Mark K Yellow Book Flashcards
1
Q
If the pH and the BiCarb are both in the same direction then it is?
A
Metabolic
2
Q
If the pH is up it is?
A
Alkalosis
3
Q
As the pH goes so goes my patient except for?
A
Potassium
4
Q
If the pH is down it is?
A
Acidosis
5
Q
If the pH is up my patient will show signs and symptoms of?
A
Increase… like tachycardia, diarrhea and borborygmi
6
Q
If the pH is down my patient will show signs and symptoms of?
A
Decrease… like decreased output, bradycardia and constipation
7
Q
If my pH is up my potassium (K+) is?
A
Down
8
Q
If my pH is down my potassium (K+) is?
A
Up
9
Q
If my patient is overventilating I should choose?
A
Respiratory Alkalosis
10
Q
If my patient is underventilating I should choose?
A
Respiratory Acidosis
11
Q
If my patient has prolonged gastric vomiting or suction I choose?
A
Metabolic Alkalosis
12
Q
If it is not lung or prolonged vomiting or suctioning I choose?
A
Metabolic Acidosis
13
Q
Kussmal Respirations
A
Metabolic Acidosis (Remember MacKussmal)
14
Q
Before measuring ABGs you should check what?
A
Allen’s test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries. Ulnar pressure is released and color should return in 7 seconds (means it’s positive and OK to take ABGs).
15
Q
Definition of Compensation
A
PH is normal! It is never compensated if it is abnormal.
16
Q
If PH normal - look in the direction it is going. Closer to Acidic? (7.35)
A
Acidosis.
17
Q
Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it’s?
A
Metabolic Acidosis.
18
Q
If CO2 is abnormal, it’s?
A
Respiratory Acidosis.
19
Q
If your pt is acidotic and you need to pick a symptom - Pick the symptom where everything is?
A
DOWN. (And vice versa)
20
Q
If you don’t know what causes an acid base balance, pick?
A
Metabolic Acidosis
21
Q
If in doubt in ABGs, always pick?
A
Headache, nausea, weakness & numbness + tingling. It can be either up or down.
22
Q
High pressure alarms are triggered when?
A
They cannot push air in.
23
Q
High pressure alarms are caused by what three types of obstructions?
A
Kinking, Water in dependent loops and mucus in the airway.
24
Q
If kinking in the tube is present you?
A
Unkink.
25
If water is present in the dependent loops you?
Open system and empty water.
26
If mucus is present you?
Turn them, cough and have them deep breath first. If ineffective you then suction.
27
Don't suction unless?
Coughing & deep breathing is deemed inappropriate.
28
In order to suction, you must be able to hear?
Mucus in the lung.
29
Low pressure alarms are triggered when?
It is too easy to push air in.
30
Low pressure alarms are normally caused by?
Disconnection.
31
If the tubing is disconnected you?
Reconnect.
32
If O2 sensor line is disconnected you?
Reconnect.
33
In a vented client respiratory alkalosis means the vent setting may be too?
High.
34
In a vented client respiratory acidosis means the vent may be too?
Low.
35
What do you do if the patient's disconnected tube is on the floor?
Bag them, (call for help) get new tube and then reconnect.
36
First question to ask if the low pressure alarm sounds?
Where is the tubing?!
37
HOLD
H- High Pressure, O- Obstruction, L- Low, D- Disconnections.
38
Never put anything in YOUR scope of practice?
On anyone else.
39
Make sure your answer is?
PATIENT FOCUSED.
40
TAKE CARE OF YOUR PATIENT!
Don't answer based on staff, building, machine, etc. PATIENT FIRST.
41
What does wean mean?
Decrease Gradually.
42
What do you do if the patient's disconnected tube is on the chest?
Reconnect ... if it's above the waist it's ok.
43
Remember is PSYCH if you are asked to Prioritize, Don't forget?
MASLOW!
44
When prioritizing, always use Maslow + ABCs?
For one patient. Don't if you have more than one patient.
45
What is the biggest problem in abuse?
Denial.
46
To treat denial you need to?
Confront them.
47
Definition of Denial?
Refusal to accept reality of their problem.
48
How do you confront?
Point out the difference between what they say and what they do.
49
What is the one circumstance that you as a nurse would support denial?
Loss and Grief.
50
Always go?
Med surg first. Then Psych.
51
What is dependency?
When the abuser gets a significant other to make decisions for them or do things for them.
52
What is codependency?
When the significant other gets positive self-esteem from doing things or making decisions for an abuser.
53
To treat dependency/codependency you?
Set limits and enforce them.
54
Say NO and follow through?
Agree in advance on what requests are allowed, then enforce the agreement.
55
What is manipulation?
When the abuser gets the significant other to do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.
56
How do you treat manipulation?
Set limits and enforce.
57
Why is manipulation easier to treat than dependency/codependency?
Because no one likes being manipulated.
58
DABDA
D- Denial, A- Anger, B- Bargaining, D- Depression, A- Acceptance.
59
Psych Needs, In order?
Denial, Depend, Manipulation.
60
To address a patient's psychological needs, they must be?
STABLE, safe, comfortable.
61
Pain?
Never killed anyone. NOT the top priority, especially if there are physiological needs in the question that make the patient unstable.
62
What is Wernickes (Korsakoffs) Syndrome?
Psychosis induced by vitamin B1 (Thiamine) deficiency.
63
Symptom of Wernickes Korsakoffs syndrome?
Amnesia with confabulation.
64
Vitamin B1 helps breakdown?
Alcohol.
65
So without B1 what happens?
Alcohol isn't metabolized correctly goes to the brain and causes Wernickes.
66
Primary symptom of Wernickes?
Amnesia with confabulation (making up stories).
67
Is Wernickes preventable?
Yes- Take Vitamin B1.
68
Is Wernickes arrestable?
Yes- Take Vitamin B1.
69
Is Wernickes reversible?
No.
70
What is the goal of patients dementia/organic brain syndrome?
Maintain function, Never Improve.
71
What is aversion therapy?
When you try and make the patient hate something.
72
Antabuse onset and duration is?
2 weeks.
73
Teach a patient taking Antabuse to avoid what?
Alcohol.
74
On top of alcohol a patient taking Antabuse should also avoid what other 7 things?
Alcohol, Aftershave, Cologne, Perfumes, Insect Repellent, Elixirs, Vanilla Extract, Vinaigrettes, Handsanitizer, Alcohol Prep Pads, Vanilla Icing.
75
How long does it take for Antabuse to get out of the system so they can drink Alcohol again?
2 weeks.
76
What are Elixirs?
95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse.
77
What happens if a person on Antabuse ingests alcohol?
Nausea, Vomiting, & Possibly Death.
78
In Overdose VS Withdrawal, Ask yourself?
Is this drug an upper or a downer?
79
What are the five uppers?
Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts.
80
Downers are?
Everything other than the five uppers.
81
S/S of upper use?
Everything goes up: Tachycardia, Increased BP, Irritability, Fever, Diarrhea, +4 Reflexes, Pupil Dilation, Excitability, Seizures, Borborygmi, ETC.
82
S/S of downer use?
Everything goes down: Bradycardia, Lethargy, Constricted Pupils, Hyporeflexia, Flaccidity, Respiratory Depression.
83
Then ask yourself?
Are they talking about Overdose or Withdrawal?
84
Overdose/Intoxication?
I have too much....
85
Withdrawal?
I don't have enough....
86
Overdose of a downer causes everything to go?
Down.
87
Overdose of an upper causes everything to go?
Up.
88
Withdrawal of an upper causes everything to go?
Down.
89
Withdrawal of a downer causes everything to go?
Up.
90
Upper withdrawal looks like?
Downer Overdose.
91
Downer Withdrawal looks like?
Upper overdose.
92
At birth if the mother was addicted to a substance always assume the newborn is?
Overdosed.
93
If 24 hours after birth assume the baby is in?
Withdrawal.
94
Every alcoholic goes through what within 24 hours after cessation?
Alcohol Withdrawal syndrome.
95
What is Alcohol Withdrawal Syndrome?
Hyper irritability state less than 24 hours after the first drink.
96
After 72 hours of alcohol withdrawal a small minority may get?
Delirium Tremens.
97
Can Delirium Tremens kill you?
Yes.
98
Can Alcohol Withdrawal Syndrome kill you?
No.
99
Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?
No.
100
Are patients with Delirium Tremens a danger to themselves or others?
Yes.
101
N/I for Delirium Tremens?
Private room near nurses station, NPO/Clear liquids, Restricted bed rest, Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine), Antihypertensive.
102
N/I for Alcohol Withdrawal Syndrome?
Semi-private room anywhere, Regular diet, Up and ad-lib, no restraint, Tranquilizer, Multivitamin (B1/Thiamine), Antihypertensive.
103
A two point restraint is?
One arm and the opposite leg.
104
N/I for restraints?
Check Q15min, Rotate sites Q2H.
105
All aminoglycosides end in?
"mycin" Vancomycin.
106
For Aminoglycosides, think?
A Mean Old Mycin.
107
Aminoglycosides treat?
Big gun antibiotics. Treat serious, life threatening, resistant infections.
108
If it has "thro" in it you?
Throw it out...Zithromycin.
109
It treats a minor infection?
Toxic effects of aminoglycosides: Ototoxicity, Nephrotoxicity, Cranial nerve 8 (vestibulocochlear nerve) which senses sound.
110
The one Aminoglycoside that doesn't end in Mycin?
Amikacin.
111
What is another word for aminoglycoside?
Glycopeptide.
112
Monitor what with aminoglycoside use?
Hearing, balance, tinnitus & creatinine (best indicator of renal function).
113
Best indicator of aminoglycoside toxicity?
Ototoxicity (Ears).
114
Frequency of administration for aminoglycosides?
Q8H.
115
Aminoglycoside route of administration?
IM or IV.
116
Aminoglycosides are given PO for what two reasons?
Hepatic Encephalopathy and Pre-op bowel surgery.
117
What is Hepatic Encephalopathy also called?
Liver Coma, Ammonia-Induced Encephalopathy.
118
If fluid resuscitation is used in shock, there will be?
Increased Urine Output.
119
Neomycin and Kanamycin are used for what?
Bowel sterilization? Can also be given for C.Diff.
120
Who can sterilize my bowel?
"Neo" "Kan".
121
If you give aminoglycosides PO, do you have to worry about side effects?
No.
122
Hepatic Encephalopathy is caused by?
High ammonia levels.
123
What raises ammonia levels the most?
E. coli in the gut.
124
Why do you draw TAP levels?
Narrow therapeutic Window.
125
When do you draw a trough level?
30 minutes before the next scheduled dose.
126
When do you draw a sublingual peak level?
5-10 minutes after it is dissolved.
127
When do you draw a IV peak level?
15-30 minutes after dose is finished.
128
When do you draw a IM peak level?
30-60 minutes after given.
129
If you must pick a time to draw the peak, pick the highest amount of time without going over the limits?
So for IV, Pick 30 Minutes, not 15.
130
Category A Bio terrorism Agents?
Most Lethal.
131
What are the Category A Bio terrorism Agents?
Smallpox, Tularemia, Anthrax, Plague, Hemorrhagic Fever, Such as Ebola, Botulism.
132
Category B?
A big, long list.
133
Category C?
Not very Lethal - Hanta Virus, Nipah Virus.
134
Small Pox Early Detection Symptom?
Rash that starts around the mouth.
135
Small pox?
Inhalation. Pt on AIRBORNE Precautions. Dies from Septicemia. No treatment.
136
Tularemia?
Inhalation. Chest Symptoms. Dies from RESPIRATORY FAILURE. Treat with Streptomycin.
137
Anthrax spreads by?
Inhalation (AIRBORNE PRECAUTIONS).
138
Anthrax looks like?
Respiratory FLU.
139
Anthrax death occurs from?
Respiratory Failure.
140
Treat Anthrax with?
Cipro, Penicillin, Streptomycin.
141
Plague spreads by?
Inhalation.
142
3 H's of Plague?
Blood Everywhere: H-emoptysis - Coughing up blood, H-ematemesis - Blood in Vomitus, H-ematochezia - Bright red blood in the diarrhea.
143
Plague patients die by?
DIC and respiratory Distress.
144
Hemorrhagic Illnesses (Like Ebola)?
Petechiae and ecchymoses = Pinpoint Hemorrhage, especially on Chest & Bruising.
145
Botulism is?
Ingested - Most Lethal. Dies from Respiratory Arrest.
146
3 Major Symptoms of Botulism?
Descending Paralysis (Starts in face and goes down), Fever, But is Alert.
147
Gullian Barre?
Ascending Paralysis.
148
Chemical Agents?
Mustard Gas, Cyanide, and Phosgine Chlorine.
149
Mustard Gas The Chemical Agent causes?
Blisters.
150
Cyanide The Chemical Agent Causes?
Respiratory Arrest.
151
What do you use to treat Cyanide Poisoning?
Sodium Thiosulfate IV.
152
What does Phosgine Chloride Cause?
Choking.
153
Sarin, the Nerve Agent, Causes?
Massive Cholinergic parasympathetic response.
154
Cholinergic, Parasympathetic effects cause?
B-ronchorrhea, B-ronchospasm, S-Salivation, L-acrimating, U-rinating Constantly, D-iaphoretic + Diarrhea, G-I distress, E-mesis.
155
Ebola (Hemorrhagic Fever) Precautions?
Standard, Contact, and Droplet.
156
What is Sodium Thiosulfate IV?
Sodium Thiosulfate IV is a chemical agent used in specific medical treatments.
157
What does Phosgine Chloride cause?
Choking
158
What does Sarin, the nerve agent, cause?
Massive Cholinergic parasympathetic response
159
What are the effects of Cholinergic, Parasympathetic response?
B-ronchorrhea, B-ronchospasm, S-Salivation, L-acrimating, U-rinating constantly, D-iaphoretic + Diarrhea, G-I distress, E-mesis
160
What are the precautions for Ebola (Hemorrhagic Fever)?
Standard, Contact, and Droplet
161
What do all chemical agents require for decontamination?
Only soap and water except for Sarin, which requires a weak bleach.
162
What do you do in a chemical attack?
Decontaminate + Treat
163
What is the Nurse's role in Chemical Decontamination?
Put clothes in a Biohazard bag that gets burned, put them in a Government Issued suit, and they may need to be housed for a while.
164
What do you do in a Biochemical Attack?
Quarantine
165
Calcium Channel Blockers are like what for the heart?
Valium
166
What are the effects of Calcium Channel Blockers?
Negative Ino, Chrono, Dromo
167
What do Calcium Channel Blockers treat? (the 6 A's)
Antihypertensive, Anti-Anginal, Anti Atrial Arrhythmia and SVTs
168
What are the side effects of Calcium Channel Blockers? (the 2 H's)
Headache and Hypotension, also Bradycardia
169
What arrhythmias do Calcium Channel Blockers treat?
Arrhythmias starting with A, as well as SVT
170
What causes angina?
Chest pain due to decreased O2 supply and demand issues.
171
What do Anti-Anginal Medications do?
Decrease O2 demand on the Heart, allowing more O2 to chest (dilate)
172
What percentage of Calcium Channel Blockers end in?
'dipine' and 'zem'
173
When giving a Calcium Channel Blocker, when do you hold and notify?
If Systolic is 100 or lower.
174
'QRS' refers to?
Ventricular
175
'P' refers to?
Atrial
176
What is Asystole?
A lack of QRS repolarizations
177
What is the treatment for Asystole?
Epinephrine (Think Heart Stimulant)
178
What is Atrial Flutter?
Rapid P-wave repolarizations in a saw tooth pattern.
179
What is the treatment for Atrial Flutter?
Pharmacological therapy, such as beta blockers, antiarrhythmics, or calcium-channel blockers, need frequent monitoring of EKG rhythm strips, heart sounds, and apical pulse rate.
180
What is Atrial Fibrillation?
Chaotic QRS depolarizations with chaotic activity between QRS, but QRS is still PRESENT.
181
What is the treatment for Atrial Fibrillation?
Heparin. IMMEDIATELY.
182
What do you do if the A-fib is unwitnessed?
1. Heparin First 2. Cardioversion 3. ADENOsine 8 second Push - Watch for the pt to go into Asystole
183
What is V-fib?
Chaotic QRS depolarizations
184
What is the treatment for Ventricular Fibrillation?
Shock therapy. You DE-FIB.
185
What is V-tach?
Wide bizarre QRS's
186
What is the treatment for Ventricular Tachycardia?
Lidocaine & Amiodarone
187
What is SVT?
Subventricular Tachycardia - Narrow QRS.
188
What is the treatment for SVT?
Adenosine 8 second Push - Watch for the pt to go into Asystole, Beta Blocker, Calcium Channel Blockers, Digitalis (Lanoxin)
189
What is PVC?
Periodic wide, bizarre QRS's
190
What is the treatment for PVC?
Lidocaine & Amiodarone
191
When should you be concerned about PVC's?
If more than 6 per minute, or 6 in a row.
192
What are the 2 lethal arrhythmias?
A-systole and V-Fib
193
What are the 4 potentially life-threatening arrhythmias?
V-tach, A-fib, A-flutter and PVC
194
What are the 6 arrhythmias you are tested over on the NCLEX?
V-fib, A-fib, A-flutter, PVC, A-systole and V-tach
195
What are the 6 arrhythmias for NCLEX in order for prioritization?
A-systole, V-fib, V-tach, A-fib, A-flutter and PVC
196
When talking about arrhythmias, what does the word 'chaotic' mean?
Fibrillation
197
When talking about arrhythmias, what does the word 'bizarre' mean?
Tachy
198
Where do PVC's fall on the wave of the previous beat?
T wave
199
When prioritizing lethal arrhythmias, if one happened 6 minutes ago and the other happened 15 minutes ago, which do you choose?
Always choose the closest to the 8 minute mark.
200
To treat PVC's, you give?
Lidocaine/Amiodarone
201
To treat V-tach, you give?
Lidocaine/Amiodarone
202
To treat supraventricular arrhythmias, you give?
Adenosine, Beta Blockers, Calcium Channel Blockers, Digitalis (Lanoxin)
203
What does 'supra' mean?
Above
204
To treat V-fib, you?
Defibrillate
205
To treat Asystole, you give?
CPR, Epinephrine (atropine no longer given), Oxygen
206
If asked how to treat A-fib first, you?
Give Heparin then ABCD.... Heparin is instant, Warfarin and Plavix take time.
207
What is the purpose of Chest Tubes?
To re-establish negative pressure in the pleural space
208
What does a Pneumothorax remove?
Air
209
What does a Hemothorax remove?
Blood
210
What does Pneumohemothorax remove?
Air and Blood
211
Where is an Apical chest tube placed?
High (for air) A for air
212
Where is a Basilar chest tube placed?
Low (for blood) B for blood
213
Chest tubes after a surgery or trauma assume it's a?
Unilateral Pneumohemothorax
214
Does a pneumonectomy get a chest tube?
No..removes the pleural space
215
What is the patient positioning after chest surgery?
Chest Tube Up, good side down or Operative side (Good lung up) Or Back (Supine)
216
What do you do if the water seal breaks on a chest tube?
Clamp it 1st, cut broken device off of tube, put the tube in water (NS), unclamp.
217
What do you do if you kick over the collection bottle?
Set it back up and tell the patient to take some deep breaths.
218
What is the BEST thing to do if the water seal breaks?
Put it in water (NS).
219
What do you do if a chest tube comes out?
Cover hole with a gloved hand, put on a vaseline gauze dressing, put on sterile dressing and then tape on 3 sides.
220
How many chest tubes (and where) for a Unilateral Pneumohemothorax?
2 chest tubes, one apical (for air/pneumo) and one basal (for blood-hemo)
221
How many chest tubes (and where) for bilateral Pneumothorax?
2 apical chest tubes (one on each side)
222
How many chest tubes (and where) for post-op chest surgery?
Unilateral, pneumohemo (2 chest tubes, one side, apical and basal)
223
What is the analogy for a Straight Catheter to a Foley Catheter?
Like a Thoracentesis is to a Chest Tube :)
224
How long can you clamp a chest tube?
No longer than 15 seconds without a doctor's order.
225
What do you use to clamp a chest tube and why?
Rubber tipped double clamps. Rubber because it won't pierce the tube and double because we're nurses and if one is good two is better.
226
Is bubbling in the water seal continuously good?
No, it is bad. You need to find the air leak, tape it, report it and then record it.
227
Is bubbling in the water seal intermittently good?
Yes, it should tidal on inhalation.
228
Is bubbling in the suction control chamber intermittently good?
No, it is bad. You need to dial up the suction, report and record.
229
Is bubbling in the suction control chamber continuously good?
Yes.
230
When picking answers, what should you do?
Narrow it down to two, then ask yourself - If I did this, but not this, what would be the outcome? Is it better?
231
In routine care, do you ever clamp a chest tube?
No. In an emergency, you can.
232
When picking answers, what should you ask yourself?
Which one is MOST important to leave undone. More so than the others.
233
All congenital heart defects that are trouble start with a?
'T'
234
What is the exception to the rule of congenital heart defects that doesn't start with a T?
Left Ventricular Hypoplastic Syndrome
235
What defects have right to left shunts and are cyanotic?
Trouble defects
236
What defects have left to right shunts and are acyanotic?
Not trouble defects
237
What do all congenital heart defects have?
Murmur and an echocardiogram done
238
What are the four defects of Tetralogy of Fallot?
Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy
239
What is the saying to help remember the four defects of Tetralogy of Fallot?
VarieD PictureS Of A RancH
240
1 fingerwidth is how many cm's?
1
241
How to measure crutches?
2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot
242
When measuring crutches, what should you not pick?
Any foot landmark like a 'toe' or 'heel'
243
When the handgrip of a crutch is properly in place, what should the elbow flexion be?
30 degrees
244
If crutch is not 30 degrees, what will happen?
Nerve Damage
245
Crutches should be how many fingerwidths below the armpit?
2-3
246
Describe a 2 point gait?
1. One crutch and opposite foot together 2. Other crutch and other foot together.
247
Describe a 3 point gait?
1. Move two crutches and bad leg together. 2. Move good foot.
248
Describe a 4 point gait?
Nothing moves together: 1. Right crutch 2. Left foot. 3. Left crutch. 4. Right foot.
249
Describe swing through?
Traditional crutching
250
Who uses Swing Through?
Amputees, non-weight bearing (sprain/break)
251
Use the even numbered gaits when weakness is?
Evenly distributed (bilateral)
252
When using the even gaits, what is for severe and what is for mild problems?
2 point gait for mild, 4 point gait for severe.
253
What is the 4 point gait for?
Fresh Post Op
254
If the question says 'systemic disease' when it comes to crutches, what should you assume?
It impacts both legs
255
Use the odd numbered gait when?
The problem is affecting one leg (unilateral)
256
When going up the stairs or down the stairs with crutches, remember?
UP with the GOOD and DOWN with the BAD
257
Crutches always move with what leg?
The bad leg.
258
What side do you hold the cane?
Strong side.
259
What side do you advance the cane with?
The weak side for a wide base support.
260
For walkers, remember you?
Pick it up, set it down and walk to it.
261
What should you remember for walkers?
Always push, never pull. NO tennis balls on legs.
262
If you put something on the walker, where should it be?
Make it the side, not front.
263
What does a non-psychotic person have?
Insight and is reality based.
264
What does a psychotic person have?
No Insight and is Not reality based.
265
Not all psych patients are?
Psychotic. Show this in your answers!
266
What are the 7 Hallucinatory Words?
Look, See, Listen, Hear, Feel, Taste, Smell
267
If the question has 'appear' in psych, it is?
A delusion (a belief)
268
What is a delusion?
A false fixed belief, idea or thought.
269
What are the three types of delusions?
Paranoid or Persecutory, Grandiose, and Somatic
270
What is a paranoid delusion?
False fixed belief that people are out to harm you (CIA, FBI).
271
What is a grandiose delusion?
False fixed belief that you are superior (God, the Pope).
272
What is a somatic delusion?
False fixed belief about a body part (X-ray vision).
273
What is a hallucination?
False, fixed sensory experience.
274
What are the five types of hallucinations?
Auditory, visual, tactile (feel), olfactory, gustatory (taste)
275
What is the most common type of hallucination?
Auditory (Especially Command)
276
What is an illusion?
Misinterpretation of reality.
277
How can you differentiate between illusions and hallucinations?
Illusion: Sensory response to something in reality; Hallucination: Sensory response but nothing in reality pertains.
278
What is an example of an illusion?
The clock on the wall is a bomb (the clock is real, but the belief isn't).
279
What are the four types of functional psychosis?
Schizophrenia, Schizoaffective disorder, Major depression/mania (bipolar).
280
Functional Psychotics have what?
The potential to learn reality.
281
If a functional psychotic is having a delusion or illusion, you?
Acknowledge the feeling, Present reality, Set a limit, Enforce the limit.
282
What should you NEVER set limits on?
Feelings.
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How should you present reality?
Positively.
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What is an example of presenting reality positively?
Tell them what they CAN do instead of what they CAN'T do.
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What are 5 examples of psychosis of dementia?
Alzheimer's, dementia, organic brain syndrome, Wernicke's, senility.
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When deciding whether to redirect or reassure, which type of psychosis do you consider?
Functional Psychotic (Schizophrenia) or Non-Functional (Dementia).
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What is re-directing NOT?
Orders, Distraction, Doing a physical action.
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What is re-direction?
Taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately.
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For patients with OCD, you?
Negotiate a balance.
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What do you do if a patient has psychotic depression?
Acknowledge their feelings and redirect them.
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What do you do if a patient with psychosis of dementia is having a hallucination or illusion?
Acknowledge their feelings and redirect them.
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What is re-direction in dementia care?
Re-direction IS taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately.
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What is NOT considered re-directing?
Re-directing is NOT orders, distraction, or doing a physical action.
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How do you manage patients with OCD?
Negotiate a balance.
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What is a characteristic of psychotic depression?
No reality. For example, a patient may not get dressed because they believe they are a prisoner in Iran.
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What should you do if a patient with psychosis of dementia is having a hallucination or illusion?
Acknowledge their feelings and redirect them. DON'T challenge them.
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What are examples of psychosis of dementia?
Examples include Alzheimer's Disease, Senility, Organic Brain Syndrome/Post Stroke Dementia, Lewy Body Disease, Parkinson's, and Wernicke's.
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Why can't patients with psychosis of dementia learn reality?
They cannot learn reality because they have brain damage.
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What causes psychotic delirium?
Chemical imbalance (electrolyte imbalance), sepsis, and UTI.
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Is psychotic delirium permanent?
No, assure them it's temporary.
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What is flight of ideas?
Jump from word to word. For example, 'This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano.'
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What is word salad?
Jump from word to word, such as 'Bob, Car, Sleep, Foot' etc.
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What are neologisms?
Make up new words.
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Should you force a psychotic patient to do things?
NO, they will become violent.
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What is a narrowed self concept?
When they refuse to leave the room or get dressed. Respond by saying, 'I see you are uncomfortable, when you are ready, you can do it.'
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What is ideas of reference?
When they think everything is about them, for example, 'Everyone is talking about me.'
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What is Type I diabetes?
Insulin dependent, juvenile onset, and ketosis prone (makes ketones).
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What is Type II diabetes?
Non-insulin dependent, adult onset, and non-ketosis prone.
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What are the signs and symptoms of diabetes?
Polyuria, polydipsia, and polyphagia (hunger).
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What is diabetes mellitus?
An error in glucose metabolism.
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What is diabetes insipidus?
Not enough ADH from the pituitary gland.
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How do you treat Type I diabetes?
Diet (3), Insulin (1), Exercise (2).
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How do you treat Type II diabetes?
Diet (1), Oral hypoglycemic (3), Activity (2) for obesity reduction.
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In a tonsillectomy, what days are most important post-op?
Days 6-8, as this is the biggest risk for bleeding.
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What is diabetes also associated with?
Dehydration.
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What does AC stand for?
Before meals.
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What does TID stand for?
3 times a day.
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What does QD stand for?
Every day/daily.
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What does OD stand for?
Once a day.
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What does QOD stand for?
Every other day.
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What does QID/QDS stand for?
4 times daily.
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What is SIADH?
Fluid overload, characterized by crackles, edema, etc.
What do you do: Fluid restrictions + sodium supplements
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