Exam 2-Care of clients with substance-related and addictive disorders Flashcards
key terms of substance use disorder
-addiction: continued use of substances or reward-seeking behaviors, despite adverse consequences
-use: ingestion, smoking, sniffing, or injection of mind altering substances
-abuse: use for purposes of intoxication or beyond intended use
-withdrawal: symptoms occurring when substance no longer is used
-detoxification: process for safe withdrawal
-relapse: recurrence
substance use disorder
occurs when there is an underlying change in brain circuitry that may persist after detoxification
-substances include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative-hypnotics, stimulants, tobacco, and more.
-gambling is considered a SUD because gambling behaviors can activate the brain’s reward system like other substances
diversity and disparity of SUD
-youth identifying as sexual minorities may have higher substance use, experience more violence victimization, and are at higher risk for suicide than other teens
-we need more access to crisis services, anti-bullying approaches, and more screening for suicide prevention
-racial/ethnic underrepresented groups are disproportionately incarcerated for drug crimes and placed in facilities that have insufficiency SUD treatment and follow up
-identify differences among the US population to design programs, services, and policies that can effectively address specific population needs
comorbidities of SUD
many who abuse substances have other mental disorders such as psychotic, anxiety, mood, or personality disorders
-some other mental disorders are a byproduct of long-term substance use, or predispose the individual to alcohol or drug abuse
etiology of substance use
-biologic: no genetic predisposition or genetic marker found
-psychosocial components: temperament, stress, feelings about self, age, motivation for change, peer pressure, parental and family relationships, social consequences for problematic behaviors
family responses to SUD
-devastating effect on family and community
-fetal alcohol syndrome resulting from drinking during pregnancy
-loss of job and family relationship
-can lead to arrests and prison, and heated disputes over child custody
-family tries to help others learn to abstain or reduce use of substances
-some who recover may find they have to distance themselves from families that are actively using or abusing drugs and alcohol
-poor family relationships and dysfunction are important predictors or addictions to all psychoactive substances.
treatment and recovery
GOAL IS TO RECOVER FROM SUBSTANCE USE DISORDER.
-involves partnership between HCPs and individual and family
-specific withdrawal symptoms depend on addictive substance: process usually involves detox than the real work toward recovery can begin
-PRIMARY CONCERN IS RELAPSE: expected part of chronic disease of addiction, and the cycle of use-detox-sobriety and relapse may continue for years.
alcohol use
CNS depressant that can lead to mild sedation, or to coma, respiratory failure, and death.
-mood swings
-reduced concentration or attention span to impaired judgment and memory
-mild sedation and relaxation, or confusion, serious impairment of motor functions, and speech
-important to screen for alcohol use disorders and also drinking patterns or behaviors: CAGE, AUDIT (alcohol use disorders identification test) (these are secondary prevention measures)
level of impairment depends on…
how much alcohol has been consumed in a specific period and how rapidly the body metabolizes it
-intoxication is based on the blood alcohol level (BAL)
alcohol withdrawal and detox
abrupt cessation of alcohol ingestion can cause mild to severe physical withdrawal symptoms
-elevated HR, BP, temperature
-disorientation, confusion, possible hallucinations and delusions
-sleep disturbances
-rejecting food and fluid
-anorexia, nausea, vomiting
-tremors
detox requires CLOSE MONITORING
-CIWA-Ar= clinical institute withdrawal assessment for alcohol scale
-may need anti-anxiety, antidepressants, and sedating drugs
long term alcohol use effects
-alcohol-induced amnestic disorders (permanent brain disorder):
-wernicke encephalopathy: thiamine deficiency leading to degenerative brain disorder
-korsakoff amnestic syndrome: affects heart, vascular, and nervous systems, but leads to memory impairment, and retrieving memories and acquiring new information
-wernicke-korsakoff syndrome: NOT REVERSIBLE (typically compromised of the two stages listed above - acute then chronic)
-alcohol withdrawal syndrome usually occurs with 12 hours after abrupt discontinuation, delirium tremens, requires prevention of relapse, medications, and psychosocial interventions.
-alcohol withdrawal syndrome occurs between 48-92 hours
delirium tremens
-shaking
-vomiting
-increased HR, BP, temperature
-sweating
*undiagnosed alcoholic may begin these s/sx after hospitalization, surgery, or procedure!! caution
stimulants- cocaine
-biological response: increased confidence, ego, mental awareness/alertness
-intoxication: CNS stimulation, restless, tremors, agitation, convulsions and eventually CNS depression
-withdrawal: severe anxiety, restlessness, agitation, depression, SLEEPINESS, cravings (seen quickly!)
stimulants- amphetamines
-CNS stimulant
-sometimes used for alertness, increased concentration, sense of increased energy, euphoria, appetite suppression
-can elevate body temperature and stimulate seizures, lead to addiction psychosis
cannabis
-cannaboids
-synthetic cannabidoids- unpredictable effects, and can be laced with fentanyl
effects:
-relaxation, drowsiness
-euphoria
-dyscoria: abnormal pupillary reaction or shape
-spatial misperception
-time distortion
-food cravings
-decreased motivation with long term use
hallucinogens
drugs that produce euphoria or dysphoria, altered body image, distorted or sharpened visual and auditory perceptions, confusion, lack of coordination, and impaired udgment and memory
-causes hallucinations and profound distortions
-more than 100 different types: peyote, LSD
acute stage: combative behavior-PRIORITY IS SAFETY
-reduce stimuli, maintain safe environment
dissociative drugs
-PCP
-DXM
-ketamine
found in cough suppressants and expectorants, commonly abused by adolescents
prescription or over the counter abuse
-taking medication prescribed for someone else
-taking a drug in higher quantity or in another manner than prescribed
-taking a drug for another purpose than prescribed
opioids and morphine derivaties
agonist that binds to an opioid receptor
-derived from poppies and used for pain
-no medical purposes: opium, heroin
-medical purposes: fentanyl, morphine, and codeine
effects: pleasure and pain, CNS depression, sedation
-tolerance develops and highly addictive!!
-opioid withdrawal syndrome: nausea, vomiting, stomach cramps, insomnia, muscle twitching, increased BP, HR, respirations, anxiety, dysphoria, depression, restlessness, feeling of cravings, dilated pupils, aches
opioid overdose, intoxication, and maintenance
overdose- respiratory depression
-naloxone is rescue drug!! active for 30-81 minutes
-need immediate emergency care
initial opioid detox: gradually reducing an opioid dose over several days or weeks
maintenance treatments: methadone, naltrexone, buprenorphine.
inhalants
types: volatile solvents, aersols, gases, nitrites
-inhalant intoxication: easily absorbed through the lungs, disrupts the normal heart rhythm
-long term complications: widespread brain damage and cognitive abnormalities
steroids
anabolic steroids are synthetic substances related to male sex hormones (androgens)
-increased irritability and aggression, euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, confusion
-increased risk for MI, stroke, blood clot, cholesterol changes, HTN, depressed mood, fatigue, restlessness, loss of appetite, insomnia, reduced libido, muscle and joint pain, severe liver problems
-reduced sperm production, testicular shrinking, difficulty or pain in urination
-breast enlargement in men
-masculinization in women
emerging drugs and trends
synthetic cathinones, hallucinogen
-severe intoxication and dangerous health effects
-chemically similar to meth and MDMA
-produce euphoria, increased sociability, increased sex drive, paranoia, agitation, hallucinatory delirium
-sold as substitutes for actual drug
-causes seizures, heart attack, or respiratory arrest and death
non-substance related addictive disorders
certain compulsive behaviors characterized by risky use, urges, cravings and highs, make them similar to substance intoxication and dependence
-behavioral addictions may have similar neurocircuitry involved in reward, motivation as SUD
-gambling
-internet
-sex
-food
EBP nursing care for SUD
-behaviors and substance use history assessment
-denial of problem
-motivation for change
-countertransference
-codependence
-assess for substance abusep
priority of care and therapeutic relationship
-priority is WHETHER THE PERSON WILL BE WITHDRAWING
-therapeutic relationship: encourage honest expression of feelings, listening to individual, expressing care, holding the individual responsible for their behavior, providing fair and consistent consequences for negative behavior, talk about specific objectionable actions, do not compromise own values or nursing practice, communicate treatment plan, monitor own reactions to patient.
evaluation and treatment outcomes
-recovery is a journey, often lasting a lifetime!!
-recovery involves a change in lifestyle and often new relationships
-short term outcomes can be evaluated within the treatment setting
-long term outcomes are established as evaluated by the patient who often continues to use professional and nonprofessional support as needed.
chemical dependency and professional nurses
risk factors such as access/availability of drugs, training in administration and injection of drugs, familiarity with and a frequency of administering drugs
-working conditions, staff shortages, acutely ill patients, inadequate patient to nurse ratios, shift rotation, shifts longer than 8 hours, increased overtime
-risk loss of license, and nurses are reluctant to seek help
-some states have mandatory reporting laws
-peer assistance programs
-signs include: mood swings, inappropraite work behavior, noncompliance, deteriorating appearance, alcohol on breath, sloppy charing, forgetful, lying, high achievement, volunteering for overtime or extra duty, onset after prescription after surgery or chronic illness, family history
alcohol use disorder
SUD where an individual has a pattern of utilizing alcohol in problematic fashion. must have 2 of 11 diagnostic characteristics in the DSM-5.
-stimulates GABA and dopamine to produce pleasant feelings, creating addictive behavior over time as neurotransmitters rely on alcohol for these effects
-may become coping mechanism
medications for alcohol withdrawal
benzodiazepines: calm body and anxiety, prevent seizures of withdrawal
-chlordiazepoxide, lorazepam, oxazepam, diazepam
recovery support: naltrexone, acamprosate, disulfiram= decrease cravings
