Module 4 Test Flashcards
What is Tuberculosis (TB)?
TB is a recurrent, chronic, infectious disease caused by Mycobacterium tuberculosis. Secondary lesions may affect the kidneys, genitalia, bones, and brain.
How does TB infect the lungs and what is the initial immune response?
Droplets with M. tuberculosis enter the lungs and implant in an alveolus or bronchiole (usually in upper lobes), causing an inflammatory response with neutrophils and macrophages.
What forms when phagocytes cannot destroy the TB bacilli?
A tubercle (sealed colony of bacilli) forms. Within it, infected tissue dies forming a cheese-like center (caseation necrosis).
What differentiates Latent TB from Active TB?
In Latent TB, bacilli remain encapsulated and harmless. If the immune system weakens, the tubercle may rupture, leading to Active TB.
What is Reactivation Tuberculosis?
When a previously healed TB lesion reactivates due to age, disease, or immunosuppressive drugs.
What are severe forms of TB?
Miliary TB: widespread blood spread, affecting lungs, bone marrow, multiple organs; may lead to anemia.
TB Meningitis: affects the brain, causing headaches, vomiting, behavioral changes, coma.
Skeletal TB: spreads to vertebrae (Pott’s disease), joints, causing kyphosis, pain, joint destruction.
Genitourinary TB: affects urinary/reproductive organs, causing UTI-like symptoms, may cause infertility.
List risk factors for TB.
HIV/AIDS
Weakened immune system
Diabetes
Malnutrition
Alcohol use disorder
Smoking
Overcrowded/poorly ventilated spaces
Prolonged exposure
Low socioeconomic status
Birth outside US
Asians, Hispanics, African Americans
How can TB be prevented?
Reduce overcrowding, improve ventilation
Improve nutrition
Increase healthcare access
Prevent/manage HIV
Screen at-risk populations (HIV+, close contacts, comorbidities, born in high-prevalence countries, underserved, substance use, long-term care residents, HCWs)
Isoniazid (INH) 6-9 months or Rifampin 4 months for latent TB
Airborne precautions in healthcare
Early ID/isolation of cases
BCG vaccine in high-prevalence countries
What is the Tuberculin Skin Test (TST/Mantoux Test)?
An intradermal injection of PPD; induration is measured after 48-72 hrs. A positive test means exposure, not active disease.
What are limitations of TST?
Requires trained personnel; false negatives possible in immunosuppressed individuals.
What is the IGRA blood test?
Interferon-gamma release assay detects response to TB antigens. Fast (24 hrs), no return visit, but costly and needs careful handling.
What is done if TST or IGRA is positive?
Further diagnostics: chest x-ray, sputum culture, NAAT.
What are infection control measures for Active TB?
Stay home first few weeks of treatment
Cover mouth/nose when coughing/sneezing
Wear mask in public
Ventilate rooms
Use airborne precautions in healthcare
What are clinical manifestations of TB?
Initially few symptoms; often unnoticed
Fatigue, weight loss, low appetite, low-grade fever, night sweats
Dry cough that may become productive or blood-tinged
TB empyema: lesion ruptures into pleural space
Bronchopleural fistula: air passage between lung/pleura, leading to pneumothorax, dyspnea
What diagnostic tests confirm TB?
Sputum smear for acid-fast bacilli (rapid)
Sputum culture (definitive, 4-8 weeks; radiometric systems are faster)
PCR for DNA detection
Chest x-ray (dense lesions, cavities)
LFTs (for INH), vision exam (for ethambutol), audiometry (for streptomycin)
What is prophylactic treatment for latent TB?
Isoniazid (INH) 300 mg/day for 6-12 months
For recent converters, close contacts, HIV+
BCG vaccine (can cause false positive TST)
What is RIPE therapy for active TB?
Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)
Initial phase: RIPE for 2 months
Continuation: INH + RIF for 4+ months
Extended for immunocompromised
How is drug-resistant TB treated?
Second line: Bedaquiline, Capreomycin, Aminosalicylic Acid
Duration: 9+ months
What is DOT and why is it used?
Directly Observed Therapy (DOT) ensures adherence by having a nurse supervise administration, especially in nonadherent patients.
How is TB monitored during treatment?
Repeat sputum cultures & x-rays
Expect negative cultures in 2-3 months
Persistent positivity may indicate drug resistance.
What are lifespan considerations for TB during pregnancy and newborn care?
Avoid contact with newborn if mother has active TB
Can breastfeed if latent TB and not on contraindicated treatment
First-line drugs not proven teratogenic; INH and RIF cross placenta but without known fetal harm
Extra testing and monitoring for newborns
Isolate baby if mother has active TB.
How does TB manifest in children?
Infants: weight loss, persistent cough, fever, decreased breath sounds, wheezing
Children: cough, poor appetite, weight loss, growth delay, chills, fatigue, night sweats, fever, lymphadenopathy
At higher risk for miliary TB and TB meningitis
Treatment: 6-9 months; 18-24 months for resistant strains.
What are TB considerations in older adults?
LTC residents at high risk
Symptoms may be vague, mistaken for pneumonia
90% due to latent TB reactivation
Yearly TST recommended; repeat test if initially negative
Treatment barriers: cognitive decline, adherence issues, access, cost
Nurses play key role in outpatient adherence and education.
What should be included in TB nursing assessment?
Breathing difficulty
Cough (productive/unproductive)
Fatigue, weight loss, night sweats
Hemoptysis, angina
TB exposure and test history
Vitals (especially temp), respiratory status, lung sounds, nutrition status.
What are key nursing diagnoses for TB?
Fatigue
Weight loss
Knowledge deficit
Risk for infection
Poor health maintenance
Social isolation.
What are TB care planning goals?
Patient prevents spread to others
Understands treatment/follow-up
Accesses required medications/supplies.
What education strategies should nurses use for TB?
Assess prior knowledge, barriers, readiness
Include family/support
Use tailored teaching tools
Set mutual goals.
How can nurses promote TB treatment adherence?
Assess self-care ability/support system
Address understanding of disease/treatment
Identify barriers; develop individualized care plans
Provide written/verbal instructions
Engage community services for housing, access.
How can nurses reduce infection risk from TB?
Use negative pressure isolation rooms
Follow standard + airborne precautions
Educate on respiratory hygiene
Mask patient for transport
Notify all staff and visitors.
What TB safety alert must be followed?
Use HEPA-filtered respirators (not surgical masks) per OSHA to protect against airborne TB exposure.
What is the expected outcome for TB care?
Latent patients complete therapy and avoid active TB
Contacts evaluated and treated if needed.
What is addiction?
Addiction is the psychological or physical need for a substance or process, despite negative consequences.
Can both legal and illegal substances be abused?
Yes, both legal and illegal substances may be abused.
What are Substance Use Disorders (SUDs)?
SUDs are chronic addictions to substances like alcohol or opiates.
What are substance-induced disorders?
They include intoxication, withdrawal, and mental disorders linked to substance use.
What factors may cause addiction?
Childhood trauma, genetics, and other environmental factors.
What is dependence?
Physical reliance on a substance, accompanied by withdrawal symptoms.
How does addiction differ from dependence?
Addiction includes both physiological dependence and a psychological need to use.
Why is treatment access difficult for addiction?
Due to the high cost and limited availability of treatment.
What is the general pathophysiology of addiction?
Addiction results from biological, genetic, psychological, and sociocultural factors, not a single cause.
Which neurotransmitters are critical to addiction development?
Dopamine, serotonin, and others.
What does dopamine regulate?
Movement, emotion, motivation, and pleasure. It is central to the brain’s reward system.
How do drugs affect the brain’s reward system?
Drugs overstimulate the system, leading to euphoria and reinforcing drug use.
What neurological effects can drug abuse have?
It may lead to neurological changes and disrupt brain signaling.
How do most abused drugs affect neurotransmitters?
They mimic or block natural neurotransmitters at receptor sites.
What are some examples of how drugs affect neurotransmitters?
Heroin/opiates mimic endorphins; cocaine/stimulants block reabsorption of dopamine, serotonin, and norepinephrine.
What is the result of neurotransmitter disruption from drugs like cocaine?
Excess neurotransmitters in the synapse, amplified effects, and disrupted signaling. Cocaine can release 2–10x more dopamine than eating or sex.
Which medical conditions may co-occur with addiction?
Anxiety, depression, and schizophrenia. Drug use may also trigger or worsen these conditions.
What factors affect the speed of addiction according to genetics?
Substance used, frequency of use, route of administration (smoking/injecting increases risk), intensity of high, and individual genetic/psychological vulnerability.
How much does genetics contribute to addiction vulnerability?
Genetics account for 40 to 60% of addiction vulnerability.
Have any specific genes been linked to addiction?
Yes, specific genes have been linked to alcohol dependence.
What psychological factors increase addiction risk?
Childhood/adolescent trauma, emotional/physical/sexual abuse, anxiety, depression, and using substances as coping strategies.
What sociocultural factors influence drug use?
Cultural acceptance or stigma, drug availability, peer pressure, and financial access to substances.
What household conditions increase addiction risk?
Parental substance use, criminal behavior, violence or abuse, and mental illness.
What additional sociocultural risk factors contribute to addiction?
Access to drugs in the neighborhood/school, friends who use drugs, academic failure, poor social skills, early use of substances, and smoking or injecting drugs (which lead to faster brain entry and more intense effects).
What are common symptoms of addiction?
Symptoms vary by substance type and duration of use, and may include: Mood changes, Cognitive impairment, Memory loss, Poor judgment, Weight loss, Organ damage, Withdrawal symptoms.
What are some key prevalence statistics about substance use (2018 data)?
31.9 million people reported illicit drug use or prescription misuse; 139.8 million people (51.1%) aged 12+ consumed alcohol; 67 million people engaged in binge drinking; 5.5 million people used cocaine; 757,000 used crack; 43.5 million people (15.9%) used marijuana (increasing due to legalization); Alcohol-related costs: $249 billion annually; Illicit drug-related costs: $193 billion annually.
What are some comorbidities commonly associated with substance abuse?
Increases risk of physical and mental illness; Tobacco-related cancers (mouth, throat, lung, stomach, kidney, bladder); Higher risk of infectious diseases: HIV, hepatitis, TB; Compromised immunity due to malnutrition, poor hygiene, risky behaviors; Mental disorders: depression, anxiety, PTSD, schizophrenia; Dependence, tolerance, and withdrawal affect brain function; Care must address mental, physical, and social needs.
What are the effects of addiction on families?
Increased social isolation; Disruption of family roles; Families may conceal addiction or avoid help; Boundaries may become rigid and limit outside support; Family members may enable addiction by covering up behaviors or giving resources; Codependency can create dysfunctional relationships; Children of parents with SUD are at higher risk for: Depression, anxiety, Behavioral issues, Future substance use; Referrals to support groups like AA or Adult Children of Alcoholics may be helpful.
What are process disorders?
Repetitive behaviors that activate the same biochemical reward systems as substance use disorders.
What are some examples of process disorders?
Gambling; Shopping; Internet gaming; Compulsive sexual behavior.
How do process addictions resemble substance use disorders (SUDs)?
They involve tolerance, withdrawal, and preoccupation; Often co-occur with substance use problems; Associated with high rates of depression, OCD, and impulse control disorders.
What cognitive impacts are associated with addiction?
Slowed reaction time; Impaired judgment and memory; Impaired intellectual development.
What is fetal alcohol syndrome and its effects?
Caused by alcohol exposure in utero; May cause cognitive deficits; Facial features include: small eye openings, thin upper lip, flattened midface, smooth philtrum.
What are some effects of cocaine abuse?
Gastric ulcers; Intestinal ischemia; Gastrointestinal tract perforations.
What are some physical consequences of alcohol abuse?
Cirrhosis; Nutrient absorption issues; Increased risk of hepatitis C in injection drug users; Increased risk of HIV, bacterial pneumonia, TB, and skin infections; Higher rates of head trauma, fractures, motor vehicle accidents (MVAs), and violence-related injuries; 14–22% of veterans with PTSD also develop substance abuse issues.
What is harm reduction in the context of substance abuse?
Interventions aimed at reducing the negative consequences of unhealthy behaviors, such as alcohol and drug abuse.
What are examples of harm reduction strategies?
Needle exchange programs; Naloxone (Narcan) distribution; Fentanyl test strips for street drugs.
Do harm reduction measures promote substance use?
No, evidence shows they do not encourage substance use.
What are some ways to support recovery and prevent relapse?
Identify triggers; Teach healthy coping strategies; Connect patients with resources; Help reduce stress.
What safety concern should be assessed in individuals with substance use issues?
Suicidality—people with alcohol and drug dependence have a 10 to 14 times greater risk of death by suicide.
What does substance use do to the brain long-term?
Drugs of abuse alter the brain’s structure and function, leading to changes that persist long after drug use has ceased, increasing relapse risk even after long abstinence.
What are some considerations for children and adolescents regarding addiction?
Parental substance use increases risk of abuse, neglect, trauma; Dysfunctional family dynamics impact long-term emotional/behavioral development; Underdeveloped prefrontal cortex causes impulsivity and poor decision making; Early drug use can cause permanent brain changes; Heavy marijuana use in teens may cause irreversible IQ loss; Substance abuse interferes with social and developmental milestones.
What are current adolescent substance use trends?
2.2 million adolescents reported drinking; 1.2 million engaged in binge drinking; 2.1% affected by marijuana use disorder; Vaping has increased among middle and high school students.
What are substance use concerns during pregnancy?
Rising use, especially marijuana; Alcohol, nicotine, illicit drugs, and some prescriptions harm fetal development; Alcohol can cause fetal alcohol syndrome; Exposure may lead to low birth weight, neurological issues, developmental delays; Opioid exposure may cause neonatal abstinence syndrome (NAS).
What are symptoms of Neonatal Abstinence Syndrome (NAS)?
Irritability; Feeding difficulties; Tremors; Seizures; Respiratory distress.
Why is substance abuse in older adults often overlooked?
Symptoms may mimic aging-related conditions; Older adults may not recognize or report substance use issues.
Why is substance abuse often underdiagnosed in older adults?
Many older adults may not seek treatment. They may not recognize they have a problem. Symptoms can mimic aging-related conditions. Rates of alcohol abuse, prescription misuse, and other SUDs are rising.
What percentage of nurses are affected by substance misuse or addiction?
10 to 20%
What increases the risk of substance abuse in nurses?
High stress work environments. Easy access to drugs.
What does the ANA Code of Ethics say about addressing impaired nurses?
Do not ignore poor performance. Do not alter assignments to accommodate impaired behavior. Do not fear confronting a nurse if patient safety is at risk.
What are warning signs of an impaired nurse?
Inaccurate narcotic counts. Excessive “wasting” of medications. Frequent tardiness. Charting errors. Isolation. Slurred speech. Flushed face. Tremors. Mood swings.
What support is available for nurses struggling with addiction?
Many states have non-punitive recovery-focused programs. Nurses are ethically obligated to seek help.
What is the most used and abused substance in the U.S.?
Alcohol, due to its availability and social acceptance.
What percentage of adults consume alcohol at least once per year?
70%
What are the classifications of alcohol use?
Moderate: 1 drink/day for women, 2 drinks/day for men. Binge drinking: 5+ drinks on one occasion in the past 30 days. Heavy use: 5+ drinks on 5+ days in the past 30 days.
What is alcoholism (alcohol use disorder)?
A primary, chronic disease influenced by genetic, psychosocial, and environmental factors, characterized by lack of control, fixation on alcohol, and continued use despite consequences.
What are some college-related consequences of binge drinking?
Alcohol poisoning. Overdoses. Sexual assaults. DUI fatalities.
What happens as alcoholism progresses?
Dependency increases over time; individuals may hide alcohol or drink in secret.
How does alcohol affect the nervous system?
It enhances GABA activity, which inhibits the autonomic nervous system.
What increases the risk of respiratory depression and death when drinking alcohol?
Combining alcohol with other CNS depressants.
What brain areas are damaged by alcohol and what are the effects?
Cerebral cortex: impaired judgment and decision making. Hippocampus: memory issues. Cerebellum: poor coordination and balance.
How is alcohol processed in the body?
Absorbed through the mouth, stomach, digestive tract. 95% metabolized by liver (alcohol dehydrogenase). 5% excreted via kidneys, lungs, and skin. Takes ~90 minutes to metabolize one standard drink (varies by individual).
What factors influence the etiology of alcoholism?
Genetics (50% of risk), epigenetics, biology, psychology. Runs in families and affects multiple generations.
Which population reports the highest alcohol use?
White population (56.7%), followed by: Black (43%), Hispanic (41.7%), Asian (39.3%), Native American (35.9%).
What are common dual diagnoses with alcoholism?
Depression, anxiety, and mood disorders.
Why is self-medication with alcohol dangerous?
It can lead to alcohol dependence and complicate co-occurring mental health issues.
What treatment approach is most effective for alcoholism?
Integrated treatment that addresses both substance use and co-occurring disorders.
What are some risk factors for alcohol abuse?
Genetic differences in alcohol metabolism. Lack of protective enzyme variants (e.g., in American Indians). Trauma exposure. Early substance use. Economic hardship. Low education levels. Lack of familial support. Systemic stigma and marginalization. Social stressors in LGBTQ individuals.
What are key alcohol prevention strategies?
Early intervention and education. Community programs targeting at-risk groups. Addressing stigma and improving access to care.
What are behavioral signs of alcohol use disorder?
Preoccupation with alcohol. Inability to stop. Risky consumption. Impairment in responsibilities. Strong cravings. Compulsive use.
What are physiological signs of alcohol use disorder?
Tolerance (need more alcohol for same effect). Withdrawal symptoms (nausea, sweating, tremors, anxiety).
What are common signs of alcohol intoxication?
Mood swings. Aggression. Poor judgment. Slurred speech. Nausea. Lack of coordination. Disorientation.
What are risks associated with alcohol intoxication?
Falls. Fractures. Head trauma.
What are symptoms of alcohol overdose/poisoning?
Amnesia. Difficulty walking. Coma. Severe drops in vital signs. Incontinence. Medical emergency requiring immediate care.
What are blood alcohol level effects?
0.10%: Ataxia, slurred speech. 0.20–0.25%: Unable to sit or stand unassisted. 0.30–0.40%: Coma possible. 0.50%: Risk of death. Legal intoxication limit (U.S.): 0.08%.
What are consequences of chronic alcohol abuse?
Liver cirrhosis. Pancreatitis. Cardiac disease. Gastritis. Cancers. Neurological damage (e.g., Wernicke-Korsakoff Syndrome).
What is Wernicke Encephalopathy (WE)?
An acute, life-threatening condition caused by thiamine deficiency. Symptoms: Confusion, ataxia, paralysis of eye movements.
What is Korsakoff Psychosis?
A chronic condition caused by thiamine deficiency. Symptoms: Memory impairment, confabulation (making up facts), behavioral abnormalities.
What are some other neurological effects of chronic alcohol use?
Cerebellar damage: coordination issues, involuntary eye movements. Cross-tolerance to anesthetics, benzodiazepines, barbiturates.
What can abrupt alcohol withdrawal lead to?
Hyperexcitability: anxiety, hypertension, tremors, nausea, insomnia. Severe complications: seizures, Delirium Tremens (DTs), respiratory failure, cardiac arrhythmias.
How does alcohol affect memory?
Impairs new memory formation by affecting the hippocampus. Can cause blackouts (memory gaps), especially with rapid consumption. Blackouts may include conversations, actions, or sexual encounters.
What is Wernicke-Korsakoff Syndrome (WKS)?
A severe memory disorder caused by thiamine deficiency. Symptoms include: Confabulation (making up details). Inability to recall past events. Cognitive dysfunction.
What is the relationship between alcohol and dementia?
Chronic alcohol abuse increases dementia risk, though moderate consumption may reduce it.
What are mild alcohol withdrawal symptoms and when do they start?
Anxiety, irritability, insomnia, decreased appetite. Onset: 6–24 hours after the last drink.
What are symptoms of acute alcohol withdrawal syndrome?
Tremors, nausea, vomiting. Elevated heart rate, increased blood pressure. Neurologic effects: insomnia, nightmares, hallucinations, paranoia, delusions. Severe complications: seizures, hyperthermia, delirium, fluctuating LOC.
What are Delirium Tremens (DTs)?
A severe alcohol withdrawal condition. Onset: 2–3 days after last drink (can be delayed up to 14 days). Symptoms: confusion, hallucinations, agitation, extreme tremors, fever, cardiovascular instability. Life-threatening: may lead to cardiovascular collapse or hyperthermia.
How is alcohol withdrawal managed?
Benzodiazepines and antiseizure meds prevent seizures and DTs. Monitoring of vitals, hydration, and med adherence during detox. Early detection reduces mortality to under 1%.
What is the simplest method to detect alcohol intoxication?
Breathalyzer test.
What does a blood alcohol level of 0.10% indicate?
Motor impairment, ataxia, dysarthria. If no symptoms present, it suggests high tolerance and possible dependence.
At what BAL do severe effects occur?
0.20–0.25%: cannot remain upright. ≥0.30%: coma possible. ≥0.50%: death risk.
When are withdrawal medications typically started?
When BAL is under 0.10%.
What biomarkers can suggest heavy alcohol use?
Liver enzymes: GGT, AST, ALT. Inflammatory markers: hs-CRP, IL-6. MCV (Mean Corpuscular Volume). CDT (Carbohydrate Deficient Transferrin). EtG and EtS urine tests (for alcohol abstinence monitoring).
What are first-line medications for withdrawal management?
Benzodiazepines (e.g., clorazepate, oxazepam).
What are medications used to treat alcohol abuse?
Acamprosate: restores brain balance, reduces cravings. Disulfiram (Antabuse): causes severe nausea/vomiting if alcohol is consumed. Naltrexone (Depade, Vivitrol): blocks alcohol’s euphoric effects.
What tools are used to assess alcohol withdrawal severity?
CIWA-Ar (Clinical Institute Withdrawal Assessment of Alcohol Scale). PAWSS (Prediction of Alcohol Withdrawal Severity Scale). LARS (Luebeck Alcohol Withdrawal Risk Scale).
What is an important safety alert during alcohol withdrawal?
Monitor vital signs and withdrawal symptoms closely. Trending CIWA-Ar, PAWSS, or LARS scores helps identify early signs of Delirium Tremens (DTs). Use PRN meds and protocols preventively.
What are examples of nonpharmacologic treatments for alcoholism?
Alcoholics Anonymous (AA). Group therapy. Individual counseling. Peer support, which is essential for long-term sobriety.
What are adolescent considerations related to alcohol use?
Drinking before age 15 increases the risk of future dependence 4x. Adolescents tolerate more alcohol before showing effects. Social reinforcement increases likelihood of use. Risk increases with: Hyperactivity, aggression, anxiety, depression. Rebelliousness, risk-taking, poor impulse control. Parental/peer alcohol use. Media influence. Trauma or family dysfunction.
How do women differ in alcohol-related risks?
Greater cognitive impairment and organ damage than men.
Develop dependence faster (telescoping effect).
Higher BAL due to lower body water content.
What are health risks of alcohol use in women?
Liver disease, alcoholic hepatitis.
Higher mortality from cirrhosis.
Heart disease, hypertension.
Breast cancer, cognitive decline, brain atrophy.
Memory deficits, Alzheimer’s disease, osteoporosis.
What are risks of alcohol use during pregnancy?
Alcohol is the most common teratogen.
Increases risk of miscarriage, stillbirth, preterm birth, and placental abruption.
Fetal Alcohol Spectrum Disorders (FASDs): growth deficiencies, facial anomalies, CNS impairments.
Alcohol in breast milk affects infant development.
Complete abstinence is the only safe approach during pregnancy.
What health risks are associated with alcohol use in older adults?
Higher risk of hypertension, cancers, liver/brain/immune damage.
Exacerbates osteoporosis, diabetes, ulcers, heart disease.
May dull cardiac pain, delaying diagnosis of heart attacks.
Can cause confusion and memory loss, mimicking dementia or depression.
What are the dangers of mixing alcohol with medications in older adults?
Aspirin: increased risk of stomach bleeding.
Antihistamines: excessive drowsiness.
Acetaminophen: higher risk of liver damage.
Cough syrups/laxatives: increased blood alcohol levels.
Sleeping pills, opioids, CNS depressants: risk of respiratory failure and death.
What are key screening and prevention insights for older adults with alcohol use?
Depression and alcohol abuse are common in suicide cases.
Alcohol relapse prevention can be as effective or even more effective than in younger adults.
What is an important safety alert regarding alcohol withdrawal timing?
Symptoms can begin within 8 hours of the last drink and peak within 24–72 hours.
In patients with severe liver damage, symptoms may last up to a week.
How many deaths are attributed to tobacco annually in the U.S.?
480,000 deaths.
How many harmful chemicals are found in commercial tobacco?
Over 7,000.
What health risks does tobacco use increase?
Cancer.
Cardiovascular disease.
Respiratory illness.
Immune system suppression.
How is nicotine absorbed into the body?
Through the lungs (smoking).
Through oral mucosa (chewing tobacco).
What cardiovascular effects does nicotine have?
Vasoconstriction.
Hypertension (HTN).
Increased cardiovascular strain.
Why is nicotine addictive?
It affects the brain’s dopamine system, which reinforces addiction.
What happens when nicotine stimulates nicotinic receptors in the brain?
Triggers dopamine and epinephrine release.
Increases blood pressure, heart rate, and cardiac workload.
Causes vasoconstriction and raises peripheral vascular resistance.
What are some physiological effects of nicotine use?
Increases gastric acid secretion → nausea and vomiting.
Reduces gas exchange → increased respiratory infections.
May lead to cyanosis and impaired breathing.
What is EVALI and what causes it?
EVALI = E-cigarette or Vaping-Associated Lung Injury.
Linked to vitamin E acetate and THC-containing vape products.
What are symptoms of EVALI?
Respiratory: cough, shortness of breath, chest pain.
GI: nausea, vomiting, stomach pain, diarrhea.
Systemic: fever, chills, weight loss.
What are nicotine withdrawal symptoms?
Craving.
Restlessness.
Irritability.
Sleep disturbance.
Impaired concentration.
Increased appetite.
Weight gain.
What are long-term consequences of chronic nicotine use?
Chronic obstructive pulmonary disease (COPD).
High blood pressure.
Cardiovascular disease.
Increased risk of lung cancer and other cancers.
What common factors influence tobacco use?
Emotional stress.
Social pressure.
Alcohol use.
Lack of education.
Age.
What makes youth more likely to use tobacco?
Smoking modeled by peers, siblings, or media.
Disengagement from school or religion.
Use of alcohol or marijuana.
How do socioeconomic and environmental factors influence smoking?
Lower SES increases smoking rates and makes quitting harder.
Lack of access to health education and cessation programs.
How does tobacco use contribute to poverty?
Diverts income from food, housing, and healthcare.
Increases financial burden on low-income households.
What additional health risks are associated with smoking?
Graves’ disease.
Infertility.
Osteoporosis.
Degenerative disc disease.
Premature aging.
Gum disease.
Bad breath.
Reduced sense of taste and smell.
What are the effects of smoking during pregnancy?
Preterm labor.
Miscarriage.
Low birth weight.
Sudden Infant Death Syndrome (SIDS).
Increased risk of learning disorders in children.
What are the risks of secondhand smoke exposure?
20–30% increased risk of lung cancer.
Higher toxin levels than directly inhaled smoke.
Linked to cardiovascular disease, asthma, and respiratory illnesses in children.
What is thirdhand smoke and why is it concerning?
Residual nicotine and chemicals that remain on surfaces after smoking.
Potential long-term health risks are still being studied.
At what age do most smokers begin smoking?
9 out of 10 try smoking by age 18.
98% try by age 26.
Why are adolescents more susceptible to smoking?
Strong influence from social and environmental factors.
How does the tobacco industry influence youth smoking?
Spends billions targeting youth and young adults.
Advertising and cultural norms contribute to initiation.
What trend was seen in smokeless tobacco use between 2011–2019?
Decreased use among middle and high school students; fewer than 5% reported use in the last 30 days.
What are effective strategies for tobacco use prevention?
Mass media campaigns (TV, radio, social media).
School-based tobacco policies and education.
Raising tobacco prices through increased excise taxes.
What are early signs of tobacco use?
Increased wrinkles.
Yellowing of fingers/nails.
Decreased sense of smell.
Persistent smoke odor.
Restlessness when restricted from smoking.
What are late manifestations of tobacco use?
Chronic cough.
Increased mucus.
COPD.
Lung, bladder, and oral cancers.
Cardiovascular diseases (e.g., CAD, PVD).
Gum disease, tooth decay.
What clinical therapies support tobacco-related conditions?
Bronchodilators, expectorants, oxygen for COPD.
Coughing, deep breathing, and proper positioning.
Smoking cessation and nicotine replacement therapy.
Chemotherapy, radiation, and pain management for cancer.
Supportive care: therapy, group support, motivational strategies.
What are common forms of nicotine replacement therapy (NRT)?
Over-the-counter: chewing gum, lozenges, patches.
Prescription: nasal spray, inhalers.
What is the goal of NRT?
Reduce withdrawal symptoms and cravings.
Support quitting efforts.
What are limitations of NRT?
Does not address psychological addiction.
Must be paired with behavioral therapy.
What are nursing considerations when using NRT?
Educate on contraindications and warnings.
Encourage participation in cessation programs.
What components make up effective smoking cessation programs?
Peer support.
Group therapy.
Behavioral therapy.
Resources from CDC, American Heart Association, and American Lung Association.
What complementary health approaches can support smoking cessation?
Acupuncture.
Meditation.
Yoga (to reduce anxiety and cravings).
Hypnotherapy (evidence is mixed; best used alongside proven cessation methods).
What are key nursing considerations for smoking cessation?
Encourage evidence-based programs.
Support the use of stress-reducing therapies as adjuncts to quitting.
What was the teen cigarette smoking rate in 2018?
2.7% (672,000 teens aged 12–17), down from 13% in 2002
What trend was seen in teen use of other nicotine products in 2018?
20.1% used non-cigarette tobacco products. E-cigarette use increased.
What are risk factors for adolescent nicotine use?
Stress, Peer/family influence, Depression, Parental smoking at home
What are protective factors against teen smoking?
Parental monitoring, Engagement in school, Religious involvement, Marketing bans and higher tobacco taxes
What are short-term health effects of smoking in teens?
Reduced lung growth and function, Shortness of breath, Increased phlegm, Elevated resting heart rate, Early vascular changes indicating heart disease
What are long-term consequences of teen smoking?
Most continue smoking into adulthood, Increased risk of lung cancer, heart disease, stroke, Increased likelihood of using: Alcohol (3x), Marijuana (8x), Cocaine (22x), Association with risky behaviors (e.g., fighting, unprotected sex)
What percentage of pregnant women used tobacco products in 2018?
11.4%
How does nicotine exposure affect the fetus?
Nicotine crosses the placenta. Fetal nicotine levels can be 15% higher than the mother’s. Cigarette smoke contains over 40 carcinogens.
What are fetal and infant health risks from nicotine exposure?
Spontaneous abortion, Preterm delivery, Respiratory diseases (asthma, allergies), Immune difficulties, Increased lifetime cancer risk
What are neurodevelopmental consequences of prenatal nicotine exposure?
Delayed psychomotor and mental development, Increased aggression in early childhood, Attention deficits, Learning/memory issues, Impulsivity and speech/language impairments
What should nurses do for pregnant women who smoke?
Educate about smoking risks, Encourage cessation during pregnancy, Provide prenatal support and behavioral therapy resources
What percentage of adults 65+ were smokers in 2018?
8.4%
What factors are common in older adult smokers?
Lower socioeconomic status, Social isolation, Higher levels of depression
What are barriers and opportunities in smoking cessation for older adults?
2/3 receive provider advice to quit, but only 1 in 20 succeed each year. A new diagnosis of chronic illness often increases motivation to quit. Heavy smokers typically need extended pharmacologic and counseling support.
What are health risks of smoking for seniors?
Increased risk of respiratory and GI cancers, Worsening of chronic conditions (COPD, cardiovascular disease, diabetes), Bone density loss, cataracts, stomach ulcers, Smokers are up to 10x more likely to develop cancer.
What are nursing considerations for older adult smokers?
Encourage evidence-based cessation treatments, Educate on health benefits of quitting at any age, Address emotional and social barriers to quitting
What is the definition of substance abuse and SUD?
Substance abuse: Pattern of use outside medical/cultural norms despite harm. SUD: Cognitive, behavioral, and physiological symptoms showing continued use despite serious consequences.
What brain changes occur with substance use and how do they affect recovery?
Persistent circuitry changes even after detox. Leads to strong cravings and increases relapse risk.
What are the DSM-5 diagnostic criteria for Substance Use Disorder (SUD)?
Impaired Control: Increased use, failed quit attempts, cravings. Social Impairment: Failure to meet obligations, social withdrawal. Risky Use: Continued use despite known harm. Pharmacologic Symptoms: Tolerance and withdrawal.
What is withdrawal and how can it affect individuals?
Occurs after stopping prolonged use. Can lead to distress, impairment, or medical emergencies.
What substance classes are included in DSM-5?
Alcohol, Caffeine, Tobacco, Cannabis, Hallucinogens, Opioids, Sedatives, Stimulants
How are co-occurring disorders related to SUD?
20% with anxiety or mood disorders also have an SUD.
SUDs are second only to mood disorders in suicide risk.
What causes SUDs from a pathophysiological perspective?
Multifactorial: biological, genetic, psychological, sociocultural factors.
What are the physiological effects of substance use?
Short-term: changes neurotransmission and brain chemistry.
Long-term: neurological adaptations from repeated use.
What is the kindling effect in addiction?
Repeated cycles of use and withdrawal increase cravings and worsen withdrawal symptoms.
Makes long-term abstinence more difficult.
What are treatment implications of the kindling effect?
Early intervention is key.
Medication-assisted treatment (MAT) helps manage withdrawal and cravings.
Behavioral therapies are needed for psychological support.
What is the etiology of SUD?
Multifactorial: varies with age, pain management, trauma, and social normalization.
Continued use can lead to tolerance and dependence.
Who is affected by SUD risk factors?
All ages, sexes, and socioeconomic statuses (SES).
What are major risk factors for SUD?
Family history/genetics.
Co-occurring mental health disorders (e.g., anxiety, depression).
What psychosocial factors increase the risk of SUD?
Using substances as coping mechanisms.
Peer pressure and social influences.
Lack of parental or family involvement.
How does addiction progression differ between men and women?
Men have higher overall rates of substance use disorders.
Women progress to addiction more rapidly (telescoping effect).
What influences the severity of SUD symptoms?
The type of substance, amount used, frequency, and combination with other substances.
What are effects of commonly abused substances?
Caffeine: Insomnia, tachycardia, irritability, withdrawal headaches.
Cannabis: Euphoria, paranoia, memory impairment, long-term respiratory issues.
CNS Depressants (e.g., benzodiazepines): Drowsiness, cognitive impairment, risk of withdrawal seizures.
Psychostimulants (e.g., cocaine, meth): Extreme euphoria, agitation, cardiovascular issues, stroke.
Opiates (e.g., heroin, prescription painkillers): Respiratory depression, severe withdrawal, overdose risk.
Hallucinogens: Altered perception, paranoia, persistent psychosis.
Inhalants: Neurologic damage, heart failure, sudden sniffing death (SSD).
Who is involved in interprofessional collaboration for SUD treatment?
Physicians.
Psychiatrists.
Nurses.
Therapists.
Counselors.
What are components of effective SUD treatment?
Detox and medical stabilization.
Pharmacologic and psychotherapeutic interventions.
Cognitive-behavioral therapy, group therapy, and self-help programs.
Inpatient medical attention for overdose cases.
Diagnostic tests to personalize treatment.
What tests are used to diagnose substance use?
Blood tests.
Urine screening.
Serum drug levels.
Saliva tests.
Sweat tests.
Hair follicle analysis.
Why is overdose considered a medical emergency?
It may involve respiratory depression, seizures, or cardiac arrest
What are general emergency measures for overdose?
Airway management
Activated charcoal
Seizure precautions
Monitoring vital signs
What medications are used in acute overdose or withdrawal management?
Opioid Overdose: Naloxone (Narcan)
Opiate Withdrawal: Methadone, Buprenorphine, Clonidine
Psychosis: Haloperidol, Risperidone
Stimulant Withdrawal: Antidepressants, dopamine agonists
Hallucinogen Overdose: Diazepam for agitation
Suicide precautions may also be needed
What are common complications in newborns exposed to substances?
Respiratory distress
Growth restriction
Jaundice
Congenital anomalies
Neurobehavioral delays
When does withdrawal typically begin and how long does it last in newborns?
Onset: within 24 hours of birth
Duration: up to 21 days
What is Neonatal Abstinence Syndrome (NAS/NOWS)?
A withdrawal condition in newborns caused by prenatal opioid exposure
What are symptoms of NAS/NOWS?
High-pitched cry
Tremors
Poor feeding
Gastrointestinal issues
Sweating
Hyperthermia
What are statistics related to NAS in 2014?
32,000 cases (1 baby every 15 minutes)
$563 million in hospital costs
What are the consequences of adolescent substance use?
Impacts brain development
Increases long-term health risks
Associated with risky behaviors (e.g., unsafe sex, impaired driving)
What are risk factors for adolescent substance use?
Peer pressure
Mental health issues (e.g., depression, ADHD)
Family drug use
History of trauma
How does early use affect long-term substance risk?
Early use significantly increases the risk of developing substance use disorders later in life
What are commonly misused substances during pregnancy?
Opioids
Alcohol
Nicotine
Cocaine
Amphetamines
Marijuana
Hallucinogens
What are potential effects of substance use on the fetus or newborn?
Alcohol: Fetal Alcohol Spectrum Disorders (FASDs)
Opioids: Low birth weight, Neonatal Abstinence Syndrome (NAS), congenital defects, SIDS
Stimulants (e.g., cocaine, meth): Premature birth, placental abruption, neurologic impairment
Nicotine: Preterm birth, SIDS, cleft lip/palate
Marijuana & LSD: Growth restriction, neurodevelopmental deficits
What legal considerations exist regarding substance use during pregnancy?
Some states classify prenatal substance use as child abuse and may mandate reporting
Why are substance use symptoms underdiagnosed in older adults?
Symptoms are often mistaken for typical aging-related changes
What is common regarding medication use in older adults?
80% take at least one prescription daily
50% take five or more medications or supplements
What increases the risk of substance-related problems in older adults?
Cognitive decline
Polypharmacy
Coexisting medical conditions
What are some consequences of substance abuse in older adults?
Increased risk of falls
Poor judgment
Overdose
Increased suicide risk
Why is identifying substance abuse in older adults challenging?
Symptoms often mimic common aging issues
What are protective factors against substance use in older adults?
Being married
Religious involvement
No history of alcohol or tobacco use
What is the definition of healthcare policy?
Government and societal actions to achieve health-related goals, including laws, regulations, and budget priorities.
What is the difference between public and private health policy?
Public policies are enforceable laws and regulations; private policies influence healthcare through professional organizations and associations.
How do federal and state governments establish health policy?
Through legislative action, executive authority, and judicial interpretation.
Which agencies implement laws and regulations to enforce public health policy?
Agencies like the CDC and state health departments.
What is the role of executive agencies in health policy?
They write regulations that provide detailed guidance on law implementation while adhering to legislative intent.
Who can initiate public healthcare policy development?
Legislators, agencies, or special interest groups.
What factors are considered in public healthcare policy development?
Affected populations, costs vs. benefits, stakeholder support, and scientific evidence.
What are the four stages of policymaking?
Agenda setting, Government response, Implementation, Evaluation.
How is funding for public health policy determined?
Through a structured budget process influenced by political stakeholders and interest groups.
What is the process for the federal budget?
Begins with the president’s proposal in February, followed by congressional appropriations; continuing resolutions may be needed if budgets are delayed.
How is access to care linked to healthcare systems and policy?
Access is linked to insurance policies, billing, and reimbursement regulations, impacting patient care and continuity.
What legal issues in nursing are regulated by state boards?
Licensure, defining scope of practice, and ensuring compliance with laws and regulations.
What is the role of AHRQ in quality improvement and policy?
Develops research and guidelines to improve healthcare safety and effectiveness, influencing national health initiatives.
What is the primary federal health agency?
The U.S. Department of Health and Human Services (DHHS).
Which divisions are overseen by DHHS?
CDC, FDA, CMS, NIH, and AHRQ.
What is OSHA and what does it do?
A division of the U.S. Department of Labor responsible for workplace health and safety standards. Implements regulations to reduce workplace hazards.
What are core public health responsibilities of state health departments?
Disease prevention, emergency response, community health promotion, and addressing health disparities.
What healthcare facilities are regulated by states?
Hospitals, long-term care facilities, childcare centers, and clinical laboratories.
What does OEMS do?
Establishes EMS training standards, accredits programs, and oversees trauma systems for high-quality emergency care.
What do county and city health departments focus on?
County: sanitation and food safety. City: clinical and population-based health services.
What types of social services support do local health departments provide?
Administer Medicaid, CHIP, and WIC programs to assist vulnerable populations.
What role do local health departments play in disease surveillance?
Monitor infection spread, conduct contact tracing, and collaborate with state health departments.
What are multilateral organizations?
Funded by multiple governments and primarily part of the UN, e.g., WHO.
Which organization is the only international health organization with legal authority?
World Health Organization (WHO).
What are bilateral agencies?
Government-funded organizations like USAID that provide aid to developing nations.
What are NGOs?
Non-Governmental Organizations, independent of government, supporting humanitarian and healthcare initiatives.
What is accreditation in healthcare?
A peer-review process recognizing organizations that meet quality standards.
What is the role of The Joint Commission?
Accredits healthcare organizations, promotes safety through National Patient Safety Goals and Sentinel Event reporting.
What organizations accredit nursing education?
CCNE, ACEN, and NLN CNEA.
What is the difference between accreditation and state board approval?
Accreditation is voluntary for quality assurance, while state board approval is required for licensure eligibility.
How do nurses contribute to accreditation?
They help develop evidence-based policies, participate in self-review activities, and collaborate with accreditation teams.
What are the roles of professional nursing associations?
Support membership, define standards and ethics, promote advocacy, education, networking, and professional identity.
What are examples of general nursing associations?
American Nurses Association (ANA), National League for Nursing (NLN).
What are examples of specialty area nursing associations?
Academy of Medical-Surgical Nurses, Oncology Nursing Society, American Association of Critical-Care Nurses.
What are examples of advanced practice nurse associations?
American Association of Nurse Practitioners, National Association of Clinical Nurse Specialists.
What are examples of demographic-specific nursing associations?
Asian American/Pacific Islander Nurses Association, National Black Nurses Association.
How was healthcare treated historically in terms of funding?
As a market-based commodity with access based on the ability to pay.
What significant legislation did not initially include healthcare coverage?
The Social Security Act of 1935.
When did the federal government begin financing healthcare?
In 1965 with the creation of Medicare and Medicaid.
What challenge remains in U.S. healthcare despite reforms?
The uninsured population remains a challenge.
