QUESTIONS AND 100% CORRECT
Chapter 2: Select Special Topics in Psychiatric-Mental Health Practice
Clinical Decision Making Process - ANSWER • ADPIE
-Assessment: 1st step, subjective and objective data
• Diagnosis: analysis, formulation of nursing diagnosis
• Planning: prioritizing problems, determining goals, plan of care
• Implementation: nursing action (rather than medical action)
• Evaluating: comparing outcomes, communicate and document findings
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Range?
Measures? - ANSWER 0-40 units/L
0-40 units/L
Hepatocellular damage
Potentially elevated in valproate therapy, hepatitis, cirrhosis
Glutamyltransferase (GGT)
1
,Alkaline phospatase (ALP)
Range?
Measures?
Examples? - ANSWER 0-30 units/L
30-120 international units/L
Cholestasis: bike flow, either extrahepatic or intrahepatic
Elevated in alcohol abuse.
Elevated in gallbladder disease, liver disease. Elevated with bone injury
Creatine Kinase (CK)
Range?
Measures?
Examples? - ANSWER 0-139 units/L
Muscle Injury. muscle enzyme found in skeletal and cardiac muscle;
elevated blood levels associated with heart attack, muscular dystrophy, and other
skeletal muscle pathologies
Urea Nitrogen (BUN)
Creatinine - ANSWER 8-20 mg/dL
2
,0.6-1.2 mg/dl
Kidney Function
Increased in impaired kidney function
Measured with lithium therapy
Creatinine is more sensitive and specific indicator of kidney disease than BUN.
Measured with lithium therapy.
Glomerular Filtration Rate (GFR)
Range?
Measures?
Examples? - ANSWER >90mL/min.
The best measurement of kidney function.
the amount of filtrate formed per minute by the two kidneys combined
Elderly pts have 30% reduced because of decreased muscle mass
Generally no dose adjustments or contraindications with psychotropics when GFR
>60mL/min
Valproate and select epileptic drugs ex. Carbamazepine.
3
, Lab testing?
Level?
Comment?
Discontinue when? - ANSWER Liver pane (ALT, AST, ALP, bilirubin, albumin, total
protein), CBC, WBC, platelet count, serum hCG, valproate level.
Level 50-120mcg/ml
Discontinue valproate with AST/ALT elevations >2-3x upper limit of normal.
Valpro ate a folate PLaTe
Lithium
Labs testing?
Comment?
What meds to avoid? - ANSWER Creatine, bun, GFR, TSH, serum electrolytes,
CBC, hCG, urinalysis.
Baseline EKG
Check serum lithium level 12 hour post dose (trough) after 4 days in medication.
Then every 4-5 days.
Lithium level 0.6-1.2
4
Chapter 2: Select Special Topics in Psychiatric-Mental Health Practice
Clinical Decision Making Process - ANSWER • ADPIE
-Assessment: 1st step, subjective and objective data
• Diagnosis: analysis, formulation of nursing diagnosis
• Planning: prioritizing problems, determining goals, plan of care
• Implementation: nursing action (rather than medical action)
• Evaluating: comparing outcomes, communicate and document findings
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Range?
Measures? - ANSWER 0-40 units/L
0-40 units/L
Hepatocellular damage
Potentially elevated in valproate therapy, hepatitis, cirrhosis
Glutamyltransferase (GGT)
1
,Alkaline phospatase (ALP)
Range?
Measures?
Examples? - ANSWER 0-30 units/L
30-120 international units/L
Cholestasis: bike flow, either extrahepatic or intrahepatic
Elevated in alcohol abuse.
Elevated in gallbladder disease, liver disease. Elevated with bone injury
Creatine Kinase (CK)
Range?
Measures?
Examples? - ANSWER 0-139 units/L
Muscle Injury. muscle enzyme found in skeletal and cardiac muscle;
elevated blood levels associated with heart attack, muscular dystrophy, and other
skeletal muscle pathologies
Urea Nitrogen (BUN)
Creatinine - ANSWER 8-20 mg/dL
2
,0.6-1.2 mg/dl
Kidney Function
Increased in impaired kidney function
Measured with lithium therapy
Creatinine is more sensitive and specific indicator of kidney disease than BUN.
Measured with lithium therapy.
Glomerular Filtration Rate (GFR)
Range?
Measures?
Examples? - ANSWER >90mL/min.
The best measurement of kidney function.
the amount of filtrate formed per minute by the two kidneys combined
Elderly pts have 30% reduced because of decreased muscle mass
Generally no dose adjustments or contraindications with psychotropics when GFR
>60mL/min
Valproate and select epileptic drugs ex. Carbamazepine.
3
, Lab testing?
Level?
Comment?
Discontinue when? - ANSWER Liver pane (ALT, AST, ALP, bilirubin, albumin, total
protein), CBC, WBC, platelet count, serum hCG, valproate level.
Level 50-120mcg/ml
Discontinue valproate with AST/ALT elevations >2-3x upper limit of normal.
Valpro ate a folate PLaTe
Lithium
Labs testing?
Comment?
What meds to avoid? - ANSWER Creatine, bun, GFR, TSH, serum electrolytes,
CBC, hCG, urinalysis.
Baseline EKG
Check serum lithium level 12 hour post dose (trough) after 4 days in medication.
Then every 4-5 days.
Lithium level 0.6-1.2
4
