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
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
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
*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.
*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.
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.
*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.
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.
*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.
a.) Readiness to change and support system
b.) Current college performance
c.) Financial ability
d.) Availability of immediate family to come to meetings
*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.
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.”
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.
The effects of opiates can be negated by a narcotic antagonist such as naloxone.
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.
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.
Benzodiazepines act by binding to α-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect.
a.) block cortisol secretion.
b.) increase dopamine release.
c.) decrease serotonin availability.
d.) exert a calming effect.
An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use.
Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence).
b. ) projection.
c. ) rationalization.
d.) reaction formation.
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.
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.
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. ) LAAM
d. ) Clonidine
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.
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.
Symptoms of opioid withdrawal resemble the “flu”; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.
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.
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
Tremors are an early sign of alcohol withdrawal.
REF: Page 414
Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose.
REF: Page 414
a.) induction of vomiting.
b.) administration of ammonium chloride.
c.) monitoring of opiate withdrawal symptoms.
d.) observation for hyperpyrexia and seizures.
Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.
REF: Page 416
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
Cocaine exerts two main effects on the body, both anesthetic and stimulant.
REF: Page 413-415 (Table 22-1)
a.) Stimulation after 15 to 20 minutes
b.) Stimulation and anesthetic effects
c.) Immediate imbalance of emotions
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
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 nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level.
REF: Page 416
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.
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.) 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.
The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol.
REF: Page 427 (Table 22-9)
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.”
Relapses can point out problems to be resolved and can result in renewed efforts for change.
REF: Page 425
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.
• 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
• LACK OF SELF-REGARD
• RISK TAKING
• FREQUENT DEPRESSION
• UNABLE TO RELAX
• DETER GRATIFICATION
• CAN’T COMMUNICATE EFFECTIVELY
• HOLD MEDS
• CATHETERIZATION PRN
• BENZOS OR OTHER PRNS
• PHYSOSTIGMINE MAYBE
• JERKY MOVEMENTS
• GI DISTURBANCE
• “SHAKING INSIDE”
• GRAND MAL SEIZURES
• AUTONOMIC HYPERACTIVITY
• SENSORIUM DISTURBANCES
• PERCEPTUAL DISTURBANCES
• FLUCTUATING LOC
• DELUSIONS, AGITATED BEHAVIORS, FEVER
• REHAB – SELF HELP GROUPS
• 90 MEETINGS, 90 DAYS
Abilify, Zyprexa, Seroquel, Risperdal, Geodon
o for acute mania
• DEPRESSED ADDICT BECAUSE OF ALCOHOLISM
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.
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.”
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
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
2.) Sobriety issue before the depression
3.) Depression before the sobriety issue
4.) Depression after the sobriety issue has been resolved
5.) People learn to change negative attitudes and behaviors into positive ones.
(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.
“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.”
• DELIRIUM / CONVULSIONS
• HYPNOTIC SEDATIVES
Act on GABA increase bioavailability of glutamate, norepinephrine and dopamine
• DECREASED BP
• IMPAIRED JUDGEMENT
• IMPAIRED ATTENTION/MEMORY
• DISINHIBITION OF SEXUAL / AGGRESSIVE DRIVES
** ABRUPT WITHRDRAWAL DEADLY**
• COCAINE (MOST POTENT)
• CAFFEINE, NICOTINE
Serotonin, dopamine, norepinephrine
• ELEVATED BP
• N/V, INSOMNIA
• PSYCHO-PERCEPTUAL DISTURBANCES
• PARANOIA, PSYCHOSIS
• DOPAMINE AGONIST – BROMOCRIPTINE
• RESPIRATORY DEPRESSION
• PSYCHOMOTOR RETARDATION
• EUPHORIA → DYSPHORIA
• USE ↑ TOLERANCE
• RUNNY NOSE
• LOSS OF APPETITE
• CHILLS / SWEATING
• ELEVATED BP
• HALLUCINATIONS DELUSIONS
• CLONIDINE(CATAPRES), NALTREXONE DETOX
• BUPRENORPHINE SUBSTITUTION
• PEYOTE, MUSHROOMS, ANGEL TRUMPET
• LSD, MDMA, PCP
• ↑ TEMP, PULSE, RESPIRATION
• 1 TO 1, TALK DOWN PATIENT
• SPEAK SLOW, CLEAR, LOW VOICE
• DIAZEPAM / CHLORAL HYDRATE FOR ANXIETY
• CNS DEPRESSION
• VISUAL HALLUCINATIONS / DISORIENTATION
• ENHANCEMENT SEXUAL PLEASURE
• BRAIN DAMAGE
• OXYGEN, METHYLENE BLUE
• B12 FOR NEUROPATHY
• COUGH SYRUP
• NYQUIL COLD MED
• VANILLA FLAVORING
• SLEEP AIDS
It contains ALCOHOL
• ANTIHISTAMINE EFFECTS
• SUPPORT ELDERLY
• TEACH PROBLEM SOLVING TECHNIQUES
• ADVOCATE POSITIVE INTERPERSONAL RELATIONSHIPS
• CONFRONTATION (TOUGH LOVE)
• MANAGE HEALTH PROBLEMS
• FAMILY EDUCATION – NO DENIAL OR ENABLING
• INVOLVE FAMILY / DISCOURAGE ADDICTION SUPORTING BEHAVIOR
• DO NOT REJECT
• TEACH NEW COPING STRATEGIES
• RELAPSE COMMON, EXPECT IT
• NON SUBSTANCE ABUSING FRIENDS