Exam #2 Flashcards
(236 cards)
1
Q
what is addiction?
A
a compulsive/abnormal behavior that relates to substances or behaviors
2
Q
what is intoxication?
A
a state of disturbed cognition, perception, behavior, LOC, and judgment
3
Q
what is withdrawal?
A
physiological and mental readjustment from stopping the use of an addictive substance
4
Q
why is alcohol use accepted?
A
because it is legal, used in ceremonies, and religions
5
Q
what is the blood alcohol level that can cause intoxication in a human?
A
80-100 mg/dL
6
Q
what is the blood alcohol level that can cause death in humans?
A
400-700 mg/dL
7
Q
what drugs are CNS depressants?
A
alcohol, sedatives, hypnotics, anxiolytics, cannabis,
8
Q
what are sedatives used for?
A
anxiety, panic, seizures, and sleep disorders
9
Q
what are hypnotics used for?
A
xxx
10
Q
what are anxiolytics used for?
A
xxx
11
Q
what are some signs of alcohol/sedative/hypnotic/anxiolytic intoxication?
A
disinhibition of sexual or aggressive behaviors
mood lability
impaired judgment and memory
impaired social/occupational function
decreased LOC
Slurred speech
Incoordination
Unseady
Nystagmus
Flushed face
12
Q
what is nystagmus?
A
uncontrolled eye movements…can be up, down, left, right, etc
13
Q
what are some chronic effects of alcohol abuse?
A
peripheral neuropathy, alcoholic myopathy, Wernicke encephalopathy, korsakoffs psychosis, alcoholic cardiomyopathy, esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis of liver, leukopenia, thrombocytopenia, sexual dysfunction
14
Q
what is peripheral neuropathy in relation to alcohol abuse?
A
nerve damage in the extremities
15
Q
what does peripheral neuropathy feel like?
A
pain, burning, and tingling, in the extremities
16
Q
what causes peripheral neuropathy?
A
having low amounts of the B vitamin Thiamine
17
Q
why do alcoholics experience peripheral neuropathy?
A
because they have poor nutrition and malabsorption of food from alcohol
18
Q
can peripheral neuropathy be reversed?
A
yes but can be permanent for some
19
Q
how is peripheral neuropathy reversed?
A
by abstinence from alcohol and improvement in diet
20
Q
what is alcoholic myopathy?
A
a condition that causes loss of function and strength in your skeletal muscles in response to long-term or heavy drinking
21
Q
what are the symptoms in acute alcoholic myopathy?
A
sudden onset muscle pain, swelling and myoglobinuria
22
Q
what is myoglobinuria?
A
occurs when myoglobin are present in the urine
23
Q
why would myoglobin be present in urine?
A
it occurs in patients who have alcoholic myopathy due to their muscles breaking down….the body excretes the product of the breakdown in the urine
24
Q
what are the symptoms of chronic alcoholic myopathy
A
gradual wasting and weakness of muscle tissue
25
is acute alcoholic myopathy reversible?
yes
26
is chronic alcoholic myopathy reversible?
no
27
what causes alcoholic myopathy?
having low amounts of the B vitamin thiamine
28
what color is myoglobinuria?
red tinged
29
what changes must be made to improve patients with alcoholic myopathy?
abstinence from alcohol and diet
30
what labs are elevated in patients with alcoholic myopathy?
aspartate aminotransferase (AST)
Alanine transaminase
(ALT)
31
what is Wernickes encephalopathy
the most serious form of thiamine deficiency that can cause death
32
what are the symptoms of Wernickes encephalopathy
death, paralysis of ocular muscles, diploplia, ataxia, somnolence, and stupor
33
what are the ocular muscles?
muscles that control your eyes
34
what is diplopia?
double vision
35
what is ataxia?
poor muscle control that causes clumsy movements
36
what is somnolence?
sleepy
37
what is a stupor?
state of unconsciousness that can be awakened with extreme stimulation
38
can wernickes be reversed?
yes
39
what is Korsakoff's psychosis?
occurs when alcohol is abused the symptoms are confusion, recent memory loss, and confabulation
40
what other diseases is Korsakoff psychosis paired with?
Wernicke
41
is korsakoffs psychosis psychosis reversable?
no
42
what is alcoholic cardiomyopathy?
accumulation of lipids on the myocardial tissue causing the heart to be bigger and have weaker contraction
43
can alcoholic cardiomyopathy be fixed?
no
44
what does alcoholic cardiomyopathy mimic?
HF and arrhythmias
45
what are the symptoms of alcoholic cardiomyopathy?
decreased ability to exert, tachy, dyspnea, edema, palpitations, and nonproductive cough
46
what labs will be elevated in alcoholic cardiomyopathy?
AST and ALT
47
what are treatments for alcoholic cardiomyopathy?
abstinence from alcohol, rest, oxygen, digitization, sodium restrictions, diuretics
48
what is esophagitis?
inflammation of the esophagus
49
what is pancreatitis?
50
what is the alcohol hepatitis?
inflammation of the liver that causes it to be enlarged and tender
51
what is cirrhosis of the liver?
when fibrous scar tissue forms on the liver decreasing filtration and absorption
52
what are the symptoms of alcoholic hepatitis?
N/v, anorexia, weight loss, abd pain, jaundice, edema, anemia, blood coagulation problems
53
why does alcoholic hepatitis cause anemia and blood coag problems?
xx
54
what can be done to treat alcoholic hepatitis?
abstinence from alcohol, diet
55
what is leukopenia
the production, function, and wbc impaired
56
what does leukopenia put you at risk for?
infection
57
what is thrombocytopenia?
decrease in platelet production
58
what is sexual dysfunction in relation to alcoholism
women have decreased menstural cycles and libido
men have decreased test, gyno, and impaired fertility
59
how do we assess alcoholism?
CAGE questions
60
what does the C in CAGE mean
have you tried to CUT down
61
what does the A in CAGE mean?
have people ANNOYED by criticizing you?
62
what does the G mean in CAGE?
have you felt bad or GUILTY
63
what does the E in CAGE mean?
have you had an eye opener drink
64
in the CAGE question what constitutes someone might have be an alcoholic?
2 or more positive responses
65
when does alcohol withdrawal occur?
from 4-12 hours from last drink
66
what are the symptoms of alcohol withdrawal?
tremmors in hand, toungue, eye
N/v
Sweating
Malaise/weak
Elevated BP/HR
Anxiety
Irritability
Hallucinations
Delirium
Headache
Insomnia
Depression
seizures
Death
67
what precautions should you keep in mind with alcoholics going through withdrawal?
seizure
68
what should you have ready for a patient under seizure precautions?
suction, nonrebreather, benzo, padded rails, vital machine
69
what should you do if a seizure occurs?
check the time, roll the patient over, apply nonrebreather, use suction, administer lorazepam
70
what lab is being monitored for alcoholic in withdrawal?
BMP for fluid, electrolytes, and blood sugar
71
why should blood sugar be monitored in alcoholics?
alcohol damages the pancreas which releases insulin and also damages the liver which releases glucose into the blood stream
72
why are alcoholics at risk for seizures?
because alcohol is a CNS depressant and when the patient stops drinking their CNS activity goes much higher than what it is used to causing increased risk of seizures
73
what med groups are used as substitution therapy for alcoholism?
benzodiazepines and anticonvulsants
74
why are benzo and anticon used to treat alcoholism?
because it lowers the CNS activity to match where it was when they were drinking
75
what does the dosage timeline for substitution therapies look like?
start of with a higher dose and slowly taper away
76
what benzodiazepines are long acting?
chlodixepoxide and diazepam
77
what benzo is short acting?
lorazepam
78
what benzo should be given to those with chronic liver diseases?
the quick-acting one lorazepam
79
what are the anticonvulsants?
carbamazepine, valporic acid, lamotrigine, topiramate
80
what are the two types of deterrent therapies for alcoholism?
Disulfiram and naltrexone
81
how does Disulfiram work?
it causes the person taking the medication to become ill when ingesting alcohol
82
how long must a patient be abstinent from alcohol before taking Disulfiram?
minimum 12 hours
83
what is required from the patient before taking Disulfiram?
consent
84
what is the worst side effect of Disulfiram?
death
85
how long does it take for symptoms of Disulfiram to start if someone drinks?
5-10 minutes
86
what must the patient avoid when taking Disulfiram
alcohol, vanilla, mouth wash, nyquil, sanitizer
87
what are side effects the patient can anticipate if they drink while taking dilfucking fuck?
n/v, flushed skin, dizzy, sweating, tachycardia, resp depression, MI, death
88
how does naltrexone work for alcoholics?
blocks pleasure receptors in the brain
89
what can naltrexone be used to treat?
alcohol and opioid abuse
90
what therapies can alcoholics use?
AA, counseling, group therapy
91
what effects do sedatives/hypnotics/ anxiolytics have on the body?
changes in sleep/dreaming, hypotension, compromised contraction, reduced urine output, lower metabolism, reduced body temp, sexual function
92
when does withdrawal begin in short acting drugs?
begins in 12 to 24 hours
93
when does withdrawal peak in short acting drugs?
24 TO 72 HOURS
94
when does withdrawal subside in short acting drugs?
5-10 days
95
when does withdrawal begin in long acting drugs?
2 to 7 days
96
when does withdrawal peak in long acting drugs?
5-8 days
97
when does withdrawal subside in long acting drugs?
10-16 days
98
what are the two drugs that contain cannabinoids?
cannabis and synthetic k2
99
what are the signs of intoxication in someone under the influence of cannabis?
euphoria, anxiety, paranoid, slowed time, impaired judgment, social withdrawal, tachy, red eyes, increased appetite, dry mouth, hallucinations, delusions
100
what are the effects on cannabis on the body/
tachycardia, orthostatic hypotension, laryngitis, bronchitis, cough, hoarse, decreased sperm count, amotivational syndrome`
101
what are signs of cannabis withdrawal?
irritability, anger, insomnia, disturbing dreams, depressed mood, abd pain, tremors, sweating, fever, chills, headache
102
what are the drugs containing opioids?
opium, heroin, mepridine, fentanyl
103
what are the symptoms of opioid intoxication?
euphoria, lethargy, somnolence, dysphoria, impaired judgment, pupillary constriction, drowsiness, slurred speech, constipation, N/V, decreased RR and BP
104
when do withdrawal symptoms start for opioids?
6-8 hours
105
when do withdrawal symptoms peak for opioids?
2-3 days
106
when do withdrawal symptoms subside for opioids?
5-10 days
107
what are the symptoms that someone is going through opioid withdrawal?
N/V, craving, muscle cramps, pupillary dialation, Lacrimation, rhinorrhea, sweating, yawning, fever, insomnia,
108
what is Lacrimation
leaking eyes
109
what is used for opioid overdose?
naloxone
110
what should you assess for before giving naloxone?
respiratory effort, bradycardia, unresponsiveness
111
if the patient does not wake up after giving naloxone when can you give them another dose?
after 2-3 minutes change the nostril and give another dose
112
what meds are used for opioid substitution therapy?
buprenorphine and methadone.....clonidine is used after
113
what is used to determine if patients are going through alcohol withdrawal
CIWA
114
what are the cns stimulants?
cocaine, amphetamines, hallucinogens, and inhalants
115
what are the symptoms of intoxication for inhalants/cocaine/amphetamine?
fighting, grandiosity, hypervigilance, psychomotor agitation, impaired judgment, tachycardia, pupilary dialtion, elevated BP, perspiration, chills, n/v, hallucinations, delirium
116
what are symptoms of cocaine/amphetamine withdrawal?
anxiety, depression, irritability, crave, fatigue, insomnia, hypersomnia, psychomotor agitation, paranoid, social withdrawal, SI
117
what happens to the body with chronic cocaine use?
pulmonary hemorrhage, bronchiolitis, pneumonia, nasal rhinitis, placenta abruption, CVA
118
what are the symptoms of hallucinogen intox?
agitation, hyperacitivty, violence, hallucinations, psychosis, convulsion, possible death`
119
what are the two kinds of reaction to hallucinogens?
panic and flashback
120
what happens during a panic reaction?
bad trip where you have anxiety, fear, paranoid, and psychosis
121
what happens during flashback reaction?
spontaneous time where you have an intoxication effect
122
what does the patient feel during a flashback reaction?
anxiety, depression, fear of losing mind, paranoid, impaired judgment
123
what do you do when the patient is on hallucinogens or has a flashback?
reorient back to reality, and safety, and stay with them
124
what does the use of inhalants do to your body?
cns and pns damage, dyspnea, pneumonia, n/v, cyanosis
125
what are the goals for all addict patients?
safe detox, assume responsibility, connection of behaviors and consequences, self-esteem improvement, and abstinence
126
what is mood?
how a person feels
127
what is affect?
how the person is displaying on the outside
128
what is bipolar disorder?
mood disorder manifested by cycles of mania and depression and times of normalcy
129
what is mania?
alteration in mood that maybe expressed by feelings of elation, grandiosity, inflated self esteem, hyperactivity, agitation, racing thoughts,
130
what is the average age of onset for mania?
25
131
what happens to the neurotransmitters during a manic episode?
norepinephrine and dopamine are high and serotonin is low
132
what drugs can cause mania?
amphetamines, antidepressants, anticonvulsants, and narcotics, steroids
133
what is bipolar 1?
when a patient has mania with periods of depresion
134
how many dig fast symptoms must a patient have to be bipolar 1?
3 or more
135
what does DIG FAST stand for?
Distractability, Indescretion, Grandiosity, Flight of ideas, Activity increase, sleep deficit, and talkativeness
136
what is bipolar 2?
bouts of major depression with episodes of hypomania
137
can bipolar 2 patients experience a manic episode?
no only hypomanic
138
what is the difference between hypomanic and manic symptoms?
hypomanic symptoms are not severe enough to mark impairment with social or occupational setting
139
what is cyclothymia?
numerous episodes of elevation of mood and depression
140
what is the longest someone with cyclothymia can go without symptoms?
2 months
141
how long must someone with cyclothymia have symptoms before being diagnosed?
2 or more years
142
what should be included in manic patient care?
monitoring risk for injury, monitoring risk for violence, ensuring good nutrition, monitoring for disturbed thought process, monitoring for disturbed sensory perception, impaired social interaction, and insomnia
143
what are nursing interventions for manic patients?
reduce stimuli, remove harmful objects, stay with client, provide a structured schedule, provide physical activities, provide high protein finger foods, set limits, show force
144
what foods are good for manic patients?
high-calorie and protein-rich finger foods`
145
when is ECT used for bipolar patients?
for type 1 acute mania and type 2 for depression
146
what is the mood stabilizer you need to know for mania?
lithium
147
what antipsychotics are used for mania??
zxx
148
what neurotransmitters are affected by lithium?
norepinephrine, serotonin, dopamine, glutamine, GABA
149
what are the therapeutic levels of lithium for acute mania?
1-1.5
150
what are the therapeutic levels of lithium for maintenance?
0.6-1.2
151
what symptoms do patients with lithium toxicity have?
N/V, diarrhea, ataxia, blurred vision, tinnitus, tremors, mental confusion
152
what education do you give a patient taking lithium?
Take regularly, dont drive, eat normal amounts of sodium, eat healthy foods, 6-8 glasses of water per day, avoid excess caffeine, carry med card, watch for weight gain, use contraception, keep appointments for serum levels
153
what happens to sodium if lithium levels are too high in your body?
blocks the absorption of sodium which cause hyponatremia
154
what meds are the anticonvulsants?
valporic acid, carbamaepine, lamotrigine
155
what education do you give for anticonvulsants?
rash, bleeding, sore throat, dark urine, dark eyes, no alcohol, carry card
156
what antipsychotics treat mania?
olanzapine, risperidone, chlorpormazine, aripiprazole, ziprasidone
157
what is anorexia nervosa?
suppressing appetite that you have
158
what are the diagnostic criteria for anorexia nervosa?
restriction of calories that cause loss in body weight, intense fear of gaining weight, disturbed body image, BMI less than 20
159
what is a normal BMI?
20-24.9
160
what are the symptoms of anorexia?
hypothermia, lanugo, bradycardia, hypotension, decreased bone density, amenorrhea, hypoglycemia, weak, poor memory
161
what labs will be seen in anorexic patients?
hypoglycemia, anemia, leukopenia, abnormal hormone
162
what medication helps with anorexia?
fluoxetine
163
what are the nursing interventions for anorexia?
eating plan, daily weight, I/O, NG tube, coping skill, monitoring for refeeding syndrome
164
what is a refeeding syndrome?
occurs when patient who is malnourished rapidly ingests food can cause death
165
what should be put on patients when they might experience refeeding syndrome?
telemetry
166
what are some goals for anorexic patients?`
2-3lbs per week, meeting cal goal, verbalize that behaviors are maladaptive, acknowledge that body fat was a misperception
167
what are the two types of anorexia?
restrictive and eating/purging
168
what is bulimia nervosa?
eating large amounts of food followed by purging or extreme exercise
169
how many times must a person participate in overeating and purging before its considered bulimia nervosa?
1x a week for 3 months
170
are bulimia nervose patients typically emaciated, normal weight or overweight?
normal
171
what are the symptoms of bulimia nervosa?
Russell sign, enlarged parotoid gland, dental carries, enamel erosion, tears in gi tract, electrolyte imbalance, anxiety, mood disorder, substance abuse
172
what labs are affected by bulimia nervosa?
low mag, k, na,
173
what do you do if patients k comes back low?
tele
174
what are the medication treatments for bulimia nervosa?
fluoxetine and topiramate
175
what are nursing interventions for bulimia nervosa?
1 to 1 from 1-2 hours post meal, daily weight, I/O, eating plan, coping skill
176
what are the goals when treating a patient with bulimia nervosa?
No signs of dehydration or electrolyte imbalance
No stash of food
Meet calorie goals
Verbalize previous behavior is maladaptive and life-threatening
Verbalises positive self-attributes
Acknowledges fat was a wrong perception
177
what is a binge eating disorder?
uncontrolled rapid ingestion of food in a short period
178
how many times must a person binge for the disorder?
1x a week for 3 months
179
what are symptoms of binge eating disorder?
weight gain, cramps, constipation, reflux, high choleserol
180
what are binge-eating patients at risk for?
diabetes type 2, hypertension, cancer, depression
181
what meds for binge eating?
topiramate and lisdexamfetamine
182
what nursing intervention for binge eating?
food diary, eating plan, progressive exercise, support group
183
what are the goals for binge eating patients?
food diary, losing 1-2lbs per week, healthy eating, exercise, plan for future weight control, know positive attributes of self, and support groups
184
what is the Maudsley approach?
family-oriented therapy for anorexia...weight gain is monitored by someone other than patient...once progress is made then the patient takes over....done outpatietn
185
what biochemicals are effected in depression patients?
decrease in norepinepherine, serotonin, dopamine
185
what gland can cause depression?
problems in the pituitary
186
what is the learning theory say about depression?
that it is learned helplessness....the person after numerous failures give up on trying to be successful
187
what does the object loss theory say about depression?
being abandoned during the first 6 months of life causes problems that persist into adulthood
188
what does the cognitive theory say about depression?
cognitive distortion that perceives things through a negative/defeated lense
189
according to the cognitive theory what negative expectations do depressed patients have?
environment, self, and the future
189
what does the transactional model of stress say about depression?
many factors cause depression not just one thing
190
what sex is more common to have depression?
female
191
what is senescence?
depression with dementia
192
what effect does socioeconomic status have on depression?
poverty and unemployment increase odds
193
what is major depression disorder?
depression that impairs social and occupational functioning
194
what is the acronym Sig E Caps stand for in relation to MDD?
Sleep disturbance
Interest decreased
Gulit
Energy decrease
Concentration problems
Appetite/Weight changes
psychomotor agitation
Suicidal ideations
195
how many symptoms must be present to diagnose MDD?
5 or more findings for 2 weeks
196
what if patient has MDD along with other factors like schizo, med, illness, or mania?
then patient does not have MDD
197
what is dysthymia/persisten depressive disorder?
milder form of depression that has an early onset
198
when does dysthymia typically set in?
adolescent
199
how long does dysthymia last?
2 years for adults and 1 year for children
200
what are the symptoms of dysthymia?
low mood, low appetite, sleep problems, poor concentration, irritablity, hopeless, inability to make descision
201
what can dysthymia turn into?
MDD
202
from the symptoms listed how many determine if they have dysthymia?
2 or more
203
what are the symptoms of premenstrual dysphoric depression?
depressed mood, anxiety, mood swings, decreased interest, during the week menses, gets better post cycle
204
what should you look for in relation to med pass with suicidal patietns?
watch for cheeking of meds
205
what is the purpose of congitive behavioral therapy?
to control thought distortion, get ride of negative thoughts,
206
what do SSRIs do?
prevent the reuptake of serotonin back into the neuron
207
what is the first line treatment for depression?
ssri
208
what cant you take with SSRI?
st john wort
209
what drugs are SSRI?
sertraline, citalopram, escitalopram, fluoxetine, and paroxetine
210
what are the complications for ssri?
serotonin syndrome, weight changes, anxiety, agitation, insomnia, cns stim, sexual dysfunction, withdrawal, HYPOnatremia, rash, gi bleed
211
what do SNRIs do?
prevent the reuptake of serotonin and norepinephrine
212
what does SNRIs treat?
depression and anxiety
213
what drug is a SNRI?
venlafaxine
214
what are complications of SNRIs
serotonin syndrome, Nausea, sweating,, insomnia, tremors, sexual dysfunction
215
what do tricyclic antidepressants do?
block reuptake of norepi and serotonin and blocks histamine receptors
216
what drug is a tricyclic antidepressant
amitriptyline
217
what are the complications of tricyclic antidepressants?
orthostatic hypo, decreased seizure threshold, sweating, increased appetite, sexual dysfunction, toxicity
218
what does tricyclic toxicity look like?
cholinergic block, cardiac toxic, dysrhythmias, seizure, coma, death
219
what do heterocyclic meds do?
block serotonin reuptake
220
what drugs are heterocyclic?
buproprion, mirtazapine, trazadone
221
what are the complications for heterocyclic medications?
lower seizure threshold, weight loss, insomnia, restless, increased HR, Gi distress, dry mouth, headache
222
what are manoamine oxidase inhibitors?
increases nor epi and serotonin
223
when are maois tried?
as a last resort
224
what drug is a MAOI?
phenelzine
225
what are the complications from taking MAOIs
Hypertensive crisis, mania, hypomania, orthostatic hypo, agitation, anxiety, cns stim
226
what must patients avoid when taking MAOIs/phenelzine?
tyramine
227
what happens if patietn taking phenelzine ingests tyramine?
hypertensive crisis
228
what are symptoms of hypertensive crisis?
Headaches, N/V, Tachy, diaphoresis, change in loc
229
what foods contain tyramine?
aged cheese, red wines, smoked/processed meats
230
what kind of seizure is induced during ECT?
grand mal
231
can a patient take meds before ECT?
no
232
when is ECT used?
to treat suicide and depression
233
what kind of memory loss is common in ECT
might forget pin to phone
234
