Psych nursing lecture
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PSYCHIATRIC NURSING
By: Meeko Videña, RN
Psychopharmacology
• Psychotropic drugs• Includes:
antipsychoticsantidepressantsmood stabilizersanxiolyticsstimulants
• Efficacy• Potency• Half-life
Principles That Guide Pharmacologic Treatment
• A medication is selected based on its effect on the client’s 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 dystoniaPseudoparkinsonismakathisia
• 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 antidepressantsSelective serotonin reuptake inhibitors
(SSRIs)Monoamine oxidase inhibitors
(MAOIs)Others such as venlafaxine (Effexor)
and bupropion (Wellbutrin)
Side Effects• SSRIs
AnxietyAgitationAkathisiaNauseaInsomniaSexual dysfunctionWeight gainSweating SedationDiarrheaHA
Side Effects• MAOIs
Daytime sedationInsomniaWeight gainDry mouthOrthostatic hypotensionSexual dysfunctionHypertensive crisis
Side Effects• Cyclic antidepressants
Dry mouthConstipationUrinary hesitancy or retentionDry nasal passagesBlurred near visionWeight gainSexual 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:
AgitationSweatingFeverTachycardiaHypotensionRigidityHyperreflexiaComa 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 diarrheaAnorexiaFine hand tremorPolydipsiaPolyuriaMetallic taste in mouthFatigue or lethargyWeight gainAcne
Side Effects• Lithium Toxicity
Severe diarrheaVomitingDrowsinessMuscle weaknessLack of coordinationIf untreated can lead to renal failure,
coma and death
Side Effects• Carbamazepine
DrowsinessSedationDry mouthBlurred visionRashesOrthostatic hypotensionAplastic anemiaAgranulocytosis
Side Effects• Valproic acid
DrowsinessSedationDry mouthBlurred visionWeight gain AlopeciaHand tremorHepatic failureTeratogenic effectsPancreatitis
Antianxiety Drugs (Anxiolytics)• Anxiety and anxiety disorders• Insomnia• OCD• PTSD• Alcohol withdrawal• Mostly benzodiazepines except for
BuspironeDiazepam (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 HASweatingDry mouthN&VDizzinessWeaknessChest painDyspneaSevere hypotensionConfusion Death
Reproductive Health and FertilityTubal 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.
PregnancySigns of Pregnancy1. Presumptive (Subjective) Signs
▫Breast changes (fullness, enlargement, color)
▫N & V▫Amenorrhea▫Urinary Frequency▫Quickening (18-20 wks)▫Skin Pigmentation (linea nigra, striae
gravidarum, chloasma)
PregnancySigns of Pregnancy2. Probable Signs
▫Serum HCG▫Chadwick’s sign▫Goodell’s sign ▫Hegar’s sign▫Ultrasound (gestational sac)▫Ballottement▫Braxton Hicks contractions (at least
12th wk)▫Fetal outline felt by examiner
PregnancySigns of Pregnancy2. Positive signs
▫Ultrasound (fetal outline)▫Fetal heart is audible▫Fetal movement felt by examiner
PregnancyCirculatory 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
90-100%
PregnancyPregnancy Related Problems• Ectopic Pregnancy
Implantation occurs outside the uterusCan cause bleeding in pregnancyMost common site is the fallopian tube
(95%)Tubal scarring due to PIDCommon to women who smoke
PregnancyPregnancy Related Problems• Hyperemesis Gravidarum
N & V past the 12th week of pregnancySevere N &V that dehydration,
ketonuria and significant weight loss occurs within the first 12 wks of pregnancy
NPOIVF with vitamin BIf no vomiting after the first 24 hrs of
NPO, small amounts of clear fluid may be given
PregnancyPregnancy Related Problems• Hyperemesis Gravidarum
N & V past the 12th week of pregnancySevere N &V that dehydration,
ketonuria and significant weight loss occurs within the first 12 wks of pregnancy
NPOIVF with vitamin BIf no vomiting after the first 24 hrs of
NPO, small amounts of clear fluid may be given
PregnancyPregnancy Related Problems• PIH
Cause is still unknownOccurs in 5-7% of pregnanciesMultiple pregnanciesPrimipara younger than 20 and older
than 40Five or more pregnanciesHave underlying disease like heart
diseases or diabetes
PregnancyPregnancy Related Problems• Gestational HPN
BP 140/90Increase in systolic 30mmHg or
diastolic 15mmHg above prepregnancy level
No proteinuria or edemaReturns to normal after birth
PregnancyPregnancy Related Problems• Mild pre-eclampsia
BP 140/90Increase 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
PregnancyPregnancy Related Problems• Severe pre-eclampsia
BP 160/110Proteinuria 3-4+Oliguria (500ml or less in 24hrs)Cerebral or visual disturbances
(headache, blurred vision)Epigastric painthrombocytopenia
PregnancyPregnancy Related Problems• Eclampsia
Seizure or coma accompanied by symptoms of pre-eclampsia
Cerebral edema
Labor and DeliveryFetal 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 DeliveryFetal Presentation and Position• Engagement
Settling of the presenting part of the fetus into the pelvis
At the level of the ischial spinesFloating – presenting part not yet
engagedDipping – has not reached the ischial
spine yet
Labor and DeliveryFetal 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 DeliveryFetal Presentation and Position• Lie
Relationship between the long axis of the fetal body and the long axis of the mother’s body
Either horizontal (transverse) or vertical (longitudinal)
Longitudinal Lie: Cephalic Breech
Labor and DeliverySigns 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 woman’s activity
Increases in duration, frequency, and intensity
Achieves cervical dilation
Labor and DeliverySigns of Labor• Show• Rupture of Membranes
Sudden gush or scanty, slow seeping of clear fluid from the vagina
Can be advantageousRisk for intrauterine infection and
prolapsed cord
Labor and DeliveryStages of Labor1. 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 DeliveryStages of Labor1. 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 DeliveryStages of Labor2. Second Stage• Period from full dilatation and cervical
effacement to birth of infant• Takes about 1 hour• Crowning
Labor and DeliveryStages of Labor3. 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 Disorders1. 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 Disorders2. 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 Disorders2. 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 Disorders3. 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 Disorders4. 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 Disorders5. Tetralogy of Fallot
▫Four anomalies are present:• Pulmonary stenosis• VSD• Overriding aorta (dextroposition)• RV hypertrophy
▫ Cyanosis▫ Polycythemia▫ Dyspnea