Professional Documents
Culture Documents
Types of Delusion:
Hallucinations can also occur in patients who are not mentally ill
as a result of stress overload, hypertension or exhaustion
P S Y C H O S I S
Psychotic Disorder: Disorganized Thinking
Describe incomprehensible language, either speech or writing, that
is presumed to reflect thinking. Consist of a loosening of
associations, or flight of ideas, so that the speaker jumps from one
idea or topic to another unrelated one (derailment) in an illogical,
disorganized, or inappropriate way
Speech is often minimal with only brief slow motion replies to questions
Thioxanthenes
thiothixene (Navane)
Nonphenothiazines
haloperidol (Haldol)
loxapine (Loxitane)
molindone ( Moban)
P S Y C H O S I S
Drug Therapy for Psychosis Contd.
Actions
The typical antipsychotic agents block the neurotransmitter dopamine in CNS
The atypical antipsychotic agents block dopamine and serotonin receptors in
CNS by varying degree
Exact mechanism is unknown
Uses Contd.
Extrapiramidal Effects
Extrapyramidal effects are the most troublesome adverse effects
and the most common cause of nonadherence associated with
antipsychotic therapy
P S Y C H O S I S
Adverse Effect of Antipsychotic Drug Therapy Contd.
Extrapyramidal Effects Contd.
Dystonias
Acute are spasmodic
Dystonia Symptoms movement of the onset
- The earliest muscleofgroups
all thesuch
EPS as
the tongue protrusion, rolling back the eyes, jaw spasm, or neck
torsion.
These symptoms are often frightening and painful for the patient..
They may be controlled by intramuscular injections of :
Ø Diphenhydramine
P S Y C H O S I S
Adverse Effect of Antipsychotic Drug Therapy Contd.
Pseudoparkinsonian Symptoms of Tremor:
Ø muscular rigidity
Ø masklike expression
Ø
P S Y C H O S I S
Adverse Effect of Antipsychotic Drug Therapy Contd.
Akathisia:
Sleep pattern:
Person’s normal sleep pattern
Assess if insomnia present
Amount and quality of sleep nightly
Dietary history:
Ask questions about appetite
Note weight gain or losses not associated with intentional dieting.
P S Y C H O S I S
Nursing Process For Antipsychotic Therapy Contd.
Nursing Diagnoses:
Risk for Injury
Impaired Environmental Interpretation Syndrome
Disturbed Sensory Perception
Impaired Verbal Communication
Ineffective Role Performance
Ineffective Coping
Risk for Other-Directed Violence
P S Y C H O S I S
Nursing Process For Antipsychotic Therapy Contd.
Planning
History of Psychotic Behavior
Explain unit rules and therapeutic rules. Keep explanations clear and
precise.
Explain the activity groups available and how and when the individual
will participate.
P S Y C H O S I S
Nursing Process For Antipsychotic Therapy Contd.
Patient Education and Health Promotion Contd.
Fostering Health Maintenance
Discuss the medication information and how it will benefit the patient’s
symptoms and circumstances
There are a number of debilitating adverse effects and others that are life-
threatening if not acted on correctly, it is important that open
communication with the health care provider, nurses, therapist, and
pharmacist be encourages throughout course of therapy.
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents
Actions
It often takes several weeks for a patient to show improvement and become stabilized on
an adequate maintenance
As result of cumulative effects of these agents, patients must be reevaluated periodically to
determine the lowest effective dosage necessary to control psychiatric symptoms
Evaluations
Common Adverse Effects:
Central Nervous System (CNS):
Chronic fatigue, Drowsiness.
If these symptoms occur, give the dose of medication at bedtime
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents Contd.
NURSING PROCESS – Evaluation Contd.
Common Adverse Effects Contd:
Cardiovascular
Orthostatic Hypotension
All antipsychotic agents may cause orthostatic hypotension
Monitor BP dayly in the supine, sitting, standing position
Teach patient to rise slowly
Sensory
Blurred Vision
Provide safety
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents Contd.
NURSING PROCESS – Evaluation Contd.
Common Adverse Effects Contd:
Gastrointestinal
Constipation, Dryness of mucosa of the mouth, throat, nose
Dryness can be relieved by sucking hard candy or ice chips, or chewing gum
High fiber diet, stool softeners (docusate, or basacodyl)
Parkinsonian Symptoms
Report drooling, cogwheel rigidity, shuffling gait, tremors, flat face
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents Contd.
NURSING PROCESS – Evaluation Contd.
Serious Adverse Effects Contd
Neurologic
Tardive Dyskinesia
Occurs more commonly with first generation antipsychotics
Report tremors of the tongue, lip smacking
Gastrointestinal
Hepatotoxicity (e.g., anorexia, N/V, jaundice, hepatomegaly, splenomegaly
abnormal liver function tests:
ØElevated bilirubin
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents Contd.
NURSING PROCESS – Evaluation Contd.
Serious Adverse Effects Contd
Hematologic
Blood Discriasias
Routine Blood Studies: WBC, RBC
Monitor for sore throat, fever, purpura, jaundice
Hypersensitivity
Hives, pruritus, rash
Photosensitivity
Patient should avoid prolonged exposure to sunlight and ultraviolet light
P S Y C H O S I S
DRUG CLASS: Antipsychotic Agents Contd.
NURSING PROCESS – Evaluation Contd.