Anxiety and Substance Abuse
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A strong sense of dread accompanied by physical symptoms and autonomic nervous system responses.
Anxiety is determined by a persons ability to deal with stressors....examples
- coping mechanisms
- presence of neurotransmitters
tension of day to day living, the individual has an alert perceptual field and can motivate learning
focus is on immediate concerns, perceptual field is narrowed, and the individual exhibits selective attention
ie taking an exam
focus is on specific detail, perceptual field is greatly reduced
ie witnessed a car accident
individual experiences a sense of awe, dread and/or terror. Individual has lost control and there is a disorganization of the personality
ie devastating earthquake
generalized anxiety disorder
when a person has excessive worrying about every day things. This occurs more days than not for at least 6 months.
S/S of Generalized Anxiety Disorder
- interference with ability to function-
- difficulty concentrating
- muscle tension
- cant complete tasks
Nursing Interventions for Generalized Anxiety Disorder
- cognitive therapy (explore feelings/thoughts and learning new ways to respond to stimuli)
- teach relaxation techniques
- teach thought stopping
- help patient to discuss irrational fears
presence of recurrent, unexpected panic attacks. After the first attack the person will have a persistent concern about having another panic attack (anticipatory fear)
Panic Disorder is:
characterized-disorganized thinking, feelings of terror, helplessness and non purposeful behavior
physical-dizzy, derealization, nausea, chest pains, SOB, hyperventilation
Nursing interventions for panic disorder
- stay with patient
- talk in a calm quiet voice
- ask if have any distractors that relieve their physical symptoms
an exaggerated behavioral response to an old fear that no longer is an adaptive coping mechanism.
Main coping mechanism for phobias?
avoidance...it is used to take the threat away, but it makes the anxiety worse cuz the patient eventually becomes for dependent on others.
Nursing Interventions for phobias
- help the client learn to function in the presence of the phobic object without experiencing panic anxiety
- assist the client to overcome fear of leaving their home
- teach relaxation techniques
unwanted repetitive and intrusive thoughts, impulses or images that interfere with ADL's and cause distress.
Theme-contamination/dirt, violence/safety, blasphemous thoughts and thoughts about one's own performance
recurrent, irrational and infinitely repetitive behaviors USED TO DECREASE ANXIETY.
Behaviors include: hand washing, cleaning, checking, counting, repeating words, hoarding objects
When does OCD occur?
when a person has a fear that's pushed out of their consciousness...anxiety occurs which causes compulsive thinking. The person gets a feeling of inadequacy. Those feelings are displaced on to an object or item and it creates a symbolic event. This symbolic event (compulsion) is used as an attempt at being able to control something which will in turn bring down their anxiety level.
Nursing interventions for OCD
- Id the underlying emotion behind the compulsion
- help the pt recognize whats going on prior to the compulsion (triggers)
- Later in therapy....relaxation techniques, reinforce positive behaviors and alter diet to not include caffeine/alcohol
Post Traumatic Stress Disorder
follows exposure to extreme trauma. Emotional response to the event involves intense fear, helplessness or horror.
What determines the extent of PTSD?
- type of traumatic experience
- age of traumatic experience (older has more coping skills)
- recovery environment (with family or away)
What's RAN for PTSD?
- R-reliving the event through nightmares or repetitive thoughts
- A-autonomic Arousal (fight or flight)
- N-numbing (person is emotionless)
Nursing Interventions for PTSD
- obtain accurate history from significant others about the traums
- stay with pt during flashbacks/nightmares
- let pt talk about trauma at their own pace
- assist pt to try and comprehend trauma
- discuss feelings of vulnerability and their "place" in the world
What's the best type of drug for panic disorders? Name them
Benzodiazepines-has the most immediate action
Teaching for Benzos
- best for short term use
- high abuse potential
- withdrawals will occur if don't maintain steady state
- don't drink alcohol-additive effect
Which medication is best for GAD and addictive disorders?
Positive about Buspar....and negative?
- Positive-no risk for physical dependence
- Negative-takes 2 weeks to start working
2 Anti Depressants that treat anxiety
What drug is good for treating GAD, OCD and PTSD?
What treats GAD and agoraphobia?
Imipramine (Tricyclic Anti Depressant)
What treats OCD?
Clomipramine (Tricyclic Anti Depressant)
What drug is good for treating situational and performance anxiety?
Beta Blockers....decreases palpitations and heart rate
What is used to sedate an anxious person?
General Nursing Interventions for all anxiety disorders
- consider their anxiety level prior to trying to teach
- teach anxiety reduction techniques
- safety, safety, safety
- assist pt with problem solving
- encourage proper diet and rest/sleep
How long does it take for alcohol to start depressing our CNS? Peak effect?
Weird things chronic alcohol use causes
- peripheral neuropathy
- Wernickes encephalopathy
- korsakoffs psychosis
- serious form of THIAMIN deficiency
- paralysis of ocular muscle
- somnolence stupor
- seen with chronic alcohol use
- syndrome of confusion
- loss of recent memory
What does alcohol overdose look like?
- shallow respirations
- cold, clammy skin
- weak, rapid pulse
What does Alcohol Withdrawal look like?
When do alcohol withdrawal symptoms start?
What do Delirium Tremors look like?
- extreme tremors
When do DT's start and how long do they last?
usually 2-3 days after last drink, but can be as long as 14 days after
last about 5 days
What kind of hallucinations does a person see with DT's?
visual and tactile
How do you treat withdrawals and DT's?
- Vitamin and Mineral replacement
- meds to prevent hyper excitability and seizures
- protect from injury
- monitor fluids
Meds that prevent hyper excitability and seizures
Main given to people with alcohol problems....
Helps to detox a person from alcohol
How does antabuse work? Teaching?
- will cause person to have bad N/V if drink while on this medication
- teach pt to stay away from all alcohol, including:
- mouthwash, aftershave and perfume
How long is the "wash out" period for antabuse?
What will happen if a person drinks a lot of alcohol while on antabuse?
- throbbing head
- low BP
What does Naltrexone treat? How?
opiate and alcohol dependency
It is an abstinence promoter and relapse reducer (for alcohol) by blocking euphoric response to substance
What is the name of the drug that a person takes after they have withdrawn from alcohol that:
reduces relapse severity
low risk for abuse
can be used safely with other meds
What's the CAGE assessment?
- Asking the patient....
- Cut down-Have you ever felt you should cut down?
- Annoyed-Do you feel annoyed when people talk to you about drinking?
- Guilt-Have you ever felt guilty about your drinking?
- Eye Opener-Have you ever needed an eye opener?
Clinical Institute Withdrawal Assessment
- Tactile/Auditory/Visual disturbances
- clouding of sensorium
Examples of Sedative-hypnotic or Anxiolytics
CNS depressants-include barbituates, non barbiturate hypnotics and anti anxiety agents
How do sedative-hypnotic or anxiolytics work?
depress CNS (brain, nerves, muscles and heart)
level of depression depends on dose and potency(mild to death)
What is used to get a person off of sedative-hypnotic or anxiolytics?
long acting barbituates or phenobarbital
What are opiate narcotics?
CNS effects of opiates
- euphoria/mood change/mental cloud
- papillary constriction
- respiratory depression
- antitussive-suppresses cough center
What do you treat opiate OD with?
S/S or opiate OD
- shallow breathing
- shallow pulse
- clammy skin
- pulmonary edema
- respiratory distress
S/S of withdrawal for opiates
- terrible craving
- goose bumps
- abdominal pain/cramps/diarrhea
- runny nose
Withdrawal treatment of opiates
- muscle relaxants
- anti diarrheal agents
- additional benzos
Why do you give a person withdrawing from opiates clonidine?
it suppresses the opiate withdrawal symptom and is non addicting when used with Methadone
2 ways to detox a person on opiates
How does Buprenorphine work with detoxing a person from opiates? What must a person have to take this med?
must do in an office and it is less powerful than methadone and safer with fewer side effects.
How does methadone work?
prevents withdrawal from opiates by filling opiate receptor sites.
Must decrease the dose
- feelings are shut down
- needs/wants go unmet
Denial is prevalent, walking on eggshells
partner stays in a relationship with substance abuser and becomes the care taker. All effort goes in to taking care of the other, thus they fail to fully take care of themselves
consciously or unconsciously facilitating the behavior of the substance abuser. It perpetuates the problem and and facilitates denial
Hero in a dysfunctional family
- shift of parent/child relationship by child taking on parents role
What does a hero have a hard time with later in life?
transitioning in to an adult role
Scapegoat in a dysfunctional family
the person the family blames for all of their problems
What usually happens with the scapegoat?
- they get in to trouble at school
- family goes in to counseling and they find out about the alcoholic because the scapegoat got in to trouble
Lost child in a dysfunctional family
they fly under the radar and do anything not to get hurt
Mascot in a dysfunctional family
jokster....learn to break the tension in the family
the use of various medications to decrease the intensity of symptoms in an individual who is withdrawing.
a memory disturbance characterized by information that appears to be made up rather than true....fill in the gaps with lies
Criteria for substance abuse
recurrent use of a substance resulting in failure to fulfill major role obligations at work, school and home
Criteria for substance dependence
- evidence of tolerance
- evidence of withdrawal symptoms
- substance is taken in larger amts or longer than intended
- pt spends lots of time trying to obtain substance
- important social/occupation are given up cuz of substance
- substance is used even though problems are occurring
use of alcohol to relieve every day stress and tension in life
- begins with blackouts
- alcohol is no longer a source of pleasure or relief
person starts to sneak drinks and feels guilty when drinks and becomes defense when talked to about drinking habits
Crucial phase of an alcoholic
binge drinking-lasts hours to weeks
loss of job, marriage, family, friends and self respect
loss of control and physiologic dependence
Chronic phase of an alcoholic
- helplessness and self pity
- person is now intoxicated more than sober
- life threatening physical manifestations in all body systems
- if abstain from alcohol-hallucinate, tremors, convusions, panic, and agitation
How long since the last drink for Antabuse?
minimum of 12 hrs.
compulsive or chronic requirement for a substance....if don't have it will experience physiological or psychological distress
Who has the highest rate of alcoholism?
What is implicated in 70% of violent crimes?
What do Mexicans abuse the most?
What do Puerto Ricans and Cubans abuse the most?
Pot and coke
Who has the lowest rate of substance abuse?
What culture has 3x the national average when it comes to alcoholism?
Substance abuse and fetus/newborn
- alcohol-leading cause of preventable birth defects
- cigarettes-low birth weight and resp. problems
- marijuana-low birth weight and small heads
What happens to the baby with Fetal Alcohol Syndrome?
- facial deformities
- hearing loss
- visual problems
- growth retardation
- cognitive problems/learning disabilities
- heart and kidney defects
suppression vs. repression
- suppression is voluntary
- repression is involuntary
4 types of involuntary committments
- mentally ill in need of treatment
- emergency commitment (behavior clearly trouble to self or others)
- involuntary outpatient (court ordered)
- gravely disabled client (cant basic necessities for self)
Emergency restraints details
- Dr. must be notified within 1hr of restraing
- then.....order must be reviewed by Dr. within 4 hrs.
- In person re-evaluation at 8 hrs.
If pt no longer in restraints when verbal order expires, Dr. must reevaluate within 24 hrs.
Charge for restraints/secluding pt without Dr. order?
Writ of habeus corpus
judicial review-go before judge and state why shouldn't be kept in a 5250
a person may request 1 per hold, they can choose to do this instead of probable cause hearing
The doctor says I am not pregnant, but I know I am
I am made of chocolate and my families going to eat me
Example of magical thinking
patients thoughts have control over things or people
literal interpretation and lack of abstract thinking
repetitive or ritualistic movement or utterance
inventing new words
rhyming all of the time
a group of words put together randomly
comfort drug for N/V
If somebody is in withdrawal from alcohol and has a CIWA score of 8....what do I do?
give 2mg or lorazepam and thiamine
What do Sedative-hypnotics and anxiolytics do to a persons sleep?
decreased time in REM...but when in withdrawal, their dreaming becomes vivid and excessive
Withdrawal from what substances can kill you?
When will you see withdrawal symptoms with sedatives-hypnotics and anxiolytics?
10-14 days after abstinence....must wean off slowly
What is phenobarbital?
Difference btwn Buprenorphine and Methadone?
Buprenorphine is done in an office and Methadone can be taken at home or wherever
antidote for benzo OD
tweeking eye when drunk
anxiety about being in places or situations from which escape would be difficult or embarrassing or in which help might no be available in the event of a panic attack
What's the most common phobia and how do they deal with it?
a vital response to physical and emotional danger...intellectual and cognitive response
conscious attempts to protect oneself from the emotional pain of anxiety....may be ineffective or effective
unconscious attempts to manage anxiety also may be adaptive or maladaptive
Sociocultural information and anxiety
- women have it more often
- minority and poor children are at risk
Elderly and benzos
- need to be reduced to protect kidney and liver functioning
- they cause cognitive impairment in them
Utilize nursing process and critical thinking to plan, implement and evaluate care for pts with anxiety disorders
- stay with pt
- reassure safety
- maintain calm nonthreatening matter of fact approach
- simple words
- consider level of anxiety when doing pt teaching
- anxiety reduction techniques
- help with problem solving
- encourage nutrition, sleep and rest
a sense of unreality or self estrangement
seeing oneself from a distance, like in a dream
perception that the environment has changed....things seem unreal, smaller, fuzzy or out of focus.
Familiar objects become strange
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