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423 Cards in this Set
- Front
- Back
- 3rd side (hint)
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NP's PRIMARY objective of Interview
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Develop a therapeutic relationship
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Coping mechanisms vs defense mechanism
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Learned and conscious vs learned and unconscious
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Defense mechanisms: Where do they come from, not what are they.
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Innate and unconscious attempts to avoid unpleasant emotions and feelings
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Most important question of interview
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Why now?
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Strengths include
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What are you proud of?
What do you like about yourself? What do you do to take your mind off problems? |
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How many days is required for a manic diagnosis.
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7
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How many days is required for a hypomania diagnosis
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Hypo has 4 letters.
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What disorder does DIGFAST relate to
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Bipolar
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What does DIGFAST stand for
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Distractibility, indiscretion, grandiosity, flight of ideas, activities incr., sleep deficit, talkative (pressured).
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Is there a genetic component to bipolar disorder
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yes-children of bipolar parents have four times the chance of being bipolar
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What disorder does AND I CREST relate to
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Anxiety
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What does AND I CREST stand for
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anxious, no control over worry, Duration 6 mo, Irrit, Conc poor, Restless, Energy low, Sleep impaired, Tension in muscles.
Anxious, No, Duration, Irrit., Conc, Restless, Energy,Sleep, Tension |
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What is the mnemonic for the specific points of the MSE
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All Borderline Subjects Are Tough Troubled Characters
absattc |
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What does "All Borderline Subjects Are Tough Troubled Characters" stand for?
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Appearance, Behavior, Speech, Affect, Thought process, Thought content, Cognitive exam.
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General Assessment tools for psych. Diorder or side effectss
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AIMS Abnormal Involuntary Mvt. Scale
MMSE Connors - ADHD HAM-D cut point is 17 |
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Self Assessment tools for depression
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BDI
Zung Symptom check list-90 Profile of mood states |
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Depression lab work
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CBC, Chem, Thyroid panel, Liver panel, B-12 and Folate.
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Dexamethasone Supression Test
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no longer used.
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Imaging for depression
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PET-positron emission tomography shows brain activities in the brain
take 2-3 hours |
My pet project.
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MRI
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Gross brain structure, dx new onset psychosis and dementia. takes 35-45 min.
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How long after drinking can alcohol be detected in the urine?
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7-12 hours
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What does ON OLD OLYMPUS TOWERING TOPS A FIN AND GERMAN VIEWED A HOP refer to
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Cranial Nerves
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What does Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens refer to?
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Cranial Nerves
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How can you tell the difference in cranial nerve I and II?
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you have I nose and II eyes
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Name the Cranial nerves
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I. olfactory II optic III oculomotor IV Trochlear V Trigeminal VI Abductens VII Facial VIII Acoustic IX Glossopharyngeal X Vagus XI Accesory XI Hypoglossal
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What is mnemonic for the function of cranial nerves
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Some Say Marry Money But My Brother Says Big Bras Matter Most (Sensory, Motor, Both)
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The patient is ask to shrug their shoulders. What cranial nerve?
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XII Accessory
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UVULA goes up and gag and swallow. What cranial nerve?
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X Vagus
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Show teeth. What cranial nerve?
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V Trigeminal
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Which Cranial nerves does the "H" test with the eyes?
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III, IV, V (3,4,6)
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(front of card) Which Cranial Nerves? Taste in front of tongue, sense in ear canal, corneal reflex, raise eyebrows, keeps eyes closed, puff cheeks
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VII Facial
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Tongue to cheek tests which nerve?
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XII Hypoglossal (motor only)
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Weber and Rhinne tests what cranial nerve?
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VIII Acoustic
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Snellen chart tests what cranial nerve
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II optic
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When giving a treatment or medication, what must we do?
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DOCUMENT the fully informing of risks, benefits, and other options.
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Health promotion of all: When do you start PAP's and Breast Exams?
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PAP: Sexually active or 18. Annually if sex, Q 3 years if no sex
Breast: Adolesence; monthly forever |
Breast exam is not a mammogram.
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Health Promotion of all: Syphilis screening?
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Start when sexually active and PRN
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Health Promotion of all: How often should you have a PPD
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once in adol, Q 2 years if risk or exposure
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Elderly Health Promotion: Complete PE is done how often
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Starting at 20 then Q 2 years.
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Elderly Health Promotion:
PAP with GC and Chlamydia |
Same. Annually is sex and Q3 years if not. Pelvics are not PAP
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Elderly Health Promotion:
How often are mammograms done? |
Baseline as young adult, and annually after 50.
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ELderly Health Promotion: How often are male testicular exams?
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Young adult then monthly
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Elderly Health Promotion:
How often and when to start Digital Exams and PSA? |
50 and over should have annual psa and DRE
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Elderly Health Promotion:
How often should a BP be done. What are the norms? |
minimum of Q 2 years. Normal is 110-135/60-85
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Elderly Health Promotion: How often do we need an EKG?
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40 baseline then Q 2 years (with cardiac risk factors)
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Elderly Health Promotion: How often for colorectal cancer screening
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Start at 50. Annual FOBT, Sigmoid Q5, colonoscopy Q 10 or double contrast barium enema (DCBE) Q 5-10 years.
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Elderly Health Promotion:
Glacoma screening should be done how often? |
Yearly
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Simply in 2 words describe Sensitivity and specificity
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Sensitivity: True Positive, or tight net
Specificity: True negative or loose net |
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What are the top 5 causes of death in those over 60? Remember, what takes them to the hospital all the time? The old man's friend.
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1. Heart
2. CVA 3. COPD 4. Pneu/ flu 5. lung and colorectal Ca. |
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Theory of health promotion:
Basically, what does Maslow say? |
First things first. i.e. treat physiology first, give meds first, therapy 2nd (when severe). 1st things 1st.
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Health promotion theory: Backer
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health influenced by threats to health and outcome expectations.
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Health promotion theory:
General systems Theory, von Bertalanffy |
nothing exists in isolation
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Prevention Model: name the stages and describe them.
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Primary - Prior to disease, i.e. diet, exercise seat belts
Secondary - screening Tertiary - (Tormentuous)Rehab |
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Thyroid Function
What do you order for screening? |
TSH and Free T4
TSH (2.5 - 13.3) T4 (0.9-2.4) T3 is for when on meds only. (Thyroxine has 3 sylables) |
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Review hypo and hyper thyroidism by their labs.
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Hyper low TSH - hi or norm FT4, high FT3
Hypo high TSH - low T4. T3 is not important. |
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HIV viral loads, quantity and life
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<10,000 - 10+ years survival
>30,000 - 4.4 years survival |
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ADC - AIDS Dementia Complex
Can you diagnose it? |
Motor is first. Hallmark presentation. Check snout reflex.
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What are Freud's ego defence mechanisms? They are all UNCONSCIOUSNESS
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Compensation, denial, displacement, identification, Intellectualization, Introjection, Isolation, projection, Rationalization, Regression, Sumblimation, Supression, Undoing
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When we compensate what do we do? Think about decompensation.
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We cover up a real or perceived weakness
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Denial is....
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refusing to acknowledge the existence of a real situation.
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Displacement
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transfer of feelings from one target to another that is less threatening or neutral.
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identification
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Attempt to increase self-worth by acquiring characteristics or attributes of an admired individual. With whom do you Identify? A football player?
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Intellectualization
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Avoiding emotions associated with a stressful situation by using intellectual processes.
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Introjection
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Integrating beliefs and values of another into one's ego structure. A minister.
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Isolation (defense mechanism)
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Seperating thoughts or memories from the feelng tone associated with it.
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Projection
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Attributing one's feelings or impulses to another person
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Rationalization
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Attempting to make excuses or formulating logical reasons to justify unacceptable feelings or behaviors.
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Excuse me for being logical so I can spend this money.
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Regression
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Retreating to an earlier level of DEVELOPMENT and comfort measures.
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Sublimitation
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Re-channeling of drives or impulses that the person considers unacceptable into contrusctive activities.
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Supression
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blocking of unpleasant feelings and experiences from awareness.
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Undoing
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symbolically cancelling out a previous action that is intolerable.
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Resistance
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Anything that interferes with and disrupts the flow of feelings, memories, and thoughts.
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Freud's Psychosexual development
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Oral 0-18 mo-acheives relief of anx through oral
Anal 18 mo - 3 years-learn ndependence by excretory function Phallic 3-6 IDent. w/ parent of same sex. Latency 6-12 Sexually repressed, focus on relationship with same sex peers Gental 13-20 libido reawakening, focus on genital organs and relationship w/ opposite sex |
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Freud's therapeutic goal was?
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make the unconscious conscious
ego strenthening so behavior is less from instinctual drives. |
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Hypnosis does what?
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Gets past the Ego.
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What is Freudian interpretation
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pointing out, teaching meanings of behavior via dreams, free assoc., resistance, and therapeutic alliance.
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Free Association
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Central Technique, non sensored.
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Harry Stack Sullivan
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"relationships with others"
*Key concepts are anx. and self esteem. |
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Harry Stack Sullivan's Developmental Perceptive
Main idea |
Good me, bad me, "not me"
Responses to feedback. "you are great!" "You are worthless." |
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Transactional Analysis
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Eric Berne, after WWII. We didn't work with folks after WWI because they were dead! Parent, Adult, and Child ego states.
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Equivalent to superego, ego, and id.
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4. Gestalt
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Frederck (Fritz) Perls
focus, here and now. Responsibility. Deal with unfinished business. Holistic. Uses the body to inform us of stuff. |
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5. Person Centered Therapy
Carl Rogers Unconditional positive regard |
Clent has potential of becoming aware of problems and resolving them. Focus on self-direction. Health=ideal self is congruent with real self.
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Carl had an ideal and worked with it real good.
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6. Behavioral therapy
(Pavlov, Skinner, Bandura, Wolpe) |
Token economy. Scientific method. How, When, Where, What more important than WHY.
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7. RET, Rational-Emotive Therapy
(Albert Ellis) |
Beginning of CBT. Neurosis is irrational thinking. Root in childhood. Error in Beliefs. PERSONAL RELATIONSHIP NOT IMPORTANT.
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8. CBT (Aaron Beck)
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Change how you think and change how you feel. Contrast to RET (Ellis) all psychopathology has similar underlying irrational beliefs.
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9. Brief Therapy
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Save MONEY. Therapy moved from the rich to the poor.
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What is the AVNET report.
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Insurance coverage for short-term outpatient psych care
Specifies 15 individual session. |
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Breif therapy phases of treatment
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pre (identifyling goals)
Beginning (rapport, focus) Middle (application) Termination (clean termination) Follow-through |
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Peplau identified six subroles of the nurse
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mother-surrogate, technician, mgr, social, health teacher, counselor
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Group therapy vs. therapeutic group
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Leader is a professional
Group relations and interaction. AA |
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Per Yalom, how many should be in a group
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5-10
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Benefits of group, per Yalom
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Universality - "I am not alone"
Hope, education, self esteem by helping others, maladaptive behavior corrected, social skills, role modeling, insight through interactions, security::belonging, safe to emote, existential (direction/responsibility) |
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Phases of group
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Initial, working phases, termination.
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Group leadership styles
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Autocratic, Democratic, Laisez-Faire
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Morino group therapy?
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Psychodrama
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Ladies and Gentlemen! Now Presenting
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Family Systems (Murray Bowen)
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Anxiety in the family is the key.
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Some keys other than anxiety about Bowen
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Differentiation of Self.
Fusion - ways to borrow or lend to self or others Cutoff-immature separation from people Emo. Reactivity - can't separate thoughts and feelings |
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Bowen talks about triangles. What are Triangles?
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person focus on a diff. object, idea, or person, to manage anx. between him or another person.
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Stragic Family Therapy (Jay Haley)
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He uses paradox. Families develop strategies to solve problems and the strategies become a problem.
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Structural Family Therapy
(Salvador Minuchin) |
Genograms. How is the family organized. Subsystems are groups within the family. People act differently in different family groups. (Mother drinking)
Boundaries- more diffuse boundaries=more chaos. rigid boundaries = less support |
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Goals of structural family therapy
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Develop clearly defined generational boundaries
Establish unified view on impt. |
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Nursing Theory
Neuman |
Health care systems model
person is a complete SYSTEM Subparts are interrelated Application: strength subsystem functions |
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Nursing Theory
Roy |
Adaptation Model, humans are an adaptive system and cope. 4 subsystems Physiologic needs, self concept, role function, and interdependence.
Application: support groups, anticipate physiological needs to reduce length of stay |
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Nursing Theory
Martha Rogers |
Unitary human beings. We are more than a sum of biological physical, social, and psych parts. Nsg devoted to study the nature and direction of unitary human devel.
Application: ID pts social/psy needs other than CC. |
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Nursing Theory
Parse |
Human is an open system able to choose options giving meaning to a situation. Share thoughts will
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Nursing Theory
Dorthy Orem |
Self Care Model
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Nursing Theory
Levine |
Conservation model: indiv. is a holistic being
Nsg goal is to maintain the person's wholeness Application: Help pts cope with new health problems |
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Nursing Theory
Imogene King |
Open systems model
Systems; personal, interpersonal, social exists. Application: Pt. can be supported to promote health by RN-pt perception, communication, and interaction |
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Nursing Theory
Aizen |
Theory of Reasoned Action
relationship among attitude, intention, and behavior. Application: ed. pt to create intention toward health promotion. |
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Nursing Theory (not a nurse)
Lazarus |
Theory of stress and coping.
Application: assist pts to explore and evaluate coping strategies and ammend PRN. |
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development: Mahler
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0-2 mo norm. autism
3-5 mo symbiosis Separation/individuation 5-8 mo differentiation 8-16 mo practicing 16-25 mo Reapproachment 25-36 mo object constancy |
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Ethological Theory
Lorenz |
Imprinting - study of graylag geese
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Ethological theory
Adaptation theory |
WE adapt to our enviroment
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Ethological theory
(Klaus and Kennel) and Attachment Bowlby) |
Intimate contct with mother at birth
Attachment similar to imprinting Bowlby Attachment 0-6 mo broad 6+ mo more specific |
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Ethological theory
Sensitive period of development (Hinde) |
Language, emotional attachment, social relationships/any deficit causes bad effects
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Ethological Theory
Social learning Bandura |
learn by observing others
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If you don't play in the Band, don't you just sit and watch?
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Ethological theory
Classical conditioning Pavlov and Watson |
Dogs and bells
Watson - based on conditioning and habit training |
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Ethological theory
Skinner |
Behavior Mod.
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Moral Development
Piaget |
result of cog. devel. and social experience
0-7 years - Amoral 7-12+/- Moral Realism, Black and white morals, based on consequences, imminent justice Late middle childhood to adol Right and wrong based on social contracts; how do actions affect others? |
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Moral Development
L, Kohlberg |
4-10 Preconventional/motivated by fear of punishment
Conventional 10-13 Interpersonal/motivated by other's expectations, wants approval and acceptance Adol and up Postconventional Social contract legalistic orientation, respect for univeral laws Universal ethical principle - internal prin. of honor, justice, respect for human dignity, guided by conscience |
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Sexual Devlopment
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2-2.5 yrs. understands gender
4-5 yrs. Heterosexual play 6-9 yrs homosexual play 10-13 yrs pubertal change/romantic interest 13-20 BIG sex feelings, having sex, concept of love, family planning 20-65 intimacy, exclusive vs open, 50% men have extramarital 25% women extramarital Hormones change later |
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Ecological System model, Bronfenbrenner
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Birth order.
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Mental Retardation: Why?
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30% prenatal causes (etoh, radiation, illness)
20% social - poor nurturing/stimulating 5% heridity - metab. chromosone 5% Postnatal infections (meningitis, encephalitis), posoning, trauma |
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What is the high cut off IQ for Mental Retardation
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70
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What is the criteria for Mental Retardation. There are two
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IQ < 70
ADL deficit |
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What axis is Mental Retardation recorded on?
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II
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Name 4 characteristics of autism
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1. Lack of awareness of others and treats others as objects
2. Abn comm 3. Repetitive behavior 4. Stereotypical hand flapping, rocking |
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Why do kids get Autism?
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Env. parental rejection, stress, poor stimulation, flawed comm. patterns
BIO: genetic, neuro (maternal rubella, PKU, Tuberous sclerosis, Anoxia at birth, Enceph, intantile spasms, CNS diseases - MR, Cong Syph, Eplip, cong rubella |
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What are nursing interventions for Autism?
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Prevent violence to self,
Improve social interaction, communication, sense of self. |
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Facts about Rett's
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Common neurodegen disease
FEMALES ONLY ULTIMATELY INSTITUTUIONALIZED don't develop, irrit, poor speech and hand skills, hand mvt, small head, sz, scoliosis, hyertonic |
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Management of Retts
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PT, OT, Speech Therapy, Sz mgt, support family, referral
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Childhood Disintegrative disorder
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Males>females
females more severe |
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Asperger's characteristics
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Similar to autism but SPEECH IS NOT AFFECTED
Males more than Females Females more severe |
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ADHD
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Most comon dx behavioral problem in childhoold
Differential for bipolar |
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MUST knows for ADHD
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Symptoms present BEFORE 7
Persist 6 mo. Must be more frequent and worse than observed in similar level of development MUST HAVE DYSFUNTION AT HOME AND SCHOOL BOTH |
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Epi. of ADHD
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3-5% school age children
Boys:girls 6:1 girls more inattentive Boys more hyper Note that there are 4 letters in ADHD. 4 is between 3-5 |
ADHD has 4 letters, which is between what?
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Predisposing factors for ADHD
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Genetics, low dop. and NE, frontal and prefrontal regions, perinatal factors (premature, fetal distress, extended labor, asphyxia), Postnatal (CNS trauma/infections), CP, Epil
Enviroment: Lead, artificial additives, dyes, sugar Psychological: dysfuntional parenting, fam hx sub abuse, hysterical or sociopathic, learning disorders |
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Comorbids with ADHD
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Learning disability 35%
Psych D/O, anx 25%, Dep 25%, ODD or Conduct d/o 50% |
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Parent says I don't want my kid on drugs. Why does a stimulant work?
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stumulants REDUCE risk of substance abuse
They STIMULATE the part of the brain that brings calm |
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Prognosis of ADHD
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50% will have symptoms into adulthood
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What is conduct disorder?
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Behavior violates rights of others and age-appropriate norms.
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Three types of conduct disorder.
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Group
Solitary aggressive Undiff |
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What age can conduct d/o be dx.
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Early onset 4-6 years
Formal dx 7 to 18. 10-13 B>G 16:4 14-16 B>G 16:9 17-20 B+/- G 9.5:7 |
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Manifestation of Conduct d/o
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Hitting, kicking, fightly, cruelty to animals or people, physical destruction, fire starting (duty to warn), Bunch of other naughty things!
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What is Oppositional Defiant Disorder ODD
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Negative, hostile defiant more than the norm
begins aroud 8 10-13 B 14% G 10% 14-16 15% boys and girls 17-20 12% both ODD SOFTER THAN CONDUCT D/O |
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Facts about Tic Disorders
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Tourette's most common (motor AND vocal)
Generational Onset 6-12 - 21 Can voluntarily control for a short time Copropraxia- obscene gestures Coprolalia obscene words |
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DX criteria for Tourette's
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Multimple motor AND vocal tics over time
Tics present for ONE YEAR Tic onset by 21 y/o Not due to Sub Abuse Often associated w/ OCD |
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Psychopharm for Tourette's
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Haldol 0.5 - 6
Clonidine patch Pimozide (orap) EEG needed before using. |
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Anx D/O in childhood
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3 categories. Separation anxiety, avoidant disorder, over anxious d/o
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Encopresis DX
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Prpetitive stool, vol or invol
in children who should be toilet trained with no primary organic patho. 2% of 8 y/o boys, 0.7% girls 3:1 boys 1% school aged children have it Phys and Psy involved. |
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Two types of Encopresis
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Retentive (liquid seeps around hard stool), retains feces.
Nonretentive: Soft stool, no distention |
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Enuresis
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Primary - Never had control
Secondary - Has invol urination after 6-12 mo. Nocturnal and Diurnal (Waking hours M>F |
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Drug treatment of Enuresis
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Imipramine
Desmopressin (DDAVP) nasal and tab Oxybutynin controls daytime incont Need drug holiday Q 3 mo to assess need After 1 mo. no wetting, taper meds SCREEN FOR UTI |
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Gender Identity Disorder
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Anotomics
GID of childhood Transexualism GID of adol or adulthood |
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Adol Suicide
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12% of deaths, rare before adol, rise after puberty and through teens
rise over past 30 years |
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Epidimiology of adol suicide
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11.2 per 100,000. Four fold rise since 1950
24% in high school report contemplating suicide 17.7% have plan 8.7 attempt 2.8% attempted need medical attention Completed suicide M:F 4:1 Girls attempt more Firearms most freq Hanging is 2nd More firearms recently |
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What is the difference in traits and disorders regarding personality disorders?
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Disorders are maladaptive and rigid, causing problems in relationships and roles. They are PERVASIVE
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Who has the highest risk of violence of personality disorders
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Substance abuse
Cluster B Less SCZ Positive correlation: paranoid, narcissistic w/ threat to ego, Pass-agg |
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Diagnostic criteria for PD
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Endures over time
Deviates from cultural standards RIGID AND PERVASIVE Onset in Adol Leads to impairment and unhappiness |
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3 Clusters of Personality Disorder
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Weird, wild, wimpy
Odd Angry Alone |
A: paranoid, schizoid, Schizotypal
B. Borderline, narcissistic, Antisocial, Histrionic C. Avoidant, Dependent, Obsessive-compulsive |
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Why are Pers. Disorders so hard to treat?
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Traits are INGRAINED and not PERCEIVED
Perceive them as positive aspects of self Time consuming Requires insight, which is lacking |
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Why is Schizopid not Delusional
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No fixed Del.
No Halluc. No Thought disorder |
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Do schizoids want close contact with family
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NO
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7.5% of gen pop. 2:1 m-F
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What is so bad about schizotypal PD
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10% commit suicide
Epi 3% of pop |
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Give some stats about antisocial pd
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75% of people convicted of crime, but not all people with ASPD are criminal
Poor Deprived of parents first 5 years - foster home/orphanage 3% male 1% female 5X greater in first degree relatives of men |
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Give some stats about Borderline PD
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1-2% of pop, F:M 2:1
hi incidence of MDD and SAD in 1st degree relatives Freq hx childhood abuse/sexual abuse |
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What are some psychopharm for BPD?
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Zyprexia help stabilize mood
SSRI for dep MAOI for impulsive bx |
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What are some characteristics of avoidant PD?
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1-10% of gen pop.
Nervous/tense needs approval Tolerates abuse/passive "inferiorty complex" Timid Real desire to be close |
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Characteristics of Dependent PD
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2.5% of all PD, more women
Adults with chronic illness as kids are more prone |
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Dx Criteria for Dependent PD
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Hallmark: needy
Needs lots of reassurance Needs others to take responsibility for their life Hard to initiate projects Great lengths to get nurturance and support Helpless when alone due to fear of inability take care self Urgently wants new relation Unrealistic fears of being left to self care |
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Characteristic of OCD PD
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M>W, most in eldest sibling, harsh parental discipline, 1st degree relatives with OCDPD
Perfectionism, defense mech are reaction formation and displacement Unable to discard worn out or worthless obects |
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There is 1 key difference between OCD PD and OCD Axis I.
What is it. |
The Personality Disorder disrupts social or occupational role functions
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Crisis intervention: What is the main intervention
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Must have a NEW solution
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What are the four phases of crisis?
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1. Confrontation by the hazard that threatens self concept and procudec disequilibrium
2. Usual problem solving doesn't work 3. Emergency problem solving resources, both internal and external, are called upon and fail, further causing disequilibrium. 4. A major disruptive state or disorganization occurs. |
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There are some assumptions made regarding crisis.
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Whether an event causes a crisis is based on: past learned coping mech, perception of event, situaltional support, immediacy is the ability to focus on only circumstances surrounding the hazardous event.
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What is Beck's Triad
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1. Person holds negative view
2. Evaluates ongoing events in a negative way 3. Misinterprets avail. data and assumes future hold no hope |
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What is the greatest predictor of violence?
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A past history of violence.
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What are some organic features to consider relating to violence?
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Head injury, HX of high fevers, brain tumors, injuries from violence
Screen for STD's, Hep., meds and drugs |
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buspirone (buspar) is good for anxiety. What is the dose and how long does it take?
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20-60 mg BID or TID
Takes 6-8 weeks!! |
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Define Abuse
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Intentional injury or harm to an individual with whom the perp has either an intimate relationship or caretaking role.
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Know them well, intention
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Define Neglect
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Caretaker fails to fulfill caretaking function knowingly or accidently
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Not intentional
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Define child abuse
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non-accidental physical physical injury by child's caretaker
Battering is striking Physical endangerment-allowing or encouraging child to engage in act. with high injury potential |
Not an accident, putting or allowing child in harm's way
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There is one unique characteristic of Sexual abuse of a child. The abuser must be....
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five years older than the child.
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What is the age requirement of physical abuse of the adult?
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If the Victim 17 or less and the perpetrator is at least 5 years older abuse of late adolescents qualifies as child abuse, but in dating and marital situation dymanimcs of adol. abuse are more like adults.
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What is the definition of the neglected of the dependent adult>
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Failure of responsible adult caretaker to make provision for meeting the needs of an adult person who by VIRTUE of MR, medical condition, psych illness is unable to meet basic needs for food, clothing or shelter independently.
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Acult caretake isn't doing it for the adult with MR, medical condition or psych illness.
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Symptoms of neglect include...
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Hungry all the time, untreated medical conditions, bedsores/contractures in bedridden, sx of physical restraints, inappr. clothing for season, dirty or smell of feces/urine, injuries from multiple falls.
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Hunger, sick,Besores, restraints, no coat in winter, smelly, dirty, many falls.
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One interesting thing about Acute Rape Syndrome is...
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Just becaue they enjoyed it does not mean they wanted it. That is simply a physiological response. NO BLAME.
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Thoughts on reporting Rape
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Nurses are mandated reporters of rape. MUST have permission of the adult to report because of competence. Kids and Geri's are not considered competent.
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No report without consent. Kids and elders OK because they aren't competent.
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Stats on Suicide
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55% of suicides done with gun.
3rd leading cause of death in people 15-24. Of all suicides of people over 65, 85% were men, 15% women. 10% of suicides go unreported. 100 to 1 are attempts. 1 of every 5.6 peole with sucide complete. 5% of suicides were inpatient. |
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Thoughts on No Self Harm Contract
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Written is better. Works better with older men.
NO EVIDENCE IT WORKS. |
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How do you word asking someone about suicide?
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Do you want to KILL yourself?
NOT, do you want to hurt yourself? |
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There are two major risks to consider when assessing suicidal ideation.
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Previous suicide attempts and hopelessness.
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Once suicidal, how long will it last, usually?
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3 months
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There are two levels of observation for someone who is suicidal. What are they?
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One to One: For the highest risk and most lacking of therapeutic relationship. Nurse with pt at ALL times. No dangerous objects. Keep pt in controlled environment. Keep pt involved. Use antipsychotics and anxiolytics. Treat withdrawal!
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Close Observation: suicidal thoughts, ambivalent, can't contract. Goal is to increase pt's sense of control and responsibility, visual contact and in public area when awake, in room with visibility, 15-30 min checks, acknowledge ambivalence, teach adaptive coping mech., do crisis intervention.
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What is the defining characteristic of a pathological grieving process?
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Normal grieving does not lose self esteem and pathological does.
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How long can normal grief last?
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Over 2 years.
ACUTE is 2 mo. |
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Do you medicate grief?
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No. It may trigger MDD or Anx. DiO
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Define Ethnicentric.
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Belief in superiority of one's own ethnic group.
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What is the difference between Acculturation and Assimilation regarding culture?
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Acculturation is only modification by contact and assimilation is adoption of customs and attitudes by prevailing culture.
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What does the Culturally and linquistically services in Health Care (CLAS) say?
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Use interpreters by same gender and only certified and qualified.
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What is are some screening statistics for Alcohol Use Disorder?
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On any single occasion during 3 months, have you had more than ___ drinks (men=5; women =4)containing alcohol.
Men may be at risk if they have had 14 drinks per week or 4 drinks per day. Women are at risk if they have more than 7 drinks in one week or 3 drinks per day. |
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What are some significant side effects of alcoholism?
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GI, Cardiac (myopathy), 30% of hospitalizations are alcohol related.
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What does CAGE stand for?
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Cut back
Annoying others Guilt Eye Opener |
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Is tolerance of Physical dependence required for a diagnosis of Substance Disorder?
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No
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What is the CIWA-A score that needs medication?
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8 or above.
8-14 nees meds 15 is immediate |
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Are there considerations other than the CIWA-A to give medication for withdrawal?
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Yes. If a patient has a history of seizures, notable co-morbid medical illness they should be treated with meds regardless of CIWA-A score.
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When considering benzodiazapines and alcohol withdrawal or liver disease, there are 3 that are not metabolized by the liver. What are they?
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LOT
Lorazepam Oxyazepam Temazepam |
LOT
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When do you start the CIWA-A?
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Last drink within 12 hours, or first sign of withdrawal.
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When do you stop the CIWA-A?
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When the score is <10 after 3 consecutive assesments.
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What is the difference in Limbic and Cortical?
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Limbic: Old brain - Hallucinations and delusions come from here, postive symptoms.
Cortical is responsible for negative symptoms, mood. |
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What is the psychobiology of psychosis?
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↑Dopamine in basal ganglia
↓5-HT Greatest change in mesolimbic-mesocortical tract |
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What is the psycobiology of depression?
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↓5-HT and ↓NE
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What is the psychobilogy of Bipolar dsorder?
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Interactions between NE, DA(dopamine), 5-HT, Acetylcholine(ACh), GABA, and Peptides.
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What is the psychobiology of Anxiety?
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↑5-HT and NE ↓GABA and peptides
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What is different about dosing SSRI's for anxiety?
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Use higher doses. i.e., fluoxetne for depression is 20 mg and for OCD is 80 mg.
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Neuroanatomy. Name the cerebrum's four lobes
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Frontal, occipital, parietal, temporal
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What is the frontal lobe responsible for?
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Voluntary motor activty (like typing), Speaking, elaboration of thought (I have to think about that one) and Executive functions (is that a bank executive and how she decides good loan risks?)
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What is the Occipital lobe responsible for?
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Processing visual input. Can you see it?
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Occipital - occular
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Parietal Lobes are responsible for what?
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Receiving and processing sensory input.
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Is the parietal lobe rough or smooth? Loud or soft? Red or green? Hot or cold?
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What are the temporal lobes involved in?
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Emotions, memory, cognition, speech and the limbic system. Limbic system has the amygdala (PTSD) and hippocampus (Memory). Also regulates behaviorial awareness, fear, social behavior, rage, sexual desire, appetite.
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Do you remember having a temper?
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What does the Thalmus do?
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It acts as a relay station for all synaptic input such as the CNS of lower extremity to brain and back.
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Do your toes hurt?
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What does the hypothalmus do?
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Homeostatic function: temp. control, thirst, hunger, urine output. It links nervous and endocrine system and helps regulate emotion and basic behavioral patters.
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Are you hypothermic? How do you feel about that?
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Pituitary gland does what?
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secretes hormones under the influence of the hypothalmus.
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it is the pits to work for the COLD hypothermic hypothalmus.
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What is the basal nuclei?
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coordinates slow, sustained movements. Supresses useless patterns of movement.
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Slow movements are so basic.
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What is the difference in Limbic and Cortical?
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Limbic: Old brain - Hallucinations and delusions come from here, postive symptoms.
Cortical is responsible for negative symptoms, mood. |
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What is the psychobiology of psychosis?
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↑Dopamine in basal ganglia
↓5-HT Greatest change in mesolimbic-mesocortcal tract |
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What is the psychobiology of depression?
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↓5-HT and ↓NE
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What is the psychobilogy of Bipolar dsorder?
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Interactions between NE, DA(dopamine), 5-HT, Acetylcholine(ACh), GABA, and Peptides.
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What is the psychobiology of Anxiety?
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↑5-HT and NE ↓GABA and peptides
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What is different about dosing SSRI's for anxiety?
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Use higher doses. i.e., fluoxetne for depression is 20 mg and for OCD is 80 mg.
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Neuroanatomy. Name the cerebrum's four lobes
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Frontal, occipital, parietal, temporal
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What is the frontal lobe responsible for?
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Voluntary motor activty (like typing), Speaking, elaboration of thought (I have to think about that one) and Executive functions (is that a bank executive and how she decides good loan risks?)
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What is the Occipital lobe responsible for?
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Processing visual input. Can you see it?
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Occipital - occular
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Parietal Lobes are responsible for what?
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Receiving and processing sensory input.
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Is the parietal lobe rough or smooth? Loud or soft? Red or green? Hot or cold?
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What are the temporal lobes involved in?
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Emotions, memory, cognition, speech and the limbic system. Limbic system has the amygdala (PTSD) and hippocampus (Memory). Also regulates behaviorial awareness, fear, social behavior, rage, sexual desire, appetite.
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Do you remember having a temper?
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What does the Thalmus do?
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It acts as a relay station for all synaptic input such as the CNS of lower extremity to brain and back.
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Do your toes hurt?
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What does the hypothalmus do?
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Homeostatic function: temp. control, thirst, hunger, urine output. It links nervous and endocrine system and ehlps regulate emotion and basic behavioral patters.
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Are you hypothermic? How do you feel about that?
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Pituitary gland does what?
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secretes hormones under the influence of the hypothalmus.
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it is the pits to work for the COLD hypothermic hypothalmus.
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What is the basal nuclei?
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coordinates slow, sustained movements. Supresses useless patterns of movement.
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Slow movements are so basic.
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Alcoholics who are drunk have problems with what part of their brain?
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Cerebellum. No balance
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If you worked in ICU you know the Brain stem controls
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Cardiovascular, respiatory and digestive control centers. reflexes involved in posture and equilibrium. It also receives input from spinal cord. It contains the sleep centers.
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We know the neurotransmitters related to psych, don't we? There are 6.
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NE, 5-HT, DA, GABA, Glutamate, ACh.
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DA controls ....
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thoughts and emotions in the frontal cortex, mesocortcal tract (attention, depression, focus)
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Dopamine in the nigra striatal controls....
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movement.
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muscles are striated.
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DA in the nucleus accumbens are part of the libic system. What do they do?
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control pleasurable feelings. AND increased DA levels in this area control psychosis.
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How can you make a person psychotic? Give too much L-dopa.
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DA in the Tuberinfundibular controls what?
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prolactin secretion. (Calcium, bone loss, sex.)
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What drug is the worst offender for increasing prolactin? Risperdal
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NE controls what?
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(Frontal cortex)attention, concentration, (limbic system) emotions and energy (Brainstem) BP
(Sympathetic neurons) bladder/urinary retention. |
Imipramine is a norepinephrine drug. Why is it given for enuresis and incontinence?
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5-HT is located in the....
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Raphe Nucleus
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5-HT controls what in the frontal lobe?
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mood and depression
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5-HT controls what in the basal ganglia?
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Movement and ocd.
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5-HT controls what in the limbic system? Remember the Limbic system is primative?
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Anxiety and panic.
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If the limbic is primative, what is our PRIMITIVE response to, say snakes!? Spiders? Mice? Boogey men? Pick your fear...
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5-HT controls what in the bran stem?
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sleep
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What does 5-HT do in the spinal cord?
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influences sexual response
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Why does fluoxetine cause sexual side effects?
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Tardive dyskensia is irreversible. What does make a difference when using antipsychotics?
|
Dose related.
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`
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What is the action of Atypical antipsychotics?
Remember the major classes of symptoms schizophrenia. |
Serotonin-dopamine antagonists
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Are you positive?
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Clozapine needs cbc's how often and what is it the best for?
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CBC: Weekly for 6 months
Q2weeks for 6 months Monthly thereafter. It is good for people who are suicidal and have thought disorders. |
1x6 2x6 4forever
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What are safe WBC and neutrophil counts for clozapine?
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WBC 3.5 or above and Neurtrophils above 2.8
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What contraindicates the use of ziprazidone?
|
Cardiac. It causes QT prolongation. Should get an EKG
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NMS is Neuroleptic malignant syndrome. There is a classic triad for the symptoms. What are they?
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Hot, Stiff, and Out of It.
Hyperthermal Rigid Confused |
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What lab abnormalities would you expect with NMS?
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Incr. WBC
Incr. CPK Incr. Myoglobin and 95% have iron deficiency |
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How long do you let a patient lay around with NMS?
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You don't want to know. The progression is rapid and they die.
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If NMS is going to happen, when is it likely to happen?
|
90% risk in first two weeks. Most risk is HIGH POTENTCY drugs like haldol.
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How long can NMS last?
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7-10 days or up to 65 days.
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What is the mortality percent of NMS?
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10-20%
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Name 3 complications of NMS.
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Rhabdomolysis, Renal Failure, DIC, Aspiration pheumonia, Pulmonary emboli, Cardiac arrest, Peripheral nerve and muscle damage.
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Permanent parkinsonism, ataxia, dementia are the morbid conditions.
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What is used to treat the rigidity of NMS?
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Bromocriptine and Dantrolene
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Side effects of SRI's and SSRI's include...
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Nervousness, insomnia, sedation (paroxetine) HA, Dry mouth, teeth clenching, sexual dysfnction, nausea and wt loss, weight gain over 6 mo, Serotonin syndrome, sweating or hyperhydrosis.
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What is the gold standard treatment for Bipolar disorder?
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Li
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How does Lithium work?
|
Don't know, but may affect NE and DA relase in central nerves.
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Who is Lithium good for
|
Mania and depression in bipolar disorder. More than 50% are refractory to it.
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What is the first sign of toxicity to Lithium?
|
Fine hand tremore. More: muscle weakness, tiredness, slurred speech, thirst, and later is N/V/D.
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Does the level of lithium matter when it comes to side effects?
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May be correlated with blood level. Most apparent about 1.2
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Can acute mania be treated with Li? What are some guidelines?
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Yes and it should be pushed up rapidly. Should monitor level twice a week.
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There are three drugs that should not be given with Lithium. What are they?
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Haldol and Ibuprofen and Calcium Channel Blockers. Use diuretics cautiously. May increase level.
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There are several short acting benzodiazepines. Name some.
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alprazolam, oxazepam, temazepam.
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Anxiety can be treated with non-benzodiazepines. Name some classes.
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Antihistamines like hydroxyzine, SSRI's, Beta-Blocker such as propanolol.
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There are two main side effects of stimulants. What are they?
|
Weight loss and insomnia.
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Drugs to treat Parkinson's disease are what type?
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Dopamine agonists
Acetylcholine antagonists (benzotropine, trihexyphenidyl (Artane), orphenadrine (Norflex). |
If sinemet is a dopamine agonist, then what can it cause? Psychosis.
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What Are the 4 main anticholinergic side effects?
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Dry mouth and urinary retention and dry skin and constipation.
Blurred vision Confusion, agitation Tachycardia (see hint) |
Mad as a hatter (confusion)
red as a beet (tachy) dry as a bone (urine-const,etc blind as a bat (blurred vision) |
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There is one major illness that is contraindicated with anticholinergics. Name it.
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Glaucoma, narrow angle glaucoma
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Stress
|
is bad. Stress diathesis. Defined as what somone PERCEIVES as a threat. So, we aren't all the same.
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When thinking about stress, what are the primary and secondary appraisals?
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primary is the individual makes a judgement based on their perception.
Secondary is to grasp how you can cope with this one. Assess your skills. How am I going to get out of this one? |
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Anxiety is not the same thing as fear.
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True
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How is anxiety manifested?
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Phys: autonomic arousal
Affective: Edginess to terror Behavioral: avoidance to COMPULSIONS Cognitive: Worry,OBSESSIONS |
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Is anxiety common?
|
one of the most common mental health issues in the US.
Women more than men. poor |
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Peplau described 4 levels of anxiety. What are they.
|
Mild, every day stuff
Moderate, some impairment Severe pathological; shutting down Panic. I think I'm gonna die. |
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Can you work up anxiety?
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Yes, but there are so many things you can't.
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Generalized Anxiety Disorder. How is it really diagnosed?
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By exclusion.
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What are some treatments (non-pharm) for phobias?
|
Desensitization: Gradual
Flooding (implosive): continuous presentation of the stimulus. Leave that to the professionals. Wait, we are, but not in that! |
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What are four somatoform disorders?
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pain, conversion, hypochondriasis, body dismorphic
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Compare psychogenic fugue with Dissociate disorder.
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Don't travel with dissoc, d/o but do with psychogenic fugue.
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Two major mood disorders are major depression and bipolar disorder. How does gender play in them?
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Depression women>men
Bioplar women=men |
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how long does a person have to have symptoms of depression before a diagnosis?
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2 weeks.
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How long does one have to have symptoms of depression to have dysthymia?
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2 years
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What is different about atypical depression?
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overeating and hypersomnia
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Other than season, what has to happen for Seasonal Affective Disorder to be diagnosed?
|
2 episodes in 2 years related to season.
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How long postpartum must one have depression, mania, or brief psychosis to call it post-partum?
|
Within 4 weeks postpartum.
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Bipolar disorder is pretty much the same in everyone. T or F
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False, it is heterogeneous, meaning it is different for everyone.
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What diagnosis has the highest rate of ATTEMPTED suicide? Think fast.
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Bipolar. 48% and 10-19% are successful.
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What gender correlates to Bipolar I and II?
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It is equal in Bipolar I and II has more women.
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There are three stages of a mania. What are they?
|
Stage I. hypomania
Stage II. Acute mania, requires hospitalization Stage III. Delirious mania. psychosis |
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If you use the Young Mania Rating Scale (YMRS), what is the cut off for mania.
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Anything above 20.
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If you use the HAM-D for depression, what is the cutoff number.
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17 and below
10 - 13 mild; 14-17 mild to moderate; >17 moderate to severe |
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For acute stabilization with Lithium, what are the target levels?
|
0.8 - 1.5
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What are the maintence levels for Lithium?
|
0.6 to 1.2
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Cyclothymia is uncommon. What are the gender characteristics?
|
3:2 female to male.
10-20% have BPD |
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Can you use atypicals during pregnancy?
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yes. Clozapine is BEST in category B.
Indian J Med Res 123, April 2006, pp 497-512 |
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Can you use Lithium and Anticonvulsants during pregnancy?
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Heck NO. NO lithium.
Indian J Med Res 123, April 2006, pp 497-512 |
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Can antidepressants be used during pregnancy?
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Tricyclics have few reports of problem.
Fluoxetine is the most studied with little problem. Bupropion is looking good. MAOI's should NOT be used. Indian J Med Res 123, April 2006, pp 497-512 |
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Can Benzo's be used during pregnancy?
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No clonazepam. Diazepam studies are pretty good. No Lorazepam. No alprazolam
Indian J Med Res 123, April 2006, pp 497-512 |
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What's the main point of treating mental illness during pregnancy?
|
See them often. High potency antipsychotics are best. Bipolar disorders are difficult. Believe it or not, lithium is the safest. Discontinue during first trimester. CAREFULLY monitor child bearing age women and counsel a lot on birth control and pregnancy choice.
Indian J Med Res 123, April 2006, pp 497-512 |
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How old do you have to be to be diagnosed as depressed and what is the early age of suicide?
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DX 5 years. Suicide 6 years.
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What is the incidence of young bipolar disorder?
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1% as early as 8 years.
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What is the percentage of prevalence of depression in the elderly?
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25-50%
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What is the hallmark symptom of anorexia nervosa?
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Weight loss
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Regarding the ego, what is the difference between Anorexia and Bulimia?
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Anorexia is a "source of self esteem"
Bulimia only enhances self esteem. |
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Does an anorectic female who is post-menarche have to have amenorrhea to have the diagnosis of Anorexia?
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Yes. 3 consecutive cycles.
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Do Bulimics have to be thin?
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NO
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A diagnosis of schizophrenia must have 2 of what 5 criteria and for how long?
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Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior Negative symptoms (affective flattening, alogia, or avolution).
Must have continous disturbance for at least 6 months with at least one month of symptoms (less if treated). |
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What percent of the mental health care budget is spent on schizophrenia?
READ the question! |
75%
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What percent of the total US health care budget goes to directly treating schizophrenia?
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2.5%
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Schiz has these symptom categories:
1. + 1. - and about half of both. |
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There are 5 phases of schizophrenia. What are they?
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Premorbid, prodomal, acute, stable or residual.
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There are 5 TYPES of schizophrenia. What are they?
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Paranoid, disorganized, catatonic, undifferentiated, residual (Serious and Persistent Mental Illness).
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What labs and other tests would you order to assess schizophrenia for the first time?
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CBC with Diff, Sed rate, BUN/Creat, Glucose, Thyroid, liver and Kidney function (TSH, T3, T4, AST, AGT, Electrolytes, Urine osmolarity, Screen for syphillis, HIV, and HepC, comprehensive drug screen, EKG).
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We are familiar with the medical model of treating schizophrenia. What are some social treatment?
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Case mgt with LOW case loads (1-10), Clubhouse programs, and more.
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Serious and Persistent Mental Illness (SPMI) is composed of 4 different illnesses. What percentage of each category?
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Schiz 90%
Unipolar Depression 20-30% Bipolar depression 40-50% Dementia 100% |
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What are the goals of treatment for SPMI?
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long term therapeutic alliance, adherence to treatment, redused symptoms and relapse, fewer and shorter hospitalizations, better satisfaction with life,
Less subjective distress, improved self care, inproved relationships and increased social functioning, good use and access to community services, better quality of life for pt and family, employment and/or meaningful work. |
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Are you familiar with the Moller-Murphy Symptom Management Assessment Tool II?
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It assists in symptoms and trigger identification and management for SPMI.
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There are two specific models of treatment for schizophrenia we should know.
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Clubhouse model, Fairweather Lodge Model. Both are consumer run. One difference is Fairweather Lodge Model opens and operates a small business.
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What criteria separates delirium and dementia? There are 3
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Delirium: Rapid onset, reversible, fluctuating.
Dementia: slow onset, irrefersible, and ongoing. |
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What is the underlying cause of delirium?
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A usually treatable medical condition.
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The decline of Alzheimer's and Vascular dementia are different. How?
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Alzheimer's is steady and vascular stair steps down.
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The hallmark symptom of AIDS dementia is...
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motor changes
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Some facts about AIDS Demetia Complex.
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subcortical, not due to direct efects of HIV, CD4 count is less than 200,, 4-15% of patients it is the presenting symptom, Signs and symptom triad: cognitive, motor and behavioral.
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Is AIDS dementia complex reversible?
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yes in 5-20% of cases if the cause is treated.
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When treating depression in patients who have dementia, the best type of SSRI is what?
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short half-life. NOT fluoxetine, venlafaxine or bupropion.
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What do SSRI's and Na have to do with each other?
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SSRI's can cause SIADH.
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What stage of dementia are these symptoms? Memory Gone, aphasia, can't name ojects, needs supervision, denial/violence, cannot express thoughts.
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Stage 3 of 4
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What stage of dementia is this? Forgetful, can't find workds. some perceptive difficulties, cannot manage activities, anxiety/anter, paranoia, delusions.
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Stage 2 of 4
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What are some impulse control disorders?
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Intermittent explosive Disorder, Kleptomania, Pyromania, pathological gambling, trichotillomania.
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What is the timeline for an adjustment disorder?
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Less than six months past the stressor.
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What is the nurse practitioner's major difference from physicians or PA's?
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We focus on health promotion and disease prevention more.
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Who set up the first NP program?
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Dr. Loretta Ford
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What type of NP was the first one?
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Pediatric
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Where was the first NP program?
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University of Colorado
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Where is the treatment emphasized for a NP? What setting?
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Ambulatory and outpatient care.
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When was the role of the NP first developed?
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1960
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Loretta Ford retired "five" years ago. (just a hint, not the truth.)
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There are three major types of research. What are they?
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Nonexperimental (descriptive), experimental (manipulation of variables), Qualitative (case studies, open ended questions)
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What is quasi-experimental research?
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It involves manipulation of variables, but lacks a comparison group or randomization. There are NO comparisons.
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Which of these is the best P-value?
A. 0.5 B. 0.1 C. 0.05 D. 0.08 |
C. O.05
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What is the confidence interval?
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An interval with limits at either end with a specified probability of including the parameter being estimated.
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What is the Standard Deviation
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It measures the spread or disppersion of a set of data.
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What is the level of significance?
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It is the probability of a false rejection of the null hyphtesis in a statistical test.
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What are the values of a perfect correlation?
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-1 to +1
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What is a p-value?
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The statistical significance. It represents the probablility of error involved in accepting our observed result as valid, that is, as "representative of the population."
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What is a t-test?
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The calculated mean and standard deviation may be chance deviate from the real mean and standard deviation.
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What is test-retest reliability?
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Index of variable consistency. It means the tool is a good one.
It is the difference between a pair of pliars bought at Sears (crafstman) and one you paid 59 cents for a the "Throwaway Discount store." |
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What does validity mean when talking about research?
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The degree to which a variable measures what it is intended to measure. In other words, is this the best tool for the job? Do you need a phillips or a flat head screwdriver?
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A p-value of 0.1 usually means what?
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It looks at trends, but not good facts.
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Where do you get your guidelines to practice?
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Your state Nurse Practice Acts.
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About what percentage of states does a NP not need physician collaboration or supervison, and the board of nursing has the authority to oversee scope of practice.
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50% (approxmiately.)
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Why are we taking this certification board?
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It shows mastery of specialized knowledge and skills.
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Is the certification board a governmental controlled agency?
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NO
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Who said it was OK for NPs to have admitting priveleges to hospitals?
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JCAHO in 1983, but physicians and hospitals can keep us out!
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Quality assurance looks at what?
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EVALUATING the care using established standards of care.
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Quality Improvement looks at what?
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Continuous review and improvement.
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Who developed the methodology for quality control?
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Deming and it was tested in Japanese industry.
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What MUST be present for there to be malpractice?
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HARM and a PROFESSIONAL
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Negligence means
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failure of an individual (any individual) to do what any reasonable person would do that results in injury to the patient. I.e., not returning phone calls.
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Assault and Batter are two different things. Do you know why?
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Assault means to place someone in imminent FEAR of illegal, willful, angry violent, or negligent attack to himself, his clothes or antying with which he is in contact.
You have to touch someone for there to be battery. You can batter someone who is unconscious but you can't assault them. |
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What is defamation?
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Any communication that caues someone to suffer a damanged reputation. Libel (defaming, distributed written material) and Slander - spoken defamation(spoken to other than the defamed party).
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When is it legal to restrain someone?
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To prevent harm to self or others, though a psychitric professional may be liable if excessive restaints are employed.
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The Good Samaritan Statue does what?
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Protects health care providers from law suits who aid at the scene of an accident and render reasonable, emergency care.
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How does "duty to warn" effect confidentiality?
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Duty to wrn supersedes confidentiality.
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What is an invasion of privacy?
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Damaging one's reputation as a result of information being shared without the patient's permission. BUT, it can't be made if it is shown to have been accurate, given in good faith, and the receiver had a valid reason for getting the information.
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What MUST be reported?
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Injury from a dangerous weapon. Criminal acts. Some diseases, animal bites. domestic violence/child abue.
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There are two goals of Health People 2010. What are they?
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Increae the quality and years of healthy life.
Eliminate health disparities among Americans. |
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The "Clinician's Handbook of Preventive Service: Put prevention Into Practice" was publised when and by who?
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1996 by the ANA
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The Guide to clinical Preventive Services was published when and by who?
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1989 by the US Preventive Services Task Force.
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"Nursing's agenda for health care reform" was published when and by who?
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ANA 1991 Proposes shift from illness and cure to prenention.
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Consider the plusses of a nurse practitioner. Education and ________.
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Define Nonmaleficense
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Duty to do no harm.
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Define Utilitarianism
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The right act is the one that procused the greatest good for the greatest number. (Take the people crawling away from the burning plane first.)
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Define Beneficense
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Duty to PREVENT harm and to promote good. (Mother Theresa)
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Define the ethical principle of justice.
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Duty to be fair.
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What is fidelity?
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Duty to be faithful.
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What is veracity?
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Duty to be truthful.
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What is autonomy
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Duty to respect an individual's thoughts and actions. This is broken with the 72 hour hold, but relies on the principle of beneficense (to prevent harm and promote good.)
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Does a patient have the right to refuse care? Says who?
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yes, Danforth amendment 1991. All patients must be adivisd at the time of their admission to a federally funded institution.
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Go FORTH and be sick no more, Dan.
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What axis is disturbed during stress, and what is the result?
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HPA axis
CRH increse leads to excess cortisol which can deplete the adrenal system over time |
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Compare schizoid with schizotypal
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Schizoid-withdrawn, no desire for relationships
Shizotypal-magical, delusional 10% suicidal |
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What defense mechanisms do borderlines use?
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Splitting, projective identity
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Compare avoidant with schizoid
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Avoidant-nervous, needs approval, seeks relationships
Schizoid-withdrawn, no desire for relationships |
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What is PEERAMID?
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a neurodevelopmental exam for ages 9-14
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Four diagnosic features of Rett's
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Cease to achieve milestones
By age 1 CNS irritability decrease in skills for age |
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Treatment of ADHD behavior
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Reward the positive
Consequence for the negative |
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The five S's of Maslows hierarchy
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Survive
Safety Sex (love) Self-Esteem Self-Actualization |
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Beck Triangle
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Me Bad
All Bad No Hope |
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Joint Commision on Mental Health
1961 declared... |
Crisis intervention treatment with 24 hr hospitalization followed by therapy
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Licensure means...
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You are qualified by the state board of nursing to practice
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Credentialing means...
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Minimal level established necessary to practice
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Certification means...
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Mastery of a specialty
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Steps of CQI/QA (JCAHO 1983)
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Planning
Delineate scope of care Critical path-key pt. care activities Care Map-Blueprint for planning |
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Bowen had genograms, what did Minuchin have?
Bowen had fusion and cut-offs, what did Minuchin have? |
Mapping
Enmeshed and disengaged |
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Match theorist to model
Neuman Self-Care Roy Humans Rogers Stress Parse Systems Orem Caring Lazarus Unitary Watson Adaptation |
Neuman Systems
Roy Adaptation Rogers Unitary Parse Humans Orem Self-Care Lazarus Stress Watson Caring |
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Serotonin Syndrome
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Altered mental state
Diaphoresis Diarrhea Fever Hyperreflexia Rigidity Tremors Tachycardia |
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Tx of Serotonin Syndrome
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DC meds
supportive measures Benzo for relaxation BB for tachycardia |
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EPS symptoms and cause
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Cause-typicals, some atypicals (Risperdal > 8mg
Dystonia, Pseudoparkinsonism Akathisia, Postural changes TD Can lead to NMS |
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Tx of EPS
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Cogentin
Benadryl |
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ETOH withdrawal sxs
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Anxiety
Agitation Tactile hallucinations Tremor |
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Opioids withdrawal sxs
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Influenza like
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Amphet/Cocaine withdrawal sxs
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Change in pupils
Dysphoria leading to MDD |
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Benzo withdrawal sxs
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Drowsy, slurred, unsteady, feeling 'good'
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Psychiatric use of anti-convulsants ?
SE's |
Anxiety, aggression, ADHD Bx., Mania-potentiates GABA
Lamictal-rash |
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Schizophrenia sxs
Premorbid stage |
delayed milestones
decreased academic performance decreased concentration withdrawal |
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Schizophrenia sxs
Prodromal stage |
peculiar, odd speech & ideas
inappropriate bxs. suspicious |
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Schizophrenia sxs
Acute/Psychotic stage |
delusions
hallucinations disorganized thinking disorganized behavior change in affect and attention |
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Which dementia involves acting out and dishinibition, impatience?
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Picks
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Which dementia involves abrupt neurological sxs and a stair step decline?
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Vascular
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Which dementia has memory loss as it's first sxs, with a gradual decline?
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Alzheimers
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Which dementia has a change in personality, seizures and myoclonic mvmt?
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Creuzfeldt-Jacob
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Which dementia has sxs of severe hallucinations and a tendancy to fall due to EPS?
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Lewy Body
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Which dementia displays choreiform mvmt., slow behavior, and personality changes?
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Huntington's
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What is the BEERS study?
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Research study to ascertain which Rx to avoid with the elderly due to increased SE's and toxicity-identified 18 medications
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