By F. Aschnu. Warren Wilson College. 2019.

Pupillary Changes In the early stages of alcoholic intoxication the pupils are said to dilate purchase biaxin 500mg with mastercard, often becoming pinpoint as the level of intoxication advances purchase 250 mg biaxin overnight delivery, particularly when the state of coma is reached (154) order 500mg biaxin mastercard. However, some commentators report the pupils as being normal-sized in alcohol intoxication (155), with current advice favoring the view that pupil size may be normal or dilated (156). Alcohol may slow the pupillary response to light, such an effect being one of the more reliable eye signs of intoxication, albeit a difficult one to detect clinically (151,157). Because it requires a high degree of coordination, it can be a sensitive index of alcohol intoxication 312 Stark and Norfolk (158). Reliable changes in speech are produced at blood alcohol levels above 100 mg/100 mL, although the effects of lower blood alcohol levels have been variable (159). Cardiovascular Effects Moderate doses of alcohol cause a slight increase in blood pressure and pulse rate (160,161). However, the most prominent effect with higher doses is a depression of cardiovascular functions. This depression is probably a com- bination of central effects and direct depression of the myocardium (144). Metabolic Effects Forensic physicians must be aware that severe hypoglycemia may accom- pany alcohol intoxication because of inhibition of gluconeogenesis. Alcohol- induced hypoglycemia, which develops within 6–36 hours of heavy drinking, typically occurs in an undernourished individual or one who has not eaten for the previous 24 hours. The usual features of hypoglycemia, such as flushing, sweating, and tachycardia, are often absent, and the person may present in coma. Death From Alcohol Poisoning Alcohol intoxication may result in death owing to respiratory or circula- tory failure or as a result of aspiration of stomach contents in the absence of a gag reflex. Levels of blood alcohol above 500 mg/100 mL are considered to be “probably fatal” (162), although survival at much higher concentrations is now well documented. In 1982, for example, the case of a 24-year-old woman with a blood alcohol level of 1510 mg/100 mL was reported. She had gone to the hospital complaining of abdominal pain and was noted to be conscious but slightly confused. Two days later, her pain had eased, her blood alcohol level fallen, and she was able to leave the hospital and return home (163). Death associated with blood alcohol levels below 350 mg/100 mL sug- gests that other complicating factors are present. Most commonly, this will be an interaction between alcohol and some other drug that has also been ingested. Diagnosis of Intoxication The terms alcohol intoxication and drunkenness are often used inter- changeably. However, a distinction between these terms is justified because people may exhibit behavioral changes associated with drunkenness when they believe they have consumed alcohol but actually have not (164). Thus, the diagnostic features of alcoholic intoxication developed by the American Psy- chiatric Association include a requirement that there must have been recent ingestion of alcohol (Table 16) (165). Table 17 Pathological States Simulating Alcohol Intoxication • Severe head injuries • Metabolic disorders (e. This is particularly important when assessing an intoxi- cated detainee in police custody. Indeed, the doctor’s first duty in examining such individuals should be to exclude pathological conditions that may simu- late intoxication (154) (Table 17), because failure to do so may lead to deaths in police custody (166). Alcohol Dependence Alcohol abuse and dependence is a major risk factor for serious health, social, and economic problems (167). Early identification of those who are dependent on alcohol increases the possibility of successful treatment, and 314 Stark and Norfolk brief intervention by the forensic physician seems both feasible and accept- able (124,168). Although not yet validated in police custody, brief interven- tions show a high acceptance among drinkers in licensed premises (169). However, obtaining accurate and reliable information about a person’s drinking habits can be extremely difficult because heavy drinkers tend to underestimate or deliberately lie about their alcohol consumption (170). The main features dif- ferentiating alcohol dependence from alcohol abuse are evidence of toler- ance, the presence of withdrawal symptoms, and the use of alcohol to relieve or avoid withdrawal. However, there is no need to treat those who simply abuse alcohol and who do not have a history of alcohol withdrawal. Alcohol Withdrawal Many alcoholics develop symptoms of withdrawal when in custody. When alcohol intake is abruptly stopped on incarceration, the com- pensatory changes give rise to signs and symptoms of withdrawal (176). The severity of the symptoms depends mainly on the amount and duration of alco- hol intake, although other factors, such as concurrent withdrawal from other drugs, like benzodiazepines, may contribute to the clinical picture (177). Uncomplicated Alcohol Withdrawal This is the most frequent and benign type, usually occurring some 12–48 hours after alcohol intake is reduced, although it can develop as early as 6 hours after drinking has stopped. The essential features are a coarse tremor of the hands, tongue, and eyelids, together with at least one of the following: Substance Misuse 315 • Nausea and vomiting. If symptoms are mild, it is safe to recommend simple observation, but significant tremor and agitation will usually require sedation. The drugs of choice are long-acting benzodiazepines, which will not only treat alcohol with- drawal symptoms but will also prevent later complications (178). The starting dosages depend on the severity of the withdrawal, but 20 mg of chlordiazep- oxide, or 10 mg of diazepam, both given four times a day, will generally be appropriate (179). Usually the benzodiazepines should not be started until such time as the blood alcohol level has reached zero (180). However, detained persons with marked alcohol dependence may develop withdrawal symptoms before this point is reached. In these circumstances, it is both safe and reasonable to initiate therapy when the blood alcohol level has reached 80 mg/100 mL or thereabouts. Alcohol Withdrawal Delirium The essential diagnostic feature of this disorder is a delirium that devel- ops after recent cessation of or reduction in alcohol consumption. Tradition- ally referred to as delirium tremens, this withdrawal state typically begins 72–96 hours after the last drink, so it is uncommon within the normal span of detention in police custody. The delirium is characterized by impaired atten- tion and memory, disorganized thinking, disorientation, reduced level of con- sciousness, perceptual disturbances, and agitation. The disorder usually coexists with other features of alcohol withdrawal, for example, autonomic hyperac- tivity, which is usually severe.

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Describe how you would advise impoverished as strange are known as and may patients who are not meeting their healthcare result in psychological discomfort or needs due to the following conditions: disturbances biaxin 500mg discount. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care 500 mg biaxin otc, 7th Edition cheap 250mg biaxin overnight delivery. Living in overcrowded conditions; absence How my beliefs differ: of running water and adequate sanitation: Nursing actions for patient: c. Explain why the following groups of people are at high risk for living in poverty. Families headed by single women: may affect the interaction of a nurse with a patient in this situation: A nurse attempts to perform a nursing history on an Appalachian woman admitted to the hospital with chest pain. Patient refuses to answer questions and refers to her “granny” woman as a source of information. Patient’s extended family is present during the interview and answers each question before the patient has a chance to speak. How would you respond to the individual special herb prepared by her folk healer to nursing needs of the following patients? Using the Transcultural Assessment: Health- abortion earlier but is ready for this new Related Beliefs and Practices located in your baby. How do this English brings his grandfather (who speaks patient’s beliefs differ from yours? The ing actions could you take to help this patient grandfather presents with the warning express and practice his or her beliefs? Interview fellow classmates and friends repre- senting different cultures to determine how they respond to an illness in the family. Identify any risk factors Health-related beliefs: they may have for serious illness, including culturally related diseases. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Use the following expanded scenario from Chapter 2 in your textbook to answer the questions below. Scenario: Danielle Dorvall, a 45-year-old Hait- ian woman, has been in the United States for 3. She recently had a and/or ethical/legal competencies are most surgical repair of a fractured femur and is now likely to bring about the desired outcome? Dorvall’s dressings, she asks that a Haitian folk healer from her neighborhood be allowed to come to the hospital to help heal her broken leg. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Immunizing children against measles is an example of which of the following levels of d. Secondary when a person feels a sense of belonging to a group or community and being loved by c. In which of the following stages of acute illness Multiple Response Questions does the patient decide to accept the diagnosis and follow the prescribed treatment plan? Which of the following are stages of illness behaviors according to Suchman (1965)? Which of the following statements accurately herself as being sick, seeks validation of describe existing models of health and illness? In stage 2, most people focus on their health and illness developed by Leavell symptoms and bodily functions. When help from a healthcare provider is the agent, host, and environment react sought, the person becomes a patient and separately to create risk factors. When a patient decides to accept a diagno- health as a constantly changing state, with sis and follow a prescribed treatment plan, high-level wellness and death being on he or she is in stage 4, achieving recovery opposite ends of a graduated scale. In stage 1, pain is the most significant Dunn (1980) described wellness as “good symptom indicating illness, although other health. Which of the following examples of basic believe to be true about themselves in rela- human needs would be considered within the tion to their health. Thinking tics, experiences, and beliefs of generalized populations to motivate health-promoting c. Performing range-of-motion exercises on a alterations in normal anatomy and patient physiology. It is characterized by stages of illness behav- development iors, which may occur rapidly or slowly. Referring a patient with a new colostomy to and lasts only a relatively short time. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Refer to the chart below to determine the type of human dimension that is represented by the 3. The reappearance of symptoms of a chronic Dimensions Needs Examples disease in a patient who has been in remission Physical Dimension Physiologic needs Circulation is known as a period of. A landscaper’s increased risk for developing Environmental Safety and Security Climate Dimension needs skin cancer because of excessive exposure to the sun is considered a(n) risk factor. A Catholic woman refuses treatment for cancer ple fractures after wrecking his car. A pregnant woman has toxemia in her there is a pathologic change in the structure or fifth month. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Physical and cultural influences: brother who died of heart attacks at an early age. An elderly man fractures a hip and ankle bone when falling down a flight of stairs c. Match the model of health and illness listed in Part A with the correct definition in Part B.

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