LPN-Psychiatry

Fiona59 · Jun 7, 2008

A co-worker moved over the provincial psych hospital and said the interview wasn't bad. Lithium levels are handy to know, the usual anti-depressants, haldol, etc. She also said they sometimes through in what foods, drinks should be avoided type question.

She loves it.

pagandeva2000, LPN · Jun 7, 2008

A co-worker moved over the provincial psych hospital and said the interview wasn't bad. Lithium levels are handy to know, the usual anti-depressants, haldol, etc. She also said they sometimes through in what foods, drinks should be avoided type question.
She loves it.

Sounds like the drugs like Nardil -to avoid thiamine. Thanks!

TheCommuter, BSN, RN · Jun 7, 2008

I had a PRN position (per required need) at a psychiatric hospital as an LVN medication nurse 2 years ago. My scope of practice at this place was very limited due to facility policies.

The RN did all assessments, charting, group sessions, and admission paperwork. All the LVN did was administer medications, nothing more and nothing less. If I attempted to complete some paperwork or document something in the nurses notes, it would need to be cosigned by an RN during the next 24 hour chart check. Since I came from a nursing home where I did basically everything, this lack of autonomy was a shock to me. I was basically bored, and sat in the medication room quite frequently.

I administered thorazine, lithium, Synthroid (many psych patients have thyroid failure), clozaril, Klonopin, Valium, Ativan, Serax, Celexa, Trazodone, Depakote, Clonidine (many psych patients have unstable BPs), nadolol, metoprolol, propanolol, atenolol, Seroquel, Haldol, Benadryl, Lunesta, Ambien, Stadol, Chloral Hydrate, Zyprexa, etc. There are many more that I have not listed, because a fully inclusive list escapes my mind at this time.

Many psych patients also have pain management issues, so we gave lots of pain meds. Hydrocodone with acetaminophen mixtures (Vicodin, Lortab, Norco), Oxycontin, Morphine Sulfate, Darvocet, Ultram, Ultracet, Ibuprofen, Tylenol, and other pain meds were commonly given.

We also received plenty of malnutritioned alcoholic patients who received multivitamins and thiamine supplements (vitamin B1). Some of the patients were pregnant addicts, so they received prenatal vitamins in addition to their psych meds.

Jules A, MSN · Jun 7, 2008

The Commuter gave you a great list to start and your idea of reviewing NCLEX would be helpful. My Saunders has a whole section on Psych meds. I didn't have to take a med test but I would bet you might see some questions regarding reactions such as dystonia, NMS, meds requiring labs due to blood dyscrasias etc. The other thing I have found is that the different facilities/Docs have their favorites when it comes to meds just like on the other units. Do you know someone that works there that could give you a heads up on the flavors of the month? Good luck and don't worry too much I can't imagine it could be that hard. :)

pagandeva2000, LPN · Jun 7, 2008

The Commuter gave you a great list to start and your idea of reviewing NCLEX would be helpful. My Saunders has a whole section on Psych meds. I didn't have to take a med test but I would bet you might see some questions regarding reactions such as dystonia, NMS, meds requiring labs due to blood dyscrasias etc. The other thing I have found is that the different facilities/Docs have their favorites when it comes to meds just like on the other units. Do you know someone that works there that could give you a heads up on the flavors of the month? Good luck and don't worry too much I can't imagine it could be that hard. :)

The agency will not give me the actual name of the psych hospital until they submit my paperwork to them. I suspect that this may be because many nurses obtain this information, sneak in, and get a position there, thus leaving the agencies with no profit. I will probably find out on Monday where it actually is, but they told me the round about area-which is very close to where I reside. I did ask a few friends, many don't remember, per se, however, one used to work as a psych aide with me, where we used to give meds as certified AMAPs. She told me that she was a new grad, then, and between that and mostly pulling from what we were taught as aides helped her. I have to really pull out my Saunders book (it is deep, somewhere). Thus far, though, I do have resources.

I have an easier textbook for pharmacology and NCLEX pharmacology review that I am tapping into and answering questions. The orientation is the 17th of this month, and they told me I have to walk in on my own time before to take the exam. I am aiming for Friday, if that is the case. I suspect the same, it can't be insane. This is why I decided not to focus on too many of the newer medications, but the tried and true. Plus, my friend that worked at the place I suspect told me that she had a friend that failed, went back and it was the exact same exam. Thanks!!

pagandeva2000, LPN · Jun 7, 2008

I had a PRN position (per required need) at a psychiatric hospital as an LVN medication nurse 2 years ago. My scope of practice at this place was very limited due to facility policies.
The RN did all assessments, charting, group sessions, and admission paperwork. All the LVN did was administer medications, nothing more and nothing less. If I attempted to complete some paperwork or document something in the nurses notes, it would need to be cosigned by an RN during the next 24 hour chart check. Since I came from a nursing home where I did basically everything, this lack of autonomy was a shock to me. I was basically bored, and sat in the medication room quite frequently.
I administered thorazine, lithium, Synthroid (many psych patients have thyroid failure), clozaril, Klonopin, Valium, Ativan, Serax, Celexa, Trazodone, Depakote, Clonidine (many psych patients have unstable BPs), nadolol, metoprolol, propanolol, atenolol, Seroquel, Haldol, Benadryl, Lunesta, Ambien, Stadol, Chloral Hydrate, Zyprexa, etc. There are many more that I have not listed, because a fully inclusive list escapes my mind at this time.
Many psych patients also have pain management issues, so we gave lots of pain meds. Hydrocodone with acetaminophen mixtures (Vicodin, Lortab, Norco), Oxycontin, Morphine Sulfate, Darvocet, Ultram, Ultracet, Ibuprofen, Tylenol, and other pain meds were commonly given.
We also received plenty of malnutritioned alcoholic patients who received multivitamins and thiamine supplements (vitamin B1). Some of the patients were pregnant addicts, so they received prenatal vitamins in addition to their psych meds.

Thanks, Commuter. This will be a side agency job, so, autonomy is not of importance to me (but I do understand your meaning). I want to say that I have psych experience and am not really looking to kill myself with too much thought, anyhow. From what I know, at times, the place I suspect does have LPNs as charge (the RN may be in the unit across the hall) and that they did their own notes. Not sure if they would have me as charge as an agency nurse, but you never know. I was also reading about disufiruam (sorry for typo) for the opiate and alcoholics, feeling somehow that this may show up.

One question...Lithium. I remember that their levels are approxiately 0.6 to 1.2 . If it is elevated, what happens? Is the drug held until the patient is evaluated? I think that when it is elevated, they worry about toxicity. Am I correct?

FutureNewYorker · Jun 8, 2008

There's a lot to remember.... i found it best to remember by class then I picked up the individual specifications as I worked.

Antipsychotics are big because psychosis is the most common reason for admission. The old schools are Haldol, Thorazine, Prolixin, Risperdal. This have the highest risk of Extrapyramidal Effects. The newer ones and atypicals are Geodon, Zyprexa, Abilify.... there's still a risk, but less.

Besides lithium, most mood stabilizers are seizure meds, so give them a brief review.... Depakote, Tegretol, Trileptal, Lamictal, Topamax. Know your levels for those that have them... especially lithium and depakote.

Antidepressants are pretty basic. Mostly you see the newer SSRIs like paxil, zoloft, prosac, celexa, lexapro. The thing patients worry about most there is sexual dysfunction as a side effect. And remember that these cause mania in bipolar patients. Rarely you still see the tricyclics. Oh, and there's always 1 question about the dietary restrictions when on MAOIs.

Anxiety meds are pretty simple, CNS depressive effects. Ativan, Klonipin and xanax are the most common. Sometimes valium.

The most common sleep meds are Restoril and Ambien. The previous posters are right in that you'll see alot of HTN and pain meds.

The other questions will be about safety and therapeutic communication. One of my friends even had this test where they showed a video and you had to write the 5 things the nurse did wrong... like she was wearing something around her neck, turned her back from the med cart, let the patient walk off with his med cup instead of watching him take the pills....... that kind of stuff.

I'm from south florida and we carry whole teams down her by ourselves. We do meds, charting, patient care, groups.... pretty much everything.

Once you get the job, if not before, pick up a lil book called Psych Notes Clinical Pocket Guide by F.A. Davis Company. It has EVERYTHING at a glance and it's waterproof and coated so you can write notes in it and clean it off with an alcohol pad.... pretty cool.

Good luck.

Jules A, MSN · Jun 8, 2008

Once you get the job, if not before, pick up a lil book called Psych Notes Clinical Pocket Guide by F.A. Davis Company. It has EVERYTHING at a glance and it's waterproof and coated so you can write notes in it and clean it off with an alcohol pad.... pretty cool.
Good luck.

Thanks for this, I just ordered one from Amazon used for under $12 shipped. Always looking for good books.

Pagandeva2000,

Not sure how it is done elsewhere but if we get a high lab value we assess the client, hold the med and call the Doc. Adverse effects from lithium tox was often a question I saw in school.

FWIW as a LPN I do almost exactly the same thing as the RNs but this is a small facility. I know at the larger state hosp the LPNs are mostly med nurses. I'm just counting the minutes til I pass NCLEX and get the $15/hour raise!

pagandeva2000, LPN · Jun 8, 2008

Thanks, everyone for their input. I am studying away, and hopefully, will pass the test the first time and get in there. I'll keep you all posted!

FutureNewYorker · Jun 10, 2008

Thanks for this, I just ordered one from Amazon used for under $12 shipped. Always looking for good books.
Pagandeva2000,
Not sure how it is done elsewhere but if we get a high lab value we assess the client, hold the med and call the Doc. Adverse effects from lithium tox was often a question I saw in school.
FWIW as a LPN I do almost exactly the same thing as the RNs but this is a small facility. I know at the larger state hosp the LPNs are mostly med nurses. I'm just counting the minutes til I pass NCLEX and get the $15/hour raise!

No problem. My bf actually bought that book for me as a little gift when I got the job. It was one of the most thoughtful things he could have done. I love it. BTW, you're exactly right about what to do with an elevated level, though I can remember the sx of it. Lethargy and disorientation and malaise I think. Would need to look that up. Rarely see lithium in use anymore down here actually. Too much upkeep with it and many other options these days. And I feel ya about the $15 raise!!! Sucks doing the same work for about half the pay! :banghead: lol.

pagandeva2000, LPN · Jun 10, 2008

No problem. My bf actually bought that book for me as a little gift when I got the job. It was one of the most thoughtful things he could have done. I love it. BTW, you're exactly right about what to do with an elevated level, though I can remember the sx of it. Lethargy and disorientation and malaise I think. Would need to look that up. Rarely see lithium in use anymore down here actually. Too much upkeep with it and many other options these days. And I feel ya about the $15 raise!!! Sucks doing the same work for about half the pay! lol.

I saw confusion, tremors and seizures, I think. I believe they give Depakote rather than Lithium these days. Have to draw electrolytes and renal functioning. I've been reading the stuff, folks. The agency called me back and asked me to email them a new picture ID because it came back too dark, and I should be getting the address of the place today. Wish me lots of luck!