NURS 6550 MIDTERM EXAM 2 STUDY GUIDE
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
NURS 6550 Midterm Study Guide 1
, 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
NURS 6550 Midterm Study Guide 2
, 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
NURS 6550 Midterm Study Guide 3
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
NURS 6550 Midterm Study Guide 1
, 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
NURS 6550 Midterm Study Guide 2
, 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
NURS 6550 Midterm Study Guide 3
