Quiz #4- Wk 10 +11

What is the main goal of psychiatric nursing? How do we do this?

to keep the pt safe!

Best method = develop a trusting relationship with clients

what are the 2 no-no words of psych nursing?

1. Why

2. How

what is ethnocentrism?

the belief that your way of thinking and behaving is the only correct way

What are some effective forms of verbal communication? (7)

1. Listen attentively

2. Allow use of silence

3. Use open-ended questions

4. Clarify vague messages

5. Rephrase key pt statements and messages

6. Offer information

7. Suggest collaboration

What are some effective forms of non-verbal communication? (7)

1. Concerned facial expressions

2. Attentive posture

3. Show listening with body language

4. Friendliness

5. Openness

6. Acceptance of pt

7. Silence

Is the priority always a psychiatric disorder with psychiatric pts?

not always! Psych pts can still be in need of medical care!

What are some examples non-therapeutic communication? (11)

1. Giving advice

2. Responding to pt before they are finished speaking

3. Arguing

4. Challenging beliefs

5. Being defensive

6. Giving approval or disapproval

7. Interrogating

8. Minimizing

9. Changing the subject

10. False reassurance- “everything will be ok” ← you don’t know this!

11. NEVER ASK “WHY?”

What are some methods to reduce communication barriers with pts?

Use appropriate words for pt education

What is a good way to reduce communication barriers for a pt with a thought disorder?

use concrete topics and clarify responses

What is a good way to reduce communication barriers for a pt with a paranoid thinking pattern?

be non-threatening and do not touch pt

What is a good way to reduce communication barriers for a pt with hallucinations?

show concern but do not reinforce the hallucination → redirect pt attention

What is a good way to reduce communication barriers for a pt with delirium?

talk directly and use simple questions

What is a good way to reduce communication barriers for a pt with dementia? (2)

Minimize distractions and use simple concise language

What is the biological theory of mental illness?

assumes the abnormal behavior is a result of a physical problem

→ seeks to understand how the brain and body interact to create memories, emotions, and perceptual experiences

→ targets the site of illness using drugs, diet, or surgery

What was the role of medication development for psych pts?

meds greatly reduce the need for hospitalization and dramatically improves the lives of those suffering from psych disorders IF THE PT IS COMPLIANT

What is the priority goal that all nursing interventions of psych nursing tend to help work towards?

reduce anxiety!

What is psychotherapy?

formal approach to talk therapy- can be long or short term

what is transference?

unconscious feeling that pt has towards healthcare workers that were originally felt in childhood for significant other

what is the goal of psychoanalysis?

encourages transference as a way to understand original relationships- helps to understand pt’s feelings

What is countertransference?

unconscious feeling healthcare worker has towards pt - strong positive or negative feelings can be a red flag! → need to have self-awareness

What is the goal of cognitive therapy? What are pts taught?

goal is to identify and change the pts negative beliefs, generalizations, and expectations

Pts are taught to identify distorted irrational thoughts and substitute positive thoughts

What is the goal of behavioral therapy?

approach relies on therapies designed to change behavioral patterns

Note there are many types!

What is aversion therapy?

Where you hear a negative stimulus that becomes associated with a maladaptive behavior

Ex. Putting nail polish on someone who bites their nails so the bad taste can help make the behavior feel less satisfactory

What is group therapy? ex?

where a trained leader guides the conversation as clients get feedbacks from their peers

Ex. AA meetings

What are the benefits of group therapy? (2)

1. Increases socialization

2. Increases # of people that can receive treatment at a decreased cost per person

What is the goal of family therapy?

evaluates relationships and communication patterns and then works to change negative interactions

What are the benefits of family therapy? (2)

1. Decrease conflict

2. Improves quality of relationships

What are some examples of crisis intervention? (3)

1. Providing emergency care 24/7 hotlines

2. mobile crisis units

3. 23 hr observations stay

What are some reasons that someone may require crisis intervention? (6)

1. Detox

2. Prevention of medical problems

3. Delusion

4. Medication

5. Restraint

6. Seclusion

What is milieu therapy? ex.?

Uses setting, structure, and emotional environment to effect positive change → environment becomes a tool for overcoming mental and emotional disorders

Ex. Acute manic client hospitalized- 1st nursing intervention = set limits on behavior

what do agonists do?

mimic effects of neurotransmitters found in brain by binding to and stimulating the receptor sites

what do antagonists do?

block neurotransmitters by obstructing their actions

What does the neurotransmitter GABA do?

major calming neurotransmitter

What neurotransmitter deficiencies lead to depression? (2)

serotonin and norepinephrine

What neurotransmitter does antipsychotic agents work on?

dopamine - block the action of it

What do anti-Alzheimer’s agents do?

inactivate the enzyme that breaks down acetylcholine

what are the 2 ways that neurotransmitters are destroyed?

1. Enzymes- immediate inactivation by enzymes at the receptor sites in the postsynaptic cells

2. Reuptake- neurotransmitter interacts with receptor then released and taken back into the presynaptic cells

what is serotonin responsible for?

happiness

what is dopamine responsible for?

reward, pleasure

what is GABA responsible for?

calming

what is a common side effect of anti-histamine?

lethargy

What conditions can be associated with an increase in norepinephrine? (3)

1. mania

2. Anxiety

3. Schizophrenia

What condition is associated with a decrease in norepinephrine?

depression

What condition is associated with a decrease in serotonin?

depression

What conditions can be associated with an increase in dopamine? (2)

1. Schizophrenia

2. Mania

What conditions can be associated with a decrease in dopamine? (2)

1. Parkinson’s

2. Depression

What conditions can be associated with a decrease in GABA? (3)

1. Anxiety

2. Schizophrenia

3. Mania

What condition can be associated with an increase in GABA?

Decrease in anxiety sx → being more calm

What is the method of action for standard (first-generation) antipsychotic drugs?

block dopamine receptors to stop positive sx of schizophrenia (paranoia, grandiose ideas, hallucinations) AKA strong dopamine antagonists

what are some side effects of standard (first-generation) antipsychotic drugs?

extrapyramidal sx (EPS)!

1. Parkinsonianism

2. Akathisia = can’t sit still

3. Tardive diskinesia = repetitive, involuntary movements (grimacing, blinking) ← FALL RISK!

What is akinesia?

inability to initiate movements (frozen)

what is akathisia?

inability to sit still

what is dyskinesia?

difficulty with voluntary movement

what is tardive dyskinesia?

repetitive involuntary movement

What are some side effects when norepinephrine is blocked? (1)

hypotension

What are some side effects when histamine is blocked? (2)

1. Sedation

2. Weight gain

What are some examples of second generation or atypical antipsychotics? (2 biggies, 3 extra)

1. Clozapine

2. Risperidone

3. Quetiapine (Seroquel)

4. Olanzapine (Zyprexa)

5. Aripiprazole (Abilify)

What is the main pro and con of utilizing atypical (2nd generation) antipsychotic drugs over standard (1st generation) antipsychotics?

Pro = fewer to no EPS- targets the negative and positive sx

Con = increased risk of metabolic syndrome → sx = increased weight, BS, and triglycerides

What is the method of action for atypical (2nd generation) antipsychotic drugs? Therapeutic effect?

binds to dopamine receptors to decrease motor side effects

What are the possible fatal side effects of clozapine? (3)

1. Agranulocytosis

2. Convulsions

3. Myocarditis

What are some possible side effects of clozapine? (5)

1. Drowsiness

2. Sedation

3. Hypersalivation

4. Tachycardia

5. Dizziness

What are the possible side effects of risperidone? (3)

1. Motor difficulties

2. Orthostatic hypotension

3. Sedation → think falls and ABCs/VS

What is a common example of a mood stabilizer?

lithium!

What is a common use for mood stabilizer medications?

Bipolar disorder - specifically the manic phase

How does lithium work to achieve its therapeutic effect?

Affects electrical conductivity of neurons reduces glutamate (excitatory) and exerts antimanic effect

What is the most important nursing consideration associated with lithium to keep in mind?

What should we teach the pt on lithium in regards to this?

it has a low therapeutic index/narrow therapeutic range which is the amount of medication required to achieve a lethal dose/effective dose

Pt must be compliant with level checks!

What level of lithium is considered to be lithium toxicity?

serum levels ≥ 2.0

What are some signs and symptoms of lithium toxicity? (5)

1. Weakness

2. Tremor

3. Diarrhea

4. Hyperthermia

5. Slurred speech

What are some side effects associated with lithium? (4)

1. Cardiac arrhythmias

2. Convulsions

3. Tremors

4. F&E imbalance

What are some examples of antiepileptic/anticonvlusant drugs? (6)

1. Carbamazepine (Tegretol)

2. Divalproex (Depakote)

3. Lamotrigine (Lamictal)

4. Gabapentin (Neurontin)

5. Topiramate (Topamax)

6. Clonazepam (Klonipin)

What is the therapeutic effect of antiepileptic/anticonvulsants?

How does this relate to bipolar disorder?

reduce firing rate of very high frequency neurons in brain; membrane stabilizing effect; can have a sedating effect

Reduce mood swings with bipolar

What are some examples of typical antidepressants or tricyclic antidepressants? (3)

1. Amitriptyline (Elavil)

2. Imipramine (Tofranil)

3. Nortriptyline (Pamelor)

What are some causes of depression? (2)

A deficiency in norepinephrine, serotonin, or both within the limbic system or nerves and network of the brain

What are some flaws of TCAs that made them no longer be used as a first line treatment for depression (2)?

1. Takes too long to reach the optimal dose

2. Far more lethal in OD

What do monoamine oxidase inhibitors (MAOIs) do to achieve its therapeutic effect? What are the monoamines? (4)

inhibit the breakdown of monoamines which increases the synaptic levels of neurotransmitters → antidepressant effects of the drug

Monoamines = organic compounds

1. Norepinephrine

2. Epinephrine

3. Dopamine

4. Tyramine

what is the root of the major adverse effects of MAOIs?

MAO destroys the monoamines (norepinephrine, epinephrine, dopamine, and tyramine) → by inhibiting it, the liver can become unable to degrade other monoamines within the body

What are some foods that are high in tyramine? (3)

1. Aged cheese

2. Pickled or smoked fish

3. Wine

What does tyramine do to the body? What life-threatening complication can result when it is in excess in the body?

Causes vasoconstriction → increases BP → HTN crisis = life-threatening

What are some examples of MAOIs? (3)

1. Isocarboxazid (Marplan)

2. Phenelzine (Nardil)

3. Tranylcypromine (Parnate)

What are some examples of selective serotonin Reuptake inhibitors (SSRIs)? (5)

1. Fluoxetine (Prozac)

2. Sertraline (Zoloft)

3. Paroxetine (Paxil)

4. Citalopram (Celexa)

5. Escitalopram (Lexapro)

What are some conditions that SSRIs are used to treat? (4)

1. Social anxiety disorder (SAD)

2. General anxiety disorder (GAD)

3. Post traumatic stress disorder (PTSD)

4. Obsessive compulsive disorder (OCD)

What is the method of action of SSRIs?

blocks reuptake of serotonin which increases the amount of the neurotransmitter available

what is the main pro and con for SSRIs?

pro = do not have anticholinergic or sedating effects

Con = takes 2-3 weeks to reach therapeutic effect

What are some adverse effects of SSRIs? (4)

1. Low libido

2. Apathy

3. N/V

4. Other GI issues

What are some examples of serotonin-norepinephrine reuptake inhibitors (SNRIs)? (4)

1. Venlafaxine (Effexor)

2. Duloxetine (Cymbalta)

3. Mirtazapine (Remeron)

4. Trazodone (Desyrel)

What is the major con of SNRIs?

2-3 weeks to work

what is the black box adverse effects of SNRIs?

suicidal thoughts

what is special about many SNRIs, specifically duloxetine (Cymbalta)?

can have a therapeutic effect on neuropathic pain

what is an example of dopamine-norepinephrine reuptake inhibitor?

bupropion (Wellbutrin/Zyban)

What are the uses of bupropion (Wellbutrin/Zyban) or the dopamine-norepinephrine reuptake inhibitor? (2)

1. Antidepressant

2. Smoking cessation

what are some benefits to using dopamine-norepinephrine reuptake inhibitors or bupropion (Wellbutrin/Zyban) over its alternatives?

1. Weight gain is minimal

2. No sexual dysfunction side effects

What are some examples of benzodiazepines? Suffixes? (7)

1. Diazepam (Valium)

2. Clonazepam (klonopin)

3. Alprazolam (Xanax)

4. Flurazepam (Dalmane)

5. Triazolam (halcion)

6. Lorazepam (Ativan)

7. Temazepam (restoril)

What is the antidote for benzodiazepines?

Flumenazil

what is the best route for acute episodes that require benzodiazepines for treatment? 2nd best?

1. IV

2. IM- ventrogluteal

What is the method of action for benzodiazepines? Therapeutic effect?

Promotes activity of GABA by increase in binding to the receptors which give a sedative effect on the brain which decreases anxiety

What are some important teaching points for a pt taking benzodiazepines? (2)

1. Can interfere with motor ability, attention, and judgement

2. Should not be combined with other CNS depressants (alcohol, opiates, or other antidepressants)- can lead to life-threatening CNS depression

What is the class of buspirone (BuSpar)?

non-sedating anti-anxiety medication

what does buspirone (BuSpar) do?

partial serotonin agonist (booster) allows more neurotransmitters to be released

What are some examples of medications that are used to treat attention deficit with or without hyperactivity disorder (ADHD/ADD)? (3)

1. Methylphenidate (Ritalin)

2. Dextroamphetamine (Adderall)

3. Atomoxetine hydrochloride (Strattera)

What are some common side effects associated with medications used to treat ADHD/ADD? (2)

What are some nursing considerations to keep in mind associated with ADHD/ADD or these side effects?

1. Anorexia

2. Sleep disturbances

1. Fall precautions- r/t hyperactivity and/or sleep disturbances

2. Weight loss/diet- r/t hyperactivity and/or anorexia