Neurotransmitters, Psychiatric Disorders, and Therapeutic Interventions, Exams of Nursing

Download Neurotransmitters, Psychiatric Disorders, and Therapeutic Interventions and more Exams Nursing in PDF only on Docsity! Modules from Georgette questions with correct answers What factors decrease renal clearance? Correct Answer-Kidney Disease NSAIDs Hydrochlorothiazide ACE Inhibitors ("Prils") What psychotropic is mainly excreted in the kidneys? Correct Answer-Lithium Gabapentin What makes adults more sensitive to psychotropics? Correct Answer-Decreased intracellular water Decreased protein binding (drugs dont have protein to bind to, free floats in blood stream) Low muscle mass Increased body fat Where is Norepinephrine produced? Correct Answer-Locus Ceruleus Medullary Reticular Formation What is serotonin also known as? and where is it produced? Correct Answer-Also known as indole Raphe Nuclei of the brainstem where is dopamine produced? Correct Answer-Substantia Nigra Ventral Tegmental Area Nucleus Accumbens Where is Acetylcholine synthesized? Correct Answer-Nucleus Basalis or Basal Nucleus of Meynert Which receptors do benzodiazepines bind to? Correct Answer-GABA receptors to potentiate calming/anxiolytic effects Autism Spectrum Disorder Correct Answer-persistent deficits in social communication and social interaction across multiple contexts: Lacks Social reciprocity Nonverbal communication Unable to efficiently develop, maintain and understand relationships Restricted repetitive behavior Stereotyped or repetitive movements Insistence on sameness Clock Drawing Test Correct Answer-The client is asked to reproduce the face of a clock set to a specific time. This test may detect difficulties with visuospatial skills, visual perception, selective attention, memory, abstract thinking, and executive functioning. Fastest screening tool for possible dementia Takes 2 mins Dopamine Pathway responsible for positive symptoms of schizophrenia Correct Answer-Mesolimbic pathway - excess dopamine Administer Cyproheptadine How long should you wait before switchin SSRIs to MAOI? Correct Answer-14 days How long should you wait when switching prozac to MAOI? Correct Answer-5-6 weeks washout period Serotonin Discontinuation Syndrome sx Correct Answer->Flu-like sx due to cholinergic rebound esp in TCAs >Fatigue and lethargy >Myalgia (muscle soreness and achiness) >Decreased concentration >Nausea tx - SSRI discontinuation syndrome Correct Answer-Do not DC abruptly May restart and taper MMSE (Folstein Scale) Correct Answer-Tool to quantify cognitive status in adults Asesses Orientation Attention Calculation Recall Language Motor skills monitors cognitive status over time Thought Process Correct Answer-Tangentiality Circumstantiality Thought Content Correct Answer-SI/HI Neurobiological defects in Schizophrenia Correct Answer-Enlarged cerebral ventricles Smaller frontal and temporal lobes Reduced Symmetry in temporal, frontal, and occipital lobes Cortical atrophy Decreased cerebral blood flow Hippocampal and amygdala reduction Suspected alterations in neuronal signal transmission in schizophrenia Correct Answer-Excess dopamine in mesolimbic pathway Excess glutamate Decreased GABA What is the focus of Therapeutic Relationship Correct Answer-Identified needs of the client Therapeutic relationship characteristics Correct Answer-Genuineness Acceptance Nonjudgment What CIWA Score does treatment start? Correct Answer-8 or higher PRN meds what COWS score can treatment start? Correct Answer-7 or higher FRAMES - Brief Interventions for Alcohol Correct Answer-Feedback - tell pt about risks on alcohol use Responsibility - reinforce any decision to change Advice - based on facts about drinking offer simple direct advice Menu - provide a menu of options for behavior change Empathetic Interviewing - consider pt's perspective be nonjudgmental Self-efficacy - encourage person to believe they can change CAGE Correct Answer-Cut-down Annoyed Guilty Eye-opener 0 for No 1 for Yes 1 or above accurately detects 91% of alcohol users 92% of drug users 2 or above is clinically significant Behavior Change Model Correct Answer-Assess risk factors, behaviors, symptoms, attitudes ad preferences Alzheimer's Correct Answer->Gradual onset and progressive decline without focal neurological deficits >Diffuse cerebral atrophy and enlarged ventricles >Decreased acetylcholine and norepinephrine HIV Dementia Correct Answer-Subcortical Cognitive decline concentration and attention Incoordination and ataxia Behavioral abnormalities Lewy Body Dementia and Parkinsons Dementia Correct Answer->Lewy body inclusion in cortex >recurrent visual hallucinations >Parkinson features: bradykinesia, cogwheel rigidity, tremor >adversely react to antipsychotics Vascular Dementia Correct Answer->second most common type after alzheimer's >primarily caused by cardiovascular disease and characterized by step-type declines >most common in men with high BP and cardio risk factors >carotid bruits, fundoscopic abnormalities, enlarged cardiac chambers Pick's Disease or Frontotemporal Dementia Correct Answer->neuronal loss, gliosis, pick's body present >more common in men >personality and behavioral changes in early stage >cognitive changes in later stages >kluyer-bucy syndrome: hypersexuality, hyperorality Huntington's Disease Correct Answer->subcortical >characterized by motor abnormalities (choreoathetoid movements) >psychomotor slowing and difficulty with complex tasks >memory language and insight usually intact until late stages >high incidence of depression and psychosis Dementia General Treatment Approach Correct Answer->Try nonpharmacological therapies first >antipsychotics for agitation and psychosis regularly >lowest effective dose first and attempt to wean periodically >elderly sensitive to EPS and anticholinergic SE, postural hypotension What is primary prevention? Correct Answer-Decrease the number of new cases of mental disorders Health teachings What is secondary prevention? Correct Answer-Decrease number of existing cases Screening and Crisis Intervention Disaster Response What is tertiary prevention? Correct Answer-Decrease disability and severity of mental disorder Rehabilitative services Day treatment programs Case management for physical/housing Social skills training Prior to starting stimulants what should you assess? Correct Answer-Cardiac history Rett Syndrome Correct Answer->Normal psychomotor development until 5-7 months >Head growth deceleration from 5-48 months >Loss of previously acquired purposeful hand skills between age 5 to 30 months >subsequent development of stereotyped hand movements Depression "SIGECAPS" Correct Answer-Sleep disturbance Interest reduced Guilt & Self-blame Energy loss & fatigue Concentration problems Appetite changes Psychomotor changes Suicidal thoughts >Child and parent problem-solving skills training >Parent-child interactional therapy >Adolescent Transitions Program Conduct D/O Correct Answer-repetitive and persistent pattern of behavior which the rights of others or societal norms or rules are violated 3 of the following criteria must be present in the past 12 months with one in the past 6 months Aggression towards animals or people Threatens, intimidates and initiates physical fights Stealing while confronting victim Forced sexual activity on someone Destruction of property Deceit or theft Conduct DO management Correct Answer-Target mood and aggression Antipsychotics Mood Stabilizers SSRI Facititious Disorder Correct Answer-Use of external agents to mimic disease (application of caustic agents or ingestion of unwarranted medications) Conversion Disorder Correct Answer-Sudden onset of physical symptoms that cannot be explained by medical evaluation usually occurring after a stressful event Adjustment Disorder Correct Answer-Unhealthy or excessive response to a stressful life event within 3 months of it happening Grief and Loss Correct Answer-Unlike Major depression, self-esteem is usually preserved Management of grief and loss Correct Answer-Encourage expression of grief and loss Use support groups PTSD Correct Answer-reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma (nightmares and flashbacks) PTSD Treatment Correct Answer-SSRIs TCAs Prazosin CBT EMDR ERP Supportive group therapy Relaxation therapies BNZ not recommended for PTSD Tourette syndrome Correct Answer-Dopamine, Serotonin, Norepinephrine, GABA, Glutamate One type of tic disorder Tics are involuntary repetitive movements and vocalizations At least 2 motor tics and 1 vocal (phonic tic) present, not necessarily at the same time Appeared before 18 Tics may was and wane frequently but have occurred for more than 1 year and is NOT caused by medical condition or substance Tourette's Pharmacologic Management Correct Answer->Atypical antipsychotic >Clonidine (Kapvay or Catapres) and Guanfacine (Intuniv) can help control behavioral symptoms such as imulse control and rage attacks >SSRIs for symptoms of sadness, anxiety, and OCD What is variance? Correct Answer-Any event that alters patient progress toward their expected outcomes. Sources of variance: Practitioner behavior (competency) Severity of illness (with high risk) "What are the steps in the plan that you have made? Do you have plan to make this change? How will you know you have been successful in making this change?" Help the person find a change strategy that is realistic, acceptable, accessible, appropriate, and effective TTM Action Correct Answer-recently started change and intends to keep moving TTM Maintenance Correct Answer-Sustained change for 6 months Engaging in behaviors to prevent relapse "What do you do to keep the change going" Help person identify the possibility of relapse and identify and use strategies to prevent relapse TTM Relapse Correct Answer-"When was the last relapse, what keeps you from having another relapse?" Behavior Therapy Correct Answer-changing maladaptive behaviors by participating in active behavioral techniques such as Exposure Relaxation Skills training Problem solving Role playing Exposure and Modelling are effective for? Correct Answer-Phobias Avoidance Exposure for PTSD Exposure with Response Prevention (ERP) Correct Answer-A technique used to reduce anxiety. It involves exposure to an anxiety-provoking stimulus (e.g. dirt) and the prevention of an anxiety-reducing response (e.g. washing) Effective in OCD and PTSD Activity scheduling and Target Setting are effective for? Correct Answer- Depression dialectical behavior therapy (DBT) Correct Answer-Marsha linehan BPD >emotional regulation >tolerance for distress >self management skills >interpersonal effectiveness >mindfulness with emphasis on treating therapy-interfering behaviors Existential Therapy Correct Answer-To live authentically Reflection and self confrontation encouraged Personal responsibility Focus on present Understand patient's subjective experience Humanistic Therapy Correct Answer-Carl Rogers Person-centered self directed growth and self actualization Each person has the potential to actualize and find meaning Family Systems Therapy Correct Answer-Focus on levels of self-differentiation Triangles and Genograms Strategic Therapy Correct Answer-Problem focused Symptom focused Paradoxical directives Straightforward directives Reframing belief systems Structural Family Therapy Correct Answer-Structural change in family Clearly defined heirarchg Genograms or structural mapping Solution Focused Therapy Correct Answer-Rework solutions that were effective to previous problems to current problems Miracle, exception-finding, and scaling questions