Substance use live engagement Flashcards
Stimulants
● Highly Addictive
● Increased Cardiac Activity
● Supportive Care
● Priority nursing interventions.
Depressants
● Rapid Tolerance
● Respiratory Tolerance
● Respiratory Depression
● Hypotension, Coma, Death
Inhalants
● Chemicals that produce chemical vapors.
● Rapid absorption by brain.
● Mind altering effects.
● Volatile solvents: ie. glues, nail polish remover
● Aerosols: ie. spray paint, hair spray
● Gases: ie. nitrous oxide, canned whipped cream (whippets)
● Nitrites: ie. room deodorizers
Tolerance vs. Dependence vs. Addiction
● Tolerance: Patient no longer responds to a drug the way they did initially.
○ A higher dose is needed to achieve the same effect.
● Dependence: When not taking the drug, body goes into withdrawal.
○ Must taper down to discontinue.
● Addiction: A disease that can result from continual use of a substance.
○ Unable to stop despite negative life consequences.
What is Ethanol and how
does it affect the body?
Alcohol, or ethanol, is the intoxicating agent
Alcohol, or ethanol, is the intoxicating agent
found in beer, wine and liquor. It affects most
cells in the body and changes levels of
neurotransmitters in the CNS. The acute
effects of Ethanol are dependent on blood
alcohol concentrations as they depress the
CNS.
Differentiate Between:
○ Risky Drinking
○ Binge Drinking
○ Alcohol Use Disorder
○ Acute Alcohol Toxicity
○ Risky Drinking: Consuming alcohol in excess of established guidelines
set forth by NIAAA.
○ Binge Drinking: Alcohol use elevating BAC levels over the legal limit for
intoxication at least once per month.
○ Alcohol Use Disorder: A chronic disease characterized by uncontrolled
drinking, a preoccupation with alcohol and the inability to control drinking
due to both physical and emotional dependence on alcohol.
○ Acute Alcohol Toxicity
■ A serious and sometimes deadly consequence of drinking too much
alcohol in a short period of time. Can impact respirations, gag reflex,
heart rate and body temperature resulting in coma and death.
■ 0.35 g/dL - 0.40 g/dL is potentially fatal for most patients.
Discuss the
pathophysiology of
Intoxication
alcohol (ethanol)
Alcohol (Ethanol) is metabolized by a normal liver at
approximately one ounce of liquor per hour. If more is
consumed the system becomes saturated and the
additional alcohol accumulates in the blood and body
tissues until it can be metabolized by the liver. The
accumulated alcohol leads to behavior changes and
alcohol-induced CNS depression
Discuss the presentation of an
intoxicated patient:
○ Loss of inhibitions.
○ Poor judgment.
○ Objective Signs:
■ Lack of coordination.
■ Unsteady balance.
■ Behaviors include confusion, aggression, inappropriate or
violent behavior.
■ Flushing.
■ Dilated pupils. Ethanol causes pupils to relax and dilate at
slower speeds causing blurred vision and inability to
focus.
■ Incoherent, rambling, slurred speech.
Nursing Interventions for intoxicated pt
Airway
○ Baseline vital signs, monitor.
○ Elevate HOB, bed in low position
○ Suction available
○ Oxygen as needed
○ Administer medications.
○ Clinical Institute Withdrawal Assessment
of Alcohol Scale (CIWA-Ar)
Serum Ethanol Level
○The diagnostic laboratory test to confirm acute
alcohol intoxication, the percent of blood
concentrated with alcohol. Varies due to weight, fat,
tolerance.
○ Legal intoxication level for driving: <0.08 g/dL
○ Example: 100 mg/dL = 0.10 g/dL (move the
decimal point to the left x 3)
Alcohol Withdrawal
Delirium
The greater the dependence on
alcohol, the greater the risk of
alcohol withdrawal delirium. Death
may result from hyperthermia,
sepsis, aspiration pneumonia, or
peripheral vascular collapse.
Airway / Oxygen
CIWA Protocol / Lorazepam
Seizure Precautions
Banana Bag
PAT
Delirium Tremens (DTs)
● Shaking
● Confusion
● Tachycardia
● Tremors
● Hypertension
● Anxiety
● Dilated pupils
● Insomnia
● Seizures
● Shallow Breathing
Alcohol Withdrawal:
Risk for Seizure
Medication
○ Changes in GABA production
(principal inhibitory
neurotransmitter) increases
seizure risk.
○ Subject to level of dependency
and presence of other changes.
Medications: Benzodiazepines
Medications: Benzodiazepines
Medications: Benzodiazepines
○ BZD’s are given to a patient experiencing alcohol withdrawal to
control neuronal hyperactivity with minimal respiratory and
cardiac depression along with anticonvulsant properties. The
goal is to prevent progression to more severe states of
withdrawal. P.O. administration is preferred, IM is unpredictable.
The muscle relaxant qualities control trembling and ataxia.
○ Use caution with hepatic disease, BZD’s are metabolized by the
liver.
○ Reversal Agent: Flumazenil (Romazicon)
Medications: “Banana Bag”
○ Thiamine 100 mg: Ethanol interferes with thiamine uptake
in the GI trace, disrupts storage in the liver and
transformation of thiamine into active form
○ Folic Acid 1 mg: Chronic alcohol consumption leads to
deficiency, intestinal malabsorption, decreased hepatic
uptake, and increased body excretion, mainly via urine.
○ Magnesium Sulfate 3 gm: Deficient in chronic alcoholism,
increased osteoporosis and CV disease r/t altered platelet
function.
○ Multivitamin 1 ampule: Related to malnutrition
Wernicke-Korsakoff Syndrome
Wernicke-Korsakoff Syndrome
Common in malnourished chronic alcoholics. A result of
thiamine deficiency that can lead to atrophy and/or infarction
of specific regions of the brain leading to encephalopathy
(brain disease, damage) which can result in death.
