mark k lecture 2 Flashcards
*How do you respond/treat to pts in denial?
Support = Loss
Confront = Abuse
Dependency
when they get the significant other to do things or make decisions for them
The abuser is dependent
Co-dependency
when the significant other derives self-esteem for doing things or making
decisions for the abuser
The significant other is the co-dependent
How do you treat dependency/codependency?
Dependent pts are “abusers” … Confront them
o Co-dependent pts have self-esteem issues … Teach pts how to set limits and enforce them
o Agree in advance on what requests are allowed then enforce
o Teach significant other to say no
o Work on self-esteem on the co-dependent person
Manipulation
Manipulation is when the abuser gets the significant other to do things or make decisions
that are not in the best interests of the significant other
o The nature of the act is dangerous and harmful to the significant other
Wernicke (Korsakoff) Syndrome
- Wernicke is an encephalopathy
- Korsakoff is a psychosis
- Psychosis induced by Vitamin B1, thiamine deficiency
- This is a situation the pt looses touch with reality due to vit B1 deficiency
Wernicke (Korsakoff) Syndrome primary S/Sx
are amnesia (memory loss) and confabulation (making up stories)
o Confabulation—The lies for this pts are just as real as reality
How do deal with a pt with Wernicke and Korsafoff who is confabulating
Redirect the pt to something he can do
o For instance, tell pt something along that line: “Why can we go watch TV to see what is
on the news today”
Characteristics of Wernicke and Korsafoff syndrome
1.Preventable … Take B1
2.Arrestable (stop it from getting worse) … Take B1
3.Irreversible (70%) … Will kill brain cells
Disulfiram
Antabuse and Revia
Antabuse—Alcohol deterrent
Revia—Antidote
Med that causes pts who drink symptoms of n/v, even
death
duration of Disulfiram
2 weeks
Onset of Disulfiram
2 weeks
Patient teaching on Disulfiram
o Teach pt to avoid all forms of EtOH. Not doing so may lead to symptoms of n/v, even
death
o Teach them to avoid the followings items as they contain alcohol … Mouth wash,
cologne, perfume, aftershave, elixir, most OTC liquid medicine, insect repellant, hand
sanitizer, vanilla extract (can’t have cupcake with unbaked icing)
o On the exam, do not pick the Red Wine vinaigrettes … It does not have alcohol in it
First thing you ask in an overdose nclex Q
Is it a upper or downer
List of uppers
- Caffeine
- Cocaine
- PCP/LSD (psychedelics/hallucinogens)
- Methamphetamines
- Adderall
SS of uppers
- Things go UP!
- Euphoria, seizures, restlessness,
irritability, hyperreflexia (3+, 4+),
tachycardia, increased bowels
(borborygmi), diarrhea
SS of downers
- Things go DOWN!
- Lethargic, respiratory depression/arrest,
constipated, etc.
The highest priority to anticipate in an Upper is
suctioning due to seizures
The highest priority to anticipate in a Downer
intubation/ventilation
At birth, you should assume the baby is withdrawing or intoxicated?
Intoxicated within 24hours
Every alcoholic goes through alcohol withdrawal approximately
24 hours after the person
stops drinking
Delirium tremens occurs about
72 hours after the person stop drinking
Nursing Care Plan Dt
NPO (seizures) or clear liquid diet
* Private room, near nursing station
* Restricted bed rest (Pt is not free to move
around as desired—no bathroom)
* Restraints (vest or 2-point lock letters)
Antihypertensive
Tranquillizer
Multivitamin containing B1
Nursing Care Plan AW
- Regular diet
- Semiprivate room, anywhere on the unit
- Pt is up ad lib (Pt is free to move around
as desired) - No restraints
Antihypertensive
Tranquillizer
Multivitamin containing B1
Aminoglycosides
Aminoglycosides are the big
guns of ABXs (antibiotics)—
use them when nothing else
works. Aminoglycosides are
unsafe at toxic levels and
safety then becomes an issue.
Aminoglycosides used to treat
used to treat serious, resistant, life-threatening, Gram negatives infections
“A Mean Old Mysin”
Aminoglycosides So, treat a mean old infection with a “Mean Old Mycin”
examples of uses for Aminoglycosides
TB, septic peritonitis, fulminating pyelonephritis, septic shock, infection
from third degree wound covering >80% of the body
All aminoglycosides end in
Mycin
Azithromycin, Clarithromycin, Erythromycin … All have THRO in the middle
THRO them off the “Mean Old Mycin” list
What are toxic effects?
Monitor hearing (#1), balance, tinnitus
(ringing of the ear, Cranial nerve 8 toxicity)
nephrotoxicity (Toxic to the kidneys)
o Therefore, monitor Creatinine
Aminoglycosides Q_?
8
route of Aminoglycosides
IM/IV can’t give PO bc they are not absorbed
2 cases that Aminoglycosides are given PO
Hepatic encephalopathy where ammonia level gets too high (kills bacteria that makes ammonia)
Pre-op bowel surgery (drug sterilizes bowel)
2 Aminoglycosides given for bowel sterilization
Neomycin Kanamycin
“TAP” Levels
“TAP”—Trough, Administer, Peak
o Trough before drug administration
o Peak after drug administration
o Trough and Peak levels are drawn because of a drug’s narrow therapeutic window or
index
o Narrow therapeutic window or index means that there is a small difference in what works
and what kills
The Trough is always drawn
30min after
For the peak,
Peak SubL 5 to 10 minutes after drug is dissolved
o Peak IV 15 to 30 minutes after drug is finished (bag empty)
o Peak IM 30 to 60 minutes
o Peak SubQ Depends on insulin (See diabetes lecture)
o Peak for PO Not necessary, not tested
