NR 607 Week 8 Final Exam Last Minute Review Sheet

2. Medica琀椀on Emergencies & An琀椀psycho琀椀c Pearls Finding Think First action Clonus + hyperreflexia + Serotonin syndrome Stop serotonergic agents; supportive care/benzodiazepines; diarrhea/diaphoresis; hours after manage hyperthermia; cyproheptadine if moderate–severe. serotonergic change Lead-pipe rigidity + fever + bradyreflexia + NMS Stop dopamine blocker; ICU-level supportive care, high CK; days after dopamine blockade fluids/cooling; consider dantrolene/bromocriptine. Coarse tremor + vomiting/diarrhea + Lithium toxicity Hold lithium; level, BMP/renal function, ECG, isotonic fluids; ataxia/dysarthria/confusion urgent evaluation/dialysis if severe. Hot, dry, flushed, dilated pupils, urinary Anticholinergic toxicity Stop agent; supportive care/toxicology consultation. retention, ileus, delirium Catatonia + fever/autonomic instability, Malignant catatonia Urgent lorazepam challenge/ECT evaluation plus medical may precede medication support. FAST DISTINCTION: Serotonin syndrome = wet, hyperreflexic, clonus, rapid onset. NMS = rigid, bradyreflexic, high CK, slower onset. EPS / movement e昀昀ects Timing/presentation Diagnosis Management Hours–days: neck/jaw/tongue spasm, oculogyric Acute dystonia IM/IV diphenhydramine or benztropine; protect airway. crisis Days–weeks: inner restlessness, pacing, cannot Akathisia Reduce/switch; propranolol often used; distinguish from sit agitation. Weeks–months: bradykinesia, rigidity, masked Drug-induced Reduce/switch; benztropine or amantadine when face, resting tremor parkinsonism appropriate. Months–years: choreoathetoid oral/facial/limb Tardive dyskinesia AIMS; reduce/switch; VMAT2 inhibitor; anticholinergics movements may worsen TD. Lithium and clozapine • Lithium level rises with dehydration, sodium depletion, renal impairment, NSAIDs, ACE inhibitors/ARBs, and thiazide diuretics. Maintain consistent salt/fluid intake; report vomiting, diarrhea, fever, or heavy sweating. • Lithium monitoring: trough level, renal and thyroid function, calcium, weight, pregnancy status when applicable, and ECG when indicated. • Clozapine: after 2 adequate antipsychotic failures; also reduces recurrent suicidal behavior in schizophrenia/schizoaffective disorder. • Clozapine vigilance: ANC, weight/BMI/waist/BP/glucose/A1C/lipids, bowel function, cardiac symptoms. Fever/sore throat → CBC/ANC; chest pain/dyspnea/tachycardia → myocarditis evaluation; constipation/abdominal pain → urgent bowel evaluation. • Smoking induces CYP1A2: abrupt smoking reduction or infection can increase clozapine concentration. Treatment resistance / LAIs • Before declaring failure: verify diagnosis, adherence, dose, duration, substance use, interactions, absorption, and psychosocial barriers. • Treatment-resistant schizophrenia generally = 2 adequate antipsychotic trials with confirmed adherence → consider clozapine. • LAIs improve transparent adherence and steady exposure; loading/oral overlap is product-specific. Establish oral tolerability when required. Olanzapine pamoate requires post-injection observation. 4. Trauma, PTSD, IPV & Brain Injury Stabiliza琀椀on before processing • Phase 1: safety, grounding, emotion regulation, sleep, substance/eating-disorder treatment, therapeutic alliance. Phase 2: titrated trauma processing only when the patient can stay safe and use skills. Phase 3: integration, relationships, goals, relapse prevention. • Do not force memory retrieval or detailed trauma disclosure. Match intervention to autonomic state. • Above resilient zone (fight/flight): reduce threat/stimulation; movement, paced exhalation, grounding, choice. Below zone (shutdown/freeze): gentle orientation, warmth, rhythmic movement, sensory grounding, safe connection. PTSD essen琀椀als • Four clusters: intrusion, avoidance, negative cognition/mood, and arousal/reactivity; symptoms persist >1 month after qualifying exposure. • First-line psychotherapy: trauma-focused CBT approaches such as CPT and prolonged exposure; EMDR is also evidence- based. • Medication options with strongest evidence include sertraline, paroxetine, and venlafaxine. Prazosin may be considered for nightmares with BP monitoring. Avoid benzodiazepines for core PTSD. TBI / CTE • TBI red flags: deteriorating consciousness, focal deficit, repeated