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

2
Secondary
• interventions that limits the severity of a
disorder.

2 Components
• Case finding
• Prompt treatment

Examples:
• Crisis intervention
• Drug administration

3
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 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
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, 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/
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 anti-
depressant to another 20
 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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