Exam 3 Flashcards by Chloe Derks

normal beh v emotional problem

compare actions of child to others at same age and dev lvl
if actions persist, impair functioning, not age appropriate or deviate from cult. norms

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intellectual disability onset

prior to 18yrs
impairmnts in measured intellectual performance and adaptive skills

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general intellectual functioning

measured by clinical assessment and IQ test
*if pt has dec IQ and impaired daily functioning= DD

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adaptive functioning

ability to adapt to requir and expectations of age

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predisposing risks for Intell. dis- pregnancy

disruptions in embryonic dev
toxicity, maternal illness/infections (prolonged fever= fetal distress)
preg complications (dec O2)
premature birth

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predisposing risks for Intell. dis- medical conditions

acquired in infancy or childhood
trauma to head
poisonings (lead, insecticides)
infections (meningitis, encephalitis)

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predisposing risks for Intell. dis- sociocul

**preventable
neglect/lack of nurturing before age 1
environm w/ poor care and inadeq nutrition
no social stimulation

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intellectual disability and social disinhibition

overly friendly or very shy

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Autism spectrum disorder def

withdrawal into self and into fantasy world
occurs more in boys, onset early in childhood
“neurodivergent”

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predisposing factors ASD

brain structure abnormalities
medical conditions (maternal rubella)
genetics
perinatal (maternal asthma)

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s/s ASD

sensory alterations-
social dysfunction
easily overstim
avoid eye contact

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medication for ASD

risperidone and aripiprzole
2nd gen antipsychotics
trts irritability, depression, compulsive drive and overstim, temper tantrums

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Risperidone ae

drowsiness, sedated and somnolence, drooling, weight gain, fatigue

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aripiprazole (abilify) ae

sedation, somnolence

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risperidone and aripipzole serious ae

NMS
tardive dyskinesia
hyperglycemia
EPS
DM (measure ht, wt and and girth)

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types of ADHD

1- inattentive (more common in girls)
2- wiggly, impulsive, hyperactive
3- combined

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stimulant trtmnt for ADHD body v brain

body- vasoconstriction (inc bp)
activates SNS- dec appetite

pts usually sick, small and malnurished

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brain scans of ASD and ADHD

similar
alters dopamine pathways

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predisposing factors of ADHD-

genetics
biochemical
pregnancy factors
environment (dietary, lead)
social (chaotic family, maternal mental disorder, low SES, unstable foster care)

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s/s ADHD

cannot perform age-appropriate tasks
distractable
disruptive/intrusive
impulsive (accident-prone)
limited attention span
low tolerance= outburst

GOAL- promote safety

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ADHD- comorbi.

oppositional defiant disorder
conduct disorder
anxiety/depression
bipolar depression
substance use

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ADHD and trtmnt of comorbid

can trt anxiety and depression and adhd at same time
bipolar depression and substance use must be stabilized before targeting adhd
substance use can mask severity of adhd
too much stimulant can cause manic episode

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ADHD- CNS stim

methyls and amines
methyl- Ritalin
amine- Adderall

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CNS stim ae general

immune and cardiac suppressing

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cns stim drug holiday

used to eval effectiveness and help malnourished kids grow

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ADHD- Atomoxetine (strattera)

selective norepi reuptake inhib
NOT stimulant
monitor cardiovasc and liver

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atomoxetine (straterra) ae

n/v, weight loss, tachy, palpitations
r/f sudden death w/ pts w/ hx of cardiovasc dis.
monitor for manic episodes
report liver abnormal (dark urine, sore throat, fever)

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ADHD- bupropion (wellbutrin)

nonselective reuptake inhib
NOT stimulant
used to dec compulsive drive

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bupropion (wellbutrin) ae

tachy, n/v, wt loss, dec seizure threshold, dec appetite (don’t give to pts w/ hx eating disorder)

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ADHD- Clonidine

centrally acting alpha agonist
same effect as stim but different MOA
used for impulsivity

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clonidine ae

bradycardia, sedation
rebound syndrome if stopped abruptly

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stimulant implementation considerations

promote safety
give after meals to reduce anorexia
give at least 6hrs before bed- prevent insomnia
give 30 min before activities w/ food
has shrt half life and fast onset

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interaction btw stimulants and OTC meds

avoid otc (cough meds and Sudafed) stimulant toxicity- dec cardiovasc function

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tourette’s

inc stress/anxiety= inc freq tics
onset 6-7
more common in boys

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tourette’s predisposing factors- environm

neurologic trauma
low birth wt
encephalitis
preg complications
carbon monoxide

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tourettes s/s

complex motor tics (tapping, skipping, hopping)
simple motor tics (eye blinking, neck jerking)
vocal tics

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tourettes- palilalia v echolalia

palilalia- involu repetition of words or phrases
echolalia- rep. of vocalizations made by another person

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tourettes- trtmnt therapy

behavioral
individual psycho
family
occupational therapy (how to cope when tics happen)
** modify environment to dec anxiety

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tourettes- trtmnt meds- haloperidol and pimozide

haloperidol- use in kids w/ severe sympt that impair functioning

pimozide (Orap)
NOT use in kids < 12
only for severe cases

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tourettes- trtmnt meds- atypical antipsychotics

risperdal, zyprexa
ae- wt gain, hyperglycemia
ziprasidone (geodon)- QT prolonged

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tourettes- trtmnt meds- alpha agonists

clonidine, guanfacine
**first choice
contraindicated w/ pre-existing cardiac dis
vasdil- dec hr- dec anxiety- dec tics

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oppositional defiant disorder def

persistent angry mood
act diff than kids same age and dev level
interferes w/ daily functioning (throw things, run in the street)

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oppositional defiant disorder

stubborn
passive-aggressive beh
running away, temper tantrums, argumentative, test limits

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ODD- planning/implementation of care

encourage cooperation w/ therapy (model, lead by ex)
help pt accept responsibility for actions
promote inc self-worth
promote socially approp beh and interactions w/other (demonstrate)

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conduct disorder def

violate basic rights of others and age-approp social norms

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conduct disorder onset

childhood (attachmnt problem)
adolescent (trauma)

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conduct dis. predisposing factors

genetics, temperament, poor peer relationships, parental rejection, inconsistent management of harsh discipline, large family size, shifting of parental figures

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conduct dis. predisposing factors- parent specific

parents w/ antisocial dis, etoh dependence, marital conflict, parental permissiveness

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conduct dis s/s

physical aggression to violate rights of others (can incl sexual)
use of drugs/etoh
have low self esteem
mimic s/s adhd (inattentive, impulsive, hyperactive)
use projection
lack feelings of guilt

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conduct disorder in adults

not real diagnosis
dx w/ antisocial personality disorder

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predisposing factors for separation anxiety

stressful life events, parental overprotection, overattachment to mother
*rarely onset in adolescence or school age

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s/s separation anxiety

shadow, nightmares, refusal to attend school in adolescence, tantrums

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separation anxiety trtmnt

goal- comfort and distract
play therapy
occupational
group
family
behavior
psychopharmacology

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aging- memory

short term dec
long term should have no changes
inc time for memory scanning

mentally active ppl have less memory decline

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aging- mental illness

depression NOT normal

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aging- intellectual

NOT decline

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aging- learning

need longer time to learn and alterations in teaching methodology

ability to learn is unchanged (just may be less motivated)

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aging- grief

not normal
grief just so happens to be very common in the elderly due to inc death

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aging- self-identity

no change in self concept or self image

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factors that favor psychosocial adjustment later in life

sustained family relationships
absence of alcoholism
absence of depressive disorder

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aging- death anxiety

not real
only fear abandonment, pain and confusion

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elderly prestige

not common in american culture

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aging- sexual (social)

sexual expression by elderly is frowned upon

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aging- changes in women sexuality

dec estrogen, dryness, menopause, dec ovarian function

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aging- changes in men sexuality

dec testosterone, ED, dec testicular size,
sperm still viable

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aging- psychiatric disorders

delirium, dementia, depression, schizophrenia, anxiety, personality dis, sleep disturbances

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Delerium

reversible
rapid onset change in cognition and level of awareness

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cause of delirium

physiologic/metabolic (head trauma, stroke, electrolyte imbal)
infection (systemic or cerebral)
drug related (rxn or withdrawal)
anticholinergics, antihtn, corticosteroids, anticonvulsant, etoh, lead, carbon monoxide

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delirium s/s

distracted, disorganized thinking, irreg speech, impaired reasoning
hallucinations, impaired recent memory
restless or somnolent

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delirium hemodynamics

inc bp, inc hr, sweating, flushed face, dilated pupils

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delirium trtmnt

low stim environm
staff stay w/ pt at all times to reorient
correct underlying cause
antipsychotic to relieve agitation and aggression
benzodiazepine if r/t substance withdrawal

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dementia- types

alzheimers, vascular, lewy body and frontotemporal

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primary NCD v secondary NCD

primary
disorder is sign of organic brain disease not r/t any other illness

secondary
r/t another condition (ex. HIV)

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neurocog disorder s/s

impulsive, poor judgement
doesn’t follow social conduct rules
neglect hygiene
change in personality

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Temporary of reversible NCD- causes

metabolic disorder, nutritional deficiency, depression, med ae or stroke

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aphasia v apraxia

aphasia- lack of vol muscle mvmnt
apraxia- difficulty performing tasks when asked

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stages of alzheimers

4- mild to moderate cog decline (recommend admit to institution)
7- severe cognitive decline (bed bound)

Alzheimers causes

genetics
head trauma
acetylcholine alterations
plaques and tangles

vascular dementia causes

cause- cerebrovasc dis (htn, cerebral emboli, cerebral thrombosis)
abrupt onset

frontotemporal dementia causes

frontal and temporal regions shrink
idiopathic
“pick’s disease”

lewy body v alzhemiers

lewy body-progresses more rapidly
affects cerebral cortex and brainstem

NCD s/t parkinsons

loss of nerve cells is substantia nigra and dec dopamine activity

can have dopamine toxicity w/ certain meds
causes s/s that parallel parkinsons ncd
determine if actual dis or caused by med (carbidopa-levodopa)

NCD r/t huntington’s dis

mendelian dominant gene
usually onset later in life

medical conditions commonly associated w/ NCD

semi reversible
hypothyroidism
thiamine deficiency
MS
electrolyte imbal
hyperparathyroidism

meds for cognitive impairment

not curative
slow progression
donepezil (aricept)
acetylcholine inhibitor
n-methyl-d-aspartic acid receptor antagonist (prevent excessive Ca from entering cells and damaging it)

meds for irritation, hallucination, wandering, aggression

risperidone, olanzapine (zyprexa), quetiapine (seroquel)
geodon- NOT first line- prolongs QT, black box warning w/ elderly
haloperiodl- NOT first line- EPS, black box warning w/ elderly

aging- meds for depression

SSRI
Trazodone- good for insomnia
dopaminergic agent- Sinemet (carbidopa-levadopa)
trts apathy
** careful- can cause s/s that mimic NCD parkinsons

aging- meds for anxiety

benzos for short term trtmnt (can exacerb ataxic issues)
diazepam (valium) lorazepam (ativan)

meds for parkinsons

Sinemet (carbidopa levadopa)
glutamate mao-b inhib
and dopamine agonist

antipsychotics can induce parkinsons if effect wrong dopamine pathway

zyprexa and parkinsons

zyprexa function
second gen antipsychotic- reduce agitation

zyprexa has higher affinity to serotonin and dopamine receptors than natural dopamine
blocks receptor sites and causes loss of movement for up to two weeks

dopamine and mvmnt

need dopamine for mvmnt
parkinsons= low dopamine lvls

confabulation

behavioral rxn to memory loss
make up things that didn’t happen
used to maintain self esteem

kubler ross stages of grief

1- denial
2- anger
3- bargaining
4- depression
5- acceptance

john bowlby stages of grief

1- numbness/protest
2- disequilibrium
3- disorientation and despair
4- reorganization

george engel stages of grief

1- shock/disbelief
2- developing awareness
3- restitution
4- resolution of the loss
5- recovery

william worden stages of grief

models the idea that you learn to cope and move on for the better

1- accepting the reality
2- processing the pain
3- adjusting to a world w/o thing
4- finding enduring connection w/ lost person while starting new life

adults grieving v younger individuals

takes older adults longer
normal is ~ 6-8wks

resolution of grief

remember comfortably and realistically both pleasures and disappointments

maladaptive responses to loss

delayed grief- stuck in denial
distorted- exaggerated- cannot do ADLs- can be categorized as depression
prolonged grief- beh are aimed at keeping the lost loved one alive

normal grief v clinical depression

w/ normal grief self esteem in intact

developmental lvl understanding of death

birth-2- cannot experience feelings of loss
3-5- cannot tell btw fantasy and reality. think death is reversible
6-9- hard to perceive own death. regressive and aggressive rxns are normal
10-12- understand finality of death. anger, guilt and depression
adolescents- take longer to process. have BIG emotions. can act out

bereavement overload

can result in depression
takes elderly longer anyway
compilation of many deaths

filipino americans

wear black for 1 year after death

jewish

cremation prohibited
7 day shiva beginning w/ burial

dorothea dix

started campaign to est mental hospitals 1841

primary prevention

reducing incidence of mental health

targeting groups at risk and providing educational programs

ex. substance use in HS

secondary prevention

minimizing early s/s of mental illness

reducing duration/prevalence of illness

early id of problems and prompt trtmnt

ex. screening for depression

tertiary prevention

reducing residual effects assoc. w/ chronic mental illness

prevent complications of the dis, promotme individ maximum lvl of functioning

ex. IEP for ADHD or disability services

populations at risk for maturational crisis

adolescence, marriage, parents, midlife, retirement

adolescence Erickson stage

role confusion
seek autonomy/privacy (keep secrets from parents)

issues w/ control

midlife issues

age related physiological changes
relationships w/ aging parents and kids
“sandwich generation”

populations at risk for situational crisis

poverty
high rate of life change events (change body image, job, divorce, death of loved one, physical illness etc)
environ. conditions
trauma

relationship btw poverty and emotional illness

poverty causes emotional illness (stress)
but poverty does not cause mental illness

mental illness can lead to poverty

secondary prevention population examples

abuse of child
depression, anxiety or substance use in midlife
inadeq grieving in elderly

secondary prevention characteristics

exacerb of mental illness
occurs when crisis intervention at primary lvl fails
can be in or out pt

tertiary prevention characteristics

functional impairment that interferes w/ job
ppl feel like they don’t belong
can be assoc. w/ suicide plan/attempt

new freedom commission barriers to care

gaps in care for children and adults w/ serious mental illness
high unemployment for mentally ill
suicide prevention not national priority

examples of tertiary prevention

community mental health centers
program of assertive community treatment
group homes

mental illness and homelessness

often go hand in hand
link to paranoia

contributing factors for homelessness

deinstitutionalization
poverty
scarcity of affordable housing
lack health care
domestic violence
addiction

common health issues w/ homeless

alcoholism
thermoregulation
tuberculosis
dietary deficiencies
STD (HIV 3.4% compared to normal pop w/ 0.4%)

mindfulness v meditation

mindfulness- paying attention to present moment- engage 5 senses
leads to meditation

meditation- can allow someone to be more mindful

benefits of mindfulness

enhance brain regions responsible for attention and exec fun

modulates amygdala
inc attention
alters experience of pain, dec HR, improves focus/cognition

mindfulness in nurses

help ppl cope- reduce r/f burnout and stress

enhances communication, performance and assessment skills

surface culture v deep culture

surface- fashion, holidays, language
deep- military, body language, roles r/t sex, class
attitudes towards elderly, approaches to marriage
courtesy and manners

military culture v civilian culture

military- job describes your identity. Unit is always the priority

civilian- emphasis on self reliance and individual. a job what what people do, not who they are

T/F veterans suffer disproprotionately from PTSD

false
they are at a higher risk, but does not mean that all veterans are guaranteed to dev PTSD

MMSE

mini mental state examination

evaluates mental capacity

mental capacity v mental competency

judges decide mental competency

psych exam decides mental capacity

NOT THE SAME

MMSE test scoring

0-17 severe cog impairment

T/F mental capacity screeners are diagnostic

nurses can perform tests
Dr. have to assess more than one test to diagnose mental illness

involuntary hold

pt is admitted through ED
held for 72hrs

activated if pt is imminent danger to self or others (society)

usually pt’s held until done withdrawing or detoxing “metabolize to freedom”

substances common for inducing psychosis

psychedelics (LSD)
synthetic marijuana

sexuality- developmental trends

inc adolescents in premarital sex
premarital sex in girls inc

avg age for first intercourse has DEC

freq/prevalence of STD dec (sex ed/condoms)

stages of sexual dysfunction

desire
excitement
orgasm
resolution

diagnosis for sexual stages 1-2

female sexual interest/arousal disorder (trted w/ testosterone therapy) (1/2)

male hypoactive sexual desire disorder (1/2)
erectile dysfunction (2)

diagnosis for sexual stages 3-4

female orgasmic disorder (3)

delayed or early ejaculation (3)

general diagnosis for sexual stages

genito-pelvic pain dis
substance induced sexual dysfunction

sexual desire disorder- causes

hormonal (prolactin) or medication/substance related

high prolactin in males- low sex drive/gynecomastia

high prolactin females- high sex drive

sexual arousal and orgasmic disorder causes

physiologic (menopause, atherosclerosis)

psychosocial (trauma)

paraphiliac disorder

sexual fantasies involve
nonhuman objects
suffering and humiliation
non consenting persons/animals

beh occur repeatedly over 6+ mo and impair function (ex. avoid social activities)

exhibionistic disorder

typically by men towards women
sexualized things infront of others or expose themselves

fetishistic disorder

objects

frotteuristic disorder

non consenting, public place

sexual masochism disorder

crave pain

sexual sadism disorder

suffering of others of themselves

voyeuristic disorder

watching others who are not aware (peeping tom)

considerations when diagnosing sexual disorder

r/o psychosis and trauma

QSEN

quality and safety education in nursing

pt-centered care requirement

erectile dysfunction trtmnt meds

stage 2 men
stage 2-3 wmn
viagra, cialis, phosphodiesterase 5 inhib

phosphodiesterase 5 inhib - AE

flushing, ha, congestion, blurred vision, gi upset, sudden blindness/deafness when used with nitrate

medication class assoc w/ erectile dysfunction

beta blockers

priapism causes- medication/drug induced

non-ischemic

psychotropics (antidep, antipsychotic, trazadone)
zoloft, risperidone, concerta, warfarin

alcohol, cocaine

priapsim causes- physiologic

ischemia

blood flow is obstructed- requires sx

gout, amyloidosis, sickle cell dis, toxic bites

priapism trtmnt

sx if ischemic (decompression)

phenylephrine IM/PO (shrinks blood vessels)

gender

male or female

gender dysphoria

dissonance btw assigned gender and experienced/internalized gender
75% male wish to be female

cause of gender dysphoria

no identified
NOT related to sexual identity (who attracted to)

goals in trtmnt of gender dysphoria

inc peer support/acceptance
trting co-occuring mental health issues
reducing likelihood of gender dysphoria in adulthood

client will demonstrate beh that is appropriate / culturally acceptable for assigned gender (will eval is someone is legit or just enjoys aspects of the other gender (ex. playing football)

absolute positive regard

interventions for gender changes

focus on positive aspects, inc self esteem, id behaviors they want to change

gender re defined definitions

cisgender (normal)
gender fluid (drag queen)
gender binary (concerete diff btw genders)
pangender (in btw) (if not one, doesn’t mean automatically the other)

gonorrhea transmission

sex, oral, hand touched infected secretions and placed in contact w/ muc mem

gonorrhea s/s

men- dysuria, purulent drainage, pharyngitis

women- initially ASYMPTOMATIC
infection of cervix, urethra and fallopian tubes

gonorrhea trtmnt

combo therapy
ceftrixone and azithromycin or doxycycline

gonorrhea complications

men- sterility
women- blindness, ectopic preg, infertility, chronic pelvic inflamm dis

syphilis transmission

sex, muc mem contact or abraded skin

syphilis s/s of stages

primary- painless lesion on body part that came into contact w/ fluid (penis, mouth, anus)

secondary- rash, ha, wt loss, fever, body aches, fever

syphilis trtmnt

long acting penicillin, and erythromycin

syphilis complications

latent- can be passed onto fetus
no s/s

tertiary- blind, heart dis, lesions

chlamydia transmission

sex and muc mem contact
most common

chlamydia s/s

men- urethral discharge and dysuria

wmn- asymptomatic or bleeding, soreness, dysuria, discharge

chlamydia trtmnt

erythromyacin

chlamydia complications

scarring of fallopian tubes, ectopic preg, infertility

genital herpes trmnt

no cure
acyclovir

genital warts s/s

cauliflower like warts

genital warts trtmnt

surgical removal
cryotherapy
podophyilin

genital warts complications

r/f cervical cancer

hep B transmission

muc mem, sex, blood

hep b s/s

n/v, fever, ha, RU quad pain, jaundice

hep b trtmnt

none
bedrest

aids transmission

body fluids, sharing needles
open skin sores
transfusion w/ contaminated blood
perinatal - breast milk

AIDS s/s

ASYMPT for up to 10 yrs after infection

early signs- wt loss, fever, night sweats, persistant infections

AIDs trtmnt

no cure
trt opportunistic infections
Truvada (PrEP) preventative for high risk populations w/in 72 hrs

AIDS complications

fatal

anorexia nervosa v bulimia nervos

anorexia- starve themselves

bulimia- binge and purge (vomit, laxative, diuretic, enema)
r/f mood and anxiety disorders

eating disorder trtmnt

behavior mod, individual psychothearpy, cbt, family trtmnt (maudsley approach)
psychopharmacology (SSRI)

refeeding syndrome

complications w/ eating disorder trtmnt
s/s- hypophosphatemia, hypokalemia, hypocalcemia, hypomagnesemia

ae- arrhythmias, cardiovasc collapse, delirium

ae of amphetamines to supress appetite

tolerance

fundamental concept of maudsley approach for eating disorder

pt family should be involved in each phase of treatment

hemodynamics of anorexia nervosa

bradycardia, hypotension, hypothermia

physical s/s of bulimia

enlarged parotid glands (overstimulated and produce more saliva bc of freq vomiting)
tooth decay
laxative use
normal wt

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Exam 3 Flashcards

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