NYU Nursing Psych Final

First thing a nurse should do when working with people with a personality disorder

know your own biases, set boundaries

Why do we give Thiamine for alcohol withdrawal?

protect the brain (From Wernicke's and Korsakoff's)

Wernicke's and Korsakoff symptoms come from ?

alcohol withdrawal, lack of vitamin B, so administer thiamine to patient.

Librium

Given to help with alcohol withdrawal. orally. works on GABA

Benzo- ativan

given for alcohol withdrawal

Opioid withdrawal

diarrhea, sweating, dilated pupils, tearing, runny nose (Everything coming out)

what type of withdrawal would a patient experiencing diarrhea, sweating, dilated pupils, tearing and a runny nose be having?

opioid withdrawal

pupils in opioid withdrawal vs intoxication

withdrawal: dilated

intoxication: constricted

what type of withdrawal would a patient experiencing sweating, tremor, seizure, hallucinations, elevated BP and elevated HR be having?

alcohol withdrawal

what key symptom does both opioid and alcohol withdrawal have

elevated BP

"splitting" is seen in which disorder

borderline personality

What interventions should a nurse do for a borderline personality pt who is exhibiting "splitting"

set boundaries

don't argue

PTSD

nightmares

intrusive thoughts

hard time in relationships

guilt and shame

depressed and anxious

hard distinguishing reality from traumatic event

dissociative state

seen in PTSD. when under severe anxiety, feels like you are out of your body

medication given for PTSD

Prazosin

nurses role for patient with an eating disorder

nutrition

look at labs

evaluate relationships in the family- treatment often involves the family

"emaciated, wearing baggy clothes and playing with food" are signs of which eating disorder

anorexia

Lanugo

hair grows on arm and face- seen in anorexia

Key signs of bulimia

eating and purging.

teeth dark and rotted, receded gums, flushed cheeks

russel's signs

normal or overweight

Russell's signs

callused knuckles due to self-induced vomiting in Bulimia

Dependent personality

easiest to treat

often in abusive relationships

dependent on other people. can become depressed when dynamics change.

How should the nurse best work with anxiety

don't get pulled into patient's anxiety

breathe, take a calm approach

"I can see that you're very concerned about this"

reassure patient

don't let it escalate

Generalized anxiety vs panic disorder

GAD: can't describe it- an impending problem/doom

Panic: ACUTE

why is heroin so addictive?

quick onset! (makes it more reinforcing)

acts shorter in the body, so you need to keep doing it.

no ceiling effect - analgesic effect doesn't stop after a certain dose so people build tolerance and OD

Dependence vs tolerance

withdrawal related to dependence

tolerance- related to the amount

why do people OD on opiates?

no ceiling effect

Histrionic disorder

story telling

exaggerate everything and can become depressed

"the loners"

Schizoids

OCD vs OCPD

OCPD= ego-syntonic

OCD= ego-dystonic (person with the disorder is distressed by their symptoms and uncomfortable with their situation)

"Preoccupation with persistently intrusive thoughts and ideas. ego-dystonic" seen in what disorder

OCD

"ego-systonic- all about them, they're the best, very rigid and stable over time" seen in what disorder

OCPD

Schizotypal

magical thinkers

not always psychotic

don't have hallucinations or delusions at baseline. It's really a matter of how they function and view reality.

think of thoughts and perceptions

"magical thinkers" refers to what disorder

schizotypal

How do you work with a patient with OCD

implement gradual changes and goals.

Use SSRi's to treat

manipulation is seen frequently in which personality disorder

borderline

systemic desensitization

gradually start to imagine themselves driving over the bridge, whatever the phobia is

Addiction characterized by:

compulsive and impulsive behavior

persistent changes in the brain's structure and function.

Tolerance develops and increased amounts are necessary

Denial in substance abuse

fuels the addiction and minimizes problem. an integral part of substance dependence

Alcohol Use Disorder

leads to impairment or distress

withdrawal, tolerance, craving.

Theories relate to use of alcohol

reduce tension, increases feelings of power, helps cope with stress or anxiety.

Heavy alcohol use can contribute to 3 leading causes of death

heart disease, cancer, stroke

Physiological effects of alcohol

induces a general reversible depression of the CNS.

20% of a single dose is absorbed immediately into the blood stream.

Blood carries it directly to the brain's central control areas then it is found in all tissues, organs and secretions of the body.

--> multi-system impairments

Peripheral Neuropathy

nerve damage from alcohol abuse.

result of deficiencies in B vitamins, particularly Thiamine.

Result of poor nutrition/malabsorption

Alcoholic myopathy

disease of muscle tissue. acute or chronic.

Muscle pain, swelling, weakness.

Reddish tinge in urine caused by myoglobin break down.

Could be result of vitamin B deficiency

Vitamin B deficiency a key problem in __

alcoholism. Can cause myopathy or neuropathy

Wernicke's Encephalopathy

Most serious thiamine (vit b) deficiency in alcoholics.

sudden onset

jerky eye movements/paralysis of ocular muscles/diplopia, unsteady gait, confusion, ataxia.

Korsakoff's Psychosis

from untreated wernicke's. confusion, recent memory loss.

alcoholism.

treat with thiamine replacement

Alcoholic cardiomyopathy

accumulation of lipids in the myocardial cells. results in enlargement, CHF, arrhythmia.

S/s: non-productive cough, exercise intolerance, tachycardia, dyspnea, edema

Alcoholic hepatitis

hepatic encephalopathy, cirrhosis

Fetal Alcohol Syndrome key sign

flat midface and indistinct philthrum and thin upper lip and low nasal bridge.

Symptoms of fetal alcohol syndrome

impaired judgement, impaired social functioning. slurred speech, incoordination, unsteady gait, flushed face.

Alcohol Withdrawal may lead to what in a few days

Delirium Tremens (DT's) in 2-3 days

Onset of alcohol withdrawal symptoms

4-6 hours after last drink

Symptoms of alcohol withdrawal

autonomic hyperactivity- sweating, pulse rate ^)

tremor

nausea/vomit

transient visual, tactile or auditory hallucinations or illusions

psychomotor agitation

anxiety

Substitution therapy

necessary to reduce life threatening effects of alcohol withdrawal.

use benzodiazepines. Start with high doses and reduce 20/25% each day.

give additional doses for breakthrough symptoms

4 Benzodiazepines (COLD)

Chlordiazepoxide- librium

Oxazepam- serax

Lorazepam- ativan

Diazepam- valium

patients with liver disease and going through treatment for alcohol withdrawal, what should you give

NOT benzos. give shorter acting Ativan (Lorazepam) and Serax (Oxazepam)

Nursing interventions for alc withdrawal

monitor intake and output

thiamine replacement

do not ambulate pt in withdrawal

- ensure pt safety,

monitor vitals every 4 hours,

administer substitution therapy

priority nursing diagnosis: risk for injury

CAGE

screens for potential alc problems. misuse and dependence

AUDIT-C

how drinking affects a person's health and safety. +4 positive for men, +3 for women

SBIRT

screening, brief intervention, referral, treatment.

uses evidence based practice to identify/reduce/prevent alc abuse

nicotine activates

dopaminergic pathways.

reaches bloodstream and brain in 15 seconds.

affects the CNS

Sedative hypnotic or anxiolytic use disorder

benzos

non-barbiturate hypnotics

barbiturates

club drugs

barbiturates

very addicting!

used for mild sedation and total anesthesia.

all end in -barbital

can be anxiolytic, hypnotic, anticonvulsant

Which medication has a general depressant effect on the CNS

barbiturates

which med decreases the amount of time spent dreaming

barbiturates

barbiturates

produce all levels of CNS depression from mild sedation to death. general depressant effect.

decrease body temp

sexual dysfunction

depressing respirations

produce jaundice

suppress urine function

inhibit raas

CNS depressant principles

GABA

cross-tolerance and cross-dependence exist between various types.

can produce physiological and psychological addiction

treatment of withdrawal from sedative, hypnotic or anxiolytics

gradual dose reduction

switch to long acting agent if appropriate

barbiturates probably need hospitalization.

same as alc withdrawal

Stimulant use disorder

increase neurotransmitters norepi, epi or dopamine. - psychomotor stimulants

caffeine and nicotine most prevalent and widely used

Stimulant withdrawal

fatigue

vivid unpleasant dreams

insomnia or hypersomnia

increased appetite

psychomotor retardation or agitation

symptoms peak in 2-4 days

intense dysphoria can occur

opioids of natural orgin

opium, morphine, codeine

synthetic opiate like drugs

methadone

Physiological effects of opioids: CNS, GI, CV

CNS: pupillary construction, mental clouding, euphoria, mood changes, drowsiness and pain reduction, resp depression

GI: peristalsis diminished

CV: hypotension

Sexual Fxn: decreased function and libido

Opioid overdose triad

pinpoint pupils

unconscious/decreased level

respiratory depression

"loud snoring"

opioid withdrawal

"everything sucked in" COWS

pupillary dilation, sweating

diarrhea, yawning, insomnia, fear

lacrimation, rhinorrhea, muscle aches,

nausea or vomit. dysphoric mood

Opioid withdrawal symptoms occur:

6-8 hours after last dose. peak in the 2nd or 3rd day.

(alc use is 3-4 hours)

3 meds given for opioid withdrawal

methadone substitution - daily from clinic

buprenorphine- one month

clonidine (catapres)- suppress symptoms

CNS effects of Cannabis

depersonalization, euphoria, panic, anxiety, long term heavy use can lead to amotivational syndrome.

Symptoms of Cannabis withdrawal

irritability, anger or aggression. nervousness or anxiety. sleep difficulty.

restlessness. depressed mood. decreased appetite or weight loss

nursing diagnoses for cannabis withdrawal

risk for suicide

powerlessness

ineffective coping

denial

risk for injury

psychodynamic theory behind eating disorder

results from early disturbances in mother-infant interactions.

unfulfilled sense of separation-individualization.

manifests itself in a disturbed body identity and distorted body image.

issue of control and rebellion

Which eating disorder exhibits: increased cortisol levels and decreased serotonin, dopamine, norepi, gonadotropins and elevated growth hormones

anorexia nervosa

Behaviors found in anorexia

secretive, refuse to eat in public, laxative and diuretic abuse, rigid and perfectionistic, over exercising/physical hyperactivity

Signs and Symptoms of Anorexia

Hypothermia

Hypotension

Lanugo (fine, soft hair)

bradycardia

amenorrhea- no menstruation

hypertrophy of salivary glands seen in what type of disorder

anorexia

"Hypercholesterolemia and elevated hepatic enzymes, hypokalemic acidosis" - seen in which disorder?

anorexia

SSRI Fluoxetine used to treat which eating disorders

anorexia, bulimia, binge eating

anxiety defined as

response to threat

key difference between anxiety and fear

fear is a known, external threat. anxiety is a response to an unknown or vague threat

cognitive symptoms of anxiety

selective attention.

distortion in thinking perception and learning

Which disorders: "norepi increased, cortisol increased, serotonin decreased, GABA decreased and CRH increased"

anxiety disorders

Corticotropin-releasing hormone (CRH)

mediates the stress response.

CRH increased activates the hypothalamus in anxiety disorders

amygdala

fear

hippocampus

memory related to fear responses

brainstem

respiratory activation, heart rate

frontal cortex

cognitive interpretations

Thalamus

integration of sensory stimuli

basal ganglia

tremor

neuroanatomy involved in panic disorders

limbic system

hippocampus (memory related to fear)