Mental health Exam #2 Substance abuse
THIAMIN (B1) IS GIVEN TO WITHDRAWAL PATIENTS TO PREVENT
WERNIKE-KORSAKOFF SYNDROME
BLOOD AND URINE SCREENS ARE UTILIZED TO DETERMINE
WHAT AND HOW MUCH OF A DRUG IS IN PT'S SYSTEM
WITH A NEWLY ARRIVED SUBSTANCE ABUSE PATIENT, WHAT QUESTIONS ARE THE NURSING PRIORITY WITH REGARD TO THE SUBSTANCE?
WHAT WAS TAKEN, WHEN LAST TAKEN, HOW MUCH
EARLY SIGNS OF ALCOHOL WITHDRAWAL APPEAR:
WITHIN A COUPLE HOURS AFTER CESSATION
IS ANTICHOLINERGENIC TOXICITY POTENTIALLY LIFE THREATENING?
YES
A SECOND MEDICATION USED TO TREAT ALCOHOLISM; ITS MECHANISM OF ACTION IS NOT FULLY UNDERSTOOD
ACAMPROSATE (CAMPRAL)
THIS DRUG WORKS ON THE CLASSICAL PRINCIPLE OF INHIBITING IMPULSIVE DRINKING, CAUSING NEGATIVE PHYSICAL SYMPTOMS UPON ALCOHOL INTAKE
ANTABUSE (DISULFIRAM
WHICH DRUG FOR ALCOHOL ABUSE WORKS ON THE CLASSICAL CONDITIONING PRINCIPLE OF INHIBITING IMPULSIVE DRINKING. CAUSES UNPLEASANT PHYSICAL EFFECTS IF ALCOHOL IS CONSUMED
ANTABUSE (DISULFIRAM)
PATIENT HAS DRY MUCOUS MEMBRANES, NON-REACTIVE PUPILS, HOT-RED-DRY SKIN, HYPERPYREXIA WITHOUT DIAPHORESIS, TACHY CARDIA, AGITATION, UNSTABLE V/S, WORSENING OF PSYCHOTIC SYMPTOMS, DELIRIUM, URINARY RETENTION, SEIZURE, REPETITIVE MOTOR MOVEMENTS. NURSE SUSPECTS?
ANTICHOLINERGENIC TOXICITY
THE DRUG OF CHOICE GIVEN TO DECREASE ALCOHOL WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND PREVENT SEIZURES/DT'S
ATIVAN (LORAZEPAM)
A SCORE OF ABOVE ___ ON THE CIWA SCALE MANDATES TREATMENT
15
Symptoms that would signal opioid withdrawal include a. ) lacrimation, rhinorrhea, dilated pupils, and muscle aches. b. )illusions, disorientation, tachycardia, and tremors. c.) fatigue, lethargy, sleepiness, and convulsions. d.) synesthesia, depersonalization, and hallucinations.
a. ) lacrimation, rhinorrhea, dilated pupils, and muscle aches. Symptoms of opioid withdrawal resemble the "flu"; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.
Two Meds given to a very agitated patient.
Ativan and Haldol
SUBSTANCE ABUSE THEORY: PATIENT DISCOVERS THE EUPHORIC STATE, ROUTINELY SEEKS IT TO "ESCAPE", AND CONTINUES TO ABUSE IN SPITE OF THE DIRE CONSEQUENCES. TREATMENT INVOLVES IDENTIFICATION OF STRESSORS IN THE PATIENT'S LIFE
BEHAVIORAL
4 RISK FACTORS TIED INTO SUBSTANCE ABUSE
BIOLOGICAL, PSYCHOLOGICAL, SOCIOCULTURAL, GENETIC
THE MAIN ORGAN OF WEAKNESS DURING SUBSTANCE ABUSE
BRAIN
WHICH SCALE IS UTILIZED TO IDENTIFY SYMPTOMS AND DETERMINE SEVERITY OF ALCOHOL WITHDRAWAL?
CIWA
THE SCALE UTILIZED TO DETERMINE THE SEVERITY OF WITHDRAWALS
CIWA SCALE
WHICH DRUG, WHICH LOWERS BP, IS GIVEN IN COMBINATION WITH THE ABOVE MED AND IS A NON-OPIOD SUPPRESSOR OF WITHDRAWAL SYMPTOMS
CLONIDINE (CATAPRES)
THE CONDITION WHERE ONE DRUG IS USED TO PREVENT THE WITHDRAWAL SYMPTOMS FOR ANOTHER DRUG
CROSS-DEPENDENCE
EARLY SIGNS OF ALCOHOL WITHDRAWAL USUAL OCCUR WHEN
FEW HOURS AFTER CESSATION
WHAT IS ALSO GIVEN TO ALCOHOL WITHDRAWAL PATIENTS TO ADDRESS MALNUTRITION
FOLIC ACID, THIAMIN, MULTIVITAMINS
IF INDICATORS OF IMPAIRED PRACTICE ARE OBSERVED BY ANOTHER NURSE, WHAT IS THE OBSERVER'S RESPONSIBILITY?
GATHER DATA, NOTIFY NURSE MANAGER, DO NOT CONFRONT
IN ADDITION TO ENVIRONMENTAL, PHYSICAL, DEVELOPMENTAL, AND PSYCHOSOCIAL FACTORS FOR ADDICTION, WHAT OTHER ASPECT IS LINKED TO ADDICTIVE PERSONALITY?
GENETIC; FOR CHILDREN OF ALCOHOLICS
A CIWA SCORE GREATER THAN WHAT WILL MANDATE USE OF BENZOS
GREATER THAN 15
FOR ALCOHOL WITHDRAWAL PATIENTS, WHAT DRUG IS GIVEN TO TREAT HALLUCINATIONS (TACTILE, VISUAL, AUDITORY, OLFACTORY)
HALDOL
WHICH TYPE OF ABUSED SUBSTANCE IS CONSIDERED THE "LAUGHING" DRUG?
INHALANTS
WHICH BENZODIAZEPINES DON'T INVOLVE THE LIVER
LORAZEPAM(ATIVAN), DIAZEPAM (VALIUM
WHICH BENZODIAZEPINES ARE USED TO DECREASE WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND PREVENT SEIZURES/DT'S
LORAZEPAM(ATIVAN), DIAZEPAM (VALIUM), CHLORIDIAZEPOXID E (LIBRIUM
A SCORE ABOVE ___ INDICATES SEVERE WITHDRAWALS
20
ALCOHOL WITHDRAWAL SIGNS PEAK AFTER:
24-48 HOURS
WITHDRAWAL SIGNS USUALLY PEAK WITHIN HOW LONG AFTER CESSATION
24-48 HOURS (2-3 DAYS)
ADDICTION IS CHARACTERIZED BY WHICH 3 ASPECTS
LOSS OF CONSUMPTION CONTROL, CONTINUED USE DEPITE PROBLEMS, TENDENCY TO RELAPSE
What drugs do you give to a Bipolar patient who is starting to show signs of mania?
Lithium, plus anti-psychotic for acting out Abilify, Zyprexa, Seroquel, Risperdal, Geodon o for acute mania
WHAT IS GIVEN WITH THIAMIN TO INCREASE ITS EFFECTIVENESS, ESPECIALLY IF THE PATIENT HAS A HISTORY OF SEIZURES
MAGNESIUM SULFATE
IF NOTIFICATION IS MADE AND THE NURSE NOTICES NO ACTION HAS BEEN TAKEN, WHAT IS NECESSARY?
MAKE NOTIFICATION TO NEXT LEVEL IN CHAIN OF COMMAND
WHY ARE MULTIVITAMINS GIVEN TO WITHDRAWAL PATIENTS
MALNUTRITION
WHAT IS THE ONLY MEDICATION CURRENTLY APPROVED FOR THE TREATMENT OF A PREGNANT OPIOD ADDICT
METHADONE
Medications used to help patients safely withdrawal from Opiod substances
Methadone, LAAM, Revia, Clonidine, Subutex
THIS MEDICATION, TAKEN BY NARCOTIC AND SOMETIMES ALCOHOL ADDICTS, BLOCKS OPIATE RECEPTORS IN THE BRAIN THUS BLOCKING THE EUPHORIC EFFECTS
NALTREXONE (REVIA)
WHICH DRUG, WHICH BLOCKS OPIOD RECEPTORS, IS ALSO GIVEN TO ALCOHOL WITHDRAWAL PATIENTS TO DECREASE THE PLEASANT, REINFORCING EFFECTS OF ALCOHOL?
NALTREXONE (REVIA)
WHAT MUST THE PATIENT ON ANTABUSE BE EDUCATED ABOUT
NEGATIVE SYMPTOMS LAST UP TO 2 WEEKS
WHAT SUBSTANCE IN THE BRAIN IS DISRUPTED BY SUBSTANCE ABUSE
NEUROTRANSMITTERS
INTERVENTION OF A NURSE ABUSING IS WHOSE RESPONSIBILITY?
NURSE MANAGER, NURSING ADMINISTRATORS
IF TAKING BENZODIAZEPINES, WHAT ANTI-SEIZURE MED CAN'T BE USED
PHENOBARBITAL
WHAT IS THE MAIN GOAL OF INTERVENTION?
PROTECT PATIENTS, GET NURSE TREATMENT, RETURN NURSE TO PRACTICE OF POSSIBLE
WHAT IS A COMMON COMORBIDITY DURING SUBSTANCE ABUSE
PSYCHIATRIC DISORDERS
SUBSTANCE ABUSE THEORY: CERTAIN PSYCHODYNAMIC FACTORS ARE PART OF THE ADDICTIVE PERSONALITY. SUCH AS: • LACK OF TOLERANCE, FRUSTRATION, AND PAIN • LACK OF SUCCESS IN LIFE • LACK OF AFFECTIONATE, MEANINGFUL RELATIONSHIPS PATIENTS HAVE A LOW SELF ESTEEM, LACK OF SELF-REGARD, RISK TAKING PROPENSITY, FREQUENT DEPRESSION, AND PASSIVITY. UNABLE TO RELAX, DETER GRATIFICATION, AND COMMUNICATE EFFECTIVELY
PSYCHOLOGICAL
Medications used to help patients safely withdrawal from Alcoholic substances
Revia, Campral, Topomax, Antabuse
A WITHDRAWAL RELATED FEVER OF 100o TO 103o LEADS TO
SEIZURE
AS A PRECAUTION, A NURSE HANDLING A WITHDRAWAL PATIENT SHOULD MONITOR FOR WHAT PHYSICAL REACTION?
SEIZURES
SUBSTANCE ABUSE COMMONLY DISRUPTS THESE ASPECTS IN INDIVIDUALS
SLEEP CYCLE, NUTRITION, JUDGEMENT, HYGIENE
SUBSTANCE ABUSE THEORY: STATES THERE IS DIFFERENCES IN THE RATE OF SUBSTANCE ABUSE AMONG VARIOUS GROUPS. CULTURE HAS AN IMPACT. ABUSERS FIND A SENSE OF BELONGING WITHIN THE SUBSTANCE ABUSE CULTURE
SOCIO-CULTURAL
HOW IS ALCOHOL WITHDRAWAL TREATED PHARMACOLOGICALLY
SUBSTITUTE DRUG (CNS DEPRESSANT) & TITRATE DOWN
WHAT ARE SUBSTANCES ABUSERS ALSO AT HIGH RISK FOR?
SUICIDE
WHAT SHOULD THE PATIENT BE EDUCATED ABOUT WHEN ON ANTABUSE?
THE NEGATIVE EFFECTS ASSOCIATED WITH ALCOHOL CONSUMPTION / EXPOSURE
WHICH MULTIVITAMINS ARE GIVEN TO WITHDRAWAL PATIENTS
THIAMIN (B1), FOLIC ACID
THE NEED FOR HIGHER AND HIGHER DOSES TO ACHIEVE THE DESIRED EFFECT
TOLERANCE
WHY DO WITHDRAWAL PATIENTS NEED TO BE "OD'ED" WITH BENZODIAZEPINES DURING TREATMENT?
TOLERANCE
Projetion is the most common defense mechanism TRUE or FALSE
TRUE
WHEN MUST THE SCREEN BE PERFORMED
UPON ARRIVAL
ALCOHOL WITHDRAWAL DELIRIUM PEAKS AFTER:
48-72 HOURS
HOW LONG IS ANTABUSE EFFECTIVE IN SYSTEM?
5 DAYS - 2 WEEKS AFTER LAST DOSE
Which assessment data would be most consistent with a severe opiate overdose? a.) Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min b.) Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min c.) Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min d.) Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min
a.) Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. REF: Page 416
The treatment team meets to discuss Cody's plan of care. Which of the following factors will be priorities when planning interventions? a.) Readiness to change and support system b.) Current college performance c.) Financial ability d.) Availability of immediate family to come to meetings
a.) Readiness to change and support system *The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital.
A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn? a.) The client has a high tolerance to alcohol. b.) The client ate a high-fat meal before drinking. c.) The client has a decreased tolerance to alcohol. d.) The client's blood alcohol level is within legal limits.
a.) The client has a high tolerance to alcohol. A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. REF: Page 416
A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating a.) denial. b. ) projection. c. ) rationalization. d.) reaction formation.
a.) denial. Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence).
The only class of commonly abused drugs that has a specific antidote is the a.) opiates. b.) hallucinogens. c.) amphetamines. d.) benzodiazepines.
a.) opiates. The effects of opiates can be negated by a narcotic antagonist such as naloxone. REF: 427
Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of a.) tremors. b.) seizures. c.) blackouts. d.) hallucinations.
a.) tremors. Tremors are an early sign of alcohol withdrawal. REF: Page 414
Norepinephrine Neurotransmitters are responsible for?
affects mood, fight or flight (Decrease= depression, increase = mania, anxiety and schizo)
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested a. ) LAAM b. )GHB c. )ReVia d. ) Clonidine
b. )GHB The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies"), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur.
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital? a.) Cody will return to a predrug level of functioning within 1 week. b.) Cody will be medically stabilized while in the hospital. c.) Cody will state within 3 days that he will totally abstain from drugs and alcohol. d.) Cody will take a leave of absence from college to alleviate stress.
b.) Cody will be medically stabilized while in the hospital. *If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.
Cocaine exerts which of the following effects on a client? a.) Stimulation after 15 to 20 minutes b.) Stimulation and anesthetic effects c.) Immediate imbalance of emotions d.) Paranoia
b.) Stimulation and anesthetic effects Cocaine exerts two main effects on the body, both anesthetic and stimulant. REF: Page 413-415 (Table 22-1)
A person who covertly supports the substance-abusing behavior of another is called a(n) a.) patsy. b.) enabler. c.) participant. d.) minimizer.
b.) enabler. An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use.
A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is a.) taking him to the gym on the psychiatric unit. b.) obtaining an order for seclusion and close observation. c.) assigning a psychiatric technician to "talk him down." d.) administering naltrexone as needed per hospital protocol.
b.) obtaining an order for seclusion and close observation. Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist. REF: Page 414
Erik is a 26-year-old patient who abuses heroin. He states to you, "I've been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want." You know this describes: a.) intoxication. b.) tolerance. c.) withdrawal. d.) addiction.
b.) tolerance *Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.
In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery? a.) Ongoing support from at least two family members must be secured. b. )The client needs to be employed. c. )The client must strive to maintain abstinence. d. )A regular schedule of appointments with a primary care provider must be set up.
c. )The client must strive to maintain abstinence. Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability.
A teaching need is revealed when a client taking disulfiram (Antabuse) states, a.) "I usually treat heartburn with antacids." b.) "I take ibuprofen or acetaminophen for headache." c.) "Most over-the-counter cough syrups are safe for me to use." d.) "I have had to give up using aftershave lotion."
c.) "Most over-the-counter cough syrups are safe for me to use." The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol. REF: Page 427 (Table 22-9)
Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? a.) Opiates b.) Marijuana c.) Barbiturates d.) Hallucinogens
c.) Barbiturates Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death REF: Page 416
Which of the following is true regarding substance addiction and medical comorbidity? a.) Most substance abusers do not have medical comorbidities. b.) There has been little research done regarding substance addiction disorders and medical comorbidity. c.) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. d.) Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.
c.) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. *The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.
An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will a.) discuss the addiction with significant others. b.) state an intention to stop using illegal substances. c.) abstain from the use of mood-altering substances. d.) substitute a less addicting drug for the present drug.
c.) abstain from the use of mood-altering substances. Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. REF: Page 422
The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses a.) are an indicator of treatment failure. b.) are caused by physiological changes. c.) result from lack of good situational support. d.) can be learning situations to prolong sobriety.
c.) result from lack of good situational support. Relapses can point out problems to be resolved and can result in renewed efforts for change. REF: Page 425
Different symptoms that are characteristic of intoxication of Opiates
constricted pupils, decreased RR, drowsiness, decreased BP, slurred speech
What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? a. )The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. b. )Neither should be reported until the nurse has collected factual evidence. c. ) No report should be made until suspicions are confirmed by a second staff member. d. )Supervisory staff should be informed as soon as possible in both cases.
d. )Supervisory staff should be informed as soon as possible in both cases. If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager's major concerns are with job performance and client safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug.
Cody is preparing for discharge. He tells you, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? a.) "It helps your mood so that you don't feel the need to do drugs." b.) "It will keep you from experiencing flashbacks." c.) "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions." d.) "It helps prevent relapse by reducing drug cravings."
d.) "It helps prevent relapse by reducing drug cravings." *Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone.
Benzodiazepines are useful for treating alcohol withdrawal because they a.) block cortisol secretion. b.) increase dopamine release. c.) decrease serotonin availability. d.) exert a calming effect.
d.) exert a calming effect. Benzodiazepines act by binding to α-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect.
A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include a.) induction of vomiting. b.) administration of ammonium chloride. c.) monitoring of opiate withdrawal symptoms. d.) observation for hyperpyrexia and seizures.
d.) observation for hyperpyrexia and seizures. Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. REF: Page 414
The term tolerance, as it relates to substance abuse, refers to a.) the use of a substance beyond acceptable societal norms. b.) the additive effects achieved by taking two drugs with similar actions. c.) the signs and symptoms that occur when an addictive substance is withheld. d.) the need to take larger amounts of a substance to achieve the same effects.
d.) the need to take larger amounts of a substance to achieve the same effects. With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. REF: 413-414
A syndrome that occurs after stopping the long-term use of a drug is called a.) amnesia. b.) tolerance. c.) enabling. d.) withdrawal.
d.) withdrawal. Withdrawl is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage. REF: 413-414
Dopamine Neurotransmitters are responsible for?
emotions and thoughts and decision making (Decrease = depression, increase = schizo and mania)
GABA Neurotransmittersare responsible for?
role in inhibition, reduces aggression, excitation, anxiety (decrease = anxiety disorder, schizo)
Serotonin Neurotransmittersare responsible for?
sleep regulation, hunger, mood, pain perception (decrease = depression)
Different symptoms that are characteristic of intoxication of Alcohol/Benzos
slurred speech drowsiness, impaired judgment, decreased blood pressure
Different symptoms that are characteristic of intoxication of Stimulants/hallucinogens
tachycardia, dilated pupils, elevated BP, n/v, insomnia, increased energy
FEATURES OF ALCOHOL WIHDRAWAL DELIRIUM
• ANXIETY, INSOMNIA • ANOREXIA • DELURIUM • AUTONOMIC HYPERACTIVITY • SENSORIUM DISTURBANCES • PERCEPTUAL DISTURBANCES • FLUCTUATING LOC • DELUSIONS, AGITATED BEHAVIORS, FEVER
NURSING INTERVENTIONS FOR ANTICHOLINERGENIC TOXICITY
• EMERGENCY COOLING • HOLD MEDS • CATHETERIZATION PRN • BENZOS OR OTHER PRNS • PHYSOSTIGMINE MAYBE
COMMON SIGNS OF ALCOHOL WITHDRAWAL
• HANGOVER • JERKY MOVEMENTS • IRRITABILITY • GI DISTURBANCE • "SHAKING INSIDE" • GRAND MAL SEIZURES
WITH REGARD TO THE "PSYCHOLOGICAL" SUBSTANCE ABUSE THEORY, NAME SOME CHARACTERISTICS OF SUBSTANCE ABUSE PATIENTS
• LOW SELF ESTEEM • LACK OF SELF-REGARD • RISK TAKING • FREQUENT DEPRESSION • PASSIVITY • UNABLE TO RELAX • DETER GRATIFICATION • CAN'T COMMUNICATE EFFECTIVELY
SYMPTOMS FOR AN IMPAIRED NURSE
• MEDICATION WASTING / NOT GETTING WASTING COUNTER-SIGNED • PATIENT COMPLAINS OF INEFFECTIVE PAIN CONTROL • COMES IN EARLY / STAYS LATE • VOLUNTEERS FOR ADDITIONAL SHIFTS • USES BATHROOM A LOT • SLOPPY CHARTING • ↑ ABSENTEEISM • FREQUENT JOB CHANGES / LOSS • JOB RELATED ACCESS • CRIMINAL RECORD
TERTIARY INTERVENTION FOR RECOVERING ADDICTS INVOLVES
• RELAPSE PREVENTION • REHAB - SELF HELP GROUPS • 90 MEETINGS, 90 DAYS • PSYCHOTHERAPY
