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90 Cards in this Set
- Front
- Back
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categories of ACES |
Emotional, physical, sexual abuse, violence against a mother, alcohol or substance use, mental illness, prison, physical neglect, emotional neglect, parental separation/divorce |
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Negative effects of ACES |
Increases risk for mental illness Aids in the development of adverse coping behaviors Alters fxn of body systems (nervous, endocrine, immune system) |
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Breaking the cycle of ACES |
primary: raise awareness, increase social services, anticipatory guidance, enrollment in programs, screen ACES secondary: build relationships to report home situations Tertiary: trauma informed care, treat mental illness, manage chronic illness |
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4 E's of trauma informed care |
Educate, empathize, educate, empower |
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Anxiety DSM definition and conditions |
Excessive anxiety and worry abut a number of events or activities--sx lasting 6 months or longer with significant impairment in fxning 3/6 symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, agoraphobia, substance/medication induced anxiety disorder |
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Anxiety screening who, when, what |
Adults 19-64 including pregnant and postpartum children 8-18 frequency unspecified GAD-7, GAD-2 |
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Anxiety psychosomatic sx and testing |
fatigue, insomnia, diaphoresis headache, dizziness, parasthesias chest pain, palpitations hyperventilation, dyspnea diarrhea, dry mouth, N/V urgency, frequency CBC, CMP, TSH, EKG, Urine Tox |
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Anxiety management |
reduce sx, improve fxn, achieve long term remission Medication mgmt, exercise, CBT |
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Medications for anxiety and f/u |
SSRI and SNRI BusPar benzos prn 2 weeks, 4-6 weeks |
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Serotonin syndrome |
agitation or restlessness, confusion, rapid hr and bp, dilated pupils, loss of muscle coordination or twitching muscles, muscle rigidity, heavy sweating, diarrhea, headache, shivering, goose bumps |
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When to refer for anxiety |
psych co-morbidities, no improvement with mgmt, benzos, suicidal ideation, serotonin syndrome |
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Panic disorder |
recurrent attacks (abrupt surge of intense fear or intense discomfort that reaches a peak within minutes with 4 sx) |
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Major depressive DO screening |
routine screening PHQ2 PHQ9, Hamilton Depression scale, Beck depression inventory, geriatric depression scale |
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Depression diagnostics |
CBC, CMP, TSH, urine tox, EKG afib, heart block MRI Neuro findings, psychotic sx, head trauma |
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Depression DSM |
5 or more sx during same 2 week period and represent change in fxn. 1 sx is depressed mood or loss of interest weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, diminished ability to think or concentrate, thoughts of death no mania, or hypomania |
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Depression management and referral |
tx underlying causes, antidepressants, CBT, exercise, suicidal ideation with a plan, when to refer (tried several times without improvement) |
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Treatment options for depression |
SSRI, SNRI, antidepressants, TCA, MAOI |
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Paxil |
SSRI, most sedating, most weight gain, shortest half life (WD sx), unsafe in pregnancy, good for very anxious (needs to slow down) |
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Prozac |
SSRI, most energizing, longest 1/2 life, sleep disturbances, good for ppl who need energy |
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Zoloft |
SSRI safe, good for elderly |
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Celexa |
for depression only |
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Lexapro |
weight neutral, for anxiety and depression |
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Wellbutrin |
for depression anxiety, approved for smoking cessation, weight neutral, no sexual SE |
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Medication management SSRIs |
start at 1/2 dose for 1 week (nausea SE), 4-6 of tx for mood improvement (energy improvement 1st) mania, sexual side effects, sleep issues, serotonin syndrome SSRI withdrawal sx |
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Mania DSM |
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day. nearly every day. During period of mood disturbance and increased energy and activity, 3 or more sx: inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas, distractability, goal oriented activity or psychomotor agitation, excessive involvement in activities Marked impairment or psychotic features |
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Hypomania |
4 consecutive days, sx do not markedly impair fxn, no psychosis with hypomania |
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Management of bipolar |
Inpt tx: suicidal ideation, mania/psychosis Psych referral if bipolar suspected, begin initial tx |
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Mood stabilizers for bipolar |
Lithium, mania, maintenance tx Depakote for mania Lamictal; maintenance only |
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2nd gen antipsychotics for bipolar |
Zyprexa-acute mania, maintenace, acute bipolar depression Seroquel: acute mania, maintenance tx, acute bipolar depression (QT, somnolence) Vraylar, Latuda, Abilify, Risperdal, Geodon |
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Bipolar screening |
MDQ yes to 7/13 in question 1 and yes to question 2 and moderate or serious to question 3 |
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ADHD treatment options |
pharmacotherapy, CBT, home strategies to promote organization |
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ADHD medications |
Stimulants (ritalin, Adderall, Vyvance) Nonstim (strattera, Wellbutrin, Clonidine for children) |
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Stimulant tx for ADHD |
CI: CV, uncontrolled htn, arrythmias, bipolar disorder, psychosis start low dose and titrate slowly trial 4-6 weeks, monitor for SE long acting stim preferred due to better tolerability controlled substances agreement, random urine drug screen, check PDMP |
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DSM Inattention ADHD |
must have had sx as a child (prior to age 12); sx persisted for at least 6 months, negatively impacts social and academic/occ fxn 5 sx for adolescents/adults lack of attention to detail, difficulty sustaining attention, does not listen when spoken to directly, does not follow through on instructions/tasks, has difficulty organizing tasks/activities, avoids/dislikes tasks that take sustained mental effort, often loses important things, distracted by extraneous stimuli, forgetful in daily activities |
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DSM ADHD hyperactivity and impulsivity |
-fidgets, taps hands or feet, squirms in seat; leaves seat when remaining seated is expected; runs about, climbs, restless; cannot play/engage in leisure activities quietly, uncomfortable sitting still, talks excessively, cannot wait his/her turn in conversation, difficulty waiting in life, interrups others (conversations, games, activities) |
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ADHD diagnostics |
BP and weight, thyroid and neuro LFT, TSH, lead |
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ADHD when to refer |
-no hx of dx (consult with psych) -childhood dx-still meet criteria? -current dx-check PDMP -substance use DO: refer to psych |
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Insomnia DSM criteria |
predominant complaint of dissatisfaction with sleep quality or quantity a/w one of the following: difficulty initiating sleep, maintaining sleep/maintaining sleep after awakening, early morning awakening with inability to return clinical sig distress or impairment at least 3 nights/week, present for at least 3 months, despite adequate opportunity for sleep |
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Insomnia diagnostics |
sleep log (1-2 weeks)/ |
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Insomnia management |
Tx precipitating factors: psych do, substance and medications, medical and neuro do, other sleep disorder implement behavioral strategies utilize pharm strategies if needed |
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Insomnia medications |
antihistamine (Benadryl), benzos (Ativan, Halcion, Restoril) Benzo receptor agonist hypnotics: Ambien, Sonata (short term) Long term Rozerem, silenor Lunesta, belsomea, qvivq, dayvigo |
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Insomnia perpetuating factors: |
conditioned response |
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Alcohol use disorder screening |
CAGE >2 or more Have you ever felt the need to cut down on your drinking Have ppl annoyed you by criticizing your drinking Have you ever felt bad or guilty about your drinking Have you ever had a drink 1st thing in the morning to stead your nerves or to get rid of a hangover AUDIT, TWEAK (pregnant women), T-ACE (women)-CRAFFT (adolescnets) |
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Alcohol use disorder DSM |
problematic pattern of alcohol use leading to clinical sig impairment or distress as manifested by at least two of the following within a 12 month period: 2 of following -larger amounts over a longer period than intended, persistent desire or unsuccessful effort to cut down or control use, large amount of time to obtain, use or recover from effects, craving or strong desire or urge to use alcohol, recurrent alcohol use resulting in failre to fulfill major role obligations, continued alcohol use despit issues, important activities given up, use when it is physically hazardous, alcohol tolerance, withdrawal - |
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Alcohol DSM tolerance |
need for markedly increased amounts of alcohol to achieve intoxication or desired effect markedly diminished effect with continued use of same amt of alcohol |
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Alcohol withdrawal |
sweating, tachycardia, hand tremor, insomnia, n/v, hallucination, psychomotor agitation, anxiety, seizures alcohol taken to relieve or avoid withdrawal sx peak 24-72 hours, tonic clonic sz at 12-48 hours severe withdrawal: diaphoresis, photophobia, hyperreflexia, more pronounced tachycardia and tremor, hallucinations, elevated BP delirium tremens: severe form of alcohol withdrawal: disorientation, confusion, frank hallucinations, elevated temp] Tx: Librium, ativan, valium |
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Chronic management-AUD |
cessation, tx programs, pharm assistance naltrexone-reduces cravings, decreases pleasure of drinking Campral reduces cravings Antabuse: induces n/v with alcohol consumption
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Chronic management AUD |
regular visits labs: H/H, BMP, LFT, GGT, CDT, blood alcohol level supplements: thiamine, follic acid, MVI |
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Substance use DO DSM |
problematic pattern, clinically significant impairment or distress manifested by 2 in a 12 month period |
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Screening for substance use |
CAGE-AID-drinking or drug use NIDA quick screen: alcohol, rx and illegal drugs |
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Management and referral of OUD |
chronic tx withdrawal: nausea, muscle cramping, depression, anxiety, agitation, opiate cravings overdose: Narcan, EMS |
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Treatment options for OUD |
cessation Tx Pharm: medications+counseling FDA approved: naltrexone, byprenorphine and methadone |
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SUD risk factors |
genetics, stress, ACES, mental illness, social determinants of health protective factors: resilience, self-regulation, ability to form attachments |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Tobacco Use 5 A's |
Ask about use Advise tobacco users to quit Assess readiness to make a quit attempt assist with the quit attempt arrange f/u care |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Tobacco Use 5 A's |
Ask about use Advise tobacco users to quit Assess readiness to make a quit attempt assist with the quit attempt arrange f/u care |
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Stages of change |
precontemplation (unaware of problem), contemplation (aware of problem and of desired behavior change), preparation (intends to take action), action (practices desired behavior), maintenance (works to sustain behavior change) |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Tobacco Use 5 A's |
Ask about use Advise tobacco users to quit Assess readiness to make a quit attempt assist with the quit attempt arrange f/u care |
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Stages of change |
precontemplation (unaware of problem), contemplation (aware of problem and of desired behavior change), preparation (intends to take action), action (practices desired behavior), maintenance (works to sustain behavior change) |
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Tobacco treatment |
Bupropion Chantix NRT NRT, classes, helplines, apps, hypnosis, acupuncture WD sx: can occur as early as 30 min, peak in 3-5 days then taper off |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Tobacco Use 5 A's |
Ask about use Advise tobacco users to quit Assess readiness to make a quit attempt assist with the quit attempt arrange f/u care |
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Stages of change |
precontemplation (unaware of problem), contemplation (aware of problem and of desired behavior change), preparation (intends to take action), action (practices desired behavior), maintenance (works to sustain behavior change) |
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Tobacco treatment |
Bupropion Chantix NRT NRT, classes, helplines, apps, hypnosis, acupuncture WD sx: can occur as early as 30 min, peak in 3-5 days then taper off |
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Risk factors for ADHD |
what is it? |
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Acute pain guidelines-consider opiods |
severe traumatic injuries, mod to severe postop pain, severe acute pain when NSAIDS and other therapies CI or likely to be ineffective No not consider: low back pain, neck pain, pain r/t MS injuries, mild postop pain, dental pain, headaches |
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Subacute and chronic pain management |
nonopioids tx prferred only consider opioids if expected benefits outweigh risks immediate release, lowest dose, do not abruptly discontinue f/u q1-4 weeks, consider offering naloxxone check PDMP, consider urine drug testing, avoid opioids and benzos, |
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Tobacco use risks |
Increased risk of CHD, stroke, COPD, lung cancer; stillbirth, preterm delivery, SIDS, osteoporosis, cataracts, macular degeneration, Type 2 DM, RA, generalized inflammation and decreased immune system |
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Tobacco Use 5 A's |
Ask about use Advise tobacco users to quit Assess readiness to make a quit attempt assist with the quit attempt arrange f/u care |
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Stages of change |
precontemplation (unaware of problem), contemplation (aware of problem and of desired behavior change), preparation (intends to take action), action (practices desired behavior), maintenance (works to sustain behavior change) |
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Tobacco treatment |
Bupropion Chantix NRT NRT, classes, helplines, apps, hypnosis, acupuncture WD sx: can occur as early as 30 min, peak in 3-5 days then taper off |
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Risk factors for ADHD |
what is it? 1st degree relative with adhd Very low birth weight Exposure to alcohol or tobacco in utero Neurotoxin exposure aces Dietary reactions |
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Perpetuating factors Insomnia |
Conditioning factors, hyperarousal |
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Precipitating factors insomnia |
Psych disorders, substances, meds, medical and neurological disorders, sleep disorders |
