It is 1000 hours in the emergency department (ed) when the ...

[kfurse]

It is 1000 hours in the emergency department (ed) when the ambulance brings in G.G., a 35-year-old man who is having difficulty breathing
 
  He complains of chest pain and tightness, dizziness, palpitations, nau-sea, paresthesia, and feelings of impending doom and unreality; he is having trouble thinking clearly. He
  tells you, I don't think I'm going to make it. I must be having a heart attack. He is diaphoretic and trem-bling. His vital signs are 184/92, 104, 28, 98.4  F (36.9  C). this episode began at work during a meeting at
  approximately 0920 and became progressively worse. aco-worker called 911 and stayed with him until
  medical help arrived. the patient has no history of cardiac problems.
 
  What initial steps would you take and what orders would you expect to receive?

Question 2

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?

[ashely1112]

Answer to Question 1

 Stabilize respiratory function. Take oximeter reading on room air; if the Spo
2is low, deliver O
2
by
nasal cannula; titrate upward until Spo
2
is over 90.
 Stabilize cardiac function. Get an ECG; draw samples for creatinine phosphokinase (CK) and
troponin levels.
 Monitor mental capacity and level of consciousness.
 Draw samples for laboratory tests: CBC; chemistry panel to assess glucose, electrolytes, and
thyroid-stimulating hormone (TSH) to check for thyroid disorder; D-dimer to check for pulmonary
embolism.

Answer to Question 2

Answers: a, d, e, g
Naltrexone, acamprosate, and disulfiram are used once the acute stage of alcohol withdrawal
delirium has subsided. The naltrexone helps reduce alcohol craving. The acamprosate and disulfiram
both work to help with adherence to abstinence from alcohol.

 Benzodiazepines, such as chlordiazepoxide (Librium), help reduce withdrawal symptoms, stabilize
VS, and prevent seizures.
 Clonidine (Catapres), an alpha-adrenergic blocker, is given to reduce the symptoms of autonomic
withdrawal.
 Antiepileptic drugs (carbamazepine Tegretol) are given to prevent the seizures that often occur
with withdrawal.
 Beta-adrenergic blockers (atenolol Tenormin) help stabilize VS, decrease craving, and reduce the
symptoms of autonomic withdrawal.

GI:Acute gastritis, pancreatitis, hepatitis, cirrhosis of the liver, esophageal varices, hemorrhoids,
ascites, vitamin B deficiencies (specifically thiamine, B12 , and folic acid)
Cardiovascular:portal hypertension, heart failure
Respiratory:susceptibility to pneumonia and other respiratory tract infections as a result of
respiratory depression and depressed cough reflex
Neurologic:central nervous system depression, peripheral neuropathy, interference with nerve
conduction, Wernicke encephalopathy (an inflammatory, hemorrhagic, degenerative condition of
the brain caused by thiamine deficiency), and Korsakoff psychosis (form of amnesia; inability to
learn new skills; disorientation)
Reproductive system:prostatitis
Fetus during pregnancy:fetal alcohol syndrome and other congenital defects
Nutritional problems:poor general nutrition; deficiencies in vitamins, particularly A, B, D, and K
(increasing bruising and bleeding tendency); deficiencies in magnesium and potassium levels
(might cause delirium, cardiac dysrhythmias, seizures); anemia and decreased white blood cells
(might cause an increased susceptibility to infection)

Complete blood count; chemistry panel with prealbumin; lipid profile; thiamine, folate, B 12, iron, magnesium levels; urinalysis; and hepatitis screen