Editing Mental Health and Psychosocial Nursing – LPN Flashcards (section)

== Medications and Physical Safety ==

;Which findings in a client taking lithium must be reported immediately?
:Coarse hand tremor, vomiting, diarrhea, drowsiness, muscle weakness, confusion, unsteady gait, or slurred speech. These suggest toxicity. Mild thirst, increased urination, a fine tremor, and modest weight gain are common expected effects.

;What fluid and diet teaching is reinforced for a client on lithium?
:Drink about 2 to 3 liters of water daily and keep salt intake about the same each day. Report vomiting, diarrhea, fever, or heavy sweating, because fluid and sodium loss raises the lithium level. Do not take NSAIDs such as ibuprofen without provider approval.

;A client on haloperidol develops a twisted rigid neck with the eyes rolled upward. What is this and what does the LPN do?
:Acute dystonia, an extrapyramidal reaction that can progress to laryngospasm and airway compromise. Stay with the client and notify the registered nurse immediately; treatment is intramuscular diphenhydramine or benztropine.

;Which signs in a client on an antipsychotic suggest neuroleptic malignant syndrome?
:High fever, severe muscle rigidity, unstable blood pressure and heart rate, profuse sweating, and decreased level of consciousness. This is life-threatening. Withhold the drug, stay with the client, and get emergency help at once.

;What is tardive dyskinesia?
:Involuntary repetitive movements such as lip smacking, tongue protrusion, chewing motions, and grimacing that develop after months to years of antipsychotic use and may be permanent. Report new movements promptly so treatment can be changed early.

;What teaching is reinforced for a client starting an SSRI such as sertraline?
:Full benefit takes about 4 to 6 weeks, so do not stop early. Do not stop the drug abruptly; it must be tapered. Report all other medicines and herbal products, including St. John's wort. Take as prescribed and report worsening mood or thoughts of self-harm right away.

;What signs of alcohol withdrawal does the LPN watch for and report?
:Rising heart rate and blood pressure, tremor, sweating, nausea, anxiety, agitation, hallucinations, and any seizure activity. Withdrawal can begin 6 to 12 hours after the last drink and can become life-threatening, so changes go to the registered nurse promptly.

;What is the LPN's responsibility when a client is in restraints?
:Check circulation, sensation, and skin under each restraint at the intervals set by policy; observe at least every 15 minutes or as specified; offer fluids and toileting regularly; release one limb at a time for range of motion; and document behavior and the less restrictive measures tried. Secure restraints to the movable bed frame, never to side rails. Restraint always requires a provider order, is never ordered PRN, is never used for staff convenience or punishment, and is removed as soon as the client is safe.