Chapter 14 - Substance Abuse - Exam 3 Flashcards
what is the difference between substance use disorder and substance induced disorder?
substance use disorder = addiction
substance induced disorder = byproducts of addiction
what does an opiate withdrawal timeline look like?
- 72 hours after last dose
- 1 week after last dose
- 2 weeks after last dose
- 1 month after last dose
- physical symptoms at their peak: chills, fever, body aches, diarrhea, insomnia, muscle pain, nausea, dilated pupils
- physical symptoms start to lessen: tiredness, sweating, body aches, anxiety, irrtability, nausea
- psychological and emotional symptoms: depression, anxiety, irritability, restlessness, trouble sleeping
- cravings and depression; symptoms can linger for weeks or months
what is a psychoactive substance
substances that, when taken in or administered into one’s system, affect mental processes, e.g. perception, consciousness, cognition or mood and emotions.
A child of an alcoholic is ____ times as likely to become an alcoholic
4
which addiction is linked to genetics
alcoholism
Alcohol use disorder:
Explain phase 1 - prealcoholic phase
a person might have one or drink after a long day at work in an effort to reduce tension, stress, and to relax
Explain phase 2 - early alcoholic phase
person starts to drink more, brief periods of amnesia/blackouts, alcohol stops being a source of please and more of a need, this person can get defensive if confronted with drinking use
Explain phase 3 - the crucial phase
this person has lost the ability to choose to drink and it is “required” i.e. they “have to have it.” This person is angry/aggressive, they may have lost their job, they may feel a sense of shame
Explain phase 4 - the chronic phase
this person is drunk more than they are sober; they have an emotional and physical dependence on alcohol. At this stage, withdrawal needs to be managed carefully
which of the following are substance-induced disorders?
-intoxication
-withdrawal
-delirium
-neurocognitive disorder
-psychosis
-bipolar
-depressive disorder
- ocd
-anxiety
-sexual dysfunction
-sleep disorders
all of them
addiction: a compulsive or chronic requirement. the need is so strong as to generate distress (either physical or ______) if left unfulfilled
psychological
individuals are considered to have a _________disorder when use of the substance interferes with their ability to fulfill role obligations (work, school, home)
substance
true or false
individuals with substance use disorders often participate in dangerous activities when they are impaired by a substance
true
true of false
once individuals realize they have a problem it is easy for them distoninue use since they know that it is contributing to a physical or psychological problem
false
substance intoxication is defined as the development of a _________ syndrome of symptoms following excessive use of a substance
reversible
once intoxicated there is a direct effect on the _____ and a disruption in physical and psychological functioning occurs
cns
true or false
caffeine is considered a psychoactive substance that is associated with substance use
true,
along with all the classic ones, plus tobacco
hereditary factors appear to be involved in the development of substance use disorders, especially ____
alcoholisim
true or false
children of alcoholics are 4 times more likely than other children to become alcoholics
true
although there is no single factor that determines whether someone will develop a substance use disorder, it is estimated that _______ accounts for 40 to 60 percent of a person’s vulnerability
genetics
there is good evidence that changes in brain structure and brain neurochemistry occur in the process of addiction.
Alcohol has demonstrated effects on almost all neurotransmitters, but those most strongly linked to sub abuse include
opioid, dopamine, glutamate, and gaba
once activated, neuronal pathways that are responsible for sensing pleasure and reward are believed to be responsible for pleasurable sensations associated with addictive substances as well as creating a memory that triggers a desire for repeated use
these pathways are referred to as
the brain-reward circuitry
certain personality traits have been associated with an increased tendency towards addiction.
can you name a few?
low self esteem, depression, passivity, antisocial, high risk taking, trouble communicating, anxiety
irrational thinking patterns have long been identified as a problem that is central in addiction
some example of irrational thinking patterns associated with addiciton include…
denial “im not addicted!”
projection “its my wifes fault i take drugs!”
rationalization “i have to take the drugs im in pain”
Exploring irrational thought patterns is the basis for ________ therapy and has shown benefits in addiction treatment
CBT
__________ is a learned response that occurs after repeated exposure to a stimulus
conditioning
substance abuse can become a learned response from the substance, environment, etc
an abbreviation for alcohol often seen in medical records is
ETOH
alcohol is thought to have more profound effect when an individual is _________ stressed or fatigued
emotionally
most alcohol metabolized in the liver, the outcome of this process is the produciton of
acetaldehyde
increased exposure to acetaldeyde leads to CNS ______
depression
phase 1 the prealcoholic phase
this phase is characterized by the use of alcohol for its effects in relieving the everyday _____ and ______ of life
the individual may have at some point learned the use of alcohol is an acceptable method of coping with stress
stress and tension
phase 2: early alcoholic phase
this phase begins with ____.
now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is _____ by the individual
blackouts, required
phase 3: crucial phase
now the individual has lost ______ and _______ addiction is clearly evident.
binge drinking is common - these episodes include sickness, loss of consciousness, squalor, degradation.
In this phase the individual is extremely ill. _____ has become the total focus, this person is willing to lose everything that was once important in order to maintain addiction
control, physiological,
Phase 4: chronic phase
this phase is characterized by emotional and physical disintegration. This person is usually ____ more than they are sober.
_______ disintegration is evidenced by profound helplessness and self pity
impairment in reality testing may result in _____
intoxicated, emotional, psychosis
phase 4: chronic phase
unmanaged withdrawal results in terrifying symptoms that include
hallucinations, tremors, convulsions, agitation, panic, depression, thoughts of suicide
alcohol is considered a food since it has calories, but unlike other food it does not have to be digested because…
the blood carries 20% of the alcohol directly to the brain where it acts on the brains central control areas, slowing or depressing activity
Effects on the body:
peripheral neuropathy is characterized by peripheral ______damage, this results in pain, burning, tingling/prickling sensations
nerve
peripheral neuropathy:
**remember this one!
researchers believe that peripheral neuropathy is a direct result of deficiencies in
the B vitamins - particularly THIAMINE
peripheral neuopathy:
this process is often reversible with abstinence, but with chronic alcohol use ________ wasting and ________ can occur
muscle, paralysis
alcoholic myopathy:
this may be an acute or chronic condition, (aka alcoholic RHABDOMYOLYSIS <— remember this term it comes up a lot)
the man (Im just using man because its quicker to type obviously could be man or woman) experiences:
muscle pain, swelling, weakness,
alcoholic myopathy:
the man may have myoglobinuria evidenced by
red tinge in urine
alcoholic myopathy:
__________ may be elevated before the appearance of symptoms
creatine kinase
alcoholic myopathy:
lab studies show elevations of the enzymes creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (_____)
AST
alcoholic myopathy:
again, the main point is that chronic alcoholic myopathy produces symptoms which are
gradual muscle wasting and weakness in skeletal muscles
alcoholic myopathy:
alco myopathy is thought to be the result of the same _______ deficiency that contributes to peripheral neuropathy
vitamin B
** important
wernicke’s encephalopathy represents the most serious form of ______ deficiency in alcoholics
thiamine
wernicke’s encephalopathy:
symptoms include
paralysis of ocular muscles, diplopia, ataxia, somnolence, and stupor
paralysis of OCULAR muscles, diplopia, ataxia, somnolence, and stupor are symptoms of what
wernicke’s encephalopathy
Korsakoff’s psychosis is identified by the syndrome of
confusion, recent memory loss, and confabulation
confusion, recent memory loss, and confabulation are symptoms of
korsakoff’s psychosis
Korsakoff’s psychosis:
it is frequently encountered in clients recovering from
wernicke’s encephalopathy
korsakoff’s psychosis:
treatment includes
parenteral or oral thiamine replacement
why is thiamine so important?
Thiamine, also known as Vitamin B1, is an essential nutrient that plays a crucial role in maintaining proper function of the nervous system, muscles, and heart. Here are some key functions of thiamine:
Energy Metabolism: Thiamine is a coenzyme in important metabolic pathways, particularly in the breakdown of carbohydrates, such as glucose, to produce energy. It helps convert food into energy that the body can use.
Nervous System Function: Thiamine is essential for the proper functioning of the nervous system. It is involved in the synthesis of neurotransmitters, which are chemicals that transmit signals in the brain and nervous system. Thiamine deficiency can lead to neurological symptoms such as confusion, memory problems, and muscle weakness.
Heart Health: Thiamine is important for the proper functioning of the heart muscle. It helps maintain the integrity of the cardiovascular system and supports normal heart function.
Gastrointestinal Function: Thiamine plays a role in the digestion of carbohydrates in the gastrointestinal tract. It helps in the production of hydrochloric acid, which is necessary for the digestion of food.
Healthy Growth and Development: Thiamine is important for normal growth and development, particularly during periods of rapid growth such as infancy, childhood, and pregnancy.
Overall, thiamine is essential for maintaining overall health and well-being, and a deficiency can lead to a variety of health problems, including beriberi and Wernicke-Korsakoff syndrome. It’s found naturally in many foods, including whole grains, legumes, nuts, seeds, and pork, among others.
alcoholic cardiomyopathy:
the effect of alcohol on the heart is an accumulation of ____ in the myocardial cells, resulting in enlargement and a weakened condition
lipids
alcoholic cardiomyopathy:
symptoms include:
exercise intolerance, tachycardia, dyspnea, edema, palpitations, nonproductive cough
alcoholic cardiomyopathy:
lab studies may show and elevation in enzymes
CPK, AST, ALT, LDH
true or false
alcoholic cardiomyopathy results in the heart shrinking
false, the enlargement of the heart
what the hell is esophagitis
inflammation and pain in the esophagus, this occurs due to the toxic effects of alco on the mucosa
Gastritis:
how does alcohol affect our stomachs?
inflammation of lining, nausea, vomiting, distension
gastritis:
alcohol breaks down the stomach’s protective mucosal barrier, allowing _______to erode the stomach wall
hydrochloric acid
pancreatitis:
usually occurs 1 to 2 days after a binge. Symptoms include constant, severe epigastric pain, N/V, and abdominal distention.
chronic pancreatitis leads to
pancreatic insufficency leading to steatorrhea, malnutrition, weight loss, and diabetes mell
alcoholic hepatitis is _________ of the liver caused by long term heavy alcohol use
inflammation
alcoholic hepatitis:
clinical s/s include: N/V, lethargy, anorexia, elevated WBC, fever, jaundice, and most notably
an enlarged and tender liver
Severe alco hepatitis can lead to cirrohis or
hepatic encephalopathy
cirrhosis of the liver:
may be caused by anything that results in chronic injury to the liver.
it is the ____stage of alco liver disease and results from long term abuse
end
Cirrhosis of the liver patho
widespread destruction of liver cells, which are replaced by fibrous (scar) tissue
cirrohsis of the liver:
clinical manifestations include: N/V, anorexia, weight loss, ab pain, edema, anemia, blood coagulation abnormalities, and most notably
jaundice
Complications of cirrhosis of the liver include:
- portal hypertension
- ascites
- esophageal varies
- hepatic encephalopathy
tell me the main points of these conditions
- portal hypertension: elevation of bp thru the portal circulation results from defective blood flow
- ascites: excessive serous fluid accumulates in th abdomen, occurs in response to portal hypertension
-esophageal varices: distended veins in esophagus from excessive pressure of defective blood flow thru the cirrhotic liver. **varies can rupture resulting in dangerous hemorrhaging
- hepatic encephlopathy: *** serious complication in response to the inability of the dis liver to convert ammonia to urea for excretion –> leads to impaired mental functioning
complications of cirrhosis:
elevation of bp thru the portal circulation results from defective blood flow thru the cirrotic liver is called
portal HTN
complications of cirrhosis:
a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal HTN.
the increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity
ascites
complications of cirrohosis:
veins in the esophagus that become distended because of excessive pressure from defective blood flow thru cirrohitc liver.
as pressure increases variscosities can rupture
esphageal varices
complications of cirrhosis:
this serious complication occurs in response to the inability of the dis liver to convert ammonia to urea for excreation.
the continued rise of ammonia results in progressively impaired mental functioning, apathy, euphoria, depression, CONFUSION, coma, death
hepatic encephalopathy
leukopenia
production, function, and movement of WBCs are impaired —> infections
thrombocytopenia
platelet production and survival are impaired -> hemorrhage
fetal alcohol syndrome includes mental, physical, behavioral and/or learning disabilities
There may be problems with:
learning, memory, attention span, communication, vision, hearing,
true or false
every infant develops FAS whose mother drinks during pregnancy
false, not every child, several factors determine consequences of maternal drinking:
pattern, metabolisim, genetics, timing,
neuroimaging of child with FAS shows that the _____ and _____ are often smaller than normal
frontal lobes, cerebellum
intoxication usually occurs at blood alcohol levels between 100 to ____ mg/dL
200
alcohol withdrawal:
4 to 12 hours after a binge the following w/d symptoms may appear:
tremors, N/V, malaise, weakness, tachycardia, sweating, increased bp, anxiety, depression
irritability, hallucinations, illusions,
ugh okay i didnt realize how long this chapter is so moving on to main points of sedative, hypnotic, or anxiolytic use disorder:
these types of substances in relation to addiction are divided into 3 categories what are they
barbiturates, nonbarbiturates, and antianxiety agents
effects on body
general depressant effect
okay sorry i cant read all this, im skipping ahead to nursing assessment stuff:
motivational interviewing is an approach that can be used with any disorder. Its focus is on using skills such as empathy and reflection to explore a client’s motivation, strengths, and readiness for change
through this process the client becomes _____to become an active partner in treatment goals while exploring feelings for any resistance to change
empowered
motivational interviewing:
for example, rather than telling a client he must abstain from alcohol and attended AA, the health care provider helps the client ______ what he wants to achieve and then facilitates the process of exploring advan and disadvan of desired behavior change
articulate
motivational interviewing:
what are some questions we could ask that client that have this approach of exploring the clients attitudes and feelings toward their addiction
are you comfortable with your drinking patterns?
have your attitudes towards drinking changed?
do you see alcohol abuse as a sign of weakness?
what did you learn from your parent about drinking?
nursing assessment:
one of the most popular screening tools is
CIWA, (the clinical institute withdrawal assessment of alcohol scale)
what does CIWA assess
monitoring of alcohol withdrawal symptoms
what are some nursing diagnosis we could use for the patient with sub abuse
denial
ineffective coping
imbalanced nutrition
risk for infection
chronic low self esteem
deficient knowledge
risk for injury
risk for suicide
what outcomes could we use for this patient
no physical injury
has not harmed self or others
accepts responsibility
acknowledges association between personal problems and use of substance
adaptive coping mech
no signs of infect
evidence of increased self worth
verbalizes importance of abstaining
codependency is able to achieve a sense of _____ only thru fulfilling the needs of others
control
the codependent person disowns his own needs and wants in order to respond to external _____ of others
demands
codependence has been referred to as “a dysfunctional realtionship with ______”
oneself
treating codependency:
explain the main points of these stages
stage 1 - the survival stage
stage 2 - the reidentification stage
stage 3 - the core issues stage
stage 4 - the reintegration stage
- let go of denial that problems exist
- individual gains glimpse of true self thru a break in denial
- individual must face that relationships cannot be managed by force of will
- self-acceptance and willingness to change - relinquish power over others and reclaim personal power
pharmacotherapy:
what is disulfiram?
drug that can be used as a deterrent to drinking - drinking causes uncomfortable symptoms
pharmacotherapy:
________ are the most widely used group of drugs for treatment in alcohol withdrawal
benzodiazepines (ativan, valium)
