November 29, 2022

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We uh we definitely put together our experiences into what we’ve learned throughout real life because i was doing my residency in psychiatry and neurology and then nurse xena what is what is your exact position in uh your hospital so i am a house supervisor for all the mental health units um so essentially i get called for every problem that happens when i am

Pulled to a unit i am pulled to the high acute female unit so i work mostly with schizophrenia bipolar and severe psychosis those are though that’s that’s kind of like the the psych board like we’re always doing my residency to a lot of a lot of people that come in that lose their meds that have um you know long-term history of of these uh mental disorders and um

Yeah and uh narazina when you you passed with me a long time ago right um it’s been over a year over yeah i’m almost ready to renew my license in a couple of months wow that’s amazing so with that said you can imagine nursing was probably a year and a half ago wasn’t it yeah so i was part of the march course and i took my boards right after so it’s the course is

Very different now you guys so if i pass with what was available to me then it’s a lot more now more information we’re more hands-on now because there’s more of us yeah we have we have a solid team and we’re we’re only growing um just to provide more information um i was going to start off with adhd i just feel it’s kind of one of those topics that um that the

Boards tend to like and um and it’s coming up so adhd so what is adhd well it’s attention deficit hyperactive disorder so everyone says oh i’ve got adhd i’ve got adhd not necessarily do you have adhd you probably have add just attention deficit disorder which i feel like a lot of us have but the the important part of this diagnosis is the hyperactive so now

How are the boards going to ask about adhd well they’re probably going to give it to you as a select all that apply why this child is going to have certain signs and symptoms or further teaching further intervention type of a question so let’s think of some of the ways that people can ask this question on the boards or how they may pop up on the boards so for me

If i was to ask this question when i say those words if i was to ask this question you should start it because that’s probably about how it’s going to pop up on the board so the way i would ask this question is first and foremost um you where are you gonna first see this who’s gonna first notice this the teacher so that’s probably a freebie question because or or

For the teaching for their intervention because what happens is these kids come home from school and the caretakers just they automatically assume oh they’ve been in school all day and um they’re just they’re just energetic now right they’re just happy to be out of school but in reality what’s going to happen is you’re going to get a question on the board that’s

Going to say who’s going to identify this first and it’s probably going to be a teacher but why what are some signs and symptoms that they’re going to develop or that they’re going to show or display that the teacher is going to notice so they’re going to have a lack of focus they’re not going to complete tasks they’re going to not complete tasks they’re going

To be disruptive and then eventually they can develop low self-esteem because they’ll have low grades and how does that all happen if anybody’s been around your child that has adhd and seen them and witnessed them in in a group setting or in a classroom setting they’re they can’t sit still right i’ll put that on there as well too they’re gonna distract other

Kids they’re gonna poke at them hey what are you doing oh what’s that what’s you know you know like they’re just constantly bugging the other students to to no fault of their own they have adhd but kids are mean so when kids are mean and this child is not focusing they’re not completing a tasks they’re getting low grades they can’t sit still and they’re poking

At the other child or the other children in that classroom kids with me like leave me alone what’s wrong with you right kids are not nice they have no filters so they’re gonna be like yo leave me alone what are you doing what’s wrong with you and the kids are going to they’re going to hurt this child’s feelings and they’re going to develop low self-esteem they

Probably won’t have the friends they may even undergo bullying excellent point so a lot of these things are important to understand as a select all that apply question again with adhd you want to know who’s going to identify it and the signs and symptoms of how they’re going to display this actual disorder well in mental health in mental health what do i always

Say is the first line of treatment in most cases okay cognitive behavioral therapy right let’s see if we can do something non-invasive and then move on from there to medication what are some situations where cbt is not going to work what are some situations bipolar and psychosis good those ones we’re gonna have to do um medication medication so i don’t know i

Don’t think i’ve ever seen arizona have you ever seen a patient come in with bipolar or psychosis and they thought therapy was a solution never yeah it goes straight straight to medications and have you medications on top of that especially if they’ve been in the system a while you and you always build a tolerance to the medication you’re given so the dosages are

Always going up or being changed yeah and that’s another thing too is um what with mental health being on the sideboard being in the psych unit um so one of the things is that you actually will see these patients over and over and over again they um they keep coming back um and again they run out of meds they get dosages need to be upped um they stop taking meds

Whatever it is in general uh they have an acute episode and they’re constantly coming back the constantly come back as as a matter of fact one of the things that i learned throughout my process of training was sometimes it’ll be actually the family that drops them off because the family needs a break so it’s uh it’s pretty uh it’s pretty intense pretty intense all

Right so what are we gonna do well we said treatment we start with cbt we start with cbt then we’ve got to take it a step further now this drug that i’m gonna i’m gonna put on here is not high yield but it is something that i’m starting to see that they’re just throwing it out there and i don’t want you to see this drug and not know what it is and then choose it

And that’s atomoxetine anybody see this on their boards so this is a it’s not a it’s not a stimulant it’s not a stimulated it’s like a hormone-based atomoxetine that um that they’re starting to use as a first line again not high yield the high yield ones are going to be what they’re going to be yeah methylphenidate and damphetamine so let’s talk about those so

With these two drugs what are they what class of drugs are they they’re stimulants so it kind of it doesn’t sound counter intuitive to give somebody who’s hyper a stimulant anybody understand that yeah good somebody knows my lecture um so the the thought process is at least that’s what the literature um taught us is that where is personality typically let’s

Do a little neuro because obviously this was one of the things i learned in the neural portion of my residency personality is going to be in the frontal lobe right and when a when a person starts to load is an underdeveloped maybe they’ll develop um adhd so what we give them is we give them a stimulant to help develop that portion of um of the brain so very

Interesting in my opinion super nerdy but you know it is what it is uh but what we’re worried about with these drugs what are we worried about with these drugs and how are they going to answer them it’s or how are they going to ask it it’s going to be a select all that apply or it’s going to be for education technical question right select all the apply education

Signs and symptoms so what are some selector that apply um things that are going to happen here well we’re going to monitor their growth and development when they get us when they get a stimulant they may not grow as fast because they may have a decreased appetite so now let’s educate them on that when are we going to give this medication after breakfast to

Have to eat first and in the morning after breakfast and in the morning or after their first meal however you want to word it we don’t want to exceed 6 pm because it does cause insomnia so if we’re worried about your appetite what are some things that we’re also going to be looking at we’re going to check their bmi undergrowth and development but we also just

In general think about this whether a child comes in with adhd and this is a great question whether a child comes in with adhd or not when they come into the pediatric office what are some things you’re going to naturally do regardless height weight vitals so don’t overthink it when you get a question like this because what’s going to happen is you’re gonna sit

There and be like if they’re an adhd meds and they’re coming in for a well visit well well visit is gonna be what i weigh vitals right so take your take the take that into account like it’s not don’t overthink it so let’s do a little recap um with adhd remember it’s the hyperactive disorder portion of it that you want to focus on because that is limit caffeine

I’ll take that as well too good job um so with that the hyperactive portion is what’s going to keep them um disruptive they’re gonna disrupt their classmates they’re going to disrupt the class they’re going to not finish tasks they’re not going to be able to make friends you’re gonna have a low self-esteem these are all signs and symptoms of adhd this is all 100

A select audit apply question right the next thing that we need to know and we’re going to uh with a recap is cbt is cognitive behavioral therapy cognitive thank you for putting that there cognitive behavioral therapy is just therapy that’s it maybe we work with a counselor maybe work with a therapist maybe work in a group setting this is all therapy right and

That’s better than getting a child onto medication especially something so strong the next one is this drug may show up it’s not high um it’s not high yield but it is something that you want to identify and know that it goes with adhd they’re not going to ask a lot about it because it’s a newer drug well it’s not really new or but it’s less commonly prescribed

The ones that they’re gonna want you to know are the more commonly prescribed medications which i just talked about d amphetamine and methylphenidate which is in real life it’s adderall and ritalin so again always know your generics i’m just putting the tie together between real life um as well too what are we worried about we’re giving them a stimulant again why

Are we getting stimulant because their frontal lobe is probably underdeveloped and then it helps stimulate that development but with these drugs we have to look at some of the side effects growth and development so watch their bmi look at their weight height vitals it’s um it’s an appetite suppressant so you’re going to educate them or the caretakers to give the

Breakfast first for the meal first and then the medication because last thing you want them to do is not be hungry and lose weight and it also it can cause insomnia so limit the amount of time or limit the time that you’re going to give it to them at um at 6 pm is what the standard is um i’ve read three but the board’s like six so um that is adhd recap cool

Transcribed from video