J.G.'s physician comes to the ICuto assess J.G. and tells you to watch out because J.G. is about to go into alcohol withdrawal delirium. the physician writes several medication orders.
What medications are commonly prescribed for patients withdrawing from alcohol? Select
all that apply.
a. Benzodiazepines, such as chlordiazepoxide (Librium)
b. Naltrexone (Revia), an opioid-reversal agent
c. Acamprosate (Campral), an alcohol deterrent agent
d. Clonidine (Catapres), an alpha-adrenergic blocker
e. Antiepileptic drugs, such as carbamazepine (Tegretol)
. Disulfiram (Antabuse), an alcohol deterrent agent
g. Atenolol (Tenormin), a beta-adrenergic blocker
Explain the rationale for each of the drugs used during acute alcohol withdrawal.
What chronic health problems are associated with alcoholism?
What laboratory tests might the physician order to assess for nutritional deficiencies or other
medical problems J.G. is experiencing?
Question 2You assess J.G.'s history of alcohol use by talking to J.G. and his brother and conclude that he is showing indications of alcohol use disorder.
Name the criteria for alcohol use disorder as outlined in the Diagnostic and Statistical
Manual of Mental Disorders,Fifth Edition (DSM-V) and put an asterisk or star next to the
ones J.G. demonstrates.
Drinking that interferes with important activities
Based on the DSM-V criteria, how would you rate the severity of J.G.'s alcohol use? Explain
your decision.
a. No problem
b. Mild
c. Moderate
d. Severe
What would be helpful for J.G.'s physician to know regarding J.G.'s substance abuse history?
Question 3J.G., a 49-year-old man, was seen in the emergency department 4days ago, diagnosed with alcohol intox-ication, and released after 8 hours to his brother's care
He was brought back to the ed12 hours ago with
an active gastrointestinal (GI) bleed and is being admitted to the intensive care unit (ICu); his diagnosis is
upper GI bleed and alcohol intoxication.
you are assigned to admit and care for J.G. for the remainder of your shift. according to the ednotes,
his admission vital signs (Vs) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV
fluids and transfused 6 units of packed red blood cells (PRBCs) in the ed. On initial assessment, you note
that J.G.'s Vsare blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anx-ious. He complains of a headache and appears flushed. you note that he has not had any emesis and has
not had any frank red blood in his stool or melena (black tarry stools) over the past 5 hours. In response
to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a
fifth of vodka daily for the past 2months. He reports that he was drinking vodka when he got home from
the edthe first time. He admits to having had seizures while withdrawing from alcohol in the past. He tells
you that he just can't help it and has strong urges to drink, but that he never means to drink very much.
He has had trouble keeping a job over the past several months.
Admission Lab Work
Hgb 10.9g/dL
Hct 23
ALT(formerlySGPT) 69units/L
AST(formerlySGOT) 111units/L
GGT 75units/L
ETOH 291mg/dL
Which data from your assessment of J.G. are of concern to you?
What do the admission laboratory results indicate?
Which of the previous laboratory results specifically reflects chronic alcohol ingestion?
What are the two most likely causes of J.G.'s symptoms?
What is the most likely time frame for someone to have withdrawal symptoms after abrupt
cessation of alcohol?
Question 4J.J. asks you whether there are other things he can do, in addition to medications, to help his anxiety. He tells you that he's heard about relaxation therapy and wants to hear more about it.
What would you discuss with J.J. about relaxation therapy?
To what other treatment modalities could J.J. be referred after his hospitalization to help treat
his PTSD and related problems?
Question 5While you are in J.J.'s room, he states that he would like to rest for a while, and he requests something to calm his nerves. you check his medical record see these PRN (as needed) medications listed.
PRN Medications
Acetaminophen(Tylenol)650mgPOevery6hoursprnpainorfe
ver
Alprazolam(Xanax)orallydissolvingtablet,0.5mgbymouthevery4hrprnanxiety
Zolpidem(Ambien)extendedrelease,12.5mgPOatbedtimeifneeded
Which medication is most appropriate to administer at this time? Explain.
What are the adverse effects of long-term use of benzodiazepine anxiolytics?
You decide to notify J.J.'s physician about his reaction to the movie. The physician writes an
order to start paroxetine (Paxil). How does this medication differ from alprazolam?
Which of these are potential side effects of paroxetine? Select all that apply.
a. Nausea
b. Constipation
c. Postural hypotension
d. Headache
e. Tinnitus
Question 6You are working the afternoon shift in an inpatient psychiatric unit. the patients are in the day room watching a movie when suddenly someone starts yelling
you and other staff rush to the day room to find
J.J., a 48-year-old male patient, crouched in the corner behind a chair, yelling at the other patients, Get
down. Get down quick. you and the other staff are able to calm J.J. and the other patients and take J.J. to
his room. He apologizes for his outburst and explains to you that the movie brought back memories of
the Gulf War. He had forgotten where he was and thought he was in combat again. He describes to you
in detail the memory he had of being ambushed by the enemy and watching several of his comrades be
killed. you remember hearing in report that J.J. is a Gulf War veteran admitted with posttraumatic stress
disorder (Ptsd).
What are common causes of PTSD, and what is the most likely cause of J.J.'s condition?
Name three criteria that must be present for a diagnosis of PTSD.
What is the difference between PTSD and acute stress disorder?
Which symptom(s) of PTSD did J.J. most likely experience?
What therapeutic measures can be done to help J.J. during your shift this afternoon?
Question 7After 3 weeks, you are providing discharge teaching for J.M. you ask her whether she is ready to go home. J.M. states, I'll be so glad to get out of this place. I'm so fat and ugly
I need to lose 10 pounds. I bet I can
do it in just a couple of days. Otherwise, I don't want to live anymore.
What will you discuss with the physician before any further discharge teaching or plans?
You report J.M.'s statements to the physician. What actions do you expect the physician to take?
What medications would be indicated for J.M. to assist with resolution of both her anorexia
nervosa and her depression?
Which statements by J.M. would indicate successful treatment? Select all that apply.
a. When you say I look 'healthy' I feel fat.
b. Lately I've been feeling a little better about things.
c. It's up to me to take care of my body by eating enough food.
d. I just have to stay skinny to feel good.
e. I am looking forward to going out with my friends again.
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