Alcoholism, Delirium Tremors, & Peak And Trough

Question 1

Number one psychological problem in ALL abuse cases

Answer 1

Denial

Question 2

_________ is the refusal to accept the reality of a problem

Answer 2

Denial

Question 3

How do you treat denial?

Answer 3

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”)

Question 4

Under which circumstance would you support rather than confront denial?

Answer 4

With loss and grieving (denial is part of the five phases of grief: denial, anger, bargaining, depression, acceptance).

Question 5

_________ is when the abuser gets the significant other to do things for them or make decisions for them

Answer 5

Dependency (the ABUSER is dependent)

Question 6

__________ is when the significant other derives positive self-esteem from making decisions for or doing things for the abuser

Answer 6

Codependency (the SIGNIFICANT OTHER is codependent of the abuser)

Question 7

Treatment for dependency/codependency

Answer 7

Set limits and enforce it (teach the SO to start saying NO); oftentimes, relationship will be lost.

Question 8

_________ is when the abuser gets significant other to do things for him/her that is not in the best interest of the significant other

Answer 8

Manipulation

Question 9

Nature of manipulation

Answer 9

Interest and harmful

Question 10

How can you tell the difference between manipulation and dependency?

Answer 10

• 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

Question 11

Treatment for manipulation

Answer 11

Set limits and enforce them — start saying no

Question 12

Wernicke’s-Korsakoff syndrome is characterized by

Answer 12

Encephalopathy (Wernicke’s) and psychosis (Korsakoff)

Question 13

Wernicke’s Korsakoff is psychosis induced by __________ deficiency

Answer 13

Thiamine (Vitamin B1)

Question 14

Primary symptom of Wernicke’s-Korsakoff

Answer 14

Amnesia (memory loss) with confabulation (making up stories)

Question 15

Nursing care for patients with wernicke’s-korsakoff

Answer 15

REDIRECT the patient; do NOT present reality because they cannot learn it (d/t permanent brain damage)

Question 16

Characteristics of Wernicke’s Korsakoff

Answer 16

Preventable (w/ B1), arrestable (prevent from getting worse by stopping drinking and taking B1), and irreversible

Question 17

Drug used for aversion therapy for treatment of alcohol abuse

Answer 17

Disulfiram (Antabuse or Revia)

Question 18

Onset and duration of disulfiram (Antabuse)

Answer 18

2 weeks (takes 2 weeks to be effective and effectiveness wears after 2 weeks weeks of discontinuation)

Question 19

Disulfiram (Antabuse) patient education

Answer 19

• 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

Question 20

Examples of abused drugs that are UPPERS

Answer 20

Caffeine, cocaine, PCP/LSD (psychedelic hallucinogens), methamphetamines, adderall

Question 21

S/S of “upper” drugs

Answer 21

Things go UP: euphoria, tachycardia, restlessness, irritability, borborygmi, diarrhea, hyperreflexia (3&4), muscle spasticity, seizure (keep suction at bedside)

Question 22

Examples of drugs that are downers

Answer 22

Everything that is NOT an upper is a downer: dilaudid, morphine sulfate, codeine, Demerol, fentanyl, ambien, Ativan, Xanax, Valium, Librium, Phenobarbital

Question 23

S/S of “downer” drugs

Answer 23

Lethargy, risk for respiratory depression/arrest

Question 24

With withdrawal, too little upper makes everything go _____, and too little downers makes everything go _____.

Answer 24

Down; up

Question 25

Upper overdose looks like what other situation?

Answer 25

Downer withdrawal

Question 26

Downer overdose looks like what other situation?

Answer 26

Upper withdrawal

Question 27

Which two drug abuse situations would respiratory arrest and depression be the highest priority?

Answer 27

Downer overdose and upper withdrawal

Question 28

Which two drug abuse situations would seizure be the highest risk/priority?

Answer 28

Upper overdose and downer withdrawal

Question 29

How old does an infant have to be before diagnosed with drug withdrawal?

Answer 29

At least 24 hours (always assume intoxication, NOT withdrawal AT BIRTH)

Question 30

Every alcoholic goes through withdrawal ___ hours after they stop drinking. Only a minority get delirium tremors after ___ hours

Answer 30

24; 72

Question 31

Nursing care for patient with alcohol withdrawal syndrome

Answer 31

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)

Question 32

Nursing care for patient with delirium tremors

Answer 32

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)

Question 33

Nursing care for BOTH AWS and DT

Answer 33

Administer Antihypertensives, tranquilizer, and B1

Question 34

Antibiotics used to treat serious, life-threatening, resistant, gram-negative infections

Answer 34

Aminoglycosides

Question 35

All aminoglycosides in end -_____

Answer 35

-mycin

Question 36

List three antibiotics that end in -mycin that are NOT aminoglycosides?

Answer 36

Drugs that include “thro”: erythromycin, zapthromycin, clarithromycin

Question 37

Aminoglycosides adverse effects

Answer 37

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)

Question 38

Aminoglycoside nursing care

Answer 38

Administer every 8 hours, monitor hearing and creatinine

Question 39

Aminoglycoside route of administration

Answer 39

IM or IV (do NOT give PO b/c they will not be absorbed)

Question 40

What are the two cases in which aminoglycosides would be given orally?

Answer 40

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!”

Question 41

_____ describes when the drug is at its lowest level in the body

Answer 41

Trough

Question 42

_____ describes when the drug is at its highest level in the body

Answer 42

Peak

Question 43

When to draw peak and trough?

Answer 43

TAP levels: draw Trough (before administration), Administer, draw your Peak (after administration)

Question 44

Peak/Troughs are drawn on medications with

Answer 44

Narrow therapeutic windows

Question 45

When should trough be drawn on a sublingual, IV, IM, Subq, and PO medications?

Answer 45

30 minutes before the next dose

Question 46

When should peak be drawn with sublingual medications?

Answer 46

5-10 min after drug is dissolved

Question 47

When should peak be drawn with IV medications?

Answer 47

15-30 min after drug is finished (when bag is empty)

Question 48

When should peak be drawn with IM medications?

Answer 48

30-60 min after administration