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05 Psychiatric Nursing

05 Psychiatric Nursing

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Published by: karendelarosa06277 on Jan 04, 2010
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08/27/2014

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Levels of Interventions in 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 anonymous Occupational therapy
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The Psychiatric Nurse

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Characteristics
• 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 Psychiatric 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 Settings
• 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 nonjudgmentally, 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 PSYCHOPHARMACOLOGY

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Major 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, masklike 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/ ANXIOLYTICS
Common indication: Anxiety disorders Desired 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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Antidepressants
Desired effects: increased appetite, adequate sleep
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TRICYCLIC ANTIDEPRESSANTS
Indication: Depression • increase the level of serotonin neurotransmitters or norepinephrine in the space between nerve endings • Deficiency  depression Examples: 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 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 antidepressant to another

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Selective Serotonin Reuptake 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 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 THERAPY
• 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

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