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56 Cards in this Set
- Front
- Back
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Nursing and "Brief Intervention" for substance abuse
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- changing client behavior
- limited to four or fewer sessions - lasting few minutes - Based on FRAMES model: Works well when clients express readiness to change their behavior F - feedback - tell the client drinking puts them at risk for serious consequences R - Responsibility - Only client can change behavior A - Advice to Change - offer ways client can reduce the risk, "low risk drinking" or abstinence M - Menu of ways to reduce drinking - keeping a diary of drinking patterns, setting a limit on alcohol intake, identfying and avoid situations, dilute and sip E - empathetic counseling - focuus on warmth and understanding instead of confrontation and blame S - Self efficacy - giving a message of empowerment, emphasize client strenghths |
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Whose study of cocaine was his first prominent and controversial - accomplishment?
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Sigmund Freud
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What was Freuds recognition of cocaine's potential?
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Role as a local anesthetic agent for eye surgery
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What did Freud self administer in a effort to cure migraine and depression?
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Cocaine
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Who offered prohibition-minded Americans a new alcohol- free "temperance drink" compounded from caffeine and cocaine?
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John Pemberton
(each 8 oz glass of Coca colal contained 60mg cocaine) |
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Cocaine
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acts in the brain reward centers to block the reuptake of neurotransmitters, especially norepinephrine an dopamine
- use as anesthesia of the nose during ENT surgery - Crack os a crystallized form of cocaine - associated with chest pain due to MIs, coronary problems and aortic dissections - responsible for ischemic and hemorrhage strokes - craving for cocaine is very common but is not included by DSM-IV-TR meeting the criteria for withdral - tolerance is common - once experience no other drug is as equally powerful - cocain deaths occur from the drug itself, not from abstinence - treatment is to prevent relapse - depression is often a problem during treatment - women are common abusers as men - currently no effective pharmocotherapy for dependence - effectiveness of treatment depends on motivation and level of functioning prior to abuse - Vaccine in research to reduce the psych. effects - help the client choose recovery to promote lifestyle change. Group support - nurse is always in a collab. role - assess for depression |
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Crack
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is a crystallize form of cocaine that can be smoked, gives a brief (5-10min) but almost instantaneous high, and provides cocaine blood levels as high or higer than those that result from IV admin.
- smoked cracked has an addictive potential |
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What is substance abuse?
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- not just use alone
- DSM-IV-TR: a maladaptive pattern of substance use leading to a clinically significant impairment or distress: recurrent substance abuse resulting in one (or more) - in loss of job; - in situation which it is physically dangerous; - related to legal problems; - despite having persisten or recurrent social or interpersonal problems Diagnosing use requires that use continue despite real or potential harm. |
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What is ICD-10 definitionof harmful use?
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causing actual physical or mental damage to the using person
- different form DSM definition: abuser need not actually harm themselves, they only hav to use the drug in hazardous ways |
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What is tolerance?
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acquired resistance to the effects of a drug
- DSM: needing to increase drug dosage or finding decreasing effect from a continuous fixed dosage |
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What is withdrawal?
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maladaptive behavior change, with pysch. and cogn. concomitants, that occurs when the lood or tissue concentrations of the substance decline in a person who had maintained prologned heavy use
- symptoms are relieved by addl. doses |
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What is drug dependence?
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when persons show a set of behaviors associated iwth inability to control use of the drug
- DSM: requires3 (or more) of these characteristics occur withing one year and related to one drug: 1. develop tolerance 2. Manifest withdrawal 3. Use more 4. Try to many times to cut down on use 5. spend a lot of time using and obtaining it 6. give up imp. activites 7. Continue to use despite knowing its effects of physical and pysch. damage |
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What is craving?
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some of the behaviors of persons who abuse or are dependent of drugs
- desire to use any abused subtance at any time - has not been found in to the definition of dependence. |
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What is addiction?
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- some have suggested that addiction may be diagnosed when both tolerance and withdrawal are present
- inabililty to abstain from drug use - combination of craving, compulsive use and relapse - not a term use in the DSM - DSM defines "physiological dependence" - either tolerance or withdral or both are included among the three or more criterial used to establish a person's diagnosis of dependence. - "without physiological dependence" - neither tolerance nor withdrawal has occured, but criteria for dependence have been met |
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History on drug use in US & esp. In the 19th Century
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- fewer drugs
- easier access for children & adults - neither alcolol, cocaine or opiates were effectively restricted - morhine widely use during the civil war to relieve pain - opium were imported yearly in the US - pure preparations of cocaine became readily available - Coca-Cola had cocaine it it - eventually removed by its own manufacturers in 1903 - alcohol was the source of consolation and misery - beer/wine produced & consumed by the Egyptians - Bronx age - had no access to alcohol, human made fermented liquors from algae, tree saps, rice and fruits - marijuanna consuption began ony 1000 yrs - Opium imp. item of commerce in the Mediterranean region over 3500 yrs ago - Cultivation of opium poppies in Europe |
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what are psychoactice substances?
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origins either as plant products or as modern lab. chemicals
- Most commonly used are: 1. Caffeine 2. Nicotine 3. Alcohol 4. Marijuanna 5. Volatile inhalants (paint, glue) - DSM does not recognize caffeine dependency as a psych. conditions despite its habituation and withdrawal symptoms - DSM does define cannabis (marijuanna) dependence and abuse - act on the brain "reward centers" that when stimulated result in inherently pleasurable stimuli - a desired high. - widely distributed in brainstem, midbrain, and forebrain, dopaminergic brain pathways - influenced by the neurotransmitter, dopamine |
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What are considered stimulants?
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act on brain neurotransmitter receptors to produce exicitation
- alertness - aggression - decrease food intake - AMPHETAMINES: cause pyschosis and hallucinations - NICOTINE |
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What are considered hallucinogens?
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produce perceptual and sensory alterations that may involve any sensory modality (vision, hearing, smell, touch and taste)
- frequent hallucinations - MARIJUANNA |
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What drugs are considered depressants?
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act to decrease CNS funtioning, and as with alcohol, their initial effect may be stimulation if inhibitory brain centers are depressed first.
- MARIJUANNA - NICOTINE |
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The control use of tobacco
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- smoking ban in public spaces 1990's
- 1639 banned smoking in NYC - most male smokers protested. Later ruling got over-turned. - perhaps the most widely abused - King James condemnation of 1604 nor his taxation stopped folks from smoking in England - increasing trend of cigar use among young persons |
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Control of Alcohol use
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- prohibition of 18th ammendment of 1920 - led to decrease in to about 2 gal per capita. death from cirrhosis dropped, as did hospital admission and disorderly conduct
- strong prohibition movements in the mid 19th century led to antiliquor laws in a majority of states - early 19th century - yearly consumption average of 7 gal of 200 proof alcohol - National prohibition did result in further, though temp. decrease in per capita consumption - the 18th ammendment repealed in 1933 |
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Control of Cocain and Opiate use
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- the Harrsison Act of 1914 prohibited sale of narcotics and cocaine without prescription
- heroin addition became less afterwards - some believe has had no significant effect on abuse frequency - street prices went up causing cocaine usage to decline a lot - but, not drug use: people use less expensive drugs - heroin - supply of stimulant drugs by doc. prescriptions - amphetamines (synthetic drug proving the high of cocain but lasting longer) - made as rapid inhalers - amphetamine decline in 1960's then increae in cocaine esp. when President Nixon announced and declared victory in his "War agains Drugs" and first lady, Nancy Reagan's "Just Say No" - No matter what the legislation, prohibition on longterm use was very farfetched |
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Which drug kills 70 times more peolpe every year than do heroin adn cocaine combine?
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Tobacco
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Effects of Nicotine
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- difficult in distinguishing which drugs (coca, morphine, nico) when admin. IV b/c the high of all 3
- relaxation and excitation - percieved anxiety is actually the effect of periodic withdrawal relieve only when taken. - studies suggest improves performance in motor tasks but not in cognitive tasks - decrease appetite in more females than males |
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Nicotie: Dependence and Withdrawal
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- withdrawal attributed to psych. distress
- Withdrawal symptoms- mood change, frustration, anger, anxiety, depresson; drowsiness, fatigue, restlessness, difficulty concentrating, or hunger, weight gain, decrease in pulse, EEG alterations, perfmance deficit, sweating - DSM diagnosis: daily use for a while immediate stopping or reductions of use in 24 hours following the symptoms mention above - little distinction between abuse and dependence - Nicotine tolerance - the absence of commond side effects despite high dosage: nausea, dizziness, and rapid heart rate. - Nicoting Withdrawal - occurs even with brief abstinencem as in nonsmoking work places or airplane rides |
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Nicotine Treatment of Dependence
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- 80% - 90% of smokers have high dependence
- withdrawal contributes difficulties of quitting - ex-smokers have just stopped on their own - gum, patches, spray help with early weeks of quitting - relapse if the greates problem when willing to quit - not just due to withdraw, but in social situation which associate with smoking...i.e. drinking or cup of coffee |
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Nurses Role in Nicotine Abuse
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- client education
- primary prevention (Have The Greatest Effect on the Greatest # of persons): community wide edu. efforts to prevent persons esp. children from becoming smokers - Antismoking in schools - no-smoking lesgilation - secondary prevention: encouraging smokers to quits smoking through involement in cessation program i.e. during pregnancy - tertiary prevention: unbiased treatment for those who have smoking related disease |
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What should always be done on persons brought to medical attention for alcohol-related symptoms? And, Why?
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A blood sugar b/c alcohol can significantly lower blood sugar, and symptoms of such hypoglycemia can easily be mistaken for intoxification: This in known as ALCOHOL INDUCED HYPOGLYCEMIA
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Tolerant person to alcohol can perform well at what?
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Blood Levels
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Which system does alcohol strongly inhibits that is closely linked to memory?
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Glutamate system, esp. through the methyl aspartate receptor
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What are the nuerological complications of alcoholism due to nutritional deficiences?
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1. Korsakoffs syndrome
2. Wernicke's Encephalopathy |
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Which neurological complication is associated with dementia, pyschosis, need supportive care, though there's poor cognitive recovery?
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Korsakoff's Syndrome
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Which complication of chronic alcoholism lend it self to delirium with cranial nerve dysfunction; mental status changes, paralysis of extraocular eye movements; due to thiamine deficiency; admin. thiamine - DO NOT give glucose w/o thiamine lead to further neuro damage; excellent recovery with thiamine admin, but residual korsakoff's syndrome?
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Wernicke's Syndrome
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Which particular cancers is associated with longterm excessive alchohol consumption?
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Esophageal and colonic
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T or F: Psych. effects on chronic alcohol abuse include multiple concomitant psych. disorders.
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True
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Which term is used to describe alcohol withdrawal?
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DT- delirium tremens
- often a sign of coexisting serious medical illness: liver disease, pneumonia, GI bleed, hypoglycemia and electrolyte imbalance. All predisposing factors. Onset: 24--72 hours after last drink most dramatic symptoms of alcohol: - seizures (either petit mal or grand mal) - delusions - hallucinations w/ animals, spiders, and insects (can be tactile, too) - delirium, fever, severe agitation - Treatment: Suppress agitation - Chlordiazepoxide, fluids, nutrition (thiamine, vitamins) |
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When should you rule out head injury, subdural hematoma, and meningities via appropriate testing?
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Abnormal mental status that may not due soley to alc. withdrawal
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For the DSM criteria on alcohol abuse and dependence: How is abuse differ from dependence?
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abuse- is diagnosed when drinking problems leads to work, family and hazardous situations
Dependence is diagnosed based on 3 or mords symptoms of withdrawal, tolerance |
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What disoder is defined as, "a compulsion to drink alcohol, causing harm to self and others?"
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Alcoholism
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Dependency of alcohol
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- common among men
- Affects 14% US - Type I involves men and women equally associated w/ environment stress: poverty relatively mild - Type II affects primary men begins in the 20s or earlier binge drinking fun in families genetic |
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Client in Alcohol Withdrawal
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Goals:
- Decrease the need of them wanting it - keep monitoring the symptoms - prevent them from going into DT's - Control the symptoms and maintain safety If left untreated, this is what happens!! - Tremulouness (the shakes 3-36 hours after last dose tremors, lack of appetite, can't sleep, racing HR, agitated, increase BP, n/v - Acute Hallucinatinations anytime after tremors psych.motors agitation, auditory hallucinations - Infamous DT's **see previous info.** |
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What is the purpose of the CAGE questionaire?
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Use to identify persons at potential risk for alcohol dependence
- "Yes" answers to 2 or more constitute a positive for alcohol problems 1. have you ever try to -C- ut down your drinking? 2. Have people -A-nnonyed you by critizing? 3. -G- uilty about drinking? 4. Have you ever need to drink in the morning to steady your nerves or get rid of your hangover (-E- ye opener)? - not use in clinical practice |
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Biological testing for alcoholism:
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- CDT - Carb. Deficient Transferrin
- EDAC test - approved by FDA - expensive - lack of provider awareness |
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Other form of Alcohol Dependence treatement
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- take into account the "natural history," personal goals for change and possibility of remission
- 4- 5 dys detox with benzodiazepine in rapidly decreasing dosages - counseling, suppport group, and med. - through AA persons has complete responsibility for his own recovery; 50% chance of long term abstention -Benzo are stopped after acute detox. - Buspirone - anxiety - Antidepress. med. - who have MDD not indicated for treating alcohol - Disulfiram (antabuse) - prevention of relapse - inhibits a major enzyme in the pathway which metabolized alch; accumulates in the body which makes you ill (flushin, n/v, up to an 1hr) if you continue to drink. in your body for 3dys so not convenient for unplanned binge drinking - Naltrexone - prevent relapse; long acting; orally admin.; antagonist of opiate effects and craving; works better combined with therapy; expensive; risk of producing unacticipated opiate withdrawal' - Acamprosate - available in Europe; not in US; reducing craving through the its effects on NMDA receptors; enhanced by therapy or counseling |
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Nurse's Role in Alcohol abuse
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The acute phase
- period of withdrawal 1. collaborative role 2. monitor 3. intervention to prevent DTs; correct fluid (overhydrated) and electrolytes; perform diagnostic measures to evaluate for other med. conditions associated with alcoholism; establish rapport; look for the most frequent defense mech., DENIAL; approach with firmness and based in reality 4. establlished protocols The recovery phase - the client and providers are establishing a treatmen plan fo rimmediate follow up care - develop a discharge plan with an interdiciplinary team - invitation to attend AA - risk for them to returning to previous social life 3rd phase - in the community, the nurse follow a client to encourage compliance and to engage in activites of such - make sure client has a plan before leaving the hospital |
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What are all chemical derivatives of opium?
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Opiates
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How does opiates have imp. medical use?
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relieving pain and apprehension
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Opiates
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- Tolerance in highly characteristic
- withdrawal occurs in 6-24 hours - was widespread use among US service ment in Veitnam - more likely to become dependent - DSM: abuse occurring in persons who use rarely but find themselves in social or legal difficulties because of that use - withdrawal or tolerance = dependence - in order for treatment to be successful one has to recognize opiate abuse is the way of life - separate the abuser from the junk and resupply with human and spiritual content - Methadone maintenance- bypasses detox process, it is as if you are taking a more acceptable drug - medically prescribed methadone - for street opiates; long acting - orally given; supress craving and withdrawal for IV heroin minus the euphoria or sedation; block the opiate receptors so further IV doses of heroin have no effect & less attractive; safe and does not impair functioning; reduces HIV transmission - some experts still prefer detox following abstinence b/c normally persons who abuse opiates typically abuse other forms of drugs. - Nurses's role is the same for an alcoholic, ( monitor methadone dose and effect) |
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Hallucinogens
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- LDC, mescaine, peyote, psylocybin and MDMA (ecstasy)
- when swallowed cause disturbances of perception or frank hallucinations - dependency is rarely seen - use is intermittent - injury results from dangerous behaviors when under the influence - violent behavior is not often, though reported |
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Inhalants
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- Volatile chemical substances found mostly in often as solvents in common houseold and industrial products paints
- aerosol spray paints - glue - gasoline - aggressive - apathy - poor judgement - hallucination is common - death results from lung or heart complications - adoloscent drug/group activity - found in setting where other drugs aren't frequently available - difficult to control legal access due to the readily availablilty of the organic solvents |
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Cannabis (marijuanna)
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- called "hemp, pot, week"
- plant (leave, stems, resin) contain the psychoactive substance that can be eaten or smoked - euphoria - impairments in memory, judgement, sensory, motor skills - hallucination - anxiety - dysphoria - not regarded as a hallucinogen - physiological dependence is rare vs. psychological - significant negative effect on personal and social functioning |
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Assessment
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- willing to view chemical dependency as a disease
- begins with the client history - assess for symptoms of withdrawal |
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Outcome ID
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- client chooses recovery and establishes a lifestyle that does not requeire use of addictive substances
- 1st. - safe withdrawal - 2nd. - choose recovery and plan changes - 3rd. remain free of substance, first for one day and then every other day of his life - 4th. - Encourage families in not taking on the addict's illness |
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Plannin/ Interventions
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- be available
- find availability of drug treatment programs - will function in a collab. role - establish a relationship, shown by firm kindness - challenge clients denial Behavioral therapy -seeks to understand the drinking behavior of an alcoholic - aimed at changing environmental factors that reinforce drinking Psychoanalytic theory - related to unment needs for oral gratification - symptoms of an underlying problem - aimed at meeting the developmental needs Interpsersonal theory - see the addicts as a person - lost much of his humanity in the process - approach the clients as a caring human being - place full responsibility for the clients recovery in his own hands. Normally addicts see themselves as worthless |
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Evaluation
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- be ready to help a client toward recovery at the level that the client wants
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Codependence
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describe the cluster of behaviors exhibited by family of one hwo is chemically addicted that serve to enable the alcoholic or addict to continue using the substance - avoiding the logical consequences of drinking
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