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CARN Study Guide Exam 2025
Questions and Elaborated Answers 100% Verified
- standard alcoholic drink: 14.5 grams of pure alcohol 12 ounces of beer 5 ounces of wine 1.5 ounces of 80 prof distilled spirits or liquor
- binge drinking: 5 or more drinks in one sitting
- Alcohol metabolism: the alcohol is metabolized by the liver (about 90%) and the other 10% is excreted in the urine or in your breath Averages 1 oz per 3 hours
- Alcohol Depresses what System: CNS
- Medication and alcohol interactions: Barbiturates Benzos General anesthetics Solvents Anticonvulsants Increases sedative affect with Antihistamines Increase change of upper GI bleed with Tylenol Gastric irritation NSAIDS
- Alcohol withdrawal symptoms: - appear within 4 - 12 hrs
- abd cramping
- vomiting
- tremors
- restlessness
- inability to sleep
- TACHYCARDIA
- HTN
- transient hallucinations or illusions
- anxiety
- increased RR, temp
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- tonic clonic seizures
- diaphoresis
- alcohol withdrawal delirium: A medical emergency usually occurring 2 to 3 days following alcohol withdrawal and lasting 2 to 3 days. Characterized by paranoia, disorientation, delusions, visual hallucinations, severe hypertension, dysrhythmia, vomiting, diarrhea, and diaphoresis. Also known as delirium tremens.
- Alcohol treatment: Overall Goal:
- Achieve and maintain abstinence •Medical/psychological/self-help
- Tranquilizers, caffeine NOPE Early Intervention before dependence
4 / High 16- 19
- CAGE: cut down, annoyed, guilty, eye opener Negative < Positive >
- alcohol abuse disorder: Primary chronic disease
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- Effects of alcohol on the body: peripheral neuropathy myopathy wernickes encephalopathy korsakoffs psychosis cardiomyopathy esophagitis gastritis pancreatitis alcoholic hepatitis cirrhosis of liver leukopenia thrombocytopenia sexual dysfunction
- Neurotransmitters effected by alcohol: GABA is down regulated Glutamate is Upregulated
- Benzodiazepines: First line treatment to prevent severe withdrawals Treats psychomotor agitation with alcohol withdrawal
- Diazepam: Benzo with fastest onset
- Lorazapam: Benzo used for pt with liver issues because it does not metabolize in liver
- Side effects of Benzos: Confusion Drowsiness Resp depression
- What to monitor with Benzos: Liver function Resp rate
- What to monitor with IV lorazapam: BUN/Creat and osmol gap
- Propofol side effect: Resp depression, hypotension, pancreatitis may need to be on vent
- Thiamine deficiency: Wernicke's encephalopathy Korakoff syndrome
- What happens is you give glucose before thiamaine: Wernicke's en- cephalopathy
- poor nutrition due to alcohol use: replacement- thiamine, calcium, potassium, phosphorus
7 / tor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers.
- Wenicke's encephalopathy: most serious form of thiamine deficiency in alco- holic pts Causes vomiting, dysfunction of the extraocular muscles, fever, ataxia and mental deterioration.
- Korsakoff's syndrome: an alcohol related disorder marked by extreme confu- sion, memory impairment, and other neurological symptoms
- Alcoholic patient history: Last drink Use any other substances amount and time been drinking Medical and BH hx Previous withdrawals (seizures DT etc)
- Most frequent labs for alcohol use: CBC CMP Blood alcohol concentration UDS
- Stages of AWS: Stage 1 5 to 8 hours after the last drink. Signs and symptoms may include anxiety, rest- lessness, mild nausea, anorexia, insomnia, diaphoresis, mild tremors, fluctuating tachycardia and hypertension, and mild cognitive impairment. Stage 2 24 to 72 hours after the last drink, manifesting as increased restlessness and agitation, increased tremors, hallucinations, disorientation, diaphoresis, nausea and vomiting, 0diarrhea, tachycardia (heart rate faster than 120 beats/minute), systolic pressure above 160 mm Hg, and seizures (usually grand mal). Untreated patients have a 25% chance of experiencing grand mal seizures 1 to 5 days after alcohol cessation. Stage 3 (DT) typically arises 72 to 96 hours after the last drink. Patients may experience fever, severe hypertension, tachycardia, delirium, drenching sweats, and severe tremors. Death may ensue from arrhythmias, fluid and electrolyte imbalances, aspiration pneumonia, or infection.
- acute detoxification phase, the main goal of nursing care: manage symp- toms by keeping the patient safe and comfortable, giving drugs as ordered, and minimizing complications. Provide nonjudgmental supportive care, perform a gen- eral assessment, evaluate nutrition and hydration status, and implement the man- agement protocol. Be sure
8 / to assess the patient's risk for falls and seizures, and use precautions as indicated. If the patient must be restrained, assess skin around the restraints hourly for breakdown and provide treatment, if needed. avoid restraints whenever possible.
10 / 0.15 Irresponsible behavior Euphoria Delayed reactions 0.20 Slurred speech Staggering Measurable effects on motor and emotional control centers Loss of balance Blurred or double vision Urinary incontinence Sedation Amnesia
11 / 0.40 Lapses in and out of consciousness Amnesia Vomiting (with the risk of pul- monary aspiration) Reduced heart rate Decreased circulation to extremities, causing cold or numb extremitiesRespiratory depression Depressed eye reflexes 0.45 Life-threatening respiratory depression and possible cessation.Markedly de- creased heart rate.Coma 0.50 Death
- Role of neurotransmitters: Excessive alcohol consumption depresses neu- ronal excitability and impulse conduction and enhances the effects of (GABA). Chronic alcohol use suppresses GABA, and the person needs increasing amounts of alcohol to obtain the desired effects. Chronic alcohol use inhibits activity of the excitatory neurotransmitter glutamate; as a result, glutamate functions at a far higher level in alcoholics. When a heavy drinker suddenly cuts back sharply or stops drinking entirely, neurotransmitters that had been suppressed by chronic alcohol use rebound, causing brain hyperexcitability and mild to severe AWS.
- How alcohol abuse and dependency affect laboratory values: Albumin De- creased Aspartate aminotransferase (ALT) Increased Ratio of ALT to alanine aminotransferase may exceed 1.0 with alcoholic cirrhosis. Gamma glutamyl transferase Increased Mean corpuscular volume Elevated in liver disease and alcoholism Total bilirubin Increased Uric acid Increased
- Nursing Assessment alcohol: admitted to a telemetry unit with pulse ox (SaO2); administer oxygen if SaO2 falls below 92%. mod- severe AWS may be admitted to ICU for close monitoring and care. monitor vital signs, heart rhythm and rate, respirations, fluid and electrolyte balance, blood
13 / Used assigns a score of 0 to 7 in each of 10 categories. The maximum score is 67 points; <= 10 Mild- no medication
= 15 increased risk of seizures and DT. P = 10 receive medications (such as benzodiazepines or anticonvulsants) to de- crease withdrawal symptoms, seizure risk, and DT. CIWA-Ar hourly amin meds as ordered until the CIWA-Ar score is below 10 for 3 hours. assess the patient and administer the CIWA-Ar every 4 hours; if the score rises above 10, resume hourly CIWA-Ar assessment. If needed, titrate medications as ordered and expect to withhold sedatives for lethargy, abnormal vital signs, or neurologic abnormalities
- Beta blockers: may be used to control hypertension and tachyarrhythmias.
- SBIRT: Screening, Brief Intervention, and Referral to Treatment
- Nursing Assessment SUD: Screen for use and eval severity Assess for s+s of intoxication and dependence Explore personal attitude about SUD
- Nursing DX SUD: States of health and illness related substance use depen- dence
- Measurable desired Outcomes (Goals ): Enhance knowledge of treatment modalities Health Promotion Understand ethical and legal issues
- Nursing implementation: Educate on the impact of SUD on health Quality nursing care for acute disease due to SUD
- Nursing Evaluation SUD: Evaluate goals Revise plan of care to maximize outcome Participate in SUD research
- Disulfiram: Antabuse
- alcohol aversion therapy
- blocks an enzyme that is involved in metabolizing alcohol intake.
- produces very unpleasant side effects when combined with alcohol in the body.
- Disulfiram alcohol Reaction DER: even small amounts, produce flushing, throbbing in
14 / head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred
