Class 5: Mental Health Flashcards
Common outcomes for schizophrenia
Reduced risk of harm to self or others
Refrains from attending to and responding to delusions and hallucinations
Increased self-care, medication adherence
Asks for validation of reality, exhibits reality-based thinking
Nursing interventions for schizophrenia
-Self-care, milieu, & group therapy
Promoting self-care + nutrition
Antipsychotics cause weight gain leading to the onset or worsening of diabetes and metabolic syndrome
Self-care in schizophrenia + attire
Clean & weather appropriate clothing
Purpose of milieu therapy
-Decrease stimuli, protection from stressors and structured activities
-Monitor for signs of aggression
Structured activities provide…
Distraction from delusions and hallucinations
Signs of aggression
Externally responding to delusions and hallucinations
Purpose of group therapy in schizophrenia
-Increase social skills, modify unacceptable behavior
-Participate in constructive leisure activities
-Provide external support and opportunities to practice new skills
Antipsychotics: General information
-Known as neuroleptics
-Highly lipid soluble
Typical antipsychotics
-1st gen/conventional antipyschotics
-CHFPFZ
-Chloropromazine
-Haloperidol
-Fluphenazine
-Primozide
-Flupenthixol
-Zuclopenthixol
Typical antipyschotic MOA
Block D2 receptors (dopamine receptors that control synthesis, release & reuptake)
Typical antipsychotic indications
-Treat positive NOT negative symptoms
-Psychosis, Schizophrenia, Bipolar, Aggression/Agitation
Other information about typical antipsychotics
-2nd line tx
-Used for depot injection (long acting, 2 weeks)
-Less weight gain, decreased incidence of metabolic syndrome
Typical antipsychotic interactions
-CNS depressants (additive, increased sedative effect)
-Stimulant (competes, decreased effectiveness)
CNS adverse effects + typical antipyschotics
Sedation & reduced seizure threshold
Extra pyramidal symptoms + typical antipsychotics
Dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia
Neuroleptic malignant syndrome + typical antipsychotics
-Muscle rigidity
-Increased temperature, HR & CK, aBP & mental status
Agranulocytosis + typical antipsychotics
Decreased neutrophils
Typical antipsychotics CV adverse events
Postural hypotension, tachycardia, non-specific ECG changes, arrhythmia
Typical antipsychotic anticholinergic adverse events
Dry mouth, blurred vision, constipation & urinary retention
Typical antipsychotic adverse events + endocrine/sexual side effects
-Increase prolactin
-Decreased sexual drive, ED, retrograde ejaculation
Typical antipsychotic GI adverse events
Constipation/diarrhea
Atypical antipsychotic medications
-2nd gen/unoconventional antipsychotics
-“pines”, “dones”, LAZCORQ
-Lurasidone, ziprasidone, risperidone
-Quetiapine, clozapine, olanzapine,
-Aripiprazole
Atypical antipsychotic MOA
-ACHS
-Blocks dopamine receptors D1 – D5 (serotonergic, alpha adrenergic, histamine, and cholinergic receptors)
-Preferential binding in the limbic area vs. the striatum area of the brain; reduces EPS
Atypical antipsychotic indications
-Treat positive & negative symptoms of schizophrenia
-TX of bipolar disorder, and for aggression/agitation
Atypical antipsychotic: Other information
-Less EPS & prolactin elevation, lower risk of TD
-Improve cognition
-Considered 1st Line Treatment
Atypical antipsychotic interactions
CNS depressants & stimulants
Atypical antipsychotic adverse reactions
-Headache, nausea, sedation, fatigue
-Anticholinergic effects
-Weight gain, edema, dyslipidemia, hyperglycemia, hyperthermia
-HTN, hypotension, tachycardia, increased prolactin, prolonged Q-T
-EPS, NMS
Antipsychotic implications for nursing
-Thorough physical assessment, change positions slowly
-Supports, finances (meds can be very expensive)
-Assess for safety concerns (more energy but same mood for first few weeks)
Adverse drug reactions: Metabolic syndrome
-Abdominal obesity: Waist circumference >40” in men & >35” in women
-Dyslipidemia, elevated fasting glucose & BP
-Lead to CVD
Adverse Drug Reaction: Metabolic Syndrome monitoring
-BP, BMI and waist circumference at baseline, 1, 2, 3, 6, 9, & 12 months
-Lipid panel & FBG at baseline at 3, 6, & 12 months
Adverse Drug Reaction: Metabolic Syndrome tx
-Diet, exercise, smoking cessation
-Medications PRN for BP, diabetes, cholesterol, and weight
Adverse Drug Reaction: Extrapyramidal symptoms (EPS)
-Dystonia, tardive dyskinesia, akathesia, & parkinsonism
-DTAP
Parkinsonism
Tremor, shuffling gait, drooling, cogwheel, rigidity
Akathesia
Muscle weakness, restlessness & rigidity
Dystonia
Spasms & cramping in face, arms, legs, and neck
Tardive dyskinesia
Bizarre facial, tongue, and upper/lower extremity movement: Lip smacking, blinking or grimacing, stiff neck, difficulty swallowing
Medications For the Treatment of Extrapyramidal symptoms (EPS): EPS can be minimized by
-Decreasing antipsychotic dose
-Adding an antiparkinsonian drug or anticholinergic agent
Medications For the Treatment of Extrapyramidal symptoms (EPS): General (trade) name
-TBD
-Trihexyphenidyl
-Benztropine mesylate
-Diphenhydramine hydrochloride
Trihexyphenidyl & benztropine mesylate + Medications For the Treatment of Extrapyramidal symptoms (EPS)
-Antiparkinsonian drugs & anticholinergic agents
Diphenhydramine hydrochloride + Medications For the Treatment of Extrapyramidal symptoms (EPS)
Antihistamine (used for its anticholinergic properties)
Adverse Drug reaction: Neuroleptic malignant syndrome (NMS)
-Has been treated with neuroleptics within 7 days
-aMental status & BP, tachycardia, hyperthermia
-Muscle rigidity, leukocytosis, & incontinence
Managing toxicity of antipsychotics in order
-Hold medication
-Manage life threatening adverse reactions
-Notify physician
-Document
Benzodiazepines may be used to…
Treat intermittent episodes of intense anxiety
Other medications may be used for…
-Their off-label sedative effects
-Examples: Imovane (hypnotic), Trazadone (antidepressant), Seroquel (antipsychotic)
-SIT
Caffeine
May be helpful for patients who exhibit negative psychotic symptoms
Nicotine can…
Decrease the release of dopamine, resulting in less intense hallucinations
Stimulants such as cocaine…
Mimic dopamine and are contraindicated in the treatment of psychotic disorders
Health teaching & promotion + schizophrenia
-Emphasis on the chronic and recurrent nature of the illness
-S&S of impending episodes: Vegetative shifts (changes in nutrition, sleep and activity)
-Side effects of medication
Evaluation of schizophrenia
-r/t quality of life
-Frequent assessment, do not evaluate presence or absence of delusions and hallucinations
BPD patient outcomes
-Personal behaviors promote effective relationships
-Positive adaptation to significant events
-Patient can exercise self-restraint of negative and destructive behaviors
Guidelines for interventions
-Set realistic goals
-Communication is clear & straightforward
-Avoid rejecting and rescuing patient when problem behaviors arise
-Consistently implement the care plan
Avoid rejecting and rescuing patient when problem behaviors arise: Examples
-Attributing behavior to past events (reminds pt of all the bad things that have happened to them)
-Attributing behavior to the diagnosis (says that patient IS a personality disorder)
-Not offering hope for change
Facilitating consistent client care
Slide 48
Nursing intervention strategies: Limit setting
-Establishing boundaries of acceptable behavior:
-Create a plan with consequences
-Accommodate reasonable changes but be careful that accommodation does not turn into bargaining
-ACE
Nursing intervention strategies: Controlling anger
-Assist the patient to identify the source of their anger
-Encourage patient to seek assistance to manage anger
-Can be a warning sign
-ACE
Nursing intervention strategies: Managing impulsivity + problem solving strategies
-Identify the problem
-Use a stop and think approach
-Brainstorm alternative courses of action
-Evaluate the outcome for the chosen course of action
Nursing intervention strategies: Managing self-harm
Slide 53
BPD dialectical behaviour therapy (DBT) premise
-Combines cognitive and behavioral techniques with mindfulness
-Emphasizes being aware of your thoughts and actively shaping them
BPD dialetical behaviour therapy (DBT) goal
Increase distress tolerance & improve social skills
BPD dialetical behaviour therapy (DBT) tx targets
Identify interventions for suicidal behavior & interrupt destructive behaviors
DBT core strategies
-Acceptance Strategies: Validation & cheerleading
-Change Strategies: Observing Limits & skill Teaching
Acceptance strategy: Validation
-Recognize the kernel of truth
-Communicates that staff accept the pt
Change strategies: Skills training
Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness
Skills training: Mindfulness
-Helps to distinguish between thoughts, assumptions, and FACTS
Skills training: Distress tolerance
-Used in the moment to reduce stress and increase safety. NOT an effective long term survival skill
-Tasks: Stay present, tolerate and accept distress, avoid impulsive actions
Skills training: Emotional regulation (emotions can be…)
Important for effective communication, can be self validating and guiding
BPD medications do…
Not treat the underlying personality disorder
BPD health teaching & promotion
-Emphasis on chronic nature of the illness
-Education r/t understanding triggers, behaviours contributing to safety risks, and establishing a safety plan
BPD long term evaluation
-Develops relationships, positive coping strategies and free from self-harm
