Psych Exam 2 Substance Abuse

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Psych Exam 2 Substance Abuse
2011-02-26 22:57:45
Nursing Psych

Substance Abuse
Show Answers:

  1. What are the 3 aspects of addiction?
    • Biological: genetics, low MAO, dehydrogenase, dopamine, acetate
    • Social: stigma, environment, peers, family, abuse
    • Psychological components: STRESS, depression, low self esteem, need for power, coping, hyperactivity, antisocial
  2. What is the brain reward system?
    • Deals with the limbic system
    • Dopamine and pleasure circuit
    • Drugs change brain physically and mentally
  3. How does the adolescent brain mature?
    • Back: areas of emotion, memory, impulse, psychomotor activity
    • Front: areas of fxn, planning, problem-solving, judgement, impulse control, organization (rational decision making)
  4. What happens to pathways when addicted?
    Pathways change & not always recovered
  5. What disorders can drug use cause?
    • Aggressiveness
    • Isolation
    • Depression
  6. Discuss addiction and brain circuits
    • Addiction changes brain circuits
    • Which leads to control circuit being impaired
  7. Define Addiction
    Uncontrollable, compulsive drug seeking & use, even in the face of negative health & social consequences
  8. Discuss Addiction
    • Chronic relapsing disorder/ disease
    • Erodes self control and ability to make decisions
    • No longer "free choice"
    • Intense impulses to seek and take drugs
    • Characterized by neuro-chemical and molecular changes in brain
  9. What Environmental Influences lead to drug use?
    • Early physical or sexual abuse
    • Witnessing violence
    • Stress
    • Peers who use drugs
    • Drug avaliability
  10. Define Craving
    • Intense wanting
    • The more you want the drug, the less you like it
  11. Discuss craving r/t physiology
    • Just 1 drink makes you want more
    • Acetate accumulates, causing the want more more acetate
  12. Where does craving occur?
    • Amygdala
    • Part of the limbic system that controls memory and emotions
  13. What are reasons for continued drug abuse?
    • Genetics, experience, environment, & drug effects create positive responses
    • Changes in neurotransmitters lead to tolerance and withdrawl syndromes
  14. Differentiate between use, abuse, & dependence
    • Abuse is using beyond the intended use
    • Dependence is physiological dependence with tolerance and withdrawl
  15. Define Physical Dependence/ tolerance
    • Not the same as addiction
    • An adaptive physiological state that results in withdrawl
    • Not drug seeking
    • Body requires more of substance to sustain the effect- body has gotten used to medication
  16. Define Substance Abuse
    • Maladaptive pattern of use leading to clinical significant impairment or distress manifested by one of the following within a 12 mo period:
    • Recurrent use with a failure to fulfill a major role at work, school, or home
    • Recurrent use in situations where use is physically hazardous
    • Recurrent substance-related legal problems
    • Recurrent use despite persistent social or interpersonal problems caused or exacerbated by substance use
  17. Defined Substance Dependence
    • At least 3 characteristics over 12 mos:
    • Evidence of tolerance
    • Evidence of withdrawl
    • Substance taken in larger amt or over long period of timd than intended
    • Persistent or unsuccessful desire to cut down or control use
    • Great deal of time spent in obtaining, using or recovering from substances
    • Cont'd use despite knowledge of persistent psychological or physical problems
  18. Differentiate Dependence vs Abuse
    • Dependence includes tolerance, withdrawl, or a pattern of compulsive use
    • Abuse includes only harmful consequences of repeated use
  19. Define Substance Induced Mood Disorder
    • A mood disturbance is prominent and persistent and is characterized by either (or both) of the following:
    • Depressed mood and markedly diminished interest or pleasure in all, or almost all, activities
    • Elevated, expansive, or irritable mood
    • Rule out: Axis 1 mood d/o or delerium
  20. Discuss Sx dev, Sx SE, and Meds of Substance Induced Mood Disorder
    • Sx developed during, or within a month of Substance Intoxication or Withdrawal
    • Sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
    • Med use is etiologically r/t the disturbance
  21. List Parts of Substance Use Assessment
    • Blood ETOH level (BAC)- 1oz/hr healthy liver metabolized
    • Drugs of Abuse Screen
    • Blackouts- still can fxn, but doesn't remember/aware
    • Withdrawal
    • Intoxication
    • Delirium Tremens
    • Relapse- recurrance of drug or ETOH abuse for significant amt of time
  22. Discuss Blackouts from Book
  23. Discuss Physiological Effect of Opioids
    • Opioids bind special proteins causing a block in transmission of pain messages to the brain
    • Opioids SE- drowsiness, constipation, respiratory depression
    • Cause Euphoria- pleasure in the brain
  24. List ACUTE Physiological Effects of ETOH
    • CNS Depressant
    • sedation
    • confusion
    • impaired motor fxn or speech
    • coma
    • respiratory failure
    • death
  25. List LONG-TERM Physiological Effects of ETOH
    • cerebellar degeneration
    • impaired coordination
    • broad-based unsteady gait
    • fine tremors
    • Dependence
    • Cirrhosis
    • ETOH-induced amnestic d/o
  26. List ACUTE Effects of Methamphetamines
    • Speeds up brain, nervous system, and body
    • Inc RR, BP, Temp
    • More alert/awake
    • Restlessness
    • Insomnia
    • Dec appetite
  27. List LONG-TERM Effects of Methamphetamines
    • Brain/heart damage
    • Labile mood
    • Violent/ aggressive behavior
    • Hallucinations
    • Paranoia
    • Wt loss
  28. List ACUTE Effects of Cocaine
    • Speeds up body and brain
    • Inc RR, BP, Temp
    • More alert/awake
  29. List LONG-TERM Effects of Cocaine
    • Lung damage
    • Nasal ulcers
    • Personality changed
    • Violent/ aggressive bahavior
    • Paranoia
    • Hallucinations
  30. List Sx of Sedative-Hypnotic Withdrawal Guide
    • Diaphoresis
    • Hallucinations
    • Confusion
    • Tremor
    • Restlessness
  31. List Assessment Pearls reguarding Sedative-Hypnotic Withdrawal Guide
    • Check neck for diaphoresis
    • Observe pt for hallucinations
    • Check abdomen for tremors
  32. Discuss Withdrawal Pt Education Handout
    • Prevent falls due to Orthostatic Hypotension
    • Get up slowly
    • Sit on edge of bed for 1 min
    • Drink 8-10 glasses of water
    • Report Dizziness
    • Do NOT flush vomit or diarrhea
  33. List Sx of Opioid Withdrawl Tool
    • Dialated pupils
    • Gooseflesh
    • Muscle Twitching
    • BP
    • Pulse
    • Temp
    • Vomitting
    • Diarrhea
  34. List Assessment Pearls reguarding Opioid Withdrawal Tool
    • Run fingers over forearm for gooseflesh
    • Sit for 5 min before BP
    • Tell pt- save vomit
    • Warm shower for aches
    • Non-med interventions
  35. Discuss Intoxication
    • Obvious impaired judgement and functioning, & maladaptive behavior
    • Scales: arousal, speech, gait, romberg, nystagmus
  36. Discuss Dual Diagnosis
    • Co-existing substance d/o and mental d/o may be assigned to special program
    • Program combines special therapies that target both problems
  37. Discuss Detoxification
    • Safe removal of the chemical from the body
    • Provide for physical, emotional, and psychological safety
  38. List Meds for ETOH detox/ Immediate Tx
    • Benzos
    • Anticonvulsants
    • Multivitamin Therapy
    • Thiamine
    • (note: tremors preceed seizures)
  39. List ETOH Delirium Tremens: DTs: Sx
    • Occur w/in 24-48 hrs, and continue 1 week
    • Agitation, confusion, anxiety, delusions, coarse tremors, fever, diaphoresis, inc heart rate, precordial pain
    • Seizures
    • Hallucinations- tactile & auditory
  40. List Delirium Tremens: Dts: Treatment
    • Life-support
    • Labs (electrolytes)
    • Hydrate
    • VS
    • Tx seizures
    • Tx BP w/ Clonidine
    • Tx w/ haldol
  41. List Tx for Opioid Detox/ Immediate Tx
    • Narcan (if resp distress)
    • ReVia or Revex (long term antagonists)
    • Methadone or Bupreorphine (slow replacement)
    • Clonidine (emergency BP)
  42. Discuss Methadone Maintenance in Prego
    • Steady State for baby
    • Baby 2-3X more intense
  43. List Nsg Intervention for Methadone Addicted Prego with W/D Sx
    • Holistic Care (esp. non-med interventions)
    • Referrals to programs
    • Care and nurture
  44. List Nsg Dx
    • Ineff denial
    • Early: Imbalanced Nutrition
    • After: Ineffective Coping
    • Not urgent: Risk for infection, low self-esteem, knowledge deficit
  45. List Outpatient Tx (Meds) for ETOH and Opioids
    • ETOH: Disulfiram, Naltrexone, Campral
    • Opioids: Burenorphine
  46. List Brief Intervention: The Frames Model
    • Feedback- drinking is risky
    • Responsibility- client change behavior
    • Advice to change
    • Menu of ways to reduce drinking
    • Empathic counseling
    • Self-efficacy (give message of empowerment)
  47. Discuss Nsg Interventions and Tx Modalities
    • Reduce
    • Harm reduction
    • Consequences (job)
    • Follow-up
  48. Discuss Rehab/ Recovery
    • Encourage cont'd participation in long-term tx
    • Promote participation in outpt support system
    • Assist client to id alternative sources of satisfaction
    • Provide support for health promotion and maintenance
  49. List HCP Priorities
    • Provide support
    • Strengthen coping skills
    • Facilitate learning
    • Promote family involvement
    • Facilitate family growth/dev
    • Provide info
  50. List HCP Common D/C Goals
    • Responsibility for own life
    • Plan for substance-free
    • Family relationships addressed
    • Tx program started
    • Condition, prognosis, therapy understood
  51. Discuss Mgt of Illness (Teaching)
    • Activities to substitute substances in times of stress
    • Relaxation techniques
    • Problem-solving skills
    • Essentials of good nutrition
  52. Discuss Naltrexone for Tx ETOH Dependence
    • Blocks receptors resulting in Reduced Craving
    • Contraindicated in acute opioid withdrawal
    • Precipitates severe withdrawal if depended on opioids
    • Monitor liver fxn
  53. Discuss Acamprosate (Campral) for Tx ETOH Dependence
    • Action: Affects glutamate neurotrasmitter
    • Monitor renal fxn
    • Adverse: SI and behavior
  54. Discuss Disulfiram for Tx ETOH Dependence
    • Action: inhibits metabolism
    • DO NOT DRINK ETOH w/in 12 hrs!!!
    • Rxn- flushing, sweating, nausea, tachycardia