NCLEX: Physiological Integrity; Pharmacological and Parenteral Therapies

Physiological Integrity; Pharmacological and Parenteral Therapies: PSYCHOTROPIC MEDICATIONS

Focus topic: Physiological Integrity; Pharmacological and Parenteral Therapies

ANTIMANIC AGENTS

A. Lithium (Eskalith, Lithane, Lithobid)—effect occurs 1 to 3 weeks after first dose.

1. Use—acute manic attack and prevention of recurrence of cyclic manic-depressive episodes of bipolar disorders.

2. Assessment:

a. Side effects—levels from 1.6 to 2.0 mEq/L may cause: blurred vision, tinnitus, tremors, nausea and vomiting, severe diarrhea, polyuria, polydipsia; ataxia. Levels greater than 2 mEq/L may cause: motor weakness, headache, edema, and lethargy. Levels greater than 2.5 mEq/L may exhibit signs of severe toxicity: arrhythmias, myocardial infarction (MI), cardiovascular collapse, oliguria/anuria; neurological (twitching, marked drowsiness, slurred speech, dysarthria, athetotic movements, convulsions, delirium, stupor, coma).

b. Precautions—cautious use with clients on diuretics; with abnormal electrolytes (sweating, dehydrated, and clients who are postoperative); with thyroid problems, on low-salt diets; with heart failure; with impaired renal function; with pregnancy and lactation; risk of suicide.

c. Dosagetherapeutic level 0.8 to 1.6 mEq/L; dose for maintenance 300 to 1,200 mg/day; toxic level greater than 2.0 mEq/L; blood sample drawn in acute phase 10 to 14 hours after last dose, taken three times a day.

3. Nursing care plan/implementation:

a. Goal: anticipate and check for signs and symptoms of toxicity.

  • Reduce GI symptoms: take with meals.
  • Check for edema: daily weight, I&O.
  • Monitor blood levels greater than 2.0 mEq/L for side effects and signs of toxicity: nausea, vomiting, diarrhea, anorexia, ataxia, weakness, drowsiness, fine tremor or muscle twitching, slurred speech.
  • Monitor results from repeat thyroid and kidney function tests.
  • Withhold drug and notify physician when 1.5 mEq/L is reached.
  • Monitor vital signs 2 to 3 times/day (pulse irregularities, hypotension, arrhythmias).

b. Goal: report fever, diarrhea, prolonged vomiting immediately.

c. Goal: monitor effect (therapeutic and toxic) through blood samples taken:

  • 10 to 14 hours after last dose.
  • Every 2 to 3 days until 1.6 mEq/L is reached.
  • Once a week while in hospital.
  • Every 2 to 3 months to maintain blood levels less than 2 mEq/L.

d. Goal: health teaching.

  • Advise client of 1- to 3-week lag time for effect.
  • Urge to drink adequate liquids (2 to 3 L/day), ice; strict oral hygiene.
  • Report: polyuria and polydipsia.
  • Diet: avoid caffeine, crash diets, diet pills, self-prescribed low-salt diet, alcohol, antacids, high-sodium foods (which increase lithium excretion and reduce drug effect); take with meals. Use sugarless candy.
  • Caution against driving, operating machinery that requires mental alertness until drug is effective.
  • Warn not to change or omit dose.

4. Evaluation/outcome criteria:

a. Changed facial affect.

b. Improved posture, ability to concentrate, sleep patterns; mood is stabilized.

c. Assumption of self-care.

d. No signs of lithium toxicity.

ANTIPARKINSONIAN AGENTS

A. Trihexyphenidyl HCl (Artane) and benztropine mesylate (Cogentin).

1. Use—counteract drug-induced extrapyramidal reactions.

2. Assessment:

a. Trihexyphenidyl HCl:

  • Side effects—anticholinergic: dry mouth, blurred vision, dizziness, nausea, constipation, drowsiness, urinary hesitancy or retention; pupil dilation; headache; weakness; tachycardia.
  • Precautions—cautious use with: cardiac, liver, or kidney disease or obstructive gastrointestinal-genitourinary disease, benign prostatic hyperplasia (BPH), or myasthenia gravis. Do not give if glaucoma present.

b. Benztropine mesylate—side effects: same as for trihexyphenidyl HCl plus:

  • Effect on body temperature (hyperpyrexia) may result in life-threatening state (heatstroke).
  • GI distress.
  • Inability to concentrate, memory difficulties, and mild confusion (often mistaken for senility); drowsiness.
  • May lead to toxic psychotic reactions.
  • Subjective sensations—light or heavy feelings in legs, numbness and tingling of extremities, light-headedness or tightness of head, and giddiness.

3. Nursing care plan/implementation:

a. Goal: relieve GI distress by giving after or with meals or at bedtime.

b. Goal: monitor adverse effects.

  • Hypotension, tachycardia: check pulse, blood pressure; increased temperature; decreased sweating.
  • Constipation and fecal impaction: add roughage to diet.
  • Dry mouth: increase fluid intake; encourage frequent mouth rinsing; offer sugarless candy or gum, ice.
  • Blurred vision: suggest reading glasses.
  • Dizziness: assist with ambulation; use side rails.
  • Urinary retention: maintain I&O.

c. Health teaching:

  • Avoid driving, and limit activities requiring alertness.
  • Delayed drug effect (2 to 3 days).
  • Potential abuse due to hallucinogenic effects.
  • Avoid alcohol and other CNS depressants; avoid hot weather.
  • Take with food.
  • Do not stop drug abruptly.

4. Evaluation/outcome criteria:

a. Less rigidity, drooling, and oculogyric crisis.

b. Improved gait, balance, posture.

c. Has not experienced symptoms of hyperthermia.

 

Physiological Integrity; Pharmacological and Parenteral Therapies: MIND-ALTERING SUBSTANCES

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Major substances used by the public to alter mental states are compared in Major Substances Used for Mind Alteration.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: ABSORPTION RATES BY DIFFERENT ROUTES

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Rates of Absorption by Different Routes lists the rates of absorption in a healthy person with normal perfusion by various routes.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: REGIONAL ANALGESIA-ANESTHESIA IN LABOR AND BIRTH

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

The characteristics and nursing implications for regional analgesia-anesthesia in labor and delivery are detailed in Regional Analgesia-Anesthesia for Labor and Birth.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: FOOD/FLUID–MEDICATION INTERACTIONS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Food and fluid considerations with various drugs are detailed in Food and Fluid Considerations with Drugs.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: ANTINEOPLASTIC DRUG CLASSIFICATIONS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Antineoplastic Drug Classifications provides a classification of the antineoplastic drugs.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: COMMON SIDE EFFECTS OF CHEMOTHERAPEUTIC AGENTS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

The common side effects of various chemotherapeutic agents are detailed in Common Side Effects of Chemotherapeutic Agents.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: PROPERTIES OF SELECTED ANALGESIC AGENTS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Properties of Selected Analgesic Agents lists the properties of some nonopioid and nonsteroidal analgesic agents.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: EQUIANALGESIC DOSING FOR OPIOID ANALGESICS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Equianalgesic Dosing for Opioid Analgesics provides information on equianalgesic dosing for the opioid analgesics.

 

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 Physiological Integrity; Pharmacological and Parenteral Therapies: DIETARY SUPPLEMENTS AND HERBS

Focus topic:  Physiological Integrity; Pharmacological and Parenteral Therapies

Information on dietary supplements and herbal products used for psychiatric conditions is provided in Dietary Supplements and Herbal Products Used for Psychiatric Conditions, and Herbs and Potential Dangers lists the potential dangers of various herbs.

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