Unit 5

opioids

morphine, meperidine (Demerol), codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, and propoxyphene, heroin, illicitly produced fentanyl, and normethadone

splitting

turning nursing staff against each other. use written rules all follow the same rules do not have a conversation about a staff member without them there splitting behavior - people are either all good or all bad, no in between

akasthesia and treatment

inability to remain still Change antipsychotic Administer Antiparkinsonian drug

criteria for diagnosing anorexia

(1) a refusal to maintain a minimally normal body weight for age and height (e.g., at least 85% of minimal expected weight or BMI ≥ 17.5); (2) an intense fear of gaining weight or becoming fat; (3) a disturbance in the way one's body size, weight, or shape is perceived; (4) amenorrhea (in girls and women after menarche).

criteria for diagnosing bulimia

(1) recurrent binge eating (at least two times per week for 3 months); (2) inappropriate compensatory behaviors such as self-induced vomiting, abuse of laxatives or diuretics, fasting, or excessive exercise that follow the binge eating episode; (3) self-evaluation that is unduly influenced by body shape and weight; and (4) a determination that the eating disorder does not occur exclusively during episodes of AN

treatment for alcohol withdrawal syndrome

(chlordiazepoxide [Librium], lorazepam [Ativan], and clonidine [Catapres]). Haloperidol (Haldol), esmolol (Brevibloc), or midazolam (Versed) may be given for severe acute alcohol withdrawal syndrome calm, nonstressful environment (usually a private room) and observed closely. The room remains lighted to minimize the potential for illusions (visual misrepresentations) and hallucinations. Homicidal or suicidal responses may result from hallucinations. Closet and bathroom doors are closed to eliminate shadows. Someone is designated to stay with the patient as much as possible. The presence of another person has a reassuring and calming effect, which helps the patient maintain contact with reality. To orient the patient to reality, any illusions are explained supplemental fluids, high protein diet

lupus nephritis treatment

- Acute glomerulonephritis and RPGN presentations require *heavy immunosuppression (high dose steroids + high dose mycophenolate mofetil or cyclophosphamide)* - Class V has a less aggressive presentation, but is often similarly treated with *steroid and mycophenolate at more moderate doses*

Lupus teaching

- Antimalarial and immunosuppressive (hydroxychloroquine) damage to the retinas should be seen by ophthalmologist every 6 months. Can take months to take effect make sure they do not stop. - Not to take hot baths can exaggerate symptoms - Lupus can affect multiple organs - Splinter hemorrhage on the fingers (tiny blood spots under the nail), weight loss, joint pain and butterfly rash may all be symptoms of lupus that the client comes in talking about - Immunosuppressants decrease immunity, increased risk of infection - Corticosteroids need to be tapered - Long term therapy affects their immune system - Can not eat raw veggies or fruits in neutropenic diet

Risk factors for Lupus

- Women between the ages of 20 and 40 - African American, Asian, or Native American descent - The incidence of lupus declines in women following menopause but remains steady in men. Estrogen plays a role. - Diagnosis of lupus can be delayed in older adult clients because many of the manifestations mimic other disorders or can be associated with reports common to the normal aging process. --Joint pain and swelling can significantly limit ADLs in older adult clients who have comorbidities. --Older adult clients are at an increased risk for fractures if corticosteroid therapy is used. - Identical twins may get Lupus more - triggers

hallucinogen intoxication symptoms

- anxiety - depression - paranoid ideation - ideas of reference - fear of losing one's mind - potentially dangerous behaviors such as jumping out a window in the belief that one can fly - sweating - tachycardia - palpitations - blurred vision - tremors - lack of coordination.

most common personality disorders in the elderly

paranoid, avoidant, dependent, and obsessive-compulsive

inhalant induced disorder

persistent dementia or inhalant-induced disorders, such as psychosis, anxiety, or mood disorders even if the inhalant abuse ceases. These disorders are all treated symptomatically.

where are cutaneous erythematous rashes seen

plaques with an adherent scale may be observed on the scalp, face, or neck. Areas of hyperpigmentation or depigmentation may be noted, depending on the phase and type of disease. The patient should be questioned about skin changes

extended use of alcohol may result in:

risk for mental and physical deterioration and infectious disease such as HIV and AIDS, hepatitis, and tuberculosis increases, especially for those with a history of intravenous (IV) drug use. An increased number of alcohol-dependent people commit suicide.

Drugs to treat bulimia

For bulimia, primarily antidepressants are used including amitryptiline, fluoxetine, desipramine, duloxetine

types of anorexia

restricting type and binge-eating/purging type

opioid withdrawal symptoms

- anxiety - restlessness - aching back and legs - cravings for more opioids - nausea - vomiting - dysphoria - lacrimation - rhinorrhea - sweating - diarrhea - yawning - fever - insomnia. Symptoms of opioid withdrawal cause significant distress, but do not require pharmacologic intervention to support life or bodily functions.

opioid intoxication symptoms

- apathy - lethargy - listlessness - impaired judgment - psychomotor retardation or agitation - constricted pupils - drowsiness - slurred speech - impaired attention and memory. Severe intoxication or opioid overdose can lead to coma, respiratory depression, pupillary constriction, unconsciousness, and death

later course of alcoholism

- characterized by periods of abstinence or temporarily controlled drinking

factors for increased substance abuse risk

- children of alcoholic parents - twins (identical) - poor family dynamics - urban areas - cultural factors

Signs of benzodiazepine withdrawal

- coarse hand tremors - seizures - sweating - elevated pulse and blood pressure - insomnia - anxiety, - nausea or vomiting.

Beneficial cannabis treatment

- short-term effects of lowering intraocular pressure - relieving the nausea and vomiting associated with cancer chemotherapy - anorexia and weight loss of AIDS - control of seizures in people who do not experience seizure control from other medications Two cannabinoids, dronabinol (Marinol) and nabilone (Cesamet), have been approved for treating nausea and vomiting from cancer chemotherapy.

child weight gain goals in eating disorders

0.5 to 2 lb per week. daily journal of intake, bingeing (excessive consumption) and purging (forced vomiting) behaviors, mood, and exercise

B12

1-2 mg/day Teach client about proper nutrition; urine may be dark yellow Cyanocobalamin (vitamin B12)

Treatment of alcohol overdose / contraindicated treatment

Gastric lavage or dialysis to remove the drug, and support of respiratory and cardiovascular functioning in an intensive care unit. The administration of central nervous system stimulants is contraindicated

PCP intoxication

belligerence, aggression, impulsivity, unpredictable behavior, seizures, hypertension, hyperthermia, and respiratory depression.

AA 12 steps

1. Admit we were powerless over alcohol 2. A power greater than ourselves can help us recover 3. Make the decision to change and turn to God 4. Create a moral inventory or ourselves 5. Admit to ourselves, others and God our wrongdoings 6. Demonstrate readiness to change for the better 7. Ask God for help 8. Make a list of everyone we harmed, make amends 9. Try to make direct amends with these people 10. Admit to being wrong, continue personal checkups 11. Maintain contact with God and ask for strength 12. Having a spiritual awakening as a result of process

four temperament traits

1. Harm Avoidance - fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability, and pessimistic worry in anticipation of problems 2. Novelty Seeking - quick-tempered, curious, easily bored, impulsive, extravagant, and disorderly. He or she may be easily bored and distracted with daily life, prone to angry outbursts, and fickle in relationships 3. Reward Dependence - tenderhearted, sensitive, sociable, and socially dependent. They may become overly dependent on approval from others and readily assume the ideas or wishes of others without regard for their own beliefs or desires. 4. Persistence - hardworking and ambitious overachievers who respond to fatigue or frustration as a personal challenge. They may persevere even when a situation dictates they should change or stop

therapeutic management of immunocompromised post transplant patient

1. Initiate neutropenic precautions as indicated by client's immune status 2. Maintain adequate nutrient intake including supplemental feedings for healing and immune function 3. Adhere to agency policy for IV bag and tubing changes (every 24 hours) and IV site changes (every 72-96 hours) 4. Provide or assist with regular mouth care to reduce oral microorganism count 5. Assist or remind client to use meticulous hand hygiene before eating and after using bathroom

nursing assessment of immunocompromised post transplant patient

1. Monitor temperature (may not be a reliable indicator of infection in an immunosuppressed client) 2. Monitor WBC count (increased immature WBCs [bands] may indicate infection) 3. Assess for signs of organ transplant rejection (indicates insufficient level of immunosuppression) 4. Assess clients for signs of infection, such as respiratory infection, urinary tract infection, or wound infection or communicable disease infections such as tuberculosis or shingles from reactivation of varicella-zoster virus 5. Assess client for opportunistic infections (nonpathogenic infections that become pathogenic because of a baseline immunosuppressed state) such as yeast (fungal) infections 6. Assess client for signs of cancer, especially of skin and lips, and lymphoid cancers

Atypical antipsychotics and side effects

1.) Clozaril = C clozapine 2.) Invega = I paliperidone 3.) Geodon = G ziprasidone 4.) Abilify = A aripiprazole 5.) Risperdal = R risperidone 6.) Seroquel = S quetiapine 1.) Metabolic Syndrome 2.) Gynecomastia 3.) Galactorrhea 4.) Weight gain 5.) Orthostatic hypotension 6.) Sedation

Typical antipsychotics and side effects

1.) Haldol (haloperidol) 2.) Thorazine (chlorpromazine) - Sedative effects (secondary to antihistaminic activity) - Hypotension (secondary to alpha-adrenergic blockade) - Anticholinergic (muscarinic) effects - Extrapyramidal side effects (EPS)/Movement disorders - Neuroleptic Malignant Syndrome (NMS) - Endocrine side effects - Dermal and Ocular Syndromes

limit setting

1.Stating the behavioral limit (describing the unacceptable behavior) 2.Identifying the consequences if the limit is exceeded 3.Identifying the expected or desired behavior

Criteria for diagnosing Lupus

4 of 11 must be present to diagnose lupus Malar rash photosensitivity oral ulcers arthritis serositis renal disease seizures fatigue weight changes anemia positive anti-nuclear antibody test

Client teaching post transplant

A. Client teaching: proper aseptic technique to reduce infection, signs and symptoms of infection and malignancy to watch for and report, and immunosuppressant drug therapy.

family differences with anorexia and bulimia

Those with anorexia do not get emotional support from their families, they may be mistreated and they cannot deal with conflict Those with bulimia have chaotic families with loose boundaries. They may also be mistreated that includes physical or sexual abuse

NSAIDs for Lupus

NSAIDs used for minor clinical manifestations are often used in conjunction with corticosteroids in an effort to minimize corticosteroid requirements

Hallmarks of borderline personality disorder

A.A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity 1.Frantic efforts to avoid real or imagined abandonment. 2.A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3.Identity disturbance: markedly and persistently unstable self-image or sense of self. 4.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) 5.Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6.Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7.Chronic feelings of emptiness. 8.Inappropriate, intense anger or difficulty controlling anger 9.Transient, stress-related paranoid ideation or severe dissociative symptoms.

medications for alcohol withdrawal

Administer benzodiazepines - lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium) - fixed schedule dosing After withdrawal may be prescribed medications to maintain abstinence from alcohol - chlordiazepoxide (Librium) or disulfiram (Antabuse) - Topiramate (Topamax)

schizotypal personality disorder + treatment

Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior, more common in males, transient psychotic episodes related to stress, may develop schizophrenia, odd appearance - unkempt, stained, ill fitting clothes, Peculiar behavior; very anxious and overly suspicious Tend to isolate themselves and have social isolation issues Magical thinking - ie. reincarnation Odd beliefs - ie. superstitious Thought or Perceptual distortions - hallucinations and delusions can exist but only briefly Magical thinking, flat affect or silly and inappropriate, like ESP and clairvoyance, children think they're superheroes, can be paranoid, anxiety around others, may have one significant relationship with first degree relative Willy Wonka is like this Treatment for symptoms- low-dose antipsychotics improve functioning and treat hallucinations/delusions and antidepressants or anxiety agents daily routine, hygiene, role play community interactions, list of community contact, social skills

Delirium Tremens + symptoms

Acute toxic state resulting from suddenly stopping alcohol consumption after a prolonged period of heavy drinking, or more often after a prolonged period of alcohol intake. Severity dependent on how much alcohol and for how long a time DTs life threatening condition with a high mortality rate if not treated Anxiety, uncontrollable fear, tremors, irritability, agitation, insomnia, and incontinence - usually talkative and preoccupied and experience visual, tactile, olfactory, and auditory hallucinations (that are often terrifying), seizures - Tachycardia, dilated pupils, profuse perspiration- Usually all vital signs are elevated.

neuroleptic malignant syndrome

Adverse reaction to antipsychotics Rare but can be fatal Severe EPS with rigidity Fever over 103 HTN, tachycardia, diaphoresis, incontinence, encephalopathy, VS instability, elevated WBC and CPK Remember FEVER(fever; encephalopathy; VS instability; elevated labs; rigidity) TX: stop the med Transfer to ICU stat

Most common manifestations of Lupus in children

Alopecia Anemia Arthralgia Arthritis Fatigue Lupus nephritis Photosensitivity Pleurisy Raynaud phenomenon Seizures Skin rashes, including malar rash Stomatitis Thrombocytopenia

physical manifestations of anorexia

Amenorrhea Low BMI Dental Caries Pedal Edema Bradycardia Electrolyte imbalance Lanugo hair on body Cold intolerance Alopecia Constipation Ritualistic behavior r/t food May binge & purge or purge without binging preoccupied with food related activities excessive exercise With general appearance and motor behavior, clients with anorexia may appear slow, lethargic, fatigued and maybe emaciated; they may be reluctant to answer questions. seldom smile, laugh, and are usually somber

Treating hyper acute vs. acute transplant rejection

An acute rejection requires early recognition and treatment with immunosuppressant therapy, whereas a hyperacute reaction requires immediate removal of the transplanted organ

Drugs known to trigger lupus flares

Antibiotics that contain sulfonamides Some herbal drugs like echinacea High-dose birth control pills Penicillin

monoclonal antibodies for lupus

Antibodies produced by a single clone of B lymphocytes and that are therefore identical in structure and antigen specificity. Belimumab (Benlysta) reduces disease activity and flares in patients with SLE. Live vaccines are contraindicated Caution should be used with all concurrent medications given the short duration that belimumab has been available.

treatment for sjogrens syndrome

Artificial tears, drops such as pilocarpine (Piloptic) Ocular ointments such as topical cyclosporine are used for dry eyes. Punctum plugs Systemic cholinergic agents such as cevimeline (Evoxac) for dry mouth Biotene oral rinse Eating small frequent meals Omitting spicy, salty, and irritating food; Avoiding smoking, excessive alcohol use, and drugs with anticholinergic side effects. /For severe cases, biologic DMARDs such as rituximab and belimumab and nonbiologic DMARDs such as hydroxychloroquine are sometimes used

atypical antidepressants and side effects

Asendin (Amoxapine) Wellbutrin (Bupropion) Remeron (Mirtazapine) Serzone (Nefazodone) Desyrel (Trazadone) stimulant properties headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia suppression of appetite, high risk for seizure- especially higher dose ranges, suicidal ideations

5 A approach to addicted pregnant mothers

Ask: Ask all women if they smoke and would like to quit. Advise: Encourage the use of clinically proven treatment plans. Assess: Provide motivation by discussing the "5 Rs":Relevance of quitting to the womanRisk of continued smoking to the fetusRewards of quitting for bothRoadblocks to quittingRepeat at every visit Assist: Help the woman to protect her fetus and newborn from the negative effects of smoking. Arrange: Schedule follow-up visits to reinforce the woman's commitment to quit.

what happens when attempting to quit gambling disorder

Attempts to quit or cut down result in restless, anxious, and irritable behavior.

Lab tests for Sjogrens

Autoantibodies to ribonucleoprotein particles (Ro[SS-A] and/or La[SS-B]), which act as antigens in this disease process. Rheumatoid factor is present in 50% to 70% of patients. ANA circulating DNA (cDNA) anti-CCP, anticentromere antibody (ACA) are all potentially present in Sjögren's syndrome and in some cases may act as markers for disease activity

diagnostic testing for autoimmunity

Autoantibody assays, complement fixation, and complement assays diagnose disorder Identification of HLA antigens provides indication of genetic inheritance

signs of alcohol overdose

Vomiting, unconsciousness, and respiratory depression. This combination can cause aspiration pneumonia or pulmonary obstruction. Alcohol-induced hypotension can lead to cardiovascular shock and death.

binge eating disorder

Binge eating disorder is characterized by recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress. Binge eating disorder frequently affects people over age 35, and it occurs more often in men than does any other eating disorder. Individuals are more likely to be overweight or obese, overweight as children, and teased about their weight at an early age

Naltrexone (ReVia, Trexan)

Blocks the effects of opiates; reduces alcohol cravings 350 mg/week, divided into three doses for opiate-blocking effect; 50 mg/day for up to 12 weeks for alcohol cravings Client may not respond to narcotics used to treat cough, diarrhea, or pain; take with food or milk; may cause headache, restlessness, or irritability opioid receptor antagonist often used to treat overdose. It blocks the effects of any opioids that might be ingested, thereby negating the effects of using p. 367p. 368 more opioids

Diagnostics for eating disorders

Blood sugar levels Electrolyte levels, to determine the presence and severity of dehydration, especially if someone is purging Liver and kidney functioning Chemicals in the urine Electrocardiogram (ECG), which ensures the heart is beating properly Blood tests may reveal low phosphorous, potassium, or magnesium Hypokalemia r/t purging

stimulants + types

drugs that stimulate or excite the central nervous system and have limited clinical use amphetamines, meth, cocaine

medications for scleroderma

Calcium channel blockers Anti-inflammatory medications can be used to control arthralgia, stiffness, and general musculoskeletal discomfort. Proton pump inhibitors are used for symptoms of gastric reflux. Aspirin and HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) are used to help reduce cardiovascular risk factors. (Flolan), bosentan (Tracleer), and sildenafil (Viagra) are used. Immunosuppressive agents such as cyclophosphamide and methotrexate have been used to improve skin and lung function. The antifibrotic agent imatinibmesylate is used to decrease fibrosis in various organs. Ultraviolet A irradiation is sometimes used to decrease the synthesis of collagen in dermal fibrosis and improve skin symptoms

Treatment of delirium tremens

Calm, non-stressful, some light, doors closed, presence of another person EKG and telemetry Seizure precautions Lorazepam, diazepam, chloriazepoxide

SSRIs and side effects

Celexa (Citalopram) Prozac (Fluoxetine) Paxil (Paroxetine) Zoloft (Sertraline) Lexapro (Escilatopram) Luvox (Fluvoxamine) .) Insomnia 2.) Sexual dysfunction 3.) Nausea 4.) Risk for suicidal thoughts

how are the personality clusters grouped?

Cluster A - Odd and eccentric Cluster B - Over-emotional and erratic Cluster C - Anxious and fearfu

history assessment of children for Lupus

Common signs and symptoms reported during the health history are history of fatigue, fever, weight changes, pain or swelling in the joints, numbness, tingling or coolness of extremities, or prolonged bleeding.

scleroderma

Compilation of autoimmune diseases affecting the connective tissue of the skin, blood vessel walls, and internal organs. Two general types: localized (affecting only the cutaneous system) and systemic. Women are affected three to five times more than men Onset occurs typically between the ages of 30 and 50 years. African American patients are affected much younger and have more diffuse symptoms with more severe lung disease. Remissions and exacerbations

Acute dystonic reaction and treatment

Contractures of neck, tongue, face, back Oculogyric crisis Eyes locked upward Treatment:BenadrylCogentin

Milan criteria

Criteria for limiting liver transplantation to patients with the best possible outcomes The Milan criteria include that the patient must have a single tumor measuring less than 5 cm, or have three or fewer lesions with none over 3 cm in size

Immunosuppressive agents for Lupus

Cyclophosphamide Azathioprine Mycophenolic acid (Myfortic) Methotrexate Alkylating agents and purine analogues) are used because of their effect on overall immune function. These medications are generally reserved for patients who have serious forms of SLE that have not responded to conservative therapies. Contraindicated in pregnancy Used most frequently in SLE nephritis

detoxifying from sedatives

Detoxification from sedatives, hypnotics, and anxiolytics is often medically managed by tapering the amount of the drug the client receives over a period of days or weeks, depending on the drug and the amount the client had been using. ESPECIALLY WITH BARBITURATES

behavior with anorexia and bulimia

Depression and obsessive-compulsive disorder are most common. Both anorexia and bulimia are characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. In addition, clients with bulimia may also exhibit high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder. Eating disorders are often linked to a history of sexual abuse, especially if the abuse occurred before puberty.

schizoid personality disorder + treatment

Detached from social relationships; restricted affect; involved with things more than people, don't care about others, common in males, avoid treatment, rarely experience enjoyment, not distressed about lack of emotion, have a rich fantasy life - fantasy relationships with someone they met briefly, can distinguish fantasy from reality, indecisive, lack future goals, self absorbed, little sexual contact Poor occupational functioning - likes solitary occupations that do not require interpersonal interaction Lack of social awareness Treat with antidepressants to increase life pleasure; second generation antipsychotics improve emotions; psychotherapy and group therapy Improve client's functioning in the community; assist client in finding case manager

how to reduce psychotic reactions to hallucinogens

Determine by urine or serum drug screen whether the patient has ingested hallucinogenic drug or has a toxic psychosis. Try to communicate with and reassure the patient."Talking down" involves understanding the process through which the patient is proceeding and helping the patient overcome fears while establishing contact with reality. Instruct the patient to keep the eyes open; this reduces the intensity of reaction. Reduce sensory stimuli by minimizing noise, lights, movement, tactile stimulation. Sedate the patient as prescribed if hyperactivity cannot be controlled; diazepam or a barbiturate may be prescribed. Have safety officers stationed near the patient's room. Monitor for hypertensive crisis if patient has prolonged psychosis due to drug ingestion.

How to find and implement education

First conduct a needs assessment Then develop an educational plan Implement a variety of teaching strategies Evaluate

Strategies to promote evidence based decision making

Develop and refine research-based policies and procedures Build consensus from the interdisciplinary team through the development of protocols, decision trees, standards of care and institutional clinical practice guidelines, and other such mechanisms Make research findings accessible through libraries and computer resources Provide organizational support such as time to do research and educational assistance in showing staff how to interpret research statistics and use findings Encourage cooperation among professionals When possible, hire nurse researchers or consultants to assist staff

stimulant intoxication symptoms + overdose

Develops rapidly - high or euphoric feeling - hyperactivity - hypervigilance - talkativeness - anxiety - grandiosity - hallucinations - stereotypic or repetitive behavior - anger, fighting - impaired judgment. Physiological effects include - tachycardia - elevated blood pressure - dilated pupils - perspiration or chills - nausea - chest pain - confusion - cardiac dysrhythmias. Overdoses of stimulants can result in seizures and coma

diagnosis of FAS

Diagnosis requires presence of three findings Documentation of all three facial abnormalities (Microcephaly- head circumference less than 10th %, small palpebral (eyelid) fissures, and abnormally small eyes Documentation of growth deficits (ht & wt both below 10th %) Documentation of CNS abnormalities

Anorexia fast facts

Earlier onset - 14 ish Below normal body weight Does not see behavior as a problem Distorted body image Severe food restriction May engage in binging and purging Avoids interpersonal conflict, can be very passive Controlling parents is a theme Need to be perfect

symptoms of bulimia

Eating large amounts of food uncontrollably (binging) Vomiting, using laxatives, or using other methods to eliminate food (purging) Excessive concern about body weight Depression or changes in mood Irregular menstrual periods Unusual dental problems, swollen cheeks or glands, heartburn, or bloating (swelling of the stomach)

symptoms of scleroderma

Edema Taut, smooth, shiny skin that eventually becomes nonfunctional Raynauds Skin and subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures No wrinkles No sweat - dry skin May remain localized in hands and feet Face appears masklike, immobile, and expressionless, and the mouth becomes rigid Can cause pulmonary hypertension CREST syndrome

Tricyclic antidepressants and side effects

Elavil (Amitriptyline) Anafranil (Clomipramine) Sinequan (Doxepin) Tofranil (Imipramine) Surmontil (Trimipramine) 1.) Sedation 2.) Orthostatic hypotension 3.) Anticholinergic effects 4.) Risk for suicide

Nursing interventions for eating disorders

Establishing nutritional eating patterns •Sit with the client during meals and snacks. •Offer liquid protein supplement if client is unable to complete meal. •Adhere to treatment program guidelines regarding restrictions. •Observe the client following meals and snacks for 1 to 2 hours. •Weigh the client daily in uniform clothing. •Be alert for attempts to hide or discard food or inflate weight. •Helping the client identify emotions and develop non-food-related coping strategies •Ask the client to identify feelings. •Self-monitoring using a journal •Relaxation techniques •Distraction •Assist the client in changing stereotypical beliefs. •Helping the client deal with body image issues •Recognize benefits of a more near-normal weight. •Assist in viewing self in ways not related to body image. •Identify personal strengths, interests, and talents.

inhalant intoxication

Euphoria, headache, disinhibition, altered level of consciousness to coma Renal, hepatic, and cardiac toxicity Aplastic anemia Fetal growth retardation Respiratory depression, arrest from CNS depression Vasodilation Nosebleeding Vertical and horizontal nystagmus Lack of convergence of eyes Sluggish pupils Temperature fluctuations Circumoral red spots/rash Air embolus

treatment of benzodiazepine intoxication

Evacuate stomach contents; lavage (if within 1 hour of ingestion); activated charcoal and a saline cathartic Dialysis for severe Start ECG monitoring. Observe for dysrhythmias. Administer flumazenil (Romazicon), a benzodiazepine antagonist (reversal agent). Refer patient for psychiatric evaluation (potential suicide intent).

Binge eating disorder fast facts

Even olde onset usually Overweight Aware that behavior is maladaptive Shame over body shape and weight Binge eating without purging Unlikely to have history of bulimia or anorexia Binging temporarily alleviates negative mood followed by intense shame

histrionic personality disorder + treatment

Excessive emotionality and attention seeking, often seek assistance for depression, unexplained physical problems, and difficulties with relationships but do not see their own behavior as being at fault, more common in females, exaggerate closeness in relationships, dramatize minor occurrences, colorful speech, may overdress, want to impress others, emotional lability, may appear phony, will agree with anything, change opinions easily, fish for compliments, Treatment with psychotherapy (treatment of choice)/antidepressant and antianxiety agents for symptoms Teach social skills; provide factual feedback about behavior, explore perceptions of others' behavior, roleplay social skills, establish eye contact, active listening, respecting personal space

tardive dyskinesia

Facial: Protruding tongue, blowing, licking, smacking, spastic facial distortion Limbs: Rapid, purposeless, irregular movements Slow, complex, serpentine movement Trunk: Neck and shoulder movement Dramatic hip jerks and rocking

lupus symptoms

Fatigue fever joint pain, stiffness, pain non movement and swelling - earliest symptom butterfly shape to rash on the face that covers the cheeks and bridge of nose or rashes elsewhere to the body skin lesions that appear or worsen with sun exposure Raynauds Phenomenon shortness of breath chest pain headaches, confusion, and memory loss splinter hemorrhages alopecia oral and nasal ulcers - especially on buccal mucosa or hard palate, occur in groups discoid rash - chronic rash with erythematous papules or plaques and scaling and can cause scarring and pigmentation changes INITIAL SKIN INVOLVEMENT IS PRECURSOR TO SYSTEMIC INVOLVEMENT

effects of alcohol on fetus

Fetal alcohol syndrome (one of the most common known causes of mental retardation) Fetal alcohol spectrum disorders Alcohol-related birth defects

narcissistic personality disorder + treatment

Grandiose; lack of empathy; need for admiration, mainy in males, fantasies of unlimited success, superiority, fragile self esteem, Fantasies of power & brilliance Needs to be admired Arrogance - lacks empathy and very demanding in relationships; feel "entitled" Over-estimates self and under-estimates others - fear abandonment and have a great deal of shame cognitive/behavioral therapy; group therapy; and family therapy Matter-of-fact approach; gain cooperation with needed treatment; teach client any needed self-care skills

Signs of transplant rejection - hyper acute, acute, chronic

HYPERACUTE = onset within 48 hours, malaise, high fever, graft tenderness ACUTE = 1 week to 2 yeras, oliguria, anuria, flank tenderness, lethargy, fluid retention, increased BP, Temp, BUN, Potassium, and Creatinine CHRONIC = gradual over months to years, increased BUN & Creatinine, fatigue, imbalance proteinuria & electrolytes

medications for anorexia

High doses of amitriptyline (antidepressant-tca) and cyproheptadine (antihistamine) promote weight gain. Olanzipine (antiphychotic) helps with distorted body image and causes weight gain. Fluoxetine(antidepressant-SSRI) Corticosteroids (Dexamethasone) increase appetite and may provide short-term weight gain Progestin (megestrol acetate) is used in palliative care because it produces temporary weigh gain of primary fatty tissue Dronabionol is a man-made form of tetrahydrocannabinol (THC) that can be helpful in reducing nausea and vomiting, appetite loss, pain, and anxiety.

Antimalarials for Lupus

Hydroxychloroquine, is effective for managing cutaneous, musculoskeletal, and mild systemic features of SLE. S/E: Digestive problems such as stomach, nausea, vomiting, and diarrhea Headache and/or dizziness Blurred vision Trouble sleeping Itchiness

Medications for GVHD

If GVHD occurs, administer immunosuppressive drugs such as cyclosporine, tacrolimus, or mycophenolate (which place the child at further risk for infection

disulfiram reaction with alcohol

If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result The client must also avoid a wide variety of products that contain alcohol, such as cough syrup, lotions, mouthwash, perfume, aftershave, vinegar, and vanilla and other extracts

four categories of symptoms of substance use disorder

Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use Risky use: substance is used in risky settings; continued use despite known problems Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)

effects of methadone on fetus

Improvement in many of the detrimental fetal effects associated with heroin use Withdrawal symptoms are common in newborns. Possible low birthweight due to symmetric fetal growth restriction Increased severity and longer period of withdrawal (due to methadone's longer half-life) Seizures (commonly severe) do not usually occur until 2-3 wks of age, when the newborn is at home. Increased rate of SIDS (3-4 times higher)

anorexia behavioral assessment

In the early stages, clients often deny having a negative body image or anxiety regarding their appearance. They are pleased with their ability to control their weight and may express this. When they initially come for treatment, they may be unable to identify or to explain their emotions about life events such as school or relationships with family or friends. A profound sense of emptiness is common. As the illness progresses, depression and lability in mood become more apparent. As dieting and compulsive behaviors increase, clients isolate themselves. This social isolation can lead to a basic mistrust of others and even paranoia.

cocaine manifestations

Increased heart rate and blood pressure Hyperpyrexia Seizures Sluggish, dilated pupillary response Muscle rigidity Increased energy, agitation, aggression Ventricular dysrhythmias Intense euphoria, then anxiety, sadness, insomnia, and sexual indifference Cocaine hallucinations with delusions Psychosis with extreme paranoia and ideas of persecution Hypervigilance Chronic psychotic symptoms may persist. Overall psychotic symptoms are short-lived compared to methamphetamines

physical manifestations of bulimia

Irregular or absent periods Not underweight Calluses or scars on knuckles or hands Discolored teeth/dental caries Puffy "chipmunk" cheeks Frequent fluctuations in weight Clients with bulimia may be underweight or overweight but generally are close to expected body weight and willing to talk usually pleasant and cheerful until they describe their binging/purging cycle. You must ask about self-harm or suicide, they may cut themselves

Thiamine (vitamin B1)

Korsakoff syndrome in alcoholism 100 mg/day Teach client about proper nutrition

Lab findings in Lupus with children

Laboratory findings may include decreased hemoglobin and hematocrit, decreased platelet count, and low WBC count. Complement levels, C3 and C4, will also be decreased. Though not specific to SLE, the antinuclear antibody (ANA) is usually positive in children with SLE.

Bulimia fast facts

Later onset around 18 Normal body weight Aware that behavior is maladaptive More normal body image Cycles of binging and purging May have history of anorexia Binging temporarily alleviates negative mood followed by intense shame

Clinical Institute Withdrawal Assessment (CIWA)

Less than 8 mild withdrawal 8-15 moderate withdrawal Greater than 15 severe withdrawal 10 or greater needs medication

Drugs to treat aggression

Lithium Anticonvulsants Low-dose antipsychotics Antipsychotics Lithium Cholinergic agonists (donepezil) Imipramine (Tofranil) Carbamazepine (Tegretol) Diphenylhydantoin (Dilantin) Benzodiazepines MAOIs SSRIs Atypical antipsychotics

effects of methamphetamines on fetus

Little research on use during pregnancy because its use is less common than cocaine or narcotics Fetal effects similar to cocaine (suggesting vasoconstriction as possible underlying mechanism) Possible maternal malnutrition, leading to problems with fetal growth and development Increased risk for preterm birth and low-birthweight newborns Infants may have withdrawal symptoms, including dysphoria, agitation, jitteriness, poor weight gain, abnormal sleep patterns, poor feeding, frantic fist sucking, high-pitched cry, respiratory distress soon after birth, frequent infections, and significant lassitude Long-term effects not known

Long term use of inhalants and signs

Long-term use results in cortical atrophy and brainstem dysfunction, in addition to cardiomyopathy and emphysemalike abnormalities of the lung. Significant others or parents may report that the patient has had poor school or work performance or attendance, weight loss, poor hygiene, fatigue, nosebleeds, and decreased appetite

treating cocaine intoxication

Maintain airway and provide respiratory support. Control seizures. Monitor cardiovascular effects; have antiarrhythmic drugs and defibrillator available. Treat for hyperthermia. If cocaine was ingested, evacuate stomach contents and use activated charcoal to treat. Whole bowel irrigation may be necessary to treat body packers ("mules"). Refer for psychiatric evaluation and treatment in an inpatient unit that eliminates access to the drug. Include drug rehabilitation counseling.

barbiturate overdose and treatment

Maintain airway and provide respiratory support. Perform suctioning as necessary. Support cardiovascular and respiratory functions Start infusion through large-gauge needle or IV catheter to support blood pressure Evacuate stomach contents or lavage if within 1 hour of ingestion to prevent absorption Assist with hemodialysis for patient with severe overdose. Patient awakening from overdose may demonstrate combative behavior. Refer for psychiatric and drug rehabilitation consultation

Disulfiram (Antabuse)

Maintains abstinence from alcohol 500 mg/day for 1-2 weeks, then 250 mg/day Teach client to read labels to avoid products with alcohol

Methadone (Dolophine)

Maintains abstinence from heroin Up to 120 mg/day for maintenance May cause nausea and vomiting

Levomethadyl (Orlaam)

Maintains abstinence from opiates 60-90 mg three times a week for maintenance Do not take drug on consecutive days; take-home doses are not permitted narcotic analgesic with the only purpose of treating opiate dependence. It is used in the same manner as methadone.

Buprenorphine/naloxone (Suboxone)

Maintains abstinence from opiates and decreases opiate cravings 4/1 mg-24/6 mg daily for maintenance May cause orthostatic hypotension, sedation; avoid CNS depressants Buprenorphine is a semisynthetic opioid, and naloxone is an opioid inverse agonist. Clients can be tapered from this medication after treatment and with adequate psychosocial support. Some clients may remain on a maintenance dose for an extended time.

MAOIs and side effects

Marplan (Isocarboxazide) Carbex (Selegeline) Nardil (Phenelzine) Parnate (Tranylcypromine) hypertensive crisis when taken with tyramine caution when taking with SSRIs, meperidine, decongestants, TCAs, antipsychotics, st johns wort, tryptophan, ritalin, asthma meds side effects include insomnia, wgt gain, anticholinergic effects, lightheadedness or dizziness, sexual dysfunction

paranoid personality disorder + treatment

Mistrust and suspicions of others; guarded, restricted affect Hypervigilant- enhanced sensory sensitivity; very "watchful"; increased anxiety that leads to exhaustion Hostile; Jealous; Controlling Projection is their defense mechanism - blames others To improve relaxation in those with paranoid personality disorder, antianxiety medications can be used. Antipsychotics can be used to aid with agitation and delusions Serious, straightforward approach; teach client to validate ideas before taking action; involve client in treatment planning, common in males ask what the client would like to accomplish in concrete terms, such as minimizing problems at work or getting along with others

cardiac complications of lupus

Most common: pericarditis - may present with substernal chest pain that is aggravated by movement or inspiration. Symptoms can be acute and severe or last for weeks at a time myocarditis hypertension dysrhythmias valvular incompetence Women who have SLE are also at risk for early-onset atherosclerosis, making them much more likely to suffer myocardial infarction or stroke. Inflammation determines this.

what mimics alcohol intoxication

hypoglycemia

stimulant intoxication

Nausea, vomiting, anorexia Palpitations, tachycardia Increased blood pressure Tachypnea, anxiety Nervousness Diaphoresis, mydriasis Repetitive or stereotyped behavior Irritability, insomnia, agitation Visual misperceptions, auditory hallucinations Fearfulness, anxiety, depression, hostility, paranoia Hyperactivity, rapid speech, euphoria, hyperalertness Decreased inhibition Seizures, coma, hyperthermia Cardiovascular collapse Rhabdomyolysis MDMA is both a hallucinogenic and stimulant. MDPV and mephedrone effects last >24 hours.

effects of heroin on fetus

Newborns of heroin-addicted mothers are born dependent on heroin Increased risk for transmission of hepatitis B and C and HIV to newborns when mothers share needles Significantly increased rates of stillbirth, fetal growth restriction, preterm birth, and newborn mortality (3-7 times greater) Small-for-gestational-age newborns, meconium aspiration, high incidence of SIDS, and delayed effects from subacute withdrawal (restlessness, continual crying, agitation, sneezing, vomiting, fever, diarrhea, seizures, irritability, and poor socialization [possibly persisting for 4-6 mo]); Intrauterine death or preterm birth is possible with abrupt cessation of heroin use

Hallucinogen withdrawal

No withdrawal, but some can crave it. Flashbacks for up to 5 years.

effects of marijuana on fetus

Not shown to have teratogenic effects on fetus; no consistent types of malformations identified Fetal growth restriction (FGR) is common due to delivery of carbon monoxide to fetus Increased risk for small for gestational age Altered responses to visual stimuli, sleep-pattern abnormalities, photophobia, lack of motor control, hyperirritability, increased tremulousness, and high-pitched cry noted in infants of mothers who smoked marijuana Research related to long-term effects is continuing

nursing interventions for NAS

Nutrition - small bottle feedings with high calorie formula, feed in upright position, Breastfeeding is encouraged unless Mother still using, assess frequency and characteristics of bowel movements Comfort - swaddling, low light, gentle handling, quite environment with minimal stimulation, use of soft voices, pacifiers to promote "self-soothing", frequent small feedings, vertical rocking. Drug therapy is indicated if the newborn has seizures, diarrhea and vomiting resulting in excessive wt loss and dehydration, poor feeding, inability to sleep, and fever unrelated to infection. - opioids (morphine or methadone) and phenobarbital if opioid does not adequately control symptoms. Promote parent-newborn interaction

anorexia risk factors

Obesity; dieting at an early age Issues of developing autonomy and having control over self and environment; developing a unique identity; dissatisfaction with body image Family lacks emotional support; parental maltreatment; cannot deal with conflict Cultural ideal of being thin; media focus on beauty, thterm-107inness, fitness; preoccupation with achieving the ideal body

bulimia risk factors

Obesity; early dieting; possible serotonin and norepinephrine disturbances; chromosome 1 susceptibility Self-perceptions of being overweight, fat, unattractive, and undesirable; dissatisfaction with body image Chaotic family with loose boundaries; parental maltreatment including possible physical or sexual abuse Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation with achieving the ideal body

fetal alcohol spectrum disorder

Other disorders included in the grouping fetal alcohol spectrum disorders (FASDs) are alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). Children with ARND primarily display intellectual disabilities related to behavior and learning while children with ARBD may have birth defects of the heart, kidneys, and/or bones.

general signs of transplant rejection

Pain at the site of the transplant Feeling unwell Crankiness (in children) Flu-like symptoms Fever Weight changes Swelling Change in heart rate Urinating less often · See your health care provider right away if you have any of these symptoms. · Organ rejection can be acute or chronic. It's fairly common to have an episode of acute rejection within a year of your transplant. Sometimes, acute rejection leads to chronic rejection. This is when an organ slowly loses its ability to function. · Rejection becomes less likely over time. But you're never quite out of the woods. It may develop even years after the surgery. That's why it's key to keep on top of your condition and get regular checkups.

When to screen Lupus patients for Osteoporosis

Patients should have a bone mineral density test performed at diagnosis and prior to beginning steroid use to determine a baseline status and then every 2 years thereafter.

Barbiturates and intoxication symptoms

Pentobarbital (Nembutal), secobarbital (Seconal), amobarbital (Amytal), gamma-hydroxybutyrate (GHB, "liquid Ecstasy") Acute intoxication (may mimic alcohol intoxication): Respiratory depression Flushed face Decreased pulse rate; decreased blood pressure Increasing nystagmus (to vertical and horizontal gaze) Sluggish pupils Lack of convergence of eyes Depressed deep tendon reflexes Decreasing mental alertness Difficulty in speaking Poor motor coordination and flaccid muscles Coma, death GHB: Sexual disinhibition Amnesia, myoclonus, agitation Overdoses when mixed with alcohol

Nursing care for lupus

assess respiratory status assess end organ function plan rest periods identify triggers refer to dietician medications: glucocorticoids, NSAIDs, cyclosphamide (immunosuppressant), antimalarials (hydroxychloroquine)

treatment of PCP intoxication

Place patient in a calm, supportive environment to minimize stimuli; protect from self-injury. Medications to control seizures and blood pressure, cooling devices, mechanical ventilation Avoid talking down. Do not leave patient unobserved. Treat symptoms as they occur. Refer all patients in this category for psychiatric and drug evaluation/rehabilitation.

obsessive-compulsive personality disorder + treatment

Preoccupation with orderliness, perfectionism, and control, mainly in males, needed to be perfect in childhood, do right thing to win parental approval, expressing emotions meant bad consequences, restricted emotional range, stubborn to relinquish control, have a hard time reaching a decision, limited insight, rigid rules, low self esteem, difficulty forming relationships, not warm towards others, frugal, antidepressants (SSRIs); psychotherapy; group therapy, self-help groups Encourage negotiation with others; assist client in making timely decisions and complete work; cognitive restructuring techniques

effects of cocaine on fetus

Preterm birth and lower birthweight Unclear impact on later development Speculation that cocaine interferes with infant's cognitive development, leading to learning and memory difficulties later in life Associated congenital anomalies: GU, cardiac, and CNS defects, and prune belly syndrome Other typical newborn characteristics: smaller head circumference, piercing cry, limb defects, ambiguous genitalia, poor feeding, poor visual and auditory responses, poor sleep patterns, decreased impulse control, stiff, hyperextended positioning, irritability and hypersensitivity, inability to respond to caretaker. Elevated vital signs secondary to stimulating effect.

maternal risk factors for NAS

Previous unexplained fetal demise, lack of prenatal care, incarceration, prostitution, cigarette smoking, preterm birth, hx STI and or HIV or HCV, mental health disorders, Hx IPV

SNRIs and side effects

Pristiq (Desvenlafaxine) Effexor (Venlafaxine) Cymbalta (Duloxetine) abnormal dreams, sweating, constipation, dry mouth, loss of appetite, weight loss, tremor, abnormal vision, headaches,nauseau, vomiting, dizziness, and loss of sexual desire, suicidal ideation

treating inhalant intoxication

Provide airway support, ventilation, and oxygen. Treat cardiac dysrhythmias and hypotension. Provide advanced cardiac life support as needed. No antidote Monitor for profound hypotension when amyl nitrate is combined with MDMA and sildenafil or with anesthetic agents. Monitor for hypertension when volatile solvents used.

treating stimulant intoxication

Provide airway support, ventilation, cardiac monitoring; insert IV line. Use GI evacuation in cases of oral overdose; activated charcoal, gastric lavage if within 1 hour of ingestion. Keep in calm, cool, quiet environment Tx with chlorpromazine (Thorazine) - antipsychotic - controls hallucinations, lowers BP and relieves nausea Administer small doses of diazepam (Valium) (IV) or haloperidol (Haldol) as prescribed for CNS and muscular hyperactivity. Treat seizures with benzodiazepines Treat sympathetic stimulation with beta-blocker agents as prescribed. Try to communicate with patient if delusions or hallucinations are present. Place in a protective environment Refer for psychiatric and drug rehabilitation evaluation.

extrapyramidal symptoms and treatment

Pseudoparkinsonism Masklike face Stiff or stooped posture Drooling Pill rolling Shuffling gait TX: anticholinergics (Artane, Cogentin)

Refeeding syndrome

Refeeding syndrome occurs when patients that have been starved begin to eat and metabolize calories. The body shifts from a catabolic state (a state of breaking down tissues for nutrients) to an anabolic state (a state of rebuilding tissues/growth).This change in metabolism leads to secretion of many hormones which contribute to shifts in salts and fluids in the body. The body is so hungry for nutrients that in an effort to rebuild cells, it moves many salts from the blood to the growing cells. Complications include heart failure, arrhythmias, respiratory failure, muscle breakdown, and death

age of lupus onset

SLE is usually diagnosed after age 5 years (usually between 15 and 45 years of age), but onset can occur at any age. The peak incidence for diagnosis is in the preadolescent years

Way to remember 11 Lupus Criteria

SOAP: S—Serositis (inflammation of different lining - pleuritis, resp problem that's common) O—Oral or nasopharyngeal ulcerations A—Arthritis P—Photosensitivity BRAIN: B—Blood disorder reproduction of cells is slowed down (Low PLT—thrombocytopenia) w/ High WBC (Low RBC - anemia) w/ high WBC R—Renal involvement Check creatinine & UA A—Abnormal ANA titer = (+) I—Immunologic phenomenon (we don't know why the body is attacking itself) N—Neurological (psychosis, behavioral changes) MD: M—malar rash (butterfly rash) D—Discoid rash (can be all over)

Treatment of alcohol withdrawal

Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms. Barbiturates can be used for benzodiazepine-resistant cases of alcohol withdrawal Disulfiram (Antabuse) may be prescribed to help deter clients from drinking Withdrawal can be accomplished by fixed-schedule dosing known as tapering, or symptom-triggered dosing in which the presence and severity of withdrawal symptoms determine the amount of medication needed and the frequency of administration

What happens when alcohol withdrawal goes untreated

Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium, called delirium tremens.

time for opioid withdrawal symptoms + treatment

Short-acting drugs such as heroin produce withdrawal symptoms in 6 to 24 hours; the symptoms peak in 2 to 3 days and gradually subside in 5 to 7 days. Longer acting substances such as methadone may not produce significant withdrawal symptoms for 2 to 4 days, and the symptoms may take 2 weeks to subside. Methadone can be used as a replacement for opioids, and the dosage is then decreased over 2 weeks. Substitution of methadone during detoxification reduces symptoms to no worse than a mild case of flu

avoidant personality disorder + treatment

Social inhibitions; feelings of inadequacy; hypersensitive to negative evaluation, low self esteem, both genders, anxious and fidgety with poor eye contact, reluctant to ask questions, sad, shy, fearful, easily devastated by criticism, low self esteem, wish for intimacy but fear rejection, eager to please supervisor antidepressants(SSRIs and SNRIs); group and individual therapy Support and reassurance; cognitive restructuring techniques; promote self-esteem

dependent personality disorder + treatment

Submissive and clinging behavior; excessive need to be taken care of, fear of separation, more common in females, runs in families especially in youngest child, seek treatment for anxious depressed somatic symptoms, pessimistic, self critical, feelings hurt easily, scared to be alone, can't make decisions, sustain relationships no matter what psychotherapy is the treatment of choice; antidepressant/antianxiety agents to aid in moving to independence; cognitive behavior therapy Foster client's self-reliance and autonomy; teach problem-solving and decision-making skills; cognitive restructuring techniques, express grief and loss over end of a relationship, identify strengths and needs, reframing, decatastrophizing

antisocial personality disorder + treatment

Superficial charm - "sociopaths" - aids in manipulation Violates the rights of others - antagonistic behaviors Lies and profound lack of empathy - callous; no remorse or guilt Extremely manipulative and deceitful Risk-taking behavior, impulsive, irresponsible Common legal/criminal conduct and substance abuse Never their fault Common in males, peak in 20s diminish after 45, normal appearance, (In adolescence, clients may have engaged in lying, truancy, sexual promiscuity, cigarette smoking, substance use, and illegal activities) Behavior therapy with safety as a priority; limit and boundary setting is important; impulse control and anger management; mood stabilizers to aid with aggression and impulsiveness •Limit setting •Consistent adherence to rules and treatment plan •Confrontation •Point out the problem behavior. •Keep the client focused on him or herself. •Help clients solve problems and control emotions. •Effective problem-solving skills •Decreased impulsivity •Expressing negative emotions such as anger or frustration •Taking a time-out from stressful situations •Enhancing role performance •Identifying barriers to role fulfillment •Decreasing or eliminating use of drugs and alcohol Positive feedback for honest Don't attempt to coax to do the right thing Rewards for acceptable behavior Avoid alcohol and drugs

treatment of opioid overdose

Support respiratory and cardiovascular functions. Establish IV lines Obtain blood for chemical and toxicologic analysis. Patient may be given bolus of glucose to eliminate possibility of hypoglycemia. Cool compresses Administer narcotic antagonist (naloxone hydrochloride IV, IM [Narcan]) as prescribed - may need repeat doses Continue to monitor level of responsiveness and respirations, pulse, and blood pressure. Send urine for analysis; opioids can be detected in urine. Obtain an ECG. Do not leave patient unattended Hemodialysis may be indicated Activated charcoal may be considered if opioids were taken orally and if the patient is alert. Monitor for pulmonary edema

Acamprosate (Campral)

Suppresses alcohol cravings 666 mg three times daily Monitor for diarrhea, vomiting, flatulence, and pruritis prescribed for clients recovering from alcohol abuse or dependence to help reduce cravings for alcohol and decrease the physical and emotional discomfort that occurs especially in the first few months of recovery. These include sweating, anxiety, and sleep disturbances Acamprosate is often thought to be more effective with "relief cravers," while naltrexone is more effective with "reward cravers"

Clonidine (Catapres)

Suppresses opiate withdrawal symptoms 0.1 mg every 6 hours PRN Take blood pressure before each dose; withhold if client is hypotensive It is most effective against nausea, vomiting, and diarrhea, but produces modest relief from muscle aches, anxiety, and restlessness

Opioid Detox

Symptoms cause great distress; however, do not require pharmacological interventions to support life or bodily functions Depending on the substance withdrawal may occur within hours or days and may take 5 days to 2 weeks to subside Methadone may given to during detox to decrease the symptoms (to no worse than a mild cold to the flu) - does is decreased over 2 weeks. Withdrawal symptoms and drug cravings may last for weeks to months

types of sedatives and effects

barbiturates, nonbarbiturate hypnotics, and anxiolytics, particularly benzodiazepines The effects of the drugs, symptoms of intoxication, and withdrawal symptoms are similar to those of alcohol.

alcohol withdrawal symptoms and when they begin, peak, and end

Symptoms include - coarse hand tremors - sweating - elevated pulse and blood pressure - insomnia - anxiety, - nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium, called delirium tremens. Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake. Alcohol withdrawal usually peaks on the second day and is over in about 5 days. This can vary, however; and withdrawal may take 1 to 2 weeks.

Lab tests for lupus

The ANA is positive in more than 95% of patients with SLE, indicating exceptional specificity. Other laboratory tests include anti-DNA (antibody that develops against the patient's own DNA) Anti-ds DNA (antibody against DNA that is highly specific to SLE, which helps differentiate it from drug-induced lupus) Anti-Sm (antibody against Sm, which is a specific protein found in the nucleus). CBC, which may reveal anemia, thrombocytopenia, leukocytosis, or leukopenia Abnormal urinalysis may show increased urine sediment rate and proteinuria, which may indicate kidney involvement.

How to diagnose Sjogrens

The classification criteria for diagnosis of Sjögren's syndrome identify six distinct indices Ocular symptoms such as chronic dry eye Positive ocular tests (evaluating tear production, corneal, and conjunctival damage). Ocular testing may include Schemer tear test or Rose Bengal tests. Oral symptoms, dry mouth. Histopathology evaluation (of salivary glands). This will help differentiate the cause of dry mouth from other causes, such as infection, malignancy, stones, and sarcoidosis. Salivary gland involvement.

fetal alcohol syndrome

The distinctive pattern identified three specific findings: growth restriction (prenatal and postnatal), craniofacial structural anomalies, and CNS dysfunction. These distinctive findings were called FAS, characterized by physical and mental disorders that appear at birth and remain problematic throughout the child's life.

distinguishing factors between anorexia and bulimia

The distinguishing features of anorexia include an earlier age at onset and below-normal body weight; the person fails to recognize the eating behavior as a problem. Clients with bulimia have a later age at onset and near-normal body weight. They are usually ashamed and embarrassed by the eating behavior

Types of medications for Lupus

The mainstay of SLE treatment is based on pain management and nonspecific immunosuppression. Therapy includes monoclonal antibodies, corticosteroids, antimalarial agents, NSAIDs, and immunosuppressive agents Flaxseed for inflammation Fish oil

when do sedatives produce withdrawal symptoms

The onset of withdrawal symptoms depends on the half-life of the drug. Lorazepam:6-8 hours Diazepam: about 1 week

assessment of lupus

The skin is inspected for erythematous rashes. Areas of hyperpigmentation or depigmentation may be noted, depending on the phase and type of disease. The patient should be questioned about skin changes (because these may be transitory) and specifically about sensitivity to sunlight or artificial ultraviolet light. The scalp should be inspected for alopecia The mouth and throat for ulcerations Cardiovascular assessment includes auscultation for pericardial friction rub Check for abnormal lung sounds. Papular, erythematous, and purpuric lesions developing on the fingertips, elbows, toes, and extensor surfaces of the forearms or lateral sides of the hand that may become necrotic Joint swelling, tenderness, warmth, pain on movement, stiffness, and edema - involvement is often symmetric and similar to that found in RA. Ask about any behavioral changes, including manifestations of neurosis or psychosis. Signs of depression are noted, as are reports of seizures, chorea, or other central nervous system manifestations.

sedative withdrawal syndrome

The withdrawal syndrome is characterized by symptoms that are the opposite of the acute effects of the drug— - autonomic hyperactivity (increased pulse, blood pressure, respirations, and temperature) - hand tremor - insomnia - anxiety - nausea - psychomotor agitation Seizures and hallucinations occur only rarely in severe benzodiazepine withdrawal

types of designer drugs

bath salts, ecstasy, special K, 2c-1 (smiles), plant food

Training vs Education

Training Organized method of ensuring that people have knowledge and skills for a specific purpose (to perform the duties of the job) Identify deficiencies so they can be corrected before they handicap the employee Implementation of best practices Education More formal and broader Training has immediate use- education develops individuals in a broader sense Recognizing educational needs and encouraging educational pursuits Managers not normally responsible for an employee's formal education

treatment of stimulant intoxication

Treatment with chlorpromazine (Thorazine), an antipsychotic, controls hallucinations, lowers blood pressure, and relieves nausea

Folic Acid (Folate)

Treats nutritional deficiencies 1-2 mg/day Teach client about proper nutrition; urine may be dark yellow

Transplant rejection hypersensitivity type

Type IV: delayed hypersensitivity reactions Pyrexia, pain, edema, and failure of transplanted organ characterize transplant rejection

What tests detect kidney transplant rejection

Ultrasonography may be used to detect enlargement of the kidney; percutaneous renal biopsy (most reliable) and x-ray techniques are used to evaluate transplant rejection. If the body rejects the transplanted kidney, the patient needs to commence dialysis. The rejected kidney may or may not be removed, depending on when the rejectionoccurs (acute vs. chronic) and the risk for infection if the kidney is left in place.

borderline personality disorder + treatment

Unstable relationships, self-image, and affect; impulsivity; self-mutilation, common if first degree relative has it, more common in women, transient psychotic symptoms under stress Unstable; significant impulsiveness; very dramatic; suicidal/homicidal; self-destructive; emotional lability (from one extreme to another that does not fit the setting) Chronic emptiness Intense fear of abandonment Splitting- see something as wonderful or horrible- they can not see both aspects at one time Treatment behavior and group therapy; anger management; health care team with a calm, united approach to enhance control; mood stabilizers (anticonvulsants)/ antipsychotics/ omega 3 supplements. May use opioid receptor antagonist to decrease self-destructive behavior •Promoting client's safety •No-self-harm contract •Safe expression of feelings and emotions •Helping client to cope and control emotions •Identifying feelings •Journal entries •Moderating emotional responses •Decreasing impulsivity •Delaying gratification •Cognitive restructuring techniques •Thought stopping •Decatastrophizing •Structuring time •Teaching social skills •Teaching effective communication skills •Entering therapeutic relationship •Limit setting •Confrontation Establishing boundaries Using I statements Structure day with activities

corticosteroids for lupus

Used topically for cutaneous manifestations Used in low oral doses for minor disease activity, and in high doses for major disease activity. Intravenous (IV) administration of corticosteroids is an alternative to traditional high-dose oral administration. One of the most important risk factors associated with the use of corticosteroids in SLE is osteoporosis and fractures.

cannabis symptoms, progression

Users report a high feeling similar to that with alcohol - lowered inhibitions - relaxation - euphoria - increased appetite - impaired motor coordination - inappropriate laughter - impaired judgment and short-term memory - distortions of time and perception - increased appetite - conjunctival injection (bloodshot eyes) - dry mouth - hypotension -tachycardia Excessive use of cannabis may produce delirium or rarely, cannabis-induced psychotic disorder, both of which are treated symptomatically Cannabis begins to act less than 1 minute after inhalation. Peak effects usually occur in 20 to 30 minutes and last at least 2 to 3 hours

Drugs for nicotine withdrawal + s/e

Varenicline - ( Chantix and Champix) iused to treat nicotine addiction. It both reduces craving for and decreases the pleasurable effects of cigarettes and other tobacco products SE: insomnia, unusual dreams, H/A, dry mouth, unpleasant taste in mouth. Bupropion (Wellbutrin): the medication should be started two weeks before the planned stop smoking date. Take for 3 months after stop smoking Common side effects include: dry mouth, anxiety, insomnia, weakness, nightmares, anxiety and changes in appetite or weight. Using nicotine and taking the medication at the same time can increase blood pressure. Suicidal thought are actions should be reported.

Cyanacobalamin

Vitamin B12

Patient precautions after transplant surgery

Wash your hands often. Hand washing is an excellent way to reduce exposure to germs. It's especially important before you eat. Avoid people who are sick. It's best to limit contact with anyone who has a cold or any other infection like measles or chicken pox. Stay out of crowded areas. For example, avoid malls and movie theaters. Don't take care of pets. Pets carry germs, so limit your exposure to them. You don't have to kick them out of the house. Instead, look at this as an excuse to make your spouse or kids clean out the litter box for a change. Don't garden. Some dangerous bacteria live in the soil. So let your garden go wild for a few months. Or hire someone to do the weeding for you. Brush and floss daily. Both help keep your mouth free of infections. Have your teeth cleaned regularly. Don't ignore cuts or scratches. Clean them and put on a bandage. Get in touch with your health care provider if you have any signs of infection. Practice very safe sex.

feeding clients with eating disorders

When clients can eat, a diet of 1,200 to 1,500 calories/day is ordered, with gradual increases in calories until clients are ingesting adequate amounts for height, activity level, and growth needs. Typically, allotted calories are divided into three meals and three snacks

tolerance break

When very small amounts of alcohol intoxicate the person after drinking heavily for a while

Nicotine withdrawal symptoms and timing

Withdrawal - crave ciarettes, trouble sleeping, sad, irritable, mild flu symptoms Peak at 2-13 days after cigarette Disappear in 3 months Usually takes several quit attempts

stimulant withdrawal

Withdrawal from stimulants occurs within a few hours to several days after cessation of the drug and is not life-threatening. - Marked dysphoria is the primary symptom - fatigue - vivid and unpleasant dreams - insomnia or hypersomnia - increased appetite - psychomotor retardation or agitation. Marked withdrawal symptoms are referred to as "crashing"; the person may experience depressive symptoms, including suicidal ideation, for several days. Stimulant withdrawal is not treated pharmacologically.

Symptoms of FAS

Withdrawal? Wakefulness Irritability Temp variations, tacycardia, tremors Hyperactivity, high pitched persistent cry, hyperreflexia Diarrhea, diaphoresis, disorganized suck Respiratory distress, rihnorrhea Apneic attaks Wt loss or failure to gain wt Lacrimation

Other treatment groups besides AA

Women for sobriety Rainbow recovery Narcotics Anonymous Al-Anon, a support group for spouses, partners, and friends of alcoholics AlaTeen, a group for children of parents with substance problems

pregnancy complications with lupus

Women with SLE are at increased risk for adverse pregnancy outcomes and cardiovascular disease. A pregnancy with lupus is prone to complications - flares of disease activity during pregnancy or in the postpartum period - preeclampsia - pregnancy loss - miscarriage - stillbirth - fetal growth restriction - preterm birth. Active lupus nephritis poses the greatest risk. The recognition of a lupus flare during pregnancy may be difficult because the signs and symptoms may mimic those of normal pregnancy

cognitive restructuring

a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs techniques such as thought stopping, positive self-talk, and decatastrophizing

Chlordiazepoxide (Librium)

alcohol withdrawal 50-100 mg, repeat in 2-4 hours if necessary; not to exceed 300 mg/day Monitor vital signs and global assessments for effectiveness; may cause dizziness or drowsiness

complications of anorexia

amenorrhea and loss of secondary sex characteristics with decreased levels of estrogen, which can eventually lead to osteoporosis. Bone loss can occur, and symptomatic compression fractures and kyphosis have been reported.40Constipation, cold intolerance, and failure to shiver when cold, bradycardia, hypotension, decreased heart size, electrocardiographic changes, blood and electrolyte abnormalities, and increased growth of lanugo (i.e., fine hair) are common.

preventing lupus flares

anti-inflammatory diet Flaxseed Fish oil Avoid birth control pills Avoid crowds Minimize salt, fat, animal protein Avoid milk, dairy, red meat Avoid caffeine, citru fruits, paprika, salt, tobacco, sugar Don't smoke

alcohol withdrawal syndrome

anxiety, uncontrollable fear, tremor, irritability, agitation, insomnia, and incontinence. They are talkative and preoccupied and experience visual, tactile, olfactory, and auditory hallucinations that often are terrifying. Autonomic overactivity occurs and is evidenced by tachycardia, dilated pupils, and profuse perspiration. Usually, all vital signs are elevated in the alcoholic toxic state.

Sjogren's syndrome + age of onset + symptoms

autoimmune destruction of minor salivary glands and lacrimal glands More than 90% of patients affected are women, and the onset tends to begin between 35 and 50 years of age dry eyes (kerotoconjunctivitis sicca) dry mouth (xerostomia) eyes feel "gritty," as if there is sand present eyes will exhibit increased redness and lack of tearing. anxiety and depression Dry and sticky mucous membranes Difficulty swallowing Sjögren's syndrome can also exhibit symptoms in many other organ systems. Vasculitis can manifest with palpable purpura on the skin Lesions may ulcerate and can be painful. Optic neuritis, trigeminal neuralgia, and sensory neuropathy may be present, with symptoms such as burning pain in the extremities, numbness, vertigo, arthralgia, and/or myalgia. Raynaud's phenomenon Cough, dyspnea, and abdominal pain may also occur.

Crest Syndrome

calcinosis (calcium deposits in the tissues), Raynaud's phenomenon esophageal hardening and dysfunction sclerodactyly (scleroderma of the digits) telangiectasia (capillary dilation that forms a vascular lesion)

night eating syndrome

characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss. Most are obese Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants

gambling disorder

characterized by problem gambling, spending money one cannot afford to lose, lying about gambling, getting money from others, and an inability to refrain from gambling for any specific time

Wernicke-Korsakoff syndrome + treatment and foods for it

chronic mental impairments and confusion produced by heavy alcohol use over a long period of time that persists after alcohol has worn off mental confusion, vision problems, coma, hypothermia, low blood pressure, and lack of muscle coordination (ataxia), amnesia, tremor, coma, disorientation, and vision problems caused by lack of thiamine B1 Need folic acid as well (which may turn urine dark yellow) Treatment: banana bag FOOD: whole grains, legumes, and some meats and fish Also need increased protein

triggers that can trigger the onset of lupus

cigarette smoke ultraviolet rays exposure from sunlight and fluorescent light bulbs medications (sulfa drugs, penicillin, or antibiotic drugs) viral, infections - especially Epstein - Barr emotional stress stress on the body (e.g., surgery, pregnancy) silica dust exposure in the occupational setting

graft versus host disease + symptoms

complication that occurs following a stem cell or bone marrow transplant in which the transplant produces antibodies against recipient's organs that can be severe enough to cause death -Fever -Profuse watery diarrhea -Vomiting -Rash -Hepatitis -Refractory pancytopenia with bleeding and infectious complications

neonatal abstinence syndrome + manifestations

compromises a constellation of drug-withdrawal symptoms that result from chronic intrauterine exposure to a variety of substances, including opioids, barbiturates, SSRIs, alcohol, benzodiazepines, caffeine, and nicotine Withdrawal in newborns Symptoms depend on drug SIDE EFFECTS BEGIN 72 HOURS AFTER BIRTH Typical behaviors: CNS hypersensitivity, autonomic dysfunction, respiratory distress, temperature instability, hypoglycemia, tremors, seizures, abnormal cry patterns (cat cry), feeding difficulties, and gastrointestinal disturbances.

where do antigen antibody complexes get deposited in lupus

connective tissue of blood vessels, lymphatic tissues, and other sites such as kidneys, spleen, GI tract, lungs, brain, heart, musculoskeletal system, skin, and peritoneum

here are three classes of medications that are prescribed for a heart transplant patient to help minimize rejection

corticosteroids (e.g., prednisone), calcineurin inhibitors (tacrolimus, cyclosporine), and antiproliferative agents (mycophenolate mofetil [CellCept], azathioprine [Imuran], or sirolimus [Rapamune]).

complications of bulimia

dental disorders, parotitis, and fluid and electrolyte disorders. Dental abnormalities, such as sensitive teeth, increased dental caries, and periodontal disease, occur with frequent vomiting because the high acid content of the vomitus causes tooth enamel to dissolve. Esophagitis, dysphagia, and esophageal strictures are common. With frequent vomiting, there often is reflux of gastric contents into the lower esophagus Vomiting may lead to aspiration pneumonia, especially in intoxicated or debilitated people. Potassium, chloride, and hydrogen are lost in the vomitus, and frequent vomiting predisposes to metabolic alkalosis with hypokalemia. An unexplained physical response to vomiting is the development of benign, painless parotid gland enlargement.

types of lupus

discoid systemic drug induced neonatal

four drugs for off-label use of cocaine cravings

disulfiram; modafinil (Provigil), an antinarcoleptics; propranolol (Inderal), a beta-blocker; and topiramate (Topamax), an anticonvulsant also used to stabilize moods and treat migraines.

Inhalants

diverse group of drugs that include anesthetics, nitrates, and organic solvents that are inhaled for their effects Amyl nitrate Freon Propane Trichloroethylene Gasoline Perchloroethylene Toluene (metallic paint spray) Helium Canned air Hand sanitizer

medications in NAS

drug therapy is indicated if the newborn has seizures, diarrhea, and vomiting resulting in excessive weight loss and dehydration, poor feeding, inability to sleep, and fever unrelated to infection Common medications used in the management of newborn withdrawal include an opioid (morphine or methadone) and phenobarbital as a second drug if the opiatterm-91e does not adequately control symptoms

factors that increase poor outcomes with alcoholism

earlier age at onset, longer periods of substance use, and the coexistence of a major psychiatric illness

rumination

eating disorder occurring in infants in which the baby regurgitates partially digested food or formula and expels or swallows it. common with intellectual disability

eating disorder risk factors

family history, female gender, Caucasian race, preoccupation with appearance, obsessive traits, or low self-esteem Eating disorders appear to be equally common among Hispanic and Caucasian women and less common among African American and Asian women. Struggle for autonomy, identity Overprotective or enmeshed families Body image disturbance/dissatisfaction Separation-individuation difficulties

Signs of refeeding syndrome

fatigue, weakness, confusion, difficulty breathing, high blood pressure, seizures, irregular heartbeat, edema, heart failure, coma

mental health promotion in mood disorders

focuses on mood stabilization, decreasing impulsivity, and developing social and relationship skills. In addition, clients perceive unmet needs in a variety of areas, such as self-care (keeping clean and tidy), sexual expression (dissatisfaction with sex life), budgeting (managing daily finances), psychotic symptoms, and psychological distress.

Lorazepam for alcohol withdrawal

for alcohol withdrawal 2-4 mg every 2-4 hours PRN Monitor vital signs and global assessments for effectiveness; may cause dizziness or drowsiness

Medications for Lupus in pregnancy

generally limited to NSAIDs (e.g., ibuprofen [Advil]), prednisone (Deltasone), and an antimalarial agent, hydroxychloroquine (Plaquenil).

Liver transplant rejection symptoms

infection, including fever, increasing liver function test results and GGT, and increasing pain, redness, and swelling at the incision site.

discoid lupus

limited to skin red to pink papules and plaques of face, scalp, ear canal, follicular plugging, eventual atrophic scarring

codependency

maladaptive coping pattern on the part of family members or others resulting from a prolonged relationship with the person who uses substances. Characteristics of codependence are poor relationship skills, excessive anxiety and worry, compulsive behaviors, and resistance to change. Family members learn these dysfunctional behavior patterns as they try to adjust to the behavior of the substance user.

Post transplant diet

o Eating at least 5 servings of fruits & veggies/day o Avoiding grapefruit & grapefruit juice d/t its effect on a group of immunosuppression meds (calcineurin inhibitors) o Drinking LOW FAT milk or eating other LOW FAT dairy products, which is important to maintain optimal CALCIUM & PHOSPHORUS levels! o Maintaing a LOW SALT & LOW FAT diet o Staying hydrated o Following food safety guidelines o Eating lean meats, poultry & fish KIDNEY & LIVER. o Eating whole-grain breads, cereals & other grains HEART & LIVER o Avoiding excessive alcohol HEART & LIVER o Monitor calories (may need to increase or decrease weight) KIDNEY o Having enough fiber in your daily diet KIDNEY · Exercise

corticosteroids - prednisone

o Immediate acting synthetic analog of hydrocortisone that has anti-inflammatory & immunosuppressant properties o Nursing Implications: § Give w/ meals or a snack § Crush tablet & give w/ fluid if pt is unable to swallow it whole § Don't stop abruptly § Monitor weight, BP, glucose levels, & sleep patterns § Monitor for hypocalcemia § Instruct pt to avoid or minimize alcohol intake

Chronic rejection

o Patho Dominant lesion in chronic rejection is arterial occlusion resulting from the proliferation of vascular smooth muscle cells, w/ graft failure resulting from ischemic damage. These arterial changes are often referred to as graft vasculopathy or accelerated graft arteriosus. o Time frame 4 MONTHS - YEARS after the transplant o Gradual deterioration of organ function. o Treatment: None o Loss of graft will occur, requiring RETRANSPLANT.

Hyperacute rejection

o Patho Produced by existing recipient antibodies to graft antigens that initiate a type III, Arthus-type hypersensitivity reaction in the blood vessels of the graft. These antibodies usually have developed in response to previous blood transfusions, pregnancies in which the mother makes antibodies to fetal antigens, or infections w/ bacteria or viruses possessing antigens that mimic MHC antigens. o Time frame WITHIN 24 HOURS. o Treatment: Immediate removal of transplanted organ!

Acute rejection

o Patho The delayed time of onset of acute rejection reflects the time it takes for the recipient's immune system to generate T cells & antibodies against the graft. Acute antibody-mediated or humoral mechanisms involve blood vessel damage & intravascular thrombosis that leads to graft destruction. o Time frame 3-14 DAYS o Will have signs of inflammation (tenderness at transplant site, fever, malaise) & Impaired organ function o Treatment Increase immunosuppression § Steroids § Cyclosporine § Nonclonal antibodies § Antilymphocyte globulins (immunosuppressants)

immunosuppressants - cyclosporine

o Primary drug in prevention of kidney, liver, heart, & bone marrow transplant rejection o Used w/ corticosteroids for maintenance o Nursing Implications: § Do not dilute oral solution w/ grapefruit juice (use orange juice, regular or chocolate milk, or apple juice & administer immediately after mixing) § Observe for adverse reactions for 30 MINUTES after initiation of IV infusion. § Be aware that nephrotoxicity is reported in up to 1/3 of transplant recipients § Give medication w/ food § Administer med at the same time each day. o IV Used for those who can't tolerate oral § Dilute w/ D5Q, NSS § Infuse over 2-6 hours. o S/E: seizures, leukopenia, thrombocytopenia, hyperglycemia, HTN, paresthesia, infections § Nephrotoxic & Hepatotoxic o Monitor: § ↑ ALT, AST, bilirubin, BUN, creatinine, glucose, LDL § ↓ Hgb, Mag, PLT, WBC o perform careful oral care & see dentist regularly o Don't use hormonal contraceptives o CON: RA or psoriasis w/ abnormal renal function, uncontrolled HTN, or malignancies; methotrexate or other immunosuppressive agents, UVB, radiation therapy

how does cyclosporine affect rejection?

o Pt taking Cyclosporine (Neoral) may not exhibit the usual S/S of acute rejection. The only sign may be an asymptomatic rise in the serum creatinine level (more than a 20% rise is considered acute rejection).

exercise after transplant

o Regular exercise o After transplant, start w/ walking o Do not lift anything heavier than 5-7 lbs. o Medical team will devise an exercise plan to meet the needs of the client.

orthorexia

obsession with proper or healthful eating Behaviors include compulsive checking of ingredieterm-105nts; cutting out increasing number of food groups; inability to eat only "healthy" or "pure" foods; unusual interest in what others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs

signs of workplace addiction

poor work performance, frequent absenteeism, unusual behavior, slurred speech, and isolation from peers. •Incorrect drug counts •Excessive controlled substances listed as wasted or contaminated •Reports by clients of ineffective pain relief from medications, especially if relief had been adequate previously •Damaged or torn packaging on controlled substances •Increased reports of "pharmacy error" •Consistent offers to obtain controlled substances from pharmacy •Unexplained absences from the unit •Trips to the bathroom after contact with controlled substances •Consistent early arrivals at or late departures from work for no apparent reason

hallucinogen examples + symptoms

psilocybin, lysergic acid diethylamide, and "designer drugs" such as ecstasy. Phencyclidine (PCP), developed as an anesthetic, is included in this section because it acts similarly to hallucinogens. - hallucinations - depersonalization - increased pulse - increased BP - increased temperature - dilated pupils - hyperreflexia

Why should you be concerned about a psychiatric illness in transplant patients?

psychiatric conditions are often aggravated by the corticosteroids needed for immunosuppression after transplantation

lupus CNS involvement

psychosis cognitive impairment seizures strokes peripheral & cranial neuropathies transverse myelitis

spontaneous remission

recovery from a disorder that occurs without formal treatment

Criteria for diagnosing binge eating disorder

recurrent episodes of binge eating at least 2 days per week for 6 months and at least three of the following: (1) eating rapidly; (2) eating until becoming uncomfortably full; (3) eating large amounts when not hungry; (4) eating alone because of embarrassment; (5) disgust, depression, or guilt because of eating episodes.

When do transplant rejections occur

rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. An acute rejection typically occurs within a few days to weeks of the transplant surgery

plasmapheresis

removes circulating immune complexes; in this treatment, plasma is removed from body, sent through a machine membrane that traps immune complexes, and returned to body

Nursing interventions with personality disorders

safety first written contract not to harm themselves or anyone else while under your care promote independence when appropriate be consistent with boundaries communicate expectations manage their expectations of what you will or won't do for them be genuine be consistent acknowledge splitting if it occurs promote discussing feelings assertiveness training for dependent and histrionic

Which personality disorders are the least likely to remain in treatment

schizotypal, narcissistic, or obsessive-compulsive personality disorders are least likely to engage or remain in any treatment... they see other people as the cause of their problems

three major character traits

self-directedness, cooperativeness, and self-transcendence

sedative intoxication symptoms

slurred speech lack of coordination unsteady gait labile mood impaired attention or memory stupor and coma

signs of alcohol intoxication

slurred speech, unsteady gait, lack of coordination, and impaired attention, concentration, memory, and judgment. Some people become aggressive or display inappropriate sexual behavior when intoxicated.

general symptoms of personality disorders

tend to be preoccupied with sex, religion, or themselves distorted view of self difficulty maintaining relationships expert manipulators excitable - excessive response to light/sound or unable to focus poor impulse control physical response to emotional pain

Assessing for kidney transplant rejection

the nurse assesses the patient for signs and symptoms of transplant rejection: oliguria edema fever increasing blood pressure weight gain swelling or tenderness over the transplanted kidney or graft. Patients receiving cyclosporine (Neoral) may not exhibit the usual signs and symptoms of acute rejection. In these patients, the only sign may be an asymptomatic rise in the serum creatinine level (more than a 20% rise is considered acute rejection)

lupus nephritis symptoms

weight gain swelling in face and ankles hypertension foamy urine Increased urination dark urine (blood)

CBC and transplant rejection

§ Infection is the leading cause of death after liver transplant (Brunner p.1381)... Þ Because immunosuppressants that we give patients to decrease the risk of rejection of the new organ decrease the formation of leukocytes and platelets. Þ Leukocytes are white blood cells that fight infection. Þ We also monitor for bleeding because of the decrease in the formation of platelets (Brunner p.1570) § Hgb & Hct, WBC, platelet counts § WBC <3000/mm³ discontinue drug

Tacrolimus

§ Inhibits T-cell activation § Used only for the prevention of liver transplant rejection § PO: hazardous drug - use safe handling Þ contains lactose (teaching) Þ XR give 1 H bf/ or 2 H af/ meal o if missed, may be taken up to 14 or 15 H af/ time o extended release in liver transplant isn't approved b/c of increased mortality rate in female liver transplant recipients Þ Immediate: give consistently w/ food Þ swallow WHOLE § IV Þ dilute w/ NSS or D5W Þ monitor pt cont. for first 30 min & frequently af/ for anaphylaxis Þ give only to those who can't take oral form Þ incompatible w/ drugs w/ pH of 9 or > (acyclovir & ganciclovir) Þ CON: w/ allergy to castor oil derivatives § SE: stroke, coma, bradycardia, hypotension, GI hemorrhage, thrombocytopenia, hyperkalemia, hypomagnesemia, hyponatremia, candida, oliguria § Neurotoxic & nephrotoxic (esp. in high dose) § Monitor: Þ TROUGH LEVELS o 6 - 11 ng/mL in the FIRST month o 4 - 11 ng/mL in all subsequent months Þ ↑ BUN, creatinine, INR, HCT, glucose Þ ↓ Mag, Hbg, WBC, PLT Þ ↑ or ↓ K § Don't breastfeed § DO NOT USE SIMULTANEOUSLY W/ CYCLOSPORINE - stop either drugs at least 24 H bf/ starting the other

s/s of rejection

§ Oliguria § Edema § Fever § Increasing blood pressure (HYPERTENSION) § Weight gain § Swelling § Tenderness over transplanted kidney or graft § Rise of serum creatinine level o Pt taking Cyclosporine (Neoral) may not exhibit the usual S/S of acute rejection. The only sign may be an asymptomatic rise in the serum creatinine level (more than a 20% rise is considered acute rejection).

1. Immunosuppressive agents (alkylating agents & purine analogues) § EX: cyclophosphamide, methotrexate, azathioprine, mycophenolic acid (Myfortic)

§ effect on overall immune function § reserved for pts who have serious forms of SLE that haven't responded to conservative therapies § Used most frequently in SLE nephritis § CON: pregnancy § cyclophosphamide: Þ take in am (eliminate drug before bedtime) Þ take on empty stomach unless GI upset Þ increase fluids to stay well hydrated Þ may cause false positive Pap tests, menstrual irregularities, & sterility

hydroxychloroquine

§ managing cutaneous (rashes), musculoskeletal (joint pain), & mild systemic features § Administration: Þ give w/ food or milk Þ take immediately bf/ or af/ meal on the same day each week § SE: seizures, cardiomyopathy, leukopenia, thrombocytopenia, aplastic anemia, hypoglycemia, angioedema, suicidal behavior, dizziness (careful driving, etc.) § Need baseline & periodic ophthalmic examinations § Monitor CBC & LFT w/ long-term use Þ May ↓ H&H, WBC & PLT § Pregnant women CAN take this § CON: retinal or visual field changes, long-term use in children

NSAIDs for lupus

§ minor clinical manifestations § often used in conjunction w/ corticosteroids to minimize steroid need

corticosteroids for lupus

§ topical - cutaneous manifestations (rashes) § oral - low dose for minor disease activity; high dose for major activity § IV - alt. to high dose oral § give in the am (< toxicity & better results) w/ food or milk § SE: ↑ glucose, seizures, TE, HF, HTN, pancreatitis, hypokalemia, hypocalcemia, acute adrenal insufficiency, infection (d/t immunosuppression) § When stopping: look for HYPOGLYCEMIA, orthostatic hypotension, depression, fatigue, fever, dyspnea § Monitor: Þ ↑ cholesterol, glucose Þ ↓ T3, T4, K & Ca § Give ↓ Na diet, ↑ protein & K; need Ca & vitamin D supplement § TAPER § RISK FACTOR w/ prolonged use: osteoporosis & fractures (said twice) § CON: systemic fungal infection, cerebral malaria, active ocular herpes, live vaccines

monoclonal antibodies (belimunab) immunosuppressants

§ ↓ disease activity & flares § Administration: Þ Drug is given at Dr's office or at hospital (don't miss appointments) Þ DON'T IVP OR BOLUS - ONLY IV INFUSION (for 1 H) Þ store in fridge Þ when ready to use, get to room temp then reconstitute w/ sterile water § Monitor for: infections, depression/suicidal ideations § CON: live vaccines (for 30 d) § Caution: will all concurrent meds

full diagnostics for lupus

ª Almost always means lupus is present ü (+) ANA titer in > 95% pts ü (+) anti - Sm (antibody against Sm, which is a specific protein found in the nucleus) in 40% ª anti - ds DNA (normal is 0) ü (antibody that develops against the pt's own DNA) (+) in about 50% pts ü you can have lupus w/o this present & it's specific to the SLE type ª CBC ü Anemia (↓ RBC, H&H) ü Thrombocytopenia (↓ PLT) ü Leukocytosis (↑ WBC) ü Leukopenia (↓ WBC) - they may be getting bigger though, just few in # ª Inflammatory Processes: ↑ CRP & ESR - ↓ C4 (indicates lupus) ü CRP - normal is < 3 ü ESR - normal is 0 - 22 ü C4 - normal is > 18 ª Urinalysis (proteins/cell fragment from blood) & creatinine (normally <1) ª ECG to show pericarditis ª Arthrocentesis to reveal joint effusions

physiological effects of long term alcohol abuse

•Cardiac myopathy •Wernicke encephalopathy •Korsakoff psychosis •Pancreatitis •Esophagitis •Hepatitis •Cirrhosis •Leukopenia •Thrombocytopenia •Ascites

cardiac lupus symptoms

® Most common: pericarditis (swelling & irritation of thin saclike membrane surrounding the heart) ® Presentation might be: substernal chest pain (feels like a heart attack) aggravated by movement or inspiration, which can be: § acute & severe § last for weeks at a time ® Other cardiac symptoms: § myocarditis ("cardiomyopathy") § HTN § cardiac dysrhythmias (irregular heartbeat) § valvular incompetence ("leaky valve"/regurgitation - blood leak backwards) § women are at risk for: early onset atherosclerosis Þ more likely to suffer MI or stroke, making their death rates higher Þ key factor in development: inflammation

Renal/ Liver/ Cardiovascular studies in transplant rejection

® Renal § BUN, Creatinine (BUN (blood urea nitrogen) is a waste product in the blood from protein metabolism. BUN/creatinine are compared to determine kidney function. Creatinine is a chemical waste product produced by muscle metabolism. Both are found in the blood. Higher levels indicate that they are not being filtered properly by the kidneys.) ® Liver § Also, liver studies: alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), urobilinogen, PT/INR (coagulation studies). These all give an indication of liver function of the transplanted liver. Serum concentrations of protein and clotting factors. Liver is responsible for the synthesis of protein and clotting factors. We may need replacement to reduce the incidence of hemorrhage. ® Cardiovascular: ECG

Assessment of lupus

² Complete hx, physical exam, blood tests ² Additional assessment for any pt w/ rheumatic disease, for known or suspected SLE ² Skin ® for erythematous rashes (palms) ® areas of hyperpigmentation or depigmentation ® skin △s ® sensitivity to sunlight or UV light ® Scalp, Neck & Face: cutaneous plaques w/ an adherent scale § also check scalp for alopecia ® Mouth: ulcerations reflecting GI involvement ² Musculoskeletal ® Joint swelling, tenderness, warmth, pain on movement, stiffness, & edema ® Joint involvement is similar to RA ² Neuro ® behavioral △s [neurosis (depression, anxiety, OCD, hypochondria) or psychosis] § depression & anxiety & difficulty coping d/t financial strain? ® seizures ® chorea (involuntary, unpredictable movements) ² Cardiovascular ® Auscultate for pericardial friction rub (possibly assoc. w/ myocarditis & accompanying pleural effusions) ® Lung sounds may be abnormal d/t pleural effusions & infiltrations ® Vascular involvement: papular, erythematous & purpuric lesions on fingertips, elbows, toes & extensor surfaces of FAs or lateral sides of hand that may become necrotic

imbalance development in transplanted organs

² Heart/lung ® S&S heart failure ® Confirm by biopsy ² Liver ® S/S liver failure ® Confirm by biopsy ² Kidney ® S/S of renal failure ® Swelling or tenderness over kidney ® Cadaver kidney may not function for 2 weeks § Dialysis may be needed until function of the kidney starts ² Failure confirmed by biopsy

in depth risk factors for lupus

² Race Þ more frequently in African Americans, Asians, Hispanics, & Native Americans than Caucasians ² Gender Þ more frequently in women (ages 15 - 44 yrs, ~ 90%) than men Þ estrogen may contribute to the body's response of overreacting to its own tissues Þ early onset menarche Þ OCs Þ Hormone replacement therapy (HRT) post menopause ² Environmental factors - thought to onset the disease process Þ UV light / fluorescent light bulbs Þ emotional stress / stress on body (surgery, pregnancy) Þ diet Þ viral infections Þ cigarette smoke Þ silica dust exposure ² Drugs Þ sulfa drugs, penicillin, or antibiotics Þ hydralazine - FYI per Dr Hales!! § most common cause of drug induced lupus § lowers BP Þ procainamide (tx of irregular heartbeat), isoniazid (anti TB), chlorpromazine (tx of: schizo, manic-depression, meth withdrawal, N/V, bf/ surgery, chronic hiccups, tetanus)

lupus diet

² high-vitamin, high iron ² high protein if no kidney involvement ² high fiber if constipated

therapeutic management of lupus

· Aimed at recognizing flare-ups and preventing further complications; individually adjusted to disease activity · Conservative measures include rest and general supportive pharmacotherapy; aggressive measures include splenectomy and chemotherapy

Treatment for transplant rejection

· Solumedrol 250-500mg IV for at least 3 days is universal common treatment. · If hyper acute (immediately after surgery) - removal of organ · If acute (one week to months after surgery) - cyclosporines - prevents Tcells from attacking the transplanted organ. · If chronic (months to years after surgery) - multiple therapies · Education, education, education!!!

Lupus target organ involvement assessment

· pleuritis and pleural effusions (lungs), renal failure (kidneys), or anorexia, nausea, abdominal pain, and diarrhea (GI) · Central nervous system (CNS) involvement: photosensitivity, subtle behavioral changes, possible stroke or seizure activity · Hematologic involvement: altered immune responses with anemia (decreased RBC count), leukopenia (noted by infection and fever), thrombocytopenia (low platelet count), and even hemolytic anemia (positive Coombs test)

serotonin syndrome + s/s

• Associated with SSRIs • Rare but life-threatening event • S/S abd pain; diarrhea; sweating; fever; tachycardia; HTN; altered mental status; muscle spasms(myoclonus); irritability; hostility; mood change; high fever. • Remember harmed (hyperthermia; autonomic instability; rigidity; myoclonus; encephalopathy; diaphoresis.

Types of anticholinergics

• Cogentin benztropine • Benadryl diphenhydramine • Artane trihexyphenidyl

mood stabilizers and side effects

• Lithium • Depakote (valproic acid) • Lamictal (lamotrigine) • Tegretol (carbamazepine) • Trileptal (oxcarbazepine) • Topomax (topiramate) Tremors, gastric distress, lack of coordination, dizziness, cardiac arrhythmia, blurred vision, fatigue, death from overdose in rare cases, thirst, excessive urination

Anxiolytics and side effects

• Xanax (alprazolam) • Ativan (lorazepam) • Tranxene (clorazepate) • Valium (diazepam) • Klonopin (clonazepam) • Serax (oxazepam) • Librium (chlordiazepoxide) respiratory depression; sleep related behaviors; physical dependence or tolerance; sedation; orthostatic hypotension; confusion.

DOH 5 point program to address opioid crisis includes:

•Access: Better prevention, treatment, and recovery services •Data: Better data on the epidemic •Pain: Better pain management •Overdoses: Better targeting of overdose-reversing drugs •Research: Better research on pain and addiction

Why is treating dual diagnoses particularly hard?

•Clients with a major psychiatric illness may have impaired abilities to process abstract concepts; this is a major barrier in substance abuse programs. •Substance use treatment emphasizes avoidance of all psychoactive drugs. This may not be possible for the client who needs psychotropic drugs to treat his or her mental illness. •The concept of "limited recovery" is more acceptable in the treatment of psychiatric illnesses, but substance abuse has no limited recovery concept. •The notion of lifelong abstinence, which is central to substance use treatment, may seem overwhelming and impossible to the client who lives "day to day" with a chronic mental illness. •The use of alcohol and other drugs can precipitate psychotic behavior; this makes it difficult for professionals to identify whether symptoms are the result of active mental illness or substance abuse.

Personality disorder clusters

•Cluster A—odd or eccentric behaviors •Paranoid personality disorder •Schizoid personality disorder •Schizotypal personality disorder •Cluster B—erratic or dramatic behaviors •Antisocial personality disorder •Borderline personality disorder •Histrionic personality disorder •Narcissistic personality disorder •Cluster C—anxious or fearful behaviors •Avoidant personality disorder •Dependent personality disorder •Obsessive personality disorder

Maladaptive traits with personality disorders

•Negative behaviors toward others, such as being manipulative, dishonest, deceitful, or lying •Anger and/or hostility •Irritable, labile moods •Lack of guilt or remorse, emotionally cold and uncaring •Impulsivity, distractibility, poor judgment •Irresponsible, not accountable for own actions •Risk-taking, thrill-seeking behaviors •Mistrust •Exhibitionism •Entitlement •Dependency, insecurity •Eccentric perceptions