What do you use Parnate (Tranylcypromine), which is an MAOI for?
Treatment of Major depressive episode without melancholia
Usually for pt that do not tolerate or respond to other modes of therapy
What does Parnate do?
It inhibits the enzyme monoamine oxidase
What are some SE of Parnate (Tranylcypromine)?
Dry Mouth, abdominal discomfort, edema, sweating, dizziness, tremors, constipation
What are some food interactions with Parnate (Tranylcypromine)?
What are some drug interactions with Parnate (Tranylcypromine)?
What is Lithium (Eskalith) used for?
Manic episodes of manic depressive illness
What does Lithium (Eskalith) physically do?
Alters cation transport in nerve & muscle
May influence reuptake of neurotransmitters
What is Lithium (Eskalith) therapeutic effect?
Prevents/Decreases incidence of acute manic episodes
What are some SE of Lithium (Eskalith)?
N/V - Abdominal Pain
Fine hand tremors
PERIPHERAL CIRCULATORY COLLAPSE
What do you need to monitor when a pt is taking Lithium (Eskalith)?
Response to Drug
Periodic Lithium Levels (8-12 Hrs prior to dose)
Periodic Thyroid Function Tests
S&S of Lithium Toxicity
(Vomitting, Diarrhea, course tremors, polyuria)
DO NOT GIVE IF OVER 2 MEQ/L & CONTACT DOCTOR
What are the lab values for the following:
Hemoglobin (Male & Female)
Male - 14-18 g/dl
Female - 12-16 g/dl
What is under each axis I-V?
I - Clinical Disorders
(Can be treated w/ Meds)
II - Personality Disorders & Mental Retardation
III - General Medical Conditions
IV - Psychosocial & Environmental Problems
Ie: Divoce 3 months prior
V - Global Assessment of Functioning GAF
What do you need to assess during the Pre-Op Assessment?
History of Present Illness
Head to Toe Exam
Cultural beliefs and Practices
Diagnostics and Labs
What are the 6 things that need to be done for Pre-Op?
Paperwork/Chart & Preps done
What is MAJOR surgery?
Any Procedure done to alter tissue or organ integrity
What is MINOR surgery?
Short time to complete
Does not open body cavity
What is involved in informed consent?
Dr. must explain
Nurse can answer questions
Must be done prior to mind altering drug
Must be competent and Conscious
What is on the Pre-Op Checklist?
Paperwork & Chart
Clinical data posted
What are the ABC's of Medical History?
A - Allergies
B - Bleeding Tendencies
C- Cortisone or Steroids
E - Emboli (Any previous events)
Why do we need to know if they use alcohol, nicotine or recreational drugs?
Alcohol - Withdrawal symptoms if they use as little as 2 drinks per day
Nicotine - Binds with hemoglobin causing polycythemia (High volume of Red Blood Cells) and potent VASOCONSTRICTION
Caffeine - May have post-op headache due to caffeine instead of other problem
What do you need to know about meds pre-op?
Prescription / OTC / Herbals
(St. Johns Wort/KAVA KAVA)
Last doses (Date/time)
HBP, Arrythmia, Antiseizure, resp related
Affects positioning , pain levels, outcomes
Includes Dementia, affects perceptions, influence teaching and learning
What physically happens if you experience physical stress due to surgery?
FIGHT OR FLIGHT
What psychologically happens due to surgical stress?
Anxiety & Fear
Fear of Unknown
Post Op Pain
Loss of limb or Organ
Loss of Job
Loss of social/family role
Vulnerability while unconcious
Separation from sig other
What are some interventions for surgical stress?
Use touch if appropriate
May require Meds to decrease Anxiety
What Labs can delay surgery?
WBC or infection
What are some factors that affect healing after surgery?
(Older = Longer to heal)
(Impair tissue healing)
(Increased stress on staples/stitches)
(Adipose tissue = Decreased blood flow)
(Protein & energy needed to rebuild tissue)
What are 3 types of surgical wounds?
Edges well Approximated
Left open to heal from inside out
Contaminated wounds that are closed later when they appear free of debris
What are the 4 W's and I of Post-Op care?
Pneumonia, Atelectasis, Pulmonary Embolism
Infection, Dehiscence, Evisceration
UTI (Check Catheter)
No bowel sounds, distention, feeling bloated, unabel to pass gas or defecate
What are 4 things you need to do Post-OP?
Receive report from PACU nurse
Head to Toe, Frequent VS, IV's, tubes, dressings, drainage, I&O, Pain & Discomforts, Safety Issues
Resp, TCDB, Spirometer, Activity, Nutrition & Fluids, Psycholigical support, spiritual support
Ensure home safety after discharge
What are some Post-Op Complicions?
Position on Side
Positive pressure ventilation for Laryngospasm
Suctioning, Oxygen Therapy, DB&C
Hypo or Hypertension
Monitor - I&O - Diuretic may be required
What is the most common reason for fever Post-Op?
The 4W's and I
What do Anti-Anxiety's do?
Decrease Mental Tension and Anxiety
What do Narcotics do?
What are some side effects of Narcotics?
What do sedatives do?
What are some Side Effects of Sedatives?
What do Anticholinergics do?
Decreased oral and respiratory secretions
What are some side effects of anticholinergics?
What do Histamine H2 Receptor Antagonists do?
Decrease gastric acid secretion
What are some side effects of Histamine H2 Receptor Antagonists?
What do Garlic, Ginger, Ginkgo & Ginseng interfere with?
What do St. Johns Wort and KAVA KAVA do to the sedative effect of anesthesia?
It prolongs it
What are some side effects of Anti-Anxiety's?
What are some signs and symptoms of Cholelithiasis?
Pain (Biliary Colic)
Intolerance of fatty foods
Vague upper abdomen sensations
RUQ tenderness w/ guarding
What happens that leads to Cholelithiasis?
Bile becomes super saturated in cholesterol or calcium
Gallbladder stasis leads to bile stasis
Infection leads to stones
MAY BE ASYMPTOMATIC
What is Cholecystitis?
Inflammation of gallbladder
May be acute or Chronic
What causes Cholecystitis?
Distention of Gallbladder
Becomes edematous & Gangrenous
Necrosis may occur
Can lead to abscess or sepsis
Gallbladder can rupture
What are signs and symptoms of ACUTE Cholecystitis?
Pain in epigastric, RUQ, Subscapular Area
Starts suddenly , increases steadily, Peaks in 30 min
Tenderness in RUQ, epigastric area or both
Deep palpation below rib cage, deep breath will cause liver and gallbladder to move down causing to touch fingers and give intense pain
N/V, Low grade Fever, Inc WBC & Liver Enzymes
What are some S&S of chronic Cholecystitis?
Pain less severe
fever not as high
WBC is lower
Vague s&s of indigestion
What is Cholelithiasis?
What is Choledocholithiasis?
Gallstones in the Common Bile duct
*Effects everything upstream and can obstruct pancreatic duct and may be genetic
What are some S&S of Choledocholithiasis?
WBC increased if common duct is inflammed
Increased Bilirubin, ALP
Other labs effected: Inc Liver Enzymes, Amylase, PT
Loss of Function
What 2 organs does Choledocholithiasis effect?
Liver & Pancreas
What are 6 tests that you can do for the Gallbladder?
Nuclear Scan (HIDH Scan)
Gallbladder Series (Cholecystogram)
Endoscopic retrograde Cholangiopancreatography (ERCP)
What are 5 medication classes for Gallbladders?
Cholesterol Dissolving Agent
(Monoctanoin, CDCA, UDCA Actigal)
(Zocor, "Statin" Meds)
Bile Acid Sequestrants
What do Cholesterol dissolving agents do?
Decrease amount of cholesterol in bile
Stones re-occure, indefinite time meds
What does lipid lowering meds do?
Decrease LDL and cholesterol synthesis
Unclear if this affects cholesterol levels in bile
What are some side effects of Bile Acid Sequestrants?
Decrease absorption of K, A, D, E
Increased Bleeding Tendencies
What are 3 types of Gallbladder surgery?
Shock waves crush the stones & pass naturally
Laparoscopic - Surgical Removal
T-Tube inserted into bile duct with cholestomy bag
What are some Pre/Post-Op care that needs to be done for gallbladder surgery?
Head to Toe Assessment & VS
Nutrition, Fluids & Electrolytes
Pain & Discomforts
Management of tubes, drains & dressing
Patient and family teaching
What are some complications with Gallbladder surgeries?
Severe pain & tenderness in RUQ
Abdominal girth Increases
Bile or blood leaking from wound
Decreased BP and Increased HR
What are some teachings for gallbladder surgeries?
Routine Pre/Post-Op teaching
Wound Care, Management of T-Tube
What are some S&S to report to PCP after gallbladder surgery?
Dark Colored Urine
Pale Colored Stools
What are some Health Promotion to do for gallbladder surgeries?
Increase Fiber, Carbs and Proteins
Decrease Saturated Fats
Ingest meals at regular intervals
Participate in vigourous Exercise
What is Anhedonia?
Inability to find meaning or pleasure in existence
What are some factors that lead to depressions?
Stressful LIfe Event
What does serotonin do for your body?
Perception of Pain
What does norepinephrine do in your body?
ANERGIA - Lack of Energy
ANHEDONIA - Inability to find meaning
What are some biochemical factors (Diseases) that affect depression?
CNS neurotransmitter abnormalities
What is learned helplessness?
Person feels they have no control over situation
If they believe it's their fault, it can't be changed
Depression is higher in ______ people and twice as common in _______.
Depression is higher in WHITE people and twice as common in WOMEN.
Depression is associated with chronic illnesses and can cause pain, suicide increases with ______.
Depression is associated with chronic illnesses and can cause pain, suicide increases with AGE.
During depression patients may have ________ or _________
During depression patients may have HALLUCINATIONS or DELUSIONS
What is Dysthymia Disorder?
Chronic Depressive syndrome
Usually not hospitalized
Onset may occur early in life
Patients with Dysthymia Disorder are at risk for developing what?
Major Depressive Disorder
What are some nick names given to people with Dysthymia Disorder?
What are 6 subtypes of Major Depressive Disorder?
What are the following subtypes of MDD?
Break with Reality - Hallucinations/Delusions
Weird Voluntary movement - Waxy Flexibility
Anorexia or Weight Loss
Within 4 weeks post baby
Fall or winter w/ remission in the spring
Weight Gain, Hypersomnia
Patient's with MDD should be watched for suicide potentional, especially if you notice a sudden ______ of _______, and they say everything is fine!
Patient's with MDD should be watched for suicide potentional, especially if you notice a sudden BURST of ENERGY, and they say everything is fine!
There are a TON of S&S for Major Depressive Disorder, What are some of the main ones?
LOOK OLDER THAN AGE
FACIAL EXPRESSIONS CONVEY SADNESS
NO EYE CONTACT
LACK OF HYGEINE
CHANGE IN EATING & SLEEPING PATTERNS
MEMORY & CONCENTRATION PROBLEMS
What is the #1 priority when dealing with patients with depression?
Them and You
What are some interventions with patients with MDD?
(Tricyclic Antidepressant TCA, SSRI, Atypical depression meds, MAOI's)
Integrative TherapiesTherapy 30-60 min/day)
St. Johns Wort
(used for Mild Depression)
What are some items you should do for safe care of patients with MDD?
No Suicide Contract
What are 2 common diagnosis for MDD patients?
(Highest priority Dx)
Disturbed thought process
What do higher needs deal with?
Feelings & how we organize our reality in our head
Emotions and the mind
(How you feel about yourself)
What is Self Esteem?
Your self concept
Self worth, self respect, privacy, dignity, self reliance
What is self actualization?
Stand up for yourself
What is Safety and Security?
Becomes a higher need when we don't feel secure
Are we in danger of being hurt
Are we safe
Action Warrants action
What is love & Belonging?
The need to feel loved & accepted
Not necessarily conventional love
*Pets/Church - Sense of belonging relationships
Physical needs come _____ EVERYTIME!
Physical needs come FIRST EVERYTIME!
Make sure there is not a physical problem causing a _______ problem.
Make sure there is not a physical problem causing a PSYCHOLOGICAL problem.
Who is the father of Psychology?
What is the primitive, pleasure-seeking part (particularly sexual pleasure) of our personalities that lurks in the unconscious mind? (FREUD THEORY)
What is our sense of self and acts as an intermediary between the id and the world by using defense mechanisms, such as repression, denial, and rationalization? (FREUD THEORY)
What is our conscience and is greatly influenced by our parents’ or caregivers’ moral and ethical stances?
What are some DO's for an effective nurse-patient relationship?
Use open ended questions
self disclose a purpose of helping patient
Use touch when appropriate in appropriate manner
What are some DON'T's for an effective nurse-patient relationship?
Give out your phone #
Don't cross boundaries
Remember why you're there, not to be friend
What are the phases of interactions?
What happens during the most important phase of interaction with a patient, Pre-Orientation?
Time preparing self for actions with patient
Talking to team members
Examining own feelings
What happeens during the orientation phase?
Determining where you are going to go
Develop plan with patient
What happens during the working phase?
Meeting them & doing interventions
Working on set goals with each other
Termination begins on __________
Termination begins on ADMISSION
What are the characteristics of caring?
Are you prepared and approachable
Victims can become perpertrators
Can you understand where they come from
Be real, mean what you say
As humans & individuals
Be trustworthy, tell truth, don't make promises you can't keep
Only when benefits pt
Be careful, can come off as cynical
What are some alternative therapies for depression/mood disorders?
What are 4 items that occur during the termination phase?
• Summarizing the goals and objectives achieved in the relationship
• Discussing ways for the patient to incorporate into daily life any new coping strategies learned during the time spent with the nurse
• Reviewing situations that occurred during the time spent together
• Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship
What are 4 reasons that going through the termination phase is so important?
• Feelings are aroused in both the patient and the nurse with regard to the experience they have shared; when these feelings are recognized and shared, patients learn that it is acceptable to feel sadness and loss when someone they care about leaves.
• Termination can be a learning experience; patients can learn that they are important to at least one person.
• By sharing the termination experience with the patient, the nurse demonstrates caring for the patient.
• This may be the first successful termination experience for the patient.
What is a healthy environment, combined with a healthy social structure within an inpatient setting or structured outpatient clinic is essential to supporting and treating those with mental illness?
Therapeutic Milieu refers to the _________ in which holistic treatment occurs and includes all members of the treatment team, a positive physical setting, interactions between those who are hospitalized, and activities that promote recovery.
Therapeutic Milieu refers to the ENVIRONMENT in which holistic treatment occurs and includes all members of the treatment team, a positive physical setting, interactions between those who are hospitalized, and activities that promote recovery.
Most Therapeutic Milieu's goals are to .....
(4 of them)
Help increase patients’ self-esteem
Decrease social isolation
Encourage appropriate social behaviors
Educate patients in basic living skills
What is the goal of group therapy?
Assumes that interaction among participants can provide support or bring about desired change among individual participants.
What is the Nurse's Role in Group Therapy?
To provide a structure to understand the group interaction
What is ECT (Electroconvulsive Therapy)?
A procedure that uses electrical current to induce a seizure, and is thought to work by affecting neurotransmitters and neuroreceptors
What happens during Psychosurgery?
A small piece of brain is destroyed or removed
What happens during phototherapy?
Exposure to daylight or to specific wavelengths of light using polychromatic polarised light, lasers, light-emitting diodes, fluorescent lamps, dichroic lamps or very bright, full-spectrum light, usually controlled with various devices. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day
In healthy individuals, the ___ is able to realistically evaluate situations, limit the ___'s primitive impulses, and keep the _______from becoming too rigid and obsessive
In healthy individuals, the EGO is able to realistically evaluate situations, limit the ID's primitive impulses, and keep the SUPER EGO from becoming too rigid and obsessive.
___________ ______________ protect people from painful awareness of feelings and memories that can provoke overwhelming anxiety. Adaptive use of ___________ _____________ helps people lower anxiety to achieve goals in acceptable ways.
DEFENSE MECHANISMS protect people from painful awareness of feelings and memories that can provoke overwhelming anxiety. Adaptive use of DEFENSE MECHANISMS helps people lower anxiety to achieve goals in acceptable ways.
What theory focuses on what occurs between people, and not the mind?
Who was considered the mother of psychiatric nursing, had a passion for clarifying and developing the art and science of professional nursing practice and believed that a scientific approach was essential to the practice of psychiatric nursing?
What are the 4 stages to Peplau's Phases of Interactions?
What is the phase of Interactions where concerns focus on being afraid of people with psychiatric problems, saying “the wrong thing,” and being unaware of the proper responses to certain patient behaviors?
What is unconsciously keeping unacceptable feelings out of awareness?
IE: A man is jealous of a good friend's success but is unaware of his feelings
What is consciously keeping unacceptable feelings & Thoughts out of awareness?
IE: A student taking an examination is upset about an argument with her boyfriend but puts it out of her mind so she can finish the test
What is the unconscious assumption of similarity between oneself and another?
IE: After hospitalization for minor surgery, a girl decides to be a nurse
What is the acceptance of another's values & opinions as one's own?
IE: A woman who prefers a simple life style assumes the materialistic, prestige-oriented values of her husband
What is attributing one's own acceptable feelings and thoughts to others?
Ie: A man who is quite critical of other thinks that people are joking about his appearance
What is blocking out painful or anxiety-inducing events or feelings?
IE: A boss tells an employer he may have to fire him. On the way home the employee shops for a new car
What is the falsification of experiences through the construction of logical or socially approved explanations of behavior?
IE: A man cheats on his income tax return & tells himself it's alright bc everyone does it
What is unacceptable feelings disguised by regression of the feeling and by reinforcement of the opposite feeling?
IE: A woman who dislikes her mother-in-law is always nice to her
What is discharging of pent-up feelings on persons less dangerous than those who initially aroused the emotion?
IE: A student who has received a low grade on a term paper blows up at his girlfriend when she asks about his grade
What is the separating an emotion from an idea or thought because the emotional reaction is too painful to be acknowledged
IE: A man learns from his Dr. that he has cancer. He studies the physiology and treatment of cancer without experiencing any emotion
What are defense mechanisms?
Psychological techniques the personality develops to manage anxiety, aggressive impulses, hostilities, resentments, frustrations and conflicts between the ID and the Superego
Used by both mentally healthy and mentally Ill
Mental health is determined by the degree that the defense mechanisms _______ the personality, _______ behavior, and ________ adjustment with others
Mental health is determined by the degree that the defense mechanisms DISTORT the personality, DOMINATE behavior, and DISTURB adjustment with others
What are the 4 types of Antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRI's)
Monoamine Oxidase Inhibitors (MAOI's)
Newer Atypical Antidepressants
What do tricyclic Antidepressants do?
Inhibit uptake of norepinephrine and serotonin
10-14 days before working
4-8 wks full effect
Start low and raise SLOWLY
What are some adverse effects of Tricyclic Antideppressants?
Drymouth, blurred vission, tachycardia, constipation, urinary retention
What are some TOXIC effects of Tricyclic Antidepressants?
CAN KILL QUICKER WITH OVERDOSE
Cant see, pee, spit, shit
What do SSRI's do?
They blok the uptake of serotonin
Decrease Anticholinergic effects
Treats anxiety disorders, OCD and Panic
What are some adverse side effects of SSRI's?
Poor sexual performance
Loose bowel movements
What is a toxic effect of SSRI's?
What are some S&S of Serotonin Syndrome?
What do MAOI's do?
Prevents breakdown of Norepinephrin, Seratonin and Dopamin
Inhibits breakdown of tyramine int he liver
Increased tyramine levels which lead to HYPERTENSION, HYPERTENSIVE CRISIS OR DEATH!
What do you use MAOI's for?
What are some adverse effects for MAOI's?
Changes in Cardiac Rhythm
What are some toxic effects of MAOI's?
Stiff or sore neck
What do Newer Atypical (NOVEL) Antidepressants do?
Blocks different neurotransmitters
Target unique populations of depressed individuals as well as other conditions
What person would you see first, one with higher or lower need?
LOWER NEED Physical needs ALWAYS come first
What is unconsciously keeping unacceptable feelings out of awareness?
What is consciously keeping unacceptable feelings out of awareness?
What is unconscious assumption of similarity between oneself & another?
What is the acceptance of another's values & opinions as ones own?
What is the attributing one's own unacceptable feeling and thoughts to others?
What is the blocking out painful or anxiety-inducing events or feelings?
What is the falsification of experiences through the construction of logical or socially approved explanation of behavior?
What is the unacceptable feelings disguised by regression of the real feeling and by reinforcement of the opposite feeling?
What is the discharging of pent-up feelings on persons less dangerous than those who initially aroused the emotion?
What is the separating of an emotion from an idea or thought because the emotional reaction is too painful to be acknowledged?
What are the 3 theories that Sullivan discusses?
Ie: I am great at football, I feel good
Ie: I failed that test, I am a failure
Ie: I didn't do it, It wasn't me
What are some patient teachings for SSRI's?
Decrease in sexual function
Drug Interactions w/ DIGOXIN/WARFARIN
Do NOT DC abruptly
Liver & Renal tests with WBC's periodically
What are some S&S of SSRI's that require IMMEDIATE attention?
Increase in suicidal thoughts
Rash or hives
Initiation of Hyperactive behavior
What are 4 other (Somatic) treatments for Depression?
Electroconvulsive Therapy (ECT)
Vagus Nerve Stimulation (VNS)
St. John's Wort
What is written deffammation?
What is spoken deffammation?
What is a verbal threat?
What is actually harming someone?