NURS 751 Midterm Study Guide, Study Guides, Projects, Research of Nursing

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NURS 751 Midterm Study Guide
1.CNS (central nervous system): consists of the brain and spinal cord
2.PNS (peripheral nervous system): the sensory and motor neurons that
connect the CNS to the rest of the body
-Autonomic- internal involuntary funct.
-Somatic- voluntary
3.Frontal lobe function: associated with reasoning, planning, parts of
speech, movement, emotions, and problem solving
-problem- personality changes
4.temporal lobe function: auditory, receptive speech (werniche)
5.occipital lobe function: vision
6.parietal lobe function: sensation, taste, read/write
-problem- agonosia
7.cerebral cortex function: Is the center for humans highest functions
governing thought, memory, reasoning, sensation and voluntary
movement.
8.Depolarization: Initial (excitatory) - when sodium is rushing into the
cell causing the interior to become more positive.
9.Repolarization: Restoration (inhibitory)- caused by reentry of
potassium into the cell while sodium exits the cell.
10.Dopamine (DA): A monoamine transmitter found in the midbrain—
especially the substantia nigra—and basal forebrain
** Ventral Tegmental Area- Nucleus accumbens.
11.Norepinephrine (NE): a monoamine neurotransmitter in locus of
ceruleus
-involved in alertness and vigilance and control of REM
sleep in mood, anxiety and concentration d/o
12.Epinephrine: Monoamine Neurotransmitter secreted by the adrenal
medulla in response to stress. Also known as adrenaline.
13.Serotonin: a monoamine neurotransmitter in RAPHE nuclei of
brainstem
-important for a wide range of psychological activity, including emotional
states, impulse control, and dreaming
-mood and anxiety d/o
14.Glutamate: Amino acid - excitatory neurotransmitter
- in seizures, mood, bipolar, & schizophrenia
15.Asparate: Amino acid- inhibitory neurotransmitter
16.GABA (gamma-aminobutyric acid): Amino acid- inhibitory
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NURS 751 Midterm Study Guide

  1. CNS (central nervous system): consists of the brain and spinal cord
  2. PNS (peripheral nervous system): the sensory and motor neurons that connect the CNS to the rest of the body -Autonomic- internal involuntary funct. -Somatic- voluntary
  3. Frontal lobe function: associated with reasoning, planning, parts of speech, movement, emotions, and problem solving -problem- personality changes
  4. temporal lobe function: auditory, receptive speech (werniche)
  5. occipital lobe function: vision
  6. parietal lobe function: sensation, taste, read/write -problem- agonosia
  7. cerebral cortex function: Is the center for humans highest functions governing thought, memory, reasoning, sensation and voluntary movement.
  8. Depolarization: Initial (excitatory) - when sodium is rushing into the cell causing the interior to become more positive.
  9. Repolarization: Restoration (inhibitory)- caused by reentry of potassium into the cell while sodium exits the cell.
  10. Dopamine (DA): A monoamine transmitter found in the midbrain— especially the substantia nigra—and basal forebrain ** Ventral Tegmental Area- Nucleus accumbens.
  11. Norepinephrine (NE): a monoamine neurotransmitter in locus of ceruleus -involved in alertness and vigilance and control of REM sleep in mood, anxiety and concentration d/o
  12. Epinephrine: Monoamine Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.
  13. Serotonin: a monoamine neurotransmitter in RAPHE nuclei of brainstem -important for a wide range of psychological activity, including emotional states, impulse control, and dreaming -mood and anxiety d/o
  14. Glutamate: Amino acid - excitatory neurotransmitter
  • in seizures, mood, bipolar, & schizophrenia
  1. Asparate: Amino acid- inhibitory neurotransmitter
  2. GABA (gamma-aminobutyric acid): Amino acid- inhibitory

2 / 21 neurotransmitter. Undersupply linked to seizures, tremors, and insomnia. -action of benzos, etoh, barbiturate, &CNS depressants

  1. Glycine: Amino acid- inhibitory neurotransmitter in the spinal cord
  2. Acetylcholine: Cholinergic neurotransmitter -Basal neuron of Meynert -enables learning and memory and also triggers muscle contraction
  3. Neuropeptides: A neurotransmitter for opioids and analgesics (endogenous opioids: endorphins)
  • a decrease is r/t substance abuse
  1. cognitive development theory: Piaget; children actively construct knowledge as they manipulate and explore their world Sensorimotor ;birth- 2yo pre- operational ;2-7yo Concrete Operations ; 7-11yo Formal Operations; 11-end of adoles
  2. major depressive disorder: a mood disorder in which a person experiences >2 weeks of (3 or more s/s) depressed moods, feelings of worthlessness, adhedonia (loss of interest), wt loss, fatigue, suicidal, dec. memory, hypersomnia
    • Safety of the patient is the top priority during acute phase TX- antidepressant such as SSRIs, TCAs, MAO's, SNRIS; therapeutic effect may take at least 4-6weeks
  • Non-pharm TX- ECT, individual therapy, transcranial magnetic, stimulation, vagal nerve stimulation, phototherapy
  1. MDD prevalence and risk factors: * High mortality rate with 15% death by suicide.
  • Genetic loading
  • Family history, especially a first-degree relative
  • Prior episode of MDD
  • Female gender
  • Postpartum period
  • Medical comorbidity
  • Single marital status
  • Significant environmental stressors, especially multiple losses
  1. Dysthymia: a low-grade chronic depression with symptoms that are milder than those of severe depression but are present for 2 or more years (1yr for children)

4 / 21 -Three stages -treat with short term antidep, sleep med, TCA

  1. Grief and Bereavement differ dx and labs: * Mental status exam findings- depression, anxiety, excessive/ uncontrolled crying
  • Diagnostic and laboratory- CBC, chemistry panel, thyroid function test, and B12 level to rule out metabolic causes or other conditions
  • Differential diagnosis- normal grief, MDD, anxiety disorder, substance related disorders
  1. premenstrual dysphoric disorder (PMDD): a condition associated with severe emotional and physical problems that are closely linked to the menstrual cycle -begins 1wk before menses, ends 1-2 days after start -TX- hormone OCP, SSRI
  2. bipolar disorder: mood disorder in one experiences both manic (lasting >1wk) and depressed episodes (2wks)
  • begins early 20s
  • rating scale - Young Mania Rating Scale TX- mood stabilizer (Lithium for mania)
  • DO NOT GIVE ANTIDEPRESSANTS, can cause mania and rapid cycling Non pharm TX- Somatic ther, CBT, ed. safety, nutri, sleep
  1. cyclothymic disorder: Chronic- a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms -less severe bipolar- can develop to it -starts in adolescence- functional TX- like bipolar
  • Later onset in life usually suggests general medical condition such as multiple sclerosis
  1. Cyclothymia risk factors: * Risk factors- Genetic loading, family history, bipolar disorder type 1, substance abuse
  • Fluctuating mood episodes
  • No psychotic episodes
  • Described by others as temperamental, moody, unpredictable, inconsistent, and unreliable
  1. Bipolar Type 1: at least one manic episode
  2. Bipolar Type II Disorder: recurrent major depressive episodes with 1 or more manic or hypomanic episodes
  3. Bipolar differential diagnosis: * If onset of manic symptoms occurs

5 / 21 after age 40, most likely symptoms are caused by another medical condition

  • Medical conditions that mimic manic symptoms:

7 / 21 Clomipramine Non pharm TX - CBT, exposure therapy

  1. dissociative disorders: A defense mechanism that protects a person from overwhelming anxiety by emotionally separating

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  1. dissociative identity disorder (DID): the occurrence of two or more distinct identities in the same individual
  • sudden switch - caused by stress -gaps in recall History of severe trauma TX- anti-anxiety, antidepressants, antipsychotic if needed Non pharm TX- Psychotherapy, Hipnosis, protect them self harm
  1. depersonalization/derealization disorder: individuals feel detached from their own mind and body or from their surroundings
  2. Body Dysmorphic Disorder (BDD): obsession with some perceived flaw or flaws in one's appearance
  3. Hoarding Disorder: Persistent difficulty discarding or parting with possessions, regardless of their actual value
  4. Trichotillomania: hair pulling disorder- not in attempt to improve flaws
  5. Excoriation Disorder: Recurrent skin picking resulting in skin lesions
  6. suicidal ideation: Increases with age TX- Antipsychotic and sedative I am Tranquilizer with paranoia or catatonic Non-farm TX psychotherapy, restraints, seclusion, involuntary ER admission, TDO
  7. Schizophrenia: a psychological disorder characterized by delusions, hallucina- tions, disorganized speech, and/or diminished, inappropriate emotional expression -DSM >2 in 1 mo, And 1 must be psychosis
  8. Schizophrenia physical symptoms: Smooth Eye movements, clumsy, tics, mirroring, L/R confusion, dec reflexes, weakness
  9. dopamine pathways: involved with diseases such as schizophrenia and Parkin- son's disease Mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular
  10. Typical antipsychotics 1st gen: Blocks dopamine in mesolimbic pathway
  11. atypical antipsychotics: First line Serotonin and dopamine antagonist D2 receptor & 5HT2a
  12. Tardive dyskinesia (TD): a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

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  1. Neuroleptic Malignant Syndrome (NMS): A rare and sometimes fatal reaction to high-potency neuroleptic drugs. -Symptoms include muscle rigidity, fever >105 and elevated WBC HypoTN. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus. TX- Dantrolene or Parlodel, Benzo, Tylenol, IV fluid
  2. 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.
  • most in older ppl
  1. Dementia: a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes
  2. Namenda (memantine): Treat Alzheimer's (mod- sev) NMDA receptor antagonist,
  3. Aricept (donepezil): Treat Alzheimer's (mild - sev) acetylcholinesterase inhibitor
  4. Exelon (rivastigmine tartrate): Treat Alzheimer's and Parkinson's -reversible cholinesterase inhibitors -may see more improvement in later stages of illness -take with full meal; severe nv, weight loss -maximum 12mg/day; start slow
  5. Alzheimer's disease (AD): Decreased ACH the most common cause of major NCD, characterized by gradual deterioration of memory and personality and marked by the formation of plaques of beta-amyloid protein and tangles of tau in the brain
  • 65 yo

  • TX - Namenda, Aricept, Exelon
  1. vascular dementia: form of dementia caused by a stroke or other restriction of the flow of blood to the brain
  2. Lewy body dementia: A form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include visual hallucinations, momentary loss of attention, falling, and fainting. -Parkinson Features
  3. Autism Spectrum Disorder (ASD): a disorder that appears in childhood and is marked by significant deficiencies in communication and social interaction, and by rigidly fixated interests and repetitive behaviors TX- Focused on symptoms -Antipsychotics for aggression, self injury

11 / 21 -Antidepressants clonidine or stimulants for self injury or obsessive behavior Non-pharm TX behavioral therapy, OT, ST

13 / 21 jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience or witnessing

14 / 21 -acute <3 mo, chronic, delayed TX- SSRI, TCAs, alpha antagonist prazosin, antipsychotics for flashbacks, NO BENZOS Non-firm TX, CBT, exposure ther, ERP, support groups, relaxation ther, Eye move- ment desent

  1. Violence /abuse phnp concerns: * Interview victim alone
  • Assess living arrangements
  • Legal custody
  • Identify primary caregiver
  • Promote safety and medical wellness
  • Domestic violent shelter referral
  • Assist with developing safety plan
  1. Gender Dysphoria: * Significant disparity between one's expressed or experi- enced gender and assigned gender.
  • 6 for at least 6 months

  • Risk and prognostic factors
  • Environmental
  • Temperamental
  • Genetics and physiological
  1. Psychosomatic: condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress
  2. personality disorders: inflexible and enduring behavior patterns that impair social functioning *Difficult to estimate incidence since individuals with personality disorders are rarely hospitalized and often receive no treatment
  • Incidence depends on disorder
  • Guessed to be around 0.5% to 5.4% in the general U.S population
  • Risk factors
  • Genetic composition
  • Dysfunctional family of origin
  • Early separation problems
  • Neurobiological impact of trauma
  1. Cluster A disorders: * Patterns of pervasive distrust and suspiciousness, with odd and unusual behavior paranoid, schizoid, schizotypal
  2. Personality disorder treatment: * Focus on issues of limit-setting, protection from self-harm, improved coping, and enhanced

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  • Individualized symptom control
  • Impulsive behavior
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Anticonvulsant mood stabilizers
  • Mood instability
  • SSRIs
  • Anticonvulsant mood stabilizers
  • Anxiety symptoms
  • Non-benzodiazepine anxiolytics
  • SSRIs
  • Benzodiazepines are used with extreme caution
  1. Ego-syntonic: describes personality disorders, a person believes that their behaviour is correct
  • Individual usually fails to recognize problem
  • Individual does not seek treatment
  1. Ego-dystonic: the individual sees the illness as something thrust upon her that is intrusive and bothersome
  • Individual usually recognizes problem
  • Person usually seeks treatment
  1. Cluster B disorders: * Patterns of pervasive affective and interpersonal disrup- tion antisocial, borderline, histrionic, narcissistic
  2. Cluster C disorders: * Patterns of pervasive anxiety and fear avoidant, dependent, obsessive-compulsive
  3. Ethics In Managed Care: * Responsibility to disclose
  • Responsibility to appeal
  • Responsibility to treat
  • Responsibility to cooperate with utilization review
  1. parietal lobe problems: Lead to sensory-perceptual disturbances, agnosia
  2. Temporal lobe problems: can cause visual or auditory hallucinations, aphasia, and amnesia.
  3. Limbic system: Important in regulation and modulation of emotions and mem- ory
  • Hypothalamus

17 / 21

  • Thalamus

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  1. ADHD (Attention-Deficit Hyperactivity Disorder): extreme inattention, hyper- activity, and impulsivity before age 7 -* DSM- • Six or more (five or more if 17 years or older) of the symptoms must be present for 6 months
  • must be seen in two or more settings (e.g., home and school)
  • documented by parent, teacher, and clinician.
  1. PTSD DSM Criteria: 1+ s/s of re-experiencing/intrusive recollection, 3+ s/s of avoidance/numbing, and 2+ s/s of increased arousal/hypervigilance S/s last for 1 month or longer ** Specify if acute, chronic, or with delayed onset!
  2. ADHD risks and rating scale: Children undergoing extreme stress (divorce, illness, homelessness, abuse)
  • CONNERS rating scale
  • if psychosis- eval for bipolar d/o
  1. Schizophrenia Etiology: Enlarged ventricles, prenatal development issues, prefrontal cortex and working memory structures
  • Etiology
  • Neurobiological theory
  • Genetics
  • Neurodevelopment
  • Genetic defects
  • Intrauterine insults
  • Neurobiological defect
  • Abnormal brain structure- enlarged ventricles; smaller frontal and temporal lobes; cortical atrophy; decreased cerebral blood flow; hippocampal and amygdala reduc- tion.
  • Abnormalities causes altered neuronal communication- excess dopamine in mesolimbic pathway; decreased GABA; decreased serotonin; excess glutamate; decreased dopamine in the mesocortical pathway.
  1. Schizophrenia negative symptoms: an absence or lack of normal mental func- tion involving thinking, behavior, and perception. You might notice lack of pleasure, no follow through, flattening
  2. Schizophrenia positive symptoms: highly exaggerated ideas, perceptions, or actions that show the person can't tell what's real from what isn't. Here the word "positive" means the presence (rather than absence) of symptoms. They can include halls, delusions

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  1. Schizophrenia risk factors: • Low birth weight, maternal diabetes, older pater- nal age, and oxygen deprivation during delivery; famine maybe too