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LPN to RN > N212 - Health across the lifespan 2 > Flashcards

N212 - Health across the lifespan 2 Flashcards

Psychiatric Nursing,

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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
Q

Biological Theory

A

Genetics
brain abnormalities
neurochemical theorists

GABA, 5Ht, NE

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26
Q

TX:

A

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

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27
Q

Anxiety Disortders

A 
.GAD (Generalized Anxiety Disorder)
.PD (Panic Disorders)
.OCD
.Phobic disorders (agorophobia etc)
.ASD (acute distress disorder) and PTSD
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28
Q

General Anxiety Disorder (GAD)

A

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 …

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29
Q

Panic Disorder

A

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

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30
Q

Panic Attack SS

A

miimc heart atack

SOB, rapid shallow breath, chest pain, pressure, nause, dizzy, chills, exagerated speech, startled

TX: therapy, cognitive behaveoral

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31
Q

Phobias

A

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

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32
Q

ASD (Acute Stress Disorder)

A

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

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33
Q

? PTSD

A

onset: acute within 6 mos after event. delayed, over 6mos after event
duration: 1-3months / 3 or more months

SS:

Tx:

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34
Q

** Personality Disorders Clusters **

A

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

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35
Q

CLUSTER A (SUSPECT)

A

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.

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36
Q

CLUSTER A:

Psycotherpeutic Mgmt

A

trust, formal, business like manner. don’t ask too many personal questions. don’t challenge their paranoid beliefs

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37
Q

CLUSTER A: Schizoid DISTANT

A 
.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
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38
Q

CUSTER A:
Schizotypal Personality
ME PECULIAR

A

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,

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39
Q 
CLUSTER B
B
H
A
N
A

.Borderline
.Histrionic
.Antisocial Personality
.Narcisist

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40
Q

Antisocial Personality Disorder TYPE B, CORRUPT

A

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

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41
Q

Limit Setting

A

3 steps
.state behavioral limit
.id consequences
.id expected behaviour

be consistent, apply consequences, avoid power struggles, avoid arguing, not personal., all business

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42
Q

Borderline Personality Disorder: TYPE B

AM SUICIDE

A

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

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43
Q

Hystrionic

PRAISE ME

A

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.

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44
Q

Narcissistic : TYPE B

A

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

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45
Q

CLUSTER C (anxious, fearful)

CRINGES

Avoidance
Dependent
Obsessive

A

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

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46
Q

Dependent RELIANCE

A

SLIDE

RELIANCE

.R
.E
.L
.I
.A
.N
.C
.E
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47
Q

Obsessive Compulsive

LAW FIRMS

A

SLIDE

LAW FIRMS

.L
.A
.W

.F
.I
.R
.M
.S

perfectionist, hoarder, miserly, cheap, rigid

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48
Q

SCHIZOPHRENIA

A

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.

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49
Q

Schizo Speech Abnormalities

A 
.clang associations (rhyming)
.echolalia (meaningless repetition)
.Loose association and flight of ideas
.word salad
.neologisms made up words w meaning only for patient
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50
Q

Schizo Thought Distortion

A

.Overly concrete thinking, delusions
.hallucinations, .thought blocking
.magical thinking

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51
Q

Schizo POSITIVE SS

A

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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52
Q

UNIT 2

A

UNIT 2

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53
Q

who coined the term ‘Schizophrenia’?

A

E. Bleuler

affective disorder

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54
Q

Schizophrenia Positive SS

A

linked to brain abnormatlities

and Temporal lobe abnormalite

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55
Q

Schizophrenia Negative SS

A

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
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56
Q

Schizophrenia Disorganized SS

A

relects abnormal thinking

confused thinking, mild to incoherent rambling

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57
Q

Speech Abnormalities

A

Catatonic, Paranoid

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58
Q

Schiz Etiology

A

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)

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59
Q

Paranoid Schitzp[hrenia

A

decline. all ss
plateau at 5 years

w have several relaps by 45 d/t non compliance with meds.

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60
Q

Schiz Tx:

A

.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

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61
Q

Extrapyramidal Syndrome

A

Parkinsonism

Tardive Dyskenesnia

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62
Q

Typical Rx

A

antipyschotic drugs. ONLY address POSITIVE ss

clorazine (first drug ever used on schitz)

Haldol

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63
Q

Atypical

A

relieve Positive AND Negative ss

lowers neutrophils

Ability
Cloanzapine

4-8wk to assess if working

Lithium
Depakote
Tegrol

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64
Q

Types of Schizophrenia

A

Paranoid
Catatonic
Disorganized

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65
Q

Paranoid Schiz

A

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

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66
Q

Disorganized SS

A

disorganized speech, loose association, blunt, silly, superficial, grmimace, can withdraw socially.

Intervention: quit envt, information boards, simple schedule

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67
Q

Catatonic

A

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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68
Q

Depression

A

Mood Disorder

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69
Q

Mood Disorder

A

.Bipolar
.Major Depressive Disorder
.Cycloclothymic

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70
Q

Major Depressive Disorder

A 
5 of ss for 2 wks
.depressed mood
.anhedonia
.change weight
.insomnia
.change psychomotor
.fatigue
.guilt
.lo concentratoin
.suicidal
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71
Q

Major Depressive Disorder

A 
5 of ss for 2 wks
.depressed mood
.anhedonia
.change weight
.insomnia
.change psychomotor
.fatigue
.guilt
.lo concentratoin
.suicidal

NI:

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72
Q

Major Depressive Disorder

A 
5 of ss for 2 wks
.depressed mood
.anhedonia
.change weight
.insomnia
.change psychomotor
.fatigue
.guilt
.lo concentration
.suicidal

NI:

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73
Q

Major Depressive NI:

A

.safety
.increase self esteem, give praise
.punching bag/foam bats

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74
Q

Mood Disorder: Bipolar

A

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

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75
Q

hypomanic

A

4 days

not sever enoght o result in signifiatnt impairment.

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76
Q

BiPolar 1 and !!

A

most severe

sever mania

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77
Q

Bipolar !!

A

hypo mania w alternate depressive episodes

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78
Q

Cyclothymic Disorder

A

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

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79
Q

Lithium Therapy

A

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

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80
Q

Delerium

A

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
Q

Dementia

A

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
Q

Alheimers

A

plaques in brain. kills neurons.

Dx: through autopsy, view amaloid plaque

83
Q

Demential SS

A

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
Q

Delerium vs Dementia

A

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
Q

Reversible Dementia

Non Reversible Dementia

A

Reversible: lupus, up lo thyroid, UTI, etc

non-reersible: alzheimers

65 yrs or older

86
Q

5 Stages of Alzheimerg

A

Mild: diff balancing checkbook
Moderate
Severe

87
Q

Mild Alzheimers

A 
.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
Q

Moderate Alzheimers: Stage 2

A 
,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
Q

Severe Alxhimers

A

.need assistance w personal care, toileting

90
Q

Profound

A

obvlivious to sorrounding

91
Q

terminal

A

bed bound, non respnosive. brain eating away at itself. no appetite.

92
Q

Alz Tx

A

no cure

look for side effects

aricept
cognix
ravistifmine
galantamine

ginko
nsaids
vite
estrogen
ccb's prevent influx
93
Q

2:37 Class 2

A

2:37, class 2

94
Q

Parkinson’s

A

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
Q

Diffuse Lewy Body Disease

A

similar to Alzheimers. rapid, no slow like Alzheimers

YOUTUBE

96
Q

Huntington’s Disease

A

disturbanec in gait, slurred speech, neuro - intellectual deterioratoin, lose muscle controld, tongue, breathing

hereditary

97
Q

Pick’s Disease

A

simiar to Alz

associaed w aging.

duration, 5-7yrs.

shrinkage of frontal lobe.

98
Q

Creutzfeldt Jakob Disease

A

aka Prion Disease

non inflam dementia.

visiaon, hearing loss, muscle wastering, tremors, hallucinations,

99
Q

Vascular or Multi Infarction Dementia

A

leading cause of vascular probs to brain 85 and older pop

100
Q

Alcoholic Dem

A

15-20yrs continuous drinking

SS:
.Toxic to neurons (wetbrain)
.disruptive neutritional defincit
.CNS defecit

101
Q

Transient Ischemic Attacks

A

micro embolisms to brain through sclerotic plaque

102
Q

Psychotherapeutic Mgmt.

A

Delerium: Safety, Optimal level of fxing. praise, touch, affection when possible, use title and last name, learn background and lifestyle

103
Q

3 Miliem Relate=d Issues

A

Stress
Safety
Wandering

Don’t change envt
No new skills
Clock/Calendar

3 stages
.Forgetfulness
.Wandering

Rx; Serox, Ativan

104
Q

Substance Abuse

A

.Alchohol,

105
Q

Alchoholism

A

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
Q

korsakoff psyvchosis

A

thiamine, niacin deficient

107
Q

wernicke’s encephalopathy

A

thiamine deficiency

108
Q

Alcholholi RX

A

Benzodiazepines
.Lorazepam (ativan)
.Diasepam (valium)

Diulfiram (antabuse)
avoid products w ETOH

Odansetron (Zofran)
Tx for methampetamine

109
Q

Stimulant Abuse

A

uppers, speed, crank

cocain: snorted

110
Q

detox

A

by 10% per day

111
Q

Intoxicatoin

A

develops rrapidly

112
Q

OD

A

arythmia, respiratory collapse

death rare

TX
induce vomiting, forced diuresis

Rx: Zofran,

113
Q

Cannabis Sat

A

2 Cannabinoids

Marinol (Dronabinol)
Cesamet (Nabilone)

114
Q

Endocrien

A

Adrenal: aldosterone
Renal Cortex: Cortisol (cushings, addison’s , stress hormone anti infla,

Medula: works with ANS, ephinepherine and norepinepherien, broncho dilater, stress hormone.

115
Q

UNIT 3 - Endocrine

A

UNIT 3 - Endocrine

116
Q

Thyroid controlled by

A

Pit - Anterior

T3/T4 metabolic rate
Calcitonin keeps Ca in bones.

117
Q

Parathyroid

A

regulates itself. Ca levels LO, para releases hormone to decrease bone decalcification

Parathyroid PULLS Ca out of bone

118
Q

Pancreas

A

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
Q

Ovaries/Testes

A

Pit - Ant

FSH and Leutenizing hormone

120
Q

Hormone Regulation

A

.neg feedback mech
.change blood levels of Ca and Glucose
.

121
Q

Pos Feedback Syst

A

body already producing the hormone. Body produces more for incident, then reduces to normal again.

122
Q

Endocrine Sys controlled by

A

Hypothalmus

123
Q

Hyperpituitariasm

A

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
Q

Hyperpituitarism SS

A

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
Q

hypopituitarism

A

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
Q

Trans-sphenoidal hypopysectomy

A

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
Q

Post Pit Complications

A

ADH (works on collecting tubules of kidney)

.Diabetes Insipidus
.AIDH

128
Q

Diabetes Insipidus (DI) - PIT Disorder

A

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
Q

SIADH (syndrome of inappropriate adh) - PIT disorder

A

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
Q

ID, SUPERGO, EGO

A

ID: Instincts (devil on shoulder)

EGO: Reality (you, conscious)

SUPER EGO: Morality (angel on shoulder)

131
Q

Freud’s 5 Stages of Psychosexual Developments

A
  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
Q

Erikson’s Developmental Tasks

A

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
Q

Eriksons 8 stages Numonic

A
  1. BUN, rust, mistrust
  2. SHOE
  3. TREE
  4. DINOSAUR
  5. DIVE
  6. STICKS
  7. HEAVEN
  8. PLATE
134
Q

1:04

A

thyroid disorder

135
Q

DI contd

A

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
Q

Thyroid Disorders

A

gland stimulates cell metab

hormones: t3(bound to T4, regulate respiratory rate / T4 (throxin, main hormone)
TSH

UP T3/T4 raisesmet rate.

137
Q

Hypothroidism

A

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

138
Q

Hypo Complications

A

.cretinism

.myxedema/ myexedema coma (med emergency)

139
Q

Myexedema Coma

A

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

140
Q

Hyperthyroidism

A

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)

141
Q

Simple Goiter

A

enlarged thyroid d/t iodine def, intake of goitrogenic foods (cabbage, turnips, soybeans), heriditary

142
Q

Thyroid Storm

A

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

143
Q

Thyroid Storm MM:

A 
.PTU - antythyroid drug
.Tapazole
.Iodine Preps (Lugal's solution with straw) or K Iodide.
.Inderal
.radioactive iodine
.Sx
144
Q

Thyroid Storm

A 
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
145
Q

Thyroidectomy Post Op

A

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.

146
Q

Throidectomy Post Op Comlications

A

.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland
. 1:38:15

147
Q

Grave’s Disease/Hyper

A

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)

148
Q

Thyroid Storm

A

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

149
Q

Thyroid Storm MM:

A

.PTU(antythyroid, block TH prod)
.Tapazole (bloks TH prod)
.Iodine Preps (Lugal’s solution with straw) or K Iodide.

150
Q

Thyroidectomy Post Op

A

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.

151
Q

Throidectomy Post Op Complications

A

.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland
.Hemorrhage

BOWTIE
assess for

Bleeding
Open airway
Whisper
Trache set
Incision
Emergency
152
Q

Tetany NI

A

.assess for numbness, tingling, twiching
.chvosterk’s sign, Trousseau’s sign
.Ca+ gluconate IV

153
Q

Homorrhage NI

A

Watch For: hypotension, tachy, hypovolemia, irreg breathing swelling choke, clearing of throat, difff swallowing

154
Q

Trousseau

A

muscle spacsms of hands and wrist

155
Q

Chvostek’s sign

A

facial twitch when tap on nerve

156
Q

Thyroid Storm

A

life threatening

.sudden UP of TH
.fever, tachy, restless (w/in 10min of sx), agitation, delierium

157
Q

Parathyroid Gland Disorders

A

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

158
Q

Calcium/Phosperos

A

inverse relationship

159
Q

Parathyroid gland

A

pulls Ca out of bone ,UP serum CA levels.

Calcitonin, secreted from thyroid gland, keeps ca in bone.

160
Q

Parathyroid hormone

A

.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.

161
Q

Calcium Fx

A

.maintain N muscle and neuromuscular responses.

.blood coag mechanisms

162
Q

Hypoparathyroidism

A

Xray, up bone density

Mgmt:
.Ca supplement (Calcium Gluconate IV?)
.Vit D
.seizure precaution
.listen fr stridor/hoarseness
.trach set@ bedside
163
Q

Normal Lab Levels

??

A

Ca
Ph
K
????

164
Q

Normal Lab Levels

??

A 
Ca
Ph
K
chloride
Mg
165
Q

Hyperthyroidism

A

.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

166
Q

Hyperthyroidism MM

A 
.Tx of choice: Diet or Sx removal
.IV PNSS 5L/d w diuretics
.cranberry juice
.low ca
.strain urine for stones
.
167
Q

Disorders of the Pancreas

A

DM I and II

learn drugs

converts food to glucose. Pancrease creates insulin which alows glucoase to enter body

168
Q

DM1

A

Absolute Insulin insufficency. Body does not make any insulin,

inability to produce insulin. any age. usually under 15.

169
Q

DM2

A

Insulin resistance.

defecit in insulin release.

over 4o. alarming how many kids getting it.

170
Q

DM

A

predisposing factors:

.idiopathic
.I, genetic, inherited, virus, pancreatitis, pancreatic tumor, autoimmune, obesity
2:54:46

171
Q

DM SS

A 
.chronic tiredness
.crave drink
.frequent urination
.numbness/tingle feet
.hungry
.weight loss
.blurred vision
.sex dyfx
172
Q

DM Dx

A

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.

173
Q

Oral Glucose Tolerance Test

A

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.

174
Q

DM Diet

A

DIABETES

Diet:
CHO 50-60%
FAT 20-30%
CHON 10=20%

175
Q

Hypoglycemia Mgmt

A

.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.

176
Q

Oral Antidiabetic Agents

A

.sulfonylureas
.biguanides
.alpha glucosidase inhibitors
.thiazolidineldiones

177
Q

See pic of above

A

blue

178
Q

Biguanides

A

Metformin (glucophage)

UP sensitivity to insulin, UP glucose uptake, LO glucose prod by lilver

179
Q

Alpha-Glucosidase Inhiio

A

Acarbose (Precose)
Migliol (Glyset)

delay absorption of glucose in intestines

180
Q

Thiazolidenediones

A

Rosiglitazone (Avandia)
Pioglitazone (Actos)

enhance insulin action at receptor sites

181
Q

Insulin: Ultra RAPID acting

Humalog

A

Onset: 15min
Peak: 2-4hrs
Duration: 6-8hrs

182
Q

Insulin: Rapid acting

Semilente

A

Onset: 1/2 - 1hr
Peak: 2-4hrs
Duration: 6-8hrs

183
Q

Insulin: Int NPH

Lente

A

Onset: 1-2 hrs
Peak: 7-12 hrs
Duration: 24-30 hrs

184
Q

Insulin: Long Acting
Protamine Zinc

Ultralente
Lantus

A

DO NOT MIX

Onset: 4-6 hrs
Peak: 18+ hrs
Duration: 30-36 hrs

185
Q

DM Teaching

A

carry rapid acting during escerzice

Exercises:
.enhances action of insulin
.LO BG levels
.LO need for insulin
.UP fxing receptor sites
186
Q

DM complications

A

.DKA
.Insulin Shock
.Hyperglycemin, .hyerosmolar

187
Q

DKA and HNNA

A

hyperglycemic crises.

can result in coma/death.

188
Q

3:42:21

A

DKA

189
Q

Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC)

A

.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
190
Q

DM Complicatoins

see pic

A
  1. Vascular Changes
    a) Macroangiopathy
    b) Microangiopathy
  2. Neuropathy
191
Q

DM Complicatoins

see pic

A
  1. Vascular Changes
    a) Macroangiopathy
    b) Microangiopathy
  2. Neuropathy
192
Q

Trioangle of DM mgmt

A

Diet
Exercise
Medication

193
Q

DM NI:

see pic

A

foot care (dont cut nails)
monitor infections
no cream betwen tooes. keep feet dry
.

194
Q

Simogy Phenomenon

A

rebound hyperglycermia following episode of hypoglycemia r/t reduction in insulin dose.

195
Q

Shogrin Phenomemnon

A

INreased lacrimal and salivary secreteion. dry eyes and mouth

196
Q

Dawn Phene

A

marked increase in insulin requirements

197
Q

Delirium SS

A 
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.

198
Q

Delerium vs Demential

A

see google doc

199
Q

Anti -Anxiety Meds

A

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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