05 psychiatric nursing
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05 psychiatric nursing






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05 psychiatric nursing 05 psychiatric nursing Presentation Transcript

  • Levels of Interventions inPsychiatric Nursing 1
  • Primary• Interventions aimed at the promotion of mental health and lowering the rate of cases by altering the stressors• Examples – Health education – Information dissemination – Counseling 2
  • Secondary• interventions that limits the severity of a disorder.2 Components• Case finding• Prompt treatmentExamples:• Crisis intervention• Drug administration 3
  • Tertiary• Interventions aimed at reducing the disability after a disorder2 Components• Prevention of complication• Active program of rehabilitationExamples:Alcoholics anonymousOccupational therapy 4
  • The Psychiatric Nurse 5
  • Characteristics• Empathy - the ability to see beyond outward behavior and sense accurately another persons’ inner experiencing• Genuineness/congruence – ability to use therapeutic tools appropriately• Unconditional positive regard - respect 6
  • Roles of the Nurse in Psychiatric Setting• Ward manager• Socializing agent• Counselor• Parent surrogate• Patient advocate• Teacher• Technician• Therapist• Reality based• Healthy role model 7
  • Principles of Care in Psychiatric Settings• The nurse views the patient as a Holistic human being with interdependent and interrelated needs• The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is• The nurse should focus on the patients strengths and assets and not on his weakness and liabilities• The nurse views the patients behavior non-judgmentally, while assisting the patient to learn more adaptive ways of coping 8
  • • The nurse should explore the patients behavior for the need it is designed to meet and message it is communicating• The nurse has the potential for establishing a nurse-patient relationship with most if not all patients• The quality of the nurse - patient relationship determine the degree of positive change that can occur in the patients behavior 9
  • Major Tranquilizers/AntipsychoticsIndication: Schizophrenia and Other PsychosisExamples:• Haloperidol (Haldol)• Prochlorperazine (Compazine)• Fluphenazine (Prolixin)• Chlorpromazine (Thorazine) 11
  • Desired Effect: Control of symptomsNursing Implications:• Best taken after meals• Report sorethroat• avoid exposure to sunlight• Report elevated temperature• Check the BP 12
  • Side effects:• Blurred vision, dry mouth, tachycardia, palpitation, constipation, urinary retention• Skin: Photosensitivity• BP: Orthostatic hypotension• EPS-Extra Pyramidal Symptoms – Pseudoparkinsonism - pill-rolling tremors, mask-like face, cog-wheel ,rigidity, propulsive gait – Akathisia - restless leg syndrome – Dystonia - defect in muscle toneAdverse effect:• Tardive dyskinesia-lip smacking• Agranulocytosis• Hepatotoxicity 13
  • MINOR TRANQUILIZERS/ ANXIOLYTICSCommon indication: Anxiety disordersDesired Effect: Decreased anxiety, adequate sleepExamples: Diazepam (Valium) Oxazepam (Serax) Chlordiazepoxide (Librium) Chlorazepate Dipotassium (Tranxene) Alprazolam (Xanax) 14
  • Nursing Implications:• Best taken before meals, food in the stomach delays absorption• Avoid driving, intake of alcohol and caffeine containing foods, since it alters the effect of the drug• Administer it separately, it is incompatible with any drug 15
  • AntidepressantsDesired effects: increasedappetite, adequate sleep 16
  • TRICYCLIC ANTIDEPRESSANTSIndication: Depression• increase the level of serotonin neurotransmitters or norepinephrine in the space between nerve endings• Deficiency  depressionExamples: Imipramine (Tofranil) Amitriptyline (Elavil) 17
  • Nursing Implications:• Best given after meals• Therapeutic effects may become evident only after 2-3 weeks of intake• Check the BP, it causes hypotension• Check the heartrate, it causes cardiac arrythmias 18
  • MAO INHIBITORS• Prevent metabolism of neurotransmitters which carry message from one nerve cell to another.• Toxic when taken with tyramine / tryptophanExamples: Tranylcypromine (Parnate) Phenelzine (Nardil) Isocarboxazid (Marplan) 19
  • Nursing Implications:• Best taken after meals• Report headache; it indicates hypertensive crisis• Avoid tyramine containing foods like: – Avocado – Banana – Cheddar and aged cheese• Soysauce and preserved foods• It takes 2-3 weeks before initial therapeutic effects become noticeable• Monitor the BP• There should be at least a two-week interval when shifting from one anti- depressant to another 20
  • Selective Serotonin Reuptake Inhibitors• Indications: Depression, anxiety, panic attacks, eating disorders• MOA: inhibition of the serotonin uptake thereby increases the synaptic transmitter levels to exert an antidepressant effect. 21
  • • Examples: – Fluoxetine (Prozac) – Celatopram (Celexa) – Sertraline (Zoloft) – Paroxetine (Paxil) – Fluvoxamine (Luvox) 22
  • Nursing Implications• Avoid the use of diazepam, alcohol, and tryptophan because these may alter the effect of these drugs.• Monitor PTT, PT• Never give to pregnant / lactating mothers. 23
  • ANTI-MANIC AGENT• Cause augmentation of serotonin function in the CNS preventing increased nerve impulse transmissionExamples: Lithium Citrate (Cibalith – S) Lithium Carbonate (Eskalith, Lithane, Lithobid) 24
  • • Nursing implications:• Best taken after meals• Increase fluid intake (3 L /day) and sodium intake (3 gm/day)• Avoid activities that increase perspiration• Never give to pregnant mothers• It takes 10-14 days before therapeutic effect becomes evident.• Antipsychotic is administered during the first two weeks• Monitor serum level, normal is .5-1.5 mEq/L 25
  • Signs of toxicity:• Vomiting• Anorexia• Nausea,• Diarrhea• Abdominal crampsAntidote: Mannitol 26
  • ELECTRO-CONVULSIVE THERAPY• Exact mechanism is unknown• Requires a consent• Usually given at 70-150 volts for about .5-2 seconds• It takes 6-12 treatments with at least 48 hour interval to notice the effect• Indicator of effectiveness: tonic- clonic seizure 27
  • Indications of use:• Depression• Mania• Catatonic schizophrenia 28
  • Contraindications (not absolute)• Fever• Increased ICP• Cardiac conditions• TB with history of hemorrhage• Unhealed fracture• Retinal detachment• Pregnancy 29
  • Before the procedure:• Diagnostic procedures – X-ray – ECG – EEG• Drugs given – Atrophine sulfate (decrease secretions) – Anectine (Succinylcholine) – relax muscles – Methohexital Na (Brevital) - anesthetic 30
  • During the procedure:• Observe for tonic-clonic seizureAfter the procedure:• Position• Check vital signs• Reorient the client• Watch out for complications: – Memory loss – Headache – Apnea – Fracture – Respiratory depression 31