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CH 25

Mr. D's substance-related disorders

The DSM-IV-TR identifies substance abuse as a maladaptive pattern of substance use
substance abuse is manifested by recurrent and significant adverse consequences related to repeated use of the substance
Which Axis are addictions considered? Axis 1
In DSM V substance addiction is considered a mental illness.
Abuse To use wrongfully in a harmful way. Improper treatment or conduct that may result in injury.
Dependence A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled.
Prefrontal Cortex Makes voluntary decisions.
Amygdala Senses fear. Emotional memory of initial rush/high (sights, sounds, smell).
Children of alcoholics are ___ times more likely than other children to become alcoholics. 3
Substance abuse has been associated with antisocial and depressive PDs
Alcohol acts as a disinhibitor
Risk factors for substance abuse: low self-esteem, loneliness, loses and failure (loss of job, house, spouse), low tolerance for emotional pain
Death rates from alcoholism among Native Americans are more than ___ the national average. twice
The incidence of alcohol dependence is higher among _______ Europeans than _______ Europeans Northern; Southern
EtOH Alcohol
Alcohol exerts a depressant effect on the CNS
The depression of the CNS, caused by alcohol, changes behavior and mood
Most states consider that an individual is legally intoxicated with a blood alcohol level of 0.08%-0.10% concentration
How fast is alcohol metabolized by the liver? 10-15ml per hour (pure alcohol)
How much alcohol is in a 12oz beer? 15ml (0.5oz)
Alcohol is responsible for __% of all E.R. admissions. 25%
Alcohol is responsible for __% of all suicides. 33%
Alcohol is responsible for __% of all domestic violence cases. 50%
The two most common defense mechanisms used by individuals with alcoholism are rationalization and denial
Dual Diagnosis This is when a person has a substance disorder and a mental illness.
Antisocial behavior has a ____% increased risk for substance abuse. 10%-15%
Schizophrenia has a ___% increased risk for substance abuse. 5%-10%
Most dual diagnosis programs take a more supportive and less confrontational approach.
Peer support groups are an ______ part of treatment. important
Individuals with dual diagnosis should be encouraged to attend 12-step recovery programs such as A.A. or N.A.
Most abused benzodiazepine Xanex
Benzodiazepine drugs Xanex, Vlium, Ativan, Klonopin
Benzodiazepine intended effects: lower anxiety, sedation
Benzodiazepine toxic effects: respiratory depression, disorientation, vomiting, agitation
Benzodiazepine withdrawal sx: anxiety, insomnia, possible psychotic sx, hypertension
Marijuana intended effects: euphoria, sedation, pain management, hallucinations (trip)
Medicinal value for legalizing marijuana? chronic pain relief
Marijuana toxic effects: lung cancer, chronic bronchitis, apathy, lower sperm count
Marijuana withdrawal sx: possible depression, mild
Is cocaine cheap or expensive? expensive
Cocaine intended effects: rush of euphoria and pleasure, increased energy
Cocaine toxic effects: irritable, chest pain, tachycardia, hallucinations
Cocaine withdrawal sx: can occur within 1 hour to several days after last fix, depression, insomnia, unpleasant dreams, craving
Nicotine intended effects: relaxation, decreased anxiety
Nicotine toxic effects: hypertension, irreversible emphysema, respiratory disease, stroke, irritation of oral mucous membranes
Nicotine withdrawal sx: nervousness, restlessness, increased appetite, insomnia, craving
Alcohol intended effects: relaxation, decreased social anxiety, coping with stress
Alcohol toxic effects: altered judgement, decreased motor skill, decreased level of consciousness
Alcohol chronic use: liver damage (fatty liver to cirrhosis), acute pancreatitis, cardiovascular damage
Alcohol withdrawal effects start within 4-12 hours of last drink
Alcohol withdrawal delirium may occur in 2-3 days after last drink
Alcohol withdrawal sx: cramping, vomiting, tremors, inability to sleep, tonic-clonic seizures, increased heart rate, hallucinations
Antabuse disulfiram
1st FDA approved med' for alcohol abuse and dependence? Antabuse
Antabuse is prescribed to help people who want to quite drinking by causing a negative reaction if the person drinks while they are taking Antabuse.
Alcohol is metabolized by the body into acetaldehyde
acetaldehyde a very toxic substance that causes many hangover symptoms
Usually the body continues to oxidize acetaldehyde into acetic acid, which is harmless
Antabuse STOPS the production of acetaldehyde
Antabuse PREVENTS the oxidation of acetaldehyde into acetic acid
Antabuse will cause a build up of acetaldehyde that is 5-10 times greater than normal when drinking alcohol
Name 4 medications for alcohol withdrawal symptoms: diazepam, lorazepam, carbamezapine, revia
Drug class and purpose: diazepam and lorazepam benzodiazepines lower agitation and lowers anxiety
Drug class and purpose: carbamezapine anticonvulsant and mood stabilizer
Drug class and purpose: revia opioid receptor antagonist (blocks good feelings caused by alcohol)
1st choice for alcohol treatment most severe alcohol addictions need IN-PATIENT facility
2nd choice for alcohol treatment HOSPITAL based programs
3rd choice for alcohol treatment (short or long term) RESIDENTIAL programs
4th choice for alcohol treatment OUT-PATIENT
5th choice for alcohol treatment 12-STEP program
___ of recovering alcoholics will relapse 2/3
___ of recovering alcoholics will not respond favorably 1/3
Nsg Dx: Rationalization. S & Sx "I don't have a problem with alcohol. I can quit any time I want to."
Nsg Dx: Rationalization. Nsg Ax Accept client. Identify ways alcohol cause problems. Don't allow client to blame others for alcohol problems.
Nsg Dx: Rationalization. Outcomes Talk about link between alcohol use and problems. Accept responsibility.
Nsg Dx: Ineffective Coping. S & Sx Alcohol use to cope
Nsg Dx: Ineffective Coping. Nsg Ax Set limits on manipulation. Use non-alcoholic coping. + feedback
Nsg Dx: Ineffective Coping. Outcomes Use of non-alcoholic coping strategies.
Nsg Dx: Imbalanced Nutrition. S & Sx dry skin, pale, underweight, malnourished
Nsg Dx: Imbalanced Nutrition. Nsg Ax Consult dietician. Monitor I&O, weight, protein intake. Restrict sodium intake. Provide small, frequent, and nonirritating meals.
Nsg Dx: Imbalanced Nutrition. Outcomes Vitals normal. Verbalize importance of adequate nutrition.
What drug is used to help recovering heroine addicts. methadone
Is meth cheap or expensive to make? Cheap
Meth drug action? CNS stimulant
Meth destroys tooth enamel
Meth can cause (mental disorder) psychosis
Enabling The tolerance, approval, giving, and or financing of drug use.
Enabling sabotages the recovery of the patient.
Reasons ppl enable: 1 Control. 2 Rationalization. 3 Minimizing. 4 Waiting or hoping that things will get better on their own.
The recovery addict must first ___ that they have a drug problem. admit/accept
A patient in _____(hint: a river in Egypt) can't be helped denial
DSM IV says that there must be at least __ of 7 characteristics to be considered substance dependent. 3
7 characteristics of substance dependence: Tolerance. Withdrawal. Larger doses and time used. Persistent uncontrollable desire. Lots of time get-n, use-n, or recov-rn from drug. Social or occupation reduced. Use continues despite knowledge of problems it causes.
Patient sent to hospital cause of binge drinking. Heavy drinking for years. Lab reports blood alcohol level of 250 mg/dL. Placed on chemical dependency unit for detox. The 1st signs of alcohol withdrawal should be expected at what time? Several hours after the last drink.
Symptoms of Alcohol withdrawal include: Diaphoresis, nausea and vomiting, and tremors.
Which medication is the physician most likely to order for a patient with alcohol withdrawal syndrome? Chlordiazepoxide (Librium)
Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan says "I don't have a problem with alcohol. I can handle booze better than any one else. My boss is a jerk." What is the best response? "You are here because your drinking was interfering with your work, Dan."
Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan says "I don't have a problem with alcohol. I can handle booze better than any one else. My boss is a jerk." The defense mechanism that Dan is using is? Denial
Dan has been admitted to alcohol rehab' after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. What is the best intervention? Send a urine specimen from Dan to the lab for drug screening.
Dan, begins attendance at AA meetings. What statement reflects the purpose of this organization? They claim they will help me stay sober.
Symptom of a chronic cocaine user. Red, irritated nostrils.
Heroin addict withdrawal symptom. nausea and vomiting, diarrhea, and diaphoresis.
A polysubstance abuser says. "The green and whites do me good after speed." What drug(s) is he abusing? The client is abusing amphetamines and anxiolytics.
Created by: Sanctus Verus