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Sleeping Medications
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Sedative-Hypnotics
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HESI MENTAL HEALTH

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Sleeping Medications Sedative-Hypnotics, Melatonin, Valerian, Benzodiazepines
Sedative-Hypnotics may be used when insomnia causes significant distress. Medications should be used with caution in older adult clients.
Melatonin influences sleep-wake cycles
Valerian increases the amount of GABA in the brain, probably by inhibiting the transaminase enzyme that normally metabolizes GABA. Increasing GABA, an inhibitory neurotransmitter, results in calming, sedative effects
Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications.
Diazepam enhances the inhibitory effect of GABA to relieve anxiety, tension, and nervousness and to produce sleep. The decreased neuronal excitability also accounts for its usefulness as a muscle relaxant, hypnotic, and anticonvulsant.
Haloperidol may be used in doses of 0.5 to 1 mg to decrease agitation and psychotic symptoms, as well as to facilitate sleep.
Caffeine Addiction Withdrawal Clinical Course Symptoms typically begin 12-24 hours after last caffeine intake. Dependent symptoms include headaches, tiredness, difficulty concentrating, nausea, muscle pain, irritability.
Patient Education in Caffeine Withdrawal Teach client to cut down slowly on amount of caffeine in the diet, do not make the mistake of stopping abruptly as it can lead to undesired symptoms, and cause relapse
Alcohol Overdose Actions Gastric Lavage, or dialysis to remove. Monitor/Support respiratory and cardio function.
Benzodiazepine Overdose Actions Gastric Lavage, followed by ingestion of activated charcoal and a saline cathartic. Dialysis is used if severe
Stimulant Overdose Action Chlorpromazine (Thorazine), which is an antipsychotic that controls hallucinations, lowers BP, and relieves nausea
Opioid Overdose Action Naloxone (Narcan), reverses all toxicity. Nay need multiple doses
Inhalants Overdose Actions Support respiratory and cardiac functioning
Alcohol Withdrawal Hospitalization Inpatient treatment is required so safe detoxification
Codependent Behaviors Children of alcoholics are four times more likely than the general population to develop problems with alcohol. Codependency may play role in substance or alcohol abuse. Even if the codependent individual enables the addict, it is likely that they'll use drugs or other substances with the person whom they're dependent to feel linked too
Detoxification Process of safely withdrawing from a substance. Symptoms typically begin 4-12 hours after stopping, or marked reduction. Usually peaks on the second day and over in about 5 days (but some lasts 1-2 weeks). Symptoms include coarse hand tremors, sweating, elevated, HR, and BP, insomnia, anxiety, and nausea or vomiting. Severe alcohol withdrawal may progress to delirium tremens which includes transient hallucinations, seizures, and/or delirium.
Clonidine (Catapres) An alpha-2-adrenergic agonist used to treat hypertension. It is given to clients with opiate dependence to suppress some effects of withdrawal or abstinence. It is most effective against nausea, vomiting, and diarrhea, but produces modest relief from muscle aches, anxiety, and restlessness.
Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. This agent's only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result. Avoid any alcohols
Alcohol Detoxification Action Regarding Vitamin Deficiency Give Vitamin B1 (thiamine) to prevent or treat Wernicke-Korsakoff Syndrome. Give Cyanocobalamin (Vitamin B12) and folic acid to treat nutritional deficiencies
Anorexia Restricting of nutritional intake necessary to maintain minimally normal body weight. Intense fear of gaining weight or becoming fat. Significantly disturbed perception of the shape or size of their body. Steadfast inability or refusal to acknowledge the seriousness or even if a problem exists. Lose weight primarily through dieting, fasting, or excessive exercising.
Bulimia Nervosa Recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid gaining weight, such as purging, fasting, or excessively exercising
Nursing Priority in Bulimia Nervosa Identifying emergency medical conditions that require hospitalizations. Urine samples should be obtain for gravity (hydration), pH levels, ketone levels, and signs of kidney damage. Weight, Height, BMI, and body temp should be recorded
Physical Characteristics of Anorexia Nervosa Amenorrhea, constipation, sensitive to cold, limited hair on body, loss of body fat, muscle atrophy, hair loss, dry skin, dental caries, pedal edema, bradycardia, arrythmias, orthostasis, enlarges parotid glands and hypothermia, electrolyte imbalances (hyponatremia, hypokalemia)
Anorexia Nervosa Behaviors Preoccupied with food-related activities, such as grocery shopping, collecting recipes or cookbooks, counting calories, creating fat-free meals, and cooking family meals. My refuse to eat around others, cut food into tiny pieces, or not allowing the food to touch their lips, along with excessive exercising
Bulimia Nervosa Behaviors Often eats in secret, often from responses of strong emotions and followed by guilt, remorse, shame, or self-contempt. May also exhibit high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder.
Bulimia Nervosa Physical Characteristics Typically are within normal weight range, but some can be underweight/overweight. Vomiting destroys tooth enamel, chipped teeth.
Characterizing of Anorexia Nervosa & Bulimia Nervosa perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder.
Eating Disorder Assessment Eating Attitudes Test. Which is often used in studies of anorexia and bulimia, which asks questions about what, where, when, how, they eat. Feelings about themselves, and about eating.
Actions with OCD patients Treatment includes medications, SSRIs, and behavioral therapy, specifically exposure and response prevention. Effective nursing interventions include therapeutic communication, teaching relaxation and behavioral techniques, following a daily routine, and client and family education about OCD and its treatment. Practicing anxiety management and behavioral techniques daily is important for positive long-term outcomes.
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