Exam 4 - FINAL EXAM NP Flashcards
1
Q
T/F: innate (natural) immunity needs no previous exposure to create an immune response
A
TRUE
2
Q
How is acquired immunity produced
A
- vaccine
2. exposure to antigen
3
Q
Which type of immunity, present at birth, remains for life?
A
Innate (natural)
4
Q
Which type of immunity involves T-cells, B-cells and Natural Killer cells?
A
Acquired Immunity
5
Q
T-cells are created where?
B-cells are created where?
A
T-cells - thymus
B-cells - bone
6
Q
Which immunoglobulin is the first to respond to an antigen
A
IgM (iMmediate)
7
Q
Which immunoglobulin lines the GI tract, respiratory tract , and GU tract
A
IgA
8
Q
Eosinophils and which immunoglobulin respond to allergens and parasitic infections
A
IgE
9
Q
Which immunoglobulin is high in acute infection
A
IgM
10
Q
What are the actions of PRIMARY immune response
A
- antigen moved to lymph node
- virgin B cells respond and develop into antibody producing plasma cells
- IgM is made (memory cells)
11
Q
What are the actions of SECONDARY immune response
A
- more rapid than primary response
2. NK cells take over
12
Q
Neonates have higher B or T cells?
A
T- cells
neonates may develop antigen specific T-cell response
13
Q
Neonates have a high susceptibility to what type of org.? why?
A
Gram negatives
IgM cannot cross the placenta
14
Q
When does IgM reach adult levels?
A
Age 1
15
Q
T/F antibodies are able to be created at birth
A
TRUE
16
Q
what type of vaccines are needed for neonates
A
conjugated
17
Q
Why do vaccines seem to be less effective in middle age
A
T-cell function declines in middle age
18
Q
What are 4 pathways to contract hepatitis
A
- Drugs
- Poisons
- Idiopathic
- Autoimmune
19
Q
What are 2 outcomes of an acute infection of hepatitis and how do you tell the difference
A
- Acute infection w/ recovery and immunity
- acute infection w/chronic disease
Difference: test for viral activity - will be active in chronic disease
20
Q
S/S of acute viral hepatitis
A
- fatigue
- fever
- skin rash
- N/V
- arthralgia/myalgia
- abd pain
- jaundice
21
Q
What may cause chronic viral hepatitis to exhibit symptoms
A
Stress
co-infection
22
Q
Which transaminase is most specific for viral liver infections?
A
ALT
23
Q
AST may be elevated in viral hepatitis but also what other types of disease
A
Heart
Liver
24
Q
What labs should be ordered for suspected hepatitis
A
AST/ALT Alk Phos Bilirubin (direct/total) LDH CBC H/H Albumin Coags
25
Which bilirubin will be high in liver disease
Direct - conjugated
26
Hep A transmission
Fecal/Oral
27
HAV's incubation period and presentation of illness
28 days
Acute - jaundice, self-limiting
28
Will HAV turn into a chronic infection
No
29
Testing of immunogloblins in HAV is?
IgM for HAV
| IgM and IgG for recovery
30
Hep B transmission
Blood
Sex
Blood Transfusion
IVDA
31
HBV can last on surfaces outside of the body how long?
7 days
32
If a patient has a high AST, what panel should be done
Hep Series (A, B, C)
33
T/F: HBV infected patients may be asymptomatic
TRUE
34
When may a patient with HBV begin to be jaundice
After day 10 of acute infection
35
What other symptoms may be present with HBV infection
- fatigue
- low grade fever
- nausea/bloating/tender and palpable liver edge
- arthralgia
- posterior cervical lymph enlargement
- icteric sclera
36
HBsAG *****
ACUTE infection or recent vaccine will make +
if + after 6 months --> indicates chronic infection
37
HBcAG
Hep B core antigen
indicates long term clinical course - is not found circulating in the blood
38
HBeAG *****
indicates active hep b viral replication
39
- HBcAB
- HBsAG
+HBsAB
means....
patient has never had HBV but has been vaccinated
40
+HBsAG
- HBsAB
- HBcAB
ACUTE PHASE in new infection
or
Reactivation of virus in chronic carrier
41
+HBcAB
-HBsAG
+HBsAB
elimination of the virus with immunity
42
the a patient to have hep D, they must first have had....
Hep B
| Hep D uses the HBV shell
43
What is the most common blood borne infection in the US
Hep C
44
What portion of HCV pts will develop chronic liver dz?
40-60%
45
What are some risk factors for HCV
- IVDA
- Dialysis/Blood transfusions
- sex
- borne b/t 1945-1965
46
Early S/S of HCV
- possible jaundice
| - otherwise asymptomatic until late stages of dz
47
What test is used to measure viral load of pt w/hepatitis and when would you order it?
```
PCR test
ordered for:
- tmtx decisions
- to test response to tmxt
- test for chronic infection or unusual presentation
```
48
What test is done to look for HCV...and if positive what should be done
HCV antibodies
if + requires confirmatory testing - RNA TESTING *****
49
T/F high ALT means liver damage is happening
FALSE
50
T/F a patient recovered from HCV will have a high anti-HCV and their ALT will return to normal
TRUE
51
What other testing should be done to determine tmtx regimens for HCV
Genotyping
| Type 1 HCV is most common in the US
52
What are some factors that may come into play when determining how severe HCV will be
ETOH use
Age > 40 at time of infection
HIV/other coinfection
Male
53
Goal of HBV tmtx
viral replication suppression
54
What meds are used in treating HBV and HCV
- Pegylated interferon
- Ribavirin
- Protesae inhibitors (adefovir, entacvir, telbivudine, tenofovir)
55
What HBV tmtx has a high risk of causing viral resistence
Lamivudine
56
T/F a patient w/a negative anti-HBe with a normal ALT and viral load less than 10^5 requires no medication treatment
- TRUE
| - check LFTs, AFP q6mo
57
Pts w/viral load >10^5 and their ALT is abnormal...
refer to GI for tmtx considerations
58
How long does someone receive tmtx for HCV
6-12 mos
| Depends on genotype, viral load and liver biospy results
59
What are some SEs of tmtx for HBV and HCV?
- nausea, fatigue
- irritability
- hair loss
- anemia, neutropenia
- drug interactions
60
pt w/ HBV and HCV both receive a liver transplant. Which one is most likely to become reinfected
HCV - almost universal reinfection rate
61
HAV vaccines are indicated for which patients
- Children age 12-23 mos.
- IVDA
- MSM
- Travelers who go to high risk areas
- pts/chronic hep
- person who work with nonhuman primates
- medical workers
62
How far apart are the 2 doses of HAV given?
6-12 mos
63
travelers should be dosed how
1 dose 4 weeks before travel, if less than 4 weeks, give IgG well
64
Postexposure prophylaxis for HAV must be completed how soon after exposure and the pt must be?
- within 2 weeks of exposure
- under age 40 and in good health
- over age 40 or with health problems = add IG
65
Booster vaccine should be used only in what patients
HD patients
66
PEP for HCV should be given how soon?
- Within 24 hours of exposure
| - unvaccinated person should receive HBIG as well
67
How may a pedi pt w/hepatits present
- Poor appetite, fatigue
- +D or +C, abd pain
- Hepatomegaly, jaundice, high liver enzymes
check abd for fatty liver and skin for urticaria ****
68
T/F - a hepatitis virus in pediatrics may resolve on its own
True
69
What other viruses cause hepatitis in peds
EBV *****
| CMV
70
Why does HAV spread so easily in daycare center and younger children
Fecal oral route
71
A pt w/HAV is contagious when
1-2 weeks before onset of symptoms
| 1 week after onset of jaundice
72
What are the 2 stages of HAV
1. Preicteric (+N/V, abdominal issues)
| 2. Jaundice phase - urine darkens, stools clay colored, poor wt gain, +Diarrhea or constipation
73
Primary prevention of HAV is
Vaccine
74
T/F Children may be born with HBV
- true
- if mother is HBs-AG+ then 70-90% chance of passing it on to child
- Screen all pregnancies
- Breastfeeding OK!
75
If a mother is HBsAg+ how do you treat the neonate
IG and vaccination w/in 12 hours of birth
| recheck antigen and antibody levels in 2-3 months after IG and vaccination
76
Successful HBV tmtx with IG and vaccination in the neonate show what?
Antigen -
| Antibody +
77
T/F: Babies born to HCV mothers may have HCV
TRUE
| Tmtx is the same for children as adults
78
Patient w/HCV should receive what vaccines
HAV, HBV
79
Growth of viral load of HCV may be markedly decreased in those children treated with....??
Interferon
| Ribavirn
80
TB is caused by what?
| Transmitted how?
mycobacterium tuberculosis
small droplets/airborne
low fomite transmission
81
What are risk factors for TB?
- Low SES
- Poor nutrition
- Lack of healthcare
- overcrowded living conditions
- ethnic minorities
82
T/F: children have a low ability to transmit disease
Why?
True
lower tidal volumes
83
4 types of TB and which is most common in the US
1. Latent (most common in US)
2. Active or primary
3. Miliary TB
4. Extrapulmonary TB
84
Skin testing for TB requires _____ which may be lowered by ____?
1. good cell-mediated immunity
| 2. Active TB
85
Presentation of pulmonary TB
- keratoconjunctivitis
- mediastinal lymphadenopathy causing difficulty w/swallowing or airway obstruction
- cough in children > 10 years
86
classic s/s of Pulm TB
- PNA, pulmonary fibrosis
- coughing, wheezing, blood tinged sputum
- chest pain
87
Miliary TB occurs in which groups
- children < 3 years
- elderly
- HIV
88
Miliary TB leads to ____ by ___
necrosis and cassation of organ function
and
seeding organs by traveling through blood or lymph
89
Miliary TB S/S
- high fever
- malase/fatigue
- poor appetite, wt loss
- lymphadenopaty, hepatosplenomegaly
90
Malpractice is an offense covered under tort law
True
91
Malpractice (definition) ****
A negligent act or failure to act, committed in the course of professional performance
92
Negligence
The doing, or not doing of an act pursuant to duty, that a reasonable person in the same or similar circumstance would do or not do
93
T/F - negligence can be both a state of mind and an objective conduct
FALSE - negligence is objective
94
Person bringing the malpractice suit
Plantiff
95
Person/org that is alleged to have been negligent
Defendant
96
A proven provider-patient relationship implies the person/organization has a ___ to the patient
Duty
97
A person/organization found to be negligent is considered to have a _______
Breach of Duty
98
Proximal Cause
Negligence that has resulted in direct patient harm
99
For a malpractice suit to result in damages against the person/organization, what must there be proof of?
Proof of Harm
100
IS the defendant allowed to contact the plaintiff
NO.
101
5 ethical principals of nursing ******
1. Autonomy
2. Nonmaleficence
3. Beneficence
4. Justice
5. Veracity
(fidelity, accountablity)
102
4 components of malpractice ******
1. Duty
2. Breach of Duty
3. Proximal Cause
4. Damages
103
Competence vs. Capacity *****
Capacity = psych functional assessment (do they know the consequence of their actions)
Competence - decided by a judge (global assessment)
104
Informed Consent *****
The duty of a HCP to disclose all significant information that he/she possesses that is material to an intelligent decision making by the patient
105
Who many signed an informed consent if the patient is unable
- POA
- HCP
- Parent of a Minor
- Guardian of an IDD individual
106
Extrapulmonary TB
TB in other places besides the lungs - can be anywhere else in the body
107
3 levels of + TB skin test
1. > 5 mm - + for immunosuppresed pts (HIV, transplant, suspected cases)
2. > 10mm - + in children < 4 years, comorbidities, immigrants, IVDA, HCP, exposures
3. > 15mm - + for everyone
108
How is a TB skin test read *****
48-72 hrs from placement
measure induration, not erythema
109
When should a skin test NOT be used ******
Previous +
| Live vaccine or IG w/in the last month
110
Who should treat TB and how? ******
- TB clinic or ID
- NEVER monotherapy
- INH most common for use in latent TB
- corticosteroids
111
What type and subtype of HIV are most common in the US
- type 1 (HIV - 1)
| - subtype B
112
Which group of people in the US are most at risk for HIV and affected by HIV
- gay, bisexual men (MSM)
| - blacks have the highest infection rates
113
Who should be tested
- pts w/high risk behaviors tested annually
- pregnant women
- pts presenting w/new STI complaints
114
Is informed consent needed for HIV testing?
- NO "opt-out screening" should be utilized
115
Risk factors for HIV include
- IVDA or partner who uses IVD
- persons exchaing sex for drugs or money
- sex partners of known HIV+ persons
- Women who have sex w/MSM
116
T/F HIV testing should only be done on people depending on level of risk
False. everyone should be tested
117
Symptoms of HIV develop how long after infection?
4-6 weeks
118
Is the HIV pt contagious before symptoms?
yes - very contagious
early bursts of viremia
HIV antibody is negative at first
119
Acute HIV infections last how long
2-3 weeks
120
What are common s/s of acute HIV infections
- fever, fatigue, rash
- HA, lymphadenopathy, pharyngitis
- myalgias/arthragias
121
What are crucial markers for HIV
Rash
| Oral ulcers
122
What testing should be done for pts suspected of having an acute HIV infection
```
HIV RNA
HIV antibody (r/o previous infections)
```
123
What is the common testing strategy for children (HIV)
ELISA confirmed by Western Blot
124
how long do neonates reatin mother's antibodies after birth
12-18 months
125
What is the usual medication regimen for exposed neonates
Zidovudine w/in 8-18 hrs after birth - continue x 16 weeks
| ADD Nevirapine if mother is not on therapy
126
What has a high mortality for HIV + neonates
PCP pneumonia
127
How should exposed neonates be treated for PCP pneumonia
PCP prophylaxis at 6 weeks of age until HIV is r/o completely
If HIV+ continue meds till one year of age
128
What is usually the first sign of an HIV infection in infants
Lymphadenopathy followed by hepatosplenomegaly, FTT, diarrhea, pneumonia, thrush
129
T/F - infants w/HIV should not receive the normal vaccination schedule
FALSE
need annual flu vaccine
live vaccinations may be deferred on case-case basis
130
How often should a child be tested for HIV
Check HIV RNA q3-4 mos
| CD4 %
131
What is the goal of antiviral therapy in children
Reduce plasma HIV RNA to below detectable levels
132
T/F - Children less than one year of age when diagnosed w/HIV have the highest risk of progression
TRUE
133
How many drugs should be used to treat HIV and why?
- 3 drugs from 2 different classes
| - drug resistance and cross-resistance is a major issue
134
What are some side effects of antiviral use in HIV
- Heme: bone marrow suppression
- Lactic acidosis, hepatic tox, pancreatitis
- metabolic abnormalities
- allergic reactions, skin rashes, hypersensitivity
135
T/F: if a patient has a reaction to HIV antiviral, the dose should be reduced
FALSE
| this may cause an increase in drug resistance
136
T/F: Adolescents on HIV antiviral treatment are still able to begin contraception
True
They may interact however and should be monitored closely
137
What are some EARLY signs of HIV infection in adults
- generalized lymphadenopathy
- unexplained wt. loss
- recurrent infections
- oral lesions, angular cheilitis
- rashes
138
What are some LATER signs of HIV infections in adults
- chronic diarrhea
- persistent fever
- oral candidiasis, oral hairy leukoplakia
- pulmonary TB
- joint infections
- unexplained anemia, neutropenia, thrombocytopenia
139
What is Kaposi's Sarcoma and when is it seen
- Purplish spots on legs, feet, or face
| - opportunistic infection/sarcoma of HIV
140
What is the goal of HIV treatment in adults
- Reduce HIV related morbidity
- Balance duration and QOL
- restore as much immunologic function as possible
- suppress viral load
- decrease/prevent transmission
141
Early ART therapy will help how?
Prevent HIV related end-organ damage
142
Prophylaxis in post HIV exposure should be conducted how
ART for several days
143
T/F ART for HIV preexposure is recommended
TRUE
| for persons who exhibit or plan risky behavior
144
What is the leading cause of suicidal behavior
Depression
145
What are the manifestations of major depressive disorder
```
Severe Sadness
Withdrawn behavior
bordem
low self esteem
feeling of helplessness or hopelessness
no meaning in life
```
146
Dx critera for MDD
* 5 of the following symptoms present during the same 2 week period along w/ depressed mood or loss of interest or pleasure
- depressed/irritable mood
- wt change/appetite change
- psychomotor agitation/retardation
- disturbed concentration or decisiveness
- diminished interest or pleasure in actives
- insomnia/hypersomnia
- feelings of worthlessness or guilt
- recurrent thought of death, SI/suicide attempts
147
What is dysthymia
- overwhelming chronic state of depression
148
What else must be r/o to dx depression
- substance abuse
- mania
- other medical conditions
149
T/F to diagnose depression a pts symptoms must cause significant distress in social, work, school, or other areas of functioning
TRUE
150
T/F: depression does not occur in those less than 5 years old
UNKNOWN
| Pts < 5 years do not have the verbal or reasoning skills to let you know
151
Children with depressed parents are how many more times likely to develop depression than those without?
3x
152
Adolescent depression is ofen
Chronic, comes and goes
153
T/F Children/Adolescents w/depression will always carry that dpression into adulthood
FALSE
| - they do have 2x-4x the chance of having depression in adulthood
154
What are some common reasons that children and adolescents do not receive care for their depression
- Stigma
- lack of providers
- insurance issues
- misdiagnosis
155
T/F Younger pts with depression tend to somaticize
True
| General aches and pains, HA, abd pain, school refusal
156
What neurotransmitters are associated with depression
- Serotonin
| - Dopamine
157
What is the most important part of the assesment in dx depression in children and adolescents
History
158
HEADSS
```
H - Home
E - Education/employment
A - activites
D - drugs, alcohol, substance
S - Sexuality
S - Suicide
```
159
T/F - when diagnosing depression, your differentials will contain mayn organic disease
True
| - anemia, chronic fatigue, eating disorders, endocrine disorders, hypothyroidsm, chronic infection
160
On the first visit for possible depression, what should be assessed for specifically
SI
161
What are the 4 aspects of depression management
Psychotherapy
CBT
Social Skills training
Meds
162
SSRIs have a black box warning for (Prozac) *****
how long does this black box warning specifically reference ****
Increased SI
Prozac has a BBW for increased SI in the first 1 month of tmtx *****
163
According to TADS, what is the best tmtx for children and adolescents w/drepression
- medication + CBT
164
First line medication for depression
SSRI
165
What is the 2nd line tmtx for depression
TCAs
| 2nd line b/c increased suicidality
166
How should med treatment be assessed
- reassess for benefit at 4 weeks, if none then change meds
| - mild response to med reassess at 10 weeks
167
How long should a person be symptom-free before decreasing medication doses
3 months
| Taper meds slowly
168
40-50% of patients that are weaned from meds will relapse w/in what time rame
2 years
169
how long should children be on antidepression meds
6-9months
up to 1 year
may be indefinite
170
T/F persons diagnosed with depression at an early age will have better outcomes in the long run
FALSE
| poorer outcomes
171
Mild to moderate childhood depression should be treated how
CBT only
172
What is the FDA approved medication for use in childhood depression?
Prozac (SSRI)
173
What disorder is characterized by unusual shifts in mood, energy or functioning
Bipolar disorder
174
What disorder is often a precursor to bipolar disorder
MDD
175
T/F: Most patients w/bipolar disorder will have multiple episodes
True - 90%
176
What are some symptoms of early onset bipolar disorder
Irritability
Rapid cycling (mania/depression)
ADHD or other behavior disorders
177
Symptoms of later onset bipolar
- classic mania
- severe mood changes
- inflated self esteem
- increased energy, decreased sleep
- distractibility
- risk-taking behavior
- physical agitation
- hypersexuality
178
what is the medication management for bipolar disorder
Lithium
179
What other tmtx may be used for biopolar idsorder
- psychiatric referral
- careful monitoring
- long-term tmtxt
- family based tmtx
180
Which gender attempts suicide more often
Female
181
What gender completes their suicide attempts most often
Male
182
What is the strongest predictor of suicide ******
Previous attempt *****
AND
first degree relative with suicide attempt
183
What are some other risk factors for suicide
- Poor social adjustment
- substance abuse
- psychological trauma
- Delinquency
- Impulsive behavior
184
T/F - pt confidentiality must be maintained even when they inform you of SI
FALSE
185
When should hospitalization be contemplated
- personal safety is in jeopardy
- ID of means of plan
- conditions of impaired judgement (depression, psychosis, substance abuse)
186
What are some warning signs of depression
- obsession w/ death
- dramatic changes in appearance/personality
- overwhelming guilt/shame
- severe drop in school performance
- irrational behavior
- threats
- change in eating
- giving away personal items
187
The CDC has listed suicde as a _____ and is promoting ______
- Public health problem
| - connectedness
188
Why does the CDC promote connectedness
- evidence shows decreased SI if pt feels connected
| - isolation is a big risk facto
189
What is similar b/t anorexia and bulimia
- serious disturbance in eating
| - concern about body shape and weight
190
What 2 categories for eating disorders were added w/ the DSM 5 revisions
- Binge eating disorder
| - Avoidant/restrictive food intake disorder
191
What are the DSM-5 criteria for anorexia
- Restriction of energy intake
- fear of wt gain even though already underweight
- disorientation w/body weight/shape/experience
192
Bulimia
- cyclic binge eating
- inappropriate compensatory behaviors (vomiting, laxative use, inappropriate exercise)
- freqent episodes (at least once weekly)
193
What time of life do most eating disorders start
Anorexia - (age 15 - 19)
| Bulimia (age 18-23)
194
What race is most affected by eating disorders
White
195
T/F bulemia may arise from anorexia
True
196
What are some risk factors for eating disorders
- obesity
- affective disorders
- serotonin disorders
- onset of puberty
- low self esteem
- hx of abuse
197
What is one of the most common entry points for eating disorders
Dieting
198
May inceidences of anorexia resolve w/ what?
normalization of body weight
199
Why might serotonin be involved in anorexia
regulatory agent in mood, stress presonse and eating behaviors
200
What is the SCOFF screning
- Do you make yourself SICK b/c you fee uncomfortably full
- do you worry you have lost CONTROL over how much you eat
- Have you recently lost more than 14lbs in 3 months
- do you believe yourself to be FAT when others say you are thing
Whould you say that FOOD dominates your life
201
BMI that indicates anorexia
< 17.5
202
Underweight BMI
17.5 - 20
203
Eating disorders are diagnosed by
Clinical presentation only
204
What labs could be drawn for a baseline
```
CBC
ESR
CMP
UA
albumin
```
205
most often the pt will have hyperkalemia or hypokalemia
hypokalemia
206
hypoglycemia or hyperglycemia
hypoglycemia
207
a patient w/anorexia should only be allowed how many calories in the first few days of refeeding
- 500 above what the pt is currently taking
| - add 200-300 calories every 3-4 days
208
Feeding a pt too many calories right away may cause what?
| What is that called?
REFEEDING SYNDROME
- cardiomyopathy and cardiac decompensation
- hypophosphatemia
209
When should a pt be hospitalized for tmtx
- BP < 80/50
- Electrolyte imbalances
- Severe malnutrition
- EKG abnormalities
- Dehydration
- Sinus bradycardia
210
Treatment of eating disorders needs to involve
- interdisciplinary team specializing in eating disorders
211
Goals of tmtx include
- stabilize medical nad nutritional status (BMI > 16)
- ID and work toward resolving psychosocial problems
- Restablish healthy eating patterns
212
Inpt goal for wt increase is
1/2 lb per day
213
Goals for wt increast in outpatient setting
1/2 - 4lb per week
214
What are some nutrition goals for reffeding
- 2-3 servings of protein
- 30-50 grams of daily fat
- 1200-1500mg ca2+ (3-4 glasses of milk)
- MVI
215
Bulimia is characterized by
cycles of binge eating and purging
216
Binging is defined as
Eating larger amount at a time than a normal individual in similar circumstances
217
Binges often include what type of food and are done how
- high cal./carbohydrate
| - in secrecy
218
Russell's sign is
Calluses on knuckles or back of hand due to repeated self-induced vomiting
219
Other signs of bulimia
- parotid swelling
- loss of dental enamel from vomiting
- GERD
- Constipation
220
T/F: a bulimic pt's weight will always be low
FALSE
| may often be a normal weight
221
What may be present if the patient is using ipecac for vomiting
Cardiomyopathy
222
T/F pancreatitis is a complication of bulimia
TRUE
223
Labs in bulimia may show
electrolyte imbalances
hypocalcemia
hyponatremia
hypochloremia
224
loss of stomach acid in bulimia may lead t0
metabolic acidosis
225
whom is more likely to be diagnosed with depression
2:1 women:men
226
What medical conditions are more likely to have depression
- fibromyalgia
- migraines/HA
- PMS (PMDD)
- IBS
- chronic fatigue symptoms
227
Pts w/ depression will present how on a brain scan
- decreased brain activity
228
What is the most common depressive disorder
Major depressive episode (single or recurrent)
229
A pt living at a subpar level w/o having severe depressive episdoes would be Dx w with??
dysthymia
230
what is doube depression
Dysthymia/MDD w/anxiety
| antidepressants often alleviate both sets of symptoms
231
Seasonal affective disorder is usually seen in what seasons
fall/winter
| - less exposure to ambient light
232
Risk for depression
- Genetics
- Parent Loss
- Early life abuse or trauma
233
S/S of depression SIG-E-CAPS
```
S - sleep
I - interest
G - guilt
E - energy
C - concentration
A - appetite
P - Psychomotor
S - suicdial thoughts
```
234
Risk for depression specific to women and hormonal shifts includ
- Puberty
- Postpartum
- Pregnancy
- Menopause
235
T/F: Moderate drinking (only one drink a day) will still predispose a pt to depression
FALSE
236
what medical conditions may mimic depression
- Hypothyroidism
- Vitamin D deficiency
- hypoglycemia
- caffeine withdrawal
- early dementia
237
Most effective tmtx of depression
- Psychotherapy
| - Meds (SSRI)
238
Antidepressants may take how long to begin to work
10-14 days
239
Who will notice the effects of the tmtx first, pt or friends and family
Friends and family
240
how long should adults continue to take their medication after remission begins
- 4-6months
| - taking meds away too soon may cause a relapse
241
how long after starting treatment should a pt trial discontinuation of the medication
within the first 12 months
242
What is a natural remedy that may help with depression but may interact with many medications
- St. John's Wort
- Increase serotonin levels
- May lower estrogen levels (OCPs need dose adjustment)
243
T/F - St. John's Wort should never be combined w/antidepressants
TRUE
244
What are some other recommendations for improving mood
Exercise, diet changes, sleep hygeine, daily structure
245
What is the most effective tmtx available, statistically for depression
ECT
246
ECT works how and may cause what?
- Change in neurotransmitters
| - Seizures
247
ECT may be indicated for what patients
Those with severe or intractable depression
248
ECT treatment includes how many tmtx in what time frame?
- 6-12 treatments
| - 4-6 weeks
249
What age group and race have the highest level of suicide
Non-hispanic white men over age 85
250
What is defined as a serious act that w/o accidental intervention, more accurate information or luck would prove fatal
Suicide attempt
251
What is an example of accidental intervention
Passerby sees pt trying to hang themselves and intervenes
252
What is an example of inaccurate information
Not knowing how much of a medication to take to have a fatal dose
253
What is a suicidal gesture
Nonfatal behavior as a cry for help or attention
254
When a pt does not intentionally attempt suicide but tests the reactions of others is called a
Suicide equivalent
255
Passive or persistent thoughts of killing one's self is called
Suicidal Ideation
256
What is the most common method of suicide in the US
Gunshots
257
What are some protective factors against suicide
- Access to care
- restricting access to means
- strong connectivity
- strong cultural and religious beliefs
- treatment of depression
258
T/F - all depressed patients will become suicidal
FALSE
259
T/F - most suicide attempts are a cry for help or attention
FALSE
260
T/F - cutting is linked to depression
FALSE
| - it is an attempt to feel something while depressed
261
Cutting is most common in what personality disorder
Borderline personality
262
Physical signs of anxiety may include ********
- Fatigue
- SOB
- CP
- diaphoresis
263
Excessive worry about both rational and irrational things is called
Anxiety
264
Other mental s/s of anxiety include
- Feelings of impedning doom or disaster
- Sleep disturbances (insomnia)
- Restlessness
- Irritability
- Difficulty concentrating
265
For dx of anxiety, the excessive anxiety and worry needs to occur for more days than not for how long
6 months
266
CBT is what
- Desensitizes patients to anxieties
- helps develop coping mechanisms
- not done in primary care
267
What is the main medication tmtx for anxiety
- SSRI
- benzos
- SNRIs
- TCAs
- Propranolol/Clonidine/Antihistamines
268
What is an oral side effect of tricyclics
Tooth decay
269
A patient w/ cyclic severe highs and severe lows may be dx w/
Bipolar disorder
270
T/F - antidepressants are not helpful in bipolar disorder
True
271
Bipolar 1
most severe - severe swings
272
Bipolar 2
Severe lows but not really manic at all
273
Mixed bipolar
addition of dysthymia or other depressive disorder w/BPD
274
What mental illness is thought to have the most genetic component
Bipolar
| commonly runs in families
275
Obsession vs. Compulsion ******
Obsession - intrusive thoughts, produce apprehension, fear or worry
Compulsions - repetitive behaviors aimed at reducing associated anxieties
276
OCD is what type of disorder *******
Anxiety disorder
277
What is the treatment for OCD *******
CBD w/exposure-ritual prevention therapy
Meds (SSRIs, SNRIs, TCAs)
ECT
278
T/F - Benzos are helpful in reducing the compulsions in OCD
FALSE - the benzos may become a compulsion
279
Schizophrenia is characterized by what 3 things
1. Thought disturbances
2. Disrupted social behavior
3. Inability to determin what is real
280
Positive symptoms of schizophrenia
experiencing things others do not
- hallucinations
- delusions
281
Negative symptoms of schizophrenia
lack of a full emotional life
- emotional blunting
- flat affect
- relationship issues
282
What is the role of the FNP in the care of a pt w/ schizophrenia
- always treat in conjunction w/ psychiatry
| - general health maintenance and upkeep
283
PHQ 9 *****
higher score = more depression
284
what to check for with SI *****
- plan
- means
- will
285
Depakote therapeutic range
50-110
286
Depakote usage
depression, mood stabilizer
287
Depakote toxicity/major risk factors
SJS risk
tox - scleral icteris
- lethargy, n/v, myoclonus, depression, respiratory depression, CNS depression
288
Smoking an zyprexa
increases metabolism of zyprexa, needs higher dosage
289
Paxil and bleeding risk
makes platelets sticky and inhibits their ability to form clots - increased bleeding risk
290
B cluster personality disorders
- dramatic, overly emotional, unpredictable thinking or behavior
- antisocial
- borderline (most common in women)
- histrionic
- narcissistic
291
cluster A personality disorders
- characterized by odd, eccentric thinking or behavior
- paranoid
- schizoid
- schizotypal
292
cluster C personality disorders
- characterized by anxious fearful thinking or behavior
- avoidant
- dependent
- OCD
293
TB S/S *****
bad: hemoptysis
| + night sweats/fever
294
Who starts TB meds *****
ID or TB clinic
295
Dietary restriction for Rifampin *****
low/no tyramine
296
high tyramine foods ****
- fermented (beer, soysauce, teryaki, bouillan, sour dough bread, miso, pickled products)
- cured (meats and fish)
- aged (cheeses - cheddar, blue)
- spoiled (over ripe fruits)
- beans (fava)
297
Children < 10 w/TB ****
no cough but can still spread
298
+HBeAB
| -HBeAG
viral replication has stopped
299
Hepatitis screening
HBcAB - assesses for previous infection
HBsAG - assesses for active infection ... if this is + then do HBeAG to see if viral replication is actively occuring
300
What HBV testing tests for viral load
HBV DNA testing
