

EATING DISORDER
● Psychodynamics: Parental
Harassment/antagonism/overprotective
parents/enmeshment (lack of boundaries)
○ Kailangan payat ako para may magmahal
sakin
○ Lahat nalang sa buhay ko pinakialaman
ng magulang ko, my weight is the only
control i have
C → Basta somatic symptom ASSESSMENT first! ● Sociocultural factor: developmental pressure
● Age group: Adolescent(18-24 yo)
POST TRAUMATIC STRESS DISORDER ● Neurotransmitter: (Same w/ Major depression)
● Cause: Rape, war, natural clamities Decreased Serotonin and Norepinephrine
● SURVIVOR’s GUILT → witness
ANOREXIA NERVOSA BULIMIA NERVOSA
MANIFESTATIONS
● > 6 yo: Hypervigilance, flashback, avoidance, Perfectionist Hunger anger cycle (Ayaw
dissociation, detachment self -imposed dietary kumain!) → lead to binging
● < 6 yo: repetitive play: Re-enactment restriction Binge-purge syndrome (Eating
Compulsive exercising → too many & too fast) → GUILT
Distract pt! EELING! → Purse (Stimulate
PSYCHOTHERAPY vomit)
● Defusing → education on stress & stress They don't refuse to talk to
management food (preoccupied w/ food) → Use of enema and laxatives
● Debriefing → ask emotional reaction to the They do calorie count!
incident They are knowledgeable *All following are complications
● Exposure therapy → confron trauma & associated about food (Do own research of bulimia nervosa except?
on calories) ● Tooth decay – D/t
thoughts rather to avoid
They do not acknowledge they purging HCL
● Adaptive disclosure therapy → empty chair have a problem (Even proud ● Hyperkalemia →
technique (Imagine mo na nasa kaupo siya of their eating pattern) wrong, should be
kaharap mo, pls tell him everyhing you want) They have ritualistic food hypokalemia!
● Catharsis → release repressed emotions through behavior (Cut into small ● Gastric ulcer
art & music pieces before eating) ● Rectal bleeding – d/t
enema
DSM5
MEDICAL MANAGEMENT
Alopecia *First to suspect bulimia
● SSRIs Anemia nervosa? → DEntist
Amenorrhea (Removed now) SUSPECT
DISSOCIATIVE DISORDER
DISSOCIATIVE AMNESIA Fatal! – Pt doesnt eat Normal body weight
● Unable to remember traumatic experience ● A client is seen doing vigorous exercise. What is
the RNs response
DISSOCIATIVE FUGUE → Invite the client for a walk (DISTRACT to forget
● Amnesia with sudden travel (bewildered anxiety!)
wandering)

RUSSELL SIGN

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

● Teeth markings on the back of palms or knuckles ● Age of diagnosis: Adolescent

from vomiting stimulation ● Age of improvement: 40-50 yo
CLUSTER A (ODD/MAD/ECCENTRIC)
NURSING DIAGNOSIS
● Electrolyte imbalance Paranoid Suspicious
● Altered nutrition
● Body image disturbance → Mostly associated in Schizoid Social isolation & Indifference (they
eating disorder ignore) can be seen in autistic child
○ Problem: person's perception of own body
Asocial
weight Alone
● Altered body image → If there's actual body Aloof
amputation/alteration
○ Amputation Schizotypal Superstitious w/ odd appearance
○ Mastectomy Believes in magic/lucky charms
○ Burns ● Teach them SOCIAL SKILLS

INTERVENTIONS CLUSTER B (BAD/ERRATIC)

● Plan meals with client
● Set time limit during meal Borderline Unstable emotion, unstable
● Supervise client after eating → Accompany pt to relationship
bathroom (baka isuka sa bathroom)
● LIMIT TIME ON SOCIAL MEDIA! Antisocial Lawbreaker
● Psychotherapy: Cognitive Behavioral Therapy →
Histrionic Attention seekers – uses body to be
Self-monitoring noticed
○ Food diary
○ Journal → Let the client associate her Narcissistic Self-entitlement
emotions with her environment! Siya pinakamagaling. Self centered
○ Nagbago ang kanyang eating pattern ● Set firm limits to px
because nabago mo ang kayang behavior

CLUSTER C (SAD/FEARFUL/ANXIOUS)

Avoidant Sensitive to criticism

Avoid responsibility

Dependent Extreme submissiveness

Depend on other for decision making
● Evaluation: Normal BMI (18.5 - 24.9)
Obsessive Extreme neatness & perfectionism
○ Asian BMI (18.5 - 22.9) Compulsive Lahat dapat maayos
● Medical treatment: SSRIs
Passive Negativistic (Indirect expression of
Aggressive feelings)
Paasa at Plastic
● Fear of failure, criticism, rejections
● Intervention: Cognitive Restructuring (CBT)

MANAGEMENT
● BEHAVIORAL THERAPY
● GOAL: help client reintegrate / community,
*Always prioritize the physiological manifestation establish meaningful relationships and find as
stable job
● Role playing!

SUBSTANCE ABUSE DISORDERS

● Abuse → drug use that is inconsistent w/ medical
or social norms
● Intoxication → results in maladaptive behavior
● Dependence → unsuccessful attempts to stop
Eliminate now the B, D is short term. Electrolyte using substance
imbalance – hypo K – Arrhythmia – Death ○ “Pagdi ako umiinom araw araw kasi
64 – C is answer manginginig ako kapag hindi”
● Contributing factor: Genetics & family dynamics

NARCOTICS (DOWNERS)
● Purpose: to escape reality
● Commonly used narcotics (OPIOIDS/ IV Pain
Meds):
PERSONALITY DISORDER ○ Codeine

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

○ Herdin ■ Pt is high, then suddenly stops

○ Oxycodone (withdrawal) → Depression! →
○ Morphine Suicide..
○ Meperidine ● Medical management: Bromocriptine (Parlodel) →
● Worst complication: HIV / Hepa B d/t sharing of Decrease craving of drug!
needles
● Signs of Abuse (Dec v/s) HALLUCINOGENS
○ Hypotension ● Purpose: To cause hallucinations
○ Bradycardia Most commonly abused hallucinogens:
○ Bradypnea ● Cannabis Sativa (Marijuana) → Bloodshot eyes
○ Pupil constriction (Inc blood flow to eyeballs)
● Sign of narcotic overdose: PINPOINT Pupils (dot ○ MJ → Weight gain (Obese)
like pupil) ● Lysergic Acid Diethylamide (LSD) → Synesthesia
● Detoxification: Methadone – Med assisted ● Phencyclidine (PCP) → Violence
therapy ● Ecstasy (XTC)→ Aggression
○ Safe withdrawal ● Transient Hallucinations: up to 5 years (Visual
○ A low potent opioid hallucinations)
○ Dose will be given by MD!
● Antidote: Naloxone (Narcan) ; Naltrexone (Revia)
○ They block the effect of narcotics!
● Early signs of withdrawal:
○ Lacrimation
○ Diaphoresis
○ Rhinorrhea
○ Yawning
○ DOWNERS → DRYNESS → During
withdrawal → WET s/sx!
● Late signs of withdrawal: Vomiting & diarrhea \
ALCOHOLISM
BARBITURATES (SEDATIVE HYPNOTICS) ● Effects of alcohol: Sedation (Large amounts)
● Purpose: To cause sedation ● Defense mechanism: Denial
● Commonly abused barbiturates: -lam / -pam
(Anxiolytics) ; -barbitals (Phenobarbital) AVERSION THERAPY → Pair a behavior wih an
● Detoxification: unpleasant stimulus (Ex. smoking, sasampalin mo sarili
○ Flumanezil (Romazicon) → Anxiolytic mo)
○ Activated charcoal → Phenobarbitals ● Purpose: to stop alcoholism or MAINTAIN
● Signs of withdrawal: Anxiety! SOBRIETY (No alcohol)
● Drug used: Disulfiram Antabuse
STIMULANTS (UPPERS) ○ Disulfiram + Alcohol → HA, vomiting,
● Purpose: To cause euphoria flushing, abdominal pain, palpitations,
● Signs of abuse: mental disorientation
○ Hypertension ● Assessment: When was the time of last intake
○ Tachycardia ○ Wait for 8hrs before giving disulfiram! →
○ Tachypnea To eliminate alcohol in circulation
○ Pupil dilation ○ Increase OFI during waiting time for
● Methamphetamine flushing
○ Shabu! (Acid) → Common in night shifts ● Contraindication: Anything with alcohol
(Di makatulog, Di makakain) – weight ○ Mouthwash
loss! ○ Cough suppressant
○ Signs of abuse:
■ Dec appetite STAGES OF ALCOHOL WITHDRAWAL
■ Insomnia
■ Rotting teeth
■ Mannerism
■ Bruxism – Grinding of teeth
■ Neglect of hygiene
○ Signs of withdrawal: hallucinations
(Usually cause crimes)
■ Board question: Use of
methamphetamine and “Lost his
job” – withdrawal ang tanong kasi
mawawalan ng pera to buy –
withdrawal STAGE 1 Pain (abdominal) Can give
● Cocaine (6-12 HRS) Anxiety anxiolytics [-pam
○ Signs of abuse: Excoriated nostrils Insomnia - lam]
○ Signs of withdrawal: Bipolar Cycling! Nausea Benzodiazepam
Chlordiazepoxid

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

● Confabulation → the production or creation of

e [Librium]
false or erroneous memories without the intent to
STAGE 2 Hypertension Clonidine deceive, sometimes called "honest lying
(12-48 HRS) Irregular breathing [Catapres] –
Tachycardia Central acting GLOBAL COGNITIVE DISORDERS

STAGE 3 Seizures and DELIRIUM DEMENTIA

(48-72 HR) Hallucinations [LASING] [LOLO]

● Large amount of alcohol → sedation effects CAUSE Impairment of Death of

(downer) → sudden stop → withdrawal → neurons neurons
increase v/s!
● Decrease the craving of alcohol = Acamprosate ONSET Sudden Gradual
[Campral]
EXAMPLE Alcohol Alzheimer’s
WIthdrawal disease
NARCOTICS
● Sedatives = PROGNOSIS Reversible Irreversible
● Antidote: Naloxone → Will block the effect of
narcotics DISORIENTATION Temporary Permanent
● Is alcohol a sedative? → Yes
Memory Loss
● Can Naloxone block the effect of alcohol? Yes
● What is the purpose of giving Naloxone to DURATION Hours to days Lifetime
alcoholic patients? → Blocks the high effect of
alcohol LEVEL OF Altered Normal
CONSCIOUSNESS*
GROUP THERAPY
ATTENTION SPAN*
● No. of participants = 8-10*
● Stage: Forming, Norming, Storming
● Formation: Circular Formation [No tables in
between]
PSYCHOSIS
SCHIZOPHRENIA
○ To establish equality CRITERIA IN THE DIAGNOSIS OF SCHIZOPHRENIA
● Leader: Stable Patient ● 2 or more of the following for at least 1 month
● Decision maker: All members ○ Hallucinations
● Prime rehabilitate: Patient ○ Delusions
● Most important element: Motivation ○ Disorganized speech [Circumstantiality,
● Tool (C-A-G-E): Tangentiality, Looseness of association,
○ Cut → Are you willing to stop drinking Flight of Ideas]
alcohol ○ Catatonia
○ Annoy → Do you feel angry every time ■ Motor syndrome associated with
someone tries to stop you from drinking thought and mood disorders.
alcohol? Muscular rigidity, posturing,
○ Guilt → What are now your regrets in life? negativism, mutism, echolalia,
○ Eye opener → w=What are your echopraxia, and stereotyped
realizations? mannerisms are characteristic
signs
WERNICKE-KORSAKOFF'S SYNDROME ○ Negative Symptoms
WERNICKE KORSAKOFF
BIOLOGIC THEORY
● Acute / Short term ● Chronic / Long ● Genetics: 1 parent [15%], 2 Parents [35%]
● Reversible term ● Neuroanatomy: Less CSF and brain tissue
● Irreversible ● Immunovirology: Exposure to influenza during the
MANAGEMENT:
2nd trimester of pregnancy
● Ataxia ● Confabulation
● Confusion ● Hallucination ● Neurochemistry* = Increase in DOPAMINE &
● Ophthalmoplegia ● Amnesia SEROTONIN
[Paralysis of eye ● Social Causation Hypothesis: Increase risk in
muscles] Lower class
● Cause: Alcoholism
● Decrease thiamine in the brain [Vitamin B1] OTHER RELATED DISORDERS
● To whom should the nurse coordinate the care? ● Brief psychotic disorder: Psychosis < 1 month
○ Dietary department → Provide ● Schizophreniform: Psychosis for > 1 month but <
Thiamine-Rich diet 6 months
■ Lean Pork Chops, Salmon, Flax ● Shared Psychotic Disorder: 2 people sharing
seeds, Navy beans, Green peas, similar delusion
Firm tofu, Brown rice, Acorn
Squash, Asparagus, Mussels 4A’s OF SCHIZOPHRENIA [PROF EUGENE BLEULER]
– 1930’s
● Ataxia → mimic those of being drunk, such as
● Autism: Client is no longer in contact w/ reality
slurred speech, stumbling, falling
● Ambivalence: 2 opposing feelings

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

● Associative looseness
d. Anxiolytic
● Abnormal Affect

SIGNS & SYMPTOMS OF SCHIZOPHRENIA 3RD GENERATION LONG TERM INJECTION

1. POSITIVE SIGNS ANTIPSYCHOTICS DEPOT THERAPY
○ Cause: Increase Dopamine [Thoughts]
○ Hallucinations ● Dopamine system ● Non-compliance
○ Delusions stabilizers ○ d/t the side
○ Disturbances in thought and perception ● Increased Dopamine effect of the
= Decrease receptor drug
2. NEGATIVE SIGNS
Sensitivity ● Memory lapses
○ Cause: Increase Serotonin [Emotions] ● Decreased ● Inaccessible health
○ Asociality: Lack of relationships Dopamine = Increase facilities
○ Avolition: Lack of motivation receptor sensitivity ● Decanoate → Long
○ Anhedonia: Lack of pleasure ● It will balance the term effect
○ Alogia: Lack of speech effect of dopamine [Haloperidol
○ Abnormal Affect [Catatonia]: Purposive lack ● -Zole Decanoate]
○ Aripiprazole ○ IM 1x/2x a
of movement (Absence of movement)
○ Brexpiprazole month
■ Waxy Flexibility

SIDE EFFECTS OF ANTIPSYCHOTICS

What is considered as an early sign of schizophrenia? ● More on anticholinergic side effects
● Lack of interest in school and work + Neglect in ○ Dry / Tuyo
hygiene
C Constipation Increase fluid, fiber in
the diet
ANTIPSYCHOTICS / NEUROLEPTICS
A Agranulocytosis* Monitor WBCs, Report
1ST GENERATION 2ND GENERATION signs of infections
CONVENTIONAL ATYPICAL [Fever, Sore throat]
ANTIPSYCHOTICS ANTIPSYCHOTICS
T Tooth decay Suck on sugarless hard
● MOA: Decrease ● MOA: Decrease candy or gum
Dopamine dopamine &
● Manages Positive SEROTONIN
[Thoughts] signs of ● Manages Negative
schizophrenia [Emotions] signs of D Dry mouth Suck on sugarless hard
● -Zine schizophrenia candy or gum
○ Chlorpromazin ● -Pine & -Done
e ○ Olanzapine O Orthostatic Gradually change the
○ Thioridazine ○ Quetiapine hypotension positions and dangle the
○ Fluphenazine [Both safe for foot before rising
● Haloperidol → High pregnancy]
potency antipsychotic ○ Clozapine G Galactorrhea Use cotton
● S/E: [Safest for undergarment
Pseudoparkinsonism geria]
○ False ○ Risperidone
Parkinson’s ○ Ziprasidone
● Contraindication: ○ Lurasidone P Photosensitivity Avoid direct sunlight,
Patients who are use umbrella, SPF 25
MORE THAN 65 lotion
years old
A Arrhythmias* Immediately report
Exemption: abnormal heart beat
M – Molindone
L – Loxapine W Weight gain Lessen intake of sugary
food and beverages

The client with Schizophrenia is having acute psychosis S Sedation Avoid driving and
and hearing voices to kill the nurse? operating machineries
● Give Haloperidol
EXTRAPYRAMIDAL SYNDROME [EPS]
What is the medication that is safest for the elderly? ● Cause: D/t decreased Dopamine [1st Generation]
● Clozapine ● s/sx → D-A-P!
● Dystonia [Acute]
What is the medication that is safest for pregnancy? ○ Early
● Olanzapine & Quetiapine ○ Uncontrollable muscle spasms
■ Dysphagia & Drooling of saliva
What is the most dangerous drug? ■ Oculogyric crisis [tumitirik mata
a. Antipsychotic → Can cause abnormal ng patient]
heartbeats (Arrhythmia – ECG) ■ Torticollis [stiff neck]
b. Antidepressant ○ Management:
c. Antimanic ■ Antinetone [Biperiden]

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■ Benadryl [Diphenhydramine] MAJOR DEPRESSIVE DISORDER

■ Cogentin [Benztropine] ● Exogenous = Loss; Self depreciation; self
● Akathisia approach
○ Restlessness / Unable to sit still ● Endogenous = involve neurotransmitters (Dec
○ Management: Propranolol [if wala → serotonin & norepinephrine) → Kabaligtad ng
ABC] Bipolar
● Pseudoparkinsonism ● Defense mechanism: Introjection → occurs when
○ Fine tremors a person internalizes the ideas or voices of other
○ Management: Amantadine [Symmetrel] [If people (parents)
wala → ABC] ● Initial sign: Sleeplessness
● Nursing Action: Report/Notify to physician but ● Hallmark sign: hopelessness, helplessness,
NEVER discontinue to prevent relapse worthlessness
● Medical Management: Decrease the dose, shift
to another generation drug CRITERIA FOR DIAGNOSIS
● Prevention: Early Detection = Early Management ● Difficulty thinking
● Insomnia
NEUROLEPTIC MALIGNANT SYNDROME [NMS] ● Weight loss/gain
● Hypertension ● Anhedonia → inability to feel pleasure
● Fever [Increase BT] ● Guilt feeling
● Muscle spasm → laryngospasm → airway ○ Impairs educational, occupational, and
obstruction → death social functioning for 2 weeks
● Most Fatal
● Nursing Action: DISCONTINUE taking the drug MANAGEMENT
● Medical Management: Baclofen Muscle relaxant ● Dosage: Start with the lowest dose to prevent
(laryngospasm) dependence and tolerance
● Prevention: Hydrate the patient ● Effectivity: After 2 to 4 weeks → Energy will
heighten → Closely monitor → High risk for
TARDIVE DYSKINESIA [TD] suicide (Suicide Precaution)
● Tardive → Late ○ Instruct the client to have a follow up visit
● Dyskinesia → Difficulty in movement after 2 weeks → To assess for possible
● Last side effect – 6 mos after taking the drug → suicidal tendencies and to monitor s/e
Irreversible/Permanent! ● Combination: Never combine → prevent seizure
● Nursing Action: Notify the physician & serotonin syndrome
● Medical Management: Valbenazine (Ingrezza) ● Shifting: wait for 5-6 weeks
● Prevention: Start w/ lowest dose ● Stop: Taper!!!
● To prevent relapse: do not stop at once, wait for
Tip: all meds: anxiolytic, antidepressant, antipsychotic 6-9 months or depending on doctor advice
→ We always start with the lowest dose in order to SEROTONIN SYNDROME
prevent dependance! ● Super Sigla “SS”
MANIFESTATION ● Clonus → set of rhythmic, involuntary muscle
● Tongue twisting movements
● Tongue protrusion ● Hypertension
● Teeth grinding ● Ataxia → poor muscle control that causes clumsy
● Lip smacking voluntary movements
● Restlessness
● Diarrhea
WATCH OUT FOR: ● Diaphoresis

Clozapine Ziprasidone
ELECTROCONVULSIVE THERAPY
● No EPS ● No EPS
● Should be LAST RESORT!
● Good for elderly ● No weight gain
● Indication: When medications are ineffective
● Highest risk for ● Cardiac arrest –
● Contraindications: Presence of metals
decreased WBC fatal! (Z - last end
(jewelries, pacemakers, hp prosthesis)
● salivation may cause death)
● Mechanism of action: Unknown (Could balance
neurochemicals in the brain)
Missed Dose: Drugs for Antipsychotic
● Less than 4 hours: and Antidepressant ● Frequency: Every other day (6-15 sessions)
TAKE ASAP! ● Pre-Meds: Succinylcholine (muscle relaxant),
● More than 4 Atropine Sulfate (anticholinergic) [Decreases
hours: SKIP the salivation], Methohexital (Anesthesia)
dose ● Voltage: 75-450 Voltz
● Effect: Grand Mal Seizure
SCHIZOPHRENIA & SUICIDE ○ Prevent aspiration: Side lying!
● Lead to depression ● Side Effect: Amnesia
● Hallucination ● Nursing Responsibility: Re-orient the patient
○ Both of these can lead to suicide (6%)

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

MONOAMINE OXIDASE INHIBITOR [MAOI]

● Maoi → Money!
● Money → PaMaNa
● Money → TIP
● May pera → si Sel
BRAND NAME GENERIC NAME

● Parnate ● Tranylcypromine
● Marplan ● Isocarboxazid
● Nardil ● Phenelzine
● Selegiline
● Eldepryl
● Avoid TYRAMINE-rich food SEROTONIN NOREPINEPHRINE REUPTAKE
● Avoid OLD food → frozen, fermented, pickled, INHIBITOR [SNRI]
preserved, and overripe fruits, avocado ● DVsoria!!!!
○ Tyramine increases when food gets older ● Duloxetine (Cymbalta)
○ Example: ● Venlafaxine (Effexor)
■ Lasagna pizza hotdog (all have ● Side effects
preservatives) ○ Increased blood sugar → No to DM
■ Safe cheese: cottage cheese, ○ Increased intraocular pressure → No to
cream cheese, ricotta cheese glaucoma
● Tyramine + MAOI = HTN crisis → Occipital ○ Increase cardiac rate → No to arrhythmia
headache / Pounding Explosive occipital
headache HERB OF DEPRESSION – ST. JOHN’S WORT
● Herb for depression
TRICYCLIC ANTIDEPRESSANTS [TCA] ● Do not combine w/ other antidepressants!

BRAND NAME GENERIC NAME REVIEW!

● Tofranil ● Imipramine MAOI (Money) TCA (Tri) SSRI SNRI
● Anafranil ● Clomipramine
● Elavil ● Amitriptyline Pa – T TOFRA Zoloft D
Ma – I ANA Lexapro V
Na – P ELA Paxil
● Pamelor ● Nortriptyline
Eldepryl – SELgiline Pamelor Luvox
Prozac
Ang magkakapatid walang mga jowa, kaya mga tigang
I - praning
– Dry! (Anticholinergic s/e
C - praning
● Common Side Effects: Anticholinergic
A - tililing
Edi syempre mga broken hearted ---
Nortriptyline
● If looking for TCA s/e → Arrhythmia (Look for
ECG answer)
NO – Tyramine Tigang → Safest → ↑ sugar x
TCA is the most fatal antidepressant!
(MAOI + Tyramine = Anticholinergi less SE DM
HPN Crisis c ↑IOP X
● Tatlong magkakapatid → TAE
N&V/ glaucoma
● Pag natatae ikaw ay pa ICA ICA
Arrhythmia → Anorexia ↑HR X
● May kapatid sila sa labas → Pamela
ECG → give Arrhythmia
● Apat na magkakapatid na Praning at may
with
Tililing
Most fatal meals

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

● If the question is about anxiety, trauma, or eating
disorder and walang anxiolytic → Choose SSRI!
● Safest antidepressant drugs
● Less suicidal tendencies
● Less side effects
○ Sexual dysfunction
○ Gastro-Intestinal disturbances (N & V)
● Fastest antidepressant
○ Effects after 1 week of use only!
● Drugs
○ Zoloft (Sertraline) NOTES:
○ Lexapro (Escitalopram) ● All medications pass through the liver → monitor
○ Paxil (Paroxetine) AST and ALT or SGPT/SGOT [If there’s no
○ Luvox (Fluvoxamine) AST/ALT] (hepatotoxic)
○ Prozac (Fluoxetine) → Most commonly ○ *if antipsychotic → Monitor WBC!
used drug given for eating disorders ● Best time to give antidepressants
○ Bed time or hours before sleep
● Early indicator of effectiveness of antidepressants
○ Improved sleep pattern

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● Ex. MAOI → Can cause different s/e in patients, CYCLOTHYMIA

may cause insomnia so the doctor may ● Alternating period of depressed mood &
re-evaluate when is the best time to give (during hypomania for 2 yrs
follow up) ○ Not depression! Medyo malungkot lang,
○ Give at AM if pt has insomnia medyo manic lang (paikot ikot mood)
○ As prescribed → Should always be DYSTHYMIA
what the dr said ● Persistent mild depression for 2 yrs
● TCA ○ Walang tigil, tuloy tuloy
○ Bed time
○ AM
○ w/ meals
○ Same time each day (umaga, umaga if
gabi, gabi)
■ Same time each day or equally
spaced around the clock
● SSRI → S/e Anorexia
○ Give with meals

Which of the following statements indicates that the

client taking phenelzine needs further teaching?
a. “I will have to avoid drinking non-alcoholic beer” MANAGEMENT
b. “I will be able to eat cottage cheese without ● DOC: Antimanic – Lithium Carbonate!
worrying” ○ How do you know your drug is antimanic?
c. “I can eat green beans on this diet.” → It contains Lithium carbonate
d. “I’m so glad I can have pizza as long as I
○ Lithotab
don’t order pepperoni” – Wrong statement!
● Even if non alcoholic, beer pa rin yan ○ Eskalith
● Correct cottage cheese ○ Carbolith
● Green beans can be eaten ● Mechanism: To stabilize mood
● Onset: after 3 weeks
BIPOLAR DISORDER ● Peak: 3 hrs after administration
● Neurotransmitter: High serotonin & norepinephrine ● Blood test: every 3 days
→ Kabaligtad ng Major depressive disorder ○ MAGIC NUMBER 3!
● Psychosocial factors: Type A personality ● Therapeutic level: 0.6-1.2 mEq/L
● Sociocultural Factors: Upper class ● Common s/e: Fine Tremors!
● Defense mechanism: Projection → If they fail ○ Tell pt: Ma’am tremors are normal and
they blame other people tremors will disappear once lithium level
○ Reaction formation → Mga angat sa has stabilized within 1-2 weeks
buhay, they will not show others na nag ○ Another s/e: polyuria and polydipsia
fail sila or nagging mahina sila ● Signs of toxicity: severe vomiting and diarrhea
● Bipolar is the mask of depression ● Must be at bedside: Mannitol (Osmotic diuretic)
● Lifetime disorder but can be managed! ● Monitor: sodium (Na) → Sodium buffers your
lithium
BIPOLAR MANIC ○ Decreased Na = Lithium toxicity
● Inflated self esteem, or grandiosity ○ Normal Na (135-145 mEq/L) → Withhold
● Dec need for sleep next dose if serum Na is low!
● Increased talkativeness ● Diet: Moderate sodium
● Distracted easily ● Client instruction: Increase OFI
● Increase in goal directed activity → Bungee
jumping TIP IN BOARD EXAM:
● Engaging in risky activities ● If walang antipsychotic, antidepressant, anxiolytic,
etc → Always look for Anti-convulsant!!!
MANIA (Pampakalma!)
● Manifestations last > 1 week
● Ex. hindi natutulog 1 week, puro shopping ANTICONVULSANT MEDICATION
● Carbamazepine
HYPOMANIA ● Divalproex → Valroic acid
● Manifestations last for only 4 days ● Gabapentin
● Ex. 4 days walang tigil kaka shoppee at walang ○ ↑ GABA
tulog ● Pregabalin
○ ↑ GABA
BIPOLAR I ● Lamotrigine
● Manic episode w/ or w/o major depression ○ For ADHD → bipolar for children
● Client taking anticonvulsant → Monitor for
BIPOLAR II rashes
● Major depression w/ hypomanic episodes ○ Notify the physician!
● Dalawa and Depressed

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 TOPRANK INTENSIVE PHASE – PSYCHIATRIC NURSING

DUAL DIAGNOSIS

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