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136 Cards in this Set
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- Back
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TRUE OR FALSE: Only illegal drugs can be considered substance abuse
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False
Substance abuse can be any drug a client misuses, whether it be illegal or prescribed. |
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What social manifestations are clincally significant in identifying substance abuse
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FAILURE TO FULFILL MAJOR OBLIGATIONS
USE WHEN PHYSICALLY HAZARDOUS RECURRENT LEGAL PROBLEMS RECURRENT SOCIAL OR INTERPERSONAL PROBLEMS |
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What signs indicate substance depedence
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TOLERANCE, defined by either
a need for markedly increased amounts of the substance to achieve intoxication or the desired effect Markedly diminished effect with continued use of the same amount of substance WITHDRAWAL, as manifested by either the characteristic withdrawal syndrome for the substance The same substance is taken to relieve or avoid withdrawal symptoms LARGER AMOUNTS TAKEN OVER A LONGER PERIOD THAN WAS INTENDED PERSISTENT DESIRE OR UNSUCCESSFUL EFFORTS TO CUT DOWN TIME SPENT IN OBTAINING THE SUBSTANCE, USING THE SUBSTANCE OR RECOVERING FROM ITS EFFECTS IMPORTANT SOCIAL, OCCUPATIONAL OR RECREATIONAL ACTIVITIES GIVEN UP OR REDUCED BECAUSE OF SUBSTANCE USE CONTINUED USE DESPITE KNOWLEDGE OF ADVERSE CONSEQUENCES |
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At least how many signs would ensure substance dependence
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Three
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TRUE OR FALSE: It is important to have the three critieria (tolerance, withdrawal, compulsion) to be defined as dependent/addicted
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FALSE
The three critieria are sufficient, but are not necessary for dependence Example: Cocaine is addictive, but has no physical withdrawal |
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What areas of the brain are affected by substance abuse
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Cerebrum
Hippocampus Hypothalamus Thalamus Amygdala |
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What is substance withdrawal?
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Physiological, behavioral, cognitive, and affective symptoms that occur after reduction or discontinuance of a drug that has been used heavily over a long period of time.
Symptoms can be different for each drug. |
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What is the worst outcome of chemical dependence
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Death if left untreated
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TRUE OR FALSE: Most people who are chemical substance abusers use many different drugs
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TRUE
Most who are chemically dependent are poly-drug users |
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Who abuses alcohol more? Men or women?
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Men
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What age range in women has alcoholism increased?
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Ages 35-64
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What three substances are most abused by MEN in today's society?
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Cocaine
Marajuana Opioids |
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What three substances are most abused by WOMEN in today's society?
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Sedatives
Antianxiety agents Amphetamines |
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What is the status of drug abuse amongst health professionals?
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About the same as the general population
Shame and guilt magnified |
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What does CAGE stand for?
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C (Cut down) Have you ever felt like you should cut down?
A (Annoyed) People have annoyed you by criticizing your drinking? G (Guilt) Have you ever felt bad or guilty about your drinking? E (Eye opener) Have you ever taken a drink in the morning as an “eye-opener”? |
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What are the effects of ALCOHOL on the body?
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Every cell affected
Cardiovascular - Direct damage to heart muscle - Causes cardiomyopathy, CHF Peripheral neuropathies Blackouts - Early sign of alcoholism - Possibly related to toxic effect of ETOH on glutamate transmission Alcoholic dementia |
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What is the etiology of Korsokoff's Syndrome?
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Chronic alcoholic abuse syndrome
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What vitamin deficiencies do people with Korsokoff's syndrome have?
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Thiamine
B12 |
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What are the main symptoms of Korsokoff's Syndrome?
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Short-term memory loss
Inability to learn new skills Usually disoriented May present with delirium and hallucinations and confabulate to conceal condition |
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What is Wernicke's Encephalopathy?
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Inflammatory, hemorrhagic, degenerative condition of brain characterized by lesions in several parts of brain: hypothalamus, mammillary bodies, tissues surrounding ventricles and aqueducts
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What are symptoms of Wernicke's Encephalopathy?
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Double vision
Involuntary and rapid eye movements Lack of muscular coordination Mild or severely decreased mental function |
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What vitamin deficiency CAUSES Wernicke's Encephalopathy?
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Thiamine
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What two organs are greatly affected by alcoholism?
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Liver
- Cirrhosis Pancreas - Pancreatitis |
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What common stomach problem is seen with alcoholism?
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Ulcers
Gastritis Gastrointestinal Bleeding |
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What are some nutritional abnormalities seen with alcoholism
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Vitamin B deficiencies
Thiamine deficiencies Magnesium deficiencies |
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What effect does alcoholism do to the esophagus?
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Can cause rupture/esophageal varices
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What happens to the body when the body is chronically exposed to alcohol?
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Tolerance
Physical and psychological dependence Physiological complications |
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What symptoms are a sign of alcohol intoxication/overdose?
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Slurred speech
Unsteady gait Nystagmus Impairment in memory and attention Stupor |
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What major alcoholic intoxication/ovedose biological issues can be life threatening?
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Coma
Respiratory depression Aspiration |
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What is the priority intervention with alcohol intoxication?
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ABCs!!!
Airway Breathing Circulation |
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What assessments should a nurse perform with alcohol intoxication?
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Blood alcohol levels
Levels of consciousness Obtain history of recent intake |
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What should the nurse check for on a patient's IV who is admitted for alcohol intoxication?
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Ensure IV line is patent
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What time frame do alcohol withdrawal symptoms start to develop?
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Can arise as fast as 6-8 hours or as late as a few days
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What autonomic symptoms would a nurse see in a patient going through alcoholic withdrawal?
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Diaphoresis
Increased blood pressure and heart rate Increased hand tremors |
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What sleeping disorder is common in alcoholic withdrawal syndromes?
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Insomnia
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What three senses experience hallucinations from alcoholic withdrawal syndrome?
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Auditory
Visual Touch (tactile) |
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What kind of CNS attack should be monitored in a patient going through alcoholic withdrawal syndrome?
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Seizures
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What term defines a an alcohlic patient going through alcoholic withdrawal syndrome with hallucinations
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Alcohol Withdrawal Delirium
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What is the onset of Alcohol Withdrawal Delirium?
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Can start 2-3 days but as late as 14 days from last drink
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What major issues in Alcohol Withdrawal Delirium can cause death?
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Cardiovascular collapse
Hyperthermia |
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What are the three "R's" a nurse can do to intervene in alcohol withdrawal syndrome?
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Rehydrate
Reorient Reassure |
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What class of drugs are used to decrease symptoms to prevent seizures and CNS hyperexcitability in alcoholic recovering patients
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Benzodiazepines
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Name drugs (benzodiazepines) that are used to treat alcoholism
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Librium
Valium Tranzene Ativan |
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What should a nurse be monitoring in a recovering alcoholic patient?
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Blood pressure
Pulse Tremors States of anxiety/agitation |
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What determines drug dosage in alcoholic recovering patients and how long is the drug titrated for?
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The symptoms seen
5 days |
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What vitamins supplements are given to alcoholic patients?
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Thiamine
- to decrease rebound effect on absence of alcohol B vitamins |
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Why are antipsychotics sometimes used in alcoholic patients?
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Alcoholics can have hallucinations during withdrawal
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What drug inhibits aldehyde dehydrogenase in order to cause an increase of acetaldehyde if alcohol is ingested?
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Antabuse
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Name some reactions alcoholics have to Antabuse
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Flushing
Nausea and vomiting Thirst Diaphoresis Dyspnea - Very important to monitor due to the fact it can cause breathing issues Hyperventilation Throbbing headache Palpitations Hypotension Weakness Confusion |
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What severe reactions can Antabuse cause?
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Coma
Seizures Cardiovascular collapse Respiratory depression Death |
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TRUE OR FALSE: Antabuse can be used independently
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FALSE
Antabuse can only be used under close medical supervision |
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What are contraindications should a health provider be aware of when considering treating an alcoholic with Antabuse?
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Cardiovascular disease
Depression Schizophrenia |
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What two classes do sedatives/antidepressants fall under?
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Benzodiazapines
Barbituates |
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What two ways can sedatives/antidepressants be given
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Orally
IV |
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What major effect do sedatives/antidepressants cause?
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Significant CNS depression
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What manifestations can be seen with people on sedatives/antidepressants?
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Lack of coordination
Euphoria Labile emotions Irritability, anxiety Impaired attention Working memory loss |
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What other drug do sedatives/antidepressants have in common in regards to potential problems?
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Alcohol
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What effect occurs if sedatives/antidepressants are taken with other CNS depressants
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Synergistic effects
Means that drug's effects will be enhanced if other drug is present during metabolism |
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What PRIORITY interventions would a nurse consider with a patient under sedatives/antidepressant overdose?
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ABCs!
Patent airway Monitor for respiratory depression/arrest Support vital functions (heart rate, breathing, urinary, etc) |
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What treatment would a patient go through if the sedatives/antidepressants they took have long half lives?
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Dialysis
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What would be on a patient's MAR if the nurse knows that the doctor prescribed antidotes for sedatives/antidepressants?
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Anexate
Romazicon |
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What are some potential symptoms of people withdrawing from sedatives/antidepressants?
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Seizures can occur
Can have delirium May use same drug or different CNS depressant and taper off gradually Monitor for same symptoms as in ETOH withdrawal |
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What is the generic name for "roofies"?
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Rohypnol (flunitrazapam)
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What are roofies commonly known as?
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The date rape drug
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What effects do roofies have on the body?
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Sedative-hypnotic effect
Muscle relaxation Blackouts Amnesia Causes short-term memory loss May cause respiratory depression, aspiration, or death May be addictive Withdrawal seizures may occur |
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What other drugs are sold as "roofies"
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Klonopin (clonazepam)
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What effects does GHB have on the body?
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Euphoric, sedative and anabolic effects
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What other drug combined with GHB can lead to unconsciousness, coma, breathing difficulties, or even death?
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Alcohol
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What risk is increased when combining GHB with amphetamines?
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Increased risk for seizures
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What are some common defense mechanisms do drug addicts have when confronted with their addiction?
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Denial
Projection Minimization Rationalization |
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What opioid is commonly used in the hospital setting?
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Morphine
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At what site do opioids act on in the brain?
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Opiate receptors
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What effects do opioids have on the body?
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Brief, intense sensation—rush or thrill
Followed by longer-lasting high, calmness Sedated appearance, motor retardation Slurred speech, decreased awareness impaired attention span Reduction of instinctual drives Euphoria, pleasure, relaxation Depress respiration Suppress coughs Inhibit GI motility Continued use decreases production of endorphin and enkephalin—results in low pain tolerance during withdrawal |
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What social characteristics are reasons why addicts abuse drugs?
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Immediate gratification
Self indulgence Easy resolution Expectation of pain free existence |
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What is the greatest concern a nurse should monitor for a patient who is under morphine?
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Respiratory depression
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What complications can occur with opioid administration?
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Liver problems
Malignant hypertension Resipiratory depression Strokes Kidney failure |
think what organs are affected
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In regards to co-dependency, why do some non-drug users continue to stay with drug abusers?
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Non drug users tend to be over-responsible, thus feeling the need to take care of their partner
Operate out of fear, resentment, helplessness, hoplessness Tries to control user's behavior Enablers facilitate substance dependence |
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What common opioid street drug can increase the risk of hepatitis and HIV infection?
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Heroin
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What is the statistic of children who were in a parental alcoholic environment?
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1 out of 8
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How fast do opioid withdrawal symptoms occur?
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As fast as a few hours and as slow as a few days after last dose
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What are opioid WITHDRAWAL symptoms?
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Craving
Muscle aches, backaches Severe abdominal cramps, diarrhea Watery eyes, runny nose, yawning Tremors Chills, sweating *Crawling sensation on skin* |
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What is the most common defense mechanism do adult children use in regards to having alcoholic parents?
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Denial
Denies stress of dysfunctional family Feels they have total obligation to their alcoholic parent |
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What are opioid OVERDOSE symptoms?
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Clammy skin
Shallow respirations Pinpoint pupils (may be dilated with hypoxia) Death from respiratory depression or irreversible pulmonary edema |
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What is considered the universal antidote to most opioids?
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Naloxone (Narcan)
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What emotional problem do adult children have with alcoholic parents?
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Have trouble expressing emotions
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What is the dosage range for Narcan administration?
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0.4-2 mg
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What route is Narcan typically given?
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IV
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How often should you repeat Narcan administration of overdose effects are still present?
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Every 2-3 minutes
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What risk is increased in adult children with alcoholic parents
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May repeat pattern by becoming an addict themselves or marrying an addict
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What drug is given for pulmonary edema, a side effect typically occuring with opoid overdose?
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Lasix
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What controversial drug is given to opioid addicts? What is it main purpose? Why is this drug controversial?
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Methadone
It acts as an anti-addictive It is controversial because a patient can become dependent on it |
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What disorder may adult children use in order to cover their feelings of inadequacy, powerlessness, and fear of abandonment?
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Being obsessive
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What is the onset of cocaine?
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2-3 minutes
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TRUE OR FALSE: Most adult children with alcoholic parents immediately seek help either from other family members or through professionals.
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FALSE: Most adult children try to solve the problem alone and most do not succeed
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What is the duration of cocaine?
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20-30 minutes
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What is the purified form of cocaine called?
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Crack
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How fast does crack work compared to cocaine?
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6-7 seconds
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How do most Americans view addiction?
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Sinful
Weak willed Addicts are totally responsible for their situation Women who drink are consider "loose" and lesbian Women who are abused are at great risk for alcoholism |
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What body system does cocaine affect?
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Stimulates the CNS
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How does cocaine work?
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Binds to dopamine receptors thus accumulating dopamine. High dopamine flood causes stimulating effects
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If a wealthy person works hard just do get drugs so the can work harder, what is this lifestyle called?
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High Tech Lifestyle
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What are the effects of cocaine?
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Uniquely addicting
Positive reinforcement thru euphoria, increased energy, mental alertness, increased self-confidence, sexual arousal Tension, fatigue, shyness disappear Talkative, playful Judgment may be impaired May become violent Negative reinforcement Rebound dysphoria, or “crash” Progressive tolerance of positive effects Intensified negative effects |
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What is an example of a High Tech Lifestyle person's drug schedule?
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Speed to work on
Coke to play on Heroin to come down on |
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What complications can cocaine cause?
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Constriction of coronary and cerebral vessels causing vasoconstriction
Cardiac and cerebral infarcts Higher risk if crack is smoked Decreased glucose utilization in frontal cortex Loss of sense of smell Pulmonary damage Hepatitis Marathon binge use, “run” Speedballing: cocaine mixed with heroin and injected IV Space-basing: crack cocaine with PCP May lead to panic, terror, violent, uncontrollable behavior |
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What are cocaine withdrawal symptoms?
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Severe craving
Depression Fatigue, irritability Vivid, unpleasant dreams |
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A patient with schizophrenia is also a raging alcoholic. What is this diagnosis called?
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Dual Diagnosis
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What are overdose effects of cocaine?
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Euphoria
Grandiosity Anger Combativeness Impaired judgment Tachycardia Cardiac arrhythmias Elevated BP Perspiration Chills Nausea, vomiting Seizures Respiratory depression Hyperpyrexia Death |
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What is the biggest concern with cocaine overdose?
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Cardiac issuses
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If someone with dual diagnosis is not properly treated, what can occur?
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High likelihood of violence
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What treatments are used with cocaine patients
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Treat the symptoms
May have to ventilate Lidocaine or propranolol IV (dysrhythmias) Acetomenophen or Dantrium (hyperthermia) Hydralazine or nitroprusside (hypertension) Diazepam or phenobarbital (seizures) |
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What are the behavioral characteristics of cocaine addicts?
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Lack of Control
Decreased inhibitions Higher risk for violence Social isolation Absenteeism Interpersonal problems Altered lifestyle |
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What is the rate of relapse amongst substance abusers?
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25-50%
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What are some reasons why people use drugs?
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Overcome boredom or depression
Manage stress, anxiety Decrease negative feelings & increase positive feelings |
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What kind of characteristic defines a patient as having a constant mood change?
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Labile
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What are some coginitive characteristics of drug abusers?
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Low self-esteem
Grandiose thoughts Blackouts (alcohol) Confabulation Paranoid thinking General decline in cognitive ability Use of defense mechanisms |
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Give an example of a treatment option that illustrates brief therapy
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Community drug center
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What is the major difference of intensive outpatient or inpatient treatment
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It allows patient to remain at home or go to work
4-5 hours of treatment a day Some patients respond better in a setting that is less restrictive |
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What clinical settings are typically known as inpatient treatment?
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Emergency Department/acute care settings
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Who is inpatient treatment typically for?
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People at high risk of severe witdrawal symptoms
People who are a danger to others People who are unresponsive to less intensive proedures |
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What is the main attraction of residential treatment?
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Patient stays at a facility for 7-21 days and is given a safe, structured environment for those who lack support and social and vocational skills
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Why are older adults harder to work with when trying to treat them beyond home?
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Some older adults are unable to go to a facility or are unwilling to leave their home to get treated.
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How do "dry drunks" act?
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Like they are still drunk
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What is the definition of sobriety?
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Having stopped using and having achieved a centered, balanced state through development of positive values, attitudes, beliefs, behaviors
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What recovery model is generally used in most substance abuse programs?
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12 step model
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What social assessment findings would a nurse see in substance abusers?
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Abusers rarely seek help
Job performance decreases Social relationships deteriorate Legal contract binds them to recover Assess patient's ambivalency about quitting Determine patients feelings about how they view their addiction as (angry, humiliated, fearful, etc) |
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How should a nurse start asking questions to a substance abuser?
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Start off with small questions such as smoking and prescription use before delving into their bigger addiction
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What is the CIWA-AR used for
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Used to determine the level of severity alcohol has done to the body. The higher the number, the worse the condition.
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What symptom is a nurse looking for in a substance abuser that the patient is undergoing impending withdrawal?
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Diaphoresis
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Describe general physical assessments a nurse would perfom on a substance abuser.
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General appearance, vital signs
Integrity of skin and scalp -Bruising -Spider angiomas -Dermatitis -Diaphoresis (sign of impending withdrawal) -Dependent edema Head -Fractures -Puffy face with flushed cheeks and nose |
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What would a nurse be looking for in a patient's eyes to determine the severity of their substance abuse condition?
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Icterus
-Yellowing of the eyes indicates liver damavge Nystagmus -Indicates Wernicke's Encephalopathy |
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What kinds of issues would a nurse be looking for when assessing a subtance abuser's torso?
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Chest
-Pneumonia -Tuberculosis -Gynecomastia --Enlargement of patients breasts Abodmen -Bulging flanks (ascites) -Enlarged liver (hepatitis or cirrhosis) -Anorexia, N&V, fever, liver tenderness (early signs of hepatitis) -Pale stools, dark urine, jaundice (later signs of hepatitis) -Dilated veins at umbilicus, GI bleeding, hemorrhoids (portal hypertension) -Vomiting bright red blood (esophageal varices secondary to portal hypertension) |
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What neurological assessments would a nurse perform on a substance abuse patient?
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LOC, cognitive function, motor function
Orientation Long-term memory loss (Korsakoff’s) Impaired abstract thinking, judgment, personality changes (alcoholic dementia) Ataxia, nystagmus, confusion (Wernicke’s encephalopathy) |
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What is a primary intervention a nurse should be concerned with most substance abuse patients?
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Safety
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What would the nurse try to identify and remove in order for a substance abuser to go back into relapse
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Triggers or recollective memories
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What is the one thing a client must have in order for abstinence to be successful?
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Motivation to be a better "you".
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What does HALT stand for? What is it's significance to substance abusers?
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Hungry
Angry Lonely Tired Describes how most substance abusers feel. Can identify with acronym. |
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