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N212 - Health across the lifespan 2 Flashcards

Psychiatric Nursing,

1
Q

DSM-IV

A

(Diagnostic and Statistical Manual of Mental Illness)

tool to Dx of mental illness

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2
Q

5 Axes of DSM

A
  1. Clinical disorder that is the focus of tx (i.e. bipolar)
  2. personality disorder/mental retardation
  3. Medical condition (i.e COPD, Cancer)
  4. Psychosocial/Envt probs (death of parent)
  5. Global Assessment of Functioning (GAF) Scale
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3
Q

Therapeutic Interaction

A

facts only, no opinions, no reassurance, no advice

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4
Q

Forbidden Phrases when dealing with Mentally Ill

A

.avoid social interactions, cliches and saying too much.
.DON”T change subjects (they think you are ignoring them)
.avoid GOOD, BAD, RIGHT, WRONG, NICE

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5
Q

Coping: Fantasy

A

unrealistic, excessive day dream, watch tv for hours,

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6
Q

Coping: Identification

A

person unconsciously adopts personality of someone else. to relieve anxiety.

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7
Q

Coping: Intellectualization

A

aka isolation. hiding emotional responses under facade of words.

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8
Q

Coping: Introjection

A

begins to follow vegan diet for no reason like others?

the unconscious adoption of the ideas or attitudes of others

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9
Q

Coping: Projection

A

project anger on others. student failed test and blames parents for tv too loud.

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10
Q

Coping: Rationalization

A

substitute acceptable reason for real and actual reason

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11
Q

Coping: Reaction Formation

A

person behaves opposite of how they feel

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12
Q

Coping: Regression

A

return to childhood behaviour

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13
Q

Coping: Undoing

A

tries to undo harm he has done to others. When others are rude to some one, he will apologize or try to make person feel comfortable.

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14
Q

Coping: Repression

A

block out events. but experience unesasy feels when near triggers. sometimes uncounsious

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15
Q

Coping: Sublimation

A

unacceptable into acceptable : chanel sex drive into sports

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16
Q

UNIT 1: Grief

A

Shock, Denial, Guilt/Anger, Bargaining, Depression, Acceptance.

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17
Q

4 Levels of Anxiety

A

general
Mild
Moderate
severe

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18
Q

Mild Anxiety

A

.Individual is ALERT
.attention i possible
. allows person to take risks, interview for new job etc.

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19
Q

Moderate Anxiety

A 
. decreased perceptual field
.difficulty concentrating
.lose site of details in envt.  
. perception narrows.
.Pacing
.PRN Meds
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20
Q

Severe Anxiety

A

trouble thinking, reasoning, muscle tighten, can not learn, brain freeze
.individual needs direction to focus

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21
Q

Panic

not panic disorder

A

feeling of impending doom. monitor for suicide, safety, stay w patient.
ss angry, aggressive, withdraw, clingy, crying need intervention

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22
Q

Psychoanalytical Theory

A

.psychic conflict
.Freud, stages of psychosexual, ID, EGO, SUPERGO
poor personal skills, difficulty w relationships

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23
Q

Interpersonal Theory

A

Sullivan, Pavlov

human development results from interpersonal relationships.

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24
Q

Cognitive/Behavioural Theory

A

Skinner, Piaget, Erikkson, Pavlov

learn through experisnce.

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25
Biological Theory
Genetics brain abnormalities neurochemical theorists GABA, 5Ht, NE
26
TX:
combo med/therapy Cognitive Behaviourl Therapy: .Assertiveness Trining (behaviral, use pos reinforcement, shaping, remodlig to reduce anxiety) .Positive Reframing (build on principals. attempt to gradually instil pos attitude towards phobia) .Decatastrophizing (desensitizing, tx of choice for phobias) .Biofeedback .Narcotherapy .Electroconversive (ECT) last resort. severe mental state
27
Anxiety Disortders
``` .GAD (Generalized Anxiety Disorder) .PD (Panic Disorders) .OCD .Phobic disorders (agorophobia etc) .ASD (acute distress disorder) and PTSD ```
28
General Anxiety Disorder (GAD)
more common WOMEN ``` .free floating anxiety .slow forming .chronic .mild - sever - debilitating .can lead to self medication ``` Cause: Idiopathic SS: .nervousness, irritability, apprehension, agitation, tension, tachy, diaphoresis, SOB, diff sleeping, overlap w panic/depressive, insomnia, cold clammy hands, poor concentration, worry over minor matters, fear of grave misfortune, procrastination, avoidance, poor problem solving skills TX: non rx first (relaxation, bio feedback ...
29
Panic Disorder
more common MEN .anxiety in most severe form. .recurrent panic attacks .late adolescents- mid adult. rarely after age 50 . diff from fear. No warning, just comes on. .duration 15-20min. can reoccur for hours. 50% develop phobia self medicate
30
Panic Attack SS
miimc heart atack SOB, rapid shallow breath, chest pain, pressure, nause, dizzy, chills, exagerated speech, startled TX: therapy, cognitive behaveoral
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Phobias
irrational .Agoraphobia: fair of marketplace .Social Phobia .Specific Phobia (natural evnt, blood inj, situational, animal, others Mgmt: assertivenes training, social skill group, behavior therapy (systematic desensitization, flooding, self exposure) TX: NO critizism
32
ASD (Acute Stress Disorder)
Develops after exposure to clearly identifiable traumatic event. ASD onset: within 4 wks after event duration: 2 days - wks SS: start during or shortly after trauma, numbness, impair fx, hurt relationships. may begin as soon as 2 days after trauma. Resolves in 4 wks could re dx to PTSD TX: discuss and validate event. ID feeling of survival guilt, tch relaxation, prn meds
33
? PTSD
onset: acute within 6 mos after event. delayed, over 6mos after event duration: 1-3months / 3 or more months SS: Tx:
34
** Personality Disorders Clusters **
Cluster A: (odd/eccentric) PSS (Paranoid, Schizoid, Schitotypical personalities) Cluster B: (Dramatic, emotional, erratic) BHAN (borderline, hystrionic and narcisistic) CLUSTER C: (anxios/fearful) ADO avoidant, dependant, OCD
35
CLUSTER A (SUSPECT)
SUSPECT ``` .Spouse fidelity, suspected .Unforgiving (grudges) .Suspicious .Perceives attacks, react quickly .Enemy or Friend .Confiding in others feared .Threats perceived in benign events ``` humorless, envious, bad temper, lack of social support, don't seek help unless there is a problem.
36
CLUSTER A: | Psycotherpeutic Mgmt
trust, formal, business like manner. don't ask too many personal questions. don't challenge their paranoid beliefs
37
CLUSTER A: Schizoid DISTANT
``` .Detached/flat affect .Indifferent to criticism or praise .Sexual little interest .Tasks solitary .Absence of close friends .Neither desire or enjoy close relations Take pleasure in few activities ```
38
CUSTER A: Schizotypal Personality ME PECULIAR
ME PECULIAR .Magical thinking/odd beleifs .Experiences unusual perceptions ``` .Paranoid ideation .Eccentric behaviour or appearance .Constricted (or innapropriate) affect .Unusual (odd) thinkingg and spech .Lack close freind .Ideas or reference .Anxiety in social situations .Rule out psychotic disorder and pervasive develpoem disorder. ``` easily overwhelmed by stress, be patient,
39
``` CLUSTER B B H A N ```
.Borderline .Histrionic .Antisocial Personality .Narcisist
40
Antisocial Personality Disorder TYPE B, CORRUPT
MEN, 50% prison population CORRUPT ``` .Conform to law, LACK .Obligations ignored .Reckless disregard for safetly or self/others .Remorse lacking .Underhanded .Planning insufficient (Impulsive) .Temper ``` charming, manipulative, arrogant, irritable, aggressive, maintain close personal/sexual relationship TX: pt making connections betwn feeling and bahaviour PEAK 20yrs under age 15 = conduct disorder
41
Limit Setting
3 steps .state behavioral limit .id consequences .id expected behaviour be consistent, apply consequences, avoid power struggles, avoid arguing, not personal., all business
42
Borderline Personality Disorder: TYPE B AM SUICIDE
AM SUICIDE .Abandonment .Mood instability ``` .Suicidal/self mutilating behavious .Unstable/intense relationships .Impulsive without thinking consequence .Control of anger .Id disturbane .Dissociative or paranoid, stress related .Emptiness, chronic feelings of ``` 20s. Suicidal, TX: mylutherapy? dont be sympathetic, promote trust, may idolize staff and not like others, will play you against others, lithium, valproic acid, benzodiazapine
43
Hystrionic | PRAISE ME
PRAISE ME ``` .Provocative behaviour .Relationships .Attention seeking .Influenced easily .Style of speech .Emotions shallow .Made up appearance to draw attention .Emotions exagerated, theatrical ``` infidelity, egocentric, lack of consideration for others TX: Meds NI: choices in care options. incorporate care options into care plan. increases their sense of control.
44
Narcissistic : TYPE B
NI: acknowlendge pt sense of self importance focus on positive. non judgemental, no aruing or defensivenes.s gain trust, teach social skills, reinforce appropriate behavior
45
CLUSTER C (anxious, fearful) CRINGES Avoidance Dependent Obsessive
CRINGES AVOIDANCE .Cretaintay or .Rejection .Intimate relationshi SLIDE ? SS: shyness, timid, low selfesteem, reluctance to speak, overtalkative, weariness w others, test sincerity, diff starting and maintain relationship rejeions of people who don't meet thier high standards, self counscious, loner, don't take personal risks, frequent escape to fantasy NI: persistent, consitent and flexible care. gain trust, give lots of advanced notice, accountable for actions, teach relaxation to manage anxiety, coping skills
46
Dependent RELIANCE
SLIDE RELIANCE ``` .R .E .L .I .A .N .C .E ```
47
Obsessive Compulsive | LAW FIRMS
SLIDE LAW FIRMS .L .A .W ``` .F .I .R .M .S ``` perfectionist, hoarder, miserly, cheap, rigid
48
SCHIZOPHRENIA
MEN/WOMEN equal more common than alzheimers group of severe disabling psychiatric disturbances in thought, senseory, emotions, mvmnts, behaviour. Types: Catatonic, Paranoid, Disorganized, Residual, Undifferentiated hard to maintain job, relationship, school, personal hygiene. Life expectancy 10yrs shorte. 10% commit suidide in first 10yrs of illness. ONSET: Men 15-25 Women 25-35 worse prognosis each episiode. most suffer lifeong. 30% not resonsive to meds.
49
Schizo Speech Abnormalities
``` .clang associations (rhyming) .echolalia (meaningless repetition) .Loose association and flight of ideas .word salad .neologisms made up words w meaning only for patient ```
50
Schizo Thought Distortion
.Overly concrete thinking, delusions .hallucinations, .thought blocking .magical thinking
51
Schizo POSITIVE SS
TEMPORAL LOBE, indicates lost touch w reality ``` .abnormal thought form .agitation, tension .association disturbances .bizaare behaviour .conceptual disorganization .delusions .excitement .feeling of persecution .grandiosity .hallucinatinos .hostility .ideas of reference .illusions .insomia .suspicious ```
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UNIT 2
UNIT 2
53
who coined the term 'Schizophrenia'?
E. Bleuler affective disorder
54
Schizophrenia Positive SS
linked to brain abnormatlities and Temporal lobe abnormalite
55
Schizophrenia Negative SS
linked to brain abnormatlities .ventricles and frontal cortex? ``` .Alogia .Apathy, lack of intereest in anything. flat affect. no expression .anhedonia asocial ebhaviour attntion efecit avolition .blunt affect .commun difficulties, diff w abstractions, passive sical weithdrawal, poor grroming//hygiene, poverty of speech ```
56
Schizophrenia Disorganized SS
relects abnormal thinking confused thinking, mild to incoherent rambling
57
Speech Abnormalities
Catatonic, Paranoid
58
Schiz Etiology
brain abnormality Phases 1. Prodromal (1 yr before obvious ss, wdraw from friends, school performance suffers, etc) 2. Active: acute psychotic ss. delusions, catatonic, d/t trauma (get worse after every episode) 3. Residual Psychological (disability levels stabilized, ss similar to prodromal)
59
Paranoid Schitzp[hrenia
decline. all ss plateau at 5 years w have several relaps by 45 d/t non compliance with meds.
60
Schiz Tx:
.neuroleptic rx (prevent relapse of acute ss) ``` Side Effects: .Parkinsonian ss .akathisia .constipation .urinary retention *.photosensitive .drowsy .pruritus *.tardive dyskinesia .neuroleptic malignant ss ``` ss present up to 24mos before tx usually starts. therapy
61
Extrapyramidal Syndrome
Parkinsonism | Tardive Dyskenesnia
62
Typical Rx
antipyschotic drugs. ONLY address POSITIVE ss clorazine (first drug ever used on schitz) Haldol
63
Atypical
relieve Positive AND Negative ss lowers neutrophils Ability Cloanzapine 4-8wk to assess if working Lithium Depakote Tegrol
64
Types of Schizophrenia
Paranoid Catatonic Disorganized
65
Paranoid Schiz
one or more delusions or prequen auditory hallcinations .grandiose delustions. less disabled than other types respond to meds don't touch. don't laugh or whisper. keep distance. serve sealed food, don't tease, joke or argue
66
Disorganized SS
disorganized speech, loose association, blunt, silly, superficial, grmimace, can withdraw socially. Intervention: quit envt, information boards, simple schedule
67
Catatonic
rare waxy, stupor rapid swing between stupor and excitement .extreme negativism or mutisim NI: immobility to minimize circulatory problems and loss or muscle tone .adequate diet, exercise and rest
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Depression
Mood Disorder
69
Mood Disorder
.Bipolar .Major Depressive Disorder .Cycloclothymic
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Major Depressive Disorder
``` 5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentratoin .suicidal ```
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Major Depressive Disorder
``` 5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentratoin .suicidal ``` NI:
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Major Depressive Disorder
``` 5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentration .suicidal ``` NI:
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Major Depressive NI:
.safety .increase self esteem, give praise .punching bag/foam bats
74
Mood Disorder: Bipolar
aka Manic, Mood Disorders .1wk .at least 3 of ss inflated self esteem, grandiosit, lo need for sleep, talkative, flight of ideas, distractibility, psychomotor agiation, excessive involvemnt in pleasurable activity .extreme HI w extreme LO ONSET 20-30
75
hypomanic
4 days | not sever enoght o result in signifiatnt impairment.
76
BiPolar 1 and !!
most severe sever mania
77
Bipolar !!
hypo mania w alternate depressive episodes
78
Cyclothymic Disorder
2 yrs, hx of hypomanic anddepressed mood ``` grandiosity rapid speech distracted imparire judgement rapid response to external stimuli .manic, depressed ``` NI: safety, reduce stimuli, safe envt, no competition, realistic limit behavior, hi cla diet, rest, sleep, hypnotic/sedative
79
Lithium Therapy
main tx for Bipolar affects cellular mechanism, Anti Inflammatory increase Lithium toxiciy monitor * blood levels (narow therapeutic margins) check 8 -12 hrs after first dose, then 2/3 times weekly, then weekly to monthly not for people who cant have regular blood testing. not for renal impairment. 0.6 - 1.2 mEq/L (.5 - NI: .6-8 glasses water (3k ml). .replace sodium, not too much or it they will lose lithium and ss return ``` SIDE EFFECTS: dry mouth tremors ataxia thirst weight gain soft stool/diarhea meds w food or after meals. muscle weaknes fatigue hair loss increase urinatino tremors ``` no driving on meds. monitor for suicide take missed does within 2 hours. don't adjust or double up. therapeutic response 2-4wks
80
Delerium
sundown, like prison Reversible. Acute, comes on fast. fearfulness, disorientation, agitation, confustion, delusion, sometimes hallucination. withdrawal from etoh, drugs watch se's. control envt. NO benzodiazapines, unless caused by etoh. phyical or cemical restrains
81
Dementia
Chronic, not normal aging process. ``` .not reversible .r/t alzheimer's or TIA's .Alzhiemers .most common cause of disabiity in elderyl .6th cause deat 85 and older . ```
82
Alheimers
plaques in brain. kills neurons. Dx: through autopsy, view amaloid plaque
83
Demential SS
Early: .Agnosia (don't recognize objects) .Ataxia ( . Mild: forgetfulness, can't find words Moderate: confusion w progressive mem loss, no complex tasks, oriented to person, place, thing. need caregiver .Severe: personality changes, delusional, wandering, help w adl's, in nursing facility
84
Delerium vs Dementia
Delerium: acute, fluid intervals, hours to weeks awareness reduces, mistake familiar places, immediate mem loss, incoherent speech, interupted sleep Demential: insidious, no change, month to years, awareness clear, orientation impaired, fragment sleep
85
Reversible Dementia Non Reversible Dementia
Reversible: lupus, up lo thyroid, UTI, etc non-reersible: alzheimers 65 yrs or older
86
5 Stages of Alzheimerg
Mild: diff balancing checkbook Moderate Severe
87
Mild Alzheimers
``` .trouble balancing check book .preparing complex= meals .med schedule probs .poor concentration .try to cover up ss .deter personal apperance .bad short term mem .sleep disturb .no new memories .clumbsy ```
88
Moderate Alzheimers: Stage 2
``` ,diff simple food prep .no clean up, yard work .help w =adls .tantrum .incontinence .make up things to hide memory loss .apraxia, agnosia, aphasia .don't remember person, plate, thing, fam members ```
89
Severe Alxhimers
.need assistance w personal care, toileting
90
Profound
obvlivious to sorrounding
91
terminal
bed bound, non respnosive. brain eating away at itself. no appetite.
92
Alz Tx
no cure look for side effects aricept cognix ravistifmine galantamine ``` ginko nsaids vite estrogen ccb's prevent influx ```
93
2:37 Class 2
2:37, class 2
94
Parkinson's
hypokenetic disorder. degenerative, progressive,chronic. EPS area of brain. Idiopathic. imbalance of acetalcholine and dopamine. caused: viral, head trauma, intoxication, LO dopamine, affect coordination. SS: pill rolling tremors, shuffling gate, mask like facial, drooling, fatigue, general weakness, constipation, orth hypotension, hallucinations Dx: PET, PEG, CAT scans NI: DIET, hi residue, hi calorie, soft food Rx: antocholernergi cogentin, sinemet, carbidopa LOTS of diff meds. NI: maintain diet, assess neuro vascular, reposition to prevent contracture, vs, daily ambulation, maintai patent airway, oral hygiene, emoti=onal support.
95
Diffuse Lewy Body Disease
similar to Alzheimers. rapid, no slow like Alzheimers YOUTUBE
96
Huntington's Disease
disturbanec in gait, slurred speech, neuro - intellectual deterioratoin, lose muscle controld, tongue, breathing hereditary
97
Pick's Disease
simiar to Alz associaed w aging. duration, 5-7yrs. shrinkage of frontal lobe.
98
Creutzfeldt Jakob Disease
aka Prion Disease non inflam dementia. visiaon, hearing loss, muscle wastering, tremors, hallucinations,
99
Vascular or Multi Infarction Dementia
leading cause of vascular probs to brain 85 and older pop
100
Alcoholic Dem
15-20yrs continuous drinking SS: .Toxic to neurons (wetbrain) .disruptive neutritional defincit .CNS defecit
101
Transient Ischemic Attacks
micro embolisms to brain through sclerotic plaque
102
Psychotherapeutic Mgmt.
Delerium: Safety, Optimal level of fxing. praise, touch, affection when possible, use title and last name, learn background and lifestyle
103
3 Miliem Relate=d Issues
Stress Safety Wandering Don't change envt No new skills Clock/Calendar 3 stages .Forgetfulness .Wandering Rx; Serox, Ativan
104
Substance Abuse
.Alchohol,
105
Alchoholism
primary drug prob. cns depressent,. rapidly into bloodstream. SS Biological dependence loss of control maladaptive consequenses Etiology: learner behaviour, inhertitted, oral fixation (freud) Effects: relaxation, SS: slurred speeech, unsteady gait, lack coordination, impared attention, concentration, memory, judgement diarrhe,a ulcers, cirrosis, delerium,
106
korsakoff psyvchosis
thiamine, niacin deficient
107
wernicke's encephalopathy
thiamine deficiency
108
Alcholholi RX
Benzodiazepines .Lorazepam (ativan) .Diasepam (valium) Diulfiram (antabuse) avoid products w ETOH Odansetron (Zofran) Tx for methampetamine
109
Stimulant Abuse
uppers, speed, crank cocain: snorted
110
detox
by 10% per day
111
Intoxicatoin
develops rrapidly
112
OD
arythmia, respiratory collapse death rare TX induce vomiting, forced diuresis Rx: Zofran,
113
Cannabis Sat
2 Cannabinoids Marinol (Dronabinol) Cesamet (Nabilone)
114
Endocrien
Adrenal: aldosterone Renal Cortex: Cortisol (cushings, addison's , stress hormone anti infla, Medula: works with ANS, ephinepherine and norepinepherien, broncho dilater, stress hormone.
115
UNIT 3 - Endocrine
UNIT 3 - Endocrine
116
Thyroid controlled by
Pit - Anterior T3/T4 metabolic rate Calcitonin keeps Ca in bones.
117
Parathyroid
regulates itself. Ca levels LO, para releases hormone to decrease bone decalcification Parathyroid PULLS Ca out of bone
118
Pancreas
Endocrine/Exocrine Beta - secretes insulin, allows liver and body to take in glucose to store as glycogen Low Blood Glucose, Alpha releases glucogon. liver breaks down and inc blood glucose levels
119
Ovaries/Testes
Pit - Ant | FSH and Leutenizing hormone
120
Hormone Regulation
.neg feedback mech .change blood levels of Ca and Glucose .
121
Pos Feedback Syst
body already producing the hormone. Body produces more for incident, then reduces to normal again.
122
Endocrine Sys controlled by
Hypothalmus
123
Hyperpituitariasm
hypermeglia, hypercretion of growht hormone SS: visual defects .large nose/jaw, teeth separated/missing .spade shaped hands/feet, arthrosis, peripheral neuropathy, sex dysf, cardiomegaly hypertension, hypertrophy of sweat/sebaceous glasds.
124
Hyperpituitarism SS
aka Simmon's Disease hypo fx of anterior pit gland. ``` NI .meds per rx .express feelings .skin care, repositiosn .monitor for infection .post op care ```
125
hypopituitarism
hypo- thermia, glycemia, tension low growth hormone DECREASED: GH from Ant Pit .poor muscle mass .no strength ACTH from Ant Pit .fatigue .diminish tolerance for stress ADH from Post Pit .Diabetes insipidus TX: Sx to remove tumor, radiation to shrink, hormone replacement therapy
126
Trans-sphenoidal hypopysectomy
A transsphenoidal hypophysectomy is a surgical procedure most commonly used to remove a tumour of the pituitary gland. Transsphenoidal means through the sphenoid sinus. This is the air sinus (cavity) at the back of your nose.
127
Post Pit Complications
ADH (works on collecting tubules of kidney) .Diabetes Insipidus .AIDH
128
Diabetes Insipidus (DI) - PIT Disorder
Deficiency of ADH disorder of water balance regulation ``` Etiology: .neuro conditions .sx .tumors .head injury .inflamm probs ``` ``` Cause: .Trauma .Tumor .Head injury .failure of kidney to respond .congenital malformation ``` SS: polyuria ``` NI: .hormonal replacement (vasopressin) .non hormonal therapy .UP fluid .monitor I&O / weight ```
129
SIADH (syndrome of inappropriate adh) - PIT disorder
UP ADH levels ``` SS: .concentrated urine .lo urine output .up weight .mental confusion (food building up in brain) .cerebral edema (sz, unconsiosness) .n/v .fluid overload ``` ``` NI: .water intake restriction .diuretics .elevate bed head (up to 5%) .Tetracycline (interfreres w action of adh) .mouth care ``` Dx Tests: 1. serum Na. - pos greater than 134. SG up 1.005
130
ID, SUPERGO, EGO
ID: Instincts (devil on shoulder) EGO: Reality (you, conscious) SUPER EGO: Morality (angel on shoulder)
131
Freud's 5 Stages of Psychosexual Developments
1. Oral stage: birth to 2; breastfeeding, putting objects in mouth 2. Anal stage: 18 months to 3 years; toilet training 3. Phallic stage: 3 to 6 years; genitalia primary erogenous zone; become aware of bodies 4. Latency stage: 6 years to puberty; external activities 5. Genital stage: puberty to adult life; independence from parents; consensual adult sexuality ``` O 0-2mos A 18mos - 3 P 3-6 L 6-pube G pube - adult ```
132
Erikson's Developmental Tasks
Trust vs. mistrust: birth to 18 months Autonomy vs. shame and doubt: ~18 months to 3 years Initiative vs. guilt: ~3 to 5 years Industry vs. inferiority: ~5 to 13 years Identity vs. role confusion: ~13 to 21 years Intimacy vs. isolation: ~21 to 35 years Generativity vs. stagnation: ~35 to 60 years Integrity vs. despair: ~60 to death
133
Eriksons 8 stages Numonic
1. BUN, rust, mistrust 2. SHOE 3. TREE 4. DINOSAUR 5. DIVE 6. STICKS 7. HEAVEN 8. PLATE
134
1:04
thyroid disorder
135
DI contd
Polyuriea Greater then 5L per day Polydyspsis 4-40L p day olorless urine, tahy, hypotension, constant ha. SG les than 1.010 urine dilute, pt always thirsty. can not make concentrated urine. Mgmt: ``` Dx adn Tx IV therapy hyration, electrolyte up anticonvulsive (tegretol) adh replacement, diuretics, antiinflam ``` monitor i/O, weight, fluid electrolyte balance.
136
Thyroid Disorders
gland stimulates cell metab hormones: t3(bound to T4, regulate respiratory rate / T4 (throxin, main hormone) TSH UP T3/T4 raisesmet rate.
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Hypothroidism
underactive. lo secreation of thyroid hormone causes: mid age women, peole w hashimotos. thyrodectomy, any pit malfunction, use of radiaocactive iodine, preg toxemia. low T3/T4 up TSH, Cholesterol LO oxidation of nutrients, met rate, heat production SS: Edema, weight gain, clammy cold skin, coarse hair, alopecia, thick tongue, swolen lip, mental sluggsh constipation, muscle weakness, aches, hypersentist to opioids, anorexia, lo diaphoresis, brittle nails/hair, dull blank expresion, eyelid edema, reced hairline, menstrual distrubances NI: 1:!2 Hurtuism
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Hypo Complications
.cretinism | .myxedema/ myexedema coma (med emergency)
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Myexedema Coma
severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate. ``` NI: .maintain airway patency .maintain circulation (iv replacement) .cardiac monitor .monitor arterials (ABGs) .ensure wrmth. NOT warming blanket, will cause shock. .replacement thyroid hormones .synthroid .i&O, daily weight .replace fluids, glucose .corticosteroids .monitor for infection. .lo calorie, lo cholesterol diet ``` MEDS: Levothyroxine (Synthroid): diuresis, lo puffiness, improved reflexes and muscle tone, UP PR
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Hyperthyroidism
over secretion of Thyroid gland (thyrotoxicosis) ``` Cause: emotional stress mid age women autoimmune graves disease adenoma, goiter, viral inflammation, DKA, pregnancy, ``` Dx: look for up blood chem Up T3/T4 protein bound Iodine lo TSH and cholesterol intake goitrogenic food. (cabage, string beans)
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Simple Goiter
enlarged thyroid d/t iodine def, intake of goitrogenic foods (cabbage, turnips, soybeans), heriditary
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Thyroid Storm
complication of Graves Disease ``` med emergency .up temp, tachy, dysrhythmias .tremors, restlessness .delirious, psychotic state/coma .up BP and RR ``` Cause: .infection` .trauma or sx .inadequate tx
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Thyroid Storm MM:
``` .PTU - antythyroid drug .Tapazole .Iodine Preps (Lugal's solution with straw) or K Iodide. .Inderal .radioactive iodine .Sx ```
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Thyroid Storm
``` NI .monitor VS .no stimulants (drugs/food w caffeine) .emotional support .cool envt. . small frequent feedings (up calories, protein 4-5k calories daily) .daily wt. .eye care .elevate HOB ```
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Thyroidectomy Post Op
removal of thyroid gland. .O2 therapy, suction secretions .HOB 30degrees .head/neck support (no tension on sutures) .assess for resp distress, hoarsness, apasia, larangeal damage. .emergency trach set in room .white board to communicate.
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Throidectomy Post Op Comlications
.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland . 1:38:15
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Grave's Disease/Hyper
Go Getter Gertrude ``` .hi anxiety .flush smooth skin .rapid mood swings .diaphoresis .dyspnea .up systolic bp .hand tremors .bulging eyes . Everything running except period. ``` Complicatios: .hpn, angina, chf .exophthalmos - eyeball protrusion .thyroid storm (excessive adrenergic response)
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Thyroid Storm
complication of Graves Disease ``` med emergency .up temp, tachy, dysrhythmias .tremors, restlessness .delirious, psychotic state/coma .up BP and RR ``` Cause: .infection .trauma or sx .inadequate tx
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Thyroid Storm MM:
.PTU(antythyroid, block TH prod) .Tapazole (bloks TH prod) .Iodine Preps (Lugal's solution with straw) or K Iodide.
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Thyroidectomy Post Op
removal of thyroid gland. .O2 therapy, suction secretions .HOB 30degrees .head/neck support (no tension on sutures) .assess for resp distress, hoarsness, apasia, larangeal damage. .emergency trach set in room .white board to communicate.
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Throidectomy Post Op Complications
.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland .Hemorrhage BOWTIE assess for ``` Bleeding Open airway Whisper Trache set Incision Emergency ```
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Tetany NI
.assess for numbness, tingling, twiching .chvosterk's sign, Trousseau's sign .Ca+ gluconate IV
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Homorrhage NI
Watch For: hypotension, tachy, hypovolemia, irreg breathing swelling choke, clearing of throat, difff swallowing
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Trousseau
muscle spacsms of hands and wrist
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Chvostek's sign
facial twitch when tap on nerve
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Thyroid Storm
life threatening .sudden UP of TH .fever, tachy, restless (w/in 10min of sx), agitation, delierium
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Parathyroid Gland Disorders
embedded w/in tyroid gland 4 pt glands. respond to serum calcium levels. 8.5 - 10.5 normal Ca affects kidney adjusts rate at which mag and phosperous, ca removed from urine .idiopathic . Dx;sserium phoserpherous, alkaline phosphate, calcium
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Calcium/Phosperos
inverse relationship
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Parathyroid gland
pulls Ca out of bone ,UP serum CA levels. Calcitonin, secreted from thyroid gland, keeps ca in bone.
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Parathyroid hormone
.mobilization of Ca and Phospherous from bone .resorption of Ca from bone to maintain serum levels. .Renal, UP Ca resbsorption and phosphate excrtion .UP abosorbion in GI tract by stim kidneys to convert VIT D to its active form.
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Calcium Fx
.maintain N muscle and neuromuscular responses. | .blood coag mechanisms
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Hypoparathyroidism
Xray, up bone density ``` Mgmt: .Ca supplement (Calcium Gluconate IV?) .Vit D .seizure precaution .listen fr stridor/hoarseness .trach set@ bedside ```
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Normal Lab Levels | ??
Ca Ph K ????
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Normal Lab Levels | ??
``` Ca Ph K chloride Mg ```
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Hyperthyroidism
.Ca relaased into blood leads to bone damage .hypercalcemia, lack of resorption of Ca into bone (bone cyst/path fx) .kidney stones .anorexia, n/v, constipation, peptic ulcer
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Hyperthyroidism MM
``` .Tx of choice: Diet or Sx removal .IV PNSS 5L/d w diuretics .cranberry juice .low ca .strain urine for stones . ```
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Disorders of the Pancreas
DM I and II learn drugs converts food to glucose. Pancrease creates insulin which alows glucoase to enter body
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DM1
Absolute Insulin insufficency. Body does not make any insulin, inability to produce insulin. any age. usually under 15.
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DM2
Insulin resistance. defecit in insulin release. over 4o. alarming how many kids getting it.
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DM
predisposing factors: .idiopathic .I, genetic, inherited, virus, pancreatitis, pancreatic tumor, autoimmune, obesity 2:54:46
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DM SS
``` .chronic tiredness .crave drink .frequent urination .numbness/tingle feet .hungry .weight loss .blurred vision .sex dyfx ```
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DM Dx
Fasting Blood Sugar .npo 12hr .normal value 80-120mg/dl .140 UP Dx of DM Postprandial Blood Sugar .blood drawn 2hrs post meal .N = < 120 mg/dl .200 mg/dl UP dx DM.
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Oral Glucose Tolerance Test
NPO 12 hrs, no smoking, cofee or tea. lo activity, lo stress .obtain FS, admin 100gm glucose po diluted in juice. obtain urine after 1, 2 and 3hrs. .n value = blood glucose rise to 140 in 1st hr adn returns to normal by 2, 3 hrs. .Abnormal = glucose does not return to normal by 2, 3 hrs. urine pos for glucose. Glycosylated hemoglobin .A1C, info re blood glucose for 3 months. glucose stays attached for 120 d life span of RBC.
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DM Diet
DIABETES Diet: CHO 50-60% FAT 20-30% CHON 10=20%
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Hypoglycemia Mgmt
.simple sugar orally (oj, candy glucose tab, sugar) .glucagon (sq, im0 IF UNCONSIOUS OR NPO .if no response, 50ml of 50% glucose IV or 1000ml 5-10% gluose IV.
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Oral Antidiabetic Agents
.sulfonylureas .biguanides .alpha glucosidase inhibitors .thiazolidineldiones
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See pic of above
blue
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Biguanides
Metformin (glucophage) UP sensitivity to insulin, UP glucose uptake, LO glucose prod by lilver
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Alpha-Glucosidase Inhiio
Acarbose (Precose) Migliol (Glyset) delay absorption of glucose in intestines
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Thiazolidenediones
Rosiglitazone (Avandia) Pioglitazone (Actos) enhance insulin action at receptor sites
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Insulin: Ultra RAPID acting Humalog
Onset: 15min Peak: 2-4hrs Duration: 6-8hrs
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Insulin: Rapid acting Semilente
Onset: 1/2 - 1hr Peak: 2-4hrs Duration: 6-8hrs
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Insulin: Int NPH | Lente
Onset: 1-2 hrs Peak: 7-12 hrs Duration: 24-30 hrs
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Insulin: Long Acting Protamine Zinc Ultralente Lantus
DO NOT MIX Onset: 4-6 hrs Peak: 18+ hrs Duration: 30-36 hrs
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DM Teaching
carry rapid acting during escerzice ``` Exercises: .enhances action of insulin .LO BG levels .LO need for insulin .UP fxing receptor sites ```
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DM complications
.DKA .Insulin Shock .Hyperglycemin, .hyerosmolar
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DKA and HNNA
hyperglycemic crises. | can result in coma/death.
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3:42:21
DKA
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Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC)
.when action of insulin severyl inhibited .seen in pts w NIDDM, elderly Cause: infection, renal failure, MI, CVA, GI hemorrhaeg, pancreatitits, CHF, TPN, Sx, Dialysis, steroids ``` SS: Polyuria - to oliguria lethargy UP temp, UP PR, LO BP, fluid deficit confusion ,seizure, coma BG OVER 600mg/100ml ```
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DM Complicatoins see pic
1. Vascular Changes a) Macroangiopathy b) Microangiopathy 2. Neuropathy
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DM Complicatoins see pic
1. Vascular Changes a) Macroangiopathy b) Microangiopathy 2. Neuropathy
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Trioangle of DM mgmt
Diet Exercise Medication
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DM NI: see pic
foot care (dont cut nails) monitor infections no cream betwen tooes. keep feet dry .
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Simogy Phenomenon
rebound hyperglycermia following episode of hypoglycemia r/t reduction in insulin dose.
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Shogrin Phenomemnon
INreased lacrimal and salivary secreteion. dry eyes and mouth
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Dawn Phene
marked increase in insulin requirements
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Delirium SS
``` Hyperactive Delirium: agitated incoherent speech delusions disorganized thoughts hallucinations disorientation ``` Hypoactive Delirium: sudden sluggish withdrawn less reactive/sullen Mixed Stated Delirium: hyper active and hypo active simultaneously.
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Delerium vs Demential
see google doc
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Anti -Anxiety Meds
Benzodiazepine and Barbituates (Benzos and Barbs) Benzos fast acting suffix: pam, lam , Ativan, Lorazepam (sedates brain, and leaves body quickly) Barbs (gabba alpha receptors) for Seizures long acting, lasts in body longer. habit forming .Barbitol, 3-5 days to leave system. Gaba in brain controls thoughts. ETOH relaxes the gaba and sedates you, similar to Barbs. Benzos act on different receptor sites of gaba itself. both are CNS depressents hr, resp rate,

LPN to RN (13 decks)

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