FINAL Exam Flashcards
Renal, thyroid, blood, Community, endocrine:
Review restraints/involuntary commitment
-Involuntary Emergency Admission (IEA): a person who is a harm to themselves or others, or shows a self-care deficit. Will be admitted for 72 hours (tops per state). Needs 2 approvals from physicians/psychiatrist.
-Restraint checked q 15 minutes. Offer water. Need constantly reapproved restraint order from physician.
Graves disease, diabetes mellitus, adenoma, anemia, neutropenia, thrombocytopenia, thyroid medication, IBS,
Graves disease: hyperthyroidism. Bulging eyes, High BP
DM: sugar level unregulated. Hyper and hypoglycemia. Tx of hyper with insulin, hypo with crackers.
Transference and Countertransference
-Transference: when a person projects someone they know onto you; positive or negative.
-Countertransference: the we project someone from our life onto our patient.
How do you assess for hallucinations.
-You don’t ask if they’re hallucinating, you ask if they’re hearing or seeing things that others can’t see.
Review Stages of Alzheimer’s, and differences between delirium and dementia and medications ( NMDA and Cholinesterase medications
AD
-Stage 1: mild short memory loss, loosing things
-Stage 2: repeating things, loss of short and long term memory, regression. Un orientated to place, time, and situation.
-Unable to speak, complete ADLS. Un orientated to person, place, and time. Swallow risk.
Dementia: an acute loss of neurocognitive function related to an underlying cause. 50% of hospital patients experience this.
-Irritability, or agitation
-Poor recall
-Moments of lucidity*
Meds:
NMDA - memantine
Cholinesterase medications: donezpezil, galantine,
Know ranges of Gabapentin
and Olanzapine
100 mg TID – 1200 mg TID
2.5 mg – 20 mg
Which personality disorder is the most manipulative? What is splitting
Most manipulative is Bipolar Personality Disorder.
Splitting is when you either hate or love someone. It can also be pitting two people against each other.
Review antidepressants and suicide risk, do the all or just SSRI’s
4 highlights of antidepressants: 1) High suicidal risk for 18-24 yo in beginning of tx 2) DON’T mix MAOIs and other depressants 3) Side Effects! Sexual dysfunction, wt changes 4) ???
Classes
-SSRIs: fluoxetine, paroxetine
Serotonin syndrome
-SNRI: duloxetine
-TCA: amitriptyline, imipramine
Anticholinergic effects
-MAOI: phenyline
Hypertensive crisis
-Atypical: bupropion/Wellbutrin
Anorexia
Anorexia: abnormal restraint on diet, through exercising, food restriction, enema/vomiting.
D- When a person restricts their diet through purging, dieting, exercising, diuretics. Low BMI (below 18.5). At risk of
E- Family hx. A r w/ substance abuse, depression/anxiety
A- At risk for electrolyte imbalance and cardiac issues. Assess for irregular pulse, hypotension, jaundice. Look at knuckles for marks from throwing up.
T- Slowly. Don’t feed them a bunch at once; they’ll get re-feeding syndrome. One-on-one observation during eating to make sure they’re not hiding food or making themselves puke. Doing desensitization to food. Deep breathing. Introduce them to larger portions at a time. Educate on disorder
H- There’s a chemical reason behind this. Come from where they are.
What are the stages of violence
-3 stages 1) Tension phase 2) Acute battering phase 3) Honeymoon phase
Review Lithium/ when to draw a Lithium level.
Therapeutic level
Know Lithium toxicity, need maintain fluid balance
Take test 8-12 hours after the last dose.
Therapeutic range: 0.6-08 or 0.6-1.0
Lithium toxicity: fever and confusions.
Antipsychotic side effects for 1st and 2nd generation. Remember conventional antipsychotics are 1st generation.
Antipsychs:
First Gen: Haloperidol. Chlorpromazine. Tx positive effects.
-Akasthia, muscle tremors, dystonia tardive
Second Gen: Clozapine, duloxetine
-Metabolic syndrome
Third Gen: Abilify. Subset of second Gen.
Propranolol (beta blockers). Used for
(Test) anxiety
Alcohol and nutritional needs
Alcohol abuse: typically malnourished from running on liquid calories. B1, 12 deficiency
-Tx: water
acute mania
-Treated with olanzepine, then lithium
-Prodromal phase: treated with medications and potentially restraints.
Positive and negative symptoms of schizophrenia
Schizophrenia
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
ADHD
Meds
Stimulants: methylphenidate/Ritalin and amphentime salts/Adderall
Non-stimulants: clonidine and guanfacine.
SNRI: atomoxetine
Atypical antidepressants
Rape Trauma syndrome stages
Rape trauma syndrome:
1. Acute phase: may be expressive, mute, or disorientated.
2. Outward adjustment phase: goes on with life while coping with trauma. May: suppress, minimize, dramatization, explanation, flight
3. The resolution phase
Review DID (dissociative identity disorder)
D - DID: when a person has two or more personalities that don’t know about one another.
E - Typically due to severe trauma.
A - May have varying affects, intonation at times. May have gaps in memory.
T - psychotherapy, counseling
H -
Medications for Alcohol and Opioids
Meds for Alcohol
-Disulfiram: makes you feel gross when you drink.
-Acamprosate: decreasing craving
Opioids
-Methadone: controlled substitute
-Suboxone: treats withdrawal and substitutes dependence.
-Sublocade: substitute.
Both
-Naltrexone: suppresses reward of behavior
detox CIWA and COWS
CIWA, or clinical institution withdrawal assessment; for alcohol withdrawal
-Scale of 0 to 15+. 8-10 mild symptoms, 10-15 moderate, 15+ BAD.
COWS, or clinical opioid withdrawal scale: for opioid withdrawal
-Scored 5 to 36, 36 being the worst.
Review anticonvulsant medications
-gabapentin
indications: idk
