concepts 2 midterm Flashcards
1
Q
CIWA
A
Clinical institute withdrawal for assessment, 10 item scale used in assessment and management of alcohol
2
Q
DSM5
A
Diagnostic and statistical manual, classification and diagnostic tools for psych diagnoses
3
Q
diabetes mellitus
A
multisystem disease related to abnormal insulin production, impaired insulin utilization or both
4
Q
prediabetes
A
blood glucose levels that are high but not high enough to be diagnosed as type 2 diabetes.
5
Q
metabolic syndrome
A
high BP, high levels of LDL cholesterol, triglycerides, low levels of HDL cholesterol and excess fat around the waist
6
Q
pathophysiology of diabetes
A
disorder of endocrine system (pancreas), destruction of beta cells in pancreas (insulin deficiency) OR defective insulin receptors on tissues, counterbalance of glucagon if insulin fails, blood glucose rises
7
Q
type 1 diabetes
A
autoimmune destruction of beta cells causing little or no insulin production, prone to ketosis, polys, need exogenous insulin, fasting glucose of >7
8
Q
type 2 diabetes
A
slower onset, exercise and diet management, oral hypoglycemic agents effective in controlling blood sugars, insulin sometimes necessary
9
Q
risk factors for type 2
A
> 40 years, first degree relative with type 2 diabetes, high risk population (Indigenous, African), hx of prediabetes, gestational diabetes
10
Q
gestational diabetes
A
temporary during pregnancy, increased risk to develop diabetes for mother and child
11
Q
cardinal signs of hyperglycemia
A
polydipsia, polyphagia, polyuria, weight loss, blurred vision, fatigue
12
Q
normal blood glucose
A
4-6 mmol fasting, 7.8 mmol 2 hours post meal
13
Q
diabetic complications
A
microvascular: retinopathy, neuropathy, nephropathy
macrovascular: coronary, cerebrovascular, peripheral
vascular risk factors: high cholesterol/other fats in blood, hypertension, overweight
14
Q
insulin
A
produced by beta cells, BG levels done before administration, helps store glucose in liver as glycogen, conversion of glycogen to fat stores in muscle and adipose tissue
15
Q
metformin
A
type 2, decrease glucose prod by liver, decrease interstitial absorption of glucose, improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue. increased glucose uptake by these organs
16
Q
hypoglycemia
A
blood sugars <4 mmol, caused by too much insulin, too little food, too much exercise or excessive drinking
17
Q
S/S hypoglycemia
A
heart palpitations, fatigue, pale, shakiness, anxiety, hunger, confusion, decreased LOC, seizures, blurred vision
18
Q
diabetic ketoacidosis
A
body produces high levels of blood acids (ketones), condition happens when body cannot produce enough insulin, without enough insulin body uses fat as fuel, buildup of acids in bloodstream (ketones). can cause diabetic coma. most common in type 1
19
Q
S/S ketoacidsos
A
flushed, hot, dry skin, polyuria, polydipsia, blurred vision, decreased LOC, tachypnea, fruity breath odour, loss of appetite, confusion
20
Q
tx of ketoacidosis
A
IV fluids, small amount of insulin, replacements of electrolytes
21
Q
hypersomolar hyperglycemic syndrome (HHS)
A
complication of diabetes triggered by infection/illness, high blood glucose w out ketones, The excess sugar passes from your blood into your urine, which triggers a filtering process that draws tremendous amounts of fluid from your body.
(elderly adults with type 2)
22
Q
phases of schizophrenia
A
prodromal, acute, recovery
23
Q
prodromal phase
A
early symptoms vague and hardly noticeable, changes in describing thoughts, perception, lose interest, withdraw, confused, trouble concentrating, apathetic, alone, preoccupied w religion or philosophy, weeks or months
24
Q
acute phase schizophrenia
A
clear psychotic symptoms, delusions, hallucinations, marked distortions in thinking, frightening, hospitalization
25
recovery phase schizophrenia
regain previous level of functioning, improve quality of life, unable to predict recovery after onset on disorder, some may require medications, stress can contribute to exacerbation
26
negative schizophrenia symptoms
flat affect, poor eye contact, decreased spontaneous movements, alogia (poverty of speech and content), apathy, anhedonia, inattention, ambivalence
27
neurocognitive symptoms of schizophrenia
Loss of short-term memory and organizational skills in planning, prioritizing and decision making.
Disorganized thinking and speech- trouble understanding language or communicating coherent sentences or carrying on a conversation. Odd word associations- word salad.
Disorganized behaviour- slow, rhythmic or ritualistic movements
28
how antipsychotics work
Antipsychotics reduce or increase the effect of neurotransmitters in the brain to regulate levels.
Generally effect of blocking DOPAMINE transmission in the brain which decrease the positive symptoms of schizophrenia.
Newer antipsychotic medications such as Risperidone, Olanzapine, Quetiapine affect other neurotransmitters in the brain including Serotonin. Therefore are effective in the treatment of positive and negative symptoms of schizophrenia
29
first gen antipsychotics
1st Generation/Typical/Conventional (antagonist, +s/s, EPS (td) b/c dopamine block, increase – s/s)
Dopamine Receptor antagonist
Haldol (Haloperidol)
Clopixol (Zuclopenthixol decanoate/acetate)
Depot vs Accuphase
Loxapine (Loxapax)
side effects
EPS (Extrapyramidal Symptoms)
Sedation
Orthostatic Hypotension
Weak Anticholinergic side effects
Development of movement disorder (tardive dyskinesia) may not be reversible.
30
second gen antipsychotics
2nd Generation/Atypical/Novel (created to produce less side effects)
Clozaril (Clozapine)
Risperdal (Risperidone)
Zyprexa/Zydis (Olanzapine)
side effects
Weight Gain (clozapine, olanzapine, seroquel, why is this important)?
Anticholinergic side effects
Sedation
Fatal Blood dyscrasias (agranulocytosis)
31
agranulocytosis
Can be seen in Clozapine
Blood disorder characterized by decrease in WBC
Symptoms develop within the 1st 6 months. Incidence of 0.3%-1%
Fatalities are due to infections related to a compromised immune system
Hyperthermia (unusually high fever).
Blood work qweek X 6months; then q2weeks
Symptoms:
Chills
Mouth Ulcerations
Sore throat
Fatigue
Signs of infection
Hyperthermia
32
neuroleptic malignant syndrome
MEDICAL EMERGENCY
3-9 days after beginning or a change in medication
Symptoms:
Sweating
Tremor
Changes in LOC
Tachycardia
Leukocytosis
Difficulty swallowing
Incontinence
Elevated/labile blood pressure
33
eps
EPS: (seen in up to 90% of pts getting typical antipsychotics). Involuntary and uncontrollable movement disorder caused by meds (anti psych).
Akinesia (weakness)
Akathisia (restlessness)
Acute Dystonic reactions (muscle spasms)
Parkinsonism
Pisa syndrome
Rabbit syndrome-
34
TD
Involuntary movement d/o appearing later in treatment (chronic exposure to dopamine receptor-blocking agents).
Will worsen with stress or when trying to hide it, etc.
Will stop with sleep
When should assessment be done after waking?
AIM Scale (beginning, q 6 months (1st generation) or qyear (2nd generation).
Ranges from mild to severe
1/3 of pts. show mild symptoms
35
What is the difference between psychosis and schizophrenia diagnoses?
Schizophrenia is a mental illness that causes psychosis
Schizophrenia also has other positive and negative symptoms.
Schizophrenia isn't the only cause of psychosis.
Other mental and physical illnesses can cause psychosis (delirium, depression, bipolar affective disorder, dementia and borderline personality disorder).
36
SYMPTOMS OF PSYCHOSIS
Hallucinations
Delusions
Paranoia
Disorganized thoughts
Disorganized speech
Feelings & behavior are also affected
37
angina
recurring chest pain/discomfort, when heart muscle does not receive enough blood and oxygen to meet bodys needs (myocardium), pressing, squeezing or crushing pain in chest and sternum
38
angina symptoms
pain radiating in arms, shoulders, jaw, neck and back, SOB, weakness/fatigue, on exertion relieved by rest, worse on exertion after a meal, emotion stress worsens
39
angina causes
when heart's workload and need for oxygen exceeds ability of coronary arteries to supply
coronary artery blood flow can be limited when arteries are narrowed by atherosclerosis
40
stable angina
occurs with activity/stress, episodes of pain or discomfort provoked by similar or consistent amounts of extertion stress
41
unstable angina
the pattern of symptoms change, more severe pain, more frequent attacks or attacks occurring at less exertion
such changes reflect sudden narrowing of coronary artery because atheroma has ruptured or clot formed
high risk of heart attack
acute coronary syndrome
42
myocardial infarction/heart attack
most deaths from MI caused by v fib of heart that occurs before victim of MI can reach ER
death of heart muscle from sudden blockage of coronary artery by blood clot
deprives heart muscle of blood and oxygen, injury to heart muscle causes chest pain and pressure
if blood not restored within 20-40 mins, irreversible death will occur
43
MI symptoms
vary among individuals, chest pain/pressure, fullness/squeezing of chest, jaw pain, toothache, headache, SOB, nausea/vomit, heartburn/indigestion, sweating, upperback pain, malaise OR no symptoms (common in DM)
may be vague or mild symptoms, just as serious
44
cause of MI
atherosclerosis (gradual processes, plaques = collection of cholesterol are deposited in walls of arteries
hardening and narrowing of inner channel (lumen) of artery
cannot delivery enough blood to maintain supply
can lead to vascular dementia or stroke
can remain silent
45
atherosclerosis and MI
surface of a plaque in a coronary artery may rupture, blood clot forms on surface of plaque, clot block allows flow of blood thru artery results in MI
cause of rupture that leads to formation of clot is unknown. cigarette and nicotine exporsure, elevated LDL cholesterol, elevated levels of blood catecholamines, high blood pressure, other biochemical forces
46
MI con't
heart muscle dies during MI and loss is permanent unless blood flow promptly restored, within 1-6 hours
between 4 and 10:00 am beccause of higher blood levels of adrenaline released from adrenal glands in morning
increased adrenaline may cont to rupture of cholesterol pl
47
women MI symptoms
neck/shoulder pain, abdominal pain, nausea, vomiting, fatigue, SOB
48
complications of MI
heart failure, if large amount of muscle dies hearts ability to pump blood to rest of body diminished-heart failure, body retains fluids and eg. kidney begins to fail
49
risk factors for atherosclerosis and MI
increased blood cholesterol, high blood pressure, use of tobacco, DM, male, family hx of coronary artery disease
some are modifiable
50
cholesterol
LDL : cholesterol combined with low density lipoproteins "bad" deposits cholesterol in arterial plaques
high levels = > risk of MI
HDL: "good" removes cholesterol from arterial plaques, low levels = > risk of MI
51
family history of heart disease
individuals with family hx of CHD have >risk of MI
>risk if family hx of early CHD, heart attack or sudden death before age 55 in father or before age 65 in mother
52
MI diagnosis
electrocardiogram-recording of electrical activity of the heart
abnormalities in electrical activity usually occur with MI and can identify areas of heart muscl that are deprived of oxygen an/areas of muscle that have died
53
cardiac enzymes
proteins that are released into blood by dying heart muscles
creatine phosphokinase CPK, and troponin and levels can be measured in blood
typically elevated in blood several hours after onset of heart attack
series of blood test for enzymes performed over 24 hour period can confirm heart attack and changes in levels over time also correlate with amount of heart muscle that has died
54
treatment for MI
chew 2 aspirins, call ambulance, reduces size of clot in coronary artery
or clopidogrel
heparin, anticoagulant
beta-blocker to sow heart rate, reduce workload
oxygen
morphine calming and for pain
nitroglycerin
55
heart failure
occurs when heart musclee becomes weak and cant pump enough blood to meet body's needs
not enough blood flow to provide organs w oxygen and nutrients
heart not working efficiently
heart tries to compensate for weakness by beating faster, more force
these mechanisms fail and heart becomes more impaired
56
2 basic problems HF
systolic dysfunction: when heart cant pump enough blood to supply bodys needs
diastolic dysfunction: when heart cannot accept all blood being sent to it
most have both systolic and diastolic
57
what is HF result of
coronary artery disease - narrowing of arteries that supply heart with blood, can damage and weaken
persistent hypertension - forces he art to pump against higher pressure, causes it to weaken over time
people with uncontrolled HTN more likely to develop HF than those with normal BP
MI, damages heart muscle
diabetes
arrhythmiass, heart pumps inefficienctly
heart valve disease
heart valve damage
viral infection
enlarged wall between chambers
certain kidney conditions that increase BP and fluid bildup
58
heart compensation HF
dilating (enlarging) to form bigger pump
adding new muscle to tissue to pump harder
beating at faster rate
heart cannot pump well enough to pump blood thru body and back to heart again, blood then backs up into legs and lungs, causing edema and SOB
59
right sided HF
blood backs up into your body
causing edema of feet, ankles and legs, may cause nocturia, sudden weight gain, weakness, vertigo, painful stomach bloating
60
left sided HF
pulmonary edema can cause breathing problems such as SOB, dyspnea, wheezing, coughing up blood tinged muscous, dry hacking cough
weakness, chest pain and rapid pulse
61
diagnosing HF
exam completed checking for edema of legs and fluid in lungs, doctor order blood and urine tests and ECG or chest xray
62
diagnosing HF
exam completed checking for edema of legs and fluid in lungs, doctor order blood and urine tests and ECG or chest xray
ECG can tell how much blood in heart is being pumped out to rest of body
proportion of blood that gets pumped out = ejection fraction
63
treating and preventing HF
cutting back on fluids, daily weight, staying active
64
HF medications
Ace inhibitors expand blood vessels, allowing blood to flow easier and make hearts work easier
angiotensin receptor blockers, may replace Ace inhibitors
certain beta blockers, help improve heart function
digoxin
diuretics
65
coronary artery disease
type of blood vessel disorder occurs when plaques build up in coronary arteries (atherosclerosis)
narrows arteries, reduces amount of blood that gets to heart
major cause of CAD is athersclerosis
66
risk factors for CAD modifiable
modifiable
high BP
high cholesterol and triglycerides
diabetes
unhealthy weight
unhealthy diet
too much alcohol
smoking
stress
67
risk factors CAD nonmodifiable
age
sex
family hx
pre-eclampsia
indigenous
socioceconomic
68
S/S CAD
angina, SOB, fatigue, pain, dizziness
women: vague chest discomfort, fatigue, sleep problems, indigestion, anxiety, MI
69
CAD diagnosis
full med hx, chest xray, angiography, echocardiogram, ECG, stress test
70
acute coronary syndromes
result from sudden blockage of coronary artery
causes unstable angina or MI depending on location and amount of blockage
chest pressure, SOB, fatigue
chew 2 aspirin
71
S/S ACS
at rest or exterion
pain back neck jaw arm
nausea
chest pain
SOB
loss of consciousness
pain in upper abdomen
sweating
72
STEMI
ST elevation myocardial infarction refers to ST segment elevation on a patient's ECG who generally have cardiac biomarkers which indicate necrosis of heart muscle
73
angina treatment
attempts to slow/reverse progression of CAD by dealing w/ risk factors
high blood pressure high cholesterol treated promptly
quitting smoking
low fat, varied diet, low in carbohydrates and exercise recommended
weight loss if needed
74
form 11
request for second medical opinion, filled out by patient
75
reasons for involuntary admission
A medical doctor signed a medical certificate for your involuntary admission because the doctor is of
the opinion that
(a) you are a person with a mental disorder that seriously impairs your ability to react appropriately
to your environment or associate with other people,
(b) you require psychiatric treatment in or through a designated facility,
(c) you should be in a designated facility to prevent your substantial mental or physical
deterioration or to protect yourself or other people, and
(d) you cannot be suitably admitted as a voluntary patient.
76
form 13
NOTIFICATION TO INVOLUNTARY PATIENT
OF RIGHTS UNDER THE MENTAL HEALTH ACT
77
rights under MHA
You have the right:
1. to know the name and location of this facility. It is
at
2. to know the reason why you are here. You have been admitted under the Mental Health
Act, against your wishes, because a medical doctor is of the opinion that you meet the
conditions required by the Mental Health Act for involuntary admission. (see Reasons for
Involuntary Admission)
3. to contact a lawyer. (see Contacting a Lawyer)
4. to be examined regularly by a medical doctor to see if you still need to be an involuntary
patient. (see Renewal Certificates)
5. to apply to the Review Panel for a hearing to decide if you should be discharged.
(see Review Panel)
6. to apply to the court to ask a judge if your medical certificates are in order.
A lawyer is normally required. (see Judicial Review (Habeas Corpus))
7. to appeal to the court your medical doctor’s decision to keep you in the facility.
A lawyer is normally required. (see Appeal to the Court)
8. to request a second medical opinion on the appropriateness of your medical treatment.
(see Second Medical Opinion)
78
form 21
A Form 21 (Director's Warrant [Apprehension of Patient]), is a form under the British Columbia Mental Health Act that is completed and allows a director (or designate) to issue a form to recall a patient if an involuntary patient leaves the hospital without permission (i.e. - absconds)
79
form 7
application for review panel
79
form 4
MEDICAL CERTIFICATE
(INVOLUNTARY ADMISSION)
79
form 6
MEDICAL REPORT ON EXAMINATION OF INVOLUNTARY PATIENT
(RENEWAL CERTIFICATE)
79
form 10
WARRANT
(APPREHENSION OF PERSON WITH APPARENT MENTAL DISORDER)
79
section 28
The police have the authority, under Section 28 of the Mental Health Act, to bring a person to the hospital to be assessed/examined by a doctor if the police have reason to believe that the person who is suffering from a mental illness is likely to cause harm themselves/others or get worse if not treated.
79
form 5
CONSENT FOR TREATMENT
(INVOLUNTARY PATIENT)
patient or director/delegate (not treating physician)
