Wellness 3 Module 3

Lithium Carbonate is used for

bipolar

MAOI (phenilzine/Nardil)

block MAO win brain. Increases the amount of nore, dopamine, and serotonin

2nd gen meds for clients who have difficulty swallowing

Aripiprazole and CLozapine both come in oral tablets that disintegrate.

Assessment of PP Psychosis Disorders

Depression scales, anxiety and irritability, poor concentration and forgetfulness, sleeping difficulties, appetite change, fatigue and tearfulness

PP Depression

Develops in about 8-20% of all postpartal women. Greatest risk around the fourth week.

Uterine Atoney Management

Fundal massage: asses lochia, position of uterus, bladder. Medications: oxytocin, methergine, carboprost (hemabate). Blood products if loss is excessive.

Amino Acid neurotransmitter believed to be dysfunctional in anxiety disorders

GABA

Client teaching for Lithium

GI effects can be minimized if taken with food, maintain healthy diet to minimize weight gain, maintain 2-3 L/day fluid intake, adequate sodium intake, monitor lithium effects.

Adverse effects of Lithium

GI, fine hand tremors, polyuria, weight gain, renal toxicity, goiter/hypothyroidism with long term treatment.

Adverse effects of Valproic Acid

GI, hepatotox, anorexia, n/v, fatigue, abdominal pain, jaundice. Pancreatitis, thrombocytopenia, teratogenesis , contraindicated in those with liver disorders.

Preparation for ECT resembles preparation for

General anesthesia

Symptoms of lithium toxicity <2

Nausea and vomiting, diarrhea, reduced coordination, drowsiness, slurred speech, and muscle weakness

S/S of shock (DIC)

Nausea, light headed Hypotension Tachycardia, weak, thready pulse Decreased pulse pressure Cool, pale, clammy skin Cyanosis Oliguria, anuria Thirst Hypothermia Behavioral changes (lethargy, confusion, anxiety)

Complications Haliperidol

Agranulocytosis- let provider know if signs of infection (fever, sore throat)

Major differences between PPD and Blues

Blues: symptoms disappear without medical interventions, occur within the first 2 weeks postpartum, able to safely care for self and baby. PPD: requires psych interventions, occurs within first 6 months post partum, unable to safely cae for self and/or baby

Nurse's response to suicide attempt

Need for unconditional positive regard for person Avoidance of patient blame Nonjudgmental approach, tone Belief that one person can make a difference in another's life Possible devastation of staff if patient commits suicide

Atypical antipsychotic for suicide

Risperidone

Client teaching for Diazepam, Lorazepam

Sedation effects, caffeine interferes with effects, do not abruptly discontinue

Conventional antipsychotic (Haliperidol) Pharm and therapeutic uses

blocks dopamine, acetylcholine, histamine, and nore in brain and periphery. Tx of acute and chronic disorders, schizo, bipolar disorder, tourette's , prevention of N/V

When there is increased activity of this neurotransmitter in the brain, it is known to cause increased impulsivity and violent behavior

dopamine

Alprazolam/Diazepam/Lorazepam/Chlordiazepoxide/Clonazepam Pharmacological action

enhances the inhibitory effects of GABA. relief from anxiety occurs rapidly.

Urinary Tract Infection Risk Factors

epidural, catherization, operative vaginal deliveries, overdistended bladder.

Mania

euphoric or agitated euthymic states.

Uterine Atony assessment findings

excessive bleeding, boggy fundus

Wavy flexibility

excessive maintenance of position

Parkinsonism

first month after beginning of tx. Bradykinesia, shuffling gait, tremors, rigidity, drooling.

Rapid Cycling

four or more episodes of acute mania within 1 year.

PPH Acute Pain

fundal massage, oxytocin, after pains, woman pain is 8 on a scale of 10, analgesia

Biologic Theories of Schizophrenia

genetic factors, neuroanatomic, neurochemical, immunovirology

Endometritis Prevention

good perineal care, hygiene, thorough handwashing, sitz bath, adequate fluid intake, diet high in protein and vitamin C.

Bruxism:

grinding and clenching of teeth, usually during sleep.

anhedonia

having no pleasure or joy in life. Losing any sense of pleasure from activities formerly enjoyed.

moderate anxiety

muscle tension, diaphoresis, pounding pulse , HA, dry mouth, high voice pitch, faster rate of speec, GI upset, frequent urination

Therapeutic uses of second generation antipsychotics

negative and positive symptoms of schiz. psychosis by levodopa therapy, relief of other psychotic manifestations, such as bipolar.

Maladaptive or Dysfunctional Personality Traits

negative behavior toward others, anger and/or hostility, irritable/labile moods, lack of guilt, remorse or emotionally cold, and uncaring. Impulsive, poor judgment. Irresponsible, not accountable for own actions, risk - taking, thrill seeking behaviors.

Neurotransmitter that affects attention and behavior

norepinephrine

Hematoma

occurs when blood collects within the connective tissues of the vagina or perineal areas related to a vessel that ruptures and continues to bleed. Difficult to determine since blood is retained within tissue, so may not be diagnosed until woman is in hypovolemic shock.

Thought withdrawal

others are taking their thoughts

Fluoxetine is used for

panic disorder and GAD

Perseveration

persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic.

Functional Status

person's ability to perform ADL's and solve problems of daily living

Conventional antipsychotics are effective at treating

positive signs ie hallucinations, delusions, and severe agitation.

First generation drugs target

positive signs of schizophrenia

alogia

poverty of thought or speech, client mumbles or responds vaguely.

Prevention of Mastitis

proper feeding techniques, supportive bra, good handwashing, prompt attention to blocked ducts.

Catatonia

psychologically induced immobility occasionally marked by periods of agitation or excitement, the client seems motionless, as if in a trance.

Primary medical treatment for schizophrenia

psychopharmacology

Qi-gong

psychotic reaction is an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic symptoms that occur after participating in the Chinese folk health-enhancing practice of qi-gong. Especially vulnerable are those who become overly involved in the practice.

Echopraxia

purposeful imitation of movements made by others.

Severe toxicity >2.5

rapid progression of manifestations leading to coma and death.

Tx of Bipolar

Antimanic agent: lithium Anticonvulsant agent used as mood stabilizer (see Table 17.6) Agents helpful in reducing manic behavior, protecting against bipolar depressive cycles

Treatment for Bipolar

Antimanic: Lithium (therapeutic ranges .5-1.5) Anticonvulsant agent used as mood stabilizer

Symptoms of PPD

Anxiety Irritability Fatigue Sense of failure Feelings of guilt Sleep disorders Appetite changes Suicide ideation Excessive concerns about the baby Lack of social support and stable relationship with partner or parents (especially her father, as a child). Dissatisfaction with herself.

Amniotic Fluid Embolism

rare but often fatal. Amniotic fluid that contains fetal cells, lanugo, and vernix enters the maternal vascular system and initiates a cascading process that leads to cardiorespiratory collapse and DIC

REEDA

redness, edema, ecchymosis, discharge, approximation.

Locura

refers to a chronic psychosis experienced by Latinos in the United States and Latin America. Symptoms include incoherence, agitation, visual and auditory hallucinations, inability to follow social rules, unpredictability, and, possibly, violent behavior.

Four stages to becoming a mother

Commitment, attachment, and preparation for an infant during pregnancy Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the early weeks after birth Moving toward a new normal during the first 4 months Achievement of a maternal identity around 4 months

Risk Factors for PPH

Neonatal macrosomia: birth weight greater than 4000 grams Polyhydramnios Operative vaginal delivery Augmented or induced labor Ineffective uterine contractions during labor. Precipitous labor and/or birth General anesthesia Critical Component 10% decrease in hematocrit post birth Saturation of the peripad within 15 minutes Boggy fundus Tachycardia Decrease BP

Advantages of atypical agents

relief of positive and negative symptoms, decrease in affective findings and suicidal behaviors, improvement of neurocognitive defects, such as poor memory, fewer or no EPS including tardive dyskinesia, due to less dopamine blockade. Fewer anticholinergic effects, less relapse.

echolalia

repetition or imitation of what someone else says

Calcium gluconate

replaces and maintains calcium level. Antidote for Mag

Defense mechanisms

repression, suppression, regression, undoing, and splitting.

Mild Anxiety

restlessness, fidgeting, GI butterflies, difficulty sleeping, hypersensitivity to noise

Respiratory changes post partum

return of chest wall compliance

Tyramine rich food

ripe avocado, figs, fermented or smoked meats, liver, dried or cured fish, most cheeses , some beer and wine, protein dietary supplements.

Calcium side effects

tingling sensations, sense of oppression or heat waves with IV use, syncope with rapid IV use, bradycardia, arrhythmias, cardiac arrest with rapid IV use, mild drop in BP, constipation, irritation, chalky taste, hemorrhage, N/V, thirst, abd pain, polyuria, renal calculi, hypercalcemia, cellulitis

A laboring client with preeclampsia is prescribed magnesium sulfate 2 g/h IV piggyback. The pharmacy sends the IV to the unit labeled magnesium sulfate 20 g/500 ml normal saline. To deliver the correct dose, the nurse should set the pump to deliver how many milliliters per hour? Record your answer using a whole number. 50 .05 4 .04

(500 ml/20 g) X 2 g/h = 50 ml/hr

Nursing Considerations for Calcium

-Double check you are giving the correct form of calcium, tell patient that foods such as spinach, rhubarb, whole grains and dairy products can interfere with calcium absorption; give med slowly around 2mL/min

Procardia/Nifedipine nursing assessment

-Monitor BP and pulse before, during and after therapy. Monitor ECG for prolonged therapy. I&O looking for signs of peripheral edema, rales/crackles, dyspnea, wt gain, jugular venous distention. Assess for Stevens-Johnson Syndrome. Teach pt to take own pulse at home while on med, and to not take med if RR is below 16

Oxytocin (Pitocin)

-Stimulates uterine smooth muscle that produces intermittent contractions. Has a vasopressor and antidiuretic properties

Betamethasone

-Suppression of inflammation and modification of the normal immune response. Replacement therapy in adrenal insufficiency. Management of adrenocortical insufficiency. Unlabeled use: Short term administration to high risk mothers before delivery to prevent respiratory distress syndrome in the newborn

Procardia/Nifedipine side effects

-dizziness, headache, lightheadedness, fever, palpitations, transient hypotension, nausea, diarrhea, constipation, flatulence, dyspnea, wheezing, SOB, chills, polyuria

Therapeutic levels of lithium

.5-1.5

Advanced indications of Lithium tox

1.5-2.0, mental confusion, poor coordination, coarse tremors, ongoing GI, n/v/d

For depression to be MDD, symptoms must last longer than

2 weeks.

Severe indications of LIthium Tox

2-0-2.5, extreme polyuria of dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension, possible death.

Major Depressive Disorder

2:1 (women to men), decreases with age in women, increases with age in men , highest in single, divorced people. 50-60% will suffer recurrence. 20% will develop a chronic form of depression.

In order to be diagnosed with GAD, symptoms must last longer than

3 months

Therapeutic effect for Buspar takes

3-6 weeks.

Blood loss limits

> 500 ml following a vaginal birth, > 1000 ml following a c-section.

Risks for DIC

Abruptio PIH HELLP Prolonged PPH AFE Sepsis Missed abortion Fetal death Risks for ITP are genetic

Risk factors for Suicide

Adolescent, young adult, adult males, Native Americans. Comorbid mental illness such as depressive disorders, anxiety disorders, substance abuse disorder, schizophrenia, eating disorders, bipolar disorder, and personality disorders Loss of employment and finances, feelings of isolation, powerlessness, prior attempts, change in functional ability, loss of loved ones.

Risk factors for suicide

Adolescent, young adult, adult males, Native Americans. Comorbid mental illness such as depressive disorders, anxiety disorders, substance abuse disorder, schizophrenia, eating disorders, bipolar disorder, and personality disorders Loss of employment and finances, feelings of isolation, powerlessness, prior attempts, change in functional ability, loss of loved ones.

Neuroleptic Malignant Syndrome

Adverse effect of first generation antipsychotic drugs, sudden high fever, dysrhythmias, changes in LOC, BP fluctuations, muscle rigidity , Coma

Benzos for Anxiety

Alprazolam/Diazepam/Lorazepam/Chlordiazepoxide/Clonazepam

One day after a client with schizophrenia began treatment with haloperidol, a nurse notices that he is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? Assume that the client is posturing. Tell the client to lie down and relax. Evaluate the client for adverse reactions to haloperidol. Put the client on the list for the physician to see the following day

An antipsychotic agent such as haloperidol can cause muscle spasms in the neck, face, tongue, back, and legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and promptly assess for related reactions. Posturing, which may occur in clients with schizophrenia, isn't the same as neck and jaw spasms. Relaxing can reduce the client's tension-induced muscle stiffness but will not affect drug-induced muscle spasms. The nurse should consider an adverse drug reaction as the possible cause of new sign or symptom and obtain treatment immediately.

What ethnicity needs lower doses of haldol to obtain therapeutic effects?

Asians.

What to take for pain relief if on lithium

Aspirin is better than ibuprofen.

Physiological changes in breasts post partum

Assess breasts for engorgement In first 24 hours, breasts are soft and non tender. Day 2- slightly firm and non tender, Day 3- breasts are firm, tender, and warm to touch. Assess nipples for signs of irritation and nipple tissue breakdown. Cracked, blistered, reddened. Patient education Apply heat to breast to increase circulation and comfort Express milk if engorged.

Symptoms of lithium tox 2-3

Ataxia, agitation, blurred vision, tinnitus, giddiness, choreoathetoid movements, confusion, muscle fasciculation, hyperreflexia, hypertonic muscles, myoclonic twitches, pruritus, maculopapular rash, movement of limbs, slurred speech, large output of dilute urine, incontinence of bladder or bowel, and vertigo

Procardia/Nifedipine nursing considerations

Avoid grapefruit

Critical elements of assessment and nurse caring during postpartum?

B-breasts U- Uterus B-Bowel B- Bladder L- Lochia E-Episiotomy, Lacerations S- Social/Emotional

used on a short term basis for a client experiencing sleep impairment related to mania.

Benzos (Lorezapam/Ativan)

Bipolar Disorder

Bipolar disorder involves extreme mood swings from episodes of mania to episodes of depression. (Bipolar disorder was formerly known as manic-depressive illness.) During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor judgment and rapid thoughts, actions, and speech. During depressed phases, mood, behavior, and thoughts are the same as in people diagnosed with major depression (see previous discussion). In fact, if a person's first episode of bipolar illness is a depressed phase, he or she might be diagnosed with major depression; a diagnosis of bipolar disorder may not be made until the person experiences a manic episode.

Urinary changes post partum

Bladder distention Incomplete emptying bladder Inability to void. All d/t decreased sensation of urge to void and/or edema around the urethra. Cystitis Bladder inflammation/infection Symptoms: frequency, urinary, pain/burning on urination and malaise.

SSRI pharm (Fluoxetine/Prozac)

Block reuptake of serotonin in space, intensifies effects.

TCA (Elavil/Amitriptyline) Pharm

Block uptake of nore and serotonin in the synaptic space, intensifying effects.

Signs of Post Partum hemorrhage

Boggy uterus, heavy lochia, clots, decrease in hematocrit and hemoglobin

Assessment of Mastitis

Breast consistency, skin color, surface temperature, nipple condition, presence of pain.

An agitated and incoherent client comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that this client was hospitalized for schizophrenia from ages 20 to 21. The physician orders haloperidol, 5 mg I.M. The nurse understands that this drug is used in this client to treat: Dyskinesia Dementia Psychosis tardive dyskinesia.

By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.

Alprazolam/Diazepam/Lorazepam/Chlordiazepoxide/Clonazepam side effects

CNS depression, Anterograde amnesia, Acute toxicity , oral tox, IV tox,. Respiratory depression, severe hypotension, Paradoxical response

Adverse effects of MAOIs

CNS stimulation, orthostatic hypotension, headache, nausea, increased heart rate, increased bp, local rash if on a patch.

A client has been severely depressed since her husband died 6 months earlier. Her physician orders amitriptyline hydrochloride, 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition requires cautious use of this drug? Hiatal hernia Hypernatremia Hepatic disease Hypokalemia

Conditions requiring cautious use of amitriptyline include pregnancy, breast-feeding, suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia, hypernatremia, and hypokalemia don't affect amitriptyline therapy

Therapeutic Uses for Buspirone (Atypical Anxiolytic)

Panic disorder, OCD, social anxiety, PTSD.

Carboprost was injected into the uterus of a client to treat uterine atony during a cesarean section. In preparing to care for this client postpartum, the nurse should assess the client for which common adverse effect of the medication? vertigo and confusion nausea and diarrhea restlessness and increased vaginal bleeding headache and hypertension

Carboprost is an oxytocic prostaglandin that causes uterine contraction in women who are bleeding heavily. Nausea, vomiting, diarrhea, and fever are common adverse effects of prostaglandin administration. Vertigo and confusion are not associated with this drug. Carboprost may not control all cases of hemorrhage, but it does not cause bleeding. Restlessness typically is a sign of shock, not a reaction to carboprost. If too large a dose is given, the client may experience headache and hypertension because carboprost contracts smooth muscles.

Symptoms of Lithium Tox (>3)

Cardiac arrhythmia, hypotension, peripheral vascular collapse, focal or generalized seizures, reduced levels of consciousness from stupor to coma, myoclonic jerks of muscle groups, and spasticity of muscles

Carboprost (Hemabate)

Causing uterine contractions by directly stimulating the myometrium; avoid contact with skin!; side effects include Dizziness, headache, wheezing, diarrhea, N/V, abd pain, cramps, uterine rupture, fever, chills. Most dangerous side effects: Uterine rupture

First priority for client with depression

Check to see if suicidal.

Client education for Lithium

Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration. Thyroid function tests usually are ordered as a baseline and every 6 months during treatment with lithium. In 6 to 18 months, one third of clients taking lithium have an increased level of thyroid-stimulating hormone, which can cause anxiety, labile emotions, and sleeping difficulties. Decreased levels are implicated in fatigue and depression. Because most lithium is excreted in the urine, baseline and periodic assessments of renal status are necessary to assess renal function. The reduced renal function in older adults necessitates lower doses. Lithium is contraindicated in people with compromised renal function or urinary retention and those taking low-salt diets or diuretics. Lithium also is contraindicated in people with brain or cardiovascular damage.

Which of the following clinical manifestations should alert the nurse to lithium toxicity? Increasingly agitated behavior. Markedly increased food intake. Sudden increase in blood pressure. Lethargy and weakness with vomiting

Clinical manifestations of lithium toxicity include muscle weakness, lack of coordination, vomiting, diarrhea, coarse hand tremors, twitching, lethargy, polyuria, and mental confusion. Agitation is not a symptom of lithium toxicity. Increased food intake is not a symptom of lithium toxicity. Increased blood pressure is not a symptom of lithium toxicity.

Antidote for Benzos

Flumazenil.

Cytotec

Cytotec Category X -Acts as prostaglandin analogue, decreasing gastric acid secretion -Prevention of gastric mucosal injury from NSAIDs -Causes miscarriage -Uterine rupture and abortion -Do not give if pregnancy is possible -Pregnancy -Do not take if may be or become pregnant -Usually begun 2nd or 3rd day of menstrual cycle. Assess for childbearing age. Monitor for uterine cramping and bleeding during therapy. Assess dilation of cervix periodically during therapy.

When is the chance of suicide highest for depressed clients?

Depressed clients who begin taking an antidepressant may have a continued or increased risk for suicide in the first few weeks of therapy. They may experience an increase in energy from the antidepressant but remain depressed. This increase in energy may make clients more likely to act on suicidal ideas and able to carry them out. Also, because antidepressants take several weeks to reach their peak effect, clients may become discouraged and act on suicidal ideas because they believe the medication is not helping them. For these reasons, it is extremely important to monitor the suicidal ideation of depressed clients until the risk has subsided.

Antisocial Personality Disorder

Deceit/manipulation False emotions; no empathy Narrowed view of world Poor judgment; no insight Egocentric, but actual self-shallow and empty Relationships as serving own needs Data analysis/nursing diagnoses

Elder considerations for Depression

Depression common among the elderly; marked increase when elders are medically ill Psychotic features common Increased intolerance to medications ECT more commonly used for treatment; more rapid response Suicide increased among elderly

Benzos for suicide

Diazepam, Lorazepam

Which client statement indicates the need for additional teaching about benzodiazepines? "I cannot drink alcohol while taking diazepam." "I can stop taking the drug anytime I want." "I can stop taking the drug anytime I want." "Diazepam will help my tight muscles feel better."

Diazepam, like any benzodiazepine, cannot be stopped abruptly. The client must be slowly tapered off of the medication to decrease withdrawal symptoms, which would be similar to withdrawal from alcohol. Alcohol in combination with a benzodiazepine produces an increased central nervous system depressant effect and therefore should be avoided. Diazepam can cause drowsiness, and the client should be warned about driving until tolerance develops. Diazepam has muscle relaxant properties and will help tight, tense muscles feel better.

Cervidil

Dinoprostone (Cervidil) Vaginal Insert Category C -produces contractions similar to those occurring during labor at term by stimulating the myometrium. Initiates softening, effacement, and dilation of cervix. Stimulates GI smooth muscle -used to ripen cervix in pregnancy or near term when induction of labor is in side effects -back pain, warm feeling in vagina, uterine contraction abnormalities. amniotic fluid metabolism. Anaphylaxis. Uterine rupture -Could cause abortion! (abortifacient) -Risk factor: Previous cesarean section or uterine surgery -notify healthcare provider if any abortifacient signs occur (fever, chills, foul-smelling vagincal discharge, lower abdo pain, or increased bleeding occurs) -Monitor frequency, duration, and force of contractions and uterine resting tone. Monitor temp, pulse, and BP. Monitor for fever that could occur 15-45 minutes after insertion. -How to insert: place transversely in the posterior vaginal fornix immediately. Use only with retrieval system. Use minimal amount of lubricant. Patient should remain supine for 2 hours after insertion. Remove when active labor begins or after 12 hours. Do not give oxytocin during or less than 30 minutes after removal

Prepidil

Dinoprostone (Prepidil) Category C -produces contractions similar to those occurring during labor at term by stimulating the myometrium. Initiates softening, effacement, and dilation of cervix. Stimulates GI smooth muscle -used to ripen cervix in pregnancy or near term when induction of labor is in indicated -back pain, warm feeling in vagina, uterine contraction abnormalities. amniotic fluid metabolism. Anaphylaxis, Uterine Rupture -Abortifacient, anaphylaxis, Cervical Ripening -avoid in prolonged uterine contractions -Risk Factors: Previous cesarean section or uterine surgery -notify healthcare provider if any abortifacient signs occur (fever, chills, foul-smelling vagincal discharge, lower abdo pain, or increased bleeding occurs) -Monitor frequency, duration, and force of contractions and uterine resting tone. Monitor temp, pulse, and BP. Monitor for fever that could occur 15-45 minutes after insertion -Determine degree of effacement before insertion of the catheter. Do not administer about the level of internal os. Bring gel to room temp. Do not use water or microwave. Patient should remain supine for 15-30 mins. Oxytocin may be administered 6-12 hrs after desired response.

During alprazolam therapy, the should be alert for which dose-related adverse reaction? Ataxia Hepatomegaly Urticaria Rash

Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, these reactions aren't dose-related.

A 79-year-old woman is brought to the outpatient clinic by her daughter for a routine medication evaluation. The daughter reports that her mother is quite stable and has no adverse effects from the risperidone she is taking. Then the daughter says, "I just think my mother could be even better if she was on a larger dosage. My son takes 1 mg of risperidone every day and my mother is only on 0.5 mg." What is the most helpful response by the nurse? "Maybe your son is sicker than your mother is." "We could increase your mother's dosage if you want." "Older clients generally need a lesser dose than younger people." "I am not seeing any symptoms of illness in your mother. Let us wait until the next visit."

Elderly clients are typically on lower dosages of antipsychotic medications due to the metabolic changes of aging. Comparing dosages is not relevant. Each client is unique in metabolizing medications. Changing medication dosages is based on an assessment of illness symptoms and the adverse effect profile, not on family preferences. Urging the daughter to wait discounts her concerns and gives no rationale for waiting.

ECT

Electroconvulsive Therapy,

Medical Management of PP Psychosis

Emergency hospitalization. Lithium. Antipsychotic medications such as Thorazine or Haldol. Sedatives. Removal of the infant. Social support. Many of the drugs used in treating pp psychiatric conditions are contraindicated in BF women.

Comfort measures for afterpains

Empty bladder Warm blanket Analgesia (ibuprofen most common) Relaxation techniques

Most common PP infection?

Endometritis

Primary Postpartum Infections

Endometritis, UTI, Subinvolution, Mastitis

Bipolar Outcome ID

Free from injury—med compliance Meet basic needs and self-care Socially appropriate behavior

MDD Outcome identification

Free from self-injury Improved mood and energy Return to previous functional level Medication compliance

UTI assessment

Frequency and urgency Dysuria Nocturia Hematuria Suprapubic pain Slightly elevated temperature

Endocrine changes post partum

Estrogen and progesterone levels drop quickly Placental hormones decline rapidly Non lactating women→ prolactin levels continue to decline first 3 postpartum weeks. Menses begins 6- 1o weeks after birth. Prolactin levels decline within 2 weeks if not breast-feeding Lactating women→ prolactin levels increase in response to the infant's suckling. Lactation suppresses menses. Diaphoresis: profuse sweating in response to decreased estrogen levels. Assists the body in excreting the increased fluid accumulated during pregnancy.

Lacerations Assessment Findings

Excessive bleeding with a firm uterus Bleeding is steady stream with no clots Tachycardia Hypotension

Paternal Transition stage

Expectations, reality, transition into mastery

Mood stabilizing Antiepileptic Drugs: Valproic Acid (Depakote)

Expected Pharm: slowing the entrance of sodium and calcium back into the neuron, thus extending the time it takes for the nerve to return to its active state, potentiating the effects of GABA, inhibiting glutamate which in turn suppresses CNS excitation. Particularly useful for clients who have rapid cycling mania and depression.

Bipolar Disorder

Extreme mood fluctuations from mania to depression (see Figure 17.1) Second only to major depression as cause of worldwide disability Onset usually in late teens, 20s, or 30s Manic episodes begin suddenly, last from a few weeks to several months

Bipolar disorder

Extreme mood fluctuations from mania to depression (see Figure 17.1) Second only to major depression as cause of worldwide disability Onset usually in late teens, 20s, or 30s Manic episodes begin suddenly, last from a few weeks to several months

Fentanyl

Fentanyl Category C -Unknown. Binds with opioid receptors in the CNS, altering perception of and emotional response to pain -Adjunct to general and regional anesthesia or to induce and maintain anesthesia. Postop pain and to manage moderate to severe chronic pain. -Narcan (Naloxone). -Confusion, sedation, seizures, headaches, arrhythmias, DVT, PE, constipation, N/V, hypoventilation, resp. depression, muscle rigidity, dependence -Respiratory Depression. Death -Hypersensitivity. -Use with caution in patients with brain tumors, COPD, decreased respiratory reserve, potentially compromised respirations, hepatic or renal disease, or cardiac bradyarrhythmias. -request drug before pain becomes too intense. When drug is used after surgery, encourage patient to turn, cough, and breathe deeply to prevent lung problems. Do not stop drug abruptly. Avoid alcohol while on Fentanyl. If patch is used separate education is necessary. Might cause constipation -Assess for allergies or hypersensitivity. Assess for other medical conditions (especially respiratory disorders) and other medications. Assess pain, VS, and LOC before and after admin.

Endometritis Assessment

Fever, Malaise, Abdominal Pain, Foul Smelling lochia, larger than expected lochia, larger than expected uterus, tachycardia.

Risk factors Subinvolution

Fibroids, endometritis, retained placental tissue

SSRI Therapeutic Uses

First line tx for trauma and stressor related disorders. OCD- reduces symptoms by increasing serotonin Panic disorder- decreases both frequency and intensity of panic attacks.

Rubella vaccine

Give MMR immediately pp to prevent MMR.

Tdap vaccine

Give immediately post-partum if not received previously Prevents tetanus, diphtheria, and pertussis

Prevention of a UTI

Good perineal hygiene Good fluid intake Frequent emptying of the bladder Void before and after intercourse Cotton underwear Increase acidity of the urine

Serotonin syndrome

Hallucinations, diaphoresis, agitation

A dystonic reaction can be caused by which medication? Diazepam Haloperidol Amitriptyline hydrochloride Clonazepam

Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness,lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.

Prevention of PP Psychosis

Help parents understand the lifestyle changes and role demands Provide realistic information Anticipatory guidance Dispel myths about the perfect mother or the perfect newborn Educate about the possibility of postpartum blues Educate about the symptoms of postpartum depression

Late PPH caused by

Hematoma, subinvolution, retained placental fragments

Bipolar assessment

History General appearance, behavior (pressured speech, flamboyancy, sexually suggestive) Mood, affect (euphoric, grandiose) Thought process, content (circumstantiality, tangentiality) Sensorium, intellectual processes (disoriented to time), Judgment, insight Self-concept (exaggerated) Roles, relationships (labile emotions) Physiologic, self-care considerations

MDD assessment

History General appearance, motor behavior (psychomotor retardation, latency of response, psychomotor agitation) Mood, affect (anhedonia) Thought process, content (rumination, suicide) Sensorium, intellectual processes (impaired memory), Judgment, insight (impairment) Self-concept (worthlessness) Roles, relationships (difficulty in this area) Physiologic, self-care considerations Depression rating scales Self-rating scales: Zung, Beck Clinician rating scale: Hamilton Rating Scale

SSRIs for anxiety

Paroxetine, Zoloft, Lexapro, Prozac, Luvox

GAS

In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and norepinephrine for fuel) and organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The lungs take in more air, and the heart beats faster and harder so it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors. If the person adapts to the stress, the body responses relax, and the gland, organ, and systemic responses abate. The exhaustion stage occurs when the person has responded negatively to anxiety and stress: body stores are depleted or the emotional components are not resolved, resulting in continual arousal of the physiologic responses and little reserve capacity.

A client with Alzheimer's disease is started on a low dose of lorazepam because of agitation and a sleep disturbance. The nurse should assess the client for which complication? nighttime agitation extrapyramidal side effects Vomiting anticholinergic side effects

In the cognitively impaired client, benzodiazepines, such as lorazepam, can increase confusion and nighttime agitation. Extrapyramidal side effects are more common with antipsychotics. Vomiting and sweating are signs of benzodiazepine withdrawal. Anticholinergic side effects are more likely with antipsychotics and tricyclic antidepressants.

Postpartum Psychosis

Incidence 1-2 per 1000, becomes evident within the first 3 months.

Seizures related to antipsychotic medications

Incidence is 1% of people taking antipsychotics. 5% for those taking clozapine.

Risks for Amniotic Fluid Embolism

Induction, C/S, AMA, previa, abruptio, eclampsia

Ibuprofen (motrin)

Inhibits prostaglandin synthesis. Treatment of mild to moderate fever. Use with extreme caution if hx of GI or bleeding ulcer.

Muscular and Nervous changes post partum

Joints return to prepregnant state except for feet Women commonly experience fatigue and activity intolerance for weeks after giving birth Abdominal muscle tone is diminished after birth and special exercises are needed to return to normal Diastasis recti abdominis: Separation of the rectus muscle.

Nursing consideration for Lithium tox

Keep sodium amount the same- decreased sodium can lead to decrease lithium excretion which can lead to toxicity. NSAIDs will increase absorption--> lithium toxicity

Tardive dyskinesia

Late EPS, involuntary movements of the tongue and face, such as lip smacking and tongue fasciculations. Involuntary movements of the arms, legs and trunk.

Docusate (Colace)

Laxative. Promotes incorporation of water into stool resulting in softer fecal mass.

Hypomania

Less severe than Mania

Affective disorders

Pervasive alterations in emotions manifested by depression, mania or both Interference with life; long-term sadness, agitation, or elation

Lithium to treat Bipolar

Lithium is a salt contained in the human body; it is similar to gold, copper, magnesium, manganese, and other trace elements. Once believed to be helpful for bipolar mania only, investigators quickly realized that lithium also could partially or completely mute the cycling toward bipolar depression. The response rate in acute mania to lithium therapy is 70% to 80%. In addition to treating the range of bipolar behaviors, lithium also can stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes (Paton et al., 2010). Lithium not only competes for salt receptor sites but also affects calcium, potassium, and magnesium ions as well as glucose metabolism. Its mechanism of action is unknown, but it is thought to work in the synapses to hasten destruction of catecholamines (dopamine, norepinephrine), inhibit neurotransmitter release, and decrease the sensitivity of postsynaptic receptors

Physiological changes in CV post partum

Loss of 400-500 ml related to vaginal birthing experience. Increase in cardiac output Returns to pre pregnant levels within 48 hours. WBC returns to normal within 7 days. Hemoglobin decreases by 1-1-5, hct decreases 3-4% Orthostatic hypotension due to decreased vascular resistance in the pelvis. Asses every 15 min the first hour, 30 the second, 4 hours for the rest of the first day, every shift thereafter. Clotting factors decrease after the birth of the placenta and return to normal within first 2 post partum weeks. Red blood cell production

Tx of Bruxism

Low dose of buspirone to counteract adverse effects, use a mouth guard, changing to a different class of antianxiety medications.

Abilify (Aripiprazole)

Low or no risk of EPS. Adverse effects: sedation, headache, anxiety, insomnia, GI upset.

Expected Pharm Second Generation antipsychotic

Mainly block serotonin, and to a lesser degree, dopamine. Also block nore, histamine, acetylcholine.

Major Depressive Disorder

Major depressive disorder typically involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision making, self-esteem, and goals. Major depression is twice as common in women and has a 1.5 to 3 times greater incidence in first-degree relatives than in the general population. Incidence of depression decreases with age in women and increases with age in men. Single and divorced people have the highest incidence. Depression in prepubertal boys and girls occurs at an equal rat

Categories of Mood Disorders

Major depressive, bipolar disorder, related disorders

Atypical antidepressant prototype: Bupropion (Wellbutrin)

Medication acts by inhibiting dopamine uptake. Used for treatment of depression, alternative for SSRIs for clients unable to tolerate the sexual dysfunction side effects, Aid to quit smoking, prevention of seasonal pattern depression. Contradicted in clients who have anorexia or bulimia

Mood stabilizer prototype (Lithium Carbonate)

Pharmacological Action: produces neurochemical changes in the brain, including serotonin receptor blockade.

Methergine

Methylergonovine Maleate (Methergine) Category C -Stimulates uterine and vascular smooth muscle, causing contractions, decreased bleeding, arterial vasoconstriction. therapeutic outcome: absence of hemorrhage -Yes with caution -treatment of hemorrhage postpartum or after abortion. uterine contractions. side effects-high blood pressure, seizures, dysrhythmias, CVA (if administered IV), tinnitus, nausea, vomiting. -anti-emetics for nausea and vomiting -hypotension, dysrhythmias, CVA -pregnancy, hypersensitivity to ergot preparations, angina, arteriosclerosis, CAD -interacts with smoking and vasopressors because of increased vasoconstriction. -advice pt to stop smoking, since increased vasoconstriction will result. Inform pt that abdominal cramps are a side effect of this medication. Instruct pt to notify prescriber if chest pain, nausea, vomiting, headache, muscle pain, weakness, or cold, numb extremities occur. -Monitor BP, pulse, watch for change that might indicate hemorrhage. Assess fundal tone, non-phasic contractions, check for relaxation or severe cramping. Assess for ergotism or overdose: nausea, vomiting, weakness, muscular pain, insensitivity to cold, paresthesia of extremities, product should be decreased or discontinued. Before administering ergonovine check Ca levels and if hypocalcemia present correction should be made to increase effectiveness. Monitor prolactin levels for decreased milk production.

Mastitis Risk Factors

Milk stasis Actions that promote excess of bacteria Nipple trauma Obstruction of ducts Failure to empty breasts Lowered maternal defenses

Narcan

Naloxone Hydrochoride (Narcan) Category C -competes with opioids at opioid receptor sites. therapeutic outcome: absence of opioid overdose. -respiratory depression induced by opioids, refractory circulatory shock, coma, hypotension. -drowsiness, nervousness, tremor, rapid pulse, ventricular tachycardia, changes in BP, nausea, vomiting, hepatotoxicity, hyperpnea, pulmonary edema. -changes in BP, hepatotoxicity, tachycardia and pulmonary edema. -hypersensitivity -interacts with tramadol (increases seizures). -explain reason for and expected results of med when patient is alert. -assess for signs of opioid withdrawal, monitor VS q3- 5 min, ABGs, cardiac status for tachycardia, hypertension and monitor ECG, assess for respiratory dysfunction.

Postpartum Blues

More severe in primiparas. Occurs in as many as 50-70% of moms. Characterized by mild depression interspersed with happier feelings. Typically occur within a few days after the baby's birth. Last from a few hours to up to 2 weeks. Seems related to the rapid alteration of estrogen, progesterone and prolactin levels after birth.

Morphine

Morphine Category C - depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors. 2 -decrease pain, used for patients with moderate to severe pain antidote-Naloxone -respiratory depression, drowsiness, dizziness, sedation, euphoria, bradycardia, changes in BP, shock, cardiac arrest, tachycardia. constipation, thrombocytopenia. -respiratory depression, coma, death, respiratory arrest, apnea -hypersensitivity, addiction, hemorrhage, bronchial asthma, increased ICP, paralytic ileus, hypovolemic shock. -addictive personality, acute MI, severe heart disease, renal/hepatic disease. -educate pt to not use alcohol because of increased effects with other CNS depressants, and do not use Rifampin because of decreased analgesic reaction. Also avoid cranberry juice and oats. Report symptoms of CNS depression and not to get up without assistance since dizziness and confusion are common side effects. -assess Vital signs especially respiration rate, pain using COLDSPA, monitor I&O check for constipation, monitor CNS changes and vital signs. Abrupt discontinuation would result in withdrawal symptoms.

Changes in endometrium post partum

Mucus membrane that lines the uterus Primary complication is endometritis- infection of the endometrial tissue Lochia- bloody discharge that reflect healing of the uterine placental site

Nubain

Nalbuphine Hydrochloride (Nubain) Category C -depresses pain impulse transmission at spinal cord level by interacting with opioid receptors - -relief of moderate to severe pain antidote-naloxone side effects-respiratory depression, drowsiness, dizziness, confusion, sedation, euphoria, changes in BP, pulmonary edema, nausea, vomiting, constipation -anti-emetics for nausea and vomiting and stool softeners for constipation -cardiac arrest, respiratory depression, coma, death. -opioid and drug dependency, acute MI, severe heart disease, increased ICP. -acute MI, severe heart disease, increased ICP. -educate pt to not use alcohol because of increased effects with other CNS depressants. Report symptoms of CNS depression and not to get up without assistance since dizziness and confusion are common side effects. instruct patient to change position slowly to prevent orthostatic hypotension. teach patient that physical dependency can result from long-term use. -assess pain using COLDPA, assess vital signs especially respiration rate, monitor CNS changes and allergic reactions. after med administration assess pain and respiratory status.

Types of drugs for schizophrenia

Neuroleptics (antipsychotic meds). First generation are dopamine antagonists. Second generation is both dopamine and serotonin antagonists.

MAOI/Phenalzine (Nardil)

No Tyramine , can cause HTN crisis. Watch for med interactions

Avoid these types of foods with MAOIs (Phenilzine/Nardil)

No tyramine rich foods; pepperoni, salami, avocados, figs , bananas, smoked fish, protein, beers and red wine

Buspirone ( Atypical Anxiolytic)

Non sedative, No Grapefruit juice, no St. Johns. NOT with MAOIs, take withfood, may take up to 3-6 weeks to see full effect.

Most prominent neurochemical theory for schizophrenia

One prominent theory suggests excess dopamine as a cause. This theory was developed based on two observations: First, drugs that increase activity in the dopaminergic system, such as amphetamine and levodopa, sometimes induce a paranoid psychotic reaction similar to schizophrenia. Second, drugs blocking postsynaptic dopamine receptors reduce psychotic symptoms; in fact, the greater the ability of the drug to block dopamine receptors, the more effective it is in decreasing symptoms of schizophrenia (Stan et al., 2009). More recently, serotonin has been included among the leading neurochemical factors affecting schizophrenia. The theory regarding serotonin suggests that serotonin modulates and helps to control excess dopamine. Some believe that excess serotonin itself contributes to the development of schizophrenia. Newer atypical antipsychotics, such as clozapine (Clozaril), are both dopamine and serotonin antagonists. Drug studies have shown that clozapine can dramatically reduce psychotic symptoms and ameliorate the negative signs of schizophrenia

Lacerations Risk Factor

Operative delivery Precipitous delivery Extension of the episiotomy Varices Fetal macrosomia

Hydrocodone (Lortab)

Opiod. Hydrocodone/Acetaminaphen. Inhibits synthesis of prostaglandins and binds to opiate receptors in CNS and peripherally blocks pain impulse generation; produces antipyresis by direct action on hypothalamic heat-regulating center; causes cough suppression by direct central action in medulla; may produce generalized CNS depression.

Oxycodone with acetaminophen (Percocet)

Opiod. Moderate to severe pain.

Adverse effects of Amitriptyline

Orthostatic hypotension, Anticholinergic effects, sedation, toxicity, decreased seizure threshold, excessive sweating.

Uterine Atony Risk Factors

Overdistention of the uterus Uterine anomaly Prolonged induction Magnesium Sulfate Multiparity

Methergine

PPH due to aterine atony or subinvolution Stimulates contraction of the uterine smooth muscle N/V cramps (side effects) IM or IV Check BP before injection- do not give if elevated without provider.

Carboprost (Hemabate)

PPH that has not responded to oxytocin or methergine therapy Action: uterine contractions Side effects: D/N/V and fever Route: IM- 250 mcg every 15/90 minutes not to exceed 2 mg.

A nurse is preparing discharge instructions for a client with resistant depression who was prescribed a new medication regimen that includes phenelzine (Nardil). If the teaching was successful, what foods should the client state that he needs to avoid? Select all that apply. Aged cheese. Cottage cheese. Milk. Wine. Salami. Fruit.

Phenelzine is an MAO inhibitor. MAO is an enzyme responsible for metabolizing neurotransmitters, serotonin and norepinephrine. This drug requires being on a tyramine-free diet to avoid hypertensive crisis. Aged cheese, salami, and wine will cause vasoconstriction and a rise in blood pressure. Cottage cheese, milk, and fruit are allowed on a tyramine-free diet.

Promethazine (phenergan)

Phenergan Category C -Phenothiazine derivative that competes with histamine for H1-receptor sites on effector cells. Prevents, but does not reverse, histamine-mediated responses. At high doses, drug also has local anesthetic effects. - -Motion sickness, N/V, Rhinitis (allergy s&s), nighttime sedation, obstetric sedation, pregnancy related N/V -Activated charcoal. laxatives, etc -drowsiness, confusion, hypo/hypertension, dry mouth, blurred vision, N/V, leukopenia, thrombocytopenia, hyperglycemia, resp. depression, rash. -Resp. depression, hyperglycemia, thrombocytopenia -Hypersensitivity -Use cautiously in patients with asthma or pulmonary, hepatic, or CV disease and in those with intestinal obstruction, prostatic hyperplasia, bladder-neck obstruction, angle-closure glaucoma, seizure disorders, CNS depression, and stenosing or peptic ulcerations. -Take oral form with food or milk. Avoid alcohol or hazardous activities. Gum, hard candy, or ice may relieve dry mouth. Photosensitivity rxns -Assess for allergies or hypersensitivity. Assess for other medical conditions and other medications for possible interactions. -Adverse reactions include burning, pain,thrombophlebitis, tissue necrosis, and gangrene. Monitor patient for neuroleptic malignant syndrome: altered mental status, autonomic instability, muscle rigidity, and hyperpyrexia

Second generation drugs target

Positive and negative signs of schizophrenia

Distinguish between PPD and blues

Postpartum blues is a common emotional letdown response many women experience after the birth. It quickly resolves without professional help. Usually rest and good nutrition are all that is needed. Postpartum depression, on the other hand, is a serious complication that is often preceded by depression prior to the birth and often prior to the pregnancy. Many women experiencing postpartum depression lose track Gf rea]jty. Inability to sleep or constant sleeping may occur. They feel a hopelessness that will not go away.Nutrition and sleep do not improve the condition. They may harm themselves and/or their baby and even other children. Not taking care of themselves and/or their baby, including even basic hygiene, are serious warning signs. They may isolate themselves. Professional therapy and often medications are needed. Thyroid imbalance may play role in this type of depression.

Oxytocin

Postpartum control of bleeding. Stimulates uterine smooth muscle to produce uterine contraction Adverse rxns: coma, seizure, hypotension, water intoxication Route and dose: 10 units in a L of IV solution or 10 units IM

Phenylephrine

Potentially fatal interaction with MAOIs,

Colace

Prevention of Constipation, promotes incorporation of water into the stool, common side effects: mild abdominal cramps.

Risk factors of PPD

Primigravida Ambivalence about pregnancy Hx of postpartum depression Hx of bipolar illness Lack of social support Lack of close supportive relationships Dissatisfaction with self Low socioeconomic status Anxiety

Nifedipine/Procardia

Procardia Category C -Thought to inhibit calcium ion influx across cardiac and smooth muscle cells, decreasing contractility and oxygen demand. May also dilate coronary arteries and arterioles

Defense mechanism for delusional thinking

Projection : a client attributes unacceptable emotions and qualities to others.

Endometritis Risks

Prolonged ROM Prolonged labor C Section Internal fetal and uterine monitoring Anemia malnutrition Diabetes

The health care provider (HCP) has prescribed prostaglandin gel to be administered vaginally to a newly admitted primigravid client. Which finding indicates that the client has had a therapeutic response to the medication? resting period of 2 minutes between contractions normal patellar and elbow reflexes for the past 2 hours leaking of clear amniotic fluid in small amounts softening of the cervix and beginning effacement

Prostaglandin gel may be used for cervical ripening before the induction of labor with oxytocin. It is usually administered by catheter or suppository, or by vaginal insertion. Two to three doses are usually needed to begin the softening process. Common adverse effects include nausea, vomiting, fever, and diarrhea. Continuous fetal heart rate monitoring and close monitoring of maternal vital signs are necessary to detect subtle changes or adverse effects. Prostaglandin gel usually does not initiate contractions; therefore, the rest period between contractions will be >2 minutes. There is no need to assess reflexes based on prostaglandin use. Leaking of amniotic fluid is not caused by the use of this gel.

Bipolar Intervention

Providing for safety Meeting physiologic needs Providing therapeutic communication Promoting appropriate behaviors Managing medications (see Tables 17.6 and 17.7) Providing patient, family teaching

MDD intervention

Providing for safety (suicide precautions) Promoting therapeutic relationship Promoting ADLs, physical care Using therapeutic communication Managing medications Patient, family teaching

Medication of choice for clients who have trouble adhering to a medication schedule

Risperidone is available as an IM shot that lasts 4 to 6 weeks.

What are some second generation antipsychotics?

Risperidone, Aripiprazole, Ziprasidone

Tx for Mood Disorders

SSRI , ie Prozac (Fluoxetine)

Meds used for MDD

SSRI, Cyclic antidepressants, atypical antidepressants, MAOIs

SSRI

SSRIs, the newest category of antidepressants (Table 17.1), are effective for most clients. Their action is specific to serotonin reuptake inhibition; these drugs produce few sedating, anticholinergic, and cardiovascular side effects, which make them safer for use in older adults. Because of their low side effects and relative safety, people using SSRIs are more apt to be compliant with the treatment regimen than clients using more troublesome medications. Insomnia decreases in 3 to 4 days, appetite returns to a more normal state in 5 to 7 days, and energy returns in 4 to 7 days. In 7 to 10 days, mood, concentration, and interest in life improve. Fluoxetine (Prozac) produces a slightly higher rate of mild agitation and weight loss but less somnolence. It has a half-life of more than 7 days, which differs from the 25-hour half-life of other SSRIs.

Assessment of Lochia

Scant- less than 1 inch on pad Light- less than 4 inches Moderate - less than 6 inches Heavy- pad saturated within 1 hour

Schizophreniform vs. Schizo

Schizo is more than 6 months. Schizophreniform is 1-6 months.

Schizophreniform vs. schizophrenia

Schizophreniform longer than 6 months = schizophrenia

What class of medication is Risperidone?

Second Generation antipsychotic

Hematoma Assessment findings

Severe perineal pain Ecchymosis Visible outline of the hematoma Blood loss may not be visible Shiny edematous perineum Tachycardia and hypotension Hematomas within 200-500 ml can become large enough to displace uterus and cause uterine atony

Adverse Effects of Prozac

Sexual dysfuntion, CNS stimulation, serotonin symptome (2-72 hours),

Risperidone

Should not be used for those with dementia. Cautiously in those with CVA, seizures, or diabetes.

Stadol

Stadol Category C -May bind with opioid receptors in the CNS, altering perception of and emotional response to pain. Decreased severity of pain -Management of moderate to severe pain. Analgesia during labor -Narcan (naloxone) for antidote side effects -Confusion, dysphoria, hallucinations, sedation, nausea, sweating -stool softeners -Respiratory depression -Hypersensitivity; pts physically dependent on opioids -Use cautiously in patients with head injury, increased intracranial pressure, acute MI, ventricular dysfunction, coronary insufficiency, respiratory disease or depression, and renal or hepatic dysfunction. -Instruct pt on how and when to ask for pain med, may cause drowsiness or dizziness. Encourage pt. to change positions slowly to minimize orthostatic hypotension. Avoid concurrent use of alcohol or other CNS depressants. -Assess pain level before admin and after. Assess BP, pulse and RR before and periodically during admin. If RR <10/min, assess level of sedation

Hematoma Tx

Surgical drainage, antibiotics, analgesics, blood products if loss is excessive.

Lacerations Management

Suture the laceration Blood products if loss is excessive IV for pain

Nursing Admin for SSRIs

Take meds in morning to minimize sleep disturbances, take with food to avoid GI disturbances, obtain baseline Na levels for older clients taking diuretics.

Reva Rubin

Taking in: dependency behaviors 24-48 hours Taking hold: beginning confidence with infant care taking Letting go: confident in care taking activities of self and infant

Immune changes post partum

Temperature Mild elevation d/t exertion/exhaustion/dehydration/hormone changes 100.4 or higher may be a sign of infection. Rubella status Immunization before discharge. Hepatitis B status Rh status If mom - and baby +, Rh given 28 weeks. Second dose after birth. Varicella status Tetanus-diphtheria-pertussis status

Antidote for Oxytocin

Terbutaline

The client with major depression and suicidal ideation has been taking bupropion 100 mg PO 3 times daily for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform activities of daily living with minimal assistance, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which behavior? seizure activity suicide attempt visual disturbances increased libido

The nurse must monitor the client for a suicide attempt at this time when the client is starting to feel better because the depressed client may now have enough energy to carry out an attempt. Bupropion inhibits dopamine reuptake; it is an activating antidepressant and could cause agitation. Although bupropion lowers the seizure threshold, especially at doses greater than 450 mg/day, and visual disturbances and increased libido are possible adverse effects, the nurse must closely monitor the client for a suicide attempt. As the client with major depression begins to feel better, the client may have enough energy to carry out an attempt.

A nurse is caring for a client receiving I.V. magnesium sulfate. Which drug is the antidote for magnesium toxicity? Calcium gluconate Hydralizine/Hydralazine Naloxone RHo(D) immune globulin

The nurse should anticipate administering 10 ml of 10% by I.V. push over 3 to 5 minutes as a calcium gluconate antidote for magnesium toxicity. Hydralizine/Hydralazine is given for sustained elevated blood pressures in clients with preeclampsia. Naloxone is used to correct opioid toxicity. RHo(D) immune globulin is given to clients with Rh-negative blood to prevent antibody formation from Rh-positive fetuses.

A client is taking diazepam while establishing a therapeutic dose of antidepressants for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply. to consult with his health care provider (HCP) before he stops taking the drug to avoid eating cheese and other tyramine-rich foods to take the medication on an empty stomach not to use alcohol while taking the drug o stop taking the drug if he experiences swelling of the lips and face and difficulty breathing

The nurse should instruct the client who is taking diazepam to take the medication as prescribed; stopping the medication suddenly can cause withdrawal symptoms. This medication is used for a short term only. The drug dose can be potentiated by alcohol, and the client should not drink alcoholic beverages while taking this drug. Swelling of the lips and face and difficulty breathing are signs and symptoms of an allergic reaction. The client should stop taking the drug and seek medical assistance immediately. The client does not need to avoid eating foods containing tyramine because interacts with monoamine oxidase inhibitors, not benzodiazepines. The client can take the medication with food.

The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine, 10 milligrams twice a day. The primary care provider prescribes a selective serotonin reuptake inhibitor (SSRI), paroxetine, 20 milligrams to be given every morning. What action should the nurse take? Gives the medication as ordered. Question the primary care provider about the order. Question the dosage ordered. Ask the primary care provider to order benztropine for adverse effects.

The nurse should question the primary care provider about the order because the client who has been taking an MAOI such as phenelzine must wait 14 days after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin syndrome, a potentially lethal consequence, can occur when combining an MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia, hyperthermia, myoclonus, and other symptoms similar to neuroleptic malignant syndrome. Giving the medication as ordered can result in serious adverse consequences, as described above. The dosage is accurate. Benztropine is not given with an SSRI; it is an antiparkinsonian agent usually ordered for the adverse effects of antipsychotic medication

The nurse is teaching the client about the appropriate use of lorazepam to manage anxiety. Which statement indicates that the client understands the nurse's teaching? "I can take my medicine whenever I feel anxious." "It is okay to double my dose if I need to." My medicine is not for the everyday stress of life." "It is safe to have a glass of wine while taking this medicine."

The statement, "My medicine is not for the everyday stress of life," indicates an accurate understanding of the nurse's teaching about the use of lorazepam. Antianxiety agents like the benzodiazepines are used to treat anxiety that is unmanageable by other means and beyond the client's ability to cope. For the drug to be effective, it must be taken as prescribed. Lorazepam can cause physical and psychological dependence. Tolerance can occur, and doubling the dose of lorazepam may increase the risk of tolerance. Lorazepam is a central nervous system depressant. When it is taken in combination with alcohol, the depressant effect increases, posing a danger to the client.

After 10 days of lithium therapy, the client's lithium level is 1.0 mEq/L (1 mmol/L). This value indicates which of the following? A laboratory error. An anticipated therapeutic blood level of the drug. An atypical client response to the drug. A toxic level.

The therapeutic blood level range for lithium is between 0.6 and 1.2 mEq/L (0.6 to 1.2 mmol/L) for adults. A level of 1.0 mEq/L (1.0 mmol/L) can be anticipated after 10 days of treatment. While laboratory error can occur, this level is therapeutic after 10 days of therapy. Questioning laboratory error is more plausible if the level were extremely high or low. An atypical response would be manifested as an unusual physical or psychological response, not through blood levels. Lithium toxicity occurs at levels above 1.5 mEq/L (1.5 mmol/L).

Can someone on psychotropic meds still breastfeed?

This would depend on the drug. Fluoxetine (Prozac) has been found to build up in the baby, but paroxetine (Paxil) does not. One recommendation is to avoid breastfeeding for 4 to 7 hours after taking any psychotropic drugs. If the baby is not breastfeeding at night, she may take medication just after the last evening feeding

Thought insertion

Thoughts placed in their mind against their will.

Which nursing intervention is most appropriate if a client develops orthostatic hypotension while taking amitriptyline hydrochloride? Consulting the physician about substituting a different type of antidepressant Advising the client to sit up for 1 minute before getting out of bed Instructing the client to halve the dosage until the problem resolves Informing the client that this adverse reaction should disappear within 1 week

To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. In these cases, the physician may decrease the dosage or order nortriptyline, another tricyclic antidepressant. It isn't appropriate for the nurse to change the dosage without discussing it with the physician. Orthostatic hypotension disappears only when the drug is discontinued.

5 T's

Tone: uterine atony, distended bladder Tissue: retained placenta and clots Trauma: vaginal, cervical, or uterine injury Thrombin: coagulopathy (preexisting or acquired) Traction: causing uterine inversion

Nursing Admin for atypical antidepressants

With seasonal pattern depression- begin taking in autumn and discontinue by spring. Avoid use with MAOIs

Cyclic Antidepressants

Tricyclics, introduced for the treatment of depression in the mid-1950s, are the oldest antidepressants. They relieve symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variations (cranky in the morning and better in the evening). Other indications include panic disorder, obsessive-compulsive disorder, and eating disorders. Each drug has a different degree of efficacy in blocking the activity of norepinephrine and serotonin or increasing the sensitivity of postsynaptic receptor sites. Tricyclic and heterocyclic antidepressants have a lag period of 10 to 14 days before reaching a serum level that begins to alter symptoms; they take 6 weeks to reach full effect. Because they have a long serum half-life, there is a lag period of 1 to 4 weeks before steady plasma levels are reached and the client's symptoms begin to decrease. They cost less primarily because they have been around longer and generic forms are available.

Borderline Personality Disorder

Unstable interpersonal relationships, self-image, and affect; marked impulsivity Wide range of behavior, appearance Dysphoric mood Polarized extreme thinking (splitting); dissociation Impaired judgment; safety not a concern Threats of self-harm Social isolation

Ondansetron (Zofran)

Used for Nausea. Blocks serotonin release, which stimulates the vagal afferent nerves, thus stimulating the vomiting reflex. Monitor for possible side effects such as diarrhea, constipation, ab pain, headache, dizziness, drowsiness and fatigue. May cause dry mouth.

Magnesium Sulfate

Used for preterm labor. Antidote is IV calcium gloconate. Side effects: drowsiness, decreased RR/paralysis, arrhythmias, bradycardia, hypotension, diarrhea, muscle weakness/decreased or absent deep tendon reflexes, flushing, sweating, hypothermia. Avoid using for more than 5-7 days for preterm labor (this may increase risk of hypocalcemia and bone changes in newborn); avoid continuous use during active labor or within 2 hr of delivery

Early PPH caused by

Uterine atony/ineffective contractions, lacerations, hematoma

Afterpains

Uterine cramps caused by contraction of the uterus More common with multiparous women Increases during breastfeeding

A multigravida is admitted to the labor area for induction with intravenous oxytocin because she is 42 weeks pregnant. The nurse should instruct the client that during the process of labor: Continuous fetal heart rate monitoring will be implemented. Frequent ultrasound examinations will be performed. At least 5 to 10 fetal scalp pH tests will be performed. Oligohydramnios will be carefully evaluated

Uteroplacental insufficiency is associated with a post-term fetus; therefore, it is recommended that the fetal heart rate and contraction pattern be monitored throughout the labor and birth process. In addition, intravenous oxytocin, which is frequently used for induction of labor, may result in hyperstimulation of the uterus. Therefore, monitoring the client is critical. One ultrasound may be performed to assess position and confirm gestational age. A scalp pH may be performed if there is evidence of fetal bradycardia, late decelerations, and a possibility of fetal hypoxia. Even so, 5 to 10 scalp pH measurements would be highly unusual. These clients generally do not have a decreased amount of amniotic fluid (oligohydramnios).

Subinvolution Assessment findings:

Uterus soft and larger than normal, lochia returns to rubra stage, back pain.

Antiepileptic med for Bipolar disorders

Valproic acid (Depakote)

A client with bipolar disorder has been taking valproic acid, 500 mg P.O. three times a day for 1 month. The serum blood level is 60 mcg/ml (416 µmol/L). The client reports having an upset stomach after taking the medication. Which of the following statements by the nurse would be most helpful? We'll adjust the dosage of your medication." "Chew the tablet before swallowing it." "Take the valproic acid with meals or food." "We'll have you take your medication all at one time."

Valproic acid can be taken with food or at mealtime to minimize gastrointestinal upset. The client's dosage of medication is appropriate, and the serum level is therapeutic between 50 and 100 mcg/ml (347 to 694 µmol/L). The tablets should not be chewed because of possible mouth and throat irritation. Valproic acid is given in two to four doses daily because of its short half-life (6 to 16 hours, peaking in less than 4 hours).

Changes in uterus post partum

begins the process of involution, by which the uterus returns to a pre-pregnant size, shape, and location; and the placental site heals. This occurs through uterine contractions and atrophy of the uterine muscle.

delusion

a fixed, false belief not based in reality.

Alogia

a lack of any real meaning or substance in what the client says.

Tardive dyskinesia

a late-appearing side effect of antipsychotic medications, is characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

pseudoparkinsonism

a type of extrapyramidal side effect of antipsychotic medication, drug induced parkinsonism, includes shuffling gait, mask-like facies , muscle stiffness (continuous) or cogwheeling rigidity, drooling, and akinesia

Avolition

absence of will, ambition, or drive to take action or accomplish tasks.

EPS

acute dystonia, parkinsonism, akathisia, tardive dyskinesia

Antidote to MAOI

administer phentolamine or nifedipine.

Those at highest risk for suicide include

adolescents, young adults, older adult males, Native Americans, those with comorbid mental disease.

Negative (Soft) symptoms of schizophrenia

alogia, anhedonia, apathy, asociality, blunted affect, catatonia, flat affect, avolition or lack of volition, inattention.

Positive (hard) symptoms of schizophrenia

ambivalence, associative looseness, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference, perseveration, bizarre behavior

Clozapine

an atypical antipsychotic drug, has not been found to cause this side effect, so it often is recommended for clients who have experienced tardive dyskinesia while taking conventional antipsychotic drugs.

Zar

an experience of spirits possessing a person, is seen in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. The afflicted person may laugh, shout, wail, bang her or his head on a wall, or be apathetic and withdrawn, refusing to eat or carry out daily tasks. Locally, such behavior is not considered pathologic.

Mastitis

an inflammation or infection of the breast. May be due to bacterial entry through cracks in nipples. Symptoms include fever, malaise, unilateral breast pain and tenderness in the infected area. Tx. includes antibiotics, analgesia, rest and hydration.

neuroleptics

antipsychotic medications

Personality disorders

antisocial, borderline, schizotypal, narcissistic, obsessive-compulsive, avoidant.

Somatic Delusions

are generally vague and unrealistic beliefs about the client's health or bodily functions. Factual information or diagnostic testing does not change these beliefs. Examples: A male client may say that he is pregnant, or a client may report decaying intestines or worms in the brain.

euthymic mood

average affect and activity

Euthymia

average affect or activity that is the normal mood.

Thought broadcasting

believe others can hear their thoughts.

Medications for anxiety

benzodiazepines or non

Findings have demonstrated that people with schizophrenia have relatively less

brain tissue and CSF than those who do not. Could represent a failure in the development or a subsequent loss of tissue.

Take SSRIs in the morning because

can cause insomnia d/t CNS stimulation

TCA/ Amitriptyline (Elavil)

change positions slowly, chew sugarless gum, eat foods high in fiber, increase fluid intake.

Borderline Personality Disorder

characterized by a pervasive pattern of unstable interpersonal relationships, self image, and affect as well as marked impulsivity. 3x more common in women. Most common personality disorder found in clinical settings.

Echolalia

client's imitation or repetition of what the nurse says.

Cenesthetic hallucinations

client's report that he or she feels bodily functions that are usually undetectable. Examples would be the sensation of urine forming or impulses being transmitted through the brain.

Nihilistic delusions

clients belief that his or her organs aren't functioning or are rotting away, or that some body part or feature is horribly disfigured or misshapen

Second generation (atypical) antipsychotic agents are the medication of choice for

clients receiving initial treatment and for treating breakthrough episodes in clients on conventional medication therapy because they are effective with fewer side effects.

Defense mechanisms

cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress; also called ego defense mechanisms

Word Salad

combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Psychotherapy:

combined with med: Interpersonal therapy--> relationship difficulties Behavior therapy: reinforcement of positive interactions Cognitive therapy: correction of cognitive distortions

Omniomania

compulsive buying; possessions are acquired compulsively without regard for cost or need for the item.

Onychophogia

compulsive nail biting.

GI Changes post partum

constipation d/t decreased GI motility and decrease physical activity. Dehydration and fluid loss from labor, perineal pain and trauma. Hemorrhoids. Appetite increase after birth of baby. Significant weight loss first 2-3 weeks.

First generation (conventional) antipsychotic medications are used mainly to

control positive symptoms of psychotic disorders and are reserved for clients who are using them successfully and can tolerate the adverse effects or are violent or particularly aggressive.

Categories of Antidepressants

cyclic antidepressants, MAOIs , SSRI, and atypical antidepressants.

Positive signs of schizophrenia

delusions, hallucinations, disturbed thinking and other psychotic symptoms.

Duramorph

depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors. Used to decrease pain. Antidote: naloxone. AE: respiratory depression, coma, death. Rifampin will decrease analgesic effect.

Most common psychiatric diagnosis associated with suicide

depression

Greatest risk with use of Buproprion

development of seizures, can lower the seizure threshold. A hx of seizures should be told to the provider.

Benzos

diazepam (valium). Avoid other CNS depressants, avoid alcohol, avoid caffeine, do not stop taking drug abruptly. Take with food.

Anterograde amnesia

difficulty recalling events that occur after dosing.

Schizophrenia

distorted and bizarre thoughts, perceptions, emotions, movements, behavior

Atypical Antidepressants / Buproprione (Wellbutrin)

do not give if client has seizures, can suppress appetite,

Nursing Admin for MAOIs

do not take with foods that contain tyramine, do not take with other prescriptions unless approved by provider.

SSRI /Fluoxetine (Prozac)

don't take St. Johns wort, weight gain over long term use can occur

Clozapine therapy has been initiated for a client with schizophrenia who has been unresponsive to other antipsychotics. The client states, "Why do I have to have a blood test every week?" Which response by the nurse would be most appropriate? "Weekly blood tests are necessary to determine safe dosage and to monitor the effect of the medication on the blood." "Weekly blood tests are done so that you can receive another week's supply of the medication." Your health care provider will want to know how well you are progressing with the medication therapy." "Everyone taking clozapine has to go through the same procedure because it is required by the drug company."

he client needs specific information about the effects of the drug, specifically that the drug can cause agranulocytosis. The statement about weekly blood tests to determine safe dosage and monitoring for effects on the blood gives the client specific information to ensure follow-up with the required protocol for clozapine therapy. Lack of accurate knowledge can lead to noncompliance with necessary follow-up procedures and noncompliance with medication. The supply of medication is not dependent on blood testing. Telling the client that the health care provider (HCP) wants to know the progress does not provide specific information for this client. The blood tests are not required by the drug company

Risperidone client teaching

healthy diet to minimize weight gain, report clients findings of agitation, dizziness, sedation and sleep providers.

PPH impaired gas exchange/oxygenation

hemoglobin < 9g/dl, dyspnea, hypoxia, restlessness

Complications of subinvolution

hemorrhage, pelvic peritonitis, salpingitis, abscess formation

PPH Fluid volume deficit

hypotension 90/60, tachy HR 110, decreased UOP (50 ml in 4 hours. Increased lochia, boggy uterus

Clang associations

ideas that are related to one another based on sound or rhyming rather than meaning.

Non benzos

ie Buspar. take with food. Side effects: Dizziness, restlessness, agitation, drowsiness, headache, weakness, n/v

Symptoms of Baby Blues

inability to cope, fatigue, anxiety, irritability, tearfulness, insomnia, weepiness, depression, poor concentration, affective lability

splitting

inability to incorporate positive and negative aspects of oneself or others into a whole images, is frequently seen in the acute mental health setting. Clients sees things as all good or all bad.

Subinvolution

incomplete involution of uterus after birth. Uterus does not decrease in size and does not descend into pelvis

Post partum hemorrhage altered tissue perfusion

increase cap refill, cold hands and feet, pale and clammy skin, dehydration, blood loss

SSRI ( Paroxetine) pharmacological action

inhibits serotonin reuptake, does not black dopamine or norepi, causes CNS stimulation ( insomnia). Up to 4 weeks for therapeutic effect.

akathisia

intense need to move about, characterized by restless movement, pacing, inability to remain still, and the client's report of inner restlessness.

Ghost sickness

is preoccupation with death and the deceased frequently observed among members of some Native American tribes. Symptoms include bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation

Oxytocin used for

labor induction and augmentation and prevention of postpartum hemorrhage

anergia

lack of energy

avolition

lack of motivation in activities and hygiene.

anhedonia

lack of pleasure in normal activities

Negative signs of schizophrenia

lack of volition and motivation, social withdrawal, and anhedonia

Early indications of LIthium tox

less than 1.5, diarrhea, n/v, thirst , polyuria, muscle weakness, find hand tremors, slurred speech.

Patient education for subinvolution

look for increased bleeding, lochia returning to bright red, tips for infections prevention, proper use of discharge medications (especially for fibroids are they are at increased risk)

Positive symptoms of schizophrenia

manifestation of things that are not normally present. This includes hallucinations, delusions, alterations in speech, bizarre behavior.

Panic

may bolt and run or totally immobile and mute, dilated pupils, increased BP and pulse, fight/flight/freeze

Paroxetine (paxil)

may increase thoughts of self harm when first taking. used temporarily to treat depression associated with psychotic disorders.

Motrin (Ibuprofen)

mild to moderate pain, decreased pain and inflammation, common side effects: HA, constipation, dyspepsia, n/v, edema

Nursing admin for TCA's

monitor for cardiac dysrhythmias, which are an indicatoin of toxicity. Administer at bedtime due to sedation and risk for orthostatic hypotension

PTSD

more than 1 mth, inability to show feelings, flashbacks and hallucinations, avoidance of stimuli.

Neuroleptic Malignant Syndrome Signs

muscle rigidity, high fever, increase muscle enzymes, leukocytosis

Symptoms of Major Depressive Disorder

sad mood, lack of interest in activities (for at least 2 weeks) plus at least 4 of the following: Changes in eating habits → weight gain or loss Hypersomnia or insomnia Impaired concentration, decision making, or problem solving Worthlessness, hopelessness, despair, guilt Thoughts of death/suicide Overwhelming fatigue, negative thinking

Major Depressive Disorder Symptoms

sad mood, lack of interest in life activities (2 weeks or more) and at least the 4 of the following symptoms: changes in eating habits, hypersomnia/insomnia, impaired concentration/decision making/problem solving, worthlessness/hopelessness/despair/guilt, thoughts of death/suicide, overwhelming fatigue/negative thinking.

Lorazepam and Clonazepam

sedative effects, blood tests to monitor for agranulocytosis, use in cxn with elderly.

Neurotransmitter that affects mood, sexual behavior, sleep cycles, hunger, and pain perception

serotonin

2 major chemical messengers implicated in mood disorders

serotonin and norepinephrine

Severe anxiety

severe HA, n/v/d, trembling, rigid stance , vertigo, pale, tachycardia, chest pain

Acute dystonia

severe spasm of the tongue , neck, face and back. 5 hr to 5 days after first tx. Tx is benadryl

Symptoms of Postpartum psychosis

sleep disturbances, confusion, agitation, irritability, hallucinations, delusions, potential for suicide of infanticide.

Verbigeration

stereotyped repetition of words or phrases that may or may not have meaning to the listener.

Thought blocking

stop talking in the middle of a sentence and remain silent for several seconds to 1 minute

Bouffee delirante

syndrome in West Africa and Haiti,. Involves a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. Sometimes accompanied by visual and auditory hallucinations or paranoid ideation.

DIC

syndrome in which the coagulation pathways are hyperstimulated with the woman's body breakdown blood clots faster than it can form them, depleting clotting factors.

Alogia

tendency to speak very little or to convey little substance of meaning.

Negative symptoms of schizophrenia

the absence of things that are normally present. ie, no affect, alogia, anergia, anhedonia, avolition

Affect

the observable response a person has to his/her feelings

Narcissistic personality disorder (NPD)

the person displays a sense of superiority and does not necessarily need approval form others because they feel others are inferior to them. They turn inward for gratification.

Histrionic Personality Disoder (HPD)

the person has an intense need to be the center of attention and seek approval from others. They depend on others for gratification.

Antisocial Personality Disorder (ASPD)

the person has complete disregard for rules and the feelings of others. In contrast to NPD, they lack insight and are impulsive, aggressive, and deceitful. In contrast to BPD, they are more likely to harm others than themselves.

Borderline Personality Disorder (BPD)

the person has poor self-esteem and attention-seeking behavior, but they most often display self-destructiveness and have angry outbursts and erratic behavior. They have chronic feelings of deep emptiness and loneliness. Their actions are less goal-oriented than NPD and HPD.

ECT is used for

the treatment of severe mania associated with bipolar disorder.

Mood

the way a person feels

Dystonic reactions

to antipsychotic medications and are characterized by spasms in discrete muscles groups such as the neck muscles (torticollis) or eye muscles (oculogyric crisis). May also be accompanied by protrusion of the tongue, dysphagia, and laryngeal and pharyngeal spasms that can compromise airway, causing a medical emergency. Acute treatment includes benadryl

Atypical antidepressants

typical antidepressants are used when the client has an inadequate response to or side effects from SSRIs. Atypical antidepressants include venlafaxine (Effexor), duloxetine (Cymbalta), bupropion (Wellbutrin), nefazodone (Serzone), and mirtazapine (Remeron) (Table 17.3). Venlafaxine blocks the reuptake of serotonin, norepinephrine, and dopamine (weakly). Duloxetine selectively blocks both serotonin and norepinephrine. Bupropion modestly inhibits the reuptake of norepinephrine, weakly inhibits the reuptake of dopamine, and has no effects on serotonin. Bupropion is marketed as Zyban for smoking cessation.

PPH delay in mother infant attachment

unable to care for newborn, fatigue

What is the normal expected blood loss for vaginal

up to 500 ml .

Stilted language

use of words or phrases that are flowery, excessive, and pompous

Terbutaline

used for management of preterm labor. Mom adverse effects: racing heart, flushing, tremors and restlessness. Increase in blood levels. Baby side effects : increase in heart rate and blood sugar.

AIMS

used to screen for symptoms of movement disorders. Client is observed in several positions and the severity of symptoms is rated from 0 to 4.

Carbamazepine

which had been used for grand mal and temporal lobe epilepsy as well as for trigeminal neuralgia, was the first anticonvulsant found to have mood-stabilizing properties, but the threat of agranulocytosis was of great concern. Clients taking carbamazepine need to have drug serum levels checked regularly to monitor for toxicity and to determine whether the drug has reached therapeutic levels, which are generally 4 to 12 µg/mL (Chen & Lin, 2012). Baseline and periodic laboratory testing must also be done to monitor for suppression of white blood cells.

PPH Anxiety

woman states she is afraid, crying, blood loss.

Neologisms

words invented by the client