NS 411 Exam 3 Week 5

olanjones's version from 2017-06-13 00:12

Chapter 25 Key Terms

Question Answer
Substance abuse disorderoverarching term used to encompass both substance abuse & substance dependence
Substance abusemaladaptive pattern of substance use manifested by recurrent and significant adverse consequences occurring within a 12-month period.
Substance dependencecluster of cognitive, behavioral & psychological symptoms indicating that the individual continues to use a substance despite significant substance-related problems.
Unlike substance abuse, substance dependence includessymptoms of tolerance, withdrawal, & a pattern of compulsive use. Need to take larger amounts of drugs than intended.
Addiction as defined by National Institute on Drug Abusea chronic, relapsing brain disease characterized by compulsive drug seeking despite negative consequences
Pseudoaddictioncharacteristics of drug-seeking compulsive behaviors that are consistent with addiction. The behaviors are same, but underlying cause is different.
Overdoseexhibition of symptoms that indicate an individual has taken a level of a drug (or combo of drugs) that exceeds one's individual tolerance
Tolerancethe capacity to ingest more of the substance than other persons w/o showing impaired function.
Co-occurring disorders or comorbiditypsychiatric disorders and SUDs
Impaired nursesthose actively using brain-altering chemicals while treating clients
Person first languageterminology that reflects nonjudgmental and culturally sensitive responses will allow for therapeautic alliances to enhance communication.
Fetal alcohol spectrum disorders (FASDs)FAS; Alcohol-related neurodevelopmental disorders (ARNDs); Alcohol-related birth defects (ARBDs)
Co-dependenceterm used to describe the r/t b/t a person with an SUD & one or more persons attempt to assist through empathy & encouragement
Detoxificationtx w/d from alcohol and other drugs might be necessary for some substance-dependent individuals
Withdrawalisolated quiet room & calmed by nursing care that includes frequent checks of VS; reassurance; reality orientation to time, place & person; pharmacotherapy
Withdrawal symptoms occur because the body/brain have been trying to create a balance w/ continual use of a drug. When drug is no longer available, the systems of the body become overcompensated and unbalanced
Recovery-oriented systems of care (ROSC)both health & recovery depend on individuals experiencing wellness or well-being in addition to the absence of disease or infirmity.
Recovery from alcohol and drug problems is... a process of change through which an indiv. achieves abstinence & improved health, wellness & QOL
Treatment success is not only abstinence from substances, but also:stable housing, social support, access to services, retention in tx, client satisfaction in care, cost effectiveness, use of EBP, decreased involvement with legal system
Medication-assisted txform of pharmacotherapy & refers to any tx for an SUD that includes pharmacological intervention as part of a comprehensive SA tx plan
Substance use vs. dependence (or abuse) (From Lecture)Abuse: maladaptive patterns of substance use; falls outside of medical necessity or social acceptance; does not meet criteria for dependence. Dependence: impaired control over the use of substance characterized by drug tolerance to “stay normal” or prevent w/d; continued use despite adverse consequences; progressive trajectory.

Substance Abuse Objective ?s 1-4

Question Answer
Describe prevalence & impact of substance use disorders on individuals, families & communities- Prevalence: Prenatal exposure may cause FASDs (incidence of FAS is est. 1 to 2/1000; FAS, ARND, ARBD is 10/1000)
- Children: A growing number of children are using alcohol & illicit drugs - Current est >28 million Americans have parents w/ alcoholism; they have ↑risk of exposure to domestic violence (both observation & experience), ↓self-esteem, impaired attention disorders, problems w/ authority, social inadequacy, ↑sense of responsibility
- Families: Increased family conflict & chaos secondary to financial difficulty & legal involvements; Co-dependancy
The community/public health nurse can assist such families by encouraging active participation in self-help groups, helping to establish social support systems, recommending counseling and intervening to bring dysfunctional family patterns into balance
Biopsychosocial AKA Public Health Model of Addictioninteraction among agent, host & env’t.
Harm Reductiontraditional/pragmatic approach focuses on reducing drug use whereas PH approach tries to do the greatest good for the greatest # of ppl. Harm reduction focuses on moderation of substance use & minimization of its harmful effects; initiates treatment at the level which the client is currently using substances and strive for future reduction of harm to self and society
Clinics for needle exchangeplaces where they can do their drugs in a clean environment to prevent spread of diseases of blood borne disorders.
Gateway theory of drug useadolescents begin with alcohol, tobacco and marijuana then later go on to experiment with other drugs as they get older (sometimes).
Addiction as a brain diseaseit is not a matter of someone's personality or character, but a chronic disease that affects impulse control & decision making.
CNS Stimulantsamphetamines, cocaine, crack, caffeine & nicotine. Acceleration of normal body functioning.
CNS Depressantsalcohol, benzos, barbs, sedatives (Valium, Librium, Xanax/Seconal, Mnembutal, Quaaludes).
Stimulants s/sAccelerates normal body functioning; Dependence develops quickly; periods of "highs" are followed by a deep depression
Depressants s/s, intoxicationdepresses body functioning; w/d from ETOH & CNS depressants is associated with severe mortality & morbidity
OD of sedatives/hypnoticsvery dangerous; alcohol potentiates effect & causes respiratory depression, coma, convulsions, death. Naloxone/Narcan antagonist
S/S of opioid intoxicationconstricted pupils, ↓ respiration & BP, drowsiness, slurred speech, euphoria, impaired attention, memory & judgement
HallucinogensLSD, Mescaline, PCP. Sx: perceptual alteration, depersonalization, tachycardia & palpitations, PCP causes belligerence (safety of others is a concern)
Cannabiscan cause problems in high amounts

Substance Abuse

Question Answer
Nursing Diagnoses that may apply to ppl with SA disordersIneffective individual coping
Ineffective health maintenance
Ineffective family coping
Disturbance in self-esteem
Risk for injury
High risk for violence
Spiritual distress
NaltrexoneUsed to reduce craving; blocks euphoric effects of opioid for up to 72 hours
Disulfiram (Antabuse)Taken daily, prevents impulsive drinking. Must avoid hidden sources of alcohol in foods, fumes, and skin preparation.
Methadonesynthetic opiate, blocks craving for & effects of heroin; must be taken daily. Keeps client out of illegal drug culture while counseling is undertaken.
Buprenorphineblocks s/s of opioid w/d; may suppress heroin use.
Nicotine Replacement Therapy (NRT)alleviates some of the symptoms of nicotine withdrawal, e.g. depression.
Buproprion (Zyban)alleviates some of the symptoms of nicotine withdrawal, e.g. depression.
Varenicline (Chantix)blocks nicotine binding eases withdrawal by maintaining dopamine levels
Primary prevention responsibilites of PHNID & modification of risk & protective factors. Basic strategies such as information dissemination; promotion of personal development; establishment of norms & standards; ID alternatives; community development. POLICY changes (smoke-free envt).
Secondary Prevention resp. of PHN Early dx & tx (Screening/detection)
Tertiary prevention responsibilities of PHN*very critical in any chronic disorder as relapse is more normal than abnormal. Relapse prevention education; 12-step programs; psychotherapy ex. cognitive behavioral therapy; pharmacotherapy.
SBIRT stands forScreening, Brief Intervention, & Referral to Treatment
What is SBIRT?Comprehensive, integrated public health approach to delivery of early intervention and treatment services for those at risk and those with substance use disorders
CAGE ?sIn the last 3 months have you have you ever felt you should CUT down on your drinking? has anyone ANNOYED you or gotten on you nerves by telling you to cut down or stop drinking?Have you ever felt bad or GUILTY or bad about how much you drink? Have you been waking up wanting to have an alcoholic drink (or EYE-OPENER)?
EBP of effective drug addiction treatment *NTKTreatment does not need to be voluntary to be effective (Ppl do not have to hit rock bottom in order to intervene) May provide interventions for family members, etc. around a table with SA person and confront person with their abuse behavior. Discharge planning has to support a stable environment for when they leave the clinical env’t.
List other EB principles of effective drug addiction treatmentNo single tx is good for all; needs to be readily available; effective tx aimed at needs of individual; tx plans need assessment & modification continually; staying in tx for a certain period of time is critical for tx effectiveness; counseling/behavioral therapies are critical components of effective tx; Meds; med detox is first stage of tx
Recovery isa Long-term process and frequently requires multiple episodes of treatment
12-step programs fundamental conceptspowerless over the addiction & lives are unmanageable; are not responsible for disease but for their recovery; can no longer assign blame to others
Outcome criteria for rehab/recoveryacknowledge ATOD & the need for tx; ID & implement strategies for managing anxiety w/o using substances; develop coping strategies & use them to manage stressors; rebuild damaged interpersonal & work relationships; ID positive aspects of self.

Federal Agencies & Community Resources

Question Answer
Office of National Drug Control Policytargets certain goals r/t controlling illicit drugs in country. President gets to allocate what % gets to go to: -SA prevention -SA Treatment -Law Enforcement -Interdiction & International Counterdrug Support
SAMHSASubstance Abuse and Mental Health Services Administration. Focuses on SA and Mental Illness. Such a large agency so mission is broad, with multiple depts.
Center for SA Prevention (CSAP)prevent & reduce the abuse of illegal drugs, alcohol & tobacco
Center for SA Tx (CSAT)supports provision of effective SA Tx & recovery services
Office of Applied Studies (OAS) primary resp. to collect analyze & disseminate behavioral health data
National Institute on Drug Abuse (NIDA)use power of science to understand addiction and abuse
National Survey on Drug Use Health (NSDUH) *NTKevery year it is done, very critical survey on the reports and patterns, and consequences of drug & ETOH use. Primary source of info. on the use of illicit drugs, alcohol, tobacco. This is where you will see patterns in the U.S. on this survey.
Drug Abuse Warning Network (DAWN)not in use anymore, but it is a novel idea (imp. part of hx) as it was a way of trying to get a jump-start on drug use patterns of people visiting the ED which became the indication that there was a new indication that there was a new drug being used out there. PH surveillance system on bigger metro areas.
HX times of Joint Commission in 2000requirement of pain scales to be used caused an increase in opioid use because we didn’t have assessment tools, education in how to screen and understand SA disorders. For instance, your patient transitioning into addiction while they are in the hospital? Problem came when being prescribed opioids for 2 months or so without being asked if they had addiction issues, alcohol issues, family hx of addiction, any other RF??
What is the nurse's role when we go to the hospital? Getting training, education (for other HCP too, but it is still not efficient.