ANS Discussion Questions and Answers

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ANS Discussion Questions CH 47 Alzheimer Disease 1. An Alzheimer’s patient is started on drug therapy. a. Discuss the main expected outcome of drug therapy for the patient.  The main expected outcome for drug therapy is to slow the progression of the disease.  Drug therapy will not cure the disease.  Drug therapy has been shown to slow the loss of memory and cognitive abilities.  Drug therapy helps to maintain independence in the patient. b. Develop a teaching plan for the patient and the caregivers  Provide a quiet stable environment for the patient.  Maintain daily routines.  Include verbal or written reminders, simple directions, adequate lighting, calendars, and the convenient placement of personal objects. 2. A patient arrives at the emergency department experiencing a cholinergic crisis. a. Discuss possible signs and symptoms this patient may be exhibiting  The patient may exhibit excessive salivation, urination, bronchial secretions, laryngospasms, bronchospasms, convulsions, drowsiness, arrhythmias, cardiac arrest, syncope, hypotension, nausea, vomiting, defecation or diarrhea, and muscle weakness.  Bradycardia is the most common arrhythmia to occur b. Discuss the plan of care for this patient. A patient is diagnosed with Parkinson’s disease.  Emergency treatment depends on the reason of the cholinergic crisis.  If the patient has myasthenia gravis, all anticholinesterase medications will be stopped. Atropine administered. Endotracheal intubation and mechanical ventilation may be necessary. The atropine will not counteract the muscle weakness.  Administer atropine and pralidoxime. The pralidoxime relieves the neuromuscular blockage produced by the nicotinic effects of the poison.  The overdose treatment may also include diazepam or lorazepam to control seizures.  For poisoning, the emergency treatment includes the use of activated charcoal and lavage to remove the drug from the GI tract, flushing the skin and eyes.  The patient may need mechanical ventilation.  CH 48 Parkinson’s Disease

1. A patient is diagnosed with Parkinson’s disease a. Discuss the pathophysiology of the disease  There is a progressive destruction of dopamine-producing cells.  The cause of nerve cell damage is not known.  Some possible causes are age, genetics, and toxins. b. Discuss the main treatment options for the patient  Dopamine receptor agonists (such as levodopa/carbidopa) correct neurotransmitter balance by increasing the level of dopamine.  Catechol-O-methyltransferase (COMT) inhibitors (such as tolcapone) inhibit the metabolism of levodopa in the bloodstream.  2. Parkinson’s disease has many clinical manifestations. a. Describe the notable signs and symptoms of the disease.  Resting tremor, inability to move, rigid limbs, shuffling gait, stooped posture, masklike facial expression, and soft voice.  Patients may also have personality changes, depression, loss of appetite, sleep disturbance, speech impairment, and sexual difficulty.  15% to 20% of patients develop dementia.  The disease is progressive. b. Describe the assessment needed to determine therapeutic effects of treatment.  The nurse would assess for improvements in mobility, balance, gait, speech, handwriting, and self-care ability.  Drooling may decrease also.  Mood may elevate.  After about 2 to 5 years, the dosage of the medication may need to be increased to maintain the improvement. 3. A patient is suspected of having overdosed on an anticholinergic drug. a. What signs and symptoms would suggest as overdose in this case.  Assess the patient for hyperthermia; hot, dry, flushed skin; dry mouth; mydriasis; delirium; tachycardia, paralytic ileus; urinary retention; myoclonic movements; seizures; coma; or respiratory arrest. b. Discuss a possible plan of care for this patient.  Administer physostigmine IV at a slow rate of injection.  Administer activated charcoal to absorb ingested poison. Several doses may be given.  Hemodialysis, hemoperfusion, or peritoneal dialysis may be used if the charcoal is ineffective. CH 53 Drug Therapy for Seizure Disorders and Skeletal muscle Disorders

1. The nurse will administer diazepam IV to a patient with status epilepticus a. Describe the precautions with administration of this drug.  Diazepam cannot be mixed with other solutions or medication in the IV bag or tubing.  Monitor pulse, BP, and respirations during administration.  During parenteral administration, the patient should be on bed rest and receive oxygen.  The nurse injects the drug in a large vein at a rate of 1mL/min.  The nurse would also monitor for CNS alterations b. Describe the manifestations associated with status epilepticus  This is a seizure activity that lasts at least 30 minutes.  It may be convulsive, nonconvulsive, or partial in nature 2. A 17-year-old patient with a spinal cord injury is having spasms in the left arm. a. Discuss the options within the plan of care for this patient  Assess for precipitating stimuli such as a distended bowel or bladder.  Perform passive range-of-motion or stretching exercises to relieve the spasm.  Assess if the spasms are impairing safety, mobility, or activities of daily living.  Administration of a skeletal muscle relaxant such as baclofen. b. The patient asks, “why don’t you must give me the pill?” How would the nurse respond to this question?  There may be a physical cause to the spasm.  The patient will remain more alert by using nonpharmacologic methods as there are no sedative effects.  The muscle relaxant medication is only an adjunctive therapy. CH 54 Drugs Therapy for Anxiety and Insomnia 1. The benzodiazepines are often used to treat anxiety and insomnia a. What are some of the adverse effects of diazepam • Drowsiness, problems with memory, confusion, depression, slurred speech, dizziness, irritability, restlessness, loss of bladder control, and decreased sexual interest

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b. What are common signs of withdrawal?  Signs of withdrawal include anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures.  Notify a health care practitioner for any signs of withdrawal. 2. Lorazepam is a commonly used benzodiazepine. a. Describe the use of lorazepam.  It produces rapid tranquilization.  It can be given IV for nausea/vomiting.  It induces procedural amnesia. b. What teaching about benzodiazepines would the nurse consider important for the patient  Recommended for short-term use.  Do not solve the underlying problem.  Avoid caffeine and stimulant drugs.  Cause drowsiness.  Cause dependence.  Avoid hazardous activity such as driving or operating machinery.  Avoid alcohol and other CNS depressants.  Do not stop the drug abruptly.  Store safely and do not share. 3. A patient is interested in taking herbal remedies for insomnia and asks several questions. a. Discuss the herbal remedies used for sleep  Inform all health care providers of herbal supplements and remedies; these can interact with other medications.  The adverse effects of kava include impaired thinking, judgment, motor reflexes, and vision. With long-term or heavy use, the patient may experience decreased plasma proteins, decreased platelet and lymphocyte counts, dyspnea, and pulmonary hypertension.  Melatonin is contraindicated in people with a history of cerebrovascular disease, depression, or neurologic disorders, and the adverse effects include altered sleep patterns, confusion, headache, hypothermia, pruritus, sedation, and tachycardia.

 The adverse effects of valerian include blurred vision, cardiac disturbance, excitability, headache, hypersensitivity reactions, insomnia, and nausea. b. What are the issues related to taking herbal remedies for sleep?  Herbal medications can react with over-the-counter and prescription medications.  Herbal medications are not federally regulated, and amounts of the herb are not necessarily consistent.  Specific herbs are contraindicated with some disease processes.  Teach the patient the signs of an herbal overdose; this varies with the herb. CH 55 Drug Therapy for Depression and Mood Stabilization 1. Tricyclic antidepressants are the oldest group of antidepressants. a. Describe their current use.  They are now considered a second-line treatment drug. b. What are the side effects?  Sedation, orthostatic hypotension, cardiac dysrhythmias, blurred vision, dry mouth, constipation, and weight gain 2. A nursing student states, “I don’t know why we need to know these medications. I want to work in a hospital, not a psychiatric facility.” a. What are your reactions to the student’s comments The student shows a definite bias to the  The student shows a definite bias to the treatment of mental health issues.  As nurses, we are to care for the entire person, including the mind.  Many people take some form of antidepressant or mood stabilizer. These medications have the potential for many adverse effects, so as a nurse, we need to know how to properly manage these medications to provide the best possible care to our patients. b. Discuss the differences among the categories of antidepressants  TCAs have a high incidence of adverse effects such as sedation, orthostatic hypotension, dysrhythmias  anticholinergic effects, and weight gain.  SSRIs have fewer serious adverse effects than the TCAs, but since they are highly bound to plasma proteins, they have a higher risk of drug interactions. Adverse effects of SSRIs include sexual dysfunction and GI bleeding.  SNRIs are contraindicated in pregnant women.

 MAOIs are rarely used today due to food interactions that can produce severe hypertension and possible heart attack or stroke.  Many of the atypical antidepressants are used as sleeping agents secondary to their side effect of drowsiness. 3. A patient presents to the emergency department and the initial thought is that she overdosed on antidepressants. a. Discuss the possible interventions that could help this patient  Cardiac monitoring.  Maintaining an adequate airway and ventilation.  The administration of activated charcoal and gastric lavage.  Manage symptoms such as nausea, vomiting, and agitation.  Initiate seizure precautions.  Assess and treat any electrolyte imbalances. b. What are the potential assessments and teaching opportunities needed to prevent this patient from repeating this behavior?  Limit the amount of medication dispensed to a few days at a time.  Store the drugs in a place inaccessible to small children.  Teach family members how to recognize the early signs and symptoms of an overdose.

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