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Nsg 212 Ch. 17

Substance Abuse

QuestionAnswer
With substance abuse, what is first thing to get altered? judgement
What are some physical s/s of withdrawal w/d? flu-like s/s: tachycardia, hypertension, diaphoresis, abd. cramps
What defines substance dependence? 3 or more of the following: tolerance - need for more to get effect withdrawal - physical/cognitive changes when no substance compulsive use persistent desire to cut down/control lots of effort to obtain decline activities, continue despite health p
what is tolerance break? situation from a small amt of substance taken that intoxicates person after bout of heavy use
What is most common defense mechanism with substance abuse? denial and alcoholics tend to stay in denial
What are the roles of children in dysfx fam? hero/martyr- caretaker,overachiever troublemaker/scapegoat- acts out lost child-3rd, lonely, shy mascot- baby, clowns, underachiever
Physiologic effects of alcohol long term use heart failure, Wernicke's encephalopathy, Korsakoff's psychosis, pancreatitis, esophagitis, hepatitis, cirrhosis, ascites
S/s of W/D of alcohol when does hangover appear? hand tremors, diaphoresis, tachy, htn, insomnia, anxiety, N/V..peaks 2d, end 5d Severe: hallucinations, seizures, delirium tremens (DTs) Hangover 4-12h
what drugs are usually given with alcohol w/d whether it's tapered or symptom triggered benzos: (lorazepam(Ativan) 2-4mg q2-4h Diazepam(Valium)- long half life clorazepate(Tranzene) 15-30mg, q2-4h chlordiazepoxide(Librium) 50-100 mg, q2-4h
what is legal toxication in TN? .08 1oz of whiskey about q 90m depending on size/wt
what deficiency is common in alcoholics? what is the disease that can occur? thiamine, B1(100mg/day) adn B-12(25-250mcg/day) deficiency Wernicke-Korsakoff syndrome
What is Korsakoff's psychosis? Wernicke's Encephalopathy? 1. form of amnesia(lie to self), not treatable 2. inflammatory hemmorhage w/ clouding consciousness, nystagmus(eyes bounce) from thiamine def
Terms for brain damage r/t alcohol Marchiafava dis? central pontine myelinosis? cerebellar degeneration? alcohol amblyopia? 1. demyelination of corpus callosum, agitated 2. myelinosis, affect brain stem, resp center 3. lose coordination, posture/balance 4. dim vision
Effects on heart from alcohol ht enlarge, hypokalemia/Mg, hyperlipidemia, narrow pulse pressure, incr diastolic pressure, tacy, Afib, htn
What is CAGE C-cut down A-annoyed by people asking to cut down G-guilty about drinking E-eye opener, need drink in morn
List from least to greatest on addiction: barbituates, heroin, codein, alcohol 1. codein 2. alcohol 3. barbituates 4. heroin
Sedatives/anxiolytics/hypnotics examples? W/D s/s? benzos, barbituates, soma(stops first pass effect) w/d: tachy, htn, tachypnea, fever, insomnia, anxiety, hand tremor...need to taper with barbituates
Stiumlants: amphetamines, cocaine- euhoric, hyperactivity, anger, dilated pupils overdose: seizure, coma w/d: unpleasant dreams, incr appetite, agitation, crashing(suicidal watch)....no drugs needed
Marijuana? Hashish? upper leaves and tops dried resin from leaves Gives euphoria, alert awareness, no W/D
Opiods s/s intoxication and overdose and withdrawal substition therapy drugs? intox: contricted pupils, slurred speech, drowsy, resp depression overdose tx: narcan 0.4-0.8mg IV q 5-15m Naloxone: til opiod level drops Naltrexone: prevent opiate overdose/alcohol cravings W/d: yawning rhinorrhea methadone, subutex/suboxone, cloni
Hallucinogens intoxication, overdose, w/d anxiety, depression, paranoid ideation, ideas of reference PCP: Safety #1, decr stimuli
Pharm tx Levomethadyl? Subutex? suboxone? Clonidine? 1. tx heroin addiction 2. substitute therapy 3. used for sustitute instead of methadone 4. htn, suppress effects of opiate w/d
How to talk to psychotic/intoxicated ind Use broad openings point out beh seek clarification avoid blaming
Created by: palmerag