Addictive Behaviors Flashcards
Substance Abuse (need 3 or more of the following..)
Failure to fulfill major role obligations, Recurrent use even when it is hazardous, Recurrent substance-related legal problems, Continued use despite relationship problems
Addiction
Primary, chronic, nuerobiologic disease with genetic, psychosocial, and environmental factors. (Loss of control over use, continued use despite knowledge of harmful consequences, compulsion to use, craving)
Dependance
Reliance on a substance that has reached the level that absence of it will cause an impairment in function
Dependence..3 or more of the following 12
Tolerance, withdrawl, taking in large amount or for longer than intended, Unable to control use, great deal of time spent getting the substance, Using the substance, or recovering from the substance, Important social/recreational activities are given up bc of the substance, Continued use even w/known health or psychological problems caused by the substance
Chantix
Gives some nicotine effects but also blocks the effects of nicotine if they resume smoking
Zyban
Antidepressant, reduces the urge to smoke, reduces some withdrawal prevents weight gain
Tobacco cessation programs used along with nicotine replacement
Hypnosis, acupuncture, behavioral interventions, aversion therapy, group support programs, individual therapy, self-help, coping skills
Tobacco Cessation 5 A’s
Ask- Identify all tobacco users at every contact, Advise- strongly urge all tobacco users to quit, Asses- determine willingness to quit, Assist- aid the patient in developing a plan to quit, Arrange- schedule follow up questions
Tobacco Cessation 5 R’s
Relevance- ask the patient to tell you why quitting is is personally relevant, Risks- ask the question to identify consequences of tobacco use, Rewards- ask the patient to identify potential benefits of stopping tobacco use, Roadblocks- Ask the patient to identify barriers to quitting smoking, Repetition- repeat process every clinic visit
Benefits of smoking cessation- 20 min
BP decreases, HR decreases, body temp of hands/feet increases
Benefits of smoking cessation- 12 hours
Carbon Monoxide levels in blood drops to normal, oxygen level increases to normal
Benefits of smoking cessation- 48 hours
Nerve endings start regrowing, ability to smell and taste is is enhanced
Benefits of smoking cessation- 2 weeks to 3 months
circulation improves, walking becomes easier, lung function increases, coughing/sinus congestion/fatigue/SOB decrease
Benefits of smoking cessation- 1 year
risk of heart disease decreases to half that of a smoker
Benefits of smoking cessation- 10-15 years
risk of stroke, lung and other cancers, and early death returns to nearly the level of people who have never smoked
How do stimulants work?
Work by increasing the amount of dopamine in the brain producing euphoria, alertness, and rapid dependance
Stimulant examples
Nicotine, cocaine, amphetamines (can be legal), methamphetamine, ritalin, caffeine
Overdose and stimulants
Common, death does occur. Restlessness, paranoia, agitated delerium, confusion, repetitive behaviors, seizures, combative, fever, high HR/BP
Antidote and stimulants
No antidote for cocaine and amphetamines
Nursing management for stimulants
patent airway, IV access, 12-lead ECG, treat dysrhythmias, treat HTN and tachycardia, give ASA to prevent MI, give valium or Ativan for seizures
Depressants
Sedatives, alcohol, hypnotics, opiods
Sedative-Hypnotics
barbituates, benzodiazepines, barbituate-like drugs
Sedative-Hypnotics actions
depress the CNS causing sedation at low doses, sleep at high doses. High doses can give an initial euphoria and intoxication, tolerance develops rapidly to the euphoria, but not to the depressant
Depressants- Opioids
Illegal- heroin Legal- fentanyl, oxycodone, demerol, vicodin, morphine, codeine
Opioid action
causes CNS depression and major effect on the brain reward system. Usually injected IV so increased risk of diseases
Depressants overdose symptoms
Overdose causes death from resp depression/arret, also causes n/v, slurred speech, confusion, drowsiness, low HR, low BP, low RR
Depressant overdose nurse management
Need serum and urine drug screens, priority is ABC’s, continuous monitoring, ensure patent airway, IV access, 12-lead ECG, drug levels, give antidotes, gastric lavage, activated charcoal. Shouldnt be released until seen by psychiatric professional
Antidote for bexodiazipines
Flumazenil. Can cause seizures in pts w/physical dependance, dose may need to be repeated
Barbituates
No antidote, may need dialysis, gastric lavage or charcoal can be given if less than 4-6 hours
Antidote for Opioids
Antidote is naloxone (narcan), dose may need to be repeated
S/S of opioid withdrawal and TX
S/S- craving, abdominal cramps, diarrhea, n/v, sweating
TX- symptom based and doesnt always require medications
Withdrawal is uncomfortable but not life threatening. Methadone is decreasing doses can decrease SX
Methadone
Very long half life so people overdose easily bc dont get relief right away
How does Methadone work?
Blocks the “high” caused by using opiates (does not cause euphoria or intoxication). It produces stable levels of the drug in the brain so the patient doesnt get a rush and feels less desire to use opioids.
What should not be used when taking Methadone?
Alcohol, it causes some depressant effects
When is methadone used? How often and where?
Sometimes used to treat chronic pain. only taken once per day and usually in a supervised setting
Alcohol dependance
Dependance generally occurs over a period of years. It is a chronic, progressive, potentially fatal disease. it affects almost all cells in the body, particulary the CNS
Will women or men have higher blood alcohol levels?
women, even with same intake
Blood alcohol levels.. 0.02,0.06, 0.08, 0.1, 0.3, 0.45
- 02- reached after one drink, light drinkers will feel an effect
- 06- judgement is mildly impaired
- 08- judgement is clearly impaired, legal intoxication in some states
- 1- legally intoxicated in most states
- 3- usually lose consciousness
- 45- stop breathing
When does alcohol intoxication occur?
After binge drinking or using alcohol w/CNS depressants causing respiratory and circulatory failure
nursing actions for alcohol intoxicatioin
Maintain ABC’s until detox is complete and alcohol is metabolized. Closely monitor VS and LOC. Administer IV thiamine (first) then IV glucose. Watch for hypoglycemia, low magnesium levels. Stay with the patient, expect agitation and anxiety. Assess for injury. Continue assessment and intervention until BAC is 0.10
Is there an antidote for alcohol?
No..DO NOT give stimulates or depressants
Alcohol withdrawal syndrome
May occur 4-6 hours after last drink and continue for 3-5 days.
Minor- anxiety, increase BP/HR, sweating, nausea, hyperreflexia, insomnia
Major- visual/auditory hallucinations, tremors, seizures, delerium
Alcohol withdrawal delerium
disorientation, visual/auditory hallucinations, hyperactivity, death from hyperthermia, peripheral vascular collapse, cardiac failure
Nursing actions for AWS
Give benzodiazepines, Tegretol or Dilantin to prevent seaizures, antipsychotics if benzo’s dont work; also thiamine, folic acid, magnesium sulfate if needed. Keep patient in a quiet, calm environment and do not restrain
Cannabis high and low dosage effects
Low- produces less effects than alcohol
High- causes euphoria, sedation, hallucinations
mostly causes problems in the brain, CV, resp systems
Opiate Withdrawal SX
sweating, diarrhea, watery eyes, n/v, abd cramps. Nursing priority is to tx symptoms, may need meds
Sedative/hypnotics withdrawal
High HR, seizures, delerium, tremors, hallucinations 9can be life threatening). nursing priority is close observation, valium to start taper
Depressant overdose
pinpoint pupils, slow RR, shallow resp, sedation. Priority is antidotes (narcan, flumazenil), support breathing, may need gastric lavage, characoal or dialysis
Stimulant overdose
High HR/BP, chest pain, agitation, fever, pupil dilation. Priority is VS, ECG, 02-can die if dysrhythmias or MI
Nursing interventions: Operative patients
increased risk of post-op complications and death, standard amounts of anesthetics/analgesics may not be sufficient, anesthetics may have prolonged sedative effect if the liver is damaged. Withdrawal symptoms may be delayed several days b/c of anesthetics. Postpone surgery if BAC is greater than 0.2
Gerontologic Considersations
HCPs are much less likely to recognize substance problems in older adults. Misuse or abuse of psychoactive drugs agents can cause delirium, confusion, memory loss, nueromuscular impairment. Decreased circulation, so they can become intoxicated at much lower levels. Screening questionnaires are not useful unless specific to geriatrics.
