Mental Health Ch. 8-13 Mid-term

Contraindications for antipsychotics

they should be used carefully in patients who are hypersensitive to medications or who have brain damage or blood dyscrasias.

patient teaching for antiparkinson agents

Use hard, sugarless candy to combat the effects of dry mouth.

Increase dietary roughage to maintain bowel functioning.

May cause drowsiness, so should not drive or operate equipment until the response to medication is established.

Contraindications of antianxiety agents

People with a history of chemical dependency are not good candidates for this classification of drug because of the potential for addiction.

Foods containing tyramine

Aged cheese(cheddar, swiss, provolone, blue cheese, parmesan)

Avocados(guacamole)

yogurt, sour cream

chicken and beef livers, pickled herring, corned beef

Bean pods

Bananas, raisins, and figs

Smoked and processed meat(salami, pepperoni, and bologna)

Yeast supplements

Chocolate

Meat tenderizers(MSG) soy sauce

Beer, red wines, and caffeine

What is a milieu (therapeutic environment)

is the setting that provides safety and where stress is minimized during the patient’s stay. Milieu therapy is intended to combine social and therapeutic environments, creating the opportunity for therapeutic interaction between the nurse and patient on a regular basis.

Electroconvulsive therapy nursing responsibility

Ensure that informed consent with the patient’s signature is present.

Kava kava(herb) drug/food interactions

Alcohol- increases risk of kava toxicity

Alprazolam(Xanax)-risk for coma exists.

CNS depressants-kava potentiates these

Levodopa-can increase parkinson-like symptoms

Phenobarbital(Luminal)-can increase effects

St. Johns wort (herb) side effects

Severe photosensitivity, GI upset, fatigue, Dry mouth, dizziness, constipation, sleep disturbances, restlessness, possible inducement of hypomania.

St. Johns wort drug/food interaction

MAOIs, antidepressants, digoxin, birth control pills

St. Johns wort patient teaching

Avoid prolonged exposure to sunlight

Use high SPF sunscreen

May increase the effects of MAIOs, OTC flu and cold medications, alcohol, do not use with these types of chemicals.

Moderate level of anxiety signs

displays noticeable behavior

has difficulty remaining focused

displays nervous habits: nail biting

has increased HR

free-floating anxiety

a type of anxiety that is described as a feeling of impending doom. The person might say something like “I just know something bad is going to happen if I go on vacation.”

signal anxiety

a type of anxiety that is an uncomfortable response to a known stressor. EX. Finals are only a week away, and I know I am going to fail even if I study”

specific phobia

most common type of anxiety disorder. Phobia can be defined as an “irrational fear.” The person is very aware of the fear and even of the fact that it is irrational, but the fear continues.

Agoraphobia

is a irrational fear of being in open spaces and being unable to leave or being very embarrassed if leaving is required.

Has to include a minimum of two:

using any public transportation, being in open spaces, being in walled or sealed off spaces, standing in a crowd, being outside alone.

Specific Phobia Nursing actions

Provide calm milieu

communicate calmy and clearly

focus on brief messages

teach early signs of escalating anxiety

Implement suicide precautions if the patient indicates any self-destructive thoughts

Document behavior changes

Encourage activities

Promote deep breathing and other relaxation methods

Offer reassurance and support to the patient.

Focus on nonthreatening topics

Reassure patient about their safety

Depressive disorders are most common in men or women?

More common in women but more be underdiagnosed in men.

Differentiating Grief from Depression

Reaction- Uncomplicated grief

Labile

Heightened when thinking of loss

Differentiating Grief From Depression

Reaction- Major Depression

Mood consistently low

Prolonged, severe symptoms.

Premenstrual Dysphoric disorder

Consistent pattern of markedly depressed mood, excessive anxiety, and mood swings during the week before menses, which start to improve after the onset of menses and then become minimal or absent after menses.

Depressive disorder nursing intervention

Identify small, achievable goals the patient can meet. Provide support and encouragement. Break down tasks into small parts for the severely depressed patient. For example, rather than encouraging the patient to get dressed, have the patient focus on putting on a t-shirt.

Bipolar disorder Cyclothymic

A chronic mood disturbance of at least 2 years’ (1 yr in children) duration involving numerous episodes of hypomania and depressed mood but of less intensity.

Physical conditions that cause manic stress

Hyperthyroidism

MS

Systemic lupus erythematosus (SLE)

Brain tumors

Traumatic brain injury (TBI)

Stroke

Lithium Carbonate important considerations in older patient

Use caution in frail older patients who are at risk for dehydration.

lithium serum level 1.5-2.0 symptoms

blurred vision, ataxia, tinnitus, N/V/D

lithium serum level 2.0-3.5 symptoms

Excessive output of dilute urine, increased tremors, muscle irritability, confusion.

lithium serum level above 3.5 symptoms

Seizures, coma, oliguria, arrhythmias, cardiovascular collapse.

Bipolar disorder nursing interventions

Provide clear, firm limits. Clearly define what is expected and what is not allowed.

Mood Stabilizing Agents

Med- Anticonvulsants nursing implications

GI upset- Administer med with meals

Drowsiness, dizziness- educate patient on safety, driving. Determine whether dosing schedule allows evening dose.

Increased suicide risk- Monitor for worsening depression, suicide risk.

Warning signs of suicide

Noticeable improvement in mood occurs.

Person starts giving away personal items.

Person starts talking about death and suicide or becomes preoccupied with learning about these things.

Suicide nursing interventions

Frequent monitoring- 1:1 may be needed.

If patient denies having a suicide plan, ask about other plans for the future and support system

What do you see yourself doing in a week, in a month, and in a year from now?

Do you feel optimistic or pessimistic about the future?

Do you have family members or friends with whom you can freely discuss your problems?

Suicidal patient nursing interventions

Listen to concerns and worries

Avoid minimizing them

Help patient identify one problem and discuss alternative ways to view it.

Provide a different perspective on the problems.

Appeal to the patient’s ambivalence by stressing reasons they do not want to do this.

Describe a recent situation where you observed the patient being successful.