180 - Mental Health Exam 1 Flashcards
1
Q
Describes certain settings/enviornments designed to help clients replace inappropriate behaviors w/ more effective personal/ psychosocial skills
Therapeutic tools include the use of eye contact, facial expressions, body movement, and other nonverbal behaviors
A
Therapeutic communication (milieu)
2
Q
What makes a patient a candidate for inpatient psychiatric admission?
A
- Persons behavior becomes threat to themselves or others
- People w/in the enviornment are not able/willing to support mentally troubled patient
- Person Perceives himselves as unable to cope/ behavior control
3
Q
Inpatient services are provided for what 3 main groups of people?
A
- People experiencing a crisis
- People with acute mental or emotional problems
- People with chronic mental illness
4
Q
Repeat inpatient admission
* AKA “revolving door syndrome” - especially schizophrenia & chemical use patients
Becomes a way of life for chronically troubled
Client feels like failure & providers are frustrated by failed past techniques
Primary reason for patient return to inpatient enviornment is due to noncompliance
A
Recidivism
5
Q
what is the goal of a therapeutic enviornment?
A
To provide protection, support, & education
6
Q
What happens in a therapeutic enviornment during an inpatient stay ?
A
Care providers assist clients in meeting needs
Clients learn to replace maladaptive behaviors
7
Q
What are the Maslow’s Hierarchy of Basic Human Needs in order?
A
- Physiological needs
- Security & safety
- Love & belonging
- Self-esteem
- Self-actualization
Must meet basic needs to move to the next
8
Q
Focus on physical surroundings
* Breath, nourishment, hygiene, & enviornment
Encourage good hygiene
A
Physiological needs - Maslow’s Hierarchy
9
Q
Most important
Feeling of physical safety & ability to feel secure
security of a limited setting
* Depressed/ SI patients protect from self harm
A
Safety & security - Maslow’s Hierarchy
10
Q
Fulfilled w/in therapeutic setting through:
* Use of communication
* Social interactions
* Relationships
Need to be accepted & find a place in a group
Isolation of mental illness is intense
A
Love
& belonging - Maslow’s Hierarchy
11
Q
Must respect yourself before others can love & respect you
* Client needs to be involved
Expectations play role in development of personal needs
A
Self-esteem needs - Maslow’s Hierarchy
12
Q
Need to achieve ones full potential
Not everyone will become
Clients become better able to cope
A
Self-actualization needs - Maslow’s Hierarchy
13
Q
What are the 4 malpractice elements?
A
Duty of care
Breach of duty
Causation
Injury/ harm
14
Q
Described as power, privilege, or existence to which one has a just claim
Helps define social interactions bc they contain principles of justice
* Equal /fair tx applied to all citizens
Associated w/ obligations
A
Rights
15
Q
Right to respectful care, privacy/confidentiallity, continuity of care, & relevant info
* Right to examin bills, refuse tx, & participate in research
A
Patient Rights
16
Q
Rights relate to respect, safety, & competent assistance
Right to full & equal participation as member of health care team
Right to set standards for quality & develop policies that affect Pt care
A
Care provider rights
17
Q
Set of rules/values that govern right behavior
Reflects:
* Values
* Principles of right/wrong
* Purpose - To protect rights
A
Ethics
18
Q
Acts as guidlinges for standards of practice
Let public know what behaviors can be accepted from their HCP
Codes of ethics are based including the following:
* Autonomy
* Beneficience, justice
* Nonmaleficence
* Confidentiality, fidelity, veracity
A
Ethical Principles
19
Q
Provide information to patients, be truthful, & support your Pts, but consult the supervisor if any question of appropriateness arises
A
Code of ethics
20
Q
Dilemmas exist when there is uncertainty/ disagreement about moral principles related to corse of action
* arise when problems cannot easily be solved
A
Ethical conflict
21
Q
What criteria does a Pt need to make in order to be admitted to Psych?
A
Patient initiates request for mental health survice
* Considered voluntary admission
* Voluntary admitted Pts may legally discharge self whenever
Involuntary psychiatric admission provide a protected, theraputic enviornment
* Pt can stay from days to years
22
Q
What would the most common crime in a mental health care setting include?
A
Homicide, controlled substance violation, & theft
* Assult/battery
* Invasion of privacy
* False imprisonment
23
Q
What are the 7 Principles of Mental Health Care?
A
- Do no harm
- Accept Pt as whole person
- Develop trust
- Explore behaviors & emotions
- Encourage responsibility
- Encourage effective adaptation-crisis intervention
- Provide consistency
24
Q
Avoid any action that may result in harm to your Pt
Relates to “reasonable & prudent nurse” (caregiver)
A
Do no harm
25
Based on concept of "whole"
* Viewing Pts involves acceptance of their lifestyle, attitudes, social interactions, & living conditions
Holistic Health Care
26
Mental health care providers encourage what?
One step at a time
Crisis intervention
Learning coping mechanisms
Recovery begins when attempts to cope with the problem result in success
27
What should you do as the nurse during a crisis intervention?
Provide immediate attention / care
Control & assess
Pt's dispossition is determined
Refferal & follow up
28
How can you provide consistancy in mental health?
Being steady, regular, and dependable
Setting limits & focusing on the positive changes that patients are making
Addressed in POC
29
How should you as the caregiver interact with a patient w/ mental illness?
Convey " a consistent, thoughtful effort directed toward developing an awareness of self and others"
Approach must be monitored & adjusted continually
Role models for good mental & physical health
- *serve as therapeutic instrument*
30
How can you as the care giver be self-aware of a patient with a mental illness?
**Objectively look w/in**
**Oversee own growth & development**
Allows individuals to direct & mold the pattern of their lives
Caregiver who encourages self-awareness must practice self-awareness
31
Concern for the well-being of another person
Behaviors associated with:
* Accepting
* Comfort
* Being honest
* Listening attentively
* Having sensitivity
Caring
32
The ability to recognize & share the emotions of another person w/o actually experiencing them
Empathy
33
The ability **to see clearly & understand** *the nature of things*
*Relies on common sense, good judgement, and prudence*
Insight
34
What is the difference between risk taking & failure?
Risk taking implies the possibility of failure
Failure provides the opportunity for change
* *One only fails when one refuses to grow from the experience*
35
Receiving the entire person and the world in which s/he functions
Does not necessarily include approving behaviors
HCP must accept the entire person
Acceptance
36
*What are vital elemants of health care, but must be balanced* by professionalism, judgment, & theraputic actions that meet Pt needs?
**A**cceptance
**C**ompassion
**E**mpathy
Tip: Think "ACE"
37
A promise to do the best you can do in every situation & to be the best that you can be
Self-commitment
38
How can you keep a positive attitude as a caregiver?
Listen to yourself talk
Change recurrent negative themes
Be own cheerleader
Visualize future successes
Act the part
Nurture yourself to be able to nurture others
39
Energy exchanged between 2 people
**A flow that moves patients toward constructive ways of thinking & effective ways of coping**
Characteristics:
* Acceptance
* Rapport
* Genuineness
* Therapeutic use of self
Components (*think TEACH*):
* **T** = Trust
* **E** = Empathy
* **A** = Auonomy
* **C** = Caring
* **H** = Hope
Therapeutic relationship
40
What are the 3 types of relationships?
Social relationship
Work relationship
Therapeutic relationship
*made up of **concepts trust, empathy, autonomy, caring, & hope***
41
What are the 5 dynamic components of a therapeutic relationship?
**T** = Trust
* Assured belief that others are capable of assisting in times of distress
**E** = Empathy
* Ability to walk a mile in anothers shoes
**A** = Autonomy
* Ability to detect & control one activities & density
**C** = Caring
* Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable
**H** = Hope
* Expectation of acheiving a future goal
* *Consists of 6 demensions - affective, affiliative, behavioral, cognitive, temporal, & contextual*
42
The working phase of the theraputic process is:
A) The final phase
B) The phase where goals are acheived
C) The phase where Pt & caregiver become aqcuainted
D) Countertransference
A) The final phase
43
What are the 4 roles of the caregiver?
Change agent
Teacher
Technician
Therapist
44
Which of the following is not on of the 3 qualities of a therapeutic relationship?
A) Confidentiality
B) Acceptance
C) Rapport
D) Genuiness
B) Acceptance
45
What are the 3 characteristics of chronic mental illness?
**Behavioral**
* Unable to function socially / occupationally
* Assultive / criminal behavior may occur
* Increase sexual behavior / increased STI risk
* Violence
**Physical**
* Dress unusual / out of season
* Lacks personal hygiene
* Malnutrition
* Chronic medical conditions are common
**Psychological**
* Several intellectual, emotional, social, & spiritual features in common
* Chronic low self-seteem, depression, loneliness, & hopelessness
* Often see themelves as helpless, ineffective, & incapable of change
46
Children with ________ have problems with the intellectual & emotional aspects of life.
A) Autism
B) Mental retardation
C) Eating disorders
D) Schizophrenia
B) Mental retardation
47
Children with ________ are in a world of their own.
A) Autism
B) Mental retardation
C) Eating disorders
D) Schizophrenia
A) Autism
48
What is the most common aquired mental health problem in older adults?
**Alzheimer's diseases** *& other dementias*
* Depression is another but less common
49
The presence of 2+ mental health disorders
Dual Dx
Comorbidity
50
When would an individual with a chronic mental health issue be hospitalized?
When their behavior poses a threat to themselves or others
51
How long is the average length of stay in an inpatient setting?
About 10 days
52
Where are many chronically mentally disordered clients discharged?
Halfway house or other group homes
Many live at **home with their families**
53
Offers opportunities for individuals with severe mental illness to meet their often neglected social needs
Uses special talents of *physicians, psychologists, nurses, occupational & physical therapists, dietitians, and other specialists*
Multidispilinary approach
54
What are therapeutic interventions designed on the basis of?
Identification problems
Available resources
Clients willingness to cooperate w/ therapeutic regimen
55
What data must the nurse gather when assessing a patient w/ a mental illness?
Thorough Hx
Physical status
Perceptions
Behaviors
56
A depressed patient appears disheveled, unkempt, and neglected. This aspect of the mental health assessment would include which of the following?
A) Emotional state
B) General description
C) Affect
D) Sensorium
B) General description
57
The nurse documents that a client is displaying a "flat affect". The clients behavior most likely would consist of:
A) Rapid dramatic changes in emotion
B) Sadness & hopelessness
C) Lack of agreement of affect & mood
D) Unresponsive emotions
D) Unresponsive emotions
58
A Pt w/ seasonal affective disorder (SAD) may be treated successfully w/ which of the following body-based practices?
A) Acupuncture
B) Phototherapy
C) Chelation
D) Eye movement desensitization
B) Phototherapy
59
The absence of disparties / **avoidable differences among socioeconomic & demographic groups / geographical areas in health status** & health outcomes such as *disease, disability, or morality*
Ex:
* **Lack of health insurance** & high health care costs
* **Language barriers, Lack of transportation**
* Provider / Pt communication
* **Biased clinical decidion making**
* Pt's mistrust & refusal
* Unequal pain management, palliative care & breast cancer screening
* **Unequal early / adequate prenatal care, & recommended immunizations**
**HRSA**
"Health disparties" / "Health equity"
60
**Ineffective emotional states**, ranging from deep depression to excited elation
* AKA - " **Affective disorder** " (Affective means emotions)
Disturbance in the emotional dimension of human functioning
Mood disorder
61
**Increase certain neruotransmitter activities**
Divided into categories based on chemical formula:
* **Tricyclic, atypical**
* *Selective seretonin / norepinephrine reuptake inhibitor* (**SSNRIs**), *monoamine oxidase inhibitor* (**MAOIs**)
**Use**:
* Bipolar, panic disorders
* OCD, ADHD
* Enuresis (bed wetting), bulimia
* Neuropathic pain, conduct disorders in children
*Require 1- 4 weeks before relief is noted*
S/s:
* **Hypertensive crisist**
* *Headache, stiff neck, palpitations* (**toxicity**)
* *Dry mouth, nose, & eyes, urinary retention, sedation* (**Anticholergic reactions**)
Interventions:
* **Report any behavior / physical changes**
* Protect from falls (postural hypotension)
* **Repost S/s of toxicity**
* *Monitor kidney / liver function*
Antidepressant medications
62
Why do antidepressants interact w/ other drugs?
They block the destruction of specific major transmitterrs
* higher levels of these chemicals circulate through the body
63
What are 3 interactions w/ monoamine oxidase inhibitors (MAOIs)?
**Anticholergic reactions**:
* *Dry mouth*, blurred vision
* Decreased tearing, *urinary hesitancy / retention*
* Constipation, excessive sweating
**Hypertensive crisis**:
* Throbbing, **radiating headache, stiff neck**
* **Palpitations**, chest tightness, **severe HTN, tachycardia**
* *Dilated pupils*, sweating
**CNS depression**:
* **Change LOC**, disorientation, confusion, agitation
* Sedation, **hallucinations**, low seizure threshold
64
What are side effects of Selective seretonin / norepinephrine reuptake inhibitors (SSNRIs)?
Dry mouth
N/V/D/C/A/H
Change in alertness
Increased sweating
Urinary & visual disturbances
Dizziness, Fatigue, weakness, tremor
65
What are some dietary interactions w/ monoamine oxidase inhibitors (MAOIs)?
AVOID:
* Beer/ ale, red wines, sherry wines, liqueurs,cognac (**Alcohol**)
* **Aged cheese**, sour cream (**Dairy**)
* **Avocados**, **bananas**, fava & broad beans, canned figs, & overriped fruit (**fruits/vegs**)
* **Pickled/smoked/ tenderizer**, bologna, ck/beef, liver, dried fish, **salami meats**, **sauasages** (***salami meats***)
* Large amounts of caffeinated **coffee, tea, or cola**
* **Chocolate**, licorice, soy sauce, *yeast*
66
What are some drug interactions w/ monoamine oxidase inhibitors (MAOIs)?
AVOID:
* prescription & OTC nasal sprays, sinus decongestions, cold/allergy/hay fever remides
* Inhalants for asthma
* Weight loss pills, pep pills, stimulants, local anesthetics
* Illicit drugs: Cocaine, any amphetamine (uppers), & narcotics
67
Depression in adolescence usually related to what 4 factors?
Self-esteem
Loneliness
Family strengths
Parent-teen communication
68
List the 3 reasons why teen depression must be recognized as serious:
Depression arising during adolescence tend to last
Have a high rate of recurrence
Associated w/ long lasting interpersonal problems
69
Which adults are at risk for depression?
women
People between ages 35-44
Whites & hispanics
Individuals w/ fewer than 12 years of school
People who live in major urban areas
People w/ physical illnesses
Recently widowed *older adults*
People who live in western U.S
70
What are some signals of depression in the elderly population?
Change in daily routine, eating, sleeping, or activity patterns
Decreased concentration, communication, & motivation
Feeling of envy, failure, indecisions, guilt & hopelessness
Loss of interest, self-confidence, & self-esteem
Worry or talk about death
71
An **emotional state in which a person has an elevated, expansive, & irritable mood** accompanied by a loss of identity, increased activity, & grandiose thoughts & actions
Seen in Bipolar disorders
* Bipolar 1 & 2
* Cyclothymic disorders
Can last 3 months
* If allowed to continue, delirium & death from exhaustion may result - eventually depression phase begins again
Hospitalization breaks the cycle
Mania
72
Feeling of sadness, disappointment, & despair
Classified into depressive episodes, depressive disorders, & dysthymia on time & recurring behavior patterns
Whole body illness that involves emotional, physical, intellectual, social, & spiritual disorders
Depression
73
Sudden/dramatic shift to emotional extremes
Emotional extremes of mania & depression
* Their thoughts, moods, & behaviors swing from normal to grandiose to depressed
2 types: 1 & 2
Bipolar disorder
74
Exaggerated sense of cheerfullness begins cycle the progresses to unstable "high of mania"
* Behaviors become more impaired
Still able to engage in daily living activities
Hypomania
75
Episodes of major depression alternating w/ episodes of mania
* **More severe **
Delusions, & hallucinations can occur
Bipolar 1
76
Associated w/ hypomanic moods that do not progress to full manic states, and are shorter than type 1
Often results in 1-2 weeks of severe lethargy, withdrawl, & melancholy, followed by several days of elevated ir irritable mood, constant activity, & risky decision making
Bipolar 2
77
What are the 3 levels of mania?
**1. Hypomania**
* Outgoing, *happy-go-lucky*, **unconcerned about the feelings of others** , **increased motor activity & sexual drives**; *moves quickly from one topic to the next, becomes easily irritated* ;decreased need for sleep
**2. Mania**
* "High" expansive , *angers quickly*, pressured speech, flight of ideas, delusions of persecution & grandiosity; **dresses inappropriately (layers, bizarre outfits, excessive makeup & jewlery), inappropriate behaviors (meddles in affaris, spends money recklessly, ect), sexually driven**, little sleep but still hyperactive
**3. Delirium**
* **Period of extreme excitement, anger, elation**; has grandiose or religious delusions, becomes disoriented, incoherent, agitated; **may injure self or others**; **poor hygiene**, *disheveled*, physically drained; **death** from exhaustion if mania goes untreated
78
Introduction of a controlled grand mal seizure by passing an electrical current through the brain
**Works by raising the levels of the neurotransmitter norepinephrine** (lower in people w/ depression)
* Tx 2-3x/week, takes about 15 min, 6-12 treatments over several weeks (*out pt/ or in Pt*)
**Used only on clients w/ severe, long-lasting depression after attempts to stabilize the mood** w/ various medications & therapies have failed
**Common side effects**: headache, confusion on awakening from the tx, short term amnesia, clients mood improves rapidly
Electroconvulsive Therapy (ECT)
79
Electroconvulsive Therapy (ECT) is not prescribed for what type of clients?
Recent MI/Heart attack
Heart disease
High/low BP
Stroke
CHF
**Why**: Tx lowers BP and slows HR
80
What Pt education & nursing interventions would you implement for Electroconvulsive Therapy (ECT)?
NPO 8 hours before treatment
Consent forms signed, remind client that confusion and memory loss are common after treatment
Baseline vital signs
Cardiac, BP, & O2 monitoring begins
Short acting muscle relaxants, sedatives, an anesthetics agents admin. IV
EEG
81
Think **"SIG E CAPS"**:
* **S**: Sleep disturbance
* **I**: Interest decreases in pleasure activities & sex
* **G**: Guilty feeling
* **E**: Energy decreases
* **C**: Concentration
* **A**: Appetite fluctuation
* **P**: Psychomotor function decreases
* **S**: SI
Depression assessment
82
What are tools to measure mental status?
**Mini Mental State**
* used to systematically and thoroughly assess mental status
* An **11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language**. *maximum score is 30 & a score of 23 or lower is indicative of cognitive impairment*
**Neecham Confusion Scale**
* developed as an instrument for rapid and non-intrusive assessment of normal information processing, early changes in information processing, and for documentation of confusional behavior, including delirium
* It can be scored by the nurse "at the bedside" in a manner similar to other nursing assessments. It makes maximum use of already collected data
**Confusion Assessment method instrument**
* *a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately*
* Allow for monitoring during/between shifts day-day/ long term
* Do not replace continuous monitoring & documentation of mental status
83
What are the 5 types of hallucinations?
**Visual**
**Auditory**
**Tactile**
* *sensations of touch without any physical stimulus*
* Patients with schizophrenia may sometimes **experience the feeling of being kissed, the feeling of someone lying by their side or feelings an animal crawling on them**
**Olfactory**
* *Makes you detect smells that aren't really there in your environment*
* Consist of unpleasant smells: **rotten fish or eggs, gasoline, excrement**
**Gustatory**
* *Cause tastes that are often strange or unpleasant*
* Relatively common symptom for people with epilepsy and schizo.
* **Often perceived as sour, bitter, or metallic**
84
How does a physician select the appropriate therapy?
Pt hx of responce to previous antidepressant
Potential adverse reactions
Physiologic manifestations alleviated within first week of therapy
Psychological symptoms improve after 2-4 weeks
85
**Prolonged action of norepinephrine, dopamine, & serotonin by blocking reuptake**
**Use**:
* *Antidepressants*, *phantom limb pain*
* Chronic pain, post herpetic neuralgia
* Periphreal neuropathy
**Adverse**:
* *Blurred vision, constipation, dry mouth/nose/throat* (**common**)
* *Parkinsonian, seizure activity, tachycardia* (**severe**)
* *HF, dysrhythmias, suicidal actions* (**severe**)
Drugs:
* Amitriptyline (Elavil)
* Clomipramine (Anafranil)
* Doxepin (Silenor)
Tricyclin Antidepressants (TCA)
86
**Blocks metabolic destruction of norepinephrine, dopamine, & serotonin neurotransmitters**
**Used when tricyclic antidepressant therapy is unsatisfactory**
**Avoid tyramine (pickled foods, yeast, nuts, processed meats ect), ages cheese, wine/alcohol**
* *causes HTN crisis*
**Used for**:
* Atypical depression
* Panic disorder, & some phobias
**adverse reaction**:
* **Orthostatic Hypotension**
* Restlessness, agitation
* Blurred vision, constipation, urinary retention
* **Dry mucosa of mouth, throat, & nose**
* **Malignant HTN (Severe)**
Drugs:
* Phenelzine (Nardil)
* Tranylcypromine
* Selegiline (Emsam)
monoamine oxidose inhibitor (MAOIs)
87
**Inhibits reuptake & destruction of seritionin** from synaptic cleft, **prolonging action of neurotransmitter**
**Use**: Widley w/ antidepressants
**Adverse**:
* Restlessness, agitation, anxiety
* Insomnia, sedative effects
* GI effects, suicidal actions
**Drug**: Venlafaxine (Effexor)
Selective serotonin reuptake inhibitors (SSRIs)
88
Normal mental state/mood in those w/ bipolar disorder that is neither manic or depressive
Behavior examples:
* Not feeling good or bad
* Feeling "okay"
Euthymia
89
Prolonged emotional state influencing ones whole personality & life function
Behavior example:
* Good or bad/ likes or dislikes
Mood
90
Outward expression of ones emotions - observable
Behavior example:
* Inappropriate response/action
Affect
91
Moderate depression for *2 years or more*
S/s of depression
Negative POV of the world
Behavior example:
* Chronically sad, major depressive episode
* Self critical
Dysthymia
92
*Focuses on helping clients w/ personal hygiene, maintaining adequate nutrition, & encouraging physical activities*
**PN responsibilities**:
* Focus on personal hygiene, maintaining adequate nutrition, & encourage physical activity
* Maintain SI precautions
Concepts:
* Adherence
* Stress & coping
* Functional ability
Physical realm
93
**PN responsibilities**:
* **Care revolves around therapeutic relationships**
* **Acceptance**/*trust*/**support**
* Encouragement/emotional support to cope w/ problems
Concepts:
* Anxiety
* Mood & affect
* Self management
Emotional Realm
94
*Extreme emotional response altering ones ability to think*
**PN responsibilities**:
* Use gentle, nonjudgemental guidance when attempting to follow through on tasks
* Give instructions clear & slow (repeat if needed)
* Provide extra patience
Concepts:
* Cognition
* Psychosis
* Sleep
Intellectual Realm
95
**Most individuals are lonely & afraid of associating w/ others**
* involves spiritual realm
**PN responsibilities**:
* Stabilize moods w/ medications
* Gental encouragment to begin intercating w/ others
Concepts:
* Anxiety
* Family Dynamics
* Stress & coping
Social Realm
96
**Antimanic**
* **Naturally occuring salt**
* *Once Pt is no longer manic, the need for drug drops dramatically*
Interaction between the level in the blood & common table salt
Theraputic level: **0.6-1.2 mEq/L (MV-250)**
* *Always be aware of level prior to admin*
**Actions**:
* Replaces intracellular & intraneuronal sodium
* Stabilizes neuronal membrane
* Reduces release of norepinephrine & increase uptake of tryptophan
* Exact action unknown
**Uses**:
* Mania
* Prevention of recurrent cycles
**Premedication assessment labs, electrolytes, glucose, BUN/Cr, UA, thyroid function**
Lithium
97
What are side effects and interventions of Lithium?
Side effects:
* Abd. discomfort, **N/D/A**, soft stool, **cramps**
* Edema (feet especially)
* Hair loss, hypothyroidism
* Muscle weakness, fatigue
* **Polyuria** (can progress to diabetes insipidus),
* **Thirst, tremors**, weight gain
Interventions:
* Give Lithium w/ food or milk
* Reassure s/s are temporary
* Check salt restrictions w/ Dr.
* Obtain thyroid function test
* Monitor I/O (report if >3000Ml/24 hr)
* Encourage to quench thirst, eliminate caffeine
* Moderatly restrict calories, reassure weight gain is common
98
What are S/s of lithium toxicity?
**Mild - Blood serum level 1.5mEq/L**
* Apathy, *sluggishness/drowsines* /lethargy
* **Diminished concentration, mild incoordination**
* Muscle weakness, muscle twitches, **course hand tremor**
**Moderate - Blood serum level 1.5-2.5mEq/L**
* N/V/D, Apathy
* **Slurred speech, blurred vision, tinnitus**
* sluggishness/drowsiness/lethargy, *muscle weakness*
* **Irregular tremors**, ataxia, frank muscle twitching
**Severe - Blood serum level 2.5mEq/L**
* Irregular muscle tremors
* **hyperactive deep tendon reflexes**
* *Oliguria, dereased urine O/P*
* **Severe LOC changes, hallucinations**
* **Grandmal seizures, coma, death**
99
**Anticonvulsants - PO/ IV**
*Decreases seizures*
**Use**:
* Simple/complex/absent/ mixed sizures
* Bipolar episodes, ADHD, Schizo.
Side effects:
* N/V/D/C/A, Rash
* Sedation
**Adverse**:
* Coma
* SI
* Hepatotoxicity
Interventions:
* Assess seizure disorder & mental status
* Blood studies (**Hct, HB, RBC, PT/PTT, platelets**)
Valproic Acid (Depakene)
100
**Antidepressant - PO**
* **SSRI**
*Potent inhibitor of neuronal serotonin & norepinephrine uptake*
*Use: Prevention/Tx of major depression*
**Adverse**:
* SI, SJS
* Tachycardia
* Angioedema
**Interventions**:
* Mental status
* Blood studies (**CBC, WBC, Cardiac enzymes**)
Venlafaxine (Effexor XR)
101
**Antipsychotic - PO/IM**
Exact mech. unknown
**Uses**:
* schizo., bipolar disorder
* Mania, major depressive disorder
**Adverse**:
* Seizures
* SI
* Tachycardia, agranulocytosis
**BBW: assess mental status before use**
**Interventions**:
* Take BP, RR, & HR Q4h during initial tx
Aripirazole (Abilify)
