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50 Cards in this Set
- Front
- Back
What is the cognitive approach to mental health therapy?
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- 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 |
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What is the behavioral approach to mental health therapy?
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- 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 |
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What is cognitive-behavioral therapy?
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- Cognitive-behavioral therapy uses both a COGNITIVE and BEHAVIORAL approach to assist a client with anxiety management
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What is the purpose of self-help groups?
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- 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 |
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What is the medication fluoxetine (Prozac) used for?
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- 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) |
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What does assertiveness training mean?
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- An assertiveness training program teaches the client to express feelings, and solve problems in a NON-AGGRESSIVE manner
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What is electroconvulsive therapy?
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- 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) |
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What are the patient outcomes from ECT?
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- The client is relieved of clinical manifestations of depression
- The client is able to perform activities of daily living |
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What should the patient do PRIOR to an ECT treatment session?
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- 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 |
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What is the post-procedure care for a client who just underwent an ECT procedure?
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- 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 |
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What are possible complication from ECT?
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- 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* |
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What are anxiolytics uses for?
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- 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 |
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What are Diazepam, alprazolam (Xanax), and lorazepam (Ativan) used for?
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- 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* |
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What is the antidote for benzodiazepines (i.e. lorazepam, diazepam)?
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- Romazicon (Flumazenil)
- Used to treat excessive drowsiness, IV toxicity |
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What is the antidote for opioids (i.e. morphine)?
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- Narcan
- Antidote for opioids (narcotics), reverses or prevents effects, an opioid antagonist |
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What is Methadone used for?
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- 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 |
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What are 3 medications a may abuse or be addicted to?
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- Opioids (morphine)
- Benzodiazepines (lorazepam) - Barbiturates (phenobarbital) |
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What are tricyclic antidepressants?
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- Tricyclic antidepressants is a type of antidepressant that is used to treat DEPRESSION, and depressive episodes of bipolar disorders
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What is amitriptyline (Elavil) used for?
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- 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* |
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A client with a history of suicide has been prescribed impiramine (Tofranil), what about the prescription should the nurse question?
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- 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 |
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What is sertraline (Zoloft) used for?
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- 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 |
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What are monoamine oxidase inhibitors (MAOI's)?
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- MAOI's are used to treat atypical depression, bulimia nervosa, and OCD
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What is an important teaching the nurse needs to include for the client who is starting a course of MAOI's?
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- 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 |
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What is phenelzine (Nardil) used for?
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- 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 |
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What is serotonin syndrome?
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- 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* |
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Neuroleptics are used to treat what kind of disorders?
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- Neuroleptics are also known as antipsychotics
- They are used in the treatment of schizophrenia and manage psychoses |
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What is the medication lithium used for?
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- 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 |
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What are the possible side effects that may occur with lithium?
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- 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) |
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What is the maintenance level for a patient who is taking lithium?
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- 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* |
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At what range of lithium treatment, could equal toxicity?
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- Greater than 1.5 indicates TOXICITY
- Watch for early signs of toxicity, DIARRHEA |
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What is chlorpromazine (Thorazine) used for?
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- Chlorpromazine (Thorazine) is a CONVENTIONAL ANTIPSYCHOTIC used in the treatment of ACUTE and CHRONIC PSYCHOSES, SCHIZOPHRENIA, BIPOLAR DISORDERS (manic phase)
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What are the possible side effects/complications that can occur with chlorpromazine (Thorazine)?
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- 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 |
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What is Ritalin used for?
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- 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 |
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What are some nursing considerations for the patient on Ritalin?
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- 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 |
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How does Haldol work in the body?
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- 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 |
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What are the possible side effects of Haldol that may occur?
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- 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 |
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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?
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- 2 weeks
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What is citalopram (Celexa) used to treat?
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- Citalopram (Celexa) is an SSRI that is used to treat MAJOR DEPRESSION, bulimia nervosa, OCD
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What is benzotropine (Cogentin) used for?
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- 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)** |
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What is ziprasidone (Geodon) used for?
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- Geodon is an atypical antipsychotic medication
- May be administered to treat schizophrenia (negative and positive symptoms), psychoses |
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What mental health medications may cause an onset of diabetes?
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- Risperidone, Geodon (atypical antipsychotics)
- Clozapine (Clozaril) |
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What medication is useful in treating PSYCHOTIC symptoms in the schizophrenia client?
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- Chlorpromazine (Clozaril) a conventional antipsychotic
- Used to treat ACUTE and CHRONIC psychoses - Schizophrenia - Risperidone (Risperidal) - Used to treat schizophrenia (NEGATIVE and POSITIVE SYMPTOMS) |
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What are the nursing considerations and contraindications for the client taking Clozaril?
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- 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 |
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What medication can be used intramuscularly to treat schizophrenia?
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- 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 |
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What is trihexyphenidyl (Artane) used for?
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- 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 |
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What are some nursing considerations for the client on lithium?
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- 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 |
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What are the signs and symptoms of lithium toxicity?
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- 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 |
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What 2 medications can be used as mood stabilizers?
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- Lithium carbonate (mood stabilizer)
- Carbamazepine (Tegretol) - mood stabilizing antiepileptic drugs |
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What are 2 medications that are used to treat ADHD in the child?
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- 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* |
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A patient is starting a course of lithium - when reviewing the MAR, what would be some medications you would question the patient receiving?
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- 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! |