Exam #3 REVIEW

Question 1

Delirium

Answer 1

-Impaired neuro cognitive function due to underlying physiological condition. S/S agitation, ALOC, acute moments of lucidity, hallucinations.

Question 2

Dementia

Answer 2

-Neurodegenerative disease. Loss of executive functioning, memory.
-E: Genetics, trauma, substance abuse.
-A: mini mental health exam
-T: pet or ct. Respite care, home health.

Question 3

Which medication for Alzheimer’s are Cholinseterase inhibitors and which are NMDA?

Answer 3

AD Tx:
-Cholinesterase inhibitor:
Donezepil 5 mg-23 mg
Galantamine 4 mg-24
-NMDA:
Memantine 5 mg-20 mg

Question 4

Dissociative Identity Disorder and Dissociative fugue

Answer 4

-DID, or multiple personality disorder: Person has two or more personalities that typically aren’t aware of one another. part of person’s consciousness is turned off as coping mechanism from trauma.
-Dissociative fugue: when something incredibility traumatic happens, and a person switches into another person. They move away from current location and start a new life, and sometimes they wake up, sometimes they don’t.

Question 5

What is Therapeutic Alliance

Answer 5

When patient and nurse create mutually agreed upon goal.

Question 6

positive and negative symptoms of Schizophrenia

Answer 6

Positive Symptoms

Thought: thought blocking, insertion, deletion, and magical thinking.

Speech
-Clang associations
-Associative looseness***:
-Echolia: like myth abt Echo
-Neologism: make new words
-Tangential speech:, or “tangents”. Person keeps digressing from original topic.
-Pressured speech
-Cognitive retardation: slow speech
-Flight of ideas: jump from one thought to another. Like flight pit stops.

Behavior !!
-Catatonia
-Motor retardation: slow movement
-Posturing, gesturing: faces and posture that don’t match situation.
-Echopraxia: copy person’s movements.
-Motor agitation: increased response to external stimuli, irritability
-Stereotyped behaviors: antsy, pacing
-Impaired impulse control
-Negativism: resistance to requests.
-Boundary impairment: everything near person is theirs.

Perception
-Hallucination
-Delusion
-Derealization
-Depersonalization: out of body experience

Negative Symptoms
-Apraxia: lack of purposeful movement
-Alogia: lack of speech
-Ahedonia: lacks pleasure from life. “Hed” will to live.
-Avolition: volition, decision. Can’t make decisions
- Asociality
-Affective blunting. **Beware! depression w negative affect.
-Apathy

Question 7

Side effects of antipsychotic medication first generation and second generation: REVIEW LIST OF ANTIPSYCHOTIC MEDICATIONS FROM CLASS

Answer 7

First Gen SE: EPS, or Extrapyramidal SE. Righty, tremors, dystonias (involuntary muscle contractions), bradykinesia (slow moving)
Second gen: less SE. Metabolic syndrome. , wt gain, high blood sugars, dry mouth!!!, sedation and dizziness.
**REVEIW LIST

Question 8

Tardive Dyskinesia, which antipsychotics help both positive and negative symptoms. Which ones cause anticholinergic symptoms? Also review antidepressants, what side effects?

Answer 8

-Tardive dyskinesia: involuntary jerking of the face, neck, and limbs.
-2nd Gen help both pos and neg symptoms. 3 rd gen kinda.
-TCA antipsychotics cause anticholinergic symptoms. What else??? Second Gen (Clozapine) dry mouth.
-Antidepressants: GIST 1) slow taper on/off 2) initially high risk of suicide 3) DON’T MIX 4) education on SE of wt changes, decreased BP
SSRIs: fluxottenine, citalopram, escitalopram, sertraline
SNRI: duloxetine
TCA: imipramine, amytripline
MAOIs: phenyline
[REVIEW MED LIST]!!!

Question 9

What is a behavioral crisis (when behavior is out of control and person becomes a danger to himself or others).

Answer 9

-Behavorial outburst. An angry outburst. Emotional dysregulation.
-out of control being when they threaten to hurt others or themself
-SSRIS, antipsychotic? mood stabilizers

Question 10

Symptoms of PTSD?

Answer 10

-Easily frightened
-Self-destructive behaviors
-Trouble sleeping/concentrating
-Overwhelming guilt/shame
-Flashbacks
-Intrusive thoughts
-Nightmares
-Triggers for trauma
-Memory loss
-Self isolation

Question 11

Involuntary hospital admissions/why?

Answer 11

-Reasons: person is risk to others or self. Are unable to meet basic needs: food shelter, water, ADLs.

Question 12

Most important about restraint use: least restrictive

Answer 12

Go from least to most restrictive. Least Ex. being talking abt problem, to Most: ex.restraints.

Question 13

When would you use Haldol? Deescalate maybe?

Answer 13

-Haloperidol is a 1st gen antipsych. It may be used for aggression in schizophrenia or behavioral crisis.!!!!!!!!!!!!!!!!!

Question 14

Therapies: Desensitization, Cognitive behavior therapy

Answer 14

-Densensitzation: prolonged exposure to stressor in controlled environment. Allows body to become used to “threat”, and realize it’s no longer a threat.
-Cognitive Behavioral therapy: rewriting your thoughts. Identity negative/ unnerving lines of thought and replacing them with more useful, productive ones.

Question 15

Review Tourette’s

Answer 15

Tourettes: one+ vocal and motor tics that last for over 1 year. Tics include jerking heading, torso, arms, necks. Shouting.

Question 16

personality disorders: some specific traits especially antisocial

Answer 16

-Antisocial: called sociopaths a lot. Disregard for others. Don’t have a problem with violating people’s rights. Starts in adolescents. Antagonistic. Love to exploit people for personal motives. Risk taking behaviors- robbing, bullying, drinking and driving. Hard to detect: usually charming, people gravitate to them, good manipulator. Usually sex offenders, serial killers.
[SEE ATI or NOTES]

Question 17

Review Autism and interventions. Any medications?

Answer 17

-Autism: delayed neurodevelopment. Congenital defect common ex. Down’s syndrome. Characterisitcs: stick to routine; don’t like changes from it. Socially awkward, don’t play w others as child. May hyper fixate. Tx ABA, school special needs, and family education,
-Meds: SSRIS, TCA, anti-psych ripsperdol for aggression. Secondary ADHD symptoms get stimulants. Anxiolytics. Anticonvulsants.

Question 18

Review ADHD and interventions. Any medications?

Answer 18

-ADHD: inattention, impulsivity, and hyperacitivity. Easily distracted, random yelling, bored easily. genetic
-Meds:
Stimulants- methylpheneline, or Ritalin. Adderall XR, or amphetamine. Mixed amphetamine salts. pharm: dopamine and norepi.
SE: anorexia, dry mouth, insomnia.
Nonstimulants: atomoxetine, guanfacine, Clonidine; non-bezo; 0.1 -0.6 mg

Question 19

Review acute mania symptoms, which medication goes with Lithium to rapidly bring someone down? Olanzapine

Answer 19

-Acute Mania S/S: alterations in perception, cognition,a nd reality. Pressured speech.
-Med tx: olanzepine (atypical antipsych) and lithium

Question 20

Review depression signs and symptoms and SSRI’s and side effects

Answer 20

-S/S of Depression: slow speech, flat affect, anhedonia - loss of pleasure in life.
-SSRIs: fluxotenine, citalopram, esciptopram, sertraline. SE: sexual dysfunction, increased suicidal ideation (a r 18-24 yo)

Question 21

Importance of debriefing staff after a suicide. Review Suicide assessment

Answer 21

-Important to self assess during, before, and after traumatic experience. Address emotion, refer to therapist/group therapy.
-Suicide assessment: “do you thoughts about harming yourself or others?” hx of suicidal ideation. Means of execution, access to means. Co morbidities - BPD and Impulsive disorder (including ADHD) make person more vulnerable to dangerous behaviors.

Question 22

Regarding Substance use disorders: important to know that Naltrexone is the only medication used to treat both Alcohol use disorder and opioid disorder.

Question 23

Know the difference between Anorexia nervosa and Bulimia nervosa, and
What personality disorder is often associated with Anorexia nervosa?

Answer 23

-Anoxeria nervosa: restricting diet. Obsession with food and fear of weight gain. Restricts calories. Low BMI (<18.5). Comorbid Anx and Dep
-Bulimia nervosa: purging after eating. Person commonly has average to slight high BMI. Look for Tussell sign, or calloused knuckles.

Anorexia
Complications: dental issues, electrolyte imbalance. Low K, malnutrition.
Assess: suicidal ideation. Family and ACEs. How? Reduce wt. Relationships.
Tx: hierarchy pyramid. Acute physiological issues first. Self esteem teaching. Fluoxetine, olanzapine.

Bulimia
Comorbidities: bipolar, MDD, substance abuse disorders.
Assess: history. Feelings during cycle. Guilt? Disgust? How they do it. AGAINNNN suicidal ideation.
Tx: SSRIs. Anxiolytics.

Question 24

When a person starts to eat again what can happen?

Answer 24

-They can get refeeding syndrome. An increase in glucose and metabolism causes hypo hypophosphatemia, hypo magnesium , hypokalemia, and low thiamine. hypophosphatemia is important in glucose metabolism, ATP creation, and resp. Magnesium potentiates low K. Thiamine helps w glucose and lactate breakdown.

Question 25

What is domestic violence and the cycle of violence., at what period is it dangerous for a person experiencing domestic violence, and when is the person likely to strike the other person

Answer 25

-Domestic violence: abuse by a partner or family member.
-Cycle of violence: tension phase, acute battering phase (most dangerous), and then honeymoon phase.

Question 26

Sexual assault can the person refuse to be evaluated? What is the assessment and the importance of chain of evidence.

Answer 26

-Yes.
-They Provide comfort for victims and collect evidence of SA. ; H to T, Medications, Allergies. Detailed questioning of events: penetration, completion/partial rape. Swabbing, document of laceration, bruising, burns.

Always one foot in court.