Albeez Flashcards
Are drugs use to treat Bipolar Disorder by stabilizing the client’s mood
Mood-Stabilizing Drugs / Mood Stabilizers
These drugs help prevent or minimize the highs and lows that characterize bipolar illnesses and treating acute episodes of mania
Mood Stabilizers
As a mood stabilizer, it is the most established drug of choice
Lithium
Other than lithium, these are also used as effective mood stabilizers
Anticonvulsants;
e.g. CLONAZEPAM (Klonopin)
These are the two other mood stabilizers that inhibit the Kindling Process (High Manic Mode)
- CARBAMAZEPINE (Tegretol)
- VALPROIC ACID (Depakote, Depakene)
These are mood stabilizers that can be used on patients with Hx of Epilepsy
Anticonvulsants;
e.g. TOPIRAMATE (Topamax)
These mood stabilizers are known to Increase the Levels of Inhibitory Neurotransmitters — GABA
VALPROIC ACID (Depakote, Depakene)
TOPIRAMATE (Topamax)
Lithium is available in what forms?
Tablet
Capsule
Liquid
Sustained Release Forms
NOTE: No Parenteral Form available
Give 2 examples of Anticonvulsants used as Mood Stabilizers:
- CLONAZEPAM (Klonopin)
- TOPIRAMATE (Topamax)
Give 3 examples of Anticonvulsants used as Mood Stabilizers
- GABAPENTIN (Neurontin)
- LAMOTRIGINE (Lamictal)
- OXCARBAZEPINE (Trileptal)
Lithium level is monitored through what?
Blood; Assessing the client’s response to the medication
The normal Serum Lithium level in the Blood
0.5 mEq/L to 1.5 mEq/L
Above what level of Serum Lithium is considered toxic?
Above 1.5 mEq/L
Serum Lithium levels should be monitored every ____ days while ____ ____ is being determined
2-3 Days;
Therapeutic Dosage is being determined
After monitoring Serum Lithium levels for 2-3 days, what frequency must it then be monitored?
Weekly
Once a patient’s condition is stable involving Lithium Therapy Tx, considering having closely monitored every 2-3 days then weekly, what frequency comes next?
Checking once a Month
Carbamazepine is initially started on what dose range?
100-200 mg/day
What is the usual dosage of Carbamazepine?
800-1200 mg/day
Maximum dosage of Carbamazepine
200-2000 mg/day
Carbamazepine tablets usually come in what milligrams
200 mg
Serum level of Lithium is obtained __ hours after __ dose
12 Hours after LAST Dose
Common Side Effects of Lithium Therapy
- Mild Nausea
- Diarrhea
- Anorexia
- Fine Hand Tremors
The common side effects of Lithium Therapy can be controlled by what medication?
Propanolol (Beta Blockers)
What do we include in our Patient Teaching when it comes to Lithium Therapy; this is regarding fluids
Limit fluid intake to ensure the therapeutic effect of the medication; But Remain Hydrated adequately to prevent Lithium Toxicity
This is because increased water/fluid intake can Dilute the Lithium, reducing its supposed therapeutic effect; Dehydration may lead to Lithium Toxicity
These side effects of Lithium Therapy appears on a later on-set
- Polydipsia (excessive thirst)
- Polyuria (excessive urination)
- Metallic Taste in the Mouth (Dysgeusia / Parageusia)
- Fatigue or Lethargy
These 2 side effects of Lithium Therapy are usually the cause for NON-COMPLIANCE
Lethargy & Weight Gain
Toxic Symptoms of Lithium Therapy
- Lack of Coordination
- Drowsiness
- Vomiting
- Severe Diarrhea
- Muscle Weakness
If Toxic Symptoms of Lithium Therapy remain untreated, this may lead to what conditions?
- Renal Failure
- Coma
- Death
When toxic signs of Lithium Therapy occurs, what should immediately be done?
Drugs Discontinued Immediately
If Lithium levels exceed __ mEq/L, this may indicate the need for ___
3 mEq/L - may indicate DIALYSIS
Side Effects of Carbamazepine and Valproic Acid
- Drowsiness
- Sedation
- Blurred Vision
- Dry Mouth
Carbamazepine can cause what side effects? (There are two identified)
- Rashes
- Orthostatic Hypotension
Valproic Acid can cause what side effects? (There are three identified)
- Weight Gain
- Alopecia
- Hand Tremor
Are used to treat:
1. Anxiety
2. Anxiety Disorders
3. Insomnia
4. Obsessive Compulsive Disorder (OCD)
5. Depression
6. Post Traumatic Stress Disorder (PTSD)
7. Alcohol Withdrawal
Anxiolytics / Antianxiety Drugs
These type of Anxiolytics prove to be the most effective in relieving anxiety and are frequently prescribed
BENZODIAZEPINES
It is a type of Anxiolytic that is a non-benzodiazepine often used for Relief of Anxiety
BUSPIRONE (Buspar)
Benzodiazepines are prescribed with _____ dose;
If abused, these are taken with ____
Controlled Dose;
Alcohol
Four identified common Benzodiazepines
- DIAZEPAM (Valium)
Very Fast Acting - CHLORDIAZEPOXIDE (Librium)
Intermediate - ALPRAZOLAM (Xanax)
Intermediate - LORAZEPAM (Ativan)
Moderately Slow Acting
This is a type of Benzodiazepine that is dangerous if taken with alcohol prior of after
FLURAZEPAM (Dalmane)
This term refers to gradual decrease of the drug’s dose
Tapering
Potential Side Effects of Anxiolytics
Physical Dependence (Sx usually appear when Drug is Stopped);
This Dependence may lead to Overuse or Abuse if not managed
In patient teaching regarding Anxiolytics, the patient should be made aware of a Decrease in ______ time, Slower ____, and Possible _____ Effects
Decreased Response Time
Slower Reflexes
Sedative Effects
Once benzodiazepines are started on the patient, it should not be Discontinued ________ without the supervision of the physician
Abruptly;
Benzodiazepines must not be Abruptly Discontinued — Tapering should be done if ordered
These drugs were used to treat psychiatric disorders in the 1930s
Stimulants (AMPHETAMINES)
These stimulants have been widely abused to produce high or remain awake for long periods
DEXTROAMPHETAMINE (Dexedrine)
Currently the primary use for stimulants is for Children with _____, Adolescents, Residual ______ Deficits in Adults, and Narco_____
- Children with ADHD
- Adolescents
- Residual Attention Deficits in Adults
- Narcolepsy
This refers to Attack of unwanted but irresistible Daytime Sleepiness that disrupt the person’s life
Narcolepsy
Stimulants’ (Amphetamines) potential for abuse is _____, and Prolonged period of use may lead to drug _____
Potential for abuse is High;
Prolonged period of use may lead to Drug Dependence
These are therapeutic treatments done if the patient has recovered post-psychotic condition; CONSIDERED FIT TO PARTAKE ACTIVITIES
Psychotherapy
A Biophysical Somatic Intervention
Electroconvulsive Therapy
In Patient Treatment, is often the last, rather than the first mode of treatment for mental illness
Community Mental Health
It is believed that it is more beneficial and cost-effective for patient and family to remain in the ________ and receive outpatient treatment whenever possible
Community (Community Mental Health)
The client can continue to work and can stay connected to family, friends, and other support systems while participating in the therapy
Community Mental Health
Outpatient therapy takes into account the person’s personality or behavior patterns, coping skills, styles of communication, and level of self-esteem, gradually developed over the course of lifetime, and cannot be changed in a relatively short time in patient Tx
Community Mental Health
Admission of Patients with Mental Disorders is indicated if the following (4) conditions arise:
- Severely Depressed and Suicidal
- Severely Psychotic
- Experiencing Drug/Alcohol Withdrawal
- Exhibiting behaviors that require close supervision in a safe and supportive environment
Is a method of bringing about change in person by exploring their feelings, attitudes, thinking, and behavior.
Individual Psychotherapy
It involves one to one relationship between the therapist and client
Individual Psychotherapy
Components of Nurse-Patient Relationship throughout the course of nursing care
- Introduction
- Working
- Termination
In the Individual Psychotherapy, both the _____ and the _____ must be compatible for a therapy to be effective
Therapist and Client
A patient participates in sessions with a group of people
Group Therapy
The members share a common purpose and are expected to contribute to the group to benefit others and benefit from others in return
Group Therapy
In Group Therapy, as a member of the group, the patient learns ___ ways of ____ at the problem or ways of ____ with or solving problems
The patient learns * NEW WAYS OF LOOKING at the problem*
Learns Ways of Coping with or Solving Problems
This therapy can help the patient to learn important interpersonal skills
Group Therapy
Group ____ are established which all members must follow
Group Rules (Group Therapy)
Give 3 expected Therapeutic Results of Group Therapy
- Giving oneself for the benefit of Others (Altruism)
- Gaining new information; LEARNING
- Gaining inspiration; HOPE
Give 4 expected Therapeutic Results of Group Therapy
- Interacting with Others
- Feeling Acceptance and Belonging
- Becoming AWARE that ONE is NOT ALONE, and that others share the same problems
- Gaining INSIGHT into one’s problems and behaviors and how they affect others
The goal is for members to learn about their behavior and to make positive changes in their behavior by interacting and communicating with others as a member of the group:
Psychotherapy Groups;
Groups may be organized around a specific medical diagnosis such as Depression, or other particular issue such as Interpersonal Skills or Anxiety Management
Often formal in structures, with one or two therapists as Group Leaders
Psychotherapy Groups
One task of the group leader is to establish ____ for the group to follow;
Rules
2 Identified Types of Groups in Psychotherapy Groups:
OPEN GROUPS
CLOSED GROUPS
A type of group that is ongoing and run infinitely, allowing members to join or leave the group as they need to
Open Group
A type of group that is structured to keep the same members in the group for a specified number of sessions;
Closed Group;
Members are the ones who decide how to handle members who wish to leave and the possible addition of a new member
Is a form of group therapy in which the patient and their family members participate
FAMILY THERAPY
The goal of this type of therapy is to include the understanding on how family dynamics contribute to psychopathology, mobilizing the family’s inherent strengths and functional resources, restructuring maladaptive family behavioral styles and strengthening family problem-solving behaviors
Family Therapy
Initially one family member is identified as the one who had a problem and needs help through the therapeutic process and other family members who also have emotional problems and difficulties
Family Therapy
It is taught by Trained Family Members.
Family Education
Family Education focuses on what mental conditions/disorders
- Schizophrenia
- Bipolar Disorder
- Depression
- Panic Disorder
- Obsessive Compulsive Disorder (OCD)
Discussion on clinical Tx of these condition and it teaches knowledge and skills that the family need to cope more efficiently
Family Education
This is designed to help providers realize the hardship that the families endure to appreciate the courage and persistence it takes to live with and recover from mental illness
Family Education
The goal of this group is to provide members information on specific issues such as:
- Stress Management
- Medication Management; or
- Assertive Training
Education Groups
Are organized to help members who share a common problem to cope with it
Support Groups
This type of group differs from psychotherapy since members are allowed to contact one another and socialize outside the sessions
Support Groups
This group tends to be an Open Group wherein members can leave or join as their needs dictate
Support Groups
Commonly, Support Groups include those with:
- Cancer
- Stroke Victims
- Person with AIDS
- Family Members of those who Committed Suicide
This can be effectively accomplished in groups; this has been found to decrease anxiety and increase self-control in clients with Generalized Social Phobia
Social Skills Training Groups
These therapy groups have manual, recreational, and creative techniques to Facilitate Personal Experiences, and Increase Social Responses and Self-Esteem
Activity Therapy Groups
Examples of Activity Therapy Groups (there are 6 identified):
- Poetry Therapy Groups
- Art Therapy Groups
- Music Therapy Groups
- Dance Therapy Groups
- Storytelling Groups
- Self-Help Groups
In this type of Therapy Group, the goal is to help members get in touch with feelings and emotions through the use of poetry
Poetry Therapy Groups
This term refers to a process of releasing negative emotional feelings such as grief and anger
Catharsis
This type of Therapy Group is selected as the therapeutic medium because they are powerful but not explicit avenues of communication
Poetry Therapy Group
In this therapy group, the composition produced by each member gives the therapist or group leader a personal insight into the artist personality of the client
Art Therapy Groups
In Art Therapy Groups, this is used as the basis for discussion and exploring members’ feelings
The artworks
This therapy consists of singing, rhythm, body movement, and listening
Music Therapy Groups
It is designed to increase members’ concentration, memory retention, conceptual development, rhythmic behavior, movement behavior, verbal & non-verbal retention, and auditory discrimination
Music Therapy Groups
This therapy group is also used to stimulate expression and discussion of Affect
Music Therapy Groups
It combines movement and verbal modes
Dance Therapy Groups
In dance members, they find it easier to express non-verbally the feeling and emotions that have been difficult to communicate by other means
Dance Therapy Groups
The person’s inner sense is often reflected in body movements and the therapist work to help members integrate their experiences verbally as well as non-verbally
Dance Therapy Groups
A process by which the group members create a story together - this can stimulate interactions and imagination
Storytelling Groups
Wenckus (1994) used an approach in which the group leader or member choose one person to be the main character in the story. The group leader can give direction to the story by having an opening question in mind that is likely to determine the direction of the story
Storytelling Groups
In storytelling groups, a group leader could ask some of the following questions:
- Where would you go if you would be given a trip?
- What would you do if you won the lottery?
- What would you title your auto biography?
- What would your epitaph say?
- If your fairy godmother could grant your wish what would it be?
In this Group, the members share a common experience, but the group is not formal or a structured therapy group
Self-Help Groups
In this group, many are run by the members and do not have a formally identified leader; famous groups like this are alcoholic
Self-help Groups
It involves providing services to people with severe persistent mental illness to help them to live in the community
Psychiatric Rehabilitation
These programs under the Psychiatric Rehabilitation are called?
Community Support Programs
This focuses on the patient’s strengths not just on their illness; includes Community Support Programs
Psychiatric Rehabilitation
The client participates in program planning; the program is designed to help the client manage the illness and symptoms, gain access to needed services and live successfully in the community
Psychiatric Rehabilitation
Are nursing activities that enhance the client’s social and psychological functioning and improve social skills, interpersonal relationships and communication
Psychosocial Intervention
Nurses often use this intervention to help meet patient’s needs and achieve outcomes in all practice meetings, not just mental health
Psychosocial Intervention
The therapeutic response of a Nurse to the Manipulative Behavior of a patient
Behavioral Limit Setting
What is this type of response of the nurse to a patient:
“You gave it a good effort. You were able to complete the task with little assistance”
Positive feedback
Give some of the Goals of Psychiatric Rehabilitation (there are 13 identified):
- Recovery from mental illness
- Personal growth
- Quality of life
- Community reintegration
- Empowerment
- Increase independence
- Decreased hospital admissions
- Improved social functioning
- Continuous treatment
- Increased involvement in treatment decisions
- Improved physical health
- Recovered sense of self
Points to ponder when working in community-based settings, there are 2 key ideas
- The patient can make mistakes, survive them, and learn from them
- The nurse will not always have the answer to solve a client’s problem or resolve a difficult situation
It is a form of shock therapy administered by stimulation of the cerebral cortex with electrical apparatus (electrodes)
Electroconvulsive Therapy (ECT)
