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NUR150 > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the definition of a psychotic disorder? Examples (5)?

A

Def: thought disturbance, interruption of reality, potential for psychosis

Ex: schizophrenia, brief psychotic disorder, substance induced psychosis, delusional disorder, schizoaffective disorder

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2
Q

What is schizophrenia?

A

the client has psychotic manifestations for at least 6 months that affect school/work, self-care, and relationships

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3
Q

What is brief psychotic disorder?

A

the client has sudden psychotic manifestations that last 1-30 days (a “break”)
-usually precipitated by extreme stress

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4
Q

What is substance induced psychosis?

A

increasing use of substances or total withdrawal of substances can produce psychotic manifestations

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5
Q

What is delusional disorder?

A
  • the client has non-bizarre delusions (most common is persecution)
  • does not usually affect ability to function
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6
Q

What is schizoaffective disorder?

A

-psychotic manifestations are a symptom of the underlying mood disorder such as bipolar or major depressive

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7
Q

What are positive symptoms of schizophrenia/psychosis? (4)

A
  • hallucinations (auditory or visual)
  • delusions (belief system)
  • paranoia
  • bizarre behavior (not wearing clothes, walking backwards)
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8
Q

What are negative symptoms of schizophrenia/psychosis? (5)

A

5 A’s

  • affect (flat, withdrawn)
  • alogia (no dialoging)
  • avolition (no motivation)
  • anhedonia (no joy)
  • anergia (no energy)
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9
Q

What is echolalia?

A

repeating your words back to you

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10
Q

What is clang associations?

A

meaningless rhyming of words

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11
Q

How can we stage a schizophrenic episode?

A

Prodromal: up to a year or more before 1st psychotic break

Acute: treatment is sought, during 1st break

Stabilizing: return to baseline

Maintenance: return to normal activities

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12
Q

What nursing care priorities do we have for the schizophrenic patient? (4)

A
  • safety: are they having command hallucinations
  • maslow: are they physically stable otherwise
  • milieu: may not be able to attend group
  • reorient: address hallucinations, don’t agree, don’t argue
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13
Q

What classes or meds would be used to treat a schizophrenic patient?

A
  • 1st and 2nd gen antipsychotics
  • anticonvulsants (no lithium)
  • antidepressants (no MAOI)
  • benzodiazepines
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14
Q

What kind of symptoms do 1st gen antipsychotics treat vs 2nd gen?

A

1st gen: positive symptoms only

2nd gen: positive and negative symptoms

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15
Q

What is a personality disorder?

A

def: characteristics that impact self-identity and relationships (usually use one of the maladaptive defense mechanisms)

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16
Q

What is paranoid personality disorder?

A

CLUSTER A- WEIRD
“the world is out to get me”
-distrust and suspicious

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17
Q

What is schizoid personality disorder?

A

CLUSTER A- WEIRD

  • emotionally detached
  • indifference to praise and criticism
  • loner
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18
Q

What is schizotypical personality disorder?

A

CLUSTER A- WEIRD

  • odd belief systems
  • eccentric
  • magical thinking
  • lack friends
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19
Q

What is antisocial personality disorder?

A

CLUSTER B- WILD

  • can be charismatic
  • against all societal conduct norms/laws
  • disregard for others
  • criminal behavior is common
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20
Q

What is borderline personality disorder?

A

CLUSTER B- WILD

  • splitting (you’re either bad or you’re good)
  • emptiness (risk for self-harm)
  • mood swings are very intense
  • fear of abandonment
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21
Q

What is histrionic personality disorder?

A

CLUSTER B- WILD

  • need to be the center of attention
  • often flirtatious, seductive
  • very emotional
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22
Q

What is narcissistic personality disorder?

A

CLUSTER B- WILD

  • arrogant
  • need for admiration
  • if they are at fault for something, blame others
  • relationships with others are superficial, based on what others can do for them
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23
Q

What is avoidant personality disorder?

A

CLUSTER C- WORRIED

  • wants close relationships
  • sees himself as socially inept
  • avoids meeting people or all situations that require interpersonal contact
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24
Q

What is dependent personality disorder?

A

CLUSTER C- WORRIED

  • excessive need to be taken care of
  • fear of abandonment
  • inability to complete anything on their own
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25
Q

What is obsessive compulsive personality disorder?

A

CLUSTER C- WORRIED

  • rigid perfectionist
  • not efficient
  • only one way to do it right
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26
Q

Which personality disorders do we have the biggest safety concerns with?

A

Borderline- self harm (cutting)

Schizoid- risk of harm to others

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27
Q

What psychotherapies are most beneficial for personality disorders?

A

CBT- most helpful

DBT (Dialectical Behavioral Therapy)

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28
Q

What are the four components of DBT?

A

mindfulness- living in the moment

interpersonal effectiveness- skills to achieve goals without damage to relationships

distress tolerance- learning to bear emotional pain by accepting self and current situation

emotion regulation- coping with negative emotions in a healthy manner

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29
Q

What are Extrapyramidal Side Effects? (4)

A
  • dystonias (severe spasms of the tongue, head, and neck)
  • akathisia (restlessness, pacing)
  • parkinsonian symptoms (salivation, shuffling gait, tremor)
  • tardive dyskinesia (involuntary muscle spasms of the face, AIMS assessment to detect early)
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30
Q

What is NMS?

A

Neuroleptic Malignant Syndrome (NMS)

  • muscle rigidity
  • high temp
  • labile BP
  • tachycardia, tachypnea
  • diaphoresis
  • drooling
  • *treat with Dantrolene
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31
Q

What are anticholinergic side effects?

A
  • blurry vision
  • dry mouth
  • constipation
  • urinary hesitancy/retention
  • sexual dysfunction
  • tachycardia
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32
Q

What are the prototypes for 1st gen antipsychotics?

A

Haloperidol- high potency (acute)

Chlorpromazine- low potency (maintenance)

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33
Q

What are the prototypes for 2nd gen antipsychotics?

A

Risperidone

Olanzapine

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34
Q

What are the general side effects of 1st gen antipsychotics?

A

Life-threatening: agranulocytosis, NMS, dysrhythmias
EPS: dystonia, pseudoparkinsonium, akathisia, tardive dyskinesia
-Anticholinergic
-Orthostatic hypotension
-Sedation

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35
Q

What are the general side effects of 2nd gen antipsychotics?

A

less EPS, less agranulocytosis, no NMS

  • metabolic syndrome (BIG weight gain)
  • sedation may be increased
  • orthostatic hypotension
  • anticholinergic
  • fine tremor
  • sexual dysfunction
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36
Q

What is insulin?

A
  • a hormone

- facilitates glucose entry into the cell for conversion to energy

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37
Q

Where is glucose stored?

A

in the liver and muscle cells as glycogen

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38
Q

What is a normal blood glucose level?

A

70-110

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39
Q

What is type I diabetes?

A
  • onset before age 30
  • beta cells are destroyed
  • insulin is not produced
  • insulin dependent for life
  • *type I has none**
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40
Q

What is type II diabetes?

A
  • decreased production of insulin by beta cells
  • cells stop responding to insulin
  • *type II cells are through**
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41
Q

What are risk factors for type II diabetes?

A
  • family history
  • poor diet
  • obesity (>25)
  • sedentary
  • hypertension
  • ethnic groups
  • waist size greater than 35-45
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42
Q

Manifestations of hyperglycemia?

A
  • glucose >250
  • polyuria
  • polydipsia
  • polyphagia
  • fatigue/weakness
  • vision changes
  • slow healing wounds
  • recurrent infections
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43
Q

Causes of hyperglycemia?

A

4 S’s

  • sepsis
  • stress
  • skip insulin
  • steroids (prednisone)
44
Q

Manifestations of hypoglycemia?

A
  • glucose <70
  • diaphoresis/clammy
  • pallor
  • dizzy
  • confusion
  • headache
  • hunger
  • sleepiness
  • lack of coordination
  • slurred speech
45
Q

Causes of hypoglycemia?

A
  • exercise
  • alcohol
  • insulin peak times
46
Q

What glucose level would indicate a diabetes diagnosis?

A

> 200

normal 70-110

47
Q

What fasting blood glucose level would indicate diabetes?

A

> 126

normal <100

48
Q

What oral glucose tolerance test results would indicate gestational diabetes?

A

> 200

normal <140

49
Q

What HbA1C would indicate diabetes?

A

> 6.5%

normal 4-6%

50
Q

What are the common times to monitor blood glucose?

A
  • before meals
  • at bedtime

Other:

  • two hours after meals
  • during illness
  • before, during, and after exercise
51
Q

What are the 3 most common rapid acting insulin? Characteristics?

A
  • lispro, aspart, and glulisine
  • fastest peak and onset makes it the most deadly
  • onset is 15-30 mins
  • peak 30min-3hr
  • *MUST BE EATING WITHIN 10-15 MINS**
52
Q

What kind of short acting insulin? Characteristics?

A
  • regular (how we cover finger sticks)
  • clear
  • onset is 30min-1hr
  • peak 1-5hrs
  • ONLY INSULIN THAT CAN BE GIVEN IV**
53
Q

What type of intermediate insulin is there?

A
  • NPH
  • cloudy
  • onset 1-2hr
  • peak 6-14hrs
  • *ONLY INSULIN THAT CAN BE MIXED WITH REGULAR**
54
Q

What are the two types of long-acting insulin? Characteristics?

A
  • glargine and detemir
  • onset 70 mins
  • administered only once and acts for 24 hours
  • does not have a peak
  • *DO NOT MIX**
55
Q

What is a biguanide? Action? Nursing?

A

Metformin
Action: reduces glucose production by the liver
Nursing: monitor GI effects, MUST STOP 48 HOURS PRIOR TO AND AFTER IV CONTRAST DYE*

56
Q

What are the sulfonylureas? Action? Nursing?

A

“-ides, -rides, -mides, -zides”

Types: glipizide, glimepiride, glyburide, glynase

Action: increases insulin release from the pancreas

Nursing: monitor for hypoglycemia, give 30 minutes before meals

57
Q

What are 2 alpha-glucosidase inhibitors? Action?

A
  • acarbose, miglitol
  • *take with food**
  • starch blocker- slows down the absorption of carbs in the intestine, resulting in lower post-prandial glucose levels
58
Q

What is the gliptin? Action?

A
  • sitagliptin

- stimulates insulin release, lowers glucagon secretion, slows gastric emptying

59
Q

What are the two meglitinides? Action?

A
  • repaglinide, nateglinide

- stimulates insulin release

60
Q

What are the thiazolidinediones?

A
  • rosiglitazone, pioglitazone
  • Good for type II diabetes
  • increases insulin sensitivity, transport, and utilization
  • *HIGH RISK CHF d/t fluid retention
61
Q

How do we mange hypoglycemia?

A

“Rule of 15”

  • Give 15g of carbs (or 3-4 glucose tabs, 4 oz of juice or soda, 2-3 tsp of honey)
  • Wait 15 mins (recheck blood glucose, if <70 then give 15 g of carbs)
  • Recheck in 15 mins
62
Q

What do we give a patient who is hypoglycemic who cannot swallow or is unconcious?

A
  • SC or IM glucagon

- 25-50ml of 50% dextrose

63
Q

How do we manage hyperglycemia?

A
  • encourage intake of fluids to prevent dehydration
  • admin insulin
  • restrict exercise when >250
  • test urine for ketones
64
Q

What are the sick day guidelines?

A

-take insulin/oral meds as usual
-test blood glucose/ketones every 3-4 hours
-drink water to prevent dehydration
Contact HCP if:
glucose >240
fever >101.5
disoriented/confused
rapid breathing
vomiting more than once
diarrhea more than 5x or more than 24 hours
unable to tolerate liquids
illness >2days

65
Q

What is DKA?

A

Diabetic ketoacidosis

  • bld glucose 300-800 (we try to get it under 240 initially)
  • due to missed insulin or illness
  • usually type 1s have this
  • *MONITOR K LEVELS
66
Q

What are the manifestations of DKA?

A 
3 P's
rapid weak pulse
metabolic acidosis
fruity breath
kussmaul respiration
lethargic. comatose
orthostatic hypotension
67
Q

What is HHS?

A

Hyperglycemic Hyperosmolar Syndrome

  • bld glucose >600
  • more common in type 2s
68
Q

What are the manifestations of HHS?

A
  • dehydration
  • elevated BUN
  • altered mental status
  • NO KETOSIS
69
Q

What causes BPH?

A

excessive accumulation of DHT stimulates overgrowth of prostate tissue

70
Q

Where is BPH most likely to develop?

A

in the inner part of the prostate (prostate cancer is more likely in the outer part of the prostate)

71
Q

What are the risk factors for BPH?

A

-aging (men 50+)
-obesity (esp waist)
-sedentary lifestyle
-high animal protein in diet
-alcohol
-ED
smoking
-diabetes

72
Q

What are the manifestations of BPH?

A
  • nocturiausually the first symptom the pt notices
  • urinary frequency
  • urgency
  • dysuria
  • bladder pain
  • incontinence
  • decreased force of urinary stream
  • difficulty initiating stream
  • dribbling
73
Q

What does a DRE tell us?

A

estimates the prostate size, symmetry, and consistency

**in BPH it is symmetrically enlarged, firm, and smooth

74
Q

When would a TRUS be indicated?

A

Transrectal Ultrasound would be indicated if the client has an abnormal DRE and high PSA

75
Q

What is a normal PSA?

A

0-4ng/ml

> 10ng/ml indicates further testing

76
Q

What conservative treatment options are there for BPH?

A
  • decreasing caffeine and artificial sweeteners, limiting spicy or acidic foods
  • avoiding decongestants or anticholinergics
  • restricting evening fluid intake
  • timed voiding schedule
77
Q

What does an enzyme inhibitor do for BPH?

A

Finasteride- block the enzyme needed for conversion of testosterone to DHT

  • reduces the size of the prostate
  • can take up to 6 mos for improvement
78
Q

What do alpha blockers (adrenergic receptor blockers) do for BPH?

A

Tamsulosin- promotes smooth muscle relaxation and facilitates urinary flow
**DOES NOT decrease the size of the prostate

79
Q

What is a TURP?

A

Transurethral Resection

-enlarged portion of prostate is removed through a resectoscope

80
Q

What is the preoperative care for a TURP?

A
  • insert a 3 way indwelling catheter (for continuous or intermittent irrigation for first 24 hours)
  • admin antibiotics
  • encourage 2-3L fluid intake
81
Q

What is the postoperative care for a TURP?

A
  • expect bloody urine
  • monitor I&O
  • bladder irrigation either manual or continuous CBI (drainage should be ideally pink and without clots)
  • stool softeners and high fiber to prevent straining
  • catheter care- tape tightly to the leg
  • teach kegel exercises
  • observe for signs of infection
  • medicate for pain/bladder spasms
  • encourage fluid intake 3L
82
Q

What things can help relieve bladder spasms?

A
  • check the catheter for clots
  • instruct the client not to urinate around the catheter
  • belladonna and opium suppositories can be used
  • relaxation techniques
83
Q

How to teach Kegel exercises?

A
  • do them 10-20 times per hour

- start and stop stream during urination

84
Q

What are the three ways that prostate cancer can spread?

A
  • through the lymph
  • through the blood
  • nearest tissues (seminal vesicles, urethral mucosa, and bladder walls)
85
Q

What are the risk factors for prostate cancer?

A
  • age (50 or older)
  • african americans
  • family history
  • elevated testosterone
86
Q

What are the clinical manifestations of prostate cancer?

A
  • hematuria
  • urgency
  • nocturia
  • retention
  • interruption of urinary stream
  • inability to urinate
87
Q

What other things can elevate a PSA?

A 
aging
BPH
recent ejaculation
consitpation
acute prostatitis
after long bike rides
88
Q

What is TNM?

A

Tumor, Node, and Metastasis

Stage 1: neg DRE, neg imaging, no node, no met, PSA <10, gleason <6

Stage 2: pos DRE, pos imaging, no node, no met, PSA 10-20, gleason 6-7

Stage 3: cancer outside the prostate (seminal ves), no node, no met, PSA high, gleason high

Stage 4: yes node, yes met

89
Q

What is the Gleason scale?

A

Grade 1 represents the most well-differentiated (lowest grade)
Grade 5 represents the most poorly differentiated cells (highest grade)

90
Q

What is the grade group?

A

grades cells based on differentiation (1-5)

91
Q

What is a radical prostatectomy?

A

entire prostate, seminal vesicles, and part of the bladder neck are removed
not for advanced stage prostate cancer

92
Q

Postop care for prostatectomy?

A
  • indwelling catheter (30ml balloon)
  • surgical site drain
  • inpatient for 1-3 days
93
Q

What are the adverse outcomes of prostatectomy?

A
  • ED (24 mos)
  • Incontinence (first few mos)
  • hemorrhage
  • urinary retention
  • infection, DVT, PE
94
Q

What is radiation therapy for prostate cancer?

A
  • 5 days/week for 4-8 weeks
  • only used to treat if it is confined to the prostate
  • side effects are: skin irritation, GI upset, urinary, sexual fxn, fatigue
95
Q

What is hormone drug therapy for prostate cancer?

A

Androgen deprivation therapy
-reduces androgens to reduce tumor size
-can be used before surgery or radiation, and in advanced disease
EX: leuprolide

96
Q

How and where do we administer IM injections?

A
  • 90 degree angle, 1-1.5in needle 23-35g
  • 0.5-1ml for deltoid, 3-5ml for bigger site
  • vastus lateralis (anterolateral thigh), ventrogluteal (lateral hip), deltoid (upper arm)
97
Q

How and where do we administer SC injections?

A
  • 45-90 degrees, 3/8-5/8in needle 25-27g
  • 0.5-1ml is normal
  • abdomen, upper arm, thigh, love handle, back
98
Q

How and where do we administer ID injections?

A
  • 15 degrees, very short needle, 26-28g
  • 0.1ml is normal
  • lower arm, chest, upper back
  • DO NOT massage site or put a bandaid on it
99
Q

What is altruism?

A

the stressor is dealt with by meeting the needs of others

ex: a woman who lost her husband volunteers doing grief counseling for others

100
Q

What is sublimation?

A

the person substitutes something constructive and socially acceptable for strong sexual or aggressive impulses
ex: aggressive man chooses to become a butcher

101
Q

What is suppression?

A

the person consciously denies the stressor

ex: I cant worry about paying rent until after my exam tomorrow

102
Q

What is repression?

A

the person UNconsciously excludes stressor from their awareness
ex: forgetting trauma

103
Q

What is reaction formation?

A

unacceptable behaviors/feelings are kept out of awareness by developing the opposite behavior or emotion
ex: a person who hates children becomes a boy scout leader

104
Q

What is projection?

A

the person UNconsciously rejects negative features of themselves and instead attributes it to other people, objects
ex: blaming, scapegoating, prejudice

105
Q

What is splitting?

A

the person cannot integrate positive and negative qualities of others

ex: people are either all good or all bad
* *boarderline especially do this

106
Q

What is displacement?

A

transferring feelings about one thing to another thing that is nonthreatening
ex: man hits his wife, wife yells at kid, kid kicks the cate

107
Q

Laws regarding restraints?

A
  • use the least restrictive restraint (verbal, chemical, then mechanical)
  • can only be for 4 hours before renewing prescription with a maximum of 24 hours
  • can be put on without a prescription if emergency, but one must be written within 1 hour
  • assess and document every 15-30 minutes

NUR150 (8 decks)

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