Psych Quiz #2 Study Guide

Conduct disorder (CD)- there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated (APA, 2013). This feature distinguishes it from ODD. Physical aggression is common, and peer relationships are disturbed. Symptomatology: The classic characteristic of CD is the use of physical aggression in the violation of the rights of others. Stealing, lying, and truancy are common problems. The child lacks feelings of guilt or remorse. The use of tobacco, liquor, or nonprescribed drugs, as well as the participation in sexual activities, occurs earlier than at the expected age for the peer group. Projection is a common defense mechanism. Low self-esteem is manifested by a "tough guy" image. Characteristics include poor frustration tolerance, irritability, and frequent temper outbursts. Symptoms of anxiety and depression are not uncommon. Biological influences: Genetic: higher # of people of CD have family members with the same disorder, the familial risk to CD is composed of two discrete dimensions of genetic risk: rule-breaking (such as truancy) and overt aggression (harming other people) and one dimension of shared environmental risk, reflecting covert delinquency (such as stealing and hurting animals). Temperament: As early as 2 years of age, children who show signs of an irritable temperament, poor compliance, inattentiveness, and impulsivity can begin to show signs of CD at later ages. More common that these children come from unstable families with frequent changes in residence and economic stress. Neurobiological Factors: three neurobiological findings relevant to CDs... 1. neuroimaging studies identify decreased gray matter in limbic structures, bilateral insula (an area of the cortex that plays a role connecting emotional responses to pain), and the left amygdala. 2. studies have found high plasma concentrations of serotonin and low levels in cerebrospinal fluid, both of which are correlated with aggression and violence. 3. aggressive children had "significantly greater relative right frontal brain activity at rest than healthy controls" Family Influences: ■ Parental rejection, neglect, or severe physical and verbal aggression ■ Inconsistent or harsh punitive discipline ■ Parental sociopathy ■ Lack of parental supervision ■ Frequent changes in residence ■ Economic stressors ■ Parents with antisocial personality disorder, severe psychopathology, and/or alcohol or other substance dependence ■ Marital conflict and divorce (particularly where there is the persistence of hostility) ***After age 18, an individual with Conduct Disorder may be diagnosed with ____antisocial personality disorder___.

Review Conduct Disorder. What is the symptomatology, biological influences, and family influences? After age 18, an individual with Conduct Disorder may be diagnosed with _____ (this is important).

A decrease in the neurotransmitter acetylcholine has been implicated in Alzheimer's disease (p. 252)

Review Figure 13-2. What transmitter has been implicated in the etiology of Alzheimer's Disease?

myoglobinuria (pg. 285)

A reddish tinge in the urine is caused by _______________, a breakdown of muscle excreted in the urine.

-The major neurotransmitters implicated in the pathophysiology of ADHD are dopamine, norepinephrine, and possibly serotonin. Dopamine and norepinephrine appear to be depleted in ADHD. Serotonin in ADHD has been studied less extensively, but recent evidence suggests that it also is reduced in children with ADHD. -Environmental Influences: evidence shows a direct link to ADHD with adverse effects of elevated serum levels of lead on cognitive and behavioral development in children -Biochemical theories: Hypotheses about the impact of neurotransmitters have been based on benefits associated with taking stimulant medications, which are known to affect dopamine and norepinephrine levels. But several studies, using single-photon emission computed tomography (SPECT), have now demonstrated increased dopamine transporter-binding densities in the striatal regions -Anatomical influences: Brain imaging studies show decreased volume and activity in the prefrontal cortex, anterior cingulated, globus pallidus, caudate, thalamus, and cerebellum. Several alterations occur in neural connectivity with evidence of decreased activation in frontoparietal areas and overactivation in visual, dorsal attention, and default networks. A recent study by Humphreys and associates (2018) found a correlation between brain volume changes, elevated ADHD symptoms, and the number of childhood stressors. This finding reinforce the need for trauma-informed care. -Prenatal, perinatal and Postnatal Factors: Maternal smoking during pregnancy has been linked to hyperkinetic-impulsive behavior in offspring. Fetal alcohol syndrome includes hyperactivity, impulsivity, and inattention as well as physical anomalies. Maternal infections during pregnancy have also been associated with higher risks for ADHD. Perinatal and postnatal influences that may contribute to ADHD are low birth weight, trauma, early infancy infections, or other insults to the brain during this period (Sadock et al., 2015). Maternal hypertension has also been implicated as a risk factor for both ADHD and ASD. -Psychosocial influences: Disorganized or chaotic environments or disruption in family equilibrium may contribute to ADHD in some individuals. Galéra and colleagues (2011) identified several psychosocial influences associated with the development of ADHD, including nonintact family, young maternal age at birth of the target child, paternal history of antisocial behavior, and maternal depression. -Tobacco use concerns: Nicotine may increase attention and reduce hyperactivity and impulsivity and, thus, may regulate behavior in individuals with ADHD. Alleviating the symptoms of ADHD and increasing cardiovascular activity through smoking may mimic the effects of stimulant medications and can be a form of self-medication. Maternal smoking during pregnancy has been linked to hyperkinetic-impulsive behavior. *** NOT SURE, unspecified in book ***

ADHD: Discuss neurotransmitters, environmental influences, biochemical theories and anatomical influences. What are the Prenatal, perinatal and Postnatal Factors? Environmental influences? Psychosocial Influences? What are the concerns regarding tobacco use?

depressant (pg. 283)

Alcohol exerts a ____________ effect on the CNS.

1. physical consequences of thiamine deficiency include peripheral neuropathy (nerve damage), wernicke's encephalopathy (paralysis of ocular muscles, myopia, eye problems), alcoholic myopathy (muscle pain/weakness), and korsakoff's psychosis (confusion, loss of recent memory, confabulation). other consequences include shortness of breath and edema. 2. tolerance is a need for an increasing dose of a substance. as tolerance develops, physical addiction also occurs. 3. ~ the two types of toxic reactions to hallucinogens are the panic reaction ("bad trip") and the flashback. symptoms of the panic reaction include an intense anxiety, fear, and stimulation. the individual hallucinates and fears going insane. paranoia and acute psychosis may be evident. the flashback refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance. 4. ~ a National Practice Guideline for use of medications to treat opioid use disorder has been established. ~ in 2016, the surgeon general declared illicit drug use and misuse of prescription drugs a national healthcare priority and committed to the need for additional research and treatment options. ~ state programs are providing naloxone education and distribution free of charge. ~ the NIH's HEAL initiative. 5. AKA "substitution therapy." medications that are used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol or other drugs and to decrease cravings by administering a controlled dose of another medication.

Answer Homework questions: 1. What are the physical consequences of thiamine deficiency in chronic alcohol use? 2. Define tolerance as it relates to physical addiction to a substance. 3. Describe two types of toxic reactions that can occur with the use of hallucinogens. 4. Describe current trends and national responses to the opiate use disorder epidemic in the United States. 5. What is medication-assisted treatment?

For women, this can mean changes in the menstrual cycle and a decreased or loss of ability to become pregnant. For men, the altered hormone levels result in a diminished libido, decreased sexual performance, and impaired fertility, and gynecomastia (changes in breasts) may develop secondary to testicular atrophy.

Alcohol interferes with female and male hormones. For women it ______their ability to become pregnant. For men, it may lead to testicular __________. The changes in breasts for a man is called _________.

4-12 · the following withdrawal symptoms may appear: coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia. · Onset of delirium is usually on the second or third day following cessation of or reduction in prolonged, heavy alcohol use. Symptoms include those described under the syndrome of delirium Pg.287

Alcohol withdrawal occurs within ____ to ____ of cessation or reduction in heavy use of alcohol. What are the symptoms of withdrawal? What is alcohol withdrawal delirium?

Methylphenidate is the most commonly prescribed drug for ADHD worldwide. It's known by a number of brand names, including Ritalin, Concerta, Metadate, Daytrana, and Quillivant.

An article regarding ADHD medications. (Name most commonly prescribed medication for ADHD)

a. Maternal smoking (p. 970 eBook) b. Bupropion - Table 4-2 in chapter 4 c. Basal Ganglia (p. 978) d. Parental overprotection, insecure parent-child attachment, maternal depression, role modeling with anxious or fearful parents (p. 996)

Answer the Homework Assignment questions a. What maternal prenatal activity has been associated with attention deficit/ hyperactivity disorder (ADHD) in children? b. Which antidepressant medication has been used with some success in treating ADHD? c. Neuroimaging brain studies in children with Tourette's disorder have been consistent in finding dysfunction in what area of the brain? d. What are some family behaviors that have been implicated as influential in the development of separation anxiety disorder?

1. tau neurofibrillary tangles, amyloid beta plaques, and neuronal damage 2. it has a more abrupt onset and highly variable course 3. depression-which is the most common mental illness among the elderly 4. to ensure patient safety, risk for falls, the risk for trauma

Answer the Homework Assignment questions (ch.13): 1. Which biomarkers are associated with the development of Alzheimer's disease? 2. How does vascular neurocognitive disorder (NCD) differ from NCD due to Alzheimer's disease? 3. What is pseudodementia? 4. What is the primary concern for nurses working with patients with NCDs?

20%, Pg. 284

Approximately __% of a single dose of alcohol is absorbed directly and immediately into the bloodstream through the stomach wall. It does not have to be digested.

CIWA score: -intermittent nausea w/ dry heaves = 4 -moderate tremor with arms extended = 4 -moderate itching = 3 -beads of sweat on her forehead = 4 -moderate anxiety = 4 -fidgety = 4 -moderately sensitive to light = 3 -moderate headache = 3 -easily frightened by the noise = 3 -cannot do serial additions = 1 33/67 -Safety and decreasing their bp *not sure* -Bp can inc with withdrawal -Patients would need additional medication for withdrawal. may go to the monitored unit or ICU *not sure* -yes use substitution therapy: The use of various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or experiencing the effects of excessive use of, substances. -shorter-acting benzodiazepines (lorazepam or oxazepam) *UNSURE* -multivitamin therapy (vitamin replacement) -Disulfiram should not be administered until it has been ascertained that the client has abstained from alcohol for at least 12 hours. If disulfiram is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks. Consuming alcohol or alcohol-containing substances during this 2-week period could result in a disulfiram-alcohol reaction. The client receiving disulfiram therapy should be aware of a large number of alcohol-containing substances. A thorough medical screening is performed before starting therapy, and written informed consent is usually required. The drug is contraindicated for clients who are at high risk for alcohol ingestion. It is also contraindicated for psychotic clients and clients with severe cardiac, renal, or hepatic disease.

Case Study, Patti ReVia. A 24-year-old female, Patti, comes into the Emergency Room with suspected Alcohol Use Disorder. Her last drink was 5 hours ago. She is exhibiting and c/o the following symptoms: intermittent nausea with dry heaves, moderate tremor with arms extended, moderate itching, beads of sweat on her forehead, moderate anxiety, fidgety, moderately sensitive to light, moderate headache, is easily frightened by the noise, and cannot do serial additions. What would you consider as her CIWA score?? Her blood pressure is 200/100, pulse 110. What would be your nursing priority? Is an elevated blood pressure expected for someone with withdrawal? (Not discussed in class but important that you know). Would the patient be discharged from the ER or sent to ICU or a monitored unit? In the process of Patti's recovery, it is important to use substitution therapy. What is substitution therapy and why is it necessary? Patti is not a candidate for Chlordiazepoxide (Librium) due to her existing diagnosis of Hepatitis C. In the case of patients with liver disease, what other medication is more appropriate? Replacement therapy with ____________ is also required to prevent neuropathy, confusion and encephalopathy. Another medication used is Carbamazepine (Tegretol) in order to decrease the incidence of seizures. Patti's psychiatric nurse practitioner considered initiating Antabuse therapy. What patient teaching would be required if Patti is initiated on Antabuse therapy?

a stimulant; after; once; tolerance; abruptly; 4-6

Case Study: Sasha is a 9 year old female, currently in third grade. She is impulsive and frequently knocks over things in her house. She cannot wait to talk and is intrusive. Sasha's low grades in her class are frustrating for her as she struggles in school. Her parents also struggle with her as Sasha has to be told numerous times to put her things away in the house or complete her homework. Sasha takes piano lessons but has a difficult time sitting still and practicing. She would rather be "outside on my swing set." Her parents decide to take Sasha to the pediatrician who starts her on Ritalin for ADHD symptoms. When talking to Sasha's parents, the pediatrician knows the action in the treatment of ADHD is _________. Instructions for Sasha's parents include the following: the medication must be administered immediately ______ meals. The client should be weighed regularly at least ______a week when receiving therapy with CNS stimulants. __________develops rapidly. The drug should not be withdrawn __________. If Sasha takes stimulants twice a day, they should be administered at least _____ to _____ hours apart.

dizziness, GI upset, fatigue, and headache, insomnia

Cholinesterase inhibitor medications: what are the adverse effects to teach the family?

Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months. Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months. Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months. Inattentive: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: -Often fails to give close attention to details or makes careless mistakes -Often has difficulty sustaining attention in tasks or play activities -Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace -Often has difficulty organizing tasks and activities -Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort -Often loses things necessary for tasks or activities -Is often easily distracted by extraneous stimuli -Is often forgetful in daily activities Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: -Often fidgets with or taps hands or feet or squirms in seat. -Often leaves seat in situations when remaining seated is expected -Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) -Often unable to play or engage in leisure activities quietly. -Is often "on the go," acting as if "driven by a motor" -Often talks excessively. -Often blurts out an answer before a question has been completed -Often has difficulty waiting for his or her turn -Often interrupts or intrudes on others

Contrast ADHD Inattentive vs Hyperactivity vs Combined.

Wernicke's encephalopathy represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue. Korsakoff's psychosis is identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke's encephalopathy. In the United States, the two disorders are usually considered together and are called Wernicke-Korsakoff syndrome. Treatment is with parenteral or oral thiamine replacement.

Differentiate between Wernicke's and Korsakoff's. Which is the most serious form of thiamine deficiency in alcoholics??

addiction: A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled. abuse: the improper use of something, treat with cruelty or violence, especially regularly or repeatedly.

Differentiate between physical and psychological abuse and addiction.

~ peer assistance programs strive to intervene early, reduce hazards to patients, and increase prospects for the nurse's recovery. these programs serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession. ~ it is very easy to overlook what "might" be a problem. denial, on the part of the impaired nurse and the colleagues, is the strongest reason for not dealing with substance abuse problems. signs of substance impaired nurses include either high absenteeism or rarely missed work depending on the source, an increase in "wasting" of drugs, increased incidences of incorrect narcotic counts, and a higher record of signing out drugs for other nurses. late in the disease process symptoms include poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall. other possible signs include irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom. ~ state boards decide each case on an individual basis. the state board may deny, suspend, or revoke a license based on a report of chemical abuse by a nurse. several state boards have passed laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. when a nurse is deemed safe to return to practice, he or she may be closely monitored for several years and required to undergo random drug screenings. the nurse may also be required under specifically circumscribed conditions for a designated period. ~ it's your duty to report!! any person suspecting impairment of a nurse's ability to provide safe nursing care may report this nurse to the Florida Dept. of Health and/or IPN. in Florida, all licensed nurses must report any suspected impairment in practice to DOH and/or IPN.

Discuss the Chemically Impaired Nurse. · What is the value of a peer assistance program? · How does one "identify" an impaired nurse? · If an impaired nurse is identified in Florida, is it possible for her to continue practice if she successfully passes the impaired nurse program? Is the same true for every state? · It is your duty to report! "Any person suspecting impairment of a nurse's ability to provide safe nursing care may report this nurse to the Florida Department of Health (DOH) and/or IPN. Under Florida's Mandatory Reporting Law, all licensed nurses must report any suspected impairment in practice to DOH and/or IPN ." (links in collaboration)

FYI link in collaboration

For students going to the ER, it is important for you to read the following article as you may encounter marijuana hyperemesis. This was not discussed in class but it was important for students to be aware of patient care.

Alpha Agonists stimulate the central alpha-adrenoreceptors in the brain resulting in reduced sympathetic output outflow in the CNS. This helps to sleep and calm (ch.4, pg. 87 and 612)

Medications for ADHD include CNS stimulants, Dexmethylphenidate and methylphenidate , atomoxetine, bupropion and alpha agonists. What is the purpose of alpha agonists?

Link in collaboration

Medications in NC

fetal alcohol syndrome

Prenatal exposure to alcohol can cause disorders of the fetus call ________ _________ _________.

-The use of various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or experiencing the effects of excessive use of, substances. -shorter-acting benzodiazepines (lorazepam or oxazepam) *UNSURE*

Define substitution therapy. What medications are used if the individual has liver disease?

CIWA stands for Clinical Institute Withdrawal Assessment of Alcohol Scale and is used to assess the risk and severity of initial and ongoing withdrawal from alcohol CIWA measures the categories: nausea/vomiting, tremors, tactile disturbances (itching, burning, tingling, etc), auditory disturbances, paroxysmal sweats, visual disturbances, anxiety, headache, agitation, orientation and clouding of sensorium. -VS- The CAGE questionnaire is more focused on assessing the risk for alcoholism and asks 1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt bad or Guilty about your drinking? 4. Have you ever had a drink first thing in the morning (Eye-opener)? (pg. 312-316)

Differentiate between CAGE and the CIWA scale

Delirium is a mental state that is characterized by an acute disturbance of cognition. Manifested by short-term confusion, excitement, disorientation, and a clouding of consciousness. Hallucinations and illusions are also common. ( page 245). Dementia is a disease process where there is progressive decline in cognitive ability in the presence of clear consciousness. It involves many cognitive deficits and significantly impairs social and occupational functioning ( page 246).

Differentiate between Dementia and Delirium. Hint: Think slow vs fast/ chronic vs acute. Consider viewing this FYI patient education information.

Autism spectrum disorder is a heterogeneous group of neurodevelopmental syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors (pg.601)

Define Autism Spectrum Disorder

-Oppositional defiant disorder (ODD) is characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, occupational, or other important areas of functioning -typically begins by 8 years of age and usually not later than early adolescence -With conduct disorder (CD), there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated (APA, 2013). This feature distinguishes it from ODD. ODD often precedes conduct disorder.

Define Oppositional Defiant Disorder, what is the typical age of dx, how does it differ from Conduct Disorder?

Aphasia is not speaking at all. Sundowning refers to psychomotor symptoms worsening in the afternoon and evening. Apraxia is the patient's inability to carry out purposeful motor activities despite intact motor function and the inability to use objects properly. (pg. 248-249)

Define aphasia, sundowning, and apraxia.

If it is determined that the client has a coexisting substance disorder and mental illness. Treatment is designed to target both problems. (Page 312).

Define dual diagnosis.

Separation anxiety disorder is characterized by excessive fear or anxiety concerning separation from those to whom the individual is attached. The anxiety is beyond that which would be expected for the individual's developmental level and interferes with social, academic, occupational, or other areas of functioning. Nursing dx: ■ Anxiety (severe) related to family history, temperament, overattachment to parent, negative role modeling ■ Ineffective coping related to unresolved separation conflicts and inadequate coping skills evidenced by numerous somatic complaints ■ Impaired social interaction related to reluctance to be away from attachment figure Interventions: 1. Establish an atmosphere of calmness, trust, and genuine positive regard. 2. Assure patient of his or her safety and security. 3. Explore the child's or adolescent's fears of separating from the parents. Explore with the parents possible fears they may have of separation from the child. 4. Help parents and child initiate realistic goals (e.g., child to stay with sitter for 2 hours with minimal anxiety; or child to stay at friend's house without parents until 9 p.m. without experiencing panic or anxiety). 5. Give, and encourage parents to give, positive reinforcement for desired behaviors. etc... Rationale: 1. Trust and unconditional acceptance are necessary for satisfactory nurse-patient relationship. Calmness is important because anxiety is easily transmitted from one person to another. 2. Symptoms of panic and anxiety are very frightening. 3. Some parents may have an underlying fear of separation from the child of which they are unaware and which they are unconsciously transferring to the child. 4. Parents may be so frustrated with child's clinging and demanding behaviors that assistance with problem-solving may be required. 5. Positive reinforcement encourages repetition of desirable behaviors. etc...

Define separation anxiety. What are the nursing dx, interventions with rationale for separation anxiety?

Steatorrhea: the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine. Leukopenia: The production, function, and movement of the white blood cells are impaired in chronic alcoholics. (dec WBC) Ascites: a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. The increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity.

Define steatorrhea, leukopenia and ascites

Substance intoxication is defined as the development of a reversible syndrome of symptoms following excessive use of a substance. Substance withdrawal occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period (pg. 280)

Define substance intoxication and substance withdrawal.

~ codependent nurses have a need to be in control. they often strive for an unrealistic level of achievement. their self-worth comes from the feeling of being needed by others and of maintaining control over their environment. they nurture the dependence of others and accept the responsibility for the happiness and contentment of others. they rarely express their true feelings, and they do what is necessary to preserve harmony and maintain control. they are at high risk for physical and emotional burnout. ~ nurses are sometimes known as "fixers" -Treatments: Stage I: The Survival Stage. In this first stage, codependent persons must begin to let go of the denial that problems exist or that their personal capabilities are unlimited. This initiation of abstinence from blanket denial may be a very emotional and painful period. Stage II: The Reidentification Stage. Reidentification occurs when the individuals are able to glimpse their true selves through a break in the denial system. They accept the label of codependent and take responsibility for their own dysfunctional behavior. Codependents tend to enter reidentification only after being convinced that it is more painful not to. They accept their limitations and are ready to face the issues of codependence. Stage III: The Core Issues Stage. In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of will. Each partner must be independent and autonomous. The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control those things that are beyond the individual's power to control. Stage IV: The Reintegration Stage. This is a stage of self-acceptance and willingness to change when codependents relinquish the power over others that was not rightfully theirs but reclaim the personal power that they do possess. Integrity is achieved out of awareness, honesty, and being in touch with one's spiritual consciousness. Control is achieved through self-discipline and self-confidence. -Self-help groups have been found to be helpful in the treatment of codependency. Groups developed for families of chemically addicted people, such as Al-Anon, may be of assistance. Groups specific to the problem of codependency also exist. One of these groups, which bases its philosophy on the Twelve Steps of Alcoholics Anonymous

Discuss the Codependent nurse and list treatment considerations for codependency. Not discussed in class but important to know as nurses sometimes are known as "fixers."

impairs cognitive functions of memory, attention, and organization, and these impairments may also contribute to some of the symptoms apparent in amotivational syndrome

Evidence supports that long-term use of marijuana cases what?

Link in collaboration

Have 2 minutes?

Alcoholic cardiomyopathy: The effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition. The clinical findings relate to congestive heart failure or arrhythmia. Symptoms include decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough. Laboratory studies may show elevation of the enzymes CPK, AST, alanine aminotransferase (ALT), and LDH. Changes may be observed by electrocardiogram, and congestive heart failure may be evident on chest x-ray films. Treatment involves total, permanent abstinence from alcohol. Specific treatment of congestive heart failure may include rest, oxygen, digitalization, sodium restriction, and diuretics. The death rate is high for individuals with advanced symptomatology.

How does alcohol affect the heart? What cardiac enzymes have changed? What is the treatment?

it decreases sperm count. in women, it may result in a suppression of ovulation, a disruption in menstrual cycles, and an alternation of hormone levels.

How does marijuana affect reproduction? It ______sperm count. In women it _______ovulation, ________the menstrual cycle and causes an alteration in the _________level.

40%, SSRI's (pg.271)

It is estimated that up to _____% of people with AD also suffer from major depression. First line medication for depression are ________

elevation of the enzymes CPK, AST, alanine aminotransferase (ALT), and LDH

Laboratory studies indicate elevations in what enzymes regarding alcoholic myopathy?

Phase I. Prealcoholic Phase This phase is characterized by the use of alcohol for its effects in relieving the everyday stress and tensions of life. As a child, the individual may have observed parents or other adults drinking alcohol and enjoying the effects; societally the individual learns that use of alcohol is an acceptable method of coping with stress. Tolerance develops, and the amount required to achieve the desired effect increases steadily. Phase II. Early Alcoholic Phase This phase begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking. Now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is required by the individual. Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. The individual feels enormous guilt and becomes very defensive about his or her drinking. Excessive use of denial and rationalization is evident. Phase III. Crucial Phase In this phase, the individual has lost control, and physiological addiction is clearly evident. This loss of control has been described as the inability to choose whether or not to drink. Binge drinking, lasting from a few hours to several weeks, is common. These episodes are characterized by sickness, loss of consciousness, squalor, and degradation. In this phase, the individual is extremely ill. Anger and aggression are common manifestations. Drinking is the total focus, and he or she is willing to risk losing everything that was once important, in an effort to maintain the addiction. By this phase of the illness, it is not uncommon for the individual to have experienced the loss of job, marriage, family, friends, and most especially, self-respect. Phase IV. Chronic Phase This phase is characterized by emotional and physical disintegration. The individual is usually intoxicated more than he or she is sober. Emotional disintegration is evidenced by profound helplessness and self-pity. Impairment in reality testing may result in psychosis. Life-threatening physical manifestations may be evident in virtually every system of the body. Unmanaged withdrawal from alcohol results in a terrifying syndrome of symptoms that include hallucinations, tremors, convulsions, severe agitation, and panic. Depression and ideas of suicide are not uncommon. For long-term, heavy drinkers, abrupt withdrawal of alcohol can be fatal.

List and describe the different phases through which the alcoholic's pattern of drinking progresses.

0.08%, 100-200, 400-700, Symptoms include disinhibition of sexual or aggressive impulses, mood lability, impaired judgement, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. (page 287)

Most states consider than an individual is legally intoxicated with a blood alcohol level of ______.% Intoxication usually occurs at blood alcohol levels between _____ and ______ mg/dL. Death has been reported at levels ranging from _____ to _______ mg/dL. What are symptoms of alcohol intoxication?

-Common substance of abuse and demonstrate a high risk for dependence. The FDA has issued warnings associated with CNS stimulants and atomoxetine of the risk for sudden death in patients who have cardiovascular disease. A careful personal and family history of heart disease, heart defects, or hypertension (hypertensive crisis) should be obtained before these medications are prescribed. Careful monitoring of cardiovascular function during administration must be ongoing. Monitor for overstimulation, restlessness, insomnia, palpitations, tachycardia, anorexia, weight loss, nausea vomiting, constipation, dry mouth, sedation, the potential for seizures, severe liver damage, new/worse psychiatric symptoms, rebound syndrome. -Atomoxetine can cause severe liver damage, Selectively inhibits the reuptake of norepinephrine by blocking the presynaptic transporter. -Buproprion lowers the seizure threshold (dose-dependent), Inhibits the reuptake of norepinephrine and dopamine into presynaptic neurons. -6 hours

Note discussed in detail in class, but important you know: What are the concerns regarding medications (e.g., Amphetamines and Amphetamine Mixtures) used with ADHD? Why is it important to monitor liver function with Atomoxetine and the potential for seizures with bupropion? CNS stimulants should be taken no later than ___ hours before bedtime.

Naltrexone

Other medications used include _________ to suppress craving and pleasurable effects.

Link in collaboration

Patient information

-Peripheral neuropathy: peripheral nerve damage, results in pain, burning, tingling, or prickly sensations of the extremities -alcoholic myopathy: sudden onset of muscle pain, swelling, and weakness along with myoglobinuria evidenced by a red tinge in the urine, a gradual wasting, and weakness in skeletal muscles -Wernicke's encephalopathy: a serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue. -Korsakoff's psychosis is identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. Treatment is with parenteral or oral thiamine replacement. -Alcoholic Cardiomyopathy- accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition -Esophagitis- inflammation and pain in the esophagus because of frequent vomiting -Gastritis- Inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention -Pancreatitis- occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention. Chronic pancreatitis leads to pancreatic insufficiency, resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus. -Alcoholic Hepatitis- inflammation of the liver caused by long-term heavy alcohol use (ascites, cirrhosis, hepatic encephalopathy) -Cirrhosis of the Liver- widespread destruction of liver cells, which are replaced by fibrous (scar) tissue (portal hypertension, ascites, esophageal varices, hepatic encephalopathy) -Leukopenia- white blood cells are impaired in chronic alcoholics -Thrombocytopenia- Platelet production and survival are impaired -Sexual Dysfunction- interferes with the normal production and maintenance of female and male hormones, and long-term alcohol use can interfere with the liver's ability to metabolize estrogenic compounds...changes in the menstrual cycle and a decreased or loss of ability to become pregnant. For men, the altered hormone levels result in a diminished libido, decreased sexual performance, and impaired fertility, and gynecomastia may develop secondary to testicular atrophy. -At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep. Chronic abuse results in multisystem physiological impairments. -Alcohol exerts a depressant effect on the CNS -alcohol is metabolized in the liver to produce acetaldehyde, At high levels, acetaldehyde causes the release of histamines and catecholamines, which can affect blood pressure and produce flushing, nausea, and vomiting.

Regarding Alcohol Use Disorder, what are the effects of alcohol on the body? ("Alcohol-itis")

gain

Regarding Cannabis Use Disorder: Cannabis use usually causes weight __________.

~ cannabis withdrawal symptoms include irritability, anger, or aggression; nervousness, restlessness, or anxiety; sleep difficulty; decreased appetite or weight loss; depressed mood; and physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache. ~ heavy, long-term cannabis use is also associated with a condition called amotivational syndrome. these persons have a lack of motivation to persist in or complete a task that requires ongoing attention. symptoms include being apathetic, anergic, weight gain, and a "slothful" appearance. ~ cannabis usually causes weight gain. an appetite stimulant. ~ marijuana & reproduction. it decreases sperm count. in women, it may result in a suppression of ovulation, a disruption in menstrual cycles, and an alternation of hormone levels.

Regarding Cannabis Use Disorder: Cannabis withdrawal symptoms include:

~ heavy, long-term cannabis use is also associated with a condition called amotivational syndrome. these persons have a lack of motivation to persist in or complete a task that requires ongoing attention. symptoms include being apathetic, anergic, weight gain, and a "slothful" appearance.

Regarding Cannabis Use Disorder: Heavy, long-term cannabis use is also associated with a condition called __________syndrome. What are the symptoms?

-The two most prevalent and widely used stimulants are caffeine and nicotine -alpha-PVP (flakka) has a chemical structure similar to bath salts. there have been reports of violent aggression, homicide, and suicide related to the use of this drug -CNS: results in tremor, restlessness, anorexia, insomnia, agitation, and increased motor activity. Amphetamines, nonamphetamine stimulants, and cocaine produce increased alertness, decrease in fatigue, elation and euphoria, and subjective feelings of greater mental agility and muscular power. Chronic use of these drugs may result in compulsive behavior, paranoia, hallucinations, and aggressive behavior -Cardiovascular and Pulmonary: amphetamines can induce increased systolic and diastolic blood pressure, increased heart rate, and cardiac arrhythmias. These drugs also relax bronchial smooth muscle. Cocaine intoxication typically produces an increase in myocardial demand for oxygen and an increased heart rate. Severe vasoconstriction may occur and can result in myocardial infarction, ventricular fibrillation, and sudden death. Inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia. Nasal rhinitis is a result of chronic cocaine snorting. Caffeine ingestion can result in increased heart rate, palpitations, extrasystoles, and cardiac arrhythmias. Caffeine induces dilation of pulmonary and general systemic blood vessels and constriction of cerebral blood vessels. Nicotine stimulates the sympathetic nervous system, resulting in an increase in heart rate, blood pressure, and cardiac contractility, thereby increasing myocardial oxygen consumption and demand for blood flow. Contractions of gastric smooth muscle associated with hunger are inhibited, thereby producing a mild anorectic effect. Sexual: CNS stimulants appear to increase sexual urges in both men and women. Women, more than men, report that stimulants make them feel sexier and have more orgasms. Some men may experience sexual dysfunction with the use of stimulants. For the majority of individuals, however, these drugs exert a powerful aphrodisiac effect. -Cocaine is the most potent stimulant derived from nature. -"crack" is processed powered cocaine with ammonia or sodium bicarbonate and water that is heated to remove the hydrochloride. -"uppers" are stimulants, "downers" are depressants. -inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia. -Nasal rhinitis is a result of chronic cocaine snorting. -Intoxication: produces euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; or impaired judgment. In severe amphetamine intoxication, symptoms may include memory loss, psychosis, and violent aggression. Physical effects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma. Intoxication from caffeine usually occurs following consumption in excess of 250 mg. Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation -Withdrawal: the presence of a characteristic withdrawal syndrome that develops within a few hours to several days after cessation of or reduction in heavy and prolonged use. This syndrome is often referred to as "crashing," which is an apt description because the symptoms include fatigue, cramps, depression, headaches, and nightmares. The dysphoria can be intense enough to result in an increased risk for suicide. The symptoms begin within 24 hours after last consumption and may include the following symptoms: headache, fatigue, drowsiness, dysphoric mood, irritability, difficulty concentrating, flu-like symptoms, nausea, vomiting, and/or muscle pain and stiffness. Withdrawal from nicotine results in dysphoric or depressed mood; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain.

Regarding Central Nervous System (CNS) Stimulants: · Stimulants: What neurotransmitter is is widely used stimulants are _______ and ______. · Discuss Alpha-PVP (AKA "flakka"). Discussed in class. Link in collaboration · What are the CNS, cardiovascular, sexual and pulmonary effects of stimulants? · What physical signs could a nurse observe that may indicate chronic cocaine use? · What is the most potent stimulant? What is "crack.?" What are "uppers" and "downers?" What can inhaled cocaine cause? Nasal rhinitis is a result of chronic cocaine ______. · What are the symptoms of intoxication and withdrawal?

How to help a child struggling from anxiety (from link): 1. Anxiety is a fear of the future and all its unpredictability. 2. Be on the lookout for the physical signs of anxiety. 3. Before you try to reason with a panicked child, help the child relax. 4. Validate your child's fear. 5. Help your child face their fears. 6. Build confidence with a baby-step plan.

Review symptoms of depression, anxiety, mood dysregulation disorder and schizophrenia in children. Children seem to have many anxious concerns where teaching, on their level, is appreciated.

1. Identifying/demographic data 2. General description (appearance, motor activity, speech patterns, general attitude) 3. Emotions (mood, affect) 4. Though processes (form of thought, content of thought) 5. Perceptual disturbances 6. Sensorium and cognitive ability 7. Impulse control 8. Judgement 9. Insight

Review the Mental Status Exam

~ Yes, tolerance to hallucinogens develops quickly and to a high degree. ~ mescaline (in Peyote cactus) is the only hallucinogenic compound used legally for religious purposes today by members of the Native American Church of the US. ~ MDMA ... AKA ecstasy or molly. a synthetic drug with both stimulant and hallucinogenic qualities. -hallucinogen intoxication: marked anxiety or depression, ideas of reference (a type of delusional thinking that all activity within one's environment is "referred to" [about] one's self), fear of losing one's mind, paranoid ideation, and impaired judgment. Physical symptoms include vertical or horizontal nystagmus, hypertension, tachycardia, ataxia, diminished pain sensation, muscle rigidity, and seizures. General effects of MDMA (ecstasy) include increased heart rate, blood pressure, and body temperature; dehydration; confusion; insomnia; and paranoia. Overdose can result in panic attacks, hallucinations, severe hyperthermia, dehydration, and seizures. Death can occur from kidney or cardiovascular failure. ~ the two types of toxic reactions to hallucinogens are the panic reaction ("bad trip") and the flashback. symptoms of the panic reaction include intense anxiety, fear, and stimulation. the individual hallucinates and fears going insane. paranoia and acute psychosis may be evident. the flashback refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance

Regarding Hallucinogens: · Is tolerance possible to hallucinogens? · What is the only hallucinogenic compound used legally for religious purposes? · What is MDMA? · What are the symptoms of hallucinogen intoxication? · There are two types of toxic reactions from hallucinogens, which are:

~ the development of opioid addiction may follow one of two typical behavior patterns. the first is an individual who has obtained the drug by prescription for the relief of a medical problem; abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment. he or she becomes obsessed with obtaining more and more of the substance and may see several physicians in order to replenish and maintain supplies. the second pattern occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. tolerance develops and addiction occurs, leading the individual to procure the substance by whatever means is required to support the habit. -CNS effects. all opioids affect the CNS. common manifestations include euphoria, mood changes, and mental clouding. other effects include drowsiness and pain reduction. pupillary restriction occurs in response to stimulation of the oculomotor nerve. respiratory centers in the medulla are depression, resulting in respiratory depression. the antitussive response is due to suppression of the cough center within the medulla. nausea and vomiting associated is related to stimulation of centers in the medulla. ~ cardiovascular effects. opioids have a minimal effects on the action of the heart in therapeutic doses. at high doses, opioids induce hypotension. methadone and buprenorphine can prolong the QTc. abuse of loperamide has been linked to cardiac dysrhythmias and death because it is highly cardiotoxic at high doses. ~ GI effects. stomach and intestinal tone are increased. the peristaltic activity of the intestines is diminished. these lead to a marked decrease in the movement of food through the GI tract. opioids have been most effective in the treatment of severe diarrhea. constipation and fecal impaction may be a serious problems for the chronic opioid used. -Symptoms of intoxication: include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Physical symptoms include pupillary constriction (or dilation due to anoxia from severe overdose), drowsiness, slurred speech, and impairment in attention or memory, Severe opioid intoxication can lead to respiratory depression, coma, and death -of withdrawal: include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia -opiate intoxication is treated with narcotic antagonists such as naloxone (narcan) or naltrexone (review, vivitrol). ~ clonidine (catapres) has been used to suppress opiate withdrawal symptoms. *KNOW* -Methadone is a replacement for the physical dependence to opioids. It can be used during opioid withdrawal and to maintain abstinence.

Regarding Opioid Use Disorder: · Regarding Opioid addiction, which typical behavior patterns are involved? · Regarding the central nervous and cardiovascular system, what are the effects?? · Regarding the GI system, what are the effects? · What are symptoms of opioid intoxication and withdrawal? Opioid intoxication is treated with what narcotic antagonist????? _______ has been used to suppress opiate withdrawal symptoms. (Important to know). · Methadone is a replacement for the physical dependence to opioids. It can be used during opioid withdrawal and to maintain abstinence.

~ cardio effects: hypotension may be a problem with large doses. high doses of barbiturates compromise cardiac contractility and vascular tone, which may result in cardiovascular collapse. individuals with congestive heart failure are more susceptible to these effects. ~ respiratory depression: barbiturates may inhibit the reticular activating system, resulting in respiratory depression, which can be lethal in overdose. in addition, additive effects can occur with the concurrent use of other CNS depressants, also effecting a life-threatening situation. ~ "club drugs" include GHB and flunitrazepam (rohypnol). these can produce a state of disinhibition, excitement, drunkness, and amnesia. they have been implicated as "date rape" drugs due to their easily disguised presence in drinks. they produce anterograde amnesia, so the events experienced while under the influence are not remembered. ~ barbiturate use decreases the amount of sleep time spent in dreaming. ~ only a slight decrease in blood pressure is noted with a normal oral dosage of barbiturates. hypotension may be a problem in large doses. ~ barbiturates may produce jaundice with doses large enough to produce acute intoxication. they stimulate the production of liver enzymes, resulting in a decrease of plasma levels of barbiturates and other drugs metabolized in the liver. -Withdrawal symptoms associated with sedative-hypnotics include autonomic hyperactivity (e.g., sweating or pulse rate greater than 100), increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, depersonalization, psychomotor agitation, anxiety, grand mal seizures, and delirium.

Regarding Sedative, Hypnotic and Anxiolytic Drugs: · What is the concern with large doses regarding cardiovascular effect? Respiratory Depression? · Describe "Club drugs" · How do barbiturates affect sleep and blood pressure? · Can barbiturates produce jaundice with large doses? · Severe withdrawal can cause what symptoms?

Hepatic encephalopathy (pg.286)

Regarding alcoholic hepatitis, severe cases can lead to cirrhosis or ________________________.

blood and urine samples, liver function studies, glucose test, electrolyte studies, thyroid tests, vitamin B12 test, drug and alcohol screening, rapid plasma reagin (syhpillis and HIV), CT scanning, MRI, lumbar puncture, PET

Regarding assessment, what laboratory evaluations are required?

■ Portal hypertension: Elevation of blood pressure through the portal circulation results from defective blood flow through the cirrhotic liver. ■ Ascites: Ascites, a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. The increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity. ■ Esophageal varices: Esophageal varices are veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. As this pressure increases, these varicosities can rupture, resulting in hemorrhage and sometimes death. ■ Hepatic encephalopathy: This serious complication occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. The continued rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbance, increasing confusion, and progression to coma and eventual death. Treatment includes complete abstention from alcohol; reduction of protein in the diet; reduction of intestinal ammonia using neomycin, rifaximin, or lactulose; and treatment of electrolyte imbalances (sodium and potassium), kidney failure, and infections

Regarding cirrhosis of the liver, what are the 4 major complications?

Protein intake should be adequate to maintain nitrogen equilibrium but should be drastically decreased or eliminated if there is potential for hepatic coma. A diseased liver may be incapable of properly metabolizing proteins, resulting in an accumulation of ammonia in the blood that circulates to the brain and can result in altered consciousness. page 320.

Regarding diet, is a high protein diet important with someone who has a diseased liver?

5-10, 5-10, 125-150 -respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. 12, 2 weeks

Regarding treatment for alcohol abuse, symptoms of Disulfiram (Antabuse) reaction can occur within __ to __ minutes of ingestion of alcohol Mild reactions can occur at blood alcohol levels as low as ___to ___mg/dL. With a blood alcohol level of approximately ____ to ____ mg/dL, severe reactions can occur. What are the reactions? Antabuse should not be administered until it has been ascertained that the client has abstained from alcohol for at least ______ hours. If it is discontinued, there may be a sensitivity to alcohol for as long as ___ weeks.

the B vitamins, particularly thiamine (B1) (pg.285)

Researchers believe neuropathies and myopathies are caused by deficiencies of...

Hypotheses about causative factors: -neurotransmitter alterations: A decrease in the neurotransmitter acetylcholine has been implicated in Alzheimer's disease. the enzyme required to produce acetylcholine is dramatically reduced. Decrease in production of acetylcholine reduces the amount of the neurotransmitter that is released to cells in the cortex and hippocampus, resulting in a disruption of the cognitive processes. Other neurotransmitters implicated in AD include norepinephrine, serotonin, dopamine, and the amino acid glutamate. It has been proposed that in NCD, excess glutamate leads to overstimulation of the N-methyl-D-aspartate (NMDA) receptors, leading to increased intracellular calcium and subsequent neuronal degeneration and cell death. Decreased levels of somatostatin and corticotropin have also been found in individuals with AD. -Plaques and tangles: an overabundance of them -Head trauma -Genetic Factors: Mutations on chromosome 14 causes abnormal presenilin 1 (PS-1) to be made, and mutations on chromosome 1 lead to the formation of abnormal presenilin 2 (PS-2). Each of these mutations results in an increased amount of the Aβ protein that is a major component of the plaques associated with AD. Individuals with Down syndrome (who carry an extra copy of chromosome 21) have been found to be unusually susceptible to AD.

Review theories for NCD, e.g., due to Alzheimer's Disease? Neurotransmitter alterations?

NURSING DIAGNOSIS: RISK FOR INJURY Interventions: 1. Ensure that patient has a safe environment. Remove from immediate area objects on which patient could injure self as a result of random, hyperactive movements. 2. Identify deliberate behaviors that put the child at risk for injury. Institute consequences for repetition of this behavior. 3. If there is risk of injury associated with specific therapeutic activities, provide adequate supervision and assistance, or limit patient's participation if adequate supervision is not possible. Rationale: 1. Objects that are appropriate to the normal living situation can be hazardous to the child whose motor activities are out of control. 2. Behavior can be modified with aversive reinforcement. 3. Patient safety is a nursing priority. Outcomes: Short- and Long-Term Goal ■ The patient will be free of injury.

Select a nursing dx and note interventions with rationale and outcomes regarding ADHD

Nursing dx: disturbed personal identity Interventions: - assist child to recognize separateness during self-care activities, such as dressing and feeding - assist the child in learning to name their own body parts. his can be facilitated using mirrors, drawings, and pictures of the child. encourage appropriate touching of, and being touched by others Rationale: Recognition of body parts during dressing and feeding increases the child's awareness of self as separate from others All these activities may help increase the child's awareness of self as separate from others (pg. 635)

Select a nursing dx, list interventions and rationale for a child with autism spectrum disorder

sedative-hypnotic medications, benzodiazepines may be useful for some clients but are indicated for relatively brief periods only (flurazepam (Dalmane), temazepam (Restoril), and triazolam (Halcion)), nonbenzodiazepine sedative-hypnotics like zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem) and the antidepressants trazodone (Desyrel) and mirtazapine (Remeron) are also prescribed

Sleep disturbances are common in NCD. What sleep medications are preferred?

Nursing dx: DISTURBED SENSORY PERCEPTION nursing interventions: 1. Do not ignore reports of hallucinations when it is clear that the patient is experiencing them. It is important for the nurse to hear an explanation of the hallucination from the patient. 2. Rule out the disturbed sensory perception as a possible side effect of certain physical conditions or medications. 3. Check to ensure that hearing aid is working properly and that faulty sounds are not being emitted. 4. Check eyeglasses to ensure that the individual is indeed wearing his or her own glasses. 5. Try to determine from where the visual hallucination is emanating and correct the situation by moving or covering the item. 6. Provide distractions for the patient. Focus on real situations and real people 7. McShane (2000) suggests that, depending on the situation, it may be better at times to go along with the patient rather than attempting to distract him or her. Nursing rationale: 1. These perceptions are very real and often very frightening to the patient. Unless they are appropriately managed, hallucinations can escalate into disturbing and even hostile behaviors. 2. Physical changes in the elderly result in less ability to metabolize medications, causing an increased risk of side effects. Some infections are also known to cause hallucinations in the elderly. 3. Faulty sounds from a hearing aid defect could be misinterpreted for auditory hallucinations. 4. Wearing the wrong prescription eyeglasses could cause the individual to misinterpret visual perceptions. 5. Patients often see faces in patterns on fabrics or in pictures on the wall. A mirror can also be the culprit when there are false perceptions. 6. Hallucinations are less likely to occur when the person is occupied or involved in what is going on around them. 7. Not all hallucinations are upsetting, and there are times when trying to distract the person from the hallucination may incur increased stress and agitation in the individual. outcomes: Short-Term Goal ■ Patient will exhibit fewer manifestations of disturbed sensory perception. Long-Term Goal ■ Patient will maintain reality orientation to the best of his or her cognitive ability.

State a nursing diagnoses for Neurocognitive Disorders, review nursing interventions with rationale. Review outcomes.

Impaired social interaction related to speech deficiencies or difficulty adhering to conventional social behavior. Interventions- 1. remain with the patient during initial interactions with others on the unit 2. explain to other patients the meaning behind the client's nonverbal gestures and signals, use simple language to explain to the patient which behaviors are acceptable and which are not, establish a procedure for behavior modification with rewards for appropriate behaviors and aversive reinforcement for inappropriate behaviors. Rationale- 1. presence of a trusted individual provides a feeling of security 2. positive, negative, and aversive reinforcements can contribute to desired changes in behavior. These privileges and penalties are individually determined as staff learns the likes and dislikes of the patient (pg.603)

State a nursing dx regarding a child dx with IDD, list interventions with rationale.

70

The highest level of IQ regarding IDD is____. Page 600- table 23-1

Benzodiazepine (pg. 436)

The least toxic and most effective of the antianxiety medications are the

Theories regarding predisposing factors for ASD are: 1. Neurological implications -Abnormalities in brain function or structure 2. Genetics -Familial association -Chromosomal involvement 3. Prenatal/perinatal influences -Mothers age, fetal expose to valproate, gestational diabetes, and gestational bleeding (pg. 961)

What are the theories regarding predisposing factors for Autism Spectrum Disorder?

No amount of alcohol during pregnancy is considered safe, and alcohol can damage a fetus at any stage of pregnancy

What amount of alcohol is safe in pregnancy?

Individuals most predisposed to developing delirium include those with serious medical, surgical, or neurological conditions

What are predisposing factors for Delirium?

-symptoms include agitation, high blood pressure, shaking and seizures, nausea and vomiting, hallucinations and paranoia, and violent behavior -K2 and Spice are synthetic cannabinoids. the strengths are variable, so the risks of using these substances are unpredictable.

What are symptoms of someone who overdoses from K2 or Spice?

a. Oppositional defiant disorder b. Conduct disorder c. Anxiety d. Depression e. Bipolar disorder f. Substance use disorders

What are the co-morbidities with ADHD?

Biological factors: Genetics: monozygotic (one egg, genetically identical) twins have a higher rate for concordance of alcoholism than dizygotic (two eggs, genetically nonidentical) twins, alcohol abuse in the family/parents, heritable personality traits such as high novelty seeking and low harm avoidance, both of which have been linked to substance use disorders Biochemical: opioid, catecholamine (especially dopamine), glutamate (especially those binding to N-methyl-D-aspartate [NMDA]), and gamma-aminobutyric acid (GABA) systems Psychological factors: Developmental Influences: punitive superego and fixation at the oral stage of psychosexual development, individuals with punitive superegos turn to drugs to diminish unconscious anxiety and increase feelings of power and self-worth, "As a form of self-medication, alcohol may be used to control panic, opioids to diminish anger, and amphetamines to alleviate depression" Personality Traits: low self-esteem, frequent depression, passivity, antisocial personality traits, high risk-taking traits, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances Cognitive Factors: Irrational thinking patterns have long been identified as a problem that is central in addictions. (ex. denial, projection, and rationalization) Sociocultural factors: Social Learning: The effects of modeling, imitation, and identification on behavior can be observed from early childhood onward. Conditioning: a learned response that occurs after repeated exposure to a stimulus. Substance abuse can become a learned response. If the environment is pleasurable, substance use is usually increased Cultural and ethnic influences: Some races and ethnic groups (notably Asian or Native American individuals) have a higher risk to affect the activity of isoenzymes involved in alcohol metabolism. Alcohol is converted quickly to acetaldehyde as well as a decrease in the rate at which acetaldehyde is oxidized. As a result of these changes, acetaldehyde rapidly accumulates in the body, producing unpleasant symptoms such as flushing, headaches, nausea, and palpitations when alcohol is consumed

What are the predisposing factors to substance-related disorders?

· A—assess for risk of suicide or harm · L—listen nonjudgmentally · G—give reassurance and information · E—encourage appropriate professional help · E—encourage self-help and other support strategies

What are the steps of Mental Health First Aid?

-symptoms of cannabis intoxication include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment and memory, and social withdrawal. physical symptoms include conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia. -symptoms of cannabis withdrawal include irritability, anger, or aggression; nervousness, restlessness, or anxiety; sleep difficulty; decreased appetite or weight loss; depressed mood; and physical symptoms, such as abdominal pain, tremors, sweating, fever, chills, or headache.

What are the symptoms of cannabis intoxication and withdrawal?

· Genetic Factors (approximately 5%) o Inborn errors of metabolism o Chromosomal disorders o Single gene abnormalities · Disruptions in embryonic development (30%) o Toxicity associated with maternal ingestion of alcohol or other drugs o Maternal illnesses and infections during pregnancy o Complications of pregnancy · Pregnancy and Perinatal Factors (approximately 10%) o Fetal malnutrition, viral or other infections during pregnancy o Trauma or complications during delivery that deprive the infant oxygen o Premature birth · General medical conditions acquired in infancy or childhood (approximately 5%) o Infections (example meningitis, encephalitis) o Poisonings (example insecticides, medications, lead) o Physical traumas (for example, head injuries, asphyxiation, hyperpyrexia) · Sociocultural and other mental disorders (15% to 20%) o Deprivation of nurturance and social stimulation o Impoverished environments associated with poor prenatal and perinatal care and inadequate nutrition o Severe mental disorders such as autism and spectrum disorder (Chapter 23 PowerPoint slides and pg. 599 & 600)

What are the theories regarding predisposing factors for IDD?

■ Abnormal facial features (Fig. 14-1) ■ Small head size ■ Shorter-than-average height ■ Low body weight ■ Poor coordination ■ Hyperactive behavior ■ Difficulty paying attention ■ Poor memory ■ Difficulty in school ■ Learning disabilities ■ Speech and language delays ■ Intellectual disability or low IQ ■ Poor reasoning and judgment skills ■ Sleep and sucking problems as a baby ■ Vision or hearing problems ■ Problems with the heart, kidneys, or bones

What are the traits for fetal alcohol syndrome?

~ denial, on the part of the impaired nurse as well as nurse colleagues, is the strongest reason for not dealing with substance abuse problems. projection, rationalization - *not sure* safety, nutrition, electrolyte balance, hygiene, etc... ~ the first step in decreasing use of denial is for the patient to see the relationship between substance use and personal problems. -1. When you were growing up, did anyone in your family drink alcohol or take other kinds of drugs? 2. If so, how did the substance use affect the family situation? 3. When did you have your first drink/drugs? 4. How long have you been drinking/taking drugs on a regular basis? 5. What is your pattern of substance use? a. When do you use substances? b. What do you use? c. How much do you use? d. Where are you and with whom when you use substances? 6. When did you have your last drink/drug? What was it, and how much did you consume? 7. Does using the substance(s) cause problems for you? Describe. Include family, friends, job, school, other. 8. Have you ever experienced injury as a result of substance use? 9. Have you ever been arrested or incarcerated for drinking/using drugs? 10. Have you ever tried to stop drinking/using drugs? If so, what was the result? Did you experience any physical symptoms, such as tremors, headache, insomnia, sweating, or seizures? 11. Have you ever experienced loss of memory for times when you have been drinking/using drugs? 12. Describe a typical day in your life. 13. Are there any changes you would like to make in your life? If so, what are they? 14. What plans or ideas do you have for seeing that these changes occur? -the purpose of peer assistance program is to serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession.

What defense mechanisms are used in chemically dependent clients? · What basic needs take priority when working with a chemically dependent client? · The first step in deceasing use of denial is for the client to see what? · What important questions are necessary for a drug history assessment? · What is the purpose of a peer assistance program?

Atomoxetine

What drug can cause severe liver damage?

arrange furniture to accommodate patients disabilities, store frequently used items within easy access, do not keep bed elevated, night light, provide area in which wandering can be carried out safely

What home safety measures are critical? (Refer to risk for falls)

-Tourette's disorder is characterized by the presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods during the illness. -Nursing dx: RISK FOR SELF-DIRECTED OR OTHER-DIRECTED VIOLENCE -Interventions: 1. Observe patient's behavior frequently through routine activities and interactions. Become aware of behaviors that indicate a rise in agitation. 2. Monitor for self-destructive behavior and impulses. A staff member may need to stay with patient to prevent self-mutilation. 3. Provide hand coverings and other restraints that prevent patient from self-mutilative behaviors. 4. Redirect violent behavior with physical outlets for frustration. -Rationale: 1. Stress commonly increases tic behaviors. Recognition of behaviors that precede the onset of aggression may provide the opportunity to intervene before violence occurs. 2. Patient safety is a nursing priority. 3. For patient's protection, provide immediate external controls against self-aggressive behaviors. 4. Excess energy is released through physical activities and a feeling of relaxation is induced. Medications: -Systematic review of current evidence supports the efficacy of antipsychotic agents, both typical and atypical agents, and the use of alpha2-adrenergic agonist agents (such as clonidine) in treating tics. (1st line of treatment is cognitive behavior therapy now) -The conventional antipsychotics: haloperidol (Haldol) and pimozide (Orap), have been approved by the FDA for control of tics and vocal utterances associated with Tourette's disorder. Not FDA approved for use in Tourette's disorder but prescribed atypical antipsychotics: risperidone (Risperdal), olanzapine (Zyprexa), or ziprasidone (Geodon). -Alpha 2 adrenergic agonist: Clonidine (Catapres) and guanfacine (Tenex; Intuniv)

What is Tourette's Disorder? Note the nursing dx, interventions with rationale. What medications are used for Tourette's?

Due to significant cerebrovascular disease when blood flow is impaired in either large or microvascular networks causing intellectual deterioration. Symptoms occur in steps rather than gradual deterioration

What is Vascular Dementia?

A drug holiday is an agreed cessation of medication for a period of time. In children with ADHD, a drug "holiday" should be attempted periodically under the direction of the physician to determine the effectiveness of the medication and the need for continuation. ch.4, pg. 89

What is a drug holiday?

The rebound effect, or rebound phenomenon, is the emergence or re-emergence of symptoms that were either absent or controlled while taking a medication, but appear when that same medication is discontinued, or reduced in dosage. It often occurs with clonidine and guanfacine. The patient should be instructed not to discontinue therapy abruptly. To do so may result in symptoms of nervousness, agitation, headache, tremor and a rapid rise in blood pressure. Dosage should be tapered gradually under the supervision of the physician. ch.4 pg. 89

What is rebound syndrome?

It is not known whether the plaques and tangles cause AD or are a consequence of the AD process. It is thought that the plaques and tangles contribute to the destruction and death of neurons, leading to memory failure, personality changes, inability to carry out ADLs, and other features of the disease

What is significant regarding plaques and tangles?

self-help group based on the concept of peer support- acceptance and understanding from others who have experienced the same problems in their lives. the sole purpose is to help members stay sober. AA encourages participants to accept things that they cannot change.

What is the purpose of AA? AA encourages participants to accept things they cannot____

Stimulants are considered first-line treatment for ADHD. These drugs are known to elevate dopamine and norepinephrine levels, it has been hypothesized that their effectiveness is in response to neurotransmitter dysregulation. The CNS stimulants discussed in this section include dextroamphetamine sulfate, methamphetamine, lisdexamfetamine, amphetamine mixtures, methylphenidate, and dexmethylphenidate. Recent research indicates that their effectiveness in the treatment of hyperactivity disorders is based on the activation of dopamine D4 receptors in the basal ganglia and thalamus, which depress, rather than enhance, motor activity. Atomoxetine inhibits the reuptake of norepinephrine, and bupropion blocks the neuronal uptake of serotonin, norepinephrine, and dopamine. Clonidine and guanfacine stimulate central alpha-adrenergic receptors in the brain, resulting in reduced sympathetic outflow from the CNS. The exact mechanism by which these nonstimulant and stimulant drugs produce the therapeutic effect in ADHD is unclear.

What medications are utilized in ADHD? How do they work?

treatment with antiseizure meds, vitamin replacement, and medication-assisted treatment. a. Increased heart rate b. Tremors c. Headache d. Diaphoresis e. Agitation; restlessness f. Nausea g. Fever h. Convulsions

What three things are important as far as a medication regimen as ordered by a physician? What are the signs of withdrawal?

An individual is considered to have a substance use disorder when use of a substance interferes with their ability to fulfill role obligations, such as at work, school, or home. Often the individual would like to cut down on or control use of the substance, but attempts fail, and use of the substance continues to increase. Addiction is evident when tolerance develops and the amount required to achieve the desired effect continues to increase. (pg.280)

When is someone considered addicted to a substance?

Clonidine and guanfacine stimulate central alpha-adrenergic receptors in the brain, resulting in a reduced sympathetic outflow from the CNS. Effects of clonidine may be decreased with concomitant use of tricyclic antidepressants and prazosin. Decreased effects of levodopa may occur with clonidine, and the effects of guanfacine are decreased with barbiturates or phenytoin. Monitor for side effects: palpitations, tachycardia, bradycardia, constipation (inf fluid and fiber), dry mouth (oral hygiene, sugarless gum, candy, etc...), sedation (refrain from driving), rebound syndrome (don't abruptly discontinue), severe hypertension. Monitor and record vital signs at regular intervals (two or three times a day) throughout therapy. Administer the last dose at least 6 hours before bedtime to avoid insomnia.

Why are alpha agonists, e.g., Clonidine (Catapress) or Guanfacine (Tenix) given for ADHD? What instruction should the nurse give the parents and patient regarding this medication? What time of day is Clonidine or Guanfacine administered?

nursing dx: risk for injury, denial, ineffective coping, imbalanced nutrition: less than body requirements/deficient fluid volume Interventions: 1. Parenteral support may be required initially. 2. Encourage cessation of smoking. 3. Consult dietitian. Determine the number of calories required based on body size and level of activity. Document intake and output and calorie count, and weigh patient daily. 4. Ensure that the amount of protein in the diet is correct for the individual patient's condition. Protein intake should be adequate to maintain nitrogen equilibrium but should be drastically decreased or eliminated if there is potential for hepatic coma. 5. Sodium may need to be restricted. 6. Provide foods that are nonirritating to patients with esophageal varices. 7. Provide small frequent feeding of patient's favorite foods. Supplement nutritious meals with multiple vitamin and mineral tablet. rationale: 1. To correct fluid and electrolyte imbalance, hypoglycemia, and some vitamin deficiencies. 2. To facilitate repair of damage to GI tract. 3. These interventions are necessary to maintain an ongoing nutritional assessment. 4. Diseased liver may be incapable of properly metabolizing proteins, resulting in an accumulation of ammonia in the blood that circulates to the brain and can result in altered consciousness. 5. To minimize fluid retention (e.g., ascites and edema). 6. To avoid irritation and bleeding of these swollen blood vessels. 7. To encourage intake and facilitate patient's achievement of adequate nutrition. Yes, but Use confrontation with caring. Do not allow the patient to fantasize about his or her lifestyle

With substance -related disorders, what are nursing diagnoses to consider? List rationale and interventions. Is it appropriate to confront the patient regarding their alcohol use?

nursing interventions: 1. Do not ignore reports of hallucinations when it is clear that the patient is experiencing them. It is important for the nurse to hear an explanation of the hallucination from the patient. 2. Rule out the disturbed sensory perception as a possible side effect of certain physical conditions or medications. 3. Check to ensure that the hearing aid is working properly and that faulty sounds are not being emitted. 4. Check eyeglasses to ensure that the individual is indeed wearing his or her own glasses. 5. Try to determine from where the visual hallucination is emanating and correct the situation by moving or covering the item. 6. Provide distractions for the patient. Focus on real situations and real people 7. McShane (2000) suggests that, depending on the situation, it may be better at times to go along with the patient rather than attempting to distract him or her. Nursing rationale: 1. These perceptions are very real and often very frightening to the patient. Unless they are appropriately managed, hallucinations can escalate into disturbing and even hostile behaviors. 2. Physical changes in the elderly result in less ability to metabolize medications, causing an increased risk of side effects. Some infections are also known to cause hallucinations in the elderly. 3. Faulty sounds from a hearing aid defect could be misinterpreted for auditory hallucinations. 4. Wearing the wrong prescription eyeglasses could cause the individual to misinterpret visual perceptions. 5. Patients often see faces in patterns on fabrics or in pictures on the wall. A mirror can also be the culprit when there are false perceptions. 6. Hallucinations are less likely to occur when the person is occupied or involved in what is going on around them. 7. Not all hallucinations are upsetting, and there are times when trying to distract the person from the hallucination may incur increased stress and agitation in the individual.

With the elderly, there are major concerns regarding disturbed sensory perception. What are the nursing interventions and rationale?

FYI link in collaboration

Working with children is especially challenging as they do not have the ability to translate their feelings into words; they sometimes accept dysfunctional behaviors as "normative" (e.g. domestic violence), and their actions can be wrongly misinterpreted, e.g., a child found picking flowers in their mother's flower bed as they want to bring flowers to surprise their mother, not because of disrespectful behavior or malice. Human trafficking (not discussed in detail in class) is something everyone needs to be involved with as children are the victims of this audacious crime. One more thing, in working with children with ADD/ADHD or combined types, it is important to have reports from the child's parents, teachers, and the child before a diagnosis can be made.

Cholinesterase, lessen (pg. 269)

__________________inhibitors are often used for treatment of mild to moderate cognitive impairment in AD. The effect of these medications will _________ as the disease progresses. It is important that patients not be given NSAIDS which can cause GI bleeding