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What is dissemination? - ✔✔Getting the research information out to those who need to know it! Publication - highest level Presenting at National ConferencePresenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? - ✔✔Moderate cognitive impairment What is Tegretol in the CYP450 system? - ✔✔Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? - ✔✔Inducer - will lower dose of Lamictal What is a Type I research error? - ✔✔There IS a difference but you say there isn't a difference. What is a Type II research error? - ✔✔There is NO difference but you say there is a difference. What is pseudo-dementia? -in the elderly. Dementia won't improve. ✔✔Cognitive impairment secondary to depression that clears when treated
Is it normal for a 1 month old to have a palmar grasp? - ✔✔Yes. What is a drug 1/2 life? - ✔✔The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? - ✔✔Zyprexa, Abilify, Seroquel - low doses
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What is a risk of using Tramadol? - ✔✔Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? - ✔✔HLAB- When might you see toxic epidermal necrolysis? - ✔✔With worsening of SJS How many generations do you include for a genogram? -2nd degree - grandparents & cousins ✔✔1st degree - mother, father, siblings 3rd degree - What does messenger RNA code for? - ✔✔Amino Acids What is epigenetics? - ✔✔Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? -Occipito-Frontal ✔✔Basal Ganglia
What happens to the brain during adolescence? -Emotions are controlled by amygdala ✔✔Dendritic pruning By adulthood, PFC involved as well When do males typically present with schizophrenia? - ✔✔10-25 yo When do females typically present with schizophrenia? - ✔✔25-35 yo What does Erythromycin to trileptal? -and erythromycin is a inhibitor ✔✔You will need to decreases the level because Trileptal(inducer)
What is the scoring with the Beck Depression Inventory? - ✔✔Self-Report - 0- 0-13 - minimal14-19 - mild 20-28 - moderate29-63 - severe
What is sensitivity? - ✔✔Helps rule-out disease = True Positive = Snout What is specificity? - ✔✔Helps rule-in disease = True Negative = Spin What does a sed rate measure? -mm RBC's have descended in 1 hour. ✔✔Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in
What is a normal sed rate or ESR? -0-29 females ✔✔0-22 males
What is a retic count? -enough RBC's are being produced by bone marrow. ✔✔Measures % of reticulocytes in blood (immature RBC's) Indicates whether
What does a decreased retic count indicate? - ✔✔Anemia - acute or chronic bleeding What does an increased retic count indicate? - ✔✔Bone marrow disorder or Vitamin Deficiency What does an abnormal retic ount indicate in general? -source of the issue. ✔✔Doesn't diagnose anything. First step is ID
What happens when you mix tegretol and macrolides? - ✔✔Increase tegretol levels.
What happens if a pregnant women takes Accutane? - ✔✔Birth defects. What labs do you get with RA? -diagnosis. ✔✔Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm CRP and ESR are both increased in RA but NOT in osteoarthritis. Where does the NP Code of Ethics come from? - ✔✔ANA When do you assume informed consent? - ✔✔Unconscious IncompetentLife Threatening Situation
What are the legal ramifications of treating w/o informed consent? - ✔✔Same as with informed consent Who can declare a patient incompetent and appoint a guardian? - ✔✔Only a court Does impaired judgment mean one is incompetent? - ✔✔No. Can an advanced directive ever be revoked? - ✔✔Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? -They are all the same. ✔✔Nothing.
Does the de facto rule of proxy apply in same sex marriages? - ✔✔No. How do Asians see HC providers? -Expect to give instructions and help make decisions ✔✔As in a position of authority.
What does it mean when an Asian patient does not make eye contact with the NP? - ✔✔SIgn of respect
Schedule III - Moderate Abuse Potential - hydrocodone, codeine Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine Schedule V - Very low abuse potential - anti-tussives, lomotil What classes of CS's is the NP approved to prescribe? - ✔✔Schedules III-V ONLY. Where does 50% of healthcare funds come from? - ✔✔The government Who is eligible for Medicare? - ✔✔>65 or under 65 with diability, ANY age with renal disease. What is incident to billing? -directly under the supervision of the MD. ✔✔Means MD initiates treatment and NP is an extension of the care and
Allows NP to get reimbursed at 100% rather than 85%. How are Medicaid benefits determined? -and Fed Govt. ✔✔State determines qualification - Partnership between State Must be impoverished Must be US resident and low or very low income. Can you have Medicare and Medicaid? -last resort. ✔✔Yes, impoverished elderly but Medicaid is always payor of
Is dental care included in Medicaid? - ✔✔Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? - ✔✔National standards for electronic HC transactions
National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state - ✔✔Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? - ✔✔Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? - ✔✔Emergency treatment Substantial communication barriers and consent is inferredInvoluntary committment
Is it ok to announce a patient's name in a waiting room? - ✔✔Yes, no other way to give care. Is it ok to leave a message on a patient's vm? - ✔✔Yes, but should be limited. What is the impact of steroid inhalers on children? -height. ✔✔Slows bone growth and may decrease ultimate
What is the long-term impact of using steroid inhalers? -skin ✔✔Cataracts, glaucoma, thinning of bones and
What is included in the treatment of fibromyalgia? -Antidepressants ✔✔Sleeping meds Pain meds What psychoactives are first line treatment for fibro? -Elavil, Pamelor ✔✔Cymbalta, Effexor
What are two important things to measure when using Zyprexa? -circumference ✔✔Lipid level and abdominal
What is included in the mini-cognitive exam? - ✔✔Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? - ✔✔Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - ✔✔Stop and repeat lab. Normal is 1500-8000 mm Can you take Buspar during pregnancy? - ✔✔Category B - ok if really needed. Can you take Klonopin during pregnancy? -milk and infant could get withdrawal symptoms. ✔✔Category C - avoid if possible; does excrete into breast-
What is the concern when prescribing Lamictal with Depakote? -other and therefore together will lower the level of both drugs. ✔✔Both are CYP450 inducers of the
Can asthma medications cause depression? - ✔✔Yes. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - ✔✔Microalbumin?
What is often common to patients with fibro? - ✔✔Sexual abuse How is telepsychiatry evaluated? - ✔✔Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? - ✔✔Levels increase
What happens with a patient taking Lithium who decreases sodium intake? - ✔✔Levels increase What happens with a patient taking Lithium and drinks a lot of water? - ✔✔Levels decrease If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - ✔✔Zyprexa
What happens when taking Lithium and NSAIDS? -for the patient to become toxic! ✔✔NSAIDS can cause Lithium levels to increase and
What medications are at risk to cause SJS in the Asian population? -of SJS. ✔✔HLAB-1502 Allele increase risks Trileptal, Tegretol and other AED's. Amgdyla - ✔✔Fear, Anxiety, and Aggression Neurotransmitter for Addiction - ✔✔Dopamine and GABA Neurotransmitter for Mood Disorder - ✔✔Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol -Carbamazepine/tegretol ✔✔Erythromycin will cause toxic levels. Decrease
Signs and Symptoms of stimulant abuse - ✔✔insomnia and tremor Depakote check - ✔✔HCG levels Depakote causes - ✔✔Spinal bifida
14 year old girl clenching her teeth - ✔✔Cranial Nerve V-Trigeminal nerve Infant dying - ✔✔Give child to parents and comfort parents borderline personality disorder Treatment - ✔✔dialectical behavior therapy Aggressive patient give - ✔✔IM geodon SIGECAPS of Depression - ✔✔Sleep InterestGuilt EnergyConcentration Appetitepsychomotor retardation Suicide DIGFAST for mania -Indiscretion ✔✔Distractibility GrandiosityFlight of ideas Activity increaseSleep deficit Talking increase 5 year old tells u his brother sodomized him -CPS implement crisis ✔✔Tell mom don't leave him alone with patient and call
Just culture -appropriate accountability ✔✔"Just culture" model: proposed to reconcile the twin needs for no-blame and The focus is on identifying and addressing systems issues that lead individuals to engage in unsafebehaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior. Distinguishes between
At-risk behavior (e.g. taking shortcuts),Human error (e.g. slips), Reckless behavior (e.g. ignoring required safety steps). In a just culture, the response to an error or near-miss is predicated on the type of behavior associatedwith the error, not the severity of the event.
Child reports Sexual Abuse - ✔✔Interview the young child and infants child with parent First sign of temprofrontal Dementia - ✔✔Behavior and personalty changes Tow amines related to depression - ✔✔Serotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability -and expenses ✔✔Revenue
Patient stopped smoking (Cessation) - ✔✔Decreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well -support ✔✔Refer to peer
Spirit stick - ✔✔Teach staff about culture competence Problems in the parietal lobe can lead -perceive objects) ✔✔Sensory-perceptual disturbances and agnosia(inability to
CIWA-Ar -9 item symptom rating scale, max score 67; <10 does not warrant intervention ✔✔Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised
Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do -his experience and provide care in a culturally specific way to that patient ✔✔Validate
Native American wants his healer present -cleared for you to involve her ✔✔Involve mother of the patient and healer, mom was
16 year old shows up with mother for first therapy is - ✔✔confidential mom sits in lobby Patient acts out due to missing session what do you do -talk about it with the patient ✔✔You relate to childhood abandonment and
How do you assess the competency of a medical procedure - ✔✔Identify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, whatdiagnosis - ✔✔Delusional disorder
Increase ICP (signs and symptoms) - ✔✔Baby Neuro cry Menopausal woman - ✔✔Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide - ✔✔Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent - ✔✔Unit staff You are a lead NP over other NPs in a rural setting how would you go about the change -form and have them vote on it ✔✔Make online
16 year old refuse treatment - ✔✔Send to psych specialist for acting out kids Positive Trendelenburg Sign - ✔✔Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. Drug affects Flonase - ✔✔Zantac (Histamine 2 Blocker) Antagonist Little boy wet his sheets, What kind of therapy would you suggest - ✔✔Behavior therapy DDVAP acts in much the same manner as antidiuretic hormone. - ✔✔Makes less urine Lithium level 1.2u what are you concerned with - ✔✔4+ Ketones What does depakote do to Lamictal - ✔✔Increase laminate 200% Inducers of Cytochrome P450 (CYP450) -John's Wort ✔✔Barbiturates, phenytoin, carbamazepine, rifampin, St. A substance that speeds up a chemical reaction Inhibitor - ✔✔A substance that slows down or stops a chemical reaction cytochrome p450 inhibitors - ✔✔CRACK AMIGOS CimetidineRitonavir Acute AlcoholCiprofloxacin Ketoconazole Amiodarone
limbic system -cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for ✔✔A doughnut-shaped system of neural structures at the border of the brainstem and food and sex. Includes the hippocampus, amygdala, and hypothalamus. Amygdala -aggression. ✔✔A limbic system structure involved in memory and emotion, anxiety, particularly fear and
PANDAS - ✔✔Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD Mental Health Parity Act 1996 -equal life time and annual limits ✔✔ensure equal coverage for mental and physical illness
charge of DEA - ✔✔state and federal Stereogenesis - ✔✔identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object Sterogenesis abnormality in - ✔✔parietal lobe Clozaril (Clozapine) -ANC LESS than 1000 (950) dc medication ✔✔WBC-
how treat child with depression - ✔✔Zoloft and therapy 3 year old masturbates, plays with self, says naught things - ✔✔normal for Piaget NMS treatment -D2 agonists (e.g., bromocriptine). ✔✔Dantrolene: MUSCLE RELAXTION
For NMS, think FEVER:Fever EncephalopathyVitals unstable Elevated enzymesRigidity of muscles
mesolimbic system - ✔✔POSITIVE symptoms of schizophrenia due to high dopamine negative symptoms of schizophrenia -rigid bodies) ✔✔the absence of appropriate behaviors (expressionless faces,
negative symptoms of schizophrenia - ✔✔mesocorticol pathway mesocortical pathway -negative symptoms ✔✔VTA to prefrontal cortex
Nigrostriatal pathway - ✔✔EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA;used to initiate movement
PDSA model -Do-carry out ✔✔PLAN- Study -examine results Act-decide what action Tanner's stages - ✔✔
