NURS 663 Exam 2 Megadeck

NURS 663 Exam 2 Megadeck

Cyclothymic Disorder

Diagnostic Criteria:

(Ans-

· Diagnostic Criteria: For at least 2 years (1 year in children and

adolescents) there have been numerous periods with hypomanic symptoms that do not meet the criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode

· During the above 1- or 2-year period, the hypomanic and depressive periods have been present for at least half of the time and the individual has not been without symptoms for more than 2 months at a time

· Prevalence is 0.4% to 1%

· 15-50% risk for turning into Bipolar I or II

Lithium labs (Ans- level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH

bipolar meds: depression

(Ans- lurasidone (13+), olanzapine + fluoxetine (10+)(symbyax)

bipolar acute and mixed mania (Ans- aripiprazole, risperidone, olanzapine (13+), quetiapine (acute only), asenapine (10+)

classic mood stabilizers (Ans- Lamotrigine (excellent medication to use), lithium, Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no evidence for true Bipolar disorder) 1 / 4

anti-depressants (Ans- class not used w/bipolar disorder

lithium (Ans- Anti-manic, antidepressant, anti-suicidal

Lithium side effects (Ans- Frequent urination, increased thirst, weight gain, sedation

lithium toxicity (Ans- sudden onset tremors, N/V/D, muscle weakness, slurred speech, confusion, seizures (slowing down, feel really out of it)

Tourette's d/o (Ans- Multiple motor and at least one vocal tic (some tics come and go, they don't have them all at the same time to receive the diagnosis)

HRT (Ans- habit reversal training can be used to manage tics

Tics tx (Ans- Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt

Specific Learning Disorders (Ans- difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities; dx by other professionals w/specialized training; NP tx comorbid d/o

Anorexia nervosa (Ans- an eating disorder in which an irrational fear of weight gain leads people to starve themselves; restrictive or binge/purge/exercise

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Bulimia nervosa (Ans- an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

Binge-eating disorder (Ans- significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise

Avoidant/restrictive eating disorder (Ans- avoiding or restricting foods in childhood. significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions around food

Pica (Ans- an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month; decrs incidence with incr age

Feeding and Eating Disorders tx (Ans- Talk therapy (counseling is needed for the distress) (intensive outpatient, partial inpatient or actual inpatient admission may be needed); most have associated depression and/or anxiety

Feeding and Eating Disorders meds (Ans- fluoxetine help but not direct tx Vyvanse approved for binge eating but not because of stimulant effects

Enuresis treatment (Ans-

1. First line is behavioral interventions: bed alarms, toileting at bedtime and

during the night, bladder training

• reassurance, resolves spontan, normal 4-5 yo

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Enuresis meds (Ans- Desmopressin nasal spray; Infants 3 months of age to children 12 years of

age:

Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Dose range is

• to 30 mcg/day. The morning and evening doses should be separately

adjusted for an adequate diurnal rhythm of water turnover.

Major Depressive Disorder Dx (Ans- 5+ for at least a 2-week period; either #1 or 2 req

• Depressed mood most of the day, nearly every day (can be irritability in

children & adolescents)

• Diminished interest or pleasure in all, or almost all, activities
• Change appetite/weight; kids not wt goals

Insomnia or hypersomnia nearly every day

• Up or down Psychomotor
• Fatigue or loss of energy
• Worthlessness/excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness (don't

confuse with ADHD, address mood first)

• Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if

hosp then 2 wk not req.

SLAP (Ans- Social supports; lethal; access to means; plan and previous attempt

Suicide risk: IS PATH WARM

(Ans- Ideation, substance abuse, purpose to live gone; anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless, dramatic moods

SIGECAPS

(Ans- Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide

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