NURS 6550 MIDTERM EXAM STUDY GUIDE
(ACUTE CARE): (2 VERSIONS)
, NURS 6550 MIDTERM EXAM STUDY GUIDE
(ACUTE CARE)
Evaluate patients with psychosocial health conditions
Develop differential diagnoses for patients with psychosocial health
conditions
Develop treatment plans for patients with psychosocial health conditions
Generalized anxiety disorder diagnosis criteria- Excessive anxiety
and worry (apprehensive expectation), occurring more days than not
for at least 6 months, about a number of events or activities (such as
work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms present for more
days than not for the past 6 months). Note: Only one item is required in
children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or
restless unsatisfying sleep)
,Primary neurotransmitter in PTSD- Due to the traumatic stress of PTSD
victims, the neurotransmitters that fuel the sympathetic versus
parasympathetic system get out of balance. As a Yale University journal
review states, “It has been suggested that alterations in NE [norepinephrine],
E [epinephrine], and 5-HT [5HTP] may have relevance for symptoms
commonly seen in survivors with PTSD
* PTSD diagnosis and treatment-assessing history of exposure to a
perceived or actual life threatening event, serious injury or sexual violence,
symptoms lasting more than 1 month. Disturbance causes clinically
significant distress or impairment in functioning
H) The disturbance is not attributable to the physiological effects of a
substance or other medical condition
DSM-5 recognizes a “with dissociative symptom” specifier when the PTSD
symptoms are accompanied by persistent or recurrent depersonalization or
derealization.
The specifier “with delayed expression” should be included if the full
criteria for PTSD are not met for more than 6 months following the trauma.
The traumatic event is persistently re-experienced:
Nightmares
Intrusive thoughts of the traumatic event
Flashbacks
Marked emotional distress when exposed to traumatic reminders
Strong physiologic reaction when exposed to traumatic reminders
Treatment psychotherapy (cognitive processing, prolonged exposure
therapy, eye-movement desensitizing) . SSRIs (sertraline, paroxetine)
clonidine 0.1mg at bed time, prazosin 2-10mg for nightmare, antiseizure
meds for anger management (carbamazepine 400-800mg daily), clonazepam
1-4mg daily for anxiety, Trazodone 25-100mg for sleep.
, Treatment of acute panic attacks- What are the medications for
initial/first line therapy- SL 0.5-1 mg alprazolam, clonazepam 0.5-1mg,
antidepressants, SSRIs (sertraline 25mg/day for 1 week, then 50mg)
Inpatient treatment of depression- ECT
o What are the therapies for patient’s that won’t eat, take
meds, etc.
When is serotonin norepinephrine reuptake inhibitor indicated, when is
it contraindicated? For pain neuropathy/fibromyalgia
Venlafaxine dosing, when is follow up? What are you monitoring? - Blood
pressure monitoring, arrhythmias DOSE is 150-225 mg daily. Patients
should be cautioned about the concomitant use of Venlafaxine tabletsand
NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since
combined use of psychotropic drugs that interfere with serotonin reuptake
and these agents has been associated with an increased risk of bleeding (see
PRECAUTIONS,Abnormal Bleeding).
Usual Adult Dose for Anxiety
Extended release:
Initial dose: 75 mg orally once a day
Maintenance dose: May increase in daily increments of 75 mg orally at
intervals of no less than 4 days
Maximum dose: 225 mg orally per day
Usual Adult Dose for Panic Disorder
Extended release:
Initial dose: 37.5 mg orally once a day
Maintenance dose: May increase dose in daily increments of 75 mg orally at
intervals of no less than 7 days
Maximum dose: 225 mg orally per day
Usual Adult Dose for Depression
Immediate release:
Initial dose: 37.5 mg orally twice a day or 25 mg orally 3 times a day
Maintenance dose: May increase in daily increments of up to 75 mg orally at
intervals of no less than 4 days
Maximum dose: (moderately depressed outpatients): 225 mg orally per day
Maximum dose (severely depressed inpatients): 375 mg orally per day
Comments:
-Daily dosage may be divided in 2 or 3 doses/day
(ACUTE CARE): (2 VERSIONS)
, NURS 6550 MIDTERM EXAM STUDY GUIDE
(ACUTE CARE)
Evaluate patients with psychosocial health conditions
Develop differential diagnoses for patients with psychosocial health
conditions
Develop treatment plans for patients with psychosocial health conditions
Generalized anxiety disorder diagnosis criteria- Excessive anxiety
and worry (apprehensive expectation), occurring more days than not
for at least 6 months, about a number of events or activities (such as
work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms present for more
days than not for the past 6 months). Note: Only one item is required in
children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or
restless unsatisfying sleep)
,Primary neurotransmitter in PTSD- Due to the traumatic stress of PTSD
victims, the neurotransmitters that fuel the sympathetic versus
parasympathetic system get out of balance. As a Yale University journal
review states, “It has been suggested that alterations in NE [norepinephrine],
E [epinephrine], and 5-HT [5HTP] may have relevance for symptoms
commonly seen in survivors with PTSD
* PTSD diagnosis and treatment-assessing history of exposure to a
perceived or actual life threatening event, serious injury or sexual violence,
symptoms lasting more than 1 month. Disturbance causes clinically
significant distress or impairment in functioning
H) The disturbance is not attributable to the physiological effects of a
substance or other medical condition
DSM-5 recognizes a “with dissociative symptom” specifier when the PTSD
symptoms are accompanied by persistent or recurrent depersonalization or
derealization.
The specifier “with delayed expression” should be included if the full
criteria for PTSD are not met for more than 6 months following the trauma.
The traumatic event is persistently re-experienced:
Nightmares
Intrusive thoughts of the traumatic event
Flashbacks
Marked emotional distress when exposed to traumatic reminders
Strong physiologic reaction when exposed to traumatic reminders
Treatment psychotherapy (cognitive processing, prolonged exposure
therapy, eye-movement desensitizing) . SSRIs (sertraline, paroxetine)
clonidine 0.1mg at bed time, prazosin 2-10mg for nightmare, antiseizure
meds for anger management (carbamazepine 400-800mg daily), clonazepam
1-4mg daily for anxiety, Trazodone 25-100mg for sleep.
, Treatment of acute panic attacks- What are the medications for
initial/first line therapy- SL 0.5-1 mg alprazolam, clonazepam 0.5-1mg,
antidepressants, SSRIs (sertraline 25mg/day for 1 week, then 50mg)
Inpatient treatment of depression- ECT
o What are the therapies for patient’s that won’t eat, take
meds, etc.
When is serotonin norepinephrine reuptake inhibitor indicated, when is
it contraindicated? For pain neuropathy/fibromyalgia
Venlafaxine dosing, when is follow up? What are you monitoring? - Blood
pressure monitoring, arrhythmias DOSE is 150-225 mg daily. Patients
should be cautioned about the concomitant use of Venlafaxine tabletsand
NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since
combined use of psychotropic drugs that interfere with serotonin reuptake
and these agents has been associated with an increased risk of bleeding (see
PRECAUTIONS,Abnormal Bleeding).
Usual Adult Dose for Anxiety
Extended release:
Initial dose: 75 mg orally once a day
Maintenance dose: May increase in daily increments of 75 mg orally at
intervals of no less than 4 days
Maximum dose: 225 mg orally per day
Usual Adult Dose for Panic Disorder
Extended release:
Initial dose: 37.5 mg orally once a day
Maintenance dose: May increase dose in daily increments of 75 mg orally at
intervals of no less than 7 days
Maximum dose: 225 mg orally per day
Usual Adult Dose for Depression
Immediate release:
Initial dose: 37.5 mg orally twice a day or 25 mg orally 3 times a day
Maintenance dose: May increase in daily increments of up to 75 mg orally at
intervals of no less than 4 days
Maximum dose: (moderately depressed outpatients): 225 mg orally per day
Maximum dose (severely depressed inpatients): 375 mg orally per day
Comments:
-Daily dosage may be divided in 2 or 3 doses/day
