PMHNP Exam Reported Questions -

What is dissemination?
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What is dissemination?
Getting the research information out to those who need to know it!

Publication - highest level
Presenting at National Conference
Presenting at Local Conference
Journal Club where one person reviews an article
What does a 17 on MMSE mean?
Moderate cognitive impairment
What is Tegretol in the CYP450 system?
Inducer -->will lower dose of Lamictal and BCP's
What do BCP's do to Lamictal?
Inducer - will lower dose of Lamictal
What is a Type I research error?
There IS a difference but you say there isn't a difference.
What is a Type II research error?
There is NO difference but you say there is a difference.
What is pseudo-dementia?
Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve.
Is it normal for a 1 month old to have a palmar grasp?
Yes.
What is a drug 1/2 life?
The time it takes for 50% of a drug to be eliminated from the body.
What 3 atypicals can be used with teens?
Zyprexa, Abilify, Seroquel - low doses
What is a risk of using Tramadol?Serotonin Syndrome as it is very serotonergic.What is the allele seen in Asians that increase the risk of SJS?HLAB-1502When might you see toxic epidermal necrolysis?With worsening of SJSHow many generations do you include for a genogram?1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree -What does messenger RNA code for?Amino AcidsWhat is epigenetics?Factors that affect genes - environmental, smoking, stress, etc...What part of the brain is involved with OCD?Basal Ganglia Occipito-FrontalWhat happens to the brain during adolescence?Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as wellWhen do males typically present with schizophrenia?10-25 yoWhen do females typically present with schizophrenia?25-35 yoWhat does Erythromycin to trileptal?You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitorACE Inhibitors are the drug of choice for what?Heart Failure HTNWhat are some psychiatric side effects seen with some asthma drugsLeukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremorWhat should you watch for with Tegretol?Agranulocytosis and HyponatremiaWhat are the 3 CK muscle enzyme tests?CKBB, CKMM, CKMBWhich one of the 3 muscle enzymes are related to cardiac muscle damage?CKMBWhat is the risk of a seriously elevated CKMB?Polymyositis RhabdoWhat is a normal CKMB?0.3 mcg/LWhat psychoactives does Detrol interact with?Topamax KCL ZonegranWhat CN are you assessing when you have the patient shrug their shoulders?CN XI - Spinal AccessoryWhat do you see in labs with HIV & Dementia?CD4 <200 Viral Load is high <20% get it with antiretroviral treatmentWhat is the scoring with the Beck Depression Inventory?Self-Report - 0-63 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severeWhat is sensitivity?Helps rule-out disease = True Positive = SnoutWhat is specificity?Helps rule-in disease = True Negative = SpinWhat does a sed rate measure?Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour.What is a normal sed rate or ESR?0-22 males 0-29 femalesWhat is a retic count?Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow.What does a decreased retic count indicate?Anemia - acute or chronic bleedingWhat does an increased retic count indicate?Bone marrow disorder or Vitamin DeficiencyWhat does an abnormal retic ount indicate in general?Doesn't diagnose anything. First step is ID source of the issue.What happens when you mix tegretol and macrolides?Increase tegretol levels.What happens if a pregnant women takes Accutane?Birth defects.What labs do you get with RA?Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm diagnosis. CRP and ESR are both increased in RA but NOT in osteoarthritis.Where does the NP Code of Ethics come from?ANAWhen do you assume informed consent?Unconscious Incompetent Life Threatening SituationWhat are the legal ramifications of treating w/o informed consent?Same as with informed consentWho can declare a patient incompetent and appoint a guardian?Only a courtDoes impaired judgment mean one is incompetent?No.Can an advanced directive ever be revoked?Yes, at any time.What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact?Nothing. They are all the same.Does the de facto rule of proxy apply in same sex marriages?No.How do Asians see HC providers?As in a position of authority. Expect to give instructions and help make decisionsWhat does it mean when an Asian patient does not make eye contact with the NP?SIgn of respectWhat is the evil eye?When a stronger or more powerful person looks at a weaker person - often infant/child resulting in a hex which presents in illness such as HA, fever, diarrhea, disturbed sleep, increased fussiness.How do you protect from the evil eye?Red ribbon on an infant Amulet for adultsHow do you treat for evil eye?Access traditional healer + traditional care.For there to be a duty to a patient, what must exist?RelationshipWhat is a proximate cause?Connection between A + B.For there to be damages, what must exist first?NegligenceWhat is an occurrence basis liability insurance?"occurred" during the policy period, no matter when the claim is brought against the insuredWhat is a claims made/based liability insurance?provides coverage for a claim that is brought within the policy period, no matter when the loss occurred.Who sets the minimum requirements for NP's?Board of Nursing StateWhat are the various controlled substance classes?Schedule I - nobody has these - not good for health - heroin, PCP, MDMA, researchers can get it sometimes. Schedule II - Significant Abuse Potential - morphine, methadone, methyphenidate Schedule III - Moderate Abuse Potential - hydrocodone, codeine Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine Schedule V - Very low abuse potential - anti-tussives, lomotilWhat classes of CS's is the NP approved to prescribe?Schedules III-V ONLY.Where does 50% of healthcare funds come from?The governmentWho is eligible for Medicare?>65 or under 65 with diability, ANY age with renal disease.What is incident to billing?Means MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD. Allows NP to get reimbursed at 100% rather than 85%.How are Medicaid benefits determined?State determines qualification - Partnership between State and Fed Govt. Must be impoverished Must be US resident and low or very low income.Can you have Medicare and Medicaid?Yes, impoverished elderly but Medicaid is always payor of last resort.Is dental care included in Medicaid?Yes, <21 gets basic dental as part of the Medicaid plan.What is the purpose of HIPAA?National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality.What must be signed prior to any healthcare in the stateNotice of Privacy Practices StatementWhat happens if a patient refuses to sign an ROI?Can decline to treat Health plan may condition enrollment on provision of consentWhen is HIPAA not required?Emergency treatment Substantial communication barriers and consent is inferred Involuntary committmentIs it ok to announce a patient's name in a waiting room?Yes, no other way to give care.Is it ok to leave a message on a patient's vm?Yes, but should be limited.What is the impact of steroid inhalers on children?Slows bone growth and may decrease ultimate height.What is the long-term impact of using steroid inhalers?Cataracts, glaucoma, thinning of bones and skinWhat is included in the treatment of fibromyalgia?Sleeping meds Antidepressants Pain medsWhat psychoactives are first line treatment for fibro?Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo'sWhat is the purpose of telepsychiatry?Increase the ability to reach rural and underserved areas.What is the purpose of Motivational Interviewing?Explore ambiguity Maintain passive positionWhat is required for Medicare submission?ICD 10 and narrative or CPTWhat is the neurotransmitter problem in Schizophrenia?Excess dopamine in mesolimbic pathway.What is the neurotransmitter problem in ADHD?Dopamine, norepinephrine and serotonergic dysfunctionWhat is the benefit of play therapy?Don't have to confront emotions head on.What neurotransmitters are involved in the bioamine hypothesis of depression?Noradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse.How do you test CN XII?Stick out your tongue.What CN are you testing when you have a patient clinch their jaw and assess temporal muscles?CN V - TrigeminalWhat are two important things to measure when using Zyprexa?Lipid level and abdominal circumferenceWhat is included in the mini-cognitive exam?Clock, memory questions from MSE.What is HIV related dementia often mistaken for, especially at the beginning?DepressionWhat do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000?Stop and repeat lab. Normal is 1500-8000 mm3Can you take Buspar during pregnancy?Category B - ok if really needed.Can you take Klonopin during pregnancy?Category C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms.What is the concern when prescribing Lamictal with Depakote?Both are CYP450 inducers of the other and therefore together will lower the level of both drugs.Can asthma medications cause depression?Yes.If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order?Microalbumin?What is often common to patients with fibro?Sexual abuseHow is telepsychiatry evaluated?Outcome based - measure at intervals.What happens with a patient taking Lithium and who gets dehydrated?Levels increaseWhat happens with a patient taking Lithium who decreases sodium intake?Levels increaseWhat happens with a patient taking Lithium and drinks a lot of water?Levels decreaseIf a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future?ZyprexaWhat happens when taking Lithium and NSAIDS?NSAIDS can cause Lithium levels to increase and for the patient to become toxic!What medications are at risk to cause SJS in the Asian population?HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's.AmgdylaFear, Anxiety, and AggressionNeurotransmitter for AddictionDopamine and GABANeurotransmitter for Mood DisorderSerotonin and norepinephrineWhich drug affects Carbamazepine/tegretolErythromycin will cause toxic levels. Decrease Carbamazepine/tegretolSigns and Symptoms of stimulant abuseinsomnia and tremorDepakote checkHCG levelsDepakote causesSpinal bifidaGrasp reflex.an infantile reflex in which an infant closes her hand into a fist when her palm is touched Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age.Moro reflex.The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months.pincer grasp9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios.Pt has MI looses his job stable on psych medicationsProvide brief supportive therapyLatida and GeodonTake with foodMoro reflex absentDo xrayHealth Care Policy ModelAccess, Cost, QualityPt wants to stop medicationsexplore reason for stopping Its their right16 year old falls with the wrong crowdConduct disorderchange agentthe person formally in charge of guiding a change effort Administrator14 year old girl clenching her teethCranial Nerve V-Trigeminal nerveInfant dyingGive child to parents and comfort parentsborderline personality disorder Treatmentdialectical behavior therapyAggressive patient giveIM geodon*SIGECAPS* of DepressionSleep Interest Guilt Energy Concentration Appetite psychomotor retardation SuicideDIGFAST for maniaDistractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase5 year old tells u his brother sodomized himTell mom don't leave him alone with patient and call CPS implement crisisJust culture"Just culture" model: proposed to reconcile the twin needs for no-blame and appropriate accountability The focus is on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior. Distinguishes between Human error (e.g. slips), At-risk behavior (e.g. taking shortcuts), Reckless behavior (e.g. ignoring required safety steps). In a just culture, the response to an error or near-miss is predicated on the type of behavior associated with the error, not the severity of the event.Child reports Sexual AbuseInterview the young child and infants child with parentFirst sign of temprofrontal DementiaBehavior and personalty changesTow amines related to depressionSerotonin and norepinephrineWant to start an consulting firm what tool would be needed to show economic viabilityRevenue and expensesPatient stopped smoking (Cessation)Decreased ZyprexiaPromote resilience in schizophrenia for a patient that lives alone and doing wellRefer to peer supportSpirit stickTeach staff about culture competenceProblems in the parietal lobe can leadSensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language)PDSA cycleFor Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences.Appreciative Inquiryan organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elementsAppreciative Inquiryan organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't workAppreciative Inquiry (AI)Identify the problem Analyze the problem Generate Solutions Implement Best Solutions Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change)Appreciative InquiryDiscovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change)CIWA-ArClinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant interventionHispanic patient lost his parent complain stomach ache his pop couldn't fix what do you doValidate his experience and provide care in a culturally specific way to that patientNative American wants his healer presentInvolve mother of the patient and healer, mom was cleared for you to involve her16 year old shows up with mother for first therapy isconfidential mom sits in lobbyPatient acts out due to missing session what do you doYou relate to childhood abandonment and talk about it with the patientHow do you assess the competency of a medical procedureIdentify a pen and recall 3 wordsPatient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosisDelusional disorderIncrease ICP (signs and symptoms)Baby Neuro cryMenopausal womanHormone therapy and replacementPatient on antidepressants for 3 weeks and attempted SuicideStop medication immediatelyYou want to decrease seclusion on your unit who considered the primary change agentUnit staffYou are a lead NP over other NPs in a rural setting how would you go about the changeMake online form and have them vote on it16 year old refuse treatmentSend to psych specialist for acting out kidsPositive Trendelenburg SignRefer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor.Drug affects FlonaseZantac (Histamine 2 Blocker) AntagonistLittle boy wet his sheets, What kind of therapy would you suggestBehavior therapyDDVAP acts in much the same manner as antidiuretic hormone.Makes less urineLithium level 1.2u what are you concerned with4+ KetonesWhat does depakote do to LamictalIncrease laminate 200%Inducers of Cytochrome P450 (CYP450)Barbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort A substance that speeds up a chemical reactionInhibitorA substance that slows down or stops a chemical reactioncytochrome p450 inhibitorsCRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole Amiodarone Macrolides Isoniazid Grapefruit juice Omeprazol SulfonamidesCarb and Barbdecrease INRDeapkote and DisulfruramIncrease INRGAL-Renall metabolizedGabapentin Acamprostate LithiumGrapefruit juiceOne glass can reduce absorption by 47% Blood levels will be IncreasedTrazodone (Desyrel)Get EKG.Trazodone (Desyrel)Get an eye exam can cause GlaucomaGrapefruit juice or grapefruitIncrease trazodonePICOTPatient population of interest Intervention of interest Comparison of interest Outcome Timelimbic systemA doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus, amygdala, and hypothalamus.AmygdalaA limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression.PANDASPediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCDMental Health Parity Act 1996ensure equal coverage for mental and physical illness equal life time and annual limitscharge of DEAstate and federalStereogenesisidentify an object without sight a sense that allows a person to recognize the size, shape, and texture of an objectSterogenesis abnormality inparietal lobeClozaril (Clozapine)WBC-2500 ANC LESS than 1000 (950) dc medicationhow treat child with depressionZoloft and therapy3 year old masturbates, plays with self, says naught thingsnormal for PiagetNMS treatmentDantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of musclesmesolimbic systemPOSITIVE symptoms of schizophrenia due to high dopaminenegative symptoms of schizophreniathe absence of appropriate behaviors (expressionless faces, rigid bodies)negative symptoms of schizophreniamesocorticol pathwaymesocortical pathwayVTA to prefrontal cortex negative symptomsNigrostriatal pathwayEPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movementPDSA modelPLAN- Do-carry out Study -examine results Act-decide what actionTanner's stagesTanner stagesMMSE (Mini Mental State Examination)-Stage May be Normal 25-30 Mild/Early 21-24 Moderate 10-21 Severe 0-9A pt states that she has been raped. What do you doensure safetyHamilton D score of 28Assess for SuicideHamilton Depression Rating Scale17-21 questions 0-7 Normal 14-18 Moderate > 20 Severe DepressionBeck Depression Inventory (BDI)0-13 Minimal depression 14-19 Mild Depression 20-28 Moderate Depression 29-63 Severe DepressionPatient Health Questionnaire (PHQ-9)1-4 minimal 5-9 Mild depression 10-14 Moderate Depression 15-19 Moderate Severe Depression 20-27 Severe Depression A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression.Hamilton Anxiety Rating Scale (HAM-A)14-17 Mild Anxiety 18-24 Moderate Anxiety 25-30 Severe AnxietyYale-Brown Obsessive Compulsive Scale (Y-BOCS)OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 ExtremePTSD (Post Traumatic Stress Disorder)EMDREMDR (eye movement desensitization and reprocessing)eye movement desensitization and reprocessingDilated pupilsStimulant intoxicationconstricted (pinpoint) pupilsOpiodsnystagmusPhencyclidineconjuctival injection, muchies (super hungry), psychomotor slowness?MarijuanaMarijuanaa drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictiveBoy states that he wishes to be a girl and tells you not to tell his parent sDon't tellODD what will you do to prevent it from becoming Conduct disorderTherapy to target mood and aggressionHerpes rooster 3 weeks later sleep difficulties and sad moodDepressionSchizophrenia in males18-25 years oldSchizophrenia in Women25-35 years oldsigns of amphetamine intoxicationTears, Runny nose, restlessness, HTN, Tremors, InsomniaCo-morbidities of bipolarAnxiety, alcohol and substance abuseBig Freaking ProblemsBupropion Fluoxetine PaxilMedicareA federal program of health insurance for persons 65 years of age and olderMedicare Advantagea program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrolleeMedicare A, B, C, DA: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: DrugsWATCHERS for GAD 3 of these *** for 6 monthsworry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep troubleTranstheoretical Model of Change1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. MaintenanceMan working at the Gym and his urine is Cherry colororder myoglobinuriaLatino women wanting prenatal classConsult with cultural group in communityAnorexiaSet up family therapyquasi-experimental designResearch method similar to an experimental design except that it makes use of naturally occurring groups rather than randomly assigning subjects to groups.The ventricle enlargement observed in clients withschizophrenia is most often accompanied byEncopresis TreatmentBehavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation CounselingMedication that contradicts albuterolAdderall (amphetamine / dextroamphetamine) Advair Diskus (fluticasone / salmeterol) amoxicillin (Amoxil, Trimox, Apo-Amoxi, Moxatag, Amoxicot, DisperMox, Biomox, Moxilin, Wymox) Ativan (lorazepam) Atrovent (ipratropium) azithromycin (Zithromax, Azithromycin Dose Pack, Z-Pak, Zmax) Benadryl (diphenhydramine) caffeine Flonase (fluticasone nasal) ibuprofen ipratropium (Atrovent, Ipratropium Inhalation Solution, Atrovent HFA, Ipratropium Inhalation Aerosol) Lasix (furosemide) metoprolol (Metoprolol Succinate ER, Metoprolol Tartrate, Lopressor, Toprol-XL, Kapspargo Sprinkle) Mucinex (guaifenesin) oxycodone (OxyContin, Roxicodone, Xtampza ER, OxyIR, Oxaydo, Dazidox, Oxyfast, Oxecta, RoxyBond, Oxydose, Percolone, M-Oxy, ETH-Oxydose, Endocodone, Roxicodone Intensol) prednisone (Deltasone, Rayos, Sterapred, Prednicot, Sterapred DS, Liquid Pred, Meticorten, Orasone, Prednicen-M) Singulair (montelukast) Spiriva (tiotropium) Symbicort (budesonide / formoterol) Tylenol (acetaminophen) Vitamin B12 (cyanocobalamin) Vitamin D3 (cholecalciferol) Zyrtec (cetirizine)t-testsstatistical measure: test means of 2 independent samples, significantly different?ANOVA (analysis of variance)3 OR MORE an inferential statistical test for comparing the means of three or more groupsPearson's ra statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scalep-valueThe probability of results of the experiment being attributed to chance. LEVEL OF SIGNGNIFICANCEEarly onset of HIV dementiaApathy Lack of Interest Abnormal of MRI-SLow But cognitive," functions such as memory, reasoning, judgment, concentration, and problem solving. Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance. show brain atrophy (shrinkage)YalomUniversality: Members recognize that other members share similar feelings, thoughts and problems Altruism: Members gain a boost to self concept through extending help to other group members Instillation of hope: Member recognizes that other members' success can be helpful and they develop optimism for their own improvement Imparting information: Education or advice provided by the therapist or group members Corrective:Opportunity to reenact critical family dynamics with group members in a corrective manner Development of socializing techniques: The group provides members with an environment that fosters adaptive and effective communication Imitative behavior: Members expand their personal knowledge and skills through the observation of Group members' self-exploration, working through and personal development Cohesiveness: Feelings of trust, belonging and togetherness experienced by the group members Existential factors: Members accept responsibility for life decisions Catharsis: Members release of strong feelings about past or present experiences Interpersonal learning- input Members gain personal insight about their interpersonal impact through feedback provided from other members Interpersonal learning- output Members provide an environment that allows members to interact in a more adaptive manner Self-understanding: m embers gain insight into psychological motivation underlying behavior and emotional reactionsMetobolic syndromegroup of signs and symptoms including insulin resistance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDLNAMInational alliance on mental illness help families of mentally ill: education, support groupshealth literacya person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellnesshealth literacyMan taking insulin asking him to read blood glucose levelinferential statisticsnumerical data that allow one to generalize- to infer from sample data the probability of something being true of a populationMood Disorder Questionnaire (MDQ)-SCREENINGMood Disorder Questionnaire Patient Name ______________________________________ Date of Visit ________________ Please answer each question to the best of your ability 1. Has there ever been a period of time when you were not your usual self and... ...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble? ...you were so irritable that you shouted at people or started fights or arguments? ...you felt much more self-confident than usual? ...you got much less sleep than usual and found that you didn't really miss it? ...you were more talkative or spoke much faster than usual? ...thoughts raced through your head or you couldn't slow your mind down? ...you were so easily distracted by things around you that you had trouble concentrating or staying on track? ...you had more energy than usual? ...you were much more active or did many more things than usual? ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? ...you were much more interested in sex than usual? ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? ...spending money got you or your family in trouble? 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? 3. How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights? No problems Minor problem Moderate problem Serious problem This instrument is designed for screening purposes only and not to be used as a diagnostic tool. Permission for use granted by RMA Hirschfeld, MD YES NOPatient comes with vague symptoms depression irritabilityBECK Depression scaleDISSEMINATED ENCEPHALOMYELITISAssess for asymmetry of extremities Along with this pattern, the patients usually get neurological symptoms which may include: Confusion, drowsiness, and even coma Unsteadiness and falling Visual blurring or double vision (occasionally) Trouble swallowing Weakness of the arms or legs Fever HACBT (cognitive behavioral therapy)Anxiety popular integrative therapy that combines cognitive (thinking) and behavior therapyImpulsivity (ADHD)Pre-Frontal Cortex Involves hasty actions taken without consideration of possible negative consequences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others.Patient shows symptoms of dizziness, tremors, sweating, What Medical DiagnosisHypogylcemiaNSAIDSLithium toxicityInterferonCauses depressionBeck Depression Inventory (BDI)Intimate therapy for a child with a score of 10 a questionnaire useful for determining the level of depressive symptoms that a person is reportingZantac (ranitidine)affects FlonaseGreatest patient at risk for ViolenceSubstance abuseDBT (dialectical behavior therapy)relaxation muscle prior to DBTPt on LithiumPrescribe SynthroidZantac (ranitidine)H2 antagonist H2 BLOCKERTegretol (carbamazepine)INDUCES Flonaseprimary preventionActions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse.Secondary prevention examples- Implement blood pressure and cholesterol screening; give a treadmill stress test. - Health screenings - Skin screenings for cancer - teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets. - mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes - Provide mental health interventions after stressful events. - The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. - Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center. - Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care. - Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. - Assess disaster victims and triage for care. - Investigate an outbreak of flulike illness in a local school. - Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems. - Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered. - To prevent the spread of disease - Notify partners and trace contacts (HIV)Collab with OB NP questionswants to establish a relationship so Mental Health can be reached by more peopleanorexia nervosaBMI less than 18.5 an eating disorder in which an irrational fear of weight gain leads people to starve themselvesAnorexia admission Criteria for hospitalization includes:weight loss over 30% over 6 months, severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm Hg, and hypokalemia (less than 3 mEq/L).Culture question: A man injects himself"tell me more about the medications"Acute Stress Disorder (ASD)can be 2-4 weeks a disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to "relive" the event in dreams and flashbacks for as long as 1 month following the eventScope of Practice in NursingStateStandards of PracticeANAADPIE - Nursing ProcessAssessment Diagnosis Planning Implementation EvaluationAdult panic disorderBusparKids panic disorderClonidine GuafacineOCD (Obsessive Compulsive Disorder)TCA ClomipramicalClomipramine (Anafranil)OCD, depression (tricyclic)agoraphobiafear of open spacesAgoraphobia treatment*BZDs* - short term symptom relief *SSRIs* - long-term maintenance fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) *SNRIs* - long-term maintenance venlafaxine (Effexor) *TCAs* - long-term maintenance imipraminesocial anxiety disorderBetaBlocker PropanololTourette syndromeinvoluntary, spasmodic, twitching movements; uncontrollable vocal sounds; and inappropriate words TICS for 1 year Has to occur by 18 years old Usually occurs by 3-9 years oldSteroidsCause maniaAssertive Question (2)Use "I want", "I need" or "I feel" to convey basic assertions and get your point across firmly. For example, "I feel strongly that we need to bring in a third party to mediate this disagreement." For example, you might say "Dave, your request has caught me off guard. I'll get back to you within the half hour."Testing for fungal infectionsshavings of toesPt on Lithium with temp, right flank pain, brown colored urine, What do you?LFTMedication ManagementBy state and federalKid with night mares screaming out doesn't remember the next morning what do you doAsk about sleep disorder in familyPT taking a breathing treatment albuterol/proventilDo not take MAOI or TCAPt in with Sob, Fatigue. When you assess the thinnest part of the skin , you notice s/sSensitivitySensitivity = TP / (TP + FN)SpecifityTNpeer consultationMutual Benefit Critical and Supportive Shared discussion and accountability The regular engagement of two or more colleagues to give and receive feedbackTegretol (carbamazepine)ANC/WBCPaplauwhat nurses do WITH pts not TO pts - nurse as a therapeutic tool - therapeutic use of self - care for the person as well as the illness - think exclusively of patients as persons, not as a dx phases: 1. orientation 2. working 3. termination roles of the nurse - stranger - resource person - teacher - leader - surrogate - conselorPaplau's Interpersonal TheoryProcess recordingGive AtivanFor Alcoholic with Liver problemsdetailed physical examPt states that God did this to meAssess spiritual needsMini-Cogis another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT)women in military and she saw her friend diePTSDMan had appt, wife came and he didntTell wife to reschedule apptTagement (Cimetidine)^ Benzo ^ CoumadinErythromycin^ Xanax levelsDisulfiram^ CoumadinPt with Eating disorder states getting fullBloating delayed Gastric emptyingRealiabilityconsistencyBiggest Concern with EHRConfidentialityQualiatativeMeasures in natural setting i.e ?, observationQuantitativeData that is in numbersinternal validityWas research done right? extent to which we can draw cause-and-effect inferences from a studyI don't know answerspseudo dementiainterferondecrease Wellbutrin^ prolactinstop prolactinEPS^ risk for TDAssess when someone ready to quit drinkingSee what stage they in Ask when ready to start txTo check for DementiaHave the patient tell you risk/benefits test capacitydairy logCBTtreating a 6 y/o pt WHO HAS dx with Luekemia 1 month ago. What do you expectHe would think he is being punished fro doing something wrongantidepressant takes5 weeks13 year old want to smokeask him of his plan to stop smokingplacement of chronically mental illACT Assertive Community TreatmentAssertive Community Treatment (ACT)community-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basisBRUISE on the padded part of his armsSay I see you have bruises on your arm Ask what happenedmedication errors on a new floor when NP starts working.educate the staff on policies on how to handle med errors.ECT THERAPYGET CERTIFIEDlesion in frontal cortexImpaired cogitate functionschild in foster homer 5 years poor eye contact, isolated self, eat without difficultyautismA man states his wife was so good if he could only be like her. what is thisIntellectualization or deflectingrare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death.decreased gastric motility check measure the stomachTagement (Cimetidine)Prevents acid from backing up into the esophagus and causing heartburnPt moving to another stateGive enough medsPt on Zoloft BMI 26BMISildenafil (Viagra)1 hour prior to sexTadalafil (Cialis)45 minutes prior to sexVardenafil (Levitra)45 minutes prior to sexAvanafil (Stendra)15 minutes prior to sexAlprostadil (PGE1)• Ductal-dependent Congenital Heart Disease (all forms) • 0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IOFemales more likely to become an alcoholic than mandue to hormonesApoptosiscell death in aging/elderlysolution therapyconducted through direct observation of clients' responses to a series of precisely constructed questions.Np wants to implement a certain policy in nursing.start with nurse managerTurner SyndromeA chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. delayed puberty, short id, 10-16 years old amenorrhea web neck, osteoporosis, lymphemeda, poor social skillsProzac causes what?increased anxiety in elderlyPrazosin (Minipress)nightmaresACE inhibitorsHTNRecovery ModelA model that is patient/consumer-centered, is hopeful and empowering, and emphasizes the person and the future rather than the illness and the present.Recovery Model Interventionmotivational interviewinga collaborative, person-centered form of guiding to elicit and strengthen motivation for changeMOTIVATIONAL INTERVIEWINGMAY WE TALK ABOUT YOUR TEST SHOWS YOU ARE VERY COURAGEOUS YOU WANT TO CHANGE, BUT LETS SEE IF I GOT ITKIDS receive to many calories ue to staff letting him eat foodMeet with dietiacan , discuss with manager