NUR2200 Midterm GREEN bank

MAOI and TCA Medications

MAOIs (Monoamine Oxidase Inhibitors) and TCAs (Tricyclic Antidepressants) are classes of medications that affect neurotransmitter levels and can have significant side effects on patients.

  • MAOIs: Example includes Phenelzine, which is known to cause orthostatic hypotension, meaning the patient experiences a significant drop in blood pressure upon standing. These medications can potentially cause a hypertensive crisis if dietary restrictions are not adhered to, particularly avoiding tyramine-rich foods.

  • TCAs: Example includes Nortriptyline, which also causes orthostatic hypotension and has side effects requiring consistent monitoring of laboratory values due to their impact on various bodily functions.

SSRIs and Their Effects

  • Paroxetine (an SSRI - Selective Serotonin Reuptake Inhibitor) is noted for initially suppressing appetite, leading patients to experience reduced hunger at the beginning of their treatment.

Important Monitoring Parameters

  • Patients on lithium, which is used for bipolar disorder, need careful monitoring. Toxicity can occur at levels ranging from 2 to 3 mEq/L, with signs including gastrointestinal (GI) disorders.

  • Risperidone can increase the risk of hyperthermic conditions, while Olanzapine is associated with significant weight gain.

Neuroleptic Malignant Syndrome and Serotonin Syndrome

  • Neuroleptic Malignant Syndrome (NMS) can result from antipsychotic medications, characterized by symptoms such as hyperthermia, muscle rigidity, and autonomic instability.

  • Serotonin Syndrome is induced by an excess of serotonin in the brain and can arise from the combination of MAOIs with SSRIs or SNRIs. Symptoms to watch for include fever, fluctuations in blood pressure, abdominal pain, and GI distress.

Monitoring Lithium

  • Therapeutic levels for lithium should be between 0.6 - 1.2 mEq/L. Elevated lithium levels (1.5 or higher) require medical attention and might show symptoms like GI upset and poor coordination. Levels of 2.0 to 2.5 mEq/L may cause blurred vision and jerky motor movements. Levels beyond this can indicate toxic side effects.

Antipsychotics and Management Strategies

  • Chlorpromazine: This drug has anticholinergic effects, which necessitate monitoring for side effects like dry mouth and constipation. It also involves metabolic monitoring (glucose, lipid levels).

  • Clozapine: Especially important for patients with schizophrenia, requires ongoing monitoring for flu-like symptoms due to its risk of agranulocytosis (low white blood cell count).

Major Considerations in Mental Health Care

  • Patients exhibiting psychosis symptoms such as delusions and hallucinations require certain communication strategies. For instance, when communicating with a withdrawn patient, it is crucial to ask their permission to engage, showing compassion through silence, and waiting for them to talk when ready.

  • Individuals with post-traumatic stress disorder (PTSD) may show symptoms like detachment, nightmares, anxiety, and hypervigilance, and often arise from experiences of frequent loss or incidents in high-stress careers like military or emergency services.

Understanding Depression and Relapse Signs

  • Symptoms of depression may include difficulty concentrating, changes in sleep patterns, lethargy, and psychomotor retardation. Patients experiencing an acute phase of relapse in schizophrenia may show early signs through difficulty concentrating and sleeping.

Trauma-Informed Care Principles

  • The foundational priority of trauma-informed care is safety. Engaging depressed patients in unit activities fosters assertiveness and combats isolation while helping them towards functional activities.

Treatment Insights and Philosophy

  • In treating patients with Obsessive-Compulsive Disorder (OCD), it is important to understand their ritualistic behaviors (like excessive hand washing) temporarily relieve anxiety. Treatment typically involves a combination of medications and therapeutic approaches.

  • When patients express feelings of worthlessness or suicidal ideation, therapeutic communication should reflect understanding without offering false reassurances. It involves acknowledging their feelings genuinely without undermining the experience.

Appropriate Nursing Actions

  • In acute cases, such as when a patient has a rapid heart rate and significant hypertension, it is crucial to prioritize addressing high blood pressure first to mitigate risks of cardiovascular events.

  • Set up structured environments for bipolar patients in manic phases, limiting stimuli to avoid aggravation of symptoms and encouraging daily activities that can help stabilize mood.

Additional Monitoring and Education

  • With the use of Valproic Acid or Depakote, liver function tests (LFTs) must be regularly monitored due to risks of liver failure. Keeping patients informed and educated about their medication's side effects leads to better adherence and outcomes.

Summary of Key Definitions

  • Orthostatic Hypotension: A form of low blood pressure that occurs when standing up from sitting or lying down.

  • Benzodiazepines: Medications that should be avoided in activities that require full attention, like driving or operating heavy machinery.

  • Neuroleptic Malignant Syndrome Symptoms: Sweating, muscular rigidity, hyperpyrexia (fever) indicative of severe complications from antipsychotic treatments.

  • Serotonin Syndrome Symptoms: Notable signs include dilated pupils, loss of muscle coordination, and fluctuating vital signs.

  • Delusions vs Hallucinations: Delusions are false beliefs while hallucinations involve sensing things that are not there.

These points provide a comprehensive overview and detailed understanding of essential pharmacological considerations and therapeutic strategies in mental health nursing care.