Chapter 75, "Psychosocial Problems in Acute Care" NRNP 6550 Question Fully Solved.

Medications to treat agitation in an assaultive person - correct answer Lorazepam 2mg; 1mg 65 Haloperidol (Haldol) 5mg; 2 mg if age 65 Olanzapine (Zyprexa): 10mg IM, oral 5mg Risperidone 2mg PO, rapid dissolving BLACK BOX WARNING: when administering antipsychotics to the elderly for dementia-related psychosis, there is an increase in mortality Depression - correct answer - Diminished interest in normal activity, fatigue, lack of motivation feelings of worthlessness, and impaired concentration nearly every day. Subjective findings - Hopelessness, helplessness, guilt, worthlessness, increased/decreased appetite, decreased libido Labs to order - TSH, CBC (r/o anemia or infection), Vitamin B12 and folate, drug screen, egg prior to starting antidepressants Questions to ask in a nonjudgemental manner to assess suicide risk - correct answer - Have you ever thought about death or dying? - Have you ever thought that life was not worth living? - Have you ever thought about ending your life? - Have you ever attempted suicide? -Are you currently thinking about ending your life? - what are reasons you want to live? or wanting to die? What is Serotonin syndrome? (adverse effect of antipsychotics) - correct answer - Serotonin toxicity r/t medications. Potentially life threatening associated with increased serotonergic activity in the CNS. - Described as a triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities, S/S: · Mental status change = anxiety, restlessness, disorientation, and agitated delirium · Autonomic manifestations = dilated pupils, diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, and diarrhea · Neuromuscular hyperactivity = tremors, myoclonus, hyperreflexia, and bilateral Babinski signs, rigidity in lower extremities, seizures SSRIs (selective serotonin reuptake inhibitors) - correct answer end in [pram], [ine] citalopram [Celexa]; escitalopram [Lexapro]; fluoxetine [Prozac]; paroxetine [Paxil] sertraline [Zoloft]; SSRIs adverse effects - correct answer Headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, dry mouth, anorexia, sexual dysfunction, SJS, serotonin syndrome, nausea - Well tolerated but many drug-drug interactions Which drug class is considered first-line for depression? - correct answer SSRIs ends in -pram How long do SSRIs and SNRIs take to become effective? - correct answer 4 to 6 week until onset of effect Do not stop SNRI abruptly why? - correct answer - withdrawal syndrome if stopped abruptly Name the SNRIs - correct answer Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) What is the black box warning for SSRIs, SNRI, TCA, atypical antidepressants? - correct answer - increase SI behavior and thinking Atypical Antidepressants - correct answer Bupropion (Wellbutrin) is the most common example. Mertazapine (Remeron) Appetite suppression is a common side-effect. Headache and