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NURS363 - Practice of Nursing IV > Week 6 Part 2: Substance Abuse > Flashcards

Week 6 Part 2: Substance Abuse Flashcards

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1
Q

Addiction

A

condition of continued use of substances (or reward seeking behaviors) despite adverse consequences

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2
Q

Withdrawal

A

Painful physical and or psychological that follow that the discontinuance of the substance(s)

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3
Q

Substance Induced Disorder

A

occur when medications used for other medical/mental health disorders cause intoxication or withdrawal or other health problems

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4
Q

Substance Use Disorder

A

occurs when substance use continues despite cognitive ,behavior, and physiological symptoms

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5
Q

Addiction is behavior patterns with…

A

overwhelming compulsive involvement with securing and using a substance

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6
Q

What is there a high tendency for what following drug discontinuation with addiction

A

relapse

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7
Q

Addiction is a disease of ____

A

perception

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8
Q

___ is a major component of addiction

A

Denail

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9
Q

People with addictions refuse to…

A

admit powerlessness over the problems

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10
Q

People with addictions will continue…

A

to use despite the negative consequences

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11
Q

How do those with addictions justify their behavior

A

they justify behaviors and use with blame on external sources for addiction

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12
Q

How big is the incidence of drug abuse

A

10.6% of those over 12 yo use ilict drugs

millions addicted to prescription painkillers, cocaine, hallucinogens, marijuana. alcohol, bing drinking, heavy alcohol use

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13
Q

How many people have a substance use disorder in the US

A

20.1 million people

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14
Q

What sort of substance use misuse is more common in teens and young adults

A

drinking

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15
Q

What groups are more likely to abuse drinking

A

teens and young adults

college students in higher quantities, but lower frequency than non college students

men drink in more harmful ways than women

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16
Q

What ends up being very costly for the US economy regarding drugs

A

abuse of tobacco, alcohol, and ilicit drug abuse

tobacco - 300 billion; alcohol 249 billion; ilicit drugs 193 billion; opioids 78.5 billions

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17
Q

___% of those with a serious mental illness have a ___ ___ ___ some time in their lives

A

50%; substance use disorder

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18
Q

Psychiatric disorders associated with substance abuse

A

acute and chronic cognitive impairment disorders

ADD

BPD and Antisocial PD

Anxiety disorders

depression and higher risk for suicide

eating disorders

compulsive behavior

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19
Q

4 Important theories of addiction

A

biological

psychological

behavior

sociocultural

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20
Q

Biological Theory of Addiction

A

specific effects on selected NTs, NIH

specific genes increase risk for addiction

physiologic mechanisms for compulsion despite consequences –> dopamine adn pleasure

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21
Q

Psychological Theory of Addiction

A

Impulsive and Risk Taking Behavior!!!

Defense against anxious impulses

oral regression (dependency)

Self medication for depression, hallucinations, thought disorders, PTSD, stress response, coping styles

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22
Q

Behavioral Theory of Addiction

A

positive reinforcement effects of drug seeking behavior

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23
Q

Sociocultural Theory of Addiction

A

social and cultural norms

socioeconomic stress

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24
Q

Tolerance

A

the need for higher and hgiher doses to achieve the desired effect

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25
Q

Withdrawal

A

after a long period of continued use, stopping or reducing a drug results in specific physical and psychological s/s

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26
Q

How does tolerance and withdrawal differ

A

Tolerance is needing higher doses for getting an effect, withdrawal is the physical and psych symptoms from discontinued use or not getting enough

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27
Q

The healthy liver can metabolizehow much alcohol per hour

A

1 ounce of alcohol

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28
Q

What happens to the excess alcohol that the liver cannot metabolize in an hour ?

A

it remains in the blood –> raises BAC/BAL

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29
Q

What BAL (mg%) causes change in mood, behavior, and impaired judgment in a non tolerant drinker

A

0.05%

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30
Q

What BAL (mg%) causes staggering, ataxia, and labile emotions in a non tolerant drinker

A

0.20%

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31
Q

What BAL (mg%) causes coma in a non tolerant drinker

A

0.40%

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32
Q

What BAL (mg%) causes death from respiratory depression in a non tolerant drinker

A

0.50%

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33
Q

BAL can be used to assess what?

A
  1. Level of intoxication

2. Level of tolerance

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34
Q

As tolerance develops, what occurs with the BAL measurement

A

there is a greater discrepancy between BAL and exepcted behavior as tolerance increases

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35
Q

What systems can be damaged and have a comorbidity due to alcohol use

A

GI System

Cardiovascular System

Liver Damage

CNS

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36
Q

What GI system comorbidities can occur from alcohol abuse

A

esophagitis

gastritis

pancreatitis

gastric ulcers

related issues of increased acid production and poor nutrition and absorption

impaired peristalsis

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37
Q

What Cardiovascular system comorbidities can occur from alcohol abuse

A

HTN

Cardiomyopathy

Dysrhythmias

Malnutrition

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38
Q

What is the primary organ for ETOH metabolism

A

Liver

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39
Q

What sort of medical comorbidities can occur from alcohol abuse in the liver

A

Fatty Liver

Hepatitis

Cirrhosis

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40
Q

Clinical Signs of Alcohol Induced Liver Damage

A

reddened palms

contractures and or clubbing of fingers and nails

white nails

NV

enlarged or inflammed liver

elevated LFTs

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41
Q

Comorbidities that can occur in the CNS from alcohol abuse

A

Wernicke’s Encephalopathy

Korsakoff’s Amnestic Syndrome

Thyamine Deficiences

Alcohol Demetia

Blackouts

Intoxication

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42
Q

Wernicke’s Encephalopathy

A

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)

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43
Q

Have to wait for what before doing a lot of nursing care for an alcoholic

A

wait till they sober up and keep them safe in the meantime

44
Q

Korsakoff’s Amnestic Syndrome

A

Comorbidity caused by alcohol in the CNS

gait disturbance, confabulation, disorientation, memory impairment

45
Q

How are Wernicke’s Encephalopathy and Korsakoff’s Amnestic Syndrome related?

A

they are different stages of Wernicke Korsakoff Syndrome

they BOTH are related to thyamine deficiencies from malnutrition

46
Q

Wernicke-Korsakoff Syndrome occurs from what

A

THIAMINE deficiencies due to alcohol abuse

47
Q

Alcohol demetia can lead to…

A

permanent brain damage

48
Q

Intoxication can lead to what bad things

A

fights

impaired judgments

interference with social and occupational functions

49
Q

Confabulations

A

stories made up but to the person seem very real

50
Q

Alcohol Withdrawal Syndrome

A

Withdrawal symptoms from decreasing or witholding from alcohol

51
Q

When do the early signs of alcohol withdrawal syndrome occur? When do the signs peak?

A

Early signs - only a few hours after decreasing alcohol

Signs peak after 24-48 then RAPIDLY DISAPPEAR

52
Q

S/S of Alcohool Withdrawal Syndrome

A

increased heart rate

increased blood pressure

diaphoresis

mild anxiety and restlessness

hand tremors

53
Q

What is a common assessment tool for quantifying alcohol withdrawal syndrome ?

A

CIWA - Clinical Institute Withdraw Assessment

54
Q

(Alcohol) Withdrawal Delirium Tremens (DTs)

A

Delirium occurring from alcohol withdrawal a level above alcohol withdrawal syndrome

55
Q

Withdrawal Delirium Trememns is a..

A

medical emergency that can result in death

56
Q

What do Withdrawal Delirium Tremens signs peak ?

A

Delirium peaks 2-3 days after cessation of alcohol and lasts 2-3 days

57
Q

S/S of Withdrawal Delirium Tremens

A

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

58
Q

it is important to have what precautions in place for DT’s

A

seizure precautions d/t grand mal seizure potential

59
Q

When will the grand mal seizures occur for DTs if they are going to happen

A

within the first 48 hours

60
Q

Common CNS Stimulants that are abused

A

Cocaine

Crack

Amphetamines

61
Q

Common signs of CNS stimulant abuse

A

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)

62
Q

Where does Crack and Cocaine come from

A

Extracted from leaf of a coca bush

63
Q

How long does crack and cocaine take to take effect and what are the effects

A

4-6 seconds for effect

5-7 minute high followed by deep depression

64
Q

2 Main Effects on Body from Crack and Cocaine

A
  1. Anesthetic

2. Stimulant

65
Q

Action of Crack/Cocaine

A

Produces imbalance in NTs –> this leads to severe cravings for the next ingestion

66
Q

Withdrawal Symptoms of Crack/Cocaine

A

Severe anxiety

Restlessness

Agitation

Depression

Cravings

67
Q

Marijuana (Cannabis Sativa)

A

Indian Hemp Plant

THC is the active ingredient in flowering tops and leaves

Usually smoked, can be orally ingested

68
Q

What properties does Marijuana have

A

depressant and hallucinogenic properties

69
Q

Desired Effects of Marijuana

A

Euphoria

Detachment

Relaxation

70
Q

Other/Side Effects of Marijuana aside from the Desired Effect

A

Talkativeness

Slowed perception of time

Inappropriate hilarity

Heightened sensitivity to external stimuli

Anxiety

Paranoia

71
Q

Long Term Effects of Marijuana

A

Lethargy

Anhedonia (w/out pleasure)

Difficulty Concentrating

Loss of Memory

72
Q

Opioids

A

any substance that binds to an opioid receptor in the brain to produce an agonist action

73
Q

What are the 2 important effects producted by opioids?

A

Pleasure

Pain Relief

74
Q

What can occur rapidly from opioids

A

physical dependence can develop rapidly

75
Q

What happens after opioid use is discontinued, after a period of continuous use?

A

A rebound hyper excitability withdraw syndrome usually occurs

76
Q

What is a highly illegal addictive opioid drug

A

heroin

can be sniffed, snorted, smoked ot injected and can lead to sharing needles.

77
Q

Methadone Treatment

A

treatment of daily stabilized dose of methadone for opioid addiction

78
Q

Suboxone

A

Naltrexone + Buprenorphine treatment for treating opioid addiction

79
Q

Hallucinogens

A

LSD or acid - lysergic acid diethylamide

Peyote - Mescaline

Magic Mushroom - Psilocybin

PCP, Angel Dust, Horse Transquilizer, Peace Pill

80
Q

Inhalants

A

Volatile Solvents:

Spray Pain

Glue

Cigarette Lighter Fluid

Propellant Gases used in Aerosols

Computer Cleaning Solvents

Bath Salts!

Synthetic Marijuana!

81
Q

Rave and Techno Drugs/Club Drugs

A

Ecstasy, MDMA, Adam, yaba, XTC, MDA, MDE

Can lead to death

82
Q

SE of Rave and Techno Drugs/Club Drugs

A

Euphoria, increase energy

Increased self confidence

Increased sociability

Feeling of closeness to others

83
Q

Adverse Effects of Rave and Techno Drugs/Club Drugs

A

Hyperthermia

Heart Failure

Kidney

Acute Dehydration

84
Q

Date Rape Drugs

A

Roofies - Rohypnol and GHB - gamma Hydroxybutric acid

85
Q

Date Rape Drugs rapidly produce what effects

A

Disinhibition

Relaxation of voluntary muscles

Anterograde amnesia - cannot make new memories after event and inability to recall sudden trauma

86
Q

What self assessment by the nurse needs to be done to care for drug abuse patients

A

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

87
Q

The wrong choice to make regarding a chemically impaired nurse is…

A

TO DO NOTHING

88
Q

__-__% of practicing nurses are chemically dependent

A

6-8%

89
Q

Co Worker of a Chemically Impaired Nurse Responsibilities

A

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

90
Q

Behaviors seen with the impaired nurse

A

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

91
Q

What is the ANA’s guidelines on chemically impaired nurses

A

alternatives to disciplines or peer assistance programs

92
Q

Things to Assess for Chemically Impaired Clients

A

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

93
Q

Relevant Nursing Dx for Drug Abuse

A

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

94
Q

Aim of Drug Abuse Treatment

A

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

95
Q

Challenges of Drug Abuse Tx

A

matching clients with types of treatment considering various needs

96
Q

What factors influence the interventions and treatment needed for a drug abuse client

A

type of addiction

age

physical health

neurpsychological health; readiness for recovery

financial situation

locaiton of program

length of time of program

family needs

97
Q

Behaviors to be addressed in drug abuse treatment

A

dysfunctional anger

manipulation

impulsiveness

grandiosity

98
Q

Communicate with a drug abuse client in…

A

culturally appropriate ways

99
Q

You ahve to make abstinence and sobriety worthwhile for the client by…

A

making benefits worthwhile for recovery - like giving permissions for stuff

100
Q

The Primary Intervention for Drug Abuse Tx is…

A

Health teaching!!!

101
Q

Things to teach in health teaching

A

promoting healthy activities - facilitate healing, exercise, hobbies, awareness of boredom, emotions, loneliness, past habits that can be triggers for relapse

102
Q

Nurse must evaluate effectiveness of drug abuse treatment by…

A

safety of client through the withdrawal process

Refrained from us

Acknowledges addiction

Developing healthy stress management

ID alternative activities

Active participation in treatment plan

103
Q

Interventions for Drug Abuse

A

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

104
Q

MICA

A

Mentally Ill Chemically Addictive

Dual diagnosed mentally ill and chemically dependent

105
Q

Psychopharm drugs for alcohol and opiates

A

Naltrexone - Revia and Trexan

Acamprosate - Campral

Disulfiram - Antabuse

methadone - dolophine

Naltrexone

Buprenorphine

106
Q

Outcomes would we hope to achieve for drug abuse patients post-treatment

A

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

107
Q

What we hope to see on evaluation of post drug abuse treatment

A

Increased time in abstinence

Decreased denial

Acceptable occupational functioning

Improved amily relationships

Ability to relate comfortably to other individuals

NURS363 - Practice of Nursing IV (17 decks)

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