Mental Health Part 1 Recording 2_default-English.txt

Okay. This is going to be the relationship of development and the therapeutic milieu recording. So let's talk about the relationship development. So the nurse client relationship is the foundation on which psychiatric nursing is established. It's relationship where not just the nurse with the client...

Okay. This is going to be the relationship of development and the therapeutic milieu recording. So let's talk about the relationship development. So the nurse client relationship is the foundation on which psychiatric nursing is established. It's relationship where not just the nurse with the client and the nurse must recognize each other as important. Mutual learning is going to occur in this relationship. This is very different than the relationship you have with clients on a medical surgical floor, in the hospital, or in any other setting. Now. Your therapeutic interpersonal relationship is the process by which the nurse will provide the clients in need for psychosocial intervention. You are going to use yourself as an instrument to deliver your care. So you're going to do things like sitting with the client that we talked about in the last lecture, who is grieving. Sit with them. That might be, um, what you can do and intervene with. You're going to use yourself when they need someone to be there. You're going to actively listen. We'll talk about active listening, and we're going to use, um, different tools to intervene and to use ourself. So, um, those communication techniques are both verbal and nonverbal. The interpersonal communication techniques, those tools. So our expression we have on our face is going to be big in this relationship development. The pitch in which we, you know, talk to these clients is going to be relevant. Our tone, the way we dress and how we carry ourselves will be, um, instrumental in this relationship developing and occurring. Those are those tools of this intervention. Now what? You need to realize that the goals of the therapeutic relationship should be. There's going to be really four things that a therapeutic nurse client relationship should be. They should be goal oriented and personal, purposeful, not personal, goal oriented and purposeful. That should be number one. Number two, they should be well defined and have clear boundaries. Three. They should be structured to meet the client's needs. And four. They should be characterized by interpersonal process that is safe, it's reliable, it's confidential, and it's consistent. So the goal of this relationship is what's underlined for you in this slide. These relationships are directed at learning and growth promotion. How am I going to get this client to learn and to grow and be able to successfully adapt to the stressor at hand, and to future stressful situations that will occur? What are they going to learn and how are they going to grow and use adaptive coping mechanisms moving forward? Now this relationship you define it. It's going to be goal oriented. So you're going to have that goal with it. It's going to be all about the client. And you're not going to be swapping nurses like you would on a floor. This is going to be like, hey, they're going to develop this relationship with you. And you'll they'll feel safety in that. They'll know it's reliable. They'll know it's consistent. Um, and they'll know they'll start to build that trust with you and start to, you know, get more and more, um, confidential, and you'll be, you know, you'll prove to them that what they say and how you, you know, treat them is confidential, and you're not judging them and you're not, you know, treating them any differently because of what they're telling me. Now, there are phases of how you develop this relationship. The pre interaction phase. This is really where you're preparing yourself. You're exploring yourself like, hey, I know I'm about to take care of a client with schizophrenia. What do I feel about schizophrenia. How you know, what can, uh, you know, change about myself? Look at my feelings before I go and try to take care of somebody with this. You also do a chart review of this, um, you know, explore, you know, potentially talk to family members or other people. Um, they're going to be helping with this care in the orientation phase. This is when you start to establish that trust, um, formulate a contract for interventions, set those goals and define boundaries. Um, establish that that you're going to be you're going to maintain confidentiality in this relationship unless, you know, obviously it's something that you have to report. Okay. So this is where, you know, you're going to set those nursing diagnoses, those nannies that you're going to try to accomplish. You're going to set those goals, and they're going to be mutually agreeable goals and develop a plan of action that's going to be realistic for this patient and talk through it. The working phase of the relationship. That's when the work's going to take place. When you're trying to promote change and problem solve, when you're trying to have that growth and that learning occur. Um, you're going to have some setbacks and resistant behaviors, and you got to overcome those and you're going to continually, continually evaluate, you know, your progress and what's working, and then maybe change according to what's not working. And then in the termination phase of the relationship, this is when you're going to share your feelings and evaluate the goals. Um, this is the conclusion of the relationship. You hope that the progress has been made to goal attainment, and that the client has a set plan of action for how to more adaptively code for future, future stressful situations. Now, there are professional boundaries. Uh, and so you do want to make sure that those boundaries are set in that orientation phase. Um, that this isn't a, uh, professional relationship and that, you know, the expectations are appropriate for that. You will want to watch in your nurse client relationship and developing and developing this therapeutic relationship. Watch for transference. So then transferring and redirecting feelings about someone in the past. And they can redirect those feelings to you. Or you need to watch for counter transference when you as an hour in feels one way. Um, and you're going to treat that client a certain way based on how you've been treated in the past by this client. So watch for those in this relationship, because those are sometimes boundaries and barriers that you'll have to overcome in this nurse client relationship. Now what conditions do there need to be present for this relationship to develop? When you look at this list, you'll see wrap, report, trust, respect, genuineness, and empathy. The biggest one you'll find is trust. When you have a client that trusts you and you can start to, um, establish trust with them, you will find that you should have a good therapeutic relationship with them. Um, being having that rapport and implies special feelings on the part of both the client and on the nurse. That's like, you know, you're going to accept, um, you know, you're showing acceptance, warmth and friendliness, um, and a non-judgmental attitude. Trust is the basis of the therapeutic relationship. Respect is, you know, when you show that, hey, like, you know, I realize that regardless of your unacceptable behavior, my attitude is going to be non-judgmental in that respect is going to be. Unconditional in that it doesn't depend on the behavior that you have. Um, that I am that I am respecting you and genuineness, you know, that's how open and real you can be, being real, quote unquote real. Um. Is how you'll convey genuine empathy, is that ability to see beyond that outward behavior and understand the situation from the client's point of view. Um, and kind of try to see that that way. And remember, empathy is different than sympathizing and sympathy. Um, you know, that's that's a, that's a different. Thing in and of itself. Nonverbal communication. Okay. This is going to be big because nonverbal communication accounts for about 80% of your communication. So what you're saying when you're not saying anything is going to be very instrumental in this development of this therapeutic relationship that you're working so hard to build. So what goes into this nonverbal communication? Well, your physical appearance and your dress, um, your clothing that goes into not just clothing, but hair, cosmetics, jewelry, all of that stuff, the way in which you're going to position yourself that communicates messages regarding self-esteem, status, warmth, coldness, touch. Be mindful of touch as it relates to your client and if that's, um, appropriate or not. But touch can be a very powerful tool in communication, and it can work both negatively and positively depending on, you know, that interaction. Um, so make sure again, you go back to that culturally, that cultural aspect and make sure it's appropriate and in use touch appropriately based on, you know, the client in hand facial expressions. Obviously those are going to, um, reveal themselves. And so make sure you realize that your face is saying things. So make sure those expressions serve to complement and to qualify other communications behaviors. Um eye contact again this this this goes back to cultural um relativity is as well. Is it appropriate for this client to be looking you in the eye? Some clients will look you in the eye, but that doesn't mean that they're not paying you attention. It just might not be appropriate for them to. So eye contact is in our American culture that conveys that you're very interested and you have a personal interest in what the other person is saying. So eye contact for us would be important. But make sure that that eye contact is showing that, you know, that channel is open and that you want them to talk to you and interact with you and the language, that's that gestural component. That's how you know the pitch, the tone, how loud or soft you're speaking those vocal cues. If you're trying to say, I love you, but you're yelling it at the client and hey, I respect you, but you're yelling it at them that might, you know, convey a different message. Than what? Than what you're trying to get across actively listening. I've got that involved because active listening is going to be huge in relationship development in the mental health client. So how can I know? Or how can my client know that I'm actively listening to them? Well, you can practice this acronym called solar. So I'm going to sit squarely in the face. I'm going to observe with an open posture, lean in eye contact, relax. Don't sit standoffish. Don't have your arms crossed and leaning back and away from the client. Act like they have something that you're going to catch, you know, because that, um, helps them develop that trust and that rapport with you and all of those things that you're looking to get with the client. Okay? So actively listen to them and practice that solar acronym as you listen. Now, therapeutic communication techniques, these are all bolded. So please, please, please you will see this again. But I want you to see examples of therapeutic communication techniques. They are listed in your book on table five three. Um, I think they're on page 112 and 113. Familiarize yourself with them. Looked at, um, you know, some of them and say, okay, what would I be saying if I am therapeutically communicating? I've got a few of them underlined, the ones that I've underlined or the one that I found students get the most, um, mixed up on. So look at the examples in your book of restating, of reflecting, focusing in response, exploring how those differ. So basic things to remember when you're therapeutically communicating is that you're never asking the client why you're never judging. And a lot of these, they're going to be open ended questions. You're going to get them to tell you more in your, um, therapeutic communication techniques. So if it's something that's offering like a yes or no answer from the client, a lot of times that's not therapeutic because you're wanting more because remember, this relationship is focused on them improving and then getting better. So how are you going to, you know, get to the root of things. If they're you're asking closed ended questions, most of these will be open ended questions, um, that you see in their offering yourself, make you available, restating repeat. You know it in a different way. What they're saying to confirm that you understand, um, present reality, correct those misconceptions, you know, if those are needed for clients who are delusional or who are, um, hallucinating. But please take a few minutes and look at that in your book. Non therapeutic communication techniques. Again, these are all bolded too because I do want you to be aware of what they are and what some examples of. Non therapeutic communication techniques would be. Um those are also in a table. Table five for I think it's on page 114 in your book. So you should recognize and eliminate the use of these, uh, communication skills to develop your relationship with your client. Avoid these communication barriers and avoiding them will enhance your relationship with your nurse, with your client. A lot of them are closed ended. And getting the client to explain themselves and asking why? Um, don't give them false reassurance. Don't judge. Don't change the subject. Those are just some general things to get. But again, look at that for if you need some further clarification on there. Now let's talk about the therapeutic milieu okay. So milieu therapy or therapeutic community that's the basis of where you're going to be giving this care, what the um, environment will be as you try to implement positive changes in positive adapt and adapting strategies for your client. Okay. So the milieu, this therapeutic community should be safe, it should be supportive and it should be therapeutic. Why. So the client can adapt and cope and learn appropriate and um, positive adaptation skills. Okay. This type of therapy isn't anything new. It was developed in the early 1960s. And really what it involves is in this environment and then milieu therapy or in a therapeutic community, the client should be an active participant in their therapy. That autonomy, that individual autonomy is huge in this milieu, therapy. So they can learn adaptive coping strategies to use now and in the future so they can adapt appropriately. Okay. The, um, different strategies have been modified over the years to kind of conform to, you know, the short term approach or the outpatient treatment programs. But the goal of this type of therapy is to manipulate your environment. So all aspects of the client's experience are therapeutic, and they encourage healthy thinking. They encourage healthy behavior. They promote the client learning the necessary tools to cope adaptively. You're going to see this type of therapy in our outpatient setting when we go to spectrum Care. So this is where the clinicians will be working in outpatient unit, um, to develop and enhance those skills that allow for a healthier lifestyle through group therapy, through case managers, through um families. Some support. With nearly therapy and with mental health therapy. Most of the time, the community itself is going to be what serves as our primary tool of therapy. So we alter this community to help the client grow. So you'll see in this picture here they have rules for, you know, being there. And they have expectations that they know they need to uphold to keep the community therapeutic and to keep the atmosphere therapeutic. And if they can't uphold that, then that's when, you know, they might need to go to a different facility and a more high level of care for them. The program within this therapeutic community, a lot of times is directed by an interdisciplinary team where you have a psychiatrist, a nurse and other designated, um, people who establish, you know, the plan of care and formulate a plan of care. Um, you'll do this typically in the beginning, your sign, the treatment plan, you all meet to update it and, you know, revise it as needed. And, um, this is how you promote, you know, um, adaptively coping and learning those skills is through all of the team members working to see, hey, what's working in this environment and what's not, um, within our therapy. So there are some basic assumptions of the therapeutic community. Uh, the health of the individual is to be realized in the health, and they're encouraged to grow. This second box is going to be a big one. Every interaction is an opportunity for therapeutic intervention. So even when you have somebody who's aggressive and somebody who is, you know, kind of going against the therapeutic and kind of working against it and being maladaptive, you're going to try to use that experience as an opportunity for them to grow and an opportunity to therapeutically intervene and change that client owns his or her own environment, again, that promotes that autonomy. They're, um, responsible for maintaining this milieu and the environment of the unit. Um. So it can not only help them, but can also help everybody else who is in this environment. The client has to own their own behavior. Peer pressure is going to be used and it is used. A lot of times this is a community. Again, this is different than the treatment of a Carmen. Search for rehab. Everybody in their own rooms. A lot of times these clients are always together in group therapy, in group rooms, um, interacting together. So a lot of times they use that peer pressure to help them. Um. You know, grow and to become, um, more aware of their coping skills and maybe what they're doing that's not adaptive and identify that, um, restrictions and inappropriate behaviors are going to be dealt with, um, as they occur. You try to avoid that if you can. But again, you have to maintain the milieu in this environment. So again, uh, you have to meet those basic physiological needs. They, um, you're going to coordinate your facility to be more therapeutic. So the seating will be open and you'll a lot of times see couches, chairs, open seating. That's neat. That's orderly, that's comfortable. Um, it's going to be an environment that will promote interaction. The color scheme, you'll see that the colors are going to be promoting people, you know, wanting to be in there. If it's appropriate. You'll have a lot of windows and a lot of light going in these areas. So the facility is also going to be altered in this new type of therapy. Um, what else was I going to say with that? I think that's actually all I've had for that section. So what is your role in this therapeutic community, in the therapeutic milieu? Well, you are consistently to focus on the client. You got to focus on the client and you assume responsibility. Um, for the management of this therapeutic environment, in this therapeutic milieu, because you're the one that's there all the time on the most common, ah, on the most hourly basis. So you still have to do your basic nursing care. So assess, diagnose, you know, plan, implement and evaluate. You have to do the day to day activities that pertain to client care. You have to assess their physical status. Um and that cannot be overlooked. You have to give meds um, to them. And a lot of times in this, in this setting, you know, you'll you'll start to give them more and more autonomy with their medicine. Like, hey, you know, you just take your medicine. Encourage them to be self-reliant on that. But you must also be that foundation of trust. You know, and you have to be the one, you know, that kind of is how they're going to maintain that safety and you maintain that consistency in how you care for them. You're also responsible for setting limits on unacceptable behavior when they're doing something that disrupts this therapeutic environment. You have to, um, you know, kind of be the one that sets those limits and writes those limits out. And then it needs to be consistently carried out by all of the staff on the floor in the setting. Consistency in carrying out those consequences, um, is is key in that. And then your role as a teacher is another important consideration for the nurse in the psychiatric area. You got to be able to know, is my client ready to learn? Are they ready to kind of learn these adaptive coping mechanisms? And, uh, are they maybe ready to learn about some of their diagnosed diagnoses and their medications and all of that and how to stress manage. Um, but that's going to be on you. So your role in this environment is, is very big. And not only do you provide your basic nursing care, but you also will be responsible for the environment in, um, the psychiatric setting. Group therapy is going to be the most common form. Most clients in the psychiatric setting learn from each other in a group setting. So how they grow. A lot of times you think, okay, well, I'm going to give somebody who has pneumonia, I'm going to give them medicine and they'll get better. That's not the case in psychiatric nursing, right? Um, a lot of times how they'll get better is through learning from each other in a group setting. So group therapy is used a lot, um, work not just with clients, but with the families. Will often take place in the form of groups with group or not only does the nurse have the opportunity to reach out to a greater number of people at one time, but those individuals also can assist each other, so peer pressure again can be used in their peers, can be used to help them grow. Um, group leaders are typically going to be well trained. Um, when you're trying to lead like a certain group for people with schizophrenia and you're trying to teach something on schizophrenia in general, those people would typically be more advanced in their degree. They'll have a higher degree in social work or psychology or nursing in medicine. Those are typically the people who will lead, um, those groups. There also are groups that focus on, um, life support and on self-help groups, like when you have a similar problem, like you'll go to an AA or in a meeting. Those a lot of times are led by not professionals, but they're led by non-professionals, people who've been there and identified. But again, you as a nurse need. To know what are the purpose of these groups, what are the benefits? Who's appropriate to go to? What kind of group? Um, the focus of groups is on that relation, on the interactions among the group members and the and there's some consideration for whatever issue those groups are trying to deal with. So the function of groups, what are some examples of functions of groups. Well some of them are for socialization, some are for support. Some are for hey I have a task that needs completing. Um, some are for camaraderie, some are for information. So you also have empowerment groups. So there's different functions of groups, the different types of groups. You have a task group. Again if the function of it is to complete a task, you'll have a task group formed, um teaching groups to convey knowledge. A lot of times you'll see those about some general topics, um, of mental health and mental illnesses, supportive groups and therapeutic groups. Those are different. Those are another type of groups. Those help teach clients ways of dealing with stress. And like I said, self-help groups. Those are groups that typically form when clients have similar problems. And it can be things like AA, na, celebrate recovery, but also can be things like Weight Watchers, things like that. Sometimes those are run by non-professionals. But again, a lot of times you as a nurse aren't going to be leading a lot of these groups as some you will, but some of them will be led by caseworkers, social workers, psychiatrists, other people with, um, some advanced teaching and knowledge on those influencing factors for group settings. Um, the ideal number of people per group, um, typically you'll see that they're, you know, you want somebody to be open to, um, accept more people. So a circle of chairs commonly is done and you sit on the same level, that type of thing. Leadership styles. You found that the best leadership styles for these is mostly democratic, where the focus is on that. Members, um, those typically are the ones that are the most successful. Now let's talk about medicines and we will finish up this part one. Now we are going to talk about these four different categories of drugs. However, you're going to be really responsible for the first two anti-anxiety and antidepressants for our portion of mental health. So let's talk about our anti-anxiety agents. These are most appropriate for the treatment of acute anxiety. And a lot of times, um, acute anxiety is going to be treated with benzos. So our anti-anxiety agents are typically, um, be used for not chronic anxiety but for acute anxiety. And the most common class of those are going to be your benzodiazepines okay. So they treat acute anxiety. They also can treat other things. But we're talking about that treatment of acute anxiety benzos or what we're going to look at. So what do we need to know in general about benzos. First need to know that they're short term. They treat acute. So they should be used for short term. Now they're going to act a lot like alcohol does. Um and so it's going to kind of inhibit your Gaba which benzos, you know, kind of work that same way. So you want to watch for use of alcohol with them because they'll enhance that sedation. They'll enhance those downwards effects like alcohol does as well. Use of benzos for more than four months has not been evaluated. Long term use if somebody has chronic anxiety, typically anti-depressants are going to be what is recommended and once given because they're not as addictive. Um, and these are some examples of our benzos. We got Klonopin, Valium, Xanax. Those are very common. And then one that's not listed on here is what when you look at that, when you give a lot of times in the hospital, especially acutely and in an inner injection form will be out of hand, right. Lorazepam. Now, you do want to, um, kind of know about what your, what you're doing with benzos. You don't want to discontinue them abruptly if somebody has been on them long term, because you can get some life threatening withdrawal symptoms if they have been on them like they're not supposed to be in a more long term use. Um, increased effects, um, benzos can be seen if they're taken with alcohol, if they're taken with narcotics or antidepressants, um, or some herbal things like melatonin, things like that, other things that will sedate you more. Now they're not going to work as well when you do things that do the opposite. So if you're trying to, um, decrease anxiety and kind of calm the body, and then you're doing things that are going to kind of bring the body up, like drink a lot of caffeine or drink some, you know, coffee or smoke, um, cigarettes. Those things will decrease the impact and decrease the effect of your, um, benzos. Now, when you are giving them, you do want to monitor your client for the sedative, the sex, because that's not what you want with the benzo to be working adequately. So what are some sedatives effects you're going to watch for? Well, some can be a lower blood pressure. So drop in the blood pressure, dizziness, confusion, sedation lowering that respiratory rate. Um, depression can be seen when when there's the day of effects from those benzos, and then you want to monitor their respiratory status because again, you don't want them to be overly sedated for the client. You want them to be effective. So how we know for benzos effective for your client. Well, if I'm giving it for somebody who's acutely anxious, maybe I know that they're working and they're effective. If they have a reduction in their anxiety and then their tension and then their restlessness, if they're working appropriately as well, they're not going to have confusion. They can still talk to you. And they're not, um, confused about what's going on. They can do their and tolerate those usual activities without sedation. Um, you'll hope that they do not have any physical injury from the dizziness or confusion that could be happening with them. Um, and then you want to teach them about, you know, what to look for. And if they have been using them for a long time, verbalize those consequences of abrupt withdrawal and teaching them to not do stimulating activities when they're trying to take a benzo and, you know, decrease their anxiety. So don't do something that's doing the opposite of that, right. So those stimulating activities should be discouraged. So now benzos are going to be are most commonly used for acute anxiety. But you'll also see other medicines like your beta blockers and SSRIs. Those will also be used for anxiety. A lot of times those are going to be used though for more long term chronic anxiety. Um, when you do give a benzo, they are going to need, you know, that you will expect them to kind of get a little lower and you expect some of that sedation from it. But again, you want them to still be able to to do their activities of daily living if they're going to be on a benzo. Um, so data blockers, SSRI those things can also be used. You'll see them mostly for chronic anxiety, but you can see and for acute anxiety um, your benzos typically work quicker. So that's why they're used especially for that more acute state. Now if we're going to give one we do need to know what the antidote is. And the antidote for your benzos is. Flu. Maza. Nil. Okay. Now. Antidepressants. These are used to treat depressive disorders, but they are also used to treat, um chronic anxiety. Okay, so we have different classes. We have moas tricyclic SSRI our eyes. And those are going to be the ones we're really going to focus on. So moas they are um some older um older ones as well. With our antidepressants they are not used as commonly because they have a lot of restrictions and interactions. They interact with a lot of foods and different drugs and they can cause hypertensive crisis. But foods high in tyramine like cheeses, red wine, chocolate. They can't take any of that or they can't have anything that's high in that. Um, when they're on an email, uh, because it'll cause, um, adverse effects and you can get a hypertensive crisis from abuse and you're going to be assessing for that. So increased blood pressure obviously be looking for that. Palpitations, headache and nausea, vomiting and potentially a coma is not, um, treated. So if you have a clown in Mayo, I um you will want to watch for the interactions of things I can't eat and watch them for, um, a hypertensive crisis. There is a table in your book in chapter four, I believe, um, table four six or table four seven. That kind of lists more of those interactions. You're tricyclic or older? Older, um, anytime depressants, they're not first line because they have a lot of side effects. Anticholinergic side effects are very common with tricyclic. So if you do have a patient who is on one and is working well, you'll want to watch for those anticholinergic side effects like can't be, can't see, can't poop. So dry mouth, blurred vision, urine retention, dilated pupils those things and they can be toxic cardiac toxic in an overdose can kill you. Um um these tricyclic. So you do have to worry with those uh or watch with those for anticholinergic side effects and for um overdose SSRI and Snorers. Those are going to be our first line medicines. Why are they first line. Because they have fewer side effects. Now those are going to be things like Celexa Prozac and Effexor, those type of things. Um. With assessors. Um. You do want to watch for. Serotonin syndrome, because what accessorise are doing is they're in pivoting or serotonin uptake. So you're going to have more serotonin available. So what you want to watch for is serotonin syndrome, which can be deadly. Um, and a lot of times this happens when you're mixing medicines. So a lot of people and accessories, you know, you make sure they're only on that. You want to watch for any interactions with medicines. They might have to avoid medicines or certain medicines. But you're going to watch for the serotonin syndrome and its mild form. You'll see diarrhea, nausea and tremors. And then if it gets severe, you'll see things like high temperature and seizure occur. Symptoms of serotonin syndrome typically will start, um, over a few hours to 24 hours and typically um. You know, you'll see when they first start those medicines. Um SSRI is are used to treat depression and anxiety. You'll see them commonly used for PTSD, which we'll talk about next week. A lot of times you'll have side effects. Um, from xrays, you want to teach your clients that typically those side effects will start going away in a few weeks. Don't just discontinue it because they're having, um, a side effect from it, like maybe they're having dizziness from it or something like that. But if they don't go away, that's when they need to report or come back. Um. Activation syndrome is something you also want to be watching for with Saras, because when you start an SSRI, you can feel better. And so they kind of get a boost in energy. So you want to watch for that and report that boost of energy. Um, because what that can mean is like really what they're doing is they can implement a suicide plan or um, you know, can do something because they have that burst of energy. They can be more impulsive to do that. Um, with in general, with your antidepressants never mix antidepressants. They should have a two week washout period between them. So make sure you allow for that between meds if you're changing them and always taper them off slowly onset and increase the dose and slowly taper them off when you're discontinuing them. It may arise and SSRI if you mix those, if they're taking both of them, serotonin syndrome is it becomes a higher risk. Um, view Spa is another medicine. You'll see. Um, that'll sometimes be given for acute anxiety or for chronic anxiety. It's a little bit different. It's not quick acting. Um, so you can't take it just right away in at work. Um, it's not a benzo. And you'll also see, um, be appropriate or will be used as well. Um, as a newer combination of. This is just a chart with some of the side effects and things you might watch out for. Mood stabilizing agents. We're really not going to talk a ton about this. Um, they used to want us to talk and introduce lithium. You'll really get lithium next semester when you go to 202. When you talk about clients with manic disorders and bipolar disorders, lithium is a sort those. I will tell you a few major things about lithium. It is a salt. So anything that depletes your sodium will make more receptor sites available and increase your risk for lithium toxicity. So if you're on a diuretic, they need to watch that because they be if they're on lithium as well they can become lithium toxic. And why that's important is because toxicity, um, is common with lithium because it's got a narrow therapeutic range 1 to 1.5. Is there an acute mania or 0.6 to 1.2 is the common maintenance, um, range. So once they kind of get in that maintenance range, you want to watch for anything that's going to increase or decrease your salt. Um, so they will need to watch for, um, you know, they'll need to kind of be consistent with their salt intake, um, and keep it consistent. They'll need to keep their fluid intake consistent, exercise consistent. Because, you know, if you change that you might be losing more salt. And that can affect that lithium level. Um. One of the primary safety things with lithium, like I said, is that near a therapeutic range. And so you want to teach them, um, and they'll know, you know, once they get to that range, they'll be aware of that, um, and what to watch for if they do develop toxicity. So like, if you're sick and they've been having a lot of nausea, vomiting, diarrhea, that's when you're watching for, um, toxicity because you're depleting sodium and giving more spots for those lithium receptors to take when they take the lithium. Um, so watch for excess urination, extreme thirst, vomiting, diarrhea, tremors. Um, and if you can identify that early, you'll just increase the fluids and try to, um, combat that. Antipsychotics. Again, we're just going to kind of introduces because we're not talking about schizophrenia and a lot of psychotic disorders in this class. But you will see these used in some clients like with Alzheimer's and things. So we'll touch on them. Antipsychotics you have typical and atypical antipsychotics typically are not used as much now um because they have a lot more side effects. So your atypical is going to be more commonly used. An example of a typical, um, antipsychotic, Haldol first generation is the ones that were kind of first invented. Again, we don't use those as commonly. We mostly use or atypical antipsychotics because they have fewer side effects. That's things like Risperdal, Geodon, Abilify, uh, Seroquel, um, those type of things you will see more commonly. Now, why do we see those use more commonly again? Because they have fewer side effects. Now, so-called antipsychotics do not have side effects. So I do want to touch on what their side effects are. Um, anticholinergic side effects for atypical and typical can be seen. So your dry mouth urinating retention constipation blurred vision um and then extrapyramidal symptoms or side effects, those are more commonly seen with typical antipsychotics. So EPS is what's your kind of hear that extrapyramidal symptoms um referred to as those are things like a tremor or pseudo parkinsonism symptoms tremor shuffling gait rigidity drooling muscle weakness dystonia. When you have those involuntary spasms of your face or of your arms, of your neck, of your legs. Tartar tardive dyskinesia is also one of those things you'll see, maybe from long term use of typical antipsychotics, or even atypical over a long period of time, tardive dyskinesia. That's when you have that, um, normal, like facial twitching or lip smacking or poking in and out of the tongue. Um, really, once that develops, there's not really a good treatment for it. It just once it occurs, you try to treat it accordingly after that. But again, you do prefer to use your atypical antipsychotics because there's a decreased chance for those EPS symptoms, those extrapyramidal symptoms such as your dystonia tardive dyskinesia as in those pseudo parkinsonism symptoms. All right.