Alcohol & Drugs

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Questions and Answers

What is a common sign of an upper overdose?

Bradycardia

Tachycardia (correct)

Constipation

Hypotension

Which condition resembles signs of downer withdrawal?

Upper withdrawal

Downer overdose

Upper overdose (correct)

Downer intoxication

Which of the following are characteristics of Alcohol Withdrawal Syndrome (AWS) compared to Delirium Tremens (DT's)?

Complete bed rest with no movement

Requires clear liquids only

Patients are unstable and dangerous

Patients receive B1 multi-vitamin (correct)

Which medication is considered an upper?

Caffeine Signup and view all the answers

What is indicated by a patient's difficulty to console during an upper overdose?

Euphoria Signup and view all the answers

Which of the following antibiotics are classified as aminoglycosides?

Streptomycin Signup and view all the answers

Which of the following symptoms would you expect in a newborn that is 24 hours old and experiencing withdrawal symptoms from drug exposure?

Shrill high pitched cry Signup and view all the answers

What essential equipment is needed for a patient experiencing respiratory arrest due to downer overdose?

Ambu bag Signup and view all the answers

What are the appropriate nursing interventions for a patient experiencing Delirium Tremens?

Restraint using two extremities Signup and view all the answers

Which of the following antibiotics is NOT an aminoglycoside?

Vancomycin Signup and view all the answers

Which of the following statements regarding monitoring drug levels in patients on aminoglycosides is accurate?

Both peak and trough levels should be monitored regularly Signup and view all the answers

What can you conclude about patients experiencing alcohol withdrawal compared to those in delirium tremens?

Patients with AWS can be managed in semi-private rooms Signup and view all the answers

When administering medications to newborns with potential drug exposure, which of the following would be essential to monitor?

Reflexes and irritability Signup and view all the answers

What is the primary problem associated with alcoholism that needs to be addressed in treatment?

Denial Signup and view all the answers

What is the primary symptom of Wernicke-Korsakoff Syndrome (WKS)?

Amnesia with confabulation Signup and view all the answers

In the context of treating denial in alcoholism, which approach is least appropriate?

Dismiss their unrealistic plans Signup and view all the answers

What should be included in patient teaching for someone taking disulfiram (Antabuse)?

Avoid all forms of alcohol completely Signup and view all the answers

What is the main characteristic that differentiates dependency from codependency in relationships impacted by alcoholism?

One derives self-esteem from the other Signup and view all the answers

Which treatment strategy is effective for addressing manipulation in relationships affected by alcoholism?

Setting limits and enforcing them Signup and view all the answers

Which statement about the treatment effect of disulfiram (Antabuse) is true?

Takes more than 2 weeks to build up in the body Signup and view all the answers

What is a key characteristic of symptoms associated with Wernicke-Korsakoff Syndrome?

They can only be arrested, not improved Signup and view all the answers

What is Wernicke-Korsakoff Syndrome primarily associated with?

Thiamine (B1) deficiency Signup and view all the answers

Which of the following actions can help a codependent individual improve their self-esteem?

Setting personal boundaries Signup and view all the answers

Which of the following substances can a patient on disulfiram safely consume?

Red wine vinaigrette Signup and view all the answers

If a patient's drug causes a withdrawal reaction, what is the initial step a nurse should take?

Assess if the drug is an upper or a downer Signup and view all the answers

When confronting denial in substance abuse, which method is recommended?

Laying out the consequences of their actions Signup and view all the answers

Which of the following situations accurately describes confabulation in a patient with WKS?

The patient insists they are a historical figure Signup and view all the answers

Which statement best describes the treatment for dependency in alcoholic relationships?

Enforce previously agreed boundaries Signup and view all the answers

What is a possible consequence of failing to provide thiamine (B1) to at-risk patients?

Worsening of dementia symptoms Signup and view all the answers

What defines manipulation in the context of alcoholism?

Causing harm or danger to the significant other Signup and view all the answers

How should one treat loss and grief differently than denial in therapy?

Support the individual without confrontation Signup and view all the answers

Regarding dual therapy for alcohol dependence, what is an essential aspect of counseling during administration of disulfiram?

Avoidance of all alcohol products Signup and view all the answers

Which characteristic of WKS indicates that it is a preventable condition?

Nutritional deficiencies can be addressed Signup and view all the answers

Which of the following is a common toxic effect associated with aminoglycosides?

Ototoxicity Signup and view all the answers

What does the number 8 symbolize in relation to the ear and aminoglycoside administration?

Cranial nerve #8, associated with hearing Signup and view all the answers

What is the normal range for creatinine, an important indicator for monitoring kidney function?

0.6-1.2 mg/dL Signup and view all the answers

Which route of administration is NOT appropriate for aminoglycosides?

PO Signup and view all the answers

When should trough levels for IV aminoglycosides be drawn?

30 minutes before the next dose Signup and view all the answers

In which scenario is it acceptable to administer aminoglycosides orally?

When attempting to sterilize the bowel pre-surgery Signup and view all the answers

How long after administration should peak levels be checked for an intramuscular dose of aminoglycosides?

30-60 minutes after the drug is given Signup and view all the answers

Which of the following potential toxic effects should be monitored closely during aminoglycoside therapy?

Nephrotoxicity Signup and view all the answers

What is indicated by the term 'narrow therapeutic range' in relation to aminoglycosides?

A small difference between effective and toxic doses Signup and view all the answers

What should be done if a patient exhibits signs of ototoxicity while receiving aminoglycosides?

Discontinue the medication Signup and view all the answers

Study Notes

Newborn Drug Addiction

Assume intoxication at birth, not withdrawal
Before 24 hours of age - baby is intoxicated
After 24 hours of age - baby is in withdrawal
Signs of withdrawal: irritability, increased temperature, hyperreflexia, increased bowel sounds, decreased respirations, difficult to arouse
Examples of withdrawal symptoms from opioid addiction: difficult to console, low core body temperature, exaggerated startle reflex, respiratory depression, seizure risk, shrill high-pitched cry

Alcohol Withdrawal Syndrome (AWS) vs. Delirium Tremens (DT's)

Every alcoholic goes through AWS after 24 hours
Only a minority experience DT's
AWS is not life-threatening; DT's can be fatal
AWS patients are usually stable and not a danger to themselves or others
DT patients are usually unstable and a danger to themselves or others

AWS Treatment

Semi-private room on unit
Regular diet
Up ad lib (no activity restrictions)
Do not restrain

DT's Treatment

Private room near nurse's station
NPO or clear liquids
Restricted bed rest (no bathroom privileges, bedpan/urinal)
Tranquilizer
B1 multi-vitamin
Should be restrained using two-point leather restraints (left arm/right leg or right arm/left leg)

Aminoglycosides

Powerful, life-saving antibiotics (the "big guns")
Treat serious, life-threatening, resistant, gram-negative infections
Examples: streptomycin, cleomycin, tobramycin, gentamycin, vancomycin, clindamycin
NOT all drugs ending in "mycin" are aminoglycosides (erythromycin, zithromycin, clarithromycin)
Key symptom of Wernicke-Korsakoff Syndrome (WKS): amnesia with confabulation
Treatment: give B1 vitamins

NCLEX Tip

Always answer with the majority

Antabuse (Disulfiram)/Revia

Treats problem drinking by creating an unpleasant reaction to alcohol
Onset and duration of effectiveness: >2 weeks
Patient teaching: avoid all forms of alcohol, including mouthwash, aftershaves, perfumes/colognes, insect repellants, OTC elixirs, alcohol-based hand sanitizers, uncooked icings
Patients CAN have red wine vinaigrette

Overdose/Withdrawals:

Is the drug an upper or a downer?
Overdose: too much of the drug
Withdrawal: too little of the drug
Upper overdose looks like downer withdrawal
Downer overdose looks like upper withdrawal
Highest priority: respiratory depression/arrest (downer overdose/upper withdrawal) and seizure (upper overdose/downer withdrawal)

Toxic Effects of Aminoglycosides

Ototoxicity: monitor for hearing loss, tinnitus (ringing in ears), vertigo/dizziness
Nephrotoxicity: monitor creatinine levels (normal range: 0.6-1.2 mg/dL)
Frequency of administration: every 8 hours
Route of administration: IM or IV, do not give PO (except for hepatic encephalopathy and pre-op bowel surgery)

Trough and Peak Levels

T(trough): lowest drug level
A(administer)
P(peak): highest drug level
Why do we draw TAP levels?: to monitor narrow therapeutic range
Time table for Trough and Peak Levels:
- Sublingual: 30 minutes before next dose (trough), 5-10 minutes after drug dissolves (peak)
- IV: 30 minutes before next dose (trough), 15-30 minutes after drug finished (peak)
- IM: 30 minutes before next dose (trough), 30-60 minutes after drug is given (peak)
- SubQ: 30 minutes before next dose (trough) - see diabetes lecture (peak)
- PO: 30 minutes before next dose (trough) - forget about it (peak)

Psychodynamics of Alcoholism

#1 Problem: denial
Treatment: confront denial by pointing out the difference between what the person says and what they do
Support in loss and grief situations, do not confront (5 stages of grief: denial, anger, bargaining, depression, acceptance)
Dependency: abuser gets the significant other to do things for them or make decisions for them
Codependency: significant other derives positive self-esteem from doing things for or making decisions for the abuser
Treatment for dependency/codependency: set boundaries and enforce them (learn to say no), agree in advance on allowed requests and enforce the agreement, work on self-esteem of the codependent person
Manipulation: abuser gets significant other to do things that are not in their best interest and are dangerous or harmful
Treatment for manipulation: set limits and enforce them (easier to treat than dependency/codependency because nobody likes to be manipulated)

Wernicke-Korsakoff Syndrome (WKS)

Neurological disorder caused by thiamine (B1) deficiency
Thiamine plays a role in metabolizing glucose to produce energy for the brain

Uppers vs. Downers

Uppers: Caffeine, cocaine, PCP/LSD, Methamphetamines, ADHD medications
Downers: everything else that is not an upper

Signs and Symptoms

Uppers (overdose): tachycardia, hypertension, diarrhea, tremors, belligerence, seizures, exaggerated shrill high-pitched cry, difficult to console, euphoria, hyperreflexia
Downers (overdose): bradycardia, hypotension, constipation, constricted pupils, flaccidity, respiratory arrest, decreased core body temperature, lethargy, hyporeflexia

NCLEX Priorities

Maslow’s Hierarchy of Needs:
1. Physiological needs
2. Safety
3. Comfort
4. Psychological
5. Social
6. Spiritual
All psych patients start as medical-surgical patients: rule out all feasible medical answers before picking psych answers

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Description

Explore the critical aspects of newborn drug addiction, focusing on signs of intoxication and withdrawal symptoms. Gain insights into Alcohol Withdrawal Syndrome (AWS) and Delirium Tremens (DT's), including key differences and treatment approaches. This quiz will enhance your understanding of these vital topics in neonatal care.