Substance-related and Addictive Disorders, Exams of Health sciences

Download Substance-related and Addictive Disorders and more Exams Health sciences in PDF only on Docsity! 222 Week 6 Notes Substance-related and addictive disorders  Substance use o Not disorders of choice o Rather, complex diseases of the brain represented by  Craving  Seeking  Using regardless of consequences o Use of substance in larger amounts or over a longer period of time than intended o Continued desire or unsuccessful attempt to control substance use o Spends a considerable amount of time obtaining, using, or recovering from the effects of the substance o Continues to use substance regardless of social or interpersonal problem associated with substances use  Reduced or quits participation in social, occupational, or recreational activities o Use substance repeatedly in physically hazardous situations, such as driving impaired o Develops a tolerance to the substance  Requires additional amounts of the substance to achieve the desired effect or to become intoxicated o Exhibits manifestations of withdrawal o Feels strong urge to use the substance  Addiction o Primary, chronic disease of brain reward, motivation, memory, and related circuitry o A disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway in the brain o Characterized by loss of control due to addition behavior  Participation continues despite continuing associated problems  A tendency to relapse back into the addictive behavior o Significant behaviors that lead in addictive disorders: non-substance related disorders  Gambling  The only non-substance related addictive disorder included in the DSM-5  Sexual activity  Shopping/spending  Internet use  Social media use  Gaming  Withdrawal – feelings of discomfort, distress, and intense craving for a substance that occurs when use of the substance or activity stops o Typical withdrawal symptoms  Cold shakes  Chills and sweating  Fever-like symptoms  Mood swings  Anxiety and depression  Bone pain  Vomiting  Insomnia  Diarrhea  Most common substances used by teens – “ All Moms Try Pretty Hard” o Alcohol o Marijuana o Tobacco o Prescription drugs o Hallucinogens  Bath salts o An ever-evolving drug, depending on chemical ingredients  Tweaking the drug but still maintain psychoactive properties o They can be purchased at convenience stores, gas stations, head shops, and on the internet  Sold as tablets, capsules, or powder in sealed envelopes o Euphoria and pleasurable “rush”  Tachycardia  Hypertension  Chest pain  Hallucinations  Paranoia  Psychosis o Bath salts are stimulants similar to o Referral to treatment: a nurse or other healthcare professional can suggest a referral for brief therapy or treatment for patients who screen positively  Assessment o Open-ended questions  Type of substance or addictive behavior  Pattern and frequency of substance use  Amount  Age at onset  Changes in occupational or school performance  Changes in use patterns  Periods of abstinence in history  Previous withdrawal manifestations  Date of last substance use/addictive behavior o Blackout or loss of consciousness o Changes in bowel movements o Weight loss or weight gain o Experience of stressful situation o Sleep problems o Chronic pain o Concern over substance use o Cutting down on consumption or behavior  Signs and symptoms are alcohol intoxication (blood alcohol level) o 20 – 100 mg = 0.02 – 0.1%  Mood and behavioral changes  Reduced coordination, impairment of ability to drive a car, or operate machinery o 101 – 200 mg = 0.101 – 0.2%  Reduced coordination of most activities  Speech impairment, trouble walking, general impairment of thinking and judgement o 201 – 300 mg = 0.201 – 0.3 %  Marked impairment of thinking, memory, and coordination  Marked reduction in level of alertness, memory blackouts, nausea and vomiting o 301 – 400 mg = 0.301 – 0.4%  Worsening of above symptoms with reduction of body temperature and blood pressure  Excessive sleeping  Amnesia o 401 – 800 mg = 0.401 – 0.8%  Difficulty walking the patient – coma  Serious decreased in pulse, temperature blood pressure, and rate of breathing  Urinary and bowel incontinence  Death o Alcohol produces relaxation, decreased social anxiety, maintaining calm o The legal intoxication level is set at 0.08% because of fine motor coordination and reaction times are measurably slow at that level o Blood alcohol level depends on many factors  Body weight  Gender  Concentration of alcohol in drinks  Number of drinks  Gastric absorption rate  Individual’s tolerance level  Signs and symptoms of alcohol withdrawal  assess Q2hr. within the first 48 hours  Q4hr assessment during the last 24 hours o Restlessness o Irritability o Anorexia (lack of appetite) o Tremor (shakiness within 24 hr.) o Insomnia (severe sign per ATI) o Impaired cognitive functions o Mild perceptual changes o Diaphoresis o Possible seizures – tonic clonic  Needs to be monitored closely  can lead to death  When to expect alcohol withdrawals o Signs usually start 4 to 12 hours of last intake o Peaks after 24 to 48 hours and the suddenly disappears o Delirium tremens = alcohol withdrawal delirium  May occur 2 to 3 days after last intake  May last 2 to 3 days  Medical emergency  Signs  Severe disorientation  Psychosis (hallucinations)  Severe hypertensions  Dysrhythmias  Delirium  Symptoms may progress to death  Treatment  Benzodiazepines – chlordiazepoxide, lorazepam o Chlordiazepoxide protocol – lasts 72 hours  First 48 hours  Q2 checks  Administer chlordiazepoxide 35 to 50 mg Q2hr PRN o Reassess within 30 to 45 min. o If ineffective, administer lorazepam 1 to 2 mg IM PRN  This will also help prevent seizures during serious withdrawal  Last 24 hours  Q4 checks  Medications for abstinence when withdrawal is over (days to weeks after withdrawal) o Disulfiram (Antabuse) – scheduled daily dose  aversion therapy  Patient will experience a headache first  Nausea and vomiting soon follows  Instruct the patient to avoid anything with alcohol  Mouthwash  Wearing cologne  Hand sanitizer  Vanilla extract o Naltrexone (ReVia)  PRN; also used to treat opioids addiction o Acomprosate – curve craving for ETOH  PRN  CNS depressants  Depression  Fatigue  Excess sleeping or insomnia  Dramatic unpleasant dreams  Psychomotor retardation or agitation  Possible SI (potential) o Amphetamines  Intended effect: increased energy, euphoria  Intoxication  Impaired judgement  Psychomotor agitation  Extreme irritability  Acute cardiovascular effects o Tachycardia o Elevated blood pressure  Withdrawal  Craving  Depression  Fatigue  Sleeping similar to those of cocaine o Tobacco/nicotine  Intended effect: relaxation, decreased anxiety  Long-term effects  Cardiovascular disease – hypertension, stroke  Respiratory disease – emphysema, lung cancer  Smokeless tobacco (snuff or chew) irritation to oral mucous membranes and cancer  Withdrawal  Abstinence syndrome o Irritability o Craving o Nervousness o Restlessness o Anxiety o Insomnia o Increased appetite o Difficulty concentrating o Anger o Depressed mood o Opioids  Intended effects: rush of euphoria, pain relief  Intoxication – “DIPSI”  Slurred speech  Impaired memory  Pupillary changes – pinpoint pupils (constrict)  Decreased respirations and LOC  Impaired judgement  Withdrawal  Abstinence syndrome o Sweating and rhinorrhea progressing to piloerection (goose bumps) o Tremors and irritability followed by severe weakness o Diarrhea o Fever o Insomnia o Pupil dilation o Nausea/vomiting o Pain in the muscles and bones o Muscle spasms  Withdrawal is very unpleasant but not life threatening  it is self-limiting to 7 days  Antidote: Nalaxone (Narcan)  Not the same as Naltrexone o Inhalants  Intended effects: euphoria  Examples  Nitrous oxide  Solvents  Intoxication – behavioral or psychological changes  Dizziness  Nystagmus  Uncoordinated movements or gait  Slurred speech  Drowsiness  Hyporeflexia  Muscle weakness  Diplopia  Stupor or coma  Respiratory depression and/or death  Withdrawal  none o Hallucinogens  Intended effects: heightened sense of self, altered perceptions (“more vivid colors”)  Examples  LSD  Peyote  PCP  Intoxication  Anxiety  Depression  Paranoia  Impaired judgement and social functioning  Pupil dilation  Tachycardia  Diaphoresis  Palpitations  Blurred vision  Tremors  Incoordination and panic attacks  Withdrawal  Hallucinogen persisting perception disorder o Visual disturbances or flashbacks o Hallucinations can occur intermittently for years  Nursing interventions  Acute metabolic: acidosis, alkalosis, electrolyte disturbances, hepatic failure, renal failure, hypoalbuminemia  Trauma: heat stroke, post-operative burns, fractures, prolonged immobilization  CNS abnormality: abscess, hemorrhage, increased intracranial pressure, seizures, stroke, tumors, vasculitis  Hypoxia: anemia, carbon monoxide poisoning, hypotension, heart failure, respiratory failure  Deficiencies: vitamins B-12, niacin, thiamine  Endocrinopathies: adrenal disorders, thyroiditis, uncontrolled diabetes  Acute vascular: hypertensive encephalopathy, shock, vasculitis, CNS-SLE  Toxins/drugs: medications, anticholinergic agents, pesticides, solvents  Heavy metals: lead, manganese, mercury  Delirium versus dementia o Delirium  Acute, rapid, over short period (hours to days)  Distractible  Speech is rambling, pressured, incoherent  Hallucinations/delusions (possible)  Restless, agitation, varies  Vital signs may be unstable  Personality changes rapidly  LOC fluctuates (sleep/wake)  Attention waves and wanes  Short lived, reversible  Develops rapidly  Recent source  Medical emergency  must determine the cause  UTI in older adults  delirium o Dementia  patient turns into a potato  Progressive, insidious (gradual deterioration, months or years)  Declines more steady  Sundowning – increased agitation seen more so in the afternoon to evening  Wandering, aggression  Vital signs are stable  Personality changes gradually  LOC unchanged  Irreversible  Profound loss/impairment in intelligence  Usually organic cause  Types of neurocognitive o Alzheimer’s disease (AD) – most common type  Commonly characterized by progressive deterioration of cognitive functioning  Formation of amyloid plaques  brain shrinks  Initial deterioration may be so subtle and insidious that others may not notice  In the early stages of the disease, the affected person may be able to compensate for loss of memory  Later on, symptoms become more obvious and start showing  Denial  Confabulation  Perseveration  Avoidance of questions  Stages of AD  Stage 1 – no impairment; normal function  Stage 2 – very mild cognitive decline o Minor memory problems o Forget where the keys are  Stage 3 – mild cognitive decline o The client may benefit from having someone live with them, to keep an eye on them o Might leave the door or fridge open  Stage 4 – moderate cognitive decline o Inability to maintain finances or pay bills  Stage 5 – moderately severe cognitive decline o Difficulty dressing o Assistance with ADLs  Stage 6 – severely cognitive decline o Loss of bladder control o Needs constant monitoring  Stage 7 – very severe cognitive decline o Loss of ability to swallow o Traumatic brain injury o Parkinson’s disease o Other disorders affecting the neurological system  Korsakoff’s syndrome or alcohol-induced persisting amnestic disorder – disturbance of short- term memory due to damage to the hippocampus  Alcoholic encephalopathy or Wernicke’s encephalopathy – a neurological disease characterized by ataxia, cranial nerve VI palsy, nystagmus, and confusion  Treated with thiamine  Basic medical workup o Chest and skull radiographic studies o Electroencephalography o Urinalysis o Sequential multiple analyzer 12-test serum profile o Thyroid function tests o Folate level o Venereal disease research laboratories (VDRL), human immunodeficiency virus (HUV) tests o Serum creatinine assay o Electrolyte assessment o Vitamin B12 level o Liver function tests o Vision and hearing evaluation o Neuroimaging, when diagnostic issues are not clear  Assessment o Aphasia – loss of language ability o Apraxia – loss of purposeful movement in the absence of motor or sensory impairment o Agnosia – loss of sensory ability to recognize objects o Confabulation o Perseveration o Memory impairment – initially the person has difficulty remembering recent events. Gradually, deterioration progresses to include both recent and remote memory o Disturbances in executive functioning – planning, organizing, abstract thinking o Agraphia – loss of the ability to write o Common medications used for dementia  Slow the progression of dementia  Donepezil (Aricept) 1997 – #1, Rivastigmine (Exelon) 1999, Galantomine (Razadyne) 2001  Taken at bedtime to reduce risk of fall and injury due to side effects of bradycardia and syncope  S/S o Diarrhea o Bradycardia o Nausea/vomiting o Syncope  Memantine (Namenda) 2003  Dizziness  Confusion  Constipation  Heart attack Family interventions  Overview of the family o The notion of family function refers to a range of characteristics. They include the family’s  Developmental needs  Response to stressors  Cultural concerns  Ability to interact with support services  Parenting skill  Relationships and interactions  Overall flexibility or resilience o Ability to provide for the physical and emotional safety of individual members o Quality of resources and support systems o Underlying issues, such as substance abuse, domestic violence, or chronic illnesses o Established patterns of behavior and interaction  Aside from the nuclear family, the following are identified types of families with children that exist in the United States o Single-parent family: one or more children who live with a single adult, male or female, related or unrelated to the children o Unmarried biological or adoptive family: one or more children who live with two parents who are not married to each other and are parents to all children in the family o Blended family: one or more children living with a biological or adoptive parent and an unrelated stepparent who are married to each other o Cohabitating family: one or more children living with a biological or adoptive parent and an unrelated adult who are cohabitating together o Extended family: one or more children living with at least one biological or adoptive parent and a related adult who is not a parent o “other” family: one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families  Family functions o A healthy family provides its members with tools to guide effective functioning within the family o Extends to functioning in other intimate relationships, the workplace, culture, and society in general o These tools are acquired through the activities associated with family life  Management activities  Communication patterns  Boundary delineation  Socialization  Emotional support  Overview of family therapy o Family systems theory posits that interventions aimed especially toward addressing family dynamics will  Decrease emotional reactivity  Encourage differentiation among individual family members  Improve patterns of family interaction o Changing dynamics in families are difficult to recognize when they occur slowly over time o The effective family therapist will demonstrate recognizing and response to family members’ anxieties and concerns  Family triangles o Triangulation describes an important and common relationship process that involves subsets of three family members o When the tension is dyad (two people) builds, a third person (child, friend, and parent) may be brought in by one of the members o The family triangle serves to stabilize interpersonal relationships in the short-term o Family triangles create emotional instability in the long run  Assessment o Families are inherently complex, and as a consequence, family assessment is complex as well o A variety of assessment tools are available to help nurses assess how the family functions as a unit and to identify individual members’ perceptions of how the family communications o Assessment in psychiatric nursing in general and particularly in work with families begins with nurses’ self-assessment o Nurses should be aware that their personal histories and styles of interactions might affect their responses to patients and their families as they express their feelings on the nursing unit  Diagnosis o Severe dysfunctional patterns can lead to physical or mental anguish among its members o A nurse’s understanding of family dynamic will foster appropriate planning and identification of diagnoses o Possible diagnosis  Risk for caregiver role strain  Caregiver role strain  Risk for impaired parenting  Readiness for enhanced parenting  Risk for impaired attachment  Dysfunctional family processes  Interrupted family processes  Readiness for enhanced family processes  Parental role conflict  Sexual dysfunction  Risk for compromised resilience  Ineffective denial  Ineffective family therapeutic regimen management  Deficient knowledge  Defensive coping  Outcome identification/goals of family therapy o Reduce dysfunctional behavior of individual family behaviors o Resolve or reduce intrafamily relationship conflicts o Encourage adaptive problem-solving behaviors o Improve family communication skills