Which patient is at highest risk for SI<\/p>\n\n\n\n
A. 30y\/o married AA female with previous SI attempt *1 risk factor<\/p>\n\n\n\n
B. 35 y\/o single Asian male with previous SI attempt *3 risk factors<\/p>\n\n\n\n
C. 38 y\/o single AA male who is a manager of a bank *2 risk factors<\/p>\n\n\n\n
D. 68 y\/o single white male with depression *5 risk factors (age, male, white, depression)<\/p>\n\n\n\n
D. 68 y\/o single white male with depression *5 risk factors (age, male, white, depression)<\/p>\n\n\n\n
Count the risk factors<\/p>\n\n\n\n
When interview teenagers (16 y\/o) that arrive with their parents what should you do?
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child.<\/p>\n\n\n\n
Which Ethnic group has the highest rate of suicide?
Native Americans<\/p>\n\n\n\n
Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d\/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome
D. Metabolic Syndrome (UMBRELLA ANSWER)<\/p>\n\n\n\n
Which antipsychotics have the least weight gain?
Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY<\/p>\n\n\n\n
Which mood stabilizer have the least weight gain?
Lamictal
-But remember all mood stabilizers cause some weight gain<\/p>\n\n\n\n
When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a
atypical<\/p>\n\n\n\n
A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?<\/p>\n\n\n\n
A. Thalamus<\/p>\n\n\n\n
B. Hypothalamus<\/p>\n\n\n\n
C. Limbic System<\/p>\n\n\n\n
D. Hippocampus<\/p>\n\n\n\n
Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out<\/p>\n\n\n\n
When a patient is hesitant to participate in treatment you should encourage?
Bring a support person like a husband<\/p>\n\n\n\n
Thyroid-Stimulating hormone normal level
0.5-5.0 Mu\/L<\/p>\n\n\n\n
When T4 and T3 are high and TSH is low what is the diagnosis
HYPERTHYROIDISM, TSH secretion decreases: TSH LOW \u00e0 key symptoms HEAT INTOLERANCE<\/p>\n\n\n\n
Key symptoms of Heat Intolerance
Hyperthyroidism<\/p>\n\n\n\n
When T4 and T3 are Low and TSH is high what is the diagnosis
(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH \u00e0 COLD INTERANCE<\/p>\n\n\n\n
Key symptoms of Cold Intolerance
Hypothyroidism<\/p>\n\n\n\n
Hyperthyroid can mimic
Mania<\/p>\n\n\n\n
Hypothyroid can mimic
Depression<\/p>\n\n\n\n
A patient on depakote complains of RUQ pain and has reddish\/brown urine
Hepatoxicity
-Check LFTs<\/p>\n\n\n\n
Signs of Depakote toxicity
Disorientation, confusion, lethargy<\/p>\n\n\n\n
You suspect depakote toxicity what do you do?
Check
-LFT
-Ammonia
-Depakote Level<\/p>\n\n\n\n
What herbal supplement can cause hepatoxicity?
Kava Kava<\/p>\n\n\n\n
When taking Kava Kava in combinations with other medications you should caution about
Risk of Hepatoxicity and Sedation<\/p>\n\n\n\n
TCAs carry a risk of
Hepatotoxicity<\/p>\n\n\n\n
Signs of Stevens-Johnson Syndrome
-fever, mouth pain, swelling, burning eyes, blisters, skin pain<\/p>\n\n\n\n
two psychotropics known to cause steven johnson syndrome
lamictal and tegretol<\/p>\n\n\n\n
What nationality is most suseptible of getting steven johnson?
Asians<\/p>\n\n\n\n
When treating asians with tegretal screen for?
HLAB-1502 Allele<\/p>\n\n\n\n
What two medications cause agranulocytosis?
Clozaril & Tegretal<\/p>\n\n\n\n
Agranulocytosis when to discontinue medication
Less than 1000<\/p>\n\n\n\n
When monitoring for agranulocytosis in patients look for s\/s of what?
Infection
-Fever, sore throat, fatigue, chills<\/p>\n\n\n\n
Before starting any mood stabilizer in a female of childbearing age be sure to check?
HCG<\/p>\n\n\n\n
Which two medications may decrease the risk of suicide?
clozaril and lithium<\/p>\n\n\n\n
Medications that increase lithium level
NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril<\/p>\n\n\n\n
Ace inhibitors are treatment of choice for?
Heart Failure<\/p>\n\n\n\n
Certain medications are known to increase lithium level, but HOW?
by reducing renal clearance<\/p>\n\n\n\n
When educating a patient about lithium teach them about
Hyponatremia
Dehydration-hot days, exercise<\/p>\n\n\n\n
Normal Lithium Level
0.6-1.2<\/p>\n\n\n\n
Lithium Toxicity
1.5 or above
Discontinue and re-order lithium level<\/p>\n\n\n\n
Lithium level of 1.4
Monitor for toxicity<\/p>\n\n\n\n
Labs before starting lithium
TSH, BUN, CREATININE, HCG, U\/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)\u00e04+ protein in urine=MONITOR FOR TOXICITY<\/p>\n\n\n\n
4+ protein in the urine of a patient on lithium
4+ protein is concerning for renal impairment<\/p>\n\n\n\n
4+ protein in urine=MONITOR FOR TOXICITY<\/p>\n\n\n\n
Lithium side effects
hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)<\/p>\n\n\n\n
-Some of these are also signs of toxicity<\/p>\n\n\n\n
Signs of lithium toxicity
confusion, ataxia, GI upset, palpitation, tremor<\/p>\n\n\n\n
NMS
muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction)<\/p>\n\n\n\n
Cherry colored urine in a patient that exercises a lot
test for myoglobinuria may be a sign of rhabdo<\/p>\n\n\n\n
Serotonin Syndrome
With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).<\/p>\n\n\n\n
Treatment for NMS
Stop Offending Medication<\/p>\n\n\n\n
-Dantrolene (muscle relaxer)<\/p>\n\n\n\n
-Bromocriptine (Dopamine D2 agonist).<\/p>\n\n\n\n
*In question focus on what they are asking for\u2026.dopamine agonist vs muscle relaxer<\/p>\n\n\n\n
Treatment for Serotonin Syndrome
Stop Med (1 or more SSRI, SSNRI, TCA, MOAI)<\/p>\n\n\n\n
-Cyproheptadine<\/p>\n\n\n\n
Triptans
Used for MIGRAINES<\/p>\n\n\n\n
-These meds increase serotonin<\/p>\n\n\n\n
example SUMATRIPTAN<\/p>\n\n\n\n
patient taking Prozac and started on sumatriptan<\/p>\n\n\n\n
-call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP<\/p>\n\n\n\n
How long do you wait when switching between an SSRI to an MAOI?
2 weeks<\/p>\n\n\n\n
How long do you wait when switching between Prozac and MAOI?
5-6 weeks wash out period<\/p>\n\n\n\n
What is the first line treatment for depression and why?
SSRI-First line treatment for depression due to less risk of injury from OVERDOSE<\/p>\n\n\n\n
If a cancer patient has depression what should you consider?
Treating with a medication with minimal drug\/drug side effects like Lexapro<\/p>\n\n\n\n
Patient with depression worries about sexual dysfunction what would be the medication of choice?
Wellbutrin<\/p>\n\n\n\n
Primary symptoms of depression include fatigue and low energy what med would you chose?
Wellbutrin<\/p>\n\n\n\n
Wellbutrin is contraindicated in patients with
Seizures and anorexia<\/p>\n\n\n\n
Which medications are best for neuropathic pain?
SNRI
Gabapentin
TCA<\/p>\n\n\n\n
Secondary to the black box warning providers caring for patients on antidepressants should assess for?
Suicidality, frequency, and severity at EVERY appointment<\/p>\n\n\n\n
Which meds have the worse serotonin discontinuation syndrome
Those with short half lives
such as zoloft<\/p>\n\n\n\n
Symptoms of serotonin withdrawal syndrome
Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET<\/p>\n\n\n\n
Shits and Shivers<\/p>\n\n\n\n
Ages of onset for schizophrenia in males vs females
-MALES 18-25 years<\/p>\n\n\n\n
-FEMALE 25-35 years<\/p>\n\n\n\n
Schizophrenia increases the risk for
SUICIDE<\/p>\n\n\n\n
HIGH RISK OF SI in SCHIZOPHRENIA<\/em><\/p>\n\n\n\n Just having schizophrenia increases your risk of suicide.<\/p>\n\n\n\n MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)<\/p>\n\n\n\n What increases the causes or increases the risk or schizophrenia -inadequate synapse formation,<\/p>\n\n\n\n -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation,<\/p>\n\n\n\n -first order relative (mom\/dad)<\/p>\n\n\n\n MRI or PET scan what is seen in schizophrenia -You will see VENTRICULAR ENLARGEMENT<\/p>\n\n\n\n Stimulants can potentiate the release of what neurotransmitter? Assertive Community Treatment (ACT) What level of prevention is ACT? What adjunctive treatment is important in schizophrenia Exercise for mental health patients can promote ACT is ideal for patients with a history of -Think about making the treatment convenient for them–>bringing it to their home<\/p>\n\n\n\n What diagnosis has the highest risk of Homicidality In the MMSE how do you test for abstraction? Thought Process-Tangential Circumstantial Mental Status-Thought Content includes Another name for MMSE How to assess concentration on MMSE Assess ability to learn new material Assess ability to recall Assess fund of knowledge What is a quick and easy way to assess for neurological issues If patient is unable to draw a clock this indicates mesolimbic pathway -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms<\/p>\n\n\n\n mesocortical pathway Nigrostriatal Pathway -Dopamine blockade in this pathway can lead to increase acetylcholine levels<\/p>\n\n\n\n -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia<\/p>\n\n\n\n Low Dopamine in the nigrostriatal pathway increases which neurotransmitter Long-standing D2 blockade in the nigrostriatal pathway can lead to<\/p>\n\n\n\n tardrive dyskinesia<\/p>\n\n\n\n Tuberoinfundibular pathway -DECREASE DOPAMINE INCREASED PROLACTIN<\/p>\n\n\n\n Long-term hyperprolactinemia can be associated with what condition<\/p>\n\n\n\n osteoporosis<\/p>\n\n\n\n Normal Prolactin Level in Men Normal Prolactin Level in Women Which medication is the highest offender for increasing prolactin Acute Dystonia + Treatment -Treatment is IM COGENTIN + continue PO COGENTIN for several days<\/p>\n\n\n\n Akathisia + Treatment -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal)<\/p>\n\n\n\n -Second line treatment is COGENTIN<\/p>\n\n\n\n -Third line treatment is benzos<\/p>\n\n\n\n Beta-Blockers such as Inderal are contraindicated with what type of asthma medication akinesia\/bradykinesia + treatment PSEUDOPARKINSON or PARKINSONIAN + Treatment -Treatment COGENTIN<\/p>\n\n\n\n tardive dyskinesia + Treatment -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT<\/p>\n\n\n\n Does Cogentin Treat TD Typical onset of TD What non-psych med can cause TD? InDucers CYP450<\/p>\n\n\n\n DECREASE<\/p>\n\n\n\n Carbamazepine<\/p>\n\n\n\n Rifampin<\/p>\n\n\n\n Alcoholics (chronic)<\/p>\n\n\n\n Phenytoin<\/p>\n\n\n\n Grisiofulvin<\/p>\n\n\n\n Phenobarb<\/p>\n\n\n\n Sulphonylureas<\/p>\n\n\n\n Crap GPS Induces me to Madness!<\/p>\n\n\n\n InhIbitors of CYP450<\/p>\n\n\n\n INCREASE<\/p>\n\n\n\n Ciprofloxacin Acute Etoh Crack Amigos<\/p>\n\n\n\n Erythromycin and Clarithromycin can cause Patient started on Clozaril or Zyprexa and two months later starts smoking<\/p>\n\n\n\n as a provider you know that the smoking can decrease the medication effectiveness<\/p>\n\n\n\n -Increase medication dose<\/p>\n\n\n\n Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey Medications that cause mania -If a patient must take steroids, the provider should increase the mood stabilizer<\/p>\n\n\n\n Medications that cause depression -may need to increase antidepressant<\/p>\n\n\n\n Accutane (isotretinoin) Flonase Increase mood stabilizer to maintain stability, steroids can also trigger depression<\/p>\n\n\n\n Flonase can trigger mood instability but it can also cause an increase in patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis<\/p>\n\n\n\n -increase the dose of antipsychotic<\/p>\n\n\n\n Neurotransmitters involved in Addiction Symptoms of Stimulant Abuse<\/p>\n\n\n\n If an anorexic patient complains of pain or bloating after eating this may indicate Medications that delay gastric emptying Proton Pump Inhibitors (omeprazole & Protonix) -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI<\/p>\n\n\n\n When initiating an SSRI on an elderly patient you should advise about Paradoxical effect Apoptosis At age 45 and above the patient displays mania for first time what should be ruled out<\/p>\n\n\n\n MEDICAL CONDITION<\/p>\n\n\n\n Patient with bipolar disorder presents with depressed mood & emotional lability<\/p>\n\n\n\n Give Depakote<\/p>\n\n\n\n Hallmark sx of Borderline Personality Treatment for Borderline Personality Creator of DBT What activity is helpful in making a diagnosis of borderline personality Conversion Disorder Adjustment Disorder -Symptoms occur within 3 months of the stressor<\/p>\n\n\n\n If question states recently moved, recent death\u2026.THINK ADJUSTMENT<\/p>\n\n\n\n factitious disorder -Faking illness but NO MOTIVE BEHIND IT<\/p>\n\n\n\n Malingering Reactive Attachment -Withdrawn and shows no emotion towards caregiver<\/p>\n\n\n\n ODD -Family Therapy is mainstay<\/p>\n\n\n\n -Child management \/Parent management skills is the focus in therapy<\/p>\n\n\n\n -Positive reinforcement<\/p>\n\n\n\n -Boundary Setting<\/p>\n\n\n\n Conduct Disorder -May need meds and therapy<\/p>\n\n\n\n -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists\/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine)<\/p>\n\n\n\n -Monitor BP with guanfacine and clonidine<\/p>\n\n\n\n Acute Stress Disorder -heightened arousal, nightmares, flashbacks<\/p>\n\n\n\n -LESS THAN ONE MONTH<\/p>\n\n\n\n PTSD -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance<\/p>\n\n\n\n -May also have NIGHTMARES\u00e0 GIVE PRAZOSIN<\/p>\n\n\n\n -Non-pharm tx of PTSD- EMDR, CBT<\/p>\n\n\n\n Panic attack vs Panic disorder (treatment) Panic Attack is ACUTE Feels like impending doom<\/p>\n\n\n\n Tourette’s Syndrome -TWO moto tics and ONE vocal tics<\/p>\n\n\n\n -LASTS more than ONE YEAR<\/p>\n\n\n\n -By age 18<\/p>\n\n\n\n CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL<\/strong><\/p>\n\n\n\n Child presents with one tic and the parent is worried Neurotransmitters involved in Tourettes Treatment for tourettes What type of medication can cause tics or exacerbate them Neurotransmitters involved in mood disorders Neurotransmitters involved in ADHD part of brain implicated in ADHD ADHD inattentive type is caused in what part of the brain dorsolateral prefrontal cortex Deficit in the _<\/strong> can lead to ADHD inattentive type Teacher reports that the stimulant only works for first few hours of class<\/p>\n\n\n\n medication has worn off too fast. Order multiple dosing throughout the day<\/p>\n\n\n\n When does the aftercare plan start If parents become anxious while you are educating about a new diagnosis what should you do -Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy<\/p>\n\n\n\n Neurotransmitters involved in OCD A tic may also be a _<\/em> Facts about OCD -A tic may be a compulsion<\/p>\n\n\n\n -If first order relative has OCD the child\u2019s risk of developing OCD is increased<\/p>\n\n\n\n -Streptococcal infections increase risk of OCD<\/p>\n\n\n\n -Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine<\/p>\n\n\n\n If question asks if the patient has Tourette\u2019s vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD<\/p>\n\n\n\n DMDD -Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad<\/p>\n\n\n\n If patient presents with irritability or labile mood and you need help further delineating symptoms Sleep Disorders are often _<\/strong> ask if someone in the family has a similar issue with sleep\u2026look for family patterns of sleep problems<\/p>\n\n\n\n GAD Delirium inattention<\/p>\n\n\n\n -Urinary Tract Infections are common cause for DELIRIUM always check UA<\/p>\n\n\n\n -Treatment is antipsychotics like HALDOL<\/p>\n\n\n\n Dementia -Mental decline in cognition, irritability, personality changes<\/p>\n\n\n\n -When asked questions they may try to answer or MAKE UP ANSWERS (confabulate)<\/p>\n\n\n\n Low levels of what labs may mimic dementia Cortical Dementia Subcortical Dementia HIV Dementia is a type of subcortical dementia<\/p>\n\n\n\n Early signs of HIV dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait<\/p>\n\n\n\n Treatment for HIV dementia Pseudo Dementia -Also assess onset of symptoms, pseudo dementia is more acute onset<\/p>\n\n\n\n -When asked questions they often say \u201cI DON\u2019T KNOW\u201d<\/p>\n\n\n\n Instruments to use to differentiate between dementia and pseudo dementia -Older individuals with depression may present with irritability and agitation<\/p>\n\n\n\n If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present<\/p>\n\n\n\n hallmark of lewy body dementia Frontotemporal lobe Dementia -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes<\/p>\n\n\n\n -May see slurred speech or difficulty getting words out<\/p>\n\n\n\n What lobe is associated with ability to understand what others are saying (comprehending speech) Neurotransmitters involved in Autism Autism When play they often like to line up their toys, stack them in tidy rows<\/p>\n\n\n\n Broken Mirror Theory of Autism Risk Factors for Autism Screening tools for Autism Where is Norepinephrine produced? Where is serotonin produced? Where is dopamine produced? Where is acetylcholine synthesized? Hippocampus Limbic System Amygdala function Thalamus function hypothalamus function anterior cingulate cortex Cerebellum signs of lead toxicity Hint home built before 1970\u2019s<\/p>\n\n\n\n TEST FOR LEAD<\/p>\n\n\n\n When caring for an infant that is about to die? Risk factors for osteoporosis Provide Education<\/p>\n\n\n\n If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAY INVOLVED IN THE CARE<\/p>\n\n\n\n Assume you are doing group therapy and there is a patient that is not comfortable sharing but you are trying to promote interpersonal learning. What should you do?<\/p>\n\n\n\n Provide adjunctive individual session that will help facilitate group participation<\/p>\n\n\n\n Cognitive Therapy Replacing irrational or distortive thoughts with positive thoughts<\/p>\n\n\n\n Behavioral Therapy Humanistic Therapy Existential Therapy Why am I here, What is my purpose<\/p>\n\n\n\n Interpersonal Therapy –Used for people who have trouble interacting with others, relationship distress<\/p>\n\n\n\n -Marital conflict<\/p>\n\n\n\n -12-16 weeks (3-4 months)<\/p>\n\n\n\n EMDR Phases Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement<\/p>\n\n\n\n Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within<\/p>\n\n\n\n Group therapy: Installation of hope Group therapy: Universality Group Therapy: Altruism Group Therapy: Imitative Behavior Group Therapy: Interpersonal learning Group Therapy: Group Cohesiveness Group Therapy: Catharsis Group Therapy: Existential Factors Group Therapy: Corrective Refocusing Group Phases Family Systems Therapy -a person’s problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Self-Differentiation, Triangulation,<\/p>\n\n\n\n Triangles<\/p>\n\n\n\n Structural Family Therapy -How, when, and who whom family members relate<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Mapping<\/p>\n\n\n\n Hierarchies<\/p>\n\n\n\n Boundaries<\/p>\n\n\n\n Strategic Therapy -Symptoms are a way to communicate metaphorically in a family<\/p>\n\n\n\n -Symptom focused<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Straightforward directive<\/p>\n\n\n\n Paradoxical directive (reverse psychology)<\/p>\n\n\n\n Reframing (you are not jealous of your sister you just care for her so much)<\/p>\n\n\n\n Solution Focused Therapy -EXCEPTION-BASED FINDING -SCALING QUESTIONS<\/p>\n\n\n\n Meditation If patient tells you something BEFORE you ASSESS- EXPRESS EMPATHY \u201cI\u2019m sorry this happened to you.\u201d<\/p>\n\n\n\n USE OPEN ENDED QUESTIONS unless talking to a child or someone that is unable to construct a narrative then use CLOSED ENDED or YES\/NO<\/p>\n\n\n\n PICOT If a patient has rheumatoid arthritis check Therapy session with husband and wife & only one shows up<\/p>\n\n\n\n Reschedule<\/p>\n\n\n\n A patient\u2019s mother calls and tells you that her son has been sodomized by their 15 year old brother<\/p>\n\n\n\n tell mother DO NOT LEAVE THE CHILD ALONE WITH THE BROTHER<\/p>\n\n\n\n -Provider calls CPS<\/p>\n\n\n\n -Arrange crisis therapy for family<\/p>\n\n\n\n Patient is moving out of state<\/p>\n\n\n\n if there is no imminent danger then provide enough medication for them to establish a new provider<\/p>\n\n\n\n Level 1 evidence Level 2 Evidence Shrill Cry Child between the ages of 3-6 masterbating Mom is concerned that her son age 10 has swelling in his chest and she is concerned he is developing breasts *reassure them that this is normal<\/p>\n\n\n\n Elderly female presents with decreased sex drive Sex Hormone-Testosterone is involved in sex drive<\/p>\n\n\n\n -MUST KNOW THAT WOMAN have TESTOSTERONE TOO<\/p>\n\n\n\n alcohol dehydrogenase -WOMAN HAVE LOWER ALCOHOL DEHYDROGENASE (metabolizes alcohol)<\/p>\n\n\n\n -This is why woman get drunk faster<\/p>\n\n\n\n -Lower levels of this enzyme may also cause a higher propensity to develop LIVER DISEASE<\/p>\n\n\n\n When OB wants to hire psych providers<\/p>\n\n\n\n they want to increase mental health access to those that need it the most<\/p>\n\n\n\n Normalizing grief and loss in children<\/p>\n\n\n\n Don\u2019t tell them what to do because grief responses vary<\/p>\n\n\n\n -i.e Don\u2019t tell them to stop working that is prescriptive advise<\/p>\n\n\n\n -With children the most important thing is to reinforce FAMILY support an supportive therapy such as group therapy so they can learn from other children who have experienced similar events<\/p>\n\n\n\n palmar grasp reflex Moro (startle) reflex Babinski reflex PDE-5 inhibitors Vardenafil (Levitra)<\/p>\n\n\n\n Tadalafil (Cialis)<\/p>\n\n\n\n RAPIDLY ABSORBED<\/p>\n\n\n\n Used for erectile disfunction<\/p>\n\n\n\n Difference between BMI in anorexia vs Bulemia Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse<\/p>\n\n\n\n Contact CPS<\/p>\n\n\n\n You read and article that says that most children with ADHD abuse substances\u2026<\/p>\n\n\n\n -To translate this information into practice what should you do?<\/p>\n\n\n\n -Screen ALL children for ADHD for SUBSTANCE USE<\/p>\n\n\n\n -OR Screen ALL children with SUBSTANCE USE for ADHD<\/p>\n\n\n\n accupuncture Habeas Corpus<\/p>\n\n\n\n legal concept that protects patients from unlawful hospitalization<\/p>\n\n\n\n -May be a reason to leave AMA<\/p>\n\n\n\n Disseminated Encephalomyelitis<\/p>\n\n\n\n inflammation of nervous system<\/p>\n\n\n\n -MUST DO NEURO EXAM<\/p>\n\n\n\n -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS<\/p>\n\n\n\n Assume you are interviewing a patient and you want them to provide information in a specific timeline, but they are unable<\/p>\n\n\n\n TO help ask them specific questions which helps to ANCHOR their memory<\/p>\n\n\n\n Before you administer a medication, you must educate them about the medication but first you should assess<\/p>\n\n\n\n BUT FIRST ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION<\/p>\n\n\n\n Patient presents with iatrogenic effect -Don\u2019t assume that it is from the medication you prescribed<\/p>\n\n\n\n When trying to pass a policy and your co-workers are against it what should you do To promote a policy how do you get the word out there Working in outpatient setting and you want to ensure continuous improvement in quality of care.<\/p>\n\n\n\n -Create an instrument to monitor clinical outcomes (this helps to identify what you are doing right or wrong)<\/p>\n\n\n\n Autoimmune disease can lead to increased If a child is urinating the bed -If that doesn\u2019t work try DESMOSPRESSIN (decreased enuresis)<\/p>\n\n\n\n Are you allowed to look up a patient on social media? Assume you started a patient on a medication and they go home and find out that there is a black box warning on the medication that you were unaware of. They call with concerns\u2026<\/p>\n\n\n\n -First, go online and do your own research<\/p>\n\n\n\n -Research the RISK vs BENEFIT before you tell the patient to stop the medication<\/p>\n\n\n\n Risk factors for sleep apnea Tolerance PHQ-9<\/p>\n\n\n\n 5 mild depression Max score 27<\/p>\n\n\n\n HAM-D<\/p>\n\n\n\n 10 Mild HAM-A<\/p>\n\n\n\n 8 Mild Beck Depression Inventory (BDI) 14 Mild Max score 63<\/p>\n\n\n\n GAD-7 Scoring 5 Mild Anxiety Max score 21<\/p>\n\n\n\n COWS Consider Subutex or Suboxone at 13 or above<\/p>\n\n\n\n Remember Methadone is the LEAST safe option due to cardiac issues<\/p>\n\n\n\n CIWA Scores of 15 or above consider scheduled medications<\/p>\n\n\n\n Patient in alcohol withdrawal and you are choosing medication for CIWA, check what? if liver disease use ATIVAN because of short half life over VALIUM<\/p>\n\n\n\n REMEMBER DETOX SHOULD NOT OCCUR OUTPATIENT–>residential or inpatient is needed<\/em> especially if pregnant. REMEMBER SAFETY FIRST<\/p>\n\n\n\n Idealization This is often seen in grieving before acceptance of the loss<\/p>\n\n\n\n Appreciative Inquiry Example do not focus on what the employee does wrong focus on what they do well<\/p>\n\n\n\n Reflective Practice -After an incident–> Debrief<\/p>\n\n\n\n Assume you started the patient on an antidepressant and now they complain of insomnia<\/p>\n\n\n\n Conflict of interest between pharmaceutical companies and Nurse Practitioners i.e promises to sponsor NP loan forgiveness. You want to create a policy to address this. First you must examine\u2026<\/p>\n\n\n\n study the relationship between the industry provided samples and industry sponsored education<\/p>\n\n\n\n If a patient is involuntarily admitted can they still refuse medications? Scope of practice is determined by Scope of practice defines If you would like to perform ECT as an NP what should you review Standard of practice is determined by -Provides a way to judge nature of the care provided<\/p>\n\n\n\n The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical<\/p>\n\n\n\n Exceptions to Confidentiality -Insurance companies<\/p>\n\n\n\n -Giving information to attorneys involved in litigation<\/p>\n\n\n\n -Intent to harm self or others<\/p>\n\n\n\n -Meeting state of federal requirements for reporting disease states<\/p>\n\n\n\n -When the need for information outweighs the principle of confidentiality i.e unconscious patient and their life is at stake<\/p>\n\n\n\n Tarasoff principle may vary by state so you must check with your state board of nursing first\u2026it may not be your responsibility to notify<\/p>\n\n\n\n If you are taking care of a patient and during the process of interview she tells you that her husband just texted her that her husband is going to kill self<\/p>\n\n\n\n -Call the police, provide the address<\/p>\n\n\n\n informed consent -Ensure they understand the risks vs benefits<\/p>\n\n\n\n If patient is able to reiterate the risks vs benefits of procedure or treatment, they are able to give consent*<\/p>\n\n\n\n Example patient comes to the hospital, and they are unable to give consent i.e to sick to agree to treatment you must<\/p>\n\n\n\n assess need for involuntary treatment<\/p>\n\n\n\n Justice Nonmaleficence Beneficence Fidelity Veracity Autonomy New male patient has a 10 year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward?<\/p>\n\n\n\n A. Beneficence<\/p>\n\n\n\n B. Fidelity<\/p>\n\n\n\n C. Non-Maleficence<\/p>\n\n\n\n D. Veracity<\/p>\n\n\n\n C. Non-Maleficence<\/p>\n\n\n\n Do no harm, giving Xanax would endanger him secondary to the high abuse potential and imminent danger if he were to overdose on Xanax<\/em><\/p>\n\n\n\n If no history of substance use, then beneficence would be appropriate because the Xanax would help the anxiety<\/p>\n\n\n\n Acute agitation and anxiety vs acute agitation and psychosis<\/p>\n\n\n\n IM ordered IM antipsychotic for agit\/psychosis<\/p>\n\n\n\n Patients have the right to be treated in the Least The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP’s next step is to: 3 Interventions vs 1 Assessment<\/em> FIRST YOU NEED TO ASSESS FIRST<\/p>\n\n\n\n What is the best way to reduce stigma *THINK WIDEST AUDIENCE<\/p>\n\n\n\n Just Culture The PMHNP is concerned about access-to-care issues in the local community and wants to help develop health care policy to help patients access care more effectively. Remember strength in numbers but STAY INVOLVED i.e asking the manager just passes off<\/em><\/p>\n\n\n\n If a patient from a specific culture is refusing to accept any diagnosis of mental health disorders because of shame what could be done to address this barrier?<\/p>\n\n\n\n A. Educate the family<\/p>\n\n\n\n B. Political advocacy<\/p>\n\n\n\n C. Public Health Concern<\/p>\n\n\n\n D. Community education programs<\/p>\n\n\n\n D. Community education programs<\/p>\n\n\n\n *Narrow down to education A\/D\u2026then think WIDE NET =Community EDUCATION<\/p>\n\n\n\n A client with Biolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you he no longer wants to be treated with medication. , and he does not have bipolar disorder, that was a misdiagnosis, He further informs you he stopped all his medications 2 months ago and is here to thank you for your care and tell you he no longer needs appointments. Understanding ethical conflict, you use which of the following ethical principles? Patient\u2019s have the right to self-determination<\/em><\/p>\n\n\n\n Recovery Model * RELAPSE IS A LEARNING OPPORTUNITY<\/p>\n\n\n\n -Treatment approach that does not focus on full symptom resolution but emphasizes on resilience and control over problems in life<\/p>\n\n\n\n -Self-Direction (do not tell them what to do)<\/p>\n\n\n\n -Individualized and Person-Centered<\/p>\n\n\n\n -Non-Linear, Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience<\/p>\n\n\n\n In counseling a 23 y\/o married Hispanic mother who brought her 4 year old son to the clinic for “mal de ojo” with symptoms of fitful sleep, diarrhea, vomiting, and fever the PMHNO; *In cultural questions remember RESPECT FIRST! Even before assessment<\/p>\n\n\n\n Quality Improvement<\/p>\n\n\n\n Projects designed to improve systems, decrease cost, and improve productivity<\/p>\n\n\n\n What is an example of a quality improvement process? Retrospective Chart Review is an example of a Quality Improvement Process<\/p>\n\n\n\n If they ask HOW the NP would do a quality Improvement Process the answer may be Plan, Do, Study, Act<\/p>\n\n\n\n The NP is responsible for initiating quality improvement at a community clinic. The effective strategy for evaluating the clients services is to<\/p>\n\n\n\n A. Chart review analysis<\/p>\n\n\n\n B. A root cause analysis<\/p>\n\n\n\n C. Plan DO Study Act<\/p>\n\n\n\n D. Failure effect mode analysis<\/p>\n\n\n\n C. Plan Do Study Act<\/p>\n\n\n\n SBIRT Erikson’s stages of psychosocial development<\/p>\n\n\n\n Piaget’s stages of cognitive development<\/p>\n\n\n\n Preoperational Stage includes Egocentric<\/p>\n\n\n\n Understand language<\/p>\n\n\n\n formal operational stage KEY WORD is LOGIC think like a scientist or do a science project you must be able to use logic ABSTRACT THINKING such as doing algebra<\/p>\n\n\n\n sensorimotor stage concrete operational stage Risk factors for suicide Women try more often. Men succeed more often.<\/p>\n\n\n\n A 72 year old female brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the likely diagnosis?<\/p>\n\n\n\n A. Alzheimer<\/p>\n\n\n\n B. Vascular Dementia<\/p>\n\n\n\n C. Depression<\/p>\n\n\n\n D. Medication Toxicity<\/p>\n\n\n\n C. Depression<\/p>\n\n\n\n *2 months=too soon for Alzheimer\u2019s, 24 is mild MMSE, HTN is not enough info to diagnose vascular dementia HALLMARKS FOR VASCULAR DEMENTIA are carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, remember PSEUDO dementia is DEPRESSION<\/p>\n\n\n\n HALLMARKS FOR VASCULAR DEMENTIA<\/p>\n\n\n\n carotid bruits fundoscopic abnormalities and enlarged cardiac chambers,<\/p>\n\n\n\n Patient comes to the office, and you score them on HAM-D a 23 and you start an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do?<\/p>\n\n\n\n Leave the dose where it is<\/p>\n\n\n\n Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what do you do<\/p>\n\n\n\n Leave the dose where it is<\/p>\n\n\n\n Zung Depression Scale Scoring<\/p>\n\n\n\n 50 Mild 25-49 is NORMAL RANGE MMSE scoring 10 moderate<\/p>\n\n\n\n 20 mild<\/p>\n\n\n\n 25 Normal<\/p>\n<\/blockquote>\n\n\n\n Kids under 10 years old are severely challenging to teach<\/p>\n\n\n\n HIGHER THE BETTER!<\/p>\n\n\n\n Teratogenic Effects<\/p>\n\n\n\n Primary prevention Secondary Prevention Tertiary Prevention Pharmacokinetics Pharmacodynamics messenger RNA codes for Poor relationships, lack of future hope, suspicious of others indicates developmental failure of what stage Poor self-esteem, low self control, self-doubt, lack of independence indicates failure of what stage Lack of self-initiative, lack of goal orientation indicates failure of what stage sense of inferiority, difficulty with working\/learning indicates a failure of what stage identity confusion, poor self-identification in groups indicates failure of what stage emotional isolation, egocentrism indicates a failure of what stage self-absorption, inability to grow and change as a person, inability to care for others indicates a failure at what stage bitterness, sense of dissatisfaction with life, despair over impending death indicates failure of what stage<\/p>\n\n\n\n 65 y\/o integrity vs despair<\/p>\n<\/blockquote>\n\n\n\n agonist effect Inverse agonist effect partial agonist effect Antagonist effect Herbals that interact with warfarin Black Cohosh Bellandonna chamomile Ginko Ginseng Valerian Hypertensive crisis can occur when MAOI are taken with Microcytic anemia macrocytic anemia Labs: Folic Acid, B12, ESR\/CRP, HGB, MCV<\/p>\n\n\n\n 14 y\/o with no axillary hair and no period Two classes of cardiac meds that should not be used together Abnormal Trendelenburg Test too little acetylcholine 4 D’s Discover, Dream, Design, Destiny Cranial Nerve V WBC 1500-2000 How can you assess cranial nerve XII? First sign of metabolic syndrome Grade 2\/5 hoarse systolic heart murmur Ibuprofen + lithium Kleinfelter’s Syndrome Mental Health Parity Act what does nuchal rigidity indicate? Patient is on interferon and lexapro, as a provider you understand that Patient complains of neuropathic pain and neurontin is not working Patient is in hospital with no family and is failing cognitive test what should you do? Phases of policy making Rhett Syndrome Signs of fetal alcohol syndrome Tegretol side effects Telemedicine legal question? A person is seen wandering the streets for 2 days Medication used for serotonin syndrome Why? it is an H1 blocker but is also has serotonin receptor blocking activity. Specifically, it acts to block 5-HT1A and 5-HT2A receptors which are the ones responsible for serotonin syndrome<\/p>\n\n\n\n When to assess a patient in restraints? Why would you be concerned with immature reticulocytes? pharm treatment for agoraphobia Anorexia admission Criteria for hospitalization includes: ANOVA precontemplation stage Contemplation stage Preparation Stage Action Stage Maintanence stage These 3 meds cause BIG FREAKING PROBLEMS Boy tells you he wishes to be a girl and asks you not to tell the parents BRUISE on the padded part of his arms Can an advanced directive be revoked? How? Can you take Buspar during pregnancy? Carb and barb + Coumadin Who is in charge of the DEA? Common comorbidities of bipolar Conjunctival injection, munchies, psychomotor slowness? Diary Log Depakote and Disulfiram What 3 atypicals can be used with teens? Np wants to implement a certain policy in nursing. Phenycyclidine (PCP) can cause? Hildegard Peplau Patient acting out due to missing session what do you do? Patient on antidepressants for 3 weeks and attempted Suicide Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis Pearson’s r pincer grasp Problems in the parietal lobe can lead To promote resilience in a patient with schizophrenia that lives alone consider referral to Patient on Lithium and Depakote and has temp, right flank pain, brown urine. What do you do FIRST? Pt states “god did this to me.” Patient taking breathing treatment Albuterol\/Proventil p-value Reliability Stereogenesis Tagamet (cimetidine) Trazadone concerns Turner Syndrome To start your own firm as an NP and need to examine economic viability 3 CK muscle enzyme tests? What are the legal ramifications of treating someone without informed consent? Two important things to measure when prescribing Zyprexa What schedule of controlled substances are NPs allowed to prescribe? What crania nerve is affected when you ask the patient to shrug their shoulders? These medications are renally metabolized grapefruit juice How do Asians see HC providers? How do you protect from the evil eye? T-test Treatment for children with panic disorder What do BCP’s do to Lamictal? What does an increased retic count indicate What do you see in Labs with HIV dementia What is occuring in the adolescent brain? Indomethacin is a Tramadol Dissemination Sensitivity vs. Specificity *In medical diagnosis, testing sensitivity is the ability of a test to correctly identify those with the disease (true positive) whereas test specificity is the ability of the test to correctly identify those without the disease (true negative)<\/p>\n\n\n\n What is the purpose of HIPAA? DETROL interactions Yale-Brown Obsessive Compulsive Scale (Y-BOCS) If you want to decrease the use of seclusion who would be considered the primary change agent Rennie vs Klein<\/p>\n\n\n\n Roger vs. Oken ROGERS GUARDIAN<\/p>\n\n\n\n Donalson vs O’Connor Donalson was a patient hospitalized for 15 years<\/p>\n\n\n\n Dusty vs United States Durham vs King Riese vs St. Mary’s Hospital Stark Law Which patient is at highest risk for SI A. 30y\/o married AA female with previous SI attempt *1 risk factor B. 35 y\/o single Asian male with previous SI attempt *3 risk factors C. 38 y\/o single AA male who is a manager of a bank *2 risk factors D. 68 y\/o single white male […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[],"tags":[],"class_list":["post-110858","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110858","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=110858"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110858\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=110858"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=110858"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=110858"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
excessive pruning of synapses<\/p>\n\n\n\n
EVERYTHING DECREASES EXCEPT VENTRICLES<\/p>\n\n\n\n
Dopamine which can worsen symptoms of schizophrenia<\/p>\n\n\n\n
a form of rehabilitation post hospitalization, in home treatment<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
-social skills training
-Exercise<\/p>\n\n\n\n
Cognition
Quality of Life
Long-term health<\/p>\n\n\n\n
Treatment non-compliance<\/p>\n\n\n\n
Antisocial<\/p>\n\n\n\n
proverb interpretation (everyone that lives in glass houses shouldn\u2019t throw stones) Are they able to think abstractly<\/p>\n\n\n\n
means that their response has nothing to do with the question<\/p>\n\n\n\n
means that their response goes in circles instead of getting to the point of the question<\/p>\n\n\n\n
SI\/HI\/AH\/VH<\/p>\n\n\n\n
Folstein Scale<\/p>\n\n\n\n
Serial 7s or perform an activity backwards i.e list the days of the week backwards<\/p>\n\n\n\n
repeat 3 words after me<\/p>\n\n\n\n
repeat 3 words after 5 minutes<\/p>\n\n\n\n
Who is the president<\/p>\n\n\n\n
Clock drawing test<\/p>\n\n\n\n
Problem with the right hemisphere, cerebrum, or parietal lobe<\/p>\n\n\n\n
Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms<\/p>\n\n\n\n
-Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia<\/p>\n\n\n\n
-This pathway mediates motor movements<\/p>\n\n\n\n
-Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach)<\/p>\n\n\n\n
-Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia<\/p>\n\n\n\n
level less than 20ng\/ml<\/p>\n\n\n\n
less than 25ng\/ml<\/p>\n\n\n\n
Risperdal<\/p>\n\n\n\n
neck stiffness, muscle spasm of upper body especially neck\/face\/tongue<\/p>\n\n\n\n
may mimic anxiety, restlessness, can\u2019t sit still, rocking, pacing<\/p>\n\n\n\n
-DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm<\/p>\n\n\n\n
A. difficulty initiating movement; slowness of movement
-Treatment Cogentin<\/p>\n\n\n\n
caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing<\/p>\n\n\n\n
abnormal facial movements, grinding teeth, lip smacking, protruding tongue<\/p>\n\n\n\n
COGENTIN MAKES TD WORSE<\/p>\n\n\n\n
OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO<\/p>\n\n\n\n
REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops<\/p>\n\n\n\n
Ritonavir
Amiodarone
Cimetidine
Ketoconazole<\/p>\n\n\n\n
Macrolides
INH
Grapefruit Juice
Omeprazole<\/p>\n\n\n\n
Increased tegretol levels<\/p>\n\n\n\n
as a provider you know that you must now decrease the dose of the antipyshcotic<\/p>\n\n\n\n
Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar<\/p>\n\n\n\n
steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone<\/p>\n\n\n\n
Can cause depression and birth defects<\/p>\n\n\n\n
As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms<\/p>\n\n\n\n
Psychosis<\/p>\n\n\n\n
Dopamine and GABA<\/p>\n\n\n\n\n
delayed gastric emptying<\/p>\n\n\n\n
Omeprazole, ranitidine, famotidine<\/p>\n\n\n\n
Decrease absorption of antipsychotics & SSRI<\/p>\n\n\n\n
increased anxiety<\/p>\n\n\n\n
when meds cause the opposite effect than expected<\/p>\n\n\n\n
programmed cell death\/neuronal loss<\/p>\n\n\n\n
Recurrent self harm<\/p>\n\n\n\n
DBT<\/p>\n\n\n\n
Marsha Linehan<\/p>\n\n\n\n
Journaling or diary keeping<\/p>\n\n\n\n
STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism<\/p>\n\n\n\n
adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying)<\/p>\n\n\n\n
when patients introduce foreign substances into their body or contaminate their food<\/p>\n\n\n\n
Faking illness for financial gain<\/p>\n\n\n\n
common in children in foster care, abuse from parents<\/p>\n\n\n\n
They deliberately annoy others, no aggression, defiance of authority<\/p>\n\n\n\n
violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE<\/p>\n\n\n\n
similar to PTSD but the timeline differs<\/p>\n\n\n\n
-OVER ONE MONTH<\/p>\n\n\n\n
Panic attack = BZ
Panic disorder = SSRI<\/p>\n\n\n\n
Panic Disorder is CHRONIC<\/p>\n\n\n\n
Criteria for diagnosis<\/p>\n\n\n\n
CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL<\/strong><\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine<\/p>\n\n\n\n
Stimulants<\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin + GABA<\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
prefrontal cortex
basal ganglia
reticular activating system<\/p>\n\n\n\n
Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION<\/p>\n\n\n\n
Attention
Executive Function
Cognition
Processing
Working Memory
Problem Solving<\/p>\n\n\n\n
Prefrontal Cortex<\/p>\n\n\n\n
on admission<\/p>\n\n\n\n
-Provide patient and parents information immediately don\u2019t wait till discharge<\/p>\n\n\n\n
serotonin, dopamine, glutamate & GABA<\/p>\n\n\n\n
Compulsion<\/p>\n\n\n\n
Obsession\/Compulsion<\/p>\n\n\n\n
6-17 years ONLY<\/p>\n\n\n\n
Administer MOOD QUESTIONAIRE
7\/13 Bipolar Diagnosis Likely<\/p>\n\n\n\n
So what should you assess if a parent reports that a child is having nightmares
GENETIC<\/p>\n\n\n\n
Worry, apprehension, fear must LAST ATLEAST 6 MONTHS<\/p>\n\n\n\n
-ACUTE (within hours to days) onset of disturbance of LOC, COGNITION,<\/p>\n\n\n\n
-Chronic and slow onset (months to years to develop)<\/p>\n\n\n\n
Vit B12 and Folic Acid<\/p>\n\n\n\n
Language and memory (aphasia and amnesia)<\/p>\n\n\n\n
Motor abnormalities\/Mood issues like apathy, depression, irritability<\/p>\n\n\n\n
subcortical form of dementia<\/p>\n\n\n\n
Antivirals<\/p>\n\n\n\n
Depression causes the memory issues, common in older adults<\/p>\n\n\n\n
-Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE<\/p>\n\n\n\n
visual hallucinations<\/p>\n\n\n\n
PICKs Disease<\/p>\n\n\n\n
Temporal Lobe<\/p>\n\n\n\n
GABA, Glutamate, Serotonin<\/p>\n\n\n\n
a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement<\/p>\n\n\n\n
Explains that the child\u2019s presentation is caused by the mirror neuron i.e dysfunction in the mirror neuron<\/p>\n\n\n\n
Male gender, genetic loading, intellectual disability, parents ages, preterm<\/p>\n\n\n\n
ADOS-G (autism diagnostic observation schedule-genetic)
ASQ (ages and stages questionnaire)
M-CHAT (modified-checklist for autism-toddler)<\/p>\n\n\n\n
locus coeruleus and medullary reticular formation<\/p>\n\n\n\n
raphe nuclei<\/p>\n\n\n\n
substantia nigra, ventral tegmental area, nucleaus accumbens<\/p>\n\n\n\n
Basal nucleus of Meynert<\/p>\n\n\n\n
a neural center located in the limbic system; helps process memory and manage stress<\/p>\n\n\n\n
The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flight responses.
-Hippocampus
-Amygdala
-Hypothalamus
-Thalamus<\/p>\n\n\n\n
Responsible for the response and memory of emotions, especially fear<\/p>\n\n\n\n
relay station for sensory impulses, pain<\/p>\n\n\n\n
homeostasis, temperature, thirst, appetite, sex drive, sleep cycle, emotions<\/p>\n\n\n\n\n
brain region that regulates cognitive function, decision making, empathy, impulse control, and emotions<\/p>\n\n\n\n
Balance and coordination<\/p>\n\n\n\n
developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, eating non-food items PICA<\/p>\n\n\n\n
GIVE THE BABY TO THE PARENTS and allow them to grieve<\/p>\n\n\n\n
Age
smoking
caffeine
lack of exercise
diet lacking calcium and vit D<\/p>\n\n\n\n
-Aaron Beck<\/p>\n\n\n\n
-Arnold Lazarus
focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors
-Exposure
-Relaxation
-Skills training
-Role Playing<\/p>\n\n\n\n
-Carl Rogers
person-centered therapy
-Self-actualization
-Self-Directive Growth
-Everyone has the potential to actualize and find meaning in life<\/p>\n\n\n\n
Victor Frankl -an insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices.
-Emphasizes accepting freedom and making responsible choices
-Focus on the present<\/p>\n\n\n\n
Gerald Kierman & Myrna Weissman<\/p>\n\n\n\n
Desensitization Phase: visualize the trauma, verbalize negative thoughts but remain attentive to physical sensations<\/p>\n\n\n\n
participants develop hope for creating a different life; they gain hope from others<\/p>\n\n\n\n
people have similar problems, thoughts, and feelings and they are NOT ALONE<\/p>\n\n\n\n
sharing of oneself with another and helping another<\/p>\n\n\n\n
Patients can increase their skills by imitating the bx of others<\/p>\n\n\n\n
interacting with others increases adaptive interpersonal relationships<\/p>\n\n\n\n
Patients develop an attraction to the group and other members as well as a sense of belonging<\/p>\n\n\n\n
Patients openly express their feelings which were previously suppressed<\/p>\n\n\n\n
Groups enable participants to deal with the mean of their own existance<\/p>\n\n\n\n
Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic<\/p>\n\n\n\n
forming, storming, norming, performing, adjourning<\/p>\n\n\n\n
Murray Bowen<\/p>\n\n\n\n
Salvador Minuchin<\/p>\n\n\n\n
Jay Haley<\/p>\n\n\n\n
-MIRACLE QUESTIONS<\/p>\n\n\n\n
if teaching about meditation must tell them about MUSCLE RELAXATION<\/p>\n\n\n\n
P: Population
I: Intervention
C: Comparison
O: Outcome
T: Time<\/p>\n\n\n\n
ESR<\/p>\n\n\n\n
systematic reviews of random control trials (RCTs) or Meta-analysis or RCT-highest internal validity due to randomizations
At least (2)<\/p>\n\n\n\n
systematic reviews of cohort studies
-little bias because the subjects are identified prior to outcome – randomization is lost<\/p>\n\n\n\n
Intracranial pressure<\/p>\n\n\n\n
Normal to play with genitals (PHALLIC STAGE) NORMAL do not assume they have been abused*<\/p>\n\n\n\n
Young boys ages 9-16 years old often have NORMAL BREAST ENLARGEMENT which disappears within 6 months<\/p>\n\n\n\n
Check Testosterone level<\/p>\n\n\n\n
an enzyme active in the stomach and the liver that metabolizes alcohol<\/p>\n\n\n\n
normal up to 5-6 months
If older baby still has this reflex->refer to specialist<\/p>\n\n\n\n
Normal till 5-6 months
If present past normal range->refer to specialist
If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury<\/p>\n\n\n\n
Normal up to 2 years
If present past normal range->refer to specialist<\/p>\n\n\n\n
Sildenafil (Viagra)<\/p>\n\n\n\n
Anorexia-Low BMI
Bulemia-Normal BMI<\/p>\n\n\n\n
used for pain and depression<\/p>\n\n\n\n
assess ALL the medications that the patient is taking<\/p>\n\n\n\n
educate them on how the policy will benefit patient care<\/p>\n\n\n\n
Think most FEASIBLE option with WIDE net or audiance<\/p>\n\n\n\n
Cytokine level<\/p>\n\n\n\n
-Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST)<\/p>\n\n\n\n
No it violates their trust<\/p>\n\n\n\n
excessive weight, obesity, diabetes, smoking<\/p>\n\n\n\n
you need higher doses of the medication in order for the medication to be effective<\/p>\n\n\n\n\n
10 moderate
15 moderately severe
20 severe<\/p>\n<\/blockquote>\n\n\n\n\n
14 Moderate
17 Severe<\/p>\n<\/blockquote>\n\n\n\n\n
15 Moderate
24 Severe<\/p>\n<\/blockquote>\n\n\n\n
0-13 Subclinical<\/p>\n\n\n\n\n
20 Moderate
29 Severe
40 EXTREME<\/p>\n<\/blockquote>\n\n\n\n
0-4: Minimal Anxiety<\/p>\n\n\n\n\n
10 Moderate Anxiety
15 Severe Anxiety<\/p>\n<\/blockquote>\n\n\n\n
Medicate with PRNS at score of 7 or above<\/p>\n\n\n\n
Begin PRN medication at 8 or above<\/p>\n\n\n\n
LFT<\/p>\n\n\n\n
Seeing someone else as perfect, ideal, or more worthy than everyone else<\/p>\n\n\n\n
is an approach to organizational change which focuses on strengths rather than on weakness<\/p>\n\n\n\n
Links theory to practice with a goal of correcting practices that are incorrect. Example Debriefing after a restraint to find out what went wrong or what went right DEBFRIEFING MAY BE A KEY WORD<\/p>\n\n\n\n\n
they can still refuse medications, UNLESS it is an emergency or if the court determines they must take medications<\/p>\n\n\n\n
State board of Nursing<\/p>\n\n\n\n
NP roles and actions
-Varies broadly state to state<\/p>\n\n\n\n
The state scope of practice standards to see if it is allowed and what certification is needed<\/p>\n\n\n\n
ANA<\/p>\n\n\n\n
-Answering court orders, subpoenas, or summonses *high yield (if you don\u2019t release or lie about knowing this is PERJURY)<\/p>\n\n\n\n
1976 – duty to warn victims of potential harm from client<\/p>\n\n\n\n
-Communication process between the provider and client that results in client\u2019s acceptance or rejection of proposed treatment<\/p>\n\n\n\n
doing what is fair, fairness in all aspects of care<\/p>\n\n\n\n
do no harm<\/p>\n\n\n\n
doing good\/promoting well-being<\/p>\n\n\n\n
being true and loyal<\/p>\n\n\n\n
telling the truth, patients have the right to know the truth about their treatment<\/p>\n\n\n\n
doing for self (right to self-determination)<\/p>\n\n\n\n
IM ativan for agit\/anx<\/p>\n\n\n\n
Restrictive Setting<\/p>\n\n\n\n
A. Create interdisciplinary teaching team
B. Develop Outcome measures
C. Market the educational plan
D. Utilize a survey to assess the educational needs of the staff
D. Utilize a survey to assess the educational needs of the staff<\/p>\n\n\n\n
THROUGH EDUCATION<\/p>\n\n\n\n
individuals are continually learning, designing safety systems, and managing behavioral choices<\/p>\n\n\n\n
A. Asking the clinical manager to explore options for access
B. Organizing a political protest
C. Working with the local chapter of the nurses professional association
D. Writing letters to the editor of the local newspaper
C. Working with the local chapter of the nurses professional association<\/p>\n\n\n\n
A. Autonomy
B. Nonmaleficence
C. Justice
D. Beneficence
A. Autonomy<\/p>\n\n\n\n
A. Identifies what steps the mother has already tried in caring for the child
B. Explain that the symptoms are viral infection
C. Educates about importance of fluid electrolyte imbalance
D. Respects the mother’s understanding of the child’s illness
A. Respects the mother\u2019s understanding of the child\u2019s illness<\/p>\n\n\n\n
Plan, Do, Study, Act<\/p>\n\n\n\n
Screening, Brief Intervention, and Referral to Treatment<\/p>\n\n\n\n\n
\n
\n
2-7 y.o- MAGICAL THINKING IS NORMAL, if they believe that monsters can fly this is NORMAL<\/p>\n\n\n\n
12+ y\/o during which people begin to think logically about abstract concepts<\/p>\n\n\n\n
in Piaget’s theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities
Object permanance<\/p>\n\n\n\n
in Piaget’s theory, the stage of cognitive development (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events
i.e finding similarities in objects, grouping things<\/p>\n\n\n\n
Sex (Male),
Age (Teenager or Elderly),
Depression,
Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness),
3 or more prescription medications,
Organized plan,
No spouse (divorced, widowed, or single especially if childless). Social support lacking.
WHITE<\/p>\n\n\n\n\n
60 Moderate
70 Severe<\/p>\n<\/blockquote>\n\n\n\n
100 is max score<\/p>\n\n\n\n
0-10 severe<\/p>\n\n\n\n\n
\n
Efforts to prevent an injury or illness from ever occurring.
-Education
-Safety Initiatives
-Modifying environment<\/p>\n\n\n\n
Efforts to limit the effects of an injury or illness that you cannot completely prevent.
-Early findings
-Screening
-Prompt and effective treatment
Example: Crisis hotline, disaster response<\/p>\n\n\n\n
-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning
-Rehab Services
-Day treatment
-Case management
-Social Skills training<\/p>\n\n\n\n
what the body does to the drug<\/p>\n\n\n\n
what the drug does to the body<\/p>\n\n\n\n
amino acids<\/p>\n\n\n\n
infancy, trust vs mistrust<\/p>\n\n\n\n
early childhood 1-3, autonomy vs shame and doubt<\/p>\n\n\n\n
Late childhood 3-6 y\/o initiative vs guilt<\/p>\n\n\n\n
school age 6-12 y\/o industry vs inferiority<\/p>\n\n\n\n
adolescence 12-20 y\/o identity vs inferiority<\/p>\n\n\n\n
early adulthood 20-35 y\/o intimacy vs isolation<\/p>\n\n\n\n
middle adulthood 35-65 y\/o generativity vs stagnation<\/p>\n\n\n\n\n
Drug binds to receptors and activates a biological response<\/p>\n\n\n\n
Drug causes the opposite effect of agonist<\/p>\n\n\n\n
Drug does not fully activate the receptors<\/p>\n\n\n\n
Drug binds to the receptor but does not activate a biological response<\/p>\n\n\n\n
Vitamin E
Omega-3<\/p>\n\n\n\n
herbal used for menopause<\/p>\n\n\n\n
herbal used for anxiety<\/p>\n\n\n\n
herbal used for sedation and anxiety<\/p>\n\n\n\n
Herbal used to treat memory, dementia, & sexual dysfunction from SSRIs<\/p>\n\n\n\n
Herbal product used for stress reduction, fatigue, and depression<\/p>\n\n\n\n
herbal used for sedation<\/p>\n\n\n\n
Meperidine
Decongestants
TCAs
Atypical Antipsychotics
St.Johns wart
L-Tryptophan
Stimulants
Asthma meds<\/p>\n\n\n\n
iron deficiency<\/p>\n\n\n\n
due to folate or vitamin B12 deficiency<\/p>\n\n\n\n
Normal tanner stage, start by 16<\/p>\n\n\n\n
ACES and ARBS (angiotensin receptor blocker)
Together can cause renal dysfunction<\/p>\n\n\n\n
Hip disease, refer child out, assessed during head to toe<\/p>\n\n\n\n
too much acetylcholine
Alzheimer’s
Parkinson’s and EPS<\/p>\n\n\n\n
Appreciative Inquiry<\/p>\n\n\n\n
Trigeminal
Clenched Teeth<\/p>\n\n\n\n
Biweekly labs
Less than 1000 Stop<\/p>\n\n\n\n
Ask patient to stick out their tongue<\/p>\n\n\n\n
large waist circumference<\/p>\n\n\n\n
aortic stenosis<\/p>\n\n\n\n
increases the serum level of lithium up to double<\/p>\n\n\n\n
male with more than one X chromosome (XXY)
-Decreased sperm, fertility issues<\/p>\n\n\n\n
forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits<\/p>\n\n\n\n
meningitis<\/p>\n\n\n\n
interferon can increase depression therefore you may have to increase the lexapro<\/p>\n\n\n\n
Try Lyrica (pregabalin) its absorbed quickly and the maximum rate of absorption is 3x of Neurontin<\/p>\n\n\n\n
MRI
Tox Screen<\/p>\n\n\n\n
formulation, implementation, evaluation<\/p>\n\n\n\n
a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally until about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities<\/p>\n\n\n\n
small head, smooth palpebral fissure, inner epicanthal folds, thin upper lip<\/p>\n\n\n\n
Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro<\/p>\n\n\n\n
Licensing Jurisdiction for the NP must be considered<\/p>\n\n\n\n
Delirium<\/p>\n\n\n\n
Cyproheptadine<\/p>\n\n\n\n
initially within 1 hour; then 8 hours<\/p>\n\n\n\n
Reticulocytes are involved in conditions affecting RBCs such as anemia.
-Low reticulocytes may be seen is iron def. anemia, pernicious anemia, folic acid deficiency, and aplastic anemia<\/p>\n\n\n\n
short term benzo, SSRI, SNRI, TCA, or beta-blocker off label<\/p>\n\n\n\n
weight loss over 30% over 6 months
severe hypothermia temp less than 96.8
HR less than 40
BP less than 70
Hypokalemia less than 3mEq\/L
BMI<16<\/p>\n\n\n\n
ANalysis Of VAriance – btwn means of 3 or more groups
An inferential statistical test for comparing the means of three or more groups<\/p>\n\n\n\n
stage of change in which people are unwilling to change their behavior<\/p>\n\n\n\n
person is considering making a change, aware that there is a problem but is not quite committed to changing<\/p>\n\n\n\n
Person has made the decision to change, is ready for action<\/p>\n\n\n\n
Person is engaging in specific, overt actions to change<\/p>\n\n\n\n
The person is engaging in behaviors to prevent relapse<\/p>\n\n\n\n
Strong inhibitors of 2D6
Bupropion, Fluoxetine, Paxil<\/p>\n\n\n\n
Don’t tell<\/p>\n\n\n\n
Say I see you have bruises on your arm
may I Ask what happened<\/p>\n\n\n\n
Yes
at any time<\/p>\n\n\n\n
Category B – ok if really needed.<\/p>\n\n\n\n
Strong Inducers of 3A4 can decrease INR<\/p>\n\n\n\n
State and Federal<\/p>\n\n\n\n
anxiety, alcohol, substance use<\/p>\n\n\n\n
Marijuana intoxication<\/p>\n\n\n\n
CBT<\/p>\n\n\n\n
increases INR<\/p>\n\n\n\n
Zyprexa, Abilify, Seroquel – low doses<\/p>\n\n\n\n\n
start with nurse manager<\/p>\n\n\n\n
Nystagmus<\/p>\n\n\n\n
Theory of Interpersonal Relations
Nurse as therapeutic tool
-Care for the person as well as the illness
-Patients are PEOPLE not DIAGNOSES<\/p>\n\n\n\n
You relate to childhood abandonment and talk about it with the patient<\/p>\n\n\n\n
stop the medication immediately<\/p>\n\n\n\n
hypoglycemia<\/p>\n\n\n\n
a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale<\/p>\n\n\n\n
9 months<\/p>\n\n\n\n
Sensory-perceptual disturbances and agnosia(inability to perceive objects)
R-L confusion
Difficulty writing (agraphia)
Aphasia(difficulty of language)<\/p>\n\n\n\n
-ACT
-Peer support<\/p>\n\n\n\n
Check LFT
If fine then check creatinine<\/p>\n\n\n\n
Assess spiritual needs first<\/p>\n\n\n\n
Do not take MAOI or TCA<\/p>\n\n\n\n
The probability of results of the experiment being attributed to chance.<\/p>\n\n\n\n
consistency of measurement<\/p>\n\n\n\n
identify an object without sight
i.e dice in hand<\/p>\n\n\n\n
H2 receptor antagonist (antacid)
Increases benzo
Increases coumadin<\/p>\n\n\n\n
EKG-QT prolongation
Priapism
Glaucoma<\/p>\n\n\n\n
A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted.
-Delayed puberty
-Amenorrhea
-Web neck, osteoporosis, lymphedema
-poor social skills<\/p>\n\n\n\n
Show Revenue and expenses<\/p>\n\n\n\n
CKMM, CKBB, CKMB (normal 0.3 mmcg\/L)<\/p>\n\n\n\n
The same as they are with informed consent
-Respect
-Beneficence
-Justice<\/p>\n\n\n\n
Waist circumference
Lipids<\/p>\n\n\n\n
II-V<\/p>\n\n\n\n
XI (11) Spinal Accessory<\/p>\n\n\n\n
Gabapentin
Campral
Lithium<\/p>\n\n\n\n
inhibitor that can reduce the absorption of the drug by 47% therefore the drug blood levels will be increased
-Decrease dose of drug<\/p>\n\n\n\n
As in a position of authority.
Expect to give instructions and help make decisions<\/p>\n\n\n\n
Red ribbon on an infant
Amulet for adults<\/p>\n\n\n\n
assesses whether the means of two groups are statistically different from each other<\/p>\n\n\n\n
clonidine
guanfacine<\/p>\n\n\n\n
Inducer – will lower dose of Lamictal<\/p>\n\n\n\n
Bone marrow disorder or Vitamin Deficiency
Normal Range 0.5-1.5<\/p>\n\n\n\n
CD4 <200
Viral Load is high
<20% get it with antiretroviral treatment<\/p>\n\n\n\n
Dendritic pruning
Emotions are controlled by amygdala
Prefrontal Cortex is still not fully developed (may be why young boys are risk takers)<\/p>\n\n\n\n
NSAID- WATCH WITH LITHIUM<\/p>\n\n\n\n
Highly serotonergic<\/p>\n\n\n\n
the act of spreading widely
-publication-highest level
-Presenting at national conference
-Journal club<\/p>\n\n\n\n
sensitivity – how well a test identifies truly ill people (True positive)
specificity – how well a test identifies truly well people (True negative)<\/p>\n\n\n\n
National standards for electronic HC transactions
-National ID for providers, health plans and employers.
-Not SIMPLY Confidentiality.<\/p>\n\n\n\n
Topamax
KCL
Zonegran<\/p>\n\n\n\n
OCD
0-7 subclinical
8-15 Mild
16-23 Moderate
24-31 Severe
32-40 Extreme<\/p>\n\n\n\n
Unit staff<\/p>\n\n\n\n\n
Until court orders it
“due process”<\/li>\n<\/ul>\n\n\n\n
determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment.<\/p>\n\n\n\n
Confinement
-It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others<\/p>\n\n\n\n
incompetent to stand trial<\/p>\n\n\n\n
Insanity defense<\/p>\n\n\n\n
7\/8 8B ruling says that there should be court determination of incompetence for involuntary committed mental persons to receive antipsychotic medications<\/p>\n\n\n\n
Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"