Editing Mental Health and Psychosocial Nursing – RN Flashcards (section)

== Personality, Eating, and Substance Use Disorders ==

;Core nursing strategy for cluster B personality disorders, including splitting
:Splitting is the inability to integrate positive and negative qualities, so people are experienced as all good or all bad; the answer is team consistency. Clear, written, consistently enforced limits with stated consequences, communicated across the entire team, delivered without anger or negotiation. Dialectical behavior therapy is the evidence-based treatment for borderline personality disorder.

;Refeeding syndrome: mechanism, hallmark lab, and consequence
:Reintroduced carbohydrate triggers an insulin surge that drives phosphate, potassium, and magnesium intracellularly. Hypophosphatemia is the hallmark and can cause arrhythmias, cardiac and respiratory failure, and death. Advance nutrition slowly with electrolyte and cardiac monitoring.

;Alcohol withdrawal timeline after the last drink
:6 to 12 hours tremor, anxiety, autonomic arousal; 12 to 24 hours alcoholic hallucinosis with clear sensorium; 24 to 48 hours withdrawal seizures; 48 to 96 hours delirium tremens, a medical emergency with meaningful mortality.

;Why is thiamine given before glucose in a client with alcohol use disorder?
:Glucose administration without thiamine can precipitate or worsen Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia or nystagmus), which if untreated progresses to the largely irreversible Korsakoff syndrome with anterograde amnesia and confabulation.

;Which withdrawal syndromes can kill, and which is merely miserable?
:Alcohol and sedative-hypnotic (benzodiazepine, barbiturate) withdrawal can be fatal from seizures and delirium. Opioid withdrawal is intensely uncomfortable but not usually life-threatening in healthy adults; neonatal opioid withdrawal, however, is dangerous.

;Disulfiram versus naltrexone versus acamprosate
:Disulfiram causes flushing, throbbing headache, vomiting, and hypotension if alcohol is ingested; teach avoidance of hidden alcohol in mouthwash, cough syrup, sauces, and hand sanitizer. Naltrexone reduces craving but precipitates withdrawal in current opioid users. Acamprosate supports abstinence and is renally cleared.