NUR 533 Healthcare Financial Management and
Business Planning for Nurse Leaders
1.What may cause false positives for Amphetamines on drug screens?:
Stimu- lants/ADHD meds, Bupropion, Fluoxetine, Trazadone, Rantidine,
Nefazodone, nasal decongestant, Pseudophed
2.What may cause false positives for alcohol on drug screen?:
Vali- um/Dizepam
3.What may cause false positives for Benzos on drug screen?:
Sertraline/Zoloft
4.What may cause false positives for cocaine on drug screens?:
Amoxicillin, most Abx, NSAID
5.What may cause false positives for heroin or morphine on drug screens?:
Quinolones, rifampin, codeine, poppy seeds
6.What may cause false positives for methadone or PCP (phenycycline)
on drug screens?: OTC meds with Dextromethorpan like Nyquil
7.What is MDD?: Common, complex brain based illness w/ persistent
disturbance in mood with excessive or distorted degree of sadness and
loss of interest in previously enjoable activities/anhedonia
Patho: Complex genetic, biochemical, enviornmental disease. NT &
hypothalamaic pituitary adrenal axis dysregulation. Dysfucntion in areas
f brain involved in emotion- al regulation (amygdala, hippocampus,
limbic system). Abnormal cortisool elevation d/t hyperecretion.
8.MDD risk factors? causes?: Leading cause of disability in the US
- average age of onset is 20
- Women > Men
- Equal across genders before puberty & after menopause
Rx: Genetics, prior episode of MDD is strongest predictor (60% after 1
episode, 70% after 2, 90% after 3), female, postpartum, medical
comorbidities, single partial status, environmental stressors, limitied
coping skills, hx of trauma or abuse
9.MDD Dx Criteria?: Prescense of 5+ symptoms for 2+ weeks
Primary S/s (at least 1 must be present):
- Depressed mood most of the day/nearly every day
- Anhedonia (loss of interest/pleasure in previosuly in enjoyable activites
,Additional S/s:
- Sleep disturbance, fatigue/loss of energy, appetite/weight changes,
psychomotos agitation, feelings of worthlessness, diminshed
concentration, recurrent thoughts of death/suicide
,May also present somatic complaints, memory impairment, irritability,
social with- drawl, poor hygiene, increased alcohol intake
10.MDD Complications?: Suicide (assess all patients for risk), substance
abuse, poor work/school performance, relationship difficulties, reduced
quality of life, high risk for CVD, DM, comorbid anxiety, increased
healthcare utilization
11.MDD Screening & Work up?: Screen:
- PHQ2 initally then PHQ9 if positive
- Edinburgh postnatal depression scale, Beck Depression Inventory,
Hamilton De- pression Rating Scale, Hamitlon Depression Rating Scale,
Geriatric Depression Scale for older adults, Assess suicide risk in all
patients
Dx:
- HX and physical, mental status exam, lab tests to r/o medical causes
(CBC, CMP, TSH, B12, UA, Toxicology, Consider additonal w/u based on
presentation)
12.MDD Differential?: - Bipolar (must r/o before prescribing
antidepressants)
- Persistent depressive disorder/dysthymia
- Adjustment disorder
- Grief/bereavement
- Anxiety disorder
- Substance induced mood disorder
- Medical conditions (thyroid, anemia, vitamin deficiencies)
- Medication side effects
- ADHD
13.MDD Management?: Non-Pharm:
- Psychotherapy is 1st line for mild depression (CBT, interpersonal
therapy, problem solving, & brief solution therapy)
- Exercise, sleep hygiene, social support enhancement, nutrition
counceling, stress management
Pharm:
- 1st line of moderate to severe depression from most energizing to
most sedating: Fluoxetine, Sertraline, Citalopram, Escitalopram,
Paroxetine)
- SNRI: Venlafexine, Duloxetine, Desvenlafaxine
- Atypical Antidepressant: Burpropion, Mirtazapine, Trzaodone
, Start low and go slow, allow 4-8 weeks for full effectiveness, continue 6-9
months after symptom remission, will need indefinite maintenance
therapt if 3+ episodes, taper to prevent withdrawal, monitor for side
effects, BLACK BOX warning for increased suicide in patients >24
If not response after 4-8 weeks at max dose, switch to another agent in
same or different class, consider augmentation strategies, and refer to
psych if poor response
14.Bipolar disorder?: Complex brain based mood disorder w/ extreme
shifts in mood, energy, activity levels, and concentration that impacts
daily fucntioning. It features depression w/ alternating periods of
mania or hypomania.
Patho: Neurobiologic dysfucntion in interconnected NT pathways.
Structural brain changes affect limbic system & prefrontal cortex.
Alterations in hypothalmic pituitary adrenal axis & circadian rhythms
15.What is Bipolar I?: at least 1 manic episode (with or w/o psyhosis and
or major depression)
16.What is Bipolar II?: Hypomanic episodes plus major depression; no hx
of manic episodes
17.What is Cyclothymia?: Hypomania and depressive sx that dont meet
full crite- ria for Bipolar I or II
18.Bipolar causes? risk factors?: Genetics (24% increase if 1st degree
relative w/ Bipolar I & 5% increased w/ Bipolar II), family hx,
neurochemical imbalances in the brain, environmental triggers like
stress/trauma/susbstance abuse, changes in sleep, hormone
imbalances
19.Bipolar S/s?: Mania 1+ week:
- elevated/expansive/irritable mood, infalted self esteem/grandiosity,
decreased need for sleep w/o fatigue, pressured speech, racing
thoughts, distractability, in- creased goal directed activity/psychomotor
agitation, excessive risk taking behav- iors
Hypomania 4+ days:
- Similar to mania but less severe, does not cause marked impairment
or require hospitlization, no psychotic features
Business Planning for Nurse Leaders
1.What may cause false positives for Amphetamines on drug screens?:
Stimu- lants/ADHD meds, Bupropion, Fluoxetine, Trazadone, Rantidine,
Nefazodone, nasal decongestant, Pseudophed
2.What may cause false positives for alcohol on drug screen?:
Vali- um/Dizepam
3.What may cause false positives for Benzos on drug screen?:
Sertraline/Zoloft
4.What may cause false positives for cocaine on drug screens?:
Amoxicillin, most Abx, NSAID
5.What may cause false positives for heroin or morphine on drug screens?:
Quinolones, rifampin, codeine, poppy seeds
6.What may cause false positives for methadone or PCP (phenycycline)
on drug screens?: OTC meds with Dextromethorpan like Nyquil
7.What is MDD?: Common, complex brain based illness w/ persistent
disturbance in mood with excessive or distorted degree of sadness and
loss of interest in previously enjoable activities/anhedonia
Patho: Complex genetic, biochemical, enviornmental disease. NT &
hypothalamaic pituitary adrenal axis dysregulation. Dysfucntion in areas
f brain involved in emotion- al regulation (amygdala, hippocampus,
limbic system). Abnormal cortisool elevation d/t hyperecretion.
8.MDD risk factors? causes?: Leading cause of disability in the US
- average age of onset is 20
- Women > Men
- Equal across genders before puberty & after menopause
Rx: Genetics, prior episode of MDD is strongest predictor (60% after 1
episode, 70% after 2, 90% after 3), female, postpartum, medical
comorbidities, single partial status, environmental stressors, limitied
coping skills, hx of trauma or abuse
9.MDD Dx Criteria?: Prescense of 5+ symptoms for 2+ weeks
Primary S/s (at least 1 must be present):
- Depressed mood most of the day/nearly every day
- Anhedonia (loss of interest/pleasure in previosuly in enjoyable activites
,Additional S/s:
- Sleep disturbance, fatigue/loss of energy, appetite/weight changes,
psychomotos agitation, feelings of worthlessness, diminshed
concentration, recurrent thoughts of death/suicide
,May also present somatic complaints, memory impairment, irritability,
social with- drawl, poor hygiene, increased alcohol intake
10.MDD Complications?: Suicide (assess all patients for risk), substance
abuse, poor work/school performance, relationship difficulties, reduced
quality of life, high risk for CVD, DM, comorbid anxiety, increased
healthcare utilization
11.MDD Screening & Work up?: Screen:
- PHQ2 initally then PHQ9 if positive
- Edinburgh postnatal depression scale, Beck Depression Inventory,
Hamilton De- pression Rating Scale, Hamitlon Depression Rating Scale,
Geriatric Depression Scale for older adults, Assess suicide risk in all
patients
Dx:
- HX and physical, mental status exam, lab tests to r/o medical causes
(CBC, CMP, TSH, B12, UA, Toxicology, Consider additonal w/u based on
presentation)
12.MDD Differential?: - Bipolar (must r/o before prescribing
antidepressants)
- Persistent depressive disorder/dysthymia
- Adjustment disorder
- Grief/bereavement
- Anxiety disorder
- Substance induced mood disorder
- Medical conditions (thyroid, anemia, vitamin deficiencies)
- Medication side effects
- ADHD
13.MDD Management?: Non-Pharm:
- Psychotherapy is 1st line for mild depression (CBT, interpersonal
therapy, problem solving, & brief solution therapy)
- Exercise, sleep hygiene, social support enhancement, nutrition
counceling, stress management
Pharm:
- 1st line of moderate to severe depression from most energizing to
most sedating: Fluoxetine, Sertraline, Citalopram, Escitalopram,
Paroxetine)
- SNRI: Venlafexine, Duloxetine, Desvenlafaxine
- Atypical Antidepressant: Burpropion, Mirtazapine, Trzaodone
, Start low and go slow, allow 4-8 weeks for full effectiveness, continue 6-9
months after symptom remission, will need indefinite maintenance
therapt if 3+ episodes, taper to prevent withdrawal, monitor for side
effects, BLACK BOX warning for increased suicide in patients >24
If not response after 4-8 weeks at max dose, switch to another agent in
same or different class, consider augmentation strategies, and refer to
psych if poor response
14.Bipolar disorder?: Complex brain based mood disorder w/ extreme
shifts in mood, energy, activity levels, and concentration that impacts
daily fucntioning. It features depression w/ alternating periods of
mania or hypomania.
Patho: Neurobiologic dysfucntion in interconnected NT pathways.
Structural brain changes affect limbic system & prefrontal cortex.
Alterations in hypothalmic pituitary adrenal axis & circadian rhythms
15.What is Bipolar I?: at least 1 manic episode (with or w/o psyhosis and
or major depression)
16.What is Bipolar II?: Hypomanic episodes plus major depression; no hx
of manic episodes
17.What is Cyclothymia?: Hypomania and depressive sx that dont meet
full crite- ria for Bipolar I or II
18.Bipolar causes? risk factors?: Genetics (24% increase if 1st degree
relative w/ Bipolar I & 5% increased w/ Bipolar II), family hx,
neurochemical imbalances in the brain, environmental triggers like
stress/trauma/susbstance abuse, changes in sleep, hormone
imbalances
19.Bipolar S/s?: Mania 1+ week:
- elevated/expansive/irritable mood, infalted self esteem/grandiosity,
decreased need for sleep w/o fatigue, pressured speech, racing
thoughts, distractability, in- creased goal directed activity/psychomotor
agitation, excessive risk taking behav- iors
Hypomania 4+ days:
- Similar to mania but less severe, does not cause marked impairment
or require hospitlization, no psychotic features
