Module 8.1B: Nursing & medications

Question 1

Outline and describe the nurse’s role in medication administration. 4 Phases.

Answer 1

1) Initiation:
- history to establish baseline
- monitor side effects
- physical assessment (allergies)
- symptoms, monitor Obs

2) Stabilisation:
- dosage adjustments
- med monitoring / changes
- symptoms management

3) Maintenance:
- ongoing monitoring of therapeutic range
- education on medications (if mental state allows)
- referral - GP

4) Discontinuation:
- cessation

Question 2

outline nursing assessment & treatment considerations for antidepressants

Answer 2

• acceptability to consumer
• Influence co-occurring disorders
• potential for drug interactions
• Individual adverse side effect
• previous response to treatment
• risk of suicide. possibility of drug overdose
• Psychiatric comorbidities

Question 3

List 6 potential side effects to antipsychotics. (the metabolic syndrome)

Answer 3

• Heart disease
• Lipid problems
• Hypertension
• Type 2 diabetes
• Dementia
• Non-alcoholic fatty liver disease

Question 4

describe Serotonin toxicity

Answer 4

Potentially life threatening emergency resulting from excessive serotonin activity.

Signs & Symptoms:

• Confusion, restlessness, agitation, mania
• Headache, pupil dilation, diaphoresis
• Increased HR & BP, tremor
• Urgent need to urinate & frequency

Emergency interventions:
* cease admin of SSRIs, administer anticonvulsant & benzodiazepine - reduce agitation & induce calm.

If left untreated:

• hyperthermia
• kidney failure
• death

Question 5

describe Serotonin discontinuation syndrome

Answer 5

From abrupt cessation of antidepressant medication

S&S:

• Flu like reaction
• Physical symptoms - headache, GI distress, nausea, dizziness, altered sensation (vision/touch)
• worsening of mood, agitation, anxiety & depression

Management / interventions
* cease administration of SSRIs, monitor, ongoing assessment, education, referral.

Question 6

What are extra pyramidal side effects (EPSE)? identify S&S. (5)

Answer 6

Due to antipsychotics

1) Dystonas (dystonia):
* muscle spasms, oculogyric crisis torticollis (prolonged upward deviation of the eyes)

2) Akathisia:
* restlessness, compulsion to move

3) Parkinsonism:
* Tremor / rigidity, hyper-salivation

4) Tardive dyskinesia:
Abnormal involuntary movements

5) Neuroleptic malignant syndrome:
* severe Parkinson like symptoms and hyperthermia
* Medical emergency

Question 7

The nurse should assess ‘special populations’ when considering psychotropic medications. identify these groups. (3)

Answer 7

1) Pregnancy & Breastfeeding:
* placental barrier
* breast milk

2) Younger people:
* efficacy
* long-term use
* growth & development

3) Older people:
* Physiological changes (liver, kidney function)
* polypharmacy