Care of a patient with an addictive personality

Detoxification

'acute phase' of recovery and is the removal of the poisonous effects of a substance.

Amotivational Cannabis Syndrome

(lack of motivation) after chronic use

What is NYS legal limit?

0.08%

A patient has begun attending AA meetings. Which statement reflects the patient's understanding of the purpose of this organization? 1. "I will attend meetings and have a support person to help me stay sober. I must not drink any alcohol again." 2. "I'll dry out in AA, and then I can have a social drink once in a while." 3. "AA is only for people who have reached the bottom." 4. "If I lose my job, AA will help me find another."

1. "I will attend meetings and have a support person to help me stay sober. I must not drink any alcohol again."

What are 4 elements of addiction?

1. excessive use or abuse 2. psychological disturbance 3. decline in social and economic function 4. uncontrolled consumption

How long after last drink of alcohol can seizures occur?

12-24 hours Usually tonic clonic (grand mal) and are not preceded by an aura

What % is alcohol involved in deaths related to motor vehicle accidents?

31%

how much of alcohol is metabolized thru the liver?

90%

Cocaine

Can be used medically, vasoconstrictor

what is used to treat nicotine addiction?

Chantix (can cause vivid dreams/nightmares)

LSD

Chronic users can have flashbacks to (bad) 'trips' a long time after use, can be within a few days to more than a year

FAS (Fetal Alcohol Syndrome)

Congenital disorder due to alcohol ingestion during pregnancy- damage to fetus appears to be greater during first trimester.

what are some things a nurse should a nurse know about cocaine use?

Crack babies: need to use swaddling (wrapping tightly), Parkinson drugs may be used to treat

stimulants

Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions.

What is a strong risk factor for developing alcohol or substance abuse?

Early age of onset of alcohol use

what is an example of a schedule 1 drug? and how is it used?

Heroin snorting, smoking, injecting

Hallucinogens

LSD MDMA ( Ecstasy & Molly)

MDMA ( Ecstasy & Molly)

Neurotoxic - releasing serotonin until depleted; serotonin regulates mood, aggression, sex drive, sleep and pain perception. Feelings of euphoria 'being in love'

Alcohol Withdrawal Syndrome

Occurs when have developed physiologic dependence and quits drinking abruptly

What is the most common drug used by nurses?

Opiods

Drug Abuse

Prescription, OTC, street drugs Includes taking drugs for reasons other than medical issues or in a dose higher then recommended

Amphetamines

Releases too much dopamine and after time depletes the brain and see Parkinson like s/s and can be permanent.

morphine is used to?

Replace normal endorphins in the brain making them highly addictive

Depressants

Sedative-hypnotics, Rohypnol (illegal in U.S, date rape drug)

what are some adverse effects of using cocaine?

Sinusitis(snorting erodes nasal septum), rhinitis - red irritated nostrils, OD = cardio/resp issues & seizures, pinpoint pupils

Wernicke's Encephalopathy

Thiamine B1 deficiency causing damage to the temporal lobe

Diuretic effect of alcoholism

Urine of heavy drinkers has increased lytes (issues?) causes f & e imbalances - lose K+, Mag & Zinc

What is the first step of the AA 12 step Program?

We admitted we were powerless over alcohol—that our lives had become unmanageable.

AA 12 step program

a resource nurses can refer alcoholics to

A patient's nervousness has escalated and this evening he keeps looking over his shoulder. He shouts out, "there's a fire!" upon entering the room, the nurse finds the patient huddled in a corner, diaphoretic and with a fearful expression. The nurse reassures him that there is no fire and assesses the patient : BP 160/95, HR 132, RR 30, Temp 100 degrees F. Which of these manifestations is consistent with delirium tremens? (select all that apply) a. Fever. b. Abdominal cramping. c. Nervousness. d. Fear. e. Disorientation

a. Fever. c. Nervousness. d. Fear. e. Disorientation

A person addicted to heroin is likely to exhibit which symptoms of withdrawal? (select all that apply) a. Nausea, vomiting, diarrhea, diaphoresis b. Tremors, insomnia, hypotension c. Incoordination and unsteady gait d. Decreased heart rate and flushing e. Chills and fever

a. Nausea, vomiting, diarrhea, diaphoresis e. Chills and fever

The nurse is caring for a patient who has been using MDMA (Ecstasy). Why is this substance considered to be neurotoxic? a. Serotonin is depleted in the brain, which damages brain cells. b. Dehydration causes neurological damage. c. Heart damage results from malignant hyperthermia. d. Inner ear damage leads to deafness.

a. Serotonin is depleted in the brain, which damages brain cells.

Many mutli-drug users begin by abusing what?

alcohol and marijuana

The nurse is ready to give the end of shift report to the nurse in charge of the unit for the next shift. When the oncoming nurse arrives 15 minutes late, she does not make eye contact, she smells of mints, her hands are trembling, her uniform is disheveled, and her shoes are untied. She asks no questions regarding any patients, and leaves the room when the report is completed. What should the first nurse do? a. Go home because the shift is completed. b. Call the supervisor and report observations. c. Stay on the unit until she is sure the oncoming nurse has no questions regarding the patients. d. Call the state board of nursing and report the oncoming nurse's behavior.

b. Call the supervisor and report observations.

The nurse is caring for a patient who is in the emergency department after a suspected "date rape." What benzodiazepine drug is most likely to be implicated? a. Diazepam (Valium) b. Flunitrazepam (Rohypnol) c. PCP d. LSD

b. Flunitrazepam (Rohypnol)

A 25 year old patient entered the hospital with diagnoses of septicemia and infective endocarditis. He admits to using IV heroin regularly. For what withdrawal symptoms should the nurse monitor? a. Red rash similar to that of chickenpox b. Head cold and flulike signs and symptoms c. Intractable singultus d. Severe join pain and back pain

b. Head cold and flulike signs and symptoms

What area of the brain is most often affected by psychoactive substances and has the potential to sustain permanent damage? a. Brainstem b. Limbic system c. Cerebellum d. Corpus callosum

b. Limbic system

A patient was found unconscious in his apartment with four empty bottles of whiskey and was brought to the hospital by his family. Upon admission, he moans out loud and is having dry heaves and diarrhea. What is the best way to maintain his airway? a. Elevate the head of the bed to ease breathing and place an emesis basin on the patient's lap. b. Place the patient in the side-lying position until the swallowing reflex is intact. c. Adjust the bed to the reverse Trendelenburg position until the patient regains consciousness. d. Tape an oral suction catheter in place to avoid aspiration.

b. Place the patient in the side-lying position until the swallowing reflex is intact.

The nurse is performing a physical assessment on a patient who has a history of long term cocaine use. Which finding is indicative of long term cocaine use? a. Constricted pupils b. Red, irritated nostrils c. Conjunctival redness d. Muscle aches

b. Red, irritated nostrils

Amotivational cannabis syndrome is suspected in a patient. What findings would support this diagnosis? (Select all that apply) a. Periods of euphoria b. Obsession with personal hygiene c. Apathy d. Sharp increases in appetite, commonly referred to as the "munchies". e. irritability

c. Apathy e. irritability

A nurse is caring for a patient who is in the acute care unit for elective surgery. What findings during the patient's hospitalization would be consistent with alcohol withdrawal? (Select all that apply) a. Euphoria and hyperactivity b. Depression and hypersomnia c. Diaphoresis and nausea d. Below normal temperature and bradycardia e. Vomiting and tremors

c. Diaphoresis and nausea e. Vomiting and tremors

A nurse with a history of drug-related charges has action taken against her practioner's license. Where is this reported? a. National Health and Welfare Records Department b. Healthcare Management Organization of the United States. c. Federal Drug Enforcement Agency Healthcare Integrity and Protection Data Bank

d. Healthcare Integrity and Protection Data Bank

Prolonged use can cause toxic effects on the intestinal mucosa causing?

decreased absorption of B1 (thiamine), B9 (folic acid), B12 (cobalamin) (this is why banana bags are used in acute care setting)

What are 3 stages of dependence?

early stage, middle stage, Late stage

Marijuana

has high abuse and addiction potential *Most commonly used illicit drug in the US

What are street drugs?

illegal substances that are not approved for use in the U.S. or are sold illegally by drug dealers.

What are some signs and symptoms of Amotivational Cannabis Syndrome?

irritability, apathy

Antabuse

medication sometimes used to encourage abstinence by 'aversion conditioning.' Causes facial flushing, nausea, tachycardia, dyspnea, dizziness and confusion when alcohol is consumed.

What are some signs and symptoms of Alcohol Withdrawal Syndrome?

mild tremors, flu like symptoms, severe agitation and hallucinations

opiod analgesics

mophine

Alcohol does not require ??? just ???

not digestion just absorption

Group Therapy

provides caring emotional support with patients with similar problems and points out negative defense mechanisms such as denial.

As nurses we may not know someone has a substance abuse disorder until what happens?

the patient shows signs and symptoms of withdrawal.

DTs (Delirium Tremens) signs and symptoms

tremors, increased activity which can increase to extreme agitation, disorientation, fear w/panic, hallucinations and elevated temp.

What education should be included with Antabuse medications?

will carry a card stating on medication; do not take cold & cough medications. Does NOT cure alcoholism...

Inhalants

~ Inhalation of volatile hydrocarbons, chemicals ie. solvents, glues, aerosols, etc. ~ Used by young people - inexpensive, easy to get, no drug screen. (some products require proof of age at purchase with qty limits in NYS) can lead to more dangerous drug abuse.

What should a nurse assess with an alcoholic patient?

~ Last drink ~ blackout periods ~ Stay nonjudgmental - gives pt reassurance and assurance of confidentiality. Denial Validate info w/family or S.O's if possible...

What is the late stage of dependence?

~ Severe impairment in all areas of function/daily life ~ Medical issues worsen with irreversible damage: ie. kidney/liver disease, stroke

what is the early stage of dependence?

~ increased drug tolerance- uses increased amount and frequency to get the same effect. ~ attendance issues - increased tardiness to or time off from work/school ~ preoccupied with drug and wanting to use it.

Nursing interventions for substance abuse?

~Detoxification = 'acute phase' of recovery ~ Safety - maintain airway: side-lying, bedside swallow screen 4:30 min F&E Seizure precautions ie padding, close to N's station Librium and/or Ativan (DTs) - help w/ tremors, nervousness, restless - call md...provider may order*** ~ Good nutrition (usually malnourished)🡪 MVI, thiamine (PO when they can take), snacks

What is the middle stage of dependence?

~User use just to feel "normal" - will continue drug to prevent hangover effects. ~ Established pattern of use ~ physical abuse & child neglect ~ blackouts of short term memory.