NUR 375 EXAM 4 |57 QUESTIONS WITH 100% CORRECT ANSWERS

Young-old adults 65-74 Middle-old adults 75-84 Old-old adults 85-100 Centenarians 100-104 Mental Health and Aging -Late-life mental illness -Major depressive disorder -Suicide (male older caucasian-highest risk) -Anxiety disorders -Delirium (secondary to general medical condition) -Neurocognitive disorders (is everything dementia) -Alcohol use disorder -Pain Barriers to accurate pain assessment -Assessment tools -Wong-Baker FACES pain rating scale -Pain assessment in advanced dementia scale (PAINAD) -Pain management (focus -may not report pain-do not want to be a bother) -Pharmacotherapy (focus-slow metabolism of drugs-overdose!!, lower doses) -Non-opioids -Opioids ( risk for fall) -Nonpharmacological pain treatments Addiction substance abuse alters the individual reward pathway to prioritize drug and then desensitize the reward pathway to demand more and more of the substance to get the same effect Substance use disorder -Repeated use of a chemical substance or behavior, leading to significant impairment in a 12 month period -Characterized by loss of control due to the substance use or behavior that continues despite associated problems and tendency to relapse back to the substance use or behavior ______ is a defense mechanism commonly used by substance abusers Denial Intoxication Use of a substance that results in maladaptive behavior under influence of the drug or substance (intended or sought effect by users) Tolerance when increased amounts of the substance are needed to achieve the same level of effect Withdrawal syndrome Negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases Detoxification The process of safely withdrawing from a substance Dependency Physiological reliance due to addiction, tolerance, and withdrawal leading to a vicious cycle of remissions relapses Risk factors for substance use disorder -Biological -Psychological factors -Alcoholic parent -Genetic vulnerability -Growing up in an alcoholic home CAGE Cut down, annoyed, guilty, eye opener AUDIT Alcohol Use Disorders Identification Test Alcohol Acute treatment/detoxification -Monitor and treat withdrawal symptoms that can occur 4-12 hours and can last 5-7 days -Goal: Focus on safely helping clients withdraw from alcohol Symptoms of alcohol withdrawal -Nausea/vomiting -Tachycardia -Elevated BP -Diaphoresis -Fever -Tremor -Irritability -Restlessness Delirium tremors the dramatic physical and psychological effects of alcohol withdrawal -S/S: psychotic symptoms, confusion, very high BP. grand mal seizures, initiate ICU transfer Nursing Interventions for alcohol withdrawal Establish safety from injury, fall precautions, seizure precaution, ECG monitoring, draw labs, nutritional support Medications for alcohol withdrawal -Benzodiazapines "alcohol substitute" -Beta blockers, alpha adrenergics - for elevated BP and HR -Carbamezapines for seizures Disulfram (antabuse) Aversion therapy- produces unpleasant symptoms if client consumes alcohol -Start medication 12 hrs after last drink -Can cause liver damage -Monitor LFTs do not use products containing alcohol including skin lotion, sanitizers, mouthwash -Wait at least 2 weeks after stopping disulfram to use alcohol containing products Naltrexone (Revia) Helps reduce craving or feel of pleasure after using alcohol Acamprosate (Campral) Helps with reducing unpleasant symptoms of withdrawal Opioid overdose symptoms apathy, lethargy, constricted pupils, drowsiness, slurred speech, agitation, respiratory depression, unconsciousness, coma, and death Antidote for opioids Naloxone (Narcan) Opioid withdrawal symptoms anxiety, restlessness, aching, craving, nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, insomnia Methadone opioid substitution treatment -Blocks the high from opioids -It can give a similar feeling and keeps the client from experiencing withdrawal symptoms and cravings -SE: weight gain, respiratory depression, pruritus, headache, mood changes ***Administered at approved treatment centers Buprenorphine/ Naloxone (Suboxone) -Used outpatient to treat opioid addiction -Have ceiling effects and naloxone ensure safety from overdose -- Available in sublingual form Nicotine withdrawal symptoms irritability, nervousness, restlessness, insomnia, suicidal ideation Transtheoretical stages of change for tobacco cessation 1. Precontemplation: client is in denial 2. Contemplation: Client acknowledges problem, but is not ready to change. 3. Preparation stage: client is ready to change 4. Action stage: client commits to a treatment plan 5. Maintenance stage: Client wants to stay smoke free for life -- Get family support/ new hobby Buproprion (wellbutrin) Reduces nicotine cravings -Does not cause sexual dysfunction or weight gain Varenicline (chantix) Reduces nicotine cravings and nicotine withdrawal symptoms -SE: Suicide, N/V, insomnia, depressed mood, mood swings Codependence a maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the person who uses substances characteristics of codependency Poor relationship skills, excessive anxiety and worry, compulsive behaviors, and resistance to change -EX: Wife calls in at work to say husband is sick when really he is drunk or hungover Nursing interventions for substance abuse -Teaching client and family about substance abuse -Dealing with family issues -Helping clients learn more effective coping mechanisms Caffeine Most widely used psychoactive in the world. Can result in intoxication and withdrawal Cannabis Most commonly used illicit drug. Fourth most used psychoactive in the US after caffeine, alcohol, and tobacco Hallucinogens Cause a profound disturbance in reality Inhalants solvents for glues and adhesives, propellants, thinners, and fuel Binge drinking Drinking excessive alcohol too quickly -Women= 4+drinks in 2 hours -Men= 5+ drinks in 2 hours Heavy drinking characterized by drinking excessive alcohol too often -women= 8+ drinks a week -Men= 14+ drinks a week T/F With eating and feeding disorders mortality is high and suicide is a large risk? True The goal with eating and feeding disorders is... normalize eating patterns and treat issues raised by illness. Anorexia nervosa -Ritualistic intake restriction causing low body weight -Fear of gaining weight or becoming fat -Disturbed self-perceived weight/shape -Underweight or low BMI Bulimia Nervosa -Eating large quantities of food, followed by inappropriate compensatory behaviors such as self-induced vomiting to get rid of excess calories -1x per week for 3 months -Can have normal weight or slightly higher BMI Purging self-induced vomiting, laxatives, diuretics, or enemas to lose or maintain weight Non-purging fasting, excessive exercise Binge eating disorder eating large quantities of food over a short time without the use of compensatory mechanisms -feelings of distress and lack of control -1x per week for 3 months -weight increases, increasing risk for T2DM, HTP, and cancer Risk factors for anorexia and bulimia nervosa -Occupation -childhood heating patterns -athletes -history of obesity -genetics -biological disturbances of serotonin -interpersonal relationships-pressure from parents -psychological-rigidity, ritualism, feelings of ineffectiveness, distorted body image -environmental-social pressure -temperamental- anxiety or obsessions in childhood