Substance Use Disorders Flashcards
Define pain
Unpleasant sensory, emotional experience with actual or potential tissue damage
Personal and subjective experience; patient is the most reliable indicator of pain.
What are the types of pain?
- Acute pain
- Chronic pain
- Breakthrough pain
Acute pain results from tissue damage, while chronic pain can be time-limited or last a lifetime.
Differentiate between acute pain and chronic pain.
Differs by duration; acute pain is result of tissue damage and chronic pain can last a lifetime
Chronic pain includes conditions like cancer and noncancer types such as peripheral neuropathy and osteoarthritis.
What is breakthrough pain?
chronic pain with acute exacerbations
What is nociceptive pain?
Physiologic pain resulting from tissue injury (somatic or visceral)
Includes somatic and visceral pain.
What is neuropathic pain?
Pathophysiologic pain resulting from damage to the peripheral or central nervous system
May occur in the absence of tissue damage and inflammation.
List the components of pain assessment.
- Self-report
- Location
- Intensity
- Quality
- Onset and duration
- Aggravating and relieving factors
- Effects on function and quality of life
Comfort-function goal is a key aspect of pain assessment.
What are the pain scales used for assessing intensity?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- Wong-Baker FACES Pain Rating Scale
- FLACC
- Faces Pain Scale-Revised (FPS-R)
- Verbal Descriptor Scale (VDS)
- CPOT
Specific scales cater to different populations, including children and patients in critical care.
What is the hierarchy of pain measures for a patient with dementia (or nonverbal)?
- Obtain self report
- Search for potential causes
- Observe behavior
- Proxy reporting
- Attempt analgesic trial
What is the goal of pain management?
Effective and safe analgesia with optimal relief
Comfort function goal is the responsibility of all members of the health care team.
How do opioid analgesics work?
Act on the CNS to inhibit activity of ascending nociceptive pathways
This mechanism helps reduce the perception of pain.
How do NSAIDs work?
Decrease pain by inhibiting cyclooxygenase (COX), which is an enzyme involved in production of prostaglandins
How do local anesthetics work?
Block nerve conduction when applied to nerve fibers
What are the classifications of analgesic agents?
- Nonopioid (Acetaminophen, NSAIDs)
- Opioid (Mu agonist, agonist–antagonist)
Examples include morphine and buprenorphine.
Fill in the blank: _______ is a common nonopioid analgesic that inhibits COX to relieve pain.
Acetaminophen
What are adjunctive agents in pain management?
- Local anesthetics (lidocaine)
- Anticonvulsants (Gabapentin, pregabalin)
- Antidepressants (TCAs, SNRIs)
- Ketamine
These agents can enhance pain relief when used in conjunction with other analgesics.
What are nonpharmacologic methods in pain management?
- Natural products (herbs, botanicals, vitamins, probiotics)
- Mind and body practices (acupuncture, chiropractic manipulation, massage therapy, yoga, tai chi)
What is opioid tolerance?
Decrease in one or more of the effects; Increase usage needed to effect pain relief
What is opioid physical dependence?
Normal response with opioid use of 2 weeks or more; manifested by withdrawal symptoms
What is substance use disorder (SUD)?
Impaired use of a substance despite major problems, characterized by impaired control, continued use despite harm, and craving
Influenced by genetic, psychosocial, and environmental factors.
List some commonly misused drugs.
- MDMA (Ecstasy)
- Spice (synthetic cannabinoid)
- Bath salts
- Inhalants
- Cannabis
- Cocaine
- Opioids
- Barbiturates
- Amphetamines
- Hallucinogens
Each of these substances has unique effects and potential for abuse.
What are some signs of substance use disorder?
- Mood changes
- Poor hygiene
- Odd sleep patterns
- Frequent injuries
- Relationship difficulties
- Poor job performance
- Social Isolation
- Anorexia
These indicators can help in assessing SUD.
What are the gerontologic considerations with opiates?
- Sensitive to sedation
- Initiate with low dose
- Increased risk for NSAID-induced GI toxicity
- Opioid dose reduction by 25-50%
- Risk for undertreated pain
Risk for undertreated pain exists in older adults.
Opiate risk assessment
- Personal or family history of substance abuse
- Psychological disease
- Sexual abuse history
List common adverse side effects of opiates.
- Sedation
- Respiratory depression
- Nausea/Vomiting
- Hypotension
- Constipation
- Pruritus (rash)
Monitoring and treatment strategies are essential for managing these side effects.
Treatment for opiate induced sedation and respiratory depression
- close monitoring, pulse ox, CO2 monitor (capnography)
- reduce doses or stop giving
- Give reversal agent (Narcan) if severe resp depression
Treatment for opiate induced nausea/vomiting
- IV antiemetics: ondansetron
- Low dose steroid: dexamethasone
Treatment for opiate induced pruritis (rash)
- Dexamethasone or other steroids
- Diphenhydramine or other antihistamines
Treatment for opiate induced hypotension
- Stop giving!
- Give IVF as ordered
- Give ephedrine
Treatment for opiate induced constipation
- Hydration
- Stool softeners
- Bowel regimen
- Peristalsis stimulation drug (metoclopramide)
What is the purpose of a nursing care plan for pain management?
To achieve and maintain the patient’s comfort-function goal
Requires a collaborative and evidence-based approach.
What is the purpose of managing anxiety related to pain?
To enhance the overall pain management experience and improve patient outcomes.
What should be evaluated in pain management strategies?
Effectiveness and appropriateness of the strategies used.
In what situations do most SUD patients seek care through the Emergency Department?
- Requesting detox from substance(s)
- Having suicidal/homicidal ideations as side effects
- Brought in by family/friends for detox
- Brought in by EMS for an acute overdose
What resources are available for patients seeking help for SUD without overdose?
- Psychological evaluation
- In-patient treatment
- Drug rehabilitation counseling (voluntary or involuntary)
What is the Clinical Opiate Withdrawal Scale (COWS)?
A scale used to assess the severity of opiate withdrawal symptoms.
What are some s/s of opiate withdrawal?
- Resting Pulse Rate
- Sweating
- Restlessness
- Pupil size
- Bone or Joint aches
- Runny nose/tearing
- GI Upset
- Tremors
- Yawning
- Anxiety or irritability
- Gooseflesh or Goose “bumps”
What is Wernicke-Korsakoff Syndrome?
A condition caused by thiamine deficiency, leading to encephalopathy and psychosis
Symptoms include vision changes and memory impairment.
What are s/s of Wernicke-Korsakoff Syndrome?
- Vision changes
- Memory impairment
- Dementia
What are short-term used of alcohol considerations for older adults?
- Motor Vehicle Accidents
- Falls
- Drowning
What are long-term use of alcohol considerations for older adults?
- HTN
- Heart disease
- Stroke
- Liver Disease
- Digestive Issues
What does Blood Alcohol Concentration (BAC) measure?
The amount of alcohol in the blood expressed as a percentage (0.08% = 0.08 g of alcohol/100 mL of blood)
Assessment for alcohol abuse
- CNS depression
- GI distress (gastritis)
- Cardiomyopathy
- Pancreatitis
- Hepatitis
- Immunosuppression
- Sexual dysfunction
S/S of delirium tremens in alcohol withdrawal
- Anxiety
- uncontrolled fear
- tremor
- irritability/agitation
- insomnia
- incontinence
- tachycardia
- HTN
- dilated pupils
- hyperthermia
- profuse perspiration
- hallucinations
What are the medical management steps for a patient with acute alcohol intoxication?
- Assess for head injury
- Check for hypoglycemia
- Protect airway
- Hydrate with isotonic IVFs
- Obtain labs
What nursing interventions are critical for a patient with acute alcohol intoxication?
- Monitor neurological status
- Protect airway
- Provide supplemental O2
- Monitor vital signs
What is the nursing goal when managing a patient with alcohol intoxication?
To ensure patient safety and comfort while monitoring their condition.
What are the medical goals in treating Alcohol Withdrawal Syndrome?
- Obtain history of ETOH use
- Manage symptoms
- Prevent injury or seizures
- Replace lost fluids
What should be monitored closely in patients undergoing treatment for Alcohol Withdrawal Syndrome?
- Vital signs
- Blood glucose levels
- CIWA protocol adherence
What does CIWA stand for?
Clinical Institute Withdrawal Assessment for Alcohol.
