Study guide for Exam 2 N5-Not all of the questions

1. Drugs to be familiar with (know class, action and significant side effects)

Drug Class Action Significant S.E.
flumazenil Therapeutic-antidotePharm-benzodiazepines. Antagonizes the CNS depressant effects of benzos w/o effect on other causes Seizures, dizziness, N&V
buspirone Antianxiety. Binds to serotonin and dopamine receptors in brain. Increases Norepi metabolism in brain Dizzy, drowsiness, excitement, fatigue, HA, insomnia, nervousness, weakness
oxazepam Antianxiety agents, sedative/hypnotics, benzodiazepines Depresses CNS, probably by potentiating GABA, decreases anxiety, decreases symptom of ETOH W/D Dizziness, drowsiness, confusion, physical and psychological dependence, tolerance
thorazine Antiemetic, antipsychotic, phenothiazine. Alters effects of dopamine in CNS, significant anti-ACH/alpha-adrenergic blocking activity, decreases S&S of psychosis, relief of N&V/intractable hiccups. Neuroleptic malignant syndrome, sedation, blurred vision, dry eyes, hypotension, agranulocytosis
clonazepam Anticonvulsants, benzodiazepines. Poss. presynaptic inhibition, produces sedative effects in CS, prob. by stimulating inhibitory GABA receptors. Prevention of seizures Behavioral changes, drowsiness, ataxia
lorazepam Analgesic adjuncts, antianxiety agents, sedative/hypnotics, benzodiazepines. Depresses the CNS, poss. by potentiating, GABA, sedation decreases anxiety, decreases seizures. Apnea, cardiac arrest, dizziness, drowsiness and lethargy
alprazolam Antianxiety agent, benzodiazepines.Acts at many levels in CNS to produce anxiolytic effect, may produce CNS depression, Effects may be mediated by GABA, relief of anxiety Dizzy, drowsy, lethargy, confusion, paradoxical excitement
diazepam Antianxiety agent, anticonvulsant, sedative/hypnotic, skeletal muscle relaxant, benzodiazepines Depresses CNS, poss. Potentiating GABA, produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways, anticonvulsant properties secondary to increasing presynaptic inhibition. Dizzy, drowsy, lethargy, respiratory depression, hypotension, physical and psychological dependence, tolerance
propranolol Antianginals, antiarrhythmics (Class II), anti HTN, vascular HA suppression, betablocker. Blocks stimulation of beta 1 and beta 2 adrenergic receptor sites, decreases HR and BP, decrease of arrhythmias, prevention of MI. Arrhythmias, bradycardia, CHF, pulmonary edema, orthostatic hypotension, impotence
disulfram Antagonist/antidote. Block oxidation of ETOH at the acetaldehyde stage Respiratory depression, CV collapse, arrhythmias, acute heart failure, sinus bradycardia, death
naltrexone Antagonist/antidote. Unknown, probably reversibly blocks the subjective effects of opioids given IV by competing with receptors in the brain Insomnia, suicidal ideation, hepatotoxicity


2. What are the biochemical factors that contribute to suicidal behavior?

Low levels of serotonin
Higher numbers of 5-HT-2 receptors in the brain and in platelets are being investigated.

3. Discuss the factors to assess when a patient describes a plan for suicide.

a. Specificity of details of the plan
b. Lethality of proposed method
c. Availability of means

4. Explain why clomipramine (Anafranil) might be the drug of choice for a patient with symptoms of obsessive-compulsive disorder.

Clomipramine-may be helpful in controlling or decreasing obsessions

5. What therapeutic class of drugs is most helpful for long-term treatment of panic disorder?
Short-term treatment?

Long term-TCAs-take time to have an effect.
Short term-benzodiazepines, short acting, short term to avoid dependence and addiction


6. What parameters would constitute orthostatic hypotension in a patient taking a benzodiazepine?
Systolic BP of 80mmgHg standing

7. Describe the term “secondary gain” and relate it to a client with somatization disorder.
Those gains derived from the symptoms alone. Exp. Getting out of usual responsibilities, getting extra attention.

8. Discuss nursing interventions for clients who need help managing anger that sometimes turns to violence.
Use least restrictive: if risk to self or others-consider restraint and seclusion
Target the underlying cause of the anger
See Box page 24-5, p. 679

Pharmacology-If hallucinations, delusions or thought disorders-antipsychotics
For short term use-benzodiazepine
Borderline personality, depression and PTSD-fluoxetine
Axis I disorder-risperadone
Brain injury(traumatic or illness)-beta-blockers

9. Discuss warning signs a patient might demonstrate prior to exhibiting aggression.

1. Hyperactivity-pacing, restlessness, increases axiety and tension-clenched jaw or fist, rigid posture, fixed or tense facial expression, verbal abuse-profanity, argumentativeness, loud voice, change of pitch or very soft voice forcing other ot strain to hear, intense eye contact or avoidance of eye contact.
2. Recent acts of violence
3. Stone silence
4. ETOH or drug intoxication
5. Carrying a weapon or object that could be used as a weapon
6. Milieu conducive to violence
a. Overcrowding
b. Staff inexperience
c. Staff provocative/controlling
d. Poor limit setting
e. Arbitrarily taking away privileges


10. Compare and contrast the terms: child neglect, child abuse (physical, sexual)

Child Neglect-can be physical, developmental or educational
Physical-failure to provide the medical, dental or psychiatric care needed to prevent or treat physical or emotional illness
Developmental-failure to provide emotional nurturing and the physical and cognitive stimulation needed to ensure freedom from developmental deficits
Educational-occurs when a child’s caretakers deprive the child of the education available in accordance with the state’s education laws.

Child abuse
Physical-infliction of physical pain or bodily harm
Sexual-any form of sexual contact or exposure w/o consent or when the victim is incapable of giving consent
Can destroy a child’s positive self-concept and can interfere with the learning of self-care skills

11. What are the priority nursing interventions for a woman at risk for repeated abuse by her
spouse?

Safety for herself and any children she has.

12. Compare and contrast the terms: drug dependence; drug abuse
Drug dependence
Maladaptive pattern of substance use leading to clinically significant impairment of distress, manifested by 3 or more of the following w/I a 12 month period.
1. Presence of tolerance to the drug
2. Presence of w/d syndrome
3. Substance is taken in larger amounts/for longer period than intended.
4. Unsuccessful or persistent desire to cut down on control use.
5. Increased time spent in getting taking and recovering from the substance. May w/d 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.

Drug abuse
Maladaptive pattern of substance abuse leading to clinically significant impairment or distress, manifested by one or more of the following w/I 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, operation a machine, exacerbation of symptoms of medical illness)
3. Recurrent legal or interpersonal problems
4. Continued use despite recurrent social and interpersonal problems.

13. Describe assessment findings and subjective signs of anorexia nervosa.

Findings

Yellow Skin
Amenorrhea
Lanugo
Cold extremities
Peripheral edema
Muscle weakness
Constipation
Abnormal lab values
Cardiovascular abnormalities
Impaired renal functions, dehydration
Hypokalemia
Anemic pancytopenia
Decreased bone density

Subjective
Low weight
Terrified of gaining weight
Preoccupied with thoughts of food
See themselves as fat when emaciated
Peculiar handling of food-cutting food into small bits, pushing food around on plate
May develop rigorous exercise regimen
Self-induced vomiting, laxatives and diuretics may be used.
Cognition so disturbed that they judge their self worth by their weight

14. Name expected personality characteristics of persons with anorexia nervosa.
Obsessive-compulsive
Perfectionist
Depression
Anxiety and social phobia
Poss. avoidant personality
Rigid.

15. Describe priority nursing interventions in the emergency department for a female victim of
stranger rape.
1. Follow your institution’s protocol for sexual assault.
2. Do not leave the person alone.
3. Maintain a nonjudgmental attitude.
4. Provide nonjudgmental care.
5. Ensure confidentiality.
6. Encourage the person to talk through empathetic listening.
7. Keep accurate records of
Physical trauma
Verbatim statements
Photos (need the person’s permission)
8. Obtain medico-legal specimens with client’s written permission
9. Engage the support system (family and friends) when appropriate.
10. Emphasize that the person did the right thing to save her life.
11. Arrange for support follow-up.