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40 Cards in this Set

  • Front
  • Back
Antipsychotic Medications
Purpose: decrease agitation, psychoses, mania, and aggression

Action: decrease dopamine. Atypical antipsychotics influence not only dopamine but also serotonin.
Antipsychotic Medications
Route: tablet, capsule, concentrate, IM, decanoate, and IV. Decanoates are long acting form of the medication. Decanoates are administered to patients who have a history of being noncompliant with oral medications. Only Haldol and Prolixin can be give in this route. Decanoates are given by deep IM injection and never administered by IV route. A 21 gauge is recommended. Decanoates lasts 1-4 weeks.
Antipsychotic Medications
Administration: routine or prn. For psychotic disorders, such as schizophrenia, this class of medications must be taken routinely.
Antipsychotic Medications
Thorazine (chlorpromazine) Orap (pimozide)
Seroquel (quetiapine) Fanapt (iloperidone)
Mellaril (thioridazine) Invega (paliperidone)
Prolixin (fluphenazine) Risperdal Consta
Trilafon (perphenazine) Abilify (aripiprazole)
Antipsychotic Medications
Stelazine (trifluoperazine) Geodon (ziprasidone)
Haldol (haloperidal) Zyprexa (olanzapine)
Navane (thiothixene) Risperdal (risperidone)
Loxitane (loxapine) Clozaril (clozapine)
Saphris (asenapine) Latuda (lurasidone)
Antipsychotic Medications
Side Effects:
-dry mouth
-urinary retention
-weight gain
-blurred vision
-drowsiness
-agitation
-constipation
-orthostatic hypotension
-QT prolongation
-oily skin, dermatitis, acne
-hyperglycemia
-agranulocytosis
-photosensitivity/changes body temperature regulation
-seizures
-gynecomastia
-lactation
EPS (extrapyramidal symptoms):
EPS (extrapyramidal symptoms):
1.akathisia-motor restlessness.
2.akinesia-motor slowness or absence of movement.
3.parkinsonism-shuffling gait, muscle rigidity, mask-like face, drooling, tremors, pill-rolling.
4.tardive dyskinesia(TD)-involuntary mouth movements such as smacking lips, protruding tongue, or chewing movements, .
5.dystonia-involuntary muscle spasms in the neck, chest, and back. Difficulty breathing. Speech becomes thick. Torticollis can occur where the patient’s neck muscles are so rigid the patient is unable to get head in an upright position. The head is tilted to the left or right side of the body. Also, the patient’s eyes may roll backwards called oculogyric crisis.
6.neuroleptic malignant syndrome (NMS)-rare but potentially fatal. The antipsychotic medication is stopped. The symptoms include high fever, muscle rigidity, respiratory distress, change in consciousness to stupor or coma, tachycardia, and diaphoresis.
Antipsychotic Medications
Nursing Implications/Teaching:
Nursing Implications/Teaching:
1. Teach patient and family about medication name, purpose, dosage, frequency, side effects, how to treat side effects, call the physician immediately if symptoms of EPS occur, and importance of compliancy.
2. For Clozaril, monitor agranulocytosis every week. Clozaril is dispensed only in a 7 day supply. If the patient does not get a WBC count done that week, the medication will not be dispensed. Teach patient to immediately notify health care professional if sore throat, fever, lethargy, weakness, or malaise occurs. The patient is placed in a national computer database when taking Clozaril. The medication is stopped if WBC count is <3,500mm.Clozaril dosage is started at 25mg QD or BID. The dosage is gradually increased 25-50mg/day over 2 weeks. Target dose is 300mg-450mg/day.
3. Risperdal Consta is a long acting form of Risperdal that is administered by deep IM injection every 2 weeks. An antipsychotic supplementation is needed during the first 3 weeks o
Antipsychotic Medications Nursing Implica
tions/Teaching:
4. For concentrate form of medication, give in small amount orange juice or water. The nurse must check for increase or decrease of medication effectiveness if another type of juice is used.
5. Patient has right to refuse medications. Medication cannot be forced unless the patient is in crisis or has been probated to take medication.
6. Check with guardian, if applicable, for permission of starting or discontinuing medication.
7. Teach patient/family to stay out of sunlight for prolonged periods of time. Wear sunscreen when outside to prevent photosensitivity reaction. Drink plenty of fluids to prevent heatstroke. Avoid extreme changes in temperature because medication causes impairment in body temperature regulation. Wear warm clothes if weather is cold. Use air conditioner or fan in hot weather.
Antipsychotic Medications
Nursing Implications/Teaching:
8. Teach patient/family to avoid alcohol because it changes the effectiveness of medication.
9. Teach patient/family to be cautious when driving or other doing activities that requires mental alertness until response from the medication is known.
10. If patient complains of EPS, check for cogwheeling. Tell the patient to relax arm. The nurse grasps the patient’s bicep by placing thumb above the patient’s elbow. The nurse extends and flexes the patient’s arm checking for muscle rigidity in the bicep muscle.
11. Saphris is an oral disintegrating tablet. Instruct patients not to eat or drink anything for 10 minutes after administration.
12. See textbook for list of other interventions and teaching information
Anticholinergic/Antiparkinson Medications
Purpose: prevent or treat EPS.
Action: decrease acetylcholine availability.
Route: po or IM.
Administration: routine or PRN.
Anticholinergic/Antiparkinson Medications
Meds:
Artane (trihexyphenidyl)
Cogentin (benztropine)
Akineton (biperiden)
Benadryl (dyphenhydramine)
Anticholinergic/Antiparkinson Medications
Side Effects:
Side Effects:
-peripheral anticholinergic side effects
-CNS side effects-confusion, agitation, exacerbation of psychoses, and disturbance in behavior.
Anticholinergic/Antiparkinson Medications
Nursing Interventions/Teaching:
Nursing Interventions/Teaching:
1. Medication name, purpose, dosage, frequency, side effects, compliancy, and when to call the physician.
2. Caution driving or other activities that require mental alertness until response to medication is known.
3. Use candy, sugarless gum, and good oral hygiene for dry mouth.
4. Caution patient to change position slowly.
Which medication can be given in decanoate form?
Haldol (haloperidol)
What is the most important item to teach the pt. who is taking Clozaril (clozapine)?
Weekly WBC level is needed to dispense medication.
What is the most important nursing intervention when caring for a pt. receiving an antipsychotic med?
Teach about the importance of using sunscreen.
What is this medication used for? Akineton (biperiden)
Akineton (biperiden) is used to treat EPS
What is this medication used for? Benadryl (dyphenhydramine)
Benadryl (dyphenhydramine) is used to treat EPS
A pt on antipsychotic medication starts to experience involuntary mouth movements. This is called ?
tardive dyskinesia
A common side effect of antipsychotic meds
Blurred vision
A common side effect of antipsychotic meds
Weight gain
What is the most important nursing intervention when caring for pt. who was receiving an antipsychotic med.
Encourage pt to change position slowly
What is the most common classification of meds used to treat paranoia?
Antipsychotic
Schizophrenia
Schizophrenia is an illness that causes psychosis or difficulty with reality based thinking. It is a cognitive or thought disorder that causes problems with perceptions such as hallucinations or illusions, and delusional thinking.
etiology of schizophrenia
The exact etiology of schizophrenia is unknown but research shows there is a high probability that is due to a biological or brain imbalance such as excess dopamine activity in the mesolimbic pathway.
etiology of schizophrenia
neurostructural brain changes seen in schizophrenia includes: 1. enlarged brain ventricles, 2. brain atrophy-so the brain is smaller in size, and 3. decreased cerebral blood flow.
etiology of schizophrenia
1.nerostructural changes
2. enlarged brain ventricles
3.brain atrophy
4.decrease cerebral blood flow
etiology of schizophrenia
1.genetic
2.born in the winter months
3.prenatal exposure to viruses & infections
4. age
5.gender
6. substance abuse
7. other illness
8. stress
9. abuse/neglect
Signs and symptoms of schizophrenia
1.autism-preoccupied with self and lives in a fantasy world.
2.affective impairment-affect is flat, with a staring eye contact, or glaring
3. ambivalence- which means experiencing two opposite emotions at the same time; such as love and hate.
4.associative- looseness or loose associations, which means thoughts that are unconnected.
Signs and symptoms of schizophrenia
5. Altered reality-problems with reality such as, delusional thoughts;here are 4 delusional thoughts that you need to focus on: paranoia, religiosity, grandiosity, & ideas of reference.
6. Altered behavior-catatonia, waxy flexibility, posturing, or echopraxia. They will be isolative, withdrawn & often have only the family members or a case manager as a support system. They don’t initiate a conversation or tolerate a long interaction. may be suspicious of others
7. Altered speech
8.Altered affect &mood
9. Altered functioning and ADL's
Negative symptoms of schizophrenia
Affect impairment
Poor eye contact
Alogia, poverty of speech
Avolition
Impaired grooming & hygiene
Disheveled appearance
Apathy, anhedonia
Concrete thinking
Social Isolation, withdrawn
Anergia
Positive symptoms of schizophrenia
Hallucination
illusion
Delusion
Loose Association
Restless, rocking, pacing
Hostility, agitated
Waxy flexibility, posturing, echopraxia
Disorganized behavior, thinking or speech
Nursing diagnosis
disturbed thought processes
disturbed sensory perception
risk other-directed violence
risk for injury
Ineffective coping
Interrupted family process
Social Isolation
Impaired verbal communication
Spiritual distress
schizophrenia nursing outcome and interventions
Outcome:Pt. will have decreased delusions, illusions and hallutionations
Interventions:
Assess for presence of hallucinations, illusions, delusions. Ask frequency & content.
Use therapeutic communication techniques. Do not argue or agree with the patients’ perceptions. Validate and accept their feelings and perceptions. For example, say “It sounds like these voices are disturbing to you.”
schizophrenia nursing outcome and interventions
Interventions cont.-
Use professional nonverbal behaviors- Begin with one-to-one interactions. Approach patients from the front keeping therapeutic spatial distance. Be calm. Use concrete phrases.
Direct them to diversional activity in a quiet environment to refocus thoughts but avoid competitive activities.
Orient with clocks, calendars, schedules.
schizophrenia nursing outcome and interventions
Interventions cont.
Monitor the milieu stimuli (Monitor stimuli such as watching tv, listening to radio, being on the computer, group attendance, loud noises, too many people in milieu, & having a roommate.
Administer antipsychotic meds to decrease psychosis. Notify the doctor if the patient refuses meds.
Monitor antipsychotic medication side effects such as agitation & EPS. An antiparkinson med is administered to prevent or treat EPS. Antiparkison meds have the side effects of confusion & psychosis.
schizophrenia nursing outcome and interventions
outcome: pt. will remain safe
intervention:
Assess for aggression & agitation.
Assess for suicidal & homicidal
encourage verbalization of feelings,
Set limits as necessary. Reinforce positive behavior.
Redirect to a diversional activity that they can accomplish in their room or in a quiet space in the milieu.
ive antipsychotic med for agitation. You can also give benzodiazepines to decrease anxiety.
Provide a safe milieu, minimize potential harmful objects, complete15 minute checks
schizophrenia nursing outcome and interventions
outcome: pt will complete ADL's with assistance or prompting as needed.
Intervention:
Monitor interactions with staff and peers. Start socialization activity first with the nurse and then arrange nonthreatening activities with a small group of peers.
Reinforce appropriate dress, grooming and hygiene. Assist with decision-making as appropriate.
onitor sleep & energy. Drowsiness is a side effect of antipsychotic meds and is commonly seen when patients have been off their meds at home. Antipsychotic meds are often prescribed at bedtime to help promote sleep.
schizophrenia nursing outcome and interventions
Teaching
outcome: pt. will verbalize and/or demonstrate _______.
Intervention:
ssessing learning barriers such as extreme psychosis or agitation.
e teaching/learning principles. Teach at the patient’s level of understanding. Use simple terminology when teaching.
Discuss the illness such as symptoms & when to contact doctor
Review positive coping skills such as stopping alcohol & drug use, pursing a hobby, being med compliance.
Teach med purposes. Don’t introduce the med as an antipsychotic but tell the patient the med is used to clear thoughts or to keep them calm
Refer to social worker and other health care team to discuss further teaching needs such as how to apply for disability, information on community agencies that deal with financial & housing concerns, outpatient appointments, & family sessions.