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...
Secondary• interventions that limits the severity  of a disorder.2 Components• Case finding• Prompt treatmentExamples:• Cr...
Tertiary• Interventions aimed at reducing the  disability after a disorder2 Components• Prevention of complication• Active...
The Psychiatric    Nurse                  5
Characteristics• Empathy - the ability to see  beyond outward behavior and sense  accurately another persons’ inner  exper...
Roles of the Nurse in         Psychiatric Setting•   Ward manager•   Socializing agent•   Counselor•   Parent surrogate•  ...
Principles of Care in Psychiatric            Settings• The nurse views the patient as a  Holistic human being with  interd...
• The nurse should explore the patients  behavior for the need it is designed to  meet and message it is  communicating• T...
BASIC CONCEPTS ONPSYCHOPHARMACOLOGY                      10
Major Tranquilizers/AntipsychoticsIndication: Schizophrenia and Other  PsychosisExamples:• Haloperidol (Haldol)• Prochlorp...
Desired Effect: Control of symptomsNursing Implications:• Best taken after meals• Report sorethroat• avoid exposure to sun...
Side effects:• Blurred vision, dry mouth, tachycardia,  palpitation, constipation, urinary retention• Skin: Photosensitivi...
MINOR TRANQUILIZERS/       ANXIOLYTICSCommon indication: Anxiety disordersDesired Effect: Decreased anxiety, adequate slee...
Nursing Implications:• Best taken before meals, food in the  stomach delays absorption• Avoid driving, intake of alcohol a...
AntidepressantsDesired effects: increasedappetite, adequate sleep                         16
TRICYCLIC     ANTIDEPRESSANTSIndication: Depression• increase the level of serotonin  neurotransmitters or norepinephrine ...
Nursing Implications:• Best given after meals• Therapeutic effects may become evident  only after 2-3 weeks of intake• Che...
MAO INHIBITORS• Prevent metabolism of  neurotransmitters which carry  message from one nerve cell to  another.• Toxic when...
Nursing Implications:• Best taken after meals• Report headache; it indicates   hypertensive crisis• Avoid tyramine contain...
Selective Serotonin    Reuptake Inhibitors• Indications: Depression, anxiety,  panic attacks, eating disorders• MOA: inhib...
• Examples:  – Fluoxetine (Prozac)  – Celatopram (Celexa)  – Sertraline (Zoloft)  – Paroxetine (Paxil)  – Fluvoxamine (Luv...
Nursing Implications• Avoid the use of diazepam, alcohol,  and tryptophan because these may  alter the effect of these dru...
ANTI-MANIC AGENT• Cause augmentation of serotonin  function in the CNS preventing  increased nerve impulse  transmissionEx...
• Nursing implications:• Best taken after meals• Increase fluid intake (3 L /day) and  sodium intake (3 gm/day)• Avoid act...
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  abo...
Indications of use:• Depression• Mania• Catatonic schizophrenia                            28
Contraindications (not absolute)• Fever• Increased ICP• Cardiac conditions• TB with history of hemorrhage• Unhealed fractu...
Before the procedure:• Diagnostic procedures  – X-ray  – ECG  – EEG• Drugs given  – Atrophine sulfate (decrease secretions...
During the procedure:• Observe for tonic-clonic seizureAfter the procedure:• Position• Check vital signs• Reorient the cli...
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05 psychiatric nursing

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05 psychiatric nursing

  1. 1. Levels of Interventions inPsychiatric Nursing 1
  2. 2. 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
  3. 3. Secondary• interventions that limits the severity of a disorder.2 Components• Case finding• Prompt treatmentExamples:• Crisis intervention• Drug administration 3
  4. 4. Tertiary• Interventions aimed at reducing the disability after a disorder2 Components• Prevention of complication• Active program of rehabilitationExamples:Alcoholics anonymousOccupational therapy 4
  5. 5. The Psychiatric Nurse 5
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. • 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
  10. 10. BASIC CONCEPTS ONPSYCHOPHARMACOLOGY 10
  11. 11. Major Tranquilizers/AntipsychoticsIndication: Schizophrenia and Other PsychosisExamples:• Haloperidol (Haldol)• Prochlorperazine (Compazine)• Fluphenazine (Prolixin)• Chlorpromazine (Thorazine) 11
  12. 12. Desired Effect: Control of symptomsNursing Implications:• Best taken after meals• Report sorethroat• avoid exposure to sunlight• Report elevated temperature• Check the BP 12
  13. 13. 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
  14. 14. MINOR TRANQUILIZERS/ ANXIOLYTICSCommon indication: Anxiety disordersDesired Effect: Decreased anxiety, adequate sleepExamples: Diazepam (Valium) Oxazepam (Serax) Chlordiazepoxide (Librium) Chlorazepate Dipotassium (Tranxene) Alprazolam (Xanax) 14
  15. 15. 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
  16. 16. AntidepressantsDesired effects: increasedappetite, adequate sleep 16
  17. 17. TRICYCLIC ANTIDEPRESSANTSIndication: Depression• increase the level of serotonin neurotransmitters or norepinephrine in the space between nerve endings• Deficiency  depressionExamples: Imipramine (Tofranil) Amitriptyline (Elavil) 17
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. • Examples: – Fluoxetine (Prozac) – Celatopram (Celexa) – Sertraline (Zoloft) – Paroxetine (Paxil) – Fluvoxamine (Luvox) 22
  23. 23. 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
  24. 24. 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
  25. 25. • 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
  26. 26. Signs of toxicity:• Vomiting• Anorexia• Nausea,• Diarrhea• Abdominal crampsAntidote: Mannitol 26
  27. 27. 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
  28. 28. Indications of use:• Depression• Mania• Catatonic schizophrenia 28
  29. 29. Contraindications (not absolute)• Fever• Increased ICP• Cardiac conditions• TB with history of hemorrhage• Unhealed fracture• Retinal detachment• Pregnancy 29
  30. 30. Before the procedure:• Diagnostic procedures – X-ray – ECG – EEG• Drugs given – Atrophine sulfate (decrease secretions) – Anectine (Succinylcholine) – relax muscles – Methohexital Na (Brevital) - anesthetic 30
  31. 31. 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

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