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What is substance abuse?
Repeated use of a drug while knowing the negative consequences
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What is substance dependence?
Poor pattern of substance use leading to impairment and loss of control
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Substance dependence common symptoms
Tolerance
Withdrawal symptoms
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If a patient is intoxicated upon admission try to get ______ and when the patient sobers up, try to get ______ again.
Informed consent
Informed consent
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Is addiction a disease?
Yes
It's pathological, so the patient can't help it
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Why aren't we all addicted?
Religion
Routine family gatherings
Support
Genetic risk factor
No trauma or psych disorders
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Substances of Abuse:
CNS Depressants
- Alcohol
- Barbiturates
- Opioids
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Substances of Abuse:
CNS Stimulants
- Amphetamines
- Nicotine
- Caffeine
- Cocaine
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Substances of Abuse:
Other
- Hallucinogens
- Inhalants
- Marijuana
- Sedatives, Hypnotics, Anxiolytics
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Chronic alcohol use can also lead to
Gastritis
- Esophagitis
- (Typical to see JVD)
- Pancreatitis
- (Very painful)
- Wernicke - temporary
- Korsakoff - permanent
- (Thiamin deficient)
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Most common problems with alcohol use is
Hepatitis and Cirrhosis
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Alcohol withdrawal:
Timeline:
S/S:***
6-12 hours after last drink
- Tremors of hands, tongue, eyelids
- N&V
- Tachycardia
- Diaphoresis
- Irritability
- Headache
- Insomnia
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Delirium Tremens:
Definition:
Onset:
S/S:
Timeline:
Treatment:
Major withdrawal causing disturbed consciousness and altered mental status
48-72 hours
- Hallucinations (see/feel bugs)
- Seizures
Lasts 1 week-1month
- Benzodiazepines
- Anticonvulsants
- Vitamins
- Thiamine (IM)
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The nurse is aware that the defense mechanism commonly used by clients who are alcoholics is
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A 20y/o male falls off a roof and fractures his right femur and left tibia. The client reveals a history of substance dependence. a primary concern for the nurse caring for this patient would be to
Realize the client will need more pain medication than the nonabuse
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A 65y/o male is admitted to a mental health facility with a diagnosis of substance-induced persisting dementia resulting from chronic alcoholism. When conducting the interview, the nurse determines the client is using confabulation. This is due to
Marked memory loss
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The nurse's plan of care for a client with substance-induced persisting dementia resulting from alcoholism should take into consideration that this disorder is thought to be caused by
A deficiency of thiamine in the diet
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When planning for a client who has a long history of heavy drinking, the nurse must be aware that symptoms of withdrawal usually occur
8-12 hours after the last drink
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A client with a long history of heavy drinking is brought to a psychiatric facility in a stupor. On the day after admission the client is confused, disoriented and delusional. The client may be developing alcoholic
Withdrawal delirium
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Opioid effects on the body:
CNS:
GI:
C/V:
Other:
Pupil constriction, respiratory depression, sedation, mood changes
Constipation, slow peristalsis
Hypotension
- Sexual dysfunction
- Euphoria
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Opioid withdrawal timelines:
Demerol:
Heroin:
Methadone:
8-12 hours, lasts 4-5 days
6-24 hours, lasts 5-7 days
1-3 days, lasts 2 weeks
(Not life-threatening, just really uncomfortable)
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Opiate overdose:
What is the antidote?
Why must you monitor VS every 15 minutes?
Narcan (Naloxone)
To make sure the patient doesn't go into respiratory depression
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Nicotine replacment therapy
- Varenicline (Chantix)
- (Has many side effects)
Buproprian (Zyban)
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Hallucinogen S/S:
- Dilated pupils
- Diaphoresis
- Sleeplessness
- Dry mouth
- Tremors
- Suppress high cerebral function
- Synesthesia ("Hear colors, smell sounds")
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Benzodiazepines must be slowly tapered off because
If not then patient will be at high risk of seizures and diaphoresis
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CAGE Questionnaire
C - Have you ever felt you should CUT down on your drinking?
A - Have people ANNOYED you by criticizing your drinking?
G - Have you ever felt bad or GUILTY about your drinking?
E - Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (EYE opener)
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