seizures
This condition is defined as two or more unprovoked seizures occurring 24 hours apart
Epilepsy
Transmission precaution for TB?
Airborne
1st sign: altered level of consciousness , pupillary abnormalities, Neuro deficits & changes (change in sense, movement, reflexes and strength)
Change in VS, headache, risk for seizures
This life-threatening reaction occurs when there’s too much serotonin in the body, causing agitation, hallucinations, fever, sweating, and muscle rigidity.
serotonin syndrome
This mood stabilizer is commonly used to treat bipolar disorder, requires regular blood level monitoring due to a narrow therapeutic range, and can cause side effects like tremors, polyuria, and hypothyroidism.
Lithium
describe the appearance or behavior of a patient diagnosed with PTSD
hyperalert, agitated and very still, flashbacks, intrusive thoughts about trauma, hallucinations, memory gaps, dissociation, impaired judgement, insomnia, over eating/ anorexia, use of substances (alcohol/durgs)
Identify disorder:
A patient constantly worries about multiple physical complaints (headaches, stomach pain, fatigue) even though tests show nothing medically wrong.
Somatic Symptom Disorder (SSD)
The term to describe redirecting negative impulses to positive behavior
Sublimation
Epileptic Seizures
Due to abnormal, excessive electrical activity in the brain.
Changes show up on an EEG
Non-Epileptic Seizures
Not due to abnormal brain electrical activity.
Often related to:
Psychological stress/trauma (PNES)
Pain
Anxiety
Syncope (fainting)
Metabolic issues (hypoglycemia)
Movement disorders
Cardiac arrhythmias
EEG:Normal during the event (no abnormal electrical firing).
2 main diagnostic testing for TB
Mantoux PPD test
Blood test - Quantiferon TB Gold
Others: acid fast bacilli culture & smear and chest x ray
This clinical “sign,” seen when blood-tinged fluid from the nose or ears forms a ring of clear fluid on gauze, indicates a possible basilar skull fracture and leakage of cerebrospinal fluid
Halo Sign
2 diagnostic testing for anxiety
GAD 7 and Hamilton anxiety rating scale
Signs of this condition include coarse tremors, confusion, vomiting, diarrhea, ataxia, and in severe cases, seizures or coma, often occurring when a patient’s lithium level exceeds the therapeutic range of 0.6–1.2 mEq/L
Lithium toxicity
This type of behavioral therapy for obsessive-compulsive disorder involves gradually confronting feared objects or situations without performing compulsive behaviors, helping patients reduce anxiety over time.
Exposure therapy
Identify disorder:
A patient constantly fears they have cancer after minor headaches, repeatedly seeking tests despite reassurances from doctors.
Illness Anxiety Disorder (Hypochondriasis)
Identify Ego defense mechanism:
A patient is angry at their doctor for a painful procedure but yells at the nurse instead
Displacement
This type of seizures is most common in children, and described as brief loss of consciousness and pt "zones out"
Absent (absence) seizure
Clinical manifestations of early TB (name big 3) & late TB (theres only 1)
Early: night sweats, fever, cough, weight loss, weakness
Late: hemoptysis
3 types of Intracranial Bleeds
(tell me where they happen in the brain, what kind of bleed it is & treatment)
1. Epidural Hematoma
Where: Between the skull and dura mater.
Type: Arterial bleed → fast.
Treatment: Emergency surgical evacuation (craniotomy); treat increased ICP.
2. Subdural Hematoma
Where: Between dura and arachnoid.
Type: Venous bleed → slower onset.
Treatment: Monitor if small; may need burr holes or craniotomy to drain.
3. Intracerebral Hemorrhage
Where: In the brain
Type: Arterial—often due to ruptured aneurysm.
Treatment: Clip or coil aneurysm, manage BP, prevent vasospasm, craniectomy/ otomy
Patients starting this class of antidepressants may be at increased risk for suicidal thoughts or behaviors, especially during the first few weeks of therapy, requiring close monitoring.
SSRIs
True or false: Bipolar II is diagnosed by at least one manic episode; depressive episodes are common but not required.
false
Obsessions: recurrent and persistent thoughts, curses or impulses that are intrusive and unwanted
Compulsions: repetitive behaviors or acts that a patient feels driven to perform
Identify Disorder:
A patient with sudden paralysis shows little concern or emotional reaction about losing the ability to move their leg.
La Belle Indifférence
Identify ego defense mechanism:
A patient who feels guilty about lying accuses their roommate of being dishonest
Projection
Describe Complex partial seizures vs Simple partial Seizures
Simple Partial Seizures: A seizure that starts in one area of the brain and the person remains fully conscious and aware.
Key Characteristics:
Awareness is preserved — patient can recall the event
No loss of consciousness
Complex Partial Seizures: A seizure that starts in one area of the brain but causes impaired consciousness or awareness.
Key Characteristics:
Awareness is impaired — patient seems awake but is not responsive
Automatisms: automatic, repetitive, purposeless behaviors
Lip smacking
Chewing
Picking at clothes
Wandering
explain latent vs active TB
pt contagious/ not contagious?
What tests are positive?
Chest x ray?
Can it spread?
Latent: asymptomatic, NOT contagious
positive TB skin test, positive blood test
NORMAL chest x ray
CANNOT spread
Active: pt has symptoms, contagious
positive TB skin and blood test
abnormal chest x ray
CAN SPREAD
What is Cushing's traid?
Cushing’s Triad (a late sign of increased ICP in TBI) includes:
Widened pulse pressure
Increasing systolic BP with decreasing diastolic BP
Bradycardia
Low heart rate
Irregular respirations
Cheyne–Stokes or other abnormal breathing patterns
This procedure, used for severe depression, mania, or treatment-resistant psychiatric disorders, involves electrically inducing a controlled seizure under anesthesia to improve mood and behavior.
Electroconvulsion therapy - ECT
Explain the difference between Bipolar 1 and 2
Bipolar 1: one lifetime manic episode
Episode is NOT due to substances, medical issues or medications
Bipolar 2: 1 lifetime hypomanic episode and 1 lifetime depressive episode
Episode is NOT due to substances, medical issues or medications
This structured therapy helps patients with PTSD by teaching them to identify and change unhelpful thoughts and gradually face trauma-related memories or situations.
Cognitive Behavioral therapy
Identify Disorder:
A parent repeatedly brings their child to the ER and secretly gives them harmful substances to make them appear sick.
Munchausen Syndrome by Proxy (Factitious Disorder Imposed on Another)
Identify ego defense mechanism:
A student cheats on a test and says, “Everyone else was doing it, so it’s not a big deal.”
Rationalization
Explain the following:
A. Phenytoin (one MAJOR adverse effect)
B. Carbamazepine (one MAJOR adverse effect)
C. Phenobarbital (When is this med often used, in what situation?, What does it do to the pt?, adverse effects?)
A. Phenytoin: tonic clonic, prevent status epilepticus
Gingival hyperplasia: Overgrowth of gums
Happens especially in children/young adults
Good oral care is essential
B. Carbamazepine – Stevens Johnsons Syndrome
C. Phenobarbital
Often used for status epilepticus when benzodiazepines and other meds fail
Also used for long-term seizure control (less common today)
What does it do to the patient?
Causes strong CNS depression
Makes the patient very sedated and slows brain activity
Can cause respiratory depression
Major Adverse Effects:
Respiratory depression
Hypotension
Sedation/drowsiness
Dependence and withdrawal risk
Explain RIPE
Common side effect of (R) med?
what should you avoid with the (I) med?
adverse effect (E) med?
Rifampin: hepatoxicity, ORANGE secretions
Isoniazid: Avoid tyramine foods (aged cheese, wine, smoked meats)
Pyrazinamide: hepatoxicity
Ethambul: Optic neuritis
Fill in the blank:
For TBI,
Systolic BP < ___
MAP > ___
Intracranial pressure (ICP) < ____
Cerebral Perfusion Pressure > ____
*ALSO explain what Mannitol is used for?*
Systolic BP < 150
MAP > 60
Intracranial Pressure (ICP) < 20 mmHg
Cerebral Perfusion Pressure (CPP) > 60 mmHg
Mannitol: osmotic diuretic that decreases ICP thru diuresis (monitor I&Os, weight, BP, and sodium levels)
3 diagnostic tools for Suicide
SAFE-T
Columbia Suicide Severity rating Scale
PHQ 9
Explain mania vs hypomania
Mania: abnormal elevated mental state
Feelings of euphoria, lack of inhibitions, racing thoughts, diminshed deep tendon reflexes, risk talking
Impulsive behaviors
REQUIRES hospitalization
Risky behavior: raced thoughts they experience which will endanger their live as well as others.
Hypomania: abnormal state that is similar but milder than mania. Characterized by elevated or agitated mood
Less severe symptoms, not serious enough to need hospitalization
DO NOT put lives of affected in danger
Does not require hospitalization
True or False: PTSD and OCD patients can be prescribed SSRIs for their symptoms.
True.
SSRIs are commonly used in both PTSD and OCD because they help regulate serotonin, a neurotransmitter involved in mood, anxiety, and stress responses.
Identify Disorder:
A patient deliberately injects themselves with bacteria to induce infection so they can be treated in the hospital.
Factitious Disorder (Munchausen Syndrome)
Identify ego defense mechanism:
A nurse who feels frustrated with a difficult patient is overly cheerful and accommodating instead.
Reaction formation