Psychiatric Nursing Map for Students

The PSYCH MAP explains a lot of concepts needed in the study of Psychiatric Nursing. I hope that this will help you in your study.

First, you have to right click on the picture above and save it in your computer.

Open and print the picture in landscape format.
Place the picture above your bed, beside your study table, in front of your bowl and study it during your BMs, in front of the mirror, above the ceiling and in every place you can think of. Memorize it and Enjoy!

The center or the word NORMAL represents a state in which there is an equilibrium or the absence of any problem. If you encounter problems or stressors, you will become ANXIOUS and your Sympathetic Nervous System SNS will be activated. Epinephrine and norepinephrine will be released. In severe cases, medications are given. The main purpose of the medication given for anxiety is to decrease the action of the SNS. GABA decreases your SNS and further to your left, you will see a list of medications used to decrease anxiety (VLASTMEVAIB). Zepam, zepine and zolam are the common ending letters of these anxiolytic medications. It will take 3 to 4 weeks until these drugs take effect. While taking these drugs, you should watch out for anticholinergic effects such as constipation and urinary retention. It is important to remember that there are safety precautions when taking these drugs. You should not drive because these drugs can make you drowsy, it also means that you should not engage yourself in an activity which requires alertness (ex. driving, operating a machine). You may also experience orthostatic hypotension. You should not drink alcohol because it is a depressant and this will potentiate the effect of the drug. On the other hand, you are also not allowed to drink coffee. It is a stimulant that counteracts the effect of your anxiolytic drugs, and besides, you are taking medications to decrease the stimulants causing your anxiety. Anxiolytic drugs or anti-anxiety drugs may lead to dependence. Withdrawal from these drugs are done gradually to prevent seizures.

There are lots of theories explaining the cause of SCHIZOPHRENIA. One theory states that there is an increase in the neurotransmitter DOPAMINE. Dopamine is a neurotransmitter responsible for cognition and regulation of emotional responses, it is generally a stimulant. Different kinds of drugs are given to a schizophrenic patient (SSTTCHAMPZR), these drugs are called Neuroleptics or Antipsychotics. The main action of these drugs is to decrease Dopamine or its effects. Ldol and azine are the common ending letters of these drugs. Side effects of these drugs include, agranulocytosis (which has an early symptom of sore throat) and photosensitivity (use wide brimmed hat). When Dopamine is severely decreased during the use of neuroleptic drugs, ACETYLCHOLINE – DOPAMINE balance is affected, when this happens, Pseudoparkinsonism and EPSE will manifest (NMS fatal). In order to bring equilibrium, two types of drugs are given, the ANTICHOLINERGIC drugs (AABC) which decreases Acetylcholine and the DOPAMINERGIC drugs (PLES) which increases the Dopamine. To remember the two types of drugs you must remember the word CAPABLES.

When norepinephine is increased, there is a distinct period during which, a mood of a person is constantly elated or persistently high, we consider this to be a manic episode or MANIA. When this happens, we place the person to be at risk for injury because of impulsive actions. The  patient is also monitored for nutritional imbalance due to loss of attention and focus on his own basic needs. Lithium is the drug of choice for mania. A narrow level of 0.6 to 1.2 meq/L must be maintained. Toxicity is manifested by gastro intestinal symptoms such as nausea, vomiting and diarrhea (VANDA). To avoid this, give liberal amount of fluid intake (3L/day). This is also the reason why we don’t combine this drug with a Diuretic. Diamox (a drug also used for Vertigo) is the antidote for lithium toxicity. Avoid strenuous activities which may lead to cardiac collapse. Monitor the kidney function because this drug is nephrotoxic. It takes 2-4 weeks before you see the effects of this drug.

Serotonin makes us happy. MAO is a substance which decreases the amount of serotonin present in our body. If serotonin level falls, depression takes place. Depression is a state in which a person’s mood is persistently low. There are different types of medications given to people who are depressed. First, the SSRI, this medication aims to inhibit the reuptake of serotonin in our body which means that the usual serotonin will be made available in the synapses for a longer period of time. Second is the TCA, this drug works just like the SSRI except that it has a different target neurotransmitter which is the norepinephrine. Third is the MAOI, a MAOI inhibits the action of a MAO therefore it inhibits the breakdown of neurotransmitters. It is important to remember that the effects of these drugs will take place after a week of continuous medication, as in the case of MAOI, it can take up to 6 weeks. At these times, we should monitor the patient for possible suicide because when a patient is lifted from depression, he will have the power to execute the suicidal ideations that is in his mind. Hypertensive Crisis (severe increase in blood pressure  which may cause organ damage or stroke ) is the adverse effect of MAOI, this happens when the drug is combined with tyramin rich food. Pentolamine is given during hypertensive episodes. During the use of antidepressants, you should monitor for any increase in the intraocular pressure which is an indication of developing glaucoma. Male sexual function may also be affected.
An ECT may be used while waiting for the therapeutic effects of the antidepressants or if the patient is not responding to medications. Prior to ECT, short-acting sedatives are given so the client may sleep (Barbiturates) and a muscle relaxant (Succinylcholine) so that there would be a less chance of injury due to the rigid effects of seizure contractions. Best position after ECT is side lying. Check the vital signs, orient the patient and reassure that memory loss is only temporary. Before giving oral intake, it is important to check the gag reflex to prevent aspiration. Pregnancy is not a contraindication to ECT.

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Written by Jay of PHILIPPINENURSE.BLOGSPOT.COM