ATI Ch 18, Substance Use and Addictive Disorders Flashcards
What are substance use disorders related to?
Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and other substances.
What is a substance use disorder?
Involves repeated use of chemical substances, leading to clinically significant impairment during a 12-month period.
What are non-substance-related disorders?
Behavioral/process addictions such as gambling, sexual activity, shopping, social media, and internet gaming.
What are the key characteristics of substance use and addictive disorders?
- Loss of control due to the substance use or behavior
- Participation continues despite associated problems
- Tendency to relapse into substance use or behavior.
What defense mechanism is commonly used by clients with substance use disorders?
Denial.
Give an example of denial in substance use.
“I can quit whenever I want to, but smoking really doesn’t cause me any problems.”
What are some risk factors for developing a substance use disorder?
- Genetics
- Adolescent population
- Chronic stress
- History of trauma
- Lowered self-esteem
- Lowered tolerance for pain and frustration
- Few meaningful personal relationships
- Few life successes
- Risk-taking tendencies.
What protective factors can reduce the risk of substance use disorders?
- Positive family support
- Social relationships
- Self-esteem
- Caregiver involvement
- Availability of community resources
- Employment.
Which cultures have a high percentage of alcohol use disorder?
Alaska natives and Native American groups.
Which cultures have a low rate of alcohol use disorder?
Asian groups.
What sociocultural factors can increase the likelihood of substance use?
- Peer pressure
- Cultural views on alcohol use.
What can lead older adults to develop patterns of alcohol/substance use?
Life stressors such as losing a partner, retirement, or social isolation.
What type of questions should a nurse use to obtain nursing history related to substance use?
Open-ended questions.
What information should be obtained in the nursing history for substance use?
- Type of substance or addictive behavior
- Pattern and frequency of substance use
- Amount of substance used
- Age at onset of substance use
- Changes in occupational or school performance
- Changes in use patterns
- Periods of abstinence in history
- Previous withdrawal manifestations
- Date of last substance use or addictive behavior.
List some expected findings in a review of systems for substance use disorders.
- Blackout or loss of consciousness
- Changes in bowel movements
- Weight loss or weight gain
- Experience of stressful situation
- Sleep problems
- Chronic pain
- Concern over substance use
- Cutting down on consumption or behavior.
What is the rate of substance use among clients aged 18 to 25?
It is highest in this age group.
How does the age at initial substance use relate to the development of substance use disorders?
The younger the person is at the time of initial substance use, the higher the incidence of developing a substance use disorder.
What trend has been observed regarding cocaine use among adolescents?
Cocaine use is decreased among adolescents.
What percentage of the adolescent population reports access to marijuana?
About half.
What are substance use disorders related to?
Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and other substances.
What is a substance use disorder?
Involves repeated use of chemical substances, leading to clinically significant impairment during a 12-month period.
What are non-substance-related disorders?
Behavioral/process addictions such as gambling, sexual activity, shopping, social media, and internet gaming.
What are the key characteristics of substance use and addictive disorders?
- Loss of control due to the substance use or behavior
- Participation continues despite associated problems
- Tendency to relapse into substance use or behavior.
What defense mechanism is commonly used by clients with substance use disorders?
Denial.
Give an example of denial in substance use.
“I can quit whenever I want to, but smoking really doesn’t cause me any problems.”
What are some risk factors for developing a substance use disorder?
- Genetics
- Adolescent population
- Chronic stress
- History of trauma
- Lowered self-esteem
- Lowered tolerance for pain and frustration
- Few meaningful personal relationships
- Few life successes
- Risk-taking tendencies.
What protective factors can reduce the risk of substance use disorders?
- Positive family support
- Social relationships
- Self-esteem
- Caregiver involvement
- Availability of community resources
- Employment.
Which cultures have a high percentage of alcohol use disorder?
Alaska natives and Native American groups.
Which cultures have a low rate of alcohol use disorder?
Asian groups.
What sociocultural factors can increase the likelihood of substance use?
- Peer pressure
- Cultural views on alcohol use.
What can lead older adults to develop patterns of alcohol/substance use?
Life stressors such as losing a partner, retirement, or social isolation.
What type of questions should a nurse use to obtain nursing history related to substance use?
Open-ended questions.
What information should be obtained in the nursing history for substance use?
- Type of substance or addictive behavior
- Pattern and frequency of substance use
- Amount of substance used
- Age at onset of substance use
- Changes in occupational or school performance
- Changes in use patterns
- Periods of abstinence in history
- Previous withdrawal manifestations
- Date of last substance use or addictive behavior.
List some expected findings in a review of systems for substance use disorders.
- Blackout or loss of consciousness
- Changes in bowel movements
- Weight loss or weight gain
- Experience of stressful situation
- Sleep problems
- Chronic pain
- Concern over substance use
- Cutting down on consumption or behavior.
What is the rate of substance use among clients aged 18 to 25?
It is highest in this age group.
How does the age at initial substance use relate to the development of substance use disorders?
The younger the person is at the time of initial substance use, the higher the incidence of developing a substance use disorder.
What trend has been observed regarding cocaine use among adolescents?
Cocaine use is decreased among adolescents.
What percentage of the adolescent population reports access to marijuana?
About half.
What risks does substance use while pregnant create for infants?
Increased likelihood of prematurity, low birth weight, and neonatal abstinence syndrome
Neonatal abstinence syndrome occurs when infants experience withdrawal symptoms from substances their mothers used during pregnancy.
What are some concerning behaviors of healthcare providers that may indicate drug diversion?
- Volunteering for overtime
- Coming to work on days not scheduled
- Deteriorating appearance and job performance
- Mood swings
- Forgetting
- Lying
These behaviors may signal substance abuse issues in healthcare settings.
What are the effects of substance use in older adults?
- Prone to falls and injuries
- Memory loss
- Somatic reports (headaches)
- Changes in sleep patterns
Older adults may experience exacerbated effects from substances due to age-related physiological changes.
What are indications of alcohol use in older adults?
- Decrease in self-care ability (functional status)
- Urinary incontinence
- Manifestations of dementia
Alcohol can affect older adults at lower doses than younger adults.
What is polypharmacy and why is it a concern for older adults?
The use of multiple medications, raising the likelihood of adverse effects such as confusion and falls
Age-related physiological changes can increase the risk of drug interactions.
Name some standardized screening tools for substance use.
- Michigan Alcohol Screening Test (MAST)
- Drug Abuse Screening Test (DAST)
- CAGE Questionnaire
- Alcohol Use Disorders Identification Test (AUDIT)
- Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
- Clinical Opiate Withdrawal Scale
- Screening, Brief Intervention and Referral to Treatment (SBIRT)
These tools are used to identify substance use issues and promote safer drinking.
What are designer or club drugs?
Substances like ecstasy that can combine drugs from different categories, producing varying effects of intoxication or withdrawal
The effects can be unpredictable due to the combination of substances.
What are opioid agonists and their intended effects?
Opioid agonists attach to CNS receptors, altering perception of and response to pain, leading to generalized CNS depression
Common opioid agonists include heroin, morphine, and hydromorphone.
What are the effects of opioid intoxication?
- Slurred speech
- Impaired memory
- Pupillary changes
- Decreased respirations and level of consciousness
- Maladaptive behavioral changes
These effects can lead to death in severe cases.
What are the withdrawal manifestations of opioid use?
- Sweating
- Rhinorrhea
- Piloerection (gooseflesh)
- Tremors
- Irritability
- Severe weakness
- Diarrhea
- Fever
- Insomnia
- Pupil dilation
- Nausea and vomiting
- Muscle pain and spasms
Withdrawal is very unpleasant but not typically life-threatening.
What are the risks associated with CNS depressants?
Physiological and psychological dependence, cross-tolerance, cross-dependency, and an additive effect when taken with other substances
Common CNS depressants include alcohol and benzodiazepines.
What is the legal blood alcohol concentration (BAC) limit for operating a vehicle in most U.S. states?
0.08% (80 mg/dL)
Acute toxicity can occur at levels greater than about 0.4% (400 mg/dL), which can be fatal.
What are fetal alcohol syndrome symptoms?
- Microcephaly
- Craniofacial malformations
- Limb and heart defects
- Developmental problems
These symptoms result from alcohol exposure during pregnancy.
What are the intended effects of alcohol use?
Relaxation and decreased social anxiety
However, excessive use can lead to serious health issues.
What are the effects of excess alcohol intoxication?
- Slurred speech
- Nystagmus
- Memory impairment
- Altered judgment
- Decreased motor skills
- Respiratory arrest
- Possible death
Chronic use can lead to significant health problems including liver damage.
What are common withdrawal manifestations from alcohol?
Abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased heart rate, transient hallucinations or illusions, anxiety, increased blood pressure, respiratory rate, temperature, and tonic-clonic seizures.
When can alcohol withdrawal delirium occur after cessation of alcohol?
2 to 3 days after cessation.
What are the manifestations of alcohol withdrawal delirium?
Severe disorientation, psychotic manifestations, severe hypertension, cardiac dysrhythmias, and delirium.
What is considered a medical emergency related to alcohol withdrawal?
Alcohol withdrawal delirium.
What types of substances are included in sedatives/hypnotics/anxiolytics?
Benzodiazepines, barbiturates, and club drugs.
What is the intended effect of sedatives like benzodiazepines?
Decreased anxiety, sedation.
List some effects of intoxication from sedatives.
- Increased drowsiness and sedation
- Agitation
- Slurred speech
- Uncoordinated motor activity
- Nystagmus
- Disorientation
- Nausea
- Vomiting
What can be fatal as a result of sedative intoxication?
Respiratory depression and decreased level of consciousness.
What antidote is available for benzodiazepine toxicity?
Flumazenil.
Is there an antidote for barbiturate toxicity?
No.
What are withdrawal manifestations from sedatives?
- Anxiety
- Insomnia
- Diaphoresis
- Hypertension
- Possible psychotic reactions
- Hand tremors
- Nausea
- Vomiting
- Hallucinations or illusions
- Psychomotor agitation
- Possible seizure activity
What substances can be smoked or orally ingested as cannabis?
Marijuana or hashish.
What are the intended effects of cannabis?
- Euphoria
- Sedation
- Hallucinations
- Decrease of nausea and vomiting
- Management of chronic pain
What are effects of intoxication from chronic cannabis use?
- Increased risk for lung cancer
- Cannabis use disorder
- Paranoia
- Increased appetite
- Dry mouth
- Tachycardia
- Impaired motor skills
What can synthetic cannabinoids like K2 and Spice be associated with?
Toxic doses.
What are withdrawal manifestations from cannabis?
- Anxiety
- Insomnia
- Lack of appetite
- Nausea
- Abdominal pain
- Tremors
- Fever
- Headache
How can cocaine be consumed?
Injected, smoked, or inhaled.
What are the intended effects of cocaine?
- Rush of euphoria
- Increased energy
List some effects of cocaine intoxication.
- Dizziness
- Irritability
- Tremor
- Blurred vision
- Hallucinations
- Seizures
- Extreme fever
- Tachycardia
- Hypertension
- Chest pain
- Possible cardiovascular collapse and death
What are withdrawal manifestations from cocaine?
- Depression
- Fatigue
- Craving
- Excess sleeping or insomnia
- Dramatic unpleasant dreams
- Psychomotor retardation
- Agitation
What are the intended effects of amphetamines/methamphetamines?
Increased energy, euphoria.
What are effects of intoxication from amphetamines/methamphetamines?
- Impaired judgment
- Psychomotor agitation
- Hypervigilance
- Extreme irritability
- Acute cardiovascular effects
What are withdrawal manifestations from amphetamines/methamphetamines?
- Craving
- Depression
- Fatigue
- Sleeping
What substances are considered inhalants?
Amyl nitrate, nitrous oxide, and solvents.
What are the intended effects of inhalants?
Euphoria.
List general effects of intoxication from inhalants.
- Behavioral or psychological changes
- Dizziness
- Nystagmus
- Uncoordinated movements
- Slurred speech
- Drowsiness
- Hyporeflexia
- Muscle weakness
- Diplopia
- Stupor or coma
- Respiratory depression
- Possible death
What are withdrawal manifestations from inhalants?
None.
What are examples of hallucinogens?
Lysergic acid diethylamide (LSD), mescaline (peyote), phencyclidine piperidine (PCP)
These substances are usually ingested orally but can also be injected or smoked.
What are the intended effects of hallucinogens?
Heightened sense of self and altered perceptions
Colors may appear more vivid while under the influence.
What are common effects of intoxication from hallucinogens?
- Anxiety
- Depression
- Paranoia
- Impaired judgment
- Impaired social functioning
- Pupil dilation
- Tachycardia
- Diaphoresis
- Palpitations
- Blurred vision
- Tremors
- Incoordination
- Panic attacks
What is hallucinogen persisting perception disorder?
Visual disturbances or flashback hallucinations can occur intermittently for years.
What are common sources of caffeine?
- Cola drinks
- Coffee
- Tea
- Chocolate
- Energy drinks
What are the intended effects of caffeine?
Increased level of alertness and decreased fatigue.
What are the effects of caffeine intoxication?
- Tachycardia
- Arrhythmias
- Flushed face
- Muscle twitching
- Restlessness
- Diuresis
- GI disturbances
- Anxiety
- Insomnia
What are withdrawal manifestations of caffeine?
- Headache
- Nausea
- Vomiting
- Muscle pain
- Irritability
- Inability to focus
- Drowsiness
Withdrawal can occur within 24 hours of last consumption.
What effects does nicotine have on the brain?
Affects nicotinic receptors in the brain, carotid body, aortic arch, and CNS.
What are the intended effects of nicotine?
Relaxation and decreased anxiety.
What are the effects of nicotine intoxication?
- Highly toxic
- Acute toxicity seen only in children or with exposure to nicotine in pesticides
- Long-term effects include:
- Cardiovascular disease (hypertension, stroke)
- Respiratory disease (emphysema, lung cancer)
- Oral irritation and cancer from smokeless tobacco
What are withdrawal manifestations of nicotine?
- Irritability
- Craving
- Nervousness
- Restlessness
- Anxiety
- Insomnia
- Increased appetite
- Difficulty concentrating
- Anger
- Depressed mood
What is a crucial aspect of nursing care during acute intoxication or withdrawal?
Safety is the primary focus.
What should a nurse do to maintain a safe environment for clients experiencing withdrawal?
- Prevent falls
- Implement seizure precautions as necessary
- Provide close observation for withdrawal manifestations
What nursing intervention should be a last resort?
Physical restraint.
What should a nurse do to support a client during withdrawal?
- Orient the client to time, place, and person
- Maintain adequate nutrition and fluid balance
- Create a low-stimulation environment
What is included in patient-centered care for clients with substance use disorders?
- Provide emotional support and reassurance
- Educate the client and family about codependent behaviors
- Begin to educate about addiction and treatment goals
What should be encouraged regarding prescription medications in the home?
Remove any that are not being used and discourage sharing medications.
What is an important aspect of developing a recovery plan for clients?
Help the client develop an emergency plan.
What should nurses encourage clients to attend?
Self-help groups.
What does dual diagnosis refer to?
The presence of both a mental health disorder and a substance use or addictive disorder
For example, an individual may have depression and an addiction to alcohol.
Why is a team approach necessary in treating dual diagnosis?
Both disorders need to be treated simultaneously
What are cognitive behavioral therapies used for?
To decrease anxiety and change behavior
Examples include relaxation techniques and cognitive reframing.
What does Acceptance and Commitment Therapy (ACT) promote?
Acceptance of the client’s experiences and commitment to positive behavior changes
What is the purpose of relapse prevention therapy?
To assist clients in identifying the potential for relapse and promote behavioral self-control
What is the format of group therapy?
Groups of clients with similar diagnoses meet in outpatient settings or mental health residential facilities
What common behavior does family therapy address?
Codependency demonstrated by significant others or family members of individuals with substance or process dependency
How does a codependent person typically react?
In over-responsible ways that allow the dependent individual to continue substance use or addiction
What should families learn about in family therapy?
Use of specific substances and issues such as family coping, problem-solving, and indications of relapse
What is one goal of client education regarding relapse?
To teach the client to recognize indications of relapse and factors that contribute to it
What cognitive-behavioral techniques should clients learn?
Techniques to help maintain sobriety and create feelings of pleasure from non-substance activities
What is encouraged for clients and families to attend?
12-step programs such as Alcoholics Anonymous and family groups like Al-Anon
What are some key teachings of 12-step programs?
- Abstinence is necessary for recovery
- A higher power is needed to assist in recovery
- Clients are not responsible for their disease but are responsible for their recovery
- They must acknowledge their feelings and problems
What is the significance of abstinence syndrome?
It occurs when a client abruptly withdraws from a substance on which they are physically dependent
What is tolerance in the context of substance use disorders?
When a client requires increased amounts of the substance to achieve the desired effect
What happens during withdrawal from a substance?
The concentration of the substance in the bloodstream declines, leading to physiological adverse effects
What can potentially life-threatening manifestations occur from?
Withdrawing from a substance that has the potential to cause abstinence syndrome
What socioeconomic factors could impact a client’s social determinants of health?
Recent job loss, financial stress, transportation issues, and lack of insurance
What questions should the nurse ask to determine social determinants of health?
Questions related to the client’s living situation, social support, and access to resources
Name some community partnerships related to SDOH that mental health nurses can explore.
Partnerships with local health services, housing organizations, and employment assistance programs
When do alcohol withdrawal manifestations typically start?
4 to 12 hours after the last intake of alcohol
Alcohol withdrawal manifestations can continue for 5 to 7 days.
What are common manifestations of alcohol withdrawal?
- Nausea
- Vomiting
- Tremors
- Restlessness and inability to sleep
- Depressed mood or irritability
- Increased heart rate, blood pressure, respiratory rate, and temperature
- Diaphoresis
- Tonic-clonic seizures
- Illusions
What is alcohol withdrawal delirium and when can it occur?
It can occur 2 to 3 days after cessation of alcohol
It is considered a medical emergency with severe manifestations.
List severe manifestations of alcohol withdrawal delirium.
- Severe disorientation
- Psychotic effects (hallucinations)
- Severe hypertension
- Cardiac dysthythmias
What are the withdrawal manifestations of opioids?
- Agitation
- Insomnia
- Flu-like manifestations
- Rhinorrhea
- Yawning
- Sweating
- Diarrhea
True or False: Opioid withdrawal manifestations are life-threatening.
False
However, suicidal ideation can occur.
What symptoms characterize tobacco (nicotine) abstinence syndrome?
- Irritability
- Nervousness
- Restlessness
- Insomnia
- Difficulty concentrating
What medications are commonly used for alcohol withdrawal?
- Chlordiazepoxide
- Diazepam
- Lorazepam
- Oxazepam
What are the intended effects of benzodiazepines in alcohol withdrawal?
- Maintenance of vital signs within expected reference ranges
- Decrease in the risk of seizures
- Decrease in the intensity of withdrawal manifestations
- Substitution therapy during alcohol withdrawal
What nursing actions should be taken during alcohol withdrawal?
- Administer around-the-clock or PRN
- Obtain baseline vital signs
- Monitor vital signs and neurologic status on an ongoing basis
- Provide for seizure precautions
List adjunct medications for alcohol withdrawal.
- Carbamazepine
- Clonidine
- Propranolol
- Atenolol
What is the intended effect of carbamazepine in alcohol withdrawal?
Decrease in seizures
What are the intended effects of clonidine, propranolol, and atenolol in alcohol withdrawal?
- Depression of autonomic response (decrease in blood pressure, heart rate)
- Decrease in craving
What nursing actions are required for adjunct medications?
- Implement seizure precautions
- Obtain baseline vital signs and continue to monitor
- Check heart rate prior to administering propranolol, and withhold if less than 60/min
What is disulfiram used for in abstinence maintenance?
It is a daily oral medication that acts as a type of aversion (behavioral) therapy.
What happens when disulfiram is used concurrently with alcohol?
It causes acetaldehyde syndrome
Symptoms include nausea, vomiting, weakness, sweating, palpitations, and hypotension.
What are potential severe effects of acetaldehyde syndrome?
- Respiratory depression
- Cardiovascular suppression
- Seizures
- Death
What client education is essential for those taking disulfiram?
- Drinking any alcohol is potentially dangerous
- Avoid products containing alcohol
- Wear a medical alert bracelet
- Participate in a self-help program
- Medication effects can persist for 2 weeks after discontinuation
What is naltrexone and its intended effects?
A pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol.
What nursing actions should be taken when administering naltrexone?
- Assess the client’s history for opioid dependency
- Suggest monthly IM injections for adherence
What is a key client education point for taking naltrexone?
Take with meals to decrease gastrointestinal distress.
What is the typical onset time for alcohol withdrawal manifestations after the last intake?
4 to 12 hours
Alcohol withdrawal can continue for 5 to 7 days.
List common manifestations of alcohol withdrawal.
- Nausea
- Vomiting
- Tremors
- Restlessness
- Inability to sleep
- Depressed mood or irritability
- Increased heart rate
- Increased blood pressure
- Increased respiratory rate
- Increased temperature
- Diaphoresis
- Tonic-clonic seizures
- Illusions
What is alcohol withdrawal delirium and when does it occur?
Occurs 2 to 3 days after cessation of alcohol
Considered a medical emergency.
What are the manifestations of alcohol withdrawal delirium?
- Severe disorientation
- Psychotic effects (hallucinations)
- Severe hypertension
- Cardiac dysrhythmias
What is the time frame for opioid withdrawal manifestations to occur?
Within hours to several days after cessation
Opioid withdrawal symptoms are not life-threatening.
List common findings of opioid withdrawal.
- Agitation
- Insomnia
- Flu-like manifestations
- Rhinorrhea
- Yawning
- Sweating
- Diarrhea
What is evidenced by tobacco (nicotine) abstinence syndrome?
- Irritability
- Nervousness
- Restlessness
- Insomnia
- Difficulty concentrating
What are some other substances associated with substance use disorder?
- Cannabis
- Hallucinogens
- Inhalants
- Sedatives/hypnotics
- Stimulants
List some benzodiazepines used for alcohol withdrawal.
- Chlordiazepoxide
- Diazepam
- Lorazepam
- Oxazepam
What are the intended effects of benzodiazepines during alcohol withdrawal?
- Maintenance of vital signs within expected reference ranges
- Decrease in the risk of seizures
- Decrease in the intensity of withdrawal manifestations
What nursing actions should be taken when administering benzodiazepines?
- Administer on a scheduled or PRN basis
- Obtain baseline vital signs
- Monitor vital signs and neurologic status on an ongoing basis
- Provide for seizure precautions
List adjunct medications used in alcohol withdrawal.
- Carbamazepine
- Clonidine
- Propranolol
- Atenolol
What is the intended effect of carbamazepine during alcohol withdrawal?
Decrease in seizures
What are the intended effects of clonidine, propranolol, and atenolol?
- Depression of autonomic response (decrease in blood pressure, heart rate)
- Decrease in craving
What nursing actions should be taken when administering adjunct medications?
- Implement seizure precautions
- Obtain baseline vital signs and continue to monitor
- Check heart rate prior to administration of propranolol, and withhold if less than 60/min
What is the purpose of disulfiram in abstinence maintenance?
It is a daily oral medication that acts as aversion therapy.
What happens when disulfiram is used concurrently with alcohol?
Causes acetaldehyde syndrome
Effects include nausea, vomiting, weakness, sweating, palpitations, and hypotension.
What are the potential severe effects of acetaldehyde syndrome?
- Respiratory depression
- Cardiovascular suppression
- Seizures
- Death
What nursing actions should be taken when a client is on disulfiram?
Monitor liver function tests to detect hepatotoxicity.
What client education should be provided regarding disulfiram?
- Drinking any alcohol is potentially dangerous
- Avoid products containing alcohol
- Wear a medical alert bracelet
- Participate in a self-help program
- Medication effects persist for 2 weeks after discontinuation
What is naltrexone and its intended effect?
A pure opioid antagonist that suppresses craving and pleasurable effects of alcohol.
What nursing actions should be taken when administering naltrexone?
- Assess the client’s history for opioid dependence
- Suggest monthly IM injections for adherence
What client education should be provided for those taking naltrexone?
Take naltrexone with meals to decrease gastrointestinal distress.
What is the intended effect of Acamprosate?
To reduce the unpleasant effects of abstinence (dysphoria, anxiety, testiness)
Acamprosate is taken orally three times a day.
What should clients be educated about when taking Acamprosate?
Diarrhea can occur; maintain adequate fluid intake to prevent dehydration
Avoid use in pregnancy.
What is Methadone substitution used for?
Withdrawal and long-term maintenance
It is an oral opioid agonist that replaces the opioid to which the client is physically dependent.
What are some nursing actions for a client on Methadone substitution?
- Encourage participation in a 12-step program
- Inform about slow tapering of the methadone dose for detoxification
- Medication must be administered from an approved treatment center
What are the intended effects of Clonidine?
To mitigate withdrawal effects related to autonomic hyperactivity (diarrhea, nausea, vomiting)
Clonidine therapy does not reduce the craving for opioids.
What should be included in client education for Clonidine?
- Avoid activities requiring mental alertness until drowsiness subsides
- Suck on hard candy and sip small amounts of water to treat dry mouth
What is Buprenorphine used for?
For withdrawal and maintenance in opioid dependence
It is an agonist-antagonist opioid that decreases feelings of craving.
What distinguishes Buprenorphine from Methadone in terms of prescription?
A primary care provider can prescribe and dispense Buprenorphine
Methadone must be administered through an approved treatment center.
What is Naloxone?
A specific opioid antagonist used to reverse respiratory depression, coma, and other effects of opioid toxicity
It can be given IM, SQ, IV, or via inhalation.
What is Flumazenil?
A competitive benzodiazepine receptor antagonist that can reverse sedative effects and toxicity
Administered IV.
What should clients avoid when using nicotine products?
Using any nicotine products while pregnant or breastfeeding.
What is the intended effect of Bupropion?
Decreases nicotine craving and manifestations of withdrawal.
What client education should be provided for Bupropion?
- Chew sugarless gum
- Suck on ice chips or hard candy
- Sip on small amounts of water
- Avoid caffeine and other CNS stimulants to control insomnia
What are some forms of nicotine replacement therapy?
- Nicotine gum
- Nicotine patch
- Nicotine nasal spray
- Nicotine lozenges
- Nicotine inhaler
What is the intended effect of nicotine replacements?
Pharmaceutical substitutes for the nicotine in cigarettes or chewing tobacco
The rate of tobacco use cessation is nearly doubled with their use.
What is a unique feature of the nicotine inhaler?
It simulates smoking because the client puffs on the inhaler, delivering nicotine.
What nursing actions should be taken for nicotine nasal spray?
- Provides pleasurable effects of smoking due to rapid rise of nicotine in the blood
- One spray in each nostril delivers the amount of nicotine in one cigarette
- Not recommended for clients with upper respiratory disorders
What should clients with asthma avoid?
Using nicotine inhalers.
How should nicotine inhaler use be managed?
Gradually taper over 2 to 3 months and then discontinue.
What are eating disorders?
A complex set of behaviors related to eating, often linked to anxiety disorders.
How do clients with eating disorders typically feel about their lives?
They often feel out of control in other areas and use food as a coping mechanism.
What can affect a client’s self-perception in eating disorders?
Distorted perceptions of their appearance.
Why is the prevalence of eating disorders often underestimated?
Due to secretiveness, denial of the illness, or avoidance of seeking help.
What is a significant risk associated with eating disorders?
High mortality rate and increased risk of suicide.
What is the focus of treatment modalities for eating disorders?
Normalizing eating patterns and addressing underlying issues.
What comorbidities are commonly associated with eating disorders?
- Depression
- Personality disorders
- Substance use disorder
- Anxiety
What is anorexia nervosa characterized by?
Persistent energy intake restriction leading to significantly low body weight.
What fear is associated with anorexia nervosa?
Fear of gaining weight or becoming overweight.
What is a key characteristic of clients with anorexia nervosa?
Preoccupation with food and rituals of eating, along with voluntary refusal to eat.
In which population does anorexia nervosa most commonly occur?
Female clients from adolescence to young adulthood.
What can trigger the onset of anorexia nervosa?
A stressful life event, such as college.
What distinguishes the restricting type of anorexia nervosa?
Drastic restriction of food intake without bingeing or purging.
What characterizes the binge-eating/purging type of anorexia nervosa?
Engagement in binge eating or purging behaviors.
What is bulimia nervosa characterized by?
Recurrent binge eating followed by inappropriate compensatory behaviors.
How often do binge eating and compensatory behaviors occur in bulimia nervosa?
On average once per week for 3 months.
What is the typical duration and quantity of binge eating in bulimia nervosa?
Discrete period (usually less than 2 hours) with larger quantities of food.
What is the typical weight range of clients with bulimia nervosa?
Weight within normal range or slightly higher (BMI 18.5 to 30).
At what age does bulimia nervosa typically onset in female clients?
Late adolescence or early adulthood.
What compensatory behaviors are used by clients with purging type bulimia nervosa?
- Self-induced vomiting
- Laxatives
- Diuretics
- Enemas
What distinguishes the nonpurging type of bulimia nervosa?
Compensation through excessive exercise and misuse of laxatives or diuretics.
What defines binge eating disorder?
Recurrent eating large quantities of food without compensatory behaviors.
What accompanies binge eating episodes in binge eating disorder?
Distress following the binge-eating episode.
How often do binge eating episodes occur in binge eating disorder?
At least once per week for 3 months.
What age group is most commonly affected by binge eating disorder?
Adults age 46 to 55.
What health risks are associated with binge eating disorder?
- Type 2 diabetes mellitus
- Hypertension
- Cancer
What are the additional categories of eating disorders?
- Pica
- Rumination disorder
- Avoidant/restrictive food intake disorder
What does pica involve?
Eating nonfood items like dirt, soap, or paint chips.
What is rumination disorder?
Regurgitating food after eating, often referred to as ‘chewing and spitting.’
What characterizes avoidant/restrictive food intake disorder?
Lack of interest in certain types of food, leading to poor growth and nutrition.
What are prodromal manifestations of eating disorders?
- Increase or decrease in weight not related to a medical condition
- Abnormal eating habits, like severe dieting
- Ritualized mealtime behaviors, like counting calories
- Lying about food intake
- Preoccupation with weight and body image
- Compulsive and/or excessive exercising
These manifestations can indicate the onset of eating disorders.
What occupational choices may encourage thinness as a risk factor for eating disorders?
- Fashion modeling
- Athletics, especially at elite levels or sports requiring specific weight
Careers that emphasize appearance can contribute to body image issues.
What individual history may increase the risk of developing an eating disorder?
- Being a ‘picky’ eater in childhood
- History of obesity
These factors can predispose individuals to disordered eating patterns.
What biological factors are implicated in eating disorders?
- Hypothalamic imbalances
- Neurotransmitter disturbances
- Hormonal or biochemical imbalances, particularly serotonin pathways
Biological influences can play a significant role in the development of eating disorders.
What psychological influences can contribute to eating disorders?
- Rigidity and ritualism
- Separation and individuation conflicts
- Feelings of ineffectiveness, helplessness, and depression
- Distorted body image
- Internal or external locus of control
- Potential history of physical abuse
Psychological factors are critical in understanding the complexity of eating disorders.
What are expected findings in the nursing history of a client with an eating disorder?
- Client’s perception of the issue
- Eating habits
- History of dieting
- Methods of weight control
- Value attached to specific shape and weight
- Interpersonal and social functioning
- Difficulty with impulsivity and compulsivity
- Family and interpersonal relationships
A thorough nursing history is essential for assessment and treatment planning.
What cognitive distortions are commonly observed in clients with eating disorders?
- Overgeneralizations
- All-or-nothing thinking
- Catastrophizing
- Personalization
- Emotional reasoning
These cognitive distortions can significantly affect a client’s self-image and behaviors.
What vital signs may indicate an eating disorder?
- Low blood pressure
- Decreased pulse
- Low body temperature
- Possible hypertension in binge eating disorder
Monitoring vital signs is crucial for identifying potential health risks associated with eating disorders.
What weight criteria characterize clients with anorexia nervosa?
Body weight less than 85% of expected normal weight
Weight assessment is a key factor in diagnosing anorexia nervosa.
What skin and hair changes may occur in clients with anorexia nervosa?
- Fine, downy hair (lanugo)
- Yellowed skin
- Pale, cool extremities
- Poor skin turgor
These physical signs can indicate severe malnutrition and require clinical attention.
What dental issues may arise from purging behaviors in eating disorders?
- Dental erosion
- Caries
Oral health can be severely impacted by behaviors associated with bulimia nervosa.
What cardiovascular symptoms may be present in clients with eating disorders?
- Irregular heart rate
- Heart failure
- Cardiomyopathy
- Peripheral edema
- Acrocyanosis
Cardiovascular health is often compromised in individuals with eating disorders.
What fluid and electrolyte imbalances can occur in clients with eating disorders?
- Acidosis or alkalosis
- Dehydration
- Electrolyte imbalances
These imbalances can have serious health consequences and require careful monitoring.
What musculoskeletal symptoms may clients with eating disorders experience?
- Muscle weakness
- Decreased energy
- Loss of bone density
The impact of eating disorders on the musculoskeletal system can lead to long-term health issues.
What is a common gastrointestinal symptom of dehydration?
Constipation
What gastrointestinal symptom can result from laxative use?
Diarrhea
What is a potential psychosocial effect of eating disorders?
Low self-esteem
What severe physical condition can occur due to bulimia?
Esophageal tears
What is amenorrhea?
Absence of menstruation
What are some mental health issues associated with eating disorders?
Depressed mood, irritability, insomnia
What weight loss percentage indicates a need for acute care treatment?
20% of ideal body weight
What vital sign indicates a critical state in patients with eating disorders?
Heart rate less than 50/min
Which electrolyte imbalance is particularly common in bulimia nervosa?
Hypokalemia
What is a common laboratory finding in patients with anorexia and bulimia?
Hypoalbuminemia
Fill in the blank: Anorexia nervosa can lead to ________ due to malnutrition.
Hypomagnesemia
What screening tool is used for assessing eating disorders?
Eating Disorder Inventory
True or False: Elevated blood urea nitrogen can indicate dehydration.
True
What are the expected findings associated with anorexia nervosa? (List)
- Dental erosion
- Loss of bone density
- Esophageal tears
- Menstrual irregularities
- Severe dieting
- Fear of gaining weight
- Amenorrhea
Which electrolyte imbalances are associated with anorexia nervosa? (Select all that apply)
- Hypokalemia
- Hyponatremia
- Hypochloremia
- Hypophosphatemia
What can excessive use of diuretics or laxatives lead to?
Dehydration
What are potential ECG changes seen in patients with eating disorders?
Prolonged QT interval
Fill in the blank: Possible impaired liver function is evidenced by increased ________ levels.
enzyme
What is a psychological criterion for acute care treatment?
Severe depression
What should a nurse perform to assess feelings regarding a client’s eating behaviors?
Self-assessment regarding possible feelings of frustration
This includes beliefs that the disorder is self-imposed or the need to nurture rather than care for the client.
What type of environment should be provided for clients requiring intensive therapy?
A highly structured milieu in an acute care unit
This helps in managing the client’s needs effectively.
What is essential to develop and maintain with the client?
A trusting nurse/client relationship
This is achieved through consistency and therapeutic communication.
What approach should be used to promote client self-esteem?
A positive approach and support
This fosters a positive self-image.
How can clients be encouraged to feel a sense of control in their care?
Encouraging client decision-making and participation in the plan of care
This allows them to feel involved in their treatment.
What type of goals should be established for clients?
Realistic goals for weight loss or gain
This focuses on achievable outcomes.
List some cognitive-behavioral therapies that can be promoted.
- Cognitive reframing
- Relaxation techniques
- Journal writing
- Desensitization exercises
These therapies help in addressing eating disorder behaviors.
What should be monitored in the client regarding their physical health?
Vital signs, intake and output, and weight
A weight change of 2 to 3 lb/week is medically acceptable.
What is the purpose of using behavioral contracts with clients?
To modify client behaviors
This helps in establishing clear expectations.
What should clients be rewarded for?
Positive behaviors such as completing meals or consuming a set number of calories
Rewards can reinforce desired behaviors.
When should clients be closely monitored?
During and after meals to prevent purging
This may require accompanying the client to the bathroom.
What should be taught and encouraged to promote client independence?
Self-care activities
This empowers clients in their recovery.
How should nutrition education be provided to the client?
In collaboration with a dietitian
This includes correcting misinformation regarding food and meal planning.
What is the initial approach to developing an eating plan?
Consider the client’s preferences and ability to consume food
This increases adherence to the plan.
What type of eating schedule is recommended at the start of therapy?
A structured and inflexible eating schedule
This promotes new eating habits and discourages binge behaviors.
What type of meals are better tolerated by clients?
Small, frequent meals
These help prevent clients from feeling overwhelmed.
What dietary restrictions should be implemented at the start of treatment?
- High-fiber diet to prevent constipation
- Low sodium to prevent fluid retention
- Limit high-fat and gassy foods
These dietary choices support overall health.
What supplement should be administered to clients?
A multivitamin and mineral supplement
This addresses potential nutrient deficiencies.
What should clients avoid to reduce the risk of increased energy?
Caffeine
Caffeine can be used by clients as a substitute for healthy eating.
What is refeeding syndrome?
A potentially fatal complication occurring when fluids, electrolytes, and carbohydrates are introduced to a severely malnourished client
This condition requires careful monitoring.
What actions should be taken during the initial treatment of refeeding syndrome?
Consult with provider and dietitian to develop a controlled rate of nutritional support
Monitoring blood electrolytes and administering fluid replacement as prescribed is also necessary.
What vital signs should be monitored for clients at risk of cardiac complications?
Continuous cardiac monitoring and frequent vital signs
This helps in detecting any changes in the client’s status.
