RN mgmt of addictions Flashcards
Addiction
-Brain disorder that involves chronic “Drug” seeking of substances that cause harm to brain and bodily functions
-Affects self control, causes stress and has a high relapse potential
-Its a cycle that involves them feeling guilt and then continuing to use due to a trigger
Misuse
-Recurrent substance use, not addiction
-Taking more than prescribed on a regular basis or outside medical necessity
- I would liken it to being your own pharmacist
Tolerance
The need for increased levels of a substance for the same affect achieved previously
-Person needing to drink more to get drunk
Drug Diversion
-Obtaining prescription drugs who are giving/selling to those who are not prescribed
-Getting oxy from your mom after your prescription ran out
Dependence
-Repeated use of a. substance resulting in tolerance, withdrawal symptoms and compulsive drug taking behavior
-“Real addiction”
-Substances taken in larger amounts and over longer periods of times than originally intended
-Unsuccessful to cut down or quit
-Daily activities revolve around use
Substance withdrawl
-Decreased blood level of a substance on which they are dependent= PHYSIOLOGICAL response
-Can withdraw due to certain events “MVA, Incarceration)
Risk factors for developing substance use disorder
-Parent has AUD and SUB (Nature and nurture)
-Acts of rebellion in youth
-Coping to deal with stressors
-Grief or loss
Dopamine
Reward center
Acetycholine
Excitatory, memory, muscular skeletal
Serotonin
Mood, appetite, sensory
True or false, a long term Coke user quits cold turkey, the dopamine comes back right away
False, dopamine does eventually come back, but it takes a longer period of time. This ties into the psych dependence of coke rather than the physical. As during this period you would be craving that dopamine
What gender becomes addicted faster
Young women become addicted faster
What gender is addicted at higher rates
Young men, this is tied to the notion that men are more likely to engage in risky behavior
Consequences of drug use
People usually wait until health issues arise to come in
-Stroke
-HD
-Cancer
-Mental health issues
-Hep C and HIV
-Dental issues
-Damage to brain or spinal cord (fetal alc)
-Death
Effects on others with drug use
-Neonatal abstinence syndrome
-Secondhand smoke and lung disease
-Risky sexual encounters with someone who is an IV drug user
-Auto accidents with an impaired driver
Is narcan a one and done
NO, its not 100% effective and still requires you to go to the hospital to receive treatment, you can still overdose
CAGE questions
C: Cutting back
A: Annoyed by criticism
G: Guilty feeling
E: Eye openers
Example:
Have you felt the need to cut back
Have people annoyed you be critiquing your drinking
Have you felt guilty about your drinking
Have you had a drink in the morning to steady your nerves
Appearance of someone with alc misuse
Speech slurred, lack of coordination, unsteady gait, restless, confusion
Vitals of someone with alc misuse
Elevated BP, elevated pulse
Synergistic effects
Certain medications increase the effect of another
-Some meds with alcohol increase CNS depression
-Alc and lithium/benzos
Alc Withdrawl
-Early signs within 7 hours, and may continue for 5-7 days
-Peaks after 24-48 hours
-Symptoms include: Abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased HR/BP/RR/Temp
-Look for sweaty, tremors
-Hyperalert, irritability, shaking, anxiety (Opposite of CNS depression)
-Tonic clonic seizures possible
-Transitionary illusions: terrifying misinterpretations of objects in environment
-Can be fatal
Repeat-ant attempts at quitting a substance
Withdrawal gets worse each time
Withdrawal Delirium
-Medical emergency, can lead to death
-Peaks 2-3 days after cessation
-Severe hypertension, dysrhythmias, increased body temp (100 degrees plus)
-Hallucinations
-Delusions
-Agitated behaviors
-Fluctuating loss of consciousness
First changes are super subtle and you have to specifically be looking for it or youll miss it, however if you can notice it, you can ensure the best outcomes
Altered mental status vs Delirium
AMS requires a baseline measurement
Delirium is an acute change: First sign is subtle
Alc delirium progression
-Day 3 issue
-First signs are subtle
-Intermediate signs are less subtle
-If caught in early signs pt can be brought back and prevent full blown delirum tremens
-Need increased observation for safety, 1:1 and restraints when allowed
-Restraints wont stop a hyperactive pt from hurting themselves
-Needs supportive care, re-orientation and re-direction
-Anti psych are used as treatment
Meds for Alc withdrawal
Benzo: Calm them down/ prevent seizures
Anticonvulsants: Prevent seizures
Beta blockers: Blood pressure
MgSO4, thiamine, folic acid and multivitamins
Why does a recently admitted alcoholic need so many different vitamins and supplements
Alc is empty calories and the majority of their calories they have been ingesting is alc
Patients lie
-ALC patients under report what they drink, partly because they dont count each drink
-Seen as socially acceptable and they down play their use to avoid treatment
-Difficult to ask for help with walking, toileting
-Rather suffer in silence
Therapies for pt with ETOH use
-Recovery isnt linear and takes a long time
-Behavioral therapy , CBT
-Psychotherapy
-Detox hospitalization
-Transitional living
-Social supports
Naltrexone
Used for alc withdrawl
-Decreases cravings, decreases use
Acamprosate
666mg po
-Decreases distress of alc cessation
-Alc withdrawal med
Disulfiram
250-500 mg po daily
-Alc withdrawal drug
-Causes a person to become violently ill when ingesting alc
Vitamin deficiency with chronic alc use
Thiamine (B1)
Niacin (B3)
Pyridoxine (B6)
Wernicke encephalopathy
-Neuro condition that causes nystagmus ataxia, and confusion
-Occurs from a lack of thiamine
Complications of chronic alc use
Vitamin deficiency.
-Wernicke encephalopathy
-Korsakoff syndrome
-Hepatitis/ Cirrosis
-Peripheral neuropathy
-CV issues in general
-PANCREATITIS
-Injuries , falls
-Bleeding esophagus, stomach anemias
How to stop bleeding in the esophagus
Insert a balloon down the throat and inflate it until they can treat the bleeding
Things to look for with Alc dependent pt
-Suffering in silence
-Under reporting use
-LABS
-Body position
-Mental health exam
-Onset of delirium
-Withdrawal can be life threatening if not managed properly
Labs to look out for with alc dependent pt
-(Liver labs)AST, ALT, Bili, Alkaline phosphate
-Ammonia (High (he said low in class but online it says high) ammonia can indicate delirium)
Depressants/Sedatives/ Hypnotics
-Alc
-Benzo
-Barbiturates (Not often as prescribed)
-Causes intox, Sleepy
-Low bp, altered mental status, lack of coordination, slurred speech, irritable
Pressed pills
-Mystery pills that may or not be what they say they are
-Street sold and manufactured
Stimulants
Amphetamines
-Crack/coke
-Causes intox
-Dilated pupils, euphoria, elevated BP/pulse, arrhythmia, insomnia , N+V, paranoia/ hallucinations seizures
-Tweaker behavior
Hallucinogens
-LSD, PCP, Mushrooms
-Intox: agitation, bizarre behaviors, diaphoresis, dilated pupils , increased BP/P, hallucinations, muscle rigidity, tremors, seizures, resp arrest
-Nursing mgmt: Low stim environment, meds for anxiety/agitation, gastric lavage, acidity, urine, monitor vitals
Inhalants
-Paint thinner, glue, NO
-Intox, enhanced sexual pleasure, and euphoria followed by drowsiness, lightheaded ,agitation, giggling, laughing
-Whippits
-Fry ya brain cell, causes perm dmg
-Nursing mgmt: supportive care for affected body system in withdrawal
Weed
-Smoked, ingested, oils
-Euphoria, relaxation , slowed perception, may develop anxiety
-Can cause chronic lethargy, amotivation syndrome, memory loss, resp issues
Club Drugs
-MDMA, GHB, Ketamine
-Causes: Euphoria, increased energy, self confidence
-Side effects : Hyperthermia, rhabdomylosis , kidney/liver dmg psychosis and death
Anabolic steroids
Heart issues
Rage
Tobacco/ Nicotine
Vaping isnt safer per say
-Causes relaxation, reduces anxiety
-Lots of people with schizophrenia self med with this
-Highly toxic
-Long term effects
-Cancer and all that
Opiate dependency
Doc over prescribed drugs and stopped filling scripts for people, causing them to become dependent on a med they no longer had access to which caused them to find other alternatives
-Body loses pain tolerance and causes it to reset, so your average pain before is now unbearable
-Intox
Symptoms: Pinpoint pupils, decreased BP, pulse drowsiness, euphoria, slurred speech, slow movements
Withdrawal: Big pupils, Increased HR and pulse, diarrhea (Opposite of intox)
Withdrawal is not typically deadly
Opiate pt lie
-Most opiate pt over report their use to get more
-They fear withdrawal because its awful
-Cluster B behaviors, Hustling all day to get more drugs
-Staff splitting manipulation
Staff splitting manipulation
-Manipulating the staff by sucking up to them, saying theyre the best to that they favor them
- May ask for favors including a larger dose
-Need to maintain professionalism
Clonidine
-Used for BP
-Opiate withdrawal
Robaxin
-Opiate withdrawal
-Muscle relaxer
Methadone
-Detox med, opiate used to ween off
-Opiate withdrawal
Buprenorphine
-Detox med
-Used for opiate withdrawal
-Weaker opiate effects, less likely to overdose
-Long duration of action
-Alleviates craving, milder neonatal withdrawal, increases retention
-Binds to the receptor super well, doesnt allow any other opiate to attach… Except fentanyl which makes this drug useless as all heroin is fentanyl
Nursing Mgmt of OD/withdrawl
-Main things: REALLY, good history, develop repor, vitals
-OD is a huge medical issue, Withdrawal isnt as big
-Be kind
-Determine type and amount of Substance
-Monitor vitals
-Secure environment
-1:1
-Calm environment
-People are gunny be cranky
-Orientate client
-Seizure precautions (Dont lie on back, N+V)
-Prevent patient from harming self or others
-Meds for withdrawal
-Labs for drug screening (Qualitative, cant tell when they used last)
-Encourage pt to participate in therapy
Recovery Paradigm
-Recovery is in stages
-Person driven, treatment for a specific person
-Emerges from HOPE
-Holistic care
-Collaborative care
-Addresses trauma
-Respect the pt
Dual diagnosis
Super common, you have to treat both of them as if you dont, they are more likely to relapse as it may be a form of self medication
Dual diagnosis Schizophrenia
Nicotine* and alc use
Dual diagnosis Bipolar
All substances depending on mania or depression
Dual diagnosis Depression
SUD and depression can cause memory loss
Fetal tolerance to alc
Zero, deprives fetus of O2 and nourishment for brain and development
Fetus and Nicotine
Low birth weight and increased risk of developmental delays
-Resp issues, increased risk of sids, infections
Weed use and fetus
Mother: anemia and inadequate weight gain
-Newborn: Prematurity tremors and IUGR
True or false Addiction is cured
No its treatable and manageable, physiological withdrawal may fade but the mental will never
Can brain function be improve or fixed entirely with cessation
Yes it can but its not guaranteed
