Mental Health
Erikson's stages of development Infancy-trust vs. mistrust
18 mo-3: Autonomy vs. Shame and doubt
3-6;Initiative vs guilt
6-12:Industry vs inferiority
12-20;Identity vs. role confusion
20-35;Intimacy vs. isolation
35-65:Generativity vs. stagnation
65+: Integrity vs. despair
Stages of cognitive development
-birth-2: sensorimotor -2-7: preoperational
-7-11: concrete -11-adulthood: formal Regression: returning to an earlier developmental stage Repression: unconscious process of blocking undesirable and unacceptable thoughts from conscious expression Sublimation: replacement of an unacceptable need with a more socially acceptable one Suppression: conscious, deliberate forgetting of painful thoughts Denial may be seen in sexual assault victims
Milieu is the environment: SAFETY is priority: therapy says that all team members are seen as equally important in helping clients meet their goals Behavior Therapy
-operant conditioning: manipulation of selected reinforcers to elicit and strengthen desired behavioral responses
-classical conditioning: individual responds to a stimulant
-desensitization: exposure to increasing increments of a feared stimulus is paired with increasing levels of relaxation -aversion therapy: negative reinforcement is used to change behavior -rational emotive therapy: cognitive therapy in which the therapist focuses on how irrational beliefs & thoughts contribute to psychological distress
-psychoanalytical group: communication is focused on the-unconscious, semiconscious, & conscious
-transactional analysis: the 3 ego states- id, ego, superego; -rogerian therapy:help members express their feelings toward one another during group sessions -gestalt therapy:?self expression/exploration/awareness
Mental Health Disorders
Anxiety
-acute: precipitated by loss or change that threatens one's sense of security
-chronic; persists as a response to daily activities Levels -mild: •tensions of everyday life
•person is alert: visual field is increased: can be motivating -moderate: •narrows perceptual field
•selective inattentiveness:
-severe: feeling that something bad is about to happen:
narrows perceptual field:focused on minute or scattered details
:learning & problem solving impossible: needs direction to focus -panic: dread and terror: feeling of impending doom: disorganized personality: unable to communicate or function effectively
increased motor activity: loss of rational thoughts: inability to concentrate: exhaustion & death can occur Actions if client experiencing anxiety
-calm environment, decrease stimuli, stay w/ client
-encourage to express feelings
-monitor for signs or self harm or harm to others
-give antianxiety Meds for severe to panic levels Generalized anxiety disorder(GAD)
-unrealistic anxiety about everyday worries -restlessness, trembling, muscular tension
-dizziness, inability to concentrate, fatigue
-sleep problems, can't see connection btw anxiety and physical symptoms
Panic disorder
-sudden onset of intense apprehension & dread -anxiety attacks lasting 5-30 min
-choking sensation, labored breathing
-pounding heart, chest pain, dizziness
-nausea, blurred vision, numbness
-fear of being trapped/dying Interventions
-use cognitive restructuring
PTSD
-reexperiencing & recurrent & intrusive dreams or flashbacks of traumatic event
-Stressors: natural events: terrorist attack
-combat experiences: accidents: rape
-crime or violence: abuse
-client will be emotionally numb: detached
-depressed: anxious: insomnia: Has nightmares: poor concentration -flashbacks; hypervigilance: guilt
•Be NONJUDGEMENTAL & SUPPORTIVE •use relaxation techniques or hynotherapy or systematic desensitization Phobias
-irrational fear of an object that persists -repression & displacement used -desensitization; relaxing techniques
OCD
-preoccupation with persistently intrusive thoughts & ideas
-compulsion: a performance of rituals or repetitive behaviors designed to prevent, divert unacceptable thoughts, & decrease anxiety
-defense mechanism: repression, undoing, displacement Somatoform Disorder
-persistent worry or complaints regarding physical illness w/o supportive physical findings -may use this to get more attention & decreased responsibilities
Conversion disorder: sudden onset of a physical symptom or a deficit suggesting loss of or altered body fiction related to psychological conflict or a neurological disorder. -blindness. Deafness. Paralysis. Inability to talk
-la belle difference: unconcerned w/symptoms
- feelings of guilt, anxiety
-secondary gain
Hypochondriasis
-preoccupation w/ fears of having a serious disease -complaints of fatigue/insomnia
-anxiety: somatic complaints Somatization disorder- multiple physical complaints that are psychological in nature
Dissociative disorder- disruption in integrative functions of memory, consciousness, or identity Dissociative identity disorder(DID): formally called multiple personality disorder -host is primary personality & others are alters
-alters are aware of host but host not aware -inability 2 recall info
-transition 2 one personality to the other is related to stress/traumatic event
Dissociative amnesia: inability to recall important personal info because it provokes anxiety Dissociative fugue: client assumes new identity in a new environment Depersonalization disorder: altered self-perception in which one's own reality is temporarily lost or changed -feelings of detachment -explore methods of coping:develop trusting relationship: focus on strength
Mood Disorders
•Bipolar
-Mania
:angers easily: delusional: limit pushin
:no inhibition: euphoria: flight of ideas
:decrease in appetite; bizarre dress: :sexual promiscuity -Depression
:decrease in normal activities
:introverted: lack of energy/confidence/initiative :increased or decreased appetite
:social isolation: suicidal thinking Meds:
-lithium: increase Na & fluid intake to decrease risk of toxicity -Valproic acid: reduce acute symptoms & maintenance therapy -carbamazepine: reduce acute symptoms & maintenance therapy -Lamotrigine: maintenance therapy -Antianxiety Meds used to manage psychomotor characteristics of mania; don't use if pt has substance abuse
-Atypical antipsychotics: sedative & mood stabilizing effects Dealing w/inappropriate behavior
-identify feelings & talk it out
-describe consequences -set limits
-maintain safety & remove hazardous object
-seclusion may be needed if hyperactive behavior is dangerous
Depression -mild: follows normal grief reaction
:lasts less than 2 weeks :feeling sad, disappointed: sleep alterations
:increased/decreased appetite: drugs/alcohol
-moderate:despondent: dejected: low self esteem; anxiety & fear: anorexia: somatic changes: social withdrawal: menstrual changes: rumination -Severe: hopelessness: guilt: flat affect
:poor concentration: decreased speech
:suicidal thoughts: poor posture :psychomotor retardation: constipation :urinary retention: lack of sexual interest
:delusions/hallucinations/insomnia -Offer high calorie/protein snacks and fluids
-Ask directly"have you thought of hurting yourself?"
ECT: treatment for depression
-causes a seizure within the brain
-pre-medicate to relax muscles
-6-12 treatments given 2-3x a week Who should get ECT
-pts in extreme agitation or stupor
-when antidepressants don't work -need for a rapid response:suicidal
Preprocedure: NPO; baseline Vitals: remove hairpins, contact lenses, dentures
During: monitor BP throughout -100% O2 mask via positive pressure
-airway it bite block 2 prevent biting
Post-may be confused:
SE: confusion. Short term memory loss Schizophrenia
-group of mental disorders characterized by psychotic features
-Positive symptoms: hallucinations: delusions : Disorganized speech: bizarre behavior -Negative symptoms: blunt affect: alogia: anergy: anhedonia: avolition
-cognitive symptoms: Inattention, impaired memory: impaired judgement -dysphoria: suicidality: hopelessness
-echolalia: echopraxia: waxy flexibility: -compulsive rituals:over-compliance
Abnormal thought processes
-circumstantiality: getting caught up in countless details & explanations -confabulation: fantasy story -flight of ideas: constant flow of speech: jumps from one topic to another
-looseness of association: interrupted connections in thought
: neologisms: made of new words
:thought blocking: sudden cessation of a thought
:word salad-mix of words and phrases Types of Delusions
Delusions- a fixed false belief Grandeur: one is powerful and important
Jealousy:one's mate is cheating Persecution: thought of being singled out DON'T argue with the pt about delusion
-loss of reference: client believes that certain events are related to them
-somatic delusions: pt believes his body is changing in an unusual way -illusion: brief experiences w/misperceptions -hallucinations; with no basis in reality :occurs within the 5 senses
:ask directly about hallucination
:AVOID touching Language & communication disturbances
-clang association:repetition of words that are similar in sound
-echolalia: repeating what others say
-mutism: not talking at all
-neologism
-pressured speech: speaking as if words are forced out quickly
-verbigeration: purposeless repetition of words -word salad
Types of schizophrenia
-catatonic: psychomotor disturbances: stupor; waxy flexibility: echolalia: automatic obedience -disorganized:social withdrawal: flat affect: stereotyped behavior: grimacing: can't do ADLs
-paranoid:suspicious: hostile: delusions
:auditory hallucinations: anger: violence -residual: time limits btw attacks: social isolation: withdrawal: impaired role function
-undifferentiated: delusions. Hallucinations :disorganized speech/behavior: flat affect: :social withdrawal -DON'T go along w/ delusions/hallucinations -Reorient client: speak in simple, direct term
-set realistic goals: don't offer choices at 1st
-set limits: decrease stimuli: suicide risk :SAFETY 1st: Paranoid disorders
-pervasive delusional system characterized by persecutory/grandiose beliefs -pt is hostile. Stubborn. Defensive -evasive. Quarrelsome: Low self esteem
:suspicious: poor judgments: hyper-vigilance
:highly sensitive: :denial. Projection. Rationalization Types: -paranoid: suspicious but everything else is normal -paranoia-induced:onset in response to stress; delusions. -paranoia:organized delusional system: psychotic state:
-paranoid schizophrenia:cold, withdrawn, :distrustful, resentful, argumentative, :sarcastic, defiant :bizarre delusions: persecutory hallucination
:psychotic state: symp. Of schizophrenia Interventions -avoid direct eye contact
-be honest: safety: don't laugh or whisper in front of Personality Disorders
-stress exacerbates manifestations -poor impulse control: acting out
:abandonment: depression: rage. Guilt. Fear
:impaired judgment/reality/self perceptions/ object relations/thought processes/ stimulus barrier -insomnia. Poor attention span
Cluster A: odd & eccentric
-schizoid: inability to form warm. Close. Social relationships
:indifferent. Lack of interest in others
-schizotypal: abnormal or highly unusual thoughts: suspicious. Paranoia. Magical thinking: relationship deficits -paranoid: as listed above for paranoid disorders
Cluster B: -histrionic: dramatic. Likes being center of attention: provocative. Dramatic. Easily bored. Overly concerned w/appearance -narcissistic: increased sense of self importance: need for admiration: lack of empathy
-antisocial personality: irresponsible & antisocial behavior, selfishness, no shame or guilt: unreliable: self centered: impulsive
-borderline personality: instability in interpersonal relationships: unstable mood and self image:impulsive :easily angered/bored: manipulator: feelings of emptiness: cuts themselves :splitting: creates conflict btw ppl
Cluster C:
OCPD: difficulty expressing warm & tender emotions, perfectionism, stubbornness, need to control others, devotion 2 work
-conscientious: hoarding: stubborn -avoidant: social withdrawal & sensitivity 2 potential rejection -dependent: lack of self confidence: low self esteem: inability to function independently: Interventions -be consistent. Allow client to make decisions -identify splitting behavior
-set & maintain limits
Cognitive disorders
-Autism: see PEDS outline
-ADHD:see PEDS outline
Dementia: progressive deterioration in intellectual functioning -memory loss: judgment impairment -self care deficit
-most common type is Alzheimer's Alzheimer's Disease
-agnosia: failure to recognize familiar objects
-amnesia: loss of memory -aphasia: language disturbance -apraxia:inability to perform motor activities
-it's irreversible: caused by nerve cell deterioration Stages
1-forgetfulness
2-confusion
3-ambulatory dementia
4-end stage(usually death) -identify & reinforce retained skills -manage memory deficits -help w/ADLs as needed
-allow plenty of time to complete a task
-allow for safe wandering
-sundowning: increase in symptoms at night
-use a firm and low pitched voice
-stand directly in front of client
-be calm: speak slowly and use short words
-repeats questions but don't rephrase -remove throw rugs or dangerous equipment
-orient client: follow a routine
-DON'T give hypnotics
Psychosexual alterations
-bisexual
-heterosexual
-homosexual
-transvestism
Transsexualism: one's gender is inappropriate & wanting traits of the opposite gender Exhibitionism: exposing genitals to strangers Fetishism: using non-living objects for sexual gratification Pedophilia: desiring sexual activity w/child younger than 13
Sexual masochism: likes receiving pain
Sexual sadism:likes inflicting pain(Christian Grey 😭😭)
Voyeurism: likes watching others have sex or get naked
Zoophilia: sexual contact with animals
Frotteurism: gets off from ribbing against an nonconsenting person
Addictions
Eating Disorders
-compulsive overeating us bingelike w/o purging
-feels depressed after eating-tries to diet w/o success -anorexia nervosa
:fears obesity: body image distorted :death can occur form starvation. Suicide. Cardiomyopathy. Electrolyte imbalance -compulsive exercising. Overachiever/ perfectionist: -low temp/pulse/BP: weight loss. :Constipation: gum & teeth deterioration: -:esophageal varices: dry, scaly skin. Lanugo :sleep disturbances; hormone deficiencies
:amenorrhea for 3 periods: cyanosis :bone degeneration
-bulimia nervosa
:eating binges followed by purging :normal weight
:attempts to lose weight through diets, vomiting, enemas, cathartics, amphetamines, diuretics
:low self esteem: poor relationships
:mood swings: electrolyte imbalances
:deceased interest in sex
-Assess nutritional status -establish trust in a relationship
-implement modification techniques
-supervise during mealtimes & after -weigh daily Substance abuse disorders -CAGE screening questionnaire(alcohol)
C-have you ever felt the need to cut down A-have you ever been annoyed at criticism
G- have you ever felt guilty
E-have you ever had an eye opener
Substance dependence/ - pattern of repeated use of a substance
-other screeners: MAST::: DAST
Substance abuse: uses recurrently: harmful consequences due to use: legal issues
Substance withdrawal: physiological & substance specific cognitive symptoms Peer pressure may contribute to substance abuse
-sometimes used as a coping mechanism
Behaviors
-impulsiveness: anger: abuse: manipulation
-denial-rationalization-projection: depression: low self esteem -codependency; presence of coexisting behaviors present in significant other which enables clients to continue Alcohol abuse
-biological: depression: low self esteem
-poor self control: rebellious: poor parental relationships Assessment
-slurred speech: uncoordination: unsteady:
-restlessness: confusion: binge drinking
-missing work: increased intolerance -BAC 0.1%
Complications -vitamin B deficiency-peripheral neuropathy
-thiamine deficiency-Korasakoff's syndrome
-amnesia: hepatitis: cirrhosis of the liver
-pancreatitis: anemias: immune system dysfunctions: brain damage: cardiac disorders -Wernicke's encephalopathy: confusion. Ataxia. Abnormal eye movements Alcohol withdrawal -anorexia: GI: anxiety: easily startled: hyperalert: insomnia: jerky movement: hallucinations: seizures: tachy: tremors: -chlordiazepoxide or Benzos to decrease symptoms -give IM of thiamine for Wernicke's encephalopathy
-withdrawal delirium: agitation. Anorexia. Delirium. Diaphoresis. Disorientation. Fever. Delusions. Tachy. HTN. Insomnia. MEDICAL EMERGENCY
•death can occur from MI. fat emboli. Peripheral vascular collapse. Electrolyte imbalance. Aspiration pneumonia. Suicide
Interventions
-monitor VS every 15 min: initiate seizure precautions: quiet,nonstimulating environ. -monitor I&O: administer vitamins
Disulfiram: sensitized client to alcohol: reaction occurs if alcohol is consumed
-AE: flushing. HA. Sweating. Neck pain. GI. -hypotension. Tachy. Respiratory distress
-avoid any products that contain alcohol
Drug dependency
-CNS depressants
•alcohol. Benzodiazepines. Barbiturates
:INTOXICATION: drowsiness. Hypotension. Impairment of memory/attention/judgment: incoordination. Irritability. Slurred speech. -OD: if awake induce vomiting & activated charcoal; flumazenil for benzo OD: -withdrawal: GI. Tachy. Diaphoresis. Irritability. Tremors. Insomnia. Seizures. CNS stimulants
-amphetamines. Cocaine. Crack
-INTOXICATION: dilated pupils. Euphoria. HTN. Impairment. GI. paranoia. Delusions. Violence. Tachy. OD can cause respiratory distress. Ataxia. Hyperpyrexia. Seizures. Coma. Stroke. MI. DEATH: treat w/antipsychotics
-withdrawals include: fatigue. Depression. Agitation. A party. Anxiety. Insomnia. Disorientation. Lethargy. Craving. : treated w/ antidepressants. Dopamine agonist. Bromocriptine. Opiods
:opium. Heroin. Meperidine. Morphine. Codeine. Methadone. Hydromorphone. Oxycodone. Fentanyl. :INTOXICATION-constricted pupils:decreased respirations: drowsiness: euphoria: hypotension: impairment of memory/attention/judgment: psychomotor retardation: slurred speech -OD treated with naloxone -withdrawal effects: yawning. Insomnia. Irritability. rhinorrhea. Cramps. GI. Muscle aches. Lacrimation. Diarrhea. Fever
-treat withdrawal w/methadone detoxification
-clonidine reduce severity of CNS symptoms Hallucinogens
-LSD. Mescaline(peyote). PCP. Psilocybin(mushrooms)
-bizarre behavior. Blank stare. Dilated pupils. Elevated VS. hallucinations. Incoordination. Muscular rigidity & jerking. Paranoia. Seizures. Tachy. Depression -Give antianxiety Meds: for PCP, gastric lavage if alert(treatments to help w/HTN. Hyperthermia. Respiratory distress) -Flashbacks can occur: SAFETY is priority
Inhalants
-intoxication: enhancement of sexual pleasure: euphoria. Excitation. Lightheadedness. Agitation. Laughter
-can cause DEATH Marijuana
-smoked but can be ingested -causes euphoria. Relaxation. Detachment. Anxiety. Paranoia
-lethargy. Difficulty concentration. Memory loss. Respiratory disorders MDMA/GHB/methamphetamine(crack,meth)/ketamine(special K)
-euphoria. Increased energy. Increased self confidence. -AE: hyperthermia. Rhabdomyolysis. Kidney failure. Hepatotoxic. Depression. Panic attacks. Psychosis. CV collapse. Death
-seizure precautions. Hydration. Dual diagnosis: when pt uses alcohol & alcohol and can mask symptoms Signs of addiction
-reporting wasted drugs but not having another nurse to witness -reporting administering max dose to pt when other nurses don't. -volunteering to carry narcotic keys: choosing shifts with less supervision. Epinephrine AE: Chest pain. HTN
Herpes is contact precautions
Low fiber with Crohn's
Droplet precautions for pneumonia
AP can perform gastrostomy feedings
Pulmonary edema: pink frothy sputum
Stages of Grief
1-shock & disbelief 2-experiencing the loss(angry/guilty) - may start bargaining: depression onset
3-reintegration : accepts the loss
-Anticipatory grief: occurs before the actual loss occurs in association w/ terminal, acute, or chronic illness
-disenfranchised grief: a loved one is loss but the culture doesn't allow it to be acknowledged openly -dysfunctional grief: prolonged emotional instability w/ no resolution of the grief
Grief in kids
-Birth to 1- no concept of death
-1 to 2: death is reversible. May scream, withdraw -2 to 5: death is reversible: worries about who'll take care of them: regressive/aggressive behavior
-5 to 9: starting to see death as permanent: thinks they're the cause: difficulty concentrating Mourning- outward & social expression of loss
Bereavement: inner feelings and outward reactions of the person experiencing the loss
Suicidal behavior
-high risk groups: previous hx of attempt: family history: adolescents: older ppl: disabled or terminally ill pts: personality disorder: substance abusers
-clues: *giving away personal items: canceling social engagements: making out or changing will
*poor appetite: insomnia: difficulty concentrating: hopeless: suicide statement: sudden calmness: interest in poisons, guns, bombs: -Assessment: Plan, Hx of attempts,psychosocial factors
-Interventions: DON'T leave the client alone: suicide precautions: remove harmful objects
Abusive behaviors -Anger. Aggression. Violence
-Assessment: glaring. Yelling. Defiant. Argumentative. Flushing. Poor impulse control. Hx of violence. Pacing . -Intervention: SAFETY: mAintain large area of space: set limits: inform client of consequences Seclusion &'Restraints
-NEVER to be used for convenience
-ONLY used after other less restrictive methods are effective
-NOT PRN: order has to be rewritten every 24 hours: HCP MUST come see patient within 1 hour of issuing script -MUST be assessed every 15-30 & needs constant supervision
Bullying
-can lead to depression, low self esteem, humiliation, isolation, & social withdrawal
Family violence
-Cycle of Violence
:begins with verbal or minor physical assault(tension building)
:abuser loses control and becomes destructive (acute battering) :abuser becomes loving(tries to make peace)
:abuser justifies the violence & says it's the victim's fault
-The most vulnerable are kids & old ppl
-Characteristics of abuser
:impaired self esteem: strong dependency needs: narcissistic & suspicious: Hx of abuse as a child: -Interventions
:report findings: look for evidence of physical abuse (bruises in multiple stages of healing)
: develop a safety plan: assess for potential of suicide/homicide: Child Abuse
-Neglect: inadequate weight gain. Poor hygiene. Inconsistent school attendance. Constant fatigue. Delinquency. -Physical: unexplained bruises. Bald spots on scalp. Apprehension. Lack of crying when approached by stranger. Spiral fractures. -Emotional: speech/learning/habit disorders. Psychoneurotic reactions. Suicide attempts
-Sexual:difficulty walking or sitting: torn,stained,or bloody underclothes. Lacerations in genital or anal area. Poor peer relations. Unwilling to change clothes
-Shaken baby syndrome: no external signs of trauma. Retinal hemorrhage. Bulging fontanels & head circumference greater than expected
-REPORT ALL suspicions
Older Adult Abuse
-Physical: sprains. Fractures. Bruises. Pressure sores. Burns. Skin tears. -Sexual: torn or stained underclothing. Difficulty walking or sitting. Unexplained genital infections. Discomfort/bleeding in genital area -Emotional: confusion. Fearful. Agitated. Changes in appetite/weight. Withdrawn
-Neglect: disheveled appearance: dehydration. Malnutrition Medications: Antidepressants
-SSRIs
:citalopram. Fluoxetine. Paroxetine. Sertraline
:inhibits serotonin uptake: Don't use St. John Worts
:SE-GI. Dry mouth. CNS stimulation(akathisia-restlessness, agitation)
-increased sweating. Photosensitive.
-BP changes. Insomnia. HA. Weight loss/gain. -Decreased libido. Tremors. Seizure activity. -monitor liver and renal function tests/WBC -Priapism(painful, prolonged penile erection)
-DON'T stop abruptly
-Serotonin syndrome: fever. Muscle rigidity. High CK levels. -SNRIs
:venlafaxine. Duloxetine. -Atypical Antidepressants :Buproprion. Mirtazapine. Trazodone Tricyclic Antidepressants
-Amitriptyline. Doxepin. Trimipramine
-blocks reuptake of norepinephrine & serotonin
-may reduce seizure threshold & effectiveness of antihypertensives: DON'T give with alcohol
-cardiac toxic
-OD: Airway. Administer O2. Give physostigmine & antidysrhythmic Meds -Signs of OD: Tachy. Intraventricular block. -Hypothermia. Flushing. Dry mouth. Dilation of pupils. Confusion. Agitation. Seizures Hallucinations
-Anti-cholinergic effects: CAN'T see, pee, spit, poop
-photosensitive,CV, orthostatic hypotension
-sedation. Seizures. Weight gain. Anxiety. -decreased/increased libido:sedation
- monitor liver and kidney tests -may take 2-4 weeks after first dose to see results: DON'T stop abruptly MAOIs
-phenelzine. Tranylcypromine. Isocarboxazid. Selegiline -inhibits enzyme monos mine oxidase
-monoamines(norepinephrine, amines, serotonin -AVOID foods containing tyramine which can lead to a hypertensive crisis :avocados. Banana. Beef or chicken liver. Yeast. Broad beans. Caffeine. Aged cheese. Eggplant. Figs. Meat extracts. Overripe fruit. Papaya. Soy sauce. Pepperoni. Red wine
-SE: orthostatic hypotension. Anticholinergic effects:insomnia. Weakness. GI. weight gain. -Edema: anxiety. Agitation. Mania. Delay in ejaculation
-Hypertensive crisis
:HTN. occipital HA. Neck stiffness. GI. Sweating. Fever. Chills. Clammy skin. Dilated pupils. Palpitations. Tachy or Brady. Chest pain. :Antidote: Phentolamine by IV :may take up to 3 weeks after first dose to see results: DON'T stop abruptly Mood Stabilizers
Lithium- affect cellular transport mechanism -therapeutic level 0.6-1.2 -cause of toxicity: low Na intake. Fluid & electrolyte loss due to excessive sweating. Dehydration. Diuretic therapy
-can cross the placental barrier -SE: polyuria. Polydipsia. GI. Fine hand tremors. Soft stools or diarrhea. Abdominal bloating. Weight gain. Mild thirst. Dry mouth. HA. Hypothyroidism. Hair loss. -DON'T give diuretics -drink plenty of water -toxicity: 1.5+
:Mild-apathy. Lethargy. Mild ataxia. Coarse hand tremors. Muscle weakness
:Moderate: GI. Ataxia and incoordination. Spurred speech. Tinnitus. Blurred vision. Muscle twitching. Irregular tremor
:Severe: nystagmus. Muscle fasciculations. Hyperreflexia. Hallucinations. Oliguria. Impaired LOC. tonic clonic seizure or coma
-monitor ECG. Renal function test and thyroid test
Antianxiety Meds
-depress the CNS, increase effects of GABA -Benzos end in pam
:diazepam. Lorazepam. Chlordiazepoxide :don't give with acute narrow angle glaucoma SE: sedation. Ataxia. Dizziness. HA. Blurred vision. Hypotension. Tremor. Amnesia. Slurred speech. Anticholinergic effects
-toxicity: somnolence. Confusion. Finished reflexes and coma. -Flumazenil is antidote -at risk from falling Barbiturates & Sedative-Hypnotics
-end in barbital(pentobarbital)
-ramelteon. Zolpidem
-depressed RAS by promoting the inhibitory synaptic action of GABA -SE: dizziness. Confusion allergic reactions. Agranulocytosis. Thrombocytopenia. Megaloblastic anemia •OD: Tachy. Hypotension. Cold,clammy skin. Dilated pupils. Weak pulse. Shock. Absent reflexes. Coma or death. •withdrawal-anxiety. Insomnia. Nightmares. Tremors. Delirium. Seizures. Antipsychotics
-affects dopamine receptors in the brain -Typical: haloperidol. Thiothixene: chlorpromazine: loxapine
•more effective for positive symptoms of schizophrenia(hallucinations, aggression, delusions:has an antiemetic effect)
-Atypicals: clozapine: risperidone: aripiprazole
•more effective for negative symptoms(avolition: apathy: alogia)
-SE: Anticholinergic effects(dry mouth Tachy. Urinary retention. Constipation. Hypotension) :Extrapyramidial effects (EPS):parkinsonian. Tremors. Mask like face. Rigidity. Shuffling gait. Drooling. Dysphagia
:Dystonias(abnormal eye movement, facial grimacing) -Akathisia(restlessness)
-Tardive Dyskinesia(TD:protrusion of tongue, chewing, involuntary body movement)
-Drowsiness, blood dyscrasias , pruritus, weight gain, high glucose, gynecomastia, photosensitive: NMS -For clozapine, monitor WBC count; can cause agranulocytosis(sore throat. Fever. Malaise)
-urine may change to pink to red-brown -report signs of liver dysfunction Neuroleptic Malignant Syndrome(NMS)
-can occur w/ ANY antipsychotics
-Assessment: dyspnea or Tachy: fever. Irregular pulse. High or low BP. increased sweating. Loss of bladder control. Muscle rigidity. Pale skin. Weakness. Altered Loc. seizures. Difficulty swallowing. Dyskinesia. High WBC count, liver function studies, and CK levels. Severe EPSs. Oculogyric crisis -interventions: notify HCP. VS. safety & seizure precautions. Discontinue Meds. Give antipyretics. ADHD Meds
-amphetamine: atomoxetine: dextromethylphenidate: -reduce hyperactive behavior & lengthen attention span -SE: Tachy. Weight loss. High BP. dizziness. Agitation. -monitor CNS. get baseline ECG. Alzheimer's Meds
-donepezil: memantine; rivastigmine: tacrine -acetylcholinesterase inhibitors used to improve cognitive functions(treats dementia)
-donepezil: SE(Nausea & diarrhea): slows HR
-memantine:SE(dizziness. HA. Confusion. GI
-rivastigmine: SE(GI. anorexia. Abdominal pain)
-Tacrine:SE(ataxia. Loss of appetite. GI): hepatotoxic.