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Nursing II - Substance Abuse
It is considered abuse when - a substance interferes with roles and obligations Causes withdrawal syndrome & tolerance - Substance Addiction Alcohol, inhalants, sedatives, opioids - CNS Depressants Methamphetamine & Cocaine - CNS Stimulants Cannabis, LSD, PCP - Hallucinogens Genetics, past trauma in substance abuse can be - non-modifiable predisposing factors Neurotransmitters, personality, work, sociocultural issues are - modifiable predisposing factors Pharmacotherapy of sedative, hypnotics, benzos, stimulants & hallucinogens include - medical stabilization, symptom management and address addictive personality/craving Adjunct meds for benzo, sedative & hypnotic addiction are - other benzos, Buspar, anticonvulsants & TCA ETOH detox includes - CIWA protocol + MVI, Thiamine, IVFs electrolyte replacement, Lactulose & Librium ETOH addictive behavior treatment is - antidepressants, drinking deterrents, narcotic antagonists Wernicke/Korsakoff presentation includes - encephalopathy and psychosis Phase IV of Alcohol use disorder complication examples - cirrhosis of the liver portal hypertension
Time presentation of ETOH intoxication and delirium - 4-12 hours of cessation 1 to 2 days for delirium The use can be lethal when exposed to alcohol - Disulfiram Treat opioid intoxication with - Naloxone (Narcan) Treat benzo, barbiturate intoxication with - Flumazenil Modalities to treat opioid addiction - narcotic antagonists, substitution (suboxone, methadone) & Catapres Therapies for addictive disorders - psycho therapies and community support group anticholinergic side effect - Confusion, dizziness, blurred vision, constipation, dry mouth, difficulty urination Serotonin syndrome symptoms - Shivering and diarrhea to severe muscle rigidity, fever and seizures extrapyramidal (EPS) symptoms - Akinesia, Akathisia, Dystonia, Oculogyric Crisis, Tardive Dyskinesia Medications to treat EPS - anticholinergics, antihistamines valproic acid may cause - blood dyscrasia are antidepressants FDA approved to treat mania? - no Least Restrictive methods of de-escalation - therapeutic communication, redirection, CPI
hallucinations vivid dreams, nightmares hypervigilance stupor/coma, vegetative state Wernicke's encephalopathy - most serious form of thiamine deficiency in alcoholic patients Korsakoff's psychosis - syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients effects of alcohol abuse on body - peripheral neuropathy myopathy cardiomyopathy pancreatitis, esophagitis, gastritis portal hypertension varices (abnormal veins) SD What causes esophageal varices? - portal hypertension and cirrhosis What causes portal hypertension? - excessive scarring of liver -> obstruction to blood through the hepatic portal vein opioid intoxication symptoms - diminished peristalsis, constipation hypotension pupillary constriction (dilation in overdose) respiratory depression opioid withdrawal symptoms - starts in 24 hours, peaks 2-4 days
flu-like symptoms lacrimation, rhinorrhea pupillary dilation yawning muscle/bone pain CNS Depressant Sedatives - barbiturates benzodiazepines hypnotics barbiturates - secobarbital (Seconal) nembutal sodium (Luminol, Pentobarbital) hypnotics - zaleplon (Sonata) zolpidem (Ambien) eszopiclone (Lunesta) choral hydrate ("knockout drops", "Mickey Finn") CNS depressant intoxication symptoms - body temperature deregulation (TDR) nystagmus lability CNS depressant withdrawal symptoms - starts 12-14 hours, peaks 1-2 days diaphoresis, tachycardia hand tremors hallucinations, illusions grand mal seizures inhalant intoxication symptoms - ataxia
substance abuse assessment done by nurse - SBIRT: Screening Brief Intervention Referral to Treatment
