Chlordiazepoxide (Librium) is the drug of choice for treating alcohol withdrawal symptoms.
For a patient who is at risk for alcohol withdrawal, the nurse should assess the pulse rate and blood pressure every 2 hours for the first 12 hours, every 4 hours for the next 24 hours, and every 6 hours thereafter (unless the patient’s condition becomes unstable).
Alcohol detoxification is most successful when carried out in a structured environment by a supportive, nonjudgmental staff.
The nurse should follow these guidelines when caring for a patient who is experiencing alcohol withdrawal: Maintain a calm environment, keep intrusions to a minimum, speak slowly and calmly, adjust lighting to prevent shadows and glare, call the patient by name, and have a friend or family member stay with the patient, if possible.
The therapeutic regimen for an alcoholic patient includes folic acid, thiamine, and multivitamin supplements as well as adequate food and fluids.
A patient who is addicted to opiates (drugs derived from poppy seeds, such as heroin and morphine) typically experiences withdrawal symptoms within 12 hours after the last dose. The most severe symptoms occur within 48 hours and decrease over the next 2 weeks.
Reactive depression is a response to a specific life event.
Projection is the unconscious assigning of a thought, feeling, or action to someone or something else.
Sublimation is the channeling of unacceptable impulses into socially acceptable behavior.
Repression is an unconscious defense mechanism whereby unacceptable or painful thoughts, impulses, memories, or feelings are pushed from the consciousness or forgotten.
Hypochondriasis is morbid anxiety about one’s health associated with various symptoms that aren’t caused by organic disease.
Denial is a refusal to acknowledge feelings, thoughts, desires, impulses, or external facts that are consciously intolerable.
Reaction formation is the avoidance of anxiety through behavior and attitudes that are the opposite of repressed impulses and drives.
Displacement is the transfer of unacceptable feelings to a more acceptable object.
Regression is a retreat to an earlier developmental stage.
According to Erikson, an older adult (age 65 or older) is in the developmental stage of integrity versus despair.
Family therapy focuses on the family as a whole rather than the individual. Its major objective is to reestablish rational communication between family members.
When caring for a patient who is hostile or angry, the nurse should attempt to remain calm, listen impartially, use short sentences, and speak in a firm, quiet voice.
Ritualism and negativism are typical toddler behaviors. They occur during the developmental stage identified by Erikson as autonomy versus shame and doubt.
Circumstantiality is a disturbance in associated thought and speech patterns in which a patient gives unnecessary, minute details and digresses into inappropriate thoughts that delay communication of central ideas and goal achievement.
Idea of reference is an incorrect belief that the statements or actions of others are related to oneself.
Group therapy provides an opportunity for each group member to examine interactions, learn and practice successful interpersonal communication skills, and explore emotional conflicts.
Korsakoff’s syndrome is believed to be a chronic form of Wernicke’s encephalopathy. It’s marked by hallucinations, confabulation, amnesia, and disturbances of orientation.
A patient with antisocial personality disorder often engages in confrontations with authority figures, such as police, parents, and school officials.
A patient with paranoid personality disorder exhibits suspicion, hypervigilance, and hostility toward others.
Depression is the most common psychiatric disorder.
Adverse reactions to tricyclic antidepressant drugs include tachycardia, orthostatic hypotension, hypomania, lowered seizure threshold, tremors, weight gain, problems with erections or orgasms, and anxiety.
The Minnesota Multiphasic Personality Inventory consists of 550 statements for the subject to interpret. It assesses personality and detects disorders, such as depression and schizophrenia, in adolescents and adults.
Organic brain syndrome is the most common form of mental illness in elderly patients.
A person who has an IQ of less than 20 is profoundly retarded and is considered a total-care patient.
Reframing is a therapeutic technique that’s used to help depressed patients to view a situation in alternative ways.
Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are serotonin reuptake inhibitors used to treat depression.
The early stage of Alzheimer’s disease lasts 2 to 4 years. Patients have inappropriate affect, transient paranoia, disorientation to time, memory loss, careless dressing, and impaired judgment.
The middle stage of Alzheimer’s disease lasts 4 to 7 years and is marked by profound personality changes, loss of independence, disorientation, confusion, inability to recognize family members, and nocturnal restlessness.
The last stage of Alzheimer’s disease occurs during the final year of life and is characterized by a blank facial expression, seizures, loss of appetite, emaciation, irritability, and total dependence.
Threatening a patient with an injection for failing to take an oral drug is an example of assault.
Reexamination of life goals is a major developmental task during middle adulthood.
Acute alcohol withdrawal causes anorexia, insomnia, headache, and restlessness and escalates to a syndrome that’s characterized by agitation, disorientation, vivid hallucinations, and tremors of the hands, feet, legs, and tongue.
In a hospitalized alcoholic, alcohol withdrawal delirium most commonly occurs 3 to 4 days after admission.
Confrontation is a communication technique in which the nurse points out discrepancies between the patient’s words and his nonverbal behaviors.
For a patient with substance-induced delirium, the time of drug ingestion can help to determine whether the drug can be evacuated from the body.
Treatment for alcohol withdrawal may include administration of I.V. glucose for hypoglycemia, I.V. fluid containing thiamine and other B vitamins, and antianxiety, antidiarrheal, anticonvulsant, and antiemetic drugs.
The alcoholic patient receives thiamine to help prevent peripheral neuropathy and Korsakoff’s syndrome.
Alcohol withdrawal may precipitate seizure activity because alcohol lowers the seizure threshold in some people.
Paraphrasing is an active listening technique in which the nurse restates what the patient has just said.
A patient with Korsakoff’s syndrome may use confabulation (made up information) to cover memory lapses or periods of amnesia.
People with obsessive-compulsive disorder realize that their behavior is unreasonable, but are powerless to control it.
When witnessing psychiatric patients who are engaged in a threatening confrontation, the nurse should first separate the two individuals.
Patients with anorexia nervosa or bulimia must be observed during meals and for some time afterward to ensure that they don’t purge what they have eaten.
Transsexuals believe that they were born the wrong gender and may seek hormonal or surgical treatment to change their gender.