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PSYCHIATRIC

NURSING
By: Meeko Videa, RN

Psychopharmacology
Psychotropic drugs
Includes:
antipsychotics
antidepressants
mood stabilizers
anxiolytics
stimulants

Efficacy
Potency
Half-life

Principles That Guide


Pharmacologic Treatment
A medication is selected based on its effect
on the clients target symptoms.
Must be given in adequate doses for some
time before their full effect is realized.
The dosage is often adjusted to the lowest
effective dosage for the client.
Older adults require lower doses than
younger clients to experience effects.

Principles That Guide


Pharmacologic Treatment
Medications are decreased gradually rather
than abruptly.
Follow-up care is essential to ensure
compliance, to make dosage adjustments
and mange side effects.
Compliance is enhance if the medication
regimen is as simple as possible.

Antipsychotic Drugs
Neuroleptics
Treatment of symptoms in schizophrenia
and manic phase of bipolar disorder
Blocks dopamine receptors
Examples:
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Loxapine (Loxitane)
Risperidone (Risperdol)

Typical and atypical


Dopamine System Stabilizers (DSS)

Side Effects
Extrapyramidal Side Effects:
Acute dystonia
Pseudoparkinsonism
akathisia

Neuroleptic Malignant Syndrome


Tardive Dyskinesia
Anticholinergic Side Effects
Elevated prolactin
Weight gain
Minor CV adverse effects
Agranulocytosis (Clozapine)

Antidepressant Drugs
Interacts with norepinephrine and
serotonin
Four Groups:
Tricylic antidepressants
Selective serotonin reuptake inhibitors
(SSRIs)
Monoamine oxidase inhibitors (MAOIs)
Others such as venlafaxine (Effexor) and
bupropion (Wellbutrin)

Side Effects
SSRIs
Anxiety
Agitation
Akathisia
Nausea
Insomnia
Sexual dysfunction
Weight gain
Sweating
Sedation
Diarrhea
HA

Side Effects
MAOIs
Daytime sedation
Insomnia
Weight gain
Dry mouth
Orthostatic hypotension
Sexual dysfunction
Hypertensive crisis

Side Effects
Cyclic antidepressants
Dry mouth
Constipation
Urinary hesitancy or retention
Dry nasal passages
Blurred near vision
Weight gain
Sexual dysfunction

Side Effects
Other antidepressants
HA (nefazodone and trazodone)
Dry mouth and nausea (nefazodone)
Loss of appetite, nausea, agitation and
insomnia (bupropion and venlafaxine)
Dizziness, sweating or sedation (venlafaxine)
Priapism (trazodone)
Liver damage (nefazodone)
Seizures (bupropion)

Drug Interactions
Taking MAOI and SSRI at the same time
can cause serotonin or serotonergic
syndrome
Symptoms:
Agitation
Sweating
Fever
Tachycardia
Hypotension
Rigidity
Hyperreflexia
Coma
Death

Mood Stabilizing Drugs


Bipolar Disorder
Stabilizes mood
Prevents or minimizes the highs and lows
of bipolar illness
Treats acute episodes of mania
Lithium
Anticonvulsants:
carbamazepine (Tegretol)
valproic acid (Depakote)
gabapentine (Neurontin)

Side Effects
Lithium
Mild nausea or diarrhea
Anorexia
Fine hand tremor
Polydipsia
Polyuria
Metallic taste in mouth
Fatigue or lethargy
Weight gain
Acne

Side Effects
Lithium Toxicity
Severe diarrhea
Vomiting
Drowsiness
Muscle weakness
Lack of coordination
If untreated can lead to renal failure, coma
and death

Side Effects
Carbamazepine
Drowsiness
Sedation
Dry mouth
Blurred vision
Rashes
Orthostatic hypotension
Aplastic anemia
Agranulocytosis

Side Effects
Valproic acid
Drowsiness
Sedation
Dry mouth
Blurred vision
Weight gain
Alopecia
Hand tremor
Hepatic failure
Teratogenic effects
Pancreatitis

Antianxiety Drugs (Anxiolytics)

Anxiety and anxiety disorders


Insomnia
OCD
PTSD
Alcohol withdrawal
Mostly benzodiazepines except for
Buspirone
Diazepam (Valium)
Chlordiazepoxide (Librium)

Side Effects
Physical and psychological dependence
Drowsiness

Sedation
Poor coordination
Impaired memory
Clouded sensorium
Next day sedation (hangover effect)
Dizziness, sedation, nausea and HA
(Buspirone)

Stimulants
ADHD
Residual attention deficit disorder
Narcolepsy
Amphetamines
Methylphenidate (Ritalin)
Pemoline (Cylert)
Dextroamphetamine

Causes release of neurotransmitters

Side Effects

Dependence
Anorexia
Weight loss
Nausea
Irritability
Dizziness
Dry mouth
Blurred vision
Palpitations
Growth and weight suppression in children

Disulfiram (Antabuse)
Treatment for alcoholism
Causes reaction to alcohol in the body:
Facial and body flushing
Throbbing HA
Sweating
Dry mouth
N&V
Dizziness
Weakness
Chest pain
Dyspnea
Severe hypotension
Confusion
Death

Reproductive Health and


Fertility
Tubal Patency
The Ability of the egg to move from the
ovary to the uterus.
Hysterosalpingography
Previous damage to tubes can cause
infertility.
Usual cause is Pelvic Inflammatory
Disease.

Pregnancy
Signs of Pregnancy
1. Presumptive (Subjective) Signs

Breast changes (fullness, enlargement, color)


N&V
Amenorrhea
Urinary Frequency
Quickening (18-20 wks)
Skin Pigmentation (linea nigra, striae
gravidarum, chloasma)

Pregnancy
Signs of Pregnancy
2. Probable Signs

Serum HCG
Chadwicks sign
Goodells sign
Hegars sign
Ultrasound (gestational sac)
Ballottement
Braxton Hicks contractions (at least 12 th wk)
Fetal outline felt by examiner

Pregnancy
Signs of Pregnancy
2. Positive signs
Ultrasound (fetal outline)
Fetal heart is audible
Fetal movement felt by examiner

Pregnancy
Circulatory System During Pregnancy
Increase in blood volume (30-50%)
Pseudoanemia (first trimester)
Increase in heart rate (10 beats)
BP decreases slightly (second trimester),
but rises again (third trimester)
Blood fibrinogen increases
Blood lipids increase by one third
Serum cholesterol level increase by 90100%

Pregnancy
Pregnancy Related Problems
Ectopic Pregnancy
Implantation occurs outside the uterus
Can cause bleeding in pregnancy
Most common site is the fallopian tube
(95%)
Tubal scarring due to PID
Common to women who smoke

Pregnancy
Pregnancy Related Problems
Hyperemesis Gravidarum
N & V past the 12th week of pregnancy
Severe N &V that dehydration, ketonuria
and significant weight loss occurs within the
first 12 wks of pregnancy
NPO
IVF with vitamin B
If no vomiting after the first 24 hrs of NPO,
small amounts of clear fluid may be given

Pregnancy
Pregnancy Related Problems
Hyperemesis Gravidarum
N & V past the 12th week of pregnancy
Severe N &V that dehydration, ketonuria
and significant weight loss occurs within the
first 12 wks of pregnancy
NPO
IVF with vitamin B
If no vomiting after the first 24 hrs of NPO,
small amounts of clear fluid may be given

Pregnancy
Pregnancy Related Problems
PIH
Cause is still unknown
Occurs in 5-7% of pregnancies
Multiple pregnancies
Primipara younger than 20 and older than
40
Five or more pregnancies
Have underlying disease like heart diseases
or diabetes

Pregnancy
Pregnancy Related Problems
Gestational HPN
BP 140/90
Increase in systolic 30mmHg or diastolic
15mmHg above prepregnancy level
No proteinuria or edema
Returns to normal after birth

Pregnancy
Pregnancy Related Problems
Mild pre-eclampsia
BP 140/90
Increase in systolic 30mmHg or diastolic
15mmHg above prepregnancy level
Proteinuria 1-2+
Weight gain of 2lbs/wk (2nd trimester),
1lb/wk (3rd trimester)
Mild edema in upper extremities and face

Pregnancy
Pregnancy Related Problems
Severe pre-eclampsia
BP 160/110
Proteinuria 3-4+
Oliguria (500ml or less in 24hrs)
Cerebral or visual disturbances (headache,
blurred vision)
Epigastric pain
thrombocytopenia

Pregnancy
Pregnancy Related Problems
Eclampsia
Seizure or coma accompanied by symptoms
of pre-eclampsia
Cerebral edema

Labor and Delivery


Fetal Presentation and Position
Attitude
The degree of flexion a fetus assumes during
labor
Good Attitude:

Complete flexion
Head is flexed (chin touching the sternum)
Arms flexed and folded into chest
Thighs flexed into abdomen
Calves are pressed against posterior aspect of
thighs

Labor and Delivery


Fetal Presentation and Position
Engagement
Settling of the presenting part of the fetus
into the pelvis
At the level of the ischial spines
Floating presenting part not yet engaged
Dipping has not reached the ischial spine
yet

Labor and Delivery


Fetal Presentation and Position
Station
Relationship of the presenting part to the
level of the ischial spine
0 station at level with ischial spine
(engaged)
+3 - +4 station presenting part is at the
perineum (crowning)

Labor and Delivery


Fetal Presentation and Position
Lie
Relationship between the long axis of the
fetal body and the long axis of the mothers
body
Either horizontal (transverse) or vertical
(longitudinal)
Longitudinal Lie:
Cephalic
Breech

Labor and Delivery


Signs of Labor
Uterine Contractions
Begins irregularly but become regular and
predictable
Felt first in the lower back and sweep
around the abdomen in a wave
Continues regardless of womans activity
Increases in duration, frequency, and
intensity
Achieves cervical dilation

Labor and Delivery


Signs of Labor
Show
Rupture of Membranes
Sudden gush or scanty, slow seeping of clear
fluid from the vagina
Can be advantageous
Risk for intrauterine infection and prolapsed
cord

Labor and Delivery


Stages of Labor
1. First Stage
a) Latent Phase

Contractions last 20-40 seconds


Cervix dilates from 0-3cm
Lasts 6hrs (nullipara) to 4.5hrs (multipara)

b) Active Phase

Dilation from 4-7cm


Contractions last 40-60 seconds every 3-5
mins
Lasts 3hrs (nullipara) to 2hrs (multipara)
Show and ROM may occur

Labor and Delivery


Stages of Labor
1. First Stage
a) Transition Phase

Contractions last 60-90 seconds every 2-3


mins
Cervix dilates from 8-10cm
Show and ROM
Full dilatation
N & V may sometimes be felt
Irresistible urge to push

Labor and Delivery


Stages of Labor
2. Second Stage
Period from full dilatation and cervical
effacement to birth of infant
Takes about 1 hour
Crowning

Labor and Delivery


Stages of Labor
3. Third Stage
Placental stage
From birth of infant to delivery of placenta
Sudden gush of blood, lengthening of
umbilical cord (placental separation)

4. Fourth Stage
First 1 to 4 hrs after birth of the placenta
Oxytocin is given

Congenital Heart Disorders


1. Ventricular Septal Defect
Most common type of CHD (30%)
Opening is present between the two
ventricles
Left to right shunting of blood
Right ventricular hypertrophy and increased
pulmonary artery pressure
Postop be alert for arrhythmias

Congenital Heart Disorders


2. Atrial Septal Defect

Abnormal communication between two atria


More common in girls
Can be caused by patent foramen ovale
Left to right movement of blood
Ventricular hypertrophy and increased
pulmonary artery pressure

Congenital Heart Disorders


2. Atrial Septal Defect

Abnormal communication between two atria


More common in girls
Can be caused by patent foramen ovale
Left to right movement of blood
Ventricular hypertrophy and increased
pulmonary artery pressure

Congenital Heart Disorders


3. Atrioventricular Canal Defect
Incomplete fusion of the endocardial
cushion
Low ASD and high VSD and distortion of the
mitral and tricuspid valves
May have left to right blood flow or between
all chambers of the heart
Common in children with trisomy 21 (50%)

Congenital Heart Disorders


4. Aortic Stenosis
Prevents blood from passing freely from the
left ventricle to the aorta
Increased pressure and hypertrophy of LV
LA pressure increase
Back pressure to pulmonary veins and
pulmonary edema
Decreased CO:
Faint pulses
Hypotension
Tachycardia
Inability to suck for long periods

Congenital Heart Disorders


5. Tetralogy of Fallot
Four anomalies are present:

Pulmonary stenosis
VSD
Overriding aorta (dextroposition)
RV hypertrophy

Cyanosis
Polycythemia
Dyspnea