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What is development?
When people start using alcohol & drugs development stops.
What is the breathalyzer limit?
- Breathalyzer intoxication- 0.080
- Blood alcohol equivalency = 80.
How fast does alcohol metabolize?
25mg/liter/hr. is the average person.
What is the DSM IV-TR Substance Dependence definition?
- Maladaptive use of substances with significant impairment in 3 or more of:
- Tolerance develops
- Withdrawal symptoms occur
- Substance taken in larger amounts over a longer time
- Has persistent desire for substances
- Unsuccessful efforts to cut down
- Spend time in procuring substance
- *Social/occupational/recreational interests given up
- *Continues to use despite physical and/or psychological problems
What is the DSM IV-TR definition for substance induced delirium?
- Impaired consciousness, reduced awareness of environment
- Changes cognition (memory, disorientation, hallucinations, illusions)
- Develops over a short time (hours to days) and fluctuates over day
- Evidence of substance use history
What is the psychological theory of substance abuse?
- Low tolerance for frustration & pain
- Lack of success in life
- Lack of affectionate, meaningful relationships
- Low self-esteem
- Takes risks
What is the psychoanalytic theory of substance abuse?
Forming a relationship with a bottle and not people.
what is the biological theory of substance abuse?
- Less alcohol dehygrogenase, especially in:
- Native Americans
Minor Effects of alcohol withdrawals?
- Minor withdrawals:
- Agitation and Anxiety
- Sleep disturbances
Autonomic effects of alcohol withdrawal?
- Increase in pulse (over 100)
- Increase in BP
- Hand tremors
Major effects of alcohol withdrawal?
- Delirium tremens:
- Autonomic hyperactivity (elevated BP, pulse, diaphoresis)
- Severely disturbed sensorium (disorientation, clouded consciousness)
- Fluctuating levels of consciousness (hyperexcitability to lethargy)
- Perceptual disturbances (Hallucinations)
- Delusions (paranoid)
- Elevated fever
- Onset occurs around 72 Hours after last drink
What Rx is used to for safe withdrawal of alcohol?
- Benzodiazepines, ie
- --Chlordiazepoxide (Librium)
- --Clorazepate (Tranxene)
- --Lorazepam (Ativan)
- Used to discourage drinking. If on disulfiram and then drink-->aldehydre reaction:
- --feels like a heart attack
- Cx if liver enzymes are elevated 5 times normal because affects liver.
Why would you use Naltrexone?
- Naltrexone (Revia and Depade) blocks the pleasure & decreases cravings
- Contraindicated if liver enzymes are elevated 5 times normal because it affects liver (safer than drinking)
- Vivitrol: Injection of Naltrexone extended release once/month
What are the intoxication effects of Stimulants-Cocaine, Crack & Amphetamine & Methamphetamine
- rush of energy,
- increased vital signs,
- pressured speech,
- slurred speech,
What are the withdrawal effects of stimulants?
- drug craving,
T/F You need to detox a pt with stimulants (crack, meth, amphetamine?
- Need sleep, proper nutrition, and exercise.
What is the crash and recovery related to meth?
- Severe fatigue, anxiety, depression, and confusion
- Meth craving strong
- Life can feel hopeless; recovery impossible
- Emotions influenced by a lack of dopamine.
- Within 2-10 days some recovery of dopamine occurs
- With proper sleep, nutrition, and exercise, brain and body begin to recover.
What are the intoxicating effects of Opiods/Heroin, Morophine, Vicodin, and Percocet?
- pain relief,
- impaired judgment,
- constricted pupils,
- slurred speech,
- respiratory depression
What are the withdrawal symptoms associated with Opioids/Heroin, Mornine, Vicodin, and Percocet?
Lacrimation, rhinorrhea, yawning, diaphoresis, In 12-72 hrs--sleep disturbance, anorexia, dilated pupils, piloerection, irritability, tremor, N/V, diarrhea, chills, fever, muscle spasm, flushing, increased vital signs, abdominal pain
What Rx are used to treat Opioid withdrawal?
- Methadone (cross addiction occurs)
- Suboxone (Buprenorphine)
- --both used to ease off opioids.
- Catapres (muscle cramping)
- --adjuncts to treat symptoms of detox.
What are the intoxicating effects of benzos/Valium?
- Depression of brain function (mood, thinking, attention, concentration, judgment, memory, affect, emotions)
- Increased reaction time
- Poor coordination
- Decreased REM sleep-->vivid dreaming.
- *Know alcohol abuse Hx, because body has a hard time distinguishing between benzos and alcohol which may lead a recovering alcoholic back into drinking.
What are the withdrawal symptoms associated with benzos/valium?
- Vivid dreaming
- Dilated pupils
- Increased pulse and BP
What do you need to know about the process of benzo withdrawal process?
- Can convulse if untreated
- Use anticonvulsant such as phenobarbital
- Can taper off medication
What are the intoxicating effects of Hallucinogens/ LSD, Mescaline, Mushrooms, Peyote
- distorted perception & hallucinations
- Time & space distortions
- Heightened awareness
- Mood lability
- Increased vital signs
- Increased salivation
- Panic attacks
What are the withdrawal effects of Hallucinogens/ LSD, Mescaline, Mushrooms, Peyote
What are the intoxicating effects of PCP?
- Psychotic experience
- Bizarre perceptions
- *Enhancement of strength
- --Both are effects of adrenaline dump, not a direct result of the PCP.
- Dilated pupils
- Red skin
What are the withdrawal symptoms of PCP?
What are the intoxicating effects of inhalants/huffing?
belligerence, assaultiveness, apathy, impaired judgement, dizzy, incoordination, slurred speech, unsteady gait, tremor, blurred vision, euphoria, anorexia
Most commonly used by high school students.
What are the withdrawal symptoms of inhalants?
- Abdominal cramping
What are the intoxicating effects of MJ/Cannabis?
altered awareness, relaxation, euphoria, reduced inhibition, red eyes, dry mouth, increased appetite, increased pulse, decreased reflexes, panic reactions
No withdrawal effects.
What are some adverse effects of MJ use?
- Reversible brain changes & sex changes (may decrease motivation and v testosterone/estrogen levels)
- Causes emphysema quicker than smoking
- Contains 60 toxins
Other illegal drugs? See yellow highlights in handout saved in Mental Health folder.
What is the CAGE assessment?
- Cut down ("have you ever tried?")
- Annoyed with others
- Guilt feelings
- Eye-opener ("Do you need one?")
What are some assessments for alcohol detox?
- **Vital signs-- BP & pulse elevates because of autonomic rebound and CIWA used to track withdrawal symptoms
- Check labs: CBC, H&H, platelets; K+, Ca+, Mg+, GGT (liver enzyme. If elevated pt has been drinking heavily over time.)
- Assess for DTs (want to know when last drink was) and seizures. Get on Benzos to prevent.
Why would you give laculose for an alcohol abuser?
Retains ammonia in colon (decreases blood ammonia concentration) by producing osmotic effects and promotes increased peristalsis and bowel evacuation.--> really bad diarrhea. Prevents ammonia build up in brain which is the cause of confusion for pt with liver damage.
What are some typical orders for alcohol withdrawal?
- Vitals at least q4h
- Folic acid
- PRN antacid
- Ecotrin (for headaches)
What are some interventions for alcohol rehab phase?
- Owns substance problem
- Attends aftercare meetings, AA, ALANON for spouse
- *Is alcohol free
- 0.00 breathalyzer
- Plans sober leisure activities
- *Accepts responsibility for own behavior
- Changes faulty thinking
- Deals with feelings
- Uses healthy coping mechanisms
Nursing interventions for substance abuse pts?
(To get free of substance)
- Establish a 1:1 trusting relationship
- Assess the level of denial
- Assist patient in grieving loss of substances
- Identify triggers to using
- Explore healthy coping skills
- Assist to find alternative ways to deal with life without substances
- Help patient accept responsibility for own behavior
- Assess guilt and assist with making amends
- Confront unhealthy thoughts and behavior
- Set limits on behavior
- Help deal with feelings
- Instruct about critical periods
- 3, 6, 9, 12 months, 1.5 and 3 years (may have vivid dreams about using the substance)
- HALT [Hungry, angry, lonely & tired]
- Assist with problem-solving
- Teach social skills as needed
- Learn new and proper ways in dealing with members of the opposite sex
- Discuss consequences of substance use
- Assist with leisure activities
- Refer for aftercare, AA, NA, CA, others