Quiz 4, bipolar, antiepileptic, benzos, non-benzos PDF

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week 4 review bipolar disorder, antiepileptic, benzodiazepines, and non-benzodiazepines, assessment 3 review...

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QUIZ 4  Lithium Toxicity what type of labs are needed o BUN (10-20 mg/dL) o Creatinine (male: 0.6-1.2 mg/dL, female: 0.5-1.1 mg/dL) o Sodium (135-145 mEq/L) o Lithium Level (0.6-1.2 mEq/L)  take medication with meals and milk  Interactions  diuretics o due to sodium excretion from diuretic and lithium excretion can lead to toxicity  NSAIDS o due to renal reabsorptions with lithium that can increase the risk of toxicity o only use ASPIRIN  Antihistamine o avoid meds that causes anticholinergic effects  Tricyclic antidepressants o avoid meds that causes anticholinergic effects  Complications  Nausea  diarrhea  abdominal pain  fine hand tremor  POLYURIA (excessive urination) o use K-sparing diuretic  SPIRONOLACTONE  RENAL TOXICITY o monitor for  BUN  Creatinine  GOITER/HYPOThyroidism o with long term use  TSH levels  T3  T4  brady dysrhythmias  hypotension  electrolyte imbalance  maintain adequate SODIUM + FLUID intake

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Levels of Toxicity  1.2-1.5 o common adverse effect  diarrhea  nausea  vomiting  polyuria  muscle weakness  slurred speech  lethargy o Nurse interaction  instruct the patient that the manifestation will improve overtime  1.5-2.0 o early adverse effect  confusion  sedation  poor coordination  coarse tremor  nausea  vomiting  diarrhea o Nurse interaction  hold medication and notify provider ASAP  VOID is promoted  administration of medication based on BLOOD LITHIUM LEVEL.  2.0-2.5 o Advance adverse effects  extreme polyuria  tinnitus  giddiness  blurred vision  ATAXIA  impaired balance and coordination  hypotension  stupor  chronic twitching  POSSIBLE DEATH FROM RESPIRATORY COMPLICATIONS o Nursing Implication  administer emetic or gastric lavage, urea, mannitol, aminophylline to elevate excretion.  2.5> o severe toxicity

seizure OLIGURIA  production of SMALL amounts of urine  coma  death Nurse Implication  hemodialysis  

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 Medication: VALPROATE o used to treat ACUTE MANIA o Side Effects  GI  nausea  vomiting  indigestion  Client Education o side effects are generally self-limiting o take medication with food or switch to enteric-coated formulation  HEPATOTOXICITY  Evidence of o anemia o nausea o vomiting o fatigue o abdominal pain o jaundice o Client Education  Observe for hepatotoxicity and notify provider ASAP  Pancreatitis  evidenced by o nausea o vomiting o abdominal pain  monitor AMYLASE levels  discontinue the medication if pancreatitis develops.  Client Education: o observe for manifestation of pancreatitis and notify provider ASAP  Thrombocytopenia  monitor platelet count o 150,000-400,000  < than 150,000 = Thrombocytopenia  >than 400,000 = Thrombocytosis

Client Education o observe for BRUISING and notify provider ASAP Can Valproate be given with Lithium? o yes What labs is needed when giving the patient Valproate? o for hepatotoxicity check for Liver function test  AST/SGOT (Aspartate Aminotransferase) (5-40 units/L)  ALT/SGPT (Alanine Aminotransferase) (8-20 units/L)  ALP (Alkaline Phosphatase) (42-128 units/L)  Total Protein  Albumin  Globulin  Bilirubin  Indirect o does NOT dissolve in water  Direct o dissolves in water o for Pancreatitis check for Enzyme levels  amylase (56-90 IU/L)  Lipase (0-110 units/L) Patient diagnosed with ACUTE MANIA; how do you know the patient has ACUTE MANIA? (BEHAVIOR) o pressured speech o agitation o inappropriate behavior o demanding and manipulative behavior o sexual preoccupation (touching themselves)” Hypersexual” o attention seeking o grandiosity o disorganized speech o impulses o neglect of ADL  nutrition  hydration Which medication is given to a patient with an acute mania? o Carbamazepine  minimal effect on cognitive function  side effects:  Nystagmus  double vision  vertigo  staggering gait 

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 How do you APPROACH a patient with ACUTE MANIA? o focus is on SAFETY and maintaining PHYSICAL HEALTH o provide a safe environment o Assess for suicidal ideation o de-escalate the situation/decrease stimulation o follow protocol regarding restrictions  verbal as a first attempt  chemical as a second attempt  physical as the last attempt o Calm, matter-of-fact specific approach o give short explanation o re-orient o provide consistency with expectations and limit setting.  THOUGHTS of a patient with ACUTE MANIA o clang association o flight of ideas  rapid  continuous speech  sudden and frequent topic change o poor judgement  DEPRESSIVE characteristics of an ACUTE MANIA patient o Flat affect o blunt affect o labile affect o ADHEDONIA  loss of pleasure and lack of interest in activities, hobbies, sexual activities.  difficulty concentrating  self-destructive behavior, including SUICIDAL IDEATIONS  decrease in personal hygiene  loss or increase in appetite  loss or increase in sleep patterns  psychomotor retardation  SOCIAL anxiety behavior o the patient experiences excessive fear of social or performance situations o the patient might report physical manifestations to AVOID a social situation  actual manifestation (real)  factitious manifestation (made-up)  PANIC attack behavior o it last 15 to 30 minutes o manifestation  palpitation  shortness of breath  chocking or smothering sensation

chest pain nausea feeling of DEPERSONALIZATION  out of body experience  fear of dying or insanity  chills or hot flashes o may experience behavior changes or persistent worrying about the next episode  Nursing implication with a patient that is having a PANIC ATTACK o assess for suicidal ideation o provide a safe and comfortable environment  a client experiencing a panic level of anxiety benefits from a CALM and QUIET environment. o instill hope for positive outcome  AVOID false reassurance o DO NOT leave client alone  What level of anxiety does the patient have when experiencing PERCEPTUAL FIELD IMPAIRMENT o Panic level  distorted perception  loss of rational thoughts  immobility  dysfunction in speech  dilated pupils  SEVERE SHAKINESS severe withdrawal  inability to sleep  delusion  hallucinations  severe hyperactivity  flight or immobility  extreme flight  horror  can lose touch with reality  completely distracted  unable to function  chills and trembling  CATATONIA  RISK FOR SUICIDE DUE TO INSOMNIA  Medication: LAMOTRIGINE o used for MAINTENANCE therapy for bipolar disorder o Side effects  double vision  blurred vision  dizziness  headache   

nausea vomiting Client Education  AVOID performing activities that require concentration or visual acuity. o Adverse Effect  Severe Skin Rash  includes Stevens-Johnson Syndrome  Client Education o WITHHOLD the medication and notify the provider ASAP if rash occurs. o to minimize the risk of rash start medication at the lowest dose and slowly increase.  Medication: CLOZAPINE (SELECT ALL THAT APPLY QUESTION) o 1st generation ATYPICAL ANTIPSYCHOTIC o is NO LONGER considered the 1st line of medication for Schizophrenia, due to adverse effects o Nursing Actions  Low risk of EPS (extrapyramidal symptoms)  HIGH risk for  weight gain  diabetes  dyslipidemia  Risk for FATAL AGRANULOCYTOSIS  indication that there is an infection o fever o sore throat  need to obtain a CBC  discontinue medication if WBC count is < than 3000 mm3.  Baseline and regular monitoring of WBC  WBC (5000-10,000 mm3)  notification of provider ASAP if there is an indication of infections  fever  sore throat  mouth lesions  PRIORITY nursing intervention for a patient that has DID (dissociative identity disorder) o RISK of injury  Difference between DISSOCIATIVE FUGUE and DISSOCIATIVE AMNESIA o Dissociation  is a disruption in consciousness, memory, identity, or perception of the environment that results in the compartmentalization of uncomfortable aspects of oneself. o Dissociative FUGUE  a type of amnesia where a patient TRAVELS to a new area and it is unable to remember one’s own identity.   

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Dissociative AMNESIA  inability to recall personal information related to a TRAUMATIC or STRESSFULL event. Depersonalization  is the feeling that a person is observing one’s own personality or body from a distance. Derealization  is the feeling that outside events are unreal or part of a dream  object may appear smaller or larger than they should....