maryville nurs 663 exam 2 (Answered) With
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Lithium labs
level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
bipolar meds: depression
lurasidone (13+), olanzapine + fluoxetine (10+)(symbyax)
bipolar acute and mixed mania
aripiprazole, risperidone, olanzapine (13+), quetiapine (acute only), asenapine (10+)
classic mood stabilizers
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)
anti-depressants
class not used w/bipolar disorder
lithium
Anti-manic, antidepressant, anti-suicidal
Lithium side effects
Frequent urination, increased thirst, weight gain, sedation
lithium toxicity
sudden onset tremors, N/V/D, muscle weakness, slurred speech, confusion, seizures
(slowing down, feel really out of it)
Persistent Motor or Vocal Tic Disorder
pt in front of you only has one or the other but not both—they usually don't even know it
is a tic, it is only meaningful if it's affecting their quality of life
Tourette's d/o
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
habit reversal training can be used to manage tics
Tics tx
Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt
Developmental Coordination Disorder
a motor disorder characterized by marked impairment in the development of motor
coordination; movement isn't consistent w/age
Stereotypic Movement Disorder
a motor disorder characterized by repetitive, seemingly driven, and apparently
purposeless motor behavior, such as hand waving or head banging, but not include
ASD sx
Specific Learning Disorders
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
an eating disorder in which an irrational fear of weight gain leads people to starve
themselves; restrictive or binge/purge/exercise
, Bulimia nervosa
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
significant binge-eating episodes, followed by distress, disgust, or guilt, but without the
compensatory purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder
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
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
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
fluoxetine help but not direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Encopresis
a childhood disorder characterized by repeated defecating in inappropriate places, such
as one's clothing
Enuresis
involuntary urination
Encopresis Treatment
Behavior management: toilet refusal behavior, scheduled toileting time, incentives.
Prevention of constipation
Counseling
Enuresis treatment
1. First line is behavioral interventions: bed alarms, toileting at bedtime and during the
night, bladder training
2. reassurance, resolves spontan, normal 4-5 yo
Enuresis meds
Desmopressin nasal spray;
Major Depressive Disorder Dx
5+ for at least a 2-week period; either #1 or 2 req
1. Depressed mood most of the day, nearly every day (can be irritability in children &
adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with
ADHD, address mood first)
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