Test 3 mental health notes Flashcards
A drug, medicine, chemical or toxicant
Substance
ingestion any chemical that affects the body
Substance use
excessive use of a drug in a way that is inconsistent with medical or social norms and despite negative consequences.
substance abuse
Substance abuse involves a __________________ of chemical substances, leading to clinically significant impairment over a 12 month period and at _____________________ of the following problems:
*Inability to perform normal duties at home, school, and work
* Taking part in hazardous situations while impaired, such as driving
*Repeated legal or other personal problems caused by the substance use
*continued use of the substance despite the problems it has caused
1) repeated use
2) at least one
Substance dependence =involves __________________, withdrawal, and compulsive use
tolerance
Substance dependence involves a repeated use of chemical substances, leading to clinically significant impairment over a 12 month period, and _______________________________ of the following problems:
*___________________________-a need for higher and higher doses to a substance to achieve a desired effect
*___________________________-the stopping or reduction of intake that results in specific physical and psychological signs and symptoms (such as tremor, headaches, and other symptoms when alcohol is not available)-course varies with drug
*the substance is taken in ____________________ or for longer periods than intended
*a persistent but unsuccessful desire to control use of the substance
*progressively more time spent in obtaining, using, and recovering from use of the substance
*reduction in normal social or occupational activities
* continued use of the substance despite the problems it has caused
1) three or more
2) tolerance
3) withdraw syndrome
4) larger amounts
use of a substance that results in maladaptive behavior
intoxication
process of safely withdrawing from a substance
detoxification
abuse of more than one substance
polysubstance abuse
a tolerance to the effects of a drug acquired through continuous use
habituation
“substance dependency” =psychological and physiological dependence and drug seeking behavior
*Characteristerics:
*loss of control due to participation in the dependency
* participation in the dependency continues despite associated problems
*tendency to relapse back into the dependency
Addiction
refraining from substance use, goal for each client; although relapse is common and should be expected
complete abstinence
refusal to accept reality or fact, defense mechanism used by clients who have problems with drug abuse or dependency
denial
Common substances abused
central nervous system depressant that is quickly absorbed into the blood stream, most commonly abused substance in the world
alcohol
a lab blood alcohol concentration of 0.08% (80 g/dl) is considered _________________________________ for adults operating automobiles in every US State; death can occur from acute toxicity in levels >0.35% (350g/dl)
legally intoxicated
a lab blood alcohol concentration of 0.08% (80 g/dl) is considered _________________________________ for adults operating automobiles in every US State; death can occur from acute toxicity in levels >0.35% (350g/dl)
legally intoxicated
90% is broken down in the liver
alcohol
the result of excessive alcohol use during pregnancy
Fetal alcohol syndrome
it affects more than 1 child per 1000 live births. it is estimated that as many as 2-5% of first grade students in the US might have this disease
Fetal alcohol syndrome
causes children to have smaller heads (microcephaly), smaller in size at birth, and fail to develop normally
fetal alcohol syndrome
this drug causes infant when exposed in utero have sleeping and eating problems, unusual levels of irritability, and high pitched cries.
cocaine
booze, hooch, moonshine, brew
street names for alcohol
mode of administration for alcohol
orally
relaxation, decreased social anxiety, and maintaining calm; drowning sorrows; peer pressure and makes me feel free
Reasons people give for drinking alcohol
*altered judgement, decreased motor skills, decreased level of consciousness, slurred speech, unsteady gait, aggressive behavior
*with higher doses -vomiting, respiratory depression, aspiration pneumonia, and death
*chronic use
-liver damage (hepatitis and cirrhosis)
cardiovascular damage (cardiac myopathy-enlarged, weak heart muscle), HTN
*erosive gastritis, GI bleeding
8 acute pancreatitis : poor nutrition , anemias, immune dysfunction
Intoxication/overdoses signs
*low degree of dependence-nausea, anxiety, and tremors
* high degree of dependence-usually see effects within 6 to 48 hours of last intake and continue for 3 to 5 days , or as long as 7 days; symptoms include- abdominal cramping, vomiting, tremors restlessness, and inability to sleep, sweating and tachycardia
hypertension, tachypnea, and elevated temperature, and seizures
*delirium tremens (DTs)- medical emergency -severe disorientation, psychotic symptoms (hallucinations) ,
severe hypertension, (all v/s increased, insomnia, cardiac dysrhythmias tremors, delirium, and may progress to death; symptoms begin 48 hours to can last up to 10 days after last drink
* assess for when they had last drink
*detox should take place under medical supervision
* benzo’s help suppress withdrawal symptoms
withdrawal/detoxification from alcohol
a form of amnesia about events that occurred during drinking periods
blackouts
alcoholic encephalopathy (brain disease ,damage, or malfunction which results from severe Vitamin B1 (thiamine) deficiency caused by poor nutrition and symptoms include ataxia (which is a lack of muscle coordination), mental confusion, nystagmus (involuntary eye movement) diplopia (double vision) and can lead to death
Wernicke’s encephalopathy syndrome
alcoholic encephalopathy (brain disease ,damage, or malfunction which results from severe Vitamin B1 (thiamine) deficiency caused by poor nutrition and symptoms include ataxia (which is a lack of muscle coordination), mental confusion, nystagmus (involuntary eye movement) diplopia (double vision) and can lead to death
Wernicke’s encephalopathy syndrome
form of amnesia characterized by a loss of short term memory and inability to learn new skills (caused by a deficiency in the Vitamin B
Korskoff’s psychosis syndrome
sedatives, hypnotics, and anxiolytics includes all CNS DEPRESSANTS SUCH AS BARBITURATES and benzodiazepines
CNS Depressants
downers, Red Devils, blue angels, yellow jackets, candy, barbs
street names for CNS Depressants
sedation and decreased anxiety
intended effects of CNS Depressants
respiratory depression and decreased level of consciousness, cardiac failure, and can lead to death ( no antidote) -ICU-dialysis to excrete
*benzodiazeprines =increased drowsiness and sedation, respiratory depression ( rarely fatal usually only when combined with other CNS depressants FOR both, slurred speech unsteady gait, lack of coordination
intoxication overdose
respiratory depression and decreased level of consciousness, cardiac failure, and can lead to death ( no antidote) -ICU-dialysis to excrete
*benzodiazeprines =increased drowsiness and sedation, respiratory depression ( rarely fatal usually only when combined with other CNS depressants FOR both, slurred speech unsteady gait, lack of coordination
intoxication overdose
symptoms opposite the acute effects of the drug -autonomic hyperactivity ( increased pulse, blood pressure, respirations, and temperature) hand tremors, hallucinations
*aggitation, inseminai, anxiety , nausea, and psychomotor agitation , insomnia, anxiety, nausea, and psychomotor agitation, increased movement, anxiety, pacing, irritability, and diaphoresis
*in severe cases seizures, delirium, and cardiovascular collapse (seen mostly in barbiturate withdrawal)
* taper off over period of days or weeks
withdrawal/ detoxification
from alcohol
drugs that stimulate or excite the Central nervous system; limited clinical use with a high potential for abuse
stimulus
Examples:amphetamines “uppers” example: adderall (can be taken orally, injected IV, or smoked such as crystal meth) popular in the past and used by people who wanted to stay awake and lose weight
*methamphetamine which is closely related to amphetamines which is closely related to amphetamines is more habit forming, longer acting, and more toxic to the CNS, is very dangerous, highly addictive and causes psychotic behavior
CNS depressants
bennies, speed, uppers, pep pills, crystal, crank, meth, speed, ice
Street names for CNS depressants
can be injected, smoked, or inhaled or snorted ) an illegal drug with no clinical use in medicine (this liquid drug is used in ER situations for nosebleeds -vasoconstricts) AND IS A POPULAR RECREATIONAL DRUG BECAUSE OF THE intense and immediate feeling of euphoria (great happiness or well-being) it produces
Cocaine
coke, crack, snow, powder, nose candy, rock
street names for cocaine
increased energy, euphoria, and rush of pleasure
intended effects from cocaine
mild toxicity, talkativeness, impaired judgement, anorexia, elevated vitals, aggression, meth can cause memory loss, compulsive repetitive behavior such as grinding the teeth or picking the skin, and dental problems
*severe effects=extreme irritability, psychosis, seizures, extreme fever, severe elevation of blood pressure and pulse, possible cardiovascular collapse and death
intoxication/overdose of cocaine
(not life threatening ) depression, craving, fatigue, excessive sleeping (sleep for days) anhedonia (inability to experience pleasure from activities usually found enjoyable), and suicidal thoughts, “crashing”
*occurs within a few hours to several days after cessation of the drug
*not treated pharmacologically
withdrawal/detoxification from cocaine
most widely used illicit substance in the United States; can be smoked or eaten- 9% of the users become addicted ``
cannabis (marijuana)
grass, joint, pot, weed, roach, magic brownies
street names for cannabis (marijuana)
Two substances of cannabis that have been approved for treating nausea and vomiting from cancer chemotherapy-others that treat anorexia and weight loss related to AIDS
Marinol and Cesamet
Euphoria and sedation
intended effects for cannabis (marijuana)
impaired motor coordination, inappropriate laughter, impaired judgement, increased appetite, and blood shot eyes, dry mouth, decreased Blood pressure, increased heart rate, and chronic use can lead to lung cancer or other respiratory effects (from inhaling into lungs),
*overdoses do not occur
Intoxication/overdose of cannabis (marijuana)
No physical withdrawal except for possibly some depression and may have craving
withdrawal/ detoxification from cannabis (Marijuana)
popular drugs of abuse because they desensitize the user to both physiologic and psychological pain and induce a sense of euphoria and well being
opioids (narcotics) CNA Depressants
morphine, meperidine (demerol), codeine, oxycodone, hydrocodone, propoxyphene (Darvon), and heroin (illegal substance)
examples of opioids (narcotics)
constricted pupils, depression, drowsiness, euphoria (feelings of great well being) nausea, respiratory depression
signs and symptoms of heroin use
shallow respirations, clammy skin, convulsions, and coma
signs and symptoms of heroin overdose
watery eyes, runny nose, sweating, muscle cramps, loss of appetite, nausea, chills, tremors, panic
signs and symptoms of Heroin withdrawal
smack, dope, horse, dollies, China white, foxy, big daddy, black stuff
street names for opioids or narcotics
oral, smoking, inhalations, IV or injection
mode of administration for opoids or narcotics
people who abuse opioids spend a great deal of their time obtaining the drugs and often engage in ____________ to get them
illegal activity
analgesia, euphoria, and cough suppression
intended effects of opoids or narcotics
impaired judgements, agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory, euphoria ‘
*severe intoxication or overdose can lead to respiratory depression, coma, pupillary constriction (pinpoint, decrease size of pupil) and death
*Antidote-Naloxone (narcan) IV (opoid antagonist, reverses all signs, give every 2-3 hours, may take days for levels to drop below toxic )
intoxication/overdose for opioids or narcotics
very unpleasant, but is not life threatening and can last 5 to 10 days,
watering eyes, sweating, rhinorrhea progressing to piloerection (goosebumps) tremors, irritability , severe weakness, nausea, aching back and legs, dysphoria (state of feeling unhappy or unwell) and yawning N/V/D, HTN, chills, fever
Withdrawal/detoxification from opoids or narcotics
very unpleasant, but is not life threatening and can last 5 to 10 days,
watering eyes, sweating, rhinorrhea progressing to piloerection (goosebumps) tremors, irritability , severe weakness, nausea, aching back and legs, dysphoria (state of feeling unhappy or unwell) and yawning N/V/D, HTN, chills, fever
Withdrawal/detoxification from opoids or narcotics
substances that distort the user’s perception of reality and produce symptoms similar to psychosis including hallucinations and depersonalization
hallucinogens
LSD (lysergic acid diethyamide, PCP (phencyclidine)-designer drugs like ecstasy
examples of hallucinogens
acid, trips, sugar cubes, angel dust, bumps, liquid G
street names of hallucinogens
heightened sense of self and altered perceptions
intended effects of hallucinogens
more psychological than physical such as anxiety, paranoid ideations, ideas of reference, fear of losing one’s mind and potentially dangerous behavior such as jumping out a window in the belief that one can fly, panic attacks and flashbacks, increased blood pressure, pulse and temperature, dilated pupils,
*PCP can cause seizures, coma, and death
intoxication/overdoes of hallucinogens
none but may experience flashbacks for several months *Cravings
withdrawal/ detoxification of hallucinogens
substances that are inhaled for their effects; most commons substances are hydrocarbons found in gasoline, glue, paint thinner, hairspray and spray paint
inhalants
sniff,(inhaled directly from an open container or from a surface upon which the substance has been applied, huff, (inhaled from an inhalant-soaked rag next to or over the mouth or nose, 0r bagged (inhaled from a plastic bag)
modes of administration for inhalants
sniff,(inhaled directly from an open container or from a surface upon which the substance has been applied, huff, (inhaled from an inhalant-soaked rag next to or over the mouth or nose, 0r bagged (inhaled from a plastic bag)
modes of administration for inhalants
poppers, buzz bomb, snappers, rush, laughing gas
street names for inhalants
euphoria
intended effects from inhalants
dizziness, lack of coordination, slurred speech, blurred vision, CNS depression, symptoms of psychosis, respiratory depression, cardiac dysrhythmias, and possible death
* no antidote or treatment for toxicity
intoxication/overdose for inhalants
no withdrawal or detoxifications for inhalants
cigarettes, cigars, and smokeless tobacco
nicotine
relaxation and decreased anxiety
intended effects of nicotine
long term effects (due to carcinogens) include : cardiovascular (hypertension and stroke), respiratory (emphysema, lung cancer), and with smokeless tobacco irritation to oral mucous membranes and cancer; increased Blood pressure and heart rate
intoxications/overdose for nicotine
irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, and difficulty concentrating
Withdrawal/detoxification of nicotine
Pharmacology
alcohol
_______________________ are drugs of choice for decreasing withdrawal symptoms from alcohol and preventing CNS hyperexcitability and prevent seizures (librium, Valium, or Ativan)
benzodiazepines
used to help with alcohol craving sensations
Topamax (anticonvulsant, also for migraines, and zofran (antiemetic)
_________________________ (disulfiram) type of aversion therapy- used to help prevent the use of alcohol by causing a reaction to occur within 5 to 10 minutes of drinking alcohol and last 30 minutes which includes symptoms such as flushing, nausea, and vomiting , thirst, diaphoresis, dyspnea, hyperventilation, throbbing, headache, palpitations, hypotension, weakness, and confusion
must only be used under careful medical and nursing supervision because severe reactions can cause death
Antabuse
inform of potential dangers of drinking any alcohol
abstain from alcohol use 12 hours before taking (must avoid alcohol due to increased risk of reaction
*Advise to avoid any products that contain alcohol such as cough syrups, aftershave, and mouthwash
*takes 14 days to be removed from the body
Antabuse teaching
pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (and also street drugs )
ReVia (naltrexone)
is also used to treat HTN and ADHD, and used to alleviate opiate withdrawal symptoms (vital signs must be monitored carefully
Catapres (opioid withdrawal)
an oral opioid that replaces the opioid to which the client is addicted and is used to treat opioid craving; the purpose is to reduce the craving to ward off withdrawal symptoms
methadone
bupropion- Wellbutrin=treat depression)
is useful in helping individual quit smoking
*nicorette and nicotrol are substances for nicotine
zyban
Nicolette and nicotrol are substitutes
substitutes for nicotine
Type of substance and method of use
Amount and frequency of substance use
age of onset and age of regular use
benefits of use ]
changes in use patterns
periods of abstinence in history
previous withdrawal symptoms
date of last substance used (very important-especially alcohol-watch for withdrawal symptoms 6-48 hours of last drink; DT’s 1-4 days )
proportion of income spent on use
under what circumstances do you use the substance
Assessment
Substance use history
Type of substance and method of use
Amount and frequency of substance use
age of onset and age of regular use
benefits of use ]
changes in use patterns
periods of abstinence in history
previous withdrawal symptoms
date of last substance used (very important-especially alcohol-watch for withdrawal symptoms 6-48 hours of last drink; DT’s 1-4 days )
proportion of income spent on use
under what circumstances do you use the substance
Assessment
Substance use history
Family assessment
history
_______________________ a maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the person who uses substances
Codependence
Family assessment
____________________________ a behavior that seems helpful on the surface but actually perpetuates (makes something continue) the substance use, may happen consciously or unconsciously
Enabling
Use of standardized screening and assessment tools
Example: CAGE in which one positive response to any of the four questions indicates that a more in-depth assessment is needed
C=has anyone ever told you that you should ________________ down on your drinking/drug use?
Cut
Use of standardized screening tools
A=have people _______________________ you by criticizing you for drinking or using drugs?
annoyed
G=have you ever felt __________________ for drinking or using drugs?
guilty
E=have you ever taken an ________________________ (morning drink or drug) to steady your nerves or to get rid of a hangover?
Eye opener
Blackout or loss of consciousness
changes in bowel movements
weight loss or weight gain
experience of stressful situations
sleep problems
chronic pain
concern over substance abuse
cutting down on consumption
Review of systems in assessment
Blackout or loss of consciousness
changes in bowel movements
weight loss or weight gain
experience of stressful situations
sleep problems
chronic pain
concern over substance abuse
cutting down on consumption
Review of systems in assessment
anxiety
risk for injury
ineffective role performance
interrupted family processes
disturbed sensory perception
disturbed sleep pattern
social isolation
Nursing diagnosis
Nursing interventions
___________________ is priority during acute stage and withdrawal
safety
during nursing interventions, assess ______________________frequently
vital signs
During nursing interventions, assess for beginning withdrawal symptoms, and maintain __________________ environment to prevent falls and injury such as bed in low position, call light in reach
Institute seizure precautions
safe
During nursing interventions,
may need one to one supervision for withdrawal symptoms
orient to person, place, and time,
decrease environmental stimuli (decrease noise, light)
speak in a ____________________ voice
low calm
administer withdrawal meds as ordered such as benzodiazepines
monitor for hidden substance abuse during detoxification period
if client is nauseated do not push fluids but offer small amounts of fluids frequently
offer high calorie feedings
assess suicide potential
provide emotional support and reassurance and encourage client to express feelings
educate about addiction and treatment and discuss the consequence of substance use
encourage self-responsibility
steps after speaking in a low calm voice when nursing interventions
Help make a list of fun, recreational activities that would be an alternative to drinking
help client identify their resources for various needs in everyday and stressful situations
Give positive feedback for abstinence on a day by day basis
watch manipulative behaviors
restraints
nursing interventions
