Unit 3 - Psych

How may beta blockers help with alchol withdrawl?

(propanolol, atenolol) decreases autonomic responses (BP, HR) & cravings.

Amitryptyline (Elavil), *imipramine (Tofranil), doxepin (Sinequan)

1st generation Antidepressants TCAs Blocks reuptake of Nor-epi & serotonin -hypotension -dysarrhythmias - will be dry -no previous/current

Fluoxetine (Prozac), sertaline (Zoloft)

2nd generation antidepressants SSRIs

A 51-year-old client has been severely depressed and has been contemplating suicide. While feeling like the client has no other way out, the client also wishes someone would help. What is this is known as?

Ambivalence Rationale:Clients considering suicide are frequently ambivalent about their ideas. Shneidman defines ambivalence as "the common, internal attitude toward suicide: to feel that one has to do it, and at the same time to yearn (even to plan) for rescue and intervention." Nurses target assessment and intervention efforts toward the part of suicidal clients that does not want to die.

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder? Anticonvulsants Antibiotics Anticoagulants Antianxiety

Anticonvulsants Rationale:Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.

valporic acid (Depakote)

Antiepileptics indications: Bipolar disorder & anticonvulsant/antiepileptic s/e: GI upset, hepatotoxicity, pancreatitis, thrombocytopenia

Carbamazepine (Tegretol)

Antiepileptics indications: Bipolar disorder & anticonvulsant/antiepileptic s/e: blood dyscrasias (anemia, leukopenia, thrombocytopenia) vision issues (double vision, nystagmus), hypo-osmolarity, rash.

Chlorpromazine (Thorazine), halperidol (Haldol)

Antipsychotic (Atypical) indications: schizophrenia, psychotic disorders. mainly positive symptoms (delusions, hallucinations). s/e: -EPS--> Dystonia, pseudoparkinsons, akasthisia (inner restlessness), TD [irreversible>> lip smacking, tongue rolling] ~Neuroleptic malignant syndrome (NMS)--> Fever, BP flucc, dysrhythmias, muscle rigidity ~others: agranulocytosis, anticholinergic effects, ortho hypotension, sedation, seizures. key: Mx VS q 1-2hrs.

Clozapine (Clozaril)

Antipsychotic (Atypical) end in -done or -pine indications: schizophrenia. Controls positive & negative symptoms (anergia, anhedonia, social withdrawl). s/e: carries risk for agranulocytosis!! >>dangerous leukopenia (lowered white blood cell count) [mostly low neutrophils]

Risperidone (Risperdal),

Antipsychotic (Atypical) end in -done or -pine indications: schizophrenia. Controls positive & negative symptoms (anergia, anhedonia, social withdrawl). s/e: diabetes, weight gain, increased cholesterol. sedation, menorrhagia, decreased libido. key: can be administered by IM injection q 2 weeks (for non-compliant pts), avoid alcohol.

A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine, a monoamine oxidase inhibitor (MAOI), for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated?

Call the therapist to discuss the need for a washout period before starting fluoxetine. Rationale:If the client is switching from an MAOI to fluoxetine, the provider should allow a washout period of at least 5 weeks (half-life of MAOI). Conversely, if a client is switching from fluoxetine to an MAOI, providers should allow a "washout" period of at least 2 weeks (half-life of fluoxetine) before beginning the MAOI.

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply.

Correct Response: Administration of a sustained serotonin reuptake inhibitor (SSRI), Cognitive therapy Rationale:For most clients with a new diagnosis of depression, medication (usually an SSRI) is combined with cognitive and behavioral interventions. MAOIs are reserved for clients unresponsive to other antidepressants. Phototherapy is used specifically for seasonal depression and rTMS is used for depression unresponsive to conventional treatment.

A nurse is preparing an education plan for the family members of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the education was effective when the family members identify which as suggesting mania? Select all that apply.

Correct Response: Talking faster than usual, Reading several books at once, Being hungry all the time Rationale:Indicators of possible mania include reading several books or newspapers at once, talking faster than usual, feeling irritable, and being hungry all the time. Avoiding people and sleeping more than usual would suggest depression.

When haloperidol is given as a depot injection, it has an effectiveness of which duration?

Correct Response:4 weeks

Antipsychotics function by blocking receptors of which neurotransmitter?

Correct Response:Dopamine Rationale:Antipsychotic drugs work by blocking receptors of the neurotransmitter dopamine that reduces dopamine activity leading to improved cognition and regulation of emotional responses.

Which term is used to describe the amount of the drug needed to achieve the maximum effect?

Correct Response:Potency Rationale:Potency is the amount of the drug needed to achieve the maximum effect. Withdrawal occurs when there are new symptoms resulting from discontinuation of the drug. Efficacy is the maximal therapeutic effect that a drug can achieve. Rebound is a temporary return of symptoms.

When teaching a group of new mental health nurses about the major difference between bipolar I and bipolar II disorders, which would be most appropriate for the nurse to include?

Correct Response:The mania symptoms of bipolar II disorder have little effect on functioning. Rationale:With bipolar I, at least one manic episode or mixed episode and a depressive episode have to occur. Bipolar II is not as easily recognized as bipolar I because the symptoms are less dramatic. Hypomania, a mild form of mania, is characteristic of bipolar II. A hypomanic episode is less intense, and there is little impairment in social or occupational functioning. The risk for suicide is present with both disorders.

Which antipsychotic drug can cause a lengthening of the QT interval?

Correct Response:Thioridazine Rationale:Certain antipsychotic drugs, such as thioridazine, can cause a lengthening of the QT interval.

The nurse knows that the most dangerous time period following a previous suicide attempt is what?

First 3 months Rationale:The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.

Which is an example of a closed-ended question? a.How have you been feeling lately? b.How is your relationship with your wife? c.Have you had any health problems recently? d.Where are you employed?

For the client experiencing acute mania, the nurse would provide snacks and high energy foods because it is highly likely that the client is unable to sit long enough to eat. Sleep hygiene is a priority but may not be realistic until medications take effect. Because of the client's activity level, frequent rest periods would be unlikely. Limiting stimuli would be helpful in decreasing agitation.

Phenelzine (Nardil) Tranylcypromine (Parnate)

MAOIs indications: depression s/e: agitation/anxiety, orthostatic hypotension, hypertensive crisis. key: do not eat foods with tyramine (aged cheese, avocados, bananas, red wine, salami/pepperoni, chocolate)

Limit setting is most appropriate in which client population?

Manic Rationale:Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.

What can be used to treat NMS?

Muscle relaxants (ex: dantrolene)

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply. Flight of ideas Widespread shopping sprees Difficulty concentrating Obsessive rumination Hypersomnia

Obsessive rumination, Hypersomnia, Difficulty concentrating Rationale:During a major depressive episode, a client would exhibit obsessive rumination, insomnia or hypersomnia, diminished ability to concentrate, or indecisiveness. >Flight of ideas and engaging in widespread shopping sprees would characterize mania.

A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline?

Orthostatic hypotension Rationale:Side effects include orthostatic hypotension, constipation, weight gain, and dry mouth.

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client? Long-term memory impairment Full of energy Confusion Numbness and tingling in the extremities

Rationale:After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom of ECT.

Which is an anticonvulsant used as a mood stabilizer? Bupropion Venlafaxine Phenelzine Divalproex

Rationale:Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply. Headache Agitation Confusion Hallucinations

Rationale:In acute overdose, almost all symptoms develop within 12 hours. Confusion, hallucinations, and agitation are signs of overdose. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Orthostatic hypotension and headache are side effects of MAOIs

Which antidepressant is potentially lethal in overdose?

Rationale:Phenelzine, an MAOI, is potentially lethal in overdose (hypertensive crisis) and poses a potential risk in clients with depression who may be considering suicide. None of the other medications carry that risk.

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which is the priority nursing diagnosis for this client?

Risk for self-harm Rationale:The client is experiencing severe hyperactivity, disorientation, and agitation as well as suicidal ideation. Therefore, the client's safety is the priority. The nurse's first action is to provide a safe environment and to address the client's risk for self-harm. The nursing diagnosis of risk for self-harm takes priority over any nursing diagnoses.

paroxetine (Paxil), sertaline, fluoxetine.

SSRIs indications: anxiety, depression. se: sexual dysfunction weight gain, insomnia. key: watch for serotonin syndrome! **agitation, hallucinations, fever, diaphoresis, tremors.

A client with which psychiatric disorder is at high risk for suicide?

Schizophrenia Rationale:Suicide is a high risk for people diagnosed with schizophrenia.

In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what?

Suicidal intent Rationale:The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats, and gestures are typically more vague and less rooted in time and place.

Which characteristic is most common among suicidal clients?

Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally. -a state in which you lack certainty or the ability to make decisions.

Amitriptyline (Elavil), imipramine

Tricyclic Antidepressants indications: depression, neuropathy, fibromyalgia, anxiety, insomnia. s/e: sedation, orthostatic hypotension, anticholinergic side effects (urinary retention, constipation, dry mouth, blurry vision, photophobia, tachycardia) sweating, seizures. key: to counteract anticholinergic effects --> chew gum, wear sunglasses, high fiber diet, increase fluids.

8A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?

Your Response: "Make sure that you don't drink any alcohol when you're taking this medication." Rationale:Interactions between benzodiazepines and alcohol can be lethal. Drowsiness, not insomnia, is likely. There are not dietary restrictions normally associated with benzodiazepine use, and these drugs are not a common cause of neuromuscular effects.

A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by the nurse would be most important to ask at this time?

Your Response: "What have you had to eat or drink today?" Rationale:The client is exhibiting signs of a hypertensive crisis, which can occur when a client is receiving MAOI therapy and ingests food or other substances that contain tyramine. Thus, the nurse should ask the client what the client has had to eat or drink. Drug levels are used to monitor tricyclic antidepressants. Asking about chest pain would be appropriate after obtaining information related to what the client has ingested. Herbal remedies can interact with medications, but this information would be obtained after determining whether the client has ingested foods and fluids containing tyramine.

How may benzos help with alchol withdrawl?

[chlordizepoxide (Librium), diazepam, lorazepam] used to stabize VS, decrease risk of seizures, decrease manifestations.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

agranulocytosis Rationale:Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a reduction in neutrophils in the blood, to develop. While the remaining options are potential side effects of antipsychotics, agranulocytosis is both life threatening and specific to clozapine.

What can be used to treat EPS symptoms?

anticholinergics (ex: benztropine)

phenytoin (Dilantin)

anticonvulsants/antiepileptics indications: treats & prevents seizures s/e: gingival hyperplasia, diplopia, nystagmus, rash ataxia, hypotension. key: serum levels need to be monitored routinely--> Narrow theraputic range 10-20 mcg/mL

Intracranial Pressure (ICP)

expected range: 10-15 mmHg increased: caused by head injury, tumor, intracranial hemorrhage, HTN SS of Increased ICP: iritability (earrrly sign!!), restlessness, headache, decreased LOC, pupil abnormalities, abnormal breathing and or posturing.

IntraOcular Press

expected range: 10-21 elevated IOP >21 Glaucoma >open-angle glaucoma is most common, results in gradual increase in IOP >closed-angle is less common and results in sudden increase in IOP

How may clonidine help with alchol withdrawl?

helps with autonomic responses (decreases BP, HR)

lithium

indication: bipolar disorder s/e: GI upset, fine hand tremors, polyuria, weight gain, kidney toxicity, electrolyte imbalances. key: mx plasma levels!! toxicity OVER 1.5 mEq/L. NO diuretics, anticholinergics, or NSAIDS. Con'indicated for pts w/renal disease. Mx sodium levels. Need adaquate fluid intake (2-3L) & sodium intake (balanced.) -->s/s of toxicity: coarse tremors, confusion, hypotension, seizures, tinnitus. must be between: 0.4-1.4mEg/L

alprazolam

indications: anxiety, alcohol withdrawl, muscle spasms, seizures. s/e: sedation, amnesia, dependency/withdrawl, respiratory depression. key: short-term use only!! do not d/c abruptly. antidote is flumazenil.

buspar

indications: anxiety, panic disorder, etc. s/e: dizziness, nausea key: no sedation, long-term use ok.

Delirium,

often called acute confusional state, begins with disorientation and if not recognized and treated can progress to changes in level of consciousness, irreversible brain damage, and sometimes death

When assessing risk of suicide, which are important assessment components? Select all that apply.

previous attempt, lethality of method, degree of hopelessness, seriousness of suicidal ideation Rationale:Assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt, suicide planning and implementation, and availability and lethality of the suicide method.

Efficacy

refers to the maximal therapeutic effect that a drug can achieve.

Half-life

s the time it takes for half of the drug to be removed from the bloodstream.

When does alcohol withdrawl start?

starts: 4-12 hours of last drink peaks: at 24-48 hours.