LMR part 2 Flashcards
Irvin Yalom characteristics of group therapy includes what
6 characteristics?
a. Instillation of hope
b. Universality
c. Group cohesiveness
d. Altruism
e. Interpersonal Learning
f. Appreciative Inquiry
Participants develop hope for creating a different life. Members are at different levels of hope, so they gain from others
Instillation of hope definition
Discover that others have similar problems, thoughts, feelings – they are not alone
Universality Definition
Attraction to group and others – sense of belonging
Group cohesiveness Definition
Sharing oneself with another and helping others
Altruism Definition
Interacting with others increases adaptive interpersonal relationships
Interpersonal learning definition
An approach to organization changes which focus on strengths rather than weaknesses
Appreciative Inquiry definition
What is PICA?
Eating things that are not food such as paint chips. (may be a sign of lead poisoning)
What are two neurotransmitters in Addiction?
GABA and Dopamine
Delusion definition
a. Firm belief maintained despite of evidence of the contrary
b. Cult
c. Church members are part of cult
What does it mean when a patient with anorexia complains of pain after eating/bloated/fullness?
Delayed Gastric Emptying
What three medications can delay gastric emptying?
a. Ranitidine
b. Famotidine
c. omeprazole
What medications can decrease the absorption of psychotropics? How long to wait between these two medications?
a. Antacids + PPI
b. Wait 2 hours between psychotropic and antacid administration
SSRIs can cause what in older adults?
It can cause increased anxiety
Make sure to avoid certain medications that cause paradoxical effect, what is an example of paradoxical effect?
This means that it causes the opposite effect.
Benzos is a medication that can have a paradoxical effect.
Citalopram can cause what?
Can cause QT prolongation
Citalopram:
a. Do not give adults more than how many mg daily?
b. What about older adults?
a. Adults more than 40mg a day.
b. Older adults no more than 20mg a day
Apoptosis definition
Death of a cell/neuronal loss
What is one way to assess depressed mood, emotional lability, and irritability?
Administer Mood Questionnaire
Sleep disorders or nightmares in children: What to assess and why?
Assess family patterns of nightmares due to genetic factors.
What are signs of lead poisoning? (Just read)
Developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness/fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, PICA
What do you do for lead poisoning?
Order test for lead.
Lead is found in rural 1970s houses
When taking care of an infant that is about to die, it is important to what?
Give child to parents to allow to grieve for their loss.
Normal grief and loss in children (just read)
a. Psychoeducation on grief reactions/response
b. Encourage support group
c. Grief responses vary = no protocol on how to grieve.
Normal grief and loss in children example
a. If child lost mom, do not tell dad how child should grieve.
b. It’s most important to have intact family to make child adapt easily.
What are the neurotransmitters in mood disorders?
a. Dopamine, Norepi, Serotonin (DNS)
b. GABA
c. Glutamate
What are risk factors for osteoporosis?
a. smoking, caffeine,
b. Lack of weight bearing exercise,
c. Lack of diet rich in calcium and Vit D.
Enmeshment definition
The relationship between two or more people in which personal boundaries are unclear.
Enmeshment example
This can occur during countertransference- Therapist might be too emotionally attached to patient where boundaries are unclear.
What are the key elements of mindfulness meditation technique?
a. Breathe awareness
b. Awareness of body sensation, thoughts or sounds
What can help build resilience in children?
Self esteem building exercises
When are yes/no, close ended questions appropriate? Example?
a. Unable to construct a chronological narrative
b. Ex: 10-year-old child who cannot construct a chronological narrative – use yes/no
You scheduled an appointment with a couple but only one showed up. What do you do next?
Reschedule appointment until both can be present
You are working in an office setting and you find out that a patient’s 5-year old son got sodomized/raped by 16 sister, what are the steps you have to do to handle this?
Do not let 5 year old alone with sibling, report to CPS, and arrange crisis therapy.
What is the Freud Phallic stage and what age?
The stage where 3-6 year olds play with their genitals and it’s normal
Boys develop enlargement/swellings/tenderness under nipples: What are the ages and when does it disappear?
They are ages 9-16 years old.
It disappears within 6 months.
What increases in rheumatoid arthritis?
Erythrocyte sedimentation rates (ESR)
An infant has a shrill/high pitched cry. What do you suspect?
They have increased intracranial pressure
An elderly female patient/post-menopausal woman is complaining of a decreased sex drive. What can this indicate?
a. Decreased levels of testosterone.
b. Decreased blood flow of the pelvic region
Alcohol dehydrogenase definition
ETOH tolerance? This means that women are more likely to get drunk compared to men because they have a decreased amount.
Men are more likely to develop ETOH induced liver compared to women: True or false
False
Women are more likely to develop ETOH induced liver problems copared to men.
When psychiatric care provider added to a non- psych practice like OBGYN = increase mental health access
Just read
Palmar reflex/grasp = until how many months?
This is when they grab someone’s finger.
5-6 months
Moro reflex/grasp = until how many months?
This is when they startle because they feel like they are falling.
Until 5-6 months
Babinski reflex/plantar = until how long? When should toes go inwards? How old for outwards?
a. Until 2 years- This is when toes go outwards
b. After 2 years is when toes go inwatds
What is Phosphodiesterase (PDE5)? What it’s used for?
a. Viagra
b. Used for sexual dysfunction
c. It is rapidly absorbed
What to check if a patient has Macrocytic normochromic anemia?
Check Vit B12 and folic acid
Adolescents ADHD = substance use. Ex: you read an article and found out that adolescents with ADHD have a higher substance use – apply in your practice by screen all adolescent ADHD patients for substance use OR screen all substance use patients for ADHD
Just read
What is acupuncture used for?
Used for pain and depression.
What does Habeas corpus mean?
It’s the legal principal that protects patients against unlawful hospitalizations (mental illness)
Symptoms for disseminated encephalomyelitis? Common in who?
Symptoms =
a. weakness
b. ataxia
c. confusion
d. paresthesia.
Common in children
What does a provider do who someone who has asymmetrical body movements on extremities?
The complete a neuro exam for diagnosis
PICOT- What level is evidence from systematic review or meta-analysis of all relevant RCTs?
Level 1
PICOT- What level is evidence obtained from at least one well-designed RCT
Level 2
What to review to establish patient diagnosis? What to do if unable to remember?
Review timeline of their symptoms.
If unable to remember, use anchor memory technique/link memorable events
What is an example of something that is based on evidence?
Current journal articles
What to do before you start a patient on a medication?
Assess patient’s knowledge and beliefs
What can cause iatrogenic disease?
If adverse effects are not treated, this can cause iatrogenic disease
Iatrogenic is common in what population?
Older adults, so assess medication history.
What do you do if you are trying to create a policy for NPs worldwide?
Host online forum/survey for feedback
What do you do if you are trying to implement a new policy at a job site but your colleagues are against you?
Discuss with them how new policy can improve quality of patient care
How to ensure continuous improvement of quality care outpatient clinic?
Develop an instrument to monitor clinical outcomes
How to ensure continuous quality improvement when treating patient with mental illness like depression/anxiety?
Use a rating scale to determine baseline scores and at regular intervals during treatment
Autoimmune diseases increase what?
Increased cytokine levels
Desmopressin can cause what?
Can cause enuresis (decreases urine production)
Why can’t you look at a patient’s social media?
It’s violating patient’s trust
What is an example of conflict of interest policy?
pharmaceutical companies promise to pay off student loans for NPs if they prescribe their medications
If a patient is on a medication but then the FDA releases a black box warning on medication and the patient is asking you about the BB warning. What should you do?
Research benefits and risks of continued use of medication
How to apply using off label use of medication?
Full disclosure documentation (benefits/risks) and evidence that supports off label use.
Risk factors for sleep apnea?
Excess weight
obesity
DM
smoking
HTN
narrowed airways
What does reflective practice mean?
Debriefing strategies after event/cause
What some legal issues of telemed?
confidentiality and medical errors.
Jurisdiction authority over what?
jurisdiction authority over licensure
A SUD is attending intensive, structured outpatient program. What if they are still blaming other for their issues?
If they are still blaming others for their issues, they may not be ready to transfer to less intensive/less structured program.
If SUD are able to identify coping skills?
They are able to transfer to less intensive program
Tarasoff principle: What is it?
It is Duty to warn.
This means we can notify potential victims of imminent danger of HI clients.
Rennie v Klein case: What is it?
An involuntary committed patient who has not been found competent, absent of emergency, has a qualified right to refuse psychotropic medications.
What is Donaldson v O’connor?
a. Confinement
b. It is unconstitutional to commit a person involuntary (for the longest time) who is not DTO/DTS.
*Donald duck can’t be confined
Erikson’s:
Appreciation of independence and relatedness
Trust vs Mistrust
Erikson’s:
Acceptance of the cycle of life, from integration to disintegration.
Autonomy vs shame
Erikson’s:
Humor, empathy, resilience
Initiative vs guilt
Erikson’s:
Humility, acceptance of the course of one’s life and unfulfilled hopes
Industry vs Inferiority
Erikson’s:
Sense of complexity of relationships; value of tenderness and loving freely
Intimacy vs Isolation
Erikson’s:
Caritas, caring for others and agape, empathy and concern
Generativity vs stagnation
Erikson’s:
Existential identify; a sense of integrity strong enough to withstand physical disintegration
Integrity/Ego vs Despair
Ability to learn how things work to understand and organize.
School age: 6-12
Industry vs Inferiority (1)
Ability to work, sense of competency and achievement
Industry vs Inferiority (2)
Friends and classmates play a role in how children progress through this stage.
Industry vs Inferiority (3)
Through proficiency at play and schoolwork, children are able to develop a sese of competency and pride in their abilities
Industry vs Inferiority (4)
Unfavorable outcome; A sense of inferiority to understand and organizing
Industry vs Inferiority (5)
a. Ages 2-7
b. Magical thinking is normal
c. Normal to dream about monsters
Piaget’s Theory: Pre-operational
Piaget’s Theory: Formal Operational
a. 11+ years old
b. Abstract logic
Ex: science project, test hypothesisi.
