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