Exam # 2 Flashcards Week 6-8
ADHD behaviors
Inattentiveness
-don’t complete tasks
-short attention span/ usually avoid tasks that require attention
-easily distracted
-don’t listen
-hard time with time management
Hyperactivity
-constant movement
-impulsive
-interrupting conversations
ADHD medications
Stimulants
- Methylphenidate
- Amphetamine Salts
- Lisadexafetamine
ADHD medication consideration
Give early in the morning before breakfast
monitor their weight couple times per week due to appetite suppression
Monitor vitals
High potential for substance abuse
Can make anxiety worse
Patches: only on for 9 hours during the day
ADHD Nursing Interventions
Safety
Low stimuli
Can be in groups
Anorexia symptoms
Poor circulation
Pallor
Palpitations
Faint
Dizziness
Menstrual disturbances
Unexplained GI disturbances (Constipation)
Cachexia
Lanugo
Hypokalemia
Anorexia: how to know if they are getting better?
Gaining weight (>30% weight, >10% body fat)
— make sure to weight pt regularly
HR goes normal (>40)
Vitals return normal (SBP >70)
Stop doing compensatory behaviors
— observe patient during eating and 1-3 hours after
Cognitive distortions are improved
they are eating something
not getting better if weight stays the same
What is Mental Status Exam (MSE) testing for?
Testing Cognition
orientation
memory
ability to follow directions (mood, behavior, perception)
counting backwards (doing basic math)
ability to focus
What to do with wandering patient?
Dementia
— Deescalate the situation first
— walk them to a room
— reorient them
— Redirect
— distract them
How would you set up a room for a patient with dementia?
Calendar
Pictures
Window
Good lighting (not too dim to avoid shadows)
No scattered rugs
Label things
Dementia assessment
4 A’s
1. Amnesia- memory loss
2. Apashia- loss of speech
3. Apraxia- loss of movement or to perform tasks
4. Agnosia - inability to interpret sensations
Priority assessment for Crisis
Psychosis
— this is the priority because they might be experience command hallucinations. Can lead to self harm or harming others.
— can also have overwhelming anxiety and panic
What makes grieving maladaptive?
More than 6 months
— still not being able to function
— still talking about grief in the present tense for more than 6 months and making plans
Ex: someone can’t sleep due to a loss. After 6 months they should start sleeping. If not.. then considered maladaptive.
Zolpidem
Sleep medication
What does it mean to have severe mental illness?
Affects ability to function
Ageism
Limiting treatment options because a person is old
Example: “he’s old, so he can’t handle it”
For older adults. What do we need to assess when taking a lot of medication?
Metabolism
— slower metabolism, drug will last a lot longer
— medication takes a lot longer to metabolize in older adults so may require a lower dose
Medication adherance
Potential interactions
Anticholinergic medications
— can cause dehydration and delirium.
— can lead to death
Anticholinergic examples
TCAs (Amitriptyline, doxepin, imipramine, nortriptyline)
Diphenhydramine
Cogentin
— all linked to decrease brain function and early death
Risk factors for suicide
Males [white] high risk
— and succeed
Substance Abuse
Family history
Stage 1: Alzheimer’s
Forgetfulness
A little forgetfulness
May have a hard time learning new things
Stage 2: Alzheimer’s
Confusion
Start to forget things they’ve known their whole life
— DOB, Phone number
Have labile emotions
Stage 3: Alzheimer’s
Ambulatory
Can still walk
Wandering
Paranoia
Can’t identify people (no recogntion)
May urinate in public places
Stage 4: Alzheimer’s
Can’t walk
Can’t talk
Can’t eat
Need total care
If died: might have been from choking
Physical characteristics of autism
Banging head
Stimming
— finger flipping, hand flapping
Delayed speech
Decreased social interaction
Preservation
— focused on a certain subject & delayed in others
Strict routines
—don’t like change
—change can cause anxiety
Echolalia
— repeating words
Disenfranchised grief
Grief that people usually keep to themselves
Person cannot openly talk about their grief/publicly mourn
Example: death of a pet or miscarriage, can also be death of a patient you cared for a long time
Anticipatory grief
Death that was expected
Example: knowing someone is going to die, therefore anticipating the grief
Fetishistic disorder
Recurrent intense arrousal from inanimate object or nongenital body part
Fetish becomes fetishistic disorder if it causes distress
Need specific item to achieve sexual desire
Exhibitionistic
These people like to flash others
Want people to watch them
— this gets them sexually excited
Unable to function because of urges and fantasies
Covert suicidal statement
Statement is indirect
General/hidden meaning
Examples: “It’s okay, soon everything will be fine”
When is an advance directive used?
When someone cannot speak for themself or make decisions
Example:
living will
— statement of how and where someone wishes to die
Directive to physician
— allowing a doctor to make a decision to their care if incapacitated, just like a durable power of attorney but this is allowing a physician to do so
Intermittent explosive disorder
Explosive behavior and angry outbursts
Example: road rage
Nursing interventions for : intermittent explosive disorder
Helping them cope with behavior
Help them get stronger
Set limits on unacceptable behavior
— helps to decrease violence
Promoting social interaction
