Monday, September 25, 2006
N5 study guide posting
Thank you for posting all the questions for the study guide this will benifit everyone. Double thumbs up for RENA!! You really posted more than your share. Guys we really need to get into the habit of this because further down the line it gets harder. The more help we get from each other the better we are 40 heads are better than 1 and your grade will show. Thanks again for everyone that helped in getting this posted. Only one more left to go and them the work really begins with N4. RIGHT ON!!!
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13 comments:
19.) Maintenance blood levels of lithium should range 0.4-1.3mEq/L. Lithium levels should not exceed 1.5 mEq/L. At the therapeutic level 0.4-1.0mEq/L = fine hand tremor, polyuria, and mild thirst and nausea, weight gain and general discomfort. 1.3-1.5= Nausea, vomiting, diarrhea, thirst, polyuria, slurred speech, muscle weakness. 1.5-2.0= Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination. 2.0-2.5= Ataxia, serious electroencephalographic changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma. Death is usually secondary to pulmonary complications. (Pg.371 and table 19-4)
20.)(Pg. 375 and 19-2) Health teaching stresses the importance of establishing regularity in sleep patterns, meals, exercise and other activities.
Sleep patterns = good sleep hygiene is critical to stability. The prodrome of a manic episode is lack of sleep. Mania may be adverted by the use of sleep medication (eg. Temazepam (restoril).)
Meals = Normal diet w/ normal salt and fluid intake. Lithium ↓ sodium reabsorption in kidneys. So, ↓ in sodium intake → ↑lithium retention = toxicity. Take lithium w/ meals to prevent irritation in stomach. Caffeine ↓ lithium levels and efficacy.
Exercise = be careful and avoid dehydration. Dehydration = ↑ lithium levels = toxicity.
Other Activities = Avoid activities that cause excess sodium loss. (heavy exertion, saunas)
21.) (pg. 480-481) Suicide prevention must recognize and affirm the value, dignity, and importance of each person. Primary intervention is prevention = support, information and education. Practiced in Schools, homes, hospitals and work settings. (box 23-5)
. Monitoring = one-to-one nursing observation and interaction 24 hrs a day. Monitor the environment for safety hazards. Including description of affect and behavior on flow sheets.
No suicide contract = written contract in which the client agrees not to harm themselves but to take an alternative action if feeling suicidal.
22.) White male over the age of 65 has an increase in suicide. Mountain states and occupations such as a physician and dentist (high stress). (box 23-1)
4. Codependent ind’s find themselves: ( pg551 box 27-1)
1. Attempting to control someone else’s drug use
2. Spending inordinate time thinking about the addicted person
3. Finding excuses for the persons drinking/drug taking or lying
4. Covering up the persons drinking/ drug use
5. Feeling responsible for the persons drug/ drinking problem
6. Feeling guilty for the addicted person’s behavior
7. Avoiding family and social events because of concerns or shame about the addicted member’s behavior
8. Making threats regarding the consequences of the alcoholic/drug abuser’s behavior and failing to follow through
9. Eliciting promises for change
10. Feeling like they are “walking on eggshells” on a routine basis to avoid causing problems, esp in relation to alcohol or drug use
11. Allowing moods to be influenced bu those of the addicted person
12. Searching for, hiding, and destroying the abuser’s drug or alcohol supply
13. Assuming the alcoholic’s/substances abuser’s duties and responsibilities
14. Feeling forced to increase control over the families finances
15. Often bailing the addicted person out of financial or legal problems
5. BAL’s and the assoc. physical signs and symptoms (pg 554 Box 27-3)
BAL
0.05 mg% 1-2 drinks Changes in mood and behavior; impaired judgement
0.10 mg% 5-6 drinks Clumsiness in voluntary motor activity; LEGAL LEVEL OF INTOXICATION IN MOST STATES
0.20 mg% 10-12 drinks Depressed function of entire motor area of the brain, causing staggering and ataxia; emotional lability
0.30 mg% 15-18 drinks Confusion, stupor
0.40 mg% 20-24 drinks Coma
0.50 mg% 25-30 drinks Death, due to respiratory depression
6. Drug abuse vs. Drug Dependence (pg 550)
Drug Abuse: Maladaptive pattern of substance use leading to clinically significant impairment or distress, manifested by one or more of the following within a 12 month period:
1. Inability to fulfill major role obligations at work, school, and home
2. Participation in physically hazardous situations while impaired (driving a car, operating a machine, exacerbating existing problem [e.g. ulcer])
3. Recurrent legal or interpersonal problems
4. Continued use despite recurrent social and interpersonal problems
Drug Dependence
Maladaptive pattern of substance use leading to clinically significant impairment or distress, manifested by 3 or more of the following in a 12 month period:
1. Presence of tolerance to the drug
2. presence of withdrawl syndrome
3. Substance is taken in larger amts/ for longer period than intended
4. Unsuccessful or persistent desire to cut down or control use
5. Increased time spent in getting, taking, and recovering from the substance; may withdraw from family and friends
6. Reduction or absence of important social, occupational, or recreational activities
7. Substance used despite knowledge of recurrent physical or psychological problems or that problems were caused or exacerbated by one substance
7.)(pg.549) "Tolerance" the need for higher & higher doses to achieve the desired effect.
"Withdrawl" occurs after a long period of cont. use, so that stopping or reducing use results in specific physical & psychological signs & symptoms.
8.) (pg.559) Nurses have a higher rate of chemical dependency than the general population. Est. range of practicing rn's:10%-20%. Wrong choice of a coworker is to do "nothing." Report observance to the nurse mgr.. Intervention is the responsibility of the nurse mgr. & other administrators. However, clear documentation by co-workers re:time, date,events, & consequences is crucial. Rn. mgr. main concerns are with job performance & client safety. Once mgr. has been informed, legal & ethical responsibilities of in-house reporting have been met. If no action has taken place, then the information is taken by the next level in the chain of command. Signs of drug use of rn: Often the impaired rn volunteers to work additional shifts to be nearer the souce of the drug; may leave the unit frequently or spend a lot of time in the bathroom; more clients may complain of their pain unrelieved by their narcotic analgesic; unable to sleep though receiving sedative meds.; increase in inaccurate drug count & vial breakage may occur.
9.) Rn dx for amphetamine-induced psychosis:
(pg.561)-Disturbed thought processes; -Disturbed sensory perception
(audio/visual hallucinations, impaired judgement,memory deficits,cognitive impairments r/t substance intox. or withdrawl.)
-Disturbed sleep patterns
(chg. in sleep-wake cycle, stg.4 sleep disturbance;inability to sleep or long periods of sleep r/t effect or withdrawl from substances.
-Imbalanced nutrition:less than body requirement
(vomiting, diarrhea,poor nutritional/fluid intake)
-Ineffective health maintainence
-self care deficit
-inadherence to health regimen
-risk for suicide
-ineffective coping
-impaired verbal communication
-anxiety
etc...
#14) Flunitrazepam (rohypnol) has no clinical use, it’s an illegal street drug in USA, also known as, (forget, roofies, club drug, roachies or rophies). It’s used as a “date rape drug”. (pg 532 table 26-1)
#16) Tricyclic antidepressants (TCA’s)
Indications:
•Clinical depression
•Pain
•Nocturnal enuresis
•Smoking cessation
Dose:
start low, go slow. (admin at night)
Major side effects:
•Dry mouth
•Constipation
•Blurred vision
•Urine retention
•hyperthermia
b) SSRI
Indication:
•Major depression
•Anxiety disorder
•Panic disorder
•OCD
•Social phobia
•Eating disorder
Dose: (depends on the drug)
admin during the day
Major side effects:
•Insomnia
•Increase appetite
•Anxiety
•Nervousness
•Drowsiness
•Sexual dysfunctions
c) MOA-I
Indication:
•Anxiety disorder
•Social phobia
•Atypical depression
Dose: (depends on the drug)
Admin during the day
Major side effects:
•Insomnia
•Hypertensive crisis (food containing tyramine are consumed)
•Orthostatic hypotension
•serotonin syndrome (if foods containing tryptophan are consumed)
Caution when using: St. John's Wort
(pg 343/350)
1.) Time that a intoxicated, chronic alcoholic will display early withdrawal symptoms--delirium tremens. (P. 554)
With cessation withdrawal symptoms develope in a few hours peaking 24-48 hours.
State of delirium usually peaks 2-3 days (48-72 hours) after cessation or reduction of intake (although it can occur later) and last 2-3 days.
2.) Features of delirium tremens:
In additional to anxiety,insomnia and anorexia and delirium features include:
1. autonomic hyperactivity (ex: tachycardia, diaphoresis, elevated bp)
2. severe disturbance in sensorium (ex: disorientation, cloudy of consciousness)
3. perceptual disturbances (ex: visual and tactile hallucinations)
4. fluctuating levels of consciousness (ex: ranging from hyperexcitability and lethargy)
5. dillusions (paranoid)-examples:
agitated behaviors and fevers between 100-103
Even if treated alcohol withdrawal delirium is considered a medical emergency and can result in death even if treated.
3. The typical course of an alcholic client's rehabilitation involves the 12 step program-Alcohol anonymous is the prototype for all 12 step programs. there are 3 basic concepts in all 12 step programs:
A. Individuals with addictive disorders are powerless over their addiction and their lives are unmanageable.
B. Individuals with addictive dissorders are not responsible for their disease but are responsible for their recovery.
C. Individuals can no longer blame people,places,and things for their addiction. They must face their problems and feelings.
1.) Time that a intoxicated, chronic alcoholic will display early withdrawal symptoms--delirium tremens. (P. 554)
With cessation withdrawal symptoms develope in a few hours peaking 24-48 hours.
State of delirium usually peaks 2-3 days (48-72 hours) after cessation or reduction of intake (although it can occur later) and last 2-3 days.
2.) Features of delirium tremens:
In additional to anxiety,insomnia and anorexia and delirium features include:
1. autonomic hyperactivity (ex: tachycardia, diaphoresis, elevated bp)
2. severe disturbance in sensorium (ex: disorientation, cloudy of consciousness)
3. perceptual disturbances (ex: visual and tactile hallucinations)
4. fluctuating levels of consciousness (ex: ranging from hyperexcitability and lethargy)
5. dillusions (paranoid)-examples:
agitated behaviors and fevers between 100-103
Even if treated alcohol withdrawal delirium is considered a medical emergency and can result in death even if treated.
3. The typical course of an alcholic client's rehabilitation involves the 12 step program-Alcohol anonymous is the prototype for all 12 step programs. there are 3 basic concepts in all 12 step programs:
A. Individuals with addictive disorders are powerless over their addiction and their lives are unmanageable.
B. Individuals with addictive dissorders are not responsible for their disease but are responsible for their recovery.
C. Individuals can no longer blame people,places,and things for their addiction. They must face their problems and feelings.
15.) Describe the main phases and characteristics of therapeutic groups. P. 719
Initial Phase: get to know each other
Working Phase: Members are encouraged to work with each other and handle conflict.
Mature Phase: Group focuses on therapeutic goals. Group develops identity and members accept each others differences.
Termination Phase: End
10.) What nursing interventions are needed for clients withdrawing from CNS stimulants.
Assess for heart trouble,vital signs, fatigue,depression,agitation,apathy,anxiety, sleepiness,disorientation,lethargy and cravings.
11.) Describe the signs and symptoms associated with a person who uses heroin.
Constricted pupils,decreased respiration,drowsiness,decreased blood pressure,slurred speech,psychomotor retardation. Psychological-perceptual: initial euphoria followed by dysphoria and impairment of attention judgement memory.
17.) Discuss electroconvulsive therapy procedures, nursing indications and effect on clients.
Explain procedure to client,get informed consent if client is voluntary. When informed consent cannot be obtained, permission may be obtained from the next of kin.
Watch for patients who have heart problems. Client may be confused and disoriented on awakening from ECT. The nurse and family may need to orient client frequently during course of treatment. Many clients state that they have memory deficits for the first few weeks after the course of treatment. Memory doesn't always come back. Suppossedly there is no brain damage. TCA's and Lithium are given after the treatment. General anesthetic and muscle paralysing(sp?) are giving during treatment so they don't feel the seizure.
18.)Describe the major criteria for diagnosis with bipolar 1,bipolar 2, cyclothymia, major depressive disorder and dysthymic disorder as well as prioritized nursing interventions for these disorders.
bipolar 1-acute mania, at least one episode mania alternating with major depression. Make sure client has finger foods and liquids available.
bipolar 2-hypomanic episode, alternating with major depression. They are more like depression.
cyclothymia-hypomanic episodes, alternating with major depression episodes at least two years in duration. Not psychotic, shopper.
MDD-patient needs to have five or more episodes over 2 week period. Monitor for suicide ideation.
Dysthymia-occurs over 2 year period (1 year for children or adolescents),depressed mood. Two or more of the following are present:
Decreased or increased appetite
Insomnia or hypersomnia
Decreased self esteem
Low energy or chronic fatigue
Poor concentration or difficulty making decisions.
Feelings of hopelessness or despair.
In the termination phase on #15 I should have also stated that this is the phase that helps the client plan for the future. just for your info.
FYI for question #22, look to page 474, Box 23-1. It states the highest risk for completing suicide is white male over the age of 85.
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