What number on a CIWA scale indicates severe alcohol withdrawal?
20
100
What is the normal blood ammonia level?
19-60
100
Which medication gets rid of ammonia from the body?
Lactulose
100
What is the legal blood alcohol level?
0.8 or less than 80 mg/dl
100
Why can you not have restraints as a PRN order?
A patient's behavior can change, want the least restrictive option, must "do no harm"
200
What are some items assessed on a CIWA scale?
Nausea and vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, orientation and clouded sensorium
200
What is hepatic encephalopathy?
Brain dysfunction in patients with chronic liver disease and portal hypertension in which the chemicals that the liver normally detoxifies are shunted past it and left to circulate in the blood
200
What is pyridoxine used for?
Produce serotonin and regulate melatonin levels to induce calmness and sleep
200
What does CIWA stand for?
Clinical Institute Withdrawal Assessment
200
What are 3 symptoms of delirium tremens?
Body tremors, changes in mental function, agitation, irritability, confusion, decreased attention span, delirium, fear, hallucinations
300
What is Korsakoff syndrome?
A chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1)
300
Identify 2 conditions of the liver that could cause hepatic encephalopathy?
Cirrhosis and Hepatitis (conditions that reduce liver function)
300
What is post-exposure prophylaxis and why would it be used?
28 day long course of 2-3 antiretroviral medications used to stop HIV, used after a needle-stick or cut
300
How does alcoholism relate to alcoholic cirrhosis?
Alcoholic Cirrhosis is a chronic scarring of the liver that occurs due to chronic alcohol abuse.
300
What are 2 ways to test for the presence of ascites?
Fluid Wave Test and Shifting Dullness Test
400
Why is thiamine administered during alcohol withdrawal?
Chronic alcoholism can lead to a thiamine deficiency which can lead to Wernicke-Korsakoff Syndrome during withdrawal
What is the time-frame for post-exposure prophylaxis?
PEP should occur within 72 hours.
400
Chronic alcohol abuse can lead to a decreased amount of which vitamin?
Vitamin B6
400
Why do spider angiomas and dilated abdominal vessels occur with hepatic encephalopathy?
They are the result of the liver’s decreased production of clotting factors. Also, portal hypertension causes an accumulation of platelets in the spleen which leads to further bruising.
500
How long after the last drink, is a patient at risk for developing Delirium Tremens?
2-4 Days
500
What are 3 LATE signs of hepatic encephalopathy?
Abnormal shaking of hands, drowsiness, slurred speech, disorientation, severe personality changes, strange behavior, slowed or sluggish movement.
500
If lactulose fails, how else would you treat hepatic encephalopathy?
Non-absorbable antibiotics- Neomycin, Rifaximin
500
What is this showing: A patient who has been taking oxycodone for chronic pain for 3 years reports that the medication is no longer effective and requests a stronger dose.
Tolerance
500
If a Paracentesis is done for Diagnostic purposes, what test(s) may be ordered on the collected fluid?