Behavior, Substance Abuse - Lilley/Varcarolis - Nursing

An overlooked problem in hospitalized patients is nicotine withdrawal. What are some of the signs and symptoms associated with this condition?

Smoking cessation leads to nicotine withdrawal. An oftenoverlooked problem in hospitalized patients is nicotine withdrawal, which manifests as irritability, restlessness, and a decrease in heart rate and blood pressure.

The nurse is providing care for a patient in the emergency department who reports a headache and weakness and is noted to have cardiac dysrhythmias on the electrocardiogram. The patient is talkative, restless, anxious, and asking to leave the emergency department. The nurse suspects that the patient might be taking which abuse substance?

Stimulants Stimulants of abuse include amphetamines and often are related to anxiety, talkativeness, headaches, weakness, restlessness, and cardiac dysrhythmias.

Substance withdrawal is treated with

Substance withdrawal is treated with a multimodal approach that includes pharmacologic and nonpharmacologic interventions.-- The family will also be in need of treatment and therapeutic support; the caring, empathic, supportive, and educative responses by nurses will convey acceptance to the patient and family and help in the overall process of recovery and rehabilitation.

Common date rape drug --

A benzodiazepine used as a recreational drug is flunitrazepam, known as roofies among young people; it creates a sleepy, relaxed, drunken feeling that lasts 2 to 8 hours. Girls and women around the country have reported being raped after being involuntarily sedated with roofies, which were often slipped into their drinks by their attackers.

A thorough patient assessment and history must include

A thorough patient assessment and history must include specific questions about the substance(s), duration of abuse, related physical and mental health concerns, and withdrawal.

(Add On note) Two common screening tools (V-CH19) to screen / assess for alcohol and drug abuse

AUDIT: The Alcohol Use Disorders Identification Test - to assess for alcohol consumption, drinking behaviors, and alcohol related problems. Page 1 is clinician administered and Page 2 is Self-Report. Patients are encouraged to answer in terms of standard drinks. A chart illustrating the approximated number of standard drinks in different alcohol beverages is included for reference. A score of 8 or more is indicative of harmful alcohol use. AUDIT has been validated across genders and in a wide range of ethnic/racial groups. It has been deemed well-suited for primary care settings. B-DAST: Brief Drug Abuse Screening Tool - 20 question self-report screening tool with scale including psychometric properties. It's used to evaluate use of prescribed drugs, OTC drugs, and non-medical use of drugs. A score of 6 or more may indicate drug abuse.

Amphetamine is a stimulant drug that is commonly abused. Three classes of amphetamine exist: _____.

Amphetamine is a stimulant drug that is commonly abused. Three classes of amphetamine exist: (1) salts of racemic amphetamine, (2) dextroamphetamine, and (3) methamphetamine. -- Methamphetamine has a much stronger effect on the CNS than the other two classes of amphetamine.

Pharmacology -- Overview Depressants:

Depressants are drugs that relieve anxiety, irritability, and tension and are also used to treat seizure disorders and induce anesthesia. • The two main pharmacologic classes of depressant are benzodiazepines and barbiturates. • Benzodiazepines and barbiturates work by increasing the action of gamma-aminobutyric acid (GABA); the alteration of GABA action in the CNS results in relief of anxiety, sedation, and muscle relaxation.

Diacetylmorphine (heroin) and opium are classified as _______.

Diacetylmorphine (heroin) and opium are classified as Schedule I drugs and are not available in the United States for therapeutic use.

(CH17) While obtaining a medication history from a patient, the nurse notes that the patient is currently prescribed naltrexone (ReVia). The nurse should question the patient about a previous history of which substance abuse?

Opioid Naltrexone (ReVia), an opioid antagonist, is used to treat opioid abuse or dependence. Naltrexone works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. When euphoria is eliminated, the reinforcing effect of the drug is lost

What are adverse effects associated with stimulants?

---CNS-related adverse effects, an extension of the therapeutic effects of stimulants, are restlessness, syncope (fainting), dizziness, tremor, hyperactive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever, and sometimes euphoria. ---Death due to poisoning or toxic levels is usually a result of convulsions, coma, or cerebral hemorrhage and may occur during periods of intoxication or withdrawal of stimulants.

What medications are used to treat opioid abuse?

---For opioid abuse or dependence, naltrexone, an opioid antagonist, works by blocking the opioid receptors so that the use of opioid drugs does not produce euphoria. ---Another opioid antagonist, naloxone [Evizio], is used for opioid dependence. it is combined with buprenorphine (Subutrex) or used alone. ---(Suboxone) contains a combination of buprenorphine and naloxone. It is used to treat narcotic (opiate) addiction.. Suboxone is not for use as a pain medication.

Drugs used to aid in smoking cessations can include --

---Nicotine formulated into drug products may reduce cravings and promote smoking cessation. ---Varenicline (Chantix), newer for smoking cessation, has shown better efficacy than bupropion.

Pharmacology -- Overview Nicotine:

---The medical significance of nicotine grows out of its toxicity, presence in tobacco, and propensity for eliciting dependence in its users. ---Smoking releases epinephrine, a hormone that creates physiologic stress in the smoker rather than relaxation; apparent calming effects may be related to the increased deep breathing.

Abuse of CNS depressants is manifested by

--Abuse of CNS depressants is manifested by a decrease in vital signs and mental functioning; therefore, frequent monitoring of vital signs and neurologic status is needed for safe care --Three most widely used depressants: Alcohol, Sedative-hypnotic drugs, Opioids

What are signs and symptoms that commonly occur with abrupt withdrawal of benzodiazapines?

Abrupt withdrawal of benzodiazepines when they have been taken for prolonged periods has resulted in autonomic withdrawal symptoms, seizures, delirium, rebound anxiety, myoclonus (involuntary muscle contractions), myalgia, and sleep disturbances. • Barbiturates are used as sedatives and anticonvulsants and to induce anesthesia. • Barbiturates and benzodiazepines are commonly implicated in suicides, especially in combination with alcohol.

Pharmacology -- Overview Alcohol:

Alcohol, more accurately known as ethanol, causes CNS depression. A new hypothesis is that it causes local disordering in the lipid matrix of the brain, termed membrane fluidization.

Pharmacology -- Overview Stimulants:

Amphetamine-related stimulants are highly addictive substances. While the use of crack cocaine and methamphetamine is illegal, amphetamines have a role in treating narcolepsy and attention deficit disorder. While most people responsibly use prescribed stimulants, prescription stimulants are frequently misused. All stimulants increase cardiac activity and excite the CNS by increasing levels of norepinephrine, serotonin, and dopamine. People use these drugs to produce feelings of euphoria, increase alertness, and boost their energy. Health problems associated with using stimulants are presented in Table 10-2. (Lewis)

Nurse Jones immediately looks up the chemical composition of Listerine and consults with the attending physician, who orders an immediate assessment of the salicylate levels. Ms. Krocker is admitted to the intensive care unit (ICU), where the staff can monitor her liver function tests, blood studies, and hydration. Ms. Krocker complains that she is being admitted to the ICU. "I do not see why I need to. I only drink Listerine." Nurse Jones tells her that a substantial amount of alcohol and salicylates are in Listerine, and that admitting her to the ICU is necessary to monitor her withdrawal symptoms. ( Substance Use Disorders: Addiction case study - 5 )

Assessment Objective Data --64-year-old employed widow --Demonstrates signs of alcohol intoxication at place of employment --BAL of 280 --Alcohol intake for 4 years --28 ounces of Listerine daily --Last drink of Listerine 3 hours before this admission ( Substance Use Disorders: Addiction case study - 6 )

Assessment of CNS stimulant abuse requires

Assessment of CNS stimulant abuse requires careful questioning about and observation for adverse effects, toxicity, and withdrawal signs and symptoms

Assessment of opioid abuse includes

Assessment of opioid abuse includes determination of the route being used for drug delivery since intravenous drug use may cause health concerns such as human immunodeficiency virus/acquired immunodeficiency syndrome or hepatitis.

The nurse is providing care to a patient with a diagnosis of an overdose. The health care provider prescribes flumazenil (Romazicon) for the patient. What type of overdose does the nurse suspect?

Benzodiazepines Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the central nervous system by directly competing with them for binding at the benzodiazepine receptor and thus reversing sedation.

CNS depressant withdrawal includes

CNS depressant withdrawal includes increased psychomotor activity; agitation; muscular weakness; hyperthermia; diaphoresis; delirium; convulsions; elevated blood pressure, pulse rate, and temperature; and eyelid tremors.

CNS stimulant withdrawal includes

CNS stimulant withdrawal includes social isolation or withdrawal, psychomotor retardation, and hypersomnia.

What is done to help patients prevent relapse to opioid abuse?

Certain medications are used to prevent relapse use once initial remission is achieved, but are useful only when concurrent counseling is provided.

Certain opioid drugs, such as ____________, are themselves used to treat opioid dependence

Certain opioid drugs, such as methadone, are themselves used to treat opioid dependence

The nurse is caring for a patient with a history of chronic alcohol abuse. The nurse recognizes the need to closely monitor the patient for which withdrawal signs and symptoms? (Select all that apply.)

Common symptoms and signs of alcohol withdrawal include hypertension [increased blood pressure], pulse, tremors, and agitation. The signs and symptoms may vary depending on the patient's usage pattern, the preferred type of ethanol, and the presence of comorbidities.

Assessment Subjective Data "I don't see why I need to be admitted to the ICU since I only drink Listerine." "I do not drink alcohol." "I had my last bottle of Listerine 3 hours earlier." Self-Assessment Ms. Krocker does not reflect Nurse Jones' perception of an alcoholic; rather, she reminds Nurse Jones of her own mother. Ms. Krocker smiles and speaks politely with the staff. Nurse Jones finds it hard to imagine Ms. Krocker in alcohol withdrawal. She is also worried about Ms. Krocker's age and her health during the withdrawal period. ( Substance Use Disorders: Addiction case study - 7 )

Diagnosis 1. Risk for injury, related to alcohol/Listerine consumption 3 hours before admission as manifested by a BAL of 280; --4-year history of alcohol intake --62 years old --28 ounces of Listerine daily 2. Denial, related to refusal to acknowledge alcohol content of Listerine as manifested by "I don't need to be admitted to the hospital. I only drink Listerine." --Lack of knowledge about content of alcohol in Listerine --Unaware of potential withdrawal symptoms ( Substance Use Disorders: Addiction case study - 8 )

Due to the high potential for abuse, opioids are classified as

Due to the high potential for abuse, opioids are classified as Schedule II controlled substances.

Assessment findings and interventions for emergency management of stimulant toxicity --

Emergency Management Stimulant Toxicity Assessment Findings Cardiovascular • Palpitations • Tachycardia • ↑ BP • Dysrhythmias • Myocardial ischemia or infarction Central Nervous System • Feeling of impending doom • Euphoria • Agitation • Combativeness • Seizures • Hallucinations • Confusion • Paranoia • Fever Interventions • Ensure patent airway. • Establish IV access and initiate fluid replacement as appropriate. • Obtain a 12-lead ECG and initiate ECG monitoring. • Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl). • Hypertension and chest pain may require administration of nitroprusside (Nipride) or phentolamine (Regitine). • Aspirin may be administered to lower the risk of myocardial infarction. • Administer IV diazepam (Valium) or lorazepam (Ativan) for seizures. • Administer IV antipsychotic drugs for psychosis and hallucinations. • Monitor vital signs and level of consciousness. • Initiate cooling measures for hyperthermia.

Evaluation After 4 days in the ICU, Ms. Krocker is discharged to her home and to the follow-up care of her primary care physician. She requires liver function studies over the next several months, along with testing for possible hearing loss, secondary to salicylate poisoning. Her niece is encouraged to look at drug and alcohol rehabilitation programs. Ms. Krocker contacts her employer and is advised that "They are keeping my job for me. They said my customers are asking about me and missing me. I have to get better and get back there." Ms. Krocker continues to deny her alcohol problem. She doesn't associate alcohol problems with middle-class and well-educated people. ( Substance Use Disorders: Addiction case study - 23 )

End of case study

Ethanol withdrawal produces varying degrees of signs and symptoms depending on

Ethanol withdrawal produces varying degrees of signs and symptoms depending on the specific blood alcohol level. Delirium tremens is characterized by hypertensive crisis, tachycardia, and hyperthermia and may be life threatening.

Evaluation of the recovery and rehabilitation process includes --

Evaluation of the recovery and rehabilitation process is important, including monitoring of the therapeutic effects of the treatment regimen and monitoring for any physiologic and/or psychologic ill effects from the withdrawal of the abused substance.

Chapter 17: Substance Abuse Textbook Case Studies (3)

First of all, call emergency services—dial 911. Fatal poisoning is unusual with benzodiazepines, such as alprazolam, when they are ingested alone. When benzodiazepines are ingested with alcohol or barbiturates, however, the combination can be lethal. It would be important to determine whether the young boy has been drinking as well. In the emergency room, flumazenil can be used to acutely reverse the sedative effects of benzodiazepines. Flumazenil antagonizes the action of benzodiazepines on the central nervous system (CNS) by directly competing with them for binding at the benzodiazepine receptor in the CNS. Flumazenil has a stronger affinity for the receptor, however, and displaces benzodiazepine molecules from the receptor, which reverses the sedative action of the benzodiazepine. Once his physical condition stabilizes, the boy and his family will need to undergo substance abuse counseling to explore issues regarding what has happened and how to prevent recurrence.

An unresponsive young adult is taken to the emergency department by friends. The friends tell the nurse, "We were too scared to call 911 because we were at a party popping roofies." Which medication would the nurse expect to administer to this patient?

Flumazenil (Romazicon) A benzodiazepine that has gained popularity as a recreational drug is flunitrazepam. The drug is known as roofies among young people. Flumazenil (Romazicon) can be used to acutely reverse the sedative effects of benzodiazepines. Naloxone (Narcan) is used to treat opiate overdosage. Naltrexone (ReVia) is used to treat opioid abuse, and chlordiazepoxide (Librium) is used to treat ethanol withdrawal.

Interventions / Rationales: d. Use confrontation in an empathetic manner. d. Confrontation minimizes patient denial; laboratory tests show that the patient is drinking a large amount of alcohol. e. Discuss the consequences of alcohol use on employment. e. "How did your alcohol use affect your job?" ( Substance Use Disorders: Addiction case study - 17 )

GOAL NOT MET Patient denies that Listerine contains alcohol and that she drinks excessively. ( Substance Use Disorders: Addiction case study - 18 )

Interventions / Rationales: c. Discuss the negative consequences of alcohol use. c. Alcohol use has a negative impact on physical health. d. List substance abuse treatment methods suitable for single older individuals. d. Treatment will be more amenable if geared to the individual patient. e. Convey a caring and empathetic manner. e. Empathy helps trust develop between the nurse and patient. ( Substance Use Disorders: Addiction case study - 21 )

GOAL NOT MET Patient is very polite and appears interested during alcohol education classes. However, privately she does not see the need for treatment because she does not believe she is an alcoholic. ( Substance Use Disorders: Addiction case study - 22 )

(Key Notes)What term_____ refers to situations in which a patient develops tolerance to a certain drug and may have mild psychologic dependence on it but does not show compulsive dose escalation, drug-seeking behavior, or major withdrawal symptoms on drug discontinuation?

Habituation refers to situations in which a patient develops tolerance to a certain drug and may have mild psychologic dependence on it but does not show compulsive dose escalation, drug-seeking behavior, or major withdrawal symptoms on drug discontinuation

What are some of the most abused drugs in the United States?

Heroin is one of the top 10 most abused drugs in the United States. Others in this opioid category are codeine, hydrocodone, hydromorphone, meperidine, morphine, and oxycodone.

Chapter 17: Substance Abuse Textbook Case Studies (1)

His behavior may reflect long-term use of marijuana, which may result in chronic respiratory symptoms (similar to those of tobacco abuse) and memory and attention deficit problems. A chronic, depressive "amotivational" syndrome has also been observed, especially among younger users.

Outcomes Identification Patient will experience minimal or no alcohol withdrawal symptoms. She will verbalize consequences of drinking Listerine and verbalize the intent to quit. Planning The nurse plans interventions that will help detoxify and rehydrate Ms. Krocker to minimize potential physical injury (e.g., dehydration, cardiac instability). Interventions will include the additional use of medications, as required, and the provision for a nonstimulating environment to prevent seizure activity. ( Substance Use Disorders: Addiction case study - 9 )

Implementation Nurse Jones makes the following nursing care plan: Short-Term Goal Intervention Rationale Evaluation ( Substance Use Disorders: Addiction case study - 10 )

Short-term Goal 1 : Patient demonstrates an absence of injuries as a result of alcohol and salicylate intake ( Substance Use Disorders: Addiction case study - 11 )

Interventions / Rationales: a. Assess patient for withdrawal as early as 8 hours after abstinence from alcohol. a. Conscientious assessment will prevent patient injuries. b. Recognize stages of withdrawal. b. Recognition of early symptoms can decrease the severity of withdrawal. c. Administer benzodiazepines for withdrawal symptoms. c. Will prevent seizures and increase patient comfort. d. Remain with the patient. d. Nurse's presence decreases the patient's fear and anxiety. ( Substance Use Disorders: Addiction case study - 12 )

Short-term Goal 2 : 2. Patient will acknowledge her excessive alcohol intake. ( Substance Use Disorders: Addiction case study - 15 )

Interventions / Rationales: a. Develop a trusting nurse-client relationship. a. Trust is the basis for all therapeutic relationships. b. Convey empathetic and nonjudgmental manner. b. Nonjudgmental attitude promotes patient self-worth. c. Discuss patient's misconceptions about Listerine and alcohol use. c. Factual information in a nonjudgmental manner increases patient acceptance. ( Substance Use Disorders: Addiction case study - 16 )

Short-term Goal 3 : 3. Patient will acknowledge the necessity for alcohol education and treatment. ( Substance Use Disorders: Addiction case study - 19 )

Interventions / Rationales: a. Discuss relationship between alcohol consumption and patient's life events. a. Connecting events and alcohol use is the first step in addressing patient denial. b. Help Ms. Krocker recognize the difficulty in stopping the use of alcohol. b. Factual information helps the patient focus on alcohol treatment and degree of addiction. ( Substance Use Disorders: Addiction case study - 20 )

Interventions / Rationales: e. Assess patient for signs of salicylate toxicity―tinnitus, headache, hyperventilation, mental confusion, lethargy, diarrhea, and sweating. e. Early identification of toxicity symptoms alerts the physician to begin treatment. Listerine contain methyl salicylate. f. Monitor hepatic function for excessive alcohol intake. f. Early identification can prevent liver damage g. Ensure that the patient has a quiet, nonstimulating environment. g. Excessive stimulation increases patient agitation. ( Substance Use Disorders: Addiction case study - 13 )

Interventions / Rationales: h. Monitor intake and output and ensure intake of 2500 ml per day. / h. Monitoring intake and output ensures patient receives adequate fluid amount. i. Pad side rails and headboard with blankets or towels. / i. Seizure precautions are necessary because the patient is at risk for seizures. GOAL MET Vital signs and laboratory values are within normal limits. Her withdrawal symptoms were mild and corrected with valium. ( Substance Use Disorders: Addiction case study - 14 )

Large doses of nicotine can produce --

Large doses of nicotine can produce tremors, convulsions, and respiratory stimulation. • The cardiovascular effects of nicotine are an increase in heart rate and blood pressure. The effects of nicotine on the gastrointestinal system are largely due to parasympathetic stimulation, which results in increased tone and motor activity of the bowel and vomiting.

Many of the non-CNS adverse effects of opioids are ______.

Many of the non-CNS adverse effects are secondary to the release of histamine.

What kind of care do many patients need while opioid withdrawal symptoms are occurring?

Many patients require formal detoxification while withdrawal symptoms are occurring.

Variants of amphetamine: designer drugs can include --

Multiple slight chemical variants of amphetamine are referred to as "designer drugs," which have psychoactive properties along with their stimulant properties. • Another synthetic amphetamine derivative is methylenedioxymethamphetamine (MDMA, "ecstasy," or "E"); it tends to have more calming effects than other amphetamine drugs. • Marijuana and alcohol are commonly listed as additional drugs of abuse in those admitted for treatment of methamphetamine abuse.

(Key Notes) Substance abuse affects people of all ages, sexes, and ethnic and socioeconomic groups.

Nearly 50% of the adult patients seen in many family practice clinics have an alcohol or drug disorder.

Nurse Jones returns to the attending physician and inquires whether the laboratory reports are back. Ms. Krocker's blood alcohol level (BAL) is 280. She is at risk for alcohol withdrawal because she drinks a large amount of alcohol and has done so for 4 years. Nurse Jones asks her, "When was your last drink of Listerine?" Ms. Krocker states that she had her last bottle of Listerine 3 hours earlier. ( Substance Use Disorders: Addiction case study - 3 )

Nurse Jones asks her, "About how much Listerine do you drink a day?" Ms. Krocker opens her purse and reveals seven 4-ounce bottles of Listerine. She says she fills them every day and uses all of them through the course of her 8-hour shift. [BAL is used to identify alcohol intoxication. BAL measures alcohol concentration in blood using mass per volume. --- Not detected (Positive results are quantified.) Limit of detection: 10 mg/dL (0.01 g/dL) Legal limit of intoxication is 80 mg/dL (0.08 g/dL). Toxic concentration is dependent upon individual usage history. Potentially lethal concentration: > or =400 mg/dL (0.4 g/dL)] ( Substance Use Disorders: Addiction case study - 4 )

Chapter 19a: Substance-Related and Addictive Behaviors Case Studies and Nursing Care Plans Substance Use Disorders: Addiction Ms. Krocker, a 64-year-old widow, is brought to the emergency department by her niece after she was called to pick up her aunt from her job for allegedly being intoxicated while working. Ms. Krocker has worked in the ladies' cosmetics section of a local department store for over 35 years. The psychiatric emergency response nurse, Ann Jones, is paged and called to the emergency department to perform an initial screening. ( Substance Use Disorders: Addiction case study - 1)

Nurse Jones begins the assessment by asking all the typical drug and alcohol screening questions—"Do you drink alcohol?" "Have you taken any medicine or drugs?"—to which Ms. Krocker answers "No" or "Never" to each question. "Why are you asking me these questions? Certainly, I am sure I have taken a vitamin or two or an aspirin for a headache now and then, but to all your questions—no ma'am, I do not and I have not." ( Substance Use Disorders: Addiction case study - 2)

The nurse helps to meet the patient's basic needs and teaches the patient, family, and/or significant others about addiction and its effect on the entire family. • Nursing interventions involve ______.

Nursing interventions involve maximizing all of the therapeutic plans and minimizing those factors contributing to the abusive behaviors.

What are the intended effects of opioids?

The intended effects are to relieve pain and diarrhea, reduce cough, and induce anesthesia.

Pharmacology -- Overview Opioids: ___________________ are synthetic versions of pain-relieving substances that were originally derived from the opium poppy plant.

Opioid analgesics are synthetic versions of pain-relieving substances that were originally derived from the opium poppy plant.

A patient reports severe back pain and asks the nurse for medication "to take the pain away." Nursing assessment findings on the physical examination include mydriasis, rhinorrhea, diaphoresis, lacrimation, blood pressure of 160/84 mmHg, heart rate of 116 beats/min, and respiratory rate of 24 breaths/min. Which condition would the nurse suspect?

Opioid withdrawal Signs and symptoms associated with opioid withdrawal include drug seeking, mydriasis, piloerection, diaphoresis, rhinorrhea, lacrimation, vomiting, diarrhea, insomnia, and elevated blood pressure and pulse rate. Nurses must be alert for this behavior in patients seeking medication for subjective pain complaints, especially when accompanied by withdrawal symptoms.

Opioid withdrawal includes

Opioid withdrawal includes seeking the drug from more than one prescriber, mydriasis, rhinorrhea, diaphoresis, piloerection, lacrimation, diarrhea, insomnia, and elevated blood pressure and pulse rate.

How do opioids work (general overview)?

Opioids work by blocking receptors in the central nervous system (CNS), resulting in the perception of pain being blocked

What is of utmost importance when a patient is experiencing signs and symptoms of substance withdrawal?

Patient safety is of utmost importance when the patient is experiencing signs and symptoms of withdrawal. Patients may enter life-threatening situations within a period of a day or two.

(Key Notes) In 2013, 23.1 million Americans 12 years of age or older were reported to be current illicit drug users.

Physical dependence and psychologic dependence on a substance are chronic disorders with remissions and relapses, as with any other chronic illness

(Key Notes) What is physical dependence with respect to substance abuse?

Physical dependence is a condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated.

Chapter 17: Substance Abuse Textbook Case Studies (2)

Praise your neighbor that his son is talking to him about these issues, but warn him that yes, indeed, alcohol is dangerous! Large amounts of alcohol may be taken in during these drinking "games." Large amounts of alcohol can produce dangerous or lethal depression of respiration. Encourage the neighbor to keep an open dialogue with his son and to discuss the consequences of drinking.

(Key Notes) What is psychological dependence?

Psychologic dependence is a condition characterized by strong desires to obtain and use a substance.

Question all patients about the use and misuse of substances because...

Question all patients about the use and misuse of substances because addiction may be encountered in all clinical specialties. Abuse/misuse of substances/prescription medications may need to be assessed in other family members as well.

What are benzodiazepines used for?

The CNS is the primary area of the body adversely affected by these drugs. • Benzodiazepines are used primarily therapeutically to relieve anxiety, to induce sleep, to sedate, and to prevent seizures. • Ingestion of benzodiazepines together with alcohol or barbiturates can be lethal; death is typically due to respiratory arrest.

The abuse of stimulants is related to ______.

The abuse of stimulants is related to their ability to cause elevation of mood, reduction of fatigue, a sense of increased alertness, and invigorating aggressiveness.

The nurse is educating a group of college students about substance abuse. When discussing the potential use and abuse of stimulants, the nurse is aware these drugs are commonly abused and cause what signs and symptoms? (Select all that apply.)

The abuse of stimulants is related to their ability to cause elevation of mood, reduction of fatigue, a sense of increased alertness, and invigorating aggressiveness. Other signs and symptoms include weight loss, diarrhea and abdominal cramps, not constipation.

Opioid Analgesics are often referred to as _____. The effects of opioids are referred to as ______.

The effects of opioids are referred to as narcosis or stupor, involving reduced sensory response, especially to painful stimuli; opioid analgesics are also referred to as narcotics.

The major CNS-related adverse effects of opioids include________.

The major CNS-related adverse effects include diuresis [increased/excessive urine production], miosis [excessive constriction of the pupil of the eye], convulsions, nausea, vomiting, and respiratory depression.

Common therapeutic uses of stimulants include --

The most common therapeutic use for stimulants is in treating attention deficit disorder or attention deficit hyperactivity disorder. Stimulants also are used in preventing or reversing fatigue and sleep (such as in narcolepsy) and in stimulating the respiratory center.

The newest drug treatment indicated for alcoholism is _____. It is used to ____.

The newest drug treatment indicated for alcoholism is acamprosate. It is used to maintain abstinence from alcohol in patients who are abstinent when starting the drug and who have additional psychosocial support. Its mechanism of action is not completely understood, but it may interact with glutamate and GABA receptors in the brain

Chapter 17: Substance Abuse 2. Textbook Critical Thinking and Prioritization Questions

The nurse needs to explain how the expected nicotine withdrawal will affect his recovery from surgery. Nicotine withdrawal may be manifested in a hospitalized patient by irritability, restlessness, and decreases in both heart rate and blood pressure. In addition, a patient may experience severe cravings for cigarettes. During the postoperative period, the symptoms of nicotine withdrawal may mask other underlying problems, such as hypoxia or even bleeding. He will also be more comfortable if the cravings are curbed. The transdermal administration of nicotine provides nicotine without the carcinogens found in tobacco; the patches are part of a stepwise reduction in subcutaneous delivery. Over time, the nicotine dosage is gradually decreased.

The purpose of a substance abuse assessment is to

The purpose of a substance abuse assessment is to determine whether substance abuse exists, to evaluate the relationship between the abuse and other health concerns, and to begin the implementation of an effective health promotion and health restoration plan.

Chapter 17: Substance Abuse 1. Textbook Critical Thinking and Prioritization Questions

This situation brings up an ethical difficulty in that a friend has confided in the nurse, yet the friend is participating in an illegal and harmful activity. First of all, she will not change her behavior unless she wants to change. The priority is the safety of the friend. The nurse can try to educate her about the dangers of taking illicit drugs, specifically the cocaine, and how an overdose or bad batch could kill her. If she wants help, the nurse can aid her in seeking professional medical care and counseling to assist with withdrawal and psychologic dependence. She also needs to realize that this will be a lifelong issue. The nurse will try to involve her family in an intervention to help her to recognize her problem.

The nurse is reading a patient's substance abuse history on admission to inpatient rehabilitation. The patient states to the nurse, "I have been increasing my drug dosage to get the same effect." What is the patient experiencing?

Tolerance Tolerance is defined as requiring an increased amount of drugs in the system to have the same desired effect

Valid and reliable assessment tools are available to nurses and health care professionals for use with patients suspected of drug or substance abuse. The goal of screening for alcohol and other drug abuse or addiction is to

Valid and reliable assessment tools are available to nurses and health care professionals for use with patients suspected of drug or substance abuse. The goal of screening for alcohol and other drug abuse or addiction is to identify patients who have or are at risk for developing alcohol or drug-related problems and to further engage them in discussion.

A nurse working in behavioral medicine is aware of associated long-term consequences of alcohol abuse. What potential vitamin deficiency can occur and potentially lead to Wernicke's encephalopathy?

Vitamins B1 Long-term excessive ingestion of ethanol is directly associated with serious neurologic and mental disorders. These neurologic disorders can result in seizures. Nutritional and vitamin deficiencies, especially of the B vitamins, can occur and can lead to Wernicke's encephalopathy, Korsakoff's psychosis, polyneuritis, and nicotinic acid deficiency encephalopathy.

How does Narcan work?

it competes with any narcotic, displacing it from its receptors and allowing LOC to increase and reversing respiratory depression

Neurochemistry of the brain [heroin] When heroin enters into the body [injection, inhalation,...] it travels through the blood stream to the brain where it is converted to

morphine by enzymes....morphine then binds to opiate receptors and travels via the reward pathway (prefrontal cortex, VTA, nucleus accumbens) to various areas in the brain and to the pain pathway (thalamus, brain stem, spinal cord) subsequently there is the development of tolerance and the body no longer responds to the drug in the initial way. *Tolerance occurs in the pain passage pathway. --A person does not develop a tolerance to the respiratory depression effects. --Addiction develops when when after repeated exposure to the drug the neurons/enzymes adapt to the exposure.... and only function normally in the presence of the drug

Naloxone (Narcan)

opiate antagonist, reverses opioid induced respiratory depression, heroin / morphine reversal agent (IV, Subcut, IM, nasal spray; effective 1-2 hours)

The signs and symptoms of heroin/morphine withdrawal occur when

the opiate receptors in the thalamus of the brain and brain stem are deprived of heroine/morphine. The withdrawal symptoms are so severe that the abuser is obsessed with finding the drug.

Patients with stimulant toxicity present with ____.

with sympathetic overdrive (increased stimulation of the sympathetic nervous system). The patient experiences restlessness, hypervigilance, agitated delirium, impaired judgment, and paranoia with psychotic symptoms. Physical effects include hypertension, tachycardia, fever, pupil dilation, seizures, confusion, and diaphoresis. Death may occur from stroke, dysrhythmias, or myocardial infarction.1 The emergency management depends on the clinical manifestations at the time of treatment (Table 10-10). A specific antidote for stimulant toxicity is not available. Supportive care measures include medications for agitation and cardiovascular symptoms.

What is the drug class of cocaine?

• Cocaine also produces strong CNS stimulation and was originally classified as a narcotic. However, unlike the opioid analgesics, cocaine does not normally induce a state of narcosis or stupor and is therefore more correctly categorized as a stimulant drug.