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114 exam #2
eating disorders managed care, schizo, alzheimer's, seizures
237
Nursing
Professional
03/01/2014

Additional Nursing Flashcards

 


 

Cards

Term
Eating disorder
Definition

A patient is diagnosed with an eating disorder when they experience severe disruption in normal eating and disturbance in perception of their body shape and/or weight

Term

Anerexia Nervosia

(restricting)

Definition

when a the patient reports no recurrent episodes of bingeing or purging in the last 3 months

Term

Anorexia Nervosa

(bindge eating type)

Definition

when the patient reports recurrent episodes of bingeing or purging in the last 3 months

Term
Mild Anorexia
Definition
>17 BMI
Term
Moderate Anorexia Nervosa
Definition
16-16.99 BMI
Term
Severe Anorexia Nervosa
Definition
15-15.99 BMI
Term
Extreme Anorexia Nervosa
Definition
<15 BMI
Term
Patho and Etiology of Anorexia Nervosa
Definition

There are multiple causes 

*genetics 

*neurobiology

*Intrapersonal Factors

~low self esteem

~Harsh self judgement

~Adolescent turmoil

~addictive Behaviors

~difficulty/ delayed maturation

~low tolerance for change.

*Gender

*age

*dieting, weight control behaviors

*sports and artistic endevors

*societal influneces

*incidence is difficult to determine.

Term
Genetic factors
Definition

Individuals from families with eating disorders are 5-10 times more likely to develop an eating disorder 12 times as likely for female relatives

Term
Neurobiologic factors
Definition
serotonin pathways are abnormal and there may be altered serotonin receptors

Unknown whether the abnormalities occur first or after development of the eating disorder
Term
Depression
Definition
what comorbidity often exists w/ anorexia nervosa?
Term

Family Dynamics

of anorexia

Definition

*controlling family system

*emphasize perfection, achievememnt and compliance

Term
Family dynamis of Bulimia
Definition
Family system chaotic with conflict and negativity
Families may have difficulty with conflict resolution

Emotionally expressive
Term
The enabler
Definition
the family is the ______ NOT the cause of a eating disorder.
Term
childhood and or adolescent abuse
Definition
often the patient with an eating disorder is the survivor of _________
Term
femlaes
Definition

Are eating disorders more common with females or males?

 

Term
teens and adult in there 20's
Definition
what age are eating disorders most prevalent?
Term
dieting
Definition
often an eating disorder starts as ______ or they use ____ as an excuse.
Term
true
Definition

true or false athletes have more eating disorders

 

Term
societal influences
Definition
includes media's obsession with being skinny and thin
Term
8-20%
Definition
it is difficult to determine the incidence due to a large number of undiagnosed cases but it is believed that eating disorders affect ____% of the population
Term

Clinical manifestations of 

Anorexia Nervosa

Definition
Refusal to maintain normal weight for age and height
Intense fear of gaining weight
Disturbed body image
Belief that one is fat despite emaciation
Energy restriction

Loss of menses for at least 3 months
 
Term
psychological ; physcial
Definition

remember that eating disorders have a _________ component; Assessment findings may not be primarily ________

Term
Intense fear of gaining weight

Disturbed body image
Energy restriction
Definition
Anorexia nervosa Diagnosis requires......
Term
amenorrhea
Definition
lose of menses for at least 3 months
Term

Disturbed body image: 

Definition
Belief that one is fat despite emaciation
Term
Anorexia is...
Definition
Characterized by
Extreme perfectionism
Significant weight loss
Body image disturbances
Strenuous exercising
Diagnostic criteria
Need to please others
Need to meet expectations
Term
solitary running
Definition
the exercise of choice for a anorexic is....
Term
hyperactive
Definition
anorexics are often.....
Term
control
Definition
weight loss is seen as a type of _____ since the patient feels they have no _____(same word) over anything else.
Term

Clinical Manifestations
 Anorexia Nervosa

(labs)

Definition
Decreased vital signs
Electrolyte imbalances
Leukopenia
Osteoporosis
Amenorrhea
Cardiac abnormalities

 

Anemia
Abnormal thyroid function
Fatty degeneration of liver, elevated cholesterol
Hematuria
Proteinuria
 

Term
labs u will see with an anorexic
Definition
Low serum potassium and a elevated BUN
Term
Physical Assessment
Anorexia Nervosa
Definition

Sunken eyes, skeletal appearance

Peripheral edema with advanced starvation

Emaciated/Cachetic

Lanugo growth

Bradycardia, hypotension, arrhythmias

Delayed gastric motility

Hypothyroid-like state

In addition to these physical assessment findings, patients with anorexia nervosa may have a low BMI, mottled cool skin, hypothermia, and prominent parotid glands from bingeing and purging

Term
Bulimia Nervosa
Definition
Begins as way to eat and stay slim
Slightly above or below ideal body weight
May not initially appear to be physically or emotionally ill
Becomes a response to stress, negative feelings
Most often occurs when alone and at home

Poor impulse control

Electrolyte imbalance is a serious consequence of bulimia in light of the purging and disruption of the body’s chemical balance.

Electrolyte imbalance, fluid imbalance, and subsequent disruption of cardiac function is a real concern and also potentially life threatening

Term
Bulimia Nervosa
Definition
Cyclic pattern
Skipping meals sporadically
Over strict dieting
Fasting
Binge eating
Purging final part of cycle
Self-induced vomiting

Laxative and diuretic abuse
Term
Binge eating
Definition
3500 kcal/hr may consume 12,000 kcal
Term
purging
Definition
this is facilitated by use of laxatives 50-100 per day, and syrup of ipecac
Term
Clinical Manifestations
Bulimia Nervosa
Definition
Cardiomyopathy
Cardiac dysrhythmias
Electrolyte imbalances
Dehydration and symptoms of fluid volume deficit
Loss of dental enamel
Parotid gland enlargement
Esophagitis &/or Esophageal tears are consequences of purging

Russell’s sign callus on knuckles from self-induced vomiting
Term
Binge-Eating Disorder
Definition
Overeating withoutpurging
2 patterns
Over-eating and feeling out of control in response to feelings and emotions

Binge in response to loss of control over weight-loss program

Generally these patients are obese

The binge eater consumes large amounts of food in one sitting and usually feels guilt for his or her actions later

May be considered a variant of compulsive overeating

May be related to depression as overeating is frequently a sign/symptom of depression

The patient reports binge eating as being soothing and helpful with mood regulation

Term

Diagnosing Binge-Eating Disorder

Definition

Episodes are associated with at least three of the following:

Eating much more rapidly than normal
Eating until feeling uncomfortable full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating

Feeling disgusted with oneself, depressed, or very guilty after overeating
Additionally, patient must experience:
marked distress regarding the binge eating
binge eating must occur on average, at least once a week for 3 months

Term
Eating disorder assessment
Definition
Determine if medical/psychiatric condition warrants hospitalization:
Hospitalization may be necessary for short time (either medical or psychiatric)
Severe hypothermia, bradycardia, hypotension, hypokalemia, cardiac abnormalities
Weight loss more than 30% of body weight over 6 months
Suicidal or self-mutilating behaviors
Severe depression or psychosis

Out of control use of laxatives, diuretics, street drugs
Term
Cannot
Definition

Binge eating can or cannot occur exclusively during the course of anorexia nervosa or bulimia nervosa?
Term
Sibutramine / Meridia
Definition
Appetite suppressant
Term
Citalopram / Celexa
Definition
antidepressant
Term
Topiramate / Topamax
Definition
Anti convulsant  / mood stabilizer
Term
treatment for bidge eating
Definition

modification of the disorder eating and associated mood changes. 

Through cognitive therapy alone and medcation therapy

Term

Eating disorder assessment

( questions)

Definition

How often do you get your period?

What changes have there been in your periods?

Term
resist
Definition

Anorexics May _____ treatment

Term
Recognize
Definition

 

Bulimics  _________ eating behavior as abnormal.

Term
Assessment
Definition
Rule out other illnesses
Patient History
Medical history
Menstrual history
Eating patterns
Self-esteem, perception of self
Review patient history for impulsive behaviors (i.e. stealing) or compulsions (bulimia)

Determine if family relationships are chaotic
Term
Assessment: Screening Questions
Definition
Tell me how you feel about the way you look.
Tell me what changes there have been in your weight?
Tell me about the ways that you are trying to change or control your weight.
Tell me what you ate yesterday.
How much do you participate in physical activity in a typical week?
How do your feelings about your body affect your mood?

How much do you worry about eating or your weight?
Term
no
Definition
There is ___ universal screening tool for eating disorders.
Term
non judgemental
Definition
initally, ask as many _____ opened ended questions
Term
=)
Definition

If the patient leads you to an eating disorder assessment, then ask questions specifically for that eating disorder.

Term
Assessment: Screening Questions....
Definition
Do you ever binge?
Have you ever induced vomiting (e.g., by using syrup of ipecac)?
Have you ever used laxatives,

  diuretics, or diet pills to

  lose weight?


These questions can be asked after initial screening questions leads to the probable diagnosis of an eating disorder

 

Term
Nursing Diagnoses 
Definition
Imbalanced Nutrition : less than bodyrequirements
Ineffective Coping
Disturbed Body Image
Chronic Low Self-Esteem
Anxiety
Deficient Fluid Volume
Powerlessness

Hopelessness
Term

Goals  for eating disorders

Definition
Client will return to and maintain at least 90% of normal weight
Client will demonstrate understanding of adequate nutrition
Client will achieve, maintain
Normal elimination patterns
Vital signs
Normalized eating patterns
Normal electrolyte balance

Female client will have normal menses
Term
Goals
Definition
Client will identify and integrate adaptive coping skills
Client will express less anxiety about
Weight
Appearance
Bulimic client will refrain from purging following meals
Client will express feelings in non-food–related way
Client will acknowledge personal strengths
Client will demonstrate improved self-acceptance

Client will address maladaptive beliefs related to eating
Term
Nursing Interventions
Definition
Directed toward examining underlying conflicts and distorted perceptions of shape and weight
Relies on interdisciplinary team approach
Long-term treatment with individual, group and family therapy
Build therapeutic alliance w/patient and family

Focus interventions on establishing trust and monitoring eating patterns

Weight restoration and monitoring create opportunities to counter disturbed thought processes (cognitive distortions)

Term

Use of highly structured setting with close monitoring to prevent

Definition

throwing food away,

falsely increasing weight,

purging

During meals

During weighing

During bathroom visits

Term

Relies on interdisciplinary team approach

Definition

Work for normalization of eating patterns

 

Work toward addressing psychological issues

Term

Nursing Interventions

Definition
Avoid authoritarianism and assumptions of parental role
Involve client in own treatment planning
Recognize patient’s distorted body image without minimizing or challenging patient’s perception

Address patient’s underlying emotions of anxiety, depression, low self-esteem, and feelings of lack of control
Term
Nursing Interventions
Definition
Determine level of family understanding about disorder and where to get support
Determine level of acceptance of treatment
Determine patient and family need for teaching

Determine patient’s and family’s desire to participate in support group
Term
Facilitating coping
Definition
Provide flexibility in ADLs, exercise, occupational therapy
Demonstrate positive belief in client’s ability
Set firm, clear limits to provide security

 

Assist client with exploring feelings
Term
Enhancing Body Image
Definition
Encourage client to express feelings
Reframe misperceptions
Emphasize health, strength, evaluation
Teach, reinforce replacing negative thinking
Ask client to draw self as they are and/or desire to be
Reinforce efforts to share and improve:
Eating behaviors

Body image
Term
Successful
Definition
Assesment is key to _____ treatment
Term
weight resortation and monitoring
Definition
opportunities to counter distrubed thought processes are achieved through ______
Term
Journal:
Definition

 an opportunity record thoughts in diary

Term
Improving Self-esteem
Definition
Help client identify positive attributes
Encourage client to journal
Explore with client attempts to achieve perfection

Model appropriate expressions of anger
Term
Nurse's
Definition
whos responsibility is it to montior fluids and electrolytes?
Term
Managing Fluids and Electrolytes
Definition
Record intake and output
Assess and document condition of skin, mucous membranes
Obtain vital signs
Monitor lab values

Provide frequent mouth care for dehydrated client
Term
Specific Nursing Interventions
Anorexia Nervosa
Definition
Use of highly structured setting with close monitoring to prevent:
throwing food away
falsely increasing weight
purging
Weigh patient
Minimal clothing
Same time of day

After voiding & before eating or drinking
Term
Cognitive-behavioral therapy
Definition

Diminishes errors in patient thinking/perceiving related to eating disordered behaviors

 

Term
Psychodynamic therapy:
Definition

 

 Addresses underpinnings of disorder

 

Term

 

Group therapy: 

 

Definition
Provides support
Term
Family theray
Definition
Does family dysfunction contribute to problem?
Term
Medications for anorexia
Definition
Medications not recommended until weight has been restored
SSRI antidepressants
Fluoxetine (Prozac): to reduce relapse
Atypical antipsychotics

Olanzapine (Zyprexa): helpful in improving mood and decreasing obsessional behaviors
Term
Prozac (Fluoxetine
Definition

is the drug of choice for treatment of bulimia nervosa but has a black-box warning of increased risk of suicidal ideation

Term
Alzheimer's Disease
Definition
losing your memeories peices at a time. One something is gone its gone for good.
Term
Dementia
Definition
Alzheimer's type for ppl over 65 years old
Term
Early dementia, 
Definition
or presenile dementia Alzheimer's type for people in their 40-50s
Term
Manifestations of AD
Definition
  • loss of memory, judgement, and visospatial perception and change in personality
Over time cognitive deterioration takes place and death takes place as a result of complications.

Incurable, with a 5-8 year prognosis once differential diagnosis is made.
Term
Patho of alzheimers
Definition
Brains shrink as part of the aging process, but this happens at an accelerated rate in AD.
Microscopic changes include neurofibrillary tangles and neuritic plaques with deposits of abnormal protein called beta amyloid. (This means degenerating nerve terminals.)
Increased vascular degeneration

Decreased levels of neurotransmitters
Term
MRI
Definition
what is the current hallmark test for alzheimers?
Term
impairments of AD
Definition

Depth perception

poor judgement

 

Term
Complications
Definition
death is result of ______ of alzheimers
Term
differental diagnosis
Definition
diagnosis made on symptoms
Term
Risk factors of AD
Definition

Age :over 65

Family :gene has been identified

Gender: more women than men

Education: lower education higher risk

Race: more Blacks, early for latinos

Head trauma, metabolic disorders , lakc of social net work

Enviroment: toxic metal, zinc and copper, herpes zoster and herpes simplex

Term
shingles
Definition
herpes zoster are also know as
Term
Cold sore
Definition
Herpes simplex are AKA
Term
Diabetes
Definition
metabolic disorder related to AD
Term
in their 40's
Definition
when are hispanics usually diagnosed with AD?
Term
HTN and Diabetes
Definition
which 2 diseases increase your chance of having AD?
Term
Stage 1: early stage : AD
Definition

Able to compensate for cognitive losses.

Forgets names, misplaces items
Short term memory loss
Unable to travel alone to new destinations, Gets lost frequently.
Subtle changes in personality; judgment
Decreased performance, especially when stressed

Decreased sense of small
Term
Not cureable!
Definition
AD is cureable or non-cureable?
Term
2nd stage : Middle stage AD
Definition
Symptoms are being recognized
Problems handling finances
Disorientation to time, place and events
Visuospatial deficits, difficulty driving
Losing speech, less talkative
Increasing dependence in ADLs
Incontinent

Wandering, trouble sleeping
Term
Final stage : Late stage : AD
Definition

severe

Completely dependent in ADLs, may be bedridden
Most motor and verbal skill lost
General neurologic deficits
Agnosia ( loss of facial recognition) Can be family or themselves.

Stages are not concrete, patient may move in and out of several stages.
Term
Agnosia
Definition
loss of facial recognition
Term
Diagnosis of AD
Definition
History: get from family as well as patient to form a total picture
Folstein’s Mini-Mental State Examination: for folks that can read. Assess five major categories and assigns a number 0-30. Lower score indicates higher dementia.

Set test for illiterate people, asks them to name items in four categories and assigns a number 0-40. Score above 25 do not have dementia.
Term

Folstein’s Mini
Definition
Mental State Examination: for folks that can read. Assess five major categories and assigns a number 0-30. Lower score indicates higher dementia.
Term
Set test for illiterate people, 
Definition
asks them to name items in four categories and assigns a number 0-40. Score above 25 do not have dementia
Term
General neurologic deficits
Definition

very lax facials.

Loss of recognizion of their own belongings.

Term
may not
Definition
Patient may or may not be a reliable source for history in AD
Term
Communication Changes with stages
Definition

Apraxia

Anomia

Aphasia

Agnosia

Term

Apraxia: 
Definition
inability to use words or objects correctly in conversation. (Early)
Term

Anomia:
Definition
Inability to find words. “what’cha ma callit” or “that thing a bob”. (Mid)
Term

Aphasia: 
Definition
Inability to speak or understand. (Late)
Term

Agnosia: 
Definition
Loss of sensory comprehension. (Late)
Term
Personality/Behavior
Definition
Aggressiveness; verbal and physical abusive
Rapid mood swings
Increased confusion, especially “sundowning
Wandering, rummaging through things, hoarding
Depression, withdrawal

Paranoia, hallucination, delusions
Term
sundowning
Definition
episodes of things happen after dark
Term
serotonin
Definition
depression is thought to be due to loss of ______ but mostly because a Alzheimer's patient life is shrinking
Term
Changes in Self Care
Definition
Decreased interest in personal appearance and hygiene.
May dress inappropriately for age, occasion and/or weather.
Loss of bowel and bladder control.
Decreased appetite, regression in eating habits.

Eventual loss of ADL ability.
Term
depends on what is going on
Definition
decreased interest in personal care depends on what?
Term
toddler like habits
Definition
AD patient may go from civilized ppl to acting like what?
Term
AD diagnosis
Definition
Labs: to rule out treatable metabolic issues.
Imaging: CT; PET; SPECT and MRI to rule out other causes and to confirm cerebral atrophy.
Electroencephalogram;(EEG) shows slow wave delta activity seen in 2nd and 3rd stages.

Today, there is a spinal tap test that is in final studies, otherwise it is a differential-vs-definitive diagnosis.
Term
antibiotics
Definition

 

things that may help symptoms of AD

Term
Anesthia
Definition
what will speed up the process of AD?
Term
isoflorane
Definition
what in anesthia speeds up the AD process?
Term
Amyloid protein
Definition
when doing a spinal tap to see if the patient may develop or have AD which protein are they looking for?
Term
cerebral atrophy
Definition
the PET, CT, MRI or SPECT scans are done with AD to confirm what?
Term
metabolic issues
Definition
Labs rule out what as the cause or AD symptoms.
Term
safety
Definition
what is the priority for interdisciplinary care with AD patients?
Term
Managing the Patient
Definition
Cognitive stimulation; memory training. (Early)
Orientation and validation therapy appropriate for stage.
Structuring the environment
Promoting self care management
Promoting bladder & bowel continence

Promoting communication for stage
Term
Cognitive stimulation (early AD)
Definition
have 2 way conversations with the patient to keep there brain active
Term
Orientation therapy AD
Definition
reorienting the patient to the day time an situation. (mild)
Term
Validation therapy
Definition
Validating the Patient's feelings and underlying cause. " i missed my breakfast" when you know she ate breakfast. validate that she is hungry.
Term
can not
Definition
alzhiemer patiwnt can or cannot learn new procedures?
Term
Prosopagnosia:
 
Definition
 inability to recognize oneself or other familial faces. Encourage family to provide labeled photos of patient and family members. Emphasis on the younger members.

 

 
Term
Reminiscence therapy: 
Definition
chat about positive experiences shared in early to mid stages.
Term

Re-orientation , validation
Definition
_________in the early phases, _______ in the later stage.
Term
exacerbate or worsen
Definition
Physical illness and environmental changes can ______ the symptoms of AD
Term
true
Definition
true or false keeping th patient healthier helps them stay in the current stage longer
Term
Communication AD
Definition
Keep communication deficit in mind. Aphasia; Anomia; and Apraxia are apparent as the stages progress.
Keep questions, instructions and sentences simple. Use pictures and gestures if possible
Limit choices to reduce frustration and confusion.

Never assume that the patient is totally confused. Always check level of understanding.
Term
Progression of Care
Definition
Early stages: Can be monitored and then cared for in the home. Plan to keep as independent as possible for as long as possible
Mid-stage: Assisted living or in home with increased monitoring. Start bringing in care givers if still in the home.

Late: Full service or skilled nursing facility that has AD precautions in place.
Term
Early stages of care in AD
Definition
 Can be monitored and then cared for in the home. Plan to keep as independent as possible for as long as possible
 
 
Term
Mid-stage of care for AD
Definition
 Assisted living or in home with increased monitoring. Start bringing in care givers if still in the home.

 

 
Term
Late care of AD
Definition
 Full service or skilled nursing facility that has AD precautions in place.
Term
Drug therapy
Definition
Cholinesterase inhibitors: improves cholinergic neurotransmission by delaying destruction of acetylcholine. Slows the rate of cognitive decline.
Donepezil (Aricept)
Galantamine (Reminyl)

Rivastigmine ( Excelon)

Namenda (Memantine)
N-methyl-D-aspartate receptor antagonist blocks excess amounts of glutamate that can damage nerve cells. Indicated for mid-severe stages and can help maintain function. Can be used with Aricept type drugs.
Antidepressants:
Selective serotonin reuptake inhibitors such as Paxil or Zoloft can be used with this population.
Tricyclic antidepressants such as Elavil, Levate or other anticholinergic drugs should not be used.
Increased confusion
Increased urinary retention
Increased constipation
Term
psychotropic, antipsyhotic or neuroleptic drugs
Definition
these drugs should be reserved for patients with emotional and behavioral health issues that sometimes accompany dementia, includeing hallucinations and delusions.
Term
Cholinesterase inhibitors:
Definition

 improves cholinergic neurotransmission by delaying destruction of acetylcholine. Slows the rate of cognitive decline.
Donepezil (Aricept)
Galantamine (Reminyl)
Rivastigmine ( Excelon)
Term
Antidepressants
Definition
Selective serotonin reuptake inhibitors such as Paxil or Zoloft can be used with this population
Term
Tricyclic antidepressants 
Definition

such as Elavil, Levate or other anticholinergic drugs should not be used.

Increased confusion
Increased urinary retention
Increased constipation.
Term
Seizure
Definition

¨Abnormal, sudden, excessive, uncontrolled electrical discharge of the neurons in the brain.
Results in a change in level of consciousness, motor or sensory ability,   and /or behavior.
Term
Epilepsy
Definition
two or more seizures experienced by a patient.
¨Chronic disorder in which multiple unprovoked seizures occur
¨May be caused by an imbalance of neurotransmitters, Gamma aminobutyric Acid (GABA)
Term
Condition
Definition
seizure is a _____ of epilepsy
Term

false

Seizures can be triggered by something such as flashing lights, certain smells, medications, and disorders

Definition

true or false 

Seizures are unprovoked

Term
cause unknown
Definition
what causes epilepsy?
Term
types of seizures
Definition

Generalized

Partial

Unclassified

Secondary

Term
Generalized Seizures
Definition
  • Involve both cerebral hemispheres
  • 6 types
    • tonic/clonic
    • tonic
    • clonic
    • myoclonic
    • Atonic
    • Absence
Term
Partial seizures
Definition
  • involve one side of the cerebra hemishpere
  • 2types
    • simple 
    • complex
Term
partial seizures are less
Definition
whicih seizure type is less responsive to medical treatment?
Term
Tonic / clonic
Definition

contracting and relaxing with jerking motions

 

"tense/clicking"

Term
Tonic
Definition

tense still seizure

 

Term
Clonic
Definition

contracting and relaxing seizure

No jerking

 

"clicking"

Term
Atonic
Definition

The body goes limp

no tone

postical = confusion

 

Term
myoclonic
Definition
brief jerking or stiffening of the extremities.
Term
Absent seizure
Definition
  • mostly found in children
  • brief periods of LOC with blank stares. 
  • if patient was talking he/she will either stop suddenly or slow down with speak dramatically and it won't make sense
  • May have automatisms
Term
automatisms
Definition
lip smaking or picking of the clothes during an absent seizure
Term
Partial seizure
Definition

These are also called local or focused seizures.

2 types

          • complex 
          • simple
Term
complex partial seizure
Definition
  • LOC (syncope) or a black out for 1-3 mins. 
  • may occur during absent seizures.
  • Patient is unaware of enviroment and may wander at the start of the seizure.
  • Patient may experience memory loss
  • Also called temoral lope seizure or psychomotor seizure.
Term
simple partial seizure
Definition
  • Patient is concious during this seizure
  • During patient may experience unusual sensation, or autonomic symptoms (change in heart rate, skin flushing, and epigastric discomfort)
Term
Unclassified or idiopathic seizure
Definition
seizures that account for half of all seizures. they occur for no known reason
Term
primary or idiopathic epilepsy
Definition
not associated with any identifiable brain lesion or specfic cause
Term
secondary seizures
Definition

seizure results from underlying brain lesion , most commonly a tumor or trauma. Also could be cause by 

      • Metabolic disorders
      • Acute alcohol withdrawl
      • Electrolyte disturbances ( hyperkalemia, H2O intoxification, hypoglycemia)
      • high fever
      • CVA
      • Head trauma
      • Substance abuse
      • heart disease

(not caused by epilepsy) 

Term
LOC
Definition
Generalized seizure will have LOC or no LOC?
Term
Altered conciousness
Definition
Complex partial seizure will have altered conciousness or no altered conciousness?
Term
Assessment Questions
Definition
¨How many seizures, how long they lasted and what pattern of the seizure
¨Ask about before the seizure, preictal phase, possible aura or warning signs.
¨Ask about after the seizure, postictal phase
¨Ask about any prescribed or recreational drug use

¨Ask about other medical conditions
Term
laboratory tests
Definition
what is used in seizures to rule out metabolic issues?
Term
Seizure precautions
Definition
  • O2
  • suction
  • stable Airway
  • IV access
  • side rails up ( if facility policy)
  • NO tongue blades
Term
have another nurse get the PRN seizure medication. (valium, other barbituate)
Definition
what should you do 1st thing a nurse should do when patient is having a seizure?
Term
seizure management
Definition
  • depends on type of seizure
  • observations and documention
  • Patient safety
  • side- lying position
  • NO restraints
  • NO tongue blades
Term
Acute seizure management
Definition

-PAMS [Lorazepam (ativan), Diazepam (valium)]

 

-Diastat

-IV pheytonin(dilantin) or fosphenytoin( cerebyx)

Term
Status Epilepticus
Definition

Call 911 or Rapid response!!!!

 

¨Prolonged seizures that last more than 5 min or repeated seizures over a course of 30 min -Establish airway
¨ABG’s
¨IV push lorazepam, diazepam
¨Rectal diazepam
¨Loading dose IV phenytoin

¨Potential complication of all types of seizures
Term
die!
Definition
if you can't get the epileptic episode to stop all muscles will contract an the patient will......
Term
rectally
Definition
If you can't give IV durin status epilepticus give the meds how?
Term
Establish and airway!
Definition
whats the 1st thing you do during status epilepticus?
Term
NEED ALL THESE TO STOP
Definition

what is the signifigance of these durin status epilepticus?

  • IV push of lorazepam or diazepam
  • rectal diazepam
  • Loading dose IV phenytoin
Term
warfarin
Definition
what should you not give with phenytoin?
Term
Drug Therapy
Definition
Be aware of drug-drug/drug-food interactions
¨Maintain therapeutic blood levels for maximal effectiveness
¨Do not administer warfarin with phenytoin
¨Document and report side/adverse effects

¨Emphasize that drugs must not be stopped without physician direction
Term
¨Dilantin (phenytoin)
Definition
 therapeutic 10-20 mcg/ml. Toxic level> 30 mcg/ml
 
 
Term
¨Tegretol (carbamazepine)
Definition
this drug will give you.... headache, vision issues
 
Term
¨Depakote (valproate sodium)
Definition
this drug can cause hair loss, increased liver enzymes, bruising

 

 
Term
¨Topamax (topiramate
Definition
is not for renal patients-increased risk for renal calculi
Term
surgical management
Definition

Last ditch effort for seizures is what?

¨Vagal nerve stimulation (VNS)
¨Conventional surgical procedures
¨Anterior temporal lobe resection

¨Partial corpus callosotomy
Term
Schizophermia
Definition
Mental disorder with periods of relapse and remission.
Term
early diagnosis
Definition
______ and treatment may reduce chronicity, and improve prognosis.
Term
schizophrenia
Definition

the most common psychotic diorder of the brain

  • causes lengthy hospital stays.
  • family distruction
  • costs a lot of money.
Term
20 % shorter lifespan
Definition
how long is the lifespan of a schizo?
Term
late adolescence, early adulthood
Definition
when is someone typically diagnosed with schizo?
Term
Risk factors for schizo
Definition
  • Genetics
  • prenatal factors
  • Advanced paternal age

 

Term
genetic facotrs for schizo
Definition
  • Identical twins have a higher riskof schizo.
  • If mom or dad has it the child may have it 
  • if both parents have it the child has a 50% chance of having schizo
Term
neuroanatomical factors
Definition
  • Brain atrophy over time
  • Blod flow is decreased
  • Blood glucose is decreased
Term
Comorbid disorders of schizo
Definition
  • As many as 50 % of schizo's have problem with nicotine, ETOH and drugs
  • Suicide (40-50% have suicidal ideations)
  • Anxiety disorders ( very nervous and paprnoid)
  • Late onset of Schizo = higher risk for alzheimer's
Term
Positive Symptoms of schizo
Definition
  • Hallucinations(auditory)
  • Delusions (disorganized thinking)
  • Disprganized speech ( loose association)
  • Bizarre behavior( hyperative, appearance ,suspiciousness ,hostility)
Term
disorganized thought
Definition
Something based on reality but it is not real and can't talk the schizo out of it
Term
loose assocations
Definition
the schizo is talking but make no sense.
Term
positive sympotoms
Definition
body and mind doesn't normally have these kind of symptoms. These are used to diagnose schizophrenia.
Term
Negative symptoms of Schizo
Definition
  • behavioral 
  • Affective
  • sensory overload
  • Social
Term
types of delusions in schizo
Definition

somatic

Mixed

Presecutory

Jealous

Grandiose

Erotomatic

Term
Somatic
Definition
has a physcial defect or medical problem
Term
Mixed delusion
Definition
2 or more types of delusions
Term
Presecutory delusions
Definition
they or someone else is being mistreated or spying on them
Term
Jealous delusion
Definition
they believe his/her spouse is cheating
Term
Grandiose delusion
Definition
over inflated sense of self worth, power, or knowledge.
Term
Erotomatic delusion
Definition
delision that someone that is famous or important is in love w/ them.
Term
Premorbid phase of schizo
Definition
period before diagnosis of schizo
Term
Prodromal phase of schizo
Definition
deterioration and more socially withdrawn. misinterpret wgat ppl say. sleep disturbance, anxiety, fatigue easily, depressed, poor concentration, preoccupied w/ things especially religion.
Term
Schizo phase of schizo
Definition
Don't work, don't take care of self, my be brought in by someone to get medicated.
Term
residual phase of schizo
Definition
like the prodromal phase but relapse
Term
females
Definition
who tends to bounce back after schizo quickly?
Term
Factors associated with a positive prognosis....
Definition
  • Good premorbid adjustment
  • Latter age at onset
  • Being female
  • Abrupt onset precipitated by a stressful event
  • good inter-episode
  • brief duration of active-phase symptoms
Term
Paranoid type schizo
Definition
Person loses touch w/ reality (psychosis) classic features of this is having delusions and hearing things that aren't real.
Term
Disorganized type schizo
Definition
Behavior is disturbed and has no purpose. Will have lots of starnge, aimless behavior and often speech that doesn't make sense
Term
Cataonic type schizo
Definition

Extremes of behavior. Can be unable to move, speak or respond

- dramatic reduction in activity where virtually all movements stop ( catatonic stupor) 

- other end can be over excited or hyper active, mimicking sounds or movements around them. Often referred to (catatonic excitement)

Term
Udifferntiated type schizo
Definition
symptoms of schizo that are not sufficiently formed or specific enough to permit classification of the illness into one of ther other subtypes.
Term

residual type schizo

 

Definition
past history of at least on episode of schizo but patient currently has no positive sympotoms. May still exhibit some negative symptoms.
Term
brief psychotic disorder
Definition
this psychotic disorder is characterized by a sudden onset of psychotic symptoms (delusions, halluciations, disorganized speech) or grossly disorganized or catatonic behavior
Term
Schizoaffective disorder
Definition
This psychotic disoder is characterized by an uniterupted period of illness during which there is a major depressive, manic or mixed episode, cocurrent with symptoms that meet criteri a for schizo
Term
Delusional disorder
Definition
psychotic disorder that involves nonbizzare delusions ( situations that occur in real life, such as being followed, infected, loved at a distance, spouse cheating, or have a disease.) for at least 1 month
Term
shared psychotic disorder
Definition
psychotic disorder where the psychotic person is living with a sane person and the psychotic person gets the sane person to believe his/her craziness
Term
substance induced psychotic disorder
Definition
psychosis induced by drugs
Term
tardive dyskineshia
Definition
involuntary movements of the lower face especially
Term
1st generation antipsychotics
Definition

Thorazine , mellaril, proloxin, haldol

 

These drugs only effected the positive symptoms of schizo

Term
haldol
Definition
what causes EPS ( extra paramital symptoms)
Term
benadryl , cogentin, artane, symmetrel
Definition

what reverses EPS?

and is given IM

Term
dystonia
Definition
acute contraction of the tongue, and jaw. Can't turn head back to front. Eyes may look up and become locked.
Term
GET PRN of benadryl
Definition
what should you do for dystonia?
Term
Atypical Antipsychotics
Definition

this drug treats the negative and positive symptoms of schizo.

 

Clorazil, geodon, risperda, serquel, zyprexa

Term
2nd generation antipsychotics
Definition
  • antipsychotics that end in done
  • treat - and + schizo symptoms
  • will gain weight in the first 6 weeks of treatment

 

Term
3rd generation antipsychotics
Definition
  • drug that end in pine for schizo
  • treats - and+ symptoms of schizo
  • weight gain in the first 6 weeks fo treatment 
  • treats mood and cognition disturbances
  • causes metabolic issues
Term
clorazil
Definition
this drug is not used a lot and causes bradyilocytosis, decreased WBC, sore throat, fever, malase and drooling.
Term
akathisia
Definition
muscle weakness
Term
Assertive Community Treatment
Definition

The ACT team. 

This treatment is for chronic relapse patients

  • they go where a patient needs them and when the patient needs them.
Term
ECT
Definition
what is used for a resistant schizo patient
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