Week 6 Part 2: Substance Abuse Flashcards
Addiction
condition of continued use of substances (or reward seeking behaviors) despite adverse consequences
Withdrawal
Painful physical and or psychological that follow that the discontinuance of the substance(s)
Substance Induced Disorder
occur when medications used for other medical/mental health disorders cause intoxication or withdrawal or other health problems
Substance Use Disorder
occurs when substance use continues despite cognitive ,behavior, and physiological symptoms
Addiction is behavior patterns with…
overwhelming compulsive involvement with securing and using a substance
What is there a high tendency for what following drug discontinuation with addiction
relapse
Addiction is a disease of ____
perception
___ is a major component of addiction
Denail
People with addictions refuse to…
admit powerlessness over the problems
People with addictions will continue…
to use despite the negative consequences
How do those with addictions justify their behavior
they justify behaviors and use with blame on external sources for addiction
How big is the incidence of drug abuse
10.6% of those over 12 yo use ilict drugs
millions addicted to prescription painkillers, cocaine, hallucinogens, marijuana. alcohol, bing drinking, heavy alcohol use
How many people have a substance use disorder in the US
20.1 million people
What sort of substance use misuse is more common in teens and young adults
drinking
What groups are more likely to abuse drinking
teens and young adults
college students in higher quantities, but lower frequency than non college students
men drink in more harmful ways than women
What ends up being very costly for the US economy regarding drugs
abuse of tobacco, alcohol, and ilicit drug abuse
tobacco - 300 billion; alcohol 249 billion; ilicit drugs 193 billion; opioids 78.5 billions
___% of those with a serious mental illness have a ___ ___ ___ some time in their lives
50%; substance use disorder
Psychiatric disorders associated with substance abuse
acute and chronic cognitive impairment disorders
ADD
BPD and Antisocial PD
Anxiety disorders
depression and higher risk for suicide
eating disorders
compulsive behavior
4 Important theories of addiction
biological
psychological
behavior
sociocultural
Biological Theory of Addiction
specific effects on selected NTs, NIH
specific genes increase risk for addiction
physiologic mechanisms for compulsion despite consequences –> dopamine adn pleasure
Psychological Theory of Addiction
Impulsive and Risk Taking Behavior!!!
Defense against anxious impulses
oral regression (dependency)
Self medication for depression, hallucinations, thought disorders, PTSD, stress response, coping styles
Behavioral Theory of Addiction
positive reinforcement effects of drug seeking behavior
Sociocultural Theory of Addiction
social and cultural norms
socioeconomic stress
Tolerance
the need for higher and hgiher doses to achieve the desired effect
Withdrawal
after a long period of continued use, stopping or reducing a drug results in specific physical and psychological s/s
How does tolerance and withdrawal differ
Tolerance is needing higher doses for getting an effect, withdrawal is the physical and psych symptoms from discontinued use or not getting enough
The healthy liver can metabolizehow much alcohol per hour
1 ounce of alcohol
What happens to the excess alcohol that the liver cannot metabolize in an hour ?
it remains in the blood –> raises BAC/BAL
What BAL (mg%) causes change in mood, behavior, and impaired judgment in a non tolerant drinker
0.05%
What BAL (mg%) causes staggering, ataxia, and labile emotions in a non tolerant drinker
0.20%
What BAL (mg%) causes coma in a non tolerant drinker
0.40%
What BAL (mg%) causes death from respiratory depression in a non tolerant drinker
0.50%
BAL can be used to assess what?
- Level of intoxication
2. Level of tolerance
As tolerance develops, what occurs with the BAL measurement
there is a greater discrepancy between BAL and exepcted behavior as tolerance increases
What systems can be damaged and have a comorbidity due to alcohol use
GI System
Cardiovascular System
Liver Damage
CNS
What GI system comorbidities can occur from alcohol abuse
esophagitis
gastritis
pancreatitis
gastric ulcers
related issues of increased acid production and poor nutrition and absorption
impaired peristalsis
What Cardiovascular system comorbidities can occur from alcohol abuse
HTN
Cardiomyopathy
Dysrhythmias
Malnutrition
What is the primary organ for ETOH metabolism
Liver
What sort of medical comorbidities can occur from alcohol abuse in the liver
Fatty Liver
Hepatitis
Cirrhosis
Clinical Signs of Alcohol Induced Liver Damage
reddened palms
contractures and or clubbing of fingers and nails
white nails
NV
enlarged or inflammed liver
elevated LFTs
Comorbidities that can occur in the CNS from alcohol abuse
Wernicke’s Encephalopathy
Korsakoff’s Amnestic Syndrome
Thyamine Deficiences
Alcohol Demetia
Blackouts
Intoxication
Wernicke’s Encephalopathy
Comorbidity caused by alcohol in the CNS
a degeneerative brain disorder, caused by Thiamine deficiency
Leads to inability to learn new information, recall remote information, unsteady gait, myopathy (muscle weakness and wasting, as well as pain and tenderness)
Have to wait for what before doing a lot of nursing care for an alcoholic
wait till they sober up and keep them safe in the meantime
Korsakoff’s Amnestic Syndrome
Comorbidity caused by alcohol in the CNS
gait disturbance, confabulation, disorientation, memory impairment
How are Wernicke’s Encephalopathy and Korsakoff’s Amnestic Syndrome related?
they are different stages of Wernicke Korsakoff Syndrome
they BOTH are related to thyamine deficiencies from malnutrition
Wernicke-Korsakoff Syndrome occurs from what
THIAMINE deficiencies due to alcohol abuse
Alcohol demetia can lead to…
permanent brain damage
Intoxication can lead to what bad things
fights
impaired judgments
interference with social and occupational functions
Confabulations
stories made up but to the person seem very real
Alcohol Withdrawal Syndrome
Withdrawal symptoms from decreasing or witholding from alcohol
When do the early signs of alcohol withdrawal syndrome occur? When do the signs peak?
Early signs - only a few hours after decreasing alcohol
Signs peak after 24-48 then RAPIDLY DISAPPEAR
S/S of Alcohool Withdrawal Syndrome
increased heart rate
increased blood pressure
diaphoresis
mild anxiety and restlessness
hand tremors
What is a common assessment tool for quantifying alcohol withdrawal syndrome ?
CIWA - Clinical Institute Withdraw Assessment
(Alcohol) Withdrawal Delirium Tremens (DTs)
Delirium occurring from alcohol withdrawal a level above alcohol withdrawal syndrome
Withdrawal Delirium Trememns is a..
medical emergency that can result in death
What do Withdrawal Delirium Tremens signs peak ?
Delirium peaks 2-3 days after cessation of alcohol and lasts 2-3 days
S/S of Withdrawal Delirium Tremens
Autonomic hyperarousal
Disorientation and clouding or changes in level of consciousness
Visual or tactile hallucination
Hyper-excitability to lethargy
Paranoid delusions, agitation
GRAND MAL SEIZURES
it is important to have what precautions in place for DT’s
seizure precautions d/t grand mal seizure potential
When will the grand mal seizures occur for DTs if they are going to happen
within the first 48 hours
Common CNS Stimulants that are abused
Cocaine
Crack
Amphetamines
Common signs of CNS stimulant abuse
Dilation of pupils, darting eye movements, avoidance or intense eye contact
Dryness of the oronasal cavity, sniffling
Excessive motor activity, hyperactivity, rapid speech and flight of ideas
Defensiveness (about use)
Where does Crack and Cocaine come from
Extracted from leaf of a coca bush
How long does crack and cocaine take to take effect and what are the effects
4-6 seconds for effect
5-7 minute high followed by deep depression
2 Main Effects on Body from Crack and Cocaine
- Anesthetic
2. Stimulant
Action of Crack/Cocaine
Produces imbalance in NTs –> this leads to severe cravings for the next ingestion
Withdrawal Symptoms of Crack/Cocaine
Severe anxiety
Restlessness
Agitation
Depression
Cravings
Marijuana (Cannabis Sativa)
Indian Hemp Plant
THC is the active ingredient in flowering tops and leaves
Usually smoked, can be orally ingested
What properties does Marijuana have
depressant and hallucinogenic properties
Desired Effects of Marijuana
Euphoria
Detachment
Relaxation
Other/Side Effects of Marijuana aside from the Desired Effect
Talkativeness
Slowed perception of time
Inappropriate hilarity
Heightened sensitivity to external stimuli
Anxiety
Paranoia
Long Term Effects of Marijuana
Lethargy
Anhedonia (w/out pleasure)
Difficulty Concentrating
Loss of Memory
Opioids
any substance that binds to an opioid receptor in the brain to produce an agonist action
What are the 2 important effects producted by opioids?
Pleasure
Pain Relief
What can occur rapidly from opioids
physical dependence can develop rapidly
What happens after opioid use is discontinued, after a period of continuous use?
A rebound hyper excitability withdraw syndrome usually occurs
What is a highly illegal addictive opioid drug
heroin
can be sniffed, snorted, smoked ot injected and can lead to sharing needles.
Methadone Treatment
treatment of daily stabilized dose of methadone for opioid addiction
Suboxone
Naltrexone + Buprenorphine treatment for treating opioid addiction
Hallucinogens
LSD or acid - lysergic acid diethylamide
Peyote - Mescaline
Magic Mushroom - Psilocybin
PCP, Angel Dust, Horse Transquilizer, Peace Pill
Inhalants
Volatile Solvents:
Spray Pain
Glue
Cigarette Lighter Fluid
Propellant Gases used in Aerosols
Computer Cleaning Solvents
Bath Salts!
Synthetic Marijuana!
Rave and Techno Drugs/Club Drugs
Ecstasy, MDMA, Adam, yaba, XTC, MDA, MDE
Can lead to death
SE of Rave and Techno Drugs/Club Drugs
Euphoria, increase energy
Increased self confidence
Increased sociability
Feeling of closeness to others
Adverse Effects of Rave and Techno Drugs/Club Drugs
Hyperthermia
Heart Failure
Kidney
Acute Dehydration
Date Rape Drugs
Roofies - Rohypnol and GHB - gamma Hydroxybutric acid
Date Rape Drugs rapidly produce what effects
Disinhibition
Relaxation of voluntary muscles
Anterograde amnesia - cannot make new memories after event and inability to recall sudden trauma
What self assessment by the nurse needs to be done to care for drug abuse patients
Examine own attitudes, feeligns, and beliefs about addicts and addiction - this may include examining your own use, use by your family members, or friends’ use of addictive substances
Avoid disapproval, intolerance, condemnation, or lack of emotional reaction to client
Develop empathy and the ability to manage the manipulative behaviors and avoid power struggles with the clients
The wrong choice to make regarding a chemically impaired nurse is…
TO DO NOTHING
__-__% of practicing nurses are chemically dependent
6-8%
Co Worker of a Chemically Impaired Nurse Responsibilities
Clear documentation (dates, times, event, consequences)
report facts to nurse manager
Nurse manager then take facts to nursing adminsitration
if no action is taken by nurse manager and co workers behavior continues, take facts to the next level in the chain of command
Behaviors seen with the impaired nurse
Increased pt. complaints of ineffective pain management for assigned patients
Frequency volunteers for alternative shifts
Absenteeism
offers to medicate other patients than assigned
Diversions of medications
Frequent requests for medication wasting
mood swings
agitation, defensiveness, and poor concentration
work and personal appearance deterioration
What is the ANA’s guidelines on chemically impaired nurses
alternatives to disciplines or peer assistance programs
Things to Assess for Chemically Impaired Clients
suicidal or homicidal thoughts or plans
overdose needing immediate medical attn
withdraawal symptoms
physical complications
clients interest in treating addiction
clients and familys knowledge of community resources
safety for those chemically impaired
Relevant Nursing Dx for Drug Abuse
Risk for suicide
Risk for self directed or other direct violence
Ineffective airway clearance
Ineffective breathing pattern
Decreased CO
Deficient fluid volume
Disturbed thought processes
Risk for infection
Imbalanced nutrition: less than body requirements
Aim of Drug Abuse Treatment
Self Responsibility
Hard to give them traction for self responsibilities, but they need to take it when they are chemically dependent and trying to heal
Challenges of Drug Abuse Tx
matching clients with types of treatment considering various needs
What factors influence the interventions and treatment needed for a drug abuse client
type of addiction
age
physical health
neurpsychological health; readiness for recovery
financial situation
locaiton of program
length of time of program
family needs
Behaviors to be addressed in drug abuse treatment
dysfunctional anger
manipulation
impulsiveness
grandiosity
Communicate with a drug abuse client in…
culturally appropriate ways
You ahve to make abstinence and sobriety worthwhile for the client by…
making benefits worthwhile for recovery - like giving permissions for stuff
The Primary Intervention for Drug Abuse Tx is…
Health teaching!!!
Things to teach in health teaching
promoting healthy activities - facilitate healing, exercise, hobbies, awareness of boredom, emotions, loneliness, past habits that can be triggers for relapse
Nurse must evaluate effectiveness of drug abuse treatment by…
safety of client through the withdrawal process
Refrained from us
Acknowledges addiction
Developing healthy stress management
ID alternative activities
Active participation in treatment plan
Interventions for Drug Abuse
Dual Diagnosis - Principles Treat Concurrently
Psychotherapy
Relapse PRevention
Self Help Groups for client and family
12 step programs - AA alcoholics anonymous
Residential programs
Intensive outpatient programs
Outpatient drug free program
Employee assistance programs
MICA
Mentally Ill Chemically Addictive
Dual diagnosed mentally ill and chemically dependent
Psychopharm drugs for alcohol and opiates
Naltrexone - Revia and Trexan
Acamprosate - Campral
Disulfiram - Antabuse
methadone - dolophine
Naltrexone
Buprenorphine
Outcomes would we hope to achieve for drug abuse patients post-treatment
BP will not be compromised
Will have no seizure activity
Will consistently dmeonstrate a commitment to alcohol use control strategies
Will consistently demonstrate acknowledgement of personal consequences associated with drug misuse
Will describe actions to prevent and manage relapses in substance use
What we hope to see on evaluation of post drug abuse treatment
Increased time in abstinence
Decreased denial
Acceptable occupational functioning
Improved amily relationships
Ability to relate comfortably to other individuals
