Nurs 420: Final questions with verified answers
Alcohol withdrawal Ans✓✓✓ -Onset within 4 to 12 hours after cessation
or marked reduction of alcohol intake; usually peaks on the second day
and complete in about 5 days
-Symptoms: coarse hand tremors, sweating, elevated pulse and blood
pressure, insomnia, anxiety
-Severe or untreated withdrawal may progress to transient
hallucinations, seizures, or delirium (DTs).
-Withdrawal can be life-threatening.
-Benzodiazepines for safe withdrawal
-Alcohol is a central nervous system depressant
-CIWA - withdrawal assessment; look for specific s/s in a person
(increased temp, BP, RR, HR) q 2-4 hrs
-Vital signs will go up (temp, BP, RR, HR) if someone is withdrawaling
from alcohol
-VS q 2-4 hours
-Ask if they have tremors, sensitive to noise, increased startle reflex,
sensitive to light, headache or pressure in the head, paresthesia, feeling
that bugs are crawling on their skin (formication), GI issues
-Score them based on how they respond
-Medication is tied to this score
-Ex. Ativan 1mg IV q 2-4 hrs for a score of __
-Someone can go through withdrawl as early as 4 hours if really
dependent on it
,-Usually peaks the second day... most dangerous time is 48-72 hours
after stop drinking
-Give thiamine and multivitamin bc those get depleted in someone
using a lot of alcohol
-If start having DTs and seizures, life-threatening!!
-Benzos for safe withdrawal (ex. Ativan)
-May give pain meds, might give Tylenol (alcohol causes bleeding
problems so avoid ibuprofen), may give anticonvulsant (dilantin,
tegretol) if have hx of seizure or they look shaky, give thiamine, niacin,
and a multivitamin bc those get depleted whenever someone is using a
lot of alcohol
-Environment with less stimulation is better for withdrawal!
-Ask how much they use and when did they last used, and if they
withdrew in the past
Altruism Ans✓✓✓ Dealing with anxiety by reaching out to others
Adaptive use: A nurse who lost a family member in a fire is a volunteer
firefighter.
Maladaptive use: N/A
Anorexia nervosa Ans✓✓✓ -Onset usually between the ages of 14 and
18
-Denial early on; depression and lability with progression; isolation;
medical complications
,-Musculoskeletal, endocrine, GI, cardiac, metabolic, reproductive,
Neurologic, etc.
-Treatment: often difficult; client is resistant, uninterested, denies
problem
-Onset around puberty (but can be earlier or later)
-Denial, person doesn't feel they have a problem, very labile mood,
hide from others how much weight they are losing, medical problems
(passing out, fainting, arrhythmias, electrolyte imbalances,
musculoskeletal problems, cardiac, GI, reproductive problems)
-Treatment difficult bc client is resistant and fear of eating and gaining
weight, not interested in treatment, denial
-30-50% of people with anorexia will achieve full recovery while 10-20%
remain chronically ill
-6x more likely to die of a medical complication or suicide than general
population
-Clients with the lowest body weights and the longest durations tend to
relapse more often
-People who started this earlier tend to relapse more often, poorest
outcomes
-Abuse laxatives at higher risk of medical complications
Anorexia nervosa pt 2 Ans✓✓✓ -Medical management
oWeight restoration/nutritional rehabilitation
oCaution - refeeding syndrome
oRehydration/correction of electrolyte imbalances
, -Psychopharmacology: amitriptyline, cyproheptadine (periactin),
olanzapine, fluoxetine
-Psychotherapy
oFamily therapy
oIndividual therapy
oCBT
-Our goal is to restore their weight and nutritional status
-Correct any electrolyte imbalances to prevent further problems for this
patient
-Join therapeutically with that person so they know what to expect
-Hopefully they are motivated and agree to the plan
-Cautious not to overload their system and cause refeeding syndrome...
very dangerous, overloading their system and could actually die from
this!!! Careful when we rehydrate and restore their nutritional status
-Generally do this in partnership with the dietician bc they're going to
carefully plan their meals and intake
-Can benefit from medications... increase the level of serotonin and
makes some improvements (maybe because there is a level of
depression in some people)
-It does affect the whole family (family therapy) - not always effective
bc sometimes very poor family support and not therapeutic for the
patien
-Individual therapy very effective... really looking at their thoughts and
issues and spending time to work on theirselves
Alcohol withdrawal Ans✓✓✓ -Onset within 4 to 12 hours after cessation
or marked reduction of alcohol intake; usually peaks on the second day
and complete in about 5 days
-Symptoms: coarse hand tremors, sweating, elevated pulse and blood
pressure, insomnia, anxiety
-Severe or untreated withdrawal may progress to transient
hallucinations, seizures, or delirium (DTs).
-Withdrawal can be life-threatening.
-Benzodiazepines for safe withdrawal
-Alcohol is a central nervous system depressant
-CIWA - withdrawal assessment; look for specific s/s in a person
(increased temp, BP, RR, HR) q 2-4 hrs
-Vital signs will go up (temp, BP, RR, HR) if someone is withdrawaling
from alcohol
-VS q 2-4 hours
-Ask if they have tremors, sensitive to noise, increased startle reflex,
sensitive to light, headache or pressure in the head, paresthesia, feeling
that bugs are crawling on their skin (formication), GI issues
-Score them based on how they respond
-Medication is tied to this score
-Ex. Ativan 1mg IV q 2-4 hrs for a score of __
-Someone can go through withdrawl as early as 4 hours if really
dependent on it
,-Usually peaks the second day... most dangerous time is 48-72 hours
after stop drinking
-Give thiamine and multivitamin bc those get depleted in someone
using a lot of alcohol
-If start having DTs and seizures, life-threatening!!
-Benzos for safe withdrawal (ex. Ativan)
-May give pain meds, might give Tylenol (alcohol causes bleeding
problems so avoid ibuprofen), may give anticonvulsant (dilantin,
tegretol) if have hx of seizure or they look shaky, give thiamine, niacin,
and a multivitamin bc those get depleted whenever someone is using a
lot of alcohol
-Environment with less stimulation is better for withdrawal!
-Ask how much they use and when did they last used, and if they
withdrew in the past
Altruism Ans✓✓✓ Dealing with anxiety by reaching out to others
Adaptive use: A nurse who lost a family member in a fire is a volunteer
firefighter.
Maladaptive use: N/A
Anorexia nervosa Ans✓✓✓ -Onset usually between the ages of 14 and
18
-Denial early on; depression and lability with progression; isolation;
medical complications
,-Musculoskeletal, endocrine, GI, cardiac, metabolic, reproductive,
Neurologic, etc.
-Treatment: often difficult; client is resistant, uninterested, denies
problem
-Onset around puberty (but can be earlier or later)
-Denial, person doesn't feel they have a problem, very labile mood,
hide from others how much weight they are losing, medical problems
(passing out, fainting, arrhythmias, electrolyte imbalances,
musculoskeletal problems, cardiac, GI, reproductive problems)
-Treatment difficult bc client is resistant and fear of eating and gaining
weight, not interested in treatment, denial
-30-50% of people with anorexia will achieve full recovery while 10-20%
remain chronically ill
-6x more likely to die of a medical complication or suicide than general
population
-Clients with the lowest body weights and the longest durations tend to
relapse more often
-People who started this earlier tend to relapse more often, poorest
outcomes
-Abuse laxatives at higher risk of medical complications
Anorexia nervosa pt 2 Ans✓✓✓ -Medical management
oWeight restoration/nutritional rehabilitation
oCaution - refeeding syndrome
oRehydration/correction of electrolyte imbalances
, -Psychopharmacology: amitriptyline, cyproheptadine (periactin),
olanzapine, fluoxetine
-Psychotherapy
oFamily therapy
oIndividual therapy
oCBT
-Our goal is to restore their weight and nutritional status
-Correct any electrolyte imbalances to prevent further problems for this
patient
-Join therapeutically with that person so they know what to expect
-Hopefully they are motivated and agree to the plan
-Cautious not to overload their system and cause refeeding syndrome...
very dangerous, overloading their system and could actually die from
this!!! Careful when we rehydrate and restore their nutritional status
-Generally do this in partnership with the dietician bc they're going to
carefully plan their meals and intake
-Can benefit from medications... increase the level of serotonin and
makes some improvements (maybe because there is a level of
depression in some people)
-It does affect the whole family (family therapy) - not always effective
bc sometimes very poor family support and not therapeutic for the
patien
-Individual therapy very effective... really looking at their thoughts and
issues and spending time to work on theirselves
