ATI Care of the Critically Ill Patient Experiencing Alcohol Withdrawal and Liver Failure, Chapter 11: Perrin: Understanding the Essentials of Critical
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Perrin: Understanding the Essentials of Critical Care Nursing
Chapter 11: Care of the Critically Ill Patient Experiencing Alcohol Withdrawal and Liver Failure
MULTIPLE CHOICE.
Choose the one alternative that best completes the statement or answers the questions
1) The nurse in the ICU is caring for a- ye6ar- old male who has been drinking heavily for 3 years. She is aware of the potential for alcohol withdrawal syndrome based on the knowledge that physiologically:
A) Alcohol is a stimulant that increases gam-mama inobutyric acid (GABA).
B) The neurotransmitters inhibit impulses on the neurons.
C) The CNS has become accustomed to the depressant effects of the alcohol and CNS excitability develops when alcohol is no longer present.
D) The neuroreceptors in the brain can begin to initiate a chemical reaction of normalcy.
Answer: C
Explanation: A) When exposed to repeated doses of alcohol, the central nervous system (CNS) becomes accustomed to the depressant effects of the alcohol and produces adaptive changes in an attempt to function normally. In the absence of or with a significant decrease in the amount of alcohol, chaos erupts within the CNS. When alcohol is no longer acting as a depressant, the compensatory actions cause excessive CNS excitability. It is analogous to having an accelerator without a brake. The time course of withdrawal is determined by the time it takes to restore balance. #1 is not correct. Alcohol suppresses the production of GABA. When alcohol is withdrawn, GABA may resume normal function which is to inhibit transmission of impulses. #2 is not correct. Neurotransmitters are usually balanced between inhibitory and stimulatory. In the presence of alcohol, transmitters are inhibited. With the absence of alcohol, the transmitters become stimulated. #4 is not correct. With the withdrawal of alcohol, neuroreceptors do not regain normalcy. Instead they are prone to become overstimulated–this is due to the depressant effect of alcohol.
Nursing Process: Evaluation Cognitive Level: Comprehension
Category of Need: Safe, Effective Management of Care
B) When exposed to repeated doses of alcohol, the central nervous system (CNS) becomes accustomed to the depressant effects of the alcohol and produces adaptive changes in an attempt to function normally. In the absence of or with a significant decrease in the amount of alcohol, chaos erupts within the CNS. When alcohol is no longer acting as a depressant, the compensatory actions cause excessive CNS excitability. It is analogous to having an accelerator without a brake. The time course of withdrawal is determined by the time it takes to restore balance. #1 is not correct. Alcohol suppresses the production of GABA. When alcohol is withdrawn, GABA may resume normal function which is to inhibit transmission of impulses. #2 is not correct. Neurotransmitters are usually balanced between inhibitory and stimulatory. In the presence of alcohol, transmitters are inhibited. With the absence of alcohol, the transmitters become stimulated. #4 is not correct. With the withdrawal of alcohol, neuroreceptors do not regain normalcy. Instead they are prone to become overstimulated–this is due to the depressant effect of alcohol. Nursing Process: Evaluation
Cognitive Level: Comprehension
Category of Need: Safe, Effective Management of Care
C) When exposed to repeated doses of alcohol, the central nervous system (CNS) becomes accustomed to the depressant effects of the alcohol and produces adaptive changes in an attempt to function normally. In the absence of or with a significant decrease in the amount of alcohol, chaos erupts within the CNS. When alcohol is no longer acting as a depressant, the compensatory actions cause excessive CNS excitability. It is analogous to having an accelerator without a brake. The time course of withdrawal is determined by the time it takes to restore balance. #1 is not correct. Alcohol suppresses the production of GABA. When alcohol is withdrawn, GABA may resume normal function which is to inhibit transmission of impulses. #2 is not correct. Neurotransmitters are usually balanced between inhibitory and stimulatory. In the presence of alcohol, transmitters are inhibited. With the absence of alcohol, the transmitters become stimulated. #4 is not correct. With the withdrawal of alcohol, neuroreceptors do not regain normalcy. Instead they are prone to become overstimulated–this is due to the depressant effect of alcohol. Nursing Process: Evaluation
Cognitive Level: Comprehension
Category of Need: Safe, Effective Management of Care
D) When exposed to repeated doses of alcohol, the central nervous system (CNS) becomes accustomed to the depressant effects of the alcohol and produces adaptive changes in an attempt to function normally. In the absence of or with a significant decrease in the amount of alcohol, chaos erupts within the CNS. When alcohol is no longer acting as a depressant, the compensatory actions cause excessive CNS excitability. It is analogous to having an accelerator without a brake. The time course of withdrawal is determined by the time it takes to restore balance. #1 is not correct. Alcohol suppresses the production of GABA. When alcohol is withdrawn, GABA may resume normal function which is to inhibit transmission of impulses. #2 is not correct. Neurotransmitters are usually balanced between inhibitory and stimulatory. In the presence of alcohol, transmitters are inhibited. With the absence of alcohol, the transmitters become stimulated. #4 is not correct. With the withdrawal of alcohol, neuroreceptors do not regain normalcy. Instead they are prone to become overstimulated–this is due to the depressant effect of alcohol. Nursing Process: Evaluation
Cognitive Level: Comprehension
Category of Need: Safe, Effective Management of Care
2) Which of the following findings might suggest to the nurse that a patient was experiencing early
physiological clinical manifestations of alcohol withdrawal? The patient:
A) Is yelling at the nurse and demanding to go home.
B) Has a BP of 160/90, HR of 110, and T of 100.
C) Is a wel-l known repeat offender and is demanding a drink.
D) Cannot sit up straight or respond appropriately to questions.
Answer: B
Explanation: A) Vital signs including temperature and pulse oximetry are evaluated. Early indications of alcohol withdrawal tend to be milder increases in heart rate, temperature and blood pressure with more severe symptoms such as hallucinations developing as the patient progresses through the continuum. #1 is not correct. Yelling and acting belligerent is a behavioral and neuropsychiatric manifestation of AWS. #3 is not correct. Being a repeat offender and demanding a drink is also a behavioral manifestation of AWS. However it can alert the nurse to the development of AWS and DT's. #4 is not correct. Lethargy and decreased responsiveness is a later manifestation of reduced sensorium.
Nursing Process: Assessment Cognitive Level: Analysis
Category of Need: Safe, Effective Management of Care
B) Vital signs including temperature and pulse oximetry are evaluated. Early indications of alcohol withdrawal tend to be milder increases in heart rate, temperature and blood pressure with more severe symptoms such as hallucinations developing as the patient progresses through the continuum. #1 is not correct. Yelling and acting belligerent is a behavioral and neuropsychiatric manifestation of AWS. #3 is not correct. Being a repeat offender and demanding a drink is also a behavioral manifestation of AWS. However it can alert the nurse to the development of AWS and DT's. #4 is not correct. Lethargy and decreased responsiveness is a later manifestation of reduced sensorium.
Nursing Process: Assessment Cognitive Level: Analysis
Category of Need: Safe, Effective Management of Care
C) Vital signs including temperature and pulse oximetry are evaluated. Early indications of alcohol withdrawal tend to be milder increases in heart rate, temperature and blood pressure with more severe symptoms such as hallucinations developing as the patient progresses through the continuum. #1 is not correct. Yelling and acting belligerent is a behavioral and neuropsychiatric manifestation of AWS. #3 is not correct. Being a repeat offender and demanding a drink is also a behavioral manifestation of AWS. However it can alert the nurse to the development of AWS and DT's. #4 is not correct. Lethargy and decreased responsiveness is a later manifestation of reduced sensorium.
Nursing Process: Assessment Cognitive Level: Analysis
Category of Need: Safe, Effective Management of Care
D) Vital signs including temperature and pulse oximetry are evaluated. Early indications of alcohol withdrawal tend to be milder increases in heart rate, temperature and blood pressure with more severe symptoms such as hallucinations developing as the patient progresses through the continuum. #1 is not correct. Yelling and acting belligerent is a behavioral and neuropsychiatric manifestation of AWS. #3 is not correct. Being a repeat offender and demanding a drink is also a behavioral manifestation of AWS. However it can alert the nurse to the development of AWS and DT's. #4 is not correct. Lethargy and decreased responsiveness is a later manifestation of reduced sensorium.
Nursing Process: Assessment Cognitive Level: Analysis
Category of Need: Safe, Effective Management of Care [Show Less]