NURS 6550 MIDTERM EXAM STUDY GUIDE. VERIFIED BY EXPERT ANSWERS. DOWNLOAD TO SCORE A

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 * 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 * 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 o Symptoms depend on localization of strokes  Alzheimer’s: plaques containing beta-amyloid peptide and neurofibrillary tangles containing tau protein, occur throughout the neocortex o Most common age-related neurodegenerative disease; incidence doubles every 5 years after age 60 o Short-term memory impairment is early and prominent in most cases o Variable deficits of executive function, visuospatial function, and language  Parkinson’s: dementia associated with Parkinson’s * Aricept  Donepezil  Mild Alzheimer’s dementia 5-10 mg PO qhs  Moderate-severe Alzheimer’s dementia 10-23 mg qhs * Management of disinhibition in elderly  distraction * Physical findings when death is imminent  nonreactive pupils  decreased response to verbal stimuli  inability to close eyelids  drooping of nasolabial fold  hyperextension of neck  grunting of vocal cords  upper GI bleed * Limits of pain medication on dying patient  pain management is a professional, moral and legal obligation  pain should be assessed  use of pain behavioral tools such as: o Pain Assessment in Advanced Dementia o Behavioral Pain Scale o Critical Care Pain Observation Tool  Use of NSAIDs as first line  Use opioids but not meperidine (it is not reversible with Naloxone) * Theories about successful aging…(Erikson’s, Levinson’s, Peck’s, Butler’s) see Successful Aging Theories in AC folder * Psychological abuse of elders  Most common abuse  Threatens of physical punishment or withholding basic needs  Deprives elderly of healthy mental well being  Prolonged periods of solitude  Can be inflicted by spouses, children, or siblings  Domestic violence within the family  Physical disability increases risk  Women who provide more than 65% of the household income are more likely to be abused  Caregiver strain increases abuse  passivity, withdrawal, or increasing depression;  evasiveness or reluctance to talk openly;  avoidance of eye contact or verbal contact with a caregiver;  cowering in the presence of the abuser;  hopelessness, helplessness, anxiety, or feelings of powerlessness (Anxiety and powerlessness are the most commonly expressed warning signs in grandfathers in the custodial role.);  fear;  confusion that is unrelated to any medical condition;  change in sleeping or eating habits;  contradictory statements;  missing appointments; and  isolation from friends or other family. * Transtheoretical model of change  focuses on intentional behavior change o Precontemplation (not ready) o Contemplation (getting ready) o Preparation (ready) o Action o Maintenance * Death anxiety  Thanatophobia  Fear of death or the dying process  Is not recognized by APA: considered GAD  SS: anxiety, dread, and distress  Tx: learning to refocus fears and talking about your feelings * Assessing driver safety in elderly  Assessment of Driving-Related Skills (ADReS)  Use direct language  Reassurance of safety in mind  If fear is expressed emphasize that you do not have the power to take the license away  Encouragement of taking a self-exam  Vision, cognition, and motor function * Geriatric Depression Screen  GDS  15 question quiz  a score of >5 suggestive of depression  as score of greater than or equal to 10 indicative of depression  as score of >5 should warrant a follow-up comprehensive assessment EENT * Eye pain from medications  Bisphosphonates: meds used to increase bone density  Fosamax, Aredia, Actonel, Skelid, Zometa, Didronel  Topamax: used to treat migraines * Cataracts  Cloudy or opaque area in the lens  Can interfere with vision  Usually in pts over 55  Blurry, or hazy vision  Reduction of intensity of colors  Increased sensitivity to glares  Difficulty night seeing * Chronic uveitis  Long-standing inflammatory disease of the anterior part of the eye  Exceeds 3 months  Swelling and destruction of eye tissue  Middle layer of eye  Consists of the iris, ciliary body, and choroid  disrupts vision by primarily causing problems with the lens, retina, optic nerve, and vitreous * Gonococcal conjunctivitis  caused by Neisseria gonorrhoeae(gonorrhea), a sexually transmitted disease that also may spread to the eye by contact with genital secretions from a person who has a gonorrheal infection.  Affects neonates  Treatment includes pre-treat the mother  include topical erythromycin ointment and an IV or IM third-generation cephalosporin * Viral, allergic, bacterial conjunctivitis  viral o highly contagious; starts in one eye and quickly spreads to the other o watery discharge o adenovirus, or herpes simplex (HSV) o may accompany URI such as measles, the flu, or common cold o treatments: drops to reduce the symptoms, decongestants to reduce swelling, vasoconstrictors to whiten the eye, antihistamines to reduce the itching  bacterial o most common cause: staph aureus, Haemophilus influenza, strep pneumoniae, and pseudomonas aerugiosa o thick discharge or pus o can affect one or both eyes o abx drops for one to two weeks  allergic o caused by allergies o itchy eyes o antihistamine drops OTC and Rx * Macular degeneration  leading cause of vision loss  incurable  deterioration of the central portion of the retina  central portion of retina is the macula  responsible for focus  hereditary and environmental  smoking, African American, Hispanics, Latinos, and genetics * Dacrocystitis  infection of the lacrimal sac 2/2 obstruction of the nasolacrimal duct at the junction of lacrimal sac. It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora * Open angle glaucoma  the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye's drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve * Metal FB in eye  attempt to irrigate  ophthalmology should be consulted for removal  pt with rust ring should be treat like pts with corneal abrasions  topical abx ointment is better than drops  pt that wear contact lens should have pseudomonas coverage (ciprofloxacin, ofloxacin, tobramycin, or gentamicin)  no contacts: erythromycin  pain control: varies according to size * Penetrating eye injury  do not force eyelids open (pressure can cause extrusion of ocular contents)  do not attempt to remove  NPO  Analgesia (If opiates are required consider concurrent antiemetic as vomiting increases intraocular pressure and may cause expulsion of ocular contents. Use ondansetron rather than agents which may precipitate dystonic reactions.)  Notify ophthalmology  image the orbit (X-ray or CT) in cases where an intra-ocular foreign body is suspected. * Corneal abrasions  a scratch or cut on the outermost surface of the cornea, the epithelium  painful bc of the many nerve terminations  most are superficial and heal spontaneously  larger abrasions are treated with abx drops or ointment  patches are sometimes used to decrease the pain and promote healing  do not keep patch on over 24 hours at a time * Orbital cellulitis  infection involving the contents of the orbit (fat and ocular muscles)  most common cause bacterial rhinosinusitis  other causes: ophthalmic surgery, peribulbar anesthesia, orbital trauma, dacryocystitis, infection of the teeth, ear, or face, an infected mucocele that erodes into orbit pain with eye movements, proptosis, and ophthalmoplegia with diplopia.  causes ocular pain and eyelid swelling with erythema, and swelling and inflammation of the extraocular muscles and fatty tissues within the orbit leading to pain with eye movements, proptosis, and ophthalmoplegia with diplopia.  Ddx: Preseptal cellulitis, Mucormycosis or aspergillosis involving the orbit, Idiopathic orbital inflammatory disease, Cavernous sinus thrombosis, Herpes simplex or varicella zoster virus infections involving the eye, Tuberculosis involving the orbit, Endophthalmitis, Tumors, posterior scleritis, periocular dermoid cyst, granulomatosis with polyangiitis (Wegener’s disease), trauma, allergic response, hordeolum, severe conjunctivitis, mucocele, thrombosed orbital varix, graves disease * Orbital fractures  Traumatic injury to the bone of the eye socket  If the fx is small it may not need to be treated with surgery  More severe when it keeps the eye from moving properly  Surgery may not be completed until swelling goes down  Decongestants and antibiotics are prescribed * Sensorineural hearing loss  Hearing loss involving the inner ear, cochlea, or the auditory nerve * Conductive hearing loss  Involving any cause that in some way limits the amount of external sound from gaining access to the inner ear. Ex: cerumen, impaction, middle ear fluid, or ossicular chain fixation * Age related hearing loss  Presbycusis * Transient hearing loss  Temporary * Acute otitis media  Inflammation of the middle ear * Vertigo (acute or central)  symptom of illusory movement  vestibular dysfunction * Epistaxis  nosebleed