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Psychiatric

Psychiatric Nursing Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

Psychiatric nursing covers mental health disorders and therapeutic communication. NCLEX focuses on depression, anxiety, schizophrenia, bipolar disorder, suicide assessment, and crisis intervention. Safety and therapeutic communication are paramount.

Key Concepts

  • 1

    Therapeutic communication: active listening, silence, reflection, clarification, summarizing; avoid giving advice, false reassurance, changing subject, why questions

  • 2

    Depression: SIGECAPS criteria (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality)

  • 3

    Suicide assessment: ideation, plan, means, intent, prior attempts; always take seriously and ensure safety

  • 4

    Schizophrenia: positive symptoms (hallucinations, delusions, disorganized speech) vs negative (flat affect, avolition, alogia)

  • 5

    Bipolar: manic episode (elevated mood, decreased need for sleep, grandiosity, pressured speech, risky behavior)

  • 6

    Anxiety disorders: GAD, panic, phobias, OCD, PTSD; panic attack peaks in 10 min, lasts 20-30 min

  • 7

    Personality disorders: cluster A (odd), B (dramatic), C (anxious); borderline = unstable relationships, self-harm, fear of abandonment

Nursing Interventions

  • Establish therapeutic relationship: empathy, genuineness, unconditional positive regard

  • Assess suicide risk at every encounter; remove dangerous objects; implement one-to-one observation if needed

  • For depression: monitor for worsening, especially when energy improves (risk of acting on suicidal ideation)

  • For mania: provide low-stimulation environment, set limits, redirect to activities, ensure nutrition and hydration

  • For schizophrenia: do not argue with delusions; redirect to reality; monitor for medication adherence and side effects

  • For anxiety: stay calm, use grounding techniques, reduce stimuli, teach relaxation and breathing exercises

  • Administer psychotropic medications; monitor for side effects: extrapyramidal symptoms, tardive dyskinesia, NMS, serotonin syndrome

Critical Red Flags

  • Suicidal ideation with plan and means — immediate safety measures, one-to-one observation

  • Command hallucinations to harm self or others — immediate intervention

  • Sudden calm after severe depression — may indicate decision to act on suicide plan

  • Serotonin syndrome: fever, agitation, tremor, clonus, hyperreflexia — stop SSRI, seek emergency care

  • Neuroleptic malignant syndrome: high fever, muscle rigidity, altered mental status — stop antipsychotic, emergency

  • Acute dystonia: sudden muscle spasm (neck, tongue, eyes) — administer anticholinergic

Key Lab Values

Lithium therapeutic: 0.6-1.2 mEq/L (toxic >1.5; maintain hydration and sodium)

Clozapine: ANC >1500 required (monitor CBC weekly ×6 months, then biweekly)

TSH: check before starting SSRIs (rule out thyroid cause of depression)

Serum sodium: monitor with SSRIs (risk of SIADH and hyponatremia)

LFTs: monitor with valproic acid and some antidepressants

Patient Teaching

  • Take medications as prescribed; do not stop abruptly; report side effects

  • Antidepressants take 4-6 weeks for full effect; continue even if feeling better

  • Recognize warning signs: mood changes, withdrawal, giving away possessions, talking about death

  • Develop coping strategies: stress management, support system, therapy, healthy lifestyle

  • Avoid alcohol and recreational drugs; they interact with psychotropic medications

  • Have a safety plan: crisis hotline, support contacts, coping strategies, professional help

Educational Use Only — Not a substitute for professional training.