NSG 562 (Acute) Exam 2 With Complete Solution

NSG 562 (Acute ) Ex am 2 Wit h Comp lete Solut ion What is the major inhibitory neurotransmitter that lowers cell excitability? - ANSWER GABA Sedatives depress brain activity by boosting GABA systems. Major CNS sedatives: alcohol, barbiturates, benzos These are signs of what kind of disorder? Poor compliance & requests for disability testimony Drug seeking behavior (feign ssx, request meds longer than needed) - ANSWER Substance use disorder Name 5 health problems suggesting presence of alcoholism. - ANSWER Emotional difficulties Poor nutrition Trauma Seizures Unexplained tachycardia Refractory HTN Dyspepsia Liver disease Pancreatitis Peripheral neuropathy Drinking can be thought of as low-risk, at-risk and high-risk. If a patient comes in for appt and smells like alcohol - why is this a bad sign? - ANSWER Because even the heaviest of drinkers will not drink before appt. This is a sign of severe dependence. What drug can cause these symptoms: Perforated nasal septum Arrhythmias, cardiac issues Withdrawal symptoms: HAs, lethargy - ANSWER Cocaine What are we talking about here: It is a mild stimulant. Involves the dopamine pathway. Withdrawal occurs 2 hours after last dose. - ANSWER Nicotine Snorting what drug can cause bronchitis resembling severe asthma ? - ANSWER Snorting heroin. Inhaling crack vapors can cause what HEENT symptoms? - ANSWER Flaming pharyngitis Tonsillar swelling. Don't inhale crack vapors. These withdrawal symptoms would be seen with which kind of drugs? Chills / sweats with NO fever Dilated pupils - ANSWER Opiates / IDU What are the 5 A's? - ANSWER Ask Advise Assess Assist Arrange What does CAGE stand for? - ANSWER C- cut down (have you ever felt like you should?) A- annoyed (have ppl annoyed you for criticizing your drinking?) G- guilty (have you felt guilty?) E- eye opener (morning drink / eye opener?) What three function tests may you want to order if you suspect substance use disorder? - ANSWER Liver function -- alcoholism, viral hepatitis Renal function -- glomerulonephropathies assoc. w/ IDU Thyroid function -- sedatives & stimulants mimic hypo & hyperthyroidism, respectively What lab values can be altered by alcohol use? - ANSWER MCV elevated from impaired folate use (macrocytic anemia) Liver enzymes (AST, ALT, GGT) What kind of attitude is most important to convey to patient with substance use disorder? A) Hopeful B) Informative C) Casual D) Hilarious - ANSWER Hopeful Name 3 formal treatment options for substance use disorders. - ANSWER 1. Outpatient methadone maintenance 2. Long term residential tx programs 3. Outpatient drug free programs 4. Individual counseling 5. Short term inpatient rehab programs What is the optimal time for residential drug/alcohol treatment programs? - ANSWER 6 months The most effective approaches to substance use disorders incorporate CBT with what two things? - ANSWER CBT + motivational interviewing + harm reduction What is an antagonistic / aversive drug used with to treat alcoholism? - ANSWER Disulfiram (Antabuse) Name a narcotic antagonist. - ANSWER Naloxone Makes it impossible for opioids to exert usual effects Why is buprenorphine/naloxone (Suboxone) better in some ways than