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What substances can lead to addictive disorders?
What is the DSM-5 criteria for an addictive use disorder?
- The continued use of any mind altering substance DESPITE THE NEGATIVE CONSEQUENCES
- Combination of substance dependence and abuse
- *Evidence of tolerance, evidence of withdrawal
As an axis 1 diagnosis, what generally goes with this diagnosis (comorbidities)?
- Mood disorders (dual diagnosis)
- Chronic disease means addicted for life
- 15 years premature fatality
Define abuse and dependence. What is the most commonly abused substance? What drug is taken most to change how a person feels?
- Abuse: use wrongfully or in a harmful way
- Dependence: compulsive/chronic requirement
- Most prevalent substance: alcohol
- Most common drug taken to change how a person feels: nicotine
What common "personality" factors may contribute to an addictive use disorder?
- Decreased tolerance for frustration and pain
- Decreased self esteem and self regard
- Lack of life success
- Lack of meaningful relationships
- Risk taking
What is a dual diagnosis? Give an example. Who has the highest incidence?
- Axis I psychiatric diagnosis with another Axis II disorder
- Prison inmates have the highest incidence
What is the legal BAL? At what level will you see coma? What level is fatal?
- .08% legal BAL
- 0.4% coma
- 0.5% possible death
What assessments can be done for substance abuse?
- Family Assessment
- Self assessment
Describe the care continuum for clients with substance abuse
- Halfway huse
- Other housing
- Partial Hosp
- Intensive Outpatient treatment
- Out patient treatment
Describe the CAGE Screening tool
- Cut Down: have you felt you should cut down on your usage?
- Annoyed: have other people annoyed you concerning your usage?
- Guilty: have you ever felt guilty about your usage?
- Eye Opener: do you need to use to wake up in the morning?
Describe the SBIRT response
- S: screening using a standardized screening tool
- B, I: brief intervention. discuss the risks associated with the use of substance
- RT: referral to treatment. Suggest referral for a positive screen
What is Wernicke-Korsakoff Syndrome?
- Due to long term alcohol use
- Memory disorder caused by inadequate intake of thiamine and a continuation of carb consumption
- S/S: amnesia, confabulation, attention deficit, disorientation, vision impairment
What is Alcohol Withdrawal Syndrome? What are the S/S? What is the most important assessment question to ask to avoid this?
- Occurs within the first 412 hrs of reduction in heavy ETOh use
- Can progress to DT
- Most important question to ask on assessment, "when was your last drink"
- S/S: tremors, insomnia, agitation
- Ativan is used for alcohol withdrawal
How is Ativan dosed for alcohol withdrawal?
- Using the CWIA tool, which is like a sliding scale
- Given with thiamine, folate, MVI through IV on ED/MS floor
Assess the current state of withdrawal to use the tool
Describe the s/s of Delirium Tremens (DTs)
- Seizures (norepi increase from removal of CNS depressant)
- Hallucinations (tactile, usually first s/s)
- Death (tachycardia, HTN, electrolyte imbalances leading to EKG changes)
What is the treatments for DTs?
- MEDICAL EMERGENCY
- IV Dilantin
- Mag sulfate
- beta blockers
What is PNAP? When was it started and what are it's goals?
- Pennsylvania Nurse Assistance Program
- Developed by the ANA in 1982
- -have nurses recognize their impairment
- -obtain necessary treatment
- -regain accountability in their profession
*AA is the most successful way to stay sober