Mental Health Ch. 23 Substance Related and Addictive Disorders
Define withdrawal.
The physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Substance withdrawal occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time.
Detoxification
The process of managed withdrawal from a substance to which one has become addicted.
Dual Diagnosis
the client is diagnosed with both mental illness and a coexisting substance disorder
Nursing Diagnosis: Loss of weight, pale conjunctiva and mucous membranes, decreased skin turgor, electrolyte imbalance, anemia, drinks alcohol instead of eating a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
F. Imbalanced nutrition: Less than body requirements/Deficient fluid volume
Korsakoff's syndrome
A syndrome of confusion, loss of recent memory, and confabulation in alcoholics caused by a deficiency of thiamine. It often occurs together with Wernicke's encephalopathy and may be termed Wernicke-Korsakoff syndrome.
Opioids
A synthetic or naturally occurring substance that acts on opiate receptors to produce opiate-like effects.
List the continuum of CNS depression with increasing doses of sedative, hypnotic, or anxiolytic drugs in the correct order.
Norma l- Relief From Anxiety - Disinhibition - Sedation - Hypnosis (sleep) - General Anesthesia - Coma - Death
Define codependency, and identify behavioral characteristics associated with the disorder.
The codependent person is able to achieve a sense of control only through fulfilling the needs of others. Personal identity is relinquished and boundaries with the other person become blurred. The codependent person disowns his or her own needs and wants to respond to external demands and the demands of others. Codependence has been called "a dysfunctional relationship with oneself." Taking care of others at the expense of one's own needs ■ Feeling responsible for fixing other people's problems ■ Having low self-esteem; expecting to perform perfectly but never feeling "good enough" ■ Desperately seeking approval from others; often identified as "people pleasers" ■ Generally unhappy and seeking things outside oneself to attempt to fulfill unmet needs ■ Tending to have come from dysfunctional families where there was abuse or neglect ■ Having weak boundaries that lead to feelings of resentment, lack of trust, and anger toward others
What is the most effective programs for chemically impaired nurses?
The most effective are programs that involve early reporting and treatment of chemical addiction as a disease, with a focus on public safety and rehabilitation of the nurse.
Define addiction.
The physiological and mental readjustment that accompanies the discontinuation of an addictive substance
What is an evidenced based tool to prevent alcohol-exposed pregnancy and risky alcohol use?
Alcohol screening and brief intervention (SBI)
Alcohol intoxication usually occurs at what levels?
Between 100-200 mg/dL
What is the strongest defense for not confronting substance abuse problems?
Denial, on the part of the impaired nurse as well as nurse colleagues.
Identify nursing diagnoses common to patients with substance-related and addictive disorders, and select appropriate nursing interventions for each.
Denial---Makes statements such as, "I don't have a problem with (substance). I can quit any time I want to." Delays seeking assistance; does not perceive problems related to use of substances; minimizes use of substances; unable to admit impact of disease on life pattern Ineffective coping-----Abuse of chemical agents; destructive behavior toward others and self; inability to meet basic needs; inability to meet role expectations; risk taking Imbalanced nutrition: Less than body requirements/Deficient fluid volume--Loss of weight, pale conjunctiva and mucous membranes, decreased skin turgor, electrolyte imbalance, anemia, drinks alcohol instead of eating Risk for infection---Risk factors: Malnutrition, altered immune condition, failing to avoid exposure to pathogens Chronic low self-esteem---Criticizes self and others, self-destructive behavior (abuse of substances as a coping mechanism), dysfunctional family background Deficient knowledge----Denies that substance is harmful; continues to use substance despite obvious consequences
Nursing Diagnosis: FOR THE PATIENT WITHDRAWING FROM CNS DEPRESSANTS: Risk factors: CNS agitation (tremors, elevated blood pressure, nausea and vomiting, hallucinations, illusions, tachycardia, anxiety, seizures) a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
E. Risk for injury
What responses promoted the growth of the chemically impaired nurse? The most effective are programs that involve early reporting and treatment of chemical addiction as a disease, with a focus on public safety and rehabilitation of the nurse.
For years, the impaired nurse was protected, promoted, transferred, ignored, or fired.
Nursing Diagnosis: FOR THE PATIENT WITHDRAWING FROM CNS STIMULANTS: Risk factors: Intense feelings of lassitude and depression; "crashing," suicidal ideation a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
G. Risk for suicide
SBIRT stands for
S - Screening B - Brief I - Intervention R - Referral T - Treatment
Tolerance
The need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.
Medication-assisted treatment
The use of various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs and to decrease cravings by administering a controlled dose of another medication.
Motivational Interviewing (MI)
This is a patient-centered approach that encourages empowerment and active engagement, and as such, it articulates well with two current trends in psychiatric-mental health nursing care: recognizing the importance of patient-centered care as an essential nursing competency (Institute of Medicine, 2003) and the recovery model (see Chapter 20, "The Recovery Model," for further discussion of this model).
Describe two types of toxic reactions that can occur with the use of hallucinogens.
Two types of toxic reactions are known to occur. The first is the panic reaction or "bad trip." Symptoms include intense anxiety, fear, and stimulation. The individual hallucinates and fears going insane. Paranoia and acute psychosis may be evident. The second type of toxic reaction to hallucinogens is the flashback. This phenomenon refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance. The DSM-5 (APA, 2013) refers to this as hallucinogen persisting perception disorder.
A syndrome of symptoms characteristic of the specific substance occurs when the individual with the addiction attempts to _______use of the substance.
discontinue
Define intoxication.
intoxication is defined as the development of a reversible syndrome of symptoms following excessive use of a substance
Tom says to the nurse, "My head hurts. I didn't sleep very well last night. I'm getting shaky and it's hot in here! I could sure use a cup of coffee and a cigarette." How would the nurse respond appropriately to this statement by Tom?
"Tom, you are experiencing symptoms related to your body's withdrawal from alcohol. When did you have your last drink?" (Confrontation with caring.)
Tom is a patient on the alcohol treatment unit. He says to the nurse, "My boss and my wife ganged up on me. They think I have a drinking problem. I don't have a drinking problem! I can quit any time I want to!" How would the nurse respond appropriately to this statement by Tom?
"Tom, you are here because it has been determined that drinking alcohol is causing problems for you at home and at your work." (Confronting reality.)
Tom says, "Sure, I missed a couple days of work. Everyone gets sick now and then. I don't think my wife cares about what happens to me. She and my boss got together and decided I needed to be here, or I lose my job!" How would the nurse respond appropriately to this statement by Tom?
"You are feeling angry toward your boss and your wife, but your drinking is apparently interfering with your job and your marriage. Unless you abstain from alcohol, you are at risk of losing both.
Inhalant Intoxication
"clinically significant problematic behavioral or psychological changes that developed during or shortly after exposure to inhalants"
What are the classes of psychoactive substances?
1. Alcohol 2. Caffeine 3. Cannabis 4. Hallucinogens 5. Inhalants 6. Opioids 7. Sedative-hypnotics 8. Stimulants 9. Tobacco (nicotine)
With in __ to ___ hours cessation of or reduction in heavy and prolonged alcohol use (several days or longer), what withdrawal symptoms appear?
4 to 12 hours, coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia.
What is the reported death level range of alcohol intoxication?
400 - 700 mg/dL
Wernicke's encephalopathy
A brain disorder caused by thiamine deficiency and characterized by visual disturbances, ataxia, somnolence, stupor, and, without thiamine replacement, death.
Haptic encephalopathy
A brain disorder resulting from the inability of the cirrhotic liver to convert ammonia to urea for excretion. The continued rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbances, increasing confusion, and progression to coma and eventual death.
Dual diagnosis
A client has a dual diagnosis when it is determined that he or she has a co-existing substance disorder and mental illness. Treatment is designed to target both problems.
Disulfiram (Antabuse)
A drug that is administered to individuals who abuse alcohol as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a great deal of discomfort and can even result in death if the blood alcohol level is high.
Alcoholic Anonymous (AA)
A major self-help organization for the treatment of alcoholism. It is based on a 12-step program to help members attain and maintain sobriety. Once individuals have achieved sobriety, they in turn are expected to help other alcoholic persons.
Amphetamines
A racemic sympathomimetic amine that acts as a central nervous system stimulant. It (and its derivatives such as methamphetamine and dextroamphetamine) is a commonly abused substance but has therapeutic use in the treatment of narcolepsy and attention deficit-hyperactivity disorder.
A client is brought to the emergency department unconscious by a friend who says he was injecting heroin. The client is assessed to have a weak pulse. Which of these interventions are priorities? a. Administer naloxone and rescue breathing. b. IV benzodiazepines and continuous monitoring of vital signs. c. Ask the friend how much heroin he took and confirm with a laboratory drug screen. d. Initiate cardiopulmonary resuscitation and prepare to use an external defibrillator.
A. Administer naloxone and rescue breathing
A client who has been admitted to the chemical dependence treatment unit after being discliplined for drinking on the job states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know." Which defense mechanism is the client using? a. Denial b. Projection c. Displacement d. Rationalization
A. Denial
Nursing Diagnosis: Risk factors: Malnutrition, altered immune condition, failing to avoid exposure to pathogens a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
A. Risk for infection
A client is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for several years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink b. 2 to 3 days after the last drink c. 4 to 5 days after the last drink d. 6 to 7 days after the last drink
A. Several hours after the last drink
Gamblers Anonymous
An organization of inspirational group therapy, modeled after Alcoholics Anonymous (AA), for individuals who desire to, but cannot, stop gambling.
A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled. Is evident when tolerance develops and the amount required to achieve the desired effect continually increases
Addiction
Describe current trends in the opiate use disorder epidemic in the United States.
Although methamphetamine use is widespread, particularly on college campuses, its use has perhaps been overshadowed by the nationwide opiate epidemic with its associated deaths. An alarming recent trend has been the increasing use of methamphetamines in combination with opiates. Ellis and associates, as cited by Dotinga (2018), report that the use of crystal meth increased by 82% in the last decade and combined use of opioids and methamphetamine almost doubled during the same time period. Ellis and associates note that individuals with opiate-use disorder sometimes use amphetamines to create a state of arousal to counteract the sedative effects of opiates. The use of combinations of drugs increases the risk of adverse effects and overdose. It also underscores the importance of assessing for multisubstance use in any individual presenting with substance use issues.
Phencyclidine (PCP)
An anesthetic used in veterinary medicine; used illegally as a hallucinogen, referred to as PCP or angel dust.
Codependency
An exaggerated dependent pattern of learned behaviors, beliefs, and feelings that make life painful. It is a dependence on people and things outside the self, along with neglect of the self to the point of having little self-identity. The concept of codependency arose from a need to define the dysfunctional behaviors that are evident among members of the family of a chemically addicted person.
Define tolerance as it relates to physical addiction to a substance.
As tolerance develops, physical addiction also occurs, resulting in a withdrawal syndrome upon cessation of drug use.
Identify symptomatology and use the information in assessment of patients with various substance-related and addictive disorders. pg. 414
Assessment In the preintroductory phase of relationship development, the nurse must examine his or her feelings about working with a patient who abuses substances. nurse may gain a greater understanding about attitudes and feelings related to substance abuse by responding to the following types of questions ■ What are my drinking patterns? ■ If I drink, why do I drink? When, where, and how much? ■ If I don't drink, why do I abstain? ■ Am I comfortable with my drinking patterns? ■ If I decided not to drink any more, would that be a problem for me? ■ What did I learn from my parents about drinking? ■ Have my attitudes changed as an adult? ■ What are my feelings about people who become intoxicated? ■ Does it seem more acceptable for some individuals than for others? ■ Do I ever use terms such as "sot," "drunk," or "boozer" to describe some individuals who overindulge, yet I overlook it in others? ■ Do I ever overindulge myself? ■ Has the use of alcohol (by me or others) affected my life in any way? ■ Do I see alcohol/drug abuse as a sign of weakness? A moral problem? An illness?
A client who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job states to the nurse, "I don't have a problem with alcohol. My boss is a jerk! I haven't missed any more days than my coworkers." What is the nurse's best response? a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work." c. "Get real! You're an alcoholic and you know it!" d. "Why do you think your boss is a jerk?"
B. "You are here because your drinking was interfering with your work."
Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Cannabidiol (Epidiolex)
B. Chlordiazepoxide (Librium)
Nursing Diagnosis: Criticizes self and others, self-destructive behavior (abuse of substances as a coping mechanism), dysfunctional family background a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
B. b. Chronic low self-esteem
Discuss predisposing factors implicated in the etiology of substance-related and addictive disorders.
Biological factors Psychological factors Sociocultural factors The etiology of substance use disorders is unknown. Various contributing factors have been implicated, such as genetics, biochemical changes, developmental influences, personality factors, social learning, conditioning, and cultural and ethnic influences. ■ Although multiple factors influence the development of a substance use disorder, it is clearly a disease of the brain.
What are the predisposing factors to substance-related disorders?
Biological, psychological, sociocultural
A client comes into the emergency department stating that he is "crashing" and feels like he'd "be better off dead." Which of these nursing interventions is a priority? a. Instruct the client not to worry; these are temporary signs of withdrawal and should go away in a few days. b. Request an order for amphetamines to ease the client's withdrawal symptoms. c. Assess the client's risk for suicide. d. Instruct the physician that the client may need naloxone.
C. Assess the client's risk for suicide
A client who has been admitted to intensive outpatient treatment for substance use disorder arrives for group therapy and appears groggy with constricted pupils. The client denies using substances. Which of the following would be the best intervention at this time? a. Ask the client to empty his pockets. b. Smell his breath for evidence of alcohol. c. Conduct a drug screen to assess for presence of opioids. d. Discharge the client for failure to comply with treatment expectations.
C. Conduct a drug screen to assess for presence of opioids
Nursing Diagnosis: Denies that substance is harmful; continues to use substance despite obvious consequences a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
C. Deficient knowledge
Symptoms of alcohol withdrawal include: a. Euphoria, hyperactivity, and insomnia. b. Depression, suicidal ideation, and hypersomnia. c. Diaphoresis, nausea and vomiting, and tremors. d. Unsteady gait, nystagmus, and profound disorientation.
C. Diaphoresis, nausea and vomiting, and tremors.
Nursing Diagnosis: Makes statements such as, "I don't have a problem with (substance). I can quit any time I want to." Delays seeking assistance; does not perceive problems related to use of substances; minimizes use of substances; unable to admit impact of disease on life pattern a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
D. Denial
A client admitted to the inpatient detoxification program for alcohol withdrawal approaches the nurse complaining of nausea and feeling shaky. The nurse notices that the client has hand tremors and appears diaphoretic. Which of these nursing interventions is a priority? a. Check the client's temperature. b. Send a urine sample to the laboratory for a random drug screen. c. Ask the client if there is anything that he is particularly stressed about. d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms.
D. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms.
Clients with a dual diagnosis are treated with traditional counseling because this approach uses more confrontation which is appropriate. True or False
False Traditional counseling approaches use more confrontation than is considered appropriate for clients with dual diagnoses. Most dual diagnosis programs take a supportive, less confrontational approach.
Nursing Diagnosis: Abuse of chemical agents; destructive behavior toward others and self; inability to meet basic needs; inability to meet role expectations; risk taking a. Risk for infection b. Chronic low self-esteem c. Deficient knowledge d.Denial e. Risk for injury f. imbalanced Nutrition: Less than body requirements/Deficient fluid volume g. Risk for suicide h. Ineffective coping
H. Ineffective coping
How to handle suspicion of impaired nurse?
If suspicious behavior occurs, it is important to keep careful, objective records. Confrontation with the impaired nurse will undoubtedly result in hostility and denial. Confrontation should not occur solely between peers but rather should involve a supervisor or other nurse manager and should include the offer of assistance in seeking treatment. If a report is made to the state board of nursing, it should be a factual documentation of specific events and actions, not a diagnostic statement of impairment.
What is fetal alcohol syndrome?
It is a condition of infants who are born to women who consume alcohol during pregnancy; characterized by growth and physical problems, mental retardation, and behavioral and learning disabilities with lifelong implications.
Discuss the issue of substance-related and addictive disorders within the nursing profession.
It is estimated that 10% of nurses have substance use disorders, which is the same rate as that for the general public (Worley, 2017). Alcohol is the most widely abused drug, followed closely by narcotics. Nurses who abuse substances have an added vulnerability because they are often handling controlled substances when providing patient care.
What is motivational interviewing?
Motivational interviewing is an approach that can be used in the assessment and intervention process for clients with any disorder, although it first gained popularity in treatment of clients with substance use disorders. It uses skills such as empathy, validation, open-ended questions, and reflection to explore the client's motivation, strengths, and readiness for change. Some of the preceding questions could easily be reframed to explore the client's attitudes and feelings. Through this process, the client is empowered to become an active partner in treatment goals while exploring reasons for resistance to behavior change. For example, rather than telling a client that he or she must abstain from alcohol and attend 12-step meetings, the health-care professional helps the client articulate what he or she wants to achieve and then facilitates the process of exploring the advantages and disadvantages of desired behavior change
Identify topics for patient and family teaching relevant to substance-related and addictive disorders.
NATURE OF THE ILLNESS 1. Effects of (substance) on the body a. Alcohol b. Other CNS depressants c. CNS stimulants d. Hallucinogens e. Inhalants f. Opioids g. Cannabinoids 2. Ways in which use of (substance) affects life. MANAGEMENT OF THE ILLNESS 1. Activities to substitute for (substance) in times of stress 2. Relaxation techniques a. Progressive relaxation b. Tense and relax c. Deep breathing d. Autogenics 3. Problem-solving skills 4. The essentials of good nutrition SUPPORT SERVICES 1. Financial assistance 2. Legal assistance 3. Alcoholics Anonymous (or other support group specific to another substance) 4. One-to-one support person
What are the physical consequences of thiamine deficiency in chronic alcohol use?
Peripheral neuropathy, characterized by nerve damage, results in pain, burning, tingling, or prickly sensations of the extremities. Researchers believe it is the direct result of deficiency in the B vitamins, particularly thiamine. Nutritional deficiencies are common in chronic alcoholics due to insufficient intake of nutrients and because the toxic effect of alcohol results in malabsorption of nutrients. The process is often reversible with abstinence from alcohol and restoration of nutritional deficiencies, but for some individuals, pain and numbness may be permanent (Schuckit, 2017). With chronic alcohol use permanent muscle wasting and paralysis can occur.
Peer assistance programs
Programs established by the American Nurses Association to assist impaired nurses. The individuals who administer these efforts are nurse members of the state associations as well as nurses who are in recovery themselves.
Common sources of Caffeine
SOURCE CAFFEINE CONTENT (mg) FOOD AND BEVERAGES 8 oz brewed coffee 90-165 8 oz instant coffee 63-110 8 oz decaffeinated coffee 2-5 1 oz espresso 47-64 8 oz brewed tea 25-48 8 oz instant tea 30 8 oz green tea 25-29 8-12 oz cola drinks 22-54 8-24 oz energy drinks 142-375 2 oz high-energy drinks 215-240 1.93 oz 10 hr energy shot 422 5-6 oz cocoa 20 8 oz chocolate milk 2-7 1 oz chocolate bar 22 PRESCRIPTION MEDICATIONS APCs (aspirin, phenacetin, caffeine) 32 Cafergot 100 Fiorinal 40 Migralam 100 OVER-THE-COUNTER ANALGESICS Anacin, Empirin, Midol, Vanquish 32 Excedrin Migraine (aspirin, acetaminophen, caffeine)65 OVER-THE-COUNTER STIMULANTS NoDoz tablets 100 Vivarin 200 Caffedrine 250
What are the facial features of fetal alcohol syndrome?
Small eye opening Skinfolds at the corner of the eye Short nose Thin upper lip Small head circumference Low nasal bridge Small midface Indistinct philtrum (groove between nose an upper lip)
Substance Intoxication
The CNS is directly affected, and disruption in physical and psychological functioning occurs. Judgment is disturbed, resulting in inappropriate and maladaptive behavior, and social and occupational functioning are impaired.
_________ is an excellent tool that is used by many hospitals to assess risk and severity of withdrawal from alcohol.
The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
Cannabis
The dried flowering tops of the hemp plant. It produces euphoric effects when ingested or smoked and is commonly used in the form of marijuana or hashish.
Impaired nurse peer program
The individuals who administer these efforts are nurse members of the state associations, as well as nurses who are in recovery themselves. For this reason, they are called peer assistance programs. Peer assistance programs strive to intervene early, reduce hazards to clients, and increase prospects for the nurse's recovery
Several signs of substance impairment in nurses
There may be an increase in "wasting" of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs than for other nurses. Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall usually occur late in the disease process. The person may also have problems with relationships. Other possible signs include irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom. He or she may frequently medicate other nurses' patients, and there may be patient complaints of inadequate pain control. Discrepancies in documentation may occur.
Some psychiatric units administer these surveys (SBIRT) to all admitted clients to help to determine what?
To determine whether there is a secondary alcohol problem in addition to the psychiatric problem for which the client is being admitted (sometimes called dual diagnosis)
Discuss treatment of codependency.
Treating Codependency Cermak (1986) identified four stages in the recovery process for individuals with codependent personality: Stage I: The Survival Stage In this first stage, codependent persons must begin to let go of the denial that problems exist or that their personal capabilities are unlimited. This initiation of abstinence from blanket denial may be a very emotional and painful period. Stage II: The Reidentification Stage Reidentification occurs when individuals are able to glimpse their true selves through a break in the denial system. They accept the label of codependent and take responsibility for their own dysfunctional behavior. Codependents tend to enter reidentification only after being convinced that it is more painful not to do so. They accept their limitations and are ready to face the issues of codependence. Stage III: The Core Issues Stage In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of will. Each partner must be independent and autonomous. The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control things that are beyond the individual's power to control. Stage IV: The Reintegration Stage This is a stage of self-acceptance and willingness to change when codependents relinquish the power over others that was not rightfully theirs but reclaim the personal power that they do possess. Integrity is achieved out of awareness, honesty, and connection with one's spiritual consciousness. Control is achieved through self-discipline and self-confidence. Self-help groups have been found helpful in the treatment of codependency. Groups developed for families of chemically addicted people, such as Al-Anon, may be of assistance. Groups specific to codependency also exist.
Describe various modalities relevant to treatment of individuals with substance-related and addictive disorders
Treatment modalities for substance-related disorders include self-help groups, deterrent therapy, individual counseling, and group therapy. Medication-assisted treatment is frequently implemented for clients experiencing substance intoxication or substance withdrawal or to prevent relapse. Treatment modalities are implemented on an inpatient basis or in outpatient settings, depending on the severity of the impairment.
What is medication-assisted treatment?
Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from or who is experiencing the effects of excessive use of alcohol and other drugs and to decrease cravings by administering a controlled dose of another medication. This type of management is referred to as medication-assisted treatment. A discussion of the types of medication-assisted treatment for specific withdrawal syndromes follows. Benzodiazepines are widely used drugs for medication-assisted treatment in alcohol withdrawal. Benzodiazepines act similarly to alcohol in their effects but can be administered in controlled doses to prevent adverse effects of alcohol withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) are the most commonly used agents.
Esophageal Varices
Veins in the esophagus that become distended because of excessive pressure from defective blood flow through a cirrhotic liver.
A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. After the nurse completes an assessment, the physician asks if there are any physical signs of long-term chronic alcohol abuse. Which of these findings should the nurse include in reporting to the physician? (Select all that apply.) a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.
a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.
Complicated withdrawal syndrome may progress to?
alcohol withdrawal delirium. Onset usually occurs on the second or third day.
he following classes of psychoactive substances are associated with substance use and substance-induced disorders:
alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative-hypnotics or anxiolytics, stimulants, and tobacco (nicotine).
Screening, Brief Intervention, Referral, and Treatment.
an integrated public health approach to accomplish early intervention and identifying people at risk for substance use disorders.
Ascites
fluid accumulation in the abdomen Excessive accumulation of serous fluid in the abdominal cavity, occurring in response to portal hypertension caused by cirrhosis of the liver
Intoxication
state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions that is directly attributable to the effects of a psychoactive drug. It may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.)
What characteristics do children with FAS exhibit?
■ Abnormal facial features ■ Small head size ■ Shorter-than-average height ■ Low body weight ■ Poor coordination ■ Hyperactive behavior ■ Difficulty paying attention ■ Poor memory ■ Difficulty in school ■ Learning disabilities ■ Speech and language delays ■ Intellectual disability or low IQ ■ Poor reasoning and judgment skills ■ Sleep and sucking problems as a baby ■ Vision or hearing problems ■ Problems with the heart, kidneys, or bones
Inhalant intoxication symptoms
■ Dizziness; ataxia ■ Euphoria; excitation; disinhibition ■ Nystagmus; blurred vision; double vision ■ Slurred speech ■ Hypoactive reflexes ■ Psychomotor retardation; lethargy ■ Generalized muscle weakness ■ Stupor or coma (at higher doses)
Describe relevant outcome criteria for evaluating nursing care of patients with substance-related and addictive disorders.
■ Has not experienced physical injury ■ Has not caused harm to self or others ■ Accepts responsibility for own behavior ■ Acknowledges association between personal problems and use of substance(s) ■ Demonstrates more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances) ■ Shows no signs or symptoms of infection or malnutrition ■ Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others ■ Verbalizes importance of abstaining from use of substances in order to maintain optimal wellness
Hallucinogenics psychological effects on the Body
■ Heightened response to color, texture, and sounds ■ Heightened body awareness ■ Distortion of vision ■ Sense of slowed time ■ All feelings magnified: love, lust, hate, joy, anger, pain, terror, despair ■ Fear of losing control ■ Paranoia, panic ■ Euphoria, bliss ■ Projection of self into dreamlike images ■ Serenity, peace ■ Depersonalization ■ Derealization ■ Increased libido
What several factors contribute to variation in the consequences of maternal drinking?
■ Maternal drinking pattern ■ Differences in maternal metabolism ■ Differences in genetic susceptibility ■ Timing of the alcohol consumption during pregnancy ■ Variation in the vulnerability of different brain regions
Hallucinogenics physiological effects on the Body
■ Nausea and vomiting ■ Chills ■ Pupil dilation ■ Increased pulse, blood pressure, and temperature ■ Mild dizziness ■ Trembling ■ Loss of appetite ■ Insomnia ■ Sweating ■ A slowing of respirations ■ Elevation in blood sugar