Unit 11 Substance Use

IMPAIRED PROFESSIONAL - "Health professionals, like anyone else, are susceptible to substance abuse. Left untreated, these problems can put them and their ________ at risk" (TCHP, 2006, p. 1). - Minnesota Board of Nursing states: --- "A nurse's practice and behavior must be safe, competent, ethical and in compliance with applicable laws and rules" (TCHP, 2006, p. 1)

IMPAIRED PROFESSIONAL - "Health professionals, like anyone else, are susceptible to substance abuse. Left untreated, these problems can put them and their patients at risk" (TCHP, 2006, p. 1). - Minnesota Board of Nursing states: --- "A nurse's practice and behavior must be safe, competent, ethical and in compliance with applicable laws and rules" (TCHP, 2006, p. 1)

RANDOM POINT ABOUT ALCOHOL: - Alcohol can be enjoyed without becoming an addict. It is very hard for an addict to recognize that they are addicted. - Alcoholism has a ________ tendency. Just remember: - The vast majority of health care professionals ______ to practice their previous profession. Substance Abuse in Health Care Professionals, TCHP, 2006

RANDOM POINT ABOUT ALCOHOL: - Alcohol can be enjoyed without becoming an addict. It is very hard for an addict to recognize that they are addicted. - Alcoholism has a familial tendency. Just remember: - The vast majority of health care professionals return to practice their previous profession. Substance Abuse in Health Care Professionals, TCHP, 2006

REPORTING - Health care professionals have an ethical obligation to report a peer who may be ___________ the lives of others through impairment. Always make sure the patient is safe if there is an immediate risk - In addition to an ethical obligation to report, there are legal obligations to report outlined in the Minnesota Nurse Practice Act. The act states: --- "Licensed professionals and institutions and organizations must ______ a health care professional under suspicion for substance abuse." Substance Abuse in Health Care Professionals, TCHP, 2006

REPORTING - Health care professionals have an ethical obligation to report a peer who may be endangering the lives of others through impairment. Always make sure the patient is safe if there is an immediate risk - In addition to an ethical obligation to report, there are legal obligations to report outlined in the Minnesota Nurse Practice Act. The act states: --- "Licensed professionals and institutions and organizations must report a health care professional under suspicion for substance abuse." Substance Abuse in Health Care Professionals, TCHP, 2006

RISK FACTORS FOR NURSES - ___ stress - ________ of drugs - ______ to narcotics - Experience with effects of drugs - Tendency to ____-medicate - Belief that drug use can be controlled - Underlying psychopathology i.e., depression and anxiety - Family history of substance abuse

RISK FACTORS FOR NURSES - Job stress - Knowledge of drugs - Access to narcotics - Experience with effects of drugs - Tendency to self-medicate - Belief that drug use can be controlled - Underlying psychopathology i.e., depression and anxiety - Family history of substance abuse

ADDICTION - Complex ________ biopsychosocial disease - Serious emotional and financial repercussions. - Dimensions: --- Physical: long term health probs, inability to perform functions --- Social: Problems at school or work, Family Probs --- Psycho-logical: Denial, hopelessness, anger.

ADDICTION - Complex lifelong biopsychosocial disease - Serious emotional and financial repercussions. - Dimensions: --- Physical: long term health probs, inability to perform functions --- Social: Problems at school or work, Family Probs --- Psycho-logical: Denial, hopelessness, anger.

ADDICTIVE DISORDERS: Biological Theory - Opioids act on ______ receptors - Alcohol and other CNS depressants act on ____ receptors - _____-tolerance occurs with opioid drugs, alcohol, benzodiazepines, barbiturates --- Affect central nervous system, causing __________ - Cocaine and amphetamines act on dopamine and serotonin --- Affect central nervous system, causing _________

ADDICTIVE DISORDERS: Biological Theory - Opioids act on opioid receptors - Alcohol and other CNS depressants act on GABA receptors - Cross-tolerance occurs with opioid drugs, alcohol, benzodiazepines, barbiturates --- Affect central nervous system, causing depressant effect - Cocaine and amphetamines act on dopamine and serotonin --- Affect central nervous system, causing stimulation

ADDICTIVE DISORDERS: Biological Theory (skipped?) - ________ --- Believed to account for 40%-60% of personal vulnerability to addiction - Effects of addictive substances on brain --- Abusive substances affect ________ systems and directly or indirectly affect limbic system or reward system, which is responsible for ________ by increasing the response to ________. - Over time, dopamine receptors/dopamine levels __crease and individual needs _____ of abusive substance in order to keep dopamine level normal

ADDICTIVE DISORDERS: Biological Theory (skipped?) - Genetics --- Believed to account for 40%-60% of personal vulnerability to addiction - Effects of addictive substances on brain --- Abusive substances affect dopamine systems and directly or indirectly affect limbic system or reward system, which is responsible for pleasure by increasing the response to dopamine. - Over time, dopamine receptors/dopamine levels decrease and individual needs more of abusive substance in order to keep dopamine level normal

ADDICTIVE DISORDERS: Medical Comorbidity - CNS related --- Wernicke's encephalopathy? --- Korsakoff's psychosis? - Gastrointestinal system --- Esophagitis --- Gastritis --- Pancreatitis --- Alcoholic hepatitis --- Cirrhosis of the liver - Tuberculosis

ADDICTIVE DISORDERS: Medical Comorbidity - CNS related --- Wernicke's encephalopathy? --- Korsakoff's psychosis? - Gastrointestinal system --- Esophagitis --- Gastritis --- Pancreatitis --- Alcoholic hepatitis --- Cirrhosis of the liver - Tuberculosis

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Comorbidity --- At least 50% people with serious _____ illness have substance use disorder as well (dual diagnosis) --- Ex: People with ADHD may medicate with marijuana

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Comorbidity --- At least 50% people with serious mental illness have substance use disorder as well (dual diagnosis) --- Ex: People with ADHD may medicate with marijuana

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Medical comorbidity --- Alcohol-related problems affect all organ systems (neurological, GI, cardiovascular) --- Cocaine abusers: extreme weight ___, malnutrition, myocardial infarctions, stroke --- Nicotine abusers develop chronic ____ disease, coronary heart disease, and stroke

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Medical comorbidity --- Alcohol-related problems affect all organ systems (neurological, GI, cardiovascular) --- Cocaine abusers: extreme weight loss, malnutrition, myocardial infarctions, stroke --- Nicotine abusers develop chronic lung disease, coronary heart disease, and stroke

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Prevalence --- 3% of individuals older than 12 years need treatment for drug use disorders --- Nicotine use: estimated 46 million Americans --- Heroin is currently super bad. --- Mental health law: A child __ or older can consent to treatment for substance abuse without parental knowledge (even though the parent will be responsible for the bill).

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Prevalence --- 3% of individuals older than 12 years need treatment for drug use disorders --- Nicotine use: estimated 46 million Americans --- Heroin is currently super bad. --- Mental health law: A child 12 or older can consent to treatment for substance abuse without parental knowledge (even though the parent will be responsible for the bill).

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Prevalence --- Lifetime prevalence of substance use disorders in U.S. is 14.6% --- _______: most common; 8.5% of population --- Illicit drugs: __creased use of marijuana, cocaine and heroin over past decade; and __creased use of club drugs, prescription pain medications, amphetamines, benzodiazepines, and anabolic steroids

ADDICTIVE DISORDERS: Prevalence and Comorbidity - Prevalence --- Lifetime prevalence of substance use disorders in U.S. is 14.6% --- Alcohol: most common; 8.5% of population --- Illicit drugs: decreased use of marijuana, cocaine and heroin over past decade and increased use of club drugs, prescription pain medications, amphetamines, benzodiazepines, and anabolic steroids

ADDICTIVE DISORDERS: Prevalence and Comorbidity --- Intravenous drug users develop infections, _________ of veins, hepatitis, and HIV --- Intranasal drug users develop _________ nasal septum

ADDICTIVE DISORDERS: Prevalence and Comorbidity --- Intravenous drug users develop infections, sclerosing of veins, hepatitis, and HIV --- Intranasal drug users develop perforated nasal septum

ADDICTIVE DISORDERS: Special Populations - Chemically impaired nurses --- Will talk about this special population later in the lecture

ADDICTIVE DISORDERS: Special Populations - Chemically impaired nurses --- Will talk about this special population later in the lecture

ADDICTIVE DISORDERS:Other Theories - Psychological theories --- Psychodynamic factors: lack of _________ for frustration and pain, impulsiveness, lack of _______ in life, lack of affectionate and meaningful relationships, low self-______, and strong propensity for ____ taking - Cultural considerations --- Differences recognized among cultural groups ------ Asian cultures: ___ rate of alcohol abuse ------ Native Americans, Alaska Natives: ____ rates of alcohol abuse

ADDICTIVE DISORDERS:Other Theories - Psychological theories --- Psychodynamic factors: lack of tolerance for frustration and pain, impulsiveness, lack of success in life, lack of affectionate and meaningful relationships, low self-esteem, and strong propensity for risk taking - Cultural considerations --- Differences recognized among cultural groups ------ Asian cultures: low rate of alcohol abuse ------ Native Americans, Alaska Natives: high rates of alcohol abuse

ALCOHOL AND OPIOIDS - Like the general population, alcohol is the most commonly abused drug among health care workers - ______ rates of abuse of prescription medications (especially opioids and benzo's) among health care workers, due to self prescribing and diversion

ALCOHOL AND OPIOIDS - Like the general population, alcohol is the most commonly abused drug among health care workers - Higher rates of abuse of prescription medications (especially opioids and benzo's) among health care workers, due to self prescribing and diversion

CONCEPT OF ADDICTION - Abuse: use of substance that falls outside of _______ necessity, resulting in adverse effects to user and others - Dependence: (addiction) occurs when _________ to drug occurs and amounts of drug consumption increase to avoid withdrawal

CONCEPT OF ADDICTION - Abuse: use of substance that falls outside of medical necessity, resulting in adverse effects to user and others - Dependence: (addiction) occurs when tolerance to drug occurs and amounts of drug consumption increase to avoid withdrawal

CONCEPT OF ADDICTION - Addiction is a brain disease, evolving over time, occurring because of individuals voluntarily taking drugs --- Repeated use causes uncontrollable and compulsive drug ______, seeking, and use that destroys functioning

CONCEPT OF ADDICTION - Addiction is a brain disease, evolving over time, occurring because of individuals voluntarily taking drugs --- Repeated use causes uncontrollable and compulsive drug craving, seeking, and use that destroys functioning

ENABLING BEHAVIORS - Excused or ________ behaviors of coworker - Never told supervisor - Accepted responsibility for co-workers _________ work - Believed that nurses do not use drugs or alcohol - Liked to use drugs or alcohol also - Exonerated a co-worker's irresponsible behavior by ________ for him or her - ________ a co-worker when suspicious behavior was questioned

ENABLING BEHAVIORS - Excused or ignored behaviors of coworker - Never told supervisor - Accepted responsibility for co-workers unfinished work - Believed that nurses do not use drugs or alcohol - Liked to use drugs or alcohol also - Exonerated a co-worker's irresponsible behavior by covering for him or her - Defended a co-worker when suspicious behavior was questioned

HEALTH PROFESSIONAL SERVICES PROGRAM (HPSP) - Two main functions of HPSP: 1) to _______ the public from impaired health care professionals 2) "__________" chemically dependent or mentally ill health care professionals. - They also provide an alternate pathway to ___________ action by the state licensing board. - They try to work with the struggling nurse. The HPSP decides whether or not to contact the _____ of Nursing. If employees are especially non-compliant, the HPSP may recommend that the nurse's license be limited/suspended/revoked. - Every _____ runs its own HPSP

HEALTH PROFESSIONAL SERVICES PROGRAM (HPSP) - Two main functions of HPSP: 1) to protect the public from impaired health care professionals 2) "rehabilitate" chemically dependent or mentally ill health care professionals. - They also provide an alternate pathway to disciplinary action by the state licensing board. - They try to work with the struggling nurse. The HPSP decides whether or not to contact the Board of Nursing. If employees are especially non-compliant, the HPSP may recommend that the nurse's license be limited/suspended/revoked. - Every state runs its own HPSP

MINNESOTA HPSP IS UNIQUE BECAUSE: - A primary focus on _______ safety - Provision of services to persons with substance, psychiatric and medical disorders - Services are provided to all ______-related professions

MINNESOTA HPSP IS UNIQUE BECAUSE: - A primary focus on patient safety - Provision of services to persons with substance, psychiatric and medical disorders - Services are provided to all health-related professions

NARCOTIC DESCREPANCIES - _________ narcotic count - Apparent ________ of narcotic vials - Large amounts of narcotics ______ - Numerous corrections on narcotics record - Patient reports of __________ pain meds - Variations in ________ of narcotics discrepancies among shifts or days

NARCOTIC DESCREPANCIES - Incorrect narcotic count - Apparent alterations of narcotic vials - Large amounts of narcotics wasted - Numerous corrections on narcotics record - Patient reports of ineffective pain meds - Variations in patterns of narcotics discrepancies among shifts or days

OPERATIONAL DEFINITION OF ADDICTION: The Three C's - ________ motivated by emotions ranging along lines of craving to compulsive spectrum - Continued use despite adverse consequences to health, mental status, relationships, occupation and finances - Loss of _______

OPERATIONAL DEFINITION OF ADDICTION: The Three C's - Behavior motivated by emotions ranging along lines of craving to compulsive spectrum - Continued use despite adverse consequences to health, mental status, relationships, occupation and finances - Loss of control

PHYSICAL SIGNS - Shakiness - Hand _______ - Slurred speech - _________ pupils - Diaphoresis - _______ gait - _____ nose

PHYSICAL SIGNS - Shakiness - Hand tremors - Slurred speech - Constricted pupils - Diaphoresis - Unsteady gait - Runny nose

PRESERVING THE NURSE - _________ of problem - Treatment

PRESERVING THE NURSE - Admission of problem - Treatment

PROTECTING THE PUBLIC: Alternative program - Voluntary, non-disciplinary, specific criteria - Primary goal: ________ the Nurse - ________ stating that you agree with the terms offered.

PROTECTING THE PUBLIC: Alternative program - Voluntary, non-disciplinary, specific criteria - Primary goal: Preserve the Nurse - Contract stating that you agree with the terms offered.

PROTECTING THE PUBLIC: DISCIPLINARY ACTION - Written reprimand: First time offense or one time abuse with no direct _______ abuse involved. - Probation: under the additional requirements that the nurse can stay in practice or there can be evidence of limited substance abuse with evidence via work behaviors. - Limited license: _________ practice, for a period of time. - License suspension: Cannot practice for some time. - License __________: Cannot practice.

PROTECTING THE PUBLIC: DISCIPLINARY ACTION - Written reprimand: First time offense or one time abuse with no direct patient abuse involved. - Probation: under the additional requirements that the nurse can stay in practice or there can be evidence of limited substance abuse with evidence via work behaviors. - Limited license: Restricts practice, for a period of time. - License suspension: Cannot practice for some time. - License revocation: Cannot practice.

STATES BOARDS CHARGE - Protect the public - _______ the nurse --- help the nurse stay healthy and keep their jobs. - The State Boards activites to regulate nursing practice include: --- identify cases involving addiction --- Taking disciplinary action --- Determining if _________ may be necessary. --- Determine if nurse might be a ____ to the patient even after completeing treatment.

STATES BOARDS CHARGE - Protect the public - Preserve the nurse --- help the nurse stay healthy and keep their jobs. - The State Boards activites to regulate nursing practice include: --- identify cases involving addiction --- Taking disciplinary action --- Determining if treatment may be necessary. --- Determine if nurse might be a harm to the patient even after completeing treatment.

STATES BOARDS RESPONSIBILITY - Abusing Nurse - Cannot continue to _________ - Must be evaluated

STATES BOARDS RESPONSIBILITY - Abusing Nurse - Cannot continue to practice - Must be evaluated

SUBSTANCE ABUSE - DSM-IV-TR defines as __________ pattern of substance use leading to clinically significant impairment or distress --- Inability to fulfill life _____ --- At first when they take a substance they will feel fine, but as they need more and more they will realize that they are having a problem --- Participation in hazardous activities when under influence, __________ are lost. --- Recurrent legal/interpersonal problems --- Continued use despite consequences, affects the entire family financially and emotionally.

SUBSTANCE ABUSE - DSM-IV-TR defines as maladaptive pattern of substance use leading to clinically significant impairment or distress --- Inability to fulfill life roles --- At first when they take a substance they will feel fine, but as they need more and more they will realize that they are having a problem --- Participation in hazardous activities when under influence, inhibitions are lost. --- Recurrent legal/interpersonal problems --- Continued use despite consequences, affects the entire family financially and emotionally.

SUBSTANCE DEPENDENCE - DSM-IV-TR defines as maladaptive pattern of substance use leading to clinically significant impairment --- Presence of ________ :The need for higher and higher doses to achieve the desired effect --- Presence of _________: After a long period of continued use, stopping or reducing drug results in specific physical and psychological signs and symptoms --- Unsuccessful attempts to cut down --- Increased time spent obtaining __________ --- Reduced time in _______ activities --- Substance use despite consequences --- Ex from lecture: When you see someone functioning well with a super high blood alcohol content, you know that they must have a high ________

SUBSTANCE DEPENDENCE - DSM-IV-TR defines as maladaptive pattern of substance use leading to clinically significant impairment --- Presence of tolerance :The need for higher and higher doses to achieve the desired effect --- Presence of withdrawal: After a long period of continued use, stopping or reducing drug results in specific physical and psychological signs and symptoms --- Unsuccessful attempts to cut down --- Increased time spent obtaining substances --- Reduced time in normal activities --- Substance use despite consequences --- Ex from lecture: When you see someone functioning well with a super high blood alcohol content, you know that they must have a high tolerance.

SUBSTANCE USE: Alcohol Withdrawal vs. Alcohol Withdrawal Delirium - Withdrawal --- Early signs usually begin _ to _ hours after cessation or marked reduction of alcohol intake --- Signs peak after 24 to 48 hours then either resolves or progresses to _______ --- Signs and symptoms ------ _____ alertness ------ _____ movements ------ Irritability ------ Easily startled ------ "Shaking inside" --- To reduce patient's anxiety ------ ______ to time and place ------ Clarify _________ to reduce patient's terror

SUBSTANCE USE: Alcohol Withdrawal vs. Alcohol Withdrawal Delirium - Withdrawal --- Early signs usually begin 6 to 8 hours after cessation or marked reduction of alcohol intake --- Signs peak after 24 to 48 hours then either resolves or progresses to delirium --- Signs and symptoms ------ Hyper alertness ------ Jerky movements ------ Irritability ------ Easily startled ------ "Shaking inside" --- To reduce patient's anxiety ------ Orient to time and place ------ Clarify illusions to reduce patient's terror

SUBSTANCE USE: Alcohol Withdrawal vs. Alcohol Withdrawal Delirium - Withdrawal delirium --- A medical emergency that can result in death --- Delirium peaks at _ to _ days after cessation of alcohol and lasts 2 to 3 days --- Signs and symptoms: ------ _____cardia, diaphoresis, ________ blood pressure ------ Disorientation and clouding of consciousness ------ Visual or tactile ___________ ------ _____excitability to lethargy ------ ________ delusions, agitation, anxiety ------ Fever (100° F to 103° F)

SUBSTANCE USE: Alcohol Withdrawal vs. Alcohol Withdrawal Delirium - Withdrawal delirium --- A medical emergency that can result in death --- Delirium peaks at 2 to 3 days after cessation of alcohol and lasts 2 to 3 days --- Signs and symptoms: ------ Tachycardia, diaphoresis, elevated blood pressure ------ Disorientation and clouding of consciousness ------ Visual or tactile hallucinations ------ Hyperexcitability to lethargy ------ Paranoid delusions, agitation, anxiety ------ Fever (100° F to 103° F)

SUBSTANCE USE: Blood Alcohol Level (BAL) - BAL can be used to assess level of intoxication and level of _________. - As tolerance develops, a discrepancy is seen between BAL and expected ________.

SUBSTANCE USE: Blood Alcohol Level (BAL) - BAL can be used to assess level of intoxication and level of tolerance. - As tolerance develops, a discrepancy is seen between BAL and expected behavior

SUBSTANCE USE: Blood Alcohol Level (BAL) BAL (mg %) Effect in Nontolerant Drinker 0.05 Change in mood, behavior, and ________ judgment 0.20 Staggering, ataxia, emotional ______ 0.40 ____ 0.50 _____ from respiratory depression

SUBSTANCE USE: Blood Alcohol Level (BAL) BAL (mg %) Effect in Nontolerant Drinker 0.05 Change in mood, behavior, and impaired judgment 0.20 Staggering, ataxia, emotional lability 0.40 Coma 0.50 Death from respiratory depression

SUBSTANCE USE: CNS Depressants - Includes: Sedative-Hypnotics Benzodiazepines, Anti_______ Agents, & Barbiturates - Current Impact: --- _____________ are the most frequently prescribed drugs in the Western world --- Frequently used in overdose ________; implicated in accidental overdoses --- Women are _____ as likely as men to take benzodiazepines for medical problems --- All have therapeutic uses but for some people are highly addicting!

SUBSTANCE USE: CNS Depressants - Includes: Sedative-Hypnotics Benzodiazepines, Antianxiety Agents, & Barbiturates - Current Impact: --- Benzodiazepines are the most frequently prescribed drugs in the Western world --- Frequently used in overdose suicides; implicated in accidental overdoses --- Women are twice as likely as men to take benzodiazepines for medical problems --- All have therapeutic uses but for some people are highly addicting!

SUBSTANCE USE: CNS Stimulants - Cocaine & Crack --- Extracted from leaf of ____ bush --- When smoked takes effect in _ to _ seconds; a 5- to 7-minute ____ follows, then a deep _________ --- Two main effects on body ------ Anesthetic: blocks pain perception ------ Stimulan --- Produces imbalance in _______________ --- Withdrawal symptoms include: ------ Depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, chills, craving

SUBSTANCE USE: CNS Stimulants - Cocaine & Crack --- Extracted from leaf of coca bush --- When smoked takes effect in 4 to 6 seconds; a 5- to 7-minute high follows, then a deep depression --- Two main effects on body ------ Anesthetic: blocks pain perception ------ Stimulant --- Produces imbalance in neurotransmitters --- Withdrawal symptoms include: ------ Depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, chills, craving

SUBSTANCE USE: CNS Stimulants - Includes: Cocaine, Crack, Amphetamines - Common signs of stimulant abuse: --- ________ of the pupils --- _______ of the nasal cavity --- ________ motor activity

SUBSTANCE USE: CNS Stimulants - Includes: Cocaine, Crack, Amphetamines - Common signs of stimulant abuse: --- Dilation of the pupils --- Dryness of the nasal cavity --- Excessive motor activity

SUBSTANCE USE: Common Effects - __________: transitory recurrences of perceptual disturbance caused by earlier use of hallucinogenic drug --- Occur during the ____-free state - Co-dependence: over-___________ behaviors often exhibited by family members of substance user

SUBSTANCE USE: Common Effects - Flashbacks: transitory recurrences of perceptual disturbance caused by earlier use of hallucinogenic drug --- Occur during the drug-free state - Co-dependence: over-responsible behaviors often exhibited by family members of substance user

SUBSTANCE USE: Common Effects - Synergistic Effects: Combining two drugs with _______ actions (depression or stimulation of CNS), intensifies the effects. --- Alcohol produces a synergistic effect when taken with other CNS __________ (like hypnotics, barbiturates, minor tranquilizers, narcotics, codeine, methadone) - Antagonistic Effects: Combining drugs to _____________ effects (combining CNS depressant [opioid] with CNS stimulant [cocaine]) --- ______ reduces the resp and CNS depression effect of opiates

SUBSTANCE USE: Common Effects - Synergistic Effects: Combining two drugs with similar actions (depression or stimulation of CNS), intensifies the effects. --- Alcohol produces a synergistic effect when taken with other CNS depressants (like hypnotics, barbiturates, minor tranquilizers, narcotics, codeine, methadone) - Antagonistic Effects: Combining drugs to counterbalance effects (combining CNS depressant [opioid] with CNS stimulant [cocaine]) --- Narcan reduces the resp and CNS depression effect of opiates

SUBSTANCE USE: Intoxication with CNS Depressants - Common symptoms of intoxication from drugs that are CNS depressants (alcohol, BZAs, barbiturates) --- _______ speech, incoordination, _______ gait, drowsiness, __creased blood pressure, impaired judgment - Treatment of intoxication/overdose --- Treated symptomatically: maintain airway/circulation, induce ________, administer __________ (Romazicon) for BZA overdose

SUBSTANCE USE: Complications of Intoxication with CNS Depressants - Common symptoms of intoxication from drugs that are CNS depressants (alcohol, BZAs, barbiturates) --- Slurred speech, incoordination, unsteady gait, drowsiness, decreased blood pressure, impaired judgment - Treatment of intoxication/overdose --- Treated symptomatically: maintain airway/circulation, induce vomiting, administer flumazenil (Romazicon) for BZA overdose

SUBSTANCE USE: Complications with CNS Stimulants - Cocaine and amphetamines --- Intoxication: __creased vital signs, nausea and vomiting, _______ pupils, insomnia, _________ behavior, euphoria, __creased energy, paranoia, amphetamine induced psychosis, _________ stimulation. --- Overdose: ataxia, resp distress, hyper_______, myocardial infarction, stroke, coma, death - Treatment of overdose --- Treatment is symptomatic: maintain airway, circulation, prevent cardiovascular events

SUBSTANCE USE: Complications with CNS Stimulants - Cocaine and amphetamines --- Intoxication: increased vital signs, nausea and vomiting, dilated pupils, insomnia, assaultive behavior, euphoria, increased energy, paranoia, amphetamine induced psychosis, excessive stimulation. --- Overdose: ataxia, resp distress, hyperpyrexia, myocardial infarction, stroke, coma, death - Treatment of overdose --- Treatment is symptomatic: maintain airway, circulation, prevent cardiovascular events

SUBSTANCE USE: Complications- Overdose from CNS Depressants - S&S: cardio and resp depression, coma, shock, convulsions, death - Treatment: --- Keep awake --- Induce ________ --- VS q __ min --- Clear airway --- IVF --- Seizure precautions --- Activated ________ to absorb the drug

SUBSTANCE USE: Complications- Overdose from CNS Depressants - S&S: cardio and resp depression, coma, shock, convulsions, death - Treatment: --- Keep awake --- Induce vomiting --- VS q 15 min --- Clear airway --- IVF --- Seizure precautions --- Activated charcoal to absorb the drug

SUBSTANCE USE: Complications- Withdrawal from CNS Depressants - Symptoms are similar to that of alcohol --- Alcohol withdrawal ------ __creased alertness, irritability, feelings of "_______ inside," presence of illusions, seizures can occur within __-__ hours. --- Alcohol withdrawal delirium ------ Anxiety, insomnia, delirium ------ _________ hyperactivity: __creased vital signs (temperature, pulse, blood pressure, respirations) ------ Disorientation, perceptual disturbances, delusions --- Delerium Tremens (DT): patients might be _______ in the air, see bugs or spiders crawling up the wall.

SUBSTANCE USE: Complications- Withdrawal from CNS Depressants - Symptoms are similar to that of alcohol --- Alcohol withdrawal ------ Increased alertness, irritability, feelings of "shaking inside," presence of illusions, seizures can occur within 48-72 hours. --- Alcohol withdrawal delirium ------ Anxiety, insomnia, delirium ------ Autonomic hyperactivity: increased vital signs (temperature, pulse, blood pressure, respirations) ------ Disorientation, perceptual disturbances, delusions --- Delerium Tremens (DT): patients might be picking in the air, see bugs or spiders crawling up the wall.

SUBSTANCE USE: Date Rape Drugs - Flunitrazepam (Rohypnol or "roofies") - γ-Hydroxybutyric acid (GHB) - Rapidly produces: --- Disinhibition --- __________ of voluntary muscles --- Anterograde _______

SUBSTANCE USE: Date Rape Drugs - Flunitrazepam (Rohypnol or "roofies") - γ-Hydroxybutyric acid (GHB) - Rapidly produces: --- Disinhibition --- Relaxation of voluntary muscles --- Anterograde amnesia

SUBSTANCE USE: Hallucinogens - Actions: Hallucinogens are psycho-__________ that alter neurotransmission of various neurotransmitters leading to alterations in thought, mood, and perceptions, often with hallucinations

SUBSTANCE USE: Hallucinogens - Actions: Hallucinogens are psycho-stimulants that alter neurotransmission of various neurotransmitters leading to alterations in thought, mood, and perceptions, often with hallucinations

SUBSTANCE USE: Hallucinogens - LSD: Most ______ of all hallucinogens --- Related Medical Problems: panic, toxic psychosis, flashbacks, apathy, __________ damage - Psilocybin ("Mushrooms"): ____ potent than LSD --- Related Medical Problems: ________, accidental death, toxic psychosis - PCP: acts as a CNS __________, an anesthetic, a tranquilizer and a hallucinogen --- Related Medical Problems: Overdose and death, ________ thinking, flashbacks, ______ problems, anxiety/depression - Treatment: Minimize ___________ and give antianxiety meds

SUBSTANCE USE: Hallucinogens - LSD: Most potent of all hallucinogens --- Related Medical Problems: panic, toxic psychosis, flashbacks, apathy, chromosome damage - Psilocybin ("Mushrooms"): Less potent than LSD --- Related Medical Problems: paranoia, accidental death, toxic psychosis - PCP: acts as a CNS depressant, an anesthetic, a tranquilizer and a hallucinogen --- Related Medical Problems: Overdose and death, impaired thinking, flashbacks, speech problems, anxiety/depression - Treatment: Minimize stimulation and give antianxiety meds

SUBSTANCE USE: Heroin (an opioid) - 1924, the US banned heroin. - Heroin doesn't have noticible ____ effects. You get to keep yo teeth! - Heroin also affects the ______ system, which determines what you're in the mood for (like more heroin.) - It makes teachers get fired! --- Poor _____...

SUBSTANCE USE: Heroin (an opioid) - 1924, the US banned heroin. - Heroin doesn't have noticible side effects. You get to keep yo teeth! - Heroin also affects the limbic system, which determines what you're in the mood for (like more heroin.) - It makes teachers get fired! --- Poor Terry...

SUBSTANCE USE: Heroin (an opioid) - It numbs the bodies ____ receptors. - 10 million a year spent on it. - Been around for 1000 years, made from the poppy plant. - Opium can be made into ________, and then made into heroin. - Heroin goes straight to the ____ where it is rapidly absorped (better than morphine). Stimulates a rush of ________ to be released. - Originally, it was sold as a _____ suppressant. - Heroin shuts down the _______ lobe (judgement)

SUBSTANCE USE: Heroin (an opioid) - It numbs the bodies pain receptors. - 10 million a year spent on it. - Been around for 1000 years, made from the poppy plant. - Opium can be made into morphine, and then made into heroin. - Heroin goes straight to the brain where it is rapidly absorped (better than morphine). Stimulates a rush of dopamine to be released. - Originally, it was sold as a cough suppressant. - Heroin shuts down the frontal lobe (judgement)

SUBSTANCE USE: Inhalants - Volatile solvents --- Spray _____ --- Glue --- ________ lighter fluid --- Propellant gases used in aerosols - Inhalants --- Produce CNS _________ similar to alcohol --- Also cause liver, brain damage

SUBSTANCE USE: Inhalants - Volatile solvents --- Spray paint --- Glue --- Cigarette lighter fluid --- Propellant gases used in aerosols - Inhalants --- Produce CNS depression similar to alcohol --- Also cause liver, brain damage

SUBSTANCE USE: Inhalants- Solvents, Glues, Aerosols - Current Impact: --- Average inhalant user is 14-__ years old --- Higher rates in some ________ groups (Native American, Hispanic) --- Sniffing usually occurs in a _____ setting - Action: --- Produce _____ intoxication because enters bloodstream quickly, going directly to brain --- Feeling of intoxication lasts 15-__ minutes followed by 1-2 hours of _________ and stupor --- ___________ tolerance common; not physical

SUBSTANCE USE: Inhalants- Solvents, Glues, Aerosols - Current Impact: --- Average inhalant user is 14-17 years old --- Higher rates in some minority groups (Native American, Hispanic) --- Sniffing usually occurs in a group setting - Action: --- Produce rapid intoxication because enters bloodstream quickly, going directly to brain --- Feeling of intoxication lasts 15-45 minutes followed by 1-2 hours of drowsiness and stupor --- Psychological tolerance common; not physical

SUBSTANCE USE: Marijuana (Cannabis sativa) - Current Impact --- Marijuana continues to be the most popular illicit drug in America --- 18 million users smoke it regularly --- Average marijuana user in USA is __-__ years old - Routes: --- ______ ("joint") --- Boiled in water and served as ___ --- Therapeutic use: prepared in capsules and given orally for various reasons - anti______, analgesic, relaxant, and treatment of ________

SUBSTANCE USE: Marijuana (Cannabis sativa) - Current Impact --- Marijuana continues to be the most popular illicit drug in America --- 18 million users smoke it regularly --- Average marijuana user in USA is 18-25 years old - Routes: --- Smoked ("joint") --- Boiled in water and served as tea --- Therapeutic use: prepared in capsules and given orally for various reasons - antiemetic, analgesic, relaxant, and treatment of glaucoma

SUBSTANCE USE: Marijuana (Cannabis sativa) - Long-term effects: lethargy, anhedonia, _________ concentrating, ____ of memory - Tolerance: occurs _______ with long-term use, even at low dose - Desired effects: euphoria, detachment, relaxation - Other effects: talkativeness, ______ perception of time, inappropriate hilarity, __________ sensitivity to external stimuli, anxiety, and paranoia

SUBSTANCE USE: Marijuana (Cannabis sativa) - Long-term effects: lethargy, anhedonia, difficulty concentrating, loss of memory - Tolerance: occurs rapidly with long-term use, even at low dose - Desired effects: euphoria, detachment, relaxation - Other effects: talkativeness, slowed perception of time, inappropriate hilarity, heightened sensitivity to external stimuli, anxiety, and paranoia

SUBSTANCE USE: Marijuana (Cannabis sativa) - THC has psycho-stimulating and psycho-depressant properties; also hallucinogenic properties - THC _______ varies, depending on the plant - Psychoactive effects of cannabis varies depending on the ___________ of the user - Physical effects: heart rate, ____ of balance, __creased motor coordination, hunger, conjunctival irritation, impaired _____ term memory

SUBSTANCE USE: Marijuana (Cannabis sativa) - THC has psycho-stimulating and psycho-depressant properties; also hallucinogenic properties - THC potency varies, depending on the plant - Psychoactive effects of cannabis varies depending on the personality of the user - Physical effects: heart rate, loss of balance, decreased motor coordination, hunger, conjunctival irritation, impaired short term memory

SUBSTANCE USE: Nursing Communication Guidelines - Accepting, nonjudgmental approach important for therapeutic relationship - Substance abuse intervention for resistant addict may be used by nurse to help patient _________ engage in treatment --- Significant others become involved in this treatment approach; specific evidence about patient's substance use/abuse is presented

SUBSTANCE USE: Nursing Communication Guidelines - Accepting, nonjudgmental approach important for therapeutic relationship - Substance abuse intervention for resistant addict may be used by nurse to help patient willingly engage in treatment --- Significant others become involved in this treatment approach; specific evidence about patient's substance use/abuse is presented

SUBSTANCE USE: Nursing Interventions for Alcohol Withdrawal - Frequent assessment of vital signs - Medications: ativan or _______ - Comfort Measures - Environment: Safety, quiet room with lights __ - Restraints - only as a last resort - Non-judgmental, calm approach, supportive and empathetic - Assess for co-existing injuries

SUBSTANCE USE: Nursing Interventions for Alcohol Withdrawal - Frequent assessment of vital signs - Medications: ativan or librium - Comfort Measures - Environment: Safety, quiet room with lights on - Restraints - only as a last resort - Non-judgmental, calm approach, supportive and empathetic - Assess for co-existing injuries

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Determine history of patient's use --- Number of drugs taken, _______ of use, dosage (ex: do you drink? how much do you drink- what constitutes a drink? when did you last drink?) ------ People usually minimize the amount they drink. --- Previous treatment for substance abuse --- Presence of blackouts, delirium, ________, withdrawal symptoms - Review history for comorbid illness

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Determine history of patient's use --- Number of drugs taken, pattern of use, dosage (ex: do you drink? how much do you drink- what constitutes a drink? when did you last drink?) ------ People usually minimize the amount they drink. --- Previous treatment for substance abuse --- Presence of blackouts, delirium, seizures, withdrawal symptoms - Review history for comorbid illness

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Further initial assessment --- Neurological changes: determine _____ injury --- _____ toxicology screen or blood level (BAL): help determine type/amount of substances. --- ____________ show how fast the body is eliminating through the breath. (BAL is more accurate.)

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Further initial assessment --- Neurological changes: determine brain injury --- Urine toxicology screen or blood alcohol level (BAL): help determine type/amount of substances. --- Breathalyzers show how fast the body is eliminating through the breath. (BAL is more accurate.)

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Responses that serve as red flags for further assessment: --- rationalizations --- _________ responses, as if the question were predicted --- slow, prolonged responses, as if being _______ as to what to say

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Responses that serve as red flags for further assessment: --- rationalizations --- automatic responses, as if the question were predicted --- slow, prolonged responses, as if being careful as to what to say

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Review _________ history for comorbid disorders (family hx?) - Determine psychosocial issues --- Effect of use on patient's life ___________ (losing a job?)

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Review psychiatric history for comorbid disorders (family hx?) - Determine psychosocial issues --- Effect of use on patient's life functioning (losing a job?)

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Use of CAGE-AID (adapted to include drugs) screening tool --- C: Have you ever felt need to ___ down --- A: Have people _______ you by criticizing your use? --- G: Have you ever felt _____ about use? --- E: Have you ever felt need for an ___ opener in morning?

SUBSTANCE USE: Nursing Process- Assessment Guidelines - Use of CAGE-AID (adapted to include drugs) screening tool --- C: Have you ever felt need to cut down --- A: Have people annoyed you by criticizing your use? --- G: Have you ever felt guilty about use? --- E: Have you ever felt need for an eye opener in morning?

SUBSTANCE USE: Nursing Process- Assessment Interview Guidelines - Random notes from lecture: ---Alcoholics are most likely to have ________ 48-72 hrs after their last drink (even if they've never had one before, it may still happen). --- Different hospitals use different drugs to help patients detox.

SUBSTANCE USE: Nursing Process- Assessment Interview Guidelines - Random notes from lecture: ---Alcoholics are most likely to have seizures 48-72 hrs after their last drink (even if they've never had one before, it may still happen). --- Different hospitals use different drugs to help patients detox.

SUBSTANCE USE: Nursing Process- Assessment Interview Guidelines - Two questions of importance 1) In the last ____ have you ever drunk or used drugs more than you meant to? 2) Have you felt you wanted or needed to ___ down on your drinking or drug use in the last year? - Details include: --- Drugs used --- Route --- Quantity --- ____ of last use --- Usual _______ of use

SUBSTANCE USE: Nursing Process- Assessment Interview Guidelines - Two questions of importance 1) In the last year have you ever drunk or used drugs more than you meant to? 2) Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? - Details include: --- Drugs used --- Route --- Quantity --- Time of last use --- Usual pattern of use

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Characteristics associated with substance abuse: --- Denial --- Depression --- Anxiety --- Dependency --- __________: NI = screen for suicide and monitor. --- Low self-______ --- _________tion

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Characteristics associated with substance abuse: --- Denial --- Depression --- Anxiety --- Dependency --- Hopelessness: NI = screen for suicide and monitor. --- Low self-esteem --- Rationalization

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Common behaviors: --- Conflict __________ --- Avoidance --- Passivity --- __________: Usually occurs largely during withdrawal.

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Common behaviors: --- Conflict minimization --- Avoidance --- Passivity --- Manipulation: Usually occurs largely during withdrawal.

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Tests mentioned in lecture: --- Hands: Have pt hold hands out in front of them and hover above your ______. If their going through withdrawal, their hand will _____ and hands will sweat --- Tongue: Have patient stick their tongue out. Observe for tongue-____ quivering. Quivering = Withdrawal. --- Others: Clammy, sweaty, _____cardia, anxiety, pacing, restlessness.

SUBSTANCE USE: Nursing Process- Assessment of Psychological Changes - Tests mentioned in lecture: --- Hands: Have pt hold hands out in front of them and hover above your hands. If their going through withdrawal, their hand will tremor and hands will sweat --- Tongue: Have patient stick their tongue out. Observe for tongue-side quivering. Quivering = Withdrawal. --- Others: Clammy, sweaty, tachycardia, anxiety, pacing, restlessness.

SUBSTANCE USE: Nursing Process: Diagnosis and Outcomes Identification - Common nursing diagnoses --- Imbalanced nutrition: less than body requirements, Deficient fluid volume, Disturbed thought processes, Acute or Chronic confusion, Hopelessness, Situational low self-esteem, Ineffective coping - Outcomes identification --- Remain free from injury while withdrawing from substances, attend treatment programs, have stable group of _______, demonstrate _______ without substances

SUBSTANCE USE: Nursing Process: Diagnosis and Outcomes Identification - Common nursing diagnoses --- Imbalanced nutrition: less than body requirements, Deficient fluid volume, Disturbed thought processes, Acute or Chronic confusion, Hopelessness, Situational low self-esteem, Ineffective coping - Outcomes identification --- Remain free from injury while withdrawing from substances, attend treatment programs, have stable group of friends, demonstrate coping without substances

SUBSTANCE USE: Nursing Process: Evaluation - Treatment outcomes are evaluated --- __creased length of time in abstinence --- __creased denial --- Acceptable occupational, social functioning --- Ability to use coping strategies --- Attendance at 12-step support group program

SUBSTANCE USE: Nursing Process: Evaluation - Treatment outcomes are evaluated --- Increased length of time in abstinence --- Decreased denial --- Acceptable occupational, social functioning --- Ability to use coping strategies --- Attendance at 12-step support group program

SUBSTANCE USE: Nursing Process: Planning and Implementation - Planning care dependent on patient's social status, income, ethnic background, gender, age, substance use history, and current condition --- Goal: _________ from abusive substances - Implementation directed toward self-_____________ and referral to specific addiction treatment program --- Treatment can take place in inpatient or outpatient setting --- Self help groups and sponsors are super great.

SUBSTANCE USE: Nursing Process: Planning and Implementation - Planning care dependent on patient's social status, income, ethnic background, gender, age, substance use history, and current condition --- Goal: abstinence from abusive substances - Implementation directed toward self-responsibility and referral to specific addiction treatment program --- Treatment can take place in inpatient or outpatient setting --- Self help groups and sponsors are super great.

SUBSTANCE USE: Opioid Abuse - Psychopharmacology - Dolophine (methadone) --- Synthetic opiate blocks _______ for and effects of heroin --- Only medication currently approved to treat ________ opioid addict - Naltrexone (Trexan, Revia) --- Antagonist that blocks _______ effects of opioids - Clonidine (Catapres) --- Nonopioid suppressor of opioid _________ symptoms --- Effective somatic treatment when combined with naltrexone

SUBSTANCE USE: Opioid Abuse - Psychopharmacology - Dolophine (methadone) --- Synthetic opiate blocks craving for and effects of heroin --- Only medication currently approved to treat pregnant opioid addict - Naltrexone (Trexan, Revia) --- Antagonist that blocks euphoric effects of opioids - Clonidine (Catapres) --- Nonopioid suppressor of opioid withdrawal symptoms --- Effective somatic treatment when combined with naltrexone

SUBSTANCE USE: Opioid Withdrawal Symptoms - Yawning - Insomnia - Irritability - _____rrhea - diaphoresis - cramping - chills * These symptoms onset at 6-8 hours after last use, peaks at __-__ hrs.

SUBSTANCE USE: Opioid Withdrawal Symptoms - Yawning - Insomnia - Irritability - Rhinorrhea - diaphoresis - cramping - chills * These symptoms onset at 6-8 hours after last use, peaks at 48-72 hrs.

SUBSTANCE USE: Opioids (narcotics) - Naturally occurring drugs extracted from the opium _____, semi-synthetic and synthetic - Current Impact: --- Street Abusers: Usually abuse ______; criminal activities and medical risks (HIV, hepatitis) --- Medical Abusers: Narcotic addicts; often obtain through legitimate ___________. Health care professionals often in this category --- Methadone Abusers: Black market Methadone --- Produces CNS _________ - ALL OPIOIDS HAVE ANALGESIC, ANTI_______, ANTI________ THERAPEUTIC EFFECTS! - Intoxication effects: ___________ pupils, __creased VS, slurred speech, and impaired cognition.

SUBSTANCE USE: Opioids (narcotics) - Naturally occurring drugs extracted from the opium poppy, semi-synthetic and synthetic - Current Impact: --- Street Abusers: Usually abuse heroin; criminal activities and medical risks (HIV, hepatitis) --- Medical Abusers: Narcotic addicts; often obtain through legitimate prescriptions. Health care professionals often in this category --- Methadone Abusers: Black market Methadone --- Produces CNS depression - ALL OPIOIDS HAVE ANALGESIC, ANTITUSSIVE, ANTIDIARRHEAL THERAPEUTIC EFFECTS! - Intoxication effects: constricted pupils, decreased VS, slurred speech, and impaired cognition.

SUBSTANCE USE: Self-Assessment by the Nurse --- Examine your own attitudes, feelings, and beliefs about addicts and addiction. This may include examining your own use, use by your family members, or friends' use of addictive substances. --- _____ disapproval, intolerance, condemnation, or lack of emotional reaction to patient. --- Develop empathy and the ability to manage the ___________ behaviors and avoid power struggles with the patients.

SUBSTANCE USE: Self-Assessment by the Nurse --- Examine your own attitudes, feelings, and beliefs about addicts and addiction. This may include examining your own use, use by your family members, or friends' use of addictive substances. --- Avoid disapproval, intolerance, condemnation, or lack of emotional reaction to patient. --- Develop empathy and the ability to manage the manipulative behaviors and avoid power struggles with the patients.

SUBSTANCE USE: Treatment for Alcohol/CNS Depressant Withdrawal - Sedation --- Use of Benzos in gradually __creasing dosages: chlordiazepoxide (Librium) - Seizure prevention --- Anti_________: gabapentin (Neurontin) --- ___ side rails - Prevention of Wernicke's encephalopathy --- _______ (vitamin B1) - Decrease in autonomic hyperactivity --- Beta blockers: _________ (Inderal)

SUBSTANCE USE: Treatment for Alcohol/CNS Depressant Withdrawal - Sedation --- Use of Benzos in gradually decreasing dosages: chlordiazepoxide (Librium) - Seizure prevention --- Anticonvulsants: gabapentin (Neurontin) --- Pad side rails - Prevention of Wernicke's encephalopathy --- Thiamine (vitamin B1) - Decrease in autonomic hyperactivity --- Beta blockers: propranolol (Inderal)

SUBSTANCE USE: Treatment for Opioid Abuse - Overdoses = Life-threatening emergencies! - Detoxification and close monitoring during withdrawal - Screening for ___, hepatitis and referral to CD treatment - Narcotic __________ like Narcan - ________ Maintenance: a synthetic narcotic analgesic - ________: newer therapy, used to help with withdrawal, then tapered off..

SUBSTANCE USE: Treatment for Opioid Abuse - Overdoses = Life-threatening emergencies! - Detoxification and close monitoring during withdrawal - Screening for HIV, hepatitis and referral to CD treatment - Narcotic antagonist like Narcan - Methadone Maintenance: a synthetic narcotic analgesic - Suboxone: newer therapy, used to help with withdrawal, then tapered off..

SUBSTANCE USE: Treatment with Psychopharmacology - Trexan, Revia (naltrexone) --- Blocks ______ receptors --- Interferes with mechanism of reinforcement --- Reduces or eliminates alcohol _______ - _______ (acamprosate) --- Helps client abstain from alcohol --- Mechanism not well understood - _______ (disulfiram): she says this is the one she's seen the most. --- Works on classical ___________ principle --- Alcohol-disulfiram reaction causes unpleasant physical effects when someone on it drinks. --- Taken lifelong.

SUBSTANCE USE: Treatment with Psychopharmacology - Trexan, Revia (naltrexone) --- Blocks opiate receptors --- Interferes with mechanism of reinforcement --- Reduces or eliminates alcohol craving - Campral (acamprosate) --- Helps client abstain from alcohol --- Mechanism not well understood - Antabuse (disulfiram): she says this is the one she's seen the most. --- Works on classical conditioning principle --- Alcohol-disulfiram reaction causes unpleasant physical effects when someone on it drinks. --- Taken lifelong.

SUBSTANCE USE:Health Teaching and Promotion - Focus is relapse __________ - Strategies of relapse prevention (ranges from AA to treatment centers) --- Keep program ______, encourage use of notebook/journaling --- Use cognitive-behavioral principles to increase ______ --- Encourage patient to join relapse prevention group --- Encourage patient to enhance personal insight through therapy

SUBSTANCE USE:Health Teaching and Promotion - Focus is relapse prevention - Strategies of relapse prevention (ranges from AA to treatment centers) --- Keep program simple, encourage use of notebook/journaling --- Use cognitive-behavioral principles to increase coping --- Encourage patient to join relapse prevention group --- Encourage patient to enhance personal insight through therapy

SUBSTANCE USE:Rave and Techno Drugs/Club Drugs - Common drugs --- _______ (3,4-methylenedioxymethamphetamine), also called MDMA, Adam, yaba, XTC --- MDA (methylenedioxyamphetamine) or "____" --- MDE (3,4-methylenedioxyethylamphetamine) or "___" --- GHB: Synthetic __________ that is undetectable in the body. It's tasteless and odorless. In urine at: 8-12 hrs In blood at: _-_ hrs. $5-30. Usually found with alcohol. Worse than roofies. Requires ED or ICU. Risk for resp __________. Coma and death can occur in the event of overdose.

SUBSTANCE USE:Rave and Techno Drugs/Club Drugs - Common drugs --- Ecstasy (3,4-methylenedioxymethamphetamine), also called MDMA, Adam, yaba, XTC --- MDA (methylenedioxyamphetamine) or "love" --- MDE (3,4-methylenedioxyethylamphetamine) or "Eve" --- GHB: Synthetic depressant that is undetectable in the body. It's tasteless and odorless. In urine at: 8-12 hrs In blood at: 4-8 hrs. $5-30. Usually found with alcohol. Worse than roofies. Requires ED or ICU. Risk for resp depression. Coma and death can occur in the event of overdose.

SUBSTANCE USE:Rave and Techno Drugs/Club Drugs - Side effects --- Euphoria, __creased energy --- Stimulation, hallucinations --- __creased self-confidence --- __creased sociability --- Feeling of _________ to others - Adverse effects --- _____thermia, _____ failure, kidney failure, acute _________, death

SUBSTANCE USE:Rave and Techno Drugs/Club Drugs - Side effects --- Euphoria, increased energy --- Stimulation, hallucinations --- Increased self-confidence --- Increased sociability --- Feeling of closeness to others - Adverse effects --- Hyperthermia, heart failure, kidney failure, acute dehydration, death

SUBSTANCE USE:Treatment with Psychotherapy and Other Modalities - Psychotherapy --- Assists patient in identifying and using alternative ______ mechanisms instead of reliance on substances - Self-help groups for patient and family --- 12-step programs most effective ------ Alcoholics Anonymous (AA: a peer support group for recovering alcoholics. Neither professional nor peer _______ are appointed ------ Al-Anon and Alateen for ______ members

SUBSTANCE USE:Treatment with Psychotherapy and Other Modalities - Psychotherapy --- Assists patient in identifying and using alternative coping mechanisms instead of reliance on substances - Self-help groups for patient and family --- 12-step programs most effective ------ Alcoholics Anonymous (AA: a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed ------ Al-Anon and Alateen for family members

TREATMENT OBJECTIVES - Achieve and maintain sobriety - Restore physical health - Restore _______ health - Achieve maximum _________ ability

TREATMENT OBJECTIVES - Achieve and maintain sobriety - Restore physical health - Restore mental health - Achieve maximum functional ability

VIDEO NOTES: - People who smoke weed are more likely to do _______. - 20% of kids sniff glue. - Meth won't help you pass your exams. Sad piano music. --- You WILL get ______ after the first hit - Little kids snorting things kills them more than any other preventable health condition! - Intense emotional music ANNNNND they lied x____

VIDEO NOTES: - People who smoke weed are more likely to do cocaine. - 20% of kids sniff glue. - Meth won't help you pass your exams. Sad piano music. --- You WILL get hooked after the first hit - Little kids snorting things kills them more than any other preventable health condition! - Intense emotional music ANNNNND they lied x1000

WARNING SIGNS - Medication ____________ - Errors in judgment - Request to work the _____ shift when fewer ppl are around. - Frequent ________ visits - Unexplained absences (calling in sick all the time.) - Utilizes more ________ than other nurses on the unit - Volunteering to give meds for other nurses' patients - Unusual _______ in pain meds - Always taking the _______ possible dose out of the pyxis.

WARNING SIGNS - Medication discrepancies - Errors in judgment - Request to work the night shift when fewer ppl are around. - Frequent bathroom visits - Unexplained absences (calling in sick all the time.) - Utilizes more narcotics than other nurses on the unit - Volunteering to give meds for other nurses' patients - Unusual interest in pain meds - Always taking the highest possible dose out of the pyxis.

WAYS IN WHICH A NURSE MAY DIVERT MEDICATIONS: - The nurse may give a _______ does to a patient and save the remainder for their personal use - When a medication is _____, the nurse may substitute water or saline - The nurse may ingest or inject "______" medications - Instead of administering an "as needed" medication dose to the patient, the nurse keeps it for his or her self

WAYS IN WHICH A NURSE MAY DIVERT MEDICATIONS: - The nurse may give a partial does to a patient and save the remainder for their personal use - When a medication is clear, the nurse may substitute water or saline - The nurse may ingest or inject "wasted" medications - Instead of administering an "as needed" medication dose to the patient, the nurse keeps it for his or her self

WHAT IF YOU ARE THE ONE CONFRONTED - LISTEN - IS THE INFORMATION ACCURATE & VALID? - CONSULT - BE PREPARED TO UNDERGO A CHEM DEP EVAL - BE PREPARED TO OBTAIN _____ COUNSEL

WHAT IF YOU ARE THE ONE CONFRONTED - LISTEN - IS THE INFORMATION ACCURATE & VALID? - CONSULT - BE PREPARED TO UNDERGO A CHEM DEP EVAL - BE PREPARED TO OBTAIN LEGAL COUNSEL

WHAT TO DO WHEN YOU SUSPECT A COLLEAGUE IS ABUSING CHEMICALS - ID examples/patterns of signs - Discuss with trusted _________ or friend - Present concerns & observations to nurse ________. - If speaking with the drug abuser, do not lecture them or scold them. Be _________. - Two options exist when a nurse is suspected of being impaired or unable to practice because of the use of alcohol, drugs or other chemicals. The nurse may be _______ to: --- The Health Professional Services Program (HPSP). --- Board of Nursing: This governing body determines whether or not a nurse may _______, and to which ______ a nurse may practice

WHAT TO DO WHEN YOU SUSPECT A COLLEAGUE IS ABUSING CHEMICALS - ID examples/patterns of signs - Discuss with trusted colleague or friend - Present concerns & observations to nurse manager. - If speaking with the drug abuser, do not lecture them or scold them. Be supportive. - Two options exist when a nurse is suspected of being impaired or unable to practice because of the use of alcohol, drugs or other chemicals. The nurse may be reported to: --- The Health Professional Services Program (HPSP). --- Board of Nursing: This governing body determines whether or not a nurse may practice, and to which extent a nurse may practice