Exam 4 - FINAL EXAM NP Flashcards
T/F: innate (natural) immunity needs no previous exposure to create an immune response
TRUE
How is acquired immunity produced
- vaccine
2. exposure to antigen
Which type of immunity, present at birth, remains for life?
Innate (natural)
Which type of immunity involves T-cells, B-cells and Natural Killer cells?
Acquired Immunity
T-cells are created where?
B-cells are created where?
T-cells - thymus
B-cells - bone
Which immunoglobulin is the first to respond to an antigen
IgM (iMmediate)
Which immunoglobulin lines the GI tract, respiratory tract , and GU tract
IgA
Eosinophils and which immunoglobulin respond to allergens and parasitic infections
IgE
Which immunoglobulin is high in acute infection
IgM
What are the actions of PRIMARY immune response
- antigen moved to lymph node
- virgin B cells respond and develop into antibody producing plasma cells
- IgM is made (memory cells)
What are the actions of SECONDARY immune response
- more rapid than primary response
2. NK cells take over
Neonates have higher B or T cells?
T- cells
neonates may develop antigen specific T-cell response
Neonates have a high susceptibility to what type of org.? why?
Gram negatives
IgM cannot cross the placenta
When does IgM reach adult levels?
Age 1
T/F antibodies are able to be created at birth
TRUE
what type of vaccines are needed for neonates
conjugated
Why do vaccines seem to be less effective in middle age
T-cell function declines in middle age
What are 4 pathways to contract hepatitis
- Drugs
- Poisons
- Idiopathic
- Autoimmune
What are 2 outcomes of an acute infection of hepatitis and how do you tell the difference
- Acute infection w/ recovery and immunity
- acute infection w/chronic disease
Difference: test for viral activity - will be active in chronic disease
S/S of acute viral hepatitis
- fatigue
- fever
- skin rash
- N/V
- arthralgia/myalgia
- abd pain
- jaundice
What may cause chronic viral hepatitis to exhibit symptoms
Stress
co-infection
Which transaminase is most specific for viral liver infections?
ALT
AST may be elevated in viral hepatitis but also what other types of disease
Heart
Liver
What labs should be ordered for suspected hepatitis
AST/ALT Alk Phos Bilirubin (direct/total) LDH CBC H/H Albumin Coags
Which bilirubin will be high in liver disease
Direct - conjugated
Hep A transmission
Fecal/Oral
HAV’s incubation period and presentation of illness
28 days
Acute - jaundice, self-limiting
Will HAV turn into a chronic infection
No
Testing of immunogloblins in HAV is?
IgM for HAV
IgM and IgG for recovery
Hep B transmission
Blood
Sex
Blood Transfusion
IVDA
HBV can last on surfaces outside of the body how long?
7 days
If a patient has a high AST, what panel should be done
Hep Series (A, B, C)
T/F: HBV infected patients may be asymptomatic
TRUE
When may a patient with HBV begin to be jaundice
After day 10 of acute infection
What other symptoms may be present with HBV infection
- fatigue
- low grade fever
- nausea/bloating/tender and palpable liver edge
- arthralgia
- posterior cervical lymph enlargement
- icteric sclera
HBsAG *****
ACUTE infection or recent vaccine will make +
if + after 6 months –> indicates chronic infection
HBcAG
Hep B core antigen
indicates long term clinical course - is not found circulating in the blood
HBeAG *****
indicates active hep b viral replication
- HBcAB
- HBsAG
+HBsAB
means….
patient has never had HBV but has been vaccinated
+HBsAG
- HBsAB
- HBcAB
ACUTE PHASE in new infection
or
Reactivation of virus in chronic carrier
+HBcAB
-HBsAG
+HBsAB
elimination of the virus with immunity
the a patient to have hep D, they must first have had….
Hep B
Hep D uses the HBV shell
What is the most common blood borne infection in the US
Hep C
What portion of HCV pts will develop chronic liver dz?
40-60%
What are some risk factors for HCV
- IVDA
- Dialysis/Blood transfusions
- sex
- borne b/t 1945-1965
Early S/S of HCV
- possible jaundice
- otherwise asymptomatic until late stages of dz
What test is used to measure viral load of pt w/hepatitis and when would you order it?
PCR test ordered for: - tmtx decisions - to test response to tmxt - test for chronic infection or unusual presentation
What test is done to look for HCV…and if positive what should be done
HCV antibodies
if + requires confirmatory testing - RNA TESTING *****
T/F high ALT means liver damage is happening
FALSE
T/F a patient recovered from HCV will have a high anti-HCV and their ALT will return to normal
TRUE
What other testing should be done to determine tmtx regimens for HCV
Genotyping
Type 1 HCV is most common in the US
What are some factors that may come into play when determining how severe HCV will be
ETOH use
Age > 40 at time of infection
HIV/other coinfection
Male
Goal of HBV tmtx
viral replication suppression
What meds are used in treating HBV and HCV
- Pegylated interferon
- Ribavirin
- Protesae inhibitors (adefovir, entacvir, telbivudine, tenofovir)
What HBV tmtx has a high risk of causing viral resistence
Lamivudine
T/F a patient w/a negative anti-HBe with a normal ALT and viral load less than 10^5 requires no medication treatment
- TRUE
- check LFTs, AFP q6mo
Pts w/viral load >10^5 and their ALT is abnormal…
refer to GI for tmtx considerations
How long does someone receive tmtx for HCV
6-12 mos
Depends on genotype, viral load and liver biospy results
What are some SEs of tmtx for HBV and HCV?
- nausea, fatigue
- irritability
- hair loss
- anemia, neutropenia
- drug interactions
pt w/ HBV and HCV both receive a liver transplant. Which one is most likely to become reinfected
HCV - almost universal reinfection rate
HAV vaccines are indicated for which patients
- 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
How far apart are the 2 doses of HAV given?
6-12 mos
travelers should be dosed how
1 dose 4 weeks before travel, if less than 4 weeks, give IgG well
Postexposure prophylaxis for HAV must be completed how soon after exposure and the pt must be?
- within 2 weeks of exposure
- under age 40 and in good health
- over age 40 or with health problems = add IG
Booster vaccine should be used only in what patients
HD patients
PEP for HCV should be given how soon?
- Within 24 hours of exposure
- unvaccinated person should receive HBIG as well
How may a pedi pt w/hepatits present
- Poor appetite, fatigue
- +D or +C, abd pain
- Hepatomegaly, jaundice, high liver enzymes
check abd for fatty liver and skin for urticaria **
T/F - a hepatitis virus in pediatrics may resolve on its own
True
What other viruses cause hepatitis in peds
EBV *****
CMV
Why does HAV spread so easily in daycare center and younger children
Fecal oral route
A pt w/HAV is contagious when
1-2 weeks before onset of symptoms
1 week after onset of jaundice
What are the 2 stages of HAV
- Preicteric (+N/V, abdominal issues)
2. Jaundice phase - urine darkens, stools clay colored, poor wt gain, +Diarrhea or constipation
Primary prevention of HAV is
Vaccine
T/F Children may be born with HBV
- true
- if mother is HBs-AG+ then 70-90% chance of passing it on to child
- Screen all pregnancies
- Breastfeeding OK!
If a mother is HBsAg+ how do you treat the neonate
IG and vaccination w/in 12 hours of birth
recheck antigen and antibody levels in 2-3 months after IG and vaccination
Successful HBV tmtx with IG and vaccination in the neonate show what?
Antigen -
Antibody +
T/F: Babies born to HCV mothers may have HCV
TRUE
Tmtx is the same for children as adults
Patient w/HCV should receive what vaccines
HAV, HBV
Growth of viral load of HCV may be markedly decreased in those children treated with….??
Interferon
Ribavirn
TB is caused by what?
Transmitted how?
mycobacterium tuberculosis
small droplets/airborne
low fomite transmission
What are risk factors for TB?
- Low SES
- Poor nutrition
- Lack of healthcare
- overcrowded living conditions
- ethnic minorities
T/F: children have a low ability to transmit disease
Why?
True
lower tidal volumes
4 types of TB and which is most common in the US
- Latent (most common in US)
- Active or primary
- Miliary TB
- Extrapulmonary TB
Skin testing for TB requires _____ which may be lowered by ____?
- good cell-mediated immunity
2. Active TB
Presentation of pulmonary TB
- keratoconjunctivitis
- mediastinal lymphadenopathy causing difficulty w/swallowing or airway obstruction
- cough in children > 10 years
classic s/s of Pulm TB
- PNA, pulmonary fibrosis
- coughing, wheezing, blood tinged sputum
- chest pain
Miliary TB occurs in which groups
- children < 3 years
- elderly
- HIV
Miliary TB leads to ____ by ___
necrosis and cassation of organ function
and
seeding organs by traveling through blood or lymph
Miliary TB S/S
- high fever
- malase/fatigue
- poor appetite, wt loss
- lymphadenopaty, hepatosplenomegaly
Malpractice is an offense covered under tort law
True
Malpractice (definition) **
A negligent act or failure to act, committed in the course of professional performance
Negligence
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
T/F - negligence can be both a state of mind and an objective conduct
FALSE - negligence is objective
Person bringing the malpractice suit
Plantiff
Person/org that is alleged to have been negligent
Defendant
A proven provider-patient relationship implies the person/organization has a ___ to the patient
Duty
A person/organization found to be negligent is considered to have a _______
Breach of Duty
Proximal Cause
Negligence that has resulted in direct patient harm
For a malpractice suit to result in damages against the person/organization, what must there be proof of?
Proof of Harm
IS the defendant allowed to contact the plaintiff
NO.
5 ethical principals of nursing ****
- Autonomy
- Nonmaleficence
- Beneficence
- Justice
- Veracity
(fidelity, accountablity)
4 components of malpractice ****
- Duty
- Breach of Duty
- Proximal Cause
- Damages
Competence vs. Capacity *****
Capacity = psych functional assessment (do they know the consequence of their actions)
Competence - decided by a judge (global assessment)
Informed Consent *****
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
Who many signed an informed consent if the patient is unable
- POA
- HCP
- Parent of a Minor
- Guardian of an IDD individual
Extrapulmonary TB
TB in other places besides the lungs - can be anywhere else in the body
3 levels of + TB skin test
- > 5 mm - + for immunosuppresed pts (HIV, transplant, suspected cases)
- > 10mm - + in children < 4 years, comorbidities, immigrants, IVDA, HCP, exposures
- > 15mm - + for everyone
How is a TB skin test read *****
48-72 hrs from placement
measure induration, not erythema
When should a skin test NOT be used ****
Previous +
Live vaccine or IG w/in the last month
Who should treat TB and how? ****
- TB clinic or ID
- NEVER monotherapy
- INH most common for use in latent TB
- corticosteroids
What type and subtype of HIV are most common in the US
- type 1 (HIV - 1)
- subtype B
Which group of people in the US are most at risk for HIV and affected by HIV
- gay, bisexual men (MSM)
- blacks have the highest infection rates
Who should be tested
- pts w/high risk behaviors tested annually
- pregnant women
- pts presenting w/new STI complaints
Is informed consent needed for HIV testing?
- NO “opt-out screening” should be utilized
Risk factors for HIV include
- 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
T/F HIV testing should only be done on people depending on level of risk
False. everyone should be tested
Symptoms of HIV develop how long after infection?
4-6 weeks
Is the HIV pt contagious before symptoms?
yes - very contagious
early bursts of viremia
HIV antibody is negative at first
Acute HIV infections last how long
2-3 weeks
What are common s/s of acute HIV infections
- fever, fatigue, rash
- HA, lymphadenopathy, pharyngitis
- myalgias/arthragias
What are crucial markers for HIV
Rash
Oral ulcers
What testing should be done for pts suspected of having an acute HIV infection
HIV RNA HIV antibody (r/o previous infections)
What is the common testing strategy for children (HIV)
ELISA confirmed by Western Blot
how long do neonates reatin mother’s antibodies after birth
12-18 months
What is the usual medication regimen for exposed neonates
Zidovudine w/in 8-18 hrs after birth - continue x 16 weeks
ADD Nevirapine if mother is not on therapy
What has a high mortality for HIV + neonates
PCP pneumonia
How should exposed neonates be treated for PCP pneumonia
PCP prophylaxis at 6 weeks of age until HIV is r/o completely
If HIV+ continue meds till one year of age
What is usually the first sign of an HIV infection in infants
Lymphadenopathy followed by hepatosplenomegaly, FTT, diarrhea, pneumonia, thrush
T/F - infants w/HIV should not receive the normal vaccination schedule
FALSE
need annual flu vaccine
live vaccinations may be deferred on case-case basis
How often should a child be tested for HIV
Check HIV RNA q3-4 mos
CD4 %
What is the goal of antiviral therapy in children
Reduce plasma HIV RNA to below detectable levels
T/F - Children less than one year of age when diagnosed w/HIV have the highest risk of progression
TRUE
How many drugs should be used to treat HIV and why?
- 3 drugs from 2 different classes
- drug resistance and cross-resistance is a major issue
What are some side effects of antiviral use in HIV
- Heme: bone marrow suppression
- Lactic acidosis, hepatic tox, pancreatitis
- metabolic abnormalities
- allergic reactions, skin rashes, hypersensitivity
T/F: if a patient has a reaction to HIV antiviral, the dose should be reduced
FALSE
this may cause an increase in drug resistance
T/F: Adolescents on HIV antiviral treatment are still able to begin contraception
True
They may interact however and should be monitored closely
What are some EARLY signs of HIV infection in adults
- generalized lymphadenopathy
- unexplained wt. loss
- recurrent infections
- oral lesions, angular cheilitis
- rashes
What are some LATER signs of HIV infections in adults
- chronic diarrhea
- persistent fever
- oral candidiasis, oral hairy leukoplakia
- pulmonary TB
- joint infections
- unexplained anemia, neutropenia, thrombocytopenia
What is Kaposi’s Sarcoma and when is it seen
- Purplish spots on legs, feet, or face
- opportunistic infection/sarcoma of HIV
What is the goal of HIV treatment in adults
- Reduce HIV related morbidity
- Balance duration and QOL
- restore as much immunologic function as possible
- suppress viral load
- decrease/prevent transmission
Early ART therapy will help how?
Prevent HIV related end-organ damage
Prophylaxis in post HIV exposure should be conducted how
ART for several days
T/F ART for HIV preexposure is recommended
TRUE
for persons who exhibit or plan risky behavior
What is the leading cause of suicidal behavior
Depression
What are the manifestations of major depressive disorder
Severe Sadness Withdrawn behavior bordem low self esteem feeling of helplessness or hopelessness no meaning in life
Dx critera for MDD
- 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
What is dysthymia
- overwhelming chronic state of depression
What else must be r/o to dx depression
- substance abuse
- mania
- other medical conditions
T/F to diagnose depression a pts symptoms must cause significant distress in social, work, school, or other areas of functioning
TRUE
T/F: depression does not occur in those less than 5 years old
UNKNOWN
Pts < 5 years do not have the verbal or reasoning skills to let you know
Children with depressed parents are how many more times likely to develop depression than those without?
3x
Adolescent depression is ofen
Chronic, comes and goes
T/F Children/Adolescents w/depression will always carry that dpression into adulthood
FALSE
- they do have 2x-4x the chance of having depression in adulthood
What are some common reasons that children and adolescents do not receive care for their depression
- Stigma
- lack of providers
- insurance issues
- misdiagnosis
T/F Younger pts with depression tend to somaticize
True
General aches and pains, HA, abd pain, school refusal
What neurotransmitters are associated with depression
- Serotonin
- Dopamine
What is the most important part of the assesment in dx depression in children and adolescents
History
HEADSS
H - Home E - Education/employment A - activites D - drugs, alcohol, substance S - Sexuality S - Suicide
T/F - when diagnosing depression, your differentials will contain mayn organic disease
True
- anemia, chronic fatigue, eating disorders, endocrine disorders, hypothyroidsm, chronic infection
On the first visit for possible depression, what should be assessed for specifically
SI
What are the 4 aspects of depression management
Psychotherapy
CBT
Social Skills training
Meds
SSRIs have a black box warning for (Prozac) *****
how long does this black box warning specifically reference **
Increased SI
Prozac has a BBW for increased SI in the first 1 month of tmtx *****
According to TADS, what is the best tmtx for children and adolescents w/drepression
- medication + CBT
First line medication for depression
SSRI
What is the 2nd line tmtx for depression
TCAs
2nd line b/c increased suicidality
How should med treatment be assessed
- reassess for benefit at 4 weeks, if none then change meds
- mild response to med reassess at 10 weeks
How long should a person be symptom-free before decreasing medication doses
3 months
Taper meds slowly
40-50% of patients that are weaned from meds will relapse w/in what time rame
2 years
how long should children be on antidepression meds
6-9months
up to 1 year
may be indefinite
T/F persons diagnosed with depression at an early age will have better outcomes in the long run
FALSE
poorer outcomes
Mild to moderate childhood depression should be treated how
CBT only
What is the FDA approved medication for use in childhood depression?
Prozac (SSRI)
What disorder is characterized by unusual shifts in mood, energy or functioning
Bipolar disorder
What disorder is often a precursor to bipolar disorder
MDD
T/F: Most patients w/bipolar disorder will have multiple episodes
True - 90%
What are some symptoms of early onset bipolar disorder
Irritability
Rapid cycling (mania/depression)
ADHD or other behavior disorders
Symptoms of later onset bipolar
- classic mania
- severe mood changes
- inflated self esteem
- increased energy, decreased sleep
- distractibility
- risk-taking behavior
- physical agitation
- hypersexuality
what is the medication management for bipolar disorder
Lithium
What other tmtx may be used for biopolar idsorder
- psychiatric referral
- careful monitoring
- long-term tmtxt
- family based tmtx
Which gender attempts suicide more often
Female
What gender completes their suicide attempts most often
Male
What is the strongest predictor of suicide ****
Previous attempt *****
AND
first degree relative with suicide attempt
What are some other risk factors for suicide
- Poor social adjustment
- substance abuse
- psychological trauma
- Delinquency
- Impulsive behavior
T/F - pt confidentiality must be maintained even when they inform you of SI
FALSE
When should hospitalization be contemplated
- personal safety is in jeopardy
- ID of means of plan
- conditions of impaired judgement (depression, psychosis, substance abuse)
What are some warning signs of depression
- 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
The CDC has listed suicde as a _____ and is promoting ______
- Public health problem
- connectedness
Why does the CDC promote connectedness
- evidence shows decreased SI if pt feels connected
- isolation is a big risk facto
What is similar b/t anorexia and bulimia
- serious disturbance in eating
- concern about body shape and weight
What 2 categories for eating disorders were added w/ the DSM 5 revisions
- Binge eating disorder
- Avoidant/restrictive food intake disorder
What are the DSM-5 criteria for anorexia
- Restriction of energy intake
- fear of wt gain even though already underweight
- disorientation w/body weight/shape/experience
Bulimia
- cyclic binge eating
- inappropriate compensatory behaviors (vomiting, laxative use, inappropriate exercise)
- freqent episodes (at least once weekly)
What time of life do most eating disorders start
Anorexia - (age 15 - 19)
Bulimia (age 18-23)
What race is most affected by eating disorders
White
T/F bulemia may arise from anorexia
True
What are some risk factors for eating disorders
- obesity
- affective disorders
- serotonin disorders
- onset of puberty
- low self esteem
- hx of abuse
What is one of the most common entry points for eating disorders
Dieting
May inceidences of anorexia resolve w/ what?
normalization of body weight
Why might serotonin be involved in anorexia
regulatory agent in mood, stress presonse and eating behaviors
What is the SCOFF screning
- 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
BMI that indicates anorexia
< 17.5
Underweight BMI
17.5 - 20
Eating disorders are diagnosed by
Clinical presentation only
What labs could be drawn for a baseline
CBC ESR CMP UA albumin
most often the pt will have hyperkalemia or hypokalemia
hypokalemia
hypoglycemia or hyperglycemia
hypoglycemia
a patient w/anorexia should only be allowed how many calories in the first few days of refeeding
- 500 above what the pt is currently taking
- add 200-300 calories every 3-4 days
Feeding a pt too many calories right away may cause what?
What is that called?
REFEEDING SYNDROME
- cardiomyopathy and cardiac decompensation
- hypophosphatemia
When should a pt be hospitalized for tmtx
- BP < 80/50
- Electrolyte imbalances
- Severe malnutrition
- EKG abnormalities
- Dehydration
- Sinus bradycardia
Treatment of eating disorders needs to involve
- interdisciplinary team specializing in eating disorders
Goals of tmtx include
- stabilize medical nad nutritional status (BMI > 16)
- ID and work toward resolving psychosocial problems
- Restablish healthy eating patterns
Inpt goal for wt increase is
1/2 lb per day
Goals for wt increast in outpatient setting
1/2 - 4lb per week
What are some nutrition goals for reffeding
- 2-3 servings of protein
- 30-50 grams of daily fat
- 1200-1500mg ca2+ (3-4 glasses of milk)
- MVI
Bulimia is characterized by
cycles of binge eating and purging
Binging is defined as
Eating larger amount at a time than a normal individual in similar circumstances
Binges often include what type of food and are done how
- high cal./carbohydrate
- in secrecy
Russell’s sign is
Calluses on knuckles or back of hand due to repeated self-induced vomiting
Other signs of bulimia
- parotid swelling
- loss of dental enamel from vomiting
- GERD
- Constipation
T/F: a bulimic pt’s weight will always be low
FALSE
may often be a normal weight
What may be present if the patient is using ipecac for vomiting
Cardiomyopathy
T/F pancreatitis is a complication of bulimia
TRUE
Labs in bulimia may show
electrolyte imbalances
hypocalcemia
hyponatremia
hypochloremia
loss of stomach acid in bulimia may lead t0
metabolic acidosis
whom is more likely to be diagnosed with depression
2:1 women:men
What medical conditions are more likely to have depression
- fibromyalgia
- migraines/HA
- PMS (PMDD)
- IBS
- chronic fatigue symptoms
Pts w/ depression will present how on a brain scan
- decreased brain activity
What is the most common depressive disorder
Major depressive episode (single or recurrent)
A pt living at a subpar level w/o having severe depressive episdoes would be Dx w with??
dysthymia
what is doube depression
Dysthymia/MDD w/anxiety
antidepressants often alleviate both sets of symptoms
Seasonal affective disorder is usually seen in what seasons
fall/winter
- less exposure to ambient light
Risk for depression
- Genetics
- Parent Loss
- Early life abuse or trauma
S/S of depression SIG-E-CAPS
S - sleep I - interest G - guilt E - energy C - concentration A - appetite P - Psychomotor S - suicdial thoughts
Risk for depression specific to women and hormonal shifts includ
- Puberty
- Postpartum
- Pregnancy
- Menopause
T/F: Moderate drinking (only one drink a day) will still predispose a pt to depression
FALSE
what medical conditions may mimic depression
- Hypothyroidism
- Vitamin D deficiency
- hypoglycemia
- caffeine withdrawal
- early dementia
Most effective tmtx of depression
- Psychotherapy
- Meds (SSRI)
Antidepressants may take how long to begin to work
10-14 days
Who will notice the effects of the tmtx first, pt or friends and family
Friends and family
how long should adults continue to take their medication after remission begins
- 4-6months
- taking meds away too soon may cause a relapse
how long after starting treatment should a pt trial discontinuation of the medication
within the first 12 months
What is a natural remedy that may help with depression but may interact with many medications
- St. John’s Wort
- Increase serotonin levels
- May lower estrogen levels (OCPs need dose adjustment)
T/F - St. John’s Wort should never be combined w/antidepressants
TRUE
What are some other recommendations for improving mood
Exercise, diet changes, sleep hygeine, daily structure
What is the most effective tmtx available, statistically for depression
ECT
ECT works how and may cause what?
- Change in neurotransmitters
- Seizures
ECT may be indicated for what patients
Those with severe or intractable depression
ECT treatment includes how many tmtx in what time frame?
- 6-12 treatments
- 4-6 weeks
What age group and race have the highest level of suicide
Non-hispanic white men over age 85
What is defined as a serious act that w/o accidental intervention, more accurate information or luck would prove fatal
Suicide attempt
What is an example of accidental intervention
Passerby sees pt trying to hang themselves and intervenes
What is an example of inaccurate information
Not knowing how much of a medication to take to have a fatal dose
What is a suicidal gesture
Nonfatal behavior as a cry for help or attention
When a pt does not intentionally attempt suicide but tests the reactions of others is called a
Suicide equivalent
Passive or persistent thoughts of killing one’s self is called
Suicidal Ideation
What is the most common method of suicide in the US
Gunshots
What are some protective factors against suicide
- Access to care
- restricting access to means
- strong connectivity
- strong cultural and religious beliefs
- treatment of depression
T/F - all depressed patients will become suicidal
FALSE
T/F - most suicide attempts are a cry for help or attention
FALSE
T/F - cutting is linked to depression
FALSE
- it is an attempt to feel something while depressed
Cutting is most common in what personality disorder
Borderline personality
Physical signs of anxiety may include **
- Fatigue
- SOB
- CP
- diaphoresis
Excessive worry about both rational and irrational things is called
Anxiety
Other mental s/s of anxiety include
- Feelings of impedning doom or disaster
- Sleep disturbances (insomnia)
- Restlessness
- Irritability
- Difficulty concentrating
For dx of anxiety, the excessive anxiety and worry needs to occur for more days than not for how long
6 months
CBT is what
- Desensitizes patients to anxieties
- helps develop coping mechanisms
- not done in primary care
What is the main medication tmtx for anxiety
- SSRI
- benzos
- SNRIs
- TCAs
- Propranolol/Clonidine/Antihistamines
What is an oral side effect of tricyclics
Tooth decay
A patient w/ cyclic severe highs and severe lows may be dx w/
Bipolar disorder
T/F - antidepressants are not helpful in bipolar disorder
True
Bipolar 1
most severe - severe swings
Bipolar 2
Severe lows but not really manic at all
Mixed bipolar
addition of dysthymia or other depressive disorder w/BPD
What mental illness is thought to have the most genetic component
Bipolar
commonly runs in families
Obsession vs. Compulsion ****
Obsession - intrusive thoughts, produce apprehension, fear or worry
Compulsions - repetitive behaviors aimed at reducing associated anxieties
OCD is what type of disorder ***
Anxiety disorder
What is the treatment for OCD ***
CBD w/exposure-ritual prevention therapy
Meds (SSRIs, SNRIs, TCAs)
ECT
T/F - Benzos are helpful in reducing the compulsions in OCD
FALSE - the benzos may become a compulsion
Schizophrenia is characterized by what 3 things
- Thought disturbances
- Disrupted social behavior
- Inability to determin what is real
Positive symptoms of schizophrenia
experiencing things others do not
- hallucinations
- delusions
Negative symptoms of schizophrenia
lack of a full emotional life
- emotional blunting
- flat affect
- relationship issues
What is the role of the FNP in the care of a pt w/ schizophrenia
- always treat in conjunction w/ psychiatry
- general health maintenance and upkeep
PHQ 9 *****
higher score = more depression
what to check for with SI *****
- plan
- means
- will
Depakote therapeutic range
50-110
Depakote usage
depression, mood stabilizer
Depakote toxicity/major risk factors
SJS risk
tox - scleral icteris
- lethargy, n/v, myoclonus, depression, respiratory depression, CNS depression
Smoking an zyprexa
increases metabolism of zyprexa, needs higher dosage
Paxil and bleeding risk
makes platelets sticky and inhibits their ability to form clots - increased bleeding risk
B cluster personality disorders
- dramatic, overly emotional, unpredictable thinking or behavior
- antisocial
- borderline (most common in women)
- histrionic
- narcissistic
cluster A personality disorders
- characterized by odd, eccentric thinking or behavior
- paranoid
- schizoid
- schizotypal
cluster C personality disorders
- characterized by anxious fearful thinking or behavior
- avoidant
- dependent
- OCD
TB S/S *****
bad: hemoptysis
+ night sweats/fever
Who starts TB meds *****
ID or TB clinic
Dietary restriction for Rifampin *****
low/no tyramine
high tyramine foods **
- 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)
Children < 10 w/TB **
no cough but can still spread
+HBeAB
-HBeAG
viral replication has stopped
Hepatitis screening
HBcAB - assesses for previous infection
HBsAG - assesses for active infection … if this is + then do HBeAG to see if viral replication is actively occuring
What HBV testing tests for viral load
HBV DNA testing
