EXAM 2: Units 3 and 4 Flashcards
(157 cards)
1
Q
Psychotic behavior and thinking present for at least 6 months
A
Schizophrenia
2
Q
Patient has impairments of personality functioning, but impairment is not as severe with schizophrenia
A
Schizotypal personality disorder
3
Q
Similar symptoms to schizophrenia, but duration is only 1-6 months. Social/occupational dysfunction may not be present
A
Schizophreniform Disorder
4
Q
Disorder where patient meets criteria for both schizophrenia AND depressive or BPD
A
Schizoaffective disorder
5
Q
Schizophrenia occurs earlier in ____
A
Earlier in males than females
6
Q
The DSM-5 criteria requires 2 or more of the following present for a significant portion of 1 month
A
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptoms
7
Q
Poverty of thought or speech (mumble or vague response)
A
Alogia
8
Q
Lack of energy
A
Anergia
9
Q
Lack of pleasure or joy
A
Anhedonia
10
Q
Lack of motivation in activities and hygiene
A
Avolition
11
Q
Phase 1 of schizophrenia
A
Premorbid phase
12
Q
Phase 2 of schizophrenia
A
Prodromal phase
13
Q
Phase 3 of schizophrenia
A
Active psychotic phase
14
Q
Phase 4 of schizophrenia
A
Residual phase
15
Q
In this phase of schizophrenia either has no symptoms, or very mild ones. These occur before there isa clear sign of illness
A
Phase 1: Premorbid phase
16
Q
In this phase of shizophrenia, signs of deterioration begin to show and it becomes apparent that an illness is present
A
Phase 2: Prodromal phase
17
Q
In this phase of schizophrenia, there are acute positive and psychotic symptoms present
A
Phase 3: Active psychotic phase
18
Q
This phase of schizophrenia usually follows the active phase and is characterized by flat affect, presence of negative symptoms, and symptoms from the active phase are barely present anymore
A
Phase 4: Residual phase
19
Q
Clinical improvement in schizophrenia occurs in ___% of patients
A
44%
20
Q
4 phases of a therapeutic relationship
A
Orientation
Identification
Exploitation
Resolution
21
Q
Anticholinergic effects, EPS, NMS, orthostatic hypotension, burred vision, and photophobia are side effects of this class of medication
A
Antipsychotic medications
22
Q
Life threatening emergency that can occur at any time while taking antipsychotics
A
Neuroleptic Malignant Syndrome
23
Q
Sudden fever, BP fluctuations, Tachycardia, Muscle rigidity, and decreased LOC are s/s of ________
A
Neuroleptic Malignant Syndrome
24
Q
Neurological condition that prevents a person from recognizing their own health problems or conditions
A
Anosognosia
25
Mild depressive disorder is called
Persistent Depressive Disorder
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PDD is also known as
dysthymia
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Mild manic expression is called
hypomania
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Mild BPD is called
cyclothymia
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Major Depressive Disorder is more common in ______
more common in females than males
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DSM-5 criteria requires these two points in diagnosing PDD
- Chronically depressed mood lasting at least every day/all day for at least 2 years
-No evidence of mania/hypomania
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Early onset of PDD is described as ______
a diagnosis occurring before age 21
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Late onset of PDD is described as ______
Diagnosis occurring at age 21 or older
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Single episode or recurrent episodes resulting in a significant change in a person's normal functioning which occur almost every day for a minimum of 2 weeks
Major Depressive Disorder (MDD)
34
Diagnostic tool that is a 21-item self assessment of the usual characteristic behaviors and attitudes present in depression
Beck Depression Inventory
35
Diagnostic tool that is a 9-question self-administered assessment that patients fill out to determine the amount and frequency of depression symptoms
PHQ-9
36
Diagnostic tool that has a version with 17 items and another version with 21 items
Hamilton Depression Scale (HDRS, Ham-D)
37
Diagnostic tool used for older adults that has 15 yes/no questions
Geriatric depression scale
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Diagnostic tool that has 5 questions (about mood, self confidence, speech, sleep, and activity) for the client to self-assess
Altman Self-Rating Mania Scale
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Leading treatment for depression
SSRIs
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A trained therapist empowers the client to change their behavior by recognizing thinking errors and changing their thinking
Cognitive Behavioral Therapy (CBT)
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Use of magnetic pulses to stimulate focaal areas of the cerebral cortex
Transcranial Magnetic Stimulation (TMS)
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A vagal nerve stimulator is implanted, through an outpatient procedure, in the left chest wall
Vagal nerve stimulation (VNS)
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Electrodes are surgically placed deep into the brain to stimulate underactive regions (more intensive than VNS)
Deep Brain Stimulation (DBS)
44
Prior to electroconvulsive therapy, which class of medications should be d/c? Why?
Benzodiazapenes should be d/c because the goal is to induce a seizure
45
Prior to electroconvulsive therapy, the client will be NPO _____ to ______ hours
NPO 6-8 hours prior to treatment
46
During ECT, ____ ______ are induced by electrical current attached to one, or both, sides of the forehead
Brief seizures are induced during ECT
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Potential side effect from ECT
Temporary memory loss
48
SES can occur within ____ after starting treatment or increasing the dose
SES can start within 2-72 hours
49
3 s/s of SES
Seizures
Fever
Hyperreflexia
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Rapid, often exaggerated changes in mood
Labile moods
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Abnormally elevated mood which can be described as expansive or irritable, usually requiring hospitalization. These last at least 1 week.
Manic episodes
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A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania.
Hypomania
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This requirement distinguishes mania from hypomania
Requirement of a hospitalization
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Four or more episodes of hypomania or acute mania within 1 year and associated with increased recurrence rate and resistance to treatment
Rapid cycling
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Rapid, continuous speech with sudden and frequent topic change
Flight of ideas
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BPD where patient has experienced at least one episode of mania alternating with major depression
Bipolar 1 disorder
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BPD where patient has had one or more hypomanic episodes alternating with major depressive episodes
Bipolar 2 disorder
58
Patient has had at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes
Cyclothymic disorder
59
During an acute manic episode, the focus is on _____ and _____ in nursing care
The focus is on safety and maintaining physical health
60
Medication used for BPD
Mood stabilizers - Lithium
60
Therapeutic procedure for BPD
Electroconvulsive Therapy (ECT)
61
3 mood stabilizing antiepileptics
(c, v, l)
Carbamazepine
Valproate
Lamotrigine
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3 classes of medications used to treat BPD
Mood stabilizers
Antiepileptics
Antipsychotics
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Maintenance level range of lithium
0.6-1.2 mEq/L
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effects of lithium begin within ____ days
5-7 days
65
Maximum benefits of lithium may not be seen for _____
2-3 weeks
66
Due to its short half life, lithium must be administered in _____ doses daily
2-3 doses daily
67
During initial treatment of manic episodes, lithium levels may require to be at higher levels, at
1-1.5 mEq/L
68
Initial s/s of lithium toxicity can progress to these 5 more severe s/s
Seizures
Severe hypotension
Stupor (decreased LOC)
Coma
Death
69
Main initial s/s of lithium toxicity
Polyuria (frequent urination)
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2 manic complications
Physical exhaustion and/or death
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Main client teaching with mental illness
Medicinal treatment is lifelong
72
Asthma affects both the ____ and ____ tracts
Asthma affects both the upper and lower respiratory tracts
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Asthma is _____ in nature
Asthma is acute in nature
74
4 main manifestations of asthma
Wheezing
Coughing
Chest tightness
Dyspnea
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Most emergent finding during an asthma attack
Absent breath sounds
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Example of bronchodilator
Albuterol
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MOA albuterol
Stimulate SNS, relaxing smooth muscle, resulting in bronchodilation
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2 side effects of albuterol
Tachycardia and tremors
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Encourage _____ vaccine to prevent triggering asthma attacks
Encourage FLU VACCINE
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Example of a corticosteroid inhaler for asthma
Fluticasone
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Nursing consideration for using a corticosteroid inhaler (fluticasone) for asthma
Use an extender and rinse the mouth with water to avoid oral thrush
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Treatment where patient shakes the device prior to use, breathes out through the mouth, inhales medication, holds breath for 10 seconds, and then exhales
Metered Dose Inhaler (MDI)
(Like the typical inhaler you see with asthma pt)
83
2 early signs of hypoxia
Confusion, altered LOC
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Late sign of chronic hypoxia
Clubbing of fingers
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First line of treatment for asthma
Bronchodilators (albuterol)
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After the first line of treatment, this is the next resort of treatment
Systemic corticosteroid treatment (IV or oral)
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How often can fluticasone be used, and what is its role in treating asthma?
Fluticasone can be used once daily and helps prevent attacks from happening
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Excessive amounts of CO2 in the blood
Hypercapnia
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An increase in these three vitals can indicate hypoxia and hypercapnia
Increased HR, RR, and BP
90
For a patient with asthma, the nurse should assess the lungs for these three sounds
Wheezing
Stridor
Dyspnea
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For treatment of asthma, the nurse should prioritize these two things
Respiratory status and oxygenation
92
3 primary therapies when treating asthma
Oxygen administration
Short-acting B2 agonists (SABAs)
Systemic corticosteroids
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Most severe form of asthma
Status Asthmaticus
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What makes Status Asthmaticus hard to treat?
Condition does not respond to common treatments
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Status Asthmaticus requires
Ventilatory support
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Aside from bronchodilators, oxygen therapy, and steroid therapy used to treat asthma, Status Asthmaticus may also require these 2 additional treatments
Emergency Intubation
Epinephrine
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COPD is an umbrella term covering these two conditions
Chronic Bronchitis
Emphysema
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#1 cause of emphysema
Smoking
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Swelling of bronchioles and bronchi
Chronic bronchitis
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Destruction of alveoli
Emphysema
101
Most clients who have emphysema also have _____
Chronic bronchitis
102
COPD is
Irreversible
103
This is characterized by the loss of lung elasticity hyperinflation of lung tissue, causing destruction of alveoli leading to decreased SA for gas exchange, CO2 retention, and respiratory acidosis
Emphysema
104
Inflammation of the bronchi and bronchioles due to chronic exposure to irritants
Chronic bronchitis
105
Pathologic changes in airways due to underlying comorbidities
COPD
106
Main risk factor for COPD
Smoking (1st, 2nd, or 3rd hand)
107
Early symptom of COPD
Productive cough in the morning
108
2 physical assessment findings indicating COPD
1) Chest tightness
2) Barrel chest/increased chest diameter (w emphysema)
109
2 labs/diagnostic studies for COPD
Spirometry
CAPTURE questionnaire
110
Barrel chest can further cause this complication
Right-sided heart failure
111
What is a main cause of barrel chest?
Air is unable to escape, so it gets trapped in the lungs
112
2 main techniques of nursing care for treatment of COPD
Pursed lip breathing technique
Postural drainage
113
This technique assists in prolonged exhalation and promotes elimination of carbon dioxide from the body
Pursed lip breathing technique
114
This technique uses gravitational assistance for secretion removal
Postural drainage
115
For someone with COPD, oxygen levels should be kept in this range
88-92%
116
Patients with COPD may need up to this much oxygen via NC, and this much with a venturi mask
2-4 L/min via NC
40% via venturi mask
117
COPD patients become
Hypercapnic (hold on to CO2)
118
Normal O2 levels for someone with COPD is
88-92%
119
How can hypoventilation occur for someone with COPD?
Hyperoxygenation (even within normal range for a healthy adult) can decrease the hypoxic stimulus to breathe
120
Carbohydrates break down into
CO2
121
3 dietary considerations for someone with COPD
1) Smaller, more frequent, high-calorie meals
2) Moderate amount of carbs
3) Soft foods
122
3 side effects with albuterol (3 T's)
Tachycardia
Trouble sleeping
Tremors (nervousness)
123
3 side effects with Ipratropium (DDB)
Dry mouth
Dizziness
Blushing
124
3 side effects with Theophylline (3 P's)
1) Poor sleep (restlessness)
2) Potty (diarrhea)
3) Pain (headache)
125
3 bronchodilators used for COPD (TIA)
Theophylline
Ipratropium
Albuterol
126
2 Anti-inflammatory medications used for COPD (P,M)
Prednisone (corticosteroid)
Montekulast (leukotriene antagonist)
127
Nursing consideration with prednisone
Take with food
128
3 side effects of prednisone
Hyperglycema
Hypokalemia
Fluid retention
129
2 side effects with montekulast
Fatigue
Headaches
130
2 kinds of pneumonia infections
Bacterial or viral
131
A gunky cough with pneumonia typically indicates this kind of infection
Bacterial infection
132
A dry cough with pneumonia typically indicates this kind of infection
Viral infection
133
Both bacterial and viral pneumonia infections bring on a
Fever
134
This type of pneumonia develops before 48 hours since admission
Community-acquired
135
This type of pneumonia develops after 48 hours since admission
Hospital-acquired
136
This type of pneumonia develops after patient breathes in liquid
Aspiration pneumonia
137
This type of pneumonia can develop when a patient had an endotracheal intubation placed more than 48 hours ago
Ventilator-associated
138
Increased incidence of pneumonia in ____
Older adults
139
two vacines that can help break the chain of pneumonia infection
Pneumococcal and flu
140
Adventitious lung sounds AKA
wet crackles in lungs
141
Cough, dyspnea, tachypnea, pleuritic chest pain, and adventitious lung sounds are all clinical presentations of
Pneumonia
142
2 labs/diagnostics for pneumonia
Chest X-Ray
CT scan (if CXR is normal)
143
Inflammation of the pleura that is triggered by chest movement when you breathe
Pleurisy
144
4 options for pneumonia treatments
1) Antibiotics
2) Bronchodilators
3) Steroid/Anti-inflammatory therapy
4) Oxygen therapy
145
Goal of oxygen therapy
O2 95%-100%
146
One thing to remember while using antibiotics to treat pneumonia
Obtain a sputum culture before starting broad-spectrum antibiotic
147
Respiratory disorder that causes mucus glands to secrete excessive amounts of thick mucus
Cystic fibrosis
148
CF is inherited from a mutated recessive gene, meaning in order for someone to inherit this, then ..
Both parents need to have the gene
149
This ethnicity has a higher risk for having CF
caucasians
150
Infants can be diagnosed with CF is they have developed a
meconium ileus (often the FIRST clinical manifestation)
151
Looking for these 2 things in a stool analysis for CF
Presence of fat and enzymes
152
High _____ and _____ are positive findings for CF in a sweat test
High sodium and chloride
153
Wheezing indicates
Upper airway restriction
154
Ronchi indicates
Lower airway restriction
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Fatty stools AKA
Steatorrhea
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this is given with all meals and snacks in dietary treatment for CF
Pancreatic enzymes to aid digestion
