PMHNP Board Prep 1 - 12 (Answered) Complete Solution

PMHNP Board Prep 1 - 12 (Answered) Complete Solution symptom presentation affective, cognitive, physical autosomal dominant genetic inheritance. will present in more than one generation. 50/50 chance of passing on trait (Huningtons) autosomal recessive two copies must be present (cystic fibrosis prior to MSE assessment includes ROS, VS, heart tone, lung sounds, neuro exam, muscle tone, rigidity SLUMS 11 items. Max 30, 27-30 normal for high school education, 21-60 mild neurocognitive disorder, 0-20 dementia MMSE 11 components. Max 30, no impairment 24-30 Delirium/dementia 18-23 mild, 0-7 severe SLAP suicide assessment. Social support, Lethality, Access to means, Plan/Previous attempt Hamilton Anxiety Rating scale most popular anxiety scale Vanderbilt Assessment Scale free ADHD assessment tool Abnormal Involuntary Movement Scale (AIMS) total score is less important than monitoring areas of the body. 2 or more is positive. Question 7 examines trunk movements WHODAS 36 item, measures six domains, understanding and communicating, getting around, self care, getting along with people, life activities and participation with society. 0=no disability, 100=full disability Metabolic syndrome abdominal obesity and any two of the following: triglycerides 150, HDL 40/50, BP 130/85, FSBS 100 or prior type 2 diabetes general screening labs CBC, chemistry panel, thyroid labs, hepatic panel, B12/folate and vitamin D PET scan localizes mental activities, primarily as experimental basis and is very expensive cranial nerves olfactory=smell, sensory optic=vision, sensory oculomotor=most EOM, motor trochlear=downward and inward eye movement, motor trigeminal=mastication muscles, sensation of face, both abducens=lateral eye movmement, motor facial=move face, close eyes, taste, saliva, tears, both acoustic=hearing and balance, sensory glossopharyngeal=phonation, gag, carotid, swallowing, taste, both vagus=talk, swallow, carotid, both spinal accessory=shrug shoulders, motor hypoglossal=moves the tounge, motor tender lymph node classic sign of infection rubbery lymph node classic sign of lymphoma soft lymph node insignificant nontender lymph node classic sign of potential malignancy lymph node size insignificant if less than 2cm, 3cm in axilla and inguinal. but if supraclavicular fossa, 1cm is significant lasts longest in the urine cannabis. 3 days to 4 weeks pneumococcal vaccine give to 19-64 year old smoker or if have asthma Pap smear every 3 years, HPV every 5 years. discontinue at age 65-70 if have 3 consecutive negative and no abnormal tests in 10 years prostate exam digital begin at age 40 and PSA at age 40 if have family history of prostate cancer or AA. ALL males 50 years and older should get screening colorectal screening starting at 50 years old, annual fecal occult blood test, flex sig every 5 years and colonoscopy every 10 years Medicare B screening coverage for cervical, breast, prostate, colorectal cancer top 4 killers of adults in US heart disease, cancer, lower resp disease, CVA lung cancer highest cancer mortality in women and men, primary prevention PROMOTES health PRIOR. healthy diet, exercise, avoiding things secondary prevention focuses on early identification and treatment of existing problems. includes REGULAR exams and screening like pap tertiary prevention rehab and restoration of health hepatitis A vaccine for military, travelers to endemic areas, men who have sex with men diabetes screening impaired if FSBS 100-125 diabetes if 126 on two separate occasions cholesterol screening evaluate serum lipid levels Total cholesterol 200 Triglycerides 150 HDL 40-60 LDL 100 (70 if heart disease) Joint National Committee Classifications (JNC) to treat hypertension AA start of thiazide diuretics, Ca channel blockers mitral regurgitation S3 at 5th ICS MCL, musical TSH 20 weight gain is more likely 4.2 indicates hypothyroid low T4 indicates disease state is due to thyroid gland hyperthyroid low TSH, high or normal T4 mimics mania hypothyroid high TSH, low T4 mimics depression management of hypothyroid in adults levothyroxine (synthroid) if less than 60, generally healthy, start 100mcg or 1.7mcg/kg daily. geriatric start at 25mcg daily synthroid adjustments monitor levels every 4-6 weeks and increase until therapeutic HIV transmission via needle stick 1:350 HIV screening ELISA for initial screening western blot is confirmatory Chlamydia treatment zithromax OR doxy. report to health department Gonorrhea rocephin 250mg IM one dose + ziethromax 1gm one dose Syphilis benzathine penicillin G 2.4 million units IM. how often depends on the stage. doxy if allergic Structure of the mind Id: unconscious instinctual drives, pleasure principle Ego: rational, maintains harmony between id and superego Superego: perfection principles, forms the conscious relief behaviors actions, healthy and not healthy, to reduce stress Ego defense mechanisms Are many in number. Must be evaluated Goals of therapy make the conscious conscious and strengthen the ego so that behavior is based more on reality and less on instinctual drives Interpersonal Therapy Harry Stack Sullivan good me, bad me, not me Transactional Analysis Eric Berne Ego states include the Parent (shoulds), the Adult (gather information) and the Child (feelings, impulses Goal is to assist client to make new decisions about present behavior and life Gestalt Therapy Frederick Perls Focuses on the now psychoanalytic psychotherapy is best matched with the client with MATURE defenses, some object constancy Person centered therapy Carl Rogers qualities of therapist are accurate empathy, warmth, unconditional positive regard. Does NOT include history taking Motivational Interviewing based on collaboration between therapist and client, evoking or drawing out the clients ideas about the change, emphasizing autonomy of the client Stages of change pre contemplation contemplation preparation action maintenance relapse Behavioral Therapy Pavolov, Skinner, Bandura, Wolpe Differs fundamentally from psychodynamic approach "why" is not useful how behavior impacts functioning and affect currently Anxiety treatment classical and operant conditioning Rational Emotive Therapy Albert Ellis personal relationship is not essential goal to eliminate clinents self defeating outlook on life psychopathology has similiar set of underlying irrational beliefs Cognitive Behavioral Therapy Aaron Beck each disorder has its own typical cognitive content requiring differing treatment approaches socratic dialogue 7 types of questions: memory, translation, interpretation, application, analysis, synthesis, evaluation psychologically minded persons capacity for self examination, self reflection, introspection and personal insight Supportive psychotherapy reinforces patients healthy and adaptive thought pattresn and functional behaviors, aiming to reduce intrapsychic conflicts, minimizing symptoms of mental disorders ego strength deal with demands of id, super ego and reality. helps us maintain emotional stability and cope with internal and external strength intrapsychic conflicts class of opposing impulses, wishes, drives or external demands triangle of unconscious impulse-feelings/anxiety/defense triangle of feelings transference/current significant person/past significant person Hildegard Peplau nursing sub roles mother surrogate technician manager socializing agent health teacher counseor or psychotherapist phases of therapeutic relationship orientation working termination orientation establish trust and set parameters with addressing immediate issues, establishing each others roles, communicate in general therapeutic goals, contracting, establish confidentiality, termination working collect information, apply problem solving skills to patient situation, enhance self esteem, support positive changes in behavior, work through patient resistance to change behaviors, help patient develop adaptive coping skills, lay ground work for termination termination occurs when therapeutic goals are realized, review of therapeutic accomplishments, communicate methods for patient to sustain and grow his mental health, discussion of feelings concerning termination are explored, guidelines for further communication are established therapeutic milieu management of therapeutic environment to facilitate the therapeutic process. involves multidisciplinary team promotes therapeutic environment structure, involvement, containment, support, validation role of NP in the milieu ensure physiological needs are met, encourage independence, reality orientation, medication management, 1-1 relationship, setting limits, teaching ideal group size 8 group membership open ended (can join anytime) close ended (pre-determined, fixed time frame Yaloms therapeutic/curative factors of group universality, hope, education, self esteem, correct maladaptive behavior, social skills, role modeling, insight, security, emotion expression, existential factors leadership styles autocratic, democratic, laissez-faire Family System Theory Murray Bowen triangles genograms focus on family relationships and not the individual Strategic Family Therapy Jay Haley and Milton Erickson families develop strategies to solve problems and the strategies become problems therapy involves design of strategies for eliminating problematic behavior Structural Family Therapy Salvador Minuchin structure, subsystems, boundaries diffuse boundaries more chaos, rigid boundaries less emotional support concordance a true partnership, communication is about collaboration, clinicians bring their expertise and clients bring their experiences, beliefs, wishes disorders of behavior behavior offers relief from tension behavior disorder serotonin metabolism evidence it is abnormal with low 5HT turnover and decreased CSF of serotonin metabolite disorders of behavior diagnosis is one of exclusion disorder of behavior characteristic degree of aggression is out of proportion to any provocation or precipitating psychosocial stressor that is NOT due to medical or substance. keleptomania failure to resist impulse to steal objects NOT needed for personal use or needs WITHOUT assistance from or collaboration of others Kleptomania family history ODC in first degree relatives Pyromania tension or affective arousal before setting fires Trichotillomania biopsy may be helpful to make diagnosis, best course of treatment unclear but biofeedback, hypnotherapy, SSRI, Pimozide, Naltrexone, BUSPAR feeding and eating disorders condition where one spends more time eating or not in response to external cues feeding and eating incidence 1: 10 male to female ratio for anorexia nervosa and bulimia nervosa anorexia age of onset usually between 12-17 with a second peak in later adolescence 17-18 years old. age of bulimia is later than anorexia Anorexia symptomatology loss of at least 15% of total body weight pigmentation on chest and abdomen metabolic imbalances hibernation appearance bulimia vs. anorexia bulimia is sexually active, anorexia is not parotid hypertrophy binging and purging Binge Eating Disorder Vyvance treatment FDA indicated mortality rates eating disorders anorexia 4% bulimia 3.9% binge eating disorder 5.2% substance related disorder behavioral evidence/diagnostic criteria of pathological use type, amount, pattern of use is less significant than behavioral manifestations impaired control, social impairment, risky use, pharmacological criteria substance abusers 20 times more likely to die by suicide than the general population and those who have died by suicide have had a loss within a year methadone withdrawal lasts longer than heroin withdrawal Impaired control behavioral manifestation consume larger amounts over longer period of time, unsuccessful efforts to cut down, significant amount of time spent in obtaining, using or recovering Social impairment behavioral manifestation failure to fulfill work, school or home obligations, continued use desptie social or interpersonal problems, other activities given up or reduced Risky use behavioral manifestation