Psych Ati Ch. 17-18

Front 1

Substance ABUSE

Back 1

Involves repeated use of chemical substances, leading to clinically significant impairment over 12 month period, and at least one of the following problems
-inability to perform normal duties at home,school, work
-taking part in hazardous situations while impaired - like driving
-repeated legal or other personal probs caused by substance abuses - lose job
-continued use of substance, despite probs it caused

Front 2

Substance Dependence

Back 2

Involves repeated use of chemical substances, leading to clinically significant impairment over a 12 month period, and 3 ore more of following:
- presence of tolerance - need for higher + higher doses of a substance to acheive desired effect
-phenomenon of withdrawal -stopping or reduction intake results in specific physical and psychological signs and symptoms - such as tremors, headaches, and others when substance not available
-Substance taken in larger amts or for longer periods than intended
-Persistent (but unseuccessful) desire to control use of substance
-more time spent in obtaining, using, and recovering from use
-reduction in normal social/occupational activites
-continue use despite probs it has caused

Front 3

Non-substance related dependency (process addictions) which dependence is on a behavior -- (4)

Back 3

-gambling
-sexual behaviors
-shopping/spending
-internet use

Front 4

Addiction characterized by

Back 4

-Loss of control due to participation in deendency, whether that dependency is on a substance or to a process
-Participation in dependency despite continuing probs
-Tendency to relapse back in to dependency

Front 5

Risk factors

Back 5

-genetics, lowered self-esteem, lowered tolerance for pain and frustration, few meaningful personal relationships, few life successes, risk-taking tendencies, sociocultural theories

Front 6

Sociocultural Theories

Back 6

Certain cultures w/in US - such as Native American groups, have high percentage of members w/alcohol dependence. Other cultures - such as Asian groups - have a low percentage of alcohol dependence

Front 7

CNS Depressants

Back 7

Can produce physiological and psychological dependence and may have cross-tolerance, cross-dependency, and an additive effect when taken concurrently

Front 8

Alcohol

Back 8

BAC 0.08% considered intoxicated. Death can occur if greater than about 0.35%

Front 9

CNS Depressants Intended Effects

Back 9

Relaxation, decreased social anxiety, maintaing calm

Front 10

CNS Depressants toxic Effects

Back 10

Effects of excess: altered judgement, decreased motor skills, decreased LOC, resp arrest, peripheral collapse, and death
Chronic Use: direct cardio damage, liver damage, erosive gastritis and GI bleeding, acute pancreatitis, sexual dysfunction

Front 11

CNS Depressants Withdrawal S/S

Back 11

- Usually start w/in 4-12 hr of last intake of alcohol, peak afer 24-48 hr, and then suddenly disappear
-Abdomincal cramping, vomiting, tremors, restlessness and inability to sleep, increased HR, BP, RR, temp, and tonic clonic seizures
-Alcohol withdrawal delirium may occur 2-3 days after cessation and last 203 days. Considered ER. S/S=severe disorientation, psychotic symptoms (hallucinations), severe hypertension, cardiac dysrhythmias, and delirium. Can progress to death

Front 12

Benzodiazepines Intended Effects

Back 12

dECREASED ANXIETY, SEDATIONS

Front 13

Benzodiazepines Toxic effects

Back 13

-Increased drowsiness and sedation, agitation, disorientation, n/v
-Resp depression
-rapid dependence

Front 14

Benzodiazepines Antidote

Back 14

Flumazenil (Romazicon) available for IV use for toxicity

Front 15

Benzodiazepines Withdrawal S/S

Back 15

Anxiety, insomonia, diaphoresis, hypertension, possible psychotic reactions, and sometimes seizure activity

Front 16

Barbituates Intended Effects

Back 16

Sedation, decreased anxiety

Front 17

Barbituates Toxic Effects

Back 17

-->pentobarbital (nembutal) or secobarbital (seconal)

Resp depression and decreased LOC (can be fatal)
-no antidote to reverse toxicity

Front 18

Cannabis Intended Effects

Back 18

Euphoria, sedation, hallucinations, decrease of n/v secondary to chemo, management of chronic pain

Front 19

Cannabis Toxic Effects

Back 19

Chronic use = lung cancer, chronic bronchitis, and other resp effects

High doses - occurence of paranoia, such as delusions and hallucinations

Front 20

Cannabis withdrawal s/s

Back 20

possibly some depression

Front 21

CNS Stimulants (cocaine) Intended Effects

Back 21

Rush of euphoria, and pleasure and increased energy

Front 22

Cocaine Toxic Effects

Back 22

Mild toxicity - dizzyness, irritability, tremor, blurred vision
severe effects - hallucinations, seizures, extreme fever, tachycardia, hypertension, chest pain, possible cardio collapse and death

Front 23

Cocaine withdrawal S/S

Back 23

-Occuring w/in 1 hr to several days of cessation
-Depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation
-Not life threatening but possible occurrence of suicidal ideation

Front 24

Amphetamines Intended Effects

Back 24

Increased energym euphoria similar to cocaine

Front 25

Amphetamines Toxic Effects

Back 25

Impaired judge, psychomotor agitation, hypervigilance, extreme irritability
-Acute cardio effects (tachycardia, increased BP) can cause death

Front 26

Amphetamines withdrawal s/s

Back 26

Craving, depression, fatigue, sleeping, not life threatening

Front 27

Nicotine Intended Effects

Back 27

Re,axation, decreased anxiety

Front 28

Nicotine Toxic Effects

Back 28

Highlt toxic, but acute toxicity seen only inc hildren or when exposure is to nicotine in pesticides
-Also contains harmful chms that are highly toxic and have long-term effects
-Long term: cardio disease, resp disease, irritation to oral membrane and cancer

Front 29

Nicotine withdrawal s/s

Back 29

- abstinence syndrome e/b irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, and diff concentrating

Front 30

Intended Effects Opioids

Back 30

Rush of euphoria, relief from pain

Front 31

Toxic effects Opioids

Back 31

Decreased respirations, and LOC - can cause death
-An antidote Narcan available for IV use to relieve symptoms of overdose

Front 32

Withdrawal S/S Opioids

Back 32

-Abstinence syndrome begins w/sweating and rhinorrhea progressing to piloerection (gooseflesh), tremors, and irritability followed by severe weakness, n/v, pain in the muscles and bones, and muscle spams
-Very unpleasant but not life threatening - self limiting to 7-10 days

Front 33

inHALANTS INTENDED EFFECTS

Back 33

Euphoria

Front 34

Toxic Effects Inhalants

Back 34

Depend on the drug, but generally can cause CNS depression, sympstoms of psychosis, resp depression, and possible death

Front 35

W/drawal s/s inhalants

Back 35

NONE

Front 36

Hallucinogens (lsd, peyote, PCP) Intended effects

Back 36

heightened sense of self and altered perceptions

Front 37

Hallucinogens (lsd, peyote, PCP) toxic effects

Back 37

panic attacks, flashbacks which can occur for years

NO WITHDRAWAL

Front 38

Alcohol Withdrawal Meds

Back 38

Diazepam (Valium)
Lorazepam (Ativan)
Carbamazepine (Tegretol)
Clonidine (Catapres)

Front 39

Alcohol Abstinence Meds

Back 39

Disulfiram (antabuse), naltrexone (revia), acamprostate (campral_

Front 40

Opioid withdrawal Meds

Back 40

Methadone (dolophine) substitution, clonopin (catapres_. buprenorphine (subutex),

Front 41

Nicotine withdrawal Meds

Back 41

Bupropion (zyban), nicotine replacement therapy (nicotine gum and nicotine patch)

Front 42

Anorexia Nervosa

Back 42

Preoccupied w/food and the rituals of eating, along w/ a voluntary refusal to eat

Front 43

Anorexia body weight

Back 43

less than 85% of expected normal weight

Front 44

Restricting type

Back 44

Drastically restircts food intake and doesn't binge/purge

Front 45

Binging/purging type

Back 45

engages in binging or perging behaviors

Front 46

Bulimia nervosa

Back 46

Recurrently eats large quantities of food over a short period of time, which may be followed by inappropriate compensatory behaviors - such as self-induced vomint to rid body of excess calories

Front 47

Avg age onset bulimia

Back 47

15-18 in females

Front 48

Males onset bulimia

Back 48

10-15% of PTs w/bulmia are males. Onset 18-26 and binging w/excessive exercise (no purging) most common

Front 49

2 tpyes of bulimia

Back 49

Purging type and nonpurging type

Front 50

Bulimia purging type

Back 50

uses self-induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight

Front 51

Bulimia nonpurging type

Back 51

May also compensate for binging through other means - like excessive exercise and misuse of laxatives, duiretics, and/or enemas

Front 52

Females risk factors

Back 52

more common with sister/mom having disorder, biological, interpersonal relationships - influenced by parent pressure + need to exceed, psychological influences - rigidity, riutalism, separation and individuation conflicts, feels of ineffectiveness, helplessness, and depression, distoreted body image, environmental - media, culture. Individual hx of being picky eater as child, participation of athleteics - especially at elite level

Front 53

Male Risk factors

Back 53

Participation in sport where lean body build is prized (bicycling) or where a specific weight is necessary
hX OF OBESITY

Front 54

Amenorrhea

Back 54

anorexia accompanied by this for at least 3 consecutive cycles

Front 55

Criteria for inpatient treatment

Back 55

-Rapid wt loss or wt loss greater than 30% of body wt over 3 months
-Unsuccessful wt gain in outpatient treatment, failure to adhere to contract
-VS w/HR less than 40 bpm, systolic pressure less than 70, body temp less than 36/96.8
-ECG changes
-Electrolyte disturbances
-Severe depression
-Suicidal behavior
-Family crisis

Front 56

Common electrolyte abnormalities

Back 56

hypokalemia
hyponatremia
hypochloremia

Front 57

refeeding Syndrome

Back 57

The circulatory collapse when a PTs completely compromised cardiac system is overwhelmed by a replenished vascular system after normal fluid intake resumes

Front 58

Refeeding syndrome nursing actions

Back 58

Care for pt in hospital setting
implement refeeding over at least 7 days
monitor serum electrolytes, and administer fluid replacement as rx