[N-clex] 엔클렉스 정리-정신

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정신

● 반응

- assertive : 남의 권리를 침해하지 않고 나의 권리를 돌직구로 말함, ‘I' 중심

- aggressive : 공격적인

- passive

- passive aggressive

: assertive 찾기위해 나머지 소거

 

● Mental status exam

1, general description : (총체적으로) 환자의 외양, 모습, speech, motor, interaction 등

2, emotional state : mood(self-report), affect(labile-flat,변덕)

3, Experience : perception(hallucination, illusion)

4, thinking

- content(what) : delusion, false fixed belief

- though process(how) : flight of idea(비약)

5, sensorium & cognition :

- LOC : T/P/P

- memory : recent(~2wk)/remote

- concentration & calculation : (100-7)

- Information & Intelligence : 속담풀이

- Judgement : 집에 갔더니 연기가 났다 어떻게 할래? 119신고

- insight : 현재 상황에 대한 인식

 

● schizophrenia

positive : normal function 과다(clong association : 리듬감, 강세주는어투)

negative : Loss, A-(Alogia,무언어증/anhedonia,무쾌감증/avolition,무의무/atentional impariment,집중↓,affective flattering)

● seasonal affected disorder(계절성우울증)

Sx

- hypersomnia(과수면), lethargy(무기력), fatigue, anxiety, wt gain, appetite↑

Tx

- Phototherapy(멜라토닌), SSRI, 충분한 sleep etc.

 

●Neuroleptic malignant syndrome(신경근이완제악성증후근)

Sx

- fever, rigidity(muscle), HR↑, incontinence(실금), sweating, tremur, leukocytosis(백혈구증가증)

Tx

- D/C med, 대증요법, muscle relaxant(dantrolene)

 

● Aggressive behavior

preventive

- self-awareness, Pt education, Assertive-training

Anticipatony

- communiation(verbal, non-verbal)

- Enviromental change

- behavior action

- 약물

containment

- crisis management

- seclusion(격리)

- restraint(chemical, physical)

 

● 비밀엄수 vs 보호

Duty to warn, protect ↔ confidenticality

- vague threat(막연한), specific threat(구체적인)

→ ethic community, 의사 및 팀과 의사소통, 간호사 고지의 의무 X, 3자에게 알릴의무 X

● Eating disorder

AN,BN 공통점

- major disoder, dysthymia(기분저하증)

AN(Anoreixa Nervosa, 신경성 식욕부진)	BN(Bulimia nervosa, 폭식증)
음식 관심 多 OCD(obsessive compulsive disorder) 강박장애 ex) 모델, 발레리나 등	anxiety disorder PTSD, substance abuse(alcohol, med등) antisocial disorder
13~20y intense, irrational belief(body) appetite denial metabolic, endocrine amenorrhea(무월경) osteopresis cold intolerance brady cardiac constipation acid base, fluid imbalance lanugo wt ↓ 안먹어서 문제	15~18y(17~25y) vomiting, laxative, diuretic abuse hypokalemia(구토해서) muscle weakness (DTR↓) gastric esophageal bowel abnormalities erosion(피부병변) callus(굳은살) 먹고 토해서 문제
강제입원 oral potassium -> K 2.5↓ HR 110↑, 45↓ 3month 이내 25% wt↓ BT 36.0↓ SBP 70↓ dehydration 심한

	Antipsyclotics	SSRI
		Acute	Relapse 방지
AN	X	X	modest = slight
BN	X	considerable	modest = slight