hey everyone welcome to today's nursing rapid review where we are mastering nclex style questions with picmonic my name is marley and really fast before we get started picmonic is an audio visual learning tool that helps you remember all the information you need to know in nursing school fast so today we are going to be covering alcohol awareness because it is alcohol awareness month and with many of us in quarantine this is going to be a very big topic for the healthcare providers to be aware of so let's start out with a question that you would see on a nursing exam or on an nclex style prep question a 45 year old woman a 45 year old toothless woman shows up to the emergency department causing a lot of commotion screaming that she's the tooth fairy and is coming to collect teeth from patients she appears confused has an unsteady gait and cannot recall her name there is a strong smell of alcohol in her breasts she is diagnosed with wernicke corsical syndrome this syndrome is most likely due to which of the following one iron deficiency two thymine deficiency three oxygen deficiency for nice and toxicity or five vitamin b1 toxicity so when approaching this kind of question you want to first read the question take a breath and then reread the entire question and ask yourself what is the question asking you so right now i'm looking at this and i'm saying okay it's asking me a content based question it's asking me if i know what wernicke korsukov syndrome is so let's step into the picmonic covering wernicke corsicoff syndrome for alcohol abuse assessment remember the story of the alcoholic martini and the assessed man waking up in jail after a night of partying alcohol intoxication involves cns depression shown by the deflating cns brain being held up cns depression can cause alterations in the neurologic respiratory and cardiac status of the patient leading to troubles with speech judgment and muscle coordination withdrawal symptoms can begin as early as two hours after the last drink and can range from mild anxiety and shakiness to severe symptoms such as seizures and delirium tremens also known as dts with alcohol withdrawal it's possible to develop wernicke korsakoff syndrome shown by the worm mickey and corset cop this syndrome typically occurs due to deficient thyamine levels secondary to alcohol abuse and can produce vision changes memory impairment and dementia moving along to medical complications alcohol abuse can produce gi distress shown by the gi flare gun due to irritation of the stomach lining chronic abuse can wear down the heart muscle and induce cardiomyopathy shown by the heart mayo with party hat and because alcohol also irritates the stomach liver and pancreas it is one of the most common causes of acute pancreatitis shown by the pancreas on fire it's metabolized slowly in the liver thus enhancing injury of the liver leading to liver inflammation referred to as hepatitis and scarring of the liver known as cirrhosis shown by the sea roses on the liver immunosuppression depicted as the moon suppressed can also occur due to impaired nutrition lastly sexual dysfunction may occur in both women and men who engage in alcohol abuse shown by the limp wiener men may experience erectile dysfunction and women may experience interruptions in menstruation remember that several screening tools including the audit and cage exist to help in the assessment of alcohol abuse shown by the screen door the martini is trying to slip out of so in short alcohol abuse results in cns depression with withdrawal possibly leading to wernicke corsica syndrome medical complications include gi distress cardiomyopathy pancreatitis cirrhosis immunosuppression and sexual dysfunction and several screening tools exist to help during assessment so when we jump into the picmonic you're going to see a fact list on the left hand side now these facts are the important key points about this topic about this particular topic that you're more likely to be tested on for your nursing exams or for the nclex and then in the center of the screen you see an image so each fact on the fact list corresponds with the character in the main image which makes up the entire scene so let's scroll down on the fact list to withdrawal where we see ornika korsakov syndrome and here you're going to see the character the worm mickey character and the corset cop and so this is often seen a lot of times in alcohol withdrawal and basically this is this can have a range of symptoms ranging from mild confusion anxiety all the way to dementia um memory impairment vision changes similar to this to the things that the woman in our question was presenting with in the emergency department so this is due to a thymine deficiency and you can read that in the definition in this fact it's due to a thymine deficiency that is secondary to alcohol abuse so that's something you're going to want to remember for your nursing exams now if you keep scrolling down you see the other facts in this fact list you see medical complications gi distress pancreatitis immunosuppression and all of these have characters associated with it so when you listen to this picmonic and you study it you'll just be able to remember the entire image because at all the crazy characters and the crazy story that goes with it and on a question like this you'll be able to pull up that picmonic in your memory and recall the information that you need to know so let's continue on jumping back and i want you to remember that uh in a lot of these questions we use the nursing process to ask ourselves what the question is asking us and find the answer just using adpie which is assessment diagnosis planning implementation and evaluation if many of you remember it is the nursing process so a lot of these questions are going to be asking us part of the nursing process so let's jump down into another question a 35 year old alcoholic patient is on the unit and experiencing withdrawals what is the nurse's next priority action so the answer options here are administered ordered naltrexone i'll administer ordered flumezone administer n acetylcysteine warp place the patient in an open space with many people around for safety now let's ask ourselves what is this question asking us is it asking us to do an assessment is it asking us to create a nursing plan no it's asking us to do an intervention and how do i know that because i'm looking at this last sentence what is the nurse's next priority action and i want you to remember that that those keywords next priority action because that's going to be triggering me to remember or think about that it's an intervention question it's not an assessment question so because of that i need to know my alcohol interventions and let's go ahead and look at the alcohol abuse interventions picmonic to help us remember some of this having knowledge of the appropriate treatment to carry out in a patient undergoing alcohol abuse can be recalled by the story of the alcoholic martini hitting rock bottom and wanting to change his ways there are several interventions to implement during the withdrawal stage this includes reducing environmental stimuli shown by the down arrow over the stimulating environment anti-anxiety medications may also be indicated shown by the anti with anxiety bag along with vitamin supplements shown by the vikings severe withdrawal may require seizure precautions to be implemented to prevent aspiration shown by caesar with a precaution sign in hand and because alcohol abuse increases the risk for suicide it may be necessary to implement suicide precautions shown by the suicide jumper with precaution sign it wasn't his fault though because the fever beaver pushed him signifying that a patient with severe withdrawal may present with a fever greater than 101 degrees fahrenheit an important part of care is to identify support systems shown by the magnifying glass over the supportive friends group therapy can also be helpful shown by the group therapeutically massaging the martini the medication disulfiram can also be prescribed in conjunction with therapy and support and is shown by the dyed shirt surfer this medication works by creating an unpleasant reaction when alcohol is consumed which helps reduce the desire to drink while the drug naltrexone shown by the long nail t-rex is an opioid antagonist and can also be used in the treatment of alcohol dependence so in summary interventions for alcohol abuse during withdrawal include reducing environmental stimuli giving anti-anxiety medications and vitamin supplements implementing seizure and suicide precautions and assessing for and treating a fever it will be helpful to identify support systems engage in group therapy and possibly administer dal sulfuram or naltrexone so when i pull up the alcohol abuse interventions pigment again i'm going to see the effect list on the left-hand side and remember each of these facts corresponds with a character in the main image and a lot of these characters we're going to see over and over again because they reoccur in the picmonic library to help you remember the different symptoms and associations so you can tie it all together so again we have our alcohol alcoholic martini the abused alcoholic martini if you remember from the last picmonic that character was in our alcohol abuse assessment pygmonic and then let's scroll down again to withdrawal so one of the key points here is that you're going to want to reduce environmental stimuli so you're not going to want to place the patient in a crowded room with a lot of people it's going to cause a lot of anxiety they need to be in a quiet room with limited amount of people limited amount of stimuli so automatically i can cross off that la last answer option on my list the one that said put the patient in a room with a lot of people no that is a big no so then we scroll down we see different options here seizure precautions suicide precautions these are all really really important things to know and then a consideration let's look down at this naltrexone character the nail t-rex so naltrexone is a medication that's indicated for alcohol and opioid dependence so remember that naltrexone the nail t-rex if you see in the pikmonic on the left-hand side that nail t-rex character that's gonna trigger you to think about this answer option which was let's go back uh administer ordered now trexzone so you're gonna be thinking about that that is a big one for um the nclex it's a big hot spot that you wanna be aware of so let's go back to the basics when answering these nclex stop questions you want to ask yourself what is the question asking me remember think about adpie the nursing process is it asking me an assessment question is it asking me an intervention question how am i supposed to know these things so reread the entire question and then look for some keywords like we just did so assessment questions are going to typically not always but a lot of times they're going to have questions or um keywords in there that say things like assess collect determine gather information these are things that are going to start to make you think oh it's asking me to assess the patient not to have an intervention but just to gather information and then an intervention question just like the one we just had are gonna have keywords like action next intervene intervention implement these are gonna be things that will make you automatically think okay what's the action here what do i need to do it's not asking me to do any more assessments it's asking me to intervene and what are those interventions so that is all we have for today thank you so much for watching and good luck with all your exams and hope everyone is staying safe out there see you next time