Core Nursing--Depression, diabetes and whatever

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1

Types of affect

Flat

Moderate

Blunted

Overreactive

2

Emotion

Immediate response--

disgust, joy, surprise, fear, anger

3

Affect

External, readable mood

4

Mood

Continuous general state of mind

5

Broad affect

normal range

6

Restricted affect

restricted range-- cries for dead wife, no happiness for birth of child

7

Parts of limbic system

amygdala, hippocampus and hypothalamus

8

Limbic system activity regulated/moderated by...

the medial prefrontal cortex

9

Key contributor in normal mood

Neurotransmitter and neuronal function

10

Part of the limbic system most effected by chronic stress

limbic system

11

Mood and Affect: contributing factors:

neuro function

stress

health status

social interaction

day and time

age

gender

12

anhedonia

decreased interest in activities

13

Hypomania

4 days of mania

14

mania

at least one week, impairs functioning

15

anxious distress

impending doom

restlessness

impaired concentration

high anxiety

fear of losing control

16

patients who experience anxious distress with bipolar/depression are

at a greater risk for suicide and harder to treat

17

mood disorders effect

10% of adults

18

Two major mood disorder neurotransmitters

serotonin and norepi (DECREASE)

19

Poor coping

avoidance

rumination

self pity

self blame

isolation

denial

helplessness

20

Altered thinking

poor memory

poor decision making

poor concentration

indecisiveness

21

MDD must include 4 of

Changes in weight (5%) or appetite

sleep disturbances

fatigue

worthlessness or guilt

poor concentration

suicide ideation

22

persistant depressive disorder is also called...

dysthymia

23

Situational depression timeline

starts within three months of event

lasts no longer than six months

higher level of anxiety may be present

24

Bipolar 1

manic

25

bipolar 2

hypomanic

26

Bipolar may come with what features

mixed (mania and depressive features during each cycle)

rapid cycling (4 or more episodes in a year)

27

Theories of depression

Sociocultural

cognitive

learning

interpersonal

inflammation

hormonal

biological

28

Primary depression strategies

teaching coping skills, diet, not smoking, relationships

29

Secondary depression strategies

screening, referral and counseling

30

Tertiary depression strategies

collaborative care and community programs

31

Most common depression screener

Patient health questionnaire (PHQ-9)

32

Transcranial magnetic stimulation targets.. to treat depression

the LEFT prefrontal cortex

33

transcranial magnetic stimulation targets... to treat mania

the RIGHT prefrontal cortex

34

Which vitamin is involved in the production of norepi and serotonin

vitamin B

35

Onset of bipolar disorder

late adolescence or 20s

36

Antidepressant approved for use in childrn

fluoxetine/prozac

37

OCD in children and adolescents treated with

Zoloft

38

Drug that causes increased risk of suicide in children and adolescents...

Paxil

39

Drugs with a category A rating (no knows risks to fetus)?

NONE

40

Risks of psychotropic drugs

Ortho hypoTN

Suicide

GI distress

Electrolyte imbalance

41

Atypical antipsychotics and older adults

increased risk of death w/ dementia

42

MAOIs details

Lots of interactions

HTN crisis

hypoglycemic potentiation of insulin etc

43

TCAs details

hard on heart

lower seizure threshold

anticholinergic side effects

44

SNRIs details

serotonin syndrome

hepatotoxicity

lower seizure threshold

not for bipolar, may intensify psychotic features

excessive drowsiness

45

SSRIs details

GI upset, take with food

serotonin syndrome w/ ginko

drowsiness

suicidal ideation and serotonin syndrome

46

Pathophysiology of depression

decreased grey matter

increased limbic center activity

decreased metabolism of medial prefrontal cortex

47

depression related neurotransmitters

norepi, serotonin, gaba, ach, glutamate, dopamine

48

depression and inflammation?

increased levels of cytokines in SOME people

49

evidence of limbic hyperactivity?

high cortisol

high CRH

50

To qualify as MDD, symptoms must last..

14+ days

51

If a depressed pt has a hx of mania...

they do not qualify as MDD

52

SAD happens in the winter because...

lack of exposure to light causes increased SERT which decreases serotonin

53

People with sad tend to overproduce...

melatonin

54

Treatment for SAD

Buporion, fluoxetine (prozac), other SSRIs and light therapy

55

Depression

unable to be cheered up

general hopelessness

refuses support

wont engage in activities

poor self esteem

vague cause

56

grief

clear cause

normal self esteem

able to temporarily cheer up

will engage in activities

accepts support

57

Number 1 nursing role with mental health

SAFETY

58

Toddler depression

regression

59

preschool depression

self destructive play themes and less normal play. irritability, lack of confidence

60

school age depression

poor grades, loss of friends, less activity, somatic complaints. talk of running away, boredom, low self esteem

61

adolescent depression

difficulty w/ parents and teachers, adult depressive symptoms, a focus on violence

62

Second most important nursing function for depression

meeting functional needs

63

emotional contagion

working with depressed patients can cause the nurse to feel down

64

Nursing interventions for depression

-suicide assessment

- planning care

- improve low self esteem

- instill hope

- help find problem solving methods

- help teach assertiveness

65

Suicide is the --- leading cause of death

10th

66

Central neurotransmitter in suicide

decreased serotonin

67

Most common comorbid disorders for suicide

schizophrenia

bipolar

BPD
Addiction

Depression

68

For males, suicide is the ___ leading cause of death

7th

69

Traits associated w/ suicide

impulsivity

aggression

pessimism

negative affect

70

The fundamental clinical manifestation of suicide

unrelenting stream of painful thoughts

71

indications for suicidal intent

IS PATH WARM

Ideation

Substance Abuse

Purposelessness

Anxiety
Trapped

Withdrawal

Anger

Recklessness

Mood changes

72

Group w/ highest suicide rate

Native americans & alaskan natives

73

Group w/ lowest suicide rate

Hispanics

74

Most common antidepressants

lexapro

paxil

zoloft

prozac

celexa

75

Suicide accounts for __% of deaths of women in the postpartum stage

20

76

The highest rate of suicide for any age group

Men, 75 and older

77

Protective factors for suicide

young children to care for

community support

access to mental health services

family connections

religious no suicide rule

78

Risk factors for suicide

social isolation

job loss

relationship loss

feelings of failure/hopelessness

access to lethal means

trauma/abuse

chronic illness/pain

79

Type 2 diabetes- insulin dependent or not?

Not

80

T2 diabetes pathophysiology

Insulin resistance with defect in compensatory insulin secretion

NONKETOTIC

insulin not sufficient to lower blood glucose

81

Group with highest rate of t2 diabetes

native americans and alaskan natives

82

Risk of obesity w/ t2 diabetes

20% overweight or bmi over 27

Causes PERIPHERAL INSULIN RESISTANCE by decreasing # of receptor sites

83

T2 diabetes risk factors

HTN

PCOS (androgen related)

over 9 lb baby birthed

gestational diabetes

sedentary lifestyle

high triglycerides

low HDL

84

Prediabetes A1C

5.7% or higher

85

Prediabetes CBG

100-125+

86

Prediabetes fasting blood glucose 2 hr test

140-199

87

Hyperosmalar hyperglycemic state..

plasma osmolality 340+

high blood glucose 600+

altered consciousness

88

What causes hyperosmalar hyperglycemic state?

High CBG--> increased urine output--> dehydration--> salty/glucosy blood

89

How low do we need to get the CBG in hyperosmalar hyperglycemia?

250

90

70% of postprandial insulin secretion is due to..

GLP-1 and GIP in gut

Greatly reduced or absent in T2 diabetes

91

Acanthos nigricans

hyperkeratotic plaques caused by insulin like growth factor---evidence of insulin resistance

92

Only med approved for children w/ T2 diabetes

Metformin (glucophage)

93

Severe hyperglycemia- pediatric

CBG 250

AIC 9%

Insulin beneficial in this case

94

Severe hyperglycemia is toxic to..

Islet cells

95

Diabetes management in peds

1- diet and exercise

2- metformin

3- insulin if no other choice

96

Diet and exercise pediatric T2 diabetes

1 hr exercise per day

small meals w/o insulin spike threats

97

T2 while pregnant- pharmacologic care

Insulin

better to avoid diabetes meds, if possible

98

Obese pregnancy- recommended weight gain

10-20 lbs, instead of 15-25

99

Pregnancy loss T1 diabetes

1st trimester

100

Pregnancy loss T2 diabetes

3rd trimester

101

Older adults w/ diabetes 2 are at a higher risk of

Hypoglycemia

102

Increased urine output in diabetes implies

osmotic diuresis due to hyperglycemia

103

Signs of hyperosmolar hyperglycemia

Increased urine output

extreme thirst

extreme hyperglycemia

dehydration

hypotension

seizures

decreasing level of consciousness

104

TID % of cases

5

105

T2D % of diagnosed cases

95

106

Stimulates breakdown of glycogen in the liver, the formation of carbs, and the breakdown of lipids in adipose and liver

Glucagon

107

Glucagon produced by..

Alpha cells

108

Insulin produced by..

Beta cells

109

Glucagon's primary function

Increase glucose levels through glycogenolysis and gluconeogenesis

110

Low blood glucose

Under 70

111

Insulin function

move glucose across cell membranes, decreasing blood glucose

112

Insulin and glucagon

Oppose each other

113

Somatostatin produced by

Delta cells

114

Somatostatin is believed to

Prevent overproduction of both insulin and glucagon

115

Organs that do not require insulin for glucose uptake

brain, liver, renal tubules and intestines

116

Other hormones that stimulate increase in glucose in emergency

T4, epi, glucocorticoids, and growth hormone

117

T1 diabetes is caused by

the destruction of beta cells

118

T1 diabetes is..

90% autoimmune

10% idiopathic

119

T1 diabetes can be caused by

mumps, coxsackievirus B, rubella

Toxins (cured meats)

Genetic predisposition often present

120

T1 diabetes is characterized by

Hyperglycemia

Ketosis

121

Group most susceptible to T1 diabetes

Caucasians

122

T1 diabetes clinical manifestation

Polyphagia (eating more food/hunger)

Polydipsia

Polyuria

Weight loss

blurred vision

malaise

fatigue

123

Can HHS occur in T1 diabetes?

No

124

Can DKA occur in T2 diabetes?

Yes

125

The Dawn Phenomenon

Increase in CBG between 4am & 8am, unrelated to food

126

Theory regarding dawn phenomenon?

Increase in growth hormone during sleep leading to decreased peripheral glucose uptake

127

Somogyi phenomenon

hypoglycemia during the night with hyperglycemia in morning

128

Why does ketoacidosis occur?

Breakdown of fat produces ketones. Bicarb is used to produce ketones, which leads to a lack of bicarb to prevent acidosis

129

DKA results in

Hyperosmality

ketoacids

dehydration

electrolyte imbalances

130

Hypoglycemia does what to the brain

Cerebral malfunction

131

When glucagon stops being produced..

Epi replaces it

132

When epi fails to replace the function of glucagon..

the individual develops unaware hypoglycemia

133

15/15 rule of hypoglycemia

15g sugar- wait 15 mins- recheck gbg- 15g sugar

134

Diabetic vascular changes

Blood vessels thicken, screwing up perfusion

135

Diabetic retinopathy

alterations in blood vessels and flow

136

Diabetic nephropathy

thickening of glomerular tissue, leaky

137

Cardiac conditions of diabetes

CAD, decreased ability to survive MI, higher chance of HF after MI, HTN, Stroke

138

Number one diabetic cause of death

CAD

139

Reccomended diagnostic test for diabetes

Fasting blood glucose

140

Elevated A1C

6.5%

141

When does blood glucose spill into urine?

180

142

What can effect blood glucose monitoring?

Hematocrit

high makes it look low and vice versa

143

What is insulin made from?

biosynthetic insulin (most common) from e coli and pork pancreas

144

What is fast acting humalog insulin made from?

e coli

145

The only insulin that can be given IV

regular insulin (clear)

146

CSII

Continuous subcu insulin infusion

147

Grams of carbs per day for diabetics

130g

45-65% of normal

148

Less CBG effect-- fructose or sucrose and starches?

frustose

149

% protein in diabetic diet?

15-20%

150

diabetics should have how much of their diet be fats?

7% or less

151

Diabetic sodium intake?

2300 mg

152

Special changes during illness for diabetics?

CBG 4 times per day, instead of 2

8-12 oz fluid per hour

test for urine ketones if CBG 240+

153

1st level of diabetic teaching

survival skills

154

2nd level of diabetic teaching

home managament

155

3rd level of diabetic teaching

improving lifestyle

156

DO type 1 diabetics take oral meds?

no

157

Food desert

Any heavily populated area more than 1 mile from a store that sells fresh produce

158

Food choice factors

Packaging

smell

taste

body image

convenience

health

cultural

habits

159

Which is more satiating?

Fat, protein, grains

Protein and probably grains

160

Vegan diets lack

omega3s, calcium, iron, zinc and B12, vit D

161

Vitamin __ helps absorbtion

C

162

Macronutrients

carbs, protein, fat

163

Micronutrients

vitamins, minerals

164

ATP requires

Fats, carbs and protein

165

Monosaccarides

glucose, fructose and galactose

166

Disaccarides

sucrose, lactose, maltose

167

Which breaks down faster, polysaccharides or monosaccharides?

Mono

168

Dietary fiber is...

A polysaccaride

legumes, root veggies and grains

169

Kal per gram of carbs

4

170

reccomended daily carb

125-175

171

Excess carbs become..

fat or glycogen

172

Too many carbs result in...

^triglycerides, caries, and obesity

173

Lipids dissolve

in alcohol but not water

174

cals per gram of fat

9

175

types of lipids

sterols, triglycerides and phospholipids

176

what provides most of the bodys functional energy?

fats

177

95% of fats consumes?

triglycerides

178

Healthy fats

unsaturated

179

What makes protein different?

It contains nitrogen

180

Complete proteins

Contain all 9 amino acids and are found in animal products

181

cals in gram of protein

4

182

daily protein for women?

45g

183

daily protein for men?

56g

184

Fat soluble vitamins

ADEK

185

water soluble vitamins

BC

186

Must be attached to a glycoprotein to be absorbed

vitamin B12

187

Type of vitamin that can be excreted in urine if taken in excess

water soluble

188

most abundant electrolyte

calcium

189

A bolus becomes____ during digestion

Chyme

190

Digestive enzymes

amylase, lipase, protease, maltase, pepsin, sucrase, lactase

191

Organ primarily responsible for metabolism

Liver

192

% of men overweight

63%

193

% of women overweight

55%

194

% of overweight children

31.8

195

DKA comes from

HYPOglycemia

196

Group most overweight

Mexican american men

197

Group most obese

mexican american women

198

Dietition

Advanced degree, medical practice

199

Nutritionist

no advanced degree

200

26% of calcium deposition is established in...

early adolescence

201

Pregnant women need more..

protein, iron, folic acid, and calcium

202

Older adults need more

Vitamin B12, B6, D and calcium

203

Decreased salivation

xerostomia

204

Blood sugar peaks at _____ after we eat

60-90 mins

205

Which contributes to poor health related poor quality of life

smoking

drinking

obesity

poverty

Obesity

206

Short acting insulin must

be given with meals

207

% of obese adults

35%

208

Men and women are____ obese

equally

209

How much of our energy is dedicated to maintaining our basal metabolic rate?

70%

210

Mature adipocytes cant multiply, but

Immature ones can, especially when exposed to estrogen

211

Fat cells store fat as

triglycerides

212

Infection and illness in a diabetic can

raise their blood sugar

213

Which part of the brain tells a person theyre hungry?

Hypothalamus

214

Hormones involved in obesity

LEPTIN, thyroid hormone, insulin

215

Leptin

Suppresses appetite

216

Purely genetic obesity is

rare

217

Most important contributor to obesity

lack of activity

218

upper body obesity is determined by a waist to hip ration of

1 in men, 0.8 in women

219

Normal BMI

18.5-24.9

220

Underweight

18.5 and under

221

overweight

25-29.9

222

Obesity 1

30-34.9

223

Obesity 2

35-39.9

224

Extreme obesity

40+

225

Metabolic syndrome includes 3 of what symptoms

high waist circumfrence

high triglycerides

Low HDL

high blood sugar

226

Most accurate way to determine amount of body fat

hydrodensitometry

227

Diets of less than ___ calories are not safe

1200

228

types of bariatric surgeries

gastric bypass

sleeve

Roux-n-Y

229

Overweight percentile range

over 85th, below 95th

230

Obese percentile range

over 95th