Transcript Substance-Related Disorders - N204 & N214L Psychiatric / Mental

Substance-Related
Disorders
West Coast University
NURS 204
Overview
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Addiction to psychoactive substances is a
worldwide health problem
Addiction is one of the most serious public
health problems in the US
Alcohol, by far is the leading substance
abused by Americans
Epidemiolgy of Alcohol
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About two-thirds of American adults consume
alcohol; about 14% of them develop problems with
dependence
 Roughly one-third of all hospital admissions are
related to alcohol abuse
 The divorce rate for couples with and alcoholic
spouse is seven times greater than that for other
couples
 Approximately one-half of all traffic accidents are
alcohol related
Substance-Related Disorders
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Substance abuse - repeated use of substances
that is maladaptive
 Substance dependence
 Tolerance: needing increased amount of a substance
 Withdrawal: uncomfortable physiologic and cognitive
behavioral changes
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Substance intoxication: reversible syndrome of
maladaptive physiologic and behavioral changes
that are due to the effect of a substance
Biopsychosocial Theories
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Biologic
Genetic
Psychological
Sociocultural
Family systems
Populations at Risk
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Teenagers
Psychiatric clients
Women
General hospital clients
Older Adults
Adult Children of Alcoholics
Health Care Providers
Alcohol
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Physical effects: Slurred speech, lack of
coordination, unsteady gait, blackouts, nystagmus
flushed face, sense of floating, and anorexia
 Psychological effects: euphoria, mood lability,
impaired judgment, sexual inhibition, decreased
concentration, aggressive behavior
 Withdrawal effects: Anxiety, agitation, and
irritability, tremors, tachycardia, hypertension,
diaphoresis, hallucinations, N/V, diarrhea, delirium
tremens
Wernicke-Korsakoff Syndrome
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Results from a deficiency in vitamin B
complex (most commonly a thiamine
deficiency)
Severely impairs cognitive functioning
Produces peripheral neuropathy, cerebellar
ataxia, confabulation, and myopathies
Death can occur if thiamine replacement
therapy is not initiated immediately
Effects of Alcoholism
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Alcohol-induced persisting amnestic
disorder
Alcohol encephalopathy
Fetal alcohol syndrome
Suicide and alcoholism
Nursing Implications
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Monitor the patient’s vital signs and behavior
Seek a physician’s order for a
benzodiazepine to decrease withdrawal
symptoms
Close observation
Promote sleep and rest
Institute seizure precautions
Encourage fluids
CAGE Questionaire
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Consist of four questions
 Have you ever felt you should cut down on your
drinking?
 Have people annoyed you by criticizing your
drinking
 Have you ever felt bad or guilty about your
drinking?
 Have you ever had a drink first thing in the
morning to steady nerves or get rid of a
hangover (eye-opener)?
Pharmacology Treatment
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Benzodiazepines: Valium and Librium for
withdrawal symptoms
Disulfiram (Antabuse): inhibits Acetaldehyde
Dehydrogenase
Naltrexone (Re Via, Trexan): block the need
to ingest alcohol
Barbiturates and
Sedatives/Hypnotics
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Physical effects: Drowsiness, fatigue, orthostatic
hypotension, anorexia, slurred speech, ataxia,
seizure, dizziness
 Psychological effects: Euphoria, irritability, anxiety,
poor memory and understanding, delirium,
depressed mood, violence
 Withdrawal effects: N/V, generalized malaise,
tachycardia, excessive sweating, anxiety,
irritablity, ortho hypotension, insomnia, seizures,
coarse tremors
Nursing Implication
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Monitor vital signs
Close observation
Promote sleep and rest
Offer fluids and light foods as tolerated
Administer medication, if ordered, to wean
the patient
Institute seizure precautions
Opioids
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Physical effects: pinhole pupils, skin picking,
sleepiness, anorexia
Psychological effects: Anxiety, impaired
cognition, delirium, euphoria
Withdrawal effects: lacrimation, rhinorrhea,
excessive sweating, yawning, tachycardia,
fever, insomnia, muscle aches, craving, N/V,
dilated pupils, chills
Nursing Implications
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Monitor vital signs
Close observation
Offer fluids and light food as tolerated
Keep environment nondistracting and
soothing
Methadone maintenance as ordered
Amphetamines
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Physical effects: anorexia, arrhythmia,
restlessness, tremors, dizziness, generalized
tonic-clonic seizures, dry mouth, dilated pupils,
hyperactive reflexes, tachycardia
 Psychological effects: Labile affect, anxiety,
delirium, euphoria, violence, hallucinations,
irritability
 Withdrawal effects: Depression, fatigue, agitation,
suicidal thought, paranoia, insomnia or
hypersomnia, disorientation
Nursing Implication
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Promote sleep and rest
Monitor vital signs
Monitor suicidal ideation
Antidepressant, if ordered
Remain with a frightened or disoriented
patient
Orient the patient to reality
Cannabis
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Derived from an Indian hemp plant
(Cannabis sativa)
Marijuana contains psychoactive substance
(delta 6-3,4-tetrahydrocannabinol)
THC is stored in the fatty tissues (especially
in the brain and reproductive system)
THC can be detected in the body for up to 6
weeks.
Cannabis
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Analgesic effect
Effective against nausea and vomiting
Treat weight loss
Dronabinol is a synthetic THC approved by
the FDA.
Cannabis
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Physical effects: slowed speech, slowed
reflexes, red eyes, dry mouth, increased
appetite, lower testosterone, 70% more
benzopyrene (major cancer causing
chemical, emphysema).
Psychological effects: apathy, reduced
inhibition, altered stated of awareness
Withdrawal effects: Anxiety and
restlessness
Nursing Implication
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Help patient with memory loss to fill in gaps
of information
Attend to self-care needs that a lethargic or
apathetic patient may have neglected
Cocaine
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Extracted from the leaves of the coca plant,
found in Bolivia and Peru.
Stimulant and decreases appetite.
Ingredient in Coca-cola until 1903.
Used as a local anesthetic.
Not physically addicting by psychologically
addicting.
Develop tolerance
Cocaine Intoxication
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Similar to alcohol withdrawal: sweating,
dilated pupils, psychomotor agitation,
increase BP and HR, high fever, arrythmias,
seizures, hallucinations
The “Post-Coke” Blues
Cocaine Treatment
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Diazepan (Valium)
Phenobarbital
Imipramine hydrochloride (Tofranil)
Propranolol (Inderal)
Bromocriptine (Parlodel)
Amantadine (Symmetrel)
Hallucinoges
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Physical effects: Hyperactive reflexes, tachycardia, labile
mood, anorexia, hypertension, dizziness
 Lysergic acid diethylamide (LSD): anxiety, sleep disturbance,
tremors, and dilated pupils
 Phecyclidne (PCP): slurred speech, blank stare, irritability, seizures,
nystagmus, violence, ataxia, delirium, depression, fatigue, memory
loss, poor impulse control
 Peyote used in religious rituals
 Psilocybin “magic mushrooms”
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Psychological effects: euphoria, restlessness,
suspiciousness, hallucination
Withdrawal effects: No physical withdrawal symptoms for
LSD, PCP: depression, lethargy, craving
Inhalants
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Physical effects: dizziness and
lightheadedness
Psychological effects: euphoria and
excitement
Withdrawal effects: none
Nicotine
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Psychoactive stimulating substance found in
tobacco.
Occupies the receptors for acetylcholine in
both dopamine and serotonin neural
pathways
Associated with cancer, heart disease,
emphysema, hypertension and death
Caffeine
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Acts acts as a stimulant
Found in coffee, tea, and chocolate
64 mg in instant coffee, 112 mg in filtered
coffee, 40 mg in tea, 7 mg chocolate, 40 mg
cola drinks, 80 mg in Red Bull
Diuretic, increases cholesterol and LDL
Withdrawal symptoms: irritability and
headaches
Treatment Approaches
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Pharmacological
Detoxification
In-facility treatment
Specialty hospital care
Residential rehabilitation
Extended residential care
Outpatient (Day) treatment
Self-help groups
Twelve-step programs (AA)
Dual Diagnosis Challenges
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Psychiatric clients are vulnerable to
substance use and abuse
Treatment must address both problems
Specialized treatment programs
Interventions
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Confrontation strategies
Education
Referral and self-help groups
Lifestyle change
Family – Al-non
Relapse Prevention
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Relapse is common
Recognize symptoms of relapse
Relapse prevention groups
Levels of addiction prevention
 Primary: education programs
 Secondary: early identification of and
intervention
 Tertiary: rehabilitation
Outcome Criteria
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Abstinence from alcohol and drugs
Coping
Decision-making
Impulse control
Maintaining Therapeutic
Optimism
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Substance abuse is a chronic relapsing
condition.
The power of a therapeutic relationship
Talk to people in recovery.
Talk to clients about spirituality.
Find mentors.
Take care of yourself!
Review Question
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Ten hours after admission to the ICU
following an auto accident, a client begins to
exhibit mild tachycardia, irritability, and
tremors. Three hours later the client has a
grand mal seizure. The staff suspect that the
client has
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A. Undetected internal bleeding.
B. Korsakoff's syndrome.
C. Alcohol withdrawal syndrome.
D. Wernicke's encephalopathy.
Review Question
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The nurse is taking the history of a
psychiatric client suspected of abusing
alcohol. Which assessment question is best
to ask?
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A. When was your last drink?
B. Do you drink regularly?
C. Who are your drinking partners?
D. Are you experiencing blackouts?
Review Question
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Which is the priority intervention for a client
admitted with acute alcohol intoxication?
 A. Place the client in seizure precaution.
 B. Restrain the client when restless and
agitated.
 C. Darken the room.
 D. Monitor vital signs frequently.
Review Question
The nurse anticipates that a client who has sedative
hypnotic dependence will experience withdrawal
symptoms. The nurse should assess for the onset
of which set of symptoms?
A. Nausea and vomiting, sweating, anxiety, and coarse
tremors
B. Runny nose, diarrhea, yawning
C. Depression, restlessness, disorientation
D. Craving, hypersomnia, irritability
Review Question
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An adolescent client presented to the emergency room
after ingesting LSD that produced a bad trip. The drug’s
effects wore off after 10 hours. What health teaching
should be provided to the client before discharge?
1. Information about the risks of narcotic use
2. Information about the risks of cocaine use
3. Information about the carcinogenic effects of marijuana
4. Information about flashbacks
Review Question
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Which of the following treatment approaches
would be most appropriate in helping a client
maintain long-term smoking cessation?
1. Bupropion (Zyban)
2. Nicotine patch
3. Nicotine gum
4. Counseling
Review Question
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The nurse anticipates that a client who has
sedative hypnotic dependence will experience
withdrawal symptoms. The nurse should assess
for the onset of which set of symptoms?
1. Nausea and vomiting, sweating, anxiety, and
coarse tremors
2. Runny nose, diarrhea, yawning
3. Depression, restlessness, disorientation
4. Craving, hypersomnia, irritability