Substance Abuse & Eating Disorders

Question 1

give 6 s/s of withdrawal from opoids narcotics.

Answer 1

1) disphoresis/ fever
2) dysphoric mood
3) rhinorhea
4) abdominal cramps
5) dilated pupils
6) muscle joint pain
7) N/V
8) flu like aches

Question 2

Define dual diagnosis

Answer 2

those w/ mental illness and substance abuse. mentally ill are at a higher risk fro substance abuse

Question 3

What is the immediate medical treatment for an alcoholic?

Answer 3

-monitor VS -seizure precautions (mag sulfate or dilantin) -fluid status assessment/ I & O’s - do NOT restrain - point out reality -thiamine and multi vits (banana bags)

Question 4

Name at least 4 w/drawl s/s of amphetamines.

Answer 4

1_ depression 2) fatigue 3) restless 4) disturbed sleep/ dreams 5) psychomotor agitation 6) crashing

Question 5

What 4 things influence relapse?

Answer 5

1) hunger 2) anger 3) loneliness 4) tiredness 5) NO NEW FRIENDS

Question 6

What do you assess for in substance abusers?

Answer 6

-CAGE: cut down, annoyed, guilty, eye opener -subjective data: open ended questions -objective data: appearance, VS, neuro checks, toxicology screen

Question 7

Name at least 6 nursing interventions for aneroxics

Answer 7

1. rule out medical problems first
2. monitor vs & electrolytes
3. set time limit for eating
4. monitor for disposal of food
5. monitor for vommiting
6. assess for water loading prior to weights
7. prevent exercise
8. contracts
9. antidepressant tx

Question 8

physical assessments for the anorexics

Answer 8

• perfectionist w/ low self esteem
• disregards traditional feminity
• disinterest in sex
• irregular heart beat
• skeletal appearance hidden by baggy clothes
• dramatically low cholesterol
• anxiety
• abnormal levels of growth hormone
• decreased gonadotropin

Question 9

P/t comes in complaining of fatigue, anxiety, insomnia and agitation. What is he withdrawing from?

Answer 9

cocaine

Question 10

What does a codependent person do?

Answer 10

-try to control person’s behavior -dependent on ppl -rescues/ blames addict -ppl pleasers -helpless on inside, competent on outside -focus on others

Question 11

What are the hallmark signs of dependence/ loss of control?

Answer 11

-physical dependence -physiological dependence -increased tolerance -withdrawal -unsuccessful attempts to cut down -lots of time spent in obtaining substance -cont use despite problems in home, work or social life -important activities given up b/c of substance

Question 12

Difference between cross tolerance and cross dependence?

Answer 12

-cross tolerance refers to a person that has become tolerant to effects of chemically similar drugs. - cross dependence is when one drug can prevent w/drawl symptoms of another drug

Question 13

What are the 3 most common defense mechanisms for an addict?

Answer 13

denial rationalization projection

Question 14

name at least 8 nursing interventions regarding eating disorders

Answer 14

1. adequate intake w/ avoidance of binge behaviors
2. monitor electrolytes
3. conract agreements
4. avoid discussions of foor or weight
5. encourage expression of anger
6. prodie structure around mealtimes
7. use positve reinforcement
8. avoid use of wellbutrin

Question 15

Where in the brain are addictive behaviors reinforced?

Answer 15

-dopamine pathways in the CNS

Question 16

Intoxication s/s of sedatives, anxiolytics, hypnotics.

Answer 16

1) sexually innapropiate 2) aggresive 3) labile 4) impaired judgement 5) slurred speech 6) nystagmus 7) impaired attention

Question 17

State the minor effects of alcohol withdrawal and when do they 1st appear?

Answer 17

-4 to 12 hours after prolonged use (few days or more) -anxiety -agitation -irritability -N/V -malaise -insomnia

Question 18

interventions for binge eaters

Answer 18

1. food journal w/ emotions
2. develop an eating plan
3. weight goals
4. exercise program
5. discuss plateaus
6. interdisciplinary approah
7. family education
8. medications. ssri’s antidepressants

Question 19

W/drawl s/s of barbiturates.

Answer 19

1) decreased respirations 2) seizures 3) coma 4) insomnia 5) tachycardia 6) N/V 7) orthostatic drops 8)muscle contractions

Question 20

s/s of inhalant intoxication

Answer 20

1) dizziness
2) nystagmus
3) incoordination
4) slurred speech
5) unsteady gait
6) lethargy
7) depressed reflexes

Question 21

intoxication efffects of cocaine

Answer 21

1) agitation/ paranoia
2) arrythmias
3) perspiration/chills
4) N/V
5) dilated pupils
6) hypretension
7) tachycardia
8) talktativeness
9) grandiosity

Question 22

What 3 meds are used to prevent relapse?

Answer 22

1) natrexone (revia) 2) acamprostate (campral) 3) disulfram (antabuse)

Question 23

W/drawl s/s of sedatives, anxiolytics, hypnotics.

Answer 23

1_ hand tremor 2) n/v 3) autonomic hyperactivity- diaphoresis, high pulses 4) insomnia 5) grand mal seizures 6)psychomotor agitation

Question 24

Name 4 biopsychosocial theories that can explain addictive personalities.

Answer 24

1) biochemical 2)genetic vulnerability 3) personality defects 4) conditioning 5) disease model of alcoholism

Question 25

Difference between abuse and dependence?

Answer 25

occasional harmful use vs. a compulsive/ chronic requirement. need is so strong physical and psychological distress can occur

Question 26

What nursing considerations are there for pt's w/ dual diagnosis?

Answer 26

pt's socialization skills, relapse prevention, suicide precaution

Question 27

What things should you look for when assesing a bulimic?

Answer 27

* hoarse, sore throat * dental enamel erosion * diaarhea, constipation, bloating * enlarged parotid glands * calluses on kunckles * amenorrhea * K+ imbalance * poor skin tugor * concentrated urine * hypotension and weakness

Question 28

Name at least 6 intoxication s/s of barbiturates.

Answer 28

1) euphoric 2) fever 3) lability 4) talkative 5) impaired attention & memory 6) slurred speech 7) irritability 8) long sleep times

Question 29

Pt is a 16 year old who appears to be euphoric. She is also restless and is trembling. Upon further physcial assessment you notice increased respirations, dilated pupils, elevated BP and an arthymia. Her mother says she has not been eating and that she has lost weight recently. What drugs are responsible?

Answer 29

amphetamines

Question 30

Name at least 6 s/s of opoid narcotic intoxication

Answer 30

1) clammy skin 2) slurred speech 3) drowsy 4) euphoric 5) pin point pupils 6) respiratory & ciculatory depression

Question 31

What pt teaching should you provide regarding Buspar?

Answer 31

-takes a long time to work 2-4 weeks -interacts w/ serotonin and dopamine -must taper dosage -no drinking alcohol -eat before ingesting -may cause drowsiness or dizziness -inform any doctors of Buspar therapy

Question 32

Name 3 drugs that produce similar effects. hint: cross tolerance

Answer 32

-alcohol -benzodiazepines -barbiturates

Question 33

s/s of inhalant w/drawl

Answer 33

1) psychomotor retardation 2) tremor 3) generalized muscle weakness 4) blurred vision/ diplopia 5) euphoria

Question 34

What are the phases of alcoholism according to the disease model of alcoholism?

Answer 34

1)pre alcoholic: drinks to relieve everyday stress, tolerance develops. 2) early alcoholic: starts blacking out, starts sneaking drinks, becomes defensive 3) crucial phase: individual has lost control. loss in home, work or social life is evident 4) chronic phase: individual is intoxicated more than they are sober. emotional and physical disintegration

Question 35

As a nurse what should you do when an addict is a coworker?

Answer 35

-be self aware -report to supervisor

Question 36

Difference between Wernicke's encephalopathy and Korsakoff's psychosis.

Answer 36

-wernicke: serious form of thiamine deficiency. can result in death -korsakoff: accompanies wernicke's. s/s include confusion, loss of recent memory

Question 37

State the major w/drawl effects of ETOH and when do they 1st appear?

Answer 37

-2 to 3 days after stopping/ reducing prolonged use - hypertension -tachycardia -diaphoresis -tremor -hallucinations - seizures -alcoholol w/drawl delirium