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Questions and Answers
What is Substance Use Disorder (SUD)?
Which of the following is NOT a characteristic of acute alcohol intoxication?
What is the first step in managing a patient with suspected substance overdose?
What are common signs and symptoms of cocaine use?
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Which treatment is essential for a person with acute alcohol intoxication?
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In the context of opioid overdose, which symptom is commonly observed?
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What is a key component of treating hyperthermia in stimulant use like cocaine?
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What vitamin is important for preventing Wernicke encephalopathy in patients with alcohol use disorder?
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What is the primary antidote used for acetaminophen overdose?
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Which option is NOT considered a form of Intimate Partner Violence (IPV)?
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What should nursing management prioritize when assessing for abuse?
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What is a major consideration for elderly individuals when assessing for abuse?
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What is the goal of treatment during the immediate response to a sexual assault?
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What type of evidence is NOT typically collected after an assault incident?
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Which task should a nurse NOT ask the patient after an assault regarding changes in their personal hygiene?
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What is the maximum time frame allowed for a urine drug test to be completed post-event?
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During a psychiatric emergency, which characteristic is essential for a nurse to maintain?
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Which of these specimens would NOT typically be collected in a sexual assault evidence management process?
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Which symptom is NOT typically associated with barbiturate overdose?
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What is the primary management approach for a patient suspected of hallucinogen overdose?
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Which of the following symptoms indicates acetaminophen poisoning?
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What is the recommended treatment for salicylate poisoning?
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What is the antidote for benzodiazepine overdose?
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In the case of amphetamine overdose, which treatment approach is typically used?
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Which situation warrants the administration of Narcan?
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What symptom is a common effect of inhalants?
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What is a common sign of acute alcohol intoxication?
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Which treatment is essential for managing hyperthermia in a patient using stimulants like cocaine?
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What specific management should be prioritized for a patient with suspected acute alcohol intoxication?
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In the management of opioid overdose, which symptom is typically observed?
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What vitamin administration should be considered in patients with alcohol use disorder to prevent complications?
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Which symptom is a common presentation in patients experiencing cocaine use?
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What action should be taken when managing a patient who has experienced a panic attack related to stimulant use?
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In treating opioid overdose with respiratory depression, what action is most crucial?
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What is the role of a sexual assault nurse examiner (SANE) in the aftermath of a sexual assault?
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What constitutes a significant indicator of elder abuse?
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Which of the following actions should be taken when assessing a patient for intimate partner violence?
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What is a crucial nursing responsibility when documenting cases of suspected abuse?
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Why should charcoal not be administered with Acetylcysteine (Mucomyst)?
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What types of evidence are collected during an investigation of an assault?
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What is the maximum time frame in which a urine drug test should be conducted following an assault?
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Which action is essential for a nurse to display during a psychiatric emergency?
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Which management strategy is prioritized for patients with psychiatric emergencies showing suicidal ideation?
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What should a nurse inquire about following an assault that could potentially alter evidence?
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Which symptom is commonly associated with opioid overdose?
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What is the primary concern when managing a patient with barbiturate overdose?
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Which management strategy is important for a patient experiencing hallucinogen overdose?
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What is a common sign of acetaminophen toxicity?
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Which of the following is a potential management strategy for patients using inhalants?
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In the case of amphetamine overdose, which symptom might you expect?
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What is the main effect of using flumazenil in benzodiazepine overdose?
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Which symptom is associated with salicylate poisoning?
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Study Notes
Substance Abuse
- Substance use disorder (SUD) is the misuse of drugs, alcohol, or medication that alters mood or behavior.
- Symptoms can range from vital sign changes to coma.
- Management includes toxicology screen, IV initiation, oxygen monitoring, and antidote administration.
- Signs of an overdose may be related to a person's chronic disease or injuries.
Acute Alcohol Intoxication
- Alcohol intoxication affects balance, reasoning, and concentration, causing central nervous system depression and hypotension.
- Management includes IV fluids, airway assessment and maintenance, and monitoring for trauma and ABCs.
- Avoid sedatives and consider administering thiamine.
- Symptoms include anxiety, uncontrolled fear, tremor, irritability, agitation, insomnia, incontinence, confusion, obtunded state, seizures, slurred speech, vomiting, aggression, grandiose ideation, and uninhibited behavior.
- Obtain blood alcohol levels for accurate analysis.
- Treatment includes detoxification, recovery, and rehabilitation.
- Vitamin B1 is important for preventing Wernicke encephalopathy.
- Medications such as haloperidol, esmolol, or midazolam may be used.
- Ensure familiarity with facility policies regarding restraints.
- Supplemental vitamin therapy and a high protein diet are recommended.
Stimulants: Cocaine
- Symptoms include rapid heart rate, increased blood pressure, muscle cramps, vomiting, hyperthermia, panic attacks, seizures, hallucinations, psychosis, delusions, and hypervigilance.
- Treatment focuses on managing hyperthermia with cooling measures and addressing arrhythmias.
Opioids: Heroin, Opium, Morphine
- Symptoms include dizziness, nausea, vomiting, bradycardia, hypotension, dyspnea (respiratory depression), pinpoint pupils, altered level of consciousness, and flash pulmonary edema.
- The antidote for opioid overdose is Naloxone (Narcan).
- Management includes ABCs, IV access, oxygen monitoring, urine analysis, and ECG.
- Multiple doses of Narcan may be necessary as its effects last about 15 minutes.
Barbiturates: Nembutal (Phenobarbital), GHB
- Symptoms can mimic alcohol intoxication and include respiratory depression, flushed face, decreased heart rate and blood pressure, agitation, decreased level of consciousness, sluggish pupils, decreased deep tendon reflexes, coma, and death.
- Management focuses on maintaining the airway and neurological status.
Inhalants: Freon, Toluene, Helium, Propane, Paint Thinner, Gasoline, Glue
- Inhalants are absorbed rapidly, leading to cravings.
- Symptoms include headache, euphoria, dizziness, altered level of consciousness, a drunk-like feeling, vasodilation, nosebleeds, sluggish pupils, and respiratory depression.
- Monitor ABCs, respiratory status, and treat hypotension.
Amphetamines: Crystal Meth, Ecstasy, Ritalin
- Symptoms include nausea, vomiting, tachycardia, increased blood pressure and respiratory rate, irritability, agitation, fear, decreased inhibition, "tweaking", fearfulness, anxiety, depression, cardiovascular collapse, tachypnea, and palpitations.
- Management requires airway support, cardiac monitoring, and IV insertion.
- Monitor for rhabdomyolysis.
- Provide a calm, quiet, and cool environment.
- Treatment includes small doses of IV diazepam and haloperidol for CNS and muscular hyperactivity, and benzodiazepines for seizures.
Hallucinogens/Psychedelics: LSD, PCP, Marijuana, Special K
- Symptoms include mild hypertension, confusion, withdrawal, hallucinations, seizures, nystagmus, and pupil dilation.
- Management includes ABCs and urine analysis.
Benzodiazepines: Diazepam (Valium), Lorazepam (Ativan), Midazolam (Versed)
- Symptoms include decreased level of consciousness, drowsiness, confusion, slurred speech, and a state resembling intoxication.
- The antidote for benzodiazepine overdose is Flumazenil (Romazicon).
- Management includes ABCs and addressing respiratory depression or circulatory collapse.
Salicylate Poisoning: Aspirin
- Symptoms include tinnitus, blurred vision, sweating, respiratory alkalosis/metabolic acidosis, and bleeding (gums, nosebleeds).
- Treatment includes sodium bicarbonate, fluids, diuretics, and hemodialysis in severe cases. Activated charcoal can be administered to absorb aspirin.
- Management includes monitoring serum salicylate levels, administering prescribed medications, and monitoring platelet counts.
Acetaminophen (Tylenol)
- Overdose occurs with intake exceeding 4 grams in 24 hours.
- Symptoms include hepatic failure, coagulopathies, lethargy, encephalopathy, diaphoresis, hepatomegaly, right upper quadrant pain, hypoglycemia, gastrointestinal upset, and metabolic acidosis.
- Activated charcoal is effective within the first hour of ingestion.
- Laboratory tests include ABG, LFT, CBC, PT/PTT, BUN/Cr.
- The antidote for acetaminophen overdose is Acetylcysteine (Mucomyst).
- Do not administer activated charcoal with NAC (Mucomyst).
Violence, Abuse, and Neglect
- Intimate partner violence (IPV) and family violence are prevalent issues.
- IPV can include physical violence, sexual violence, stalking, psychological aggression, neglect, financial abuse, or intimidation by a former or intimate partner.
- Be aware of signs of abuse and neglect.
- Suspicious injuries, injuries in various stages of healing, anxiety, and high stress are red flags.
- Disabled individuals are at a higher risk of abuse.
Gerontological Considerations
- Elderly individuals may exhibit signs of abuse such as poor hygiene, ulcers, infections, poor nutrition, missed doctor appointments, and unfilled prescriptions.
- Elder abuse can include physical, sexual, emotional, and verbal abuse, with the majority committed by family members.
Nursing Management:
- Maintain a high level of suspicion and speak to patients alone.
- Mandatory reporting is essential for child abuse.
- Ask patients about their safety and well-being.
- Document all observations and discussions clearly and concisely for future legal proceedings.
Sexual Assault
- Crisis intervention is critical for survivors of sexual assault.
- A Sexual Assault Nurse Examiner (SANE) assesses and provides medical and legal evidence, offers psychological care, and guides victims through the legal process.
- Provide emotional support and psychological counseling.
- Maintain the chain of evidence by collecting specimens photographically and through video documentation.
- Inquire about potential alterations to evidence, such as bathing, douching, brushing teeth, changing clothes, urinating, or defecating since the assault.
- Urine drug testing should be conducted within 96 hours of the assault.
- Collect specimens like vaginal aspirates, secretions, smears from oral/vaginal/anal areas, cultures, blood serum, pregnancy tests, foreign materials, and pubic hair samples.
Psychiatric Emergencies
- Signs include overactive, underactive, depressed, suicidal, or violent behavior.
- Nursing management emphasizes safety, non-judgmental care, and assessing psychiatric history.
- Maintain a calm and reassuring demeanor.
- Utilize crisis intervention services when available, particularly for suicidal patients and involuntary commitments.
- Tailor care to the specific type of psychiatric emergency.
Substance Abuse
- Substance use disorder (SUD) is the misuse of drugs, alcohol, or medication that alters mood or behavior.
- Signs and symptoms of SUD can range from vital sign changes to coma.
- Management includes: toxicology screening, initiation of IV access, oxygen monitoring, and administration of antidotes.
- Alcohol intoxication affects balance, reasoning, and concentration, leading to central nervous system depression and hypotension.
- Management of alcohol intoxication includes IV fluids, airway assessment and maintenance, and monitoring of vital signs.
- Stimulants like cocaine induce rapid heart rate/tachycardia, increased blood pressure, muscle cramps, vomiting, hyperthermia, panic attacks, seizures, and hallucinations.
- Treatment for stimulant intoxication focuses on managing hyperthermia and arrhythmias.
- Opioids such as heroin, opium, and morphine cause dizziness, nausea and vomiting, bradycardia, hypotension, dyspnea (respiratory depression), pinpoint pupils, altered level of consciousness, and flash pulmonary edema.
- The antidote for opioid overdose is Narcan (Naloxone), which lasts approximately 15 minutes and may require repeated doses.
- Barbiturates, including Nembutal (Phenobarbital) and GHB, can mimic alcohol intoxication and cause respiratory depression, flushed face, decreased heart rate and blood pressure, agitation, decreased level of consciousness, sluggish pupils, decreased deep tendon reflexes, coma, and death.
- Management of barbiturate intoxication focuses on maintaining the airway and neurological status.
- Inhalants, such as Freon, toluene, helium, propane, paint thinner, gasoline, and glue, are rapidly absorbed and can lead to cravings.
- Signs and symptoms of inhalant intoxication include headache, euphoria, dizziness, altered level of consciousness, a drunk-like feeling, vasodilation, nosebleeds, sluggish pupils, and respiratory depression.
- Management of inhalant intoxication involves monitoring ABCs (airway, breathing, circulation) and respiratory status, and treating hypotension.
- Amphetamines such as crystal meth, ecstasy, and Ritalin are stimulants known as "uppers."
- Amphetamine intoxication causes nausea and vomiting, tachycardia, increased blood pressure and respiratory rate, irritability, agitation, fear, decreased inhibition, anxiety, depression, cardiovascular collapse, tachypnea, and palpitations.
- Management of amphetamine intoxication includes airway support, monitoring cardiac status, insertion of an IV, and prevention of rhabdomyolysis.
- Hallucinogens/psychedelics such as LSD, PCP, marijuana, and Special K cause mild hypertension, confusion, withdrawal, hallucinations, seizures, nystagmus, and pupillary dilation.
- Management includes monitoring ABCs and conducting urine analysis.
- Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and midazolam (Versed) cause decreased level of consciousness, drowsiness, confusion, slurred speech, and can mimic alcohol intoxication.
- The antidote for benzodiazepine overdose is flumazenil (Romazicon).
- Management includes maintaining ABCs and addressing respiratory depression or circulatory collapse.
- Salicylate poisoning, commonly caused by aspirin, presents with tinnitus, blurred vision, sweating, respiratory alkalosis/metabolic acidosis, and bleeding.
- Treatment for salicylate poisoning includes sodium bicarbonate, fluids, diuretics, and hemodialysis if necessary. Activated charcoal may be given to absorb aspirin.
- Acetaminophen (Tylenol) overdose occurs with more than 4 grams in 24 hours.
- Signs and symptoms include hepatic failure, coagulopathies, lethargy, encephalopathy, diaphoresis, hepatomegaly, right upper quadrant pain, hypoglycemia, gastrointestinal upset, and metabolic acidosis.
- Charcoal is effective in absorbing acetaminophen within the first hour.
- The antidote for acetaminophen overdose is acetylcysteine (Mucomyst). Charcoal should not be administered with Mucomyst.
Violence, Abuse, and Neglect
- Intimate Partner Violence (IPV) and family violence can include physical violence, sexual violence, stalking, psychological aggression, neglect, financial abuse, or intimidation by a former or intimate partner.
- Signs of abuse may include a story inconsistent with injuries, injuries in various stages of healing, anxiety, and significant stress.
- Those who are disabled are at a higher risk of experiencing abuse.
- Gerontological considerations related to elder abuse include poor hygiene, ulcers, infections, poor nutrition, missed doctor's appointments, unfilled prescriptions, physical, sexual, emotional, and verbal abuse, and neglect.
- The majority of cases of elder abuse are perpetrated by family members.
- Nurses must maintain a high level of suspicion, ask patients alone if they feel safe at home or are afraid of people close to them, and ensure mandatory reporting for children.
- Proper documentation is critical during the assessment and interaction with patients to support future legal proceedings.
- Sexual assault is a crisis that requires immediate intervention, and the victim should be made to feel safe.
- A Sexual Assault Nurse Examiner (SANE) provides medical and legal evidentiary care, psychological care, and support throughout the legal process.
- Psychological counseling is crucial during these times.
- Maintaining a chain of evidence is vital and involves collecting photographic and video documentation, and conducting laboratory analysis of specimens.
- Patients should be asked if they have bathed, douched, brushed their teeth, changed clothes, urinated, or defecated since the attack.
- Urine drug testing must be completed within 96 hours of the event. Emesis may also be collected as evidence.
- Laboratory specimens from suspected victims of sexual assault include vaginal aspirates, secretions, smears from the oral, vaginal, and anal areas, cultures for gonorrhea, blood serum for syphilis, pregnancy tests, foreign material (leaves, grass, dirt), and pubic hair samples.
Psychiatric Emergencies
- Psychiatric emergencies involve patients who are overactive, underactive, depressed, suicidal, or exhibiting violent behavior.
- Safety is the priority.
- Management of psychiatric emergencies requires a non-judgmental approach and assessment of the patient's history of psychiatric disorders.
- Nurses must remain calm.
- Crisis intervention is utilized when appropriate, especially in cases of suicidal ideation.
- Determination of involuntary commitment may be necessary.
- Treatment should be tailored to the type of psychiatric emergency.
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Description
This quiz covers the key concepts of substance use disorder and acute alcohol intoxication. Test your knowledge on symptoms, management strategies, and the physiological effects of substance misuse. It highlights the importance of monitoring and treatment approaches for overdose cases.
