Alcoholism, Delirium Tremors, & Peak And Trough Flashcards
Number one psychological problem in ALL abuse cases
Denial
_________ is the refusal to accept the reality of a problem
Denial
How do you treat denial?
Confront the problem by pointing out the difference to the person of what they say and what they do (EX: “you say you are not an alcoholic, but it is 10 am and you already drank a six-pack”; “you say you are not a child abuser, but protective services has your children”)
Under which circumstance would you support rather than confront denial?
With loss and grieving (denial is part of the five phases of grief: denial, anger, bargaining, depression, acceptance).
_________ is when the abuser gets the significant other to do things for them or make decisions for them
Dependency (the ABUSER is dependent)
__________ is when the significant other derives positive self-esteem from making decisions for or doing things for the abuser
Codependency (the SIGNIFICANT OTHER is codependent of the abuser)
Treatment for dependency/codependency
Set limits and enforce it (teach the SO to start saying NO); oftentimes, relationship will be lost.
_________ is when the abuser gets significant other to do things for him/her that is not in the best interest of the significant other
Manipulation
Nature of manipulation
Interest and harmful
How can you tell the difference between manipulation and dependency?
- Manipulation occurs when what the SO is asked to do is inherently harmful or dangerous to the SO; EX) A 49 year old alcoholic gets her 17 year old daughter to go to the store for her = manipulation b/c minor buying alcohol is illegal
- Dependency occurs when what the SO is asked to do is neutral (no harm, no foul); EX) A 49 year old alcoholic asks her 50 year old husband to go to the store and buy alcohol for her = dependency b/c there is no harm to the husband
Treatment for manipulation
Set limits and enforce them — start saying no
Wernicke’s-Korsakoff syndrome is characterized by
Encephalopathy (Wernicke’s) and psychosis (Korsakoff)
Wernicke’s Korsakoff is psychosis induced by __________ deficiency
Thiamine (Vitamin B1)
Primary symptom of Wernicke’s-Korsakoff
Amnesia (memory loss) with confabulation (making up stories)
Nursing care for patients with wernicke’s-korsakoff
REDIRECT the patient; do NOT present reality because they cannot learn it (d/t permanent brain damage)
Characteristics of Wernicke’s Korsakoff
Preventable (w/ B1), arrestable (prevent from getting worse by stopping drinking and taking B1), and irreversible
Drug used for aversion therapy for treatment of alcohol abuse
Disulfiram (Antabuse or Revia)
Onset and duration of disulfiram (Antabuse)
2 weeks (takes 2 weeks to be effective and effectiveness wears after 2 weeks weeks of discontinuation)
Disulfiram (Antabuse) patient education
- Avoid things that contain alcohol: mouthwash, aftershave, perfumes/cologne, insect repellents, OTC that ends in -elixir, alcohol-based hand sanitizers, uncooked icings (d/t vanilla extract)
- NOTE: red wine vinaigrette is OKAY! It does NOT contain alcohol
Examples of abused drugs that are UPPERS
Caffeine, cocaine, PCP/LSD (psychedelic hallucinogens), methamphetamines, adderall
S/S of “upper” drugs
Things go UP: euphoria, tachycardia, restlessness, irritability, borborygmi, diarrhea, hyperreflexia (3&4), muscle spasticity, seizure (keep suction at bedside)
Examples of drugs that are downers
Everything that is NOT an upper is a downer: dilaudid, morphine sulfate, codeine, Demerol, fentanyl, ambien, Ativan, Xanax, Valium, Librium, Phenobarbital
S/S of “downer” drugs
Lethargy, risk for respiratory depression/arrest
With withdrawal, too little upper makes everything go _____, and too little downers makes everything go _____.
Down; up
Upper overdose looks like what other situation?
Downer withdrawal
Downer overdose looks like what other situation?
Upper withdrawal
Which two drug abuse situations would respiratory arrest and depression be the highest priority?
Downer overdose and upper withdrawal
Which two drug abuse situations would seizure be the highest risk/priority?
Upper overdose and downer withdrawal
How old does an infant have to be before diagnosed with drug withdrawal?
At least 24 hours (always assume intoxication, NOT withdrawal AT BIRTH)
Every alcoholic goes through withdrawal ___ hours after they stop drinking. Only a minority get delirium tremors after ___ hours
24; 72
Nursing care for patient with alcohol withdrawal syndrome
Regular diet, semi-private room anywhere on unit, up ad lib (pt can be get up and go around anywhere they want to go), NO restraints (not danger to self or others)
Nursing care for patient with delirium tremors
NPO (risk for seizures and aspiration), private room near nurses station, bed rest, restraints with vest or two-point locked leathers (danger to self and others)
Nursing care for BOTH AWS and DT
Administer Antihypertensives, tranquilizer, and B1
Antibiotics used to treat serious, life-threatening, resistant, gram-negative infections
Aminoglycosides
All aminoglycosides in end -_____
-mycin
List three antibiotics that end in -mycin that are NOT aminoglycosides?
Drugs that include “thro”: erythromycin, zapthromycin, clarithromycin
Aminoglycosides adverse effects
Ototoxicity, tinnitus, vertigo/dizziness, nephrotoxicity (REMEMBER: MYCIN sounds like MICE. Think of mouse ears to remember effects on hearing; also, human ear looks like kidney. This helps to remember nephrotoxicity)
Aminoglycoside nursing care
Administer every 8 hours, monitor hearing and creatinine
Aminoglycoside route of administration
IM or IV (do NOT give PO b/c they will not be absorbed)
What are the two cases in which aminoglycosides would be given orally?
1) Hepatic encephalopathy (aminoglycosides will kill E. Coli in gut, which produces ammonia)
2) Pre-op bowel surgery (sterilizes bowel — typically w/ neomycin and kanamycin)
MEMORY TRICK: “who can sterilize my bowel?” … “Neo Kan!”
_____ describes when the drug is at its lowest level in the body
Trough
_____ describes when the drug is at its highest level in the body
Peak
When to draw peak and trough?
TAP levels: draw Trough (before administration), Administer, draw your Peak (after administration)
Peak/Troughs are drawn on medications with
Narrow therapeutic windows
When should trough be drawn on a sublingual, IV, IM, Subq, and PO medications?
30 minutes before the next dose
When should peak be drawn with sublingual medications?
5-10 min after drug is dissolved
When should peak be drawn with IV medications?
15-30 min after drug is finished (when bag is empty)
When should peak be drawn with IM medications?
30-60 min after administration
