VUSN HEHI Study Guide
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | Impulsivity
Hopelessness
Substance abuse
History of abuse during childhood
Head injury, chronic illness
Monday
Late spring/early summer
Acute- anxiety, insomnia, substance abuse
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| show | Primary- Preventing individuals from every considering suicide by improving social supports
Secondary- recognizes and treats immediate suicide risk
Tertiary- care provided to at risk individuals who display suicidal tendencies/behaviors
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| show | Psychosocial- therapeutic relationship, reaffirm hope
Resources- use the client's personal protective resources (history, social supports, PCP, effective coping skills)
Pharmacological- SSRI's, ECT...
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| A client would be deemed inappropriate for outpatient treatment for suicidal ideation if... -Intact support system -Unable to control impulses -Uses alcohol -Has history of seeking help -Suicide attempt -Lives alone -Low levels of stress | show 🗑
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| Suicide: It's about the (_______) not the (_____)! | show 🗑
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| show | 1) Mental illness
2) ETOH/drug use
3) Being overwhelmed
4) Control
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| One neurobiological theory of the etiology of suicide finds that this neurotransmitter tends to be lower in individuals who have attempted or completed suicide than in those who have not. | show 🗑
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| When assessing a client, what direct signs and symptoms should indicate that your client may be a suicide risk? | show 🗑
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| show | Sudden behavioral changes
Unexplained physical changes (weight loss, pain, sleep disturbances)
Emotional alterations (ambivalence, irritability)
An extreme loss has occurred
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| show | Sex (male)
Age (<19 or >45)
Depression
Previous attempts
ETOH/Drugs
Rational thinking loss
Social support lack
Organized plan/serious attempt
No spouse
Sickness
0-5 D/C w/ follow up
6-8 Psychiatric consultation
8+ Hospitalization
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| When assessing the potential lethality of a suicide plan, what would be considered "hard"? Soft? Why? | show 🗑
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| Hospitalized patients may require certain suicide precautions. Explain 1:1, safety observation, and seclusion/restraint and when each is appropriate. | show 🗑
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| T/F- You cannot discharge someone on suicide precautions. | show 🗑
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| show | Typical: Anxiety that aids in the work of living
Mild-Moderate: Psycho-physiologic factors affecting medical conditions
Moderate-Severe: Anxiety, personality, eating, dissociative disorders.
Psychosis: Depressive Bipolar Schizophrenic Cog. disorders
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| show | Preventative treatment- Attending AA groups for addiction, learning new coping skills
Maintenance intervention- Receiving ECT or taking your meds regularly
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| show | Provides diagnostic characteristics and categories used in the classification of mental disorders. Significant interference in person's life, doesn't meet other criteria, time criteria, not due to substance abuse or other medical condtition
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| Discuss legal guidelines for safe practice as they relate to treatment and hospitalization of the mentally ill person. | show 🗑
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| show | False- 1/3 American adults will meet the diagnostic criteria for a mental disorder in their lifetime.
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| You are more likely to develop this mental illness in your life-time if a family member also suffered from this. -Bipolar -Schizophrenia -Panic -Generalized Anxiety -Depression | show 🗑
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| show | Identify the illness correctly
Decrease the time of active illness
Halt the progression or severity
Decrease the likelihood of relapse (tertiary treatment)
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| What are the classification differences between DSM 4 and 5? | show 🗑
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| Describe the difference between Voluntary, Involuntary, Observational and Indeterminate inpatient admissions. | show 🗑
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| T/F- Most psychiatric inpatients do not receive therapy. | show 🗑
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| Describe Short-term focused therapy, Interpersonal therapy, Supportive therapy, Behavioral therpy, and Cognitive therapy. | show 🗑
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| What is the difference between a Milieu group and a Self-help group? | show 🗑
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| show | Attends to stimuli
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| What is the primary function of the Temporal lobe? | show 🗑
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| What is the primary function of the Frontal lobe? | show 🗑
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| If your frontal lobe is not functioning properly, you can expect... If the frontal lobe is working slowly you can expect... | show 🗑
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| show | regulate and mediate motor activity, help express and regulate emotions and cognition
Use dopamine to control motor activity (if block too much dopamine with schizophrenia treatment, can lead to motor movement complications like Parkinson's.)
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| Where are the highest concentrations of dopamine found? | show 🗑
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| What is the Limbic system? What are it's part? | show 🗑
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| What is dopamine? What does it do? You can expect increased levels in this mental illness and decreased levels in these. | show 🗑
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| What is norepinephrine (NE)? What does it do? You can expect decreased levels to contribute to _____ and increased or overactivity to contribute to _________. | show 🗑
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| show | A neurotransmitter that, similar to norepinephrine, is a general modulator with multiple roles. Can be excitatory OR inhibitory.
Underactivity- depression
Overactivity- anxiety
May play a role in psychosis.
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| show | A neurotransmitter excitatory or inhibitory. effects MEMORY, muscle coordination, some mood regulation, and has many effects in the peripheral nervous system (blocked, anticholinergic effect)
Underactive- Alzheimers, Parkinsons
Overactive- depression
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| What is GABA? What does it do? You can expect decreased GABA activity to lead to ______. | show 🗑
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| show | An EXCITATORY amino acid that affects learning and memory and helps relay sensory information.
Decreased is associated with schizophrenia.
Increased is associated with improvement in dementia
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| show | Part of the stress response, secreted by Hypothalamus leading to pituitary release of corticotropin which stimulates adrenal glands lead to release of cortisol.
Too much?- Depression and anxiety
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| If a patient is taking Beta Blockers or Antihypertensives, it is important to know that they may exhibit _______- symptoms. | show 🗑
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| show | Similar to seizures, dysregulated neurotransmitter systems lead to more frequent and more intense episodes of illness (schizophrenia) with less required stimulation because the affected cells recruit surrounding cells.
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| Why is chronic, uncontrolled stress such a problem for neurotransmitters? | show 🗑
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| There is a genetic predisposition to schizophrenia. Describe it and how stress can contribute. | show 🗑
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| Describe the relationship between schizophrenia, dopamine, and frontal lobe activity. | show 🗑
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| Describe how associated neurotransmitters are affected in schizophrenia. | show 🗑
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| show | Small frontal lobe (hypofrontality) with enlarged ventricles on MRI, Temporal lobe is overactive causing abnormal movements and information processing, Memory is impacted
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| Describe the (+) symptoms of schizophrenia. | show 🗑
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| What is a hallucination? Most common type? | show 🗑
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| What are delusions? Types? | show 🗑
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| show | 5 A's
Affective flattening
Alogia- impoverished thinking
Anhedonia- inability to experience pleasure
Attentional impairment
Avolition- lack of energy
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| What are some common cognitive symptoms of schizophrenia? | show 🗑
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| There are 4 symptom groups or domains of Schizophrenia which may need to be targeted. Name them | show 🗑
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| show | Restricted/constricted
Blunt- sever restriction
Flat
Inappropriate
Labile- extremes
Aggressive
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| What is schizophrenia? | show 🗑
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| show | 50% attempt suicide with 10-15% success
Highest risk for males <30, college education, unemployed, recently hospitalized and history of depressive episode
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| show | True b/c women develop around 25 whereas men develop around 15. Women have more time to develop better coping skills> better outcomes
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| show | False- likely but because they are trying to have a social group
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| show | Prodromal- before active phase (up to 1 year) with gradual development of symptoms/loss of social skills
Acute- Full blown schizophrenic episode
Residual- lingering affective flattening (negative symptoms more common), may be interrupted with active
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| show | 2 or more within one month
-Delusions*
-Hallucinations*
-Disorganized speech*
-Grossly disorganized/catatonic behavior
-Negative symptoms (5A's)
-Dysfunction in major life areas
(must include one of first 3)
Duration >6mos cont. signs
>1mo sympt.
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| show | (Paranoid
Catatonic
Disorganized
Undifferentiated
Residual)
Symptom severity level, #symptoms, Duration symptoms, Course of illness
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| show | 2+ Characteristic symptoms present
Episode (including prodromal, active, and residual) lasts at least 1 month but less than 6 months
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| show | Meets criteria for schizophrenia and depression/bipolar at same time. Major mood episode present for majority of duration, 2+ weeks of delusions/hallucinations w/o mood symptoms
Mood symptoms present for most of active/residual periods of illness.
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| What is a delusional disorder? When does is occur? What are the 5 subtypes? | show 🗑
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| When treating a patient with Schizophrenia, it is important to... | show 🗑
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| show | Extrapyramidal side effects (^motor activity)
Anticholinergic side effects (see, pee, spit, poop)
Cardiovascular effects
Potential toxicity
Weight gain
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| show | Oocyte ovulated-> fertilization by sperm-> Zygote formation-> Morula -> Blastocyst (implants in the uterus) -> Embryo (first 8 weeks)-> Fetus
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| Describe development, structure, and functions of the placenta. | show 🗑
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| Describe amniotic fluid and its corresponding functions. What is it called if you have too little? Too much? | show 🗑
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| Describe the development of the fetus and embryo. | show 🗑
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| T/F- The Umbilical Cord has pain receptors which is why babies go into distress if it becomes knotted. | show 🗑
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| show | Early conception, weeks 0-3
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| show | Weeks 3-8
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| An embryo is most likely to have functional disturbances during this time. | show 🗑
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| show | End of 4 weeks (One month)
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| At this time, the baby is 1-1/8 inch long, has a functioning heart, eyes,nose, lips, tongue, ears and teeth are forming, penis is developing and baby is starting to move (but you can't feel it yet). | show 🗑
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| show | End of 12 weeks (Three months)
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| show | End of 16 weeks (Four months)
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| show | End of 20 weeks (Five months)
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| At this time, the baby is 11-14 inches long, weighs 1.75-2 lbs. Eyelids part and eyes open sometimes. Skin covered in vernix (petroleum jelly substance). Baby can hiccup/ | show 🗑
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| At this time, the baby is 14-16 inches long, weighs 2.5-3.25 lbs. Taste buds there, fat layers forming, organs maturing, skin wrinkled and red. Premature. Size of butternut squash. | show 🗑
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| At this time, the baby is 16.5-18 inches long, weighs 4-6 lbs. Growth is RAPID. Brain grows. Most organs developed EXCEPT lungs, kidneys good. Kicks are visible! Skin less wrinkled. Fingernails beyond fingertips. Cabbage size. | show 🗑
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| show | End of 36 weeks (Nine months)
37 weeks is full term.
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| When does the respiratory system develop? | show 🗑
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| When does the cardiovascular system develop? What is an appropriate Fetal Heart Rate? | show 🗑
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| Explain the umbilical cord and it's function/ | show 🗑
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| What are the fetal circulatory adaptations? Describe each. | show 🗑
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| show | 4-6 weeks starts, fully after birth
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| When are the bones and muscles developing? When does the fetus start to have arm/leg movements? What is a fontanel? | show 🗑
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| When does the GI system form? What is an Omphalocele? Meconium? | show 🗑
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| When do the kidneys form? Function? | show 🗑
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| show | Forms during 3rd week
Respiratory 18.5 weeks
Swallowing 12.5 weeks
Sucking 29 weeks
Quickening- 16-20 weeks
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| show | 20 weeks
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| show | Time since last menstrual period.
Ability to survive outside of uterus at the earliest gestational age 22-24 weeks depending on maturity of CNS and lungs
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| What does EDC< EDD< and EDB mean? | show 🗑
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| When should a baby be born? | show 🗑
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| Why does a fertilized ovum stay in the Fallopian tube for 3 days? | show 🗑
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| T/F- Two arteries carry oxygenated blood and nutrients while one vein carries deoxygenated blood and waste products. | show 🗑
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| What is the purpose of the placenta? | show 🗑
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| show |
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| Discuss nursing responses to common discomforts of pregnancy. | show 🗑
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| When can a pregnancy test tell if pregnant? how dies it work? | show 🗑
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| What is included in Presumptive evidence of pregnancy? | show 🗑
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| What are probable signs of pregnancy? | show 🗑
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| show | 5-6 weeks vaginal ultrasound
6 weeks Fetal Heart Tones by ultrasound
16 weeks, ultrasound
17-19 weeks, Fetal heart sounds by fetoscope
19-22 weeks, fetal movements
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| show | Obtain fetal heart tones to ensure pregnancy is real
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| What is GPTPAL? | show 🗑
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| What is the GTPAL of Amelia. She has one spontaneous abortion, one elective abortion, one C-section, twins at 29 weeks, still birth at 36 weeks and is currently pregnant. | show 🗑
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| show | Used to tell you the due date. First day of last menstrual period, subtract 3 calendar months, add 7 days.
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| show | Decrease production of prostaglandin which causes smooth muscle to relax and prevent uterine constriction. Also relaxes vessel walls (potential for hypotension)
Affect uterus, cervix, vagina, vulva
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| A pregnant woman presents to your office complaining of "nipple lumps". These may be... and you tell her... | show 🗑
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| During pregnancy, the cardiovascular alterations mean that there is ___ flow and ___ resistance and it is hyperdynamic. What happens to BP during pregnancy? | show 🗑
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| show | Single- 1200-1500 mL
Twins- 2000 mL
4-6= 11% increase
32= 40-45% increase
2 weeks post=33% decrease
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| show | Your RBCs increase by 20-30% while your plasma increase by 40-45% which dilutes the Hematocrit and leads to decreased blood viscosity. Totally normal. Hematocrit of normal pregnant woman is 34.7 (as opposed to 38.2 nonpregnant)
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| show | Not to worry, it is normal for a HR to increase by 10-15 bpm during pregnancy.
Stroke volume also increases 25% by 20-24 weeks and 50% by term
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| Normal non-pregnant CO is about 5 liters per minute. What is a normal pregnant CO? In what position should a woman sleep to ensure optimal cardiac output? When does a woman have low CO | show 🗑
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| show | Kidneys have 30% increase
Uterus has 50mL/min at 10 weeks and 500 mL/min at term
Skin gets extra CO
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| show | False- pregnant women actually have an increase in clotting factors and are hypercoagulable with puts them at risk for DVT This is great for delivery to prevent woman from bleeding to death. Note: Assess for DVT and add heparin to saline locks
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| show | -Diaphragm is pushed up
-Ribs do flare
-APL ratio INCREASES
-RR may increase slightly
-Tidal volume does increase
-Lung capacity is UNCHANGED or slightly DECREASED
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| show | BMR increases 10-20% by 3rd trimester due to increased O2 demands and consumption
Pregnant women are heat intolerant, have peripheral vasodilation, sweat more, are tired easily and need more sleep
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| T/F- Slight respiratory alkalosis is typical for pregnant women. | show 🗑
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| show | False- levels should decrease due to increased perfusion and GFR
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| Why are pregnant women more susceptible to UTI? | show 🗑
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| T/F- Glucose in the urine during pregnancy always indicates diabetes. | show 🗑
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| A pregnant woman presents with blotchy, brownish hyperpigmentation of tthe skin over her cheeks nose and forehead. you recognise this as... | show 🗑
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| show | Pigmented line that extends from the fundus to the symphysis pubis. Totally normal
Stretch marks, common in 50-80% of pregnant women
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| show | This is common in 50-90% of women, caused by estrogen, HCG and relaxation of smooth gastric muscle. Usually resolves by 12-16 weeks but peaks around 8-12 weeks
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| show | True b/c decreased gastric emptying allows for increased absorption of water from intestines
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| T/F- The liver maintains its normal size, histology, blood flow and function in pregnancy but has some mechanical displaement | show 🗑
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| show | 1st trimester
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| In what trimester should you screen for fetal phenotype abnormalities and monitor maternal/fetal health. This is also when you do gender screening and anatomy ultrasound | show 🗑
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| In what trimester should you monitor for pregnancy-induced hypertension as well as monitor fetal health? You will also do diabetes testing, GBS testing, repeat HIV and STI and give RhoGam if needed. | show 🗑
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| The first prenatal visit is very important. What type of medical history, maternal exam and testing can you expect? What education should you provide? | show 🗑
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| show | No live vaccines
Get TDaP every pregnancy and the Flu vaccine
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| This is the most common and fastest spreading STI. It is often silent and highly destructive. Who should be screened? What is the preferred diagnostic method? How do you treat it? | show 🗑
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| show | Gonorrhea (aerobic gram - diplococcus)
Screen all women @ risk, test during first trimester and at 36 weeks
Culture of cervix
Treat with Ceftriaxone
Note: Concomitant treat w/ Chlamydia
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| T/F- You should treat a pregnant woman with Gonorrhea with Ceftriaxone as well as Amoxicillin b/c you should also treat for chlamydia b/c they travel together. | show 🗑
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| show | Syphilis
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| show | True
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| Who should be screened for Syphilis? How do you test? How accurate are test? How do you treat? | show 🗑
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| show | True
False- cannot breastfeed
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| Herpes simplex virus 1 is transmitted __________ while Herpes simplex virus 2 is transmitted ______. Many with herpes are asymptomatic. what are some symptoms? Treatment? | show 🗑
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| T/F- The CDC recommends that all sexually active individuals be tested for Herpes simplex virus. | show 🗑
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| T/F- A mother known to have Herpes Simplex Virus 2 can have a vaginal birth, even if they have lesions, as long as they have taken acyclovir. | show 🗑
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| What are TORCH infections? | show 🗑
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| What should a pregnant mom expect during a normal prenatal visit? | show 🗑
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| show | GBS is part of normal vaginal flora in 20-30% women but can cause neonatal MM from respiratory issues, sepsis, or death.
Screen at 35-37 weeks
Give IV penicillin to prevent spread of GBS to newborn
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| Who recieves RhoGam? When? | show 🗑
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| What are symptoms of pre-term labor? | show 🗑
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| show | False, non invasive tests are not definitive, only invasive tests like amniocentesis or Chorionic Villii Sampling are
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| show | Underweight- 28-40 lbs
Normal weight- 25-35 lbs
Overweight- 15-25 lbs
Obese- 11-20 lbs
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| show | Non-lactating- 0.5-0.9 kg/week
Lactating women- 1 kg/month
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| show | Hypertension (affects 10%)
2nd leading cause of maternal mortality in US
15% die from HTN
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| What puts you at risk for HTN during pregnancy? | show 🗑
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| show | Chronic HTN (begins prior to 20 weeks, doesn't resolve w/in 12 weeks post BP>140/90)
Gestational HTN (BP>140/90 after 20 weeks, W/O proteinuria)
Preeclampsia/eclampsia
CHTN w/ preeclampsia
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| show | Begins after 20 weeks gestation, BP >140/90 twice, 4 hours apart
AND
Proteinuria (>300 mg/24hr urine colletion)
OR
Thrombocytopenia, Renal insufficiency, Impaired liver function, pulmonary edema, Cerebral/visual symptoms
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| show | BP >140/90
Proteinuria >300mg in 24 hr urine or >1+ in urine dipstick
Edema
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| show | SBP >160
DBP>110
Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
or
Cerebral disturbance
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| show | Meets criteria for preeclampsia (BP>140/90, Proteinuria(>300) or Edema, Thrombocytopenia, renal insufficiency, Impaired liver function, Cerebral/visual symptoms
++++ Grand mal seizure activity
Leads to increased maternal mortality
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| show | Had HTN before 20 weeks gestation
+++
New onset of Proteinuria
Sudden increase in well controlled BP
Any severe features of preeclampsia
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| What is the cure for preeclampsia? | show 🗑
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| show | Vasospasm leads to decreased blood flow and tissue/cellular hypoxia
Leads to endothelial damage (leaky vessels>edema and hypovolemia >decreased CO)
Leads to platelet aggregation/clot formation (microvascular obstruction and further cellular hypoxia)
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| You suspect a pregnant patient with hypertension has pulmonary edema. You want to know... | show 🗑
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| show | Decreased urine output (<30mL/hour) > decreased GFR > decreased clearance of uric acid
Severe vasospasm can damage endothelium leading to oliguria of pfogdinufiz
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| show | Check for liver functioning, assume hepatic ischemia R/T preeclampsia
May also indicate HELLP syndrome
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| show | High resistance and low blood flow leads to restricted gas exchange which can lead to intrauterine growth restriction
Also Oligohydramnos, Pre-Term labor, Placental abruption, Infarction or intrauterine fetal demise
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| show | Severe form of preeclampsia, diagnosed by lab values, hard to detect and increases maternal death. SS Tired, NV, RUQ pain, visual changes, Proteinuria, increased BP? Bruising under BP cuff?
Hemolysis
Elevated
Liver enzymes
Low platelets
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| T/F- after delivery, the risk for eclampsia disappears? | show 🗑
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| What does Magnesium Sulfate have to do with Preeclampsia? What are indicators of Mag Sulfate toxicity? How do you treat? | show 🗑
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| What are the common medications for preeclamptic mothers in acute hypertensive crisis? | show 🗑
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| show | <37 weeks- bedrest, assessments
37-40 weeks- close assessments, risks vs. benefits, MgSO4 and delivery
40+ weeks- MgSO4 and delivery
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| Describe the delivery timing and management for a mother with Preeclampsia WITH severe features. | show 🗑
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| Which DTR is most indicative for preeclampsia which may lead to eclampsia? | show 🗑
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| When do you need to notify the physician about a patient with preeclampsia? -SBP>160, DBP >110 -UOP<30 mL/hr -Worsening Headache, RUQ pain, visual changes, edema, changed LOC -Quick clotting -Improving lab values -RR<12, loss of DTR's | show 🗑
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| White lists two classifications of diabetes in pregnancy, A1 and A2. Describe each. | show 🗑
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| T/F_ Insulin and glucose cross the placenta to maintain blood sugar in the fetus. | show 🗑
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| show | Decrease during first trimester (mom isn't eating as much, baby is taking more of the glucose, hormones are working)
Increase during second and 3rd trimester
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| Congenital malformations are a major concern in babies born to mothers with pregestational diabetes. What are the major ones? | show 🗑
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| show | Complicates 3-9% of all pregnancies
Obese women who develop GDM are at increased risk to birth infant with CNS defect
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| Who gets screened for Gestational DM? When? | show 🗑
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| How do you screen for Gestational DM? | show 🗑
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| show | True- baby may have low blood sugar after born because excess blood glucose is removed. Usually not major problem b/c baby is fed within 6 hours
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| show | 10 fetal movements ever 2 hours
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| show | Insulin requirements decrease dramatically
Risk for infection and hemorrhage increases due to uterine distention due to baby size/extra amniotic fluid
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| How likely is it for a woman who had GDM to develop Type 2 diabetes? | show 🗑
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| show | Fasting- 60-99
1 hour post meal- 100-129
2 hours postmeal- <120
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You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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