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107 Cards in this Set
- Front
- Back
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What is the Use Substance abuse and dependence?
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Pattern of repeated use of a substance that is maladaptive in that significan adverse consequences occur and this pattern falls outside medical necessity or social acceptance.
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What are following symptoms for abuse?
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*Recurrent use and cannot fulfill responsibilities
*Recurrent use in physically hazardous conditions *Recurrent use that creates legal problems *Continued use despite persistent effects of the drug |
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What is dependence?
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Maladaptive pattern of substance use leading to clinically significant impiarment or distress. Need 3 or more follwing symptoms in the same 12 months
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What is Tolerance?
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Need for higher doses to obtain same desired effect
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Withdrawal
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stopping the drug results in physical and psychological symptoms
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Dependence symptoms
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*Tolerance
*Withdrawal *Substance taken in larger amounts than inteneded or over longer period of time *Persistent desire or unsuccessful in cutting down or quitting *Great deal of time spent in activities to obtain or use *Important social, occupational or recreational activities are given up or reduced *Substance conitnued despite recurrent physical or psychological problems that have been caused or exacerbated by the substance |
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What is addiction?
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Severe psychological and behavioral dependence on drugs or alcohol
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Symptoms for addiction
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*Craving
*Continued use despite health consequences *Loss of control |
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What is intoxication
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A reversible syndrome of maladaptive physiologic and behavioral changes due to the effects of a substance
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What is withdrawal?
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Development of maladaptive physiologic, behavioral and cognitive changes due to reducing or stopping the heavy and regular use of a substance
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What is detoxification?
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Safe withdrawal under medical supervision
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What is relapse?
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Recurrence of drug dependence in a person who previously achieved and maintained abstinence for significant time beyond detoxification
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What is overdose?
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Use more than prescribed amount and irreversible damage could occur (death)
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Synergistic effects are?
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When some drugs are combined, the effect of either or both are intensified or prolonged, example alcohol and CNS depressant
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What is antagonistic effect?
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The effect of the drug is inhibited, heroin softens high of coacain treatment for overdose of heroin is Narcan
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What is co-dependent behavior?
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Behaviors that indicate person feels responsible for another's drug abuse
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What is dual diagnosis?
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Patients have mental illness and substance related disorder
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If a patient has dual diagnosis would you only treat one diagnosis at a time or do we treat both simultaneously?
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Treat both simulanteously
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What is alcohol?
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CNS depressant, legal, act on GABA receptors(promotes relaxation)
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What is amphetamines, methamphetamine, cocaine?
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CNS stimulants, diet stimulants may be legal
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What is cannabis(marijuana)
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Chemical tetrahydrocannabional, may be medically legal for pain control
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What are side effects for designer drugs: bathsalts, blue silk?
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Severe paranoid, violence, seizures, self-mutliation, chest pain, decreased need for sleep
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What do all psychoactive drugs in gernal stimulate?
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The reward system of the brain-ventral tegmental area, nucleus cumbens, part of cerbral cortex; dopamine is released in limbic system
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Risk factors for substance abuse GENETIC
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If had a biologic parent and raised apart, tended to develop alcoholism, short alleles and alternations in allele of dopamine receptor D12
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Risk factors for substance abuse: INDIVIDUAL
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Personality: traits and psychodynamic issues related to dependency, acceptance, success, dual disorder
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Risk factors for substance abuse: SOCIAL
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child sexual abuse, peer drug use
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Risk factors for substance abuse: NEUROBIOLOGICAL
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Drugs of abuse stimulate dopamine and brain reward center
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Risk factors for substance abuse: BEHAVIORAL
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Conduct disorders in choldhood and deviance
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What is over assessment for Substance Use?
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*Get history of patient's substance use
*Get medical history *Get psychiatric history *Understand that psychosocial issues and be aware that defenses especially denial will be used to protect again anxiety and maintain self-esteem---so be genuine, start with nonthreatening questions and more to more threatening ones, be non-judgmental, show care |
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What is CAGE screening toold for alcoholism?
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*Have you ever felt like you should CUT down your drinking?
*Have people ANNOYED ever had a drink first thing in the mou by criticizing your drinking? *Have you ever felt GUILITY about your drinking? *Have you ever had a drink first thing int he morning (EYE-OPENER) to steady your nerves, get rid of hangover or to get the day started? |
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How long does the body take to metabolize a drink?
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1 hour (1oz lquore, 5oz glass wine, 12 oz can of beer)
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BAL .05mg%?
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1-2 drinks
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BAL .10mg%?
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5-6 drinks is legal intoxication
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What is symptoms of INTOXICATION FOR CNS Depressants(Alchol, barbiurates)?
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*Slurred speech
*unsteady gait *decreased BP *Impair judgement *Poor impuse control |
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What medication is used to prevent relapse after treatment program?
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ANTABUSE
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What are signs of overdose for CNS depressants?
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Cardio-respiratory depression, shock, coma, death
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Waht is the treatment for CNS depressants?
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Immediate physical emergency measures
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What are the withdrawal signs for CNS depressants?
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Nausea, vomiting, diaphoresis, temors, seizures, delirium
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What are are Withdrawal treatment for CNS depressants?
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*Sedatives: ativan, valium,serax
*Seizure Control: tegretol, depacote, magnesium sulfate *Alleviation of ANS: betablockers, alpha blocer, folic acid |
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What are signs of alcohol intoxication?
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Slurred speech, unsteady gait, nystagmus, stupor
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What are signs of alchol withdrawal delirium?
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*autonomic hyperactivity(sweating, tachy, diaphoresis, high bp)
*Sever disturbance insensorium-disorientation, clouded consciousness *perceptual disturbances-hallucinations *fluctuating consciousness ranging from hyper-excitability to lethargy *delusions-paranoid, agitation, fever 100-103 |
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Therapeutic interventions for substance abuse
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*teach relapse prevention strategies
*self-help groups for families *12 step program in AA *Programs: residental, outpatient, in-patient |
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General assessment for chemically impaired patients
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*assess for withdrawal
*assess for overdose *assess for suicidal thoughts *assess for physical complications *assess level of motvation are they interested in changing *assess the family level of knowledge about the resources for help |
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Stimulant withdrawal
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Depression: psychomotor retardation follwoed by agiation, fatigue then insomina, severe dysphoria and anxiety, cravings, vivid and unpleasant dreams, increased appetite
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Narcotic Withdrawal Stage 1
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lacrimation, rhinorrhea, diaphoresis, yawning, restlessness, insominia
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Narcotic withdrawl Stage 2
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dialted pupils, piloerection, muscle twitching, myalgia, arthralgia, abdominal pain
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Narcotic withdrawal stage 3
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tachy, hypertension, tachypnea, fever, anoriexia, nausea, restlessness
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Narcotic withdrawal stage 4
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diarrhea, vomiting, dehydration, hyperglyceia, hypotension and curled up
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Withdrawal syndrome in sedatives, hypnotics, anxiolytics
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anxiety rebound and agitation
*hypertension *tachy *sweating *sensory and motor excitment *insomnia *tonic-clonic convulsions *nightmares *delirium *depersonalization *hallucinations |
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Benzodiazepine withdrawl
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anxiety rebound-tension agiation
autonomic rebound-hypertension, tachy, sweating sensory excitement-photophobia, sensivitiy to sound, illusions motor excitation-tremors, muscle weakness, tonic-clonic convlusions cognitive excitation-nightmares, delirum, hallucinations |
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Treatment rx of alcohol withdrawal delirium
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sedatives:safe withdrawal, anticonvulsant effects,
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Treatment rx of alcohol withdrawal delirium: SEIZURE CONTROL
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reduces the requirement of a benzodiazepine
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Magnesium sulfate for rx alcohol withdrawal delirium
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increases effectiveness of vitamin B1 and helps reduce post-withdrawal seizure
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Thiamine for rx alcohol withdrawal delirium
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prevent wernicke's encephalopathy
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What is splitting?
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Highly emotionally charged process wherein the person divides himself and others into all good and all bad with the possibility of reversing those feeligns at any moment and time. Keep apart the opposing concepts of the self and others
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What is projective identification?
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A defense of ascrbing aggressive aspects of the self to other people then unconsciously pressuring these others to own or act out the projected attribue. Unaware that a self-fulfilling prophesy is set up the recipient complies and acts it out
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What is considered odd eccentril personaly disorders?
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schizoid, shizotypal, paranoid
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What is considered dramatic emotional errado?
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antisocial, borderline, histronic, narcissistic
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What is considered anxious fearful personality disorders?
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avoidant, dependent, obsessive-compulsive
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What types of affects for personality disorders?
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STRONG affect, rage, envy, shame
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Type of defense for personality disorders
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Unable to use higher level adaptive defense mechanisms. Instead use IMMATURE defenses: passive aggression, acting out, devaluation, idealization, splitting, projective identification
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Cognition for personality disorders
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Leads to false thinking: good/bad split, self as empty, vague sense of self, wishes become reality, needs become smoething entitled to, difference between no and yes not clear
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Behaviors for personality disorders
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attacking, clinking, lying, identity diffusion, cruelty
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Assessment areas for personality disorders
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*are they suicidal or homicidal?
*is there a medical condition? *is this normal functioning within a culture *was there an important recent loss? *is there substance abuse? *pay attention to your feelings, they will give cluses as to what the patient is experiencing |
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Outcomes for personality disorders
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*devrease self and other destructive behaviors
*reduce manipulative behavior *help think through consequences * help plan to prevent crisis *practive management of anger, shame, envy, anxiety |
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Nursing approaches for personality disorders
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~Limit needs to be clear and consisten, provide clear boundaries, describe and carry out consequences
~interven in manipulative behavior ~help pt identify needs and feelings before impulsive acts ~document behavior ~enforce consequences after explaining ~assess behavior before labeling as maipulative ~all staff behave in consistent manner ~don't discuss your personal life, don't accept gifts, don't give favors ~assess your feelings and reactions ~discuss feelings of frustration/anger with supervisor to try to re-frame and understand dynamics of pt behaviors |
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What is personality?
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Enduring pattern of perceiving, relating to and thinking about the environment and oneself
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Personality disorders include behaviors that
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are inflexible, pervasive, unstable and enduring that lead to significant distress and impairment functioning
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Genetic theory personality disorder
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More frequent relatives
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Chronic trauma theory personality disorder
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Reorganizes the brain's cortical map and cognitive behavioral development
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Psychosocial theory personality disorder
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overuse of defenses such as repression, suppression, undoing
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Temperment theory personality disorders
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difficult or passive
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Biological theroy personality disorders
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alteration in serotonin decrease and alpha-noradrenergic receptor sites increase leading to hyperactivity, impulsiveness, etc.
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server family pathology theory personality disorders
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abuse, neglect, violence
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What is identify
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View self in complex ways
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What is object relations
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stable and satifying relationships
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What is affect tolerance?
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experience in self and others a full range of affects
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What is affect regulation?
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Regulate impulses that facilitate adaption
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What is superego and ego
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function in with a consistent moral sensiblitity
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What is reality testing?
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appreciate what is realist and conform or not
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What is ego strength and resilience?
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Respond to stress and recover from painful events
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What is neurotic to healthy?
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helped by conventional therapy, able to self-observe and benefit from understanding the historical antecedents of current feelings and behavior
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What is borderline theraputic?
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need therapeutic relationships to address anxiety, fear of abandonment, intense reactiviy and potential for disorganizing regression, medication
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Psychotic therapeutic?
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supportive therapy with education and medications, monitor medication compliance and build on psychological strength
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What is paranoid?
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suspicious, fear others will exploit or harm them, hyper-vigilant
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What is schizoid?
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Avoids close relationships, cold, aloof
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What is shizotypal?
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magical thinking, odd beliefs, vague, blunted affect
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What is antisocial?
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superficial charm, violates rights of others, lacks remorse, prison population, aggressive
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What is borderline?
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unstable, intense relationships, self-mutilation, feels empty, fear of separation, seen in er's after breakup with cutting, od, etc.
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What is histronic?
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center of attention, flamboyant, seductive, dramatic
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What is narcissistic?
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grandiose but gragile ego, demands the best of evertyhing, entitlement, when boundaries set feels depressed and humilated
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What is avoidant
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hypersensitive to crticism, fear of rejection, social inhibition
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What is dependent?
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unable to make decisions without advice of to others, submissive
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What is obsessive compulsive?
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preoccupied with rules, too busy to have friends, rigid control and complains about other's deficiencies
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Theories psychosocial
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presents clinically at mean age of 18 years, family dysfunction, trauma, sexual abuse that presents sequelae symptoms in vulnerable adults
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Psychoanalytic
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intense fear of spearation anger
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Defeneses
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projective identification used to falsely attribute to tohers, their own unacceptable feelings, thoughts, impulses. this is used to protect a ofragile ego
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Affective symptoms
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affective instability due to marked reactivity of mood
inappropriate, intense anger or difficulty controlling anger chronic feelings of emptiness |
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Impulsive symptoms
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Recurrent suicidal symptoms
impulsivity in at least 2 ears-spending, sex, substance abuse, reckless driving, binge eating |
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Interpersonal symptoms
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frantic effors to avoid real or imagined abandoment
identify disturbance-markedly and persistently unstable self-image or sense of self |
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Cognitive symptoms
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transient stress related paranoid ideation or severe dissociative
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Treatment personality-dialective behavior
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collect data about problem
prob solve emotional regulation communication triad I statements-I feel.... non-judgemental attitude twards feelings help learn how to restore comfort |
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Treatment personality-rx
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antipsychotic for transietn psychosis
mood stablizers anti-anxiety GABAergic anticonvulsants to decrease impuslivity |
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Psychotic symptoms
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give rise to aggr, careful medical and psychiatric hisotry, physical exam, lab testing, lower tone of voice, acceptance, firmness, conflict resoltuion training
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Dependent and somatic patients
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symptoms that resemble fibromayalgia, chronic fatiuge syndrome, ibs, overused medical servie, reports high emotional distress
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Nursing treatment for dependent and somatic patients
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scehdule regular appointments every 4-6 weeks
do physical exam avoid unnecesary diagnostic procedures avoid parent statements like stop worrying focus on daily life, activies and realtionships give general support if symptoms are brought up but avoid inquiring and focus resonse |
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Manipulative pt nursing treatment
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don't grant favors and stick to setting guidelines and clear boundaries
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