Term
|
Definition
| The use of mind-altering substances goes back to antiquity. |
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Term
| What are the 3 c's of addiction? |
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Definition
“Craving to Compulsive use”
Continued use despite adverse consequences
Loss of Control |
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Term
| What is the additional C? |
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Definition
| Another “C”—Cognitive impairment in core executive functions |
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Term
| What are the non substance addictions? |
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Definition
Compulsive: Gambling, overeating, shopping, sex
addictions, cell phone sexting, Internet use (e.g., pornography, online gambling) |
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Term
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Definition
| Use of a substance occurs outside of a medical necessity. |
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Term
| What is substance DEPENDENCE? |
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Definition
| Control over substance is lost. |
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Term
| When does one use in abuse? |
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Definition
| Use of a substance occurs outside of social acceptance. |
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Term
| What is associated with DEPENDENCE? |
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Definition
| Tolerance occurs when a person has to take more of the drug to “stay normal” and/or to prevent withdrawal |
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Term
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Definition
| regulates pleasure and pain and plays a major role in all addictions. |
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Term
| What do drugs of abuse affect? |
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Definition
| the limbic (reward) system. |
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Term
| What does first time drug abuse do? |
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Definition
| releases a large amount of dopamine. |
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Term
| Can neurons regulate dopamine? |
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Definition
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Term
| Can dopamine stimulate the reward center? |
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Definition
|
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Term
| What is used to increase dopamine? |
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Definition
|
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Term
| What are the cognitive deficits associated w/ substance abuse? |
|
Definition
Impaired memory
Decreased LOC
Impaired judgment
Impaired social functioning
Impaired attention, executive function, Impulse control |
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Term
| What nursing diagnoses are associated w/ substance use and dependence? |
|
Definition
Imbalanced nutrition: less than body requirements
Ineffective airway clearance
Ineffective breathing pattern
Ineffective health maintenance
Disturbed thought processes
Disturbed sleep patterns
Hopelessness
Risk for suicide
Risk for other-directed violence |
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Term
|
Definition
| Reduces or eliminates alcohol craving. |
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Term
| What is acamprosate? (ReVia) |
|
Definition
| Helps patient abstain from alcohol. |
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Term
| What is topiramate? (Campral) |
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Definition
| Works to decrease alcohol cravings. |
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Term
| What is disulfiram? (Antabuse) |
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Definition
| Alcohol-disulfiram reaction causes unpleasant physical effects. |
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Term
| Your patient asks, “Will Antabuse really help me with my drinking problem?” What is your most appropriate response? |
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Definition
B. “Yes, if you use it correctly.”
This answer incorporates most factors (correct use) related to success with Antabuse. Correct use includes motivation, correct dosage, right time, and support systems. |
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Term
| What should be focused on in the assessment of addiction? |
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Definition
Nursing health history
Medical history
Physical assessment
History of substance use and abuse
Results of laboratory and diagnostic tests
Assessments from other health professionals
Psychiatric history
Psychosocial history |
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Term
| What are common signs of stimulant abuse? |
|
Definition
Dilation of the pupils
Dryness of the oronasal cavity
Excessive motor activity |
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Term
| Where do cocaine and crack come from? |
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Definition
|
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Term
| What happens when crack/cocaine are smoked? |
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Definition
It takes effect in 4 to 6 seconds.
After 5 to 7 minutes, a “high” follows |
|
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Term
| What are the 2 main effects of cocaine/crack? |
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Definition
|
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Term
| What does crack/cocaine do to the neurotransmitters? |
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Definition
|
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Term
| What are withdrawal syndromes of cocaine/crack? |
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Definition
| depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, and chills. |
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Term
| What are the intoxication effects of opiates? |
|
Definition
Constricted pupils
Decreased respiration
Decreased blood pressure
Slurred speech
Drowsiness
Psychomotor retardation
Initial: euphoria
Later: dysphoria
Impaired:
Concentration
Judgment
Memory |
|
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Term
| What are the withdrawal effects of opiates? |
|
Definition
Yawning
Insomnia
Irritability
Rhinorrhea
Panic
Diaphoresis
Cramps
Nausea and vomiting
Muscle aches
Chills and fever
Lacrimation
Diarrhea |
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Term
|
Definition
Morphine
Heroin
Codeine
Fentanyl
Methadone
Meperidine |
|
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Term
| What does methadone (Dolophine) do? |
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Definition
| Is a synthetic opiate that blocks the craving for and effects of heroin. |
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Term
| What does l-α-acetylmethadol (LAAM) do? |
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Definition
| Is an alternative to methadone. |
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Term
| What is Naltrexone (ReVia) used for w/ opiates? |
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Definition
| Is an antagonist that blocks the euphoric effects of opioids. |
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Term
| What does clonidine (Catapres) do? |
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Definition
| Is an effective somatic treatment when combined with naltrexone. |
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Term
| What does buprenorphine (Subutex) do? |
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Definition
| Blocks the signs and symptoms of opioid withdrawal. |
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Term
|
Definition
|
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Term
| How is marijuana usually ingested? |
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Definition
|
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Term
| What is the active ingredient in pot? |
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Definition
| Tetrahydrocannabinol (THC |
|
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Term
| What properties does pot contain? |
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Definition
| Has depressant and hallucinogenic properties |
|
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Term
| What is the desired effect of pot? |
|
Definition
| include euphoria, detachment, and relaxation. |
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Term
| What are the long term effects of pot? |
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Definition
| lethargy, anhedonia, difficulty concentrating, and loss of memory |
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Term
| What are the hallucinogens? |
|
Definition
Lysergic acid diethylamide (LSD) or acid
Mescaline (Peyote)
Psilocybin (magic mushroom)
Phencyclidine piperidine (PCP), angel dust, horse tranquilizer, and peace pill |
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Term
|
Definition
Volatile solvents
Spray paint
Glue
Cigarette lighter fluid
Propellant gases used in aerosols |
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Term
|
Definition
Common drugs
• Ecstasy—Is also called MDMA, Adam, Yaba, XTC
• MDA—“Love”
• MDE—“Eve |
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Term
|
Definition
| produce subjective effects resembling stimulants and hallucinogens |
|
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Term
| What are the date rape drugs? |
|
Definition
Flunitrazepam (Rohypnol or “Roofies”)
Gamma hydroxybutyric acid (GHB) |
|
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Term
| What are the date rape drugs effect? |
|
Definition
Disinhibition
Relaxation of voluntary muscles
Anterograde amnesia |
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Term
| What are you looking for when assessing the chemically impaired? |
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Definition
Withdrawal syndrome
Overdose that warrants medical attention
Suicidal thoughts or other self-destructive behaviors
Knowledge of the patient and family of community resources
Evaluate for physical complications related to drug abuse.
Explore the patient’s interest in doing something about the drug or alcohol problem. |
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Term
| What is AA? How is this spiritual? |
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Definition
Alcoholics Anonymous (AA) and other recovery modalities.
Spirituality practices are related to improved outcomes.
Higher spiritual levels often correlate with:
Sense of purpose
Gratitude
Forgiveness |
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Term
| What are the signs of alcohol WITHDRAWAL? |
|
Definition
Early signs within a few hours
Peaks 24 to 48 hours
Rapidly and dramatically disappears unless it progresses to delirium
Irritability and “shaking inside”
Grand mal seizures possible in 7 to 48 hours after cessation
Illusions |
|
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Term
| What are the signs of alcohol DELERIUM? |
|
Definition
Medical emergency
Possible death
Peaks 2 to 3 days after cessation and reduction
Autonomic hyperactivity
Sensorial and perceptual disturbances
Fluctuating loss of consciousness (LOC)
Delusions (paranoid)
Agitated behaviors
Body temperature 100° F and higher |
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Term
| What is the C in cage-aid? |
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Definition
| Have you ever felt you ought to Cut down on your drinking (or drug use)? |
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Term
| What is the A in cage-aid? |
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Definition
| Have people Annoyed you by criticizing your drinking (drug use)? |
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Term
| What is the G in cage-aid? |
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Definition
| Have you ever felt bad or Guilty about your drinking (drug use)? |
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Term
| What is the E in cage-aid? |
|
Definition
| Have you ever had a drink (used drugs) first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover? |
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|
Term
| What is the AID in cage-aid? |
|
Definition
|
|
Term
| Jessie (see Case Study on Slide 13) had a blood alcohol level (BAL) of 0.11% upon arrival at the emergency department (ED). She is now your patient in the hospital psychiatric unit, day 4. She tells you, “ I wasn’t drunk. I just had a few beers.” What is an appropriate response? |
|
Definition
B. “Jessie, your BAL was 0.11%. That clearly indicates that you had alcohol intoxication.”
This response offers clear and documented evidence of Jessie’s BAL. It is an appropriate response in this situation and presents reality without judgment. |
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Term
| How does teamwork and collaboration factor into helping an impaired colleague, as well as providing safety for the patients under his or her care? |
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Definition
Reporting an impaired colleague is a peer responsibility.
Clear documentation by co-workers is crucial.
Intervention is the responsibility of the nurse manager and administrators.
If an impaired nurse remains in the situation and no action is taken by the nurse manager, then information must be taken to the next level in the chain of command.
Provide alternative-to-discipline (ADT) programs. |
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Term
|
Definition
Excused or ignored peer behaviors.
Never told a supervisor about behaviors that may indicate impairment.
Accepted the responsibility for a colleague’s unfinished work.
Believed that nurses do not use drugs or alcohol (impairment).
Liked to use drugs or alcohol myself and feel guilty for reporting.
Exonerated peer’s irresponsible actions.
Defended a colleague. |
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Term
| What Nursing Care and Pharmacologic Therapy is involved w/ alcohol withdrawal? |
|
Definition
Safely and comfortably help achieve detoxification.
Enhance motivation for abstinence and recovery.
Medications include:
benzodiazepines
anticonvulsants
beta-blockers
magnesium sulfate, thiamine (B1), folic acid, and multivitamins |
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Term
| Describe assessment strategies for people with alcohol and drug problems? |
|
Definition
1.) History of substance use (screening is the 1st step)
2.) Medical History
3.) Psychiatric History
4.) Psychosocial issues |
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|
Term
| What are congenital treatments used for addiction? |
|
Definition
Psychotherapy
Group therapy
Cognitive-behavioral therapy (CBT)
Motivational incentives
Motivational interviewing |
|
|
Term
| What are recovery models? |
|
Definition
12 Step Programs: AA, Al-Anon, Ala-Teen
SMART—self-management and recovery training
Programs:
Residential intensive outpatient
Outpatient drug-free
Employee assistance |
|
|
Term
| What are the relapse prevention strategies for patient planning? |
|
Definition
-Basics
+Keep the program simple at first.
+Review the instructions with health team members.
+Write down important information and telephone numbers.
-Skills
+CBT
-Relapse Prevention Groups
-Enhancement of personal insight |
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Term
| Jessie (see Case Study on Slide 13) is now attending AA meetings three times a week for the past 6 weeks. She has been sober during this time and visits bi-weekly the community mental health outpatient clinic. Jessie’s nurse counselor wants to talk with her about the AA meetings. Which initial question or statement is most appropriate? |
|
Definition
Tell me about the last AA meeting you attended.
Initially asking Jessie to talk about the last meeting gives Jessie an opportunity to elaborate. Asking specifically about the last meeting helps Jessie focus. |
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Term
| Jessie has missed three sessions at the mental health center and sporadically attends AA meetings. She is drinking heavily this weekend and has sustained a 2-inch gash in her forehead after swerving off the road into a shallow ditch. She is taken by rescue to the ED. You are her nurse. She tells you, “I hope I just go to sleep and never wake up.” What is your best intervention? |
|
Definition
Stay with Jessie, call the supervisor, and arrange for continuous monitoring.
*Jessie needs continuous monitoring since she has voiced suicidal ideation. Notifying the nursing supervisor and the attending ED physician is appropriate protocol. A 24-hour sitter or family member needs to stay with Jessie. |
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Term
Addiction is a term, along with habituation, which the WHO recommends be substituted with substance use.
T or F? |
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Definition
False
Rationale: Addiction is a term, along with habituation, which the WHO recommends be substituted with substance dependence. However, clients and practitioners commonly use addiction. |
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Term
| What behaviors are associated w/ substance abuse? |
|
Definition
Problems at work, home, and school
Problems with family or friends
Physical danger
Trouble with the law |
|
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Term
|
Definition
The use of alcohol, illicit drugs, and nonmedical use of prescription medications
Illicit drugs include cannabis, cocaine, heroin, hallucinogens, inhalants, and methamphetamine.
Nonmedical use of prescription medications includes pain relievers, tranquilizers, stimulants, and sedatives. |
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|
Term
With no use of illicit substances or alcohol in the preceding 9 months, a person is considered “abstinent”.
T or F? |
|
Definition
|
|
Term
| What should be substituted for dependence? |
|
Definition
|
|
Term
| What is substance dependence? |
|
Definition
Health and emotional problems associated with substance use
Unsuccessful efforts to cut down on use
Symptoms of tolerance or withdrawal
Reducing other activities to use the substance
Spending time in activities related to substance use
Using the substance in greater quantities or for a longer period of time than intended |
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|
Term
The United States leads the world in rates of substance use.
T or F? |
|
Definition
|
|
Term
| What is the focus of all interventions of substance abuse/use? |
|
Definition
The agent (the distributor of the substance)
The host (the addicted person)
The environment (local, national, or international) |
|
|
Term
| Who is at high risk for a substance disorder? |
|
Definition
Pregnant women
Children under the age of 14
College students, older adults in the baby-boom generation |
|
|
Term
Studies of disadvantaged adolescents in impoverished areas or homeless youth have found that youth follow a stepwise progression of substance use.
T or F? |
|
Definition
False
Studies of disadvantaged adolescents in impoverished areas or homeless youth have not found that these youth follow such a stepwise progression of substance use. |
|
|
Term
| What environmental factors increase incidence of substance problems? |
|
Definition
Poverty
Lack of access to health services
Capacity of law enforcement to constrain supply |
|
|
Term
| What ethnic groups are more likely to suffer from substance problems? |
|
Definition
Native Americans
Alaskan Natives
African Americans |
|
|
Term
| What are the biopsychosocial risk factors? |
|
Definition
Genetic history
Family history
History of trauma
Early initiation
Environmental factors
+Poverty
+Group affiliation |
|
|
Term
| What internvetions decrease substance problems in adolescents? |
|
Definition
Regulatory
Developmental prevention
Early screening
Harm reduction |
|
|
Term
| What interventions are r/t college students and binge drinking? |
|
Definition
Developmental prevention programs
Early screening and brief intervention
Government laws and school policies to reduce harmful incidents
Tertiary treatments for those who meet criteria for substance use disorder or other associated mental disorders |
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|
Term
| What is behavioral counseling of alcohol abuse? (5 A's!) |
|
Definition
Assess using standardized screening instruments
Advise the older adult to reduce alcohol consumption to moderate levels
Agree on goals for reducing alcohol use or abstinence
Assist clients with acquiring the motivations, self-help skills, or supports needed for behavior change
Arrange follow-up counseling and treatment |
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|
Term
Screening for substance use is the second step in assessing if a person has substance use disorder.
T or F? |
|
Definition
False
Rationale: Screening for substance use is the first step in assessing if a person has substance use disorder. |
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