Mental health Exam #2 Substance abuse

BRAIN
THE MAIN ORGAN OF WEAKNESS DURING SUBSTANCE ABUSE

NEUROTRANSMITTERS
WHAT SUBSTANCE IN THE BRAIN IS DISRUPTED BY SUBSTANCE ABUSE

SLEEP CYCLE, NUTRITION, JUDGEMENT, HYGIENE
SUBSTANCE ABUSE COMMONLY DISRUPTS THESE ASPECTS IN INDIVIDUALS

PSYCHIATRIC DISORDERS
WHAT IS A COMMON COMORBIDITY DURING SUBSTANCE ABUSE

SUICIDE
WHAT ARE SUBSTANCES ABUSERS ALSO AT HIGH RISK FOR?

GENETIC; FOR CHILDREN OF ALCOHOLICS
IN ADDITION TO ENVIRONMENTAL, PHYSICAL, DEVELOPMENTAL, AND PSYCHOSOCIAL FACTORS FOR ADDICTION, WHAT OTHER ASPECT IS LINKED TO ADDICTIVE PERSONALITY?

PSYCHOLOGICAL
SUBSTANCE ABUSE THEORY:
CERTAIN PSYCHODYNAMIC FACTORS ARE PART OF THE ADDICTIVE PERSONALITY. SUCH AS:
• LACK OF TOLERANCE, FRUSTRATION, AND PAIN
• LACK OF SUCCESS IN LIFE
• LACK OF AFFECTIONATE, MEANINGFUL RELATIONSHIPS
PATIENTS HAVE A LOW SELF ESTEEM, LACK OF SELF-REGARD, RISK TAKING PROPENSITY, FREQUENT DEPRESSION, AND PASSIVITY. UNABLE TO RELAX, DETER GRATIFICATION, AND COMMUNICATE EFFECTIVELY

BEHAVIORAL
SUBSTANCE ABUSE THEORY:
PATIENT DISCOVERS THE EUPHORIC STATE, ROUTINELY SEEKS IT TO “ESCAPE”, AND CONTINUES TO ABUSE IN SPITE OF THE DIRE CONSEQUENCES. TREATMENT INVOLVES IDENTIFICATION OF STRESSORS IN THE PATIENT’S LIFE

SOCIO-CULTURAL
SUBSTANCE ABUSE THEORY:
STATES THERE IS DIFFERENCES IN THE RATE OF SUBSTANCE ABUSE AMONG VARIOUS GROUPS. CULTURE HAS AN IMPACT. ABUSERS FIND A SENSE OF BELONGING WITHIN THE SUBSTANCE ABUSE CULTURE

b.) tolerance
*Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.
Erik is a 26-year-old patient who abuses heroin. He states to you, “I’ve been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want.” You know this describes:
a.) intoxication.
b.) tolerance.
c.) withdrawal.
d.) addiction.

c.) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.

*The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.

Which of the following is true regarding substance addiction and medical comorbidity?
a.) Most substance abusers do not have medical comorbidities.
b.) There has been little research done regarding substance addiction disorders and medical comorbidity.
c.) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
d.) Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.

b.) Cody will be medically stabilized while in the hospital.
*If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody’s treatment plan while in the hospital?
a.) Cody will return to a predrug level of functioning within 1 week.
b.) Cody will be medically stabilized while in the hospital.
c.) Cody will state within 3 days that he will totally abstain from drugs and alcohol.
d.) Cody will take a leave of absence from college to alleviate stress.

a.) Readiness to change and support system

*The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual’s cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient’s perceived need for change and having others who can lend support outside the hospital.

The treatment team meets to discuss Cody’s plan of care. Which of the following factors will be priorities when planning interventions?
a.) Readiness to change and support system
b.) Current college performance
c.) Financial ability
d.) Availability of immediate family to come to meetings

d.) “It helps prevent relapse by reducing drug cravings.”

*Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone.

Cody is preparing for discharge. He tells you, “Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?” Which response is appropriate teaching regarding naltrexone?
a.) “It helps your mood so that you don’t feel the need to do drugs.”
b.) “It will keep you from experiencing flashbacks.”
c.) “It is a sedative that will help you sleep at night so you are more alert and able to make good decisions.”
d.) “It helps prevent relapse by reducing drug cravings.”

d.) withdrawal.
Withdrawl is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage.

REF: 413-414

A syndrome that occurs after stopping the long-term use of a drug is called
a.) amnesia.
b.) tolerance.
c.) enabling.
d.) withdrawal.

a.) opiates.

The effects of opiates can be negated by a narcotic antagonist such as naloxone.

REF: 427

The only class of commonly abused drugs that has a specific antidote is the
a.) opiates.
b.) hallucinogens.
c.) amphetamines.
d.) benzodiazepines.

d.) the need to take larger amounts of a substance to achieve the same effects.

With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect.

REF: 413-414

The term tolerance, as it relates to substance abuse, refers to
a.) the use of a substance beyond acceptable societal norms.
b.) the additive effects achieved by taking two drugs with similar actions.
c.) the signs and symptoms that occur when an addictive substance is withheld.
d.) the need to take larger amounts of a substance to achieve the same effects.

d.) exert a calming effect.

Benzodiazepines act by binding to α-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect.

Benzodiazepines are useful for treating alcohol withdrawal because they
a.) block cortisol secretion.
b.) increase dopamine release.
c.) decrease serotonin availability.
d.) exert a calming effect.

b.) enabler.
An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use.
A person who covertly supports the substance-abusing behavior of another is called a(n)
a.) patsy.
b.) enabler.
c.) participant.
d.) minimizer.

a.) denial.
Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence).
A client who is dependent on alcohol tells the nurse, “Alcohol is no problem for me. I can quit anytime I want to.” The nurse can assess this statement as indicating
a.) denial.
b. ) projection.
c. ) rationalization.
d.) reaction formation.

d. )Supervisory staff should be informed as soon as possible in both cases.

If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager’s major concerns are with job performance and client safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not “see” what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug.

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol?
a. )The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place.
b. )Neither should be reported until the nurse has collected factual evidence.
c. ) No report should be made until suspicions are confirmed by a second staff member.
d. )Supervisory staff should be informed as soon as possible in both cases.

b. )GHB
The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, “roofies”), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur.
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested
a. ) LAAM
b. )GHB
c. )ReVia
d. ) Clonidine

c. )The client must strive to maintain abstinence.
Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability.
In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery?
a.) Ongoing support from at least two family members must be secured.
b. )The client needs to be employed.
c. )The client must strive to maintain abstinence.
d. )A regular schedule of appointments with a primary care provider must be set up.

a. ) lacrimation, rhinorrhea, dilated pupils, and muscle aches.
Symptoms of opioid withdrawal resemble the “flu”; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.
Symptoms that would signal opioid withdrawal include
a. ) lacrimation, rhinorrhea, dilated pupils, and muscle aches.
b. )illusions, disorientation, tachycardia, and tremors.
c.) fatigue, lethargy, sleepiness, and convulsions.
d.) synesthesia, depersonalization, and hallucinations.

c.) Barbiturates
Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death
REF: Page 416
Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support?
a.) Opiates
b.) Marijuana
c.) Barbiturates
d.) Hallucinogens

a.) tremors.
Tremors are an early sign of alcohol withdrawal.

REF: Page 414

Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of
a.) tremors.
b.) seizures.
c.) blackouts.
d.) hallucinations.

d.) observation for hyperpyrexia and seizures.

Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose.

REF: Page 414

A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include
a.) induction of vomiting.
b.) administration of ammonium chloride.
c.) monitoring of opiate withdrawal symptoms.
d.) observation for hyperpyrexia and seizures.

a.) Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min

Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.

REF: Page 416

Which assessment data would be most consistent with a severe opiate overdose?
a.) Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min
b.) Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min
c.) Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min
d.) Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

b.) Stimulation and anesthetic effects

Cocaine exerts two main effects on the body, both anesthetic and stimulant.

REF: Page 413-415 (Table 22-1)

Cocaine exerts which of the following effects on a client?
a.) Stimulation after 15 to 20 minutes
b.) Stimulation and anesthetic effects
c.) Immediate imbalance of emotions
d.) Paranoia

c.) abstain from the use of mood-altering substances.

Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term.

REF: Page 422

An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will
a.) discuss the addiction with significant others.
b.) state an intention to stop using illegal substances.
c.) abstain from the use of mood-altering substances.
d.) substitute a less addicting drug for the present drug.

a.) The client has a high tolerance to alcohol.
A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level.

REF: Page 416

A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn?
a.) The client has a high tolerance to alcohol.
b.) The client ate a high-fat meal before drinking.
c.) The client has a decreased tolerance to alcohol.
d.) The client’s blood alcohol level is within legal limits.

b.) obtaining an order for seclusion and close observation.

Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client’s unpredictable violent potential. Naltrexone is an opiate antagonist.

REF: Page 414

A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is
a.) taking him to the gym on the psychiatric unit.
b.) obtaining an order for seclusion and close observation.
c.) assigning a psychiatric technician to “talk him down.”
d.) administering naltrexone as needed per hospital protocol.

c.) “Most over-the-counter cough syrups are safe for me to use.”

The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol.

REF: Page 427 (Table 22-9)

A teaching need is revealed when a client taking disulfiram (Antabuse) states,
a.) “I usually treat heartburn with antacids.”
b.) “I take ibuprofen or acetaminophen for headache.”
c.) “Most over-the-counter cough syrups are safe for me to use.”
d.) “I have had to give up using aftershave lotion.”

c.) result from lack of good situational support.

Relapses can point out problems to be resolved and can result in renewed efforts for change.

REF: Page 425

The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses
a.) are an indicator of treatment failure.
b.) are caused by physiological changes.
c.) result from lack of good situational support.
d.) can be learning situations to prolong sobriety.

INHALANTS
WHICH TYPE OF ABUSED SUBSTANCE IS CONSIDERED THE “LAUGHING” DRUG?

LOSS OF CONSUMPTION CONTROL, CONTINUED USE DEPITE PROBLEMS, TENDENCY TO RELAPSE
ADDICTION IS CHARACTERIZED BY WHICH 3 ASPECTS

BIOLOGICAL, PSYCHOLOGICAL, SOCIOCULTURAL, GENETIC
4 RISK FACTORS TIED INTO SUBSTANCE ABUSE

GATHER DATA, NOTIFY NURSE MANAGER, DO NOT CONFRONT
IF INDICATORS OF IMPAIRED PRACTICE ARE OBSERVED BY ANOTHER NURSE, WHAT IS THE OBSERVER’S RESPONSIBILITY?

NURSE MANAGER, NURSING ADMINISTRATORS
INTERVENTION OF A NURSE ABUSING IS WHOSE RESPONSIBILITY?

MAKE NOTIFICATION TO NEXT LEVEL IN CHAIN OF COMMAND
IF NOTIFICATION IS MADE AND THE NURSE NOTICES NO ACTION HAS BEEN TAKEN, WHAT IS NECESSARY?

PROTECT PATIENTS, GET NURSE TREATMENT, RETURN NURSE TO PRACTICE OF POSSIBLE
WHAT IS THE MAIN GOAL OF INTERVENTION?

• MEDICATION WASTING / NOT GETTING WASTING COUNTER-SIGNED
• PATIENT COMPLAINS OF INEFFECTIVE PAIN CONTROL
• COMES IN EARLY / STAYS LATE
• VOLUNTEERS FOR ADDITIONAL SHIFTS
• USES BATHROOM A LOT
• SLOPPY CHARTING
• ↑ ABSENTEEISM
• FREQUENT JOB CHANGES / LOSS
• JOB RELATED ACCESS
• CRIMINAL RECORD
SYMPTOMS FOR AN IMPAIRED NURSE

ATIVAN (LORAZEPAM)
THE DRUG OF CHOICE GIVEN TO DECREASE ALCOHOL WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND PREVENT SEIZURES/DT’S

HALDOL
FOR ALCOHOL WITHDRAWAL PATIENTS, WHAT DRUG IS GIVEN TO TREAT HALLUCINATIONS (TACTILE, VISUAL, AUDITORY, OLFACTORY)

FOLIC ACID, THIAMIN, MULTIVITAMINS
WHAT IS ALSO GIVEN TO ALCOHOL WITHDRAWAL PATIENTS TO ADDRESS MALNUTRITION

NALTREXONE (REVIA)
WHICH DRUG, WHICH BLOCKS OPIOD RECEPTORS, IS ALSO GIVEN TO ALCOHOL WITHDRAWAL PATIENTS TO DECREASE THE PLEASANT, REINFORCING EFFECTS OF ALCOHOL?

CLONIDINE (CATAPRES)
WHICH DRUG, WHICH LOWERS BP, IS GIVEN IN COMBINATION WITH THE ABOVE MED AND IS A NON-OPIOD SUPPRESSOR OF WITHDRAWAL SYMPTOMS

CIWA
WHICH SCALE IS UTILIZED TO IDENTIFY SYMPTOMS AND DETERMINE SEVERITY OF ALCOHOL WITHDRAWAL?

15
A SCORE OF ABOVE ___ ON THE CIWA SCALE MANDATES TREATMENT

20
A SCORE ABOVE ___ INDICATES SEVERE WITHDRAWALS

METHADONE
WHAT IS THE ONLY MEDICATION CURRENTLY APPROVED FOR THE TREATMENT OF A PREGNANT OPIOD ADDICT

WITHIN A COUPLE HOURS AFTER CESSATION
EARLY SIGNS OF ALCOHOL WITHDRAWAL APPEAR:

24-48 HOURS
ALCOHOL WITHDRAWAL SIGNS PEAK AFTER:

48-72 HOURS
ALCOHOL WITHDRAWAL DELIRIUM PEAKS AFTER:

WHAT WAS TAKEN, WHEN LAST TAKEN, HOW MUCH
WITH A NEWLY ARRIVED SUBSTANCE ABUSE PATIENT, WHAT QUESTIONS ARE THE NURSING PRIORITY WITH REGARD TO THE SUBSTANCE?

SEIZURES
AS A PRECAUTION, A NURSE HANDLING A WITHDRAWAL PATIENT SHOULD MONITOR FOR WHAT PHYSICAL REACTION?

ANTABUSE (DISULFIRAM)
WHICH DRUG FOR ALCOHOL ABUSE WORKS ON THE CLASSICAL CONDITIONING PRINCIPLE OF INHIBITING IMPULSIVE DRINKING. CAUSES UNPLEASANT PHYSICAL EFFECTS IF ALCOHOL IS CONSUMED

THE NEGATIVE EFFECTS ASSOCIATED WITH ALCOHOL CONSUMPTION / EXPOSURE
WHAT SHOULD THE PATIENT BE EDUCATED ABOUT WHEN ON ANTABUSE?

5 DAYS – 2 WEEKS AFTER LAST DOSE
HOW LONG IS ANTABUSE EFFECTIVE IN SYSTEM?

• LOW SELF ESTEEM
• LACK OF SELF-REGARD
• RISK TAKING
• FREQUENT DEPRESSION
• PASSIVITY
• UNABLE TO RELAX
• DETER GRATIFICATION
• CAN’T COMMUNICATE EFFECTIVELY
WITH REGARD TO THE “PSYCHOLOGICAL” SUBSTANCE ABUSE THEORY, NAME SOME CHARACTERISTICS OF SUBSTANCE ABUSE PATIENTS

ANTICHOLINERGENIC TOXICITY
PATIENT HAS DRY MUCOUS MEMBRANES, NON-REACTIVE PUPILS, HOT-RED-DRY SKIN, HYPERPYREXIA WITHOUT DIAPHORESIS, TACHY CARDIA, AGITATION, UNSTABLE V/S, WORSENING OF PSYCHOTIC SYMPTOMS, DELIRIUM, URINARY RETENTION, SEIZURE, REPETITIVE MOTOR MOVEMENTS. NURSE SUSPECTS?

YES
IS ANTICHOLINERGENIC TOXICITY POTENTIALLY LIFE THREATENING?

• EMERGENCY COOLING
• HOLD MEDS
• CATHETERIZATION PRN
• BENZOS OR OTHER PRNS
• PHYSOSTIGMINE MAYBE
NURSING INTERVENTIONS FOR ANTICHOLINERGENIC TOXICITY

TRUE
Projetion is the most common defense mechanism TRUE or FALSE

FEW HOURS AFTER CESSATION
EARLY SIGNS OF ALCOHOL WITHDRAWAL USUAL OCCUR WHEN

• HANGOVER
• JERKY MOVEMENTS
• IRRITABILITY
• GI DISTURBANCE
• “SHAKING INSIDE”
• GRAND MAL SEIZURES
COMMON SIGNS OF ALCOHOL WITHDRAWAL

24-48 HOURS (2-3 DAYS)
WITHDRAWAL SIGNS USUALLY PEAK WITHIN HOW LONG AFTER CESSATION

SEIZURE
A WITHDRAWAL RELATED FEVER OF 100o TO 103o LEADS TO

• ANXIETY, INSOMNIA
• ANOREXIA
• DELURIUM
• AUTONOMIC HYPERACTIVITY
• SENSORIUM DISTURBANCES
• PERCEPTUAL DISTURBANCES
• FLUCTUATING LOC
• DELUSIONS, AGITATED BEHAVIORS, FEVER
FEATURES OF ALCOHOL WIHDRAWAL DELIRIUM

SUBSTITUTE DRUG (CNS DEPRESSANT) & TITRATE DOWN
HOW IS ALCOHOL WITHDRAWAL TREATED PHARMACOLOGICALLY

LORAZEPAM(ATIVAN), DIAZEPAM (VALIUM
WHICH BENZODIAZEPINES DON’T INVOLVE THE LIVER

LORAZEPAM(ATIVAN), DIAZEPAM (VALIUM),
CHLORIDIAZEPOXID
E (LIBRIUM
WHICH BENZODIAZEPINES ARE USED TO DECREASE WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND PREVENT SEIZURES/DT’S

PHENOBARBITAL
IF TAKING BENZODIAZEPINES, WHAT ANTI-SEIZURE MED CAN’T BE USED

TOLERANCE
WHY DO WITHDRAWAL PATIENTS NEED TO BE “OD’ED” WITH BENZODIAZEPINES DURING TREATMENT?

THIAMIN (B1), FOLIC ACID
WHICH MULTIVITAMINS ARE GIVEN TO WITHDRAWAL PATIENTS

MALNUTRITION
WHY ARE MULTIVITAMINS GIVEN TO WITHDRAWAL PATIENTS

WERNIKE-KORSAKOFF SYNDROME
THIAMIN (B1) IS GIVEN TO WITHDRAWAL PATIENTS TO PREVENT

MAGNESIUM SULFATE
WHAT IS GIVEN WITH THIAMIN TO INCREASE ITS EFFECTIVENESS, ESPECIALLY IF THE PATIENT HAS A HISTORY OF SEIZURES

CIWA SCALE
THE SCALE UTILIZED TO DETERMINE THE SEVERITY OF WITHDRAWALS

GREATER THAN 15
A CIWA SCORE GREATER THAN WHAT WILL MANDATE USE OF BENZOS

WHAT AND HOW MUCH OF A DRUG IS IN PT’S SYSTEM
BLOOD AND URINE SCREENS ARE UTILIZED TO DETERMINE

UPON ARRIVAL
WHEN MUST THE SCREEN BE PERFORMED

CROSS-DEPENDENCE
THE CONDITION WHERE ONE DRUG IS USED TO PREVENT THE WITHDRAWAL SYMPTOMS FOR ANOTHER DRUG

ANTABUSE (DISULFIRAM
THIS DRUG WORKS ON THE CLASSICAL PRINCIPLE OF INHIBITING IMPULSIVE DRINKING, CAUSING NEGATIVE PHYSICAL SYMPTOMS UPON ALCOHOL INTAKE

NEGATIVE SYMPTOMS LAST UP TO 2 WEEKS
WHAT MUST THE PATIENT ON ANTABUSE BE EDUCATED ABOUT

NALTREXONE (REVIA)
THIS MEDICATION, TAKEN BY NARCOTIC AND SOMETIMES ALCOHOL ADDICTS, BLOCKS OPIATE RECEPTORS IN THE BRAIN THUS BLOCKING THE EUPHORIC EFFECTS

ACAMPROSATE (CAMPRAL)
A SECOND MEDICATION USED TO TREAT ALCOHOLISM; ITS MECHANISM OF ACTION IS NOT FULLY UNDERSTOOD

• RELAPSE PREVENTION
• REHAB – SELF HELP GROUPS
• 90 MEETINGS, 90 DAYS
• PSYCHOTHERAPY
TERTIARY INTERVENTION FOR RECOVERING ADDICTS INVOLVES

Ativan and Haldol
Two Meds given to a very agitated patient.

Lithium, plus anti-psychotic for acting out

Abilify, Zyprexa, Seroquel, Risperdal, Geodon
o for acute mania

What drugs do you give to a Bipolar patient who is starting to show signs of mania?

slurred speech drowsiness, impaired judgment, decreased blood pressure
Different symptoms that are characteristic of intoxication of Alcohol/Benzos

tachycardia, dilated pupils, elevated BP, n/v, insomnia, increased energy
Different symptoms that are characteristic of intoxication of Stimulants/hallucinogens

constricted pupils, decreased RR, drowsiness, decreased BP, slurred speech
Different symptoms that are characteristic of intoxication of Opiates

Revia, Campral, Topomax, Antabuse
Medications used to help patients safely withdrawal from Alcoholic substances

Methadone, LAAM, Revia, Clonidine, Subutex
Medications used to help patients safely withdrawal from Opiod substances

emotions and thoughts and decision making (Decrease = depression, increase = schizo and mania)
Dopamine Neurotransmitters are responsible for?

affects mood, fight or flight (Decrease= depression, increase = mania, anxiety and schizo)
Norepinephrine Neurotransmitters are responsible for?

sleep regulation, hunger, mood, pain perception (decrease = depression)
Serotonin Neurotransmittersare responsible for?

role in inhibition, reduces aggression, excitation, anxiety (decrease = anxiety disorder, schizo)
GABA Neurotransmittersare responsible for?

TOLERANCE
THE NEED FOR HIGHER AND HIGHER DOSES TO ACHIEVE THE DESIRED EFFECT

WITHDRAWAL
OCCURS AFTER A LONG PERIOD OF CONTINUED USE; STOPPING OR REDUCING USE RESULTS IN SPECIFIC PHYSICAL AND PSYCHOLOGICAL SIGNS AND SYMPTOMS

FLASHBACK
TRANSITORY RECURRENCE OF PERCEPTUAL DISTURBANCE CAUSED BY A PERSON’S EARLIER HALLUCINOGENIC DRUG USE. RANGE FROM MILD/PLEASANT TO FRIGHTENING

SYNERGISTIC EFFECTS
THE INTENSIFIED OR PROLONGED EFFECT WHEN DRUGS ARE TAKEN TOGETHER

ANTAGONISTIC EFFECTS
COMBINING DRUGS TO WEAKEN OR INHIBIT THE EFFECT OF ONE OF THE DRUGS

CODEPENDENCE
A CLUSTER OF BEHAVIORS OFTEN MANIFESTED BY PERSONS LIVING WITH A SUBSTANCE ABUSING INDIVIDUAL. EXHIBIT OVER-RESPONSIBLE BEHAVIOR, DOING FOR OTHERS WHAT THEY COULD DO FOR THEMSELVES

DUAL DIAGNOSIS
NECESSARY WHEN A PERSON IS SUBSTANCE ABUSING AND HAS A PSYCHIATRIC ILLNESS

• MENTALLY ILL AND SELF MEDICATES
• DEPRESSED ADDICT BECAUSE OF ALCOHOLISM
WHEN A PERSON IS SUBSTANCE ABUSING AND HAS A PSYCHIATRIC ILLNESS IT MUST BE DETERMINED WHICH CONDITION IS PREDOMINANT. MUST DISTINGUISH BETWEEN PERSON WHO IS:

SIMULTANEOUSLY
HOW MUST A DUAL DIAGNOSED PATIENT’S CONDITIONS BE TREATED

CROSS ADDICTION
THE TERM FOR THE ABUSE OF TWO TYPES OF SUBSTANCES

MOOD ALTERING
WHICH TYPE OF DRUG IS NOT SAFE WHEN TREATING AN ADDICTED PATIENT

ASIAN
ALCOHOL ABUSE IS LOW IN THIS CULTURE DUE TO A BIOLOGICAL DEFICIENCY IN ALDEHYDE DEHYDROGENASE; AN ENZYME THAT BREAKS DOWN ALCOHOL ACETALDEHYDE?

FEMALE
WHICH GENDER HAS LOWER SUBSTANCE ABUSE RATES?

1.) Control addictive and impulsive behaviors.
A nurse is teaching a group of clients about addiction. One client says he can stop drinking whenever he wants. The nurse concludes that this client does not yet understand that addiction is a disease in which individuals primarily lose ability to do which of the following? (1 point)
1.) Control addictive and impulsive behaviors.

2.) Act sober even if they are not.

3.) Think logically about their addictive behaviors.

4.) Recognize that addictive behavior is harmful to themselves and others.

c.) “Your son has probably seen changes in you when you were drinking.”
After orienting the client to the addiction treatment unit, the nurse suggests that the client invite his 13-year-old son to the family sessions. The client questions why the son needs to participate, because he has not seen his father drunk. What is the best response by the nurse? (1 point)
a.) “Your son probably knows that you are an alcoholic.”

b.) “Thirteen-year-olds are old enough to start learning about the effects of alcohol.”

c.) “Your son has probably seen changes in you when you were drinking.”

d.) “It’s good that you have concern for your underage son.”

4.) Feeling that nurses’ knowledge about drugs protects them from drug dependency
The nurse conducts an in-service session about impaired nursing practice. The nurse evaluates that the teaching was effective when one of the nurses says that the most influential risk for impaired nursing practice is which of the following? (1 point)
1.) Thinking that professionals are not at high risk for substance dependency

2.) Having grown up in a dysfunctional family

3.) Having a tendency to involve self in codependent professional and personal relationship

4.) Feeling that nurses’ knowledge about drugs protects them from drug dependency

2.) Denial
A male client comes to day treatment surrounded by an intense odor of alcohol. The client staggers when walking but insists that that he has not consumed any alcohol. The nurse concludes that this behavior constitutes which of the following? (1 point)
1.) Rationalization

2.) Denial

3.) Transference

4.) Countertransference

4.) “Perhaps they have noticed that your drinking creates consequences for you.”
A female alcohol-dependent client who has cardiomyopathy tells the nurse that she is certain that her family and friends are against her. The client goes on to say, “They stay on my back about my drinking and say I could die from it.” What would be the best response by the nurse? (1 point)
1.) “Anyone saying this to you must have a problem with his or her own drinking.”

2.) “Although their intentions are good, they have no right to judge another person’s drinking.”

3.) “Do you think they may be jealous that you can drink more than they can?”

4.) “Perhaps they have noticed that your drinking creates consequences for you.”

1.) Sobriety issue and depression at the same time
A client who is recovering from alcoholism presents in the psychiatric unit and tells the admitting nurse she is very depressed and has a hard time staying sober. The nurse concludes that the most likely treatment sequence for this client will be which of the following? (1 point)
1.) Sobriety issue and depression at the same time

2.) Sobriety issue before the depression

3.) Depression before the sobriety issue

4.) Depression after the sobriety issue has been resolved

4.) Once an individual has achieved sobriety, he or she continues to be at risk for relapse into drinking.

5.) People learn to change negative attitudes and behaviors into positive ones.

As part of the clinical experience, a student nurse is required to attend an Alcoholics Anonymous (AA) meeting and write a report about what was learned. What information would the student include in the report about the twelve-step program?
(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. (1 point)
1.) A Higher Power will protect individuals if they feel like using.

2.) Once an individual learns how to be sober, he or she can graduate from attending meetings.

3.) Acceptance of being an alcoholic will prevent urges to drink, since it represents giving up one’s denial.

4.) Once an individual has achieved sobriety, he or she continues to be at risk for relapse into drinking.

5.) People learn to change negative attitudes and behaviors into positive ones.

4.) Alcohol
The nurse working in the maternal care area is reinforcing physician health teaching about the risks of substance use during pregnancy. When questioned by the client, the nurse should reply that which drugs are most likely to lead to significant physical, cognitive, and developmental problems for any infant? (1 point)
1.) Cocaine

2.) Benzodiazepines

3.) Hallucinogens

4.) Alcohol

“Inhaling fumes from paints and wood stains may cause a disulfiram reaction.”
Having requested it as part of a comprehensive treatment program, the client is to receive disulfiram (Antabuse). Which statement should the nurse include when teaching the client about this drug? (1 point)
“Taking disulfiram will reduce your physical craving for alcohol.”

“Eating inadequately cooked seafood may lead to disulfiram resistance.”

“Inhaling fumes from paints and wood stains may cause a disulfiram reaction.”

“If you consume alcohol while taking disulfiram, rapid intoxication will occur.”

DENIAL
HALLMARK SIGN OF SUBSTANCE ABUSE

• DYSFUNCTIONAL ANGER
• MANIPULATIVE
• IMPULSIVE
BEHAVIORS ASSOCIATED WITH SUBSTANCE ABUSE

DEPRESSION & SUICIDE
COMMON IN PATIENTS WHETHER SOBER OR INTOXICATED

CODEPENDENCY
THE TERM FOR THE ATTEMPT TO CONTROL THE ADDICT’S BEHAVIOR

CHANGES IN MOOD AND BEHAVIOR, IMPAIRED JUDGEMENT
BLOOD ALCOHOL LEVEL of 50 mg/dL Effects?

ATAXIA; LEGAL LEVEL OF IMPAIRMENT IN MOST STATES
BLOOD ALCOHOL LEVEL of 100 mg/dL Effects?

DEPRESSED FUNCTION OF ENTIRE MOTOR AREA OF BRAIN; ATAXIA, STAGGERING, EMOTIONAL LABILITY
BLOOD ALCOHOL LEVEL of 200 mg/dL Effects?

CONFUSION, STUPOR
BLOOD ALCOHOL LEVEL of 300 mg/dL Effects?

COMA
BLOOD ALCOHOL LEVEL of 400 mg/dL Effects?

DEATH DUE TO RESPIRATORY DEPRESSION
BLOOD ALCOHOL LEVEL of 500 mg/dL Effects?

• ANXIETY
• INSOMNIA
• TREMORS
• DELIRIUM / CONVULSIONS
SYMPTOMS OF WITHDRAWAL FOR CNS DEPRESSANTS

• ALCOHOL
• BARBITUATES
• BENZODIAZEPINES
• HYPNOTIC SEDATIVES

CNS DEPRESSANTS
Act on GABA increase bioavailability of glutamate, norepinephrine and dopamine

TYPES OF CNS DEPRESSANTS

• SLURRED SPEECH
• ATAXIA
• DECREASED BP
• DROWSINESS
• IMPAIRED JUDGEMENT
• IMPAIRED ATTENTION/MEMORY
• DISINHIBITION OF SEXUAL / AGGRESSIVE DRIVES
PHYSICAL EFFECTS OF CNS DEPRESSANTS

• CAREFULLY TITRATED DETOXIFICATION WITH SIMILAR DRUG

** ABRUPT WITHRDRAWAL DEADLY**

INTERVENTIONS OF CNS DEPRESSANTS

• AMPHETAMINES
• NON-AMPHETAMINES
• METHAMPHETAMINES
• COCAINE (MOST POTENT)
• CAFFEINE, NICOTINE
Serotonin, dopamine, norepinephrine
TYPES OF CNS STIMULANTS

• APATHY
• HYPERSOMULENCE
• IRRITABILITY
• DEPRESSION
• DISORIENTATION
SYMPTOMS OF WITHDRAWAL FOR CNS STIMULANTS

• DILATED PUPILS
• TACHYCARDIA
• ELEVATED BP
• N/V, INSOMNIA
• PSYCHO-PERCEPTUAL DISTURBANCES
• PARANOIA, PSYCHOSIS
PHYSICAL EFFECTS OF CNS STIMULANTS

• ANTIDEPRESSANTS
• DOPAMINE AGONIST – BROMOCRIPTINE
INTERVENTIONS OF CNS STIMULANTS

• HEROIN Most common used in the streets.
• MORPHINE
• CODEINE
• METHADONE
• DEMEROL
TYPES OF OPIODS

• PUPIL CONSTRICTION
• RESPIRATORY DEPRESSION
• PSYCHOMOTOR RETARDATION
• EUPHORIA → DYSPHORIA
• USE ↑ TOLERANCE
PHYSICAL EFFECTS OF OPIODS

• WATERY EYES
• RUNNY NOSE
• LOSS OF APPETITE
• IRRITABILITY
• TREMORS
• PANIC
• CRAMPS
• NAUSEA
• CHILLS / SWEATING
• ELEVATED BP
• HALLUCINATIONS DELUSIONS
SYMPTOMS OF WITHDRAWAL FOR OPIODS

• METHADONE TAPERING
• CLONIDINE(CATAPRES), NALTREXONE DETOX
• BUPRENORPHINE SUBSTITUTION
INTERVENTIONS OF OPIODS

• MESCALINE
• PEYOTE, MUSHROOMS, ANGEL TRUMPET
• LSD, MDMA, PCP
Affects dopamine
TYPES OF HALLUCINOGENS

• PUPIL DILATION
• TACHYCARDIA
• DIAPHORESIS
• PALPITATIONS
• TREMORS
• INCOORDINATION
• ↑ TEMP, PULSE, RESPIRATION
PHYSICAL EFFECTS OF HALLUCINOGENS

• ROOM WITH ↓ LIGHT / STIMULI
• 1 TO 1, TALK DOWN PATIENT
• SPEAK SLOW, CLEAR, LOW VOICE
• DIAZEPAM / CHLORAL HYDRATE FOR ANXIETY
INTERVENTIONS OF HALLUCINOGENS

• HAIRSPRAY
• GAS
• WHITEOUT
• SOLVENTS
• ANESTHETICS
TYPES OF INHALANTS

• EUPHORIA
• CNS DEPRESSION
• VISUAL HALLUCINATIONS / DISORIENTATION
• ENHANCEMENT SEXUAL PLEASURE
• BRAIN DAMAGE
PHYSICAL EFFECTS OF INHALANTS

• SUPPORT AFFECTED SYSTEMS
• OXYGEN, METHYLENE BLUE
• B12 FOR NEUROPATHY
INTERVENTIONS OF INHALANTS

• ANTIHISTAMINES
• COUGH SYRUP
• NYQUIL COLD MED
• MOUTHWASH
• VANILLA FLAVORING
• SLEEP AIDS
It contains ALCOHOL
TYPES OF OTC DRUGS

• ALCOHOL EFFECTS
• ANTIHISTAMINE EFFECTS
• MANY
PHYSICAL EFFECTS OF OTC DRUGS

• TREAT SYMPTOMS RELATED TO USE
INTERVENTIONS OF OTC DRUGS

• EDUCATE YOUNG
• SUPPORT ELDERLY
• TEACH PROBLEM SOLVING TECHNIQUES
• ADVOCATE POSITIVE INTERPERSONAL RELATIONSHIPS
PRIMARY SUBSTANCE ABUSE INTERVENTIONS /STRATEGIES

• DETOXIFICATION (3-5 DAYS)
• MONITOR
• CONFRONTATION (TOUGH LOVE)
• MANAGE HEALTH PROBLEMS
• FAMILY EDUCATION – NO DENIAL OR ENABLING
• INVOLVE FAMILY / DISCOURAGE ADDICTION SUPORTING BEHAVIOR
SECONDARY SUBSTANCE ABUSE INTERVENTIONS /STRATEGIES

• PREVENT RELAPSE
• DO NOT REJECT
• TEACH NEW COPING STRATEGIES
• RELAPSE COMMON, EXPECT IT
• NON SUBSTANCE ABUSING FRIENDS
TERTIARY SUBSTANCE ABUSE INTERVENTIONS /STRATEGIES

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