Psych Nursing Module 5 Part 1

Alcohol withdrawal occurs within ____ to ____ of cessation or reduction in heavy use of alcohol.

4 to 12 hours

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, sever 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.

5 to 10 minutes 5 - 10 mg/dl 125 - 150 mg/dl Reactions include flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea, vomiting, sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision, and confusion. At a severe level, reactions can include respiratory depression,cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. 12 hours!! 2 weeks!!!

Discuss Alpha-PVP (AKA "flakka")

A synthetic cathinone - Chemical structure is similar but not identical to bath salts. Drug can be snorted, injected, eaten, and vaporized for inhalation in e-cigs

What is MDMA?

AKA Ecstasy a synthetic drug with both stimulant and hallucinogenic qualities

Because of their extreme fear of ____________________clients with BPD should not be left alone at a stressful time.

Abandonment

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

Amotivational syndrome Amotivational syndrome is the lack of motivation to persist in or complete a task that requires ongoing attention. People have symptoms apatheic, anergic, weight gain, and slothful.

Narcissistic Personality Disorder

An exaggerated sense of self-worth. Lack empathy and are hypersensitive to the evaluation of others. Often do not conceive their behavior as being inappropriate or objectionable. Lack humility, being overly self-centered and exploiting others to fulfill their own desires. Mood is usually optimistic, relaxed, and carefree but can easily change because of their fragile self esteem

Maximus is a 26 year old male. He tends to ignore rules and authority and is flagrant in his disrespect for the law. He is irresponsible, deceitful and impulsive. His goal is to exploit and manipulate. He trusts only in himself. He lacks remorse and frequently is indifferent to others. When things go his way, he is charming and cheerful. In his mind, he is always the victim. The nurse considers his personality disorder as ______________________.

Antisocial Personality Disorder

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."

Assumed the role as "fixer" as a child in a dysfunctional home - chose this career path because they are needed but resent receiving so little in return. - Emotional needs go unmet; however they deny that these needs exist. -unmet emotional needs may be manifested through use of compulsive behaviors such as work or spend excessively, or addictions to food or substances - Have a need to be in control and often strive for an unrealistic level of achievement - do what is necessary to maintain control and preserve harmony - at high risk for burnout!!! Treatment: Stage I: The survival stage; Stage II: The Reidentification Stage; Stage III: The Core Issues Stage; Stage IV: The Reintegration Stage Self-help groups are very helpful!!

Severe withdrawal can cause what symptoms? (Regarding Sedative, Hypnotic and Anxiolytic Drugs)

Automatic hyperactivity, increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, and grand mel seizures

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

B vitamins

What are the predisposing factors for Antisocial Personality Disorder?

Biological Influences: More common among first-degree biological relatives of those with the disorder than general population. Likelihood of developing this disorder is increased if individual had ADHD or conduct disorder as a child. Deficits present in prefrontal cortex gray matter and decreased activity in amygdala. Dysregulation of dopamine and serotonin and testosterone and cortisol. Family dynamics: chaotic home environment, physical abuse and neglect, teasing, and lack of parental bonding.

Predisposing factors to substance-related disorders

Biological factors: Hereditary factors appears to be involved. Neurotransmitters involved include opioid, catecholamine (esp dopamine), and GABA systems. Psychological factors: Personality traits like low self-esteem, frequent depression, passivity, antisocial personality traits, inability to relax and the inability to communicate effectively Sociocultural factors: Effects of modeling, imitation, and identification from early childhood. Conditioning (a learned response from the substance itself as well as the environment) Cultures also help to establish patterns of substance use by molding attitudes, influencing patterns of consumption bases on cultural acceptance and determining the availability of the substance.

Beth is a 25 year old female. She frequently self-mutilates, especially if she feels abandonment. She feels empty, and displays intense anger and temper by engaging in recurrent physical fights. She demonstrates impulsivity regarding spending, sex, substance use, driving and reckless eating. She has recurrent suicidal behavior, gestures or threats. She has a pattern of unstable relationships. The Nurse considers her diagnosis as _______________________________.

Borderline Personality Disorder

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 noise, and cannot do serial additions. What you would 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. Patti's psychiatric nurse practitioner considered initiating Antabuse therapy. What patient teaching would be required if Patti is initiated on Antabuse therapy? To assist you:

CIWA score = 33

What are the CNS, cardiovascular, sexual and pulmonary effects of stimulants?

CNS: causes tremor, restlessness, anorexia, insomnia, agitation, and increased motor activity; more potent stimulants cause increased alertness, decreased fatigue, elation, euphoria, and subjective feelings of greater ability; also causes compulsive behavior, paranoia, hallucinations, and aggressive behavior Cardiovascular: amphetamines can induce an increased systolic and diastolic blood pressure, increased heart rate, and cardiac arrhythmia; Cocaine causes a rise in myocardial demand for O2 and increased heart rate. Severe vastoconstriction may occur and cause myocardial infarction. ventricular fibrillation, and sudden death. Caffeine causes palpitations, increased heart rate, extrasystoles, and cardia arrhythmias. Nicotine causes an increased heart rate, blood pressure, and cardia contractility Sexual: increase sexual urges in both men and women. Women report feeling sexier and have more orgasms. Some men may experience sexual dysfunction. But for the most part it is a powerful aphrodisiac Pulmonary: Amphetamines relax bronchial muscles. Cocaine causes pulmonary hemorrhage, chronic bronchiolitis, and pneumonia and nasal rhinitis when snorted. Caffeine induces dilation of pulmonary blood vessels.

Regarding the central nervous and cardiovascular system, what are the effects?? (opioid addiction)

CNS: euphoria, mood changes, and mental clouding. drowsiness and pain reduction. Pupillary constriction. Respiratory depression. nausea and vomiting Cardiovascular: In therapeutic doses, they have minimal effect on the heart. At high doses, they induce hypotension.

The most widely used stimulants are _______ and ______.

Caffeine and nicotine

How should a nurse care for the self-inflicted wounds of a client with BPD?

Care for client's wounds in a matter-of-fact manner. Do not give positive reinforcement to this behavior by offering sympathy or additional attention.

Pre alcoholic phase

Characterized by the use of alcohol to relieve 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. The child 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.

Psychosocial influences for Borderline Personality Disorder regarding risk factors include __________________________________.

Childhood trauma (neglect, abuse, parental substance abuse, etc)

What are the primary psychosocial predisposing factors to avoidant personality disorder?

Childhood trauma or neglect leading to fears of abandonment or to viewing the world as a hostile and dangerous place

CIWA scale

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised is an excellent tool that is used by many hospitals to assess risk and severity of withdrawal from alcohol. It may be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms.

Laboratory studies indicate elevations in what enzymes regarding alcoholic myopathy?

Creatine phosphokinase (CPK) and lactate dehydrogenase (LDH)

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

Decreases Suppresses Disrupt Hormone

What defense mechanisms are used in chemically dependent clients?

Denial is the most common!

Alcohol exerts a ____________ effect on the CNS.

Depressant

The type of therapy indicated for a BPD patient would include_______________________ (multiple types).

Dialectical Behavior Therapy - Group skills training: taught skills considered relevant to particular problems such as core mindfulness skills, interpersonal effectiveness skills, emotion modulation skills, and distress tolerance skills - Individual psychotherapy: Dysfunctional behavioral patterns, personal motivation, and skills strengthening weekly - Telephone contact: therapist is available to the client by telephone help and support applying the skills to real life between sessions and avoiding self-injury - Therapist consultation and team meeting: Therapists support for each other As well as, symptom targeted psychopharmacology.

Avoidant Personality Disorder

Extremely sensitive to rejection and consequently may lead to a very socially withdrawn life. - awkward and uncomfortable in social situations. - speech is usually slow and constrained with frequent hesitations, fragmentary thought sequences, and occasional confused and irrelevant digressions.

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

Fetal Alcohol Spectrum Disorders (FASD) Most common is Fetal Alcohol Syndrome (FAS)

Describe "Club drugs"

Gama-hydroxybutyric acid and flunitrazepam They can produce a state of disinhibition, excitement, drunkeness, and amnesia. Produce anterograde amnesia, rendering the inability to remember events experienced while under the influence AKA date rape drugs

Miley is a 30 year old female. She is uncomfortable unless she is the center of attention. Miley uses her physical appearance frequently to draw attention to herself. She is self-dramatizing, theatrical and has exaggerated expression of emotions. Her interaction with others is often characterized by inappropriate sexual seductive or provocative behavior. As a child, she received positive reinforcement only when she performed. Parental acceptance with inconsistent. The nurse considers the personality disorder as __________________.

Histrionic

What are the symptoms of cannabis intoxication?

Impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgement and memory, difficulty performing tasks and social withdrawal. Physical symptoms are conjunctional injection(red eyes), increased appetite, dry mouth, and tachycardia

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

Impairs cognitive functions of memory, attention, and cognition.

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.

What are symptoms of opioid intoxication and withdrawal?

Intoxication: initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment. Pupillary constriction (or dilation due to anoxia from SEVERE overdose), drowsiness, slurred speech, impairment in attention or memory. SEVERE intoxication leads to respiratory depression, coma, and death. Withdrawal: dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia

What are the symptoms of intoxication and withdrawal for CNS stimulants?

Intoxication: maladaptive behavioral and psychological changes. (Amphetamines and cocaine cause euphoria, affective blunting, changes in sociability, hyper vigilance, interpersonal sensitivity, anxiety, tension, or anger, stereotyped behaviors or impaired judgment.) there are a ton more so look on page 298!! Withdrawal: fatigue, cramping, depression, headaches, and nightmares. Increased risk for suicide.

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

K2 and Spice are synthetic cannabinoids with chemicals related to THC but are more powerful and dangerous. Symptoms of overdose includes agitation, high blood pressure, shaking and seizures, nausea and vomiting, hallucinations and paranoia and violent behavior.

Dependent personality disorder

Lack of self confidence and extreme reliance on others to take responsibility for them, sometimes to the point of intense discomfort with being alone for even a brief period. - typically passive and acquiescent to the desires of others. - overly generous and thoughtful and underplay their own attractiveness and achievements. - sees the world through rose-colored glasses, but when alone feels pessimistic, discouraged, and dejected. - avoid positions of responsibility and become anxious when forced into them

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

Major self-help organization for the treatment of alcoholism. Accepts alcoholism as an illness and promotes total abstinence as the only cure, emphasizing that the alcoholic person can never safely return to social drinking. CONTROL

If self mutilation occurs with a BPD patient, the nurse must care for the patient in a _______________________ manner. It is critical the nurse not provide any ____________________reinforcement to the behavior by offering sympathy or additional attention.

Matter-of-fact Positive

What is the only hallucinogenic compound used legally for religious purposes?

Mescaline (primary ingredient of the peyote cactus)

A ____________ unit provides the appropriate environment for the client with this disorder. Feedback from peers is often more effective than confrontation.

Milieu

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

Myoglobin

What amount of alcohol is safe in pregnancy?

NO AMOUNT

"Gastone" is a 28 year old male. He demonstrates a grandiose sense of self-importance and exaggerates achievements and talents. He is preoccupied with fantasies of unlimited success, power, brilliance, beauty and love. He believes he is very special and requires special admiration. He tends to take advantage of others and believes that others are envious of him. He demonstrates arrogance, haughty, behaviors and attitudes. The nurse considers his diagnosis as ____________________.

Narcissistic Personality Disorder

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

No, proteins should be reduced with someone who has a diseased liver

CNS Stimulants What neurotransmitter is potentiated?

Norepinephrine, epinephrine, or dopamine

Substance withdrawal

Occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time. - the physiological and mental readjustment that accompanies the discontinuation of an addictive substance.

"Scrooge" is a 24 year old male. He frequently attributes his short coming to others and refuses to accept responsibility for his own behavior. He reads hidden demeaning or threatening meanings into benign remarks or events. He was suspicious about the fidelity of his girlfriend and decided to break the engagement. He suspects everyone and is reluctant to confide in others because of his fear that information will be used maliciously against him. He distrust of others became more apparent in early adulthood. His nurse considers the personality disorder he may have is ____________________.

Paranoid personality disorder

Paranoid Personality Disorder

Pattern of pervasive distrust and suspiciousness of others and misinterpretation of other's motives as malevolent. Pattern begins by early adulthood Constantly on guard, hyper vigilant, and ready for any real or imagined threat Extremely oversensitive and maintain their self-esteem by attributing their short comings to others.

What are the effects on the body with Alcohol Use Disorder, what are the effects of alcohol on the body?

Peripheral Neuropathy Alcoholic Myopathy Wernicke's Encephalopathy Korsakoff's Psychosis Alcoholic Cardiomyopathy Esophagitis Gastritis Pancreatitis Alcoholic Hepatitis Cirrhosis of the Liver Leukopenia Thrombocytopenia Sexual Dysfunction Fetal Alcohol Syndrome (when using when pregnant)

Is tolerance possible to hallucinogens?

Recurrent use can cause tolerance, encouraging users to resort to higher and higher dosages.

Nursing diagnoses and interventions/rationales for substance-related disorders

Risk for injury - assess client's level if disorientation; determine if specific requirements for safety must be made Ineffective denial - Begin by working to develop a trusting nurse-client relationship. Be honest. Keep all promises; Trust is the basis of a therapeutic relationship. Ineffective coping - Encourage the client to verbalize feelings, fears, and anxieties. Answer any questions he or she may have regarding the disorder; Verbalization of feelings in a nonthreatening environment may help the client come to terms with long unresolved issues. Imbalanced nutrition - Parenteral support may be required initially; to correct fluid and electrolyte imbalance, hypoglycemia, and some vitamin deficiencies.

An ego defense demonstrated by Beth (the case study with BPD) that is common is ___________.

Splitting

Regarding the GI system, what are the effects? (opioid addiction)

Stomach and intestinal tone are increased, but peristaltic activity of intestines is diminished. Causes constipation and even fecal impaction

What is the purpose of a peer assistance program?

Strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery.

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

Substitution therapy is using various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. It may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. In clients with liver disease, accumulation of the longer-acting agents (chlordiazepoxide and diazepam) may be problematic, and use of the shorter-acting benzodiazepines (lorazepam or oxazepam) is more appropriate.

What physical signs could a nurse observe that may indicate chronic cocaine use?

Tachycardia/bradycardia, pupillary dilation, elevate or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardia arrhythmias, confusion, seizures, dyskinesias, or coma

Substance Intoxication

The development of a reversible syndrome of symptoms following excessive use of a substance. - a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor

Object constancy

The phase in the separation / individuation process when the child learns to relate to objects in an effective, constant manner. A sense of separateness is established, and the child is able to internalize a sustained image of the loved object or person when out of sight.

How does one "identify" an impaired nurse?

There may be a high absenteeism if the person's source is outside of work or the person may rarely miss work because their source is at work. There may be an increase in wasting of drugs, increased incidences of incorrect narcotic counts, and a higher record of signing out drugs than other nurses Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall are other signs that appear later

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.

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 evidence 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.

What is the value of a peer assistance program?

To strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery

Is it appropriate to confront the patient regarding their alcohol use?

Use confrontation WITH caring. Do not allow client to fantasize about his or her lifestyle.

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

Wernicke's encephalopathy is the most serious form of thiamine deficiency in alcoholics. It can be fatal if thiamine replacement therapy is not started quickly. Symptoms include paralysis of ocular muscles, diplopia, ataxia, somnolence, and stupor. Korsakoff's psychosis occurs frequently in patients who are recovering from Wernicke's encephalopathy. Symptoms include confusion, loss of recent memory, and confabulation. Treatment involves oral or parenteral thiamine replacement. In the United States, these two disorders are considered together and are known as Wernicke-Korsakoff syndrome.

When is someone considered addicted to a substance?

When he or she is unable to control its use, even knowing that it interferes with normal functioning; when more and more of the substance is required to produce desired effects; and when characteristic withdrawal symptoms develop upon cessation or drastic decrease in use of substance

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?

Yes but disciplinary action will take place and they will be watched closely. It depends on the state and the state that they are coming from must send their approval as well so it would be difficult.

Can barbiturates produce jaundice with large doses?

Yes!

Ascites

a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension.

Schizoid personality disorder

a profound defect in the ability to form personal relationships and individuals with this disorder are often seen by others as eccentric, isolated, or lonely. - Lifelong pattern of social withdrawal, and their discomfort with human interaction is apparent - Able to invest enormous affective energy in intellectual pursuits

Dialectical Behavioral Therapy

a type is psychotherapy that was designed specifically as a treatment for the chronic self-injurious and parasuicidal behavior of clients with BPD. It is a complex, eclectic treatment that combines the concepts of cognitive, behavioral, and interpersonal therapies with Eastern mindfulness practices. It has four primary modes: group skills training, individual psychotherapy, telephone contact, therapist consultation and team meeting

Medications are not prescribed for this disorder due to the strong susceptibility to _____________.

addictions

Regarding psychopharmacology, the treatment of BPD is symptom targeted which includes________________________________________________.

antipsychotics in treating cognitive-perceptual symptoms, SSRI in treating emotional dysregulation, and mood-stabilizers in treating emotional dysregulation and impulsive aggressive symptoms

What are the symptoms of hallucinogen intoxication?

anxiety, depression, ideas of reference, paranoid ideation, impaired judgment, depersonalization, derealization, illusions, hallucinations, synesthesia Its a sympathomimetic so it also causes tachycardia, hypertension, sweating, blurred vision, papillary dilation, and tremors

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 _________.

decreases atrophy gynecomastia

What are symptoms of alcohol intoxication?

disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face.

Steatorrhea

excess fat in the feces due to a malabsorption syndrome caused by disease of the intestinal mucosa or pancreatic enzyme deficiency. Chronic pancreatitis from alcohol use leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus.

Cannabis use usually causes weight __________.

gain

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

hepatic encephalopathy

Cannabis withdrawal symptoms include:

irritability, anger or aggression, nervousness, restlessness, or anxiety, sleep difficulty, decreased appetite or weight loss, depressed mood, abdominal pain, tremors, sweating, fever, chills, and/or headache

Splitting

manifested by an inability to integrate and accept both positive and negative feelings. In their view people- including themselves-and life situations are either all good or all bad. it's a primitive ego defense mechanism in people with BPD

Ann is a 42 year old female. All the clothes in her closet are color coded. She is preoccupied with details, rules, lists, order, organization and schedules. She is devoted to work and is overconscientious. She has a miserly spending style towards both her self and others. She shows rigidity and stubbornness. The nurse is considering the diagnosis of _________________________.

obsessive-compulsive personality disorder

In trying to redirect violent behavior, other outlets for a BPD client's anxiety include:___________________.

physical activities (ex. punching bag, jogging

Leukopenia

the production, function, and movement of the white blood cells are impaired in chronic alcoholics. Places the individual at high risk for contracting infectious diseases as well as for complicated recovery

CAGE scale

used to determine whether an individual has a problem with substances

Define dual diagnosis

when a client has a co-existing substance disorder and mental illness, he or she may be assigned to a special program that targets both problems. Psychiatric units sometimes use surveys such as the CAGE Questionnaire to determine if a client has a secondary alcoholism problem in addition to the psychiatric problem.

What are the traits for fetal alcohol syndrome?

• Abnormal facial features (see Figure 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

Schizotypical personality disorder

"latent schizophrenics" Behavior is odd and eccentric but does not decompensated to the level of schizophrenia. - symptoms look more like schizophrenia than schizoid. - aloof, isolated and behave in a bland and apathetic manner. - Includes magical thinking, ideas of reference, illusions, and depersonalizations. - Speech pattern is sometimes bizarre and under stress, they may demonstrate psychotic symptoms.

What are the symptoms of withdrawal? What is alcohol withdrawal delirium?

- 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 - Alcohol withdrawal delirium: onset of delirium (acute disturbance of cognition, which is manifested by short-term confusion, excitement, disorientation, and a clouding of consciousness. Hallucinations and illusions are common) is usually on the second or third day of cessation.

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 ______.

- Cocaine - refers to the crackling sound of heard when mixture is smoked - uppers are stimulants which are taken in the morning and the downers are depressants such as alcohol or sleeping pills at night. - Inhaled cocaine causes pulmonary hemorrhage, chronic bronchiolitis, and pneumonia. - Snorting

What are some of the types of family dynamics that may predispose to antisocial personality disorder?

- Frequently arises from a chaotic home environment. - Parental deprivation during the first 5 years of life appears to be a critical predisposing factor - Seperation due to prenatal delinquency is more highly correlated than parental loss from other causes - highly associated with physical abuse or neglect, teasing, and lack of parental bonding in childhood.

Outcomes for BPD would include:__________________.

- Has not harmed self. - Seeks out staff when desire for self-mutilation is strong. Is able to identify true source of anger. - Expresses anger appropriately. - Relates to more than one staff member. - Completes activities of daily living independently. - Does not manipulate one staff member against the other in order to fulfill own desires

Regarding Sedative, Hypnotic and Anxiolytic Drugs: What is the concern with large doses regarding cardiovascular effect? Respiratory Depression?

- Hypotension - Barbiturates are capable of inhibiting the reticular activating system, resulting in respiratory depression

Opioid intoxication is treated with what narcotic antagonist????? _______ has been used to suppress opiate withdrawal symptoms.

- Naloxone (Narcan) - Methadone is best for withdrawal, Clonidine (Catapres) can also be used but doesn't work as well

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

- Prealcoholic phase - Early alcoholic phase - Crucial phase - Chronic phase

What nursing diagnoses and outcomes are considered for Antisocial Personality Disorder?

- Risk for other-directed violence - Defensive coping - Chronic low self-esteem - Impaired social interaction - Ineffective health maintenance Outcomes: Discusses angry feelings with staff and in group sessions. Has not harmed self or others. Can rechannel hostility into socially acceptable behaviors. Follows rules and regulations of the therapy environment. Can verbalize which of his or her behaviors are not acceptable. Shows regard for the right of others by delaying gratification of own desires when appropriate. Does not manipulate others in an attempt to increase feelings of self-worth. Verbalizes understanding of knowledge required to maintain basic health needs.

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

- The effect of alcohol on the heart is an accumulation of lipid in the myocardial cells, resulting in enlargement and a weakened condition. - enzymes changed: Elevation of CPK, AST, alanine aminotransferase (ALT), and LDH - Treatment is a total permanent abstinence from alcohol - Treatment for congestive heart failure may include rest, oxygen, digitalization, sodium restriction, and diuretics.

What important questions are necessary for a drug history assessment?

- When you were growing up, did anyone in your family drink alcohol or take drugs? - If so, how did the substance use affect the family situation? - When did you have your first drink/drug? - How long have you been drinking/taking drugs on a regular basis? - What is your pattern of substance use? When? What? How much? Where? - When did you have your last drink/drug? What was it and how much did you consume? - Does using cause problems for you? Describe. - Have you ever experienced an injury bc of your substance use? - Have you ever been arrested for drinking or using drugs? - Have you ever tried to stop? If so, what was the result? Did you experience any symptoms? - Have you ever experienced memory loss? - Describe a typical day in your life. - Are there any changes that you would like to make? - What plans or ideas do you have for seeing these changes occur?

How do barbiturates affect sleep and blood pressure?

- decreases the amount of sleep spent dreaming. - In high doses, can cause hypotension- decreases cardiac output, decreased cerebral blood flow, and direct impairment of myocardial contractility

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 400 to ____ mg/dL.

0.08% 100 and 200 mg/dl 400 to 700 mg/dl

There are two types of toxic reactions from hallucinogens, which are:

1. Panic reaction or bad trip: intense level of anxiety, and stimulation; hallucination and fear of going insane as well as paranoia and acute psychosis 2. Flashback: transient, spontaneous repetition of a previous LSD induced experience that occurs in absence of the substance

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

1. Portal hypertension: elevation of blood pressure through the portal circulation results from defective blood flow through the cirrhotic liver. 2. Ascites: a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. 3. Esophageal varices: 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. 4. Hepatic encephalopathy: 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, and reduction of intestinal ammonia using neomycin or lactulose.

Regarding Opioid addiction, which typical behavior patterns are involved?

1. an individual obtains the drug by prescription from a physician for relief of a medical problem. The individual increases the amount and frequency of use and then becomes obsessed with obtaining more. 2. Individual who is using the drug for recreational purposes and obtains them from illegal sources

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.

20%