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Psychiatric > Substance, MDD, Culture > Flashcards

Substance, MDD, Culture Flashcards

1
Q

What is Substance-Use Disorders?

A

Addiction
The need is so strong

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2
Q

What is Substance-Induced Disorders?

A

Intoxication
Withdrawal

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3
Q

Patient using substances
Tolerance

A

Need for increasing amount of the medication or substance is required to produce the desired effect
More, more, more and more!!

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4
Q

What will occur when you abruptly stop drinking

a) How long till symptoms occur?
b) Symptoms

A

Alcohol withdrawal
a) 4 to 12 hours
b) Abnormal cramping, vomiting, shakes, insomnia, and anxiety.

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5
Q

Interventions Alcohol withdrawal

a) Assess what is the prior to providing care?
b) What is the primary concern for AW?
c) Encourage attendance to what group?
d) For environment?

A

a) Nurse must self-assess their own feelings
b) Safety
c) 12 steps Self-help groups (AA)
d) Maintain a safe environment
low stimulation environment
Emotional support

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6
Q

Medications used in alcohol withdrawal.

A

Benzodiazepines!!
chlordiazepoxide
carbamazepine
Clonidine

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7
Q

What is Delirium tremens/ DTs?

A

The most severe form of ethanol withdrawal
Medical emergency!!!

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8
Q

The signs and symptoms of DTs
alcohol withdrawal delirium

Occurs typically ?

A

On the 2-3 days of withdrawal

Severe shaking
Confusion
Hallucinations
Heard voices

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9
Q

What is CAGE assessment instrument?

A

Substance Abuse Screening Tool

Cut down on your drinking?
Annoyed you by criticizing your drinking?
Guilty about your drinking?
Eye-opener

If the patient answers “yes” they get 1 point
if they answer “no” they get 0 points

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10
Q

CAGE assessment
a) Score of 0-1?
b) Score of 2-3?

A

a) low risk of drinking problem
b) high suspicion of alcoholism

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11
Q

What is the Wernicke’s encephalopathy?

Why it occur?

A

Lack of thiamine,brain damage
Caused by lack of vitamin B1
Treatment: thiamine replacement

Occurs d/t heavy alcohol consumption

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12
Q

Wernicke’s encephalopathy
Signs and symptoms

A

Ataxia (loss of muscle coordination)
Diplopia(double vision)
Somnolence(drowsiness, desire to fall sleep)
Stupor(-unconsciousness)

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13
Q

What is Korsakoff syndrome?

A

Memory disorder that results from lack of vitamin B1
Seen in clients recovering from Wernicke’s encephalopathy

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14
Q

Korsakoff syndrome
Signs and symptoms

A

Inability to form new memories
Loss of memory
Making up stories (confabulation)

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15
Q

What is withdrawal?

A

Physiological and mental readjustment of the discontinuation
Occurs abrupt, 4-12 hours

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16
Q

What is Alcoholic hallucinosis?

A

Auditory hallucinations occur either during or after heavy alcohol consumption

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17
Q

What is Blackout?

A

brief periods of amnesia(memory loss) that occur during or immediately following a period of drinking

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18
Q

Peripheral Neuropathy?

A

Nerve damage result in pain
D/t lack of vitamins B (thiamine)
Treated by: abstinence from alcohol

*Paralysis can occur if pt doesn’t stop drinking

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19
Q

Alcoholic myopathy?

A

Acute: sudden onset of muscle pain, swelling, weakness, elevated muscle enzymes
Chronic: gradual wasting and weakness in skeletal muscles – no pain or elevated muscle enzymes

D/t lack of vitamins B (thiamine)

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20
Q

Priority nursing diagnosis in alcohol withdrawal? 5

A

Risk for injury
Denial
Ineffective Coping
Dysfunctional family process
Imbalanced nutrition less than body requirement

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21
Q

Alcohol withdrawal
Denial

A

Commonly used
Conscious or unconscious attempt
“ I can quit whenever I want to”

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22
Q
  1. Which of the following has been implicated
    in the predisposition to substance abuse?
    A. Hereditary factor
    B. Fixation in the adolescent stage of
    psychosexual development
    C. Punitive ego
    D. Narcissistic and dependent personality traits
A

A
Especially evident with alcoholism
Children of alcoholics are 4 times more likely than other children to become alcoholic

hereditary 遺伝的な

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23
Q

A client is brought to the emergency department.
The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician’s orders is thiamine. Which is the rationale for this intervention?

A. To prevent nutritional deficits
B. To prevent pancreatitis
C. To prevent alcoholic hepatitis
D. To prevent Wernicke’s encephalopathy

A

D
Wernicke’s encephalopathy is the most
serious form of thiamine deficiency in clients
diagnosed with alcoholism.
If thiamine replacement therapy is not
undertaken quickly, death will ensue.

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24
Q

A client diagnosed with chronic alcoholism
and he wants to stop drinking. which medication would the nurse provide information?
A. Carbamazepine (Tegretol)
B. Clonidine (Catapres)
C. Disulfiram (Antabuse)
D. Folic acid (Folvite)

A

C

Disulfiram is used as a deterrent 抑止する to drinking.
Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort.

It is important that the patient understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.

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25
Q

A nurse is planning a staff education program on substance use in older adults.
Which of the following information should the nurse to include in the presentation?

a) Older adults require higher doses of a substance to achieve a desire effect
b) Older adults commonly use rationalization to cope with substance use disorder.
c) Older adults are at an increased risk for substance use following retirement.
d) Older adults develop substance use to mask manifestations of dementia.

A

C
Life style change stressors increase the risk for substance use

b
Daniel not rationalization 合理化

26
Q

A nurse is assessing a pt who has alcohol use disorder and is experiencing withdrawal.
Which one is expecting finding?

a) Bradycardia
b) Fine tremors of both hands
c) Hypotension
d) Vomiting
E) Restlessness

A

B, d, e

Restlessness 落ち着きのなさ
a Tachycardia
c hypertension

27
Q

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following findings should the nurse identify as primary?

a) Orient the client frequently to time, place,
and person.
b) Offer fluids and nourishing diet as tolerated.
c) Implement seizure precautions
d) Encourage participation in group therapy

A

c
The greatest risk to the client is injury.

a, b,c
This is not primary intervention

28
Q

A nurse is caring for a client who has alcohol use disorder.
The client no longer experiencing withdrawal.
Which meds administering to assist the client with maintain abstinence from alcohol?

a) Chlordiazepoxide
b) Bupropion
c) Disulfiram
d) Carbamazepine

A

C

a, d
acute alcohol withdrawal
b
nicotine withdrawal

29
Q

A nurse is providing teaching to the family of a client who has substance use disorder.
Which following statements by family indicate understand of teaching?

a) “ We need to understand that our sibling is responsible for their disorder”
b) “Eliminating codependent behavior will promote recovery”
c) “our sibling should participate in an AI-Anon group tp assist with recovery”
d) “The primary goal of treatment is abstinence from substance use”
e) “Our sibling needs to discuss personal feelings about substance use to help recovery”

A

b,d,e
b　互いに強く依存
c Client must acknowledge their feelings

a) they are not responsible for their disease but are responsible their recovery.
c) Al-Anon is a recovery group for the family, rather than for a client.

30
Q

Major Depressive Disorder
Symptoms

A

For at least 2 weeks
At least five of the following clinical

Suicidal thoughts
Interest decreased
Guilt
Energy decreased
Concentration decreased
Depressed mood
Difficulty sleeping or excessive sleeping

No history of manic behavior

31
Q

MDD
Acute phase

A

Sever clinical findings of depression
Treatment 6 to 12 weeks
They need hospitalized
Asses suicide risk
One-to-one observation as needed

32
Q

MDD
Maintenance phase

A

Remission of manifestation
This phase can last for years.
Prevention of future episode

Remission
治療の結果(時には無治療で)病気の勢いがゆるんだ(＝弱まった)状態を言う。

33
Q

MDD
Continuation phase

A

Increase to ability to function
Treatment 4-9 months
relapse prevention through education, medication, therapy and goal treatment

34
Q

Major depressive disorder characterized by?

A

depressed mood

35
Q

An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent’s belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately?

A. Post trauma syndrome related to parent’s death
B. Anxiety (severe) related to parent’s death
C. Coping, ineffective related to parent’s death
D. Grieving, complicated related to parent’s death

A

D 悲しむ
This symptoms are indicative of dysfunctional or complicated grieving

36
Q

When teaching about the tricyclic group of
antidepressant medications, which information should the nurse include?
A. Strong or aged cheese should not be eaten while
taking this group of medications.
B. The full therapeutic potential of tricyclics may not be reached for 4 weeks.
C. Long-term use may result in physical dependence.
D. Tricyclics should not be given with anti-anxiety agents.

A

B

37
Q

A patient has been diagnosed with major
depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching?

A. Do not eat chocolate while taking this medication.
B. The medication may cause priapism.
C. The medication should not be discontinued
abruptly.
D. The medication may cause hotosensitivity

A

B
Antidepressants, such as paroxetine, must be
tapered and not stopped abruptly

持続勃起症

38
Q

Symptoms of alcohol withdrawal

A

abdominal cramps
vomiting
tremor of hands
increase BP

39
Q

What medication most likely to take for alcohol withdraw?

A

Benzodiazepines!!
chlordiazepoxide
oxazepam
lorazepam
diazepam

40
Q

Alcohol use pattern phase 1 and 2?

A

Phase 1
Relieve everyday stress
Enjoying drinking

Phase 2
Begin with blackouts
No longer a source of pleasure
Secreting drinking

41
Q

Alcohol use pattern phase 3??

A

Lost control
Extremally ill
Loos of consciousness

lose a job, marriage, family and friends

42
Q

Alcohol use pattern phase 4??

A

Emotional and physical disintegration 崩壊
Hallucinations, tremors, panic
For long time heavy drinkers, abrupt withdrawal of alcohol can be fetal

43
Q

Priority interventions with caring for an American Indian elder

A

-Touch is not highly regarded
a handshake may be viewed as aggressive
- Some Native Americans will not touch a dead person
- Avoid eye contact
it is considered rude in their culture
- Alcohol use disorder is most common psychiatric diagnosis

Others high risks for illness include DM, TB, CVD, homicide, suicide, pneumonia, flu

44
Q

Negative aspects of cultural assumptions

A

Not to assume that all individuals who share a culture or ethnic group are identical
=Stereotype
Every individual must be appreciated for his or her uniqueness

45
Q

A patient with a bipolar disorder diagnosis is
having religious delusions. How might the
delusions impact the spiritual assessment?

A. Delusional patients cannot participate in
assessments.
B. Religious delusions will have no impact on the spiritual assessment.
C. Assessment findings cannot be relied upon.
D. It may be difficult to differentiate from general religious beliefs.

A

D
Approximately 15 percent of people with
bipolar disorder have religious delusions.

Sometimes these delusions can be difficult to
differentiate from general religious or cultural
beliefs.

46
Q

Which of the following statements indicate
that love may be an important component
of the healing process?

A. Love increases the production of cortisol
B. Love increases the inflammatory response
C. Love increases the production of dopamine.
D. Love increases the fight-or-flight response

A

C
Love increases the production of
norepinephrine and dopamine and may stave
off depression.

47
Q

To assess for biological variations of a
patient, which question should the nurse
ask?
A. “What do you do to keep well?”
B. “Who purchases the food in your
household?”
C. “How do you deal with pain?”
D. “What time do you usually eat your meals?”

A

B
Nutritional preferences and deficiencies are a
biological variation.
Asking ”who purchases the food in your household?” is an assessment
strategy used to determine biological variations.

生物学的変化

48
Q

“The blues” are a)_________responses to
everyday disappointments in life.

A

a) normal, healthy

If these occur then problem
Adaptation is ineffective
Symptoms impair functioning

49
Q

A client is widow of 6 months, she told her sister “doesn’t have anything more to live for” she has been hospitalized MDD.
What is the priority diagnosis?

a) Imbalanced nutrition
b) Complicated grieving
c) Risk for suicide
d) Social isolation

A

c

50
Q

The goal of cognitive behavior therapy with depressed clients is to

a) Identify and change dysfunctional patterns of thinking
b) Resolve the symptoms and initiate or restore adaptive family functioning
c) Alter the neurotransmitters that are creating the depressed mood
d) Provide feedback from peers who are having similar experience

A

a

51
Q

A client has just been admitted to the psych unit with MDD.
Which behavioral manifestation might the nurse expect?

a) Slumped posture
b) Hallucinations
c) Feeling of despair
d) Appears to have boundless energy
e) Anorexia

A

a,c,e

Slumped posture　しゃがんだ姿勢
despair　絶望
Anorexia　拒食症
Either anorexia or bulimia nervosa

boundless energy 無限のエネルギー

52
Q

A client with depression ask the nurse why would you be checking my thyroid function?

a) An underactive thyroid gland can manifest as depression
b) Depression has been proven to be hormonal illness
c) Thyroid hormone replacement is a first line treatment

A

a

An underactive thyroid gland is where your thyroid gland does not produce enough hormones

53
Q

An acutely depressed client isolates her self in her room. What a nurse should say?

a) Do you like exercise?
b) Come with me, I will go with you to group therapy
c) Would you like to got group therapy, stay in bed. or come out to the day lounge?
d) Why do you stay in your room al the time?

A

b

54
Q

A client whose husband died 6 month ago is given MDD.
She said “ I start feeling angry that he died and left me all alone. he should stopped smoking years ago! But then I start feeling guilty for feeling that”
What is the appropriate response?

a) Yes, he should stopped smoking.
b) I can understand how you must feel
c) Those feelings are a normal part of the grief response
d) Just think about the good time tha you had with him

A

c

55
Q

Substance addiction
relationship and sociality?

A

difficulty with interpersonal relationship
Socially isolation

56
Q

Substance use disorder
a)What % is a legal intoxication?
b) What % is acute toxicity?

A

a) 0.08% (80g/dL)
b) 0.4%(400d/dL)

57
Q

Medication
Opioid overdose

A

Narcan
Naltrexone
Nalemfene

58
Q

Substance used disorder
Individual therapy

A

Cognitive behavior therapy
-relaxation or cognitive reframing
-can be used decrease anxiety and change behavior

59
Q

Substance used disorder
group therapy

A

A group who has similar diagnosis can meet in an outpatient setting or residential facilities

60
Q

Substance used disorder
Family therapy

A

Family sometimes can act enabler
Families learn about change that behavior
Codependency 共依存
Enabler 助けてあげるつもりでやったことがかえって相手のためにならないようなことをする人

61
Q

What bupropion used for?

A

Nicotine withdrawl

Psychiatric (21 decks)

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