NURS 6550 MIDTERM EXAM STUDY GUIDE

NURS 6550 MIDTERM EXAM STUDY GUIDE
NURS 6550 Acute Care Study Guide for midterm

Psychosocial

* Generalized anxiety disorder diagnosis criteria

 Excessive anxiety and worry occurring more days than not for 6 months
 Difficulty controlling worry
 3 or more of the following: restlessness, feeling keyed up or on edge; easily fatigued;
difficulty concentrating or mind going blank; irritability; muscle tension; sleep
disturbances
 significant distress or impairment on social, occupational, or other important areas
 symptoms not attributed to another medical condition or substance abuse
 symptoms not explained by another medical disorder

* Treatment of acute panic attacks

 physical activity
 selective serotonin reuptake inhibitors are first line therapy
 continue medication for 12 months after symptoms improve prior to tapering
 antidepressants and benzodiazepines may speed recovery from anxiety-related symptoms
but do not improve long term outcomes. Benzodiazepines are associated with tolerance
and should only be used short term
 psychotherapy can be as effective for GAD and PD; cognitive behavior therapy has the
best level of evidence
 tailored options to individuals have the best outcomes and may include a combination of
therapies

* Inpatient treatment of depression

 reasons for inpatient: suicidal behavior; refusal to eat; severe malnutrition; catatonia;
presence of general medical or comorbid psychiatric conditions that make outpatient
treatment unsafe or ineffective (Depression Mgnt Guidelines AC folder)

* When is serotonin norepinephrine reuptake inhibitor indicated

 most often prescribed for anxiety/sleep disorders
 influence on thalamus and prefrontal areas of the cortex
 fibromyalgia
 when SSRIs don’t work
 side effects are worse




NURS 6550 Midterm Study Guide 1

,* Venlafaxine dosing

 generalized anxiety disorder/major depressive disorder: 75-225mg qd
 social anxiety disorder: 75mg qd

* Endogenous depression pathophysiology

 type of MDD
 biological or genetic predisposition

* Differences between panic attacks and panic disorder

 panic attack: sudden, intense fear or anxiety may feel shortness of breath or dizzy or may
make your heart pound. Feeling they are having a heart attack. Lasts 5-20 minutes.
 panic disorder: when the panic attacks occur often

* Depressive disorder symptoms

 persistent sad, anxious, or empty mood
 feelings of hopelessness, or pessimism
 irritability
 feelings of guilt, worthlessness, or helplessness
 loss of interest or pleasure in hobbies and activities
 decreased energy or fatigue
 moving or talking more slowly
 feeling restless or having trouble sitting still
 difficulty concentrating, remembering, or making decisions
 difficulty sleeping, early-morning awakening, or oversleeping
 appetite and or weight changes
 thoughts of death or suicide, or suicide attempts
 aches or pains, headaches, cramps, or digestive problems without a clear physical cause
and/or that do not ease even with treatment

* Primary neurotransmitter in PTSD

 catecholamines
 serotonin

* PTSD diagnosis and treatment

 history of exposure to perceived or actual life-threatening event, serious injury, or sexual
violence
 comorbidity depression or panic disorder
 comorbidity alcohol and substance abuse
 treatment: psychotherapy and SSRIs


NURS 6550 Midterm Study Guide 2

, * Lithium side effects

 coma, seizures, ventricular arrhythmias, severe bradycardia, syncope, Brugada syndrome,
goiter, hypothyroidism, hyperparathyroidism, pseudotumor cerebri, Raynaud
phenomenon. Diabetes insipidus, tremor, polyuria, polydipsia, weight gain, diarrhea,
vomiting, drowsiness, cognitive impairment, impaired coordination, muscle weakness,
anorexia, nausea, blurred vision, xerostomia (dry mouth), fatigue, reversible leukocytosis,
acne, edema

* Common adverse effects of atypical antipsychotics

 dry mouth, dizziness, lightheadedness, weight gain, sleep problems, extreme tiredness
and weakness

* Mental status changes related to UTI in elderly

 confusion

* Delirium in geriatric patients

 rapid onset and fluctuating course
 coexists with dementia frequently
 primary deficit is in attention
 may be hypoactive or hyperactive
 review of medications
 meds that increase delirium: sedatives/hypnotics, anticholinergics, opioids,
benzodiazepines, and H1 and H2 antihistamines

* Short Confusion Assessment Method (Short CAM)

 algorithm for delirium assessment

* Types of dementia (Lewy body, vascular, Alzheimer’s, Parkinson’s)

 Lewy body: histologically indistinguishable from Parkinson’s, alpha-synuclein-
containing Lewy bodies occur in the brainstem, midbrain, olfactory bulb, and neocortex.
Alzheimer pathology may coexist
o Cognitive dysfunction with prominent visuospatial and executive deficits
o Psychiatric disturbances, with anxiety, visual hallucinations and fluctuating
delirium
o Parkinsonian motor deficits with or after other features
o Cholinesterase inhibitors lessen delirium; poor tolerance of neuroleptics and
dopaminergics
 Vascular: multifocal ischemic change
o Stepwise or progressive accumulation of cognitive deficits in association with
repeated strokes

NURS 6550 Midterm Study Guide 3