Download - 05 psychiatric nursing
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Levels of Levels of Interventions in Interventions in
Psychiatric Nursing Psychiatric Nursing
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Primary• Interventions aimed at the promotion
of mental health and lowering the rate of cases by altering the stressors
• Examples– Health education– Information dissemination– Counseling
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Secondary • interventions that limits the severity
of a disorder.
2 Components• Case finding• Prompt treatment
Examples:• Crisis intervention• Drug administration
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Tertiary• Interventions aimed at reducing the
disability after a disorder
2 Components• Prevention of complication• Active program of rehabilitation
Examples:Alcoholics anonymousOccupational therapy
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The Psychiatric The Psychiatric Nurse Nurse
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CharacteristicsCharacteristics• Empathy - the ability to see beyond
outward behavior and sense accurately another persons’ inner experiencing
• Genuineness/congruence – ability to use therapeutic tools appropriately
• Unconditional positive regard - respect
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Roles of the Nurse in Roles of the Nurse in Psychiatric SettingPsychiatric Setting
• Ward manager • Socializing agent• Counselor• Parent surrogate• Patient advocate• Teacher• Technician• Therapist• Reality based• Healthy role model
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Principles of Care in Psychiatric Principles of Care in Psychiatric SettingsSettings
• The nurse views the patient as a Holistic human being with interdependent and interrelated needs
• The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is
• The nurse should focus on the patients strengths and assets and not on his weakness and liabilities
• The nurse views the patient's behavior non-judgmentally, while assisting the patient to learn more adaptive ways of coping
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• The nurse should explore the patient's behavior for the need it is designed to meet and message it is communicating
• The nurse has the potential for establishing a nurse-patient relationship with most if not all patients
• The quality of the nurse - patient relationship determine the degree of positive change that can occur in the patient's behavior
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BASIC CONCEPTS ON BASIC CONCEPTS ON PSYCHOPHARMACOLOGY PSYCHOPHARMACOLOGY
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Major Major Tranquilizers/Antipsychotics Tranquilizers/Antipsychotics
Indication: Schizophrenia and Other Psychosis
Examples:• Haloperidol (Haldol) • Prochlorperazine (Compazine) • Fluphenazine (Prolixin)
• Chlorpromazine (Thorazine)
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Desired Effect: Control of symptoms
Nursing Implications:• Best taken after meals• Report sorethroat • avoid exposure to sunlight• Report elevated temperature • Check the BP
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Side effects:• Blurred vision, dry mouth, tachycardia,
palpitation, constipation, urinary retention• Skin: Photosensitivity• BP: Orthostatic hypotension• EPS-Extra Pyramidal Symptoms
– Pseudoparkinsonism - pill-rolling tremors, mask-like face, cog-wheel ,rigidity, propulsive gait
– Akathisia - restless leg syndrome– Dystonia - defect in muscle tone
Adverse effect:• Tardive dyskinesia-lip smacking• Agranulocytosis• Hepatotoxicity
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MINOR TRANQUILIZERS/ MINOR TRANQUILIZERS/ ANXIOLYTICSANXIOLYTICS
Common indication: Anxiety disordersDesired Effect: Decreased anxiety, adequate
sleep
Examples: Diazepam (Valium) Oxazepam (Serax)Chlordiazepoxide (Librium)Chlorazepate Dipotassium (Tranxene)Alprazolam (Xanax)
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Nursing Implications:• Best taken before meals, food in the
stomach delays absorption • Avoid driving, intake of alcohol and
caffeine containing foods, since it alters the effect of the drug
• Administer it separately, it is incompatible with any drug
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AntidepressantsAntidepressantsDesired effects: Desired effects:
increased appetite, increased appetite, adequate sleepadequate sleep
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TRICYCLIC TRICYCLIC ANTIDEPRESSANTSANTIDEPRESSANTS
Indication: Depression• increase the level of serotonin
neurotransmitters or norepinephrine in the space between nerve endings
• Deficiency depressionExamples:
Imipramine (Tofranil) Amitriptyline (Elavil)
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Nursing Implications:• Best given after meals • Therapeutic effects may become evident
only after 2-3 weeks of intake • Check the BP, it causes hypotension• Check the heartrate, it causes cardiac
arrythmias
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MAO INHIBITORSMAO INHIBITORS • Prevent metabolism of
neurotransmitters which carry message from one nerve cell to another.
• Toxic when taken with tyramine / tryptophan
Examples:Tranylcypromine (Parnate) Phenelzine (Nardil) Isocarboxazid (Marplan)
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Nursing Implications:• Best taken after meals• Report headache; it indicates
hypertensive crisis• Avoid tyramine containing foods like:
– Avocado– Banana– Cheddar and aged cheese
• Soysauce and preserved foods• It takes 2-3 weeks before initial
therapeutic effects become noticeable • Monitor the BP• There should be at least a two-week
interval when shifting from one anti-depressant to another
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Selective Serotonin Selective Serotonin Reuptake InhibitorsReuptake Inhibitors
• Indications: Depression, anxiety, panic attacks, eating disorders
• MOA: inhibition of the serotonin uptake thereby increases the synaptic transmitter levels to exert an antidepressant effect.
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• Examples:– Fluoxetine (Prozac) – Celatopram (Celexa)– Sertraline (Zoloft) – Paroxetine (Paxil)– Fluvoxamine (Luvox)
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Nursing Implications• Avoid the use of diazepam, alcohol,
and tryptophan because these may alter the effect of these drugs.
• Monitor PTT, PT• Never give to pregnant / lactating
mothers.
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ANTI-MANIC AGENTANTI-MANIC AGENT • Cause augmentation of serotonin
function in the CNS preventing increased nerve impulse transmission
Examples:Lithium Citrate (Cibalith – S)Lithium Carbonate (Eskalith, Lithane, Lithobid)
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• Nursing implications:• Best taken after meals• Increase fluid intake (3 L /day) and sodium
intake (3 gm/day)• Avoid activities that increase perspiration • Never give to pregnant mothers• It takes 10-14 days before therapeutic
effect becomes evident.• Antipsychotic is administered during the
first two weeks • Monitor serum level, normal is .5-1.5
mEq/L
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Signs of toxicity: •Vomiting•Anorexia•Nausea,•Diarrhea •Abdominal cramps
Antidote: Mannitol
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ELECTRO-CONVULSIVE ELECTRO-CONVULSIVE THERAPYTHERAPY
• Exact mechanism is unknown• Requires a consent• Usually given at 70-150 volts for
about .5-2 seconds• It takes 6-12 treatments with at least
48 hour interval to notice the effect• Indicator of effectiveness: tonic-
clonic seizure
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Indications of use:• Depression• Mania• Catatonic schizophrenia
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Contraindications (not absolute)• Fever• Increased ICP• Cardiac conditions• TB with history of hemorrhage• Unhealed fracture• Retinal detachment• Pregnancy
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Before the procedure:• Diagnostic procedures
– X-ray– ECG– EEG
• Drugs given– Atrophine sulfate (decrease secretions)– Anectine (Succinylcholine) – relax muscles– Methohexital Na (Brevital) - anesthetic
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During the procedure:• Observe for tonic-clonic seizure
After the procedure:• Position• Check vital signs• Reorient the client• Watch out for complications:
– Memory loss– Headache– Apnea– Fracture– Respiratory depression