Exam #2 Flashcards
what is addiction?
a compulsive/abnormal behavior that relates to substances or behaviors
what is intoxication?
a state of disturbed cognition, perception, behavior, LOC, and judgment
what is withdrawal?
physiological and mental readjustment from stopping the use of an addictive substance
why is alcohol use accepted?
because it is legal, used in ceremonies, and religions
what is the blood alcohol level that can cause intoxication in a human?
80-100 mg/dL
what is the blood alcohol level that can cause death in humans?
400-700 mg/dL
what drugs are CNS depressants?
alcohol, sedatives, hypnotics, anxiolytics, cannabis,
what are sedatives used for?
anxiety, panic, seizures, and sleep disorders
what are hypnotics used for?
xxx
what are anxiolytics used for?
xxx
what are some signs of alcohol/sedative/hypnotic/anxiolytic intoxication?
disinhibition of sexual or aggressive behaviors
mood lability
impaired judgment and memory
impaired social/occupational function
decreased LOC
Slurred speech
Incoordination
Unseady
Nystagmus
Flushed face
what is nystagmus?
uncontrolled eye movements…can be up, down, left, right, etc
what are some chronic effects of alcohol abuse?
peripheral neuropathy, alcoholic myopathy, Wernicke encephalopathy, korsakoffs psychosis, alcoholic cardiomyopathy, esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis of liver, leukopenia, thrombocytopenia, sexual dysfunction
what is peripheral neuropathy in relation to alcohol abuse?
nerve damage in the extremities
what does peripheral neuropathy feel like?
pain, burning, and tingling, in the extremities
what causes peripheral neuropathy?
having low amounts of the B vitamin Thiamine
why do alcoholics experience peripheral neuropathy?
because they have poor nutrition and malabsorption of food from alcohol
can peripheral neuropathy be reversed?
yes but can be permanent for some
how is peripheral neuropathy reversed?
by abstinence from alcohol and improvement in diet
what is alcoholic myopathy?
a condition that causes loss of function and strength in your skeletal muscles in response to long-term or heavy drinking
what are the symptoms in acute alcoholic myopathy?
sudden onset muscle pain, swelling and myoglobinuria
what is myoglobinuria?
occurs when myoglobin are present in the urine
why would myoglobin be present in urine?
it occurs in patients who have alcoholic myopathy due to their muscles breaking down….the body excretes the product of the breakdown in the urine
what are the symptoms of chronic alcoholic myopathy
gradual wasting and weakness of muscle tissue
is acute alcoholic myopathy reversible?
yes
is chronic alcoholic myopathy reversible?
no
what causes alcoholic myopathy?
having low amounts of the B vitamin thiamine
what color is myoglobinuria?
red tinged
what changes must be made to improve patients with alcoholic myopathy?
abstinence from alcohol and diet
what labs are elevated in patients with alcoholic myopathy?
aspartate aminotransferase (AST)
Alanine transaminase
(ALT)
what is Wernickes encephalopathy
the most serious form of thiamine deficiency that can cause death
what are the symptoms of Wernickes encephalopathy
death, paralysis of ocular muscles, diploplia, ataxia, somnolence, and stupor
what are the ocular muscles?
muscles that control your eyes
what is diplopia?
double vision
what is ataxia?
poor muscle control that causes clumsy movements
what is somnolence?
sleepy
what is a stupor?
state of unconsciousness that can be awakened with extreme stimulation
can wernickes be reversed?
yes
what is Korsakoff’s psychosis?
occurs when alcohol is abused the symptoms are confusion, recent memory loss, and confabulation
what other diseases is Korsakoff psychosis paired with?
Wernicke
is korsakoffs psychosis psychosis reversable?
no
what is alcoholic cardiomyopathy?
accumulation of lipids on the myocardial tissue causing the heart to be bigger and have weaker contraction
can alcoholic cardiomyopathy be fixed?
no
what does alcoholic cardiomyopathy mimic?
HF and arrhythmias
what are the symptoms of alcoholic cardiomyopathy?
decreased ability to exert, tachy, dyspnea, edema, palpitations, and nonproductive cough
what labs will be elevated in alcoholic cardiomyopathy?
AST and ALT
what are treatments for alcoholic cardiomyopathy?
abstinence from alcohol, rest, oxygen, digitization, sodium restrictions, diuretics
what is esophagitis?
inflammation of the esophagus
what is pancreatitis?
what is the alcohol hepatitis?
inflammation of the liver that causes it to be enlarged and tender
what is cirrhosis of the liver?
when fibrous scar tissue forms on the liver decreasing filtration and absorption
what are the symptoms of alcoholic hepatitis?
N/v, anorexia, weight loss, abd pain, jaundice, edema, anemia, blood coagulation problems
why does alcoholic hepatitis cause anemia and blood coag problems?
xx
what can be done to treat alcoholic hepatitis?
abstinence from alcohol, diet
what is leukopenia
the production, function, and wbc impaired
what does leukopenia put you at risk for?
infection
what is thrombocytopenia?
decrease in platelet production
what is sexual dysfunction in relation to alcoholism
women have decreased menstural cycles and libido
men have decreased test, gyno, and impaired fertility
how do we assess alcoholism?
CAGE questions
what does the C in CAGE mean
have you tried to CUT down
what does the A in CAGE mean?
have people ANNOYED by criticizing you?
what does the G mean in CAGE?
have you felt bad or GUILTY
what does the E in CAGE mean?
have you had an eye opener drink
in the CAGE question what constitutes someone might have be an alcoholic?
2 or more positive responses
when does alcohol withdrawal occur?
from 4-12 hours from last drink
what are the symptoms of alcohol withdrawal?
tremmors in hand, toungue, eye
N/v
Sweating
Malaise/weak
Elevated BP/HR
Anxiety
Irritability
Hallucinations
Delirium
Headache
Insomnia
Depression
seizures
Death
what precautions should you keep in mind with alcoholics going through withdrawal?
seizure
what should you have ready for a patient under seizure precautions?
suction, nonrebreather, benzo, padded rails, vital machine
what should you do if a seizure occurs?
check the time, roll the patient over, apply nonrebreather, use suction, administer lorazepam
what lab is being monitored for alcoholic in withdrawal?
BMP for fluid, electrolytes, and blood sugar
why should blood sugar be monitored in alcoholics?
alcohol damages the pancreas which releases insulin and also damages the liver which releases glucose into the blood stream
why are alcoholics at risk for seizures?
because alcohol is a CNS depressant and when the patient stops drinking their CNS activity goes much higher than what it is used to causing increased risk of seizures
what med groups are used as substitution therapy for alcoholism?
benzodiazepines and anticonvulsants
why are benzo and anticon used to treat alcoholism?
because it lowers the CNS activity to match where it was when they were drinking
what does the dosage timeline for substitution therapies look like?
start of with a higher dose and slowly taper away
what benzodiazepines are long acting?
chlodixepoxide and diazepam
what benzo is short acting?
lorazepam
what benzo should be given to those with chronic liver diseases?
the quick-acting one lorazepam
what are the anticonvulsants?
carbamazepine, valporic acid, lamotrigine, topiramate
what are the two types of deterrent therapies for alcoholism?
Disulfiram and naltrexone
how does Disulfiram work?
it causes the person taking the medication to become ill when ingesting alcohol
how long must a patient be abstinent from alcohol before taking Disulfiram?
minimum 12 hours
what is required from the patient before taking Disulfiram?
consent
what is the worst side effect of Disulfiram?
death
how long does it take for symptoms of Disulfiram to start if someone drinks?
5-10 minutes
what must the patient avoid when taking Disulfiram
alcohol, vanilla, mouth wash, nyquil, sanitizer
what are side effects the patient can anticipate if they drink while taking dilfucking fuck?
n/v, flushed skin, dizzy, sweating, tachycardia, resp depression, MI, death
how does naltrexone work for alcoholics?
blocks pleasure receptors in the brain
what can naltrexone be used to treat?
alcohol and opioid abuse
what therapies can alcoholics use?
AA, counseling, group therapy
what effects do sedatives/hypnotics/ anxiolytics have on the body?
changes in sleep/dreaming, hypotension, compromised contraction, reduced urine output, lower metabolism, reduced body temp, sexual function
when does withdrawal begin in short acting drugs?
begins in 12 to 24 hours
when does withdrawal peak in short acting drugs?
24 TO 72 HOURS
when does withdrawal subside in short acting drugs?
5-10 days
when does withdrawal begin in long acting drugs?
2 to 7 days
when does withdrawal peak in long acting drugs?
5-8 days
when does withdrawal subside in long acting drugs?
10-16 days
what are the two drugs that contain cannabinoids?
cannabis and synthetic k2
what are the signs of intoxication in someone under the influence of cannabis?
euphoria, anxiety, paranoid, slowed time, impaired judgment, social withdrawal, tachy, red eyes, increased appetite, dry mouth, hallucinations, delusions
what are the effects on cannabis on the body/
tachycardia, orthostatic hypotension, laryngitis, bronchitis, cough, hoarse, decreased sperm count, amotivational syndrome`
what are signs of cannabis withdrawal?
irritability, anger, insomnia, disturbing dreams, depressed mood, abd pain, tremors, sweating, fever, chills, headache
what are the drugs containing opioids?
opium, heroin, mepridine, fentanyl
what are the symptoms of opioid intoxication?
euphoria, lethargy, somnolence, dysphoria, impaired judgment, pupillary constriction, drowsiness, slurred speech, constipation, N/V, decreased RR and BP
when do withdrawal symptoms start for opioids?
6-8 hours
when do withdrawal symptoms peak for opioids?
2-3 days
when do withdrawal symptoms subside for opioids?
5-10 days
what are the symptoms that someone is going through opioid withdrawal?
N/V, craving, muscle cramps, pupillary dialation, Lacrimation, rhinorrhea, sweating, yawning, fever, insomnia,
what is Lacrimation
leaking eyes
what is used for opioid overdose?
naloxone
what should you assess for before giving naloxone?
respiratory effort, bradycardia, unresponsiveness
if the patient does not wake up after giving naloxone when can you give them another dose?
after 2-3 minutes change the nostril and give another dose
what meds are used for opioid substitution therapy?
buprenorphine and methadone…..clonidine is used after
what is used to determine if patients are going through alcohol withdrawal
CIWA
what are the cns stimulants?
cocaine, amphetamines, hallucinogens, and inhalants
what are the symptoms of intoxication for inhalants/cocaine/amphetamine?
fighting, grandiosity, hypervigilance, psychomotor agitation, impaired judgment, tachycardia, pupilary dialtion, elevated BP, perspiration, chills, n/v, hallucinations, delirium
what are symptoms of cocaine/amphetamine withdrawal?
anxiety, depression, irritability, crave, fatigue, insomnia, hypersomnia, psychomotor agitation, paranoid, social withdrawal, SI
what happens to the body with chronic cocaine use?
pulmonary hemorrhage, bronchiolitis, pneumonia, nasal rhinitis, placenta abruption, CVA
what are the symptoms of hallucinogen intox?
agitation, hyperacitivty, violence, hallucinations, psychosis, convulsion, possible death`
what are the two kinds of reaction to hallucinogens?
panic and flashback
what happens during a panic reaction?
bad trip where you have anxiety, fear, paranoid, and psychosis
what happens during flashback reaction?
spontaneous time where you have an intoxication effect
what does the patient feel during a flashback reaction?
anxiety, depression, fear of losing mind, paranoid, impaired judgment
what do you do when the patient is on hallucinogens or has a flashback?
reorient back to reality, and safety, and stay with them
what does the use of inhalants do to your body?
cns and pns damage, dyspnea, pneumonia, n/v, cyanosis
what are the goals for all addict patients?
safe detox, assume responsibility, connection of behaviors and consequences, self-esteem improvement, and abstinence
what is mood?
how a person feels
what is affect?
how the person is displaying on the outside
what is bipolar disorder?
mood disorder manifested by cycles of mania and depression and times of normalcy
what is mania?
alteration in mood that maybe expressed by feelings of elation, grandiosity, inflated self esteem, hyperactivity, agitation, racing thoughts,
what is the average age of onset for mania?
25
what happens to the neurotransmitters during a manic episode?
norepinephrine and dopamine are high and serotonin is low
what drugs can cause mania?
amphetamines, antidepressants, anticonvulsants, and narcotics, steroids
what is bipolar 1?
when a patient has mania with periods of depresion
how many dig fast symptoms must a patient have to be bipolar 1?
3 or more
what does DIG FAST stand for?
Distractability, Indescretion, Grandiosity, Flight of ideas, Activity increase, sleep deficit, and talkativeness
what is bipolar 2?
bouts of major depression with episodes of hypomania
can bipolar 2 patients experience a manic episode?
no only hypomanic
what is the difference between hypomanic and manic symptoms?
hypomanic symptoms are not severe enough to mark impairment with social or occupational setting
what is cyclothymia?
numerous episodes of elevation of mood and depression
what is the longest someone with cyclothymia can go without symptoms?
2 months
how long must someone with cyclothymia have symptoms before being diagnosed?
2 or more years
what should be included in manic patient care?
monitoring risk for injury, monitoring risk for violence, ensuring good nutrition, monitoring for disturbed thought process, monitoring for disturbed sensory perception, impaired social interaction, and insomnia
what are nursing interventions for manic patients?
reduce stimuli, remove harmful objects, stay with client, provide a structured schedule, provide physical activities, provide high protein finger foods, set limits, show force
what foods are good for manic patients?
high-calorie and protein-rich finger foods`
when is ECT used for bipolar patients?
for type 1 acute mania and type 2 for depression
what is the mood stabilizer you need to know for mania?
lithium
what antipsychotics are used for mania??
zxx
what neurotransmitters are affected by lithium?
norepinephrine, serotonin, dopamine, glutamine, GABA
what are the therapeutic levels of lithium for acute mania?
1-1.5
what are the therapeutic levels of lithium for maintenance?
0.6-1.2
what symptoms do patients with lithium toxicity have?
N/V, diarrhea, ataxia, blurred vision, tinnitus, tremors, mental confusion
what education do you give a patient taking lithium?
Take regularly, dont drive, eat normal amounts of sodium, eat healthy foods, 6-8 glasses of water per day, avoid excess caffeine, carry med card, watch for weight gain, use contraception, keep appointments for serum levels
what happens to sodium if lithium levels are too high in your body?
blocks the absorption of sodium which cause hyponatremia
what meds are the anticonvulsants?
valporic acid, carbamaepine, lamotrigine
what education do you give for anticonvulsants?
rash, bleeding, sore throat, dark urine, dark eyes, no alcohol, carry card
what antipsychotics treat mania?
olanzapine, risperidone, chlorpormazine, aripiprazole, ziprasidone
what is anorexia nervosa?
suppressing appetite that you have
what are the diagnostic criteria for anorexia nervosa?
restriction of calories that cause loss in body weight, intense fear of gaining weight, disturbed body image, BMI less than 20
what is a normal BMI?
20-24.9
what are the symptoms of anorexia?
hypothermia, lanugo, bradycardia, hypotension, decreased bone density, amenorrhea, hypoglycemia, weak, poor memory
what labs will be seen in anorexic patients?
hypoglycemia, anemia, leukopenia, abnormal hormone
what medication helps with anorexia?
fluoxetine
what are the nursing interventions for anorexia?
eating plan, daily weight, I/O, NG tube, coping skill, monitoring for refeeding syndrome
what is a refeeding syndrome?
occurs when patient who is malnourished rapidly ingests food can cause death
what should be put on patients when they might experience refeeding syndrome?
telemetry
what are some goals for anorexic patients?`
2-3lbs per week, meeting cal goal, verbalize that behaviors are maladaptive, acknowledge that body fat was a misperception
what are the two types of anorexia?
restrictive and eating/purging
what is bulimia nervosa?
eating large amounts of food followed by purging or extreme exercise
how many times must a person participate in overeating and purging before its considered bulimia nervosa?
1x a week for 3 months
are bulimia nervose patients typically emaciated, normal weight or overweight?
normal
what are the symptoms of bulimia nervosa?
Russell sign, enlarged parotoid gland, dental carries, enamel erosion, tears in gi tract, electrolyte imbalance, anxiety, mood disorder, substance abuse
what labs are affected by bulimia nervosa?
low mag, k, na,
what do you do if patients k comes back low?
tele
what are the medication treatments for bulimia nervosa?
fluoxetine and topiramate
what are nursing interventions for bulimia nervosa?
1 to 1 from 1-2 hours post meal, daily weight, I/O, eating plan, coping skill
what are the goals when treating a patient with bulimia nervosa?
No signs of dehydration or electrolyte imbalance
No stash of food
Meet calorie goals
Verbalize previous behavior is maladaptive and life-threatening
Verbalises positive self-attributes
Acknowledges fat was a wrong perception
what is a binge eating disorder?
uncontrolled rapid ingestion of food in a short period
how many times must a person binge for the disorder?
1x a week for 3 months
what are symptoms of binge eating disorder?
weight gain, cramps, constipation, reflux, high choleserol
what are binge-eating patients at risk for?
diabetes type 2, hypertension, cancer, depression
what meds for binge eating?
topiramate and lisdexamfetamine
what nursing intervention for binge eating?
food diary, eating plan, progressive exercise, support group
what are the goals for binge eating patients?
food diary, losing 1-2lbs per week, healthy eating, exercise, plan for future weight control, know positive attributes of self, and support groups
what is the Maudsley approach?
family-oriented therapy for anorexia…weight gain is monitored by someone other than patient…once progress is made then the patient takes over….done outpatietn
what biochemicals are effected in depression patients?
decrease in norepinepherine, serotonin, dopamine
what gland can cause depression?
problems in the pituitary
what is the learning theory say about depression?
that it is learned helplessness….the person after numerous failures give up on trying to be successful
what does the object loss theory say about depression?
being abandoned during the first 6 months of life causes problems that persist into adulthood
what does the cognitive theory say about depression?
cognitive distortion that perceives things through a negative/defeated lense
according to the cognitive theory what negative expectations do depressed patients have?
environment, self, and the future
what does the transactional model of stress say about depression?
many factors cause depression not just one thing
what sex is more common to have depression?
female
what is senescence?
depression with dementia
what effect does socioeconomic status have on depression?
poverty and unemployment increase odds
what is major depression disorder?
depression that impairs social and occupational functioning
what is the acronym Sig E Caps stand for in relation to MDD?
Sleep disturbance
Interest decreased
Gulit
Energy decrease
Concentration problems
Appetite/Weight changes
psychomotor agitation
Suicidal ideations
how many symptoms must be present to diagnose MDD?
5 or more findings for 2 weeks
what if patient has MDD along with other factors like schizo, med, illness, or mania?
then patient does not have MDD
what is dysthymia/persisten depressive disorder?
milder form of depression that has an early onset
when does dysthymia typically set in?
adolescent
how long does dysthymia last?
2 years for adults and 1 year for children
what are the symptoms of dysthymia?
low mood, low appetite, sleep problems, poor concentration, irritablity, hopeless, inability to make descision
what can dysthymia turn into?
MDD
from the symptoms listed how many determine if they have dysthymia?
2 or more
what are the symptoms of premenstrual dysphoric depression?
depressed mood, anxiety, mood swings, decreased interest, during the week menses, gets better post cycle
what should you look for in relation to med pass with suicidal patietns?
watch for cheeking of meds
what is the purpose of congitive behavioral therapy?
to control thought distortion, get ride of negative thoughts,
what do SSRIs do?
prevent the reuptake of serotonin back into the neuron
what is the first line treatment for depression?
ssri
what cant you take with SSRI?
st john wort
what drugs are SSRI?
sertraline, citalopram, escitalopram, fluoxetine, and paroxetine
what are the complications for ssri?
serotonin syndrome, weight changes, anxiety, agitation, insomnia, cns stim, sexual dysfunction, withdrawal, HYPOnatremia, rash, gi bleed
what do SNRIs do?
prevent the reuptake of serotonin and norepinephrine
what does SNRIs treat?
depression and anxiety
what drug is a SNRI?
venlafaxine
what are complications of SNRIs
serotonin syndrome, Nausea, sweating,, insomnia, tremors, sexual dysfunction
what do tricyclic antidepressants do?
block reuptake of norepi and serotonin and blocks histamine receptors
what drug is a tricyclic antidepressant
amitriptyline
what are the complications of tricyclic antidepressants?
orthostatic hypo, decreased seizure threshold, sweating, increased appetite, sexual dysfunction, toxicity
what does tricyclic toxicity look like?
cholinergic block, cardiac toxic, dysrhythmias, seizure, coma, death
what do heterocyclic meds do?
block serotonin reuptake
what drugs are heterocyclic?
buproprion, mirtazapine, trazadone
what are the complications for heterocyclic medications?
lower seizure threshold, weight loss, insomnia, restless, increased HR, Gi distress, dry mouth, headache
what are manoamine oxidase inhibitors?
increases nor epi and serotonin
when are maois tried?
as a last resort
what drug is a MAOI?
phenelzine
what are the complications from taking MAOIs
Hypertensive crisis, mania, hypomania, orthostatic hypo, agitation, anxiety, cns stim
what must patients avoid when taking MAOIs/phenelzine?
tyramine
what happens if patietn taking phenelzine ingests tyramine?
hypertensive crisis
what are symptoms of hypertensive crisis?
Headaches, N/V, Tachy, diaphoresis, change in loc
what foods contain tyramine?
aged cheese, red wines, smoked/processed meats
what kind of seizure is induced during ECT?
grand mal
can a patient take meds before ECT?
no
when is ECT used?
to treat suicide and depression
what kind of memory loss is common in ECT
might forget pin to phone
