Final Haul Flashcards
what is a healthcare strategy that focuses on early detection and intervention for diseases and injuries AFTER they have ALREADY OCCURRED
secondary prevention
Examples of secondary prevention
- screenings -help detect disease in early stage
- lifestyle changes
- immunizaton to contacts of people
timeframe of adjustment disorder
typically begins within 3 months of a stressor and lasts no longer than 6 months
major differences between conduct disorder and ODD
- ODD involves being defiant, rebellious toward authority figures, arguing, breaking rules, sx appear in preschool. Often considered milder form of CD.
- conduct disorder violates rights of others, property destruction, may lead to legal consequences, often develops in later childhood and adolescence.
major difference between intermittent explosive disorder and disruptive mood dysregulated disorder
- DMDD, the person must be in an angry state for most of the time between aggressive outbursts
- those with IED spend less than 50% of the time between aggressive outbursts in an angry state
Criteria for Tourettes
- at least 2 motor tics and 1 vocal tic for for at least one year (they can occur at different times but must be present for at least one year)
When do symptoms of Rett syndrome typically begin
(affects 1 in 10,000 girls per year. More in girls because the gene mutation occurs on the x chromosome, rarely occurs in boys
* Can be normal for first 5-6 months then see changes 6-18 months.
Intellectual disability
- low intellect and adaptive functioning
- onset before age 18
- mild, moderate, severe
- based on adaptive functioning, not IQ scores
- Downs (chromosome 21), FMRI - fragile X, tay sachs, tuberculosis
what is most preventable cause of intellectual disability
fetal alcohol syndrome
characteristics of fetal alcoholism
- epicanthal skin folds (also seen in down’s, asians)
- low nasal bridge
- short nose
- smooth or indistinct philtrum (dimple above lips)
- small head circumference
- small eye openings
- wide set eyes
- curved 5th finger
- top of ear underdeveloped
- thing upper lip
cryptorchidism
failure of one or both testicles to descend
neurocognitive disorder in TBI
evidence of traumatic brain injury with one or more of the following:
* loss of conciousness
* posttraumatic amnesia
* disorientation and confusion
* neurological signs (neuroimaging demonstrating injury, new onset of seizures, worsening seizure disorder, visual field cuts, hemiparesis, anosmia (loss of smell)
moderate to severe symptoms of TBI
- chronic worsening headaches
- repeated nausea and vomiting
- seizures
- difficult to arrouse from sleep
- unequal pupils
- confusion
- restlessness and agitation
- slurred speech
- extreme weakness or numbness
- loss of coordination
catatonia sx
LIMP MEN
* Lethargy (stupor)
* Immobility
* Mutism
* Positioning
* Motor abnormalities
* Echolalia / echopraxia
* Negativism -
negativism in catatonia
not following or resisting commands
dysthymia is now called
persistent depressive disorder
Persistent depressive disorder criteria
HES 2 SAD
* hopelessness
* energy
* self-esteem
* 2+ years
* sleep
* appetite
* Decision making
Bipolar disorder criteria nmeumonic
mania - DIG FAST
* distractability
* impulsivity
* grandiosity
* flight of ideas
* activity increase
* sleep (less need for)
* talkativeness
“3-4/7 one fun week”
simple clue for bipolar mixed episode
low mood with increased activity
simple clue hypomania
DIG FAST criteria but less impairing
age diagnose DMDD and what family history to screen for
- 6-17
- family history of bipolar disorder
mood stabilizers and antidepressants approved for children
- lithium - age 7 and older
- prozac - 8 and > MDD; 7-17 OCD
- Lexapro - ages 12 and older
- Lurasidone - 10-17, MDD associated with bipolar
- zyprexa - 13 and older for schizophrenia and bipolar
Key receptor reduced in asians and african americans
2C19
factors in elderly that affect drug metabolism
- decreased intracellular water
- decreased protein binding
- low muscle mass
- reduced metabolism
- increased body fat
refering to drug metabolism when liver disease
inhibit enzyme activity, increase risk of drug toxicity (first pass effect)
chronic alcohol use inhibitor or inducer
inducer
short term heavy alcohol use leads to inhibition or induction
inhibitor
nmemonic for most common CYP inducers
SARS
* St. John’s wort
* Anti-epileptics (phenytoin, phenobarbital, oxcarbamazepine, carbamazepine)
* rifampin
* smoking
what is first pass effect
the recirculaion process (uptake and conversion) by which substrates (changed drug) are significantly reduced by the CYP450. Non-enteric drugs bypass first-pass effect
where does absorption of a drug occur in the body.
small intestine with oral agents
the distribution of the drug in the body depends on the amount of
muscle and fat
what special situations would lamictal be a good choice for mood stabilizer
*least weight gain
* bipolar depression (not as good for mania)
Metabolic syndrome criteria
3 or more of the following
* a waist circumference > 40 men, > 35 women
* triglycerides > 150
* HDL < 40 men, < 50 women
* fasting glucose > 100
* BP of 130/85 or higher
Key components of recovery model
- prioritizes resilience, managing life challenges as opposed to complete sx elimination
- individualized, person-centered
encourage self-guidance and independence
** non-linear **- recovery is an ongoing process (growth, learning, relapses and experiential learning) - Places emphasis on lessons learned from past experiences
- focus is not on diagnosis, but on person’s capabilities, interests, and aspirations
mal de ojo
common middle east, latin america, europe
belief that if someone gives you a “bad look” it transfers bad energy to another person causing them to be sick, have bad luck and even death.
in quality improvement, what are the goals of project design
- improve the system
- decrease cost
- improve productivity
a common strategy in quality improvement projects
retrospective review (retrospective chart review)
what is PDSA
a process of quality improvement
Plan, Do, Study, Act - process
Examples of steps in PDSA
- **Plan **- recruit team, define what aiming to accomplish, describe current context and process (brainstorm), gather more detail, describe the problem, analyze cause
- DO - implement actioni plan, collect data as go such as problems, unexpected effects, and general observations
- Study - use data from the above 2 steps determine was their improvement, trends, worth investment, unintended side effects
- ACT - reflect on plan and outcomes. IF plan was successful, standarize the improvement, return to step after some time to see where there could be more improvement, if a different approach was determined to be more successful, return to step 1
What are the 4 components of Health Policy
- process
- policy reform
- policy environment
- policy makers
regarding health policy, what is involved in process component
- FIE - Formulation, Implementation, Evaluatoin
regarding health policy, what is involved in policy reform component
changes in programs and practices
regarding health policy, what is involved in policy environment component
where the proccesses take place (government, media)
regarding health policy, what is involved in policy maker component
key players and stake holders
First step in health policy
Assess the organizations barriers and facilitators
second step in health policy
Brainstorm with stakeholders
what would an PMHNP do to assess facilitators and barriers to evidence-based principles
assess knowlege, beliefs, and practices among health providers through surverys
** policy queston answers typically do not want funding as the correct answer**
describe just culture of care and give an example
individuals are committed to continual learning and designing safety systems while managing behavioral choices
-example: should a nurse commit a medication error, the immediate action is to assess patient safety
prioritize patient safety by addressing it first rather than reporting a coworker
Justice with example
commiting to fairness in ALL aspects of patient care
*example: excluding someone from a medication trial soley based on financial status is a breach of justice
nonmalificence with example
abstaining from causing harm
*example: stopping a med that might be harmful to patient or imniment danger - not giving stimulants to a patient with SUD of stimulants.
Beneficience with example
encouraging well-being and performing good deeds
*example- prescribing antidepressants to someone with depressoin
Fidelity with example
maintaining faithfulness and loyalty, promise-keeping, integrity, honesty
*example: fulfilling patient’s legitimate expectations of role fidelity, such as being respectful, competent, and professional
Patient Advocacy
- ensures patient’s autonomy and self-determination are honored
- prioritize patient’s best interest while honoring the family’s role and perspective
How is the stigma associated with mental illness reduced
patient advocacy - comprehensive psychiatric education
When choosing an education method, choose reaching for a broader audience (radio) and community versus family
how is the AUDIT score used in regards to SBIRT
AUDIT score determines appropriate intervention according to SBIRT protocol
What are 3 patient rights
- right to the least restrictive environment
- right to informed consent
- right to confidentiality
what is veracity
upholding the truth
Example - INFORMED consent
Best way to transfer medical records (non-electronic)
Fax information - NO DELEGATION for anyone to hand carry
what should you do before making a referral
anything helpful, such as ordering labs. Things that the other provider might do, so they patient does not have to wait for them to order and then wait for results.
In cases where postpartum suicide risk assessment has not been done
Collaboration with the OB department before patient discharges.
can a patient with dementia give informed consent
yes, if they can articulate risks and benefits
In metabolic syndrome what appears first
abnormal hip to waist ratio
symptoms of aplastic anemia
symptoms of bleeding
Notorious strong inhibitors
“Flu Flu flu keto”
Fluvoxamine, fluoxamine, fluconazole, ketococazole
Notoriously strong inducers
Carbamazepine, phenobarbital, phenytoin, rifampin
“Carb, barb, & phil , have a Rif”
5 most common mood stabilizers
All antieleptic drugs (AED) except lithium
- Lithium
- Valproate
- Lamictal
- Carabamazepine
- Oxcarbmazepine (tripletal)
all mood stabilizers are AED except lithium
Important to know regarding discontinuing AED
Abrupt discontinuation may cause a seizure even in those without seizure disorder. Must taper slowly.
Should use antidepressants in bipolar depression?
NO, may be effective in short term, but may destabilize mood in long term.
What medication can be used with acute mania - works fasted
SGA
What is black box warning on Lithium
States that a lab for testing must be near by.
What disorder happens 6-fold (15%) when taking Lithium
Hypothyroidism (interferes with production of thyroid hormone)
Most common meds that may decrease lithium levels
Caffeine, theophylline, mannitol, topiramate
Lithium levels increased most commonly by which drugs
Thiazide diuretics, ACEI, ARBs, NSAIDs, COX-2 inhibitors, antimicrobial (flagyl), tetracycline
Maintenance dose lithium
900-1200 (1200-1800 for acute mania)
Difference between SJS and benign lamictal rash
SJS - 1-12 weeks after starting, tender, rapidly confluent and wide spread, neck and above, purpuric (non-blanching), may involve conjunctiva, mucous membrane, fever, malaise, lymphadenopathy, leukocyte is
Benign rash- 10-14 days, non-tender, spotty (non-confluent), below neck
Black box warning depakote
Hepatotoxic, pancreatitis, neural tube defdcts
What to do with mental status changes with depakote
Check ammonia level. Increased ammonia levels may be dose dependent and may decrease with dose decrease.
Unique side effect Belsomra (suvorexant)
*good for sleep maintenance not onset
Narcolepsy (cataplexy)
NDRI
Norepinephrine dopamine reuptake inhibitor
Wellbutrin
NRI
Norepinephrine reuptake inhibitor
Atomoxetine (Straterra)
SNRI meds
Cymbalta
Effexor
Pristiq
Fetizma
NaSSA
Noradrenergic & specific serotonergic antidepressant
Remeron
SMS
Serotonin modulator and stimulator
Vibryd (vilazidone)
Vortiotextine (Trintellix)
Side effect cymbalta
Liver damage (rare)
DNRI
Methylphenidate
Amphetamine
Lysdexafetamine (vyvanse)
DRI
Modanfinil (provigil)
Armodafinil (nuvigil)
Daytime sleepiness
D2 receptor antiemetic
Promethazine (Phergan)
Prochlorperazine (compazine)
Metoclorpramide (Regan)
Muscanaric (cholinergic) overload
Everything wet “SLUDGE”
Salivation
Lacrimation
Urination
Diaphoresis
GI upset (diarrhea)
Emesis
Anticholinergic (antimuscarinic)
Everything dry
Dry as a bone
Mad as a hatter
Blind as a bat
Can’t shit, can’t piss
Strongest anticholinergic drug
Atropine
Glycopyrrolate
Robinul - can be used for excessive salvation and hyperhidrosis
What are AChE inhibitors
Enhance cholinergic (muscanaric) activity by inhibiting acetylcholinesterace the enzyme that breaks down acetylcholine. Used as a cognitive enhancer in Alzheimer’s
Name 3 AchE inhibitors
Donepezil (Aricept)
Rivastigmine (exelon patch)
Galantamine (razadyne)
NMDA receptor receptor antagonist
Cognitive enhancer used for severe dementia. NMDA receptors are involved in synaptic plasticity and memory. It’s lightly blocked, just enough to improve memory. If they are completely blocked neurons cannot function, street drug PCP.
Memantine (nemanda)
Alpha 2 adrenergic (norepinephrine) receptor agonist
Clonidine
Guanafacine
Lofexidinec(Lucemyra) - opioid withdrawal
Alpha 1 antagonist
Prazosin - minipress
Smooth muscle relaxer (BPH, Raynaud’s, PTSD nightmares
First line treatment for Akathisa
Propranolol
Dopaminergics
Carbidopa-levodopa
Ropinrole (requip) (restless legs)
Pramipexole (mirapex)
Bromocriptine
How would assess for ebstein anomaly
Assess for murmur
ADPIE
Assess, diagnose, plan, implement, evaluate
Normal CPK
10-20
Kids doing great on SSRi, but expresses SI
D/C med
Age range Prozac
6 and older
Which medication cannot be given with previous TBI
Wellbutrin
What age ranges do SSRI have highest SI risk
Adolescent, < 26
Trazodone
SARI - serotonin antagonist reuptake inhibitor
When you see person taking kava what is first action
LFT
Which SGA decrease prolactin
Abilify
What medication might be considered in borderline personality disorder with self- harm
Lithium
OCD transmitters
Serotonin and norepinephrine
Prioritization in clinical judgement
- questions that emphasize “priority or initial action”
1. Ensure ABC (airway, breathing, circulation) first choice
2. apply maslows hierarchy of needs
3. use nursing process - assessment first step - collect data, literature reviews, lab results
safety contracts on test
always wrong answer
which medications can cause tics
stimulants - always discontinue first
which neurotransmitters involved in tourettes
hyperactivity of dopamine, serotonin and norepinephrine involved
medications to treat tourettes
Alplha 2 adrenergive agonists
Clonidine and guanaficine
3 main steps EMDR
- desensitization
- instillation
- body scan
basal ganglia
millions of nerve cell bodies
execute smooth muscle movement
(cerebral cortex decides on body movement)
Reticular activating system
in brain stem, medulla, connection of nerve fibers responsible for sensation, conciousness, attentionm, and sleep-wake cycle. Transmits sensory messages to different areas of cerebral cortex through the thalmus. It has gating properties that holds back unnecessary information from a sense organ while strong or necessary sensations are sent through.
ages to use amphetamine
3 and up
(all other medication for ADHD is 6 and up)
what ages are guanafacine and clonidine for ADHD
6-17
where must symptoms of ADHD be present for diagnosis
2 settings
dorsolateral prefrontal cortex
- executive function
- planning, working memory
- problem-solving
- task attention
one of the greatest family history factors in bipolar disorder
family history across generations
main treatment for oppositional defiant disorder
- family therapy with management skills
- teach parents + reinforcement and boundary setting
- goal - prevent from leading to conduct disorder
Key points for conduct disorder
- < 18 years of age
- property destuction, hurting animals
- destruction, violate personn rights
- no remorse
- may have childhood onset before age 10 or adolescent onset
- prosocial emotions - lack of remorse, empathy. unconcerned about performance, shallow or defficient affect
- stay out past curfue and/or ran away from home before age of 13
- treated with meds for mood aggression - SSRI, alpha agonist clonidine and guanafacine
- family therapy mat be helpful
what cyp enzyme primarily metabolizes clozaril
CYP 1A2
which medication can cause maniam, depression and psychosis
steroids
case management
considers patient and provider satisfaction as well as cost considerations to help manage overall health
positive aspects of case management
enhance clients self-care, diminish fragmentation of care, improve quality of care throughout continuum, boost staff and provider satisfaction, cost effective use of resoources, members of multidisciplinary teams
What are limited prosocial factors
- lack of remorse or guilt
- callous- lack of empathy
- unconcerned about performance
- shallow or deficient affect
derailment
- aka loosening of associations
- spontaneous speech that slips of track, with ideas that are unrelated or loosely related.
What does the brainstem include
- midbrain, pons, medulla, cerebellum, reticular formation
what does the mid-brain house
ventral tegmental area and substantia nigra
what does the pons hosuse
locus ceruleus
What does the medulla do
together with the pons, contains autonomic control centers that regulate internal body functions
what is the cerebellum responsible for
- maintaining equilibrium;
- acts as gross motore control center
- each hemisphere of the cerebellum has ipsilateral control
Problems within the cerebellum can lead to what and what test, tests cerebellum function/deficiences
- lead to ataxia (impaired coordination)
- Romberg test can detect cerebellar deficiencies
reticular formation system
- the primitive brain
- receives input from the cortex
- it is an integration area for input from postsensory pathways
- innervates thalamus, hypothalmus, and cortex
brainstem regulation functions
- involuntary movement
- reflex
- muscle tone
- vital sign control
- critical to conciousness and ability to mentally focus, to be alert and pay attention to environmental stimuli
brain structures in the limbic system
- Limbic, latin word for limbus which means border, referring to location of these brain structures situated on the edge of the cerebral hemispheres, bordering the brainstem
- amygdala
- hippocampus
- hypothalamys,, thalamus
what are the limbic system functions
- processing and regulating emotion, memory, and sexual arousal
- important element of the body’s stress and is highly connected to the endocrine and autonomic nervous system
- responsible for processing the body’s response to odors
what can problems in the limbic system lead to
affect emotions, behaviors, risk-taking, decision making and can affect memory too
amygdala responsibilities
- mediating mood, fear, emotion, aggession
- responsible for connecting sensory smell information with emotions
hypothalamus function
plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation
thalamus
sensory relay station EXCEPT FOR SMELL; modulates flow of sensory information to prevent overwhelming the cortex; regulates emotions, memory, and related affective behavior
the brain is subdivided into the
cerebrum and brainstem
cerebral cortex
outermost layer of the cerebrum AKA gray matter
the cerebrum is divided into left and right hemispheres by what
corpus collosum (basal ganglia large part), thick track of nerves at the base of the fissure that allows communication between the right and left hemisphere
each hemisphere is divided into what
4 lobes
1. frontal lobe
2. parietal lobe
3. occipital lobe
4. temporal lobe
major functions of the frontal lobe
largest lobe, involved in personality, decision making, movement and speech
major function of the parietal lobe
- middle, top of head -
- involved in identifying objects, understanding spatial relationships, interpreting pain and touch
- primary sensory area, taste, readning and writing
Occipital lobe function major function
located in the back of the brain, involved in vision
temporal lobe function
- located on the sides of the brain,
- wernickek’s area (receptive speecch or language comprehension)
- primary auditory area
- integration of vision with sensory information
- perception, face recognition,
- involved in short term memory, speech, musical rhythm, and some smell recognition
basal ganglia
- serves as a complex feedback system to modulate and stabilize somatic motor activity
- plays a role in movement initiation; complex motor functions with with association connections
- functions in learning and autonomic actions
- contains extrapyramidal motor functions
- functions in involuntary motor activities
problems in this area of the brain can lead to bradykinesia, hyperkinesia, and dystonia
basal ganglia
Sensory information relayed to the thalmus to
processed and integrated into the cortex
problems in this sensory area can lead to sensory and perceptual disturbances and agnosia
- agnosia - inability to recognize, objects, people or sounds
- Parietal lobe
important substructures of the frontal lobe
- prefrontal cortex and orbitofrontal cortex
- involved in attention and thought, voluntary movement, decision making, and language
where is the Broca’s area
frontal lobe
expressive speech
what area of the brain is most focal for personality development
frontal lobe
what area of brain is responsible for controlling voluntary motor activity fo specific muscles
frontal lobe
Premotor area - coordinates movement of multiple muscles
Association cortex
in the frontal lobe, allows for multimodal sensory input to trigger memory and lead to decision making.
problems in this lobe can lead to auditory hallucinations, aphasia, amnesia
temporal lobe
nucleus acumbens
- considered part of basal ganglia
- reward circuit of the brain
- VTA project to nucleus acumbens to increase dopamine levels
how does the basal ganglia receive information from the cortex about the “movements you want to make”
- most information travels 1st to caudate or putamen via the corticostriatal pathway
problems in the caudate leads to this disorder
strongly linked to huntingtons
putamen
- part of the basal ganglia and the dorsal striatume which also includes the caudate nuclues
- part of corticostriatal pathway
- contain GABA
- strongly linked (along with the caudate) to huntington’s, parkinsons
substantia nigra
- located in brainstem, part of basal ganglia
- contains large amounts of dopamine (along withe the adjacent VTA)
- projects to the striatum (putamen and caudate) forming the nigostriatal pathway
- Movement is one of the substantially nigra main functions
- PARKINSON’s - death of dopamine neurons in the substantia nigra
caudate and putamen together are known as the
striatum
Bandura theorist
self efficacy and social learning theory
* behavior is result of cognitive and environmental factors
* people learn by observing, relying on role-modeling
* self-efficacy - perception of the one’s ability to perform a certain task at a certain level of accomplishment
* behavioral changes and maintenance are functions of outcome expectations and efficacy expectations
Simvastatin is a what and what can it cause if prescribed with
CYP450 3A4 substrate and should not be combined with a 3A4 inhibitor like Prozac. Causes increased blood levels of statin leading to rhabdomyolosis.
When is a root cause analysis most effective
whenever a problem repeatedly occurs within a process
steps in root cause analysis
- defining the problem
- gathering data
- indentifying the causative factors
- developing corrective factors
