Med Surg Test 1 Review (addictive behaviors)

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FeverRN
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Med Surg Test 1 Review (addictive behaviors)
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2010-06-16 16:59:30
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med surge test one addictive behaviors drug use
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Med Surg Test 1 Review (addictive behaviors)
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  1. Addiction
    • - Addiction has been defined as an illness characterized by
    • ◦Compulsion
    • ◦loss of control
    • ◦continued patterns of abuse despite perceived negative consequences
    • ◦obsession with a dysfunctional habit (ANA, 1987).

    }= term used to define a state of chronic or recurrent drug intoxication, characterized by psychological and physical dependence as well as tolerance.
  2. Stimulants
    • }Nicotine
    • }Cocaine
    • }Amphetamines
    • }Caffeine
  3. Nicotine
    • }Characteristics
    • ◦Cigarettes, chewing tobacco

    • }Effects of use
    • ◦stimulant that elevates BP & increases heart rate

    • }Complications
    • ◦Lung cancer, COPD, and others

    • }Collaborative care
    • ◦Prevention of tobacco use
    • ◦Tobacco cessation

    Nicotine- always assessed on admission!
  4. Cocaine
    • }Characteristics
    • ◦Powder form (snorted), IV, smoked (crack)

    • }Effects of use
    • ◦pupillary dilation; increased blood pressure, respirations, and temperature; less common effects: loss of appetite, insomnia, impaired thinking, agitation, panic attacks or cocaine psychosis.

    • }Complications
    • ◦Stimulant psychosis
    • ◦Acute cocaine toxicity

    Collaborative care
  5. Amphetamines
    • }Characteristics
    • ◦Poor man’s cocaine

    • }Effects of use
    • ◦“pep pills”; directly stimulate CNS
    • ◦ Effects on the body: increased heart rate; elevated blood pressure; excitability; hand tremors; talkativeness; diaphoresis; dry mouth; abnormal heart rhythms; headaches; pallor; diarrhea; unclear speech.

    • }Complications
    • ◦“Overamping”Collaborative care
  6. Caffeine
    • }Characteristics
    • ◦Most widely used psychoactive substance

    • }Effects of use
    • ◦stimulant that elevates BP & increases heart rate.

    }Complications

    }Collaborative care
  7. Depressants
    }Alcohol

    }Sedative/Hypnotics

    }Opiods
  8. Alcohol
    • }Characteristics
    • ◦Consumed by more than ½ Americans age 12 & >

    • }Effects of use
    • ◦Relaxation, emotional lability, hypotension, bradycardia, constricted pupils

    • }Complications
    • ◦Acute alcohol toxicity
    • ◦Wernicke’s encephalopathy

    • }Collaborative care
    • ◦Detoxification
  9. Alcoholism
    }= CNS depressant; produces relaxation, loss of inhibitions

    • }Intoxication:
    • ◦slurred speech, unsteady gait. lack of coordination; impaired attention, concentration, memory, and judgment

    • }Overdose:
    • ◦ vomiting, unconsciousness, respiratory depression, hypotension, death

    • }Withdrawal can be life-threatening; detoxification under medical supervision is needed.
    • ◦coarse hand tremors, sweating, elevated blood pressure and pulse, insomnia, anxiety, nausea or vomiting

    • }Severe or untreated withdrawal:
    • ◦transient hallucinations, seizures, delirium tremens (DTs)

    }Safe withdrawal from alcohol includes use of vitamin B1 (thiamine) supplements to prevent or treat Wernicke-Korsakoff’s syndrome, folic acid, multivitamins, cyanocobalamin (vitamin B12) for nutritional deficiencies, sedation, calm well lit environment.

    }Withdrawal can take 2 days to 2 weeks.
  10. Sedative-Hypnotics
    • }Characteristics
    • ◦Substances: benzodiazepines; barbiturates; hypnotics; prescription sleeping medication; and all anxiolytic medications.

    • }Effects of use
    • ◦Increased inhibition, impaired judgement, hypotension, bradycardia, bradypnea, constricted pupils
    • ◦Rebound anxiety

    }Complications

    }Collaborative care
  11. Opioids
    • }Characteristics
    • ◦Resemble opium or alkaloid derivatives; opiate: any chemical derived from opium. Considered most addictive drugs.

    • }Effects of use
    • ◦Analgesia, euphoria, impaired judgment constricted pupils, nausea, decreased respirations

    }Complications

    }Collaborative care
  12. Other Drugs of Abuse
    • }Cannabis
    • }Characteristics
    • - most widely used illicit drugs in U.S.
    • - THC
    • }Effects of use
    • ◦Euphoria
    • ◦Sedation
    • ◦Hallucinations
    • }Complications
    • }Collaborative care

    • }Psychedelic Agents
    • ◦change in level of consciousness (hallucination, psychosis)
    • ◦increased vital signs, dilated pupils, feeling of enormous strength
    • ◦ Ex.-LSD, Ecstasy, PCP, mushrooms, and others
  13. Inhalants
    • }Four main classes
    • ◦Volatile solvents
    • ◦Aerosols
    • ◦Anesthetic agents
    • ◦Nitrites

    }Cause confusion, excitement, and hallucinations

    }Commonly abused inhalants: glue, gasoline, lighter fluid, paint thinner, varnish, shellac, nail polish remover, aerosol-packaged products.
  14. Treatment of Addictions
    }= based on the concept that alcoholism & drug addictions a medical illness: chronic, progressive, characterized by remissions and relapses

    }Tx may be as out or inpatient depending on client’s circumstances & ability to abstain from alcohol or drugs (as well as insurance)

    }Attitudes of the nurse can influence quality of care they provide.

    • }Disulfiram (Antabuse) to help client abstain from alcohol;
    • ◦methadone as a substitute for heroin
    • ◦Naltrexone (ReVia) to block effects of opioids and reduce cravings for alcohol
    • ◦Clonidine (Catapres) to suppress opiate withdrawal
    • ◦Bromocriptine (Parlodel) to decrease cocaine cravings

    • }12-step program developed by Alcoholics Anonymous (AA)
    • ◦Focus is on group experiences involving education, problem-solving techniques, cognitive techniques to identify and modify faulty thinking, coping with life, stress, and other people without the use of substances
  15. Nursing process with substance abuse
    • }Assessment
    • ◦Michigan Alcoholism Screening Test (MAST)
    • –http://www.1016.org/MiAlcTst.html
    • ◦Denial is a major component of substance abuse, so identifying clients can be difficult. Several screening devices are available. Detoxification is a priority.
    • ◦History: chaotic family life, family history, crisis that precipitated treatment
    • ◦General appearance and motor behavior: depends on physical health; likely to be fatigued, anxious
    • ◦Mood and affect: may be tearful, expressing guilt and remorse; angry, sullen, quiet, unwilling to talk
    • ◦Thought processes and content: users often minimize substance use, blame others for problems, rationalize their behavior, say they can quit on their own

    • ◦Sensory & intellectual processes: usually alert and oriented; intellectual abilities intact (unless neurologic deficits from long-term alcohol or inhalants)
    • ◦Judgment and insight: poor judgment while intoxicated and due to cravings for substance; insight usually limited
    • ◦Self-concept: low self-esteem, feels inadequate at coping with life
    • ◦Roles and relationships: strained relationships and problems with role fulfillment due to substance use
    • ◦Physiologic considerations: may have trouble eating and sleeping; HIV risk if IV drug user
    • ◦Other health problems associated with substance use
  16. }Assessment-Substances Other Than Alcohol
    • –Direct questions towards:
    • –substance identification
    • –amount and frequency of use
    • –duration of use
    • –route of administration
    • –history of suicidal ideation or attempts
    • –withdrawal symptoms
    • –longest drug-free period
    • –desire for treatment.

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