Noncompliant Patient

Question 1

Delirium tremens

Answer 1

. Nightmares, agitation, global confusion, disorientation, visual and auditory hallucinations, tactile hallucinations, fever, high bp, autonomic hyperactivity
. Occurs due to alcohol withdrawal

Question 2

Alcohol withdrawal timeline

Answer 2

. 1: anxiety, insomnia, nausea, abdominal pain (8hrs)
. 2: high bp, inc. body temp (1-3 days)
. 3: hallucinations, fever, seizures, and agitation (past 1 week)

Question 3

GI bleed

Answer 3

. Can be from mouth to anus
. Vomiting red blood, bloody stool, or black stool
. Etiology: trauma, erosion/tear, rupture of enlarged vein, inflammation/infection, alcohol and drug consumption (NSAID), vascular disorder, intestinal/anal disorder

Question 4

Suicidal ideation

Answer 4

. Suicidal thoughts or suicidal ideation, means thinking about or planning suicide
. Must obtain psych evaluation
. Can be medication side effect: SSRIs

Question 5

Depression

Answer 5

. Medical illness causes a person to have feelings of sadness that do not go away
. Feels hopeless, low energy, and has no interest in activities that he or she may have enjoyed in the past
. Affects thoughts, feelings, behavior, mood, and physical health

Question 6

Depression screening questions

Answer 6

. Over he past 2 weeks, have you felt down, depressed, or hopeless?
. Over the past 2 weeks have you felt little interest or pleasure in doing things you normally do?

Question 7

Psychosis

Answer 7

. Loss of contact w/ reality
. Ability to perceive and respond to the environment is significantly disturbed, and the individual’s functioning is impaired
. Symptoms: may include hallucinations, delusion, incoherency and overt agitation

Question 8

Lack of medical knowledge

Answer 8

. Directly dependent on patient’s background knowledge

Question 9

Münchausen syndrome

Answer 9

. Fabrication of symptoms to undergo medical tests, hospitalization, surgery, or obtain meds

Question 10

Non-compliance

Answer 10

Failure or refusal to comply

. Patient doesn’t follow a course of treatment

Question 11

Characteristics of noncompliant patient

Answer 11

. Low literacy 
. Language barrier
. Angry 
. Crying patient 
. Talkative patient
. Altered cognition

Question 12

Addiction

Answer 12

. Primary, chronic, neurobiological disease w/ genetic, psychosocial, and environmental factors inflicting development 
. Impaired control over drug use 
. Compulsive use of drugs 
. Continued use despite harm 
. Craving

Question 13

Physical dependence

Answer 13

. Drug-class specific withdrawal symptom produced by: 
. Abrupt cessation of drug 
. Rapid dose reduction
. Dec. blood level of drug
. Administration of antagonist

Question 14

Tolerance

Answer 14

. State of adaptation in which exposure to a drug induces changes that results in diminution of drug effect over time

Question 15

Key reasons for non-compliance

Answer 15

. Lack of time 
. Denial of problem 
. Cost of treatment 
. Difficulty of regimen 
. Side effects of treatment 
. Lack of patient-physician trust
. Apathy 
. Previous experience

Question 16

Common triggers of hostile behavior

Answer 16

. Ineffective communication skills 
. Frustration.overwhelmed
. Perceived disrespect or belittlement 
. Perceived loss of control
. Fear

Question 17

Nonmaleficence

Answer 17

First do no harm

Question 18

Beneficence

Answer 18

Actions need to be motivated by what is in the patient’s best interest

Question 19

Autonomy

Answer 19

Patient has the right to determine what is best for them

Question 20

Tavistock principle

Answer 20

. Rights: people have right to healthcare
. Balance: care of individual patient is central, but the health of population also concern
. Comprehensiveness: in addition to treating illness, we must ease suffering, minimize disability, prevent disease, and promote health
. Cooperation
. Improvement
. Safety
. Openness

Question 21

Postnatal depression

Answer 21

. Persistent sadness/low mood
. Loss of energy, interest
. Trouble sleeping
. Difficulty bonding with baby
. Problems concentration and making decisions, frightening thoughts about hurting baby
. Treatment: psychological therapy, antidepressants

Question 22

Risk factors for postnatal depression

Answer 22

. History fo mental health issues
. No close friends or family for support
. Poor relationship w/ partner
. Recent stressful life events

Question 23

Scale used for postnatal depression

Answer 23

. Edinburgh postnatal depression scale

Question 24

Adolescent depression screening

Answer 24

. Whole child assessment
. Strengths and difficulties questionnaire
. Pediatric symptoms checklist
. Youth pediatric symptoms checklist
. Clinicians encouraged to seek training for screening tools
. 12+ should be screened
. Patient w/ risk factors to be identified and systematically monitored

Question 25

Banana bag

Answer 25

. Thiamine
. Folate: 400-1000 mcg, deficiency can cause psychosis, agitation, and sleep disturbances
. Magnesium
. Multivitamin
. Mixed in isotonic saline w/ 5% dextrose
. Corrects electrolyte abnormalities