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 [Show Less]