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