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18 Cards in this Set
- Front
- Back
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List at least three criteria for a diagnosis of substance abuse and at least four additional criteria for a diagnosis of chemical dependency.
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SUBSTANCE ABUSE
(1) failure to fulfill role oblibations (work, school, home) (2) use that presents a danger (driving) (3) recurrent use-related legal problems (driving under the influence , disorderly conduct, arrest for burglary and other crimes. CHEMICAL DEPENDENCY (1) Tolerance-the person needs more of the drug to cause intoxication, or the person experiences decreased effects from previously sufficient amounts. (2) Withdrawal-characteristics withdrawal symptoms occur when the person stops using the drug, or the person must take the same or related substance to avoid withdrawal symptoms. (3) The person uses the drug in larger amounts or for a longer time than planned (binge) (4) The person wishes to stop using or cutd own but is unable to do so. (5) The person gives up formerly important activities (family, entertainment) secondary to drug use. |
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Discuss three theories put forth as possible contributing factors to development of chemical dependency. Identify the most common characteristics of the chemically dependent person.
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Physical Factors Theory is believed that excessive amounts of substances is the immediate cause of addiction.
Genetic Theory is believed that is has yet to be determined if addiction to alcohol and other drugs is based on direct biological transmission or if it is a learned behavior in children who constantly interact with alcohlic or substance-abusing family members. Emotional and Psychological Theory: PSYCHOLOGICAL explanations of drug abuse differ, but generally agree that the person abuses the substance to escape STRESS. Low self esteem is noted as the most potent precipating factor in substance abuse. PSYCHOLOGICAL explanations of drug abuse differ, but generally agree that the dependent person needs the drug to feel good about life and self. The stress theory is compatible with this idea because stress can cause self-worth. CHARACTERISTICS of the chemically dependent person: low self-esteem, difficulties in interpersonal relations; dissatisfication with life; low tolerance for frustration; co-exis |
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List four specific steps in managing chemical dependency.
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Recognition: admitting that you dependent. (2) Intervention, active intervention must occur (3) Treatment CD often responds to structured therapy, rarely does the person see the impact of their behavior and stop using. (4) Recovery is being active in AA or some type of 12 step program.
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Describe signs that you might see in a client that indicate substance abuse, including characteristic behavioral changes and physical signs. Describe the steps of progression to chemical dependency.
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It is hard to distinguish an abuse by appearance. Signs of a substance abuser is one who gets their prescriptions filled early that intended by doctor. One who states they need more medicine than prescribed because it does not work. Weight loss, needle marks, dilated pupils, anemia and uncleaniness is a physical sign. Aggitated or loss of interest in normal activity is a characteristics.
STEPS TO PROGRESSION: |
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Identify at least ten pertinent questions to ask in a nursing assessment for chemical dependency.
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(1) what doe you take to relieve pain or stress (2) do you drink or use chemicals alone or with other (3) what type of beverages do you drink (4) do you combine alcohol and other drugs (5) do you drink at work (6) do you drin and drive (7) have you had any legal problems because of drugs (8) how often do you miss work (9) at what age did you start using (10) in what form do you use the drug
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Describe nursing measures in detoxification of at least four categories of chemicals, including alcohol. State the chemical from which withdrawal is most life-threatening.
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Sedatives you follow protocal and maintain an open airway. Heroin and Narcotics watch vital signs and assess for infections. Speed, Meth you will maintain calm atmosphere and anticipate client acting out. Cocaine the nurse will watch for seiure and control hypertension. Most all detoxes are the same as far as follow protocol and provide safety and assess vital signs. Again, very important to watch vitals and doctor can prescribe valium for comfort from symptoms. Regarding alcohol, a nursing care plan is determined. Withdrawals will occur within 48 to 96 hours. Follow protocol; check vitals every 15 minutes for first 8 to 12 hours, every 30 minutes for 12 hours then every 1 to 4 hours for 12 hours for a total of 96 hours or 4 days after clients last drink. Do not lower blood pressure too quickly. Keep room quiet and calm. I&O, daily weight and caloric intake are documents, small feedings are recommended. Sugar intake is carefully watched and the client may crave sugar. Alcohol is most dangerous to withdraw
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Explain the meaning of refeeding syndrome; describe precautions taken to avoid this condition
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If a drug abuser is severly malnourished careful dietary management is vital and should be rehydrated very slowly. Carbohydrates must be given very carefully. Carbohydrates include Dextrose IV solution, tube-feeding mixture and liquid dietary supplements. The sudden influx of carbohydrates stimulates insulin production and other events that can serioulsy upset electrolyte balance. Refeeding syndrome can cause cardiac failure, hypertension, peripheral edema, neurologic complicaitons and respiratory failure and death. If you introduce carbs too quick to the malnourished client it can upset the bodies metabolism and cause the symptoms above.
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Identify and describe at least three programs or theories for the long-term treatment of chemical dependency.
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After detox the client goes on to either Inpatient or Outpatient treatment and this is usually based on a AA or NA--some type of 12 program, Rational Recovery or Dialectical Behavior Therapy. 12-step program believes CD is an progressive, incurable disease and you must not use to keep the disease in remission. Rational Recovery (RET=rational emotive therapy)is based on a belief that a person's values and beliefs control behavior or a thought that "illogical beliefts influence irrational behaviors." Dialectical Behavioral Therapy was developed by Marsha Linehan specifically to treat ppl with Bordeline Personality Disorder and emphasis the "here and now." The utlimate goal is a "wise mind".
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List and describe the three stages of unmanaged alcohol withdrawal. Define delirium tremens and alcohol hallucinosis.
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Stages: (1) Automonic Hyperactivity, symptoms include elevated vital signs. Presence of tremors is evident at this stage;note they start inside first and the client can subjectively describe but nurse cannot see then they are objective and seen to the nurse; and usually occurs 12 to 18 hours after last drink=Stage 1. (2) Neuronal Excitations. Severe tremors, panis, insomnia and increased agitation. The client is very paranoid and at risk for suicide. (3) Sensory-perceptiual Disturbances. Client will have vivid visual hallucinations such as flashing lights, tonic-clonic seizures and severe agitation. This stage is a medical emergency and can lead to death; it occurs 3 to 4 days after last drink.
Delirium tremens means sudden and severe mental changes and neurologic changes caused by abruptly stopping the use of alcohol. Alcohol hallucinosis means having delusional and vivid hallucinations such as seeing bugs crawling and increased vitals signs. This can last for few days to several weeks. Tachycardia is pr |
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Describe specific nursing care in alcohol withdrawal.
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The nurse needs to observe closely, check vitals every 15 minutes and then 30 and so on. Follow protocol and keep client in a calm environment. Provide frequent, small feedings to avoid refeeding syndrome if malnourished. Administer any PRN meds to reduce seizures. Monitor the vital is most important and report any abnormalities immediately.
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Describe the role of the codependent in alcoholism. Identify how the cycle of dependence is interrupted.
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A codependent is one who has allowed the alcholics behavor to affect them and is obsessed to control the behavior. The role they play is keeping the family together and fending off the creditors. The codependent is often the one the alcholic blames for the entire situation.
To break the cycle the codependent must stop covering up the problem allow the alcoholic to get consequences for their actions like getting fired from work or being embarassed for their actions. Often when codependent gets help they stop covering the alcoholic or they leave and then the alcoholic will get help because there is no one else to blame and the cycle will stop. |
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List the signs of abuse and withdrawal symptoms for sedatives, cannabis, narcotics, cocaine, hallucinogens, anabolic steroids, nicotine, and caffeine.
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Signs of abuse for sedatives, hypnotics is generalized body depression including slurred speech, unsteady gait. Withdrawal symptoms are seizures. CANNABIS signs of abuse are delirium, delusions anxiety or panis. Withdrawal symtoms usually do not appear until after one week of use and include diarrhea, "wet dog" shakes and yawning. NARCOTICS-signs of abuse are drowiness or slurred speech, bradypnea and depression. withdrawal symptoms are body aches, diaphorersis and insomnia. COCAINE. signs of abuse are hyperactivity and sleep disorder. Withdrawal symptoms are aggitation and sleeplessness. HALLUCINOGENS symptoms of abuse are hallucinations auditory and visual; withdrawal may not noticable because hallucinogens are believed to not cause physical dependence. ANABOLIC STEROIDS. symptoms of abuse are increased muscle mass. Withdrawal symptoms are agitations.
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Describe the adverse effects of methamphetamine abuse; identify nursing actions and precautions when dealing with these clients.
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Explain how opiate-blocker drugs (opiate agonists) are used in maintenance programs for narcotic substance abuse.
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Discuss the dangers of abuse of hallucinogens and volatile substances.
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Describe problems related to abuse of over-the-counter drugs; of prescribed drugs.
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Identify and discuss special problems associated with drug abuse in pregnant women, adolescents, and older adults.
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Discuss legal obligations of nurses who believe coworkers are abusing drugs or alcohol.
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