foundations of nursing chapter 35

delirium tremens (DTs)

a complication of alcohol withdrawal. an acute psychotic reaction as a result of excessive alcohol consumption over a long period of time risk of death = 15% even with treatment

cocaine

a strong CNS stimulant. chronic abuse by snorting erodes the nasal septum and often causes sinusitis and rhinitis smoking crack = bodily injury from burns, hemoptysis, pneumonitis overdose = cardiorespiratory distress and seizures HCP use amantadine (Symmetrel) and bromocriptine (Parlodel) to reduce cravings. Useful in TX of PD

gamma-hydroxybutyrate (GHB)

abused and used for its euphoric, sedative, and bodybuilding (anabolic) effects. odorless, tasteless, and colorless

alcoholism

addiction to alcohol

depressants (CNS)

alcohol, sedative-hypnotic medications, opioid analgesics

what benzodiazepine what the most prescribed in the 1990's?

alprazolam (Xanax)

withdrawal sxs CNS stimulants

apathy, somnolence, fatigue, irritability, depression, drug craving, crashing, depression, paranoia, suicidal ideation, tachycardia, heart failure, malnutrition

s/sxs produced by CNS depressants

ataxic gait (staggering) decreased respirations memory loss nausea and vomiting passiveness, listlessness pinpoint pupils (opioid effect) reduced hunger or thirst reduced sexual drive slurred speech sense of heaviness in extremities

sedative-hypnotic medications

barbiturates and benzodiazepines taken orally in tablet or capsule form

s/sxs alcohol intoxication

behavior dependent on blood serum levels: slurred speech; ataxia; blurred vision; decreased level of consciousness; possible N/V/D; loss of consciousness and respiratory depression with high blood level

hallucinogens

can be natural or synthetic and affect several areas of the brain. alter perception and thinking some effects can last 6-12 hours death has occurred due to altered perceptions triggering fight or flight response.

Amphetamines

causes powerful release of the neurotransmitter dopamine. Dopamine depletion can result in PD like symptoms. brain cell damage can be permanent. anorexia heart attack or stroke due to possible overstimulation of the heart with raising BP

fetal alcohol syndrome

congenital anomaly resulting from maternal use of alcohol during pregnancy. more common in mothers who drank heavily during pregnancy, but no specific amount of alcohol has been identified as the amount that will result in the syndrome. avoid alcohol during pregnancy

addiction

consists of four elements: 1. excessive use or abuse of a substance 2. display of psychological disturbance 3. decline of social and economic function 4. uncontrollable consumption

respiratory disorders associated with alcoholism

decreased cough reflex, aspiration pneumonia

s/sxs associated with cessation of alcohol consumption

diaphoresis; tachycardia; hypertension; tremors; nausea; vomiting; anorexia; restlessness; disorientation; hallucinations; serizures

group therapy

effective treatment modality. provides a caring, emotionally supportive atmosphere in which the patient is able to acknowledge the relationship of substance abuse with negative consequences in their life. the group tends to point out negative defense mechanisms such as denial or displacement and to offer possible solutions to its members

Nicotine

effects= increased alertness, concentration, appetite suppression, vasoconstriction withdrawal= craving, irritability, restlessness, impatience, hostility, anxiety, confusion, difficulty in concentration, disturbed sleep, increased appetite, decreased HR

s/sxs CNS stimulants

elevated VS, cardiac dysrhythmias, flushing or pallor, agitation, paranoia, fever, convulsions, cardiac arrest

addictive personality

exhibiting a pattern of compulsive and habitual use of a substance or practice to cope with psychic pain from conflict and anxiety

what benzodiazepine is sometimes referred to as the "date-rape drug"?

flunitrazepam (Rohypnol) it is easy to mix it secretly into an alcoholic drink so that the victim consumes it unknowingly. alcohol increases its effects

GI disorders associated with alcoholism

gastritis, pancreatitis, cancer of the mouth, esophagus, and stomach; esophageal varices, GI bleeding, malabsorption of nutrition, ascities

hepatic disorders associated with alcoholism

hepatitis, cirrhosis, fatty liver, liver failure, hepatic encephalopathy

cardiovascular and hematologic disorders associated with alcoholism

hypertension, enlarged heart, high cholesterol, heart failure, portal hypertension, low blood glucose, anemia, poor clotting ability,. increased susceptibility to infection

early stage of dependence

increased drug tolerance strong denial defending drug use in response to family concerns more socializing with users increased tardiness to or time off from work/school possible legal problems good prognosis for recover, even without a treatment program

AA

international nonprofit organization that began in 1935 as a way for abstinent alcoholic people to help other alcoholic people become and stay sober through group support, shared experiences, and faith in a power greater than themselves.

What is the purpose of methadone (Dolophine)?

it is a synthetic opioid that helps suppress withdrawal symptoms in the morphine or heroin addict. once the patients condition stabilizes, the methadone dosage decreases daily until the addict is methadone free. people can also be addicted to methadone

TX CNS depressants

lavage if ingestion was recent, maintain ventilation, lay on their side. Monitor VS 15-30 minutes, meds as needed for cardiac dysrhythmias, barbiturate dosages must be tapered down to reduce risk of status epilepticus. maintenance therapy can start with methadone or LAAM

what blood values will appear elevated with alcoholism?

liver enzymes, hypoglycemia, and abnormal blood protein

personality trait of someone with addictive personality

low tolerance for stress, dependency, negative self-image, feelings of insecurity, and depression. not clear if these traits are present before the development of dependence or a result from it

Opioid analgesics

made from the opium poppy Hippocrates praised the poppy's pain relieving properties heroin = widely abused. schedule 1, snorting, smoking, injecting morphine = schedule 2, orally or injected replace natural endorphins in CNS, making them highly addictive also: cough suppressants, slow peristalsis in GI, mildly contract the bladder tolerance develops rapidly

TX of patient with alcohol intoxication

maintain ventilation; lay unconscious pt on side, VS q30-60 minutes; check emesis and stool for occult blood; fluids and bland foods when swallowing is intact. get up as tolerated, but prevent overexertion thiamine as ordered, IM or IV, then PO Sedative PRN for tremor and restlessness check for: urine retention with librium

psychoactive drugs

make the user feel good

birth defects related to alcohol use (FAS)

mental retardation, growth disorders, craniofacial abnormalities; wide set eyes and flattened face; and malformed body parts

middle stage of dependence

moderate impairment withdrawal signs with abstinence using drug to feel normal established pattern of use further alienation from family drug-related behavior such as lying, stealing, mood swings decline in physical health noticeable weight loss blackouts financial/legal problems job loss or frequent job changes low chance of recovery without treatment

musculoskeletal disorders associated with alcoholism

myopathies, bone fractures from falls, joint damage from injury

neurologic disorders associated with alcoholism

neuritis, organic brain diseases such as wernick encephalopathy and Korsakoff psychosis, nerve palsies, gait changes, short-term memory loss

alcohol withdrawal syndrome

occurs in a person who has developed physiologic dependence and quits drinking abruptly. highest in older adults, people who have previously suffered delirium tremens, malnourished people, and people who have another acute illness. s/sxs: mild tremor, flu like sxs, severe agitation and hallucinations

Wernicke Encephalopathy

occurs in association with thiamine (Vitamin B1) deficiency, causing brain damage in the temporal lobes of the brain. memory loss, aphasia, involuntary eye movement, double vision, lack of muscle coordination, and disorientation with confabulation

subjective data collected pertaining to the patient with an addictive personality

persons normal using or drinking pattern, as well as the date and time of the last drink or use of a drug. the specific substance and the quantity the person uses are important

urologic/reproductive disorders associated with alcoholism

prostatitis, impotence, urinary flow problems

s/sxs CNS depressants

range of relaxation to sleepiness to coma; depressed VS; pinpoint pupils; respiratory depression

club drugs

refer to substances that people frequently take for euphoric effect at parties, concerts, dance clubs, or all night raves

detoxification

removal of the poisonous effects of a substance

caffeine

resent in a variety of foods, soft drinks, OTC medications and appetite suppressants chemically related to theophylline which is useful in COPD lasts 5-7 hours after consumption withdrawal = fatigue, HA, irritability can aggravate anxiety disorders, schizophrenia, heart conditions

withdrawal sxs CNS depressants

restlessness, yawning, lacrimation, diaphoresis, rhinorrhea, anorexia, abdominal cramping, body ache, tremors, gooseflesh, insomnia, drug craving, possible seizures with barbiturates, sxs like DTs

late stage of dependence

severe impairment in all areas of function continuous use but inability to achieve normal feeling worsening medical problems; organ involvement worsening malnutrition poor problem solving and judgment manipuilativeness; denial of problems unemployment often homelessness no chance of improvement without treatment

what are the sxs of acute opioid overdose?

severe respiratory depression, pinpoint pupils, stupor, coma, aspiration is common

Korsakoff Psychosis

sometimes occurs in people with chronic alcoholism. short term memory loss, disorientation, muttering, delirium, insomnia, hallucinations, polyneuritis, and painful extremities with foot drop affecting the gait

what are the three general types of opioid abusers?

street abusers who get opioids illegally abusers of opioids from medical sources methadone abusers

street drugs

substances that users buy from illegal drug dealers.

TX of opioid overdose?

supporting ventilation and administering naloxone (Narcan) Sometimes HCP use clonidine (Catapres)

when does substance abuse become a disease and a problem?

the indicator appears to be the loss of control. the disease of dependence is chronic, incurable, progressive one

confabulation

the patient fills in memory gaps with inappropriate words.

withdrawal sxs of a patient with alcohol intoxication

tremors of hands, haw, torso restlessness, pacing, illogical thinking demanding, drug craving manipulation, diaphoresis, chain smoking, visual and auditory hallucinations, confusion, if patient is unable to reorient, appears panicked, and temperature is elevsated, suspect DTs

signs of DTs?

tremors; increase in activity, sometimes to the point of agitation; disorientation; fear with an appearance of panic; hallucinations; elevated temp.

when does DTs most often occur?

1 to 4 days after cessation of alcohol use and usually last from 2 days to a week

What does the success of a patient going through a substance abuse treatment program depend on? 1. The motivation of the user 2. The type of assistance received while in the program 3. The treatment plan established by the physician 4. The effectiveness of group therapy

1. The motivation of the user All the help available will not help an addict kick a habit and be successful in a cessation program, unless the patient is motivated to stop the abuse.

CAGE questions

1. have you ever felt you ought to CUT done on your drinking 2. have people ANNOYED you be criticizing your drinking 3. have you ever felt bad or GUILTY about your drinking 4. have you ever had a drink first thing in the morning to steady your nerves or for your hangover (i.e. EYE opener)

what is the average that a boy has his first alcoholic drink?

11

when can seizures occur after cessation of alcohol?

12-24 hours after. usually these are tonic-clonic and often are not preceded by an aura

what is the average age that a girl has her first alcoholic drink

13

Phencyclidine (PCP)

1960's, powder, mixes well in water/alcohol. sometimes people sprinkle on marijuana low to moderate doses= sxs of generalized numbness/poor coordination, flushing/sweating w/raise in BP and PR. some people feel increased strength and power. overdose= sxs of schizophrenia like psychosis with extreme violence or attempted suicide. seizures, coma, drop in RR, PR, BP, loss of balance, blurred vision, nausea, vomiting.

Lysergic Acid Diethylamide (LSD)

1960's. most potent, effects >12 hrs. referred to as a "trip". dilation of pupils, sweating, loss of appetite, dry mouth, sleeplessness, and tremors, "hearing colors", "seeing sounds"

during what decade did alcoholism and drug addiction gain recognition as diseases?

1970's

A nurse is caring for a patient who is suspected of drug dependence. What is the most appropriate question for the nurse to ask? 1. "How long were you going to try to hide this from your friends?" 2. "What type, how much, and what effects do the drugs have on you?" 3. "Why did you start doing drugs?" 4. The nurse does not ask questions about drugs for fear the patient might deny any problems.

2. "What type, how much, and what effects do the drugs have on you?" During the assessment process, the nurse obtains subjective data that include the patient's normal patterns of use and what effects are seen. The remaining options involve casting blame or being judgmental and insensitive toward the patient, or avoiding garnering subjective data pertinent to the concern.

What do the four elements of excessive use or abuse, display of psychological disturbance, decline of social and economic function, and uncontrollable consumption indicating dependence define? 1. Alcoholism 2. Addiction 3. Abuse 4. Addictive personality

2. Addiction These are the four elements of addiction that are often used as a synonym for drug dependence and substance abuse. Alcoholism refers to the addiction to alcohol. Abuse is the misuse of alcohol, tobacco, caffeine, nicotine, or other drugs. Addictive personality is a person who exhibits a pattern of compulsive and habitual use of a substance or practice to cope with psychic pain from conflict and anxiety.

A patient says that he drinks alcohol on a regular basis. During your discussion, the patient admits to "having a problem." To which support group would the nurse refer the patient? 1. Families Anonymous 2. Alcoholics Anonymous 3. Fresh Start 4. Al-Anon

2. Alcoholics Anonymous Alcoholics Anonymous consists of abstinent alcoholics helping other alcoholics to become and stay sober through group support, shared experiences, and faith in a power greater than themselves. Families Anonymous is for parents of children who abuse substances. Fresh Start is for nicotine addicts. Al-Anon is a group for families of alcoholics.

The nurse is caring for a patient who has been abusing a CNS depressant and anticipates finding which signs and/or symptoms during the assessment process? (Select all that apply.) 1. Agitation 2. Decreased respirations 3. Dilated pupils 4. Increased hunger and thirst 5. Memory loss 6. Slurred speech

2. Decreased respiration's 5. Memory loss 6. Slurred speech Signs and symptoms commonly seen with a CNS depressant include: listlessness, decreased respiration's, pinpoint pupils, reduced hunger and thirst, memory loss, slurred speech, and ataxic gait. A depressant drug would not produce agitation. A CNS depressant drug would not produce dilated pupils, increased hunger, or increased thirst.

A nurse is caring for a patient who has stopped drinking and runs the risk of alcohol withdrawal syndrome. The nurse monitors the patient knowing that tremors from alcohol cessation are usually seen _____ after cessation 1. within an hour 2. within 2 days 3. within 1 week 4. within 2 to 3 weeks

2. within 2 days Tremors from alcohol cessation are seen 6 to 48 hours after the last drink and may last for 3 to 5 days.

A patient is having trouble abstaining from alcohol. Which drug is often prescribed to encourage abstinence? 1. Librium (chlordiazepoxide) 2. Thorazine (chlorpromazine) 3. Antabuse (disulfiram) 4. Wellbutrin (bupropion)

3. Antabuse (disulfiram) Antabuse is the drug of choice if given. It causes facial flushing, nausea, tachycardia, dyspnea, dizziness, and confusion. Librium is an antianxiety drug. Thorazine is an antipsychotic drug. Wellbutrin is an antidepressant drug.

Which drug gained notoriety in the 1990s, is associated with club drug use, and is often call the "date-rape" drug? 1. GHB (gamma-hydroxybutyrate) 2. Opioid analgesic heroin 3. Rohypnol (flunitrazepam) 4. Morphine

3. Rohypnol (flunitrazepam) Rohypnol has been misused in many sexual assaults and can have a lethal effect when combined with alcohol. GHB, heroin, and morphine are often abused, but they are not considered the "date-rape" drug.

The nurse has been assigned a patient who abuses alcohol. The patient is at risk for DTs (delirium tremens). While monitoring the patient, what signs would alert the nurse to the development of DTs? 1. Hypotension, coarse hand tremors, agitation 2. Stupor, agitation, muscle rigidity 3. Hypotension, ataxia, vomiting 4. Elevated temperature, changes in LOC, hallucinations

4. Elevated temperature, changes in LOC, hallucinations Elevated temperature, changes in LOC, and hallucinations are signs of DTs. Hypotension, coarse hand tremors, agitation, stupor, muscle rigidity, ataxia, and vomiting are not signs of DTs.

Which drug is the most commonly used illegal drug in the United States? 1. Cocaine 2. MDMA (Ecstasy) 3. PCP and LSD 4. Marijuana

4. Marijuana Marijuana is considered a gateway drug and remains the most commonly used illicit drug used in the United States. Cocaine, MDMA, PCP, and LSD are often abused, but they are not the most commonly used drugs in the United States.

how long will withdrawal sxs appear and what are the sxs?

6 hours flu-like signs and sxs, body aches, watery eyes, runny nose, dilated pupils, vomiting, cramps, diarrhea, diaphoresis, tachycardia, hypertension, chills, fever. s/sxs usually peak in 2-3 days and subside within 5-10 days

when do tremors associated with alcohol cessation occur?

6-48 hours after the last drink. sometimes last for 3-5 days can occur in the hands but may also be present in the tongue, chin, trunk, and feet.

stimulants

CNS. ranges from caffeine to cocaine and amphetamines

what ere the first benzodiazepines to be introduced in the 1960's?

Flurazepam (Dalmane) and chlordiazepoxide (Librium) diazepam (valium) followed shortly after and was shortly thereafter the most frequently prescribed anti anxiety agent.

TX CNS stimulants

Monitor VS, quiet environment, reorient patient to reality, encourage consumption of fluids and nutrition, cardiac drugs as ordered, amantadine and other antiparkinsonian drugs may be given to reduce cocaine craving