| Question |
 |
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| Answer |
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| Capacity for enduring a large amount of a substance (food, drug, or poison) without an adverse effect and showing a decreased sensitivity to subsequent doses of the same substance. |
Tolerance |
| The presence of mental illness in a patient with a history of concurrent substance abuse. |
dual diagnosis |
| a phenomenon in which a person functions normally while drinking but later has no memory of what occured during that period with no accompanying loss of consiousness |
blackout |
| Most serious form of withdrawl from alcohol occurs after cessation or reduction in prolonged heavy drinking, can be a medical emergency and needs immediate treatment |
Delirium Tremens (DT's) |
| Alcoholic amnesia related to thiamine deficiency |
Wernicke-Korsakoff Syndrome |
| A Syndrome Charaterized by a group of congenital birth defects caused by a mother drinking while she is pregnant. |
Fetal Alcohol Syndrome |
| chemical dependence as a primary, chronic, relapsing disease with genetic psychosocial, and enviromental factors influencing it. |
Substance abuse |
| Often progressive and fatal, it is characterized by continous periodic impaired control over the substance use of the substance despite adverse consequences, and distortion in thinking, most notably denial |
Substance abuse |
| ______ _______ is associated with using a drug in a way that is inconsistent with medical or social norms and despite negative consequences. |
Substance abuse |
| Suicide rate of substance abuse is ___% higher than the average person |
20% |
| Why do people drink? |
Short term euphoric response is generated by drug use, which eventually leads to the symptoms of addictive thinking, denial and impaired control. |
| What engenders the immediate profound desire for re-admission? |
Euphoric response |
| What is the positive immediate short term euphoria overshadow? |
Any long-term consequences associated with engagin in addictive behaviors. Continued use leads to the developement of tolerance. |
| Continued use of substances leads to what? |
tolerance |
| Individuals with dual diagnosis & who are intoxicated are at an increased risk of |
Suicide |
| Treatment for dual diagnosis is more succesful if both illnesses are treated _____. |
Concurrently |
| Substance abuse often mask mood disorders, anxiety disorders, adjustment disorders, sleep disorders, personality disorders, antisocial disorders basically, |
all types of psych disorders. |
| Research suggest a ______ link to substance abuse. |
genetic |
| What are psychological risk of substance abuse? |
antisocial, introversion, impulsiveness |
| What are developmental risk for substance abuse? |
abuse survivor, lack of nutrance in childhood, coping skills deficit |
| 33% of every person with a psychiatric disorder develeps |
addiction |
| 33% of persons with an addiction develops a |
psychiatric disorder |
| What is the most abused substance? |
alcohol ( ethanol) |
| Most common cause of death for an alcoholic |
aspiration from vomiting, respiratory distress from withdrawl |
| What is an early warning sign that a person is drinking too much? |
blackouts |
| When a person is intoxicated by alcohol what will you see? |
slurred speech, impulsivness, ataxia, impaired concentration, memory, judgement, aggresive, blackouts if severe, respiratiory depression leading to coma or death. |
| When does withdrawl from alcohol begin? |
four to twelve hours after the last drink. |
| What is an important question to ask an alcoholic? |
When did you take your last drink? To know when withdrawl may begin |
| When an alcoholic is going through withdrawl, what do they experience? |
hand tremors, tachycardia, hypertension, insomnia, anxiety, nausea, vomiting. |
| If a person gets to 100 (diastolic, temp, pulse) then what is going on? |
They are not managing withdrawl well |
| What might withdrawls in an alcoholic progress to? |
Hallucinations, seizures, deliruim tremens (DT) |
| What usually peaks by day two and is over by day five? |
Alcohol withdrawl. |
| Alcohol withdrawl needs to be done where? |
Under medical supervision. |
| What are the detox drugs of choice? |
Benzidiazepenes(ativan) |
| Detox protocol is determined by whom? |
The American Society of Addicitive Medicine & Substance Abuse Treatment |
| What are medical consequenses of alcohol abuse? |
gastritis, malnutrition, pancratitis, esophagitis, alcohol cardiomegaly, hepatatis, cirrhosis, increased risk of cancer of the mouth, pharynx, esophagus, stomach, pancreas, and fetal alcohol syndrome |
| Withdrawl from sedatives, hypnotic, and anxiolytic is.... |
timeline specific to the drug used |
| What does a pt experience when they withdrawl from a sedative, hypnotic, or anxiolytic? |
autonomic hyperactivity, hypertension, tachycardia, hyperthermia, hand tremors, insomnia, anxiety, nausea, psychomotor |
| How do you treat withdrawl from sedatives, hypnotics, and anxiolytics? |
taper the drug under supervision, esp barbituates. |
| Abrupt withdrawl from these may be life threatening |
Barbituates |
| What does a pt that is intoxicated by amphetamines and Cocaine look like? |
euphoria, hyperactivity, talkative, anxiety, grandiosity, hallucinations, anger, impaired judgement, hypertension, tachycardia, diaporesis, chest pain, confusion. |
| What causes pshycosis and often incurs police involvement? |
Methampetamines |
| When does withdrawl from amepetamines or cocaine begin? |
Hours to days after cessation |
| What is the primary symptom of withdrawl from amphetamines or cocaine? |
dysphoria "crashing" |
| What might a pt have for several days after withdrawling from Ampetamines or cocaine? |
Suicidal Ideations. |
| What happens when a pt is intoxicated by maijuana? |
short-term- decreases intraocular pressure, similar to alcohol, more decreased inhibitions & bloodshot eyes |
| What happens when a person withdrawls from Maijuana? |
nothing significant, muscle aches, sweating, stays in system a long time |
| What are some expamples of opiods? |
morphine, demerol, oxycodone, heroin |
| What does an intoxicated pt on opiods look like? |
apathy, lethargy, impaired judgement, impaired memory, agitation, constricted pupils, slurred speech, OD can result in death. |
| What does a pt look like when they are withdrawling from opiods? |
anxiety, restlessness, back and leg pain, cravings for opiods, nausea, vomiting, dysphoria, rhinorrhea, sweating, diarreha, fever, insomnia, anhedonia, insomnia, and cravings may last for months or weeks |
| What does a pt look like when they are having hallucinogen intoxicaion? |
halluciongens (visual) anxiety, depression, parionoia, fear of losing mind, impulsiveness, ( jumping out of window believeing they can fly) |
| What happens with a person who is withdrawling from Hallucinogens? |
they may have flashbacks for months or years |
| Where is inhalants abuse most seen? |
In a younger crowd. |
| What signs and symptoms will a nurse see in a pt that is intoxicated with inhalants |
dizziness, lack of cordination, slurred speech, ataxia, tremor, aggression, apathy, impaired judgement |
| If Inhalant abuse is severe it may cause what? |
anoxia, respiratory depression, cardiac arrythmias, death |
| What are the medical consequences of excessive Inhalant use? |
persistent dementia, psychosis, mood disorders |
| What should a nurse assess on a substance abuse pt? |
nutrition-vitamin deficient, malnourishment, weight gain or loss, elmination, sleep, chronic pain, lab data (SGOT/SGPT, urine drug screen, albumin levels, CBC,WBC |
| What things should the nurse asses for the psychological assessment |
Mood and affect, thought process, intellet/orientation, judgement/insight and self concept. |
| Which pt's mood needs the most imediate attention when withdrawling from a substance? |
The pt that is sad and remorseful |
| When a substance abuse pt is happy what does this mean? |
They are in denial |
| If a person is withdrawling from a substance it is normal for their mood to be |
irritable |
| What is a substance abuse pts thought process? |
minimizing use, blaming others, rationalizing behavior, and desire to continue using. |
| How is a substance abuse pt's intellect/orientation affected? |
cognitive function impairment from long term use or inhalants |
| What should you assess with a substance abuse pts family? |
co-dependence, role and relationship with fly members, family life(chaotic, financial burdens) family hx of abuse |
| What does a nurse assess for during a chemical abuse assessment? |
type of substance used, detox protocol, identify seeking behaviors, patterns and frequency &amounts, age of onset, changes in use pattern, hx of periods of abstinence, previous withdrawl symptoms, date/time last used drug, discuss drugs seperately |
| What should a nurse assess for the social history assessment of a substance abuse pt? |
coping skills, personal pain avoidance( biggest issue for ppl to work through), relationship history and support system |
| What are some nursing diagnosis associated with substance abuse? |
Ineffective Denial, Ineffective coping skills, altered family process, Ineffetive role performance, imbalanced nutrition, less than body requirements, constipation, diarrhea, selfcare deficit, risk for injury relaspe or complications of substance withdraw |
| What are two defense mechanisms used by most people who abuse chemicals? |
denial and ratinalization |
| How would a nurse maintain safety for a substance abuse pt? |
suicide percautions, seizure percautions |
| How would you manage physiologic alterations /substance abuse pt |
detox protocol-ASE form, Insomnia, constipation, diarrhea, pain |
| What impedes recovery? |
denial ( but too much reality is hard |
| Educate as ______ ________ not _______ ________ -this decreases the need for denial |
disease process, not character flaw |
| Suggest substance abuse pts keep and open mind about________ they are recieving |
feedback |
| Help substance abuse pts develop discrepancy between the way they see themselves..... |
and the way they really are |
| How do you manage anxiety? |
remember their drug is their solution to uncomfortable feelings, discuss stress management tech, exercise, talking, meditation, journaling, address pt issues of shame guilt and loss |
| What kind of coping strategies do abusers usually have? |
maladaptive, immature, coping stategies, denial, projection, acting out, and avoidance |
| How do substance abuse pts appraise situations? |
in an ego threatening way |
| What should you teach a substance abuse pt? |
mood management, S&S of impending relapse (lonlines, thougths of using, ect) praise desire to change patterns. |
| How should you teach a substance abuse pt to improve self esteem? |
don't let them hide from devistation caused by the abuse, make amens to those harmed and maintain sobriety, stop negative self talk, facilitate hope, teach social skills- manner, putting others first, ect. |
| What are healthy activites that a nurse should promote for a substance abuse pt? |
use support systems, outpatient groups, assist pt in putting structure & dicipline in their lives, may tk 2 or more treatment programs before pt is successful, encourage prayer, encourage asking for help. |
| What is the 12 step program called? |
Alcoholics Anonymous |
| What are the key elements of the 12 step program/aka alcoholics anonymous? |
acceptance, surrender, processing grief, higher power, power of the group |
| ____% of nurses working in most specialties & ____ % of nurse anesthesists develop addiction. |
10% , 15% |
| What are risk factors for a nurse becoming an impaired nurse. |
access to drugs, long hours, tremendous responsibility, job-related stress, family history of chemical dependence |
| what are s&s of an "impaired" nurse? |
increased irritability, mood swings, rapidly shifting, calm after drug use, withdrawn, isolative (desire nights, avoid get togethers), late for work, misses work, elaborate ex. for missing work, work quality decreases, charting is illegible, signs |
| S&S of the impaired nurse continued. |
signs out more narcotics than most nurses on the unit, her/his patients deny pain relief after analgesics charted as given |
| State board of Nursing offers supportive interventions rather than loss of license if the impaired nurse does what? |
Seeks treatment and follows the monitoring recommendations from the board. |
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