MENTAL HEALTH TEST 1 REVIEW

MENTAL HEALTH TEST 1 REVIEW 1. Clozapine (Clozaril): know what normal WBC/ANC (absolute neutrophil count) is a. Normal Range ANC = 1.5 - 8.0 (1,500 to 8,000) b. Normal Range for WBC = 5k - 10k c. HOLD MEDS IF ANC LOW: i. Mild: 1,000 - 1,499 ANC, blood drawn 3x, weekly until back up to 1,500 ii. Moderate: going to hold med and order daily ANC was 606 and WBC was 1,300 iii. Severe: < 500 ANC, daily blood drawn d. Can cause hypersalivation, lower sedation and weight gain 2. Know nurse patient relationship and phases of it ) (hildegard peplau) a. Pre-orientation b. Orientation: start termination or discharge plan c. Working d. Termination e. Transference (Pt to RN) i. Patient unconsciously transfers feelings toward the nurse that the patient has towards someone else f. Countertransference (RN to Pt) i. Nurse unconsciously transfers feelings onto the patient that the nurse has towards someone else 3. Know side effects of antipsychotic drugs a. First Generation i. typical,conventional LOW potency (Elixir and IM formulation) Chlorpromazine (Thorazine) >What labs need to be checked? Others: Thioridaze (mellaril) Mesoridazine (Serentil) Labs: Check Fasting Blood Sugar (FBS) and Fasting Lipid Panel (FLP) >Common S/E of Low Potency Agents ● Anticholinergic ○ Dry Mouth ○ Constipation ○ Blurred Vision (student nurse offer a magazine to read, student needs more teaching) ○ Urinary retention ○ Confusion ● Sedation-Histamine Blockage ● Adrenergic Blockage- Muscarinic/Hypotension ● EPS** *The Dr. orders a pt. thorazine. The pt. spits the medication out and is noncompliant. What action do you take next? -contact the physician and recommend the medication in a liquid form (patient advocate) MENTAL HEALTH TEST 1 REVIEW HIGH Potency (Elixir and IM formulation) Haloperidol (Haldol) Fluphenazine (Prolixin) >If patient is noncompliant to taking the medication, give Depot formulation IM every 4 weeks (Haldol) and every 2-4 weeks (Prolixin) Others: Primozide (orap) Thiothiexene (navane) Trifkuperazine (Stelazine) Perphenazine (Trilafon) Loxapine (loxitane) **Give Benedryl, Cogentin, and Artane with High Potency drugs to reduce EPS Common S/E: ● EPS: - Dystonia- abnormal muscle tone that causes spasm - Akathisia- agitation, distress, and restlessness - Pseuodoparkinsonism- shuffle gait, drooling tremors, bradykinesia, rigidity (Wife state husband shuffling due to this… clutter free environment) - hold haldol if notice a twitch and assess for involuntary movement - tardive dyskinesia- difficulty moving ● Anticholinergic SE ● Sedation ● **Weight Gain! b. Atypical (Second generation) i. effective for both positive and negative symptoms