Georgettes LMR study set with Complete Solutions

Georgettes LMRWhen questions ask for a priority action...think about... ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: the umbrella answer Wh ...

Georgettes LMRWhen questions ask for a priority action...think about... ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: the umbrella answer What is the most common side effect of olanzapine/zyprexa metabolic syndrome what is the difference between typical and atypical antipsychotics Atypical 5HT2A specific 1st psychotic break... two actions to take UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain Latuda, Abilify, Geodon Always encourage interprofessional collaboration between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 T3, T4 low TSH low, then...t3/t4 T3, T4 high cold/hot sensitivity with t3/t4 relationship T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat anxiety and insomnia Rash and fever associated with tegretol, suspect What allele is HLAB 1502 associated? Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine SJS labs to checke BEFORE starting on lithium BUN CRE urine protein What does protein in urine indicate kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. lithium best choice med for si in schizophrenia clozaril best choice med for SI in borderline lithium What medications will INCREASE Li levels NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels dehydration hyponatremia lithium s/e inc N/V, which will effect electrolytes, and dehydration status what type of tremors will you see with lithium toxicity? course tremors lithium can cause what other comorbidities? hypothyroidism maculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS muscle rigidity Sx's/labs associated with NMS Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does DC the offending agent bromocriptin-D2 agonis dantrolene: muscle relaxant Make sure if ? is asking for agonist or relaxant Sx of SS HYPERREFLEXIA myoclonic jerks treatment for SS ciproheptadine how to best PREVENT SS follow proper transition protocols SSRI to MAOI=14 days Prozac to MAOI=5-6 weeks Triptans (Imitrex sumatriptan) can also cause SS due to serotonin increase with the use give any NDRI welbutrin Why are SSRIs considered the safest for use in depression safest for OD first line treatment for depression antidepressant for cancer citalopram and escitalopramless drug to drug interactions depressed patient presents with fatigue and low energy, consider: NDRI wellbutrin sexual s/e with ssri? try... wellbutrin due to lower risk of sexual s/e What medication must be avoided if client has seizure history or eating disorder? why? wellbutrin due to decreasing the seizure threshold if client has depression and neuropathic pain SNRI or TCA for treatment of BOTH What med class treats neuropathic pain well alpha 2 delta ligands Gabapentin Lyrica What medication class is good for depression with comorbid CA SSRI least chance of drug drug interactions Celexa and lexapro are good choices Black box warning on SSRI increase SH kids, and young adult Required education for rx ssri long time for effect side effects esp n/v/d NO ABRUPT stopping d/t Serotonin discontinuation syndrome what to ask when client is depressed (additional question) alcohol use Sx's of serotonin discontinuation syndrome fever, shivering, muscle aches and nausea diarrhea, agitation, cog impairment... (think flu like sx's) disequilibrium What are some scenarios that place patients at risk of a hypertensive crisis? MAOI and tyramine MAOI and TCA MAOI and Atypical AP MAOI and decongestant MAOI and stimulants MAOI and asthma meds Sx of Hypertensive crisis HA Diaphoresis fever facial flushing pupillary dilation palpitation Treatment for HTN Crisis DC Agent Give Phenolamine age of onset for male / female schizophrenia male 18-25 female 25-35 schizophrenia has high rate of suicide always be assessing for SI what is the cause of schizophrenia inadequate synapse formation excessive pruning of synapses intrauterine insult (drugs/toxin/viral agent/malnutrition/substance use, mental illness, o2 deprivation) on MRI /PET schizonphrenia ventrical enlargement positive sx of schizophrenia caused by... excess DA in mesolimbic pathway positive sx of schizophrenia on a stimulant? will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine What is ACT Assertive community treatment Post hospital DC not in the hospital delusions, you respond how? do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction interpret a proverb assess thought process why? and potential findings to assess organization of patients thoughts tangential: no rip to a ? circumstantial: gets around to anss after going in circles with unnecessary details MMSE thought content include SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? tool used to assess cognitive status in adults concentration/attention/calculation assessed how? spell a word backward or serial 7's Registration/ability to learn new material assessed how? remember 3 words orientation is assessed by Person place time fund of knowledge assessed how? Who is the president? Governor? clock drawing assesses? takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway positive sx of schizophrenia decreased DA in mesocoritcal pathway negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia what does high prolactin levels lead to breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia risperidone Male prolactin female prolactin---normals male less than 20ng/ml female less than 25ng/ml EPS caused by DA blockade in the NS pathway acute dystonia acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia cogentin/benztropine IM, but may need Oral follow up for several days akathisia ANXIETY restless cannot sit still pacing rocking 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? propranolol/or beta blocker client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers 2nd line: cogentin/benztropine 3rd line: benzos akanesia difficulty iniating motion treatment for akanesia cogentin/benztropin Sx of akinesia DIFFICULTY INITIATING MOVEMENT; PSEUDO PARKINSONIAN SX'S: muscle rigidity shuffling gait mask like facial expression affect may be flat or blunted pill rolling tremors (motor slowing) Tardive dyskinesia (TD)/timeframes chewing/lip smacking facial dyskinesia Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril. can have onset between a few weeks and 2 years post starting of medication Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? TD what medication can worsen TD? benztropine/cogentin Inducers cause low serum levels inhibitors cause high serum levles reglan and compazine can both cause TD Smoking and dosing of meds smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication tegratol what meds can cause mania disulfram steroids isoniazide antidepressants what meds can cause depression steroids beta blockers interferon accutane-can cause birth defects too if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine increase the dose to adjust for the medication (steroids) influencing mania treating a patient with zoloft and starts taking interferon. what do you do with zoloft dosing? increase dose of zoloft to adjust for the increase in depression for the interferon addiction neurotransmitters DA GABA Gamma-aminobutyric acid main function major inhibitory neurotransmitter Sx's of stimulant abuse irritability insomnia tremors delayed gastric emptying-feeling fullness/bloated Pt with anorexia complains of pain after eating/bloating/fullness Signs of delayed gastric emptying what meds can delay gastric empying? PROTON PUMP INHIBITORS famotidine omeprazole ranitidine ANTACIDS /PPI do what to psychotropic medications? Decrease absorption of psychotropic medication advise client to take other meds 2 hours AFTER antacids/PPI Older adults and SSRIs for anxiety? May increase anxiety paradoxical effect Older adults and benzos? May increase agitation paradoxical effect apoptosis neuronal loss or cell death BP1 pneumonic DIGFAST DIGFAST Distractible Impulsive choices Grandiosity Flight of ideas Active Sleep not needed Talkative Borderline sx in regard to impulsivity impulsivity is often with associated with recurrent SI and self harming behavior Therapy for BPD/goal/founder DBT to decrease recurrent SI Marsha Linehan Conversion Disorder (Functional Neurological Symptom Disorder) can be result of a stressful experience present with neuro sx: parasthesia paralysis blindness Mutism adjustment disorder (anxiety/depressive/mixed) an emotional disturbance caused by ongoing stressors within the range of common experiences (dx of a new disease) (recent move) (loss of loved one) factitious disorder Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. Ie drinking contaminated urine Reactive Attachment Disorder common in kids from foster care kid goes back to real parent and may appear withdrawn, no emotions toward caregiver, FOSTER is key word Doesn't seek comfort when distressed ODD NO AGGRESSION in ODD defiant to authority deliberately annoy others treatment for ODD • Family Therapy with emphasis on child management skills CD conduct disorder no remorse violent raping/beating theft arson INTENSE AGE 6-17 When 18; think of Antisocial personality disorder Treatment for CD Medication and therapy to target symptoms of mood and aggression Alpha agonist aka alpha 2 adrenergic receptor blockers (clonidin, guanfacine) Family therapy acute stress disorder An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last LESS THAN 1 MONTH Over 1 month is PTSD PTSD cluster of sx Increased arousal Reexperiencing the event avoidance nightmares nightmare trmt in ptsd prazosin/minipress PTSD treatment EMDR SSRI CBT phases of EMDR see purple book Panic attack vs disorder panic attack: acute/seldom disorder: chronic leads to feelings of impending doom propanolol Tourette dx criteria 2 motor tic 1 vocal tic for ONE year (even if ? says 6 months) its still most likely the correct answer NT in tourette DA-da dysfunction is major NT in tourette NE S tics can be caused by what type of medication stimulant how do you treat a kid with tics for adhd non stimulant guanfacine and clonidine are good choice for adhd in kid with tics TRUE Meds for tourettes FDA approved haldol abilify pimozide guanfacine clonidine esp if kid is having impulse control problems are tics in kids normal yes normal. normally by teen years they disappear. no treatment unless meeting dsm criteria for tourettes. tourettes needs trmt. 2 motor 1 vocal brain region affected in adhd frontal cortex basal ganglia- dorsolateral PFC--executive function, attention, cognitive processes (problem solving, working memory) reticular activating OCD NT's S NE Pandas causes OCD from strep infection treat with SSRI prozac in kids, in adults use sertraline. adults can also get TCA like clomipramine DMDD (disruptive mood dysregulation disorder) in kids, mood d/o 6-17yo kid has bipolar disorder but is not 18 yet moody for no reason irritible for no reason tantrums for no reason Mad/Sad for no reason IED (intermittent explosive disorder) reacts grossly out of proportion to the situation violent aggressive HAVE REMORSE, feel bad about it all later irritibility, depression, labile mood...utilize a________ mood questionnaire nightmares in children can be genetic or psychological assess the family tree/hx for this GAD (Generalized Anxiety Disorder) AT LEAST SIX MONTHS If less it is ASD Autism Spectrum Disorder NTs Gaba glutamate SE impaired communication poor cognition broken mirror theory of autism- what two things do you have to have to diagnose adhd a teacher and a parent evaluation Do stimulants increase DA? Yes, so don't give a vmat 2 and a stimulant together. wipes one another out P450 Inducer meds carbamazepine rifampin alcohol phenytoin griseofulvin phenobarbital sulfonylureas P450 inhibitor Valproate ketoconazole isoniazid sulfonomides choramphenical amiodarone erythromycin quinidine grapefruit juice pneumonic for inducers CRAP GPS induces my rage Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas 450 subtypes 1A2 2E1 2C9 2D6 3A4 1A2. AcetAminophen- 1 big word with 2A 2E1 - 21 years to drink ETOH 2C9- Warfarin factors 2, C, 9 2D6- 2D echo-cardiac drug metabolism 3A4- most common, metabolizes up to 60% of ALL medications, so if its not one of the above it is likely 3A4. What NT are involved with OCD NE SE Trmt med for kid with ocd SSRI: prozac trmt med for adult with ocd ssri: sertralin or TCA (clomipramine) GAD pneumonic WATCHERS x 6 months Worry Anxiety Tension Concentration Hyperarousal Energy Loss Restlessness Sleep issues Stages of change precontemplation: Not acknowledged an issue. " I don't have a drug problem" contemplation: acknowledges, but NOT YET ready to change. "i know heroin is killing me, but i have no time for rehab"... some self doubt preparation: acknowledges issue, intends to eventually act. "Ive been thinking about rehab or buprenorphine, what do you think?" No action or behavioral modification yet... researching action: behavioral change occurs. "I'm in inpatient rehab and I'm feeling much better!" maintenance: effort made to sustain the change. "Ive been on buprenorphine for a year and I'm still doing well" relapse: reversion to a previous stage... goes back to a prior stage to start over. Autism hallmarks impaired communication impaired social interaction poor eye contact sensory issues poor cognition Broken mirror theory of autism-responsible for childs presentation of autism symptoms mirror neuron is dysfunctional Risk factors for autism male intellectual disability genetic loading-inc risk with family member with autism screeners for autism? M-Chat: modified checklist for autism ADOS-G: autism diagnostic observation schedule-generic ASQ: ages and stages questionnaire nightmares in children can be genetic so ASSESS family for same problem NT in Autism Spectrum disorder Gaba and Glutamate If patient presents with irritibility, personality changes, check their: Vit B12 and folic acid if ? presents lack of coordination, slowing, motor symptoms, and apathy, depression, irritability think about this dx subcortical dementia cortical dementia effects mostly... memory and language cognitive deficits motor, behavioral pseudo dementia cognitive screening present with: agitation irritability what disorder does a provider hear a lot of "I don't know answers" pseudo dementia aphasia is associated with which region of the brain prefrontal cortex visual hallucinations are associated with which type of dementia lewy body frontotemoporal dementia frontal lobe picks disease personality changes behavioral language (slurred) Signs of lead abuse developmental delay learning difficulties irritability loss of appetite weight loss sluggishness fatigue abd pain vomiting constipation hearing loss seizures pica TEST LEAD LEVELS Components of the COW Scale Pulse sweating restlessness pupil size bone aches running nose tearing GI upset yawning tremors anxiety/irritability goosebumps anterior cingulate is responsible for what cognitive functions decision making emotions impulse control NE is produced in the locus ceruleus and the ... medullary reticular formation SE is produced in the_________? And is involved in ______? raphe nuclei of the brainstem/sleep DA is produce in the substantia nigra and ______? the ventral tegmental area VTA and nucleus accumbens Acetylcholine is synthesized by the basal nucleus of _____? Meynert NT in mood disorders SE and NE risk factors for osteoporosis smoking caffeine lack of exercise diet low in cal and vit D What is the hippocampus responsible for? ST to LT memory emotions stress learning Amygdala fear anger anxiety aggression stress cerebellum balance anterior cingulate cognitive functions decision making empathy impulse control emotions decision making frontal lobe issues social skills tumor here can cause behavioral problems If you are caring for an infant that is dying and the parents are present, what action should you take give the infant to the parents to hold and grieve their loss osteoporosis can be prevented by a diet rich in what? and other ways to prevent calcium and vitamin d weight bearing exercises not using tobacco Cognitive theory basics trying to replace automatic negative beliefs/irrational thoughts with positive / functional thoughts Humanistic therapy basics Person centered self actualization self directed growth Behavioral therapy problem solving techniques role playing skills training relaxation SKILLS SKILLS interpersonal therapy (IPT) interpersonal distress with lots of people and in several settings. also used in marital conflict for a 12-16 weeks. Think relationship distress with this Family systems therapy triangles triangulation self differentiation genograms structural family therapy hierarchies keyword structural mapping genograms strategic family therapy problem focused/symptom focused paradoxical strategies or a straight forward directive Reframe patients belief system solution focused family therapy miracle question miracle solution exception based finding questions scaling questions Appreciative inquiry focused on the strengths of client if question answers give closed ended questions and one open ended question and all are appropriate, choose open ended because open ended questions promote the relationship promote the relationship between client/provider. if they won't talk, you can f/u with closed ended questions if the child remains avoidant... stays avoidant, then go to parents as a last resort therapy session with a couple and only one party shows up, what do you do? reschedule both of them. they must both be present. if someone has lost someone, ask them....? how is that loss affecting you...how do you feel about it? Not affected? maybe you don't need to focus on it too much If client is moving to another state, how can you assist in not abruptly stopping medications? give plenty of meds until they can see a new provider...maybe three month supply Sibling abuse 5yo sodomized by his 15yo borther reported to you. Inform parent to ______, and call______? tell parents to separate the siblings cps suspect rheumatoid arthritis, check.....? ESR level, which indicates inflammation PICOT Population Intervention Comparison Outcome Time Level 1 evidence systematic reviews of random control trials (RCTs) -highest internal validity due to randomizations Level 2 evidence at least 1 RCT how do you continue to give evidence based care? by reading current up to date journals Shrill cry in infant intracranial pressure; inconsolable when do you start aftercare plan? when patient is admitted masturbating is normal in what age range? Freud stage? 3 to six year old phallic stage normal for young boys to develop breast enlargement/swelling/tenderness. Usually goes away in....? six months sex drive is driven by what hormone? testosterone. so check this if c/o dec libido. Testosterone decreases as we...? age if male or female c/o dec sex drive, chec...? testosterone Alcohol dehydrogenase etoh enzyme women have less than men so get intoxicated faster compared to men best way to normalize the grieving process in children? supportive group therapy do psychoeducation do not give prescriptive advise these reflexes go away at what age: grasp/palmar moro/startle babinski grasp/palmar 5-6 months moro/startle 5-6 months babinski 9-12 months what class of medications are PDE5? sexual dysfunction viagra short absorption, rapidly absorbed know diff between AN and BN AN BMI is very low, high chance of hospital admission VS changes like bradycardia. if parents won't admit call cps. bmi to admit are 12, 13, 14. Screen all adhd presentations for substance use high risk for sub use in depression population use early screening and early intervention recommend accupuncture for depression and pain inform adolescents all info is confidential except harm to self or others what is habeus corpus legal, not medical concept, that protects patients from unlawful hospitalization substance induced psychosis has a very high rate of ? HI. even more than ASPD. disseminated encephalomyelitis nervous system is affected asymmetrical body movements do a neuro exam patient has a mood disorder. started depakote and been stable. BMI 25 now 30. eating alot of sweets and juices. recommendations? A. switch med b. dec depakote c. ask them to exercise how can you help your client remember something by anchoring their memory. how do you do thta? ask a specific question that will provide an anchor to a timeline, like a wedding, bday, new job, etc. ask what they know about medications before rxing assesses their knowledge of meds polypharmacy can lead to adverse side effects assess medication hx iatrogenic an iatrogenic illness is an illness that is caused by a medication or physician. tardive dys: caused by a med rx'd by a doc post online forms to give responses to influence policy making advocacy autoimmune diseases can lead to increased....? cytokine levels Desmopressin (DDAVP) for nighttime bed wetting reduces urine production esp at noc guanfacine and clonidine is disliked by some patients due to? have low tolerability due to lowers BP cannot look up patietns information on Social media violates trust treatment for nighttime wetting under 12yo? nonpharm setting alarms bladder training if addicts are still blamining others they are not ready for....? discharge. If still blaming others they are not ready. Need to take responsibility for their actions. non compliant with medication? intervention based on why they are not compliant assess data before changing anything if patient comes to your with concerns make sure you validate their concerns to promote communication come to office or discuss by phone documentation for off label use? do this.... document why. and document support for off label use. MSL or trials risk factors for sleep apnea excessive weight obesity diabetes smoking HTN narrowed airways what is macrocytic anemia vit B12 deficiency MMSE high score means? Good! low score is severe cognitive deficit if depression is "severe" assess for SI MMSE scale 25-30 is normal 21-24 mild 10-20 moderate 0-9 severe SLUM scale 27-30 Normal 21-26 Mild 0-20 dementia HAM D 0-7 Normal 8-13 mild 14-18 moderate 19-22 severe 23 plus very severe PHQ 9 0-4 normal 5-9 mild 10-14 moderate 15-19 moderate to severe 20-27 severe Beck 0-9 normal 10-18 mild 19-29 moderate 30-63 severe HAM A under 17 mild 18-24 moderate 25 plus severe GAD 0-4 normal 5-9 mild 10-14 moderate 15-21 severe COWs 0-4 none 5-12 mild 13-24 moderate 25-35 mod to severe 35 plus severe CIWA 0-9 none 10-15 mild 16-20 moderate 21 plus severe cows criteria mod: treatment at 13 and above for scheduled. consider buprenorphine or Suboxone. methadone consider safety concerns and under supervision pulse sweating restlessness pupil size-dilated bone aches runny nose tearing gi upset yawning tremors anxi/irritable goosebumps ciwa scheduled medication starts at score of 15 Nausea vomiting tremor sweats anxiety agitation tactile disturbances auditory disturbances HA orientation etoh abuse treatment disulfram no etoh for two weeks after stopping/none 12 hours before starting aversion therapy naltrexone idealization exaggeration of good qualities of the person or object lost, followed by acceptance for the loss. widow exaggeraes how amzing her not so amazing husban is false positive screen for pcp tramadol dextromethorphan alprazolam clonazepam carvedilol diphenhydramine rationalization always to work late and tells boss "I'm not the only one" intellectualization new diagnosis so you go home and do tons of research scope of practice varies state to state defines role and action varies broadly standard of practice determined by american nurses association judges care given reasonably prudent is standard confidentiality the assurance that messages and information are available only to those who are authorized to view them exceptions to confidentiality when info outweighs risk (think murder trial) intent to harm self or others info given to atty in litigation releasing records to insurance companies answering court orders, subpoenas, summons Meeting state requirements for mandatory reporting of dx of condition informed consent in apt with dementia if client can repeat the benefits and risks o the med/ autonomy is: right to self determination EXCEPT rennie vs klein: right to refuse medication if NOT-found incompetent Rights of patient re environment least restrictive first just culture safety continual learning designing safe systems managing behavioral choices Recovery model treatment approach doesn't really focus on the dx/illness looking beyond the dx and search out abilities dreams goals self direction finding meaning in life despite the dx person centered individualized NON LINEAR not step by step but based on growth setbacks and learning experiences quality improvement projects focus on... improving systems decrease cost improve productivity a retrospective chart review would be a type of.... quality improvement initiative PDSA is a process not a project an effective strategy reflective practice linking theory to practice providing feedback industry vs inferiority school age 6-12 becoming industrious and getting confidence about what they can do... fx is feeling bad and inferior intimacy vs isolation age 20-35 in a loving relationship starting a family fx is feeling alone and isolated piaget age 2-7 magical thinkeers preoperational "if i think about a new dress I will get one" piaget 11 and up formal operations logical and abstract algebra etc primary prevention example screening and community education secondary prevention crisis intervention hotlines disaster response tertiary prevention rehab active treatment