NURS-3320: Substance Use & Abuse

Long-term consequences of child abuse and neglect

-chronic health conditions, greater likelihood of suffering from cardiovascular disease, lung and liver disease, hypertension, diabetes, asthma, obesity, impaired brain development, brain injury with head trauma, emotional conditions such as chronic fear, hypervigilance. -isolation, inability to trust, low self-esteem, depression, relationship difficulties. -grade repetition, substance use, delinquency, truancy, sexual risk-taking, juvenile delinquency and adult criminality, employment problems, financial problems.

Categories of drugs include:

1. Alcohol 2. Sedatives, hypnotics, and anxiolytics 3. Stimulants 4. Cannabis 5. Opioids 6. Hallucinogens 7. Inhalants

Protocol for nurses handling vicims of IPV:

1. Screen for IPV in a private and safe setting with the patient alone and not with partner, friends, family. 2. Use professional language interpreters and definitely do not use someone associated with patient. 3. At the beginning of the assessment, offer a framing statement to show that screening is done universally and not because IPV is suspected. 4. Do not give printed materials. Give patient information for an organization like the Dove Center by putting it in the patient's phone inconspicuously, e.g. "Susie from highschool" 5. Screen every patient, every time.

What is the cycle of violence/abuse?

1. Triggers (tension builds in the relationship. Victims report their partners becoming increasingly irritable, frustrated, and unable to cope with every-day stresses.) 2. Violent/battering episode 3. Honeymoon phase

Physiological effects of long-term alcohol use

1. cardiac myopathy 2. Wernicke encephalopathy 3. Korsakoff psychosis 4. Pancreatitis 5. Esophagitis 6. Hepatitis 7. Cirrhosis 8. Leukopenia 9. Thrombocytopenia 10. Ascites

Describe: GI distress associated with alcohol use disorder

Alcohol use disorder can produce gastrointestinal irritation, bleeding, and inflammation of the stomach lining leading to the development of gastritis, esophagitis, or esophageal tears (esophageal varices). In addition, GI inflammation leads to interruptions in vitamin B absorption in the stomach.

Compare and contrast: Benzodiazepines and Barbiturates

Both are: - CNS depressants - the most frequently abused drugs in the drug category of Sedatives, Hypnotics, and Anxiolytics. Benzos are rarely fatal in overdose, but makes the person lethargic and confused. Tx includes gastric lavage followed by ingestion of activated charcoal and a saline cathartic. Barbs can be lethal in overdose, and can cause coma, respiratory arrest, cardiac failure and death.Tx in ICU includes using lavage or dialysis to remove drug from system and to support respiratory and cardiovascular function.

Screening tools for alcohol use disorder

CAGE and AUDIT. The CAGE assessment asks a series of questions including if the patient has ever felt the need to Cut down, if the patient has ever been Annoyed with criticism about their drinking, if they have ever felt Guilty for drinking, or if they have ever started the day off with a drink as an Eye-opener. 2 or more "yes" answers indicate alcohol use disorder. The Alcholol Use Disorders Identification test (AUDIT) is a 10 question tool that the patient answers, responding with a Likert 5 point scale. A score of 8 or more for men and 7 or more for women indicate problems with alcohol use.

Cannabis: onset, peak, duration

Cannabis begins to act less than 1 minute after inhalation. Peak effects usually occur in 20-30 mins and last at least 2-3 hours. Signs and symptoms include impaired motor coordination, inappropriate laughter, impaired judgement, short term memory and distortions of time and perception. Increased appetite, bloodshot eyes, dry mouth, hypotension, and tachycardia. Overdose does not occur.

What cardiac issue is associated with alcohol use disorder?

Cardiomyopathy. Chronic alcohol use can wear down and injure the heart muscle leading to inadequate contraction of the heart and decreased oxygen delivery to vital organs. This produces alcohol induced cardiomyopathy.

What factors are considered in the substance use disorder assessment?

Changes in mood, weight loss, poor hygiene, odd sleep patterns, relationship or job difficulty, social isolation, poor performance, frequent injuries, and financial problems.

What is disulfiram and how does it work?

Disulfiram aka Antebuse is a medication that is used to treat alcohol use disorder. Disulfiram works by blocking the breakdown of alcohol in the body. This leads to buildup of a toxic alcohol-related compound that can cause people who drink alcohol while taking this medication to become very sick.

Stimulant drugs and their intoxication/physiologic effects:

Drugs that excite the CNS. Examples include amphetamine, methamphetamine, & cocaine. Intoxication effects include the high/euphoric feeling, hyperactivity, hypervigilance, talkativeness, grandiosity, anxiety, hallucinations, anger, fighting, impaired judgement. Physiologic effects include tachycardia, elevated BP, dilated pupils, perspiration or chills, nausea, chest pain, confusion, & cardiac dysrhythmias. Overdose can result in seizures and coma; deaths are rare.

Mandated Reporters

Mandated reporters are people who have regular contact with vulnerable people such as children, disabled persons, and senior citizens, and are therefore legally required to ensure a report is made when abuse is observed or suspected. Specific details vary across jurisdictions—the abuse that must be reported may include neglect, financial, physical, sexual, or other types of abuse.

Antidote for opioid overdose

Naloxone Naloxone attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. However, naloxone has no effect on someone who does not have opioids in their system, and it is not a treatment for opioid use disorder.

What is naltrexone? How does it work?

Naltrexone lowers one's desire for alcohol. It binds to the endorphin receptors in the body, and blocks the effects and feelings of alcohol. Naltrexone reduces alcohol cravings and the amount of alcohol consumed. Once a patient stops drinking, taking naltrexone helps patients maintain their sobriety.

Withdrawal and Detox of Stimulant Drug:

Occurs within a few hours to several days after cessation of the drug and is not life-threatening. Marked dysphoria is the primary symptom, fatigue, vivid/unpleasant dreams, insomnia, increased appetite, and psychomotor retardation or agitation. The person may "crash" and experience depressive symptoms including suicidal ideation.

Physical and psychological effects of elder abuse

PHYSICAL: injuries (bruises, lacerations, dental problems, broken bones, pressure sores), persistent physical pain and soreness, nutrition/hydration issues, sleep disturbances, increased susceptibility to new illnesses (including STDs), exacerbation of pre-existing health conditions, increased risk of premature death. PYSCHOLOGICAL: increased risk for developing fear and anxiety reactions, learned helplessness, PTSD

Which medication is used to prevent alcohol withdrawal symptoms? a. Lorazepam (Ativan) b. Clonidine (Catapres) c. Folic acid (Folate) d. Naltrexone (ReVia)

Safe withdrawal usually is accomplished with the administration of benzodiazepines, such as lorazepam, chlordiazepoxide, or diazepam, to suppress the withdrawal symptoms.

Which schedule drugs have high abuse potential and no accepted medical use?

Schedule 1. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.

What is horizontal violence?

Violence and abuse between healthcare workers in the workplace is known as horizontal violence. Intimidating and undisciplined behavior in the healthcare industry results in more than just hurt feelings. It contributes to medical errors and poor patient satisfaction. Clinical educators and administrators have a responsibility to provide a safe and productive workplace environment free from horizontal violence. However, direct care nurses also have a responsibility to report any horizontal violence that occurs so it can be dealt with appropriately. Learning effective methods of dealing with horizontal violence, including physician verbal abuse, can help change the culture of the workplace, improve nurse/physician relationships, and ultimately enhance patient outcomes and safety.

Types of Violence

Violence may be physical, psychological, economic, sexual, and/or emotional.

A nurse suspects that a 9-year-old girl who is in the office today regarding a sprained wrist has been physically abused. The nurse would like to screen the girl for signs of abuse. The girl's father is in the examination room. What should the nurse do in this situation? a. Ask the father to leave the room so that the nurse can talk with the child in private b. Proceed with the screening with the father present c. Postpone the screening until a more opportune time d. Ask that the mother also be present for the screening

a. Ask the father to leave the room so that the nurse can talk with the child in private

Students are preparing a class presentation on elder abuse. Which of the following would they include as the most common type of elder abuse? a. Neglect b. Emotional c. Financial d. Sexual

a. Neglect

The nurse has received a client into care who was admitted with a heroin overdose. The client has a 5-year history of illicit substance use with cocaine, heroine and oxycodone. The client develops a sudden onset of wheezing, restlessness and a cough that produces a frothy, pink sputum. The nurse suspects the client has most likely developed which complication of opioid overdose? a. Pulmonary edema b. Pneumonia c. Congestive heart failure d. Panic attack

a. pulmonary edema The nurse should suspect the client has developed pulmonary edema, which is frequently seen in clients who abuse/overdose on narcotics. Many drugs — ranging from illegal drugs such as heroin and cocaine to aspirin — are known to cause noncardiogenic pulmonary edema.

The nurse is counseling a female victim of intimate partner violence. What should the nurse encourage the client to have prepared as part of a safety plan? Select all that apply. a. Cash b. Credit cards c. Driver's license d. Marriage license e. Bank account numbers

a., c., d., e. Items to have prepared as part of a personal safety plan include cash, driver's license, marriage license, and bank account numbers. Credit cards can be traced and are not considered a part of a personal safety plan.

Which of the following is most likely a medical complication associated with alcohol use disorder? a. Willaims Syndrome b. Immunosuppresion c. Libman-Sacks endocarditis d. Deafness

b. Immunosuppression Excessive alcohol use reduces the body's ability to defend itself from infection causing immunosuppression. This can occur due to impaired nutrition. Leukopenia and thrombocytopenia fruther lead to immunosuppression.

Which of the following is most likely an assessment finding of substance use disorder? a. Russell's sign b. Social isolation c. Retinal deposits d. Angioedema

b. Social isolation Individuals affected with addiction are often alienated and isolated from their families, workplaces, and communities, along with experiencing significant barriers, such as stigma.

Which of the following diseases or disorders is most likely associated with alcohol withdrawal? a. Alkaptonuria b. Wernicke-Korsakoff Syndrome c. Renal Cell Carcinoma d. Paget's Disease

b. Wernicke-Korsakoff Syndrome Withdrawal symptoms can begin as early as 2 hours after the last drink, and can range from mild anxiety and shakiness to severe symptoms such as seizures and delirium tremens (DTs). With alcohol withdrawal, it is possible to develop Wernicke-Korsakoff Syndrome, which is Wernicke's encephalopathy combined with Korsakoff psychosis. This typically occurs due to deficient thiamine (vit B1) levels secondary to alcohol use disorder. This syndrome can produce vision changes, memory impairment, and dementia.

A nurse assesses a client who was physically assaulted by her boyfriend. The nurse learns that the client was stabbed in the thigh with a knife. After marking the area of injury on the body map, what score should the nurse document for this abuse? a. 4 b. 5 c. 6 d. 7

c. 6 The nurse should document the abuse score as 6, which indicates use of a weapon or a wound from a weapon. Beating up and severe contusion is given a score of 4, and head injury and internal injury is given a score of 5. A score of 7 is not possible on this scale.

Which drugs may be abused because of tolerance and physiologic dependence? a. lithium and divalproex b. verapamil and chlorpromazine c. alprazolam and phenobarbital d. clozapine and amitriptyline hydrochloride

c. alprazolam and phenobarbital Benzodiazepines such as alprazolam and barbiturates such as phenobarbital are addictive, controlled substances. Lithium, divalproex, verapamil, chlorpromazine, clozapine, and amitriptyline aren't addictive substances.

Alcohol is a CNS ____________________________.

depressant. CNS depression can cause alterations in neurologic, respiratory and cardiac status of the patient. This can lead to trouble with speech, judgement, and muscle coordination. Severe alcohol use may result in coma or death.

Alcohol use disorder is one the the most common causes of acute ___________________________.

pancreatitis. This occurs because alcohol irritates the stomach, liver, and pancreas producing inflammation and injuring the tissue. This leads to further difficulty with digestion and decreased production of important enzymes.

Detoxification

the process of safely withdrawing from a substance

Categories of Family Violence

•Intimate partner violence •Child Abuse •Elder Mistreatment