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Antidepressants
Tricyclic antidepressants: imipramine, amitriptyline
Nursing Problems
- Risk for violence/injury towards self
- Altered nutrition
- Self-care deficit
- Sleep disturbance
- Altered social interaction
- Isolation
- Low self esteem
- Social impairment
Assessment
- Onset of symptoms
- Presence of comorbid substance, alcohol, and medications (to rule out side effects from
substances)
- Functioning of the patient
- Physical examination
- Presence of non-mood psychiatric disorders (schizophrenia, Alzheimer’s, anxiety)
- Resources and social support system
- Interpersonal and coping abilities
- Level of stressors
- Presence and or level of suicidal ideations
Principles of communication
1. Depressed person suffers from low self esteem
2. Developing meaningful relationship is important to the client’s sense of worth
3. The nurse must be sincere and empathetic
4. Intellectual understanding does not help severely depressed clients
5. Typically dependent
6. Do not embarrassed clients out of being depressed
7. Never reinforce hallucinations, delusions, and irrational beliefs
8. Depressed clients tend to be angry
9. Withdrawn patients can be helped by spending time with them
10. Depressed persons can have difficulty in decision making
11. It may help to categorize depressed persons as suicidal risk individuals
Milieu management
Nutrition
Encourage to eat, can be small frequent feeding
Do not force to finish meal
Allow the patient to have participation in selecting meal
Make sure that proper diet, adequate fluid, and proper exercise
Sleep disturbance
Record the amount and quality of patient’s sleep
Establish client’s sleeping pattern before hospitalization
Adjusting TCA’s dosage to single bedtime dose
Discourage daytime napping, give activities to spend energy
Discourage consumption of stimulation food
Psychotherapy
- Individual – exploring feelings, thoughts, behaviors.
o To understand themselves and their behavior
o To make personal changes
o To improve interpersonal relationships
o To get relief from emotional pain or unhappiness
- Group – clients participate in sessions with group of people
o To learn about ther behavior
o To make positive changes in their behavior
o Communicate with others
o Formal in structure
o Gives a sense of belongingness
o To establish the rules for the group
- Family therapy – to understand the family dynamics
o Mobilizes the family’s strength and functional resources
o Maladaptive family behaviors
o Strengthening family problem solving
- Play therapy
- Reminiscence therapy
- Life review therapy
Bipolar disorder – individuals who are experiencing the extremes of mood polarity
- Person may feel euphoric or very depressed
- Equal for both men and women
- Early 20’s
- Runs in the family
- 15% will die at their own hands
Bipolar disorder - manic episodes usually behinds suddenly, escalate rapidly and last from a
few days to several months
Psychotherapeutic management
- Anti-manic medications: lithium, anticonvulsants
- Nurse-patient relationship
- Milieu management
Anti mania – actions: Blocks the influx of Na ions intracellular
- Inhibition of the “kindling” activity of the brain
- Effects: sedation, drowsiness
- Side effects: polyuria, polydipsia, mild hand, tremors, metallic taste
- Agranulocytosis, nausea, anorexia, and vomiting, transient hair loss, weight gain,
tremors, GI upset, thrombocytopenia
NURSING CONSIDERATIONS
- Lithium – contraindicated to clients with cardiovascular and renal problem
- Normal serum level and the manifestation of toxicity
- If toxicity occurs, discontinue drug and appropriate nursing intervention is implemented
to maintain life
- Increase fluid intake 8-10 glasses
- Eat diet that has adequate salt
- Coffee eliminates lithium and counteract
Nursing problems
- Risk for violence
- Impaired nutrition
- Sleep disturbance
- Self-care deficit
- Fatigue
- Altered social interpersonal and occupational relationships
- Alterations in activity and appearance
- Alterations of affect
- Alterations of perception
Nurse-patient relationship
- matter of fact attitude
- clear, concise direction, and comments
- limit setting
- reinforcement of reality
- respond to legitimate complaints
- redirect to healthy activity
Milieu Management
1. safety
2. consistency
3. decrease stimuli
4. management of aggression
5. reinforcement appropriate hygiene and grooming
6. nutrition and sleep issue
Toxicity Management
- mild – withhold net dose, call physician, serum level determination
- moderate – same as mild, gastric lavage, iv infusion of plain NSS
- severe – same as moderate, aminophylline, mannitol
Suicide FACTS:
- Predisposed: Male
- Previous suicide attempts
- Hx of completed suicide/attemps in the family
- Hx of psychiatric illness
- Severe depressive illness
- Alcoholics
- Suicidal ideation
- Suicidal gestures
- Suicidal threats
- Suicidal attempts
- Completed suicide
Interventions
- Face to face
- Over the telephone
- Internet
Suicide Interventions
- Developing nurse-patient relationship=positive client outcome
- Screening client for risk of committing suicide
- Evaluate patient’s depression, recent loss, alcohol or drug abuse, self-destructive
hallucination
- Implement level of suicide prevention
- Frequent observation (level 1) – not immediate risk
- Continuous observation (level 2) – immediate and serious threat of suicide
- Encourage exploration and expression of suicidal feelings
Level 1 risk
- Periodic observation (every 10 minutes)
- Monitor activities: shaving, use of eating utensils, drug intake
- Staff communicating the concern and control
Level 2 risk
Assessment
Plan – the more developed the plan the higher the risk of successfully completing the plan
- Impulsive acts are less often lethal
Methods – lethality
- Gun
- Jumping from high places
- Drowning
- Hanging
- Carbon monoxide poisoning
- Drugs and alcohol
Accessibility
Rescue – deceiving a would be rescuer is a high lethality
- Leaving notes or messages is likely to be rescued