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MK REVIEW > Alcoholism > Flashcards

Alcoholism Flashcards

1
Q

Psychological aspects of alcoholism is called?

A

Psychodynamics

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2
Q

The #1 problem in Abuse is?

A

Denial- because abusers must deny in order to continue the behaviour.

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3
Q

What is the definition of Denial?

A

Refusal to accept the reality of a problem

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4
Q

How do we treat Denial?

A

BY CONFRONTING IT!

You confront it by pointing out the difference
between what they say and what they do.

i.e. “you say your not an alcoholic, but you drink a 6 pack before 10 am!”

” You say your not a child abuser, yet protective services have your children”.

” You say your not a spousal abuser, but you have a restraining order against you”

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5
Q

What is the difference between CONFRONTATION and AGGRESSION?

A

CONFRONTATION addresses the behaviour “ you say your not an alcoholic but…” and AGGRESSION attacks the person “you jerk”.

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6
Q

In Nurse/Doc scenerios good answers have “I” in the answers and bad answers have “you” in the answer. Give an example.

A

” I seem to be frustrating you”
“ Im having difficulty understanding can you pls. explain
what you mean by…”
“ Help me understand…”
“ I am having difficulty interpreting what you want….”.

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7
Q

If a patient is in denial you _______?

A

Confront! “They deny, you confront”

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8
Q

How is denial different in loss and grief then in abuse?

A

Denial in loss and grief is natural healthy response, so you SUPPORT it NOT CONFRONT it.

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9
Q

With ABUSE you ______? and with Grief you ______?

A 
Abuse = Confront
Grief = Support
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10
Q

What is the #2 Psychological problem with abuse?

A

Dependancy (absuser) and Codependency (spouse)

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11
Q

Define Codependency

A

Co-dependency is when the spouse gains positive self esteem by making decisions for and doing things for the abuser.

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12
Q

How do you treat dependency and co-dependency?

A

Set limits and enforce them!

Start by teaching the spouse to say NO!

In order for the tx. to work you must work on the self esteem of the co-dependent b/c as soon as they start saying no, the abuser starts saying things like “ yu dont love me anymore” “ your horrible” attacking the spouses self esteem. Therefore codependent must tell themselves they are saying “NO” b/c they are a good person. Often times the co-dependent persons ends up leaving the relationship.

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13
Q

What is Manipulation?

A

When the abuser gets the spouse to do things that are not in the best interest of or cause harm. i.e. sending under age daughter to the LCBO to buy alcohol is illegal therefore causes harm to daughter. However if she asked her husband it would be considered dependency vs. manipulation as it does not cause direct harm.

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14
Q

How do you treat Manipulation?

A
  1. Set limits and Enforce them! Say NO!
  2. Its easier to tx. co-dependency vs. dependency b/c nobody likes being manipulated.

note: there is no positive self esteem issues going on with manipulation like there is with dependency/co-dependency

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15
Q

How many pt. do you have with denial, dependent & manipulation?

A 
Denial = 1pt
Dependent = 2pt
Manipulation = 1pt
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16
Q

Define Wernickes and Korsakoff’s specific to alcholism

A

They are separate but often lumped together.

WERNICKES is an encephalopathy, which is a disease that damages your brain, its a syndrome of overall brain dysfunction.

KORSAKOFF’S = Psychosis, insanity, psychotic.

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17
Q

What the signs and symptoms of WERNICKES and KORSAKOFF’S?

A
  1. Psychosis induced by thiamine (B1) deficiency loss touch with reality. They go insane because they don’t have B1.
  2. Amnesia with confabulation ( make up stories b/c they forgot). They believe their lie as if it was reality! They forget entire decade.
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18
Q

So, how do we deal with a pt. suffering from WERNICKES and KORSAKOFF’S?

A

Redirect and don’t present reality because they cant learn it.

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19
Q

Characteristics of WERNICKES and KORSAKOFF’S?

A
  1. Preventable - by taking vitamin B
  2. Arrestable - stop it from getting worse by taking Vit. B1
  3. Irreversible - 70% irreversible go with majority.
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20
Q

What is the drug used to treat alcoholism?

A

Antabuse (Disulfirum) AKA: Aversion therapy-makes you have a gut hatred for alcohol because the pt. gets extremely ill if they drink while taking the drug. Onset/duration of Antabuse = 2 weeks!

21
Q

When taking Antabuse what should the nurse teach the pt. to avoid?

A

All forms of alcohol!

  1. Mouth wash even swish n spit.
  2. Afterwash
  3. Insect repellents
  4. Over counter meds “ elixer”
  5. Perfumes / Colongues
  6. Alcohol based hand sanitizers
  7. Uncooked icings - no bake icings - vanilla.
  8. Ok, to have red wine vineger
22
Q

Overdose and Withdrawals: Abused drugs include:

A

Uppers and Downers.

23
Q

For Overdose and Withdrawal questions ask:

A
  1. Is it an upper or a downer?

2. Overdose/Withdrawl

24
Q

Uppers include?

A
  1. Caffeine
  2. Cocaine
  3. PCP/LSD
  4. Methanpheamines
  5. Aderol

NOTE: there are 5 uppers in total therefore everything else is a downer (135)

25
Q

What are the signs and symptoms of UPPERS?

A

EVERYTHING GOES UP!

  1. Euphoria
  2. Tachacardia
  3. Restlessness
  4. Irritability
  5. Bowels - Borborygmi
  6. Reflexes +3 +4
  7. Spastic
  8. Seizure - therefore need suction
26
Q

What are the signs and symptoms of Downers?

A

EVERYTHING GOES DOWN!

  1. Lethargy -Obtundant
  2. Respiratory depression - arrest need ambu bag
  3. Reflexes flaccid 0-1
  4. Paralytic illeus
  5. Bradycardia etc…
27
Q

If a pt. overdoses on an upper then everything goes….

A

UP!

28
Q

Withdrawal on an upper everything goes?

A

Down!

29
Q

Withdrawal on a downer

A

UP!

30
Q

Upper overdose looks like ?

A

Downer Withdrawal

31
Q

Downer overdose looks like ?

A

Upper Withdrawl.

32
Q

In which 2 situations should seizure be of highest concern?

A

Upper O/D

Downer W/D

33
Q

If a pt. o/d on cocaine what do you expect to see? SATA

  1. Reflexes +3 +4
  2. Borborygmi
  3. Irritability
  4. Respirations < 12
  5. Difficult to arose
  6. Increased Temp
A
  1. Reflexes +3 +4
  2. Borborygmi
  3. Irritability
  4. Increased Temp

W/D on coke would be opposite

  1. Respirations < 12
  2. Difficult to arose
    * Need Narcane
34
Q

Drug Addiction in Newborns:

What are you to always assume with a newborn at birth?

A

Always assume intoxication at birth NOT withdrawal.

35
Q

When is the baby in withdrawal?

A

24hrs after birth

36
Q

When caring for a baby to a quaalude addicted mom 24 hrs after birth. Is the baby in OD/WD? on Uppers or downers? SATA

  1. Difficult to console
  2. Low core temp
  3. Exaggerated startle reflex
  4. Resp. depression
  5. Seizure risk
  6. Urine W/D
  7. Shrill high pitch cry
A

Downer w/d so everything goes UP!

  1. Diffulcult to console
  2. Exaggerated startle reflex
  3. Seizure risk
  4. Shrill high pitch cry

*Remember when you don’t know what the drug is pick downer.

37
Q

Alcohol withdrawal syndrome (AWS) vs. Delirium Tremens. Describe the difference between them?

A

Every alcoholic goes thru W/D within 24hrs after stopping drinking.

Only a minority (20%) get delirium tremens - 72 hours after they stop drinking.

W/D ALWAYS comes first 24hrs after pt. stops drinking then delirium tremens comes 72hrs after for some, but not for all.

AWS is not life threatening , but DT can kill you. Pt. with AWS are not a threat to themselves or others where as pt. with DT ARE a danger to themselves or others.

AWS = Stable, no harm
DT = Unstable, Harmful, dangerous
38
Q

What kind of care would the nurse provide for a pt. with AWS and DT?

A 
AWS: 
1. Regular diet
2. Semi private rm
3. Up Adlib
4, No restraints

DT:

  1. NPO or clear liquids
  2. Private rm near nurses station
  3. Restricted bed rest ( bedpans/urinals)
  4. Restraints - vest or 2pt locked leathers = 2 extremities = 1 leg with opposite arm, rotate every 2 hrs lock then release.

Both:
Get antihypertensives b/c BP> remember everything goes up in W/D.

Tranquilizers b/c everything goes up!

Vit. B1. prevent Wrenickes and Korsakoff’s
“No B1, you’ll BE ONE” lol.

39
Q

AMINOGLYCOSIDES: Think?

A

A MEAN OLD MYCIN.

40
Q

AMINOGLYCOSIDES are powerful antibiotics used to

TX.?

A

Serious, resistant, life threatening, gram negative - mean old infections.
“ You use a mean old Mycin to treat a mean old infection never any other time.

41
Q

Which Mycins are NOT mean old mycins?

A

Erythromycin, Azithromycin, Clarithromycin

THRO-mycins are NOT mean old mycins. They tx. minor infections not life threatening. If it ends in mycin its a mean old mycin it if has THRO in it its NOT a mean old mycin, so throw it off the list of mean old mycins.

Note: if it ends in MYCIN its a mean old mycin, if it has THRO in it, its ot a mean old mycin - throw it off the list of mean old mycins.

42
Q

What are the 2 toxic affects of aminoglychosides?

A
  1. Ototoxicity, so monitor hearing*, ringing, dizziness.
  2. Nephrotoxicity, monitor CREATINE- best indicator of kidney function!

Remember kidney shaped like an 8 rule. Amnioglycocides are toxic to the 8th cranial nerve (Hearing) and you give every 8hrs

43
Q

What route do you give Aminoglycocides?

A

IV and IM

DO NOT give PO because they are not absorbed therefore have no systemic affect.

44
Q

What are the 2 causes where you CAN give Aminoglycosides PO?

A
  1. Hepatic Encephalopathy aka: Hepatic Coma =too much ammonia.
  2. Pre-op Bowel Surgery
    They are given in both cases to sterilize bowel.

Neomycin and Canmycin
“ who can sterilize your bowel? Neo Can”

45
Q

Peaks and Trophs: What is a peak? what is a troph?

What does TAP stand for?

A 
Peak = Drug is at its highest
Troph = Drug is at its lowest

Troph
Administer
Peak

TAP- tells you when to administer your drugs. Troph is drawn b/f administration and Peak is drawn after administration.

46
Q

Why do we draw TAPS?

A

Because some drugs like amnioglycosides have a narrow therapeutic window. Therefore there is a very small window with what wrks and what kills.

i.e. smallest dose of lasix equals 5-120, which is a WIDE range therefore no need to draw TAPS.

Digoxin however is, 0.125-.25, which is a very narrow range , so a TAP must be drawn. Mean old Mycin also have a narrow window therefore a TAP must be drawn.

47
Q

Drawing PEAKS and TROPHS depends on the administration ROUTES. What are the routes for both peaks and trophs?

A

PEAKS:

  1. Sublingual - draw 5-10 min after drug is dissolved.
  2. I.V. - draw 15-30 min after drug is finished - NOT HUNG
  3. I.M. 30-60 min after administration
  4. Sub Q - See Diabetes Lecture
  5. PO - Do not test peaks

TROPHS:
For all administration routes IM, Sub Q, IV etc. always draw trophs 30min before administration.

48
Q

When you get an answer where there are 2 values in a range that are right pick which one?

A

The higher one. i.e. draw at 10:45 or 11am pick 11am or 1-3wks pick 3 weeks

MK REVIEW (16 decks)

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