Reflexes expected at 1 month
Moro until 4 months, Palmer until 4 months, Plantar util 8 months, Babinski (2 years is disease)
Signs of fetal
... [Show More] alcohol syndrome
small head, shoey palpebral fissure, inner epicanthal folds. Do IEP and early intervention specialist
Rhett Syndrome
a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities
EPS types
Tardive dyskinesia happen after years (eps is a precursor). Acute dystonia (hours), Parkinsons (weeks), Akathisia (days)
Where do EPS originate
nigrostiatal tract.
How does tegretol interact with cipro
cipro and erythromycin are inhibitors. Cause increased level of Tegretol. Black box warning
Tegretol side effects
Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro
nuchal rigidity
stiffness in cervical neck area, meningitis
ACE inhibitors
-pril, CHF
signs of serotonin syndrome
-shivering
-anxiety
-diaphoresis
-hyperthermia
Shits and Shivers
diarrhea, shivering, hyperreflexia/myoclonis, increased temperature, vital sign instability, encephalopathy, restlessness, sweating
Serotonin Discontinuation Syndrome
syndrome caused by abrupt withdrawal of an antidepressant drug, resulting in sensory disturbances, sleeping disturbances, disequilibrium, flu-like symptoms, dizzy, vertigo, paresthesia (brain zaps), nausea/vomiting, and gastrointestinal effects
NMS
neuroleptic malignant syndrome
Severe fever
Changing LOC
Autonomic instability
Rigidity
Sweating and drooling
FEVERS- fever, encephalopathy, vitals instability, elevated white blood cell count/cpk, rigidity
Levels of Prevention
Primary: prevent/promotion, classes, safety initiatives, education, classes, modifying environment
Secondary: screen-early detection, crisis hotlines, disaster
Tertiary: treat- to prevent further deterioration, rehab, restoration, day treatment, social skills
Risk factors for serotonin syndrome
more than 1 SSRI, st johns wart, tramadol, demerol, ultram, maperidone, 5HT
Grade 2/5 hoarse systolic heart murmur
aortic stenosis
Woman with GAD advise on medication
stop benzos because can cause floppy baby syndrome and cleft palate, cotinue buspar
What to give to agitated pt in seclusion
IM Geodon
Labs for macrocytic anemia
Folic acid, vitamin B12, ESR/CRP, HGB, MCV (liver)
When to assess a patient in restraints for face/face
1 hour then 8 hours
therapeutic communication
open ended, 'tell me'
Reluctant/silent patient
open ended questions
Patients husband shows up but not the patient
both people need to be present, reschedule
Abnormal Trendelenburg Test
Hip disease, refer child out, assessed during head to toe
Hamilton Depression Scale
i. Severe 19- 23 (monitor for SI)
ii. Moderate 14 - 18
iii. Mild 8 -13
0-7 normal
GAD-7 scale
More than 15 severe
HAM-A
Hamilton Anxiety Scale, most commonly used
14 domains, 14=mild, 18-24= moderate, 25-30=severe
Anxiety 25/15 severe
Scope of practice
comes from the state, board of nursing/american nurse association
Elderly patient with dementia how do you know id can give consent
Able to repeat back risks and benefits
elements= nature/pupose of tx, risks/benefits of tx, risks/benefits not doing tx, alternatives, diagnosis/prognosis
Patient moving states, what do you do with medication?
send enough medication is standard of practice
just culture
refers to an organization's commitment to accountability and a focus supporting universal safety in health care. Find out the error ad where went wrong
2 classes of medications that should not be used together?
Ace inhibitors and ARBs together
Keeping chronically mentally ill in the community?
ACT model
Law that makes sure people with mental health issues get the same financial treatment?
Parity Laws
Brother sexually abusing sister
make sure that he is not left alone with her and call CPS, mandatory reporter, arrange crisis therapy
Kleinfelter's Syndrome
male with more than one X chromosome (XXY), little to no sperm, fertility treatment
clozaril wbc+anc
If less than 950 discontinue the medication and get a repeat level, 1000 is the cutoff
1.5-2 cbc biweekly
1-1.5 hold, cbc q dayx 3 weeks
less than 1- Stop medication
12.5initial, target 300-900mg/d once or bid
schizophenrenia/pscyhosis
agranulocytosis, seizures, myocarditis (inflammed heart muscle -chest pain,diff breath)
wg, increase lipids/glucose
REMS pharmacy need clozaril registry to dispense
to start: WBC must be >_3500 and ANC >_2000
WBC + ANC weekly q6months, then every 2w q6months, then monthly
Labs for rheumatoid arthritis
. ESR erythrocyte sedimentation rate elevation. Synovial fluid analysis. X ray of joints. Rheumatoid factor titer, CRP, Hgb
PTSD nightmares
prazosin
adjustment disorder
reaction to a specific life event (identified stressor), symtoms within 3 monhts but no more than 6 months. Think about a patient move
Norepinephrine (NE)
Synthesized in locus coeruleus arousal and other functions like mood, hunger, and sleep
locus coeruleus
a small nucleus in the reticular formation that is involved in directing attention
5HT
raphe nucleus
raphe nuclei
a string of nuclei in the midline of the midbrain and brainstem that contain most of the serotonergic neurons of the brain
substantia nigra
midbrain structure where dopamine is produced; involved in control of movement
dopamine production
substantia nigra and ventral tegmental area
ventral tegmental area (VTA)
midbrain structure where dopamine is produced: associated with mood, reward, and addiction
Acetylcholine (ACh)
nucleus basalis of meynert
Nucleus basalis of Meynert
Alzheimer disease
cognitive and memory function
PICOT
P: Population/problem
I: Intervention/issue
C: Comparison
O: Outcome
T: Time
shrill cry
Increased cranial pressure
PANDAS
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. OCD- recent strep throat
PTSD
Acute stress disorder- less than 1 month
PTSD- after 1 month
Medicine that can cause mania
steroids/prenisolone, antabuse, isoniazid,
patient wakes up screaming at night
ask family if anyone else has sleep problems
pulling hair out
OCD/trichotillomania
how do you get paid for medicare
CPT current procedural code
patient in hospital with no family and failing cognitive test
perform an MRI, labs to rule out substances
Patient cold what labs to get?
Check TSH.
What medication to give for serotonin syndrome
Cyproheptadine
Medication for NMS?
Dantrolene and bromocriptine
Zung scale
from 25-100, 25-49 is normal, 70+ is severe
Beck Scales
Eight, separate, self-report inventories designed to assess different areas.
Scores from 0-63
over 30 is severe
PHQ9
score 1-27, over 20 is severe
zung, beck, PHQ9, HAM
70, 30, 20, 25
DEA regulation monitoring
State and Federal, PMP
Aggression in brain
Stimulation of the amygdala results in augmented aggressive behavior
hypothalamus, is believed to serve a regulatory role in aggression
nurse attacked 3 weeks ago and now scared to go to work
Acute Stress Disorder, as it happened less than 1 month ago
masturbating 3 year old
Phallic stage is normal 3-6 years old
Elderly female with decreased sex drive
check testosterone level
OB/PMHNP in same clinic
increased access to mental health access
NMS
-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool
NMS labs
increased CPK, WBC
Lithium level is 1.4
monitor for toxicity, toxicity=1.5, nausea, vomiting
Lithium toxicity
1.5, 3 is an emergency, severe diarrhea/nausea/vomiting, metallic taste, tremor, slurred speech, number one intervention, give fluids, sweating give electrolytes too
NSAIDs & ACE inhibitors effect
can double lithium levels
ibuprofen + lithium
increases the serum level of lithium up to double
Lab values concerning for patients on lithium
4+ protein in urine, Leukocytosis, creatinine, BUN, Na,
Erythromycin and Tegretol
Erythromycin is an inhibitor (H=high level). If on Tegretol and Erythromycin together would want to reduce the dose of Tegretol
14 year old with no axillary hair, has not gotten her period yet
Normal tanner stage, start by 16
On Interferon and Lexapro
Interferon can cause depression, increase Lexapro
Accutane
can cause depression and birth defects
Patient on risperdal and elevated prolactin
stop or decrease the medication, tubin tract
Neurotransmitters involved in alcoholism
dopamine and gaba
Patient abusing stimulants, what does NP assess for
Insomnia and tremor, irritability, weight loss, nervous, hypertension, tachycardia
Anorexic teenager with pain when eating
refeeding syndrome causes delayed gastric emptying
Beck inventory score of 10?
0-63, over 30 severe, dont start medication just start therapy
Treatment for ADHD
stimulant and therapy together
65 year old started on a SSRI
may experience an increase in anxiety in elderly, expect increased side effects, do an EKG
What medication can alter absorption of antipsychotics?
Antacids, can decrease antispsychotic effects
Dark brown urine
check LFT,
Person with EPS will most likely experience what
Tardive dyskinesia
Apoptosis?
neuron loss because of suffocation, enzyme breakdown
Patient lost a friend now experiences paralysis
conversion syndrome, repression of unconscious intrapsychic conflicts
patient continues to say "I dont know"
depression, not dementia
MMSE scores
24-30 no cognitive impairment
18-23 mild cognitive impairment
0-17 severe cognitive impairment
Early signs of aids dementia
memory, inattention, concentration changes, worry over decreased cognition
Frontal lobe dementia
A form of dementia characterized by personality changes/social changes ,
Wandering, disoriented person on the streets for 2 days
delirium
The health care policy is access, cost and ____
quality
Phases of policy making
formulation, implementation, evaluation
Flonase interacts with what mood stabilizer?
Tegretol (inhibitor)
Smoking cessation and antipsychotic
decrease the level of Zyprexa, smoking is an inducer causing decreased levels of the medication. When stop smoking re-increase the medication
Clenched teeth?
CN 5 Trigeminal (masseter or masticatory muscle).
Puff cheeks
CN 7 facial (sensory and motor)
Started on a medication then comes back in 2 weeks?
Increase the dose after 1-2 weeks, therapeutic effects 4-6 weeks
Zantac is for what?
H2 inhibitor
Best therapy for negative thinking
CBT, all or nothing thinking catastrophic thinking
Humanistic therapy-self
Existential- reflection/self control/personal responsibility
Patient is borderline and suicidal what therapy?
DBT, goal to decrease emotional reactivity/crisis bxs and self validation.
Tics what advise?
fairly common in children and will often remit on its own, ADHD concomittant
ODD child
help the parents with positive reinforcement and parenting skills, limit setting, logical consequences, consistency, power stuggle/control issues problematic, parenting/family dysfunction exacerbates
Fungus on toenial
scrape toenail and sent for testing
Age for schizophrenia female
25-35
bipolar not taking medication
"tell me how the medication works in your body"
patient has neuropathic pain, what medication will help? gabapentin not helping
Alpha 2 delta, pregabalin- lyrica
When opening independent practice
consider cost and revenue, must calculate the time spent with patient vs time spent on risk called indirect vs direct processing
Can disclose info to medicare /CMS without consent
...
First line neuro-protective for bipolar
lithium
What to check in terms of depakote in young girl
check HCG, blackbox for pregnancy, can cause spinal bifida-tetrogenic, also check LFTs, CBC
assertive inquiry
...
Appreciate Inquiry
strengths and competencies. What is being done currently and assessment of strenghts, no problem focused, 3 steps are discovery, understanding, amplifying
Np notices teen with DKA leaving without eval
collaborate with ER to provide a psych assessment
MMSE part for thought disorder
proverb interpretation, abstract vs concrete interpretations
Teen commits suicide, NP does presentation
to teens in order to normalize the grieving process
To reduce stigma among teens seeking mental health...
educate friends/peers
Experiencing irritability/depression/edginess?
best assessment is mood questionnaire for bipolar, 7/13 bipolar likely
Telemedicine asking a legal question??
Licensing jurisdiction for the np
Adolescent with substance abuse and working out has muscle aches
urine is red colored- hematuria, concerned for rhabdomyolysis (muscle breakdown),
What are you looking at when you are assessing the function of an elderly individual
ability to manage a checkbook, instrumental ADLs go first (meds, phone, drive, house week, balancing check book), then ADLs eating/dressing, Exec functions=judgement, planning, taxes
First symptom of metabolic syndrome?
large waist circumference
Autistic child not responding to your verbal commands
this is normal, repetitive patterns of bx, impaired social interactions, verbal/nonverbal communication common
Women is anxious about administering medication to a child
stop and address her anxiety
Why would you be concerned about immature retuculocytes?
tests looking at reticulocytes hep evaluate conditions affecting RBCs such as anemia, low reticulocytes may be seen with iron deficiency anemia, pernicious anemia, folic acid deficiency, aplastic anemia
First line neuro-protective for bipolar
lithium
What medication can alter absorption of antipsychotics?
... [Show Less]