Term
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Definition
2/3rds of the American adult population drink alcohol regularly
Alcohol dependence or abuse problems have effected 13.8% of American adults at some time in their life per studies
2.4 million Americans over 12 yrs old need treatment for drug use disorders |
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Term
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Definition
Tolerance - occurs when the user needs increasing doses to reach the needed effect of the drug
Withdrawal can occur after a long time of continued use when the drug is stopped or decreased & the user experiences physical & psychological symptoms
Flashbacks are drug induced hallucinations which may return after initial use & effects are over |
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Term
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Definition
Substance Use:
has immediate & desirable effects which lead to abuse
is use of any mind altering agent which interferes with functioning but causes a “feel good” effect on the Central Nervous System |
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Term
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Definition
Substance abuse:
is uncontrolled
it continues in spite of related problems
person can relapse after treatment
has physical, psychosocial, biological developmental, environmental factors |
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Term
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Definition
Need of increasing amounts of substance to produce desired effects
Syndrome of withdrawal upon cessation
Tissue dependence
Addiction symptoms |
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Term
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Definition
Substance use necessary to maintain optimal state of personal well-being
Loss of control over use
Compulsion to use is strong & all consuming |
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Term
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Definition
Defense Mechanisms: denial, projection, rationalization
Characteristic Thought Process: all or none thinking, selective inattention
Characteristic Behaviors: conflict minimization, avoidance, passivity, manipulation |
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Term
Abuse & Dependence
Synergism and Antagonism |
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Definition
Alcohol + Benzodiazepines = increased CNS depression
Cocaine + Heroin oppose each other |
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Term
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Definition
50% of those with serious mental illness have or had a substance use disorder
Substance abusers have a 3 to 4 times higher risk of suicide & 15% will succeed
Dual diagnosis clients need longer treatment & have more crisis events
Medical comorbidity-Text pg 406-7, Table 18-1 |
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Term
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Definition
Has diagnosis of mental illness & substance abuse
Management includes principles of both substance abuse & mental health treatment
May also have co-morbid medical diagnosis
Relapse can effect both diagnosis |
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Term
| Assessment Guide- Types of questions |
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Definition
Use open ended questions, non-judgmental questions:
Tell me what you’ve been using?
“In the last year, have you ever drunk or used more than you meant to?”
“Have you felt or have you wanted or needed to cut down on your drinking or drug use in the last year?”
Text p 408 |
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Term
Assessment Tools
(Standard Tests) |
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Definition
Michigan Alcoholism Screening Test (MAST)
Drug Abuse Screening Tool (DAST)
CAGE questionnaire (cut down, annoyed, guilty, eye-opener)
Breathalyzer (BAL) > 0.10% without signs and symptoms of intoxication is tolerance
Blood and urine screenings, non-invasive best
Nursing Assessment Guidelines in Text, pg 409, Box 18-2 |
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Term
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Definition
Alcohol
Barbiturates
Non-barbiturates
Sedatives
Benzodiazepines
Non-benzodiazepine antiolytics |
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Term
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Definition
Intoxicating
Sedating
Amnesiac effects (memory loss)
Severe morbidity and mortality (death)
Disinhibition of sexual or aggressive drives
Decreases sexual functioning
Disrupts sleep/wake cycle & dreaming
Depresses cardiovascular & respiratory function
Damages hepatic & renal systems
& may lead to system failure
Coma & death |
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Term
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Definition
Initially stimulating then causes sedation as GABA is decreased
Intoxication is a serum level of 100 – 200 mg/dL
Decrease judgment & increases risk of injury
Multiple systemic effects leading to chronic disease |
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Term
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Definition
Peripheral neuropathy
Alcoholic myopathy
Wernicke’s encephalophy: abnormal eye movements, ataxia, confusion
Korsakoff’s Psychosis: severe memory problems
Esophagitis
Gastritis
Pancreatitis
Alcoholic hepatitis
Cirrhosis of liver
Portal HTN, ascites
Hepatic encephalopathy
Leukopenia
Thrombocytopenia
Sexual dysfunction |
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Term
Alcohol Withdrawal
Onset and Peak |
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Definition
Withdrawal symptoms can begin within a few hours after stopping or reducing heavy or prolonged use
Withdrawal symptoms peak after 24 to 48 hours & disappear unless withdrawal progresses to alcohol withdrawal delirium
Use tools to evaluate withdrawal status & medicate symptoms |
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Term
| Alcohol Withdrawal Delirium |
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Definition
Symptoms peak 2 to 3 days without alcohol
Considered a medical emergency as 5% die related to complications
Autonomic Nervous System hyperactivity w/ tachycardis, diaphoresis, elevated BP
Respiratory arrest
Dehydration & hyperthermia
Arrthymias & circulatory collapse
Alcoholic ketoacidosis
Severe disturbance in sensorium: decreased orientation, confusion
Perceptual disturbances: hallucinations or illusions
Fluctuation level of consciousness from lethargy to hyperexcitability
Agitation
Delusions |
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Term
| Alcohol Withdrawal Treatment |
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Definition
Re-hydrate & decrease autonomic reactivity
Maintain fluids, electrolytes, vitamins
Offer safe, quiet environment
Reorient & offer support to help decrease illusions & hallucinations
Decrease risk of seizures with anticonvulsants, MgSO4
Monitor via flow sheets & use treatment protocols |
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Term
| Psychopharmacological Interventions |
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Definition
Alcohol withdrawal: treat symptoms *Text pgs 425-6, Table 18-9
Encourage abstinence
Disulfirm/Antabuse causes severe reactions with alcohol, reacts to even hidden sources
Naltrexone (Trexan, Revia): used to treat high cravings & somatic symptoms from alcohol, blocks opiate receptors
Acamprosate (Campral) helps with abstinence but mechanism of action unknown |
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Term
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Definition
Swallowed or injected
Experience similar to alcohol
Rapid tolerance & cross tolerance developed
Dangerous withdrawal can lead to seizures
Taper with decreasing doses |
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Term
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Definition
Similar to barbiturates & alcohol in usage effects & withdrawal
Later onset of withdrawal symptoms with danger of seizures
Delirium Tremons-like withdrawal reaction with panic & psychosis
Taper with decreasing doses |
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Term
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Definition
Overdose leads to cardiovascular & respiratory depression, coma, shock, convulsions, death
Treatment: lavage/activated charcoal, monitor VS, keep patent airway, IV fluids
Seizure precautions
Romazicon (flumazenil), benzodiazepine receptor agonist, used IV to reverse sedation, respiratory depression, psychomotor retardation, & memory loss |
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Term
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Definition
Cocaine, crack – shorter high
Amphetamines- dextroamphetamines, methamphetamines,
Crank – more intense, longer high w/ dose related effects & toxicity leading to death
Anabolic steroids can cause manic “roid rage”
Use depletes available dopamine & norepinephrine
Text pg 413, Table 18-4 |
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Term
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Definition
Assultive
Grandiose
Paranoid
Increased HR, BP
Hyperpyrexia
Convulsions/seizures
Coma
Respiratory distress
Dilated pupils
Fatal arrhythmias: chest pain, irregular pulse
Death |
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Term
CNS Stimulants
OD/WIthdrawal Treatment |
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Definition
Treatment of overdose:
Antipsychotic medications for agitation, hallucinations
Cool fever
Benzodiazepines for seizures
Treatment of withdrawal:
Antidepressants
Dopamine agonist (Bromocriptine) |
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Term
Narcotics & Opiates
Examples |
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Definition
Heroin
Morphine
Hydrocodone
Codeine, codine-analogues
Methadone
Hydromorphone
Fentanyl, fentanyl analogs
Text pg. 414, Table 18-5 |
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Term
Narcotics & Opiates
Effects |
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Definition
Released endorphins bind to brain receptors causing increased pleasure
Impairment of cognition: judgment, memory, attention
Initial euphoria followed by dysphoria or feelings of depression |
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Term
Narcotics & Opiates
OD and treatment |
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Definition
Overdose:
Respiratory depression
Pinpoint pupils
Coma
Death
Treatment:
Narcotic antagonists – Narcan (naloxone) |
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Term
Narcotics & Opiates Withdrawal
Onset,duration, s/s |
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Definition
Begins in 6 to 24 hours from last use
Symptoms decrease in 5 to 7 days
Flu-like symptoms
Dilated pupils
Piloerection
Yawning |
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Term
Narcotics & Opiates Withdrawal
Meds |
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Definition
Methadone (Dolophine) for synthetic taper, given daily, blocks the cravings & effects of herion
Levo-Alpha Acetyl Methadol (LAAM) is effective up to 3 days, blocks opiate effects, no “high” feelings
Clonidine (Catapres) & Naltrexone (Revia, Trexan) combination: non-addicting, non-opioid, clonidine suppresses opioid withdrawal symptoms while naltrexone blocks euphoric effects of opioids
Buprenorphine (Subutex): opioid agonist blocks withdrawal s/s, taken daily sublingually |
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Term
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Definition
Marijuana (Cannabis Sativa) – active ingredient is Tetrahydrocannabinol (THC)
Hashish is concentrated resin with increased THC potency
Depressant & hallucinogenic properties
Controversial Antimotivational Syndrome
Where can I sign up for this study? |
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Term
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Definition
Euphoria or pleasure
Impaired coordination & judgment
Anxiety
Slowed time
Hunger & thirst increased
Short term memory loss
Fertility may be effected
Respiratory disease, chronic cough/bronchitis |
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Term
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Definition
LSD (lysergic acid diethylamide), semi-synthetic drug of the tryptamine family
Peyote or mescaline comes from a small spineless cactus
PCP (phencyclidine piperdine) synthetic dissociative anesthetic with neurotoxin properties
Dextromethorphan, usually in cough syrup, contains CNS depressant for the cough suppressant & has hallucinogenic properties at higher doses
Psilocybin mushrooms intoxicate for 3-5 hrs, give extreme sensory effects
MDMA or Ecstasy is a synthetic drug with hallucinogenic & amphetamine effects, depletes serotonin
Ketamine (Special K) is a dissociative anesthetic developed for veterinary medicine |
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Term
| Hallucinogen Intoxication |
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Definition
Increased awareness & pleasure
Out of body experience
Disorientation
Hallucinations,agitation
Modified sensory input such as “synesthia” where senses are misinterpreted, i.e., tasting colors
Altered mental state in very short time
Increased HR, tachycardia
Distortions of time & space
Anxiety
Paranoia
Depersonalization
“Bad trips” or psychosis |
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Term
| Hallucinogen Intoxication |
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Definition
Treatment:
Environment should have low stimuli
Try to “talk down”
Use benzodiazepines for seizure control
Balance fluids & electrolytes
Maintain airway, use oxygen prn |
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Term
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Definition
Rapid onset after ingestion
Causes severe adverse reactions
related to dose & route
Produces acute anxiety to severe psychosis
Behavior is unpredictable & can be violent
Acute toxic reactions can lead to depression & suicidal ideation or to coma
Detox in non-stimulating environment |
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Term
Inhalants & Solvents
Tell Tale Signs of use: |
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Definition
Chemical odors
Empty containers
Rash on nose or mouth |
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Term
| Inhalants & Solvents’ Effects |
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Definition
Intoxication can produce an anesthetic effect
Euphoria, laughter, & disorientation
Tingling feeling all over
Staggering & lightheadedness
Disinhibition, bizarre or violent behavior
Excitation followed by drowsiness
Seizures |
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Term
Inhalants & Solvents’ Effects
Damage to body’s systems: |
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Definition
Damage to body’s systems:
Pulmonary complications, esp. suffication
Cardiovascular
Neurological
Renal
Brain |
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Term
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Definition
Monitor for safety
Support effected systems
Assess damage to nervous system & cognition with extended use |
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Term
Rave & Techno Drugs
Entactogens
(Examples) |
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Definition
Rohypnol or flunitrazepam is a benzodiazepine derivative with sedative, hyponotic, antianxiety, & muscle relaxant effects
Rohypnol added to GHB for stronger effect, used in sexual assault
Gamma-hydroxybutyrate (GHB) is naturally occurring in the CNS, used to treat insomnia, depression, narcolepsy, alcoholism, & to enhance athlete’s endurance |
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Term
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Definition
Produces increased mood or euphoria & energy or hostility, depression, panic, &/or paranoia
Irreversible effects to memory & learning
Rapid disinhibition, relaxation, & memory impairment
Blackouts
Alcohol has synergistic effect |
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Term
Rave & Techno Drugs
Effects |
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Definition
Effects serotonin function
Headache
Nausea/vomiting
Hyperthermia
Muscle rigidity
Seizures, coma
Rhabdomyolysis (destruction of skeletal muscle cells)
Acute renal failure
Cardiovascular collapse
Death |
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Term
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Definition
Prescription drug abuse
Vicodin, Xanax, Oxycontin
Adderall, called “kiddie cocaine” is crushed & snorted
Legal, easily accessible & inexpensive
Danger of synergistic effects |
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Term
Chemically Impaired Nurse
(Incidence) |
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Definition
Approximately 10% of RNs are chemically impaired
Narcotic addiction in RNs is greater than in the general population
RNs are at 32-50% higher risk than the general population for substance abuse |
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Term
Chemically Impaired Nurse
Early Indicators |
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Definition
Changes in lifestyle to focus on substance use related activities
Inconsistency between actions & statements
Increasing irritability & projecting blame
Isolates self from social contacts
Tardiness & absences from work
Increased depression
Patients complaining of pain unrelieved
More breakage of narcotic medication vials |
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Term
Chemically Impaired Nurse
Reporting |
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Definition
Reporting is an ethical & legal obligation
Not to report is illegal
Gather complete data
Need accurate, clear, factual documentation
Intervention is responsibility of nurse manager
If nurse manager unwilling or unable to intervene go up the chain of command
Text pg 418, Box 18-3, “Have I Enabled?” |
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Term
| Chemically Impaired Nurse |
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Definition
Peer Assistance Program (Diversion Bill, ANA 1982) offers self-regulation
Review treatment program options
Escort to inpatient program as there is an increased risk of suicide with intervention
Report to State Board of Nursing with the facts |
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Term
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Definition
Cluster of maladaptive thoughts, feelings, behaviors, and attitudes common to those in relationships with substance abusers
Overly responsible
Makes excuses
Feels guilty
Hides the truth from family and friends
Threatens the abuser with consequences but doesn’t follow through
Text pg 405, Box 18-1 |
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Term
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Definition
Don’t ague when your partner is intoxicated
Follow through on threatened consequences
Take only reasonable amount of responsibility
Do what is enjoyable for you
Socialize & keep up relationships with family and friends |
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Term
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Definition
Encourages denial by agreeing the client only drinks or takes drugs socially
Ignores client’s cues and discusses any topic but substance abuse
Offers sympathy to the client for their problems
Promotes will power as a way to recovery |
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Term
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Definition
Allow the client to talk about substance abuse openly
Assess the extent of substance abuse using open ended questions, non-judgmental
Be honest about client’s behavior
Discuss problems client has as a result of substance abuse
Discuss and encourage treatment options |
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Term
| Substance Abuse Interventions |
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Definition
Goal is self responsibility, not compliance
Educate on how to increase tolerance to anxiety & depression without use of substance of choice
Offer caring & non-judgemental persistence
Be a listener
Show honesty
Appropriate program for each client based on cost, insurance, employment, support
Abuser often displays dysfunctional anger, manipulation, impulsivity, & grandiosity but needs acceptance from the RN
Expect abstinence
Individualize care
Put limits on behavior
Redirect vs. remove defenses
Recovery is in stages |
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Term
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Definition
Primary Prevention :
For children & teens is health teaching
Participation in groups
Part-time jobs
Target elderly who are experiencing stressful events
Prevent HIV infection for needle users |
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Term
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Definition
Family Therapy to stop enabling
Al-Non, Narc-Anon, Al-a-Teen,
Alcoholics Anonymous (AA), Narcotics Anonymous (NA) - 12 Step Recovery
Rational Recovery
Milieu therapy as in-patient
Intensive out-patient programs
Employee Assistance programs |
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