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Exam 3 - 503 > Exam 4 - FINAL EXAM NP > Flashcards

Exam 4 - FINAL EXAM NP Flashcards

1
Q

T/F: innate (natural) immunity needs no previous exposure to create an immune response

A

TRUE

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2
Q

How is acquired immunity produced

A
  1. vaccine

2. exposure to antigen

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3
Q

Which type of immunity, present at birth, remains for life?

A

Innate (natural)

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4
Q

Which type of immunity involves T-cells, B-cells and Natural Killer cells?

A

Acquired Immunity

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5
Q

T-cells are created where?

B-cells are created where?

A

T-cells - thymus

B-cells - bone

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6
Q

Which immunoglobulin is the first to respond to an antigen

A

IgM (iMmediate)

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7
Q

Which immunoglobulin lines the GI tract, respiratory tract , and GU tract

A

IgA

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8
Q

Eosinophils and which immunoglobulin respond to allergens and parasitic infections

A

IgE

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9
Q

Which immunoglobulin is high in acute infection

A

IgM

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10
Q

What are the actions of PRIMARY immune response

A
  1. antigen moved to lymph node
  2. virgin B cells respond and develop into antibody producing plasma cells
  3. IgM is made (memory cells)
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11
Q

What are the actions of SECONDARY immune response

A
  1. more rapid than primary response

2. NK cells take over

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12
Q

Neonates have higher B or T cells?

A

T- cells

neonates may develop antigen specific T-cell response

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13
Q

Neonates have a high susceptibility to what type of org.? why?

A

Gram negatives

IgM cannot cross the placenta

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14
Q

When does IgM reach adult levels?

A

Age 1

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15
Q

T/F antibodies are able to be created at birth

A

TRUE

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16
Q

what type of vaccines are needed for neonates

A

conjugated

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17
Q

Why do vaccines seem to be less effective in middle age

A

T-cell function declines in middle age

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18
Q

What are 4 pathways to contract hepatitis

A
  1. Drugs
  2. Poisons
  3. Idiopathic
  4. Autoimmune
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19
Q

What are 2 outcomes of an acute infection of hepatitis and how do you tell the difference

A
  1. Acute infection w/ recovery and immunity
  2. acute infection w/chronic disease

Difference: test for viral activity - will be active in chronic disease

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20
Q

S/S of acute viral hepatitis

A
  • fatigue
  • fever
  • skin rash
  • N/V
  • arthralgia/myalgia
  • abd pain
  • jaundice
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21
Q

What may cause chronic viral hepatitis to exhibit symptoms

A

Stress

co-infection

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22
Q

Which transaminase is most specific for viral liver infections?

A

ALT

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23
Q

AST may be elevated in viral hepatitis but also what other types of disease

A

Heart

Liver

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24
Q

What labs should be ordered for suspected hepatitis

A 
AST/ALT
Alk Phos
Bilirubin (direct/total)
LDH
CBC
H/H
Albumin
Coags
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25
Q

Which bilirubin will be high in liver disease

A

Direct - conjugated

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26
Q

Hep A transmission

A

Fecal/Oral

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27
Q

HAV’s incubation period and presentation of illness

A

28 days

Acute - jaundice, self-limiting

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28
Q

Will HAV turn into a chronic infection

A

No

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29
Q

Testing of immunogloblins in HAV is?

A

IgM for HAV

IgM and IgG for recovery

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30
Q

Hep B transmission

A

Blood
Sex
Blood Transfusion
IVDA

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31
Q

HBV can last on surfaces outside of the body how long?

A

7 days

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32
Q

If a patient has a high AST, what panel should be done

A

Hep Series (A, B, C)

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33
Q

T/F: HBV infected patients may be asymptomatic

A

TRUE

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34
Q

When may a patient with HBV begin to be jaundice

A

After day 10 of acute infection

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35
Q

What other symptoms may be present with HBV infection

A
  • fatigue
  • low grade fever
  • nausea/bloating/tender and palpable liver edge
  • arthralgia
  • posterior cervical lymph enlargement
  • icteric sclera
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36
Q

HBsAG *****

A

ACUTE infection or recent vaccine will make +

if + after 6 months –> indicates chronic infection

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37
Q

HBcAG

A

Hep B core antigen

indicates long term clinical course - is not found circulating in the blood

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38
Q

HBeAG *****

A

indicates active hep b viral replication

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39
Q
  • HBcAB
  • HBsAG
    +HBsAB
    means….
A

patient has never had HBV but has been vaccinated

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40
Q

+HBsAG

  • HBsAB
  • HBcAB
A

ACUTE PHASE in new infection
or
Reactivation of virus in chronic carrier

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41
Q

+HBcAB
-HBsAG
+HBsAB

A

elimination of the virus with immunity

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42
Q

the a patient to have hep D, they must first have had….

A

Hep B

Hep D uses the HBV shell

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43
Q

What is the most common blood borne infection in the US

A

Hep C

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44
Q

What portion of HCV pts will develop chronic liver dz?

A

40-60%

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45
Q

What are some risk factors for HCV

A
  • IVDA
  • Dialysis/Blood transfusions
  • sex
  • borne b/t 1945-1965
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46
Q

Early S/S of HCV

A
  • possible jaundice

- otherwise asymptomatic until late stages of dz

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47
Q

What test is used to measure viral load of pt w/hepatitis and when would you order it?

A 
PCR test 
ordered for:
- tmtx decisions
- to test response to tmxt
- test for chronic infection or unusual presentation
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48
Q

What test is done to look for HCV…and if positive what should be done

A

HCV antibodies

if + requires confirmatory testing - RNA TESTING *****

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49
Q

T/F high ALT means liver damage is happening

A

FALSE

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50
Q

T/F a patient recovered from HCV will have a high anti-HCV and their ALT will return to normal

A

TRUE

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51
Q

What other testing should be done to determine tmtx regimens for HCV

A

Genotyping

Type 1 HCV is most common in the US

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52
Q

What are some factors that may come into play when determining how severe HCV will be

A

ETOH use
Age > 40 at time of infection
HIV/other coinfection
Male

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53
Q

Goal of HBV tmtx

A

viral replication suppression

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54
Q

What meds are used in treating HBV and HCV

A
  • Pegylated interferon
  • Ribavirin
  • Protesae inhibitors (adefovir, entacvir, telbivudine, tenofovir)
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55
Q

What HBV tmtx has a high risk of causing viral resistence

A

Lamivudine

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56
Q

T/F a patient w/a negative anti-HBe with a normal ALT and viral load less than 10^5 requires no medication treatment

A
  • TRUE

- check LFTs, AFP q6mo

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57
Q

Pts w/viral load >10^5 and their ALT is abnormal…

A

refer to GI for tmtx considerations

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58
Q

How long does someone receive tmtx for HCV

A

6-12 mos

Depends on genotype, viral load and liver biospy results

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59
Q

What are some SEs of tmtx for HBV and HCV?

A
  • nausea, fatigue
  • irritability
  • hair loss
  • anemia, neutropenia
  • drug interactions
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60
Q

pt w/ HBV and HCV both receive a liver transplant. Which one is most likely to become reinfected

A

HCV - almost universal reinfection rate

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61
Q

HAV vaccines are indicated for which patients

A
  • Children age 12-23 mos.
  • IVDA
  • MSM
  • Travelers who go to high risk areas
  • pts/chronic hep
  • person who work with nonhuman primates
  • medical workers
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62
Q

How far apart are the 2 doses of HAV given?

A

6-12 mos

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63
Q

travelers should be dosed how

A

1 dose 4 weeks before travel, if less than 4 weeks, give IgG well

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64
Q

Postexposure prophylaxis for HAV must be completed how soon after exposure and the pt must be?

A
  • within 2 weeks of exposure
  • under age 40 and in good health
  • over age 40 or with health problems = add IG
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65
Q

Booster vaccine should be used only in what patients

A

HD patients

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66
Q

PEP for HCV should be given how soon?

A
  • Within 24 hours of exposure

- unvaccinated person should receive HBIG as well

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67
Q

How may a pedi pt w/hepatits present

A
  • Poor appetite, fatigue
  • +D or +C, abd pain
  • Hepatomegaly, jaundice, high liver enzymes

check abd for fatty liver and skin for urticaria **

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68
Q

T/F - a hepatitis virus in pediatrics may resolve on its own

A

True

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69
Q

What other viruses cause hepatitis in peds

A

EBV *****

CMV

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70
Q

Why does HAV spread so easily in daycare center and younger children

A

Fecal oral route

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71
Q

A pt w/HAV is contagious when

A

1-2 weeks before onset of symptoms

1 week after onset of jaundice

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72
Q

What are the 2 stages of HAV

A
  1. Preicteric (+N/V, abdominal issues)

2. Jaundice phase - urine darkens, stools clay colored, poor wt gain, +Diarrhea or constipation

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73
Q

Primary prevention of HAV is

A

Vaccine

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74
Q

T/F Children may be born with HBV

A
  • true
  • if mother is HBs-AG+ then 70-90% chance of passing it on to child
  • Screen all pregnancies
  • Breastfeeding OK!
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75
Q

If a mother is HBsAg+ how do you treat the neonate

A

IG and vaccination w/in 12 hours of birth

recheck antigen and antibody levels in 2-3 months after IG and vaccination

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76
Q

Successful HBV tmtx with IG and vaccination in the neonate show what?

A

Antigen -

Antibody +

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77
Q

T/F: Babies born to HCV mothers may have HCV

A

TRUE

Tmtx is the same for children as adults

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78
Q

Patient w/HCV should receive what vaccines

A

HAV, HBV

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79
Q

Growth of viral load of HCV may be markedly decreased in those children treated with….??

A

Interferon

Ribavirn

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80
Q

TB is caused by what?

Transmitted how?

A

mycobacterium tuberculosis
small droplets/airborne
low fomite transmission

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81
Q

What are risk factors for TB?

A
  • Low SES
  • Poor nutrition
  • Lack of healthcare
  • overcrowded living conditions
  • ethnic minorities
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82
Q

T/F: children have a low ability to transmit disease

Why?

A

True

lower tidal volumes

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83
Q

4 types of TB and which is most common in the US

A
  1. Latent (most common in US)
  2. Active or primary
  3. Miliary TB
  4. Extrapulmonary TB
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84
Q

Skin testing for TB requires _____ which may be lowered by ____?

A
  1. good cell-mediated immunity

2. Active TB

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85
Q

Presentation of pulmonary TB

A
  • keratoconjunctivitis
  • mediastinal lymphadenopathy causing difficulty w/swallowing or airway obstruction
  • cough in children > 10 years
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86
Q

classic s/s of Pulm TB

A
  • PNA, pulmonary fibrosis
  • coughing, wheezing, blood tinged sputum
  • chest pain
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87
Q

Miliary TB occurs in which groups

A
  • children < 3 years
  • elderly
  • HIV
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88
Q

Miliary TB leads to ____ by ___

A

necrosis and cassation of organ function
and
seeding organs by traveling through blood or lymph

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89
Q

Miliary TB S/S

A
  • high fever
  • malase/fatigue
  • poor appetite, wt loss
  • lymphadenopaty, hepatosplenomegaly
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90
Q

Malpractice is an offense covered under tort law

A

True

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91
Q

Malpractice (definition) **

A

A negligent act or failure to act, committed in the course of professional performance

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92
Q

Negligence

A

The doing, or not doing of an act pursuant to duty, that a reasonable person in the same or similar circumstance would do or not do

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93
Q

T/F - negligence can be both a state of mind and an objective conduct

A

FALSE - negligence is objective

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94
Q

Person bringing the malpractice suit

A

Plantiff

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95
Q

Person/org that is alleged to have been negligent

A

Defendant

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96
Q

A proven provider-patient relationship implies the person/organization has a ___ to the patient

A

Duty

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97
Q

A person/organization found to be negligent is considered to have a _______

A

Breach of Duty

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98
Q

Proximal Cause

A

Negligence that has resulted in direct patient harm

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99
Q

For a malpractice suit to result in damages against the person/organization, what must there be proof of?

A

Proof of Harm

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100
Q

IS the defendant allowed to contact the plaintiff

A

NO.

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101
Q

5 ethical principals of nursing ****

A
  1. Autonomy
  2. Nonmaleficence
  3. Beneficence
  4. Justice
  5. Veracity
    (fidelity, accountablity)
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102
Q

4 components of malpractice ****

A
  1. Duty
  2. Breach of Duty
  3. Proximal Cause
  4. Damages
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103
Q

Competence vs. Capacity *****

A

Capacity = psych functional assessment (do they know the consequence of their actions)
Competence - decided by a judge (global assessment)

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104
Q

Informed Consent *****

A

The duty of a HCP to disclose all significant information that he/she possesses that is material to an intelligent decision making by the patient

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105
Q

Who many signed an informed consent if the patient is unable

A
  • POA
  • HCP
  • Parent of a Minor
  • Guardian of an IDD individual
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106
Q

Extrapulmonary TB

A

TB in other places besides the lungs - can be anywhere else in the body

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107
Q

3 levels of + TB skin test

A
  1. > 5 mm - + for immunosuppresed pts (HIV, transplant, suspected cases)
  2. > 10mm - + in children < 4 years, comorbidities, immigrants, IVDA, HCP, exposures
  3. > 15mm - + for everyone
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108
Q

How is a TB skin test read *****

A

48-72 hrs from placement

measure induration, not erythema

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109
Q

When should a skin test NOT be used ****

A

Previous +

Live vaccine or IG w/in the last month

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110
Q

Who should treat TB and how? ****

A
  • TB clinic or ID
  • NEVER monotherapy
  • INH most common for use in latent TB
  • corticosteroids
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111
Q

What type and subtype of HIV are most common in the US

A
  • type 1 (HIV - 1)

- subtype B

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112
Q

Which group of people in the US are most at risk for HIV and affected by HIV

A
  • gay, bisexual men (MSM)

- blacks have the highest infection rates

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113
Q

Who should be tested

A
  • pts w/high risk behaviors tested annually
  • pregnant women
  • pts presenting w/new STI complaints
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114
Q

Is informed consent needed for HIV testing?

A
  • NO “opt-out screening” should be utilized
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115
Q

Risk factors for HIV include

A
  • IVDA or partner who uses IVD
  • persons exchaing sex for drugs or money
  • sex partners of known HIV+ persons
  • Women who have sex w/MSM
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116
Q

T/F HIV testing should only be done on people depending on level of risk

A

False. everyone should be tested

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117
Q

Symptoms of HIV develop how long after infection?

A

4-6 weeks

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118
Q

Is the HIV pt contagious before symptoms?

A

yes - very contagious
early bursts of viremia
HIV antibody is negative at first

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119
Q

Acute HIV infections last how long

A

2-3 weeks

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120
Q

What are common s/s of acute HIV infections

A
  • fever, fatigue, rash
  • HA, lymphadenopathy, pharyngitis
  • myalgias/arthragias
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121
Q

What are crucial markers for HIV

A

Rash

Oral ulcers

122
Q

What testing should be done for pts suspected of having an acute HIV infection

A 
HIV RNA
HIV antibody (r/o previous infections)
123
Q

What is the common testing strategy for children (HIV)

A

ELISA confirmed by Western Blot

124
Q

how long do neonates reatin mother’s antibodies after birth

A

12-18 months

125
Q

What is the usual medication regimen for exposed neonates

A

Zidovudine w/in 8-18 hrs after birth - continue x 16 weeks

ADD Nevirapine if mother is not on therapy

126
Q

What has a high mortality for HIV + neonates

A

PCP pneumonia

127
Q

How should exposed neonates be treated for PCP pneumonia

A

PCP prophylaxis at 6 weeks of age until HIV is r/o completely

If HIV+ continue meds till one year of age

128
Q

What is usually the first sign of an HIV infection in infants

A

Lymphadenopathy followed by hepatosplenomegaly, FTT, diarrhea, pneumonia, thrush

129
Q

T/F - infants w/HIV should not receive the normal vaccination schedule

A

FALSE
need annual flu vaccine

live vaccinations may be deferred on case-case basis

130
Q

How often should a child be tested for HIV

A

Check HIV RNA q3-4 mos

CD4 %

131
Q

What is the goal of antiviral therapy in children

A

Reduce plasma HIV RNA to below detectable levels

132
Q

T/F - Children less than one year of age when diagnosed w/HIV have the highest risk of progression

A

TRUE

133
Q

How many drugs should be used to treat HIV and why?

A
  • 3 drugs from 2 different classes

- drug resistance and cross-resistance is a major issue

134
Q

What are some side effects of antiviral use in HIV

A
  • Heme: bone marrow suppression
  • Lactic acidosis, hepatic tox, pancreatitis
  • metabolic abnormalities
  • allergic reactions, skin rashes, hypersensitivity
135
Q

T/F: if a patient has a reaction to HIV antiviral, the dose should be reduced

A

FALSE

this may cause an increase in drug resistance

136
Q

T/F: Adolescents on HIV antiviral treatment are still able to begin contraception

A

True

They may interact however and should be monitored closely

137
Q

What are some EARLY signs of HIV infection in adults

A
  • generalized lymphadenopathy
  • unexplained wt. loss
  • recurrent infections
  • oral lesions, angular cheilitis
  • rashes
138
Q

What are some LATER signs of HIV infections in adults

A
  • chronic diarrhea
  • persistent fever
  • oral candidiasis, oral hairy leukoplakia
  • pulmonary TB
  • joint infections
  • unexplained anemia, neutropenia, thrombocytopenia
139
Q

What is Kaposi’s Sarcoma and when is it seen

A
  • Purplish spots on legs, feet, or face

- opportunistic infection/sarcoma of HIV

140
Q

What is the goal of HIV treatment in adults

A
  • Reduce HIV related morbidity
  • Balance duration and QOL
  • restore as much immunologic function as possible
  • suppress viral load
  • decrease/prevent transmission
141
Q

Early ART therapy will help how?

A

Prevent HIV related end-organ damage

142
Q

Prophylaxis in post HIV exposure should be conducted how

A

ART for several days

143
Q

T/F ART for HIV preexposure is recommended

A

TRUE

for persons who exhibit or plan risky behavior

144
Q

What is the leading cause of suicidal behavior

A

Depression

145
Q

What are the manifestations of major depressive disorder

A 
Severe Sadness
Withdrawn behavior
bordem
low self esteem
feeling of helplessness or hopelessness
no meaning in life
146
Q

Dx critera for MDD

A
  • 5 of the following symptoms present during the same 2 week period along w/ depressed mood or loss of interest or pleasure
  • depressed/irritable mood
  • wt change/appetite change
  • psychomotor agitation/retardation
  • disturbed concentration or decisiveness
  • diminished interest or pleasure in actives
  • insomnia/hypersomnia
  • feelings of worthlessness or guilt
  • recurrent thought of death, SI/suicide attempts
147
Q

What is dysthymia

A
  • overwhelming chronic state of depression
148
Q

What else must be r/o to dx depression

A
  • substance abuse
  • mania
  • other medical conditions
149
Q

T/F to diagnose depression a pts symptoms must cause significant distress in social, work, school, or other areas of functioning

A

TRUE

150
Q

T/F: depression does not occur in those less than 5 years old

A

UNKNOWN

Pts < 5 years do not have the verbal or reasoning skills to let you know

151
Q

Children with depressed parents are how many more times likely to develop depression than those without?

A

3x

152
Q

Adolescent depression is ofen

A

Chronic, comes and goes

153
Q

T/F Children/Adolescents w/depression will always carry that dpression into adulthood

A

FALSE

- they do have 2x-4x the chance of having depression in adulthood

154
Q

What are some common reasons that children and adolescents do not receive care for their depression

A
  • Stigma
  • lack of providers
  • insurance issues
  • misdiagnosis
155
Q

T/F Younger pts with depression tend to somaticize

A

True

General aches and pains, HA, abd pain, school refusal

156
Q

What neurotransmitters are associated with depression

A
  • Serotonin

- Dopamine

157
Q

What is the most important part of the assesment in dx depression in children and adolescents

A

History

158
Q

HEADSS

A 
H - Home
E - Education/employment
A - activites
D - drugs, alcohol, substance
S - Sexuality
S - Suicide
159
Q

T/F - when diagnosing depression, your differentials will contain mayn organic disease

A

True

- anemia, chronic fatigue, eating disorders, endocrine disorders, hypothyroidsm, chronic infection

160
Q

On the first visit for possible depression, what should be assessed for specifically

A

SI

161
Q

What are the 4 aspects of depression management

A

Psychotherapy
CBT
Social Skills training
Meds

162
Q

SSRIs have a black box warning for (Prozac) *****

how long does this black box warning specifically reference **

A

Increased SI

Prozac has a BBW for increased SI in the first 1 month of tmtx *****

163
Q

According to TADS, what is the best tmtx for children and adolescents w/drepression

A
  • medication + CBT
164
Q

First line medication for depression

A

SSRI

165
Q

What is the 2nd line tmtx for depression

A

TCAs

2nd line b/c increased suicidality

166
Q

How should med treatment be assessed

A
  • reassess for benefit at 4 weeks, if none then change meds

- mild response to med reassess at 10 weeks

167
Q

How long should a person be symptom-free before decreasing medication doses

A

3 months

Taper meds slowly

168
Q

40-50% of patients that are weaned from meds will relapse w/in what time rame

A

2 years

169
Q

how long should children be on antidepression meds

A

6-9months
up to 1 year
may be indefinite

170
Q

T/F persons diagnosed with depression at an early age will have better outcomes in the long run

A

FALSE

poorer outcomes

171
Q

Mild to moderate childhood depression should be treated how

A

CBT only

172
Q

What is the FDA approved medication for use in childhood depression?

A

Prozac (SSRI)

173
Q

What disorder is characterized by unusual shifts in mood, energy or functioning

A

Bipolar disorder

174
Q

What disorder is often a precursor to bipolar disorder

A

MDD

175
Q

T/F: Most patients w/bipolar disorder will have multiple episodes

A

True - 90%

176
Q

What are some symptoms of early onset bipolar disorder

A

Irritability
Rapid cycling (mania/depression)
ADHD or other behavior disorders

177
Q

Symptoms of later onset bipolar

A
  • classic mania
  • severe mood changes
  • inflated self esteem
  • increased energy, decreased sleep
  • distractibility
  • risk-taking behavior
  • physical agitation
  • hypersexuality
178
Q

what is the medication management for bipolar disorder

A

Lithium

179
Q

What other tmtx may be used for biopolar idsorder

A
  • psychiatric referral
  • careful monitoring
  • long-term tmtxt
  • family based tmtx
180
Q

Which gender attempts suicide more often

A

Female

181
Q

What gender completes their suicide attempts most often

A

Male

182
Q

What is the strongest predictor of suicide ****

A

Previous attempt *****

AND

first degree relative with suicide attempt

183
Q

What are some other risk factors for suicide

A
  • Poor social adjustment
  • substance abuse
  • psychological trauma
  • Delinquency
  • Impulsive behavior
184
Q

T/F - pt confidentiality must be maintained even when they inform you of SI

A

FALSE

185
Q

When should hospitalization be contemplated

A
  • personal safety is in jeopardy
  • ID of means of plan
  • conditions of impaired judgement (depression, psychosis, substance abuse)
186
Q

What are some warning signs of depression

A
  • obsession w/ death
  • dramatic changes in appearance/personality
  • overwhelming guilt/shame
  • severe drop in school performance
  • irrational behavior
  • threats
  • change in eating
  • giving away personal items
187
Q

The CDC has listed suicde as a _____ and is promoting ______

A
  • Public health problem

- connectedness

188
Q

Why does the CDC promote connectedness

A
  • evidence shows decreased SI if pt feels connected

- isolation is a big risk facto

189
Q

What is similar b/t anorexia and bulimia

A
  • serious disturbance in eating

- concern about body shape and weight

190
Q

What 2 categories for eating disorders were added w/ the DSM 5 revisions

A
  • Binge eating disorder

- Avoidant/restrictive food intake disorder

191
Q

What are the DSM-5 criteria for anorexia

A
  • Restriction of energy intake
  • fear of wt gain even though already underweight
  • disorientation w/body weight/shape/experience
192
Q

Bulimia

A
  • cyclic binge eating
  • inappropriate compensatory behaviors (vomiting, laxative use, inappropriate exercise)
  • freqent episodes (at least once weekly)
193
Q

What time of life do most eating disorders start

A

Anorexia - (age 15 - 19)

Bulimia (age 18-23)

194
Q

What race is most affected by eating disorders

A

White

195
Q

T/F bulemia may arise from anorexia

A

True

196
Q

What are some risk factors for eating disorders

A
  • obesity
  • affective disorders
  • serotonin disorders
  • onset of puberty
  • low self esteem
  • hx of abuse
197
Q

What is one of the most common entry points for eating disorders

A

Dieting

198
Q

May inceidences of anorexia resolve w/ what?

A

normalization of body weight

199
Q

Why might serotonin be involved in anorexia

A

regulatory agent in mood, stress presonse and eating behaviors

200
Q

What is the SCOFF screning

A
  • Do you make yourself SICK b/c you fee uncomfortably full
  • do you worry you have lost CONTROL over how much you eat
  • Have you recently lost more than 14lbs in 3 months
  • do you believe yourself to be FAT when others say you are thing
    Whould you say that FOOD dominates your life
201
Q

BMI that indicates anorexia

A

< 17.5

202
Q

Underweight BMI

A

17.5 - 20

203
Q

Eating disorders are diagnosed by

A

Clinical presentation only

204
Q

What labs could be drawn for a baseline

A 
CBC
ESR
CMP
UA
albumin
205
Q

most often the pt will have hyperkalemia or hypokalemia

A

hypokalemia

206
Q

hypoglycemia or hyperglycemia

A

hypoglycemia

207
Q

a patient w/anorexia should only be allowed how many calories in the first few days of refeeding

A
  • 500 above what the pt is currently taking

- add 200-300 calories every 3-4 days

208
Q

Feeding a pt too many calories right away may cause what?

What is that called?

A

REFEEDING SYNDROME

  • cardiomyopathy and cardiac decompensation
  • hypophosphatemia
209
Q

When should a pt be hospitalized for tmtx

A
  • BP < 80/50
  • Electrolyte imbalances
  • Severe malnutrition
  • EKG abnormalities
  • Dehydration
  • Sinus bradycardia
210
Q

Treatment of eating disorders needs to involve

A
  • interdisciplinary team specializing in eating disorders
211
Q

Goals of tmtx include

A
  • stabilize medical nad nutritional status (BMI > 16)
  • ID and work toward resolving psychosocial problems
  • Restablish healthy eating patterns
212
Q

Inpt goal for wt increase is

A

1/2 lb per day

213
Q

Goals for wt increast in outpatient setting

A

1/2 - 4lb per week

214
Q

What are some nutrition goals for reffeding

A
  • 2-3 servings of protein
  • 30-50 grams of daily fat
  • 1200-1500mg ca2+ (3-4 glasses of milk)
  • MVI
215
Q

Bulimia is characterized by

A

cycles of binge eating and purging

216
Q

Binging is defined as

A

Eating larger amount at a time than a normal individual in similar circumstances

217
Q

Binges often include what type of food and are done how

A
  • high cal./carbohydrate

- in secrecy

218
Q

Russell’s sign is

A

Calluses on knuckles or back of hand due to repeated self-induced vomiting

219
Q

Other signs of bulimia

A
  • parotid swelling
  • loss of dental enamel from vomiting
  • GERD
  • Constipation
220
Q

T/F: a bulimic pt’s weight will always be low

A

FALSE

may often be a normal weight

221
Q

What may be present if the patient is using ipecac for vomiting

A

Cardiomyopathy

222
Q

T/F pancreatitis is a complication of bulimia

A

TRUE

223
Q

Labs in bulimia may show

A

electrolyte imbalances
hypocalcemia
hyponatremia
hypochloremia

224
Q

loss of stomach acid in bulimia may lead t0

A

metabolic acidosis

225
Q

whom is more likely to be diagnosed with depression

A

2:1 women:men

226
Q

What medical conditions are more likely to have depression

A
  • fibromyalgia
  • migraines/HA
  • PMS (PMDD)
  • IBS
  • chronic fatigue symptoms
227
Q

Pts w/ depression will present how on a brain scan

A
  • decreased brain activity
228
Q

What is the most common depressive disorder

A

Major depressive episode (single or recurrent)

229
Q

A pt living at a subpar level w/o having severe depressive episdoes would be Dx w with??

A

dysthymia

230
Q

what is doube depression

A

Dysthymia/MDD w/anxiety

antidepressants often alleviate both sets of symptoms

231
Q

Seasonal affective disorder is usually seen in what seasons

A

fall/winter

- less exposure to ambient light

232
Q

Risk for depression

A
  • Genetics
  • Parent Loss
  • Early life abuse or trauma
233
Q

S/S of depression SIG-E-CAPS

A 
S - sleep
I - interest
G - guilt
E - energy
C - concentration
A - appetite
P - Psychomotor
S - suicdial thoughts
234
Q

Risk for depression specific to women and hormonal shifts includ

A
  • Puberty
  • Postpartum
  • Pregnancy
  • Menopause
235
Q

T/F: Moderate drinking (only one drink a day) will still predispose a pt to depression

A

FALSE

236
Q

what medical conditions may mimic depression

A
  • Hypothyroidism
  • Vitamin D deficiency
  • hypoglycemia
  • caffeine withdrawal
  • early dementia
237
Q

Most effective tmtx of depression

A
  • Psychotherapy

- Meds (SSRI)

238
Q

Antidepressants may take how long to begin to work

A

10-14 days

239
Q

Who will notice the effects of the tmtx first, pt or friends and family

A

Friends and family

240
Q

how long should adults continue to take their medication after remission begins

A
  • 4-6months

- taking meds away too soon may cause a relapse

241
Q

how long after starting treatment should a pt trial discontinuation of the medication

A

within the first 12 months

242
Q

What is a natural remedy that may help with depression but may interact with many medications

A
  • St. John’s Wort
  • Increase serotonin levels
  • May lower estrogen levels (OCPs need dose adjustment)
243
Q

T/F - St. John’s Wort should never be combined w/antidepressants

A

TRUE

244
Q

What are some other recommendations for improving mood

A

Exercise, diet changes, sleep hygeine, daily structure

245
Q

What is the most effective tmtx available, statistically for depression

A

ECT

246
Q

ECT works how and may cause what?

A
  • Change in neurotransmitters

- Seizures

247
Q

ECT may be indicated for what patients

A

Those with severe or intractable depression

248
Q

ECT treatment includes how many tmtx in what time frame?

A
  • 6-12 treatments

- 4-6 weeks

249
Q

What age group and race have the highest level of suicide

A

Non-hispanic white men over age 85

250
Q

What is defined as a serious act that w/o accidental intervention, more accurate information or luck would prove fatal

A

Suicide attempt

251
Q

What is an example of accidental intervention

A

Passerby sees pt trying to hang themselves and intervenes

252
Q

What is an example of inaccurate information

A

Not knowing how much of a medication to take to have a fatal dose

253
Q

What is a suicidal gesture

A

Nonfatal behavior as a cry for help or attention

254
Q

When a pt does not intentionally attempt suicide but tests the reactions of others is called a

A

Suicide equivalent

255
Q

Passive or persistent thoughts of killing one’s self is called

A

Suicidal Ideation

256
Q

What is the most common method of suicide in the US

A

Gunshots

257
Q

What are some protective factors against suicide

A
  • Access to care
  • restricting access to means
  • strong connectivity
  • strong cultural and religious beliefs
  • treatment of depression
258
Q

T/F - all depressed patients will become suicidal

A

FALSE

259
Q

T/F - most suicide attempts are a cry for help or attention

A

FALSE

260
Q

T/F - cutting is linked to depression

A

FALSE

- it is an attempt to feel something while depressed

261
Q

Cutting is most common in what personality disorder

A

Borderline personality

262
Q

Physical signs of anxiety may include **

A
  • Fatigue
  • SOB
  • CP
  • diaphoresis
263
Q

Excessive worry about both rational and irrational things is called

A

Anxiety

264
Q

Other mental s/s of anxiety include

A
  • Feelings of impedning doom or disaster
  • Sleep disturbances (insomnia)
  • Restlessness
  • Irritability
  • Difficulty concentrating
265
Q

For dx of anxiety, the excessive anxiety and worry needs to occur for more days than not for how long

A

6 months

266
Q

CBT is what

A
  • Desensitizes patients to anxieties
  • helps develop coping mechanisms
  • not done in primary care
267
Q

What is the main medication tmtx for anxiety

A
  • SSRI
  • benzos
  • SNRIs
  • TCAs
  • Propranolol/Clonidine/Antihistamines
268
Q

What is an oral side effect of tricyclics

A

Tooth decay

269
Q

A patient w/ cyclic severe highs and severe lows may be dx w/

A

Bipolar disorder

270
Q

T/F - antidepressants are not helpful in bipolar disorder

A

True

271
Q

Bipolar 1

A

most severe - severe swings

272
Q

Bipolar 2

A

Severe lows but not really manic at all

273
Q

Mixed bipolar

A

addition of dysthymia or other depressive disorder w/BPD

274
Q

What mental illness is thought to have the most genetic component

A

Bipolar

commonly runs in families

275
Q

Obsession vs. Compulsion ****

A

Obsession - intrusive thoughts, produce apprehension, fear or worry
Compulsions - repetitive behaviors aimed at reducing associated anxieties

276
Q

OCD is what type of disorder ***

A

Anxiety disorder

277
Q

What is the treatment for OCD ***

A

CBD w/exposure-ritual prevention therapy
Meds (SSRIs, SNRIs, TCAs)
ECT

278
Q

T/F - Benzos are helpful in reducing the compulsions in OCD

A

FALSE - the benzos may become a compulsion

279
Q

Schizophrenia is characterized by what 3 things

A
  1. Thought disturbances
  2. Disrupted social behavior
  3. Inability to determin what is real
280
Q

Positive symptoms of schizophrenia

A

experiencing things others do not

  • hallucinations
  • delusions
281
Q

Negative symptoms of schizophrenia

A

lack of a full emotional life

  • emotional blunting
  • flat affect
  • relationship issues
282
Q

What is the role of the FNP in the care of a pt w/ schizophrenia

A
  • always treat in conjunction w/ psychiatry

- general health maintenance and upkeep

283
Q

PHQ 9 *****

A

higher score = more depression

284
Q

what to check for with SI *****

A
  • plan
  • means
  • will
285
Q

Depakote therapeutic range

A

50-110

286
Q

Depakote usage

A

depression, mood stabilizer

287
Q

Depakote toxicity/major risk factors

A

SJS risk
tox - scleral icteris

  • lethargy, n/v, myoclonus, depression, respiratory depression, CNS depression
288
Q

Smoking an zyprexa

A

increases metabolism of zyprexa, needs higher dosage

289
Q

Paxil and bleeding risk

A

makes platelets sticky and inhibits their ability to form clots - increased bleeding risk

290
Q

B cluster personality disorders

A
  • dramatic, overly emotional, unpredictable thinking or behavior
  • antisocial
  • borderline (most common in women)
  • histrionic
  • narcissistic
291
Q

cluster A personality disorders

A
  • characterized by odd, eccentric thinking or behavior
  • paranoid
  • schizoid
  • schizotypal
292
Q

cluster C personality disorders

A
  • characterized by anxious fearful thinking or behavior
  • avoidant
  • dependent
  • OCD
293
Q

TB S/S *****

A

bad: hemoptysis

+ night sweats/fever

294
Q

Who starts TB meds *****

A

ID or TB clinic

295
Q

Dietary restriction for Rifampin *****

A

low/no tyramine

296
Q

high tyramine foods **

A
  • fermented (beer, soysauce, teryaki, bouillan, sour dough bread, miso, pickled products)
  • cured (meats and fish)
  • aged (cheeses - cheddar, blue)
  • spoiled (over ripe fruits)
  • beans (fava)
297
Q

Children < 10 w/TB **

A

no cough but can still spread

298
Q

+HBeAB

-HBeAG

A

viral replication has stopped

299
Q

Hepatitis screening

A

HBcAB - assesses for previous infection

HBsAG - assesses for active infection … if this is + then do HBeAG to see if viral replication is actively occuring

300
Q

What HBV testing tests for viral load

A

HBV DNA testing

Exam 3 - 503 (2 decks)

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