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Hi, I recently accepted a position in psych nursing in an adult inpatient unit and wanted to know how to best prepare for my new job(1st hospital job). Any books I can read or any tips you guys and give me. Thanx in advance!!
Make sure you are familiar with the medications used in an emergency situation on an inpatient psych unit. We use a lot of haldol, Benadryl, Ativan, and Thorazine (either IM or PO) in emergencies. Also review some of your routine psych meds given such as depakote, lithium, zyprexa or latuda. Be aware of your environment at all times, keeping a clear exit to the nearest door. Best of luck!
Thank you! I'll re-visit the meds!!
Also, a lot of people don't seem to realize that manics won't clear for days, even a couple weeks or more. An acute episode of mania requires an antipsychotic to break, not just a mood stabilizer. I have seen practitioners not order anything except a mood stabilizer for acute mania. Not typical, but sometimes.Thank you!! This was super helpful!!
With psychosis, voices are not usually impacted for an average of 20-30 days. The premise that you can give an anti-psychotic for voices as a PRN, much like you would a pain pill for pain, is nonsense. You might temper their anxiety and slow them some with an antipsychotic, but the voices aren't going away. Unless it's substance-induced or some other short-term metabolic etiology, then it's gonna take a while. So give the PRNs, just remember, it's not doing what people think. Try and give benztropine (Cogentin) with antipsychotics. Sometimes they're only PRN but the patient is on a scheduled Zyprexa or Haldol, so it's not hurting to stave off EPS/akathisia. Benadryl is fine for this too, just not as commonly used from my experience. Propranolol is better for akathisia.
I will also remark, despite this being a personal opinion only, that Abilify and Latuda seems to be pure crap. I have seen no true symptom reduction in patients prescribed these meds as a primary antipsychotic. Maybe some effect when used as an augmentative, but never on their own. I don't care what the textbooks say, they are junk.
With benzodiazepines, Ativan is really your go-to drug. It's preferred for any possible liver impairment d/t glucuronidation metabolism and no active metabolites. **Important - very few people, even some NPs and MDs, seem to know that benzodiazepine half-life is not a true measure of clinical effectiveness because lipophilicity determines the effect. For example, diazepam (Valium) is extremely lipophilic and is redistributed out of the brain after 1 to 2 hours. Only repeated administration results in concentration gradients that translate to longer half-lives. Slower onset BZDs, such as lorazpam will take longer to enter the brain but last longer, again, because lorazepam is less lipophilic. As with most agents, the faster the onset, the shorter the half-life or clinical effectiveness. This explains it well: Benzodiazepines: A Guide to Safe Prescribing | The Carlat Psychiatry Report
Puertoriiquena
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Thank you!! This was super helpful!!