Class 9 Flashcards
(30 cards)
Public health
Specific field of medicine
Mission is to assure conditions in which the community can be healthy
Includes health promotion and prevention
Prevention
intervention with high risk populations
Evidenced based psychiatry
Multi-faceted approach to treating mental health: pharmacotherapy, education, ressource linkage and psychotherapy
Requires referalls and collaboration
Role of NPs
Team work, evaluation and dx, pharmacotherapy, team leader
Determinants of health
Health services, gender, financial and social status, culture, biology and genetic, healthy child development, personal health practices and coping skills, social support networks, physical environments, education and literacy, employment/ work conditions,
Hypertension
sustained bp over 135/ 85
Vast majority is idiothic.
Malignant hypertension
extremelyhigh blood pressurethat develops rapidly with or without some type of organ damage. A person withmalignant hypertensionhas ablood pressurethat’s typically above 180/120.Malignant hypertensionshould be treated as a medical emergency.
Hypertension consequences
coronary artery disease, heart failure or left ventricular dysfunction, left ventricular hypertrophy, aneurysmal subarachnoid hemorrhage, carotid artery disease, intracerebral hemorrhage, ischemic stroke or transient ischemic attack, vascular dementia, intermittent claudication, lower extremity tropics changes, albuminuria, chronic kidney disease
Psych rx that causes hypertension
TCAs and FGAs have anticholinergic effects that may be responsible for increases in blood pressure. Weight gain associated with antipsychotics or other psychotropic medications may also mediate changes in blood pressure. venlafaxine, MAOI, amphetamines
Psych rx that causes hypotension
clozaril , second generation antipsychotics, benzos
Betablockers and psych complications
fatigue sedation depression
ACE inhibitors and psych complications
Ace can induce delirium/ mania very rarely
Ca channel blockers and psych complications
fatigue and sedation
Diuretics and psych complications
can indirectly cause neuropsychiatric effects due to electrolytes and effects an Li excretion
Clonidine and psych complications
fatigue, sedation, dep
use to trx ADHD and tourettes
Questions to know if he needs to go to ER
chest pains, palpitations, shortness of breath, facial drooping, arm weakness, asymmetry, speech difficulty rule out MI and stroke and then (not medical emergency) loss of vision, pain in legs when walking, difficulty urinations, erectile dysfuntion
Irritable bowel syndrome
functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits.Affects more commonly women and people over 50 yo.
IBS dx
r/o celiac
r/o IBD
Use a positive dx strategy: careful clinical history, focus on key sx of abdo pain and altered bowel habits, absence of alarm features, more than 6 mo
ROME IV criteria:
Recurrent abdo pain on average 1 day a week in the last 3 mo, associated with 2 or more of the following criteria
1.Related to defecation
2.Associated with change in stool frequency
3.Associated with a change in the form/ appearance of stool
For at least 3 mo with sx onset 6 mo ago
Trx IBS
FODMAP, soluble fiber, no more antispasmodics, peppermint oil for pain, no probiotics, no PEG, chloride channel activators for IBS-C, guanylate cyclase activators for IBS-C, rifaximin for IBS-D or mixed opioid antagonist-agonist, TCAs, gut directed psychotherapy
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis and Crohn disease. Ulcerative colitis affects the colon, whereas Crohn disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum, and the extent often involves more proximal portions of the colon in a continuous fashion. Crohn disease is characterized by transmural inflammation and by skip areas of involvement (ie, segments of normal-appearing bowel interrupted by areas of disease). The transmural inflammatory nature of Crohn disease may lead to fibrosis and strictures and to obstructive clinical presentations that are not typically seen in patients with ulcerative colitis. Transmural inflammation may also result in sinus tracts, giving rise to microperforations and fistula formation.
Dx IBD
Stool cultures to RO other causes of diarrhea
Labs to assess severity in the acute phase
Colonoscopy with biopsy
IBS and psych
About 50–90% ofIBSpatients also have associatedpsychiatricailments; most commonly anxietydisordersand depression.
Red flags IBS
blood in stool, weight loss, fevers chills fatigue, low appetite, mucus in stool
Menopause
Permanent cessation of menstrual periods as determined retrospectively after a women has experienced 12 mo of amenorrhea without any other obvious pathological or physiological cause. Average age is 52 yo
