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Side effects of Antidepressant drugs

Anticholinergic effects, postural hypotention

Nurses non verbal communication:

May be more important than the verbal communication.

For clients with PTSD, the nurse should:

1. Actively listen to clients stories of experiences surrounding the traumtic event. 2. Assess suicide risk. 3. Assist client to develop objectivity about the event and problem-solve regarding possible means of controlling anxiety r/t the event. 4. Encourage group therapy with other clients who have experience the same of related traumatic events.

The best time for interaction with a client is:

At the completion of the performed ritual. The client's anxiety is lowest at this time; therefore, it is an optimal time for learning.

Side effects of MAO Inhibitors

Hypertensive crisis

For children, the nurse is legally responsible for reporting all suspected cases of abuse. In intimate-partner abuse, it is the adult's decision; the nurse should be supportive of the decision.

Remember to document objective factual assessment data and the client's exact words in cases of sexual abuse and rape.

Questions on the NCLEX-RN exam regarding physical and sexual abuse usually focus on 3 aspects:

1. Physical manifestations of abuse. 2. Client safety 3. Legal responsibilities of the nurse.

Manic clients can be very caustic toward authority figures

Be prepared for personal putdowns. Avoid arguing or becoming defensive.

Know the side effects of drugs commonly used to treat schizophrenia because:

Client behaviour changes may be due to drug reactions instead of schizophrenia.

Antabuse is often used as a deterrent to drinking alcohol.

Client teaching for Antabuse should include the effects of consuming ANY alcohol while on Antabuse. Encourage client to read all labels of OTC meds and food products that may contain small amounts of alcohol.

Rape victims are at high risk for:

PTSD. Immediate intervention to diminish distress is vital. The nurse should also assess for and intervene for sequelae such as unwanted pregnancy, STDs and HIV risk.

Use Bleuler's four A's to help remember the important characteristics of schizophrenia:

1. Autism- preoccupied with self 2. Affect- flat 3. Associations- loose 4. Ambivalence- difficulty making decisions

Basic communication principles that can be applied to all clients:

1. Establish trust. 2. Demonstrate a nonjudgmental attitude. 3. Offer self; Be empathetic, not sympathetic 4. Use active listening 5. Accept and support client's feelings. 6. Clarify and validate client's statements. 7. Use matter-of-fact approach.

Nursing interventions for the confused older adult should focus on:

1. Maintaining the client's health and safety 2. Encouraging self-care 3. Reinforcing reality orientation 4. Providing a consistent, safe environment; engaging client in simple tasks and activities to build self-esteem

Harm reduction is a community helath strategy designed to reduce the harm of substance abuse to families, individuals, community, and society. Examples:

1. More compassionate drug treatment options, including abstinence and drug-substitution models 2. HIV-related interventions, such as needle exchanges; 3. Directed drug-use management should the client wish to continue use 4. Changes in laws concerning possession of paraphernalia and drug use

What interventions should the nurse use if a client becomes abusive?

1. Redirect negative behavior or verbal abuse in a calm, firm, nonjudgmental, defensive manner. 2. Suggest a walk or other physical activity. 3. Set limits on intrusive behavior. For example: "When you interrupt, I cannot explain the procedure to the others; please wait your turn." 4. If necessary, seclude or administer medication if client becomes totally out of control. Always remember to use compassion because nurses are "nice" people.

The most important s/s of depression are a depressed mood with a loss of interest in the pleasures of life. The client has sustained a loss. Other symptoms include:

1. Significant change in appetite, often accompanied by a change in weight (loss or gain) 2. Insomnia or hypersomnia (usually sleeping during the day, often because the client is not sleeping at night due to anxiety) 3. Fatigue or lack of energy 4. Feelings of hopelessness, worthlessness, guild or overresponsiblity. 5. Loss of ability to concentrate or think clearly 6. Preoccupation with death or suicide.

The nurse should suspect an imminent suicide attemp if:

A depressed client becomes "better", Be aware: a happy affect may signifiy that the client feels relieved that a plan has been made and is prepared for the suicide attemt.

There are 5 types of schizophrenia specified in the DSM-IV-TR, which is:

A diagnostic manual prepared by the American Psychiatric Assoc. that provides diagnostic criteria for all psychiatric disorders.

The client's lack of remorse or guilt about the antisocial behavior represents:

A malfunction of the superego, or conscience. The id functions on the basic instinct level and strives to meet immediate needs. The ego is in touch with external reality and is the part of the personality that makes decisions.

Select only 1 nurse to care for an abused child.

Abused children have difficulty establishing trust. The child will be less anxious with one consistent caregiver.

When a client describes a phobia or expresses and unreasonable fear, the nurse should:

Acknowledge the feeling (fear) and refrain from exposing the client to the identified fear. AFter trust is established, a desnesitization process ay be prescribed. Desensitization is the nursing intervention for phobia disorders. The nurse shoudl: 1. Assist client to recognize the factors assoc with feared stimuli that precipitate a phobic response. 2. Teach and practice with client alternative adaptive coping strategies, such as the use of thought substitution (replacing a fearful thought with a pleasant thought) and relaxation technizues. (Role-playing is usedful when the client is in a calm state). 3. Expose client progressively to feared stimuli, offering support with the nurses presence. 4. Provide positive reinforcement whenever a decrease in phobic reaction offers.

The basic difference between deliriiumand dementia is that delirium is:

Acute and reversible, whereas dementia is gradual and permanent.

The purpose of therapeutic interaction with clients is to:

Allow them the autonomy to make choices when appropriate. Keep statements value-free, advise-free and reassurance-free. Remember, just the facts! No opinions!

What action should the nurse take in a psychiatric situation when the client describes a physical problem?

Assess, assess, assess! Just because the focus of the clients situation is on his/her psych needs, it does not mean that the nurse can ignore physiologic needs

When dealing with a depressed client, the nurse should:

Assist with personal hygiene tasks and encourage the client to initiate grooming activities even when he/she does not feel like doing so. This helpfs promote self-esteem and a sense of control.

Do not argue with a client about the delusions. Logic does not work; it only increases the client's anxiety.

Be matter-of-fact and divert delisional thought to reality. Trust is the basis for all interactions With these clients. Be supportive and nonjudgmental. Stress increases anxiety and the need for delusions ad hallucinations. Do not agree that you hear voices (you should be the client's contact with reality), but acknowledge your observation of the client; for example, "You look like you're listening to something."

Individuals with bulimia often use syrup of ipecac to induce vomiting. If ipecac is not vomited and is absorbed:

Cardiotoxicity may occur and can cause conduction disturbances, cardiac dysrhythmias, fatal myocarditis, and circulatory failure. Because HF is not usually seen in the age group, it is often overlooked. Assess for edema and listen to breath sounds.

Phenothiazine problems/concerns

Causes extrapyramidal effects (EPS); tardive dyskinesia can be permanent if client is not assessed regularly for signs of tardive dyskinesia!

Patient teaching Phenothiazines

Causes photosensitivity. Client must wear protective clothing and sunglasses

Provising a consistent caregiver is a priority in planning nursing care for the confused older client.

Chage increases anxiety and confusion.

Anxiety is very contagious and is easily transferred from:

Client to nurse AND nurse to client. First, the nurse must assess his/her own level of anxiety and remain calm. A calm nurse helps the client to gain control, decrease anxiety, and increase feelings of security.

Depressed clients have dissifulty hearing and accpeting compliments because of their lowered self-concept.

Comment on signs of improvement by noting their behavior e.g. "I noticed you combed your hair today" not "You look nice today"

Confusion in older adults is often accepted as being part of growing old. However, the confusion may be due to:

Dehydration with resulting electrolyte imbalance. "sudden change" when obaining a history. Such changes are usually due to a specific stressor, and treatment will usually result in corecting the confusion.

Know what defense mechanisms are used by chemically dependent clients. Two most common:

Denial and rationalization Are the two most common coping styles used. Their use must be confronted so the client's accountability for his or her own behavior can be developed.

It is difficult for an elderly person to admit abuse for:

Fear of being placed in a nursing home or being abandoned. Therefore, it is imperative to establish a trusting relationship with the elderly client.

What type of therapy is used with chemically dependent clients?

Group therapy is effective, as are support groups such as Alcoholics Anonymous and Narcotics Anonymous.

Children also experience depression, which often presents as:

Headaches, stomachaches, and other somatic complaints. Be sure to assess suicide risk, especially in the adolescent.

Compulsion acts are used in response to anxiety, which may or may not be related to the obsession. It is the nurses responsibility to:

Help alleviate anxiety. Interfering will increase anxiety. These acts should be allowed as long as the client's acts are free of violence. The nurse should: 1. Actively listen to the client's obsessive themes. 2. Acknowledge the effects that ritualistic acts have on the client. 3. Demonstrate empathy 4. Avoid being judgmental.

What behaviors are expected during withdrawal?

In the alcoholic, DTs occur 12-36 hours after the last intake of alcohol. Know the symptoms. In drug abuse, withdrawal symptoms are specific to the type of drug.

RE: Eating disorders Physical assessment and nutritional support are a priority; the physiologic implications are great. Nursing interventions should:

Increase self-esteem and develop a positive body image. Behavior modification is useful and effective. Family therapy is most effective because issues of control are common in these disorders.

Common physiological responses to anxiety include:

Increased HR and BP; rapid shallow respirations; dry mouth and tight feeling in throat; tremors and muscle tension; anorexia; urinary frequency; and palmar sweating.

Confabulation

Is not lying. It is used by the client to decrease anxiety and protect the ego

Be aware of your own feelings when dealing with this type of client (Somatoform Disorder).

It is a challenge to be nonjudgmental. The pain is real to the person experiencing it. These disorders cannot be explained medically; they result from internal conflict. The nurse should: 1. Acknowliedge the symptom or complaint. 2. Reaffirm that diagnostic test results reveal no organic pathology. 3. Determine the secondary gains acquired by the client.

There are always questions about drugs on the NCLEX-RN. Tips:

Know the common side effects of drug groups. Know specific problems and concerns in durg therapy. Know specific client teachings about drug theraphy.

What medications can the nurse expect to administer to chemically dependent clients?

Librium or Ativan are commonly used.

Where should a manic client be placed on the unit?

Make every attempt to reduce stimuli in the environment. Place the client in a quiet part of the unit.

Personality disorders are long-standing behavior traits that are:

Maladaptive responses to anxiety that cause difficulty in relating to and working with other individuals.

What activities are appropriate for a manic client?

Noncompetetive physical activities that require the use of large muscle groups.

What basic needs take priority when working with chemically dependent clients?

Nutrition is a priority. Alcohol and drug intake has superseded the intake of food for these clients.

A question concerning nurse-client confidentiality appears often on the NCLEX-RN. For a nurse to tell a client that he/she will not tell anyone about their discussion:

Puts the nurse in a difficult position. Some information must be shared with other team members for the client's safety (e.g. suicide plan) and optimal therapy.

Women who are abused may:

Rationalize the spouse's behavior and unnecessarily accept blame for his actions. The woman may or may not choose to press changes. Be sure to give her the number of a shelter or help line for future offurrences and help her to develop a safety plan.

People with anorexia gain pleasure from providing others with food and watching them eat. These behaviors:

Reinforce their perceptuion of self-control. Do not allow these clients to plan or prepare food for unit-based activities.

Patient teaching MAOI

Require dietary restrictions to prevent hypertensive crisis.

Lithium problems/concerns

Requires renal function assessment and monitoring

Side effects of Antianxiety drugs

Sedation, drowsiness

An important nursing intervention for the depressed client is to:

Sit quietly with the client. When answering NCLEX-RN questions, remember that you are working at Utopia Hospital and there is plenty of time and staff to provide ideal nursing care. Do not leg the realities of clinical situations deter you from choosing the best nursing intervention. The best intervention is to sit quietly with the client, offering support with your presense.

Schizo Observe for increased motor activity and/or erratic response to staff and other clients

The client may be experienceing an increase in command hallucinations. When this occurs, there is an increased potential for aggressive behavior.

When evaluating client behaviors, consider:

The medication the client is receiving. Exhibited behaviors may be manifestations of schizophrenia or a drug reaction.

Client behaviors

The nurse should be aware that all behavior has meaning

Monitor serum lithium levels carefully.

The therapeutic and toxic levels are very close to each other On the readings. Signs of toxicity are evident when lithium levels are more than 1.5 mEq/L. Blood levels should be drawn 12 hrs after last dose.

The nurse knows depressed clients are improving when:

They begin to take an interest in their appearance or begin to perform self-care activities that were previously of little or no interest to them.

Avoid giving clients with dissociative disorder:

Too much information about past events at one time. The various types of amnesia that accompany DID provide protection from pain. Too much, too soon may cause decompensation.

Nausea is a common complaint after ECT.

Vomiting by an unconscious client can lead to aspiration. Because post-ECT clients are unconscious, the nurse must observe closely for the possibility of aspiration: maintain a patent airway!

The nurse should place an anxious client:

Where there are reduced environmental stimuli (a quiet area of the unit, away from the nurses' station).