unit 3 test substance abuse

Question 1

incentive salience

Answer 1

when a person is presented w a stimulus from an addicitve drug, they will experience overwhelming desire to use the drug again

• CNS affected
• leads to high rate of relapse

Question 2

psychological dependance

Answer 2

believes sub needed to function optimally

Question 3

withdrawl concepts-4

Answer 3

• substance specific
• sym not due to med do
• early recognition is critical
• delerium seen if w/d not treated properly

Question 4

4 key concepts of addiction

Answer 4

1. denial
2. rationalization
3. minimization of consequences
4. projection-lays blame outside self

Question 5

CNS depressants-4

Answer 5

1. alcohol
2. sedative/hypnotic and anxiolytic
3. club/date rape drugs
4. opiates/opioids

Question 6

4 phases of alcohol abuse

Answer 6

1. pre-alcoholic- needs to cope, develops tolerance
2. early alcoholic- blackouts/ETOH required/preoccupation w drinking begins
3. crucial phase- control lost, physiological dependance
4. chronic- physical and emotional disintegration, can lead to death

Question 7

wernicke encephalopathy (alcohol)-5

Answer 7

• delirium w cranial nerve dysfunction
• thiamine deficiency
• life threatening w/o thiamine replacement
• “Acute confusion” RN diagnoses
• impaired speech, cognition, orientation, and arousal

Question 8

korsakoffs delirium

Answer 8

delirium w profound loss of recent memory, confusion, and confabulation
-treat w thimine replacement

Question 9

alcohol intoxication char-8

Answer 9

labile mood, impaired judgement, impaired social and occupational funct, slurred speech, incoordination, unsteady gait, nystagmus, flushed face

Question 10

alcohol w/d-4

Answer 10

• symptoms occur 4-12 hrs after last drink
• DTs 5-7 days after
• symptoms peak 24-28 hrs
• risk for seizure give MgSO4

Question 11

delirium tremens (DT)-9

Answer 11

• onset 2-3 days after last drink, peak after 2-3 days
• vivid hallucinations, confusion and disorientation, agitation, autonomic hyperactivity (hyperthermia, HTN, tachycardia, diaphoresis->can lead to death)

Question 12

Alcohol w/d interventions-5

Answer 12

1. decrease environmental stim (low light for illusions)
2. fluids- PO or IV
3. ativan or librium protocol
4. MgSO4- seizures
5. nutritional supplements- multivitamin (b-complex for neuropathies), folic acid, thiamine

Question 13

sedative/hypnotics include 2 drug types

Answer 13

1. barbituates-seconal (secobarbital), amytal (amobarbital)

2. non-barbituates- chloral hydrate, zolpidem (ambien)

Question 14

anxiolytic/benzodiazepines-3 drugs

Answer 14

alprazolam (xanax), chlordiazepoxide (librium), lorazepam (ativan)

Question 15

perscription drug patters-2

Answer 15

1. prescribed by dr-tolerance, dr shop

2. recreational use illegally

Question 16

club and date rape drugs-2 kinds

Answer 16

1. gamma hydroxybutyric acid (GHB)

2. flunitrazepam (rohypnol)

Question 17

sedative/hypnotic/anxiolytic/date rape intox symptoms-7,6

Answer 17

• ataxia, slurred speech, drowsiness/sedation, N/V, resp depression, decreased LOC
• disorientation, labile mood, disinhibited aggressive or sexual drives, impaired judgement/social funct/attention/memory, irritability

Question 18

sedative/hypnotic w/d symptoms-6

Answer 18

• autonomic hyperactivity-elevated vitals, sweating, tremors, anxiety, N/V, insomnia
• delirium 4-7 days

Question 19

sedative w/d interventions-5

Answer 19

decrease environmental stimuli,

seizure precautions, administer benzos or barbituates, fluids, abrupt w/d can lead to death

Question 20

pseudo addiction

Answer 20

symptoms develop from inadequate pain mgt

Question 21

opiate intoxication symptoms-3

Answer 21

1. initial euphoria
2. apathy, dysphoria, and impaired judgement
3. slurred speech, impaired memory, constricted pupils

Question 22

opiate overdose symptoms-3

Answer 22

dilated pupils, depressed resp, change in LOC

• can lead to coma, seizures, death
• assess for suicide if intentional

Question 23

opiate w/d symptoms-9

Answer 23

• sweating, rhinorrhea, piloerection, tremors, irritability
• severe weakness, diarrhea, fever, muscle spasms
• not life threatening

Question 24

opiate w/d interventions-5

Answer 24

• narcan-w/d in 10 min
• clonidine- mon BP
• methadone-heroine
• fluids
• treat somatic symptoms

Question 25

stimulant drug types-4

Answer 25

1. amphetamines 2. cocaine 3. synthetic stimulants 4. prescription non-amphetamine stim drugs

Question 26

cocaine change in brain chem

Answer 26

imbalance of dopamine and norepi

Question 27

amphetamine change in brain chem

Answer 27

destroy brain cells that contain dopamine and seratonin

Question 28

amphetamine and cocaine med emergency-3

Answer 28

chest pain, irregular pulse, or hx of heart disease

Question 29

amphetamine intox sym-4

Answer 29

1. increased energy and euphoria 2. impaired judgement, hypervigilance, irritability, psychomotor agitation 3. delerium and delusional 4. acute cardio effects - high risk for violence

Question 30

tweaking safety-6

Answer 30

- most dangerous - 7-10 ft distance - slow low voice - slow movements - keep hands visible - keep them talking to keep delusions at bay

Question 31

amphetamine w/d sym-4

Answer 31

not life threatening - "crashes" - wakes w ravenous appetite - starts to crave

Question 32

cocaine w/d

Answer 32

can precipitate suicidal ideation

Question 33

cocaine and meth w/d interventions-4

Answer 33

- decrease stim - inject antipsychotic and benzodiazepine if agitated - antidepressants - bromocriptine-regulation of dopamine and cravings

Question 34

hallucinogen sym-6,5

Answer 34

- tachycardia, dilated pupils, sweating, palpitations, blurred vision, tremors - altered perceptions, depersonalization, paranoia, depression, intense anxiety

Question 35

hallucinogen treatment

Answer 35

-don't leave alone, reassure in plesant environment

Question 36

PCP intox sym-4,2

Answer 36

- beligerance, superhuman stregnth, bizarre behaviors, risk of suicide - haldol and ativan for agitation

Question 37

codependancy char-3

Answer 37

- self worth depends on others - feels responsible for others happiness - commonly denies prob exists

Question 38

RN diagnoses-8

Answer 38

1. ineffective denial 2. ineffective coping 3. imbalanced nutrition 4. risk for infection 5. chronic low self esteem 6. deficient knowledge 7. risk for injury 8. risk for suicide