SUD w3 Flashcards
__________- unconscious feelings that HC workers have toward patient
- occurs unconsciously displaces feelings r/t significant figures from nurses past onto the patient
- overinvolvement or impairs therapeutic relationship
- nurse must examine own attitude, recognize past experiences may impact their perception and influence how they provide care
countertransference
alcohol craving and acetate
- alcohol breaks down into acetate
- acetate triggers craving for more acetate
- normal drinker = acetate moves through system quickly
- in addiction = acetate accumulates in their body with only one drink bc it is barely processed out (r/t slow filtering of pancreas and liver) so by staying in the body it triggers craving for more acetate
- control is lost and the craving cycle begins
- alcohol and nicotine metabolize into acetate
__________ – excessive use of substance that results in reversible substance specific syndrome
- judgement impaired, inappropriate and maladaptive behaviors, impaired functioning
- CNS changes, disruption in pshysiological and psychological functioning
- Can happen with one time use of substance
- Ex: alcohol – physiological symptoms (slurred speech, poor coordination, impaired memory, stupor, coma) and behavioral symptoms (inappropriate behavior)
substance intoxication
_________– occurs when a person no longer responds to the substance in the way that the person initially responded
- Using increasing amounts of substance overtime to achieve the same level of response and a diminished effect occurs with continued use
- Some substances cause rapid physiological tolerance (cocaine) and some cause tolerance after weeks or months of use (rx pain meds)
- Increased tolerance may result in a person being able to tolerate a higher Blood alcohol level (BAC) while exhibiting fewer symptoms
Tolerance
__________ – co-ocurring mental illness and substance use or addictive disorder
Dual diagnosis
___________ – a set of physiological symptoms that occur when a person stops using a substance
- Specific to each substance
- Mild to life threatening
- The more intense the symptoms = the more likely the person is to start using again
Substance withdrawal
Timing of withdrawal symptoms following alcohol intake
6-12 hours
- Minor withdrawal s/s
- Insomnia
- Tremors
- Mild anxiety
- GI upset
- h/a
- diaphoresis
- palpitations
- anorexia
12-24 hours
- hallucinations – visual, auditory, tactile
24-48 hours
- seizures – generalized, tonic-clonic
48-72 hours
- delirium tremens
- hallucinations – visual usually
- disorientation
- tachycardia
- hypertension
- low grade fever
- agitation
- diaphoresis
s/s ________ withdrawal
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual
s/s ________ withdrawal
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin
alcohol (CIWA)
Opioid (COWS)
treatment: alcohol withdrawal
goals
- control agitation
- decrease seizure risk
- decrease morbidity and mortality
meds
- chlordiazepoxide
- diazepam
- lorazepam
- thiamine - daily replacement critical, give prior to IV dextrose, helps prevent wernickes syndrome
- schedule and PRN dosing for breakthrough autonomic symptoms
- clonidine – HTN
not tested on meds
____________
- most severe form of alcohol withdrawal
- can result in death
- can occur in 48-72 hours after cessation of heavy drinking
- hepatitis or pancreatitis can increase chance
- rare in individuals with good physical health
- risk of being misdiagnosed as a psychiatric disorder
s/s
- agitation
- increased anxiety
- confusion
- tremors
- seizures
- delusions
- hallucinations
- paranoia
- autonomic hyperactivity – tachycardia, diaphoresis, fever, anxiety, insomnia and HTN
delirium tremens (DTS)
treatment: DTS
- prevention
- medicate adequately
- monitor closely
- listen and respond to patients subjective symptoms
- treat complications
- give thiamine and other meds
- life support as indicated
- labs – electrolytes
- hydration
- vitals
- anticonvulsants (phenytoin or phenobarbital) to treat seizures
- oral diazepam to treat symptoms of acute agitation, tremors, impending or acute DTS, hallucinations
- IV lorazepam to treat severe symptoms when delirium appears
- Antipsychotics (haloperidol) prn
- Clonidine to treat HTN
- Oral or IV fluids to treat dehydration exacerbated by diaphoresis and fever
not tested on meds
Treatment: opioid withdrawal
- Give scheduled methadone on time
Nonpharmacological interventions done before prn meds
- Nausea – crackers, ginger ale, tea, flat warm cola
- Muscle aches – hot shower, warm compress
- Anxiety reduction – distraction, relaxation, talk therapy
Pharmacologic interventions
- n/v (Must see emesis before giving) – ondansetron, promethazine PO or rectal suppository (avoid giving IM r/t rush effect)
- anxiety, lacrimation (watery eyes), rhinorrhea – hydroxyzine, avoid benzodiazepines
- insomnia – trazadone
- pain – acetaminophen (long term alcohol use pt may have esophageal varices or gastric ulcers), NSAIDS
- diarrhea – kaopectate (first line), avoid loperamide b/c sedation effect
not tested on meds
treatment: substance use disorder
medication assisted treatment
- combo medication, counseling, and behavioral therapies
pharmacotherapy
- naltrexone
- disulfiram
- clonidine
- acamprosate
reduce cravings and controls withdrawal symptoms for opioid addiction
- methadone – no ceiling effect, monitor closely
- buprenorphine + naloxone
- buprenorphine – ceiling effect, limits OD potential
not tested on meds
__________ syndrome
Neurological disorder caused by lack of thiamine (vitamin B1)
- requires immediate treatment
Develops most often in people with AUD or malnutrition
- Chronic alcoholism decreases intestinal absorption of thiamine
- Must r/o other causes of thiamine deficiency – malnutrition, ED, chronic infections, surgery
Wernicke-korsakoff
Wernicke-korsakoff syndrome: 2 stages
___________
– Acute and reversible
- May clear up within a few weeks of may progress into korsakoffs syndrome (more severe, and chronic)
___________
– chronic and debilitating
- Not reversible
Wernicke encephalopathy
Korsakoff syndrome
- ½ of people with Wernicke encephalopathy eventually develop korsakoff syndrome
Wernicke-korsakoff syndrome: 2 stages
____________: s/s
- Confusion
- Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors
- Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping
____________ s/s:
- Confusion
- Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors
- Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping
- Severe, irreversible persistent memory impairments – problems forming and recalling memories
- Confabulation – unknowingly lying
- Hallucinations
- Repetitious speech and actions
- Problems with decision making
Wernicke encephalopathy
korsakoff syndrome
