MHA
Your patient has been certified x1 under the mental health act. What forms need to be completed?
Form 4, 5, 13, 15, 16
What is the difference between typical and atypical antipsychotics?
The main difference between the two types of antipsychotics is that the first generation drugs block dopamine and the second generation drugs block dopamine and also affect serotonin levels.
2nd generation have less side effects (EPS)
Name one medication per class of antidepressants
SSRI: citalopram, escitalopram, fluoxetine, fluvoxmine, paroxetine, sertraline
TCA: amitriptyline, clomipramine, imipramine, nortriptyline
SNRI: duloxetine, venlafaxine
MAOI: phenelzine, tranylcypromine, isocarboxazid
Atypical: wellbutrin
Define SBAR
Situation
Background
Assessment
Recommendation
Used for reports/handover
Your patient was admitted under the MHA on April 1/21. It is now April 28/21 and they are being discharged on extended leave. What forms will you send to their mental health outpatient team?
Form 4s, 5, newly done 6, and 20 (13, 15, 16)
You will NOT do a discharge certificate as the client is being discharged from the hospital NOT from extended leave
Name 3 1st generation
Name 3 2nd generation
First: Chlorpromazine, Droperidol, Fluphenazine, Haloperidol, Loxapine, Perphenazine, clopixol
Second:Aripiprazole, Asenapine, Clozapine, lurasidone, Olanzapine, Paliperidone, Quetiapine, Ziprasidone, risperidone
Considerations with Lithium
- Do blood work - Lithium toxicity: nausea, vomiting, hand tremors, confusion, vision changes
- Do not just stop taking it abruptly
- Side effects: polyuria, polydipsia, polyphagia, headache, N/V, diarrhea, dizziness, changes in appetite, hand tremors, dry mouth
What is SOAP charting? Provide 3 examples of subjective versus objective data with regards to a respiratory assessment
Subjective - denied difficulty breathing. Denied discomfort with exertion. Denied use of cigarettes, cannabis, or inhalation of illicit substances. Reported having a non-productive cough x2 days.
Objective - vital signs stable (with vitals here), Good air entry noted to all lung quadrants. Crackles evident to lower left lobe.
Assessment
Plan
Your patient is under 16 and is not suitable for admission. Can they be certified? What is the process?
Legal decision-making rests with legal guardian (unless “mature minor” under Infants Act). If the guardian wants admission but child DOES NOT, it’s technically “voluntary” (though child is going involuntarily)
- Recommend these admissions are under Mental Health Act to protect patient’s rights (e.g. regular
reviews, access to Review Panel, etc)
- Need:
o Form 1 (Request for Voluntary Admission), filled by guardian
o Form 2 (Consent for Voluntary Treatment), filled by guardian
o Form 3 (Medical Report, Exam for < 16), filled by MD
Clozapine:
- how to start
- side effects
- ongoing tests and how often
Titration: reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis.
side effects: weight gain; dizziness, tremor; fast heart rate; headache, drowsiness; nausea, constipation; dry mouth, or increased salivation; AGRANULOCYTOSIS/NEUTROPENIA; NMS (neuroleptic malignant syndrome); vision problems; fever, increased sweating
- blood work q1 week x26weeks; q2 week x26weeks; q4weeks ongoing
Sexual dysfunction, stomach upset, suicidal ideation
Serotonin Syndrome: Too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures). Severe serotonin syndrome can cause death if not treated.
Signs and symptoms include:
Name all components of MSE
ABC STAMP LICKER
Appearance
Behaviour
Cooperation
Speech
Thought content & form
Affect
Mood
Perceptions
LOC / Orientation
Insight & Judgement
Cognitive function & Sensorium
Knowledge
Ends (suicide/homicide)
Reliability
Name the 4 criteria of involuntary admission
Criteria: Information must be based on exam, but can include collateral
1. is suffering from a MENTAL DISORDER that seriously IMPAIRS the person’s ABILITY TO REACT appropriately to his or her environment or to ASSOCIATE with others;
2. requires psychiatric treatment in or through a designated facility;
3. requires care, supervision, and control in or through a designated facility to prevent the person’s substantial mental or physical deterioration or for the person’s own protection or the protection of others
4. is not suitable as a voluntary patient
S/S of NMS and nursing considerations if you believe your pt has this condition in the community
HOSPITALIZE. Treat fever and fluids. Antiparkinsonianism drugs and stop the medication
NMS symptoms usually last for 7 to 10 days. They may include:
Nutrition education with MAOIs
Main components of a suicide assessment
Ideation
Substance abuse
Purposelessness
Anxiety
Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood changes
(Psychosis)
- ideation, plan, means, intent protective factors
Your client was discharged from hospital on august 21, 2020 on extended leave. They are recalled from leave due to decompensation on sep 2, 2021. What form was filled out for recall? Who does this form get sent to? Upon admission to hospital what happens to your clients extended leave documentation?
Form 21, police and pes, resets form 6 with new admission date
What is EPS? What are types of EPS?
Movement disorder caused by dopamine blockade or depletion in the basal ganglia
acute dystonias, akathisia, Parkinsonism, and tardive dyskinesia (TD)
Importance of metabolic monitoring...
antipsychotics are associated with weight gain, lipid disturbance, and glucose dysregulation, thereby contributing to the development of metabolic syndrome.
COWS assessment (components) and what score is needed for a suboxone start?
Heart Rate
Sweating
Restlessness
Pupil size
Bone/joint aches
Runny nose/tearing
GI upset (over last 30 mins)
Tremor
Yawning
Anxiety/Irritability
Gooseflesh