Substance abuse disorders. Okay, first question. Your patient's diagnosed with alcohol use disorder.
Which are the symptoms of alcohol withdrawal? Would it be hallucinations and seizures, elevated blood pressure and diaphoresis, bradycardia and hypothermia, or decreased appetite and weight loss? Which would be early symptoms of alcohol withdrawal in a patient that is dependent on alcohol? What do you guys think?
Okay, guys. So the correct answer is elevated blood pressure and diaphoresis. So what you would expect for that patient who's dependent on alcohol and now they're going through withdrawals.
You're going to expect to see autonomic hyperactivity. You're going to expect to see increased blood pressure, increased heart rate. Patient may experience tremors, diaphoresis. Okay.
Remember something that you guys fail to think about. Alcohol itself is a depressant. Okay.
You wouldn't think so because you watch the movies and people get drunk and they're hype and you're thinking it's a stimulant, but no. It's a depressant. So when that patient's going through withdrawal, by the way, alcohol withdrawal is one of the deadliest withdrawals that patient can go through. So you have to be very careful.
You have to monitor them very, very closely. We're going to be concerned about that elevated blood pressure, that elevated heart rate, and those other symptoms that can turn deadly in that patient. Okay. They can have cardiac dysrhythmias. All right.
Next question. Your patient's admitted for acute alcohol intoxication. Which of the following would you prioritize as a nurse? Would it be to obtain a urine toxicology screen? Would it be to monitor the vital signs closely?
Would it be to start an IV line and administer thiamine? Or would it be to encourage a client to attend an Alcoholics Anonymous meeting? Your patient has just been admitted for alcohol intoxication. Which of the following would you prioritize? Remember, when you're prioritizing, you can only choose one answer.
Which is the most important thing to do? Very good. And I kind of gave you this answer.
Oh, sorry, guys. I kind of gave you this answer in my last explanation where I told you patients going through withdrawal, you're going to be monitoring them very, very closely. I want you to think about it.
If the patient comes in with alcohol intoxication, so they come in completely drunk. Are you going to be giving them alcohol under your care? No.
So what's going to happen? They're going to be going through withdrawals, which can be very deadly, which means you're going to have to monitor them very closely. You better be checking those vitals because again, we're concerned about hypertension. We're concerned about tachycardia. We're concerned about cardiac dysrhythmias.
We're concerned about the tremors and diaphoresis and all those other things that can happen to the patient as they're what? Withdrawing from that alcohol. Okay. Um, being, so I said that with them going through the withdrawals, but it takes time for them to go through that withdrawal. Let's talk about what happens to that patient right then and there as they're intoxicated.
Guess what? But monitoring vital signs is still going to be a priority because as I stated before on the first slide, alcohol is a depressant. So before they start going.
through the withdrawal symptoms where we're seeing the opposite, we're seeing the hypertension, we're seeing the tachycardia, what's going to be happening as they're intoxicated? The opposite, decreased blood pressure, decreased heart rate, decreased respirations. They can have respiratory depression. Guess what, guys?
Either way, whether it's going up or down, that can kill your patient. Remember. Abnormal vital signs, that falls under physiological integrity in Maslow's hierarchy of needs. When we're talking about Maslow's hierarchy of needs, we're talking about the most important thing to you for your patient, which is going to be physiological integrity, vital signs, airway, breathing, circulation, hemodynamic status, oxygenation, glucose, fluid, electrolytes, seizures, MI, all those good things that actually can kill your patient. That's always going to be your priority.
So guys, whenever you get these kinds of questions that's asking you, what should I prioritize? What should I do first? Always say to yourself, what is going to keep my patient alive the longest or what can kill them the fastest?
Now look at these other choices. Obtain a urine toxicology screen. Yes, that's important, but it's not going to be a priority. Why? We already know they're intoxicated.
Okay. We can confirm that with the urine toxicologies. And by the way, that urine toxicology, even if it does come back immediately, we still, who cares about that if the patient's dead, right? Next, start an IV line and administer thiamine.
Wonderful. Absolutely. We're going to want to make sure we keep that patient hydrated.
We're going to want to make sure they get thiamine, especially if they're alcohol dependent, but who cares about that if they're dead? And last, encourage your client to attend an Alcoholics Anonymous meeting. That's great for down the line when they get discharged, but we care about here and now.
And again, who cares about that if your patient is dead? So that's why we're going to be monitoring the vital sign closely. All right, which of the following statements by a client indicates an understanding of the medication disulfiram, also known as Antabuse?
I can drink small amounts of alcohol as long as I take the medication. I'll need to avoid alcohol-containing products like cough syrups. I can stop taking the medication when I feel like the cravings are gone.
Or this medication will cure my alcohol use disorder. What do you guys think? Very good.
I will need to avoid alcohol containing products like cough syrup or even mouthwash. Anything that has alcohol. Let me tell you something. This type of medication, disulfiram, you got to know it. It is a deterrent.
And the reason it's a deterrent from alcohol is because you get deathly ill whenever you ingest or your skin even absorbs anything with alcohol in it. You will want to go throw yourself in some lake or river. You will get deathly ill.
Okay. You cannot have any alcohol whatsoever. Your patient's been taking barbiturates for months and then they suddenly stop.
What would you monitor for? Bradycardia and hypothermia, increased appetite and weight gain, anxiety and seizures, or muscle weakness and lethargy. So your patient's been taking barbiturates for months and then they suddenly stop.
What would you be concerned about? bradycardia hypothermia increased appetite and weight loss anxiety and seizures or muscle weakness and lethargy very good anxiety and seizures i want you to think about it what drug are we talking about we're talking about barbiturates um example of a barbiturate would be something like um phenobarbital okay So barbiturates are downers. So think about what happens as that patient's withdrawing from, because it says this patient's been taking barbiturates for months.
And the fact that I told you this patient has been taking barbiturates for months, you should have another concern. Okay. Cause barbiturates are very addictive.
Okay. So we're going to be concerned that this patient's dependent, but anyway, I digress. This is a downer. So they've been taking it for months and then they suddenly stop. We're going to be worrying, worried about those withdrawal symptoms, like the patient having.
hallucinations or delirium or even seizures, right? That's what we're going to be concerned about. All right.
Which patient teaching should you include about phenobarbital? Remember, I just told you phenobarbital is an example of a barbiturate. So what teaching would you include? Avoid consuming alcohol while taking this medication.
Take this medication on an empty stomach. Increase your intake of vitamin C while you're taking this medication. Or discontinue the medication if you experience drowsiness.
Avoid consuming this medication. Avoid consuming, excuse me, alcohol while you're taking this medication. I want you to think about this.
I just explained to you that this is a downer. And I already told you that alcohol is a downer, right? So think about it. Does it make any sense for a patient to be taking a medication that's already a downer and to be taking another downer? Absolutely not.
That's number one. Number two, do you ever take alcohol with any medication? There's not a medication on earth that you're going to be told to take alcohol with.
Absolutely not. So a patient who's been taking something like phenobarbital, as they're withdrawing from it, one of our biggest concern is that patient developing what? Seizures. You got to be very careful.
Okay. TikTok is giving me a warning. I think they think I'm talking about something bad, but this is all health related matters.
Oh my gosh. I'm going to have to fight them on this. How are you guys doing on the live?
Your patient has a history of taking barbiturates for insomnia. What should be reported to the healthcare provider immediately if it happens? The client reporting having occasional headaches.
The client having developed a tolerance for the medication. The client experiencing dizziness after standing up quickly. The client reporting difficulty concentrating at work.
The patient has a history of taking barbiturates for insomnia. Which would you report to the healthcare provider immediately? Only seven people chose.
The client has developed a tolerance to the medication. Guys, like literally in the last slide or the one right before that, I told you that this medication is highly addictive. And one of our biggest concerns is that the patient.
is dependent on it. They're addicted to it. Remember, this is a downer.
We got to be very careful. You have to be watching out for it. Let's look at the other choices. So you can see why the other choices are wrong.
Cause my goodness, 14 of you guys chose yellow. So let's go over red. It says the client reports, occasional headaches.
Let me tell you what one word, matter of fact, on the live, what is the one word in that sentence that lets you know that answer choice was wrong. The client reports, occasional headaches. What word in that phrase made you know it's wrong? The client reports occasional headaches.
What's the word? Thank you. Occasional.
Do you know what occasional means? That means sometimes. Guess what?
Sometimes I get headaches and I don't take barbiturates. When you have to choose one answer, you have to choose the best answer. You're not going to choose something that says, oh, occasional or sometimes or on and off because guess what?
If it's occasional, that patient's life isn't at risk. but developing a tolerance to a depressant, absolutely, your life is at risk. Look at the next option that most of you guys chose. The client experiences dizziness after standing up, what? Quickly.
I don't have to take a barbiturate to experience dizziness if I get up quickly. All I got to do is be sitting down. or lying down for a long time. And then when I get up quickly, what happens?
Your blood pressure drops. You get orthostatic hypotension. I mean, we don't want it to happen, but guess what?
Barbiturates, that's a side effect, orthostatic hypotension. Why are you going to report a known side effect to the healthcare provider? That's not putting that patient's life at risk like that dependence will.
And then last, the client reports difficulty concentrating at work. Well, duh! They're going to have difficulty concentrating at work. Again, this is a depressant. Depresses everything, even what?
Thinking, cognition. Hello? All right, let's keep going.
Your patient takes methylphenidate for ADHD. Which of the following side effects should the nurse monitor for? Weight gain, bradycardia, insomnia, or constipation.
Again. Your patient's taking methylphenidate for ADHD, which of the following side effects should the nurse monitor for? Weight gain, bradycardia, insomnia, or constipation. How are you guys doing on the live?
Very good. insomnia. So I want you guys to think about that because we've been talking about downers, right? Now we're talking about methylphenidate, which is what? An upper.
And doesn't that sound weird? Because ADHD, that patient's already hyper-stimulated. Why would we be giving an upper to a patient that's already hyper-stimulated? It works.
It has the opposite effect, calms them down. Okay. So that patient. that's taking this stimulant because that's what the drug is what side effect will we be concerned about insomnia they're going going going their mind is going going going they're not going to be able to sleep Weight gain, no.
If anything, they'd have what? Weight loss. Bradycardia, no. If anything, they'd have tachycardia. Constipation, no.
Even your GI tract is going. You got peristalsis. If anything, you're having the opposite, diarrhea.
So the only correct answer here, guys, is insomnia. That's right. That's the only answer that makes sense. True or false? Speed and crystal meth is a barbiturate.
Is this true or is this false? Speed and meth is a crystal barbiturate. Guys, those on the live, just work with me. My business district is closed today because of the storm.
So I'm working from home. I'm trying my best. Okay. All right. Is speed and crystal meth a barbiturate?
False. False. It is not a barbiturate. Remember, I told you a barbiturate is a downer.
Speed, crystal meth, guess what? Those are stimulants. Those are uppers.
They cause increased heart rate, increased blood pressure, increased respirations. Patient has chances of having hallucinations, seizures, things like that. Okay.
Very good. They're uppers. True or false?
LSD, also known as acid. And PCP, also known as angel dust, are hallucinogens. Is this true or is this false? Very good. True.
We're going to be concerned about that patient having seizures. mania, they're all over the place. Hallucinations, hypertension, hyperthermia, we're going to be monitoring the patient's vital signs very closely. We're going to be making sure that that patient's safe. And number one, we're going to make sure that we protect that airway because who cares about anything else if that patient's not even breathing, right?
We're going to be constantly checking that patient's level of consciousness. We want to make sure that we keep that patient safe and everyone else around them safe. Because remember with hallucinogens, You may see a person and you think they're a monster trying to kill you, right? You're hallucinating. So safety is a very big priority for these types of patients.
Something else with these hallucinogen type medications, we are going to want to decrease stimuli. They're already at 100, okay? So we're not going to have them at the nurse's station where nurses are getting reports from other nurses, where the healthcare providers are giving orders, where the phones are ringing.
where the family's acting a fool. No, we're going to have them at the end of the hallway. The lights are going to be dimmed.
There's not going to be a TV on. There's not going to be a radio on. The bed's going to be in the lowest position possible, right? The call light's going to be within reach. We want to decrease stimulation, not increase it.
All right, one more slide. Select all that apply. What are important nursing interventions for patients taking narcotics?
So your patients taking narcotics, what are important nursing interventions? And here are your options. Maintain patient airway, control the seizures, assess the level of consciousness, assess vital signs, have naloxone readily available, and have a defibrillator available. I spelled that wrong, but that's what it says, available. Okay?
What are going to be your nursing interventions? All of them. Your patient's taking a narcotic. You want to maintain a patent airway because we don't care about anything else if our patient's not breathing. We're going to be concerned about seizures, right?
So that patient's going to be on seizure precautions. We're going to be assessing the level of cognition, assess the vital signs. Naloxone, what's that? Narcan.
We need to make sure it's available in case we need to reverse. Um, any overdose and have a defibrillator available that patient can have cardiac dysrhythmia. We've got to make sure that we have that on hand. Um, patients taking things like morphine, heroin, dilaudid, uh, the list goes on.
Yep. Narcan. Very good guys. Thank you so much for rocking with me through this Kahoot.
It's been because of the storm. I just really had to change things around if I wanted to do a Kahoot. this evening with you guys.
And I really did. So thank you for your patience. let's see how you guys did