Antipsychotics
First-Generation Antipsychotics:
Side Effects?
Nursing interventions for potential side effects
•Can cause extrapyramidal side effects (EPS) due to the blockage of D2 receptors
•Acute dystonia, Akathisia, Pseudoparkinsonism, Tardive dyskinesia
•May adjust dose, change drug, or add oral anticholinergic (benztropine)
- monitor NMS (FEVER)
When caring for a patient experiencing alcohol withdrawal, what areas (types of questions) might the nurse ask to obtain assessment information for the CIWA?
CIWA is assessing the following areas:
Stimulant (meth, cocaine, etc) abuse can lead to patients experiencing what types of complications?
Hallucinations
Violence/Aggression (potential for violence)
Impaired judgment
Severe to panic levels of anxiety
his medication rapidly reverses opioid overdose
naloxone (Narcan)
This personality disorder cluster is characterized by social detachment and little desire for close relationships.
Cluster A
What are positive symptoms associated with schizophrenia? (think of examples of how a patient may present)
What are negative symptoms associated with schizophrenia? (think of examples of how a patient may present)
Positive symptoms are "adding" to the situation
Negative symptoms are "taking away" from the situation
signs of EPS include?
Treatment of EPS would include what immediate medication administration?
Tardive dyskinesia (TD) - involuntary muscular spasms of the face and jaw, lip smacking, or unusual tongue movements,
Acute Dystonia: severe spasms of the muscles of the tongue, head and neck, fixed upward deviation of the eyes, severe back spams
Akathisia: internal restlessness, inability to site still ( pacing, fidgeting)
Pseudoparkinsonism: stiffening of muscular activity, shuffling gait, tremors,
Prevention is essential- patients should begin with benztropine when starting antipsychotics
Treatment may include: benztropine IV/IM or diphenhydramine IM/IV
Medications used to help patients maintain sobriety from alcohol include?
•Disulfiram (Antabuse)- helps with impulse drinking d/t long lasting effects, when mixed with alcohol the patient will have violent physical reactions
•Naltrexone (Vivitrol)- reduces desired pleasant feelings by blocking release of endorphins, also blocks cravings
•Acamprosate (Campral)- reduces unpleasant symptoms of abstinence and decreases cravings
A stimulant overdose can lead to this dangerous cardiac rhythm disturbance
arrhythmia
Gooseflesh skin, yawning, and muscle aches are signs of this stage of opioid use
withdrawal
The best nursing approach for borderline personality disorder involves this type of structure.
setting clear boundaries and consistency
think behavioral contracts
one assigned member to cut down on staff splitting
When working with patients who have a substance abuse diagnosis, what are some ways we can help with relapse prevention?
- Identify triggers
-Practice health coping skills
-Role play potentially triggering situations
-Develop a plan AHEAD of time
Neuroleptic Malignant Syndrome (NMS)
What are clinical manifestations?
Treatment includes?
F: Fever
E: Elevated CPK/WBC
V: Vital signs instability
E: Encephalopathy
R: muscle Rigidity
Treatment includes aggressive treatment of symptoms: antipyretics to treat high temp; dantrolene to reduce muscle spams; IV fluids for dehydration
What are foods/products a client should avoid when taking disulfiram?
What are signs they may have consumed alcohol when taking this medication?
Anything containing alcohol:
- mouthwash
- hand sanitizer
-food extracts
- cough medicine
Signs: Flushing, headache, nausea and vomiting, hypotension, diaphoresis, tachycardia, vertigo
In the emergency department, patients with severe agitation from stimulant overdose may be treated with this class of medication.
benzodiazepines
Opioid withdrawal is treated with what medications? (how is it managed)
Substitution therapy is a main form of treatment/management:
Methadone (tapered slowly is the end goal)
Buprenorphine (also the idea is to taper the patient off of it)
Clonidine can be used to manage autonomic symptoms (n&v, diarrhea)
Clients also benefit from peer support and outpatient therapy to determine the underlying cause of their substance abuse
Which personality disorder would we expect to say "I need everyone to look at me! Don’t I look amazing?"
Histrionic
Alcohol withdrawal can begin during what time frame?
Opioid withdrawal can begin during what time frame?
Alcohol: 8-12 hours after the last drink (or significant decreased consumption)
Opioids: as little as 1 hour; but various (can sometimes be as long as 12 hours)