Alcoholism, Delirium Tremors, & Peak And Trough Flashcards

1
Q

Number one psychological problem in ALL abuse cases

A

Denial

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2
Q

_________ is the refusal to accept the reality of a problem

A

Denial

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3
Q

How do you treat denial?

A

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”)

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4
Q

Under which circumstance would you support rather than confront denial?

A

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

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5
Q

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

A

Dependency (the ABUSER is dependent)

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6
Q

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

A

Codependency (the SIGNIFICANT OTHER is codependent of the abuser)

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7
Q

Treatment for dependency/codependency

A

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

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8
Q

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

A

Manipulation

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9
Q

Nature of manipulation

A

Interest and harmful

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10
Q

How can you tell the difference between manipulation and dependency?

A
  • 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
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11
Q

Treatment for manipulation

A

Set limits and enforce them — start saying no

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12
Q

Wernicke’s-Korsakoff syndrome is characterized by

A

Encephalopathy (Wernicke’s) and psychosis (Korsakoff)

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13
Q

Wernicke’s Korsakoff is psychosis induced by __________ deficiency

A

Thiamine (Vitamin B1)

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14
Q

Primary symptom of Wernicke’s-Korsakoff

A

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

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15
Q

Nursing care for patients with wernicke’s-korsakoff

A

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

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16
Q

Characteristics of Wernicke’s Korsakoff

A

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

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17
Q

Drug used for aversion therapy for treatment of alcohol abuse

A

Disulfiram (Antabuse or Revia)

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18
Q

Onset and duration of disulfiram (Antabuse)

A

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

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19
Q

Disulfiram (Antabuse) patient education

A
  • 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
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20
Q

Examples of abused drugs that are UPPERS

A

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

21
Q

S/S of “upper” drugs

A

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

22
Q

Examples of drugs that are downers

A

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

23
Q

S/S of “downer” drugs

A

Lethargy, risk for respiratory depression/arrest

24
Q

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

25
Upper overdose looks like what other situation?
Downer withdrawal
26
Downer overdose looks like what other situation?
Upper withdrawal
27
Which two drug abuse situations would respiratory arrest and depression be the highest priority?
Downer overdose and upper withdrawal
28
Which two drug abuse situations would seizure be the highest risk/priority?
Upper overdose and downer withdrawal
29
How old does an infant have to be before diagnosed with drug withdrawal?
At least 24 hours (always assume intoxication, NOT withdrawal AT BIRTH)
30
Every alcoholic goes through withdrawal ___ hours after they stop drinking. Only a minority get delirium tremors after ___ hours
24; 72
31
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)
32
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)
33
Nursing care for BOTH AWS and DT
Administer Antihypertensives, tranquilizer, and B1
34
Antibiotics used to treat serious, life-threatening, resistant, gram-negative infections
Aminoglycosides
35
All aminoglycosides in end -_____
-mycin
36
List three antibiotics that end in -mycin that are NOT aminoglycosides?
Drugs that include “thro”: erythromycin, zapthromycin, clarithromycin
37
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)
38
Aminoglycoside nursing care
Administer every 8 hours, monitor hearing and creatinine
39
Aminoglycoside route of administration
IM or IV (do NOT give PO b/c they will not be absorbed)
40
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!”
41
_____ describes when the drug is at its lowest level in the body
Trough
42
_____ describes when the drug is at its highest level in the body
Peak
43
When to draw peak and trough?
TAP levels: draw Trough (before administration), Administer, draw your Peak (after administration)
44
Peak/Troughs are drawn on medications with
Narrow therapeutic windows
45
When should trough be drawn on a sublingual, IV, IM, Subq, and PO medications?
30 minutes before the next dose
46
When should peak be drawn with sublingual medications?
5-10 min after drug is dissolved
47
When should peak be drawn with IV medications?
15-30 min after drug is finished (when bag is empty)
48
When should peak be drawn with IM medications?
30-60 min after administration