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278 Cards in this Set
- Front
- Back
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Suicide is the ____ leading cause of death among 14-25 year olds
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third
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Highest risk for suicide
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elderly
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Highest suicide rate is
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white men over 85
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COmorbidity:
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Deperssion, bipolar, schizophrenia, alcohol, personality disorders, panic disorder
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Suicide could be from low levels of ______
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serotonin
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Nonfatal self-injury with a clear intent to cause bodily harm or death; clear risk of suicide
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Parasuicide
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If there is not a clear dersire to die, should be treated as _____
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outpatient
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Using a gun, jumping off a high place, hanging, poisoining w/ carbon monoxide and staging car crash
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higher-risk methods, hard
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People who have plans for time, place and means are _____
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high risk
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Slashing wrists, inhaling natural gas, pills are examples of
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Lower-risk methods/ soft
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When poeple are psychotic they are always _____ b/c impulse control and judgement and grossly imparied
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high risk
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SAD scale:
0-2 = 3-4 = 5-6 = 7-10 = |
0-2 = Send home with follow-up
3-4 = Closely follow up; consider hospitalization 5-6 = Strongly consider hospitalization 7-10 = Hospitalize or commit |
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Universal reactions that nurses have toward suicidal pt:
1. ____ = concern about professional consequences; thoughts about own death |
anxiety
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Universal reactions that nurses have toward suicidal pt:
2. ____ = people who have multiple suicide attempts |
Irritation
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Universal reactions that nurses have toward suicidal pt:
3. ____ = kept at a distance when they don't show improvement |
Avoidance
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Universal reactions that nurses have toward suicidal pt:
4. ____ = minimizing suicidal ideation; like "I can't understand why anyone would want to take their own life."; also can occur when identification with person is strong |
Denial
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Levels of Suicide intervention:
This includes activities that provide support, info and education; in schools, homes, hospitals and work |
Primary intervention
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Levels of Suicide intervention:
Treatment of the actual suicide crisis; could be over telephone hotline, clinics and hospitals |
Secondary intervention
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Levels of Suicide intervention:
INtervention with family and friends of person who has commited suicide to reduce the traumatic aftereffects |
Tertiary intervention / postvention
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Charting should include affect and behavior, indicate clear accountability for staff; these are examples of _____
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Milieu therapy with suicide precautions
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Suicide risk is hightest during ______ and ______
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first few days and staff rotation
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Assessment of suicide is _____
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ongoing process
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Suicide assessment should be made particulary _______ or _______
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before a change in level of oberservation or upon sudden improvemtn or worsening of symptoms
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Counseling with suicide:
They key element is establishing a working alliance to encourage the cleint to engage in more _______ |
Realistic problem solving
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Long-term ______ treatment for bipolar disorder and major depression reduces suicide
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Lithium
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WHen on lithium treatment, need _____ and _____
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Blood work and family/ client education
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Depressed or psychotic clients who can't wiat for med, pregnant women, client's who can't tolerate med and client's who do not resond to med may have _____
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ECT
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emotional responce to the perceptoin of frustration of desires, threat to one's needs or challenge; normal responce
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Anger
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Harsh physical or verbal action that reflects rage, hostility and potential for physical or verbal destructiveness
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Aggression
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Anger and aggression are the last two stages of a responce that begins with feelings of ____ and then ____
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vulnerability and then uneasiness
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Client's often communicate ____ before escalating to anger
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anxiety
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Comorbidity of anger:
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ADHD; opposititional defiant disorder; impulsivity; depression; mania; alzheismers; tourette's
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Anger and hosility are risk factors for:
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CVD; HTN
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Children learn anger from watching and repeating others
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Behavioral base theory
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Percieved assault on areas of personal domain, such as values, moral code and protective rules, can also lead to anger
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Cognitive theory base
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Site in brain asspociated with aggression; mediates primitve emotion
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Limbic system
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This part of the brain mediates anger experences, judging events as aversive or rewarding
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amygdala
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The ____ lobe has to do with aggression
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temporal
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Relationship b/w impulsive aggression and low levels of _____
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sertonin
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History of client's _____, ____ and _____ when assessment of aggression
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Background, coping skills and client's perception
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This is the most important predictor of imminent violence
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Hyperactivity like pacing, reslesness
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A ______ of violence is the single best predictor of future violence
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History
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Idelly, intervention with aggression occurs at the point of _______ _____
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ineffective coping
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______ of anger is the primary nursing intervention
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deescalation
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Intervention:
During this stage, the client is increasingly agitated |
Preassaultive stage
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Deescalation Approaches in preassaultive stage:
Determine what the client is feeling; attempting to hear feelings; gathering info as an observer (if you don't know client well) or listening and attending (if you do know client well); move to place that is quite; acknowledge client's needs |
Analyze the client and situation
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Deescalation Approaches in preassaultive stage:
Be excellent listener and respond therapeutically; convey calm, open, caring; relaxed posture |
Use verbal techniques of deescalation
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Deescalation Approaches in preassaultive stage:
If client is sitting, should sit too; eyes at same level; client's poised for violence need more space |
Demponstrate respect for the client's presonal space
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Deescalation Approaches in preassaultive stage:
speak in low/ calm voice; don't end sentences in "okay?"; this approach decreases the sencse of powerlessness |
Interact with client
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Deescalation Approaches in preassaultive stage:
have time frame in mind; depressed, suicidal or frightened clients need more time while manipulative cleints = less time; 8-10 min |
Invest tiem in teh process
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Deescalation Approaches in preassaultive stage:
This is critical; quite place but one visible to staff; want cleint to regain control; inform other staff |
Pay attention to the environment
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Deescalation Approaches in preassaultive stage:
Must have this in order to communicate in calm manner; always know layout of area; provide feedback about what you are observing; avoid confrontation (don't do a show of force with security guards) |
Assure your safety
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Intervention:
During this stage, five staff members are needed; includes retraint, meds and seclusion |
Assaultive stage
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The involuntary confinement of a client alone in a room, which the cleint is prevented from leaving
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Seclusion
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Any manual method or adjacent/ attachment to the cleint's body that cannot be easily removed that restricts freedom of movement or normal access to one's body
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Restraint
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Intervention for aggressive client:
When the client and staff talk about what happened to learn, id stress and plan new ways of responding |
Postassaultive stage
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Staff analysis of the episode of violence; crucial to ensure quality of care to cleint by staff; ask self questions
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Return to baseline: Critical incidental debriefing
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Assessment of bx preassaultive stage; interventions and evaluation; descriptions of bx during assaultive stage; cleint's responce; restraints and seclutions; milieu all need to be....
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documented
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With these cleints, need to talk with family memebers and get good hx; then find ways to reestablish similar means of dealing with hosp
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Angry client with healthy coping who are overwhelmed
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Angry client with healthy coping who are overwhelmed:
When ___ feeling to help client feel understood |
Name
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These cleints are poorly equipped to use alternatives; manifest anger quickly from preassaultive stage to assaultive stage; esp true for chem dependent cleints; externalize blame
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Angry cleints with Marginal coping skills
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Intervention for Angry cleints with Marginal coping skills begin with...
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attempts to understand and meet client's needs
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Anxiety can be minimized by reducing _____ by using clear communication; also can use distractions
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ambiguity
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Intervention for Angry cleints with Marginal coping skills help when interaction with health care team is
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predictable
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The two most significant predictability of violence is _____ and ____
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History of violence and impulsivity
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____ _____ like vulnerability and powerlessness, unrealistic expectation, needs being ignored contribulte to client anger and aggression
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situational factors
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With client's who have cognitive deficits, should _____ and use _____
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Orientate and med
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To respond to episodes of agitation, should id the _____ and _____
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antecedents and consequences
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More helpful to refect back to client the feels behind their demand and show understanding and concern and don't try to reorient client if they try to return to ealier years; like "I have to go home and take care of my babies"
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Validation therapy
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This is the fourth leading cause of disbility in US; twice as common in women; 5.1%
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Depression
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Comorbidity of drepression
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Anxiety; sub abuse; schiz; eating disorders
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One of the more common psychiatric presentation
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mixed anxiety-depression
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This has been shown for a higher rate of suicide, greater severity of depression and greater impariment
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Comorbidity of depression
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Cleints with this experience substantial pain and suffering and well as disability
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Major depressive disorder (MDD)
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History of one of more major depressive episode and no hisotry of manic episode; this represents change in person's usual functioning
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MDD
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Chronic depressive syndrom that is usually present for more of the day, more days than not, for at least 2 years; this does NOT represent change is person's usual functioning
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Dysthymic disorder (DD)
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Onset of DD
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early childhood, teenage years to early adulthood
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MDD specifiers:
Breaks with reality; hallucinations, delusions |
Psychotic features
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MDD specifiers:
Peculier volentary movement, echopraxia (the abnormal repetition of the actions of another person), negatism |
Cataonic features
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MDD specifiers:
Anorexia/ wt loss; diurnal variations sym worse in morning; early morning awaking |
Melancholic features
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MDD specifiers:
4 wks after birth; anxiety |
Postpartum onset
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MDD specifiers:
Fall/ winter |
SAD; seaonal features
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MDD specifiers:
Apt change, wt gain, hypersomnia; sensitivity to perceived interpersonal rejection |
Atypical features
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Decrease in ______ and _____ may explain biochemical factor to depression;
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Serotonin and norepinephrine
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With stressful life events, especially losses, neurotrasm deplession of ____, ____ and ____ may occur
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Serotonin, norepin and acetylocholine
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Neuroendocrine in depression: _______ of the hypothalamic-pituitary-adrenal cortical axis
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Hyperactivity
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_______, an exogenous steroid that suppresses cortison, is abnormal is depressed people
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Dexamethasone
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____ REM latency and deficiets in _______ sleep persist following recovery from depressed episode
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Reduced; slow-wave
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Depressed people process info in negative ways
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Beck; cognitive therory
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The goal of CBT is to
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change the way cleint's think and rellieve depressive syndrome
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About ____ to ____ % of depressed people commit suicide
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10-15
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60-90% experience
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depression
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Inability to carry out simple tasks
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Helplessness
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Believe that things will never change
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hopelessness
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One of the core char of depression and suicide; cognitive and emotional
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Hopelessness
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The two natural outcomes of profound feelings of helplessness
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anger and irritability
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About ____ % report anerexia with depression
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60-70%
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Overeating occurs more often with ______
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dysthymia
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Consipation =
Diarrhea (less frequently) = |
Psychomotor retardation
Psychomotor agitation |
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First priority nursing diagnosis
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Risk for suicide
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This intervention for depressed pt is directed at reduction of depressive symptoms and retoration of psychosocial and work function; 6-12 wks
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Acute phase
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This intervention for depressed pt is directed at prevention of pelapse through pharmocotherapy, education and depressed-specific psychotherapy; 4-9 months
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continuation phase
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This intervention for depressed pt is directed at prevention of further episodes of drepression; 1 or more years
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Maintenance phase
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On of the purposes of this is to clarify teh interpersonal stresses and discuss steps that can alleviate tension in family systems
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Predischange counseling
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Helps people change neg styles of thinking and behaving
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CBT
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Focuses on working through personal relationships that may contribute to depression
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Interpersonal therapy (IPT)
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Focus on assertiveness and coping skills; incrase in postivie reinfment from other poeple
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Social skills training
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First-line therapy for all types of drespression except psychotic, melancholic and mild
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SSRI
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This is thought to be r/t overactiation of the central serotonin receptors and caused by either too high a dose or interaction with other drugs
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Central serotonin syndrome
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Symptoms for Central serotonin syndrome
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Abd pain, d, sweating, fever, tachy, increased B/P, delirium, myoclonus, mood change
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Greatest risk factor for central serotonin syndrome
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SSRI plus MAOI (needs to be a two week gap b/w two meds)
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Teaching of SSRI
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Sexual dysfunction, no dig and warfarin, (2 wks before/after maoi; no alcohol; do not d/c abruptly
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Meds to be adm if central serotonin syndrom
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Cyproheptadine, methysergide, propranolol
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Other emergancy interventions if cen sero syn
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Cooling blankets, diazepam for muscel rigidity; anticonvulsnats, ven, paralysis
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This benzodiapazapine anxiolytic can cvause dependence and potentially severe withdrawal reactions after abrupt d/c
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Xanax
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These inhibit reuptake or norepinephrine and serotonin by teh presynaptic neurons in CNS; NE and Serotonin available to the postsynaptic receptors is increased
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TCA
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Client who is lethargic and fatique may need to start a more stimulating TCA like
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Norpramin or vivactil
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Client who needs a sedating effect for agitaiton or restlessness need TCA like
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Elavil and Sinequan
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Good TCA for elderly
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Surmontil
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Adverse reactions to TCA
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Anticholinergic actions
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Anticholinergic actions that warrent immediate medicaiton attention
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Urinary retention and constipation
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Should take TCA at
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night
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Cannot take _____ with TCA
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MAOI
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Contraindications of TCA
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MI, narrow-angle glaucoma or hx of serizers, preg women
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Mood elevation of TCA can take _____ days and up to ____ weeks to see full effect
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7-28 days
6-8 wks |
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If client forgets dose, should take within ____ hrs or wait until next day
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3
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Monoamine oxidase is resposible for inactivating amines like
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norep, serotonin, dopamine and tyramine
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Increase in tyramine =
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higher b/p, htn crisis and CVA
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Foods that cannot be taken with MAOIs
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avocados, figs, bananas, meats that are fermented, liver, bologna, all cheeses, yeast, soy sause, caffeinated beverages, chocolate, ginseng
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Side effects of MAOIs
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otho hypo; wt gain, edema, cons, sexual dys, muscle twitching, hypomanic/ manic bx
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Toxic effects of MAOIs
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increase b/p, coma, IC hemorrhage, fever
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The beginning of HTN crisis may occur in first few hrs of taking MAOIs and begin with
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HA, stiff neck, palpitations, HR increase/ decrease; n, v, pyrexia
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TX of HTN crisis
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Antihypertensive med (Regitine)/ phentolamine adm IV; ice packets
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If have surgery within ____ days cannot take MAOIs
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10-14
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Teaching about MAOIs
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avoid all medications, avoid chinese resturants, severe HA = ED; monitor b/p for first 6 wks; if med stopped, should do dietary/ drug restrictions for 14 days
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Client with bipolar disorder who has many episodes of mood swings close together (four or more in 1 year)
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Rapid cycler
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People who may do ECT for depression
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rapid cycler, psychotic symptoms, psychomotor retardations/ stupor; resistant to lithium and antuspychotic drugs; schiaophrenia (catatonia); preg, Parkinson's disease
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ECT not effective in cliens with
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DD, atypical depression and person disorder, drug dep
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ECT treatment =
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two or three treatments/ wk for total of 6-12 treatments
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Procedure of ECT
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informed concent, general anesthetic, and muscle-paralyzing agent
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Adverse reaction of ECT
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upon awakening, confused; need to prient, may have memory deficits
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St. John's wort not taken in..
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preg, major depression, age younger than 2
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Teaching with St. John wort
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increase in Central serotonin syn when taken with other meds; should avoid tyramine-containing foods; may interact with HIV meds, chemo, antiCA drugs. SE: photophobia, GI upset, sinus tachy, abd pain
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Bipolar disorder is marked by shifts in
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person's mood, energy and ability to function
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At least one episode of mania alternating with major depression
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Bipolar I disorder
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Hyopmanic episodes alternating with major depression
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Bipolar II disorder
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Hyopmanic episodes alternating with minor depresive episodes (at least 2 years in duration)
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Cyclothymia
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As high as ___ % have bipolar disorder
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3
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Bipolar I is more common among ____ while II is more common among ____
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men
women |
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Cyclothymia usually begins in _____
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adolescence or early adulthood
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Comorbidity of bipolar
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Substance-abusing; anxiety, aneorexia, adhd
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Bipolar disorders have _____ genetic component
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strong
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During manic eposide, have an increase in
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Norephinephrine and epinephrine
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Neuroendocrine facts of bipolar
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Hypothyroidism
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Sociological factor in bipolar
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upper socioeconomic classes, higher education...
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THe nonstop physical activity and lack of sleep during manic esposide =
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emergency
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Stringing togehter of workds because they rhyme; manic eposide
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Clang association
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Topic to topic; manic eposide
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flight of ideas
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THink that God is talking to them; FBI is out to get them
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Grandiose presecutory delusions; bipolar
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Some skills that must be done by staff in order to reduce splitting from the Bipolar client
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Setting limits, consistency, frequent staff meetings
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Outcome Criteria:
The main goal in Phase I: actue phase/ actue mania |
prevent injury; (well hydrated, cardiac status, tissue integrity, get sleep, demonstrate thought self-control, make no attempt to self harm
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Outcome criteria:
The main goal in Phase II: COntinuation of Treatment Phase; 4-9 months |
Relapse preventions; psychoeducational classes, support groups, communication and problem-solving skills
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Outcome Criteria
The main goal in Phase III: maintance treatment phase |
Focus on prevention of relapse and to limit the severity and duration of future eposides; learning interpersonal strategies, psychotherapy/group
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Intervention:
During phase I or acute phase |
Hospitalization; safety; firm calm approach, short concise explanations, limits, medication; frequent sleep; high-calorie fluids/foods; low level of stimuli
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Mood stabilizers are _____ maintenance for bipolar cleints
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Lifetime
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Lithium carbonate therapeutic levles
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0.8-1.4 mEg/L
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Lithium carb maintence blood levels
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0.4-1.3 mEg/L
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Toxicity for Lithium
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over 1.5 mEg/L
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Lithium tox above 2.0 interventions
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Life-threatening emergancy; gastric lavage/ tx with urea, mannitol and aminophylline; hemodialysis
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Two major long term risk of Lithium
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Hyopthyroidism, impairment of kidney's ability to concentrate urine
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Antiepilepic Drug:
Divalproex (depakote) info |
Acute phase; Rapid cyclers, dysphorinc manic; monitor liver and platelet count
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Antiepilepic Drug:
Lamotrigine (Lamictal) |
Acute and Maintance phase; serious but rare rash
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Antiepilepic Drug:
Carbarazepine (tegretol) |
rapid cyclers; severely paranoid; angry/ manic clients; blood levels monitored for first 8 weeks
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Anxiolytics:
CLonazapam (Klonopin) and Lorazepam (Ativan) |
acute mania; managing psychomotor agitaiton; avoided if hx of substance abuse
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Antipsychotics:
Zyprexa, Seroquel |
Mood-stabilizing properites; anxiety symptoms
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Major adverse effect in Tegretol
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Agranulocytosis and aplastic anemia
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Milieu therapy: seclusion is used in bipolar pt b/c
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reduces stimuli, protects injury, prevents destruction of property
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Intervention: Continuation Phase
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Outcome is prevent relapse; community resources, medicaiton compliance, education (sleep very important, no alcohol/caffeine)
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Intervention: Maintence Phase
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aimed at preventing recurrencce; CBT to identify maladaptive cognition and bx; Support groups
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CBT for bipolar focuses on
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adherence to med, early detection and intervetnion, stress and lifestyle management and treatment of depression and comorbid conditions
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Prevalence of schizophrenia
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1%
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Onset of schiz
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Late teens/ early twenties
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Comorbidity of schiz
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Substance abuse disorders (40-50%); depressive symptoms
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Leading cause of premature cuase of death
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suicide
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Compulsive drinking of 4-10 L of water/ day
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Psychosis-induced polydipsia
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This is a crucial neurotransmitter during periods of neual materation and may play a part in Schiz
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Glutamate
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Low rate of blow flow and glucose metabolism in the _____ lobes
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Frontal
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_____ volume of gray matter in temportal and frontal lobes
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reduced
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Fundamental signs of schiz:
outward manifestation; bluted, flat, bizarre or inappropriate |
Affect
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Fundamental signs of schiz:
Haphazard and confused thinking |
associative looseness
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Fundamental signs of schiz:
thinking that is not bound to reality but reflects the private perceptual world of the ind; delusions, hallus and neologisms are examples |
Autism
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Fundamental signs of schiz:
Simultaneously holding two opposing emotions, attitudes ideas or wishes toward the same person/situation or object |
Ambivalence
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Prevention of relapse can be more importnat than the risk of _____ ____
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side effects of meds
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WIth each relapse of psychosis, there is increase in ____ _____ and _____
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residual dysfunction and deterioration
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Course of the Disease:
Florid positive symptoms (hallucinations, delusions) as well as neg symp (apathy, withdrawal, lack of motivation) |
Acute phase
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Course of disease:
acute symptoms decrease in severity |
maintenance phase
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Course of disease:
period in which symptoms are in remission |
stabilization phase
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Positive symptoms
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Hallucination, delusoins, bizarre bx, positive form thought disorder and speech patters (derailment, illogical, distractible, clang associations)
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Negative symptoms
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Affective flattening; alogia (speech), avolitation/ apathy (impaired grooming/ hygiene, lack of work) anhedonia (few relationships), attention deficits
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Florid psychotic symptoms; the ones that capture our attention
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Positive symptoms
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These persist and seem to be the most destructive b/c they render the person inert and unmotivated
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Negative symptoms
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Overemphasis on specific details and impairment in teh ability to use abstract concepts; the pt answer is literal
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concrete thinking
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Loss of ego boundries
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Derealization and depersonalization
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False perception by a person that the environment has changed; bigger or smaller
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Derealization
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Stilted rigid demeanor, eccentric dress or grooming, rituals
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Bizarre bx
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Motor patters that originally had meaning to the person, but are now mechanical and lack purpose
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Sterotyped bx
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The client does the opposite of what he/she is told to do
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active negativism
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Person does not perform activies that are normal expectations
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passive negativism (catatonia)
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____ control is lacking
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impulse
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These develop over a long time; interfere with the individual's adjustment and ability to survive
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Negative symptoms
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giggling, mumbling, grimacing to oneself
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bizarre affect
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This is one cognitive indicator that the ind eventually can function within the community
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Good verbal memory
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Precursors to burnout when dealing wiht schiz
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Frustration and helplessness
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To help not burnout, should
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reassessment tx outcomes and scale down unrealistic goals
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Outcomes for schiz should focus on
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enhancing person's strenghts and minimizing effects of the cleint's deficits
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For the acute phase in schiz, goal is
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Client safety and medical stabilization
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Goal for phase II, or maintance and phase III or stabilization is
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helping client adhere to medication regimens, understnad schiz and participate in psychoeducational acticities
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Phase III outcomes target
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negative symptoms and ability to participate in social, vocational and self-care skills; also addresses anxiety control and relapse prevention
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Planning for acute phase in schiz
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brief hospitaliztion when client is a danger, refusing ot eat/drink or too disorganzied to provide self-care; efforts to keep in community programs/ social support
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Planning for maintenance and stabilization in schiz
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family eduction and skills training; relapse prevention skills are vital
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During acute phase, important to provide ____ b/c it is better than open unit that allows greater freedom
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structured milieu
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Activities for schiz pt
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group work/ therapy
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WHen cleint is experiencing hallus, nurse should
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call pt by name, ask about halluci, don't negate experience, diversions
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When pt is experinceing delusions, nurse should
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ask cl to describe delusion, focus on feelings
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These drugs target the positive symptoms of schiz
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Conventional (traditional) antipsychotics
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These drugs can deminish the neg and pos symptoms
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Atyical (novel) antipsychotics
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Antipsychotic agents usually take ___ to ___ wks to take effect
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3-6 wks
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Atypical antipsychotics
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Zyprexa, seroquel, geodon and abilify
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Potential of Zyprexa and Seroquel- atypical
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WT gain; metabolic abn and increase likelihood of cardiac condition and diabetes
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Convential (traditional) antipsychotics SE
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Extrapyramidal side effects; anticholinergic effects, lowered seizer threshold, orthstasis
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EPS, symptoms is due to ____
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blockage of D2 (dopamine) receptor sites
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EPS symptoms are
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akathisia, dystonia, parkinsonism, and tardive dyskinesia
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Convential antipsychotic meds
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chlorpromazine (Thorazine)sedating agent; haloperidol (Haldol) least sedatitave
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High sedation + high ACH + low EPS
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low potency
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Low sedation + low ACH + high EPS
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high potency
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Traditional antipsychotic are used in caution with people who have a hx of
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seizers
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Atypical Antipsychotic Agents
Adverse reaction: Agranulocytosis, high seizure rate, tachy, wt. gain; |
Clozapine (Clozaril)
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Atypical Antipsychotic Agents
SE: hypotention, sedation, sexual dys, can also be used to treat bipolar |
Risperidone (Risperdal)
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Atypical Antipsychotic Agents
SE: WT gain, insomnia, agitation, akathisia |
Olanzapine (Zyprexa)
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Atypical Antipsychotic Agents
SE: Wt gain, HA, Orthostasis |
Quetiapine (Seroquel)
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Atypical Antipsychotic Agents
SE: ECG changes, QT prolonged |
Ziprasidone (Geodon)
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Atypical Antipsychotic Agents SE: little or no wt gain
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Aripiprazole (Abilify)
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Typical Antipsychotics High Potency:
SE= low sed properties; good for elderly; high EPS |
Haloperidol (Haldol)
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Typical Antipsychotics High Potency:
SE = Low sed effect, EPS |
Trifluoperazine (Stalazine)
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Typical Antipsychotics High Potency:
SE = lead sedating |
Fluphenazine (Prolixin)
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Typical Antipsychotics High Potency:
high incidence of akathisia |
Thiothixene (Navane)
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Typical Antipsychotics Med Potency:
Wt. reduction |
Loxapine (Loxitane) and Molindone (Moban)
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Typical Antipsychotics med potency:
Can help vom |
Perphenazine (Triafon)
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Typical Antipsychotics low potency:
SE: photophobia, highest sed and hypotensive effects |
Chlorpromazine (Thorazine)
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Typical Antipsychotics low potency:
SE: Wt gain |
Chlorprothixene (Taractan)
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Typical Antipsychotics low potnency:
SE: watch ECG changes |
Thioridazine (Mellaril)
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Typical Antipsychotics low potency:
Among most sedating, n, v in adults |
Mesoridazine (Serentil)
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Given if pt are forgettful; Typical Antipsychotics
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Decanotate: long-acting
Haldol (z-track IM, q 3-4 wks) Prolixin (z track IM) q 2-4 wks |
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EPS:
Muscle cramps of the head and neck |
Acute dystonia
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EPS:
Internal restlessness and external restless pacing or fidgeting |
Akathisia
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EPS:
Stiffening of muscular activity in teh face, body, arms and legs; 5 hrs to 30 days |
Pseudoparkinsomism
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Anticholinergic symptoms are side effects of _____ and include
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Traditinal antipsychotics; dry mouth, urinary retention, constipation, blurred vision, photosen, dry eyes and impotence in men
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EPS nursing intervention for _____:
Alert medical staff; anticholinergic agen (Artane, Cogentin) |
Psudoparkinsomism
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EPS nursing intervention for _____:
benadryl (first choice) Benztropine (second); 1-5 days this will happen |
Acute dystonic reactions
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Tetanic heightening of entire body, head and belly up
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Opisthotonos
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Eyes locked upward
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Oculogyric crisis
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EPS nursing intervention for _____:
Inderal, Ativan, Valium |
Akathisia
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TX of Standard antipsychotic neuroleptic malignant syndrom or severe EPS, hyperpyrexia, autonomic dysfunction
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Parlodel (relieve muscle rigidity) and Dantrium (muscle spasm), cool body, hydrate
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This is characterized by decrease LOC, increased muscle tone, autonomic dysfunction including hyperpyrexia, tachy, tachypnea, sweating, drooling
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Neuroleptic malignant syndrome
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Use of this benziodiazepine with antipsychotic drug therapy could help
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clonazepam
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This is the most common defense mechanism used by people who are paranoid
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Projection
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Counseling: communication guidelines for paranoia
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Will look at shortcommings in others; misinterprets messages
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Self-care needs for paranoia
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stronger ego (better hygiene); nutrition may be problem; fearful going to sleep
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Milieu needs for paranoia
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sense of security and safety minimizes anxiety; distract from hallucination and delusions
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Couseling for cataonia withdrawn phase
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may remain mute for hrs/ days; are acutely aware of environment
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Self-care for cataonia withdrawn phase
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hand/ tube fed; assessment of bowel urnary retention; skin breakdown; ROM exercises
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Milieu needs for cataonia withdrawn phase
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Can show brief outbursts of gross motor activity
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Catatonia: excited phase counseling
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talk, shourts continually, verbalizations may be incoherent
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Safety needs for catatonia excited phase
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antipsychotic agent IM; additional fluids, calories and rest
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Most regressed and socially impared schiz; marked looseness of associates, odd bx...
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Disorganized schiz
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|
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Disorg Schizo couseling
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Persistent and severe perceptual problems; clang association, looseness of association, blocking (sudden cessation in train of thought)
|
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Disorg Schizo self care needs
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Grooming neglected; no awareness of social expectations
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Disorg Schizo milieu needs
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Bx = bizarre
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