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101 Cards in this Set
- Front
- Back
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abuse of substance:
dependence: |
abuse of substance: someone can abuse a substance but not be dependent on it
dependence: physiological…the body is dependent on the substance…when they are not taking the substance, withdrawal occurs |
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_________causes physiological changes to occur when blood and tissue concentrations of a drug decrease in individuals who have maintained heavy and prolonged use of a substance
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withdrawal
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-________is the most common drug abuse and poses the greatest withdrawal danger
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alcohol
-withdrawal from ETOH is potentially fatal |
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-withdrawal from an opioid or alcohol
which is not fatal? |
-withdrawal from opioid is not fatal, but OD can cause death
-the autonomic nervous system is highly active (seizures can kill you) |
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-substance abuse causes what 3 things:
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-flashbacks
-synergistic effects -antagonistic effects |
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substance abuse
-transitory recurrences of perceptual disturbance caused by a persons earlier hallucinogenic drug use when he/she is in a drug-free state |
Flashbacks
not doing the drug but have a flashback to when you were doing the drug |
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substance abuse
Synergistic or Antagonistic effect?? -when some drugs are taken together, the effect of either or both the drugs is intensified or prolonged |
Synergistic Effects
-all these drugs are CNS depressants -when people take 2 of these drugs together, it results in further CNS depression |
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substance abuse
Synergistic or Antagonistic effect?? -ex: combinations of ETOH plus a benzodiazepine, |
Synergistic Effects
-all these drugs are CNS depressants -when people take 2 of these drugs together, it results in further CNS depression - ETOH and benzos work with each other to make them both stronger |
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substance abuse
Synergistic or Antagonistic effect?? ETOH and an opiate |
Synergistic Effects
-all these drugs are CNS depressants -when people take 2 of these drugs together, it results in further CNS depression |
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substance abuse
Synergistic or Antagonistic effect?? ETOH and a barbiturate |
Synergistic Effects
-all these drugs are CNS depressants -when people take 2 of these drugs together, it results in further CNS depression |
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substance abuse
Synergistic or Antagonistic effect?? -many people combine drugs to weaken or inhibit the effect of one of the drugs |
Antagonistic Effects
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substance abuse
Synergistic or Antagonistic effect?? -cocaine is often mixed with heroin (speedball) |
Antagonistic Effects
-the heroine (CNS depressant) is meant to soften the intense letdown of withdrawal from cocaine (CNS stimulant) |
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substance abuse
Synergistic or Antagonistic effect?? 1 drug weakens the other drug |
Antagonistic Effects
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substance abuse
-what is the opiate antagonist that is given to people who have OD on an opiate (Heroin) to reverse respiratory and CNS depression |
-Naloxone (Narcan)
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Codependence / substance
-people who are codepdent often exhibit |
over-responsible behavior:
doing for others what others could just as well do for themselves |
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Codependence / substance
-behaviors: |
making up excuses, covering up, keep it private from family
-they are prevented from living full and satisfying lives due to thoughts, attitudes, behaviors -they value oneself by what one does, what one looks like,what one has, rather than who they r |
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Codependence / substance
-list of behaviors p. 405 chart |
look it up
define their self-worth as caring for others to the exclusion of their own needs |
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Comorbidity
-_____% of people with mental illness abuse are dependent on substances |
50%
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Comorbidity
-_____risk is 3-4x higher in substance abusers than in the general public (loss of ambition) |
suicide
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medical comorbidity:
if you develop a medical problem with using drugs, it’s related to what? stimulants affect what? alcohol affects what? what is related to?? |
the drug is and what the route of use is
(if the route is IV you are more prone to hepatitis and AIDS), stimulants affect the cardiac system, alcohol is a esophageal area stomach area, ulcers, direct effects on the liver -related to amount and length of time |
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Addiction
-characterized by: |
-loss of control of substance consumption
-substance use despite associated problems -tendency to relapse |
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True or False
Etiology: -alcoholics runs in families |
true
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addiction
-what is a big part of the picture? -what is also part of the problem? |
-part of the picture is RELAPSE
-lack of responsibility is part of the problem |
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addiction
-3 main defense mechanisms |
denial,
projection rationalization -I can quit any time I feel like it. Rationalization is a defense mechanism that involves explaining an unacceptable behavior or feeling in a rational or logical manner, avoiding the true reasons for the behavior. For example, a person who is turned down for a date might rationalize the situation by saying they were not attracted to the other person anyway, |
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addiction
-what is their thinking like?? |
-kind of thinking that is all or none or selective attention
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addiction
-what is their behavior like? |
-behaviors: conflict minimization and avoidance, passivity, and manipulation
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addiction --Physiological factors ** test **
what do they do/cause? |
-they influence addiction
-manipulation (contribute the behavior to the problem that pt) -denial -depression -anxiety -dependency -hopelessness -low self esteem -Psychological Factors: -lack of tolerance for frustration and pain -lack of success in life -lack of affectionate/meaningful relationship -low self-esteem -lack of self regard -risk taking propensity |
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addiction - 3 depressant categories / meds
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-ETOH
-barbiturates -benzos |
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General assessment
-always look at pupils -if they are constricted (suspect ______) -if they are dilated (suspect _______) -blood shot (suspect _____) -alochol: |
-always look at pupils
-if they are constricted (suspect opioids) -if they are dilated (suspect stimulants) -blood shot (suspect marijuana) -alochol: smell on breath |
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General assessment
-how to approach the person |
-nonjudgmental and matter of fact
-if they are making up excuses, that’s a clue for you to assess further -people that are abusing will minimize the amount that they are using |
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Red flags that need further assessment
(5) |
-“you’d smoke dope too if..”
-automatic responses -as if the ? were predicted (“I figured you’d ask me that”) -slow, prolonged response (as if the person were being careful about what to say -can’t provide a drug history |
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three potential reasons that cause patients who abuse substances to feel threatened in their interactions with nurses
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1) concerned about being rejected because not all nurses are willing to care for people w/ addictions
2) people who abuse substances may be anxious about giving up the substance they think they need to survive 3) people addicted to substances often are concerned about failing at recovering |
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Psychological changes
--characteristics associated with substance abuse are (5) |
denial, depression, anxiety, -dependency and hopelessness
-many people drink to self medicate for anxiety and or depression -alcohol is the fastest way to cut anxiety so it’s very reinforcing to drink |
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-Signs of alcohol poisoning include:
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-cool or clammy skin
-respirations less than 10 per min -cyanosis under the fingernails or gums |
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True or False
-as patients age, their symptoms of withdrawal continue for longer periods and are more severe than in younger patients |
true
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Alcohol withdrawal
-Early symptoms: develop when? peak when? |
-early signs develop within a few hours after cessation or reduction of alcohol intake
(6-8 hours is average) -peak after 24 to 48 hours then rapidly and dramatically disappear |
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Alcohol withdrawal
-early symptoms: -what system is heightened? |
may appear hyperalert, manifest jerk movements, irritability, startle easy, experience subjective distress often described as “shaking inside”
-ANS is heightened (elevated vitals, anxiety, irritability, startle reflex, tremors, shaky inside, subjective description/v, lack of appetite, illusions) |
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Alcohol withdrawal / early symptoms
Nurse interventions: |
warm carrying support manner, consistent and frequent orientation to time and place, family and close friends to stay with the pt.
-illusions can be clarified |
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Alcohol withdrawal
CIWA- |
clinical institute of withdrawal assessment
-scoring symptoms and giving benzos based on the score (Ativan quiets the system down and has an antiseizure property) |
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Alcohol withdrawal
-Tremors- |
-tremors can be occurring but may not be visible (touch the person to see if they are there. put their hand in your hand)
-hands out and touch nose, distract them) |
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Alcohol withdrawal delirium
-considered a medical emergency, why? |
-considered a medical emergency and can result in death if not treated
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Alcohol withdrawal delirium
death is usually due to |
sepsis, MI, fat embolism, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide
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Alcohol withdrawal delirium
-peaks/onset ?? -lasts?? |
-peaks 2-3 days (48-72 hours) after cessation or reduction of intake
-lasts 2-3 days |
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Alcohol withdrawal delirium
-withdrawal symptoms is _____ the nures should intervene to prevent? |
heightened
-intervening prevent falls (seizure precautions) padding in bed… manage envt stimuli (keep it low, 1 on 1 attendance) -make sure nutrition and hydration is addressed -give benzos -keep vitals in normal limits |
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Alcohol withdrawal delirium
-after the person is done with withdrawal, the nurse can do what? |
-coping mechanisms (preparing bridges, broken relationships, encourage self responsibility, and owning the behavior)
-- remember that the pt is going to be ambivalent and fear that they will fail |
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Planning
-it is safest to propose _________ as a treatment goal for all addicts |
abstinence
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Implementation
-aim of treatment is ___________, not compliance |
self-responsibility
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Counseling and Communication techniques
focus: functional behaviors like? -what is a gradiosity thought? |
-(anger, manipulation, impulsiveness, grandiosity)
-grandiosity thought: I can quit anytime I want -lack of responsibility, they blame |
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guidelines for the nurse
what can the nures use for leverage of strength |
periods of sobriety
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Health promotion and teaching
-brief interventions based on the FRAMES model to effect behavior change -key interventions are: |
F-feedback of personal risk
R-responsibility of the patient (personal control) A- advice to change M- menu ofw ays to reduce substances use (ptions) E- empoathetic counseling S- self-efficacy or optimism of the pt |
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Relapse prevention
-goal of relapse prevention: |
help pt learn from these situations so periods of sobriety can be lengthened over time and lapses and relapses are not viewed as total failure
-relapse can result in a renewed and refined effort toward a change -learn from relapse is the main goal |
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Relapse prevention
-general strategies for relapse prevention and cognitive and behavioral (3) |
1) recognizing and learning how to avoid/cope with threats to recovery
2)learning how to participate fully in society w/o drugs 3) securing help from other people or social support |
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Relapse prevention
-focus on what? -don't convey what? identify what 2 things? |
-focus on success
-don’t convey that relapse means failure, it’s expected part of the disorder -identify support systems (main problem lack of interpersonal relationships and support) -identify triggers |
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Pharmacology treatment of alcohol
-meds that reduce craving like what?? |
-antabuse:
(what do you teach?) -if you ingest alcohol you get violently ill -know its different -teach that there is alcohol in food items (cough items, candys) |
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Relapse prevention
look at page |
423 for interventions (chart)
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Cocaine and Crack
-when crack is smoked, it takes effect in ______, producing a fleeting high (5-7 min) followed by a period of _____________that reinforces addictive behaviors and continued use of the drug |
4-6 seconds
deep depression |
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Cocaine and Crack
-cocaine = substance II (high potential) -2 main effects on the body |
1) anesthetic (for pain)
2) stimulant for sexual arousal and violent behavior |
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-includes opium, morphine, heroin, codeine, fentanyl, methadone, meperidine
are all examples of: |
Opiates
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CNS stimulants
-3 common symptoms |
-common signs include:
-dilation of pupils -dryness of the oronasal cavity -excessive motor activity |
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CNS stimulants
--all stimulants (increase or decrease) the normal functioning of the body and affect the CNS 3 examples of stimulants |
accelerate (increase)
-ex: cocaine, crack, amphetamines, |
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Opiates
-most widely used? |
heroin
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Opiate symptoms:
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decreased RR,
drowsiness, decreased BP vitals are down, slurred speech restricted pupils, |
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Opiate/ Heroin toxication withdrawals (phase 1 and 2)
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-1st phase: euphoria, can be sexual (facial flushing, deepening of voice)/rush that occurs immediately after injection
-2nd phase: “the high” –sense of well being, can go for several hours |
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Opiate/ Heroin toxication withdrawals (phase 3 and 4)
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-3rd phase: “the nod” –escape from reality that can range from lethargy to virtual unconsciousness
-4th phase: period before withdrawal occurs -often seek more of the drug in order to avoid withdrawal |
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-w/drawl from a substance is not life threatening but OD is
true or false |
true
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Opioid treatment
is what drug: when should you give the drug? |
-methadone
-meds should not be given until the symptoms of withdrawal are seen |
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treatment for?
methadone -tell me about it |
opioids
-addicting -given daily -only med approved for pregnant woman (baby needs to be weaned) -if you stop taking it, you go through withdrawals |
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-Oxycotin is common opiod addiction
true or false |
true
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Disulfiram (Antabuse)
--used with what kind of pts? |
motivated pts who have shown the ability to stay sober
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Disulfiram (Antabuse)
-what priciple does it work off of? |
-works on the classical conditioning principle of inhibiting impulsive drinking because the pt tries to avoid the unpleasant physical effects caused by alcohol-disulfiram reaction
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Disulfiram (Antabuse)
-reactions if pt drinks alochol when they take this drug? -adverse reaction begins within how many minutes? -how long will they last? symptoms are followed by what??? |
-facial flushing, sweating, throbbing, h/a, neck pain, tachycardia, respiratory distress, decrease in BP
and n/v -adverse reaction begins within minutes to 30min after drinking and may last 30-120 min -symptoms are followed by drowsiness and are gone after the person naps -must be taken daily |
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Disulfiram (Antabuse)
-most effective when? |
-most effective in the recovery process
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Disulfiram (Antabuse)
-pt must be informed that any substances that contain alcohol can trigger side effects |
-alcohol can be hidden in food, medicines, preparations that are applied to skin, avoid inhaling fumes and substances that might contain alcohol such as (paints, wood stains, tripping compounds)
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why are benzos useful for treating alcohol withdrawal?
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they produce a calming effect
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"alcohol is no problem to me. i can quit anytime i want to" is an example of which defense mechanism
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denial
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while helping the individual plan for ongoing treatment, what is the 1st priority for safe recovery?
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client strives to maintain abstinence
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opioid withdrawal symptoms
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resemble the flu
running nose tearing diaphoresis muscle aches cramps chills fever |
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are tremors an early or late sign of alcohol withdrawal?
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early
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what are the 2 dangerous symptoms in CNS stimulant over dose?
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hyperpyrexia and convulsions
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opiate over dose results in what??
BP HR RR |
decrease BP
decrease RR icnrease HR |
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cocaines 2 main effects on the body is:
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anesthetic
stimulant |
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what is an appropriate logn term goal/outcome for a recoverign substance abuser would be that the client will
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abstain from the use of mood altering substances
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what can relapses do?
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point out problems to be resolved and can result in renewed efforts to change
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initial counselign interventions for a nurse when caring for a chemically dependent patient is to:
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look for therapetuic leverage by making sobrity and abstinence worthwhile
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optimal time for group therapy for a pt with dual diagnosis is:
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during inpatient treatment
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CNS stimulant intoxication
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dilation of pupils
dryness in nose excessive motor activity |
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what is characterized by both physiological and physological withdrawal symptoms
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addiction
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what goal for treatment of alcoholism is priority
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achieving physiological stablity
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what refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for their actions
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codependence
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Opiates
intoxication symptoms |
constricted pupils
decreased RR drowsiness decreased BP slurred speech motor retardation |
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Opiates
intoxication - psychological perceptual: |
inital euphoria followed by dysphoria and impairement of attention judgement and memory
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Opiates
effects of overdose |
possible dilation of pupils due to anoxia
respiratory depression or arrest coma shock convulsions death |
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Drug treatment of patients with alcohol withdrawal
what are the 4 drug classes |
benzos
beta adrenergic blockers alpa adrenergic blocks antiepileptics |
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Drug treatment of patients with alcohol withdrawal
benzodiazepines purpose: |
decrease withdrawal symptoms
stablize vital signs prevent seizures and delirium |
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Drug treatment of patients with alcohol withdrawal
alpha adrenergic blockers purpose: |
reduce autonomic withdrawal symptoms
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Drug treatment of patients with alcohol withdrawal
antiepileptics purpose: |
decrease withdrawal symptoms and prevent seizures
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Drug treatment of patients with alcohol withdrawal
beta adrenergic blockers purpose: |
stabalize vital signs
decrease craving reduce autonomic withdrawal symptoms |
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stimulants
intoxication symptoms: |
tachycardia
dilated pupils elevated BP n/v insomnia |
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stimulants
effects of over dose |
respiratory distress
ataxia hyperpyrexia convulsions coma stroke MI death |
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CNS depressants
Barbiturates Benzos Alcohol intoxication symptoms |
slurred speech
incordination unsteady gait drowsiness decreased BP |
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CNS depressants
alcohol effects of withdrawal |
n/v
tachycardia diaphoresis anxiety or irritablity tremors marked in somnia grand mal seizures after 5-15 years of heavy use: delirium |
