NRS 308NCLEX-Uworld_LATEST
Abu • Every psych patient is first and foremost a med-surg client
• Perform med-surg eval before psych eval
se
• All intoxicated clients should be given IV thiamine before (or with) IV
(Alcoholis
glucose to prevent Wernicke encephalopathy
m)
Psychological Problems
• #1 Denial (anger, bargaining,
depression, loss)
o Alcoholism – confront and try to
stop
o Grief and Loss – support and allow to continue
• #2 Dependency/Co-dependency
o Nature of act is harmless
o Dependent – Has time to focus on abuse
o Co-dependent – Derives positive self-esteem by doing things for
the abuser
o Treatment
▪ Set limits and enforce them
▪ Decide ahead of time which requests are reasonable and
which are not and then enforce agreements
▪ Self-esteem needs of co-dependent must come from
within
• #3 Manipulation
o Nature of act is harmful
o Abuser gets significant other to do things for him/her that are
not in his/her best interest
o Treatment - set limits and enforce them
Wernicke-Korsakof (Alcoholics)
• Irreversible
• Psychosis due to brain damage
• Induced by vitamin B1 (thiamine deficiency), which is necessary for
alcohol metabolism to occur
• Primary symptom - amnesia with confabulation
Aniverse Revia Disulfiram
• Alcohol aversion therapy
• Onset – 2 weeks
• Duration – 2 weeks
• Teach patient to avoid all forms of alcohol:
o Insect repellants
o Aftershave
o Mouthwash
o Elixirs (Benadryl, Robitussin)
, o Vanilla extract
o Alcohol based hand sanitizers
o Perfumes and colognes
o Vinaigrette
Stimulant (Upper) Depressant (Downer)
(Cafeine, Cocaine, PCP/LSD (Everything that’s not a
(hallucinogen), Methamphetamine, stimulant)
Methamphetamine salts)
Withdrawal = Depressant Withdrawal = Stimulant
Hyper Hypo
Tachy Brady
Increased Decreased
Borborygmi Paralytic ileus
Irritability/agitation Lethargy
Diarrhea Constipation
Seizures (death) - suction Respiratory arrest
Spastic/Tetany/Tremors Flaccidity
Elevated/Exaggerated Depressed/Suppressed
Hunger (increased appetite) Anorexia
Wide eyed Constricted
Clonus
Belligerent
Rhinorrhea
Alcohol Withdrawal & Delirium
Tremens (DTs)
, Acid-Based ABGs
• pH: 7.35 – 7.45
Balance
o Down = acidosis
o Up = alkalosis
o Normal = compensated
• pCO2: 35-45
• HCO3: 22 – 26
• SaO2: 95-99%
Principles
• pH and bicarb in the same direction = metabolic (bicarb, both, bolic)
• As the pH goes, so goes my patient (except for potassium)
• Ventilation = gas exchange (SaO2)
Alcohol Withdrawal Delirium Tremens (DTs)
Every alcoholic Only a minority
Starts within 8 hours of last drink and 72 hours after last drink
peaks at 24-72 hours
ALWAYS precedes delirium tremens Does not always follow alcohol
withdrawal
Not life threatening (stable) Life threatening (unstable)
Semi-private anywhere Private near nurse’s station
Up ad lib (can go anywhere if they let Restricted bed rest (no bathroom
you know) privileges)
Regular diet NPO or clear liquids (seize/aspiration)
No restraints Restraints
Anti-hypertensives Anti-hypertensives
Tranquilizer Tranquilizer
Vitamin B1 Vitamin B1
, • Assess SaO2 BEFORE respiration rate
o Over-ventilating (↑ SaO2) = Respiratory Alkalosis
o Under-ventilating (↓ SaO2) = Respiratory Acidosis
• If SaO2 is normal, look at RR
Examples
• Respiratory Acidosis – near drowning
• Respiratory Alkalosis – panic
• Metabolic Alkalosis – ONLY prolonged suctioning or vomiting
• Metabolic Acidosis – Everything else that isn’t lung or metabolic
alkalosis
o GI bicarb losses (diarrhea)
o Ketoacidosis (diabetes, alcoholism, starvation)
o Lactic acidosis (sepsis, hypoperfusion)
o Renal failure (hemodialysis with shunt)
o Salicylate toxicity
o Pyelonephritis
o Hypotension
Abu • Every psych patient is first and foremost a med-surg client
• Perform med-surg eval before psych eval
se
• All intoxicated clients should be given IV thiamine before (or with) IV
(Alcoholis
glucose to prevent Wernicke encephalopathy
m)
Psychological Problems
• #1 Denial (anger, bargaining,
depression, loss)
o Alcoholism – confront and try to
stop
o Grief and Loss – support and allow to continue
• #2 Dependency/Co-dependency
o Nature of act is harmless
o Dependent – Has time to focus on abuse
o Co-dependent – Derives positive self-esteem by doing things for
the abuser
o Treatment
▪ Set limits and enforce them
▪ Decide ahead of time which requests are reasonable and
which are not and then enforce agreements
▪ Self-esteem needs of co-dependent must come from
within
• #3 Manipulation
o Nature of act is harmful
o Abuser gets significant other to do things for him/her that are
not in his/her best interest
o Treatment - set limits and enforce them
Wernicke-Korsakof (Alcoholics)
• Irreversible
• Psychosis due to brain damage
• Induced by vitamin B1 (thiamine deficiency), which is necessary for
alcohol metabolism to occur
• Primary symptom - amnesia with confabulation
Aniverse Revia Disulfiram
• Alcohol aversion therapy
• Onset – 2 weeks
• Duration – 2 weeks
• Teach patient to avoid all forms of alcohol:
o Insect repellants
o Aftershave
o Mouthwash
o Elixirs (Benadryl, Robitussin)
, o Vanilla extract
o Alcohol based hand sanitizers
o Perfumes and colognes
o Vinaigrette
Stimulant (Upper) Depressant (Downer)
(Cafeine, Cocaine, PCP/LSD (Everything that’s not a
(hallucinogen), Methamphetamine, stimulant)
Methamphetamine salts)
Withdrawal = Depressant Withdrawal = Stimulant
Hyper Hypo
Tachy Brady
Increased Decreased
Borborygmi Paralytic ileus
Irritability/agitation Lethargy
Diarrhea Constipation
Seizures (death) - suction Respiratory arrest
Spastic/Tetany/Tremors Flaccidity
Elevated/Exaggerated Depressed/Suppressed
Hunger (increased appetite) Anorexia
Wide eyed Constricted
Clonus
Belligerent
Rhinorrhea
Alcohol Withdrawal & Delirium
Tremens (DTs)
, Acid-Based ABGs
• pH: 7.35 – 7.45
Balance
o Down = acidosis
o Up = alkalosis
o Normal = compensated
• pCO2: 35-45
• HCO3: 22 – 26
• SaO2: 95-99%
Principles
• pH and bicarb in the same direction = metabolic (bicarb, both, bolic)
• As the pH goes, so goes my patient (except for potassium)
• Ventilation = gas exchange (SaO2)
Alcohol Withdrawal Delirium Tremens (DTs)
Every alcoholic Only a minority
Starts within 8 hours of last drink and 72 hours after last drink
peaks at 24-72 hours
ALWAYS precedes delirium tremens Does not always follow alcohol
withdrawal
Not life threatening (stable) Life threatening (unstable)
Semi-private anywhere Private near nurse’s station
Up ad lib (can go anywhere if they let Restricted bed rest (no bathroom
you know) privileges)
Regular diet NPO or clear liquids (seize/aspiration)
No restraints Restraints
Anti-hypertensives Anti-hypertensives
Tranquilizer Tranquilizer
Vitamin B1 Vitamin B1
, • Assess SaO2 BEFORE respiration rate
o Over-ventilating (↑ SaO2) = Respiratory Alkalosis
o Under-ventilating (↓ SaO2) = Respiratory Acidosis
• If SaO2 is normal, look at RR
Examples
• Respiratory Acidosis – near drowning
• Respiratory Alkalosis – panic
• Metabolic Alkalosis – ONLY prolonged suctioning or vomiting
• Metabolic Acidosis – Everything else that isn’t lung or metabolic
alkalosis
o GI bicarb losses (diarrhea)
o Ketoacidosis (diabetes, alcoholism, starvation)
o Lactic acidosis (sepsis, hypoperfusion)
o Renal failure (hemodialysis with shunt)
o Salicylate toxicity
o Pyelonephritis
o Hypotension
