Midterm 11, 12, 13 Flashcards
Autism
- Complex neurobiological and developmental disability
- Affects normal development of social interaction and communication skills
- Ranges from mild-moderate-severe
- more common in boys
- only 1/3 can live independently
When does Autism appear
first 3 years of life
Autism S/S
i. Deficits in social relatedness and relationships
ii. Repetitive speech
iii. Obsessive focus on specific objects
iv. Over-adherence to routines
v. Hyper or hyporeactivity to sensory
vi. Resistance to change
ADHD
- Inappropriate degree of inattention, impulsiveness, and hyperactivity
- Often linked with poor health
ADHD S/S
- unable to complete tedious tasks
- become easily bored
- lose thing frequently
- require frequent prompting to complete things
ADHD in children
- Only inattentive are diagnosed with ADD
- To diagnose a child with ADHD —> s/s must occur in two setting like home and school and occur before age 12
- Often detected when the child has a difficult time adjusting to elementary school
- Peer relationship suffer due to difficulty taking turns, poor social boundaries, intrusive behaviors, and interrupting others
When does ADHD onset?
Usually onset at age 7 and occurs more frequently in boys
Haloperidol
- Dopamine antagonist
2. used for schizophrenia and targets positive symptoms like hallucinations and delusions
How often do you take Haloperidol?
Every 4 weeks
Advantage of Haloperidol
Not as expensive since it is a first generation
Disadvantages of Haloperidol
- EPS (tardive dyskinesia and minimal to none)
- Acetylcholine effects
- weight gain
- sexual dysfunction
- gynecomastia
- agranulocytosis
- QT prolongation
- Neuroleptic malignant syndrome
- dyslipidemia
- increase blood glucose
- insulin resistance
What are early signs of agranulocytosis
- Sore throat and fever
2. monitor CBC
S/S of neuroleptic malignant syndrome
- Muscle rigidity
- sudden high fever
- seizures
- cardiac arrest
- rhabdo (muscle pain)
- acute renal failure (b/c rhabdo –> muscle wasting)
Positive symptoms of schizophrenia
Presence of something that should not be present and usually appear early
- Hallucinations (Visual and auditory most common)
- Delusion (False beliefs)
- Disorganized speech
- Bizarre behavior
- Paranoia
- disorganized or bizarre thoughts
- concrete thinking - can’t think abstractly
Negative symptoms of schizophrenia
Absence of something that should be present
- Blunted affect or absence of essential human qualities (Reduced or minimal emotional response)
- Poverty of thought (Reduction in speech/thought)
- Loss of motivation
- inability to experience pleasure or joy
Cognitive symptoms of schizophrenia
Sudden or obvious impairment in memory, attention or thinking
- Inattention, easily distracted
- Impaired memory
- Poor problem-solving skills
- Poor decision-making skills
- Illogical thinking
- Impaired judgment
Affective symptoms of schizophrenia
Symptoms involving emotions and their expression
- Dysphoria (dissatisfaction)
- Suicidality
- Hopelessness
Bipolar Treatment: ECT
- Used to subdue severe manic behavior especially for treatment resistant mania or patients with rapid cycling
- More effective than medications
- Indication for this treatment severe depression, catatonic, and treatment resistant depression
Bipolar Treatment: Teamwork and safety
- Treatment team is trained to recognize changes that may lead to unsafe behavior
- Frequent team meetings to plan strategies for dealing with challenging patient behaviors
Bipolar Treatment: Seclusion protocol
- When dangerously out of control, danger to others or themselves, patient is unable to control their actions, or other measures have failed
- Both restraint and seclusion require an order
- If emergency, nurse can place seclusion or restraint without an order, but an order must be obtained within 15-30 minutes
- Vitals every 1-2 hours
Bipolar Treatment: Health teaching and health promotion
- Information about bipolar disorder and that it is chronic and highly recurrent
- Learn warning signs and symptoms of episodes of mania (Changes in sleep patterns)
- Importance of maintaining a schedule that includes eating, sleeping, exercise and other activities
- Teaching aimed at weight reduction and management is essential to keeping the patients physically healthy and emotionally stable as bipolar medications can cause weight gain
- Follow collaborative care model to encourage adherence to treatment
Bipolar Treatment: Cognitive-behavioral therapy (CBT)
- Preformed by advanced practice providers
- Used with medications
- Changes the persons negative thought and behaviors about themselves
- I’m always going to be a loser
- I might as well drink
- Focuses on adherence to medications, early detection and intervention for manic and depressive episodes, stress, and lifestyle management
- CBT = more likely to take medications as prescribed
Bipolar Treatment: Interpersonal and social rhythm therapy
- Preformed by advanced practice providers
2. Aims to regulate social routines and stabilize interpersonal relationships to improve depression and prevent relapse
Bipolar Treatment: Family-focused therapy
- Preformed by advanced practice providers
- Improves communication among family members
- Help people recognize and reduce negative expressed emotions and stressors that provoke episodes
Bipolar Treatment: Medications
- Second generation antipsychotics
- Mood stabilizer
- Anticonvulsant mood stabilizer
- First generation antipsychotics
Second generation antipsychotics
- Olanzapine (Zyprexa)
2. Risperidone (Risperdal)
Mood stabilizer
- Lithium
Anticonvulsant mood stabilizer
- Valproate (Depakote)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
First generation antipsychotics
- Chlorpromazine (Thorazine)
2. Loxapine (Adasuve) inhaled
Bipolar treatment
- Medications
- Family-focused therapy
- Interpersonal and social rhythm therapy
- Cognitive behavioral therapy
- Health teaching and health promotion
- Support groups
- seclusion protocol
- teamwork and safety
- ECT
Bipolar Etiology: Biological factors
- Genetics
- Neurotransmitter
- Brain structure and function
- Neuroendocrine
Bipolar Etiology: Neurotransmitter
- Too many –> mania
- Not enough –> depression
- Receptor site insensitivity (enough neurotransmitter but not getting where it needs to go)
Bipolar Etiology: Brain structure and function
- Dysfunction in the prefrontal cortical region associated with executive decision making, personality expression and social behavior
Bipolar Etiology: Neuroendocrine
- Hypothyroidism is most common physical abnormality
2. In manic and depressive states peripheral inflammation is increased
Bipolar Etiology: environmental
- Children w/ biological risk are vulnerable in bad environments
- Stressful family life and adverse life events —> severe course of treatment
- Stress = common trigger for mania and depression
Bipolar Etiology: Psychological
- Mania thought to be a defense against underlying anxiety or depression
- Faulty ego uses mania when it’s overwhelmed by pleasure or fear impulses like aggression
- Overactive and critical superego is replaced with the euphoria of mania
Lithium levels
- Therapeutic: 0.6-1.2 mEq
- Toxicity: 1.5 mEq
- Maintenance: 0.4 to 1.3 mEq/L
- Takes 7-14 days to reach a therapeutic level
Blood monitoring - Lithium
- Blood levels should be measures 5 days after beginning and changing doses until therapeutic
- Blood levels are checked every month until stability has been reached for 6 months to a year and then can be checked every 3 months
- Blood should be drawn in morning, 10-12 hours after last lithium dose
Why are children with ADHD given a stimulant?
Kids need to stimulant to calm down. They need something to focus on. The extra stimulation will help them not get bored and tune everyone out. For example, if you give a child with ADHD a pad to color on while teaching, they will understand more.
Interventions for ADHD
- Family involvement
2. Stimulant
Interventions for autism
- play therapy
- expressive arts therapy
- music therapy
- family interventions
Bipolar DSM-5 criteria
- two or more of symptoms for a significant portion of time (delusions, hallucinations, disorganized speech, gross disorganization or catatonia, negative symptoms, functional impairment of some kind)
- Continuous disturbance for at least 6 months
Phases of schizophrenia: acute
Exacerbation of symptoms
Phases of schizophrenia: stabilization
Symptoms diminishing
Movement toward previous level of functioning
Phases of schizophrenia: Maintenance or residual
- New baseline is established – symp. free or manageable
- New normal for the patient
- Established at the beginning as the goal
- Goal: function independently and in society
Potential nursing diagnosis for positive symptoms
- Disturbed sensory perception
- Risk for self-directed or other-directed violence
- Impaired verbal communication
Potential nursing diagnosis for negative symptoms
- Social isolation
2. Chronic low self-esteem
Two main foci for pharmacological interventions for bipolar
- Agitation
2. Mood stabilization
What 4 things to assess to determine if in manic or depressive state
- Mood
- Behavior
- Thought processes and speech patterns
- Cognitive functioning
