Alcohol & Drugs PDF

2.) Alcohol Note: Remember in a psych question, if you are asked to prioritize > DO NOT forget Maslow!! Use the following priorities: 1. Physiological 2. Safety 3. Comfort 4. Psychological 5. Social 6. Spiritual Also, ALL PSYCH PATIENTS START AS MED SURG PATIENTS...RULE OUT ALL FE...

2.) Alcohol Note: Remember in a psych question, if you are asked to prioritize > DO NOT forget Maslow!! Use the following priorities: 1. Physiological 2. Safety 3. Comfort 4. Psychological 5. Social 6. Spiritual Also, ALL PSYCH PATIENTS START AS MED SURG PATIENTS...RULE OUT ALL FEASIBLE MED ANSWERS BEFORE PICKING PSYCH ANSWERS. Psychodynamics of Alcoholism The #1 problem = DENIAL*refusal to accept the reality of a problem* You treat denial by confronting it Treatment: ○ Confront it by pointing out to the person the difference between what they say and what they do ○ In contrast, support the denial loss & grief, don’t confront it 5 stages of grief: Denial Anger Bargaining Depression Acceptance ○ Example: You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to playing the piano”... You say “Oh, how long have you played, etc? - you NEVER say “You can’t because you only have 1 hand” abuse = confront loss = support Dependency/Codependency (#2 problem) Dependency: when the abuser gets the significant to do things for them or make decisions for them Codependency: when the significant other derives positive self-esteem from doing things for or making decisions for the abuser. Treatment: ○ Set boundary (limits) and enforce them...Learn to say NO!! ○ Agree in advance on what requests are allowed than enforce the agreement ○ Work on self-esteem of the codependent person Manipulation Definition: when the abuser gets the significant other to do things for him or her that is not in the best interest of the significant other... the nature of the act is dangerous or harmful to the significant other. How is manipulation like dependency? the abuser is getting the other person to do something  ○ Example: No harm = dependent / co-dependent (wife buying alcohol for husband) dangerous/harmful = manipulated (kid buying alcohol for father)...depends on legal/illegal..... Treatment: ○ Set limits and enforce them ○ It's easier to treat than dependency/codependency because nobody likes to be manipulated Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Psychosis induced by a deficiency in the B1 vitamin thiamine. ○ Thiamine (B1) plays a role in metabolizing glucose to produce energy for the brain. Primary symptom of WKS = amnesia with confabulation ○ Making up stories to fill in memory los; they believe it is true ○ Example: You have a pt who believes he is Ronald Reagan's National Security Officer... And they want to go to a cabinet meeting.../ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower and then we’ll go watch CNN and see what the news is in Washington D.C.”) Characteristics: ○ Preventable Give B1 vitamins ○ Arrestable Can stop it from getting worse - not imply better ○ Irreversible Dementia symptoms don’t get better - only worse **NCLEX Tip: Always answer with the majority Antabuse (disulfiram)/Revia - alcoholism medication *aversion therapy! * It can treat problem drinking by creating an unpleasant reaction to alcohol. It's used in recovery programs that include medical supervision and counseling. Onset and duration of effectiveness > 2 weeks ○ Take drug for 2 weeks and builds up in the blood level that when drinking alcohol, they will become horribly sick ○ If they stop taking the drug for 2 weeks, they will be able to drink alcohol without getting sick Patient teaching - Avoid ALL forms of alcohol to avoid nausea , vomiting and possibly death ○ NO: mouthwash, aftershaves, perfumes/colognes, insect repellants, any OTC elixirs (ex: Robitussin), alcohol-based hand sanitizers, un-cooked icings (vanilla extract)... ○ However, they CAN have RED WINE VINAIGRETTE! *Overdoses/Withdrawals... First ask yourself, “Is the drug an upper or a downer?” Exception > Laxative (not upper or downer) but can be abused by the elderly.. Uppers ↑ Downers ↓ Names: Names Caffeine Everything else that is not an upper Cocaine PCP/LSD (Psychedelic hallucinogens) Methamphetamines - speed ADHD - adderall/Ritalin Bath Salts (Cath-Rath) Signs/Symptoms: Signs/Symptoms: Tachycardia Hypertension Bradycardia Hypotension Diarrhea Agitation Constipation Constricted pupils Tremors Clonus Flaccidity Respiratory arrest Belligerence Seizures Decreased core body temp Lethargy Hyporeflexia Exaggerated, shrill, high pitched cry **Need Ambu bag Difficult to console Borborygmi Euphoria Hyperreflexia **Need suction Then ask yourself, “Are they talking about overdose or withdrawal?” Overdose/Intoxication Withdrawal “I have too much…” “I don’t have enough…” Too much upper: > Everything is UP ↑↑ Too little upper: > Everything is DOWN ↓↓ Too much downer: > Everything is DOWN ↓↓ Too little downer: > Everything is UP ↓↓ Upper overdose LOOKS LIKE downer withdrawal Downer overdose LOOKS LIKE upper withdrawal 2 situations (highest priority): Respiratory depression/arrest: Downer overdose/upper withdrawal.. Seizure: Upper overdose/downer withdrawal... ○ Example: Overdose on cocaine: UPPER/OVERDOSE.. (too much UPPER) *aka everything goes ↑* What would you expect to see? (select all that apply) - irritability, reflex 3/4, increased temp, borborygmi (increased bowel sounds), respirations < 12, difficult to arouse Drug addiction in the NEWBORN ☹ Always assume intoxication, not withdrawal at birth Before 24 hours- it’s intoxicated After 24 hours - it’s in withdrawal  Example: You are caring for an infant born to a equaline (pain killer) addicted mother... It is 24 hours after the birth... What do you expect to see.. SELECT ALL THAT APPLY: difficult to console , low core body temp, exaggerated startle reflex, respiratory depression, seizure risk, shrill high pitched cry... Alcohol Withdrawal Syndrome vs. Delirium Tremens Differences: ○ Every alcoholic goes through alcohol withdrawal syndrome (AWS) after 24 hours ○ Only a minority get delirium tremens (DT’s) ○ AWS is not life threatening. DTs can kill you Patients with AWS are usually stable and not dangerous to themselves or others Patients with DT’s are usually unstable and are dangerous to themselves and others AWS DT’s BOTH Anti-hypertensives Semi-private room Anywhere Private room on the unit Near nurse’s station Regular diet NPO or Clear Liquids Tranquilizer Up Ad Lib (no activity restrictions) Restricted bedrest (no bathroom B1 multi-vitamin privileges, bedpan/urinal) (to prevent dementia) Do not restrain Should be restrained (2 point leather restraints) 2 extremity restricted- L arm/R leg or R arm/L leg **Aminoglycosides - powerful antibiotics (the BIG GUNS!!!) think: a mean old mycin Treats serious, life threatening, resistant, gram negative infections (TB, septic peritonitis, fulminating pyelonephritis, septic shock, infection of third degree burns over 80% of your body, etc.) Examples: Streptomycin, Cleomycin, Tobramycin, Gentamycin, Vancomycin, Clindamycin Not all drugs that end in mycin are aminoglycosides: erythromycin, zithromycin, clarithromycin / if it has thro = throw it off the list... Toxic Effects: ○ The most famous feature on the world’s famous mouse (Mickey Mouse’s ears)  Toxic effect > ototoxic !! Monitor hearing , tinnitus (ringing in ears), vertigo/dizziness ( equilibrium) ○ The human ear shaped like kidney... Toxic effect > nephrotoxicity ! Monitor creatinine (best indicator for kidney function) Normal range: 0.6-1.2 mg/dL ○ The number 8 drawn in the ear reminds you of: Cranial nerve #8 ( can cause hearing loss) Frequency of administration: Every 8 hours Route of Administration: ○ Give IM or IV ○ Do not give PO (it is not absorbed ) except in these two cases: Hepatic Encephalopathy Also called liver coma, ammonia-induced encephalopathy When you want a sterile bowel Due to high ammonia levels Pre-Op Bowel Surgery Remember military sound-off: ○ NEOmycin ○ KANamycin ○ Who can sterilise my bowel? NEO KAN Trough and Peak Levels ○ T (trough): when the drug level is at its lowest ○ A (administer) ○ P (peak): when the drug level is at its highest Why do we draw TAP levels? Narrow therapeutic range ○ Time Table: ROUTE TROUGH (lowest) PEAK (highest) Sublingual 30 min before next dose 5-10 min after drug dissolves IV 30 min before next dose 15-30 min after drug finished IM 30 min before next dose 30-60 min after drug is given SubQ 30 min before next dose See diabetes lecture PO 30 min before next dose Forget about it