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RNSG 2213 Exam 2 mental health LATEST 2024
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RNSG 2213 Exam 2 mental health LATEST 2024 RNSG 2213 Exam 2 mental health LATEST 2024 RNSG 2213 Exam 2 mental health LATEST 2024
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1Psychopharmacology (Ch. 2) *know all BBW in chapter Commented [s1]:
o Principles that guide the use of medication include:
effect on the client’s target symptoms, adequate dosage for sufficient time, lowest dose needed for maintenance, lower
doses for the elderly [also may take longer for a drug to achieve its full therapeutic effect], tapering rather than abrupt
cessation to avoid rebound [temporary return of symptoms] or withdrawal [new symptoms resulting from
discontinuation of the drug], follow-up care is essential [to ensure compliance], simplify the regimen for increased
compliance.
o Efficacy: refers to the maximal therapeutic effect that a drug can achieve.*
(o2 #23-Nurse is instructing a pt on taking lithium for bipolar. the pt
will need to have blood draws q 2-3 days initially to determine what?
Efficacy)
o Potency: describes the amount of the drug needed to achieve that maximum effect; low potency drugs require higher doses to
achieve efficacy; high-potency drugs require lower doses to achieve efficacy*
o Half-life: is the time it takes for half of the drug to be removed from the bloodstream.
o (o2 #25-aggressive Pt brought to ED who is non-compliant w meds, what
statement by family informs nurse of their understanding of the mental
illness?-bc of mental illness, my brother cannot think clearly or
understand the need for his meds)
o Receptor agonist has what function?=binds to a receptor & causes a change in cellular function [M-#1]-chemicals bind to and
block a receptor, producing no response and preventing agonists from binding or attaching to the receptor,
o Drug antagonists=preventing substances from activating cell function [M#2]
o Refractoriness/downregulation= desensitization of cells to a drug over time; if pt is taking drug for 2 yrs and never misses it &
says med doesn’t seem to be working [M#3]-generally occurs when agonists continually stimulate cells.
o Antipsychotic drugs: [formerly called neuroleptics] weight gain common
3 types: conventional, atypical, new generation:
Uses: to t/x symptoms of psychosis, such as delusions, hallucinations- seen in schizophrenia, schizoaffective
disorder & manic phase of bipolar disorder
o primary med for: schizophrenia [M-#12](n2 #28)
o Also used: in psychotic episodes of acute mania, psychotic depression, and drug-induced
psychosis.
o Off label- anxiety, insomnia, aggressive behavior, and delusions, hallucinations and other
disruptive behaviors that sometimes accompany Alzheimer's disease*
Action: block dopamine receptors. If it blocks D2=EPS effects-1st gen [M#13]
EPS=serious neurologic symptoms. Major side effect of antipsychotics caused by blockage of D2 in midbrain-
especially 1st gen
Can also have subjective EPS [internal-can't see b/c they don’t have the twitching/movement, etc] & objective EPS
o (n2 # 15-Acute dystonia, pseudoparkinsonism, akathisia)
o Tx=lower dose, different antipsychotic, anticholinergic meds (antiparkinson agent)
o Acute dystonia-muscular rigidity/cramping, stiff/thick tongue w difficulty swallowing
(severe=laryngospasm/resp difficulties).
Most likely in 1st week of tx, younger than 40 yrs, male, and w high potency drugs
(Haloperidol and thiothixene)
Can also cause torticollis (twisted head/neck, Opisthotonus (tight body, head back,
neck arched), oculogyric crisis (eyes rolled back in a locked position)**
,2
(n2 #22-which is a term used to describe
eyes rolling back in a locked position
which occurs w acute dystonia?-
Oculogyric crisis)
Painful and frightening
Tx=immediate anticholinergics (IM Benztropine[Congentin] or IV Benadryl), then
addition of a PO dose to med regimen to prevent recurrence. Otherwise switch or
lower antipsych drug
(n2 #29-pt suddenly cries out in fear. Nurse
notes pts head is twisted to 1 sd, back is
arched, eyes have rolled back. Pt has
recently begun drug
therapy w Haldol. What would nurse’s 1st action be?-give PRN dose of
Benztropine (congentin) IM)
** RN caring fot client who has been taking
fluphenazine [Prolixin] for 2 days-a
Phenothiazines-neuroleptic med; pt
suddenly cries out, neck twists to 1 side, &
his eyes appear to roll back in the sockets.
RN finds which PRN meds to
administer?=Diphenhydramine [Benadryl]
25 mg IM,
,3 PRN [remember if choices give Cogentin PO- pick the Benadryl IM-NO
PO!!]
o Pseudoparkinsonism-drug induced parkinsons-mimics s/s seen in PD
Stooped posture, mask face, decreased/absent arm swing, shuffling/festinating gait,
cogwheel rigidity, drool, tremor, bradykinesia, pill-rolling at rest
(n2 #27-which would not be included as
a symptom of drug induced
parkinsonism?-Tachycardia)
Tx
-add PO anticholinergic or Amantadine to regimen or change antipsych
med
Can develop gradually and slowly and may go unnoticed to pt & dr-us notice
tremors, but not change in balance/movement-slow
Typical antipsychotics & Risperidone [atypical] can cause it
Issue w/ compliance b/c s/e noticeable & is stigmatized by other ppl
-note: only 2 drugs that don’t worsen it= Quetiapine [Seroquel] & Clozapine
o Akathisia-intense need to move about/inability to sit still-reversible. Most common EPS s/s
S/S: BODY Restless [us on thighs or abs-pt feel this discomfort], anxious, agitated,
rigid posture/gait, lack of spontaneous gestures, inability to sit still/rest, frequent
pacing
Can present as: Behavioral akathisia-compulsive sexual behavior, suicidal behavior,
violence, agitation, seclusion room episodes [look out for it-not usually akathisia-but
dr should consider it as a potential cause if new behaviors that correlate with onset
or increase of antipsychotic med dose] or subjective akathisia [from EPS video]
Causes med noncompliance [pt us do not know what is happening & can turn to
suicide]
Tx-switch med/decrease dose or add B-blocker, anticholinergic(CONGENTIN) or
Benzo
Teach: reassure it can go away-don't freak them out, tell them it’s a s/e-to decrease
pt fear
(n2 #21-pt is seen w inability to sit still and a rigid
posture-Akathisia)
Neuroleptic Malignant Syndrome(NMS)-potentially fatal idiosyncratic rxn to antipsychotics-most likely in 1st 2
weeks or after increasing dose but can occur anytime
o s/s: Rigidity, high fever, autonomic instability(labile BP, diaphoresis, pallor), elevated CPK,
confused/mute, agitation/stupor, (incontinence?)
(n2 #30-1 week after beginning therapy w
Thiothixene(Navene), the pt demonstrates
muscle rigidity, temp of 103, elevated CPK,
stupor and incontinence. These symptoms
indicate-NMS)
o All antipsychotics can cause it, but most common w high doses of high potency drugs
o Dehydration, poor nutrition and comorbities also increase risk
(n2 #24-which increases rf NMS?-dehydration)
o Tx-immediate discontinuation of antipsychotics, supportive tx for dehydration and
hyperthermia until stable
o Must weight risk vs benefits of antipsych tx if this occurs
, 4 Tardive Dyskinesia-TD: irreversible involuntary movements/movement disorders caused by long term antipsych
drugs-
o Tongue, face, neck, upper/lower extremities, truncal musculature, tongue thrusting, lip
smacking, blinking, grimacing, [can include chorea, dystonia, tics, myoclonus, dysphonia
[voice]-eps video
o Do AIMS assessment
o No tx, but discontinuation will halt the progression-
o ”passive healing”-can sometimes help-but can come back
o Use lowest dose to prevent. Detect early-difficult rt antipsych drugs mask intital s/s [will us
monitor pt if doing good on antipsych med]
o (n2 #20-pt w a severe and persistent MI has been
taking antipsychotic meds for 20 yrs. Nurse observes
repetitive movements of mouth and tongue, facial
grimacing, rocking back and forth. Nurse recognizes
these as-tardive dyskinesia)
Teaching for Antipsychotic meds:
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