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50 Cards in this Set

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  • Back
What is the cognitive approach to mental health therapy?
- Cognitive therapy is based on the COGNITIVE model, which focuses on INDIVIDUAL THOUGHTS and behaviors to solve current problems
- It is used to treat DEPRESSION, ANXIETY, EATING DISORDERS, and other issues that can be improved by CHANGING a client's attitude toward life experiences
What is the behavioral approach to mental health therapy?
- Behavioral therapy is based on the theory that behavior is learned and has consequences
- Abnormal behavior results from an attempt to avoid painful feelings
- Behavioral therapies teach clients ways to DECREASE anxiety or avoidant behavior and give clients an opportunity to practice techniques
- Behavioral therapy has been SUCCESSFUL in treating clients with phobias, addictions, and other issues
What is cognitive-behavioral therapy?
- Cognitive-behavioral therapy uses both a COGNITIVE and BEHAVIORAL approach to assist a client with anxiety management
What is the purpose of self-help groups?
- Self-help groups consist of members that come together for support and share a similar addiction (alcohol abuse)
- Members provide SUPPORT for each other
- A 12 step program uses 12 steps to help members achieve and maintain sobriety
What is the medication fluoxetine (Prozac) used for?
- Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI)
- This medication is used to treat major depression, obsessive compulsive disorder (OCD), bulimia nervosa, panic disorders, PTSD, premenstrual dysphonic disorders
- Adverse effects: sexual dysfunction, CNS stimulation (agitation, inability to sleep), weight loss early in therapy, serotonin syndrome may occur 2-72 hours after starting treatment - and may be LETHAL), withdrawal syndrome (headache, nausea, visual disturbances, anxiety, tremors and GI bleeding)
What does assertiveness training mean?
- An assertiveness training program teaches the client to express feelings, and solve problems in a NON-AGGRESSIVE manner
What is electroconvulsive therapy?
- Electroconvulsive therapy (ECT) delivers an electrical current that produces a grand-mal seizure
- ECT is used to treat clients who have SEVERE DEPRESSION that is NOT responsive to pharmacologic treatment
- ECT is also used for clients who are ACTIVELY SUICIDAL and are in need for a RAPID THERAPEUTIC response
- ECT may also be used for clients who have bipolar disorders with rapid cycling (4 or more episodes of acute mania within 1 year)
What are the patient outcomes from ECT?
- The client is relieved of clinical manifestations of depression
- The client is able to perform activities of daily living
What should the patient do PRIOR to an ECT treatment session?
- Any medications that affect the client's seizure threshold must be DECREASED or DISCONTINUED SEVERAL DAYS before the ECT procedure
- MAOI's and lithium should be DISCONTINUED 2 weeks BEFORE the ECT procedure
- Severe hypertension is controlled, since a short period of hypertension occurs immediately AFTER the ECT procedure

*30 minutes PRIOR to the beginning of the procedure, an IM injection of ATROPINE sulfate or glycopyrrolate (Robinul) is given to DECREASE secretions and counteract any vagal stimulation
What is the post-procedure care for a client who just underwent an ECT procedure?
- When stable, client is transferred to a recovery area where vital signs, LOC, cardiac status and oxygen saturation continue to be monitored
- Position client on their SIDE to facilitate drainage and PREVENT ASPIRATION
- During recovery phase, ORIENT the client FREQUENTLY, because confusion and short-term memory loss are common during this time
What are possible complication from ECT?
- Memory loss or confusion
- Short-term memory loss or confusion, and disorientation may occur immediately following the procedure - memory loss may persist for several weeks
- Headache, muscle soreness, and nausea can occur during and following the immediate recovery period

*PROVIDE A SAFE ENVIRONMENT FOR THE CLIENT TO PREVENT INJURY*
What are anxiolytics uses for?
- Anxiolytics are used to treat GENERALIZED ANXIETY DISORDERS (GAD), seizure disorders, insomnia, muscle spasms, alcohol withdrawal (for prevention and treatment of acute symptoms), induction of anesthesia
- Anxiolytics are sedative/hypnotics - BENZODIAZEPINES
What are Diazepam, alprazolam (Xanax), and lorazepam (Ativan) used for?
- Used to treat anxiety, and generalized anxiety disorders
- Adverse effects: CNS depression (sedation, light-headedness, ataxia, decreased cognitive function), paradoxical response (insomnia, excitation, euphoria, anxiety and rage - the OPPOSITE of medications action), withdrawal symptoms (can occur infrequently with short-term use - tremors, anxiety, diaphoresis)
- These medications should not be taken with alcohol, barbiturates or other opioids - may result in RESPIRATORY DEPRESSION

*ADVISE CLIENTS OF POSSIBLE DEVELOPMENT OF DEPENDENCY DURING AND AFTER TREATMENT*
What is the antidote for benzodiazepines (i.e. lorazepam, diazepam)?
- Romazicon (Flumazenil)
- Used to treat excessive drowsiness, IV toxicity
What is the antidote for opioids (i.e. morphine)?
- Narcan
- Antidote for opioids (narcotics), reverses or prevents effects, an opioid antagonist
What is Methadone used for?
- Used for opioid withdrawal, an opioid substitution
- Methadone REDUCES withdrawal symptoms in clients who are addicted to opioids
- Methadone may be used as a pain reliever
- Methadone also PREVENTS ABSTINENCE SYNROME
What are 3 medications a may abuse or be addicted to?
- Opioids (morphine)
- Benzodiazepines (lorazepam)
- Barbiturates (phenobarbital)
What are tricyclic antidepressants?
- Tricyclic antidepressants is a type of antidepressant that is used to treat DEPRESSION, and depressive episodes of bipolar disorders
What is amitriptyline (Elavil) used for?
- Amitriptyline (Elavil) is a tricyclic antidepressant used to treat depression
- Adverse effects: orthostatic hypotension (client should change positions slowly), ANTICHOLINERGIC EFFECTS (dry mouth, constipation, PHOTOPHOBIA, blurred vision, tachycardia), sedation, DECREASED SEIZURE THRESHOLD, excessive sweating

*Concurrent use of MAOI's and St. John's wort may lead to serotonin syndrome - avoid concurrent use*
A client with a history of suicide has been prescribed impiramine (Tofranil), what about the prescription should the nurse question?
- Impiramine (Tofranil) is a TRICYCLIC ANTIDEPRESSANT
- Tricyclic antidepressants are TOXIC if overdoses
- DO NOT GIVE CLIENT WHO HAS A HISTORY OF SUICIDE TRICYCLIC ANTIDEPRESSANTS - if overdosed, could cause DEATH
What is sertraline (Zoloft) used for?
- Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that is used to treat MAJOR DEPRESSION, obsessive compulsive disorders (OCD), bulimia nervosa, panic disorders, PTSD
- Side effects: sexual dysfunction, CSN stimulation, SEROTONIN SYNDROME (may occur 2-72 hours after starting treatment and may be LETHAL), withdrawal syndrome (resulting in headache, nausea, visual disturbances, anxiety, dizziness and tremors), GI bleeding
What are monoamine oxidase inhibitors (MAOI's)?
- MAOI's are used to treat atypical depression, bulimia nervosa, and OCD
What is an important teaching the nurse needs to include for the client who is starting a course of MAOI's?
- Inform clients that HYPERTENSIVE CRISIS may result from dietary intake of foods rich in TYRAMINE
- In severe hypertension, the client will experience headache, nausea, increased heart rate, and blood pressure
- Foods containing tyramine the clients needs to AVOID are: aged cheeses, pepperoni, salami, avocado, figs, bananas, smoked fish, protein dietary supplements, soy sauce, some beers, red wine
What is phenelzine (Nardil) used for?
- Phenelzine (Nardil) is an MAOI used to treat atypical depression, bulimia nervosa, and OCD
- Teach the client to AVOID foods with TYRAMINE, as that will lead the client to be in a hypertensive crisis
- Check client's MAR to be sure they are not on an SSRI, as concurrent use may lead to SEROTONIN SYNDROME
- Client should also avoid OTC decongestants and cold remedies, as that can also lead to hypertensive crisis
What is serotonin syndrome?
- Serotonin syndrome may begin 2-72 hours after starting treatment and may be LETHAL!!!
- Manifestations include: fever, mental confusion and difficulty concentrating, agitation, anxiety, hallucinations, incoordination, diaphoresis and tremors
- Use of MAOI's and St. John's wort may increase the risk for serotonin syndrome
- Concurrent use of MAOI's and SSRI may also lead to serotonin syndrome

*TOO MUCH SEROTONIN*
Neuroleptics are used to treat what kind of disorders?
- Neuroleptics are also known as antipsychotics
- They are used in the treatment of schizophrenia and manage psychoses
What is the medication lithium used for?
- Lithium carbonate is a MOOD STABILIZER drug used in the treatment of acute mania in clients who have bipolar disorders
- Lithium also can help PREVENT the return of MANIA or DEPRESSION and decreases the incidence of suicide
- Lithium is ESPECIALLY used for EUPHORIC MANIA
What are the possible side effects that may occur with lithium?
- GI distress (nausea, diarrhea and abdominal pain), advise patients that these symptoms are usually transient
- Fine hand tremors that can interfere with purposeful motor skills and can be exacerbated by factors such as stress and caffeine
- Polyuria and mild thirst (instruct clients to maintain adequate fluid intake, 2-3 L/day
- Weight gain (advise clients to follow a healthy diet and a regular exercise routine)
- Renal toxicity (MONITOR BASELINE KIDNEY FUNCTION)
- Goiter and hypothyroidism with LONG-TERM treatment (monitor client's baseline thyroid levels prior to starting treatment, and then annually - levothyroxine may be used)
What is the maintenance level for a patient who is taking lithium?
- Advise patient that serum lithium levels will need to be monitored while undergoing treatment
- During initial treatment, of a manic episode, levels should be between 0.8-1.4

*MAINTENANCE LEVEL RANGE IS 0.4-1.0*
At what range of lithium treatment, could equal toxicity?
- Greater than 1.5 indicates TOXICITY
- Watch for early signs of toxicity, DIARRHEA
What is chlorpromazine (Thorazine) used for?
- Chlorpromazine (Thorazine) is a CONVENTIONAL ANTIPSYCHOTIC used in the treatment of ACUTE and CHRONIC PSYCHOSES, SCHIZOPHRENIA, BIPOLAR DISORDERS (manic phase)
What are the possible side effects/complications that can occur with chlorpromazine (Thorazine)?
- ACUTE DYSTONIA: severe spasms of tongue, neck, face, or back - this is a CRISIS situation that requires RAPID treatment (treat with ANTICHOLINERGIC agents such as benzotropine (Cogentin)
- PARKINSONISM: bradykinesia, rigidity, shuffling gait, drooling and tremors (treat with benzotropine (Cogentin), amantidine (Symmetrel)
- Akathisia: inability to sit or stand still, continual pacing and agitation (manage symptoms with a benzodiazepine)
- LATE EPS and TD: involuntary movements of the tongue and face, such as lip-smacking, which causes speech and/or eating disturbances, TD also may include involuntary movements of arms, legs, or trunks
- Neuroleptic malignant syndrome: sudden high-grade fever, BP fluctuations, change in LOC, muscle rigidity, developing into a COMA
- ANTICHOLINERGIC EFFECTS: dry mouth, blurred vision, photophobia, urinary hesitancy, constipation. tachycardia
- ORTHOSTATIC HYPOTENSION
- SEDATION
- NEUROENDOCRINE EFFECTS (GYNECOMASTIA)
- Agranulocytosis
What is Ritalin used for?
- Ritalin is a CNS stimulant that is used to treat ADHD and conduct disorders
- Side effects: CNS stimulation (insomnia and restlessness), WEIGHT LOSS AND POSSIBLE GROWTH SUPPRESSION, cardiovascular effects, development of psychotic symptoms such as hallucinations and paranoia, withdrawal reaction
What are some nursing considerations for the patient on Ritalin?
- Monitor the client's HEIGHT and WEIGHT and compare to baseline height and weight
- Advise clients NOT to stop taking the medication suddenly, as this may lead to depression and severe fatigue
How does Haldol work in the body?
- Haldol is a conventional antipsychotic medication that BLOCKS dopamine and acetylcholine histamine and norepinephrine receptors in the brain and periphery
- Inhibition of psychotic symptoms is believed to be a result of dopamine blockade in the brain
What are the possible side effects of Haldol that may occur?
- ACUTE DYSTONIA: severe spasms of tongue, neck, face, or back - this is a CRISIS situation that requires RAPID treatment (treat with ANTICHOLINERGIC agents such as benzotropine (Cogentin)
- PARKINSONISM: bradykinesia, rigidity, shuffling gait, drooling and tremors (treat with benzotropine (Cogentin), amantidine (Symmetrel)
- Akathisia: inability to sit or stand still, continual pacing and agitation (manage symptoms with a benzodiazepine)
- LATE EPS and TD: involuntary movements of the tongue and face, such as lip-smacking, which causes speech and/or eating disturbances, TD also may include involuntary movements of arms, legs, or trunks
- Neuroleptic malignant syndrome: sudden high-grade fever, BP fluctuations, change in LOC, muscle rigidity, developing into a COMA
- ANTICHOLINERGIC EFFECTS: dry mouth, blurred vision, photophobia, urinary hesitancy, constipation. tachycardia
- ORTHOSTATIC HYPOTENSION
- SEDATION
- NEUROENDOCRINE EFFECTS (GYNECOMASTIA)
- Agranulocytosis
A patient is on an MAOI and is now changing to an SSRI, how long do they have to wait before they can start taking the SSRI?
- 2 weeks
What is citalopram (Celexa) used to treat?
- Citalopram (Celexa) is an SSRI that is used to treat MAJOR DEPRESSION, bulimia nervosa, OCD
What is benzotropine (Cogentin) used for?
- Cogentin is an anti-parkinson drug that REDUCED SYMPTOMS of Parkinson's disease
- Used in the treatment of ACUTE DYSTONIA (severe spasms of the tongue, neck, face or back) caused from taking CHLORPROMAZINE (Thorazine), conventional antipsychotics
**Helps to control muscle spasms (side effects from conventional antipsychotics)**
What is ziprasidone (Geodon) used for?
- Geodon is an atypical antipsychotic medication
- May be administered to treat schizophrenia (negative and positive symptoms), psychoses
What mental health medications may cause an onset of diabetes?
- Risperidone, Geodon (atypical antipsychotics)
- Clozapine (Clozaril)
What medication is useful in treating PSYCHOTIC symptoms in the schizophrenia client?
- Chlorpromazine (Clozaril) a conventional antipsychotic
- Used to treat ACUTE and CHRONIC psychoses
- Schizophrenia

- Risperidone (Risperidal)
- Used to treat schizophrenia (NEGATIVE and POSITIVE SYMPTOMS)
What are the nursing considerations and contraindications for the client taking Clozaril?
- Nursing considerations: advise clients to AVOID OTC medications that contain anticholinergic agents such as sleep aids - these will increase anticholinergic effects, advise clients to AVOID alcohol and other medications that cause CNS depression

- Contraindications: use CAUTIOUSLY in clients with GLAUCOMA, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease and seizure disorders
What medication can be used intramuscularly to treat schizophrenia?
- Risperidone is available IM route as a depot injection
- Administered IM every 2 weeks, used for clients who have difficulty adhering to the medication regiman
What is trihexyphenidyl (Artane) used for?
- Used to treat Parkinson's disease by IMPROVING muscle control and reducing stiffness, allows more normal movements of the body
- Used to control severe muscle spasms/reactions and other SIDE EFFECTS from certain drugs that are used to treat severe nausea or other conditions caused by HALDOL
What are some nursing considerations for the client on lithium?
- Monitor serum lithium levels while undergoing treatment
- MAINTAIN LEVELS BETWEEN 0.4-1.0 mEq/L
- Levels that are GREATER than 1.5 indicate toxicity
- Provide nutritional counseling, stress importance of adequate fluid and sodium intake
- Instruct clients to monitor signs for toxicity, and to contact the provider
- Instruct client to STOP taking the medication if experiencing DIARRHEA, VOMITING, or EXCESSIVE SWEATING
What are the signs and symptoms of lithium toxicity?
- Early signs: diarrhea, nausea, vomiting, thirst, polyuria, slurred speech

- Advanced signs: ongoing GI distress, mental confusion and poor coordination

- Severe toxicity: extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, possible DEATH resulting from respiratory complications
What 2 medications can be used as mood stabilizers?
- Lithium carbonate (mood stabilizer)
- Carbamazepine (Tegretol) - mood stabilizing antiepileptic drugs
What are 2 medications that are used to treat ADHD in the child?
- Ritalin
- Adderall

-Nursing considerations: advise clients to NOT stop the medication abruptly, as this will lead to a withdrawal reaction (depression and severe fatigue)

*Used to treat ADHD and CONDUCT DISORDERS*
A patient is starting a course of lithium - when reviewing the MAR, what would be some medications you would question the patient receiving?
- Lithium is CONTRAINDICATED in clients with a hypersensitivity to tartzone, renal or cardiovascular disease, sodium depletion, dehydration and in clients who are receiving DIURETICS

- The nurse should question the following medications: lasix (loop diuretics), NSAIDS, ANTACIDS, and ANY SODIUM DEPLETING MEDICATIONS

*Sodium is excreted with the use of diuretics, REDUCED SERUM SODIUM (excreting from use of diuretics), will lead to DECREASED LITHIUM EXCRETION, making the client prone to TOXICITY!