Exam 2 Flashcards
What is PTSD?
Mental disorder characterized by persistent, distressing symptoms lasting longer than 1 month after exposure to an extreme traumatic stressor
Common symptom of PTSD?
hypervigilance
What helps with PTSD patients, esp. war vets?
1st: Group therapy with those who have suffered the same trauma
- PET therapy
- Yoga
What is one of the most important thing for substance abuse to remain sober?
peer support groups
Huffing INGESTION symptoms?
euphoria, labile effect, impaired judgement, respiratory depression.
Long term: neurotoxicity, parkinsonian syndrome. dizziness
Huffing OVERDOSE can lead to?
sudden sniffing death, permanent damage to lungs, liver and renal failure
Huffing interventions?
vitals, O2 and ABGs
A patient ingested a drug drug 10 minutes ago, which pt would you be most concerned about? Inhalant or drug taken PO?
Inhalant: short term effects are bronchospasms (airway)
Huffing withdrawal symptoms?
tremors, hallucinations, sleep disturbances
What defense mechanism do substance abusers usually use?
denial
How do you treat alcohol withdrawal?
- Benzodiazepines (Librium and Ativan)
What do you need to have in order to be a candidate for alcohol detox?
- must not be drunk (havent drank for 12-72 hrs)
2. increased HR & BP
When a person comes into the E.R. drunk - what do we worry about?
1st: Safety because of ataxia. “weebles wobble but drunks fall down”
* head trauma = CNS depression —> subdural hematoma
2nd: blood sugar
What do you worry about when someone is on the unit for Detox?
1st concern: withdrawal symptoms (seizures, delirium tremors, elevated HR & BP)
2nd concern: hydration & nutrition
Days after they stop drinking - what do we notice in patients on the detox unit?
they eat alot!
What is Antabuse (disulfiram)?
behavior modification drug
when taken w/ alcohol it makes you feel really sick (vomit, GI upset, etc)
patients wont drink alcohol because of the adverse effects when mixed with Antabuse
What will happen if an alcoholic going through withdrawal is not hospitalized?
will seize to death from withdrawal from irritation of the meninges
How to know someone is in withdrawal from alcohol?
subjective: seizures and hand tremors
objective: elevated HR and BP
If you just stop drinking alcohol, what are you at risk for? What do we have to do? Why? What does it prevent?
@ risk: HYPOGLYCEMIA! (alcohol has alot of sugar)
what to do: give “banana bag” dextrose and thiamine
What will happen if you don’t give banana bag?
patient will get disconjugate gaze. their eyes will lose symmetry
What causes disconjugate gaze in an alcoholics?
occurs when rapid sugar is given with no thiamine
What does adding thiamine to D10 prevent?
- disconjugate gaze
2. confabulation (memory loss) due to Kasacoff’s syndrome
What happens if you don’t eat before you drink?
there’s no protein to maintain liver causing cirrhosis of liver
When drug addicts lie and say they drink more for more meds, wihat is the solution to this problem?
medicate based on “Symptom-Triggered Treatment Plan”
1. need to show obj symptoms (high HR and BP) of withdrawal to get benzos
Patient is admitted for alcoholic overdose but is NOT a candidate for detox. What do you do with the pt?
hold pt till they are no longer drunk in order to prevent them from harming themselves
Deadly combinations with alcohol?
Barbituates and alcohol (deadlier!!)
Benzos and alcohol
Interventions for alcohol withdrawal?
IV hydration and banana bag (thiamine and dextrose)
What med is often used for alcohol abuse?
- Naloxone stops craving for alcohol
- Benzos works for alcohol withdrawal
Patient comes in seeking detox and theyre experiencing elevated HR and BP. They are a candidate for detox, should we worry about glucose levels?
NO,
b/c they are a candidate for detox it means they stopped drinking awhile ago. They are not intoxicated and glucose is NO longer an issue
What primary symptom of alcohol overdose must we worry about?
loss of gag reflex
Would you provide PO hydration to intoxicated alcoholic?
No, because dont want to add volume and gag reflex probs.
What are symptoms of mild anxiety?
- “fight or flight” response
- more focused
- increased conc.
- too much mild anxiety can turn into moderate anxiety
What are the signs of patient coping with anxiety?
patient starts to see and address all things that have been repressed and understand that what they were experiencing is anxiety
How would you treat mild, moderate and severe anxiety?
MILD: exercise
MODERATE: talk therapy and anxiety
SEVERE/PANIC: benzos short term or PRN (Xanaz and Klonopine)
What is secondary gain?
exaggerating symptoms for personal gain
What is the problem with secondary gain?
it effects the pt’s ADLs. they never go back to doing things for themselves
How must one deal with a patient who’s been raped?
- maintain privacy
- call 911
- collect all evidence (brown paper bag)
- maintain chain of custody for evidence
- educate on HIV & STD testing
- give antibiotics
- therapy
Sexual assault vs. sexual abuse?
sexual assault: performing sexual act with a child
sexual abuse: showing porno to kid, performing acts in front of kid
What locations on a child’s body would raise suspicion of abuse?
on abdomen
on back
What are red flags for suspicion of abuse?
- bruises on places that typically arent hit in a fall
- bruises that req a story
- multiple injuries to diff people in household
- traveling long distances to receive care
What type of burn is indicative of abuse?
any type of burn that is well-delineated and symmetrical
ie: cigarette, cigar
What type of fracture indicate abuse?
spiral fractures = twisting
What is the affect/behavior of child who is abused?
child is indifferent
not as fearful as a normal child
What is an ACS report?
someone will stop by and look at the scenario a little bit more because they cant discharge the child till someone sees home and family.
Phenelzine
- brand name, drug class, action, contraindicated
Brand name: Nardil
Drug class: antidepressant
Action: improved mood in depressed patients
Contraindication: dont give to patient on tyramine diet
What is anorexia? Diagnostic criteria? Priority intervention when theyre admitted?
- anorexia: mixture of very low body weight, fear gaining weight,
- diagnostic criteria: 15% under normal body weight
- priority intervention: vitals
What is anorexia driven by?
- market that provides the image of beauty
2. family, support and nature where they came from
Ways to purge in anorexia?
- vomit after eating (ALKALOSIS)
- diuretics
- laxatives (ACIDOSIS)
signs and symptoms of anorexia?
bradycardia hypothermia dry pale skin jaundice brittle nails amenorrhea hypo BS
As nurses, what must we do to care for anorexia patients?
- watch pt closely
- watch 40 mins after eating
- monitor if patient loses 2 lbs in a day
- monitor diurnal weight changes
Why do people binge eat?
eating stimulate vagus nerve, makes you feel good
What is binge eating used for? What is the cause of bulimia?
used to make us feel good
eating too much causes guilt and this causes bulimia
What type of patient is more likely to die from the disorder? (anorexia or bulimia)
anorexia patient
will die from vit K
How many pints in a pound?
ONE
Types of Opiates
Percocet, Vicodin, oxycodone, OxyContin, heroine, Demerol, methadone, DIlaudid, codeine
Opiate ingestion symptoms
euphoria, reduces pain, shallow respiration, constipation
Opiate overdose symptoms
What can quickly reverse opiate overdose?
respiratory suppression
respiratory ARREST
Naltrexone/Naloxone (Narcan)
-opioid antagonist
Opiate withdrawal symptoms
dilated pupils, severe diarrhea, goosebumps, clammy and cold skin, increased HR and BP
Where does the phrase “going cold turkey” relate to?
pts going through opiate withdrawal and when they get clammy, cold skin with pyeloerection (goosebumps)
What is mean to “kick the habit”?
with severe opiate withdrawal it causes akathesia and pts kick and move feet alot
How to treat opiate withdrawal?
Methadone
- stop from hurting other
- pts will be much more comfortable
Catapres
- antiHTN
- give w/ motrin to reduce pain
Suboxone
- decreases opiate craving
Order which patient you would prioritize?
oxycodone w/ dilated pupils, cocaine chest discomfort, weed grandiosity, PCP
1st: cocaine chest discomfort
2nd: PCP
3rd: weed
4th: oxycodone
What happens in conversion disorder?
convert anxiety into a physical manifestation
How do you differentiate between somatization and conversion disorders?
Somatization: manifestation of psychological distress as physical symptoms
Conversion: severe emotional distress or unconscious conflict is expressed through physical symptoms
Patients suffering from conversion disorder goes in for labs and all tests come back negative what night?
- reinforce to pt that all the tests came back negative
2. talk to them about underlying anxiety issues
What is a phobia?
irrational fear
What is the first phobia that is likely to occur from a panic attack?
agoraphobia = fear of and often avoidance of places and situations
Treatment of phobias
- CBT
- Systematic desensitization
- Flooding
systematic desensitization vs. flooding
systematic desensitization: 1st week = give PRN, teach relaxation, watch movies with phobia. 2nd week = go to area where phobia takes place, teach relaxation techs. month later = expose pt to phobia
flooding: wrks best like fear factor. contraindicated for pts with cardiac issues
