Create
Learn
Share

Psych Exam IV Substance-Related Disorders

rename
amprevel's version from 2017-02-12 02:23

Alcohol Use Disorder

Question Answer
Timeline for ETOH w/d4-12 hrs after cessation/redux of heavy use
M ETOH w/d- coarse tremor: tounge, hands, eyelids,
- n/v
- mailsae, weakness, tacky, sweating
- elevated BP
- anxiety, depressed, irrit
- transient halluc/delus
- H/A, insomnia
Complicated w/d syndrome- ETOH w/d delirium
- 2nd/3rd day following cessation heavy use
M substance w/d delirium- diffuculty w/ attention, destractible
- disorganized thinking
- speech incoherent, pressured
- disorientation time and place
- recent memory impairment
- disturbances sleep/wake cycle
-changes in LOC, sleep pattern, cognitive processes, emotional instability
Nursing Diagnoses-Risk for low cardiac output
-Anxiety/fear r/t physiological withdrawal AEB increased tension, apprehension
-Risk for injury
-Sensory-Perceptual Alteration r/t chemical alteration AEB disorientation
ETOH use complixcardiomyopathy, neuropathy (peripheral), cirrhosis, Wernicke-Korsakoff’s syndrome
CardiomyopathyCHF, arrhythmia, accumulation if lipid in myocardial cells, results in enlargement and weakened condition
Neuropathy-peripheral nerve dmg, pain , burning, tickling, prickly sensation.
-Et: Vit B and Thiamine deficiency
Wernicke-Korsakoff’s Syndrome- Wernicke’s encephalopathy: diplopia, ataxia, somnolence, stupor. et: thiamine def, paralysis of ocular muscles
- Korsakoff’s psychosis: confusion, loss of recent memory, confabulation. Frequently encountered in pts recovering from Wernicke’s enceph.
CIWA (10 criteria) Rated from 0-7 except orientation & clouding of sensation 0-4Nausea/vomiting, Tremor, Anxiety, Agitation, Paroxysmal sweat, Orientation & clouding of sensation, Tactile disturbance, Auditory disturbance, Visual disturbance, headache
Interventions includeAdminister medications as prescribed for intoxication & withdrawal, Monitor for covert substance use during detoxification, Emotional support
DetoxificationProvide safe and supportive environment, Administer substitution therapy
Intermediate CareExplain physical symptoms; Promote understanding & identify causes of substance dependency; Help client accept use of substance as a problem; Provide education & assistance to client and family
RehabilitationParticipation in long-term treatment; Participation in outpatient support system; Assist client to identify alternative sources of satisfaction
Early Treatment MedsBenzodiazepines, Barbiturates, Thiamine, Magnesium sulfate, Phenergan
Sobriety Maintenance DrugsDisulfiram (Antabuse), Naltrexone (Revia), Vivitrol, Acamprosate (Campral)
Biochemical/anatomical changes in substance UDOchanges in nucleus accumbens, changes in expression of NTs inc. serotonin and dec. Dopamine. ETOH causes release of morphine-like subs in brain, genetic variants of ADH gene, alleles for GABA. Asians have decreased functionality of ADH --> aversion to drinking.
memorize

AUD Teaching

Question Answer
Therapeutic communicationVery important for nurse to examine own attitudes about substance use - clients in recovery need to know they are accepted for themselves, regardless of past behavior
Explain toleranceamount required to achieve the desired effect increases steadily with use of substance (takes more each time)
Treatment programsAl-Anon/Alateen, Alcoholics Anonymous (AA), Self-Management and Recovery Training (SMART)
Residential Programs, Intensive Outpatient Programs, Subacute Inpatient Programs (Roger Williams Medical Center)
TeachingClient/family about co-dependency, about addiction & initial treatment goal of abstinence, about removing prescription medication in the home that are not being used
Develop motivation & commitment for abstinence & recovery, Encourage self-responsibility
Help client develop emergency plan-a list of things clients would need to do and people he would need to contact, Encourage attendance at self-help groups
Prevention teaching for an addict to recognizeEarly Relapse: Any relapse less than one year - signs: Cravings, Triggers
Late Relapse: Any relapse greater than one year - signs: Spontaneous Cravings, Re-exposure, Stress
memorize

Pharm tx ETOH UDO

Question Answer
Pharm treatment ETOH overdosebenzodiazepine, barbiturates, thiamine, mag sulfate, phenergan
CI for longer acting benzos in which pts for ETOH w/d? What to use insteadCI for pts w/ hepatic dis: diazepam/Valium, chlordiazepoxide/Librium. Use instead: lorazepam/Ativan and oxazepam/Serax
Pharm treatment ETOH abuse txdisulfiram (Antabuse), Naltrexone (Revia), Vvivitrol, Acamprosate (Campral)
Naltrexone/Vivitrol/Revia NCnarcotic/opiod antagonist, competitive binding, induces w/d, stimulates resp.
- short acting
- sx of resp depression signify wearing off. May need additional doses. Call provider if miss a dose!
- CI: hepatic disease
Antabuse /disulfiram NC-interacts w/alchohol to produce rxn of flushing (acetaldehyde accumulation), coughin, diff breathing, nausea, vomiting, pallor, anxiety.
- CI: DM, atherosclerosis, cirrhosis, kidney dis, psychosis – based on behavioral therapy. Overt sensitization
Acamprosate (Campral) MOA/NCmaintaining abstinence from ETOH by balancing excitation(+)/relaxation(-) works on glutamate(+) and GABA(-). Will not eliminate sx of w/d. If relapse: keep taking drug!
Benzodiazepine overdose antidoteFlumazenil (Romazicon) is a competitive benzodiazepine receptor antagonist
Substitution therapyused to reduce life-threatening effect from substances
Thiamine, MOA in ETOH w/d txcommonly def in chronic ETOH. Replacement prevents neuropathy, confusion, and encephalopthy
memorize

Pharm tx other substance UDO

Question Answer
Pharm treatment Opioids overuseNaloxone/Narcan; Nalmefene/Revex, Naltrexone/Vivitrol/Revia – narcotic antagonists. Methodone for suppression w/d sx.
Buphrenorphine opiod UD txsafer, less SE than methadone. Use for cts mildly/moderately addicted. Provider must be member of Amer. Soc. Addiction Med, Amer. Acad. ofPsychiatry, Amer. Psych. Assoc; and can only tx 100 pts on this drug.
Clonidine/Catapres opiod UD txsx of opiod w/d, adjunct
Pharm treatment Opioids abuse txNaltrexone/Vivitrol/Revia – competitive inhibition.
-methadone; synthetic narcotic – block effects of narcotics, eliminates craving & w/d Sx.
- daily UO drug screen
Pharm tx depressant (esp. barbituates) w/dsubstitution therapy w/ long acting barbiturates: phenobarbital/Luminal. Dose reduced 30 mg/d until w/d complete.
Pharm tx non barbiturates CNS depressantsusu. Long acting benzodiazepines. I.e. diazepam/Valium, chlordiazepoxide/Librium
Pharm tx stiumulantsminor tranq ie. Chlorodiazepoxide/Librium-->progresses to--> haloperidol/Haldol. Antidepressants for depression sx.
Pharm tx cocaine w/d & abstinenceDespramine
BOLO for what when giving antipsychotics such as haldol for stimulant intoxicationseizures (may lower threshold for). Can tx repeated seizures w/ IV diazepam/Valium
Goal of stimulant w/d txreduce drug craving, manage severe depression
memorize
Pharm treatment Hallucinogens abuse tx
Question Answer
Pharm treatment Hallucinogens OD (LSD/PCP)Substitution therapy not required:
- tx panic/anxiety with Diazepam/Valium or chlordiazepoxide/Librium
memorize

– tx psychotic rxns w/ antipsychotics

Other Substances

Question Answer
SBIRTScreening, brief intervention, & referral to treatment is a comprehensive, integrated, public health approach to the delivery of early intervention & treatment services (used for: Persons with substance use disorders, Those whose use is at higher levels of risk)
COWs (11 criteria) Rated from 0-7 except orientation & clouding of sensation 0-4GI upset, Tremor, Anxiety, Restlessness, Sweating, Pupil size, Gooseflesh, Runny nose, Yawning, Bone/Joint pain, Pulse
S/S inhalant useDizziness, ataxia, muscle weakness
Euphoria, excitation, disinhibition, slurred speech
Nystagmus, blurred/double vision
Psychomotor retardation, hypoactive reflexes, Stupor/coma
S/S opiate withdrawal–From short-acting drugs (heroin): s/s occur w/in 6-8 hours, peak w/in 1-3 days, & gradually subside in 5-10 days
–From long-acting drugs (methadone): s/s occur w/in 1-3 days, peak between 4 & 6 days, & subside in 14-21 days
–From ultra-short-acting (meperidine): s/s begin quickly, peak in 8-12 hours, & subside in 4-5 days
Priority intervention for patients using methamphetamineSuicide precautions, antidepressant therapy, quiet atmosphere; Risk for suicide - RF: intense feeling of lassitude & depression when withdrawing "crashing"
Priority intervention for opiate addict in crisisMethadone, rest, adequate nutritional support; Risk for injury - RF: CNS agitation (tremors, elevated BP, N/V, hallucinations, illusion, tachycardia, anxiety, seizures)
S/S stimulant OD
Cannibus mechanism of intoxicationlimit amt of NT release (dopamine)
memorize

Care planning for pts with substance UDO’s