Comprehensive exams for Mental Health Q 215
A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert for which of the following?
A. Epilepsy
B. Myocardial Infarction
C. Renal failure
D. Respiratory failure
Correct Answer: D. Respiratory failure
Barbiturates are CNS depressants; the nurse would be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate overdose. Acute barbiturate toxicity may occur as the result of an intentional or unintentional overdose. Barbiturates have a history of abuse, New York City Health Department data showed 8469 cases of barbiturate poisoning in the period between 1957 through 1963. Overdose of phenobarbital symptoms includes CNS depression, respiratory failure, and hemodynamic instability. No antidote exists. Treatment of an overdose includes supportive care, activated charcoal (if taken orally), and urinary alkalinization. Case reports exist of successful treatment of overdosage with hemodialysis.
Option A: Tolerance is a gradual loss of effectiveness such that the dose has to be increased to maintain the same effect. This effect is explainable in part from enzyme induction in the liver. Animal models have demonstrated tolerance. Withdrawal symptoms may occur: nervousness, tremor, agitation, and hypotension may develop 2 to 8 days after the abrupt discontinuation of barbiturates. Additionally, the patient may develop delirium or grand mal seizures.
Option B: When given in IV anesthetics, barbiturates will produce a reduction in blood pressure and an increase in heart rate. Respiratory depression and apnea may occur.
Option C: Extravasation of thiopental (a vesicant) may cause severe tissue necrosis. If extravasation occurs, treatment measures include hyaluronidase and phentolamine. Case reports of successful treatment also include topical application of a eutectic mixture of local anesthetics (EMLA) along with the local injection of lidocaine.