NR606 Week 1 Study Set Questions and Answers

NR606 Week 1 Study Set Questions and Answers Common maternal mental health disorders depression, anxiety, OCD, PTSD, bipolar disorder, and substance use disorder Prescribing considerations in maternal mental health -you must consider the risks vs benefits for both mother and baby -work with the client 6-12 months prior to a planned pregnancy -most medications are tolerated, but in cases where the -medications are contraindicated with pregnancy, discuss birth control and a contingency plan should the client become pregnant -taper drugs when possible -physiological changes during pregnancy impact pharmacokinetics so monitor drug levels and symptoms so dosages may be adjusted as necessary Switching medications during pregnancy -if the client is stable on their current medication regimen, it is usually better to continue with the same regimen -switching exposes the fetus to more substances and meds are tapered up and down during the switch What to do when a mental health client informs you of pregnancy -schedule and appointment to discuss a treatment plan as soon as possible (the companion may be included) -have the client to continue to current medication regiment for now -education her to track symptoms (mood, sleet, etc) Informed consent for maternal mental health -initiate a discussion regarding informed consent, including risks vs benefits of medications during pregnancy and breastfeeding -clients who must stay on high-risk medications may benefit from a referral to a perinatal psychiatrist who specialized in psychiatric medication administration during pregnancy (valproic acid) -documentation of informed consent is required and should contain a description of the conversation with the client including a discussion of all potential serious complications associated with treatment. (consider this...you do not want a patient to say you knowingly gave them medication that caused congenital defects without the client's consent. You have to make the risk and benefits clear and let them choose.) -discuss all common and serious adverse effects, regardless of incidence -document the informed consent with each pregnancy, no matter if the client is new or established. Medications for depression and anxiety during pregnancy -SSRIs are first-line Tx for depression and anxiety during pregnancy. -SNRIs, TCAs, and bupropion are considered safe Tx options -SSRIs and SNRIs commonly causes neonatal withdrawal syndrome within the first 2-4 days of the neonate's life (30% of the time; S/Sx include tremors, high-pitch cry, and disturbed sleep). -Benzodiazepines may be taken with caution Medications for bipolar disorder during pregnancy -lamotrigine (Lamictal) is considered safe during pregnancy for may not be effective for manic episodes -lithium exposure during the 1st trimester may cause cardiac malformations, and risk increases with higher doses. -valproic acid and carbamazepine are considered teratogenic during the first trimester, avoid, taper to discontinue, if the drug must be continued monitor clotting parameters and test to detect birth defects, and consider vitamin k during the last 6 weeks of pregnancy, encourage folic acid during 1st trimester -atypical antipsychotics and anticonvulsants such as valproic acid may be after lithium during the postpartum period when breastfeeding -carbamazepine decreases the levels/efficacy of hormone contraction, the client should use an alternative contraceptive to avoid pregnancy, especially since carbamazepine is teratogenic during the 1st trimester Valproic acid during pregnancy -Teratogenic effects in developing fetuses such as neural tube defects, neurodevelopmental delay, etc. -It's considered safe during breastfeeding but has been found in breastmilk -keep in mind valproic acid is teratogenic when caring for female clients of childbearing age Medications for psychosis during the perinatal period -atypical antipsychotic medications, particularly olanzapine and quetiapine, increases the risk of gestational diabetes -Olanzapine has been found to increase the risk of musculoskeletal malformations in infants -risperidone and quetiapine are the most used antipsychotics during pregnancy, neither appear to cause malformations -antipsychotics may cause neonatal withdrawal syndrome Mental health and breastfeeding -most psychotropic medications pass into breast milk -some women who are taking psychopharmacologic agents, bottle feeding may be the best option Safe for Breastfeeding -SSRIs -benzodiazepines (infants should be monitored for sedation and poor feeding) -valproic acid (infant serum drug levels must be monitored) -quetiapine *switch to bottle feeding, if necessary Safer to bottle feed -lithium (serum lithium levels must be monitored and the infant should be observed for signs of toxicity including cyanosis and hypotonia) -lamotrigine -clozapine (monitoring of white blood counts in the infant is required) Substance-use disorder in perinatal period -The most used substance in the perinatal period is tobacco, followed by alcohol, cannabis, and other illicit drugs. -All have adverse pregnancy outcomes for mom and baby. -Tobacco has an increased risk of SIDS or may interfere with lung development. -Cocaine use specifically has been associated with premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries. Example of structural stigma -policies, regulations, or laws that intentionally or unintentionally lead to discrimination; thus, limiting access to resources and other opportunities. -Ex. A program policy that prohibits individuals from using specific forms of prescribed medication for addiction (MAT) treatment. Example of public stigma -attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. -Ex. a doctor believing a patient with a Hx of substace use disorder is simply seeking pain medication when presenting to the ER for pain Example of self stigma -shame individuals internalize about negative stereotypes. -Ex. a woman feeling she is unworthy of motherhood due to her mental illness. neonatal abstinence syndrome (NAS) -a withdrawal symptom experienced by some opioid-exposed infants after birth. Criminalization of opioid use in pregnancy Policies that punish pregnant women for substance use is linked to more newborns experiencing drug withdrawal Screening tools for SUD in pregnancy -Substance Use Risk Profile-Pregnancy scale (SURP-P) and 4P's Plus© Alcohol use disorder treatment in pregnancy -Inpatient treatment is recommended for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the CIWA-Ar. *Acamprosate and naltrexone are commonly used in medication-assisted treatment (MAT) in nonpregnant adults Tobacco use disorder treatment in pregnancy -After reviewing the risks and benefits with the client, nicotine replacement therapy (NRT), bupropion, or a combination of these interventions may be initiated. -Higher doses of NRT may be required in pregnant clients due to the metabolic changes that occur during pregnancy. -Use of immediate-release preparations of NRT such as gum or an inhaler rather than a slow-release preparation can help minimize infant exposure during pregnancy and breastfeeding. Opioid use disorder treatment in pregnancy -avoid the abrupt discontinuation of opioid use as opioid withdrawal during pregnancy can risk harm to both the mother and infant. -Methadone and buprenorphine are the most prescribed MAT for OUD in pregnancy. -Naltrexone is not usually recommended for use during pregnancy due to concerns about detoxification and an uncertain safety profile in pregnancy. -treatment through pregnancy, labor, delivery, and the postpartum period. -methadone, buprenorphine, and naltrexone are considered safe during breastfeeding. Collaborative Tx plans in pediatric mental health Collaboration between the PMHNP, clients, and families when creating the treatment plan is key to ensuring the plan meets the client's needs and is comfortable and manageable for the family. Privacy and HIPAA considerations in pediatric mental health Informed consent in pediatric mental health -Parents may decide whether to allow treatment if the child is unable to provide true informed consent. -Children may not be able to give legal consent, but they should be included in discussions whenever possible. Mandatory reporting in pediatric mental health -The Federal Child Abuse Prevention and Treatment Act (CAPTA) requires each State to have provisions or procedures for requiring certain individuals to report known or suspected instances of child abuse and neglect. -PMHNPs (...all nurses) are mandatory reporters.