Chapter 6: Substance Use Assessment

Mean Corpuscular Volume (MCV)

size of red blood cells

Withdrawal begins...

72 hours after their last binge drink

The nurse would expect an older adult to have higher blood alcohol levels because older adults have A. decrease liver metabolism and kidney functioning B. an increased consumption of alcohol C. more lean muscle mass D. increased GI motility

A. decrease liver metabolism and kidney functioning Rationale: Older adults have numerous characteristics that can increase the risk for alcohol use. Liver metabolism and kidney functioning are decreased, which increases the bioavailability of alcohol in the blood for longer time periods. Aging adults lose muscle mass; less tissue for the alcohol to be distributed means an increased alcohol concentration in the blood. The prevalence of current alcohol use decreases with increasing age. Older adults have decreased gastrointestinal motility.

A pt with chronic alcohol use is most at risk for developing which of the following cardiovascular diseases? A. bradycardia B. hypertension C. acute MI D. DVT

B. HTN Rationale: Chronic alcohol use is associated with increased risk for alcoholic cardiomyopathy, hypertension, and atrial fibrillation. Chronic alcohol use is associated with fast heart rates (tachycardia). Chronic alcohol use does not increase the risk for deep vein thrombosis. Chronic alcohol use is not associated with a higher incidence of acute myocardial infarctions.

For a pt to meet the criteria for a diagnosis of alcohol abuse, the pt must report that alcohol has repeatedly caused or contributed to: A. needing more than 3 drinks to feel the effects B. relationship trouble with family or friends C. amnesia episodes while drinking D. one or more family members complaining about alcohol use

B. relationship trouble with family or friends Rationale: To meet the criteria for a diagnosis of alcohol abuse, the patient must admit that drinking alcohol repeatedly causes or contributes to one or more of the following occurring in the past 12 months: (1) risk for bodily harm (drinking and driving, operating machinery, swimming); (2) relationship trouble (family or friends); (3) role failure (interference with home, work, or school obligations); or (4) run-ins with the law (arrests or other legal problems). Amnesia indicates at-risk drinking. Taking three or more drinks to feel high is termed tolerance. Family members complaining about alcohol use is a sign of at-risk drinking.

If a pt admits not being able to quit drinking, having to have more drinks to get the same effect, and having withdrawal symptoms, the pt meets the criteria for: A. harmful drinking B. at-risk drinking C. alcohol dependence D. hazardous drinking

C. alcohol dependence Rationale: The criteria for a diagnosis of alcohol dependence are met if a patient admits to three or more of the following: not being able to stick to drinking limits (repeatedly going over them); not being able to cut down or stop (repeated failed attempts); showing tolerance (needing to drink a lot more to get the same effect); showing signs of withdrawal (tremors, sweating, nausea, or insomnia when trying to quit or cut down); continuing to drink despite problems (recurrent physical or psychological problems); spending a lot of time drinking (or anticipating or recovering from drinking); and spending less time on other matters (activities that have been important or pleasurable). For men, consuming 14 or more drinks per week or 4 or more drinks per occasion is at-risk drinking; for women, consuming 7 or more drinks per week or 3 or more drinks per occasion is at-risk drinking. A hazardous drinking pattern puts a person at high risk for future damage to physical or mental health. Harmful drinking is defined as alcohol use that already results in problems.

A pt denies having a drinking problem. Which of the following lab tests is commonly used as a biochemical marker that indicates chronic drug use? A. elevated serum aspartate aminotransferase (AST) B. elevated mean corpuscular volume (MVC) C. elevated gamma-glutamyl transferase (GGT) D. elevated blood alcohol content (BAC)

C. elevated gamma-glutamyl transferase (GGT) Rationale: A serum protein GGT is the most commonly used biochemical marker of alcohol drinking, especially of chronic alcohol use. AST is a less sensitive biochemical marker. MCV is a less sensitive biochemical marker. BAC is an indicator of alcohol consumption but does not provide information to validate chronic alcohol use.

If the pt has a drinking problem, which statement by the nurse is most appropriate? A. Your alcohol consumption is not that bad. You only need to cut down on the amount by drinking only on the weekend. B. I want you to record how much you drink over the next 2-3 months. This will help you determine if you have a drinking problem. C. If you continue to drink, you might develop serious health problems. It is up to you to find help and the way to quit. D. I believe that you have an alcohol problem and strongly recommended that you quit drinking. I am willing to help.

D. I believe that you have an alcohol problem and strongly recommended that you quit drinking. I am willing to help. Rationale: If the health care provider determines the patient has an alcohol use disorder, the health care provider should state this conclusion and recommendation clearly. In addition, the health care provider should relate to the person's concerns and medical findings if present. If the assessment has determined the patient has at-risk drinking, state the conclusion and recommendation clearly. If a drinking problem has been identified, the nurse should state the conclusion. The nurse should offer assistance to the patient.

Which of the following questionnaires was designed specifically to be used when screening older adults for an alcohol use disorder? A. CAGE B. AUDIT C. TWEAK D. SMAST-G

D. SMAST-G Rationale: The SMAST-G questionnaire should be used for older adults who report drinking alcohol. The CAGE questionnaire can be used with anyone; however, it may not detect low but risky levels of drinking and is less effective with women and minority groups nor is it designed specifically for use with older adults. The TWEAK questions are designed for use when screening women, especially pregnant women. The AUDIT is one that can be used with any age group, but was not specifically designed for use with older adults.

A female pt asks the nurse about the safe use of alcohol before and during pregnancy. The best response by the nurse is to instruct the pt to A. reduce alcohol intake before pregnancy and to avoid alcohol after a positive pregnancy test B. limit alcoholic beverages to two or fewer drinks per week during pregnancy C. talk about alcohol use with the physician D. avoid alcohol before conception and during pregnancy

D. avoid alcohol before conception and during pregnancy Rationale: No amount of alcohol has been determined safe for pregnant women. All women contemplating pregnancy and who are pregnant should be screened for alcohol use, and abstinence should be recommended. The nurse should provide information to the patient about alcohol use before and during pregnancy. Teaching is within the scope of nursing practice.

Pts should be instructed to consume alcohol in moderation. To consume at a moderate drinking pattern, a female pt should be instructed to consume no more than: A. two drinks per day B. six drinks per week C. three drinks per week D. one drink per day

D. one drink per day Rationale: An adult should be instructed that alcohol intake should be moderate. Recommendations for moderate drinking patterns for men are two or fewer drinks per day; for women, the recommendation is one or fewer drinks per day.

One of the most frequently abused prescription opioid pain medications is: A. morphine B. propoxyphene C. meperidine D. oxycodone

D. oxycodone Rationale: The three most frequently abused prescription opioid pain relievers are products using oxycodone, hydrocodone, and methadone. Meperidine is not a frequently abused prescription pain medication. Morphine is not a frequently abused prescription pain medication. Propoxyphene is not a frequently abused prescription pain medication.

Breath alcohol legal limits

age 21 or older 0.08, under age 21 0.02, and commercial vehicle driver 0.04

Age specific substance use considerations for pregnant women

alcohol and illicit drugs cross the placenta and can cause major fetal deficits (Fetal alcohol syndrome and drug withdrawal)

Phosphatidylethanol (PEth)

alcohol specific blood test that is a little more sensitive

Increased alcohol intake increases risk of...

cancer development, hypertension, coronary artery disease, mental illness, cognitive impairment, social issues, and birth problems

Withdrawal

cessation of the substance leads to physiological effects

Abuse

daily or recurrent use such as the impairment and decreased functioning has occurred leading to ongoing problems

Subjective data to collect for substance use

do you sometimes drink alcohol, has your drinking caused risk for bodily harm, trouble with relationships, role failure, and run ins with the law; have you not been able to stop or cut down, shown intolerance, and spent a lot of drinking

Alcohol and elicit drug use activate the release of...

dopamine

Binge drinking qualifications for men and women

for men it is 5 of more drinks in one sitting and for women it is 4 or more drinks per sitting

Objective data to gather

gamma glutamyl transferase (GGT), carbohydrate deficient transferrin (CDT), aspartate aminotransferase (AST), mean corpuscular volume (MVC), phosphatidylethanol (PEth), blood alcohol concentration (BAC), and breath alcohol

Clinical Institute Withdrawal Assessment (CIWA)

how we score people based on clinical symptoms that show us they're withdrawing from alcohol (the score determines how we medicate them)

Binge drinking increases the risk for...

injury, violence, alcohol poisoning, and other risky behaviors

Aspartate aminotransferase (AST)

liver enzyme; if elevated can indicate a drinking problem

Intoxication

maladaptive behavioral changes due to effects on CNS from substance

Which is the most commonly used elicit drug?

marijuana and after that opioids/pain relievers

7 categories of elicit drug use

marijuana, cocaine, heroin, hallucinations, inhalants, methamphetamine, and psychotherapeutics

What is considered heavy or at-risk for over consumption of alcoholic beverages?

men- 15 or more drinks per day women- 8 or more drinks per day

What is considered low to moderate risk for over consumption of alcoholic beverages?

men- 2 or more drinks per day women- 1 or more drinks per day

Substances

non-medical agents taken to alter mood or behavior

Dependence

physiological dependence on a substance

Age specific substance use considerations for aging adults

poly pharmacy in combination with alcohol or illicit drug use can be detrimental (causes falls, GI issues and overdose)

Gamma-glutamyl transferase (GGT)

protein level and if it is elevated can be a drinking issue (also fatty liver can cause it)

Tolerance

requires more of the substance to get the desired effect

Age specific substance use considerations for adolescents

substance abuse correlates with risky sexual activity, injuries, poor school performance, and worsening problems in adulthood

Blood Alcohol Concentration (BAC)

the amount of alcohol in a person's blood, expressed as a percentage (normal is 0.08% or less)