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Maryville NURS 663 Exam 2 (Summer 2022 From Dr. Langford's test review) Questions with Certified Solutions 2024-2025
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Phases of Grief · Shock and denial (days-weeks) acute anguish, lost patterns of conduct, resolution (months-year) · Denial, bargaining, depression, anger, acceptance · No real timeline, comes in waves Grief vs. MDD
· Grief - Sx may meet syndromal criteria for MDD episode, but survivor rarely has morbid feelings of guilt, worthlessness, SI, or psychomotor retardation o Considers self bereaved o Dysphoria often triggered by thoughts or reminders of the deceased o Onset within 2 months of bereavement o Duration of depressive episode is less than 2 months o Functional impairment is transient and mild o No family or personal hx of depression o Predominant affect is emptiness and loss o Pain of grief accompanied with positive emotions and humor, self-esteem generally preserved Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0: / 0: Full screen Brainpower Read More MDD vs. Grief MDD
Delirium Vs. Dementia Delirium o 4A & 3C: disturbance in a ttention and a wareness. o A brupt/acute onset with a ltering severity throughout the day. o C ognitive disturbance, c onsequence of another medical condition or substance related. o C an’t be explained by neuro-cognitive dx or coma o More short-term memory than long term memory impaired o Orientation grossly disorganized o Prominent hallucinations o Poor attention o Judgment, social skills, and behavior are grossly impaired o Associated with acute illness, vital signs often abnormal, neuro exam may be abnormal Dementia vs. Delirium Dementia o More long-term memory impaired than short term o Attention less impaired o Orientation varies o Rare hallucinations o Judgment, social kills, and behavior are initially relatively intact o Onset usually insidious o Short term course varies, but stable o Chronic and progressive Normal signs of aging and memory performance
o Everything tends to slow down as we age o Erikson: integrity vs despair. Central conflict is coping, maintaining self-esteem, reconciliation. o Complains about memory loss, but can provide detailed examples of forgetfulness o Occasionally searches for words o May have to pause for directions, but doesn't get lost in familiar places o Remembers recent important events, conversations not impaired o Interpersonal social skills not impaired Screening tools for neurocognitive disorders in the geriatric population Mini-mental status exam (MMSE)
o REM sleep disturbances, insomnia, increased daytime sleepiness o Onset: 50+ Frontal Lobe Dementia o Cause: Abnormal amounts of Tau and TDP-43 accumulate in in the neurons of the frontal and temporal lobes o Progressive behavioral or personality changes that impair social conduct o Impulsive behaviors, emotional extremes (flatness or excessive) o Language impairment- difficulty making or understanding speech o Possible preserved episodic memory o Shaky hands, problems with balance and walking o Onset: between 45 & 64 Donezepil (Aricept) o Cholinesterase inhibitor o GI side effects: nausea/vomiting, diarrhea, (resolve within 3 weeks of use) o Bradycardia found usually in those with underlying heart disease o CYP-450 metabolism o Indicated for mild to severe cognitive impairment o Slows the progression of memory loss o Diminishes apathy, depression, hallucinations, anxiety, euphoria, purposeless motor behaviors o Helps retain cognitive and adaptive faculties at a stable level for several months o May be beneficial for Lewy body dementia and vascular dementia o Warning: may cause catastrophic reaction with signs of grief and agitation- DC use. Galantamine
o Cholinesterase inhibitor o GI side effects: dizziness, headache, nausea/vomiting, diarrhea, and anorexia (mild and transient) o CYP450 metabolism o Indicated for mild to moderate memory impairment o Rarely prescribed Memantine (Namenda) o NMDA receptor antagonist o May protect cells from excess glutamate by partially blocking NMDA receptors o Indicated for moderate to severe memory impairment o Fewer side effects than cholinergics, titrate over 4 weeks to target dose o Safe and well tolerated o Side effects: dizziness, headache, constipation, and confusion Do not use in severe renal impairment The risks of prescribing antipsychotics for patients with dementia · Black Box warning for all anti-psychotics · Increased risk of mortality of elderly patients with dementia-related psychosis · Primarily due to increased risk of cardiovascular events · Weigh risks vs benefits. · Know for education for families and patients Depression vs. Dementia · Depression o Onset can be dated with some precision o Rapid progression of sx after onset o Patients usually complain of some cognitive loss
o Most common in adolescent boys o Type of hypersomnolence o At least two episodes of excessive sleepiness and sleep duration, each persisting from two days to 5 weeks o Episodes occur multiple times a year, but at least once every 18 months o Patient has normal alertness, cognitive function, behavior, and mood in between episodes. o At least one of the following during an episode: cognitive dysfunction, altered perception, eating disorder (Anorexia or hyperphagia), or disinhibited behavior (hypersexuality, impulsive behaviors) Medications to treat insomnia -Benzodiazepine hypnotics -Non-benzo hypnotics (Z-drugs) -Antidepressants -Hypocretin/Orexin antagonist -Melatonin receptor angonists -Antihistamine -Antipsychotics (not reviewed) -Anticonvulsants (not reviewed) Benzodiazepine Hypnotics for insomnia o Benzodiazepine hypnotics o Estazolam, flurazepam, quazepam, temazepam, triazolam o Enhance GABA and galanin o Do not consume with alcohol or opiates- very dangerous Non-benzo hypnotics (Z-drugs)
o Eszopiclone, zaleplon, zolpidem o Black box warning: unsafe sleep behaviors o Enhance GABA and galanin o Taking with high fat meal will impact absorption and effect Antidepressants for insomnia o Trazadone -Mainly through antihistamine effects. -Dosing for sleep is lower: 25-150mg Doxepin Hypocretin/Orexin antagonist o Block orexin, decreases arousal and helps sleep o Suvorexant, Lemborexant Melatonin receptor angonists o Melatonin -acts on M1, M2, and M3. Helps with phase delayed sleep problems. Non- addictive, OTC. Not regulated o ramelteon, tasimelteon
o Binge/purge type- self-induced vomiting, laxative abuse, diuretic abuse, enema abuse. NOT BULIMIA- difference is extremely low body weight. o Severity based on BMI. o Extremely high mortality rate- 6x more likely to die. Mainly due to physiological complications, but 20% die by suicide o Physiological findings: lanugo, carotenemia (orange discoloration of skin, palms, does NOT affect sclera) Binge Eating Disorder o ED o BO- “binge eaters overeat”
Bulimia Nervosa o ED o BOCP
of lead. Anemia can be cause o Differential Dxs: Autism and anemia Pica Treatment Treatments: physical and test for mineral imbalances, lead poisoning, etc. Control for behavior and environmental factors. CBT, daily logs to examine if there's a trigger or association of eating nonfood items. Seek to reduce impulse to eat abnormally Rumination Disorder o FD o Repeated regurgitation of food (to be rechewed, reswallowed, or spit out) for at least one month o Regurgitation is not due to medical condition o Regurgitation dues not occur solely during course of other feeding/eating disorder o If it occurs with another mental or medical condition, the severity o the eating behavior can warrant additional clinical attention o High rate of spontaneous remission o No FDA approved treatment. More of behavioral training Anorexia Nervosa Treatment o No FDA approved medications specifically for Anorexia. o May require medical treatment, hospitalization for dehydration/ electrolyte abnormalities o Treat other psychiatric issues such as anxiety, depression. o Psychotherapy (Usually CBT) Binge Eating Disorder Treatment
o Vyvanse (Lisdexamfetamine) o Psychotherapy (Usually CBT) Bulimia Nervosa Treatment o Fluoxetine (SSRI) o Psychotherapy (Usually CBT) Wellbutrin in Eating Disorders · Contraindicated in ANY eating disorder- Black box warning. Can increase risk of seizures.
