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37 Cards in this Set

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Interventions for acute alcohol w/drawal
-Physical assessment is KEY!!!
-Vital signs
-CIWA-Clinical Institute Withdrawal Assessment-
-Physical & biological safety is KEY!!!
-CNS depressants
-Fluid replacement- w/d causes fluid loss
-Supplements of Vitamins, Thiamine, Folic acid
CIWA
look over hand out
Interventions for acute alcohol w/drawal: Vital signs
tells if w/drawal is worsening or stabilizing; VS climb if not adequately managed.

Ex: if someone in w/drawal spikes a temp, may not be managed adequately usually used to assess
Interventions for acute alcohol w/drawal
-Supplements
- Vitamins, Thiamine, Folic acid
--->Thiamine can lead to acute & chronic mental status changes
--->Folic acid-prevents anemia, often PO, but can IV, IM, subQ
-->Multivitamin-poorly nourished from alcohol
Interventions for acute alcohol w/drawal
-CNS depressants
-used b/c they are cross tolerant w/ alcohol. They work at the same receptor sites in the brain as alcohol does. Helps to lessen s/s of w/drawal and prevents progression of acute w/drawal syndrome.
common CNS depressants
-Librium-longer acting benzodiazepine-SEVERE w/drawal or has had in past
-Ativan-common protocol
-Phenobarbital-barbituate/anticonvulsant; causes less sedation which allows participation earlier in tx; raises seizure threshold to ↓risk
Knowing & Caring
-Calmly reorient, give one-step directions, & reassure as needed-if anxious, irritable & agitated
-Treat w/ respect and teach that alcohol dependence is a treatable disease-it is essentially a brain disease
-Maintain a professional and therapeutic relationship
-Be aware of your own feelings about alcohol
Relapse Prevention
1.Abstinence
2.Addiction education
3.Motivation
4. Support Network
Relapse Prevention: Motivation
family, job, health, legal issues-evaluate person’s readiness and motivation to acknowledge the problem w/ their alcohol use & whether they are cognizant of need to abstain from consuming alcohol
Relapse Prevention; Support Network
12 Step program; meetings/sponsor-after inpatient hospitalization, some go to halfway house (structured program, live for a period of time, get counseling, peer support) or sober house (home where a # of people live who want to stay sober) or sponsor (go home to live, but rely on sponsor, meetings, 12 Step program)
Post Acute Withdrawal Syndrome (PAWS)
PAWS is a condition that persists after acute w/drawal phase is over; once complete w/drawal, continue to have mild symptoms:
-peak 3-6 months after abstinence begins
-persist up to 24 months after abstinence begins
PAWS Symptoms:
-Inability to solve simple problems
-Inability to think clearly-foggy, difficulty prob.solving
-Emotional overreaction or numbness
-Sleep disturbances, drink dreams; wake w/ cravings
-Inability to handle stress
-Memory impairment
PAWS Symptoms important to remind pt
-remind pt this is transient-reassure will get better, feeling won’t last forever
Meds to assist w/ abstinence
-Disulfiram (Antabuse)
-Naltrexone (Revia/Vivitrol)
-Acamprosate (Campral)
-SSRIs
-Disulfiram (Antabuse)
-causes distressing symptoms, including flushing, headache, nausea, & vomiting, if a person drinks alcohol while taking the drug.
-can be triggered after drinking 1/2 glass of wine or half a shot of liquor & last from 1/2 hr-2, depending on dosage of the drug & amount consumed.
-taken once a day, but effect can last up to 2 wks
-OD dangerous; low bp, chest pain, SOB, death.
Studies on effectiveness of -Disulfiram (Antabuse)
-not shown the use of disulfiram to have any effect on staying abstinent, although total number of drinking days was less in people who took the drug.
-may also be more effective in married pt, or family/caregivers, AA "buddies" to ensure med taken
Naltrexone studies
-long acting opiod antagonist, blocks the pleasurable effects & reduce cravings. effective for pt w/ low-med risk along w/ support groups/couseling
-In one 10-wk program, pt who were abstinent only 37% of the time= to 89%, & ave # drinks 9.5 to 2.5.
Naltrexone s/e & interventions
-most common nausea, usually mild and temporary.
-High doses cause liver damage. Check baseline liver function tests. do not be admin to pt who has used narcotics w/i a wk to 10 days.
-Useful for treatment of opiod addiction
Naltrexone doses
Dose: 50mg once daily

(Vivitrol) naltrexone 380 mg delivered intramuscularly every four weeks or once a month.
Acamprosate (Campral) about
-calms the brain & reduces cravings by inhibiting the transmission of the neurotransmitter (GABA).
-one European study, 18% of pts were still abstaining after 1 yr vs only 7% who did not take the drug.
-fully effective after about a week of treatment
Acamprosate (Campral) s/e intervention
-may cause occasional diarrhea
-It should be used along with counseling.
-Combo therapy w/ naltrexone or disulfiram possible
-instructed pt to continue taking even if h/b drinking
-may be taken with or without food
-may cause dizziness/drowsiness caution when driving, op. machinery, or other hazardous activities.
Campral For less serious side effects
-instruct pt continue taking and talk to physician.
-headache, tremor, nervousness, or anxiety stomach pain, constipation, increased appetite, weight gain abnormal vision, difficulty tasting; amnesia, abnormal thinking, tremor, flushing decreased sex drive or impotence
Campral
DOSE: 333mg. 2 tabs three times a day.
Treatment Goal: Sober Living
-Inpatient vs. Out Treatment-depends on severity
-12 Step Programs-AA/NA
-Residential Programs-sober & halfway houses
-Intensive Outpatient Programs
-Group &/OR Individual Therapy
Treatment Goal: Sober Living
-Intervention
-family meet to let pt know how alcohol is affecting everyone; try to get person to agree to tx
Treatment Goal: Sober Living
Relapse Prevention
sober living rarely occurs w/ 1st tx, pt has to want it; usually takes several attempts allowing pt to develop tool box of coping mechanisms & use their adaptive skills
Codependency
-Over involvement in another person’s life w/ constant preoccupation w/ their behavior
-Feeling unnecessarily guilty when not taking care of the other person’s needs
-Codependent partner feels guilt and shame for the users behavior
-codependency cycle themes in the codependency cycle:
Often stems from low self esteem: “My feelings are not important; I’m not good enough; I’m not loveable; my having problems is not acceptable; its not okay for me to have fun; I am responsible for my friend or significant other’s behavior”
---coping mechanism is denial & rationalization
Enabling allows:
-The user to continue the problem behavior
-The enabler does not have to acknowledge that anything is wrong (DENIAL)

-Both need counseling & intervention
helpful resources
-Alanon & Alatee; organizations geared to help those who care about someone w/ problem. Similar to NA & AA, but directed to codependent person
How can the nurse help? goals
-Assist both abuser & dependent person
-Help substance abuser to fix both the chemical & psychological bonds they have
-Help codependent individual to understand reason they feel the need for the dependency
Nursing Substance Abuse Rehabilitation Program (SARP) MA State Board of Nursing
-5 year program allows nurses to maintain the license and avoid a record of license disciplines
-Voluntary alternative to complaint resolution process
-Complaints are closed upon a nurse’s admission
-Complaints are dismissed upon successful completion from the program
-Nurse can submit app. if you realize you have a prob
-Program involves monitoring during 5 yrs w/ drug testing, urine testing, AA & NA meetings, counseling
-1st couple of year, probably cannot work as a nurse; may after a periods of sobriety
-Slowly able to admin. non-narcotics/addictive meds
-Over time, gain back all nursing responsibilities
Controlled Substances: Schedule Categories
“I” No accepted medical use
-Heroin, marijuana, LSD, MDMA, GHB, (bath salts, synthetic marijuana)
Controlled Substances: Schedule Categories
“II” High abuse potential w/ severe dependence liability
-Morphine, methadone, oxycodone, amphetamines
Controlled Substances: Schedule Categories III
“III” Less abuse potential than schedule I and schedule II substances
-Acetaminophen that contains limited quantities of certain narcotic drugs
Controlled Substances: Schedule Categories IV
“IV” Less abuse potential than schedule III substances
Phenobarbital, benzodiazepines, propoxyphene (no longer available in US), pentazocine
Controlled Substances: Schedule Categories V
“V” Least abuse potential of scheduled substances
Buprenorphine, propylhexedrine