varcarolis’ foundations of psychiatric mental health nursing a clinical approach
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Johns Hopkins University School Of Nursing
MENTAL HEALTH FINAL EXAM STUDY GUIDE
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EXAM STUDY GUIDE
Mental
Health Final
Exam
LATEST MENTAL HEALTH FINAL
EXAM STUDY GUIDE
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1
Diagnostic Classes of Substance Abuse
• Intoxication: use of a substance that results in maladaptive behavior
• Withdrawal syndrome: refers to the 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
• Substance abuse: drug is used outside the medical or social norm despite
negative consequences
• Substance dependence: problem associated with addiction
Alcoholism
• First episode of intoxication → continuing problems with alcohol → first blackout →
continued drinking → development of tolerance → tolerance break → continued drinking →
functioning becoming affected → periods of abstinence/temporary controlled drinking →
escalation of alcohol intake → more problems → subsequent crisis → continuation of cycle
• Related disorders: gambling, caffeine and tobacco additions
• CNS depressant: relaxation/loss of inhibitions
1. Slurred speech, unsteady gait, lack of coordination, and impaired
attention, concentration, memory, and judgment
2. Aggressive behavior or display inappropriate sexual behavior; the person who
is intoxicated may experience a blackout
• Treatment of an alcohol overdose: gastric lavage or dialysis to remove the drug and support of
respiratory and cardiovascular functioning in an intensive care unit
• Symptoms of withdrawal
1. Onset within 4 to 12 hours after cessation or marked reduction of alcohol
intake; peaking on second day; complete in about 5 days
2. Severe or untreated withdrawal may progress to transient hallucinations, seizures,
or delirium (DTs)
3. Benzodiazepines for safe withdrawal
Substance Abuse Treatment
• Concept: medical illnesses, chronic, progressive, characterized by remissions and relapses
• Treatment models: Hazelden Clinic model and 12-step program of Alcoholics Anonymous
• Individual, group counseling
• Treatment settings
• Pharmacologic treatment: safe withdrawal; prevent relapse
• Medications help manage withdrawal or cravings, but is not a specific treatment for
substance abuse
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Alcohol Intoxication and Overdose
• An overdose, or excessive alcohol intake in a short period, can result in
vomiting, unconsciousness, and respiratory depression
• This combination can cause aspiration pneumonia or pulmonary obstruction
• Alcohol-induced hypotension: can lead to cardiovascular shock and death
• Treatment: similar to that for any central nervous system depressant—gastric lavage or
dialysis to remove the drug, and support of respiratory and cardiovascular functioning in an
intensive
care unit
• The administration of central nervous system stimulants is contraindicated
Physiological Effects of Alcoholism/Long Term (Box 19.1)
• Cardiac myopathy
• Wernicke encephalopathy: an acute neurological condition characterized by a clinical triad
of ophthalmoparesis with nystagmus, ataxia, and confusion
• Korsakoff psychosis: a late complication of persistent Wernicke encephalopathy and results
in memory deficits, confusion, and behavioral changes
• Pancreatitis
• Esophagitis
• Hepatitis
• Cirrhosis
• Leukopenia
• Thrombocytopenia
• Ascites
Alcohol Withdrawal and Detoxification
• Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction
of alcohol intake.
• Symptoms: coarse hand tremors, sweating, elevated pulse and blood pressure,
insomnia, anxiety, and nausea or vomiting
• Severe or untreated withdrawal may progress to transient hallucinations, seizures, or
delirium, called delirium tremens
• Alcohol withdrawal usually peaks on the second day and is over in about 5 days; withdrawal
may take 1 to 2 weeks
• Safe withdrawal is usually accomplished with the administration of benzodiazepines, such
as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the
withdrawal symptoms
• Total scores less than 8 indicate mild withdrawal, scores from 8 to 15 indicate moderate
withdrawal (marked arousal), and scores greater than 15 indicate severe withdrawal
(Clinical
Institute Withdrawal Assessment of Alcohol Scale)
Disulfiram (Antabuse)
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