PSYCH EXAM #2

Substance Use

any ingestion

Substance Abuse

use for intoxication or beyond intended purpose

Physiological Dependence

tolerance and withdrawal (body adapts)

Psychological Dependence

emotional craving/need

Withdrawal

symptoms when substance decreases

Detoxification

controlled medical process to manage withdrawal

Psychotropic Substances

affect mental functioning

Psychoactive Substances

crosses blood brain barrier

Wernicke Encephalopathy

acute (confusion, ataxia, vision issues)

Korsakoff Syndrome

chronic memory loss and confabulation

CIWA scoring needs

<10: no meds, >10: give benzos

Methadone

full agonist

Buprenorphine

partial agonist

Naltrexone

antagonist

Opioid Intoxication Signs

pinpoint pupils, respiratory depression, sedation

Stimulations Intoxication Signs

dilated pupils, agitation, increased HR

Disulfiram — SUD med

alcohol deterrent, avoid alcohol, if taken when drinking = flushing, palpitations, N/V

Naltrexone — SUD med

blocks opioid and ETOH reward, must be opioid free for 7-10 days, GI upset, monitor LFT’s

Acamprosate — SUD med

maintains alcohol abstinence, avoid in renal failure

Methadone — SUD med

opioid agonist management, prevents withdrawal, monitor QT, risk of respiratory depression

Buprenorphone/Suboxone — SUD med

partial agonist for OUD, prevents craving, start after mild withdrawal

Naloxone — SUD med

opioid overdose reversal, short half-life (may need repeat dosing), watch RR and O2

Thiamine and Folic Acid — SUD med

prevent Wernicke-Korsakoff syndrome, administer before Gl in ETOH withdrawal

Lorazepam — SUD med

alcohol withdrawal, CIWA dosing, prevents seizures

Bupropion — SUD med

smoking cessation, depression, contraindicated in ED and seizure hx, may cause insomnia

Varenicline — SUD med

partial nicotine agonist, monitor for mood changes, vivid dreams

Obsessions

recurrent, intrusive, unwanted thoughts/urges/images, cause significant anxiety, attempts made to suppress/neutralize — contamination, harm, religious guilt

Compulsions

repetitive behaviors/mental acts, done to decrease anxiety or prevent feared event, often excessive or unrealistic — excessive handwashing, check locks, counting/repeating

What is the gold standard for OCD as a nursing intervention?

ERP (exposure and response prevention)

SSRI — OCD med

first line for OCD, given at high doses for 8-12wks, monitor for suicidal ideation early in therapy

TCA — OCD med

second line for OCD if SSRI fails, watch for orthostatic hypotension

Themes of delusions — persecutory

people are after me

Themes of delusions — referential

everything is about me

Themes of delusions — grandiose

im famous

Themes of delusions — erotomanic

someone is in love with me

Themes of delusions — nihilistic

catastrophe is coming

Themes of delusions — somatic

body disease

POSITIVE S+S

behaviors are added, too much brain activity — delusions, auditory hallucinations, disorganized speech, disorganized behavior/catatonia

NEGATIVE S+S

loss of normal function — (5 A’s): affective flattening (flat affect), apathy (lack of enthusiasm), avolition (persistent lack of motivation), alogia (poverty of speech), anhedonia (decreased ability to experience pleasure)

COGNITIVE S+S

poor attention, memory issues, poor problem solving, slow processing, impaired social cognition

1st gen antipsychotics

typical, greater movement of S+S, strong dopamine blockers — Haloperidol

2nd gen antipsychotics

atypical, greater metabolic S+S, Clozapine, Risperidone

Anticholinergic Crisis

“hot, dry, blind, red, mad”, tx: physostigmine

Neuroleptic Malignant Syndrome (NMS)

autonomic instability, rigid, increased CK, increased fever, LIFE THREATENING, tx: stop meds, give Dantrolene, cooling measures and IV fluids

Serotonin Syndrome

hyperreflexia, clonus, agitation, diarrhea, not rigid like NMS

Extrapyramidal S+S

dystonia, parkinsonism, akathisia

Haloperidol — antipsychotic

1st gen for schizophrenia and acute agitation, watch for EPS (dystonia, akathisia, parkinsonism), NMS (fever, rigidity, increased CK)

Chlorpromazine — antipsychotic

1st gen, sedation, orthostatic hypotension, anticholinergic effects, monitor VS

Risperidone — antipsychotic

2nd gen, weight gain, increased prolactin, montior Gl and lipids

Olanzipine — antipsychotics

2nd gen, severe metabolic syndrome risk, advise on diet and exercise

Clozapine — antipsychotic

2nd gen, treatment resistant schizophrenia, agranulocytosis (sore throat, fever) — hold med, check ANC (weekly labs for 6mo)

What electrolyte imbalance are heart palpitations associated with in ED’s?

HYPOkalemia

Personality

unique patterns of thoughts, feelings, and behaviors that define a person, largely outside awareness

Personality Traits

patterns of perceiving, relating and thinking — influenced by biology, environment and experiences

ACCEPTS

activities, contribute, compare, emotions, push away, thoughts, sensations

General med notes — Clozapine

monitor ANC, stop with signs of infection

General med notes — Disulfiram

avoid alcohol containing products

General med notes — Bupropion

never use with eating disorders or seizure histories

General med notes — Thiamine

give before glucose in chronic alcohol users

General med notes — NMS (Neuroleptic Malignant Syndrome)

stop drug, initiate cooling, give Dantrolene