EXAM 2: Units 3 and 4 Flashcards
Psychotic behavior and thinking present for at least 6 months
Schizophrenia
Patient has impairments of personality functioning, but impairment is not as severe with schizophrenia
Schizotypal personality disorder
Similar symptoms to schizophrenia, but duration is only 1-6 months. Social/occupational dysfunction may not be present
Schizophreniform Disorder
Disorder where patient meets criteria for both schizophrenia AND depressive or BPD
Schizoaffective disorder
Schizophrenia occurs earlier in ____
Earlier in males than females
The DSM-5 criteria requires 2 or more of the following present for a significant portion of 1 month
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptoms
Poverty of thought or speech (mumble or vague response)
Alogia
Lack of energy
Anergia
Lack of pleasure or joy
Anhedonia
Lack of motivation in activities and hygiene
Avolition
Phase 1 of schizophrenia
Premorbid phase
Phase 2 of schizophrenia
Prodromal phase
Phase 3 of schizophrenia
Active psychotic phase
Phase 4 of schizophrenia
Residual phase
In this phase of schizophrenia either has no symptoms, or very mild ones. These occur before there isa clear sign of illness
Phase 1: Premorbid phase
In this phase of shizophrenia, signs of deterioration begin to show and it becomes apparent that an illness is present
Phase 2: Prodromal phase
In this phase of schizophrenia, there are acute positive and psychotic symptoms present
Phase 3: Active psychotic phase
This phase of schizophrenia usually follows the active phase and is characterized by flat affect, presence of negative symptoms, and symptoms from the active phase are barely present anymore
Phase 4: Residual phase
Clinical improvement in schizophrenia occurs in ___% of patients
44%
4 phases of a therapeutic relationship
Orientation
Identification
Exploitation
Resolution
Anticholinergic effects, EPS, NMS, orthostatic hypotension, burred vision, and photophobia are side effects of this class of medication
Antipsychotic medications
Life threatening emergency that can occur at any time while taking antipsychotics
Neuroleptic Malignant Syndrome
Sudden fever, BP fluctuations, Tachycardia, Muscle rigidity, and decreased LOC are s/s of ________
Neuroleptic Malignant Syndrome
Neurological condition that prevents a person from recognizing their own health problems or conditions
Anosognosia
Mild depressive disorder is called
Persistent Depressive Disorder
PDD is also known as
dysthymia
Mild manic expression is called
hypomania
Mild BPD is called
cyclothymia
Major Depressive Disorder is more common in ______
more common in females than males
DSM-5 criteria requires these two points in diagnosing PDD
- Chronically depressed mood lasting at least every day/all day for at least 2 years
-No evidence of mania/hypomania
Early onset of PDD is described as ______
a diagnosis occurring before age 21
Late onset of PDD is described as ______
Diagnosis occurring at age 21 or older
Single episode or recurrent episodes resulting in a significant change in a person’s normal functioning which occur almost every day for a minimum of 2 weeks
Major Depressive Disorder (MDD)
Diagnostic tool that is a 21-item self assessment of the usual characteristic behaviors and attitudes present in depression
Beck Depression Inventory
Diagnostic tool that is a 9-question self-administered assessment that patients fill out to determine the amount and frequency of depression symptoms
PHQ-9
Diagnostic tool that has a version with 17 items and another version with 21 items
Hamilton Depression Scale (HDRS, Ham-D)
Diagnostic tool used for older adults that has 15 yes/no questions
Geriatric depression scale
Diagnostic tool that has 5 questions (about mood, self confidence, speech, sleep, and activity) for the client to self-assess
Altman Self-Rating Mania Scale
Leading treatment for depression
SSRIs
A trained therapist empowers the client to change their behavior by recognizing thinking errors and changing their thinking
Cognitive Behavioral Therapy (CBT)
Use of magnetic pulses to stimulate focaal areas of the cerebral cortex
Transcranial Magnetic Stimulation (TMS)
A vagal nerve stimulator is implanted, through an outpatient procedure, in the left chest wall
Vagal nerve stimulation (VNS)
Electrodes are surgically placed deep into the brain to stimulate underactive regions (more intensive than VNS)
Deep Brain Stimulation (DBS)
Prior to electroconvulsive therapy, which class of medications should be d/c? Why?
Benzodiazapenes should be d/c because the goal is to induce a seizure
Prior to electroconvulsive therapy, the client will be NPO _____ to ______ hours
NPO 6-8 hours prior to treatment
During ECT, ____ ______ are induced by electrical current attached to one, or both, sides of the forehead
Brief seizures are induced during ECT
Potential side effect from ECT
Temporary memory loss
SES can occur within ____ after starting treatment or increasing the dose
SES can start within 2-72 hours
3 s/s of SES
Seizures
Fever
Hyperreflexia
Rapid, often exaggerated changes in mood
Labile moods
Abnormally elevated mood which can be described as expansive or irritable, usually requiring hospitalization. These last at least 1 week.
Manic episodes
A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania.
Hypomania
This requirement distinguishes mania from hypomania
Requirement of a hospitalization
Four or more episodes of hypomania or acute mania within 1 year and associated with increased recurrence rate and resistance to treatment
Rapid cycling
Rapid, continuous speech with sudden and frequent topic change
Flight of ideas
BPD where patient has experienced at least one episode of mania alternating with major depression
Bipolar 1 disorder
BPD where patient has had one or more hypomanic episodes alternating with major depressive episodes
Bipolar 2 disorder
Patient has had at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes
Cyclothymic disorder
During an acute manic episode, the focus is on _____ and _____ in nursing care
The focus is on safety and maintaining physical health
Medication used for BPD
Mood stabilizers - Lithium
Therapeutic procedure for BPD
Electroconvulsive Therapy (ECT)
3 mood stabilizing antiepileptics
(c, v, l)
Carbamazepine
Valproate
Lamotrigine
3 classes of medications used to treat BPD
Mood stabilizers
Antiepileptics
Antipsychotics
Maintenance level range of lithium
0.6-1.2 mEq/L
effects of lithium begin within ____ days
5-7 days
Maximum benefits of lithium may not be seen for _____
2-3 weeks
Due to its short half life, lithium must be administered in _____ doses daily
2-3 doses daily
During initial treatment of manic episodes, lithium levels may require to be at higher levels, at
1-1.5 mEq/L
Initial s/s of lithium toxicity can progress to these 5 more severe s/s
Seizures
Severe hypotension
Stupor (decreased LOC)
Coma
Death
Main initial s/s of lithium toxicity
Polyuria (frequent urination)
2 manic complications
Physical exhaustion and/or death
Main client teaching with mental illness
Medicinal treatment is lifelong
Asthma affects both the ____ and ____ tracts
Asthma affects both the upper and lower respiratory tracts
Asthma is _____ in nature
Asthma is acute in nature
4 main manifestations of asthma
Wheezing
Coughing
Chest tightness
Dyspnea
Most emergent finding during an asthma attack
Absent breath sounds
Example of bronchodilator
Albuterol
MOA albuterol
Stimulate SNS, relaxing smooth muscle, resulting in bronchodilation
2 side effects of albuterol
Tachycardia and tremors
Encourage _____ vaccine to prevent triggering asthma attacks
Encourage FLU VACCINE
Example of a corticosteroid inhaler for asthma
Fluticasone
Nursing consideration for using a corticosteroid inhaler (fluticasone) for asthma
Use an extender and rinse the mouth with water to avoid oral thrush
Treatment where patient shakes the device prior to use, breathes out through the mouth, inhales medication, holds breath for 10 seconds, and then exhales
Metered Dose Inhaler (MDI)
(Like the typical inhaler you see with asthma pt)
2 early signs of hypoxia
Confusion, altered LOC
Late sign of chronic hypoxia
Clubbing of fingers
First line of treatment for asthma
Bronchodilators (albuterol)
After the first line of treatment, this is the next resort of treatment
Systemic corticosteroid treatment (IV or oral)
How often can fluticasone be used, and what is its role in treating asthma?
Fluticasone can be used once daily and helps prevent attacks from happening
Excessive amounts of CO2 in the blood
Hypercapnia
An increase in these three vitals can indicate hypoxia and hypercapnia
Increased HR, RR, and BP
For a patient with asthma, the nurse should assess the lungs for these three sounds
Wheezing
Stridor
Dyspnea
For treatment of asthma, the nurse should prioritize these two things
Respiratory status and oxygenation
3 primary therapies when treating asthma
Oxygen administration
Short-acting B2 agonists (SABAs)
Systemic corticosteroids
Most severe form of asthma
Status Asthmaticus
What makes Status Asthmaticus hard to treat?
Condition does not respond to common treatments
Status Asthmaticus requires
Ventilatory support
Aside from bronchodilators, oxygen therapy, and steroid therapy used to treat asthma, Status Asthmaticus may also require these 2 additional treatments
Emergency Intubation
Epinephrine
COPD is an umbrella term covering these two conditions
Chronic Bronchitis
Emphysema
1 cause of emphysema
Smoking
Swelling of bronchioles and bronchi
Chronic bronchitis
Destruction of alveoli
Emphysema
Most clients who have emphysema also have _____
Chronic bronchitis
COPD is
Irreversible
This is characterized by the loss of lung elasticity hyperinflation of lung tissue, causing destruction of alveoli leading to decreased SA for gas exchange, CO2 retention, and respiratory acidosis
Emphysema
Inflammation of the bronchi and bronchioles due to chronic exposure to irritants
Chronic bronchitis
Pathologic changes in airways due to underlying comorbidities
COPD
Main risk factor for COPD
Smoking (1st, 2nd, or 3rd hand)
Early symptom of COPD
Productive cough in the morning
2 physical assessment findings indicating COPD
1) Chest tightness
2) Barrel chest/increased chest diameter (w emphysema)
2 labs/diagnostic studies for COPD
Spirometry
CAPTURE questionnaire
Barrel chest can further cause this complication
Right-sided heart failure
What is a main cause of barrel chest?
Air is unable to escape, so it gets trapped in the lungs
2 main techniques of nursing care for treatment of COPD
Pursed lip breathing technique
Postural drainage
This technique assists in prolonged exhalation and promotes elimination of carbon dioxide from the body
Pursed lip breathing technique
This technique uses gravitational assistance for secretion removal
Postural drainage
For someone with COPD, oxygen levels should be kept in this range
88-92%
Patients with COPD may need up to this much oxygen via NC, and this much with a venturi mask
2-4 L/min via NC
40% via venturi mask
COPD patients become
Hypercapnic (hold on to CO2)
Normal O2 levels for someone with COPD is
88-92%
How can hypoventilation occur for someone with COPD?
Hyperoxygenation (even within normal range for a healthy adult) can decrease the hypoxic stimulus to breathe
Carbohydrates break down into
CO2
3 dietary considerations for someone with COPD
1) Smaller, more frequent, high-calorie meals
2) Moderate amount of carbs
3) Soft foods
3 side effects with albuterol (3 T’s)
Tachycardia
Trouble sleeping
Tremors (nervousness)
3 side effects with Ipratropium (DDB)
Dry mouth
Dizziness
Blushing
3 side effects with Theophylline (3 P’s)
1) Poor sleep (restlessness)
2) Potty (diarrhea)
3) Pain (headache)
3 bronchodilators used for COPD (TIA)
Theophylline
Ipratropium
Albuterol
2 Anti-inflammatory medications used for COPD (P,M)
Prednisone (corticosteroid)
Montekulast (leukotriene antagonist)
Nursing consideration with prednisone
Take with food
3 side effects of prednisone
Hyperglycema
Hypokalemia
Fluid retention
2 side effects with montekulast
Fatigue
Headaches
2 kinds of pneumonia infections
Bacterial or viral
A gunky cough with pneumonia typically indicates this kind of infection
Bacterial infection
A dry cough with pneumonia typically indicates this kind of infection
Viral infection
Both bacterial and viral pneumonia infections bring on a
Fever
This type of pneumonia develops before 48 hours since admission
Community-acquired
This type of pneumonia develops after 48 hours since admission
Hospital-acquired
This type of pneumonia develops after patient breathes in liquid
Aspiration pneumonia
This type of pneumonia can develop when a patient had an endotracheal intubation placed more than 48 hours ago
Ventilator-associated
Increased incidence of pneumonia in ____
Older adults
two vacines that can help break the chain of pneumonia infection
Pneumococcal and flu
Adventitious lung sounds AKA
wet crackles in lungs
Cough, dyspnea, tachypnea, pleuritic chest pain, and adventitious lung sounds are all clinical presentations of
Pneumonia
2 labs/diagnostics for pneumonia
Chest X-Ray
CT scan (if CXR is normal)
Inflammation of the pleura that is triggered by chest movement when you breathe
Pleurisy
4 options for pneumonia treatments
1) Antibiotics
2) Bronchodilators
3) Steroid/Anti-inflammatory therapy
4) Oxygen therapy
Goal of oxygen therapy
O2 95%-100%
One thing to remember while using antibiotics to treat pneumonia
Obtain a sputum culture before starting broad-spectrum antibiotic
Respiratory disorder that causes mucus glands to secrete excessive amounts of thick mucus
Cystic fibrosis
CF is inherited from a mutated recessive gene, meaning in order for someone to inherit this, then ..
Both parents need to have the gene
This ethnicity has a higher risk for having CF
caucasians
Infants can be diagnosed with CF is they have developed a
meconium ileus (often the FIRST clinical manifestation)
Looking for these 2 things in a stool analysis for CF
Presence of fat and enzymes
High _____ and _____ are positive findings for CF in a sweat test
High sodium and chloride
Wheezing indicates
Upper airway restriction
Ronchi indicates
Lower airway restriction
Fatty stools AKA
Steatorrhea
this is given with all meals and snacks in dietary treatment for CF
Pancreatic enzymes to aid digestion
