NURS 414 Psychology Final Review

NURS 414 Psychology Final Review ADHD o family dynamics family is dysfunctional inattention and neglected during development poverty lack of resources family stress marital discord parental substance abuse o objective signs & subjective symptoms present before age of 7 years present for at least 6 months hyperactivity talks excessively figety or restless acts as if “driven by a motor” difficulty playing quietly leaves seat when expected to remain seated runs of climbs excessively in inappropriate situations impulsivity blurts out answers before a question has been completed difficulty awaiting their turn causes frequent interruptions or intrusions inattentiveness difficulty sustaining attention during tasks easily distracted by unrelated stimuli or thoughts fails to pay close attention to detail difficulty organizing tasks or activities appears not to listen when spoken to directly fails to follow on instructions or finish assigned work o key assessment data biologic classroom behavior school performance teacher evaluation standardized instruments to measure impulsivity, hyperactivity, inattention development history medical history eating patterns sleeping patterns activity patterns psychological hyperactivity impulsivity inattention discipline issues difficulty in decision making social family situation and interaction parenting style household stability consistency of rules and routines life event school performance o planning care & determining outcomes management overview: o CBT ▪ cognitive therapy ▪ behavioral therapy • token economy – rewarding positive behaviors and punishing negative behaviors o stimulant drugs ▪ methylphenidate [Ritalin, Concerta] ▪ dexmethylphenidate [Focalin] ▪ dextroamphetamine [Adderall, Dexedrine (60s and 70s)] ▪ amphetamine & dextroamphetamine sulfate combination [Adderall] ▪ pemoline [Cylert] biologic interventions modify nutrition promote sleep pharmacological antidepressants bupropion [Wellbutrin] venlafaxine [Effexor] tricyclic antidepressants Psychological imipramine [Tofranil] desipramine [Norpramin] notriptyline [Pamelor] CNS psychostimulants Amphetamines [Adderall, Dexedrine], methylphenidate [Ritalin], dexmethylphenidate [Focalin] Atomoxetine [Strattera] Alpha-2A agonists Clonidine [Catapres], guanfacine [Intuiv XR] social o behavioral programs – nonpharmacological method ▪ token economy rewards for positive behavior consequences for negative behavior o cognitive behavioral techniques • clear limits with clear consequences • predictable environment with decreased stimuli • one assignment at a time • calm environment with few stimuli • homework in a quiet place • eye contact before giving directions about limits and consequences • ask to repeat what was heard family treatment parent training school programming specific remediation comorbid deficits in learning or language alcohol abuse o key assessment data blood alcohol level (BAL) o objective signs & subjective symptoms o nursing interventions banana bag-NS, thiamine, multivitamins IV, folate, B12) replace fluid and electrolyte losses monitor electrolytes, blood pressure, and renal function CV and respiratory support to control blood pressure and maintain airway Assess for other drug use, esp benzos or opioiods Monitor until withdrawal beings and then start treatment o withdrawal symptoms & nursing assessment assessment symptoms within 12 hours and can last for up to 3-5 days o long term sequelae o discharge planning & relapse prevention relapse prevention psychosocial interventions psychopharmacologic agents disulfiram [Antabuse] naltrexone [Relistor] health promotion adequate nutrition vitamin supplementation regular exercise adequate rest/sleep social support 12 step meetings Sponsor Recovery communities Structure/routine Spirituality gratitude amphetamines o tolerance elevation of mood suppression of appetite stimulation of heart & blood vessels o adverse effects CNS hyperstimulation weight loss cardiovascular effects psychosis – delusional, violent, self-harm o acute toxicity dizziness hypertension confusion hallucinations paranoid delusions palpitations – feel as if heart will come out of chest dysrhythmias death is rare o overdose convulsions coma cerebral hemorrhage o Tx if amphetamine overdose Hallucinations chlorpromazine [Thorazine] Hypertension alpha-adrenergic blocker phentolamine [Regitine] chlorpromazine [Thorazine] Seizures diazepam [Valium] Acidifying urine accelerates excretion avoid citrus fruits and diary increase protein and cranberries, prunes, and plums • anorexia nervosa • food intake management • nutritional rehabilitation • daily target for calorie intake • registered dietician (RD) consult • sit with patient for all meals/snacks • during and 30 mins after • refeeding protocol • refeeding syndrome  potentially fatal • atomoxetine [Stattera] • therapeutic use • ADHD • Non-stimulant • No abuse potential • Dose dependent on weight • 70kg • 70kg • Action • a noradrenergic reuptake inhibitor • selective inhibitor of norepinephrine reuptake • not classified as a stimulant • pharmacokinetics • administered once a day • plasma levels peak within 1 to 3 hours • metabolized in liver • adverse effects • gastrointestinal reactions • reduced appetite • dizziness • somnolence • mood swings • trouble sleeping