Exam 3 Flashcards
1
Q
normal beh v emotional problem
A
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
2
Q
intellectual disability onset
A
prior to 18yrs
impairmnts in measured intellectual performance and adaptive skills
3
Q
general intellectual functioning
A
measured by clinical assessment and IQ test
*if pt has dec IQ and impaired daily functioning= DD
4
Q
adaptive functioning
A
ability to adapt to requir and expectations of age
5
Q
predisposing risks for Intell. dis- pregnancy
A
disruptions in embryonic dev
toxicity, maternal illness/infections (prolonged fever= fetal distress)
preg complications (dec O2)
premature birth
6
Q
predisposing risks for Intell. dis- medical conditions
A
acquired in infancy or childhood
trauma to head
poisonings (lead, insecticides)
infections (meningitis, encephalitis)
7
Q
predisposing risks for Intell. dis- sociocul
A
**preventable
neglect/lack of nurturing before age 1
environm w/ poor care and inadeq nutrition
no social stimulation
8
Q
intellectual disability and social disinhibition
A
overly friendly or very shy
9
Q
Autism spectrum disorder def
A
withdrawal into self and into fantasy world
occurs more in boys, onset early in childhood
“neurodivergent”
10
Q
predisposing factors ASD
A
brain structure abnormalities
medical conditions (maternal rubella)
genetics
perinatal (maternal asthma)
11
Q
s/s ASD
A
sensory alterations-
social dysfunction
easily overstim
avoid eye contact
12
Q
medication for ASD
A
risperidone and aripiprzole
2nd gen antipsychotics
trts irritability, depression, compulsive drive and overstim, temper tantrums
13
Q
Risperidone ae
A
drowsiness, sedated and somnolence, drooling, weight gain, fatigue
14
Q
aripiprazole (abilify) ae
A
sedation, somnolence
15
Q
risperidone and aripipzole serious ae
A
NMS
tardive dyskinesia
hyperglycemia
EPS
DM (measure ht, wt and and girth)
16
Q
types of ADHD
A
1- inattentive (more common in girls)
2- wiggly, impulsive, hyperactive
3- combined
17
Q
stimulant trtmnt for ADHD body v brain
A
body- vasoconstriction (inc bp)
activates SNS- dec appetite
pts usually sick, small and malnurished
18
Q
brain scans of ASD and ADHD
A
similar
alters dopamine pathways
19
Q
predisposing factors of ADHD-
A
genetics
biochemical
pregnancy factors
environment (dietary, lead)
social (chaotic family, maternal mental disorder, low SES, unstable foster care)
20
Q
s/s ADHD
A
cannot perform age-appropriate tasks
distractable
disruptive/intrusive
impulsive (accident-prone)
limited attention span
low tolerance= outburst
GOAL- promote safety
21
Q
ADHD- comorbi.
A
oppositional defiant disorder
conduct disorder
anxiety/depression
bipolar depression
substance use
22
Q
ADHD and trtmnt of comorbid
A
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
23
Q
ADHD- CNS stim
A
methyls and amines
methyl- Ritalin
amine- Adderall
24
Q
CNS stim ae general
A
immune and cardiac suppressing
25
cns stim drug holiday
used to eval effectiveness and help malnourished kids grow
26
ADHD- Atomoxetine (strattera)
selective norepi reuptake inhib
NOT stimulant
monitor cardiovasc and liver
27
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)
28
ADHD- bupropion (wellbutrin)
nonselective reuptake inhib
NOT stimulant
used to dec compulsive drive
29
bupropion (wellbutrin) ae
tachy, n/v, wt loss, dec seizure threshold, dec appetite (don't give to pts w/ hx eating disorder)
30
ADHD- Clonidine
centrally acting alpha agonist
same effect as stim but different MOA
used for impulsivity
31
clonidine ae
bradycardia, sedation
rebound syndrome if stopped abruptly
32
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
33
interaction btw stimulants and OTC meds
avoid otc (cough meds and Sudafed) stimulant toxicity- dec cardiovasc function
34
tourette's
inc stress/anxiety= inc freq tics
onset 6-7
more common in boys
35
tourette's predisposing factors- environm
neurologic trauma
low birth wt
encephalitis
preg complications
carbon monoxide
36
tourettes s/s
complex motor tics (tapping, skipping, hopping)
simple motor tics (eye blinking, neck jerking)
vocal tics
37
tourettes- palilalia v echolalia
palilalia- involu repetition of words or phrases
echolalia- rep. of vocalizations made by another person
38
tourettes- trtmnt therapy
behavioral
individual psycho
family
occupational therapy (how to cope when tics happen)
** modify environment to dec anxiety
39
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
40
tourettes- trtmnt meds- atypical antipsychotics
risperdal, zyprexa
ae- wt gain, hyperglycemia
ziprasidone (geodon)- QT prolonged
41
tourettes- trtmnt meds- alpha agonists
clonidine, guanfacine
**first choice
contraindicated w/ pre-existing cardiac dis
vasdil- dec hr- dec anxiety- dec tics
42
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)
43
oppositional defiant disorder
stubborn
passive-aggressive beh
running away, temper tantrums, argumentative, test limits
44
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)
45
conduct disorder def
violate basic rights of others and age-approp social norms
46
conduct disorder onset
childhood (attachmnt problem)
adolescent (trauma)
47
conduct dis. predisposing factors
genetics, temperament, poor peer relationships, parental rejection, inconsistent management of harsh discipline, large family size, shifting of parental figures
48
conduct dis. predisposing factors- parent specific
parents w/ antisocial dis, etoh dependence, marital conflict, parental permissiveness
49
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
50
conduct disorder in adults
not real diagnosis
dx w/ antisocial personality disorder
51
predisposing factors for separation anxiety
stressful life events, parental overprotection, overattachment to mother
*rarely onset in adolescence or school age
52
s/s separation anxiety
shadow, nightmares, refusal to attend school in adolescence, tantrums
53
separation anxiety trtmnt
goal- comfort and distract
play therapy
occupational
group
family
behavior
psychopharmacology
54
aging- memory
short term dec
long term should have no changes
inc time for memory scanning
mentally active ppl have less memory decline
55
aging- mental illness
depression NOT normal
56
aging- intellectual
NOT decline
57
aging- learning
need longer time to learn and alterations in teaching methodology
ability to learn is unchanged (just may be less motivated)
58
aging- grief
not normal
grief just so happens to be very common in the elderly due to inc death
59
aging- self-identity
no change in self concept or self image
60
factors that favor psychosocial adjustment later in life
sustained family relationships
absence of alcoholism
absence of depressive disorder
61
aging- death anxiety
not real
only fear abandonment, pain and confusion
62
elderly prestige
not common in american culture
63
aging- sexual (social)
sexual expression by elderly is frowned upon
64
aging- changes in women sexuality
dec estrogen, dryness, menopause, dec ovarian function
65
aging- changes in men sexuality
dec testosterone, ED, dec testicular size,
sperm still viable
66
aging- psychiatric disorders
delirium, dementia, depression, schizophrenia, anxiety, personality dis, sleep disturbances
67
Delerium
reversible
rapid onset change in cognition and level of awareness
68
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
69
delirium s/s
distracted, disorganized thinking, irreg speech, impaired reasoning
hallucinations, impaired recent memory
restless or somnolent
70
delirium hemodynamics
inc bp, inc hr, sweating, flushed face, dilated pupils
71
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
72
dementia- types
alzheimers, vascular, lewy body and frontotemporal
73
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)
74
neurocog disorder s/s
impulsive, poor judgement
doesn't follow social conduct rules
neglect hygiene
change in personality
75
Temporary of reversible NCD- causes
metabolic disorder, nutritional deficiency, depression, med ae or stroke
76
aphasia v apraxia
aphasia- lack of vol muscle mvmnt
apraxia- difficulty performing tasks when asked
77
stages of alzheimers
4- mild to moderate cog decline (recommend admit to institution)
7- severe cognitive decline (bed bound)
78
Alzheimers causes
genetics
head trauma
acetylcholine alterations
plaques and tangles
79
vascular dementia causes
cause- cerebrovasc dis (htn, cerebral emboli, cerebral thrombosis)
abrupt onset
80
frontotemporal dementia causes
frontal and temporal regions shrink
idiopathic
"pick's disease"
81
lewy body v alzhemiers
lewy body-progresses more rapidly
affects cerebral cortex and brainstem
82
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)
83
NCD r/t huntington's dis
mendelian dominant gene
usually onset later in life
84
medical conditions commonly associated w/ NCD
semi reversible
hypothyroidism
thiamine deficiency
MS
electrolyte imbal
hyperparathyroidism
85
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)
86
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
87
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
88
aging- meds for anxiety
benzos for short term trtmnt (can exacerb ataxic issues)
diazepam (valium) lorazepam (ativan)
89
meds for parkinsons
Sinemet (carbidopa levadopa)
glutamate mao-b inhib
and dopamine agonist
antipsychotics can induce parkinsons if effect wrong dopamine pathway
90
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
91
dopamine and mvmnt
need dopamine for mvmnt
parkinsons= low dopamine lvls
92
confabulation
behavioral rxn to memory loss
make up things that didn't happen
used to maintain self esteem
93
kubler ross stages of grief
1- denial
2- anger
3- bargaining
4- depression
5- acceptance
94
john bowlby stages of grief
1- numbness/protest
2- disequilibrium
3- disorientation and despair
4- reorganization
95
george engel stages of grief
1- shock/disbelief
2- developing awareness
3- restitution
4- resolution of the loss
5- recovery
96
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
97
adults grieving v younger individuals
takes older adults longer
normal is ~ 6-8wks
98
resolution of grief
remember comfortably and realistically both pleasures and disappointments
99
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
100
normal grief v clinical depression
w/ normal grief self esteem in intact
101
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
102
bereavement overload
can result in depression
takes elderly longer anyway
compilation of many deaths
103
filipino americans
wear black for 1 year after death
104
jewish
cremation prohibited
7 day shiva beginning w/ burial
105
dorothea dix
started campaign to est mental hospitals 1841
106
primary prevention
reducing incidence of mental health
targeting groups at risk and providing educational programs
ex. substance use in HS
107
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
108
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
109
populations at risk for maturational crisis
adolescence, marriage, parents, midlife, retirement
110
adolescence Erickson stage
role confusion
seek autonomy/privacy (keep secrets from parents)
issues w/ control
111
midlife issues
age related physiological changes
relationships w/ aging parents and kids
"sandwich generation"
112
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
113
relationship btw poverty and emotional illness
poverty causes emotional illness (stress)
but poverty does not cause mental illness
mental illness can lead to poverty
114
secondary prevention population examples
abuse of child
depression, anxiety or substance use in midlife
inadeq grieving in elderly
115
secondary prevention characteristics
exacerb of mental illness
occurs when crisis intervention at primary lvl fails
can be in or out pt
116
tertiary prevention characteristics
functional impairment that interferes w/ job
ppl feel like they don't belong
can be assoc. w/ suicide plan/attempt
117
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
118
examples of tertiary prevention
community mental health centers
program of assertive community treatment
group homes
119
mental illness and homelessness
often go hand in hand
link to paranoia
120
contributing factors for homelessness
deinstitutionalization
poverty
scarcity of affordable housing
lack health care
domestic violence
addiction
121
common health issues w/ homeless
alcoholism
thermoregulation
tuberculosis
dietary deficiencies
STD (HIV 3.4% compared to normal pop w/ 0.4%)
122
mindfulness v meditation
mindfulness- paying attention to present moment- engage 5 senses
leads to meditation
meditation- can allow someone to be more mindful
123
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
124
mindfulness in nurses
help ppl cope- reduce r/f burnout and stress
enhances communication, performance and assessment skills
125
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
126
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
127
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
128
MMSE
mini mental state examination
evaluates mental capacity
129
mental capacity v mental competency
judges decide mental competency
psych exam decides mental capacity
NOT THE SAME
130
MMSE test scoring
0-17 severe cog impairment
131
T/F mental capacity screeners are diagnostic
NO
nurses can perform tests
Dr. have to assess more than one test to diagnose mental illness
132
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"
133
substances common for inducing psychosis
psychedelics (LSD)
synthetic marijuana
134
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)
135
stages of sexual dysfunction
1. desire
2. excitement
3. orgasm
4. resolution
136
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)
137
diagnosis for sexual stages 3-4
female orgasmic disorder (3)
delayed or early ejaculation (3)
138
general diagnosis for sexual stages
genito-pelvic pain dis
substance induced sexual dysfunction
139
sexual desire disorder- causes
hormonal (prolactin) or medication/substance related
high prolactin in males- low sex drive/gynecomastia
high prolactin females- high sex drive
140
sexual arousal and orgasmic disorder causes
physiologic (menopause, atherosclerosis)
psychosocial (trauma)
141
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)
142
exhibionistic disorder
typically by men towards women
sexualized things infront of others or expose themselves
143
fetishistic disorder
objects
144
frotteuristic disorder
non consenting, public place
145
sexual masochism disorder
crave pain
146
sexual sadism disorder
suffering of others of themselves
147
voyeuristic disorder
watching others who are not aware (peeping tom)
148
considerations when diagnosing sexual disorder
r/o psychosis and trauma
149
QSEN
quality and safety education in nursing
pt-centered care requirement
150
erectile dysfunction trtmnt meds
stage 2 men
stage 2-3 wmn
viagra, cialis, phosphodiesterase 5 inhib
151
phosphodiesterase 5 inhib - AE
flushing, ha, congestion, blurred vision, gi upset, sudden blindness/deafness when used with nitrate
152
medication class assoc w/ erectile dysfunction
beta blockers
153
priapism causes- medication/drug induced
non-ischemic
psychotropics (antidep, antipsychotic, trazadone)
zoloft, risperidone, concerta, warfarin
alcohol, cocaine
154
priapsim causes- physiologic
ischemia
blood flow is obstructed- requires sx
gout, amyloidosis, sickle cell dis, toxic bites
155
priapism trtmnt
sx if ischemic (decompression)
phenylephrine IM/PO (shrinks blood vessels)
156
gender
male or female
157
gender dysphoria
dissonance btw assigned gender and experienced/internalized gender
75% male wish to be female
158
cause of gender dysphoria
no identified
NOT related to sexual identity (who attracted to)
159
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)
160
absolute positive regard
interventions for gender changes
focus on positive aspects, inc self esteem, id behaviors they want to change
161
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)
162
gonorrhea transmission
sex, oral, hand touched infected secretions and placed in contact w/ muc mem
163
gonorrhea s/s
men- dysuria, purulent drainage, pharyngitis
women- initially ASYMPTOMATIC
infection of cervix, urethra and fallopian tubes
164
gonorrhea trtmnt
combo therapy
ceftrixone and azithromycin or doxycycline
165
gonorrhea complications
men- sterility
women- blindness, ectopic preg, infertility, chronic pelvic inflamm dis
166
syphilis transmission
sex, muc mem contact or abraded skin
167
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
168
syphilis trtmnt
long acting penicillin, and erythromycin
169
syphilis complications
latent- can be passed onto fetus
no s/s
tertiary- blind, heart dis, lesions
170
chlamydia transmission
sex and muc mem contact
most common
171
chlamydia s/s
men- urethral discharge and dysuria
wmn- asymptomatic or bleeding, soreness, dysuria, discharge
172
chlamydia trtmnt
erythromyacin
173
chlamydia complications
scarring of fallopian tubes, ectopic preg, infertility
174
genital herpes trmnt
no cure
acyclovir
175
genital warts s/s
cauliflower like warts
176
genital warts trtmnt
surgical removal
cryotherapy
podophyilin
177
genital warts complications
r/f cervical cancer
178
hep B transmission
muc mem, sex, blood
179
hep b s/s
n/v, fever, ha, RU quad pain, jaundice
180
hep b trtmnt
none
bedrest
181
aids transmission
body fluids, sharing needles
open skin sores
transfusion w/ contaminated blood
perinatal - breast milk
182
AIDS s/s
ASYMPT for up to 10 yrs after infection
early signs- wt loss, fever, night sweats, persistant infections
183
AIDs trtmnt
no cure
trt opportunistic infections
Truvada (PrEP) preventative for high risk populations w/in 72 hrs
184
AIDS complications
fatal
185
anorexia nervosa v bulimia nervos
anorexia- starve themselves
bulimia- binge and purge (vomit, laxative, diuretic, enema)
r/f mood and anxiety disorders
186
eating disorder trtmnt
behavior mod, individual psychothearpy, cbt, family trtmnt (maudsley approach)
psychopharmacology (SSRI)
187
refeeding syndrome
complications w/ eating disorder trtmnt
s/s- hypophosphatemia, hypokalemia, hypocalcemia, hypomagnesemia
ae- arrhythmias, cardiovasc collapse, delirium
188
ae of amphetamines to supress appetite
tolerance
189
fundamental concept of maudsley approach for eating disorder
pt family should be involved in each phase of treatment
190
hemodynamics of anorexia nervosa
bradycardia, hypotension, hypothermia
191
physical s/s of bulimia
enlarged parotid glands (overstimulated and produce more saliva bc of freq vomiting)
tooth decay
laxative use
normal wt
