1
Q
What is the definition of a psychotic disorder? Examples (5)?
A
Def: thought disturbance, interruption of reality, potential for psychosis
Ex: schizophrenia, brief psychotic disorder, substance induced psychosis, delusional disorder, schizoaffective disorder
2
Q
What is schizophrenia?
A
the client has psychotic manifestations for at least 6 months that affect school/work, self-care, and relationships
3
Q
What is brief psychotic disorder?
A
the client has sudden psychotic manifestations that last 1-30 days (a “break”)
-usually precipitated by extreme stress
4
Q
What is substance induced psychosis?
A
increasing use of substances or total withdrawal of substances can produce psychotic manifestations
5
Q
What is delusional disorder?
A
- the client has non-bizarre delusions (most common is persecution)
- does not usually affect ability to function
6
Q
What is schizoaffective disorder?
A
-psychotic manifestations are a symptom of the underlying mood disorder such as bipolar or major depressive
7
Q
What are positive symptoms of schizophrenia/psychosis? (4)
A
- hallucinations (auditory or visual)
- delusions (belief system)
- paranoia
- bizarre behavior (not wearing clothes, walking backwards)
8
Q
What are negative symptoms of schizophrenia/psychosis? (5)
A
5 A’s
- affect (flat, withdrawn)
- alogia (no dialoging)
- avolition (no motivation)
- anhedonia (no joy)
- anergia (no energy)
9
Q
What is echolalia?
A
repeating your words back to you
10
Q
What is clang associations?
A
meaningless rhyming of words
11
Q
How can we stage a schizophrenic episode?
A
Prodromal: up to a year or more before 1st psychotic break
Acute: treatment is sought, during 1st break
Stabilizing: return to baseline
Maintenance: return to normal activities
12
Q
What nursing care priorities do we have for the schizophrenic patient? (4)
A
- safety: are they having command hallucinations
- maslow: are they physically stable otherwise
- milieu: may not be able to attend group
- reorient: address hallucinations, don’t agree, don’t argue
13
Q
What classes or meds would be used to treat a schizophrenic patient?
A
- 1st and 2nd gen antipsychotics
- anticonvulsants (no lithium)
- antidepressants (no MAOI)
- benzodiazepines
14
Q
What kind of symptoms do 1st gen antipsychotics treat vs 2nd gen?
A
1st gen: positive symptoms only
2nd gen: positive and negative symptoms
15
Q
What is a personality disorder?
A
def: characteristics that impact self-identity and relationships (usually use one of the maladaptive defense mechanisms)
16
Q
What is paranoid personality disorder?
A
CLUSTER A- WEIRD
“the world is out to get me”
-distrust and suspicious
17
Q
What is schizoid personality disorder?
A
CLUSTER A- WEIRD
- emotionally detached
- indifference to praise and criticism
- loner
18
Q
What is schizotypical personality disorder?
A
CLUSTER A- WEIRD
- odd belief systems
- eccentric
- magical thinking
- lack friends
19
Q
What is antisocial personality disorder?
A
CLUSTER B- WILD
- can be charismatic
- against all societal conduct norms/laws
- disregard for others
- criminal behavior is common
20
Q
What is borderline personality disorder?
A
CLUSTER B- WILD
- splitting (you’re either bad or you’re good)
- emptiness (risk for self-harm)
- mood swings are very intense
- fear of abandonment
21
Q
What is histrionic personality disorder?
A
CLUSTER B- WILD
- need to be the center of attention
- often flirtatious, seductive
- very emotional
22
Q
What is narcissistic personality disorder?
A
CLUSTER B- WILD
- arrogant
- need for admiration
- if they are at fault for something, blame others
- relationships with others are superficial, based on what others can do for them
23
Q
What is avoidant personality disorder?
A
CLUSTER C- WORRIED
- wants close relationships
- sees himself as socially inept
- avoids meeting people or all situations that require interpersonal contact
24
Q
What is dependent personality disorder?
A
CLUSTER C- WORRIED
- excessive need to be taken care of
- fear of abandonment
- inability to complete anything on their own
25
What is obsessive compulsive personality disorder?
CLUSTER C- WORRIED
- rigid perfectionist
- not efficient
- only one way to do it right
26
Which personality disorders do we have the biggest safety concerns with?
Borderline- self harm (cutting)
| Schizoid- risk of harm to others
27
What psychotherapies are most beneficial for personality disorders?
CBT- most helpful
| DBT (Dialectical Behavioral Therapy)
28
What are the four components of DBT?
mindfulness- living in the moment
interpersonal effectiveness- skills to achieve goals without damage to relationships
distress tolerance- learning to bear emotional pain by accepting self and current situation
emotion regulation- coping with negative emotions in a healthy manner
29
What are Extrapyramidal Side Effects? (4)
- dystonias (severe spasms of the tongue, head, and neck)
- akathisia (restlessness, pacing)
- parkinsonian symptoms (salivation, shuffling gait, tremor)
- tardive dyskinesia (involuntary muscle spasms of the face, AIMS assessment to detect early)
30
What is NMS?
Neuroleptic Malignant Syndrome (NMS)
- muscle rigidity
- high temp
- labile BP
- tachycardia, tachypnea
- diaphoresis
- drooling
* *treat with Dantrolene
31
What are anticholinergic side effects?
- blurry vision
- dry mouth
- constipation
- urinary hesitancy/retention
- sexual dysfunction
- tachycardia
32
What are the prototypes for 1st gen antipsychotics?
Haloperidol- high potency (acute)
| Chlorpromazine- low potency (maintenance)
33
What are the prototypes for 2nd gen antipsychotics?
Risperidone
| Olanzapine
34
What are the general side effects of 1st gen antipsychotics?
Life-threatening: agranulocytosis, NMS, dysrhythmias
EPS: dystonia, pseudoparkinsonium, akathisia, tardive dyskinesia
-Anticholinergic
-Orthostatic hypotension
-Sedation
35
What are the general side effects of 2nd gen antipsychotics?
less EPS, less agranulocytosis, no NMS
- metabolic syndrome (BIG weight gain)
- sedation may be increased
- orthostatic hypotension
- anticholinergic
- fine tremor
- sexual dysfunction
36
What is insulin?
- a hormone
| - facilitates glucose entry into the cell for conversion to energy
37
Where is glucose stored?
in the liver and muscle cells as glycogen
38
What is a normal blood glucose level?
70-110
39
What is type I diabetes?
- onset before age 30
- beta cells are destroyed
- insulin is not produced
- insulin dependent for life
* *type I has none**
40
What is type II diabetes?
- decreased production of insulin by beta cells
- cells stop responding to insulin
* *type II cells are through**
41
What are risk factors for type II diabetes?
- family history
- poor diet
- obesity (>25)
- sedentary
- hypertension
- ethnic groups
- waist size greater than 35-45
42
Manifestations of hyperglycemia?
- glucose >250
- polyuria
- polydipsia
- polyphagia
- fatigue/weakness
- vision changes
- slow healing wounds
- recurrent infections
43
Causes of hyperglycemia?
4 S's
- sepsis
- stress
- skip insulin
- steroids (prednisone)
44
Manifestations of hypoglycemia?
- glucose <70
- diaphoresis/clammy
- pallor
- dizzy
- confusion
- headache
- hunger
- sleepiness
- lack of coordination
- slurred speech
45
Causes of hypoglycemia?
- exercise
- alcohol
- insulin peak times
46
What glucose level would indicate a diabetes diagnosis?
>200
| normal 70-110
47
What fasting blood glucose level would indicate diabetes?
>126
| normal <100
48
What oral glucose tolerance test results would indicate gestational diabetes?
>200
| normal <140
49
What HbA1C would indicate diabetes?
>6.5%
| normal 4-6%
50
What are the common times to monitor blood glucose?
- before meals
- at bedtime
Other:
- two hours after meals
- during illness
- before, during, and after exercise
51
What are the 3 most common rapid acting insulin? Characteristics?
- lispro, aspart, and glulisine
- fastest peak and onset makes it the most deadly
- onset is 15-30 mins
- peak 30min-3hr
* *MUST BE EATING WITHIN 10-15 MINS**
52
What kind of short acting insulin? Characteristics?
- regular (how we cover finger sticks)
- clear
- onset is 30min-1hr
- peak 1-5hrs
* *ONLY INSULIN THAT CAN BE GIVEN IV***
53
What type of intermediate insulin is there?
- NPH
- cloudy
- onset 1-2hr
- peak 6-14hrs
* *ONLY INSULIN THAT CAN BE MIXED WITH REGULAR**
54
What are the two types of long-acting insulin? Characteristics?
- glargine and detemir
- onset 70 mins
- administered only once and acts for 24 hours
- does not have a peak
* *DO NOT MIX**
55
What is a biguanide? Action? Nursing?
Metformin
Action: reduces glucose production by the liver
Nursing: monitor GI effects, **MUST STOP 48 HOURS PRIOR TO AND AFTER IV CONTRAST DYE***
56
What are the sulfonylureas? Action? Nursing?
"-ides, -rides, -mides, -zides"
Types: glipizide, glimepiride, glyburide, glynase
Action: increases insulin release from the pancreas
Nursing: monitor for hypoglycemia, give 30 minutes before meals
57
What are 2 alpha-glucosidase inhibitors? Action?
- acarbose, miglitol
* *take with food**
- starch blocker- slows down the absorption of carbs in the intestine, resulting in lower post-prandial glucose levels
58
What is the gliptin? Action?
- sitagliptin
| - stimulates insulin release, lowers glucagon secretion, slows gastric emptying
59
What are the two meglitinides? Action?
- repaglinide, nateglinide
| - stimulates insulin release
60
What are the thiazolidinediones?
- rosiglitazone, pioglitazone
- Good for type II diabetes
- increases insulin sensitivity, transport, and utilization
* *HIGH RISK CHF d/t fluid retention
61
How do we mange hypoglycemia?
"Rule of 15"
- Give 15g of carbs (or 3-4 glucose tabs, 4 oz of juice or soda, 2-3 tsp of honey)
- Wait 15 mins (recheck blood glucose, if <70 then give 15 g of carbs)
- Recheck in 15 mins
62
What do we give a patient who is hypoglycemic who cannot swallow or is unconcious?
- SC or IM glucagon
| - 25-50ml of 50% dextrose
63
How do we manage hyperglycemia?
- encourage intake of fluids to prevent dehydration
- admin insulin
- restrict exercise when >250
- test urine for ketones
64
What are the sick day guidelines?
-take insulin/oral meds as usual
-test blood glucose/ketones every 3-4 hours
-drink water to prevent dehydration
Contact HCP if:
glucose >240
fever >101.5
disoriented/confused
rapid breathing
vomiting more than once
diarrhea more than 5x or more than 24 hours
unable to tolerate liquids
illness >2days
65
What is DKA?
Diabetic ketoacidosis
- bld glucose 300-800 (we try to get it under 240 initially)
- due to missed insulin or illness
- usually type 1s have this
* *MONITOR K LEVELS
66
What are the manifestations of DKA?
```
3 P's
rapid weak pulse
metabolic acidosis
fruity breath
kussmaul respiration
lethargic. comatose
orthostatic hypotension
```
67
What is HHS?
Hyperglycemic Hyperosmolar Syndrome
- bld glucose >600
- more common in type 2s
68
What are the manifestations of HHS?
- dehydration
- elevated BUN
- altered mental status
- NO KETOSIS
69
What causes BPH?
excessive accumulation of DHT stimulates overgrowth of prostate tissue
70
Where is BPH most likely to develop?
in the inner part of the prostate (prostate cancer is more likely in the outer part of the prostate)
71
What are the risk factors for BPH?
-aging (men 50+)
-obesity (esp waist)
-sedentary lifestyle
-high animal protein in diet
-alcohol
-ED
smoking
-diabetes
72
What are the manifestations of BPH?
- nocturia**usually the first symptom the pt notices**
- urinary frequency
- urgency
- dysuria
- bladder pain
- incontinence
- decreased force of urinary stream
- difficulty initiating stream
- dribbling
73
What does a DRE tell us?
estimates the prostate size, symmetry, and consistency
| **in BPH it is symmetrically enlarged, firm, and smooth
74
When would a TRUS be indicated?
Transrectal Ultrasound would be indicated if the client has an abnormal DRE and high PSA
75
What is a normal PSA?
0-4ng/ml
>10ng/ml indicates further testing
76
What conservative treatment options are there for BPH?
- decreasing caffeine and artificial sweeteners, limiting spicy or acidic foods
- avoiding decongestants or anticholinergics
- restricting evening fluid intake
- timed voiding schedule
77
What does an enzyme inhibitor do for BPH?
Finasteride- block the enzyme needed for conversion of testosterone to DHT
- reduces the size of the prostate
- can take up to 6 mos for improvement
78
What do alpha blockers (adrenergic receptor blockers) do for BPH?
Tamsulosin- promotes smooth muscle relaxation and facilitates urinary flow
**DOES NOT decrease the size of the prostate
79
What is a TURP?
Transurethral Resection
| -enlarged portion of prostate is removed through a resectoscope
80
What is the preoperative care for a TURP?
- insert a 3 way indwelling catheter (for continuous or intermittent irrigation for first 24 hours)
- admin antibiotics
- encourage 2-3L fluid intake
81
What is the postoperative care for a TURP?
- expect bloody urine
- monitor I&O
- bladder irrigation either manual or continuous CBI (drainage should be ideally pink and without clots)
- stool softeners and high fiber to prevent straining
- catheter care- tape tightly to the leg
- teach kegel exercises
- observe for signs of infection
- medicate for pain/bladder spasms
- encourage fluid intake 3L
82
What things can help relieve bladder spasms?
- check the catheter for clots
- instruct the client not to urinate around the catheter
- belladonna and opium suppositories can be used
- relaxation techniques
83
How to teach Kegel exercises?
- do them 10-20 times per hour
| - start and stop stream during urination
84
What are the three ways that prostate cancer can spread?
- through the lymph
- through the blood
- nearest tissues (seminal vesicles, urethral mucosa, and bladder walls)
85
What are the risk factors for prostate cancer?
- age (50 or older)
- african americans
- family history
- elevated testosterone
86
What are the clinical manifestations of prostate cancer?
- hematuria
- urgency
- nocturia
- retention
- interruption of urinary stream
- inability to urinate
87
What other things can elevate a PSA?
```
aging
BPH
recent ejaculation
consitpation
acute prostatitis
after long bike rides
```
88
What is TNM?
Tumor, Node, and Metastasis
Stage 1: neg DRE, neg imaging, no node, no met, PSA <10, gleason <6
Stage 2: pos DRE, pos imaging, no node, no met, PSA 10-20, gleason 6-7
Stage 3: cancer outside the prostate (seminal ves), no node, no met, PSA high, gleason high
Stage 4: yes node, yes met
89
What is the Gleason scale?
Grade 1 represents the most well-differentiated (lowest grade)
Grade 5 represents the most poorly differentiated cells (highest grade)
90
What is the grade group?
grades cells based on differentiation (1-5)
91
What is a radical prostatectomy?
entire prostate, seminal vesicles, and part of the bladder neck are removed
**not for advanced stage prostate cancer**
92
Postop care for prostatectomy?
- indwelling catheter (30ml balloon)
- surgical site drain
- inpatient for 1-3 days
93
What are the adverse outcomes of prostatectomy?
- ED (24 mos)
- Incontinence (first few mos)
- hemorrhage
- urinary retention
- infection, DVT, PE
94
What is radiation therapy for prostate cancer?
- 5 days/week for 4-8 weeks
- only used to treat if it is confined to the prostate
- side effects are: skin irritation, GI upset, urinary, sexual fxn, fatigue
95
What is hormone drug therapy for prostate cancer?
Androgen deprivation therapy
-reduces androgens to reduce tumor size
-can be used before surgery or radiation, and in advanced disease
EX: leuprolide
96
How and where do we administer IM injections?
- 90 degree angle, 1-1.5in needle 23-35g
- 0.5-1ml for deltoid, 3-5ml for bigger site
- vastus lateralis (anterolateral thigh), ventrogluteal (lateral hip), deltoid (upper arm)
97
How and where do we administer SC injections?
- 45-90 degrees, 3/8-5/8in needle 25-27g
- 0.5-1ml is normal
- abdomen, upper arm, thigh, love handle, back
98
How and where do we administer ID injections?
- 15 degrees, very short needle, 26-28g
- 0.1ml is normal
- lower arm, chest, upper back
* DO NOT massage site or put a bandaid on it
99
What is altruism?
the stressor is dealt with by meeting the needs of others
| ex: a woman who lost her husband volunteers doing grief counseling for others
100
What is sublimation?
the person substitutes something constructive and socially acceptable for strong sexual or aggressive impulses
ex: aggressive man chooses to become a butcher
101
What is suppression?
the person consciously denies the stressor
| ex: I cant worry about paying rent until after my exam tomorrow
102
What is repression?
the person UNconsciously excludes stressor from their awareness
ex: forgetting trauma
103
What is reaction formation?
unacceptable behaviors/feelings are kept out of awareness by developing the opposite behavior or emotion
ex: a person who hates children becomes a boy scout leader
104
What is projection?
the person UNconsciously rejects negative features of themselves and instead attributes it to other people, objects
ex: blaming, scapegoating, prejudice
105
What is splitting?
the person cannot integrate positive and negative qualities of others
ex: people are either all good or all bad
* *boarderline especially do this
106
What is displacement?
transferring feelings about one thing to another thing that is nonthreatening
ex: man hits his wife, wife yells at kid, kid kicks the cate
107
Laws regarding restraints?
- use the least restrictive restraint (verbal, chemical, then mechanical)
- can only be for 4 hours before renewing prescription with a maximum of 24 hours
- can be put on without a prescription if emergency, but one must be written within 1 hour
- assess and document every 15-30 minutes
NUR150
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