Substance Related Disorder Flashcards
How can you tell if someone has a problem with abuse
ASSESSMENT
Dependence must have 3 or more of the following:
- tolerance
- withdrawal
- need for more than intended
- inability to stop even when want to
- social, occupational, recreational problems
- great deal of effort/time in acquiring substance
- continued use despite knowing problems involved
Abuse
- maladaptive pattern of sub abuse which leads to impairment or distress in 1 or more of the following:
- failure to fulfill major role obligation (work, school, home)
- recurrent sub use in hazardous situations
- recurrent sub-related legal problems
- continued use despite problems
Intoxication
- development of substance-specific syndrome due to ingestion of substance
- not due to general medical condition
- not better accounted for by another medical disorder
Withdrawal
- development of substance specific syndrome due to cessation or reduction of intake
- causes clinically significant distress or impairment
- not due to general medical condition or accounted for by other mental disorder
S&S of substance abuse
- frequent accidents or injury
- watery, reddened eyes, tremors, slurred speech
- increasing isolation
- absenteeism
- drowsiness, flushed face
- disappearing prescriptions
Abuse Assessment
- amount/type of alcohol or drugs used
- medical problems associated with alcohol or drugs in pt and family members
- blood/urine drug screens; BAC
- look for s/s (red, watery eyes, smell, tracks)
Interview Approaches
- matter of fact
- nonjudgmental
- be prepared for defensiveness
- genuine concern helps overcome this
- be aware of own feelings and avoid projecting negative attitudes onto patient
- get accurate info (HIGH priority)
- initially focus on legal drug use (caffeine, nicotine)
What is primary drug problem in North America
alcohol
Psychodynamic Theory of Alcohol Abuse
- stereotypical characteristics (low self-esteem, passivity, introversion)
- result of and not cause of sub dependence
Biologic Theory of Alcohol Abuse
- heredity
- predisposition
- children of alcoholics are 4-10x more likely to become alcoholics
___% of alcohol is absorbed by small intestine
80
On an empty stomach ___% of alcohol is in the bloodstream within ___min
50; 15
Alcohol is equally distributed thru the body tissue according to______
water content
Men tend to be able to drink more than women because
muscle contains more water than fat tissue does
___mL of alcohol is metabolized per hour in a healthy body
15
Some common myths of alcohol:
hot coffee, sweating, and other home remedies don’t increase ETOH metabolism or hasten up sobering process
Women become more intoxicated then men because _____
- alcohol dehydranase
- women’s bodies don’t undergo first pass metabolism
BAL of 0.0
no alcohol
BAL of 0.05
euphoria, decreased inhibition
BAL of 0.08
legally drunk in many states
BAL of 0.1
labile mood, talkative
BAL of 0.15-0.2
double vision, slurred speech
BAL of 0.3
altered perceptions, hallucinations
BAL of 0.4
stupor, coma
BAL of 0.4-0.5
severe respiratory depression, DEATH
Alcohol is a ____
CNS depressant
Effects of alcohol
- black outs
- brain atrophy (gray matter loss)
Rebound phenomenon
- first sedation, then psychomotor activity increases
- if alcohol dependent
- will have withdrawal symptoms
Symptoms of alcohol withdrawal
-tremors, diaphoresis, palpitations
Delirium tremors occur __-__ hours after last drink
48-72
-first assessment question needs to be when was last drink!!
Symptoms of delirium tremors:
- extreme motor agitation
- hallucinations, seizures
- increased HR, BP, fever
- coarse tremors
- diaphoresis (soaking wet)
What will you give to treat delirium tremors
IV fluids and vitamins (B’s)
Wernicke-Korsakoff Syndrome is the result of
poor nutrition
Symptoms of Wernicke
- amnesia, memory loss
- confabulation
- falsification of memory
- trying to fill in gaps they don’t remember
- Vitamin B1 and B3 deficiency
Disulfiram (Antabuse)
- makes drinking painful
- if drink alcohol will become violently ill
- sweating, flushing, throbbing HA, N/V
- need to teach pt not to drink alcohol
- mouth wash, after shave, purel
Naltrexone (Revia)
- decreases pleasure of drinking
- increases abstinence and reduces alcohol craving
- need to let other Dr aware you are taking
- may have decreased response to pain meds
Acamprosate (Campral)
- restores chemical balance in alcoholic brain
- can be used once abstinence has begun, but not while alcohol-dependent person is still drinking
- thought to enhance abstinence behaviors
Fetal Alcohol Syndrome (FAS)
- 10% of pregnant women drink
- alcohol inhibits development during 1st trimester
- 3rd most common cause of mental retardation
- ONLY cause that is preventable
What is a good screening tool for alcohol
CAGE
- have you ever felt you should Cut down on drinking
- have people Annoyed you by criticizing drinking
- felt bad or Guilty about drinking
- had Eye-opener in morning to steady nerves or get rid of hangover
- *2 is positive, suggestive of alcoholism
- *3 or 4 is diagnostic
Phenobarbital, Seconal, Amytal
Barbiturates
Barbiturates are a CNS
- depressant
- coma and death are possible
Barbiturates uses
- anxiety
- help people sleep
Symptoms that can occur while on barbiturates or even while detoxing from
anxiety, muscle twitching, tremors, dizziness, N/V, orthostatic hypotension
____withdrawal of barbiturates for detox
- gradual
- symptoms begin 8 hours after last dose
- if stop cold turkey (more severe symptoms)
Ativan, Klonopin, Valium, Xanax
Benzodiazepines
Gamma Hydroxybutyrate (GHB)
- Liquid X, Liquid Ecstasy, Georgia Homeboy
- mixing with alcohol can lead to death
- PO, snorted, injected
Glue, rubber cement, hair spray, etc
- Inhalants
- dangerous bc amount inhaled cannot be controlled
- death from asphyxiation, suffocation, choking on vomit
- cross blood brain barrier quickly
Big side effect of inhalants
- mouth ulcers
- also GI problems, anorexia, confusion, HA, ataxia
Dilaudid, Demerol, Oxycontin, Heroin, Fentanyl, Codeine
- Opioid’s, Narcotics
- swallowed, injected, snorted, smoked
- CNS depressant (drowsiness or nodding and sleep are common effects)
What class is the only one with an antidote
- Opioids
- Narcan
Withdrawal and detox from CNS depressants
- leg spasms
- yawning
- piloerection (goosebumps)
- restless; irritable
- diarrhea, vomiting
- can last up to one week
What med can help with cravings of CNS depressants
Clonidine (CCB used for BP)
-patch is good for a week to help with side effects and take edge off
Methodone
- helps prevent withdrawal symptoms
- very addictive
What class of drug is Cocaine
stimulant
Cocaine
- white, odorless powder
- introduced as anesthetic
- psychological dependence greater than physical
- don’t need meds to help them detox
- may get anti-anxiety to help nerves
Formication
- believe bugs under skin or sense foul smell
- common in cocaine users
Crack
- smoked, cheaper than cocaine
- AKA “rocks”
- mixed with baking soda, water, heated and hardened
- will have dilated pupils, increased BP, paranoid
- worry about pt with hypertension and arrhythmia
Adderol, Speed, Crank, Ice, Meth
Amphetamines
Amphetamines
- high will last longer with these (may look manic)
* not eating, sleeping, all over the place
Methamphetamine (crystal meth)
- longer high than cocaine, less expensive
- don’t sleep, eat
- DENTAL problems
- intense feeling of pleasure
- paranoid
- RAGE when high wears off (tweaking)
Ecstasy
- club drug
- heightened sexuality, decreased inhibition
- psychedelic effects
- can cause tachycardia, dry mouth, increased BP
- memory impairment
- serotonin syndrome
- loss of serotonin neurons
Hallucinogens (psychotomimetic)
- heighten awareness or cause terrifying psychosis like reactions
- “bad trip”
Mescaline
- natural from cactus
- colors are vivid; sounds intense
- pupil dilation and tremors
- high can last up to 12 hours
Psilocybin
- mushrooms
- sense of unreality
- perceptual alterations
Marijuana
- most widely used in US illegally
- euphoria, relaxed, increases hunger (munchies)
- red eyes, dilated pupils, increased HR, dry mouth
- antiemetic effects make useful for chemo pt
Lysergic Acid Diethylamide (LSD)
- synesthesia (blending of senses)
- see sounds, smell colors, etc
- flashbacks
- scary; may feel like going crazy
- psychotic episodes
- bad trips, anxiety, paranoia, acute panic
Phencyclidine and Ketamine
- angel dust, PCP, Special K (Ketamine)
- PCP: often go to ER, are very violent
- back an forth between coma and violence
- caution when providing care bc unpredictable
- BP and HR elevated
- blank stare
Salvia
- legal herb
- psychoactive properties
- lasts 1-5 minutes
- increased sights, uncontrollable laughter, visions, improved moods
Nurse Pt Relationship
- build trust (pt safety is priority)
- be genuine, empathetic
- apply rules consistently
- instill hope (careful not to instill false hope)
- confront denial
- manage manipulation
“You say you have not been drinking, but I can smell alcohol on your breath” is an example of
Confrontation
Lifestyle Changes
- exercise increases mental and physical vitality
- relaxation, avoid stress, plenty of rest
- balanced diet
- mineral and vitamin supplementation
- detach from old playmates and playgrounds
The presence of at least on psych disorder in addition to a substance abuse/dependence
Dual Diagnosis
Examples of some dual diagnosis
- Schizophrenia
- alcohol is a depressant and pot is a hallucinogen that relaxes and bring down, cocaine is stimulant that will keep them up
- Depression
- use stimulants to boost energy
- Personality Disorders
- pretty much anything can be used
Issues with treating pt with dual diagnosis
- treatment disrupted (one unit to another)
- some believe detox must occur first
- unrealistic expectations by staff
- difficulty concentrating in group
- funding
Nurses Role
- nonjudgmental
- watch the “wow” factor
- ask pt how substances affect mood
- education about effects of drugs/alcohol
- strategies for relapse prevention
- set limits, enforce rules
- supportive, gentle confrontation techniques
