Mental Health Nursing: Antipsychotics

• Study notes for Mental Health Nursing

Antipsychotic Medications

• Antipsychotics may induce side effects like sedation, weight gain, dry mouth, constipation, dizziness, and orthostatic hypotension.
• Extrapyramidal Symptoms (EPS) are a notable side effect, encompassing dystonia, akathisia, and tardive dyskinesia.
• Neuroleptic Malignant Syndrome (NMS) is a severe potential effect, characterized by fever, rigidity, and altered mental status.

EPS Treatment

• Benztropine (Cogentin) is an anticholinergic drug used for dystonia and Parkinsonism.
• Diphenhydramine (Benadryl) can treat acute dystonic reactions.
• Propranolol (Inderal) is used to manage akathisia.

Medication Compliance Strategies

• Long-acting injectables (LAIs) such as Risperdal Consta, Haldol Decanoate, Invega Sustenna, and Abilify Maintena aid patients struggling with daily oral medication adherence.

Barriers to Medication Compliance

• Factors hindering compliance include lack of insight, side effects, cost, stigma, fear of dependency, lack of social support, and forgetfulness.

Benzodiazepines

• Common side effects include drowsiness, dizziness, confusion, and respiratory depression, particularly with high doses.
• Benzodiazepines pose a risk of dependence and withdrawal symptoms.
• Risks include sedation, falls (especially in elderly patients), and paradoxical reactions in some individuals.
• Concurrent alcohol use should be avoided due to increased CNS depression.

Restraints

• The immediate nursing action involves assessing the patient's safety, behavior, and the necessity for restraints.
• A provider's order must be obtained immediately, if not already in place.
• The nurse has ultimate responsibility for continuous patient assessment and safety.
• An order for restraints must be written by a provider within 1 hour of application.
• Restraint orders cannot be PRN (as needed) and must be renewed every 24 hours.
• Patients in restraints must be assessed every 15 minutes.
• Restraints should be released every 2 hours to assess circulation and provide range of motion.

Overdose and Withdrawal

• Opioid overdose presents with respiratory depression, pinpoint pupils, and unresponsiveness.
• Alcohol withdrawal manifests as tremors, seizures, hallucinations, tachycardia, and hypertension.
• Benzodiazepine withdrawal symptoms include seizures, anxiety, tremors, and agitation.
• Opioid overdose intervention involves administering Narcan (Naloxone) and supporting the airway.
• Alcohol withdrawal is managed by administering Benzodiazepines like Ativan or Librium.
• Benzodiazepine withdrawal requires gradual tapering of the medication and monitoring of vital signs.
• Narcan can be administered via IV, IM, SubQ, or intranasally.
• Education is needed on Narcan's short half-life, possibly requiring repeated doses.

Prioritization (Maslow’s Hierarchy of Needs)

• Physiological needs (airway, breathing, circulation, food, water) take priority over psychological needs.
• If a patient presents with both physiological and psychological needs, address physiological needs first.

Professional Boundaries & Ethics

• When encountering a previous patient in public, maintain confidentiality and do not initiate conversation unless the patient acknowledges first.
• Therapeutic communication builds trust, encourages openness, and enhances patient engagement in treatment.

Behavioral Considerations

• One-to-one monitoring is used for high-risk patients, such as those with active suicidal ideation or violent behavior.
• Suicide precautions include removing all dangerous objects, increased monitoring, and therapeutic communication.
• Cultural considerations require respecting beliefs about mental health, medication, and treatment preferences.

Involuntary Hospitalization Criteria

• Involuntary hospitalization is warranted if a person poses a danger to themselves or others.
• It is also justified for individuals unable to care for their basic needs due to a mental illness.

Suicide Risk Assessment

• Suicide risk can be assessed using tools like the Columbia Suicide Severity Rating Scale (C-SSRS), SAFE-T (Suicide Assessment Five-Step Evaluation and Triage), and the Beck Depression Inventory (BDI).
• Nursing interventions for active suicidal ideation include one-to-one observation, removal of dangerous items, contract for safety, and involving crisis intervention.

Key Mental Health Terms & Examples

• Countertransference refers to the nurse’s emotional reaction to the patient based on personal experiences.
• Duty to Warn stipulates that if a patient expresses intent to harm someone, the nurse must warn that person.
• HIPAA (Health Insurance Portability and Accountability Act) protects patient privacy, so information cannot be disclosed without consent.
• Breach of privacy involves discussing patient information publicly or accessing records without authorization.
• Tolerance is defined as needing a higher dose of a substance to achieve the same effect.

Abuse

• Common perpetrators of child abuse include parents, caregivers, or family members.

Mania (Bipolar Disorder Management)

• Best foods for manic patients are high-calorie, portable options like sandwiches, protein bars, and milkshakes.
• Managing behavior in manic patients involves reducing stimuli, setting clear boundaries, and using calm communication.

Levels of Prevention in Mental Health

• Primary Prevention aims to prevent mental health issues through education and support groups.
• Secondary Prevention focuses on early detection and intervention, such as screening for depression.
• Tertiary Prevention manages existing conditions to prevent worsening, employing rehabilitation programs.

Electroconvulsive Therapy (ECT)

• Before ECT, obtain informed consent.
• Patients should be NPO for 6-8 hours before ECT.
• Remove dentures, glasses, and contacts prior to the procedure.
• Administer Atropine to reduce secretions.