Legal, Ethical, Substance abuse

Question 1

What are important legal and ethical concepts?

Answer 1

Beneficence, autonomy, justice, fidelity, veracity.
A fundamental goal of psychiatric care is to strike a balance between the rights of the individual patient and the rights of society at large.

Question 2

What is required for admission into a hospital in addition to having a psych problem that is based on DSM-5?

Answer 2

Patients with mental health illness are to be placed in less restrictive community settings rather than in institutions.
Illness must present an immediate crisis. Other, less restrictive alternatives are inadequate or unavailable.
The expectation exists that hospitalization and treatment will improve the immediate problem.

Question 3

What is a BA-52?

Answer 3

52 is an emergency involuntary hospitalization, Baker act.

Question 4

What is a 32?

Answer 4

Temporary involuntary. A specified number of physicians must certify that the person’s mental health status justifies detention and treatment;
a judicial review

Question 5

Ex parte?

Answer 5

Family members legally have individual hospitalized

Question 6

Allows client to challenge unlawful detention by requesting a judicial hearing.
Safe guards a voluntary client

Answer 6

Writ of habeas corpus

Right to Release

Question 7

What are the patient rights? What is involved in each one?

Answer 7

Right to treatment: human environment, staff qualified and sufficient, individualized plan of care
Right to refuse treatment: withhold consent, withdraw consent
Right to informed consent

Question 8

What are the four types of admissions?

Answer 8

Voluntary, involuntary (commitment), long-term formal commitment, involuntary outpatient commitment

Question 9

This involves a surrogate decision maker. What else about it?

Answer 9

Advance psychiatric directive. Instructions about hospital choices, medications, treatment options, and emergency interventions. Identify individuals who are to be notified of hospitalization and who may visit.

Question 10

What three things should nurses in the psychiatric setting understand? What do most state laws prohibit the use of?

Answer 10

Assault, battery, false imprisonment

Seclusion, restraint

Question 11

When are behavioral restraint and seclusion authorized?

Answer 11

Behavior is physically harmful to the pt or another. Alternative measures are insufficient in protecting the pt and others. Decrease in sensory overstimulation is needed (seclusion only). Pt requests seclusion.

Question 12

What are the requirements for restraint and seclusion?

Answer 12

Written order of a physician. Confined to specific, time-limited periods. Specify the type of restraint. In an emergency, the nurse may place the pt in seclusion and/or restraints and then obtain an order.

Question 13

How often is a restrained or secluded pt’s condition reviewed and documented?

Answer 13

Very regularly, e.g. every 15-30 mins. Original order may be extended after a review and reauthorization.

Question 14

What is documented about seclusion and restraints?

Answer 14

Behavior leading to the rest/seclu and alternatives already tried. Time pt is placed in and released from. All assessments and care.

Question 15

What does the duty to warn and protect third parties include?

Answer 15

Tarasoff ruling
Assessing and predicting a pt’s danger of violence toward another. Identifying specific individuals being threatened. Identifying appropriate actions to protect victims.

Question 16

How do drugs affect neurobiology, changing the structure of the brain and how it works?

Answer 16

It disturbs a person’s norma hierarchy of needs and desires and substitutes new priorities. Overrides ability to control impulses. Similar to other mental illnesses.

Question 17

How much of an individuals vulnerability to addiction is attributable to genetics?

Answer 17

40-60%

Question 18

What are the characteristics substance abuse?

Answer 18

Use of a substance occurs outside of a medical necessity, outside of social acceptance. Results in adverse effects to the abuser or others.

Question 19

What are the characteristics of substance addiction?

Answer 19

Tolerance occurs when a person has to take more of the drug to “stay normal” and prevent withdrawal. Control over the substance is lost. Can be fatal.

Question 20

What are the 4 C’s of addiction?

Answer 20

Compulsive behavior (finding and taking the substance), cravings, chronic relapsing brain disorder, cognitive impairment

Question 21

Top ten classes of psychoactive substances in the DSM5?

Answer 21

Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, tobacco, other or unknown.

Question 22

Inflammatory, hemorrhagic, degenerative condition of the brain. Symptoms?

Answer 22

Wernicke’s encephalopathy

Double vision, nystagmus, lack of muscular coordination, mild or severely depressed mental function

Question 23

Amnesia seen in chronic alcoholics

Answer 23

Korsakoff’s psychosis

Short term memory loss, inability to learn new skills, usually disoriented

Question 24

How do drugs target the pleasure receptors of the brain?

Answer 24

Affect the limbic or reward system. First-time use releases a large amount of dopamine, resulting in pleasure. Neurons are unable to regulate dopamine. Dopamine is unable to stimulate the reward center. More of a drug is needed, causing a cycle of tolerance.

Question 25

What do all drugs of abuse do?

Answer 25

Target the brain’s pleasure center, increasing dopamine.

Question 26

Continuum of drug abuse?

Answer 26

Social and recreational use
Abuse, experiences problems
Dependence, impaired control, cannot consistently stop

Question 27

What is the assessment order for drug abuse?

Answer 27

Clarify presenting signs, assess for withdrawal, for overdose, for self harm potential, evaluate physiological response, explore individual’s interest in getting help, assess knowledge of community resources.

Question 28

What should be known when assessing for drug abuse?

Answer 28

History of substance abuse, medical history, psychiatric history, psychosocial issues

Question 29

CAGE-AID screening tool?

not for detoxing a pt. use CIWA-AR for active detox

Answer 29

Have you ever felt you ought to Cut down on your drug use?
Have people Annoyed you by criticizing your drug use?
Have you ever felt bad or Guilty about your drug use?
Have you ever used drugs first
thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?

Question 30

Explain alcohol withdrawal?

Answer 30

Early signs within a few hours. Peaks within 24-48 hrs. Irritablity and shaking inside. Intense cramps. Vomiting. Increased BP, HR, temp. Rapidly and dramatically disappears unless it progresses to delirium. Grand mal seizures possible in 7-48 hrs after cessation.

Question 31

Explain withdrawal delirium for alcohol?

Answer 31

Possible death. Peak 2-3 days after cessation and reduction. Autonomic hyperactivity (tachycardia, diaphoresis, elevated BP). Sensorial and perceptual disturbances. Fluctuating LOC. Delusions and paranoia. Agitated behaviors. Body temp 100F or higher.

Question 32

Examples of medications for alcohol withdrawal?

Answer 32

Benzodiazepines (Librium, Ativan)
Anticonvulsants
magnesium sulfate,
beta-blockers thiamine (vitamin B1), folic acid, and multivitamins

Question 33

Reduces or eliminates alcohol craving, used to block the effects of opiates

Answer 33

naltrexone (ReVia)

Question 34

Helps pt abstain from alcohol

Answer 34

acamprosate (Campral)

Question 35

An aversive agent that causes unpleasant physical effects.

Answer 35

disulfiram (Antabuse)

Question 36

For outpatient detoxification and maintenance

Answer 36

Buprenorphine hydrocholporide

Question 37

What are common signs of stimulant abuse?

Answer 37

Dilation of the pupils, dryness of the oronasal cavity, excessive motor activity

Question 38

When smoked it takes effect in 4-6 seconds. After 5-7 minutes a high follows. Has two main effects on the body: anesthetic and stimulant

Answer 38

Cocaine and crack. Produce an imbalance in the neurotransmitters dopamine and norepinephrine.

Question 39

What are withdrawal symptoms for cocaine? Recent use?

Answer 39

Depression, agitation, fatigue, anxiety, disorientation, craving, lethargy, irritability.
Recent use for someone displaying psychotic features includes paranoia, tactile hallucinations, agitation, severe panic levels.