chapter 25 Flashcards
Alcohol/substance dependence
What does addiction mean ?
A condition of contained use of substance ( or reward-seeking behaviors ) despite adverse consequences
key terms we need to understand and define
use ?
abuse ?
withdrawal?
detoxification ?
relapse ?
ingestion, smoking, sniffing or injection of mind-altering substance
use for purpose of intoxication or beyond intended use
symptoms occurring when substance no longer used
process for safe withdrawal
recurrence
we usually like to diagnose patents with two types of categories what are they and explain to me what it means ?
substance use disorders
- you using the actual drug
substance induced disorder
- having a disorder that increases the chances of you behaving in those substances
how does abuse occur in a patient ?
when the purpose of intoxication or medical usage of the drug goes beyond the use
so like using weed to help aid pain, but now using weed to just get high and enjoy yourself
typically when dealing with patients with substance use, they usually present themselves with 3 coping mechanisms, which are and can you describe them to me?
denial
- I dont have a problem
projection
- you are the problem
rationalization
- im like this because of this non controllable factor
what is the most abused substance in the United States ?
alcohol
what is the patho behind how addiction comes to be ?
the increase in dopamine you get from the addiction that goes into your nucleus accumbens ( reward center )
more terms to understand?
tolerance
dependence
withdrawal
overdose
enabling
the more you need to feel a high
mental and physical need to do it to live
symptoms occurring when substance no longer used
toxic point of the consumption where life is on the line
enforcing and allowing the behavior
what type of approach should a nurse use when dealing with a patient in denial of their problem ?
noncontrontational approach
why do we want to use a noncontrtational approach with a patient with a substance abuse issue ?
dont blame them, you simply want to be kind and empathic
we also discussed about last time that the best way to interview a patient with substance abuse is ??
motivational interviewing
why is motivational interviewing beneficial to patients with substance abuse ?
helps the patient realize the discrepancy between life goals and engaging in substance use, it gives the patient the personal choice to treatment and changing behaviors
what race do we usually see alcohol abuse in the most ?
white
what is the primary treatment and recovery for patients with alcohol ?
recover, preventing relapse and working to safe detox
alcohol is known as a what ?
cns depressant
how does alcohol work as a cos depressant ?
it works by engaging in your gaba receptors to cause mild sedation and relaxation
in the online powerpoint used for alcohol, they want us to ask CAGE questionnaire questions, what does cage stand for ?
have you ever felt you should CUT DOWN on your drinking?
have people ANNOYED you by criticizing your drinking?
ever felt bad or GUILT about your drinking?
ever had an EYE OPENER to steady nerves in the morning?
what are some long term effects that patients can experience when using alcohol ?
usually develop a tolerance
need to drink increasing amounts before experiencing an high and show cognitive and motor effects
bals reflect increased
alcohol withdrawal and detoxification can present in many physiologic and psychological ways.
typically when do early signs of withdrawal symptoms occur ?
when do peak of withdrawal symptoms occur ?
4-12 hours
24-48 hours (2days)
typically patients who are going through a withdrawal or detox, symptoms rapidly disappear within the first 24-48 hours, however if they dont disappear and withdrawal progresses, what does it turn into ?
alcohol withdrawal delirium (awd) otherwise known as dt (delirium tremens )
typically how do patients who are experiencing alcohol withdrawal delirium or delirium tremens look like ? (7)
shaking
vomitting
increase pules
increase bp
increase temp
sweating
eventually can lead to a seizure
AWD or delirium tremens is a medical emergency and why so?
the reason behind this is because patients will end up dying from the severe side effects and the brain will start to shut down typically seizure first
what is the assessment or the tool we use to help ovulate a patient with alcohol usage?
ciwa
clinical institute withdrawal assessment
what are 3 medications we are only going to be giving to these patients when they stop drinking alcohol to help prevent the consumption of it ?
naltrexone
acamprosate
disulfiram
naltrexone
acamprosate
disulfiram
describe what each of them do and what we need to tell for one of them to avoid
blocks the high feeling of alcohol, reduces the appeal of alcohol
reduce physical distress and emotional discomfort
severe adverse reaction, and must instruct patient to avoid the use of any substance that contains alcohol, like cough medications, rubbing alcohol
what are the main medical concerns we have with patients who are consuming alcohol ? (4)
respiratory depression
n/v
tachycardia
aspiration
how do patients who are intoxicated look like ?
dont overthink it
slurred speech
unsteady gait
poor judgment
loss of memory
loss of inhibition
increase aggression
increase impulsiveness
patients, typically after many years of drinking, can develop wernickes-korsakoff syndrome, which is ?
a combination of encephalopathy and amnestic syndrome
what is wernickes encephalopathy
what is the symptoms associated with it ?(5)
degenerative brain disorder caused by thiamine defiencency
vision impairment
ataxia
hypotension
confusion
coma
what is Korsakoff amnestic syndrome ?
what is the symptoms associated with it ? (5)
involves heart/vascular/ and nervous system but the pimrary problem is acquiring new information and retrieving memories
amnesia
confabulation
attention deficit
disorientation
vision impairment
what are 3 medications we are going to prescribe to patients with alcohol issues to help aid in their recovery ?
benzodiapines
thiamine
zofran
why are we going to give benzodiapines , thiamine, zofran ?
benzo - help with that gaba receptor, by relaxing the patient
thiamine - help prevent wenikes syndrome
zofran - aid with the nausea that comes with withdrawals
- Prevention of Relapse
- Psychosocial interventions
- Medications: disulfiram, acamprosate calcium, naltrexone
- Promotion of Health
- Adequate nutrition and supplemental vitamins
- Multivitamins essential due to malnutrition: thiamine, folic acid, magnesium sulfate
cocaine is often ingested as inhalant, injected or smoke
what do you think the effects are on a person who does cocaine ?
sudden burst of mental alertness and energy
cocaine rush is that sudden burst of mental alertness that usually last for 10-20minutes, however its often followed by ?
depression, craving for more and irritability
how do patients who use cocaine/crack look like ?
dont over think it
dilated pupils
hallucination
nose bleedings
sniffing
tachycardia
long term usage of cocaine has been found to effect your sleep, causing patients to sleep 12-18 hours.
recovery is very difficult because of the intense craving that come with the withdrawal, so nursing interventions should focus on helping patients solve problems related to manage these cravings
nicotine is an uprising pandemic that has caught the nation by suprisied, its a stimulate that causes increase alertness, attention and suppresses your appetite.
not only thing, mood swings and cravings are massive symptoms associated with nicotine
its been used to help stop smoking but not a good way though
caffeine, increase mental acuity
restless, gi disbutrances, tachy
cannabis and marijuana has been legalized in many states, and has helped with relaxation and medical usages of pain
long term effects though can be lung irritating and addictive
hallucinogens and dissociative drugs causes what ?
euphoria, dysphoria, alerted body image, distorted or sharpened visual and auditory perception, confusion, incoordination and impaired judgment and memory
what is an example of hallucinogens ?
LSD
Currently believed that 15.2 million Americans use OTC medications for nonmedical purposes
- Opioids: oxycodone, hydrocodone, morphine, fentanyl, codeine are the most commonly abused
- Barbiturates and benzodiazepines
- OTC cough medicines containing dextromethorphan (similar effects as with ketamine or PCP)
what is the most abused opioid ?
heroin
what happens when a patient overdose on opioids, what do we use ?
narcan
what are some symptoms of opioid withdrawal ? (6)
yawning
runny nose
fever
n/v
dysphoria
insomnia
withdrawal peaks for patients for opioids when
and when does it subside typically ?
2-3 days
5-7 days or longer
what is the treatment for opioids?
methadone
Suboxone
naltrexone
what do we use to test or evaluate a patient with an opioid addition ?
cows test
inhalants is a ______
causes what effects?
risk for ?
cns depressant
euphoria
sudden sniffing death
(cardiac arrest)
steroids cause euphoria effects and sexual arousal, however patients get the risk for heart attacks and blood clots
men typically have
women typically have
breast enlargement
masculinization
gambling disorder is when it is persistent and recurrent, leading to clinically significant impairment and distress
patient experience an aroused, euphoric state during the actual betting
patients are unable to control their gambling and may lie to family, friends and employers to hide their gambling habit
the disorder has 4 phases
winning
lossing
desperation
hopelessness
