exam4 cc

Major Depressive Disorder, a syndrome of persistent sad mood lasting ________ or longer and having 5 or more of the following symptoms

• at least one symptom should be either depressed mood or loss of interest and/or pleasure

2 weeks

Major Depressive Disorder: s/sx

• a depressed mood

• loss of interest in life’s activities most of the day

• ______________

• fatigue or loss of energy daily

  • sleep disturbances are common, may report insomnia or ___________

  • difficulty falling asleep or early morning awakening

worthlessness or excessive guilt, hypersomnia

Major Depressive Disorder: s/sx

• weight gain or loss

• poor _________, so ___________

• recurrent thoughts of death and speaks of suicide

• delusions and hallucinations

concentration, talk slow and use silence

Major Depressive Disorder: TX

• help with self-care

• _____________ for pt with depression. interacting with others helps

• help experience accomplishments

• severely depressed, ________ with client and make no demands

• when feeling better, have pt describe feelings

• help pt set accomplishable goals

• if capable, pt can walk, run, lift weights

• ______________

prevent isolation, sit, assess suicide risk

Major Depressive Disorder:

when does suicide risk increase?

when depression lifts

Major Depressive Disorder:

Observe pts with depression when they start taking ______ b/c their risk for suicide goes up during this time.

• first ______ of starting

• a sudden change in mood towards the better may indicate they have made the decision to kill themselves

antidepressants, 2 wks

Major Depressive Disorder

Culturally, American Indians have a higher suicide rate.

___________ pts are particularly at risk for suicide, more success d/t lethal methods

Elderly

Major Depressive Disorder: suicide risk

• ask if they have a plan, what is the plan, how lethal?

• determine if pt has access to the plan

• watch for:

  • isolating themselves

  • writing a will

  • collecting harmful objects

  • __________________

giving away belongings

Major Depressive Disorder: suicide interventions

• Direct, _________________

• safe environment (room near nurse, with another patient, ATC watch)

• safe-proof the room

closed ended statements

Bipolar Disorder:

one pole is ______ and the other is _________

mania, depression

Bipolar Disorder: s/s affect mood, cognitive and perceptive abilities, or activities and behaviors

• continuous high

  • inflated __________. emotions change quickly from euphoria to agitation and angry, or sad and crying

• rapid thinking that leads to ___________

• pressured speech: FAST AND LOUD WITH NO PAUSES

• poor decision making

• Delusions are ____________

  • grandeur

  • persecution

• Manipulation is seen in acute mania: gives client idea feelings of security and power

• constant motor activity → __________

• _____________

• poor impulse control: socially or sexually unihibited

self-esteem, flight of ideas, false idea, exhaustion, decreased need for sleep

Bipolar Disorder: Tx

• decrease _______

• __________ about their delusions

  • dont talk about their delusions

  • accept their belief, but you do not believe it

  • persecution delusion → need to feel safe

  • grandeur delusion → self-esteem needs

• set limits and be consistent. Remove hazards (i.e, cotton balls)

  • structured schedule

• feels secure in _______________

• stay with pt as anxiety and manic behavior increases

• provide ______ to replace non-purposeful activity

• promote nutrition to increase caloric intake

  • supply finger foods

  • walk with client __________

• FLUIDS

• maintain dignity

stimuli, dont argue, one-on-one relationships, activity, during meals

Bipolar Disorder: TX; ECT (electro-convulsive therapy)

• can induce _________

• used for severe depression and manic episodes

• Preprocedure

  • ________ necessary

  • general anesthetic (short-acting barbituate) usually given

  • NPO, _____, ________ is given

  • ___________ given to relax muscles

• given in a series of treatments depending on the pt’s response

tonic clonic seizures, signed consent, void, atropine, succinylcholine

Bipolar Disorder: TX; ECT (electro-convulsive therapy)

Post-procedure

• position client on the ____ to prevent aspiration

• stay with the pt

• _____________ expected

• reorient repeatedly

• return to day-to-day activities asap

side, temporary memory loss

Schizophrenia Spectrum Disorder: negative symptoms

• pt creates their own _______

• ___________

World, inappropriate affect

Schizophrenia Spectrum Disorder: positive: Alterations in Speech

• disorganized thoughts (___________)

• ineffective communication skills

• Echolalia (repetition of what they hear)

• ___________:making up new words → say you don’t understand

• ____________

Looseness of associations, neologism, word salads

Schizophrenia Spectrum Disorder: Alterations in Thinking

• delusions - false belief

  • religiosity - a delusion of a special relationship with God or they are God or a special messenger of God

• ________________

Concrete thinking

Schizophrenia Spectrum Disorder: Alterations in Perception

• hallucinations: _________ most common

  • 90% experience

  • Can be visipual, olfactory, gustatory, or tactile hallucinations also

  • Usually connected to times of _________

Auditory, anxiety

Schizophrenia Spectrum Disorder: TX

• Decrease stimuli

• Observe ______ w/o looking sus

• Orient frequently

• Keep convos reality based

• Observe for Hallucinations

  • - warn before you touch them

  • - don’t refer to voices as “they”

  • - let pt know you ____________

  • - get pt involved in activity

  • - out of hallucination into the real world

  • - ______________

  • - turn off the TV

  • - offer reassurance

frequently, do not share perception, elevate HOB

Schizophrenia Spectrum Disorder

Auditory hallucinations that instruct client to hurt themselves or others.

Often frightening for pt and can be a signal of a psychiatric mental health emergency

Command hallucinations

Obsessive Compulsive Disorder (OCD): s/sx

• recurrent thought (obsession)

• Recurrent act : can’t stop - compulsion

• Preoccupied with ________, control, orderliness

Perfection

Obsessive Compulsive Disorder (OCD): tx

• ensure basic needs are met

• Allow verbalization of feelings and concerns about life, family, and occupation

• Need a structured routine

• Give pt ________

• Slowly decrease ritual time, using _________

• Provide a CONTRACT to decrease the ritual and reward non-ritual behaviors

• Never take ritual away without replacing it with another coping mechanism such as anxiety reduction techniques

Time for rituals, time delay techniques

Paranoid Personality Disorder: s/sx

• Inappropriate suspiciousness and distrust of others but without reason

• You cannot explain away delusions or ______ beliefs of the pt

• Pathological __________

  • - hypersensitive to comments or actions

• Cannot Relax, has no humor, and is unemotional

• Abnormal anger response, so may respond with rage when provoked

False, jealously

Paranoid Personality Disorder: TX

• ____________

• Be honest

• Consistent nurses and ___________

• Be matter-of-fact

• Respect personal space

• Be careful with TOUCH

• DONT MIX MEDS

• may need to eat _________

Be reliable, brief visits, sealed foods

________ Personality Disorder: Restraints

• may be used when pt is a threat/danger to themselves or others

  • used as a last resort

• Accurate monitoring

Paranoid

Joint Commission: Restraints

• pt must be evaluated in-person by a HCP within _____ of restraint

• Orders must be renewed

  • every 4 hrs for adults

  • every 2 hrs for ages 9-17

  • every hour for less than 9yrs

• Check pt face-to-face every ________

• If or under 14yrs, must have constant face to face observation

1hr, 15min

T or F?

Anxiety increases performance at mild levels, decreases performance at high levels

T

Generalized Anxiety Disorder: S/SX

• chronic anxiety. Pt feels anxious at least 50% of the time for more than ________

• Worrying

• Daily anxiety

• Uneasiness

• _________

• Fatigue

• Muscle tension

• Difficulty thinking

• Sleep alterations

6 months, irritability

Generalized Anxiety Disorder: TX

• stay with highly anxious client

• Highly anxious pt needs _____________ to make decisions

• Relaxation techniques, deep breathing, imagery, deep muscle relaxation, meditation

• ______________

• Journaling over time

• Rechannel anxiety through __________

Step by step instructions, psychotherapy, exercise

Generalized Anxiety Disorder:Tx drugs

• anxiolytics like ____________

• Antidepressants like:

  • SSRIs (sertraline- Zoloft)

  • ________ like ____________

Buspirone, SNRIs, duloxetine

T or F?

Generalized Anxiety Disorder: Has panic attacks

F

Panic Disorders: s/sx

• onset of panic attacks start in the late twenties

• Can be as frequent as _______, or spread out, like monthly

• Attack comes on suddenly, lasts about _______ and then subsides

Weekly, 10min

Panic Attack: a sudden, rapid, intense, and escalating anxiety with four or more of the following:

• palpitations

• Sweating

• Tremors

• SOB

• Sense of ________

• Chest pain

• _________

• Dizziness

Suffocation, nausea

T or F

Panic attacks present with classic MI symptoms

T

Panic Disorders: TX

• stay with pt. in non-threatening way, give them ________

• If hyperventilating, slow down their breathing and __________

• Use ___________ when talking

• Teach ways to stop anxiety. Attack should be gone within 20-30 min

• Journaling

• Relaxation techniques

Space, breathe with them, simple words

T or F

No possibility of panic disorders having hallucinations

F though it is rare

Phobias: s/sx

• the object the pt fears ______ present a danger

• Unconscious anxiety

Does not

Phobias: tx

• must develop a ______ relationship with the client

• __________ is the key to recovery, but it must occur over time

• Help the pt with self-esteem and self-control

  • use _______________- involves thinking about a negative or challenging situation in a more positive way

Trusting, desensitization, positive reframing

Anorexia Nervosa: s/sx

• distorted body image

• __________, but won’t eat

• Dehydration and ____ imbalances

• BRADYCARDIA, HYPOTENSION

• weight loss

• Amenorrhea

• Lanugo on face and back

• Decreased sexual development

• Hypothermia

• _____________

• Perfectionism, obsessive thoughts and actions r/t food, shame, people pleasing

• Want ________ over their therapy

Preoccupied with food, f&e, intellectualization, complete control

T or F

bulimia nervosa: often at or close to ideal body weight, but assessment reveals physical and emotional problems

T

Bulimia Nervosa: s/sx

• overeat then vomits

  • teeth have erosion of enamel and damage

• laxatives and ________ use

• Strict dieters: fasts, exercises, binges

• Binges are alone and secret

  • initially pleasurable but then self-criticism may occur

• Normal weight

Diuretic

Bulimia Nervosa: TX

• sit with pt at meals and observe for ___-_____ hours after eating

• Allow 30-min for meals

• Take focus away from the food

• Self-esteem building

• A contract to specify amount and type of food each meal is beneficial

• Feel in control as long as they eat or don’t eat like they want

• ______________

1-2, intense family therapy

Trauma and Stress-related Disorders: exposure to life threatening events whether it is severe trauma, a _________, or a war

Natural disaster

Trauma and Stress-related Disorders: Signs/symptoms

• pt relives the experience: nightmares, flashbacks, hyperarousal symptoms like insomnia, hyper vigilance, irritability, and angry outbursts

• _____________

• Difficulty with relationships

• Isolate themselves

Emotionally numb

Trauma and Stress-related Disorders: TX

• establish a balance of rest & sleep with activity

  • relaxation techniques

• Establish a sense of safety and trust (same RN)

• Engage pt in learning new coping skills (progressive muscle therapy, __________)

• _______________

Thought stopping, support groups

Alcohol Use Disorder: Stage I - Minor withdrawal

• starts within ___-_____ of cessation of drinking

• Mild tremors, nervous, nausea, insomnia, headaches and palpitations

• Oriented to time, place, person

4-12 hrs

Alcohol Use Disorder: Stage II - Moderate to Severe withdrawal

• increased tremors, confused, _________, hyperactive, nightmares, ________ & ______, HALLUCINATIONS and illusions

• Carefully assess and provide treatment during Stage I and II to prevent the pt from progressing to delirium tremens

Hyperthermic, increased BP n RR

Alcohol Use Disorder: Stage III - most dangerous withdrawal: ______________

• MEDICAL EMERGENCY

• kinesthetic DTs are most common

  • pt feels things ___________

• _____________ are possible

Delirium Tremens, crawling on them, tonic clinic seizures possible

Alcohol Use Disorder: tx

• ___________ b/c they are scared

• Encourage a close friend or family member to stay with them

• QUIET environment

• Walk and talk to them

• Orient the client frequently

• Clarify illusions

• SEIZURE PRECAUTIONS

• __________________

• ___________ like benzodiazepines

Keep lights on, anxiolytics, sedatives

Alcohol Use Disorder: tx

Examples of benzodiazepines (used bc they also have anticonvulsant qualities)

• _______________

• ________________

• _________________

Chlordiazepoxide, Valium, ativan

Assessment tool that guides alcohol withdrawal medication dosing

Tx begins when scores reach 8-10; ICU for >20

CIWA-Ar

Alcohol Use Disorder: tx- hydration

• usually have LOW: ____________, magnesium, calcium, potassium, ___________

• Replacement with multi-vitamins, electrolyte solutions, and injections

Thiamine, phosphorus

Alcohol Use Disorder: tx: Thiamine Injections

• thiamine deficiency can lead to chronic conditions of ___________ and ______________

Wernickes encephalopathy, Korsakoffs psychosis

Alcohol use disorder

Anxiolytic drug that is often used for outpatient detox

Librium

wernickes encephalopathy: s/sx

• paralysis of the __________

• Diplopia (double vision)

• _____

• Somnolence

• Stupor

Ocular muscles, ataxia

Syndrome of confusion and loss of recent memory

Korsakoffs psychosis

Disulfiram (Antabuse): deterrent to drinking

• __________

• Stay away from all alcohol including:

  • cough syrup, aftershave, colognes, chemicals like varnish

• Support once detox is over. Family therapy

• 12-step program effective

Signed consent

Opioid Abuse: most common opiates

Heroine, oxycodone, meperidine

Opioid Abuse: s/sx of addiction

• Needs more drugs and more often

• No longer drug seeking , ________

Survival

Opioid Abuse: Intoxication s/sx:

• _________

• Respiratory depression

• _______

Pinpoint pupils, coma

Account for >50% of opioid overdose deaths

Fentanyl

Opioid Abuse: Intoxication treatment

• administer Naloxone (Narcan) - immediately reverses signs of overdose

  • may be given IV, IM, SubQ, or intra-nasally

  • Initial dose of 0.4-2.0 msg may be given IV

  • If respirations don’t improve, can be repeated ——- intervals

2-3 min

Opioid Abuse: Follow-up treatment

• all pts given Naloxone in the field MUST go to the hospital

• Naloxone is short-acting and must be administered every ______ until the opiate levels are non-toxic

  • can lead to death if failed

  • Most commonly found as intranasal spray in emergency kits, clinics, AEDs

Few hours

Opioid Withdrawal:

• can occur within hours to days of stopping the drug. Depends on drug

• Heroin users have symptoms ___-_____ after use is stopped

• Meperidine withdrawal is even earlier ^^

6-8hrs

Opioid Withdrawal: s/sx

• agitated and anxious mood

• N/V

• Muscle aches

• ____________

• Sweating

• ____________

Rhinorrhea, pupil dilation

Opioid Withdrawal: tx

_________- is a long acting opioid that can be substituted for addiction

• can be titrated downward during rehab to ease withdrawal symptoms

• Users DO NOT crave!!

• Must be monitored in a long term clinic, for dose adjustments

Methadone

_____________

• always identify yourself and call the pt by name

• Talk about meaningful things like happy memories (unless pt had troubled life)

• Keep clocks, calendars and personal items within vision and reach

• Mark days on calendar with a Big X

Alzheimer’s Disease

Alzheimer’s Disease: Communication

• speak ________

• Short, simple sentences and words

• Communicate face-to-face

  • with one or two arms-length distance

Slowly

Alzheimer’s Disease:

• be sure glasses and hearing aids are accessible to assist with orientation

• Identify all doors with pictures or easily identifiable labels

• Monitor food & fluid intake

• ____________

• Group activities like singing or based on pt preferences

• Dress in their own clothes

• Atmosphere calm

• Allow self independence where they can

Weigh weekly

Cancer: risk factors

• alcohol

• tobacco

• suspected dietary causes: low fiber diet, increased red meat, increased ________, _________(processed sandwich meats), alcohol, preservatives and additives

• obesity, physical inactivity, and poor nutrition

animal fat, nitrites

top 2 risk factors for preventable cancer

tobacco, obesity

cancer;

• increased incidence in the immunosuppressed

• most important risk factor for cancer is ________

• AA highest incidence, followed by caucasian men

• heredity

• UV radiation

• exposure to carcinogens

• __________

• chronic irritation

aging, stress

Cancer: primary prevention

• no smoking

• exercise and good nutrition

• maintain normal body weight

• limit or eliminate ______ intake

• vaccines for preventable viral exposures such as Hep B and ________

• avoid exposure to know carcinogens

  • wear sunscreen, avoid sun exposure, avoid second-hand smoke

alcohol, HPV

Cancer: secondary prevention

what days of the menstrual cycle are best for doing the breast self-exam?

7-12

Cancer: secondary prevention

post-menopausal or women who have had a hysterectomy should perform the breast self-exam on ________________

same day every month

Cancer: secondary prevention

Women age 25-65 with a cervix should have a primary HPV test every _________.

• can be done as a co-test with Pap-smear

5 years

Cancer: secondary prevention

Women over 40 years of age should get _______ clinical breast exams.

20-39 yrs, one every 3 years

annual

Cancer: secondary prevention

Mammogram-annually starting at age _____, with two views of each breast

45

Cancer: secondary prevention

Before a Mammogram, what should you teach your client NOT to apply to their body?

no lotion, no powder, no deodorant

Cancer: secondary prevention

Pap smears beginning at age 21 and performed every ______ if there have been no problems

3 yrs

Cancer: secondary prevention

colorectal cancer screening starts at age _____, then every 10 years if there have been no problems

• can be a stool-based test or a visual exam (colonoscopy)

45

Cancer: secondary prevention- Colorectal cancer

testing the stool for fecal occult blood should be done ______ beginning at age

Cancer: secondary prevention

, unless previous problems or a positive family history

yearly

Cancer: secondary prevention; MALE

• provide info on breast self-awareness and have ____ clinical testicular exams

yearly

Cancer: secondary prevention; MALE

Testicular tumors grow quickly, have pt. do _______ testicular self-exams (TSE)

• major group age is young males, between 15 and 36 yrs old

monthly

Cancer: secondary prevention; MALE

Digital rectal exam, prostate exam, and prostate specific antigen (PSA) over age ____ or earlier if higher risk

50

Cancer: secondary prevention; MALE

Colorectal screening starting at age 45 and then every ___ years

10

Cancer; tertiary prevention

• focuses on the management of LTC for pts with complex treatments for cancer

• centered on improving client’s _____ of life and survivorship

  • __________ and rehab programs

quality , support groups

Cancer; s/sx

• Change in ___________ habits

• A______ that doesnt heal

• Unusual _______

• Thickening or ____________ in breast or elsewhere

• I___________or difficulty swallowing

• Obvious change in _________

• N_____________

bowel/bladder, sore, bleeding/discharge, lump, indigestion, wart or mole, nagging cough or hoarseness

Cancer; s/sx

can invade bone marrow, which can lead to anemia, leukopenia, _____________

thrombocytopenia

Cancer; s/sx more

• unexplained weight loss

  • cachexia means _________ and malnutrition

• pain

extreme wasting

early sign of blood cancers and lymphomas

fever

#1 symptom that pts with cancer complain of

fatigue

Cancer: blood tests

• abnormal CBC & diff

  • always worry about _______ count

• _________

• tumor markers (biomarkers)

  • ex: CA 15-3 for breast cancer

neutrophil, elevated AST n ALT

Cancer: positive diagnostic studies

• chest x-ray

• CT scan

• ______

• PET scan

• bone marrow biopsy

• tissue biopsy

• imaging studies

MRI

Curative Surgery: tx for Laryngeal Cancer

• total laryngectomy (removal of vocal cords, epiglottis, and thyroid cartilage)

• since the whole larynx (this includes epiglottis) is removed m this patient will have a PERMANENT _______ or laryngectomy

• position post-op: ____________

• NG feedings to protect suture line (peristalsis can disrupt the suture line)

tracheostomy, mid-fowlers (35-45)

Curative Surgery: tx for Laryngeal Cancer: TOTAL LARYNGECTOMY

• Monitor drains to prevent fluid accumulation

• WATCH FOR ________________

• rupture of the innominate artery

• frequent ______ to decrease bacterial count in the mouth

• NPO clients tend to get pneumonia

• when pt leaves hospital, a ___ will be used to cover the trach b/c it acts like a filter

carotid artery rupture, oral care, bib

Curative Surgery: tx for Laryngeal Cancer: TOTAL LARYNGECTOMY

• humidified environment helps

• with a total laryngectomy, all _________ is done through the ________.

  • they talk with a electrolarynx, but the Blom-Singer device is the most common

breathing, stoma

T or F

A client with a total laryngectomy can whistle, drink through a straw, smoke, and swim

F

_________ surgery

• commonly used with breast cancer

• A mastectomy may be partial or total (radical)

• can be done with initial surgery or a later surgery

reconstructive

Post-Op care following a mastectomy

• bleeding → check dressings front and back

  • __________ of blood can occur

• If reconstructions includes using their own tissue, they will also have an _____ surgical site

  • can harvest adipose tissue from other sites for reconstruction, but the abdomen is the most common site

• Hemovac or Jackson-Pratt drains

pooling, abdomen