Mental Health Unit 2

Paroxetine (Paxil)

SSRI antidepressant

Trycyclic antidepressants

Amitriptyline Amoxapine Clomipramine Desipramine Doxepin Imipramine Nortriptyline Protriptyline Trimipramine

dementia

An abnormal condition marked by multiple cognitive defects that include memory impairment.

Fluoxetine (Prozac)

Antidepressant, SSRI

Hallucination Interventions

Ask the client directly about the hallucination. Avoid reacting to the hallucination as if it were real. Decrease stimuli or move the client to another area. Do not negate the clients experience. Focus on reality-based topics. Attempt to engage the clients attention through a concrete activity. Respond verbally to anything real that the client talks about. Avoid touching the client. Monitor for signs of increasing anxiety or agitation, which may indicate that hallucinations are increasing.

Interventions for Delusions

Ask the client to describe the delusion. Be open and honest in interactions to reduce suspiciousness. Focus conversation on reality-based topics, rather than on the delusion. Encourage the client to express feelings and focus on feelings that the delusions generate. If the client obsesses on the delusion, set firm limits on the amount of time spent talking about delusions. Do not argue with the client or try to convince the client that the delusions are false. Validate if part of the delusion is real.

Trycyclic antidepressants Nursing Interventions for Overdose

Check airway and maintain a patent airway. Administer oxygen. Check vital signs. Obtain electrocardiogram. Prepare for gastric lavage with activated charcoal. Prepare to administer physostigmine and antidysrhythmic medications. Document the event and actions taken and clients response.

A hospitalized client is started on phenelzine for the treatment of depression. The nurse should instruct the client which foods are to consume while taking this medication? Figs Yogurt Crackers Aged Cheese Tossed Salad Oatmeal raisin cookies

Crackers Tossed Salad

Paroxetine (Paxil) Nursing Considerations

Decreased Digoxin levels take consistently at same time daily, therapeutic effect 4 weeks GI upset - take with food or milk May increase suicidal thoughts Avoid alcohol, CNS depressants Taper - do not discontinue abruptly

Coma cocktail DONT

Dextrose Oxygen Naloxone Thiamine

Jealousy Delusions

False belief that ones partner is going out with other persons

Antidote for benzodiazepines

Flumazenil (Romazicon)

SSRIs antidepressants

Fluoxetine Paroxetine Sertraline Citalopram.

types of delusions

Grandeur Jealousy Persecution

MAOI antidepressants

Isocarboxazide Phenelzine Selegiline Tranylcypromine

Fluoxetine (Prozac) Nursing Considerations

Nursing considerations: Pt. increased risk for suicide [monitor moods], taper off drugs, bleeding problems if used with anticoagulants, NSAIDs. Take at same time of day. Full therapeutic effects 4 weeks

Paroxetine (Paxil) Side Effects

Palpitations, Postural hypotension Nervousness, Insomnia GI - nausea, vomiting, diarrhea, constipation Sweating decreased appetite

visual hallucinations

Seeing objects, people, or things that do not actually exist

Fluoxetine (Prozac) Side Effects

Side effects: Nausea, insomnia, sexual dysfunction [decreased libido, impotence, delayed ejaculation, absent orgasm], hyponatremia, increased risk of GI bleeding, bruxism [clinching/grinding of teeth], serotonin syndrome

sundowning

Signs, symptoms, and behaviors of AD increase during hours of darkness

A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets the stomach. Which of the following instructions should the nurse give to the client? "Take the medication an hour before breakfast." "Take the medication with some food." "Take the medication at bedtime." "Take the medication with 4 oz. of orange juice."

Take the medication with some food

alcoholism

a drinking pattern that interferes with physical, social, familial, vocational, and emotional functioning

catatonia

a state of unresponsiveness to one's outside environment, usually including muscle rigidity, staring, and inability to communicate

social skills training

a therapy approach that helps people learn or improve social skills and assertiveness through role playing and rehearsing of desirable behaviors

electroconvulsive therapy (ECT)

a treatment that involves inducing a mild seizure by delivering an electrical shock to the brain

Dystonia

abnormal or involuntary eye movements, including oculogyric crisis facial grimacing twisting of the torso or other muscle groups

paranoia

an irrational suspiciousness or distrust of others

Side effects of antipsychotics

anticholinergic effects extrapyramidal effects dystonias akathisia tardive dyskinesia

What is important to inform a client about antidepressants?

antidepressant medications may take several weeks to produce the desired effects typically 4 weeks

Symptoms of Alzheimer's

aphasia apraxia amnesia agnosia confabulation

Tyramine containing foods

avocados, soybeans, figs, smoked meats, dried or cured fish, cheese, yeast products, beer, chanti wine, chocolate, caffeiated beverages

Mania

becomes angry quickly delusional self-confidence constantly pushing limits, manipulating, and finding fault euphoric with intense feelings of well-being sexual promiscuous urgent motor activity grandiose and persecutory delusions unlimited energy dress that is inappropriately bizarre, loud, colorful

Expected medications for withdrawal and DTs

benzodiazapines thiamine IM or IV folic acid multivitamins magnesium sulfate anticonvulsants antipsychotic

seritonin syndrome

confusion agitation dilated pupils headache hypertension GI upset tachycardia tremor loss of muscle coordination shivering heavy sweating

The client with depression has been consistent with taking 12.5 mg of paroxetine (Paxil) extended release daily. The nurse judges the client to be benefitting from this drug therapy when the client demonstrates which of the following behaviors? Select all that apply. - Takes 2-hour evening naps daily - Completes homework assignments. - Decreases pacing. - Increases somatization. - Verbalizes feelings.

decreased pacing

gynecomastia

development of breast tissue in males

The primary health care provider prescribes fluoxetine (Prozac) orally every morning for a 72 year old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? Nausea Dizziness Sedation Dry mouth

dizziness

Anticholinergic effects

dry mouth constipation urinary retention blurred vision Tachycardia hypotension

gustatory hallucinations

experiencing tastes in the absence of stimuli

Delisions

false beliefs held to be true, even when there is evidence to the contrary

grandeur delusion

false beliefs that one is a powerful and important person

waxy flexibility

feature of catatonic schizophrenia in which people rigidly maintain the body position or posture in which they are placed by others

tactile hallucinations

feeling touch sensations in absence of stimuli

auditory hallucinations

hearing voices, noises, music, or sounds that are not actually real

echopraxia

imitating another's actions

agnosia

inability to recognize familiar objects, tastes, sounds, and other sensations even people

Depression

increased/decreased appetite easily fatigues lack of energy, initiative, sexual interest, self confidence low self-esteem decrease in activities of daily living decreased emotion and physical activity

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors

ataxia

lack of muscle coordination

apraxia

loss of purposeful movement. inability to use an object correctly because they are unable to identify it.

confabulation

makes up stories/answers to questions to maintain self esteem

echolalia

meaningless repetition of another person's spoken words as a symptom of psychiatric disorder.

amnesia

memory loss caused by brain degeneration

delirium

mental disorder marked by confusion; uncontrolled excitement; ADJ. delirious

neologism

new word or expression

aphasia

problems understanding or using language - progresses with disease

Akathisia

restlessness constant moving about

Hallucinations

sense perception for which no external stimuli exists; can have an organic functional cause

extrapyramidal symptoms

side effects such as restlessness, involuntary movements, and muscular tension produced by antipsychotic medications

olfactory hallucinations

smelling odors that are not really present

drug abuse

state of dependency produced by repeated use of a substance that causes altered perception or mood, or booth

confabulation

the act of filling in memory gaps

Wernicke's encephalopathy

thiamine deficiency in alcoholics symptoms - paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor pickling of the brain

persecution delusion

thought that one is being singled out for harm by others

Immediate action for a client with anxiety

to decrease stimuli in the environment and provide a calm and quiet environment