E3 Concepts Flashcards
Psychosis
Losing contact with reality, happens in many different psychiatric disorders
More than one symptom: difficulty processing information and coming to a conclusion, delusions, hallucinations, incoherence, catatonia, aggressive or violent behavior
Schizophrenia
Chronic psychotic disorder, begins in adolescence or early adulthood contains cognitive, positive and negative symptoms
Cognitive symptoms of schizophrenia
Disorganized thinking, problems with memory, poor attention span
Positive symptoms of schuzophrenia
Exaggeration of normal function: Agitation, delusions, paranoia, hallucinations, incoherent speech
Negative symptoms of schizophrenia
Depression of normal function, more chronic/persistent: Poor self-care, poverty of speech, social/emotional withdrawal, flat affect
EPS - Extrapyramidal symptoms or Pseudoparkinsonism
Tremors, masklike face, rigidity, shuffling gait, bradykinesia
Antipsychotic agents
Blocks the action of dopamine (risk of EPS)
Two major categories: Typical/First Generation (FGA) or Atypical/Second Generation (SGA)
Atypical Second Generation Antipsychotics (SGA)
Treats both positive and negative symptoms of schizophrenia
EPS is not as likely, still has other side effects (weight gain, DM2, constipation, fatigue, insomnia, increased appetite, headache)
Typical side effects of SGA’s
Prolonged QT, weight gain, diabetes, and leukopenia/neutropenia (ANC <1000)
Z-Track Injection Method
Pulls skin to leave a (zig-zag) in the skin, reduces any ‘spillage’
Used for long acting antipsychotics, 21 G needle with no massage
Nursing interventions r/t antipsychotics
Monitor for EPS, NMS and WBCS, inform may take 3-6 weeks to achieve effectiveness, encourage smoking cessation, do not combine medications with alcohol, narcotics or other CNS depressants, do not discontinue abruptly
Anxiety
Signs: sense of dread, choking, rapid HR, shaky, feeling faint
Still functional until it is situationally inappropriate or disabling
Benzodiazepine withdrawal
Develops in 2-10 days
Symptoms: Tremor, agitation, nervousness, sweating, insomnia, anorexia, paranoia, seizures
Benzodiazepine Interventions
Monitor vital signs, labs for signs of leukopenia, encourage pt to rise slowly to avoid dizziness, do not use for more than 3-4 months, check for cheeking, no antacids or caffeine at the same time (delays absorption) pt should take with meals to decrease Gi discomfort
Serotonergic Reuptake Inhibitors
Long term treatment of anxiety takes 8-12 weeks for full effect
SE: nausea, headache, insomnia, weight gain, sexual dysfunction, increased anxiety (start low)
Examples of SSRIS
Escitalopram (lexapro) Fluoxetine (prozac) paraxetine (paxil) sertraline (zoloft) citalopram (celexa)
SNRIS examples
Venlafaxine (effexor XR) duloxetine (cymbalta)
Tuberculosis
Mycobacterium tuberculosis (acid fast bacillus) spreads person to person via droplets, contained until AIDS epidemic in 1980s
Disease of lungs, liver, kidneys and other organs
Issues with: susceptibility (AIDS) drug resistance, poor compliance, lack of medications world wide
High Risk: homeless shelters, prison/jails, some nursing homes
Diagnosing TB
Mantoux (tuberculin) skin test (positive does not confirm infection) indicates exposure, those with vaccine may also show positive
Other tests: TB blood, sputum sample
Skin Test: Read in 48-72 hours, measuring the raised, hardened or swelled area in millimeters)
Latent TB
They are infected but do not have the disease, blood will be positive
They are not infectious and cannot spread TB since the bacteria is not multiplying, treatment is required (prophylaxis)
Treatment of latent TB
Isoniazid 6-9 months OR
Isoniazid plus rifapentine 3 mo OR
Rifampin 4 mo (when pt cannot tolerate isoniazid)
Herpes simplex virus type 1 (HSV-1)
Cold sores
Herpes simplex virus type 2 (HSV-2)
Genital herpes
Varicella-zoster viruses (HSV-3 or VZV),
Chickenpoz or shingles
Epstein-Barr virus (HSV-4 or EBV)
Mononucleosis
Cytomegalovirus (HSV-5 or CMV)
pneumonia or blindness in immunocompromised
Hepatitis C (HCV)
Serious, chronic liver infection
Transmission: Blood contact, IV drug use (contaminated needles), sexual contact (less likely that HBV), birthing process
May be asymptomatic for years can result in liver failure over time
Hepatitis B (HBV)
Serious chronic liver infection
HBV: Needlestick, intimate sexual contact, or childbirth, HBV is found in all body fluids, including blood, semen, and vaginal fluid
S/S: Anorexia, vomiting, diarrhea, jaundice, malaise, myalgia
Influenza
Contagious viral infection with antigens A, B, C
Spanish flu 1918 - 50 million deaths, killed many young adults quickly, US troops took to Europe in WW1
Influenza Vaccines
Change yearly based on prediction of prominent strains, contains egg protein (CDC no longer considers allergy a contraindication)
Nasal spray: not to be used in pregnant or immunocompromised
Diagnostic tests for influenza
Nasal swabs - not all tests detect both A/B strains
SARS - Severe acute respiratory syndrome
Spread via animals (civets from china) outbreak in 2002-2003
Ebola virus disease (EVD)
Infection from bats/primates
Discovered in 1976 as a breakout of fatal hemorrhagic fever
Spread - direct contact + fluids
2014-2016 outbreak in Guinea became and epidemic with some spread to the US
MERS - Middle East respiratory syndrome
2012 outbreak with respiratory and GI symptoms, high death rate
Treatment: hydrations, antipyretics, pain relievers, O2, respiratory support
Corona Viruses
Some affect humans, spread from exchange with wild animals
Fungal infections (mycosis)
Superficial infections: mucous membranes, hair, nails, and moist skin areas, mild
Ex: Oral candidiasis/thrush + vaginal candidiasis + athletes foot (tinea pedis)
Systemic Infections: lungs, CNS or abdomen - severe
Opportunistic fungal infections
Occur in immunocompromised, those taking antibotics, corticosteroids, chemotherapy or other immunosupressants
Candidiasis, asperfillosis, cryptococcosis, mucormycosis
Nonopportunistic fungal infections
Often caused by environmental factors, bird droppings or spores
Ex: sporotrichosis, blastomycosis, histoplasmosis and coccidioidomycosis
Antifungals General Nursing Assessment + Intervention
Cultures - identify organism
Toxicity: Monitor UO, BUN, creatine and liver enzymes
Assess for side effects
Education: Nystatin - swish, gargle, swallow/spit + Ketoconazole (no ETOH)
Malaria - Phases
Protozoa transmitted by mosquitos
Pre-erythrocytic stage: Invasion of liver cells, lasts 12-26 days, often asymptomatic
Erythrocytic phase: Infections of erythrocytes - SS fever, chills, sweating, flulike symptoms
Species of Malaria
P. Vivax - most common, 26 day incubation, fever chills, sweating in 48 hr cycle, relapse can occur for up to 2 years if treatment is not provided
P. Falciparum - more deadly, drug resistant, chills, sweats, fever, anemia, weakness r/t RBC destruction, dark urine d/t hemoglobin excretion, pulmonary edema, encephalopathy. Treatment needed immediately death can occur in days, no relapse
Malaria prophylaxis - non pharm
Cover skin with clothing, use of DEET, permethrin-infused clothing + mosquito nets
Helminths + groups + sources
Nematodes (roundworms)
Cestodes (tapeworms)
Trematodes (flukes)
Contaminated raw food, insects or direct penetration of the skin
Assessment of Helminths
History or food intake, travel, family member symptoms, bowel pattern history + changes, anal itching, affected pets, children (sandbox/handwashing)
Diagnostic: stool sample
Lower UTI
Acute cystitis, urethritis
E.Coli (most common pathogen)
More common in females
Symptoms: pain/burning on urination, frequency, urgency, pyuria
Upper UTI
Acute pyelonephritis
Symptoms: chills, fever, flank pain, painful urination, frequency, urgency, pyuria, CVA tenderness
Diagnosis of UTI
Urinalysis with dipstick - if positive (abnormal level of nitrites, blood, WBC) then urine is sent for culture and sensitivity
