ANTI- 1.

Alogia P – Parnate L – Lithane

PSYCHOTIC/NEUROLEPTIC/MA 2. Anhedonia N –  Nardil (Phenelzine SO40) L – Lithizine
JOR 3. Avolition M – Marplan (isocarboxacid) Lithotabs
TRANQUILIZER 4. Apathy Mannerix (Moclobemide) Lithonate
FOR:SCHIZOP HRENIA 5. Affective D/O
↑ DOPA → Anti-Psychotic → 2-4 (3)SSRI:PP ZLT (xetine) TOXICITY
weeks P –  Prozac (Fluoxetine HCl) tremors
ANTI- P –  Paxil (Paroxetine HCl) nausea/vomiting
TYPICAL: MaHaL Na PaSTa DEPRESSANTS/THYMOLEPTIC Z –  Zoloft (Sertraline HCl) thirst
M– Mellaril (Thioridazine) S L –  Luvox (Fluvoxamine) polyuria
H– Haldol (Haloperidol) FOR:DEPRESSION T –  Trazodone (Desyrel) coma
L–  Loxitane (Loxaprine) ↓ serotonin→ Anti-Depressant + seizure
N-  Navane (Thiothixene) → 2-4 weeks
P –   Prolixin (Fluphenazine) (SSRI.MaOi) 2-6 weeks (TCA) ANTI-PARKINSONIAN (2)LITHIUM CITRATE:C
S–  Stellazine, Serenace ↓ norepi C – Cibalith
T –   Thorazine (1)ANTI-CHOLINERGIC:CAKA Therapeutic Level of Lithium: /
(Chlorpromazine) TRICYCLIC –Anti-cholinergic C –  Cogentin (Benztropine) Check every
Taractan (1)TCA: mr TAN SAVE (pramine, A –  Akineton (Bisperiden) 12º 2x/week
(Chlorprothixene) tryptilline) K – Kemadin (Procyclidine) 0.6 – 1.2 mEq/L
Trilafon (Pherphenazine) A –  Artane (Trihexaphenidyl) 0.7
T –  Tofranil (Imipramine)
(for (+) symptoms) A –  Ascendin (Amoxapine) (2)DOPAMINERGIC:Pu lse
1. Delusion N –  Norpramine (Desipramine) P –  Parlodel (Bromocriptine) ANTI-ANXIETY / MILD
2. Hallucination (AUDITORY) S – Sinequan L – Levodopa TRANQUILIZER
3. Disorganized thoughts A –  Anafranil (Clomipramine) S –  Symmetrel (Amantadine) FOR: ANXIETY D/O
4. Behavior V –  Vivactil (Protryptilline) E – Eldepryl ↓ GABA → Anti-anxiety → 2-4
5. Speech E –  Elavil (Amitryptilline) weeks
↑ epi,norepi
ATYPICAL: CaR of SuZy is brand S.E. ANTI-MANIC
new Sedation FOR: MANIA / Adequate sodium Be My LAST VIVE
(new) Urinary Retention intake B –  BusPar (Buspirone)
C –  Clozaril (Clozapine) Orthostatic Hypotension ↑ serotonin → Anti-manic → 2-4 M – Miltown
R –  Risperdal (Risperidone) Blurred Vision weeks ↑ norepi L –  Librium (Chlordiazepoxide)
S – Seroquel (Quetiapine) Drowsiness (1)LITHIUM CARBONATE:D' A –  Ativan (Lorazepam)
Z – Zyprexa (Olanzapine) CELL S –  Serax (Oxazepam)
(2)MAOi:PaNaMa D – Duralith T –  Tranxene (Chlorazepate)
(for (+) & (-) symptoms) - avoid tyramine foods C – Carbolith V –  Valium (Diazepam)
(-) 5A's: - lead to hypertensive crisis E – Es k alith

I – Inder al E – Equanil
V – Vi s t r a n e l

C- cogentin P- parlodel B- benadryl

A- artane A- akineton L- larodopa
E- Eldepryl decreased BP
S- symmetril Enhances action of GABA D-riving is contraindicated
T-teach client to rise slowly from supine E-ffect has a delayed onset of 7-21 days
Increase protein and give B6 position P-regnancy consult with your physician
Akathisia Y-es alcohol should also be avoided. R-elieves symptoms but never cure
Dystonia E- valuate vital sign
Tardive Dysinesia S-toppind drug abruptly is Out!
Neuroleptic Malignant Syndrome MAOI Drugs  S-afety measures
I-nstruct to report undesirable side effect
M-marplan O-bserve for suicidal tendencies
ANTI-ANXIETY N-nardil N-o alcohol or CNS depressants
P-parnate
V-valium ANTI-MANIC DRUGS
L-librium Hypertensive crisis within several hours of
A-ativan ingestion of tyramine containing foods Lithium- Eskalith
S-serax Tyramine foods:
T-tranxene aged cheese, beer, ale, red wine, pickled Increase risk of toxicity when given with:
foods, smoked or pickled fish, beef or thiazide diuretics, methyldopa, and NSAIDs
M-miltown chopped liver, avocado of figs. Decrease lithium levels with excess sodium
E- equanil and antacids.
V-vistaril Increase CNS toxicity with Haloperidol
A-taxene ANTI-DEPRSSION
I-Inderal 0.6-1.2 -meq/l Therapeutic Effect
B-buspar A- asendin > 1.5 meq/l Toxic
N-norpramin 2.0 meq/l lethal
Tolerance develop until seven days T- tofranil
L- evel - therapeutic 0.6-1.2 meq/l
A- void abrupt discontinuation after S-sinequan I-ncreased Urination
prolonged use A-anafranil T-hirst Increased
N- Not give if BP is up, hepatic/renal - aventyl H-eadaches and Tremors
dysfunction or history of drug abuse V-vivactil I-ncreased fluids
X-xanax, ativan, serax is also an anti- E-Elavil U-nsteady
anxiety meds P-paxil M-orton's Salt -adequate intake
I-increase in 3D's- drowsiness, dizziness, Z-zoloft

SIGNS
01. PTB – low-grade afternoon fever.
02. PNEUMONIA – rusty sputum.
03. ASTHMA – wheezing on expiration.
04. EMPHYSEMA – barrel chest. 39. HODGEKIN’S DSE/LYMPHOMA – painless, progressive enlargement of
05. KAWASAKI SYNDROME – strawberry tongue. spleen & lymph tissues, Reedstenberg Cells
06. PERNICIOUS ANEMIA – red beefy tongue. 40. INFECTIOUS MONONUCLEOSIS – Hallmark: sore throat, cervical lymph
07. DOWN SYNDROME – protruding tongue. adenopathy, fever
08. CHOLERA – rice watery stool. 41. PARKINSON’S – Pill-rolling tremors
09. MALARIA – stepladder like fever with chills. 42. FIBRIN HYALIN – Expiratory Grunt
10. TYPHOID – rose spots in abdomen. 43. CYSTIC FIBROSIS – Salty skin
11. DIPTHERIA – pseudo membrane formation 44. DM – polyuria, polydypsia, polyphagia
12. MEASLES – koplik’s spots. 45. DKA – Kussmauls breathing (Deep Rapid RR)
13. SLE – butterfly rashes. 46. BLADDER CA – painless hematuria
14. LIVER CIRRHOSIS – spider like varices. 47. BPH – reduced size & force of urine
15. LEPROSY – lioning face. 48. PEMPHIGUS VULGARIS – Nikolsky’s sign (separation of epidermis caused
16. BULIMIA – chipmunk face. by rubbing of the skin)
17. APPENDICITIS – rebound tenderness. 49. RETINAL DETACHMENT – Visual Floaters, flashes of light, curtain vision
18. DENGUE – petechiae or (+) Herman’s sign. 50. GLAUCOMA – Painfull vision loss, tunnel/gun barrel/halo vision
19. MENINGITIS – Kernig’s sign (leg flex then leg pain on extension), (Peripheral Vision Loss)
Brudzinski sign (neck flex = lower leg flex). 51. CATARACT – Painless vision loss, Opacity of the lens, blurring of vision
20. TETANY – hypocalcemia (+) Trousseau’s sign/carpopedal spasm; 52. RETINO BLASTOMA – Cat’s eye reflex (grayish discoloration of pupils)
Chvostek sign (facial spasm). 53. ACROMEGALY – Coarse facial feature
21. TETANUS – risus sardonicus. 54. DUCHENNE’S MUSCULAR DYSTROPHY – Gowers’ sign (use of hands to
22. PANCREATITIS – Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners push one’s self from the floor)
spots. 55. GERD – Barretts esophagus (erosion of the lower portion of the
23. PYLORIC STENOSIS – olive like mass. esophageal mucosa)
24. PDA – machine like murmur. 56. HEPATIC ENCEPHALOPATHY – Flapping tremors
25. ADDISON’S DISEASE – bronze like skin pigmentation. 57. HYDROCEPHALUS – Bossing sign (prominent forehead)
26. CUSHING’S SYNDROME – moon face appearance and buffalo hump. 58. INCREASE ICP – HYPERtension BRADYpnea BRADYcardia (Cushing’s
27. HYPERTHYROIDISM/GRAVE’S DISEASE – exopthalmus. Triad)
28. INTUSSUSCEPTION – sausage shaped mass, Dance Sign (empty portion 59. SHOCK – HYPOtension TACHYpnea TACHYcardia
of RLQ) 60. MENIERE’S DSE – Vertigo, Tinnitus
29. MS – Charcot’s Triad (IAN) 61. CYSTITIS – burning on urination
30. MG – descending muscle weakness 62. HYPOCALCEMIA – Chvostek & Trosseaus sign
31. Guillain Barre Syndrome – ascending muscle weakness 63. ULCERATIVE COLITIS – recurrent bloody diarrhea
32. DVT – Homan’s Sign 64. LYME’S DSE – Bull’s eye rash
33. CHICKEN POX – Vesicular Rash (central to distal) dew drop on rose petal
34. ANGINA – Crushing stubbing pain relieved by NTG
35. MI – Crushing stubbing pain which radiates to left shoulder, neck, arms,
unrelieved by NTG
36. LTB – inspiratory stridor
37. TEF – 4Cs’ Coughing, Choking, Cyanosis, Continous Drooling
38. EPIGLOTITIS – 3Ds’ Drooling, Dysphonia, Dysphagia
ABG  2.5-3.5 Prosthetic heart valves 10 – 20 mg/dL
Ph 7.35 - 7.45 8-25 mg/dL (Saunders)
PCO 2 35 – 45 mm Hg Bleeding Time
HCO 3 22 – 27 mEq/ml 3 - 7 mins. UO
PO2 80 – 100 mm Hg 8 - 15mins (Saunders) Adult: 30 cc/hr and 720 cc/24 hours
SaO2 93 – 100% Pedia: 2cc/ kg/ hr
Electrolytes
RBC K 3.5 - 5.1 mEq/ L AST/ ALT
Male 4.5 - 6.2 million/ cubic mm Mg 1.6 - 2.6 mEq/ L 5-40 IU/L
Female 4.0 - 5.5 million/cubic mm Ph 2.7 - 4.5 mEq/ L
Na 135 - 145 mEq/ L Ammonia
WBC Cl 98-107 mEq/ L 9-33 µmol/L
4,300 - 10,800/ cubic mm Ca 8.6 - 10 mg/dL 35-65 mcg/ dl

Platelets Potassium Chloride Albumin

150,000 - 350,000/ cubic mm With a dilution of not more than 1mEq/ 10ml 3 - 5 g/dL
Maximum infusion rate of 5-10 mEq/ hr
Hgb NEVER to exceed 20 mEq/ hr at any Amylase
Male 14 - 16.5 g/dL Female 12 - 15 g/ dL circumstance 25-151 units/ L

Hct Blood Sugar Lipase

Male 42 - 52% 70 – 110 mg/dL 10-140 units/ L
Female 35 - 47%
Glycosylated Hgb (glycohemoglobin) Bilirubin (Total)
PT (Warfarin/ Coumadin) less than 7.5% Good less than 1.5 mg/ dL
Male 9.6-11.8 secs 7.6 - 8.9% Fair
Female 9.5-11.3 secs greater than 9% Poor Pulmonary capillary mean wedge pressure
Should be 1.5 to 2 times the Normal 4-12 mmHg
Vanillylmandelic Acid (VMA)
0.7 - 6.8 mg/24 hrs Central Venous Pressure
PTT/ APTT (Heparin) 2-6 mmHg
20-36 secs / 30-45 secs GFR
Should be 1.5 to 2.5 times the Normal 125 ml/min Plasma Osmolality
280-300 mOsm/kg
INR Creatinine
2 – 3 Standard Warfarin therapy 0.8 - 1 mg/dL Serum Alcohol
3 – 4.5 High dose Warfarin therapy 0.6-1.3 mg/dL (Saunders) LEGAL .08 - .10
2-3 Atrial fibrillation, DVT and Pulmonary TOXIC! grater than 0.15 (50mg/100cc of blood)
embolism BUN greater than 8%
For Withdrawn clients For Compulsive clients
· Allow client to set pace · Allow client to engage in rituals (these are used to cover up anxiety)
· Encourage social activities or games · Gradually limit length of time for rituals.

For Depressed client For Manipulative clients

· Assess suicide potential · Set clear limits
· Let client talk about personal problems · Hold client responsible for behavior
· Do not leave alone
For Dependent clients
For Suicidal clients · Don’t reward dependent behavior
Crisis intervention to assess suicide protential. · Client should share responsibility for treatment
· Communicate intent “ are you tired of living?”
· Previous attempts For Paranoid clients
· Specific plan · Don’t argue with client (simply state that you don’t share his beliefs)
· Social support system · Be reliable and consistent
· DO NOT make “ suicide contract”!
For Delusional clients
For Anxious clients · Stay with client
· Convey interest and care · Don’t argue about the reality of delusions
· Don’t “force” client · Orient frequently to reality (place, situation)
· Help client identify source of anxiety · Assess potential for self harm
· Suggest relaxation techniques
For Somatization clients
For Violent clients · Respect client and his problems (client is not faking)
· Remain calm and in control of the situation · Rule out physical basis for symptoms
· Give client space, avoid sudden movements · Help client express anxiety
· Encourage verbal expression of anger
· Restrain or seclude if necessary
DEFENSE MECHANISMS: Gradual impairment of cognitive functions, memory
1. Conversion: A college student develops diarrhea on day of exam · Alzheimer dementia: early memory loss
2. Regression: Returning to immature ways of dealing with stress: crying, tantrums… · Multi infarct dementia: step like decline
3. Repression: Blocking of unacceptable urges and feelings from awareness.
4. Denial: Blocking of unacceptable information or perceptions from awarness. Delirium
5. Dissociation of affect: A girl laughs when telling about her failed exam Acute, organic, short lasting
6. Rationalization: Substituting an acceptable motive for attitudes or behavior for an Clouded consciousness
unacceptable motive Confusion, disorientation, anxiety
7. Reaction formation: you want to “kick your bosses ass” but end up kissing it. Sometimes hallucinations
8. Identification: A teenager dresses like Madonna and mimics her behavior.
9. Projection: “ you are acting like a teenager, not I” Delusions
10. Introjection: A boy yells at his dog like his father does him Persistent false belief despite invalidating evidence
11. Displacement: Client is upset about disease and yells at nurse. Nurse gets upset Grandeur
and yells at nursing assistant Paranoia
12. Undoing: “ magic,” Somatic delusions

SIGNS AND SYMPTOMS illusions

Misperception of external stimuli
Aphasia
Receptive (Wernicke =difficulty to comprehend language) or expressive (Broca = Hallucinations
difficulty to find “the right word” language disorder Perception without external stimuli

Apraxia
Failure to do, despite intact motor function TERMS:
1. Neologisms: invents new words: Schizophrenia
Agnosia 2. Echolalia: echoes words or sentences: Schizophrenia
Failure to recognize 3. Word Salad: jumble of words without meaning: Schizophrenia
4. Flight of ideas: rapid switching from topic to topic: Mania
Dementia 5. Confabulation: invents stories to fill memory gaps: Korsakoff encephalopathy.
 § Advance directive should be drafted as early as possible
DELIRIUM
Ø Acute onset
GRIEF DEPRESSION
Ø Fluctuating consciousness
Ø Disorientation Initial: shock/ denial Feeling of hopelessness
Ø Optical hallucinations
Illusions/hallucinations may occur Feeling of worthlessness

DEMENTIA Low risk of suicide High risk of suicide

Ø Gradual onset
PERSONALITY DISORDERS:
Ø No impairment of consciousness
Ø Loss of intellectual functions: memory, orientation, language.  Behavior is inflexible across a broad range of situations

 Behavior is markedly deviant from cultural norms

ALZHEIMER’S  Significant distress and impairment of functioning

DEPENDENT Afraid of being helpless

ASSESSMENT:
§ Progressive memory loss Need to be cared for
§ Declining mental, social, and self care abilities
COMPULSIVE Fear of loss of control

ANALYSIS: Tries to control physician

§ Risk of injury due to cognitive deficits
PASSIVE-AGGRESSIVE Appears willing but is not compliant
§ Family/caregiver burnout

HISTRIONIC Dramatic, emotional

IMPLEMENTATION:
May display inappropriate sexual
§ Support family caregivers
behavior
§ Provide safe and familiar environment
§ Support client’s attempts at independence NARCISSISTIC Feels better than others
§ Continually orient client to time, date and person
Perfect self image is threatened by
 disease detached from oneself

PARANOID May blame nurse or others for disease AGORAPHOBIA Hx of panic attacks

SCHIZOID Anxious, withdrawn Patient avoids places where panic attack

might occur (especially public places)
(doesn’t want close relationships)
OBSESSSIVE COMPULSIVE Obsessions: recurrent thoughts
BORDERLINE Severe disorder!
Compulsions: repetitive behavior
Intense unstable relationships
POSTRAUMATIC STRESS DISORDER Traumatic event in client’s history
Paranoia and suicidal behavior
May occur any time after event
Features of psychoses
Persists for > 1 month
ANXIETY DISORDERS:
HYPOCHONDRIASIS & MALINGERING:
 Clients are distressed and know that their symptoms are irrational.

HYPOCHONDRIASIS Unrealistic interpretation of body signs

PHOBIA Persistent excessive of specific objects or
situations. Client believes to have serious disease
that is unrecognized by family and
Patient knows that his fear is unrealistic
physicians
PANIC ATTACK Abrupt onset, peak within 10 min.
FACTITIOUS DISORDER Intentional feigning of symptoms
Palpitations, tachycardia
Motivation: to assume the sick role:
Sweating, trembling, shaking external incentives such as economic
gain or avoiding legal responsibilities
Fear of dying
are absent
Derealization: feeling of unreality of the
MALINGERING Intentional feigning of symptoms
external world.

Motivation: economic gain

Depersonalization: feeling of being
 Avoiding leagal responsibilities
BIPOLAR DISORDER:
Manic episodes alternate with episodes of major depression.
Some clients have only manic episodes, no depressive episodes.
MAJOR DEPRESSION
ASSESSMENT:
ASSESSMENT:
 Euphoria
 Feeling of worthlessness  Grandiose ideas
 Thoughts of death or suicide  Uninhibited sexuality
 Lethargy  Buying sprees
 Slow, muted speech  Psychomotor agitation
 Anorexia, weight loss
 Early morning awakening
IMPLEMENTATION:

ANALYSIS:  Low stimulus environment

 Provide frequent small meals, snacks
 Risk of suicide  Encourage physical activity as a means to “act out”

IMPLEMENTATION: MEDICATION:

 Assess suicidal risk ( ask client directly)  Lithium

 Remove potentially harmful objects  Watch for signs of toxicity
 Encourage verbal expression of feelings
 Encourage participation in group activities
Abdominal pain, nausea

MEDICATIONS: Hand tremor

 Antidepressants (require several weeks for full effect)

Ataxia, nystagmus
 Watch for anticholinergic side effects:

Slurred speech
 Blurred vision
 Monitor serum levels closely
 Dry mouth

Not to exceed 1 mEq/L

 Constipation

 Urinary retention

SCHIZOPHRENIA:
ASSESSMENT:
 Neuroleptics: monitor for signs of tardive dyskinesia
 Defect in reality testing
 Affect incongruent ( does not match thoughts) Choreoathetosis
 Thought form: tangential, circumstantial, loose associations
Lateral movements of jaw
“POSITIVE SYMPTOMS”
Tongue protrusion
Delusions
CLIENT EDUCATION:
Hallucinations
Stress importance to comply with follow up visits
“NEGATIVE SYMPTOMS”
Encourage family support
Flat affect

Loss of interest DRUG ABUSE:

Ambivalence Abuse: recurrent use of drugs resulting in social failures at home, school or work,
legal problems or hazardous situations.
Autism Dependence: Tolerance (needs larger doses to achieve effect). Withdrawal
symptoms.
CATATONIA:
INTOXICAITON WITHDRAWAL
Waxy rigidity of muscles
ALCOHOL Euphoria Nausea
Client maintains bizarre positions
Disorientaion Delusions, hallucinations
IMPLEMENTAION:
Unsteady gait Delirium
Establish trusting, honest relationship
Tremor, seizures
Maintain calm, consistent manner
BARBITURATES Sedation Delirium
Don’t challenge client’s thought content
Epilepsy
Decrease environmental stimuli
Coma, death
MEDICATION:
BENZODIAZEPINES Antianxiety Anxiety

Sedation Irritability

insomnia

AMPHETAMINES, COCAINE Arousal Fatigue

Euphoria Dysphoria

OPIOIDS Euphoria Nausea, vomiting

Apathy Sweating, fever

Muscle aches

LSD Hallucinations NONE

Anxiety

Paranoid ideas