stress part 2 Flashcards
anxiolytics action
reduce anxiety by reducing over activity in CNS
binds to GABA receptors
anxiolytics indication
ethanol withdrawal, insomnia, muscle spasms, seizure disorders, anesthesia, depression, anxiety
anxiolytics contraindications
known drug allergy, narrow-angle glaucoma, pregnancy
anxiolytics side effects
CNS depression hypotension drowsiness dizziness lethargy headache ataxia slurred speech depression bradycardia hypotension constipation diarrhea nausea vomiting
anxiolytics prototype class
Benzodiazepines
anxiolytics prototype drug
Lorazepam
anxiolytics overdose
not usually severe
experience excessive sedation, hypotension, seizures
no specific antidote, Flumazenil may be used
Lorazepam (ativan) route onset peak half life duration
intermediate acting benzodiazepine oral or injectable PO/SL/IV 30-60 min 2 hours 11-16 hours 8 hours
nursing considerations for anxiolytics
carefully monitor clients condition
assess need for medication
asses for anxiety symptoms
educate on overdose symptoms
non-pharmacological therapy
psychotherapy family, social, spiritual support systems physical exercise well balanced diet relaxation exercises
coping responses
cognitive assessment
primary appraisal
secondary appraisal
engagement
primary appraisal
initial assessment of stressor to determine if stressor is a threat
secondary appraisal
evaluation of resources to:
overcome stressor
eliminate stressor
reduce stressor
coping strategies
problem focused
emotion focused
meaning focused
problem focused
evaluating the situation
taking action to manage or change the situation
focus on eliminating or reducing the stressor
emotion focused
regulating the emotional response to the stressor
controlling response, not addressing specific stressor
meaning focused
draws on values, beliefs, goals
modify the interpretation and response to the stressor
maladaptive coping
inability to accurately assess stressor
denial/avoidance
actual/perceived lack of control/support
no/poor experience in managing stressful situations
elements of assessment
Goal: determine individuals appraising stage and coping strategies
history
exam
use of instruments
history
perception of threat
past coping patterns
medical history
social history
examination
observation of behaviour
mental health assessment
use of instruments
enhance objectivity to assessment
provide ability to monitor over time
multiple available, some for specific populations or situations
collaborative care
education
developing an action plan
accessing resources
cognitive restructuring
addiction
overwhelming compulsion that drives someone to take drugs despite health consequences
variables to addiction
agent or drug factors (cost, availability, onset, length of use) user factors (genetic factors, prior experience with drugs, high risk behaviours) environmental influence (social norms, role models, peer influences)
physiologic process of addiction
neurochemical interactions within reward centers of brain
addictive substances link to this reward center
neurotransmitters involved in reward center
dopamine Y-aminobutyric acid (GABA) glutamate acetylcholine norepinephrine serotonin
consequences of addiction
habituation adaptation tolerence withdrawal consequences dependent on individual and type of addiction
physical dependence
nervous system adapts tp repeated substance use
when drug is stopped very uncomfortable symptoms may arise (withdrawal)
body responds as though it is normal for the substance to be continually present
psychological dependence
no signs of physical discomfort when drug is discontinued
overwhelming desire to continue use despite the consequences
cravings may continue months to years
withdrawal syndrome
prescription drugs can be used to decrease symptoms of withdrawal
severe for clients using alcohol or sedatives
best accomplished at treatment facility
tolerance
body adapts to substance after repeated use
higher doses are required to get the same effect
manifestations of withdrawal
appears older than actual age undernourished standard dose of sedatives do not have therapeutic effect fatigue insomnia headaches anorexia reported sexual dysfunction reported changes in mood reported weight loss vague physical complaints
primary prevention
NIDA recommends identification of drug problems in communities and then building resources
successful models promote healthy families and healthy communities
promotion of individual positive coping strategies
screening
NIAAA quantity and frequency questions
CAGE questionnaire
many other questionnaires and screening tools
emergency management
prevent life threatening complications
treatment is substance and complication specific
recovery
goal is to help patient to get the help needed to achieve and maintain sobriety
collaborative care is used to facilitate
