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150 Cards in this Set
- Front
- Back
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Delerium: S/Sx
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fluctuating/reversible disorientation, memory deficit, language disturbances, visual hallucinations, impulsive, tend to 1 task at a time; short duration with rapid onset
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Delerium: causes
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physiological causes are #1; fevers, infection, metabolic change
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Delerium: treatment (1^, 2^, 3^)
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treat the underlying cause (1/4 of all pts with delerium will die within 1 month); 2^ prevention: control infection, 3^: haldol/risperdal, gabapentin, abx; mms exam for baseline
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Dementia: types
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AIDS dementia complex (with low CD4 count), vascular (cardiovascular complications- stroke/HTN), infection (syphilis), alcoholism (wenicke-korsakoff), brain injury, DAT (alzheimer's)
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Alzheimer's: Pre-clinical stage s/sx
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amyloid buildup in 3 phases (eventual downstream neurodegeneration in 3rd phase); no clinical s/sx
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Alzheimer's: pre-clinical stage dx and use of findings
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detect using biomarkers (imaging, spinal fluid protein); use for research only not for client Dx
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Alzheimer's: DAT stages
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1) pre-clinical (no s/sx)
2) pre-dementia (no ADL impair.) 3) DAT (impaired fxn) |
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Alzheimer's: Pre-dementia stage s/sx
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early s/sx memory lapse, changes in memory/learning, mild cognitive impairment (MCI)--> fxn less than norm for age; no ADL impairment
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Alzheimer's: pre-dementia stage dx
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subjective (patient's own perception of changes in fxn), family, brain imaging (amyloid plaques)
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MCI
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mild cognitive impairment--functioning less than norm for age; seen in stage 2 DAT (pre-dementia)
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Alzheimer's: Stage 3 DAT
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cognitive changes that impair ADLs and function
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Dementia: reversible causes
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pseudodementia (common w/ depression), hypothyroid, infections, dehydration, malnutrition, meds (sedatives, hypnotics)
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pseudodementia
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occurs with depression; apathy, memory disturbances, cognitive slowing; REVERSIBLE
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Dementia: clinical course- early dementia/onset s/sx
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recent memory loss; disorientation (use MMSE to see if ANOx3 and get baseline), cognitive communication changes (anomia, aphagia, etc.), personality change, anxiety, denial, changes in appearance (hygiene), apraxia
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aphagia:
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loss of language ability
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anomia:
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difficulty remembering words
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agraphia:
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loss of writing ability
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alexia:
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inability to understand written words
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agnosia:
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inability to recognize objects or people
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apraxia
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loss of purposeful movements such as brushing teeth; seen in the early/onset phase of dementia
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Dementia: clinical course- Middle phase s/sx
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increase in behavior problems, catastrophic reactions/eccentric, sundowner's syndrome
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Sundowner's Syndrome: define, tx
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as the light dims and environmental stimuli decrease, confusion increases (diurnal regulation); keep lights dim at night and radio on
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Dementia: clinical course: terminal phase
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bedridden: unsteady gait, motor inabilities; bewilderment or wandering (risk for falls), incontinence, dysphagia- AIRWAY
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Dementia: Nursing Process- assessments
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use subjective and objective data; MMSE for trends/baseline, assess for depression (can worsen dementia), look for comorbid medical conditions
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apraxia
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loss of purposeful movements such as brushing teeth; seen in the early/onset phase of dementia
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Dementia: clinical course- Middle phase s/sx
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increase in behavior problems, catastrophic reactions/eccentric, sundowner's syndrome
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Sundowner's Syndrome: define, tx
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as the light dims and environmental stimuli decrease, confusion increases (diurnal regulation); keep lights dim at night and radio on
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Dementia: clinical course: terminal phase
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bedridden: unsteady gait, motor inabilities; bewilderment or wandering (risk for falls), incontinence, dysphagia- AIRWAY
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Dementia: Nursing Process- assessments
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use subjective and objective data; MMSE for trends/baseline, assess for depression (can worsen dementia), look for comorbid medical conditions
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Dementia: nursing process- interventions
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fall precautions, reality orientation (post-its, photos, calendars), socialization/pets, coping (build on good skills), encourage independence (not too many choices), reminisce therapy
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Dementia: nursing Dx
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altered thought process, risk for violence, risk for falls, self care deficit, low self esteem
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Dementia: family considerations
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burnout potential (respite care such as day care, res. living, snf, in home care, board and care), educate on disease process and create realistic goals
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Medicare: describe program
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federal entitlement program for people 65+ (and others who meet spec. criteria) to get social insurance
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Medicare: Part A, what does it cover, length of coverage
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Hospital insurance (inpatient fees for tests, room, food, SNF if SNF stay is for same Dx as hosp admission), not for ADL/non- skilled care; 20 days fully paid, 80 with copay; 100 day max
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Medicare: Part B
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outpatient insurance (physician, nursing, xray, dialysis, chemo); must be administered at an office (not hospital); covers some equipment like canes
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Medicare: Part C
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"choice"--optional; private insurance you can buy that covers what A,B,D don't cover; not standardized, don't always cover everything anyways
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Medicare: Part D
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drugs; amount/brands limited, anyone who has A and B gets part D but must pick which plan they want
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Medicaid/Medical: describe
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federal and state funded welfare program (for low income and resources)--managed by the states; in SF must be on SSI to get medical
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Psychodynamic theory of personality disorders
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misuse of ego defense mechanisms (acting out, controlling, displacement, idealization/devaluation, splitting, denial, transference, projection)
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transference
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unconscious desires that affect thinking (can be positive or negative)
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displacement
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taking anger out on something/someone else
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projection
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putting your thoughts onto others
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personality disorder: definition
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stable, inflexible, long-standing maladaptive patterns of behavior that persist thru the lifetime, deviates from one's cluture, affect the way we think, perceive, and relate; IMPAIR FXN
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Cluster A PD's
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paranoid, schizoid, schizotypal
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Paranoid PD: s/sx
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general suspicion, tendency to misinterpret other's actions as harmful, look for hidden meanings, trust issues, question partner fidelity, refuse consent, high violence risk, self referential thought
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Paranoid PD: tx
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share notes/chart/records, explain all actions/procedures, don't confront paranoia but don't agree
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Schizoid PD: s/sx
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overlaps with negative s/sx of schiz; see world as engulfing and retreat into own fantasy world; do not want close relationships
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schizoid tx (meds also)
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support relationships, be accessible, active listening, teach social skills and assertiveness training; antipsychotics and antidepressants
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Schizotypal PD: s/sx
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overlaps with positive s/sx of schiz; odd beliefs, unusual perceptions (special powers, etc.), friendless but want interaction
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Oppositional Defiant Disorder: s/sx, onset
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precursor to antisocial, mood swings, low threshold, loss of tmeper, blame others, usually apparent by age 8
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Conduct disorder
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no conscience, aggression to animals, lying, fires, violence; this dx always trumps ODD
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Antisocial PD: s/sx
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dx over age 18; lack empathy/guilt, no remorse, charming, intellectual, manipulative, criminal activity
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Antisocial PD: tx (meds)
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assess for violence, firm boundaries, confront lies/manipulation, positive reinforcement with negative consequences; meds: mood stabilizer and SSRIs
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Borderline PD: s/sx
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splitting, idealization/devaluation, many comorbidities (SA, MDD, BAD, ED, ASPD), fear abandonment, rapid mood swings/labile, self mutiliation, SI/attempts
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Borderline: tx (meds)
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consistency across staff, firm boundaries, DBT therapy; mood stabilizers, ssri, antipsychotics
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Histrionic PD: s/sx
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dramatic, shallow, attention seeking, assume closer relationships than actually exist, somatiform
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narcissistic PD: s/sx
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grandiosity, need for admiration, indifferent to criticism, arrogant, childhood without feedback, condescending
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Avoidant PD: s/sx
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introversion, fear of rejection, social phobia, minor setbacks seen as much bigger
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dependent PD: S/Sx
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submissive behavior, need emotional support, endure bad relationship
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OCPD: s/sx
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ego-syntonic obsessions/compulsions (don't bother), fixation on details, intelelctualization, rigid, don't see big picture
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OCPD: tx
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consistency, behavioral contracts
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DBT
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focus on mindfullness, interpersonal effectiveness, distress tolerance, emotional regulation; good for ED's and borderlines
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secure attachment (infants)
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learn that world is safe, gain the trust of caregiver who responds to fears
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insecure attachment: avoidant
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child that avoids caregiver and goes to strangers
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insecure attachment: resistant
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go to parent but pushes them away
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insecure attachment: disorganized
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no pattern, sometimes go to parent, other times to stranger
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Reactive Attachment Disorder
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DSM diagnosis: inhibited (overly fearful child) or disinhibited (overly friendly to strangers)
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separation anxiety norms
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7-18 months
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ADD/ADHD types
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combined, inattentive, hyperactive
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ADD/ADHD S/Sx
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decrease attention to details, difficulty sustaining interest in tasks, failure to follow thru on duties, forgetful, distracted, leaves seat, on the go, blurt out answers
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ADD/ADHD tx
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behavioral therapy that uses incentives; stimulants (adderal, ritalin), wellbutrin, Strattera (non-stimulant, not addictive, SSRI side effects)
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Schizophrenia: neurostructual changes
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larger ventricles, frontal and temporal lobe gray matter changes, hippocampus changes
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Schizophrenia: biochem
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excess dopamine and glutamate
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Schizophrenia: diathesis stress
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genetic loading + environmental stressor= dz
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Schizophrenia: DSM criteria for dx
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>2+ for 1 month or longer over 6 mo:
1. positive s/sx (hallucinations, delusions, disorganized speech or bx) 2. negative s/sx (flat affect, anhedonia, alogia, avolition) 3. marked impairment in fxn |
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Schizophrenia: SCPT (schizophrenia chronic paranoid type)
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hallucinations/delusions (persecution or grandeur) regarding paranoia of some kind
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Schizophrenia: Disorganized
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flat or inappropriate affect, childlike
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Schizophrenia: delusional disorder
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fixed delusion on 1 or 2 things
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Schizophrenia: brief psychotic disorder
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substance induced or out of the blue
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Schizophrenia: schizophreniform
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<6 months in duration
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Schizophrenia: schizoaffective
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with mood component/lability
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Schizophrenia: prodromal s/sx
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magical thinking, speech-vague or overly concrete, socially withdrawn; usually about 5 years before psych break; Tx early with low dose antipsychs
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Typical Antipsychotics: list meds, side effects
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Haldol, Prolixin; EPS side effects (akathesia, dystonia, parkinsonism, tardive dyskinesia, photosensitivity, anticholinergic)
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anticholinergic side effects
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dry mouth, blurry vision, constipation, urinary retention, orthostasis
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EPS side effects: list/describe
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akathesia: inner tickle/jump out of skin
dystonia: rigid muscles parkinsonism: shuffle, pill roll, flat face tardive dyskinesia: involuntary mvt (lip smack, blink) |
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EPS side effects tx
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congentin, benadryl, atarax
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atypical antipsychotics: list drugs, side effects
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seroquel, risperdal, abilify, zyprexa, clozaril (agranulocytosis); some EPS, photosensitivity, metabolic syndrome (wt gain, hyperlipidemia)
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NMS: cause, s/sx
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adverse effect of antipsychotics; increased vitals/temp, confusion, stiff, increased cpk, low wbc
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bulimia nervosa: dsm dx criteria
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recurrent binge episodes (eating large amounts in a short time); purging (vomiting, laxative, diruetics, meds, exercise); lack of control over behavior, concern over body image/weight
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bulimia nervosa: physical s/sx (GI, labs, cv)
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decrease tooth enamel, esophagitis, Mallory Weiss tears (GI bleed from wearing down lining), cardiac arrhythmias, Russel's sign (abrasion on knuckle), low K+
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binge eating disorder: s/sx
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eat rapidly, eat past fullness, eat large amounts when not hungry, eat alone, guilt after eating, can't prevent weight gain, ashamed after
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binge eating disorder: tx
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topomax (anticonvulsant/mood stabilizer and assists with weight loss); side effect= low IQ
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Female Athletic Triad: dx criteria, tx
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amenorrhea, altered eating habits, osteoporosis; 1500mg Ca, 800mg Vit D
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Anorexia Nervosa: DSM dx criteria
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refusal to maintain body weight (<85%), intense fear of gaining weight or becoming fat, rituals with food, disturbed body image, amenorrhea
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anorexia nervosa: physical s/sx (vitals, sexual side effects, labs, integument, fatal s/sx
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bradycardia, hypotension, hypthermia; amenorrhea, low libido, impotence, low estrogen; low Zn,K,Ca,Fe,PO4; thin hair, lanugo, chapped lips, keratinemia; refeeding syndrome: food reintroduced too fast leads to liver failure
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anorexia nervosa: psychological s/sx
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excessive exercise, fainting, secretive about eating, social withdrawal, self harm, constant weighing, looking in the mirror
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substance abuse definition
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maladaptive pattern within 12 month period with 1 or more: recurrent use, missed obligations, hazardous situations, legal problems, use despite awareness of issue
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substance dependence definition
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1 year with 3 or more:
tolerance, withdrawal, need higher dose for effects, unsuccessful attempts to stop, time/effort to obtain substance, give up on social/life/work, use despite knowledge of problem |
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Etoh withdrawal timing
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starts as early as 4-6 hours after last drink
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etoh withdrawal s/sx
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nausea, insomnia, headache, tremor, increased vitals
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alcoholic hallucinosis
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auditory hallucinations, 24-48 hours after last drink; ego dystonic
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Delerium Tremens
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alcohol withdrawal lasting 1-5 days; severe memory disturbances, anorexia, hallucinations, tremors, seizure; medical emergency that requires detox
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Wernicke/Korsakoff
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Korsakoff: short term memory loss
Wernicke: progression to encephalopathy; ataxia/confusion; permanent damage to hippocampus requiring vitamin B (thiamine) injections |
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Naltrexone/Revia
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decrease cravings for alcohol
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Antabuse/Disulfram
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makes you sick if you drink alcohol; must watch for over the counter meds, mouth wash, etc
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Etoh detox meds
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Benzos (anticonvulsants, usually librium unless liver issue then ativan), MgSO4 (anticonvulsant), IM thiamine (wernicke-korsakoff and peripheral neuropathy)
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endemic
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disease that is always present and has flare ups
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epidemic
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disease that is not always present and has resurgence or flare up on occasion (doesn't have to affect a large someone of poeple); ie small pox if it came back
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pandemic
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existence of a disease in a large portion of the population
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control over disease
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reduce the incidence (new cases) or prevalence (total cases) to an acceptable level as a result of deliberate effort
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eradication
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reduce incidence and prevalence to ZERO as a result of deliberate effort with no need to further control (ie smallpox)
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stages of infection:
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latent: replicating virus before shedding
communicable: shedding (contagious) incubation: between invasion and symptoms active: s/sx present |
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infectious agents
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virus, bacteria, fungus, etc
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reservoirs
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what can hold the disease (water, etc)
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portals of entry/exit
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nasal passage, mouth, skin, etc
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mods of transmission
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direct: person to person
indirect: vectors, fecal-oral, etc |
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passive immunity
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transfer of antibody from immune to non-immune (mom to baby=vertical), person to person immunoglobulins =horizontal
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active immunity
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exposure to antigen of infectious agent leads to creation of antibodies
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herd immunity
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immunity of a group or community (based on resistance of a high proportion >80% of individuals who are immune thereby covering the rest of the population)
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vaccination vs immunization
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vaccination is getting antigen injection; immunization is building up antibodies properly to prevent the disease; vaccines can fail to seroconvert, etc.
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VAERS
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vaccine adverse event reporting system: anyone with strange reaction must be reported
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PPD
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shows exposure to TB but not active infection
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PPD reading 5mm or >
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positive if HIV positive, positive chest xray or exposure to someone with TB recently
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PPD 5- 10mm
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positive if IV drug user, alcoholic, diabetic, foreign born in country with lots of TB, low income, resident of jail, children under 4
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PPD >10mm
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positive in all over 4 years old
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GAD: generalized anxiety disorder s/sx
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excessive anxiety and worry on more days than not for 6 months; difficult to control worry, anxiety causes significant distress or impairment in fxn
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anxiety s/sx
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restlessness, on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances (difficulty falling asleep or restless sleep)
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anxiety pharmacology
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benzos (short term use, habit forming), BuSpar (qid/tid, requires compliance), ssri's
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panic attack: criteria
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palpitations, pounding heart, seating, trembling or shaking, sensation of SOB or choking, nausea or abd distress, dizzy, faint/light-headed, fear of going crazy, chills, etc
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PTSD: describe, s/sx
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exposure to trauma leads to dz; reexperiencing the event, avoidance of things that resemble event or remind victim of event, numbing of emotions, hypersensitivity
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OCD: s/sx
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anxiety disorder, ego-dystonic thoughts and impulses that lead to actions repeatedly performed; takes more than 1 hour a day
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OCD meds
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luvox (ssri), anafranil; don't work for OCPD
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anxiety disorders caused by other medical conditions
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thyroid, copd, vit b12 deficiency
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Major depression: DSM dx
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depressed mood or anhedonia and:
weight change, insomnia/hypersomnia, fatigue, psychomotor agitation or retardation, worthlessness, guilt, impaired concentration, SI |
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ddepression: biochem
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low 5ht and norepi
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adolescent depression
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high suicide risk, difficulty expressing emotion, acting out, moodiness, anger, withdrawal
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geriatric depression
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NOT dementia, must assess (GDS scale)
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dysthymia
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depressed mood most of the day, more days than not for at least 2 years w/: under/over eating, sleep dif., fatigue, low self esteem, difficulty concentrating, feeling hopeless; no MDD in those 2 years
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TCAs: purpose, list drugs
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first generation antidepressants Tofranil, Elavil, Anafranil
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TCAs: side effects
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lethal in overdose, sedating, anticholinergic
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MAOIs: list drugs, side effects
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Marplan, Nardil, Parnate; hypertensive crisis is tyramine (pickled, alcohol, smoked, chocolate)
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Serotonin syndrome; s/sx, tx
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5ht toxicity; increased hr, diaphoresis, headache, nausea, diarrhea, hyperthermia, DIC, coma, death; tx with benzos, hyperreflexia
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antidepressants and suicide
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can increase energy level but not fix underlying deprssion, must keep watch during first few weeks
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Bipolar I
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mania present (major lability), depressed and grandiose
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Bipolar II
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hypomania with major depressive disorder
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cyclothymic disorder
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cyclical hypomanic states, can appear seasonal
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manic episode
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elevated mood for 1 week with 3:
inflated self esteem, decreased need for sleep, hyperverbal, pressured speech, flight of ideas, distractible, impulsive |
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hypomanic episode
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4 day minimum: elevated, expansive, irritable mood, not severe to cause marked impairment in social or occupational function
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Bipolar Meds
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Mood stabilizers: lithium (0.6-1.2 mmol/L as serum level), anticonvulsants: tegretol, depakote, topomoax, lamictal, neurontin
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lithium side effects
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cognitive blunting, fine hand tremor
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