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Nursing 4 exam 1

What is Thorazine used for and what class of medication is it?
What is the Parity law? States that mental health shall be reimbursed the same as any other illness.
What are challenges to mental health? Stigma, HMO's, Neglected populations, technology, pharmacology, delivery system
What are the neglected populations? Childern and the elderly.
Why are HMO's a challenge to mental health? They determine who gets care and what care they get.
What is meant by stigma? The view of being outside what is considered normal. Also thought of as devient.
What was the most significant advancement of the decade of the brain? The understanding that each mental illness has a physiological component.
What is the CMHC act of 1963? Community mental health center actstated that no more institutions shall be built. Each community shall care for those with a mental illness in their community.
What are the two continuums of mental health? 1: Adaptive to maladaptive; 2: constructive to destructive (defences).
In the DSM IV, what is defined in Axis I? Primary psychological disorder diagnosis (Clinical disorder) involve poor decision making.
In the DSM IV, what is defined in Axis II? Personality disorders
In the DSM IV, what is defined in Axis III? Any medical condition
In the DSM IV, what is defined in Axis IV? Any recent stressor
In the DSM IV, what is defined in Axis V? Global assessment of Functioning (GAF)
What are the 4 characteristics of mental health? Self Esteem; Open, flexible attitude toward life; Minimal nervous tension and anxiety; Effective coping skills and problem solving abilities.
What is meant by categorizing mental illness? Classifying and defining specific mental disorders (disorders, not people) and each defined entity classifies behaviors or syndromes that result in distress or disability.
Define Primary prevention: Patient does not have a problem and actions are taken to prevent a problem from occurring.
Define Secondary prevention: Patient does have a problem and action is taken to return the patient back to no problem and prevent irreversible damage.
Define Teriary prevention: Patient does have a problem and actions are taken to bring the patient back to optimal level of functioning.
Define Crisis: A time limited event resulting in a state of disequalibrium where all previous coping mechanisms have failed.
What are the three types of crisis? 1. Situational; 2. Maturational or developmental (aging, marriage, ...); 3. Adventious (Global ex: 911, Newtown ...)
What is the effect if maturational and situational combine? The effect is greater then 2 fold.
In mental health, how is most care provided? By a team.
What is the role of the psychiatric nurse?
What are ethics? The understanding of how we should act.
What is autonomy? The ability to make decisions of ones own care with informed concent (if compitent)
Define compitent: Can understand choices that are presented to them.
What is the Patients Bill of Rights? The legal aspect that protects the patients civil rights, right to concent, right to communicate with the outside, freedom from harm, dignity & respect, confidentially, participation of the treatment plan.
What is a voluntary admission? Patient desires to get help and poses a danger to self or others.
What is an involuntary admission? Patient is admited against their will (most restrictive) by the decision of a psychiatrist and must go before the mental health court within 10 days.
How can a patient with a mental illness be released from the hospital? Voluntary admit: Filing an ITL form; Meeting the NOC and Goals.
How does the ITL work? Patient can fill out an Intent To Leave form requesting to sign out but can be held for an additional 24 hours or one business day for re-evaluation (determine if they need to changed to an involuntary admit)
What is Parens patriae? When a judge determines for the patient that they must take their medication.
What is most important to consider when selecting a treatment plan? It needs to be the least restrictive alternative that is likely to be successful.
What are the considerations for a patient to refuse treatment? They must be compitent, and not under a court order for the treatment.
What is informed concent? The patient must be presented with the different treatment options, the risks and benefits of each, be compitent and then agree to the treatment.
What is implied concent? When a patient can not make the decision due to incompitence, lack of conscousness, or court order.
What is the order of restrictiveness for restraint or seclusion? 1. verbal; 2. Chemical; 3. Physical
Define Assult: Threat to do harm
Defime Battery: Doing harm
Define False imprisonment: Restraint without the patients concent or court order.
Define punitive damages: A financial penalty
What are the factors of negligence? 1. Duty (standard of care); 2. Breach of duty; 3. Cause and proximate cause; 4. Damages
What are exceptions to confidentiality? Duty to warn: A specific threat to a specific person
What is the purpose of a Psychiatric Assessment? 1. Current level of functioning (GAF); 2. Establish trust; 3. Assess coping skills; 4. Develop a treatment plan.
What are the parts of the Mental Status Exam? Appearance, Behavior, Speech, Mood, Disorders of thought, Perceptual disturbances, Cognition, Ideas of harming self or others
Define Delusion: Disorder of thinking - a fixed false belief that can not be corrected.
Define Hallucination: A perceptual disturbance - False sensory perception of any of the senses.
What is the most commonl overlooked part of psychiatric assessment? Culture
Why is culture relevent in mental health? Cultural norms, normal in one culture may be deviant in another.
What is Writ of habeas corpus? Formal written order to free the person.
The statement of the problem is really defining the patients what? The unmet need
An outcome Criteria should have what 5 characteristics? 1. Measurable or observable; 2. Client specific; 3. Time limited; 4. Stated clearly with brevity; 5. Positively stated.
Nursing interventions have 4 characteristics, what are they? 1. Safe; 2. Appropriate; 3. Effective; 4. Individualized.
What are the three possible measurements for the outcome goal? 1. Goal met; 2. Goal partially met; 3. Goal not met.
What type of relationship should the nurse-patient relationship be? Therapeutic - Focus is on the patient
Focusing on the patient growth and behavioral change, even if it is not accomplished, is part of what? The therapeutic relationship.
Why is it important to have therapeutic boundaries? Because people do best when they know what to expect.
The characteristics of a therapeutic relationship are: Boundaries, Empathy, Genuiness, Positive regard.
What are the three phases of the Nurse-Client relationship? 1. Orientation; 2. Working; 3. Termination
What is the major goal of the orientation phase? Establishing trust with the patient.
During the working phase, along with goals and problem solving, you also want to do what? Promote self esteem
During the termination phase, what is evaluated? Therapeutic outcomes, status of the goal (Met, Not met, Partially met), Patient's feelings, Nurse's feelings.
Therapeutic communication encompases: Genuiness, Empathy, Problem solving, focus on the patient, and following through with commitments that are made.
What are the six elements of communication? 1. Stimulus (Referent) reason to communicate; 2. Sender; 3. Message; 4. Channel (Medium); 5. Receiver; 6. Feedback.
What is the most important element of communication? Feedback
90% of communication is: Nonverbal - communication behaviors
The goal of the interaction of verbal and nonverbal communication is: to achieve congruence
What factors influence communication? Perceptions & stereotypes, personal space, values, emotions, clarity, timing, and relevance
Listening, offering self, open communication, use of silence, clarification, presenting reality, and feedback are all part of what? Therapeutic communication
Non-therapeutic communication includes: Why questions, Giving advice, minimizing feelings, stereotypical comments, and giving approval.
Assessing the nature of hallucinations or delusions means: Is it a danger to self or others.
When communicating with a patient with hallucinations you want to: Assess the nature of it, reduce anxiety, offer self, present reality, do not argue, provide structure (distraction individualized).
When communicating with a patient with delusions you want to: Assess the nature of it, reduce anxiety, promote safety, present reality, do not argue, provide structure (distraction individualized)
What is terminal language? The use of Always and Never
Instead of terminal language, you want to: Use supportive language
When documenting a patients behavior you should: Describe the behavior as accurately as possible.
When documenting something that was said you should: Use quotes when possible.
Any documentation should: Avoid labels or judgements and be done with clarity & brevity.
All charting should be done according to: The treatment plan.
Define an addiction: The loss of controll over a substance with a tendency to relapse. Also it interferes with the level of functioning.
Intoxication is: The development of reversible substance syndrome resulting from the effect on the CNS shortly after use.
Tolerance is The need for increased amounts of the substance to produce the same or desired effect.
Withdrawal is: The development of substance-specific syndrome upon cessation or reduction in heavy prolonged use.
Abuse and Dependence: See slide page 3.
Synergistc effects are: Combining 2 drugs resulting in an effect greater than either drug alone.
Antagonistic effects are: Combining 2 drugs to weaken the effect of either of the drugs.
Which leads on an EKG represent an Inferior Wall Infarct? II, III, & AVF
Which leads on an EKG represent an Lateral Wall Infarct? I, AVL, V5, & V6
Which leads on an EKG represent an Anterior Wall Infarct? I, AVL, V1 - V4
Which leads on an EKG represent an Posterior Wall Infarct? V1, V2 (Tall R wave with ST depression)
What EKG changes are associated with Acute MI (Ischemia) Inverted T wave
What EKG changes are associated with Acute MI (Acute injury) ST Segment elevation
What EKG changes are associated with Acute MI (Infarction) Q wave
What is a transmural infarct? Injury to all three layers of the heart (STEMI)
What is a Non-transmural infarct? Injury to only one or two of the layers of the heart (Non-STEMI, Non Q wave MI)
What is Prinzmental Angina? CP at rest or sleep &/or coronary artery spasm.
What Rx do you use for Prinzmental Angina? Calcium channel blockers & nitrates
What is used for continuous monitoring of the blood pressure? An A-line
What Rx is used for an NSTEMI? Antiplatelet IV therapy
Where does the graft for a CABG usually come from? Safitin vein
For PTCA/Stents, what % blockage must the vessel have? 80%
For Coronary artery disease, what Rx options might be used? MONA (Morphine, O2, Nitro, ASA), Heparin, Beta blockers, ACE inhibitors
Following a cardiac cath, what do we have the patient do? Bedrest 4-24 hours, Supine if femoral insertion site, not flexing the insertion site, Maintain until ACT reaches approx 150.
What labs do we want to check prior to a cardiac cath? BUN, Creatinin, INR, PTT, H&H, platelets, electrolytes
How o you measure the Ejection Fraction? With a TEE
Normal ejection fraction is 50% - 75%
What is cardiogenic shock? Impaired ability of the heart to function as a pump (severe left ventricle failure)
What is Dresser's syndrome? Pericarditis post MI, fever, CP, dyspnea, EKG changes, CP worse with thorasic movement and deep breath
What is the Tx for Dresser's syndrome? NSAIDS &/or Corticosteroids
What is Cardiac Cripple Syndrome? Pt resists resuming ADLs due to anxiety, fear of death, & disability
What is a Thromboemboli? Thrombus formation in the left ventricle which may lead to systemic circulation.
What is ICU Psychosis? Confused, personality changes, fear of death, sleep deprivation, death.
What is Wernicke-Korsakoff syndrome? An irreversible condition from long term alcohol use caused by Thiamine (vit. B1) deficiency.
What are S/S of Wernicke-Korsakoff syndrome? Progressive mental deterioration, peripheral neuropathy, paralysis of ocular muscles, cerebral ataxia, myopathy, confusion, memory loss, confabulation, somnolence, stupor, death.
What is cardiac rehabilitation Phase I? Disease management, education, activity progression, low level exercise.
What is cardiac rehabilitation Phase II? Discharge to home/community with supervised exercise program.
What is cardiac rehabilitation Phase III? Maintenance; Focus on resuming normal lifestyle.
What is the oal of cardiac rehabilitation? Limitation of potential adverse psychological consequences of CVD.
1g of salt has how much Na? 400mg
No added salt means: 4g Na diet
All salt eliminated from cooking means: 2g Na diet
Salt substitutes contain what? Potassium
Pericardium normally contains ow much fluid? Approximately 20 - 30mL
Define pericardial effusion: When the pericardial sac fills to a point such that it can no longer expand.
What is pericardial (cardiac) tamponade? WHen the pericardial sac starts to apply pressure on the heart and reduces the efficiency of the heart.
What is pulsus Paradoxsus? When the pressure gradient between the right atrium and right ventrical increases which decreases the SBP with inspiration.
What is the Tx for pericarditis? Bedrest, NSAIDS, ASA, Motrin, sometimes steroids, abx if bacterial.
What tests are used to Dx pericarditis? Echocardiogram, CXR, EKG, CT scan, Cardiac MRI
What is the pulse pressure in pericardial tamponade? < 30mmHg
What is Beck's triad? Decreased BP, Invreased CVP, & Muffled heart sounds.
Pericardial tamponade nursing care includes: Have pericardiocentesis available, monitor VS, Administer meds as ordered, low fowler's, EKG, monitor telemetry, monitor for Kussmauls sign, monitor for JVD.
What are some causes for cardiogenic shock? MI, dysrhythmias, severe CHF, cardiac tamponade, cardiomyopathy, spontaneous damage to heart valves.
Rx management for cardiogenic shock includes: Vasopressors: Dopamine & Dobutamine; Alpha adrenergic stimulators: Norepinephrine; Vasodilators: Nipride & NTG IV
Define Thorasic Aorta Dissection: A tear in the intimal lining allowing blood to get between intima and media layers (in a false lumen)
S/S of Thorasic Aorta Dissection: Sudden severe pain in the anterior part of the chest described as ripping or tearing and may mimic an MI.
Define Preload: The amount of blood that fills the ventricles during diastole.
Afterload and Preload are reduced by: Drugs that dilate such as Lasix, Morphine Sulphate, and nitrates.
Afterload and Preload are increased by: Drugs that constrict such as Dopamine & Epinephrine
Define Afterload: The force that the ventricles must overcome to eject blood through the valves.
Thiazides are what type of drug? Diuretic
What is the function of Thiazides? Inhibits NA/CL transprot pumps in distal tubule of the kidney. Used for Hypertension.
What thiazide drug do we need to know? Hydrochlorothiazide (HCTZ)
What do Beta-blckers do? Blunt the effect of catacholamines, reduce HR, decrease cardiac output, decrease the work of the heart, decrease contractility.
What is Carvedilol (Coreg) used for? Used specifically for patients with Heart Failure and Systolic dysfunction. (Thought of as a beta blocker)
What are the two types of calcium channel blockers? Dihydropyridines and Non-Dihydropyridines
Dihydropyridines include: Amlodipine, Felodipine, Nifedipine, Nicardipine
What is the effect of Dihydropyridines? Decrease BP
What is the effect of Non-Dihydropyridines? Decrease HR, BP, and CO
What are some common side effects of calcium channel blockers? Edema and headaches
Non-Dihydropyridines include: Verapamil & Diltiazem
ACE Inhibitors are used for: HTN, CHF, post-MI, low EF <50, Anterior MI, Pulmonary congestion. Must give within 24 hours of a STEMI.
Angiotensin II Receptor blockers the 'sartan' medications (Candesartan=Atacand)
What class of medication is Natrecor? B-type naturetic peptide (BNP)
The effectsof Natrecor are: Arterial and venus ilation, decreased wedge pressure, increased cardiac output, increased O2 demand.
What is Natrecor used for? Acutely decompensated CHF.
What are some nursing concerns of Natrecor? VS qh, monitor for hypotension
What is Heparin SQ used for? Only for DVT
Lovenox Antithrombin, insystem for 24 hours, less bleeding than heparin.
Plavix Oral antiplatelet, used to prevent vascular ischemic events.
Pradaxa (dabigatran) anticoagulant, no antidote, does not require regular blood work like coumadin.
Xeralto (rivaroxaban) Anticoagulant, Reduce risk of stroke and systemic embolism in patients with non-valvular A-fib.
What does stenosis mean? A problem with the forward flow of blood.
Primary cardiomyopathy is caused by: Unknown cause
Secondary cardiomyopathy is caused by: Viral, bacterial, metabolic, or pregnancy
Thromboembolytic agents are used for: MI, must be started within 4-6 hours of onset of Sx.
What is the effect of Thromboembolytic agents: Restores blood flow, limits myocardial damage, preserve left ventricle, prevent death, dissolves clots, reperfusion of myocardium.
What are some nursing interventions for Thromboembolytic agents? Minimize risk of bleeding, direct pressure for 20-30 minutes of any puncture sites, monitor for occult blood, neurochanges, slurred speech, lethargy, hypotension, tachycardia, gross hematuria.
What are the effects of morphine? Reduces O2 demand, releives anxiety, promotes vasodilation (decreases HR, BP, & Respiratory rate)May be used as Tx for MI.
Demerol Atropine like effect, increases HR. Not for use with MI, increases workload of the heart.
Created by: brian.belson