How do you assess cranial nerve V trigeminal?
Tell patient to close eyes, take piece of cotton or other soft item and lightly touch either one of both
... [Show More] sides of each of the three divisions of the trigeminal.
How do you assess for cranial nerve VII facial?
Observe the patient for nystagmus or twitching of the eye. This nerve controls facial movements and expression, check for symmetry. Have the patient wrinkle forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks.
primitive reflexes
reflexes, controlled by "primitive" parts of the brain, that disappear during the first year of life
Mororeflex
Extending of limbs when they hear a loud noise (defend themselves)
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple
palmer grasp
grasping with the whole hand
scope of practice
The range of clinical procedures and activities that are allowed by law for a profession
Quality Improvement (QI)
an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy
PDSA model
Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI)
Trendelenburg sign
Occurs with severe subluxation of one hip
When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side
CYP450 inhibitors
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline
CYP450 inducers
Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
St John's Wort
What is the adverse effect of Depakote on the liver?
can cause liver damage, and the risk is more likely to occur during the first 6 months of taking the medication. Signs might include nausea or vomiting, loss of appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the skin or white of eyes
What would you do for a patient on Depakote with +4 protein in the urine?
Rule out UTI, no adjustment for medication is needed
What happens when you take carbamazepine (tegertal) and erythromycin together?
It will decrease the effect of the antibiotic by inhibition
What happens when you take zyprexa and smoke?
nicotine will increase the excretion of the drug thereby inhibiting it's effect
ICP in Infants S/S
Bulging fontanels, high-pitch cry, irritability, restlessness
ICP
CHILDREN signs and symptoms
• Headache
• Vomiting (usually projectile)
• Seizures
• Diplopia (Dbl vision), blurred vision
Neuro cry
high-pitched and very grating on the ears due to their neurological sxs being overwhelmed
Neuroleptic Malignant Syndrome
Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes.
FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles
NMS treatment
Dantrolene
D2 agonists (e.g., bromocriptine).
lead poisoning
A medical condition caused by toxic levels of the metal lead in the blood
Lead poisoning treatment
chelation therapy
Amygdala's role in emotion
- Aggression center
- Role in storing implicit emotional memories
- Stimulation (+) anger/violence or fear/anxiety
- Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior
Amygdala role in aggression
Small volume increase aggression.
Frontal Lobe Atrophy
As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. ... Scientists think that FTLD (frontal temporal lobe dementia) is the most common cause of dementia in people younger than age 60
Four dopaminergic pathways
mesocortical
mesolimbic
nigrostriatal
tuberoinfundibular
mesocortical pathway
a path through which dopaminergic projections travel to reach the neocortex
mescolimbic pathway
The mesolimbic pathway, sometimes referred to as the reward pathway, is a dopaminergic pathway in the brain. The pathway connects the ventral tegmental area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain. The ventral striatum includes the nucleus accumbens and the olfactory tubercle.
Nigrostriatal pathway
the dopaminergic tract from the substantia nigra to the striatum
Tuberoinfundibular pathway
from hypothalamus to anterior pituitary -> DA released from these neurons inhibit prolactin secretion -> when DA receptors here are blocked prolactin levels rise cause galactorrhea)
primary prevention
Efforts to prevent an injury or illness from ever occurring.
secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent, screening exams.
tertiary prevention
actions taken to contain damage once a disease or disability has progressed beyond its early stages
menopause hormone therapy
most effective therapy for moderate -severe vasomotor symptoms - use quality of life scales to identify degree of vasomotor symptom severity
*should not be used for protection against CVD or dementia
congestive heart failure and depression
MDD is highly prevalent in these patients
Thyroid levels while on lithium
Because of the high incidence of thyroid dysfunction that occurs during lithium treatment, patients should have a careful thyroid physical examination and determination of serum thyroid-stimulating hormone (TSH) and antithyroid peroxidase antibody titers before lithium treatment is begun. Patients with normal thyroid function initially should be reevaluated every 6 to 12 months for several years, and thyroid dysfunction should be treated if diagnosed. The development of thyroid dysfunction does not typically require discontinuation of lithium. If thyroid function is abnormal at the initial evaluation, lithium can still be given if necessary, but the thyroid dysfunction should be treated.
SSRIs MOA
block reuptake of serotonin by inhibiting the presynaptic reuptake
SNRIs mechanism
Inhibit 5-HT and norepinephrine reuptake.
Lithium mechanism of action
Not established, possibly related to inhibition of phosphoinosital cascade It inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission.
Carbamazepine mechanism
Block voltage-dependent sodium channels
Structural Therapy
A therapeutic approach directed at changing or realigning the organization of a family to modify dysfunctional patterns and clarify boundaries. Developed by Salvador Minuchin.
crisis intervention
five-step problem-solving technique to promote adaptation and improve future coping
Irvin Yalom
A leading figure in contemporary group therapy, especially the interpersonal approach
group therapy
therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction
boderline personality disorder
impulsive actions, often with the potential for self-harm as well as mood instability and chaotic relationships
DBT (dialectical behavior therapy)
a form of therapy used to treat borderline personality disorder that combines elements of the behavioral and cognitive treatments with a mindfulness approach based on Eastern meditative practices
eating disorder treatment
-correct dangerous eating patterns
-address psychological and situational factors that have led to / are maintaining the disorder
-often requires family and friend participation
When to admit for eating disorder?
75% below ideal body weight and/or electrolyte imbalances
just culture
culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action
GERIATRIC ANEMIA
lower than normal RBC that is common in seniors
PHQ-9 scores
1-4 min depression
5-9 Mild depression
10-14 moderate depression
15-19 Moderately severe depression
20-17 Severe depression
Beck Depression Inventory (BDI)
1-10 normal
11-16 Mild
17-20 Borderline depression
21-30 Moderate
31-40 Severe
Over 40 Extreme
HAM-D
0-7 normal
8-16 Mild
17-23 Moderate
24 (+) Severe
HAM-A
17 or less indicates mild anxiety
18-24 mild to moderate anxiety
GAD-7
1-4 minimal anxiety
5-9 Mild anxiety
10-14 Moderate anxiety
15-21 Severe anxiety
Zung Self-Rating Depression Scale
50-69 indicates depression
70 (+) severe depression
MoCA
26-30 normal
22.1 mild impairment
16.2 Alzheimer's Disease
MMSE
24-30 normal
23-20 mild
19-10 middle-moderate Alzheimer's
9-0 Late stage-severe Alzheimer's
Dementia
a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes
delirium
an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech.
Pediatric SSRIs
fluoxetine (ages 8 and up)
escitalopram (ages 12 and up)
Pediatric OCD FDA medications
clomipramine (anafranil) 10 years and up
fluoxetine (prozac) 8 years and up
fluvoxamine (luvox) 8 years and up
sertraline (zoloft) 6 years and up
galactorrhea
abnormal flow of milk from the breasts
Dopamine
a neurotransmitter that regulates motor behavior, motivation, pleasure, and emotional arousal
Serotonin
A neurotransmitter that affects hunger,sleep, arousal, and mood.
GABA
An inhibitory neurotransmitter in the brain.
Glutamate
A major excitatory neurotransmitter; involved in memory
Acetylcholine
A neurotransmitter that enables learning and memory and also triggers muscle contraction
Crisis training is proven to be effective in helping to deescalate situations to prevent the officer from using what?
Lethal force
Signs of child abuse
Head injuries;bruises and welts in the shapes of objects;Burns;human bites;rope burn;fractures in different stages of healing
AIDS dementia complex (ADC)
Encephalitis, behavioral changes, decline in cognitive function
Progressive slowing of motor functions
Apoptosis
process of programmed cell death
Recovery (training principle)
Holistic, person-centered approach to mental health care. Two premises: 1) It is possible to recover from a mental health condition; 2) The most effective recovery is patient-directed
neuron death
the stage of early nervous system development during which large numbers of neurons die, typically those that have not established effective synaptic contacts
Mini-Cog Test
■ Quick method for assessing dementia. If abnormal, screen further with MMSE.
■ Use these two methods: the clock drawing test with word recall test (three unrelated words).
■ Instruct patient to draw a clock and mark it with the hands showing a certain time.
■ Example: Instruct patient to "Draw a clock that shows 20 minutes past 4."
- Scoring clock test: Hands point to the correct time and numbers on clock are in correct
sequence.
meta-analysis
a statistical technique that averages the results of two or more studies to see if the effect of an independent variable is reliable
PTSD diagnostic criteria
Three or more of the following should be present for more than 1 month:
1. Inability to recall an important aspect of the event
2. avoidance of activities, people, places that remind the patient of the event
3. attempts to avoid thinking or talking about the event
4. Feelings of detachment or estrangement from others
5. markedly decreased interest or anhedonia (inability to experience pleasure)
6. Restricted Range of Affect
7. Belief ones future has been foreshortened because of the event
8. Increased state of arousal characterized by insomnia, irritability, angry outbursts, poor concentration, hypervigilance, exaggerated startle response
PTSD treatment
MEDICATIONS:
- Antidepressants (Zoloft, Paxil).
- Anxiolytics.
- If manifestations include nightmares or insomnia, Minipress has been prescribed. (Normally used to treat HTN, Minipress blocks the brain's response to NE and has been effective in suppressing nightmares.)
THERAPY:
- Cognitive Therapy
- Exposure Therapy
Zyprexa (olanzapine)
monitor for metabolic syndrome
Risperidone (Risperdal)
monitor for prolactin level increases
gastric emptying drugs
Metoclopramide, Erythromycin, Domperidone, Cisapride
oversupply linked to schizophrenia. undersupply linked to tremors and decreased mobility in Parkinson's disease
Dopamine
With Alzheimer's disease, ACh-producing neurons deteriorate.
Acetylcholine
undersupply of serotonin
linked to depression
Undersupply of norepinephrine.
can depress mood
undersupply of GABA
linked to seizures, tremors, and insomnia [Show Less]