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130 Cards in this Set
- Front
- Back
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Alcohol Withdrawal symptoms
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Occur minutes to days after last drink
- Autonomic hyperactivity (tremors, sleep disturbances, insomnia, nightmares) - N/V - auditory visual, and tactile hallucinations (bugs and snakes common) - psychomotor agitation - anxiety - grand mal seizure--> sttus epilepticus --> death - elevated temperature, BP, pulse |
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Delerium Tremens (or Alcohol Withdrawal Delirium)
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24-72 hours after last drink
- elevated vital signs (T>= 100, P>= 100) - Restless, tremulousness (do fingertip assessment), agitation, hyperalertness - sound/light sensitive - illusions/hallucinations - medical emergency or death may occur if not treated librium valium, ativan used for treatment of withdrawals |
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When does withdrawal from opioids start
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12- 16 hours after last use
** find out when last use was! Will subside in 5-10 days if no treatment |
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Symptoms of opioid withdrawal
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- good bumps
- watery eyes - rhinitis - yawning - sneezing - diaphoresis - dilated pupils - tremors - restlessness - irritability - muscle cramps - abdominal cramps - nausea - vomiting - diarrhea - fever |
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Methamphetamine use can cause
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- neuro toxic effects destroy brain cells containing dopamine and serotonin
- Parkinson like symptoms may develop longer use: - cracked teeth - skin infections - strokes - lung disease - kidney damage - liver damage - birth defects - death |
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CAGE screening test for alcoholism
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- have you ever tried to CUT down on your drinking?
- have people ANNOYED you by criticizing your drinking? - have you every felt bad or GUILTY about your drinking? - have you ever had a drink first thing in the morning to steady your nerves? (EYE OPENER) - |
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CIWA- AR
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Clinical Institute Withdrawal Assessment of Alcohol
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3 phases of abuse
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tension building
abuse honeymoon phase |
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Hans sayle
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stress related response research --> dilated pupils
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Kemp
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wrote book about waxy-like postures of severely abused child
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#1 legality factor
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if believe that threats will be acted upon (i believe him when he says he will kill me)
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Bistandard effect
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no one stepping up to say stop (ie: a group of men gang-raping a girl)
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Dating red flags
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- partner tells you who u can and cannot see
- gets upset when u spend time with friends and famiy - verbally puts u don't in front of thers - pressures to have sex - extreme jealousy - destroys property - upset when late - grabs, chokes, hits, pushes - pressure to do drugs - threatens to hurt you or pets if break up - begs for forgiveness |
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recant
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resend what said, children do this especially if scared
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Abuse #, 24 hour hotline
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1-800-96- ABUSE
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Finkelhor (theorist)
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lookes at individuals that have been victims and there are 4 things that they have to deal with:
- betrayal - anger - depression - stigma |
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Alcohol dependence
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- tolerance and withdrawal
- cognitive, behavioral, and physiologic - more intake than intended over time - persistent desire with no success to cut down - social, occupational, and recreational given up because of drinking - significant amount of time spent doing stuff to obtain alcohol - over 12 month period - continued drinking despite knowledge of physical or psychological problem |
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Alcohol abuse
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within 12 months:
- recurrent drinking resulting in failure to fulfill major role obligations in work, school, or home - recurrent drinking in situations in which it is physically hazardous - recurrent alcohol related legal problems - continued despite persistent or recurrent social or interpersonal pro blems caused by it |
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Addiction
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Illness characterized by compulsion, loss of control and continued patterns of abuse despite perceived negative consequences
- obsession with dysfunctional habit |
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Habituation
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Psychological dependence- continuous or intermittent craving for a substance to avoid a dysphoric or unpleasant mood
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Tolerance
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Person's ability to obtain a desired affect from a substance and the need to increase dosage to obtain it over time
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Physiologic dependence
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- physical effects after multiple uses of a substance that result in withdrawal if substance is stopped
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Behavioral dependence
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- Substance seeking activities and pathological use patterns of the person using the substances
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Codependency
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- Behavioral patterns of family members/friends who have been significantly affected by the other;s substance use or abuse
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Enabling
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- Behavior that perpetuates another persons substance use or abuse
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Biologic theory of drug abuse
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- All drugs of abuse stimulate dopamine secretion
- brains of addicts have fewer dopamine receptors - Individuals risk for addiction may be due to high level of stress hormone, a deficit of dopamine function that is temporarily corrected by the substance |
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Behavioral or learning theories
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- Addiction results from the positive effect of mood alterations and reduction of feelings of fear and anxiety that one experience when using a substance
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Sociocultural Theories
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- Potential for addiction is affected by economic conditions, cultural, ethnic traditions, companionship and approval of other drug users
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Psychodynamic theory
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- Individuals who use substances fixed oral or infantile level of development
- Abusers searches for immediate gratification of needs or ways to escape tension |
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ETOH shortens and individuals life by
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12-15 years
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Alcohol level and alcohol poisoning
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0.8 and ~5 or greater (if tiny person can be less)
Someone's liver could also be "used" to it |
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Alcohol Abuse does not include-
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tolerance, withdrawal, or pattern of compulsive use
- have to have one of the previously listed definition choices |
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Opioid related disorders
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- drugs derived from poppy plant used for pain relief
- Natural (morphine) - semi-synthetic (heroin) - Synthetic forms (codeine/methadone) - take orally, inhale, inject - user becomes passive and listless - decreased feelings of hunger, thirst, pain, and sexual desires (usually dehydrated) |
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Withdrawal from opioids begins
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12-16 hours after the last done
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Withdrawal can be done by-
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- symptom based management
- Suboxone (buprenorphinr and naloxone) 4mg twice a day for 2 days, 2mg twice a day for 2 days, then done --carefully prescribed so it doesn't become like methadone |
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Cannabis
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- THC
- effects felt in 15 min and last about 204 hours - affects mood, thinking, behavior, and judgement - may cause hallucinations - stored in fat cells so stays in body for like 30 days - possible gateway drug - most commonly abused drug |
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Cocaine
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- coco plant from South America
- short acting CNS stimulant * Chest pain common, can die of acute MI |
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Methamphetamine
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- fastest growing drug threat
- highly addictive stimulant - neuro toxic effects destroy brain cells containing dopamine and serotonin - parkinson like symptoms develop - longer term used: cracked teeth, skin infections, strokes, lung disease, kidney damage, liver damage, birth defects and death |
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CIWA-AR
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- Clinical Institute Withdrawal Assessment of Alcohol
- used to aid in management of alcohol withdrawal - Structures assessment that guides orders for medications |
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Drug Screens
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- Urine or blood
- tests for specific substances requested - Depends on 1/2 life of drug if it will be present - hair |
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Impaired Nurse
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- higher rates of addiction than general public
- some are chemically dependent |
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Signs of impaired nurse
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- more pts complaining of pain when RN working or not sleeping even though medicated
- RN leaving the unit or in the bathroom frequently - RN wants to work more shifts or is an overachiever |
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Residential Treatment
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- away from influences to focus on recovery
- need to be detoxed prior to beginning - interdisciplinary ie: 28 day program |
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Self help groups
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AA
AN Al-Anon Alateen |
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Dual Diagnosis
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- Expect to be the norm not exception
- Treatment programs need to focus on both the mental health issue and the substance issue simultaneously - Staff need to be knowledgeable about mental health disorders and substance disorders and the treatment that goes with it - Staff needs to be non-judgmental about substances |
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Korsakoff's psychosis
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-a form of amnesia characterized by a loss of short-term memory and inability to learn new skills
- A CNS disorder associated with alcoholism - confabulation - disorientation |
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Wernicke's encephalopathy
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- a CNS disorder associated from alcoholism
- double vision - involuntary and rapid eye movements - lack of muscular coordination - decreased mental function - may be mild or severe |
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Alcohol intoxication
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- occurs after recent ingestion of alcohol
- evidenced by behavioral changes such as decreased inhibition, impaired social or occupational functioning, fighting, or impaired judgement - may exhibit mood changes - increased verbalization - impaired attention span - irritability - slurred speech - disorientation - facial flushing - lack of coordination - unsteady gait - nystagmus - impaired memory stupor or coma |
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PCP
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- gives people " super human strength"
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MAST
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Michigan Alcohol Screening Test
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Physical indicators of child abuse
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- bruises that do not break skin, usually found on posterior in unusual patterns or clusters
- various stages of healing - burns- buttocks, palms, soles of feet, wrists, ankles, genitals - lacerations, abrasions, welts, and scars may be noted on lips, eyes, face, and external genetalia - missing or loosened teeth - separation, stiff, swollen, enlarged joints - head injuries - internal injuries - make sure you know child's medical hx |
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Munchausen's syndrome by proxy
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biologic mother, father, or female caregiver fabricates or deliberately causes illness or injury in the child in order to gain sympathy or attention for themselves
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Shaken Baby syndrome
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- form of child abuse
- leading cause of brain injury in infants - shakes child violently |
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Physical findings of shaken baby syndrome
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- bruising from being grabbed firmly
- major head injury such as a subdural hematoma or cerebral edema - blindness (reitnal hemorrhage) - cerebral palsy - cognitive impairment - death |
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Behavioral indicators of abuse
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- depends on age and frequency of abuse, and severity
- fear of parents or adult physical contact - extreme passivity or aggression, crying often or seldom - sudden regressive behaviors - learning problems that can't be diagnosed - inappropriate dress (to hide abuse) - excessive compliance to avoid confrontation - sporadic temper tantrums - violence toward other children or animals - demanding behavior |
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Indicators of emotionally abused or neglected child
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- low self concept
- "It's all your fault" - rejection or immature behaviors of parents or caretakers - continued friction or conflict at home - discriminatory treatment of the children - shuttering - enuresis or encopresis - Deliquency, truancy, or disciplinary problems - hypochondriasis - autism or failure to thrive - overeating - childhood depression - suicide attempts |
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Physical sexual abuse indicators
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- itching, pain, bruising, bleeding of external genetalia, vagina, or anal area
- edema of cervix, vulva, perineum - torn, stained, or bloody undergarments - stretched hymen at a very young age - semen or STD - pregnancy in an older child - bladder infections |
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Behavioral sexual abuse indicators
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- fear of being touched
- difficulty walking or sitting - reluctance to participate in recreational activities - poor peer relationships - deliquency, truancy, acting out, running away - preoccupation with sexual organs of self or others (in young children) - sexual promiscuity or prostitution (older children) - change in sleeping patterns, nightmares, or sudden fear of falling asleep - bedwetting or thumb sucking (inappropriate to age) - use of drugs or alcohol |
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Factors contributing to Domestic violence
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- neurologic impairments, agitate depression, antisocial or borderline
- drug abuse and alcohol - lack of nurturing and mothering during childhood so are unable to nurture themselves -poor socioeconomic conditions (increased stress, etc) - poor communication skills - learned behavior - may increase after death of family member, loss of job, move, physical or mental illness, developmental change, or pregnancy or birth |
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Profile of abuser
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- usually male (but not always!)
- low self esteem - beleive that man should be head of household - jealousy from insecurities and fears - grew up in violent home - use force and blame - denial |
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Profile of abuse victim
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- raised with rigid traditional views regarding male and female roles
- exposure to violence as a child - getting married as a teenager - learned helplessness - religious or cultural beleifs about gender roles |
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when are victims at greatest risk
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when trying to leave or when pregnant
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When abuse goes public
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- sign of escalation
- abuser doesn't care who sees it cause they are doing it anyways |
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If choked- Make sure to look....
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- behind the ear for choke marks and tongue may be bluish, purple
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Phases of abuse
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1. tensions building phase
2. beating/abuse 3. Honeymoon phase |
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Hans Sayle
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stress research
- dilated pupils |
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Kemp
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In 70's wrote a book about battered child and stated that if a child is seriously physically or emotionalloy abused then you can put then in an odd posture that they will stay in (waxy)
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signs of a male abuser
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- hovering around
- hard to isolate woman so can talk to ** act like going to take an x-ray or a urine sample |
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Nurses are mandatory reporters for-
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elderly, children, and disabled
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#1 legality factor
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Belief that his threats will be acted on
"I believe him when he says he is going to kill me!" |
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Pit Bull vs. cobra abuser
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Pit bull- outwardly aggressive
cobra- sneaky, gonna get ya (worse!) |
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Armed abuser
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lethal
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Possible elderly abuse indicators
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- bruising, lacerations, various stages of healing, evidence of sexual abuse, statement of vitim, contractures, decubiti, malnutrition, dehydration
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Bistandard effect
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like in a gang rape no one stepping in to say stop
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Some mothers that have been abused suffer from psychoses, putting them at higher risk for
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further abuse or them actually abusing their children
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Abuse
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something done to a person
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Neglect
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omission, something left out
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Hard abuse to prove
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emotional (no physical marks)
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on assessment..
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spend a lot of time on skin!, get in hair, covered areas, look between fingers and toes
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assessment of genetalis in children (position)
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frog legs
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recant
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resend what they have said (children do this a lot) especially when afraid or threated that dad will go to prison if they say something or are threatend by abuser to hurt them or mom
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conflict of interest
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- can't be nurse for abuser and victim (cause this would be bad in court)
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#1 risk for deliquency in youth
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violence
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Do not make...
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promises you can not keep!!
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tell child
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it was not their fault
and NEVER give up on a child |
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Florida abuse hotline
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1-800-96 ABUSE
call where child can hear you and they can talk to person too so they know who is coming to talk to them |
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Finkelhor
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- theorist
- people that are victims have 4 things they must deal with 1. betrayal (people that love them are hurting them) 2. anger (towards others or self) 3. depression 4. stigma (like their is something wrong with them) |
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Shaken baby syndrome are more with female or male babies?
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Male
- "males shouldn't cry" or cry is worse with higher pitch - can cut off oxygen to brain |
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Mandatory reporters
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- physicians
- nurses - medical examiners - social workers - LEO - school teachers - mental health professional |
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Major differences in neuroleptic malignant syndrome, serotonin syndrome and alcohol withdrawal
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- BP and other vitals go UP in alcohol withdrawal but not in others
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Neuroleptic malignant syndrome
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- lead pipe rigidity
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Both neuroleptic malignant syndrome and alcohol withdrawal have...
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seizures- can be fatal!
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With detox main concern is..
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Seizures
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Conduct disorder
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males
- trouble with authority - destruction of property - hurting animals, small children, homeless (things considered less than them) AFTER conduct disorder and BEFORE antisocial |
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Oppositional defiant disorder (ODD)
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trouble with authority figures (best to treat now before gets worse)
- this is BEFORE conduct disorder |
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Antisocial personality disorder
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- onset before age 15
- may appear normal, but starting having problems with law as a child and continued into adulthoos - lack of remorse (lack of empathy for victims or people in general) - at least 18 yo - evidence of conduct disorders before age 15 If before 18 can be called "cluster B traits" |
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Borderline personality disorder
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- most challenging and prevalent
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Personality disorder
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- nonpsychotic illness characterized by MALADAPTIVE BEHAVIOR, which the person uses to fulfill his or her needs and bring satisfaction to him or herself.
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Cluster A
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- paranoid
- schizoid - schizotypal |
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Paranoid
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- IN TOUCH with reality but are distrustful and suspicious
- unfounded beliefs that others what to harm, exploit, or deceive person |
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Schizoid
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- emotional detachment
- uncooperative - "super shy" |
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Schizotypal
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- odd and eccentric
- magical thinking - no clear delusions or hallucinations |
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Cluster B
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- antisocial
- borderline - Histrionic - Narcissistic |
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Borderline
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- instability of affect, identity, relationships
- fear of abandonment - splitting - manipulation - impulsive - self mutilation or possible suicidal - most challenging and most prevalent |
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Histrionic
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- emotional attention seeking
- needs to be center of attention - seductive and flirtatious - vain, self absorbed, fickle, dramatic - uses physical appearance to draw attention - consider relationships more intimate than actually are - shallow emotions, people think they are fake - may bring gifts, don't accept - difficulty in handling criticism |
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Narcissistic
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- arrogance
- grandiose views of self - need for consistent admiration - lack of empathy--> strains on relationships - sensitive to criticism - chronic or difficult to treat - may use meds to treat mood swings (treat depression) |
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Cluster C
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- Avoidant
- Dependent - Obsessive- Compulsive |
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Avoidant
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- social inhibition and avoidance of all situations that require interpersonal contact
- despite wanting close relationships, due to extreme fear of rejection - anxious in social situations |
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Dependent
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- extreme dependency in a close relationship with urgent search to find a replacement if one ends
- most frequently seen personality disorder seen in clinical setting |
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Limit setting is good for
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- important, especially for antisocial and borderline
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Assertiveness is good for
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dependent and histrionic disorders
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If they want social isolation (like in schizoid or schizotypal)
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respect that
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Combination of meds for personality disorders
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antidepressant, anxiolytic, antipsychotic or combo
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Dialectical behavioral therapy
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- for borderline
- gradual behavioral changes that provides acceptance and validation - they are very frequently suicidal or have self-mutilating behaviors 1. individual therapy 2. group therapy (socialization skills) 3. Phone calls with therapist between sessions 4. Consults with therapist |
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Cluster A treatment
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- treated with low dose antipsychotics and antidepressants
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Cluster B treatment
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- mood stabalizers and anticolvulsants
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Cluster C treatment
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- antianxiety meds
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Clusters that severity of disease goes down over time
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Cluster A and B severity goes down over time but C does not
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Personality disorders are normally associated with-
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abuse, neglect, and separation from parents
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Treatment for paranoid
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low dose antipsychotics and SSRIs
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why is treatment of personality disorders difficult?
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- they mistrust everyone and don't trust meds or doctors
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Signs of fetal alcohol syndrome
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- small head circumfrance
- small eyes - Low nasal bridge - Epicanthal folds - Minor ear abnormalities - Thin upper lip - Receding jaw - Short palpebral fissures - Short nose - Flat midface - limb and cardiac defects |
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ecstacy (MDMA) adverse effects
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- critical elevation of BP, P
- Severe hyperthermia - heart and kidney failure - brain damage |
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Meth adverse effects
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- dramatic CNS effects
- increased energy and alertness - decreased appetite - convulsions - Hyperthermia - Tremors - CVA - Cardiac arrythmia |
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Stages of change model (alcohol and substance abuse)
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- Precontemplation (unaware of problem)
- Contemplation (pros, cons) - Preparation (support, tx options) - Determination (support) - Action (support and monitor efficacy) - Maintenance (identify pos. coping, problem solving, groups) - Relapse (identify triggers that lead to relapse and prevention for future) |
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Medical problems associated with substance abuse
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- cardiovascular
- respiratory infections - Renal failure and rhabdomyolysis - Neuro- Seizures, dementia, amnesia - Endocrine- amenorrhea, hyperthryoid mimic - Obstetric complications - oral - malnutrition, F&E, skin, impotence, HIV/AIDS |
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Antipsychotics for personality disorders
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Haldol- arrythmias, EPS
Zyprexa- weight gain, EPS Risperdal- monitor for GI, tachy, weight gain, EPS |
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Anticonvulsants for personality disorders
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Tegretol- liver function, skin
Depakote- liver, ammonia, rash |
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Antidepressants for personality disorders
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Prozac- SSRI
Effexor- HTN, dreams, tremors |
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Antianxiety agents for personality disorders
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Anafranil- anticholinergic
Klonopin- liver, paradoxical excitement first 2 weeks |
