Addiction
Define addiction and how does it differ from tolerance?
a compulsive or chronic requirement. Withdrawal occurs when the concentration of the substance in the client’s bloodstream declines and the client experiences physiological adverse effects. The need is so strong it can create physical or psychological distress. Tolerance occurs when a client requires increased amounts of the substance to achieve the desired effect.
Name a physical symptom seen in alcohol withdrawal
tremors, n/v, abdominal pain, sweating, tachycardia, seizures, dilated pupils, palpitations, fatigue, fevers, etc
Alcohol is a CNS depressant, so during withdrawal, what abnormal vital signs would the RN expect to see?
Htn, tachycardia or elevated temperature
The RN is detoxing a patient using substitution therapy. A commonly used medication for treating benzodiazepine withdrawal is _____________.
lorazepam or any other benzo. supportive medications could also include antihypertensives and anti-convulsant medication.
The ED RN suspects the patient she is caring for may have consumed alcohol recently and is not being forthcoming. What test result will confirm the RN's assessment?
Blood Alcohol Concentration from a urine drug screen. The legal limit for BAC is 80g/dl (0.08%). Intoxication occurs between 100-200g/dl and ETOH toxicity occurs at 400g/dl
Name a risk factor for substance use disorder
genetics (children of alcoholics are 4x more likely), chronic stress, hx of trauma, low pain tolerance, risk-taking tendencies, low self esteem, social isolation, etc
A patient presents to the ER with GI upset, headache and muscle aches. The nurse notes a temp of 100.6 and diaphoresis. What type of withdraw does the nurse suspect?
opioid withdrawal. the patient may also experiencing yawning, runny nose & eyes and insomnia
Name this concept: physiological and mental readjustment that accompanies the discontinuation of an addictive substance (hint: pg 280 Morgan & Townsend)
Withdrawal!
A patient is receiving lorazepam during alcohol withdrawal. What are some side effects the RN should monitor for during treatment?
drowsiness, hypotension, light-headedness, confusion, unsteadiness (falls!) dizziness, muscle weakness, dry mouth..Many of these side effects put patient at risk for injury which is already a nursing diagnosis for alcohol withdrawal. PATIENT SAFETY is priority!
The patient makes statements such as "I don't have a problem with marijuana" and "I can quit smoking any time I choose". They minimize their use and are unable to admit to a problem. What nursing diagnosis/defense mechanism might be appropriate for this patient?
Denial
True or False: genetics and culture can play a role in addiction.
True! Culture, ethnicity and social factors influence alcohol use. ex: alaskans and native americans have a high percentage of etoh use disorder. ex: twins have a higher risk for developing alcoholism
Which of these is NOT a common finding in a patient living with alcohol addiction? vitamin deficiencies, hair loss, weight loss/gain or low immunity
hair loss is not linked to alcoholism. Sleep disturbances, chronic pain, changes in bowel movements are some other expected findings.
How long does it take for alcohol withdrawal to take place and when is it most dangerous?
4-12 hours after cessation. Peaks and worsens by the 2-3rd day!
On the first day of a client's alcohol detoxification, which nursing intervention should take priority? Attend groups, complete a CIWA, educate the patient or administer thiamine and b12?
The priority nursing intervention for this client should be safe withdrawal. The CIWA will help the nurse determine the severity of withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.
The nurse is providing discharge teaching to a patient suffering from alcohol use disorder. What is a long term effect of chronic alcohol use the nurse could educate the patient on?
Korsakoffs/Wernickes/encepalopathy, peripheral neuropathy, cardiomyopathy, cirrohis, sexual dysfunction/impotence, cancer, low immunity, muscle wasting, Gi issues, ulcers, malnutrition, anemia, seizures, gout, diabetes, insomnia...etc
Name a characteristic or symptom of substance use disorder
substance use disorders are characterized by loss of control due to use or behavior, participation that continues despite associated problems...An individual is considered to be addicted to a substance when he or she is unable to control its use, even knowing that it interferes with normal functioning; when more and more of the substance is required to produce the desired effects; and when characteristic withdrawal symptoms develop upon cessation or drastic decrease in use of the substance.
Which of the following findings should the nurse include when educating on the health risks of heroin use?
A. pancreatitis B. nasal septum perforation C. short-term memory loss D. respiratory depression
Slowed or arrested breathing is just one of the many physical complications related to heroin use. Others include drowsiness, impaired coordination, nausea, and sedation.
Acute pancreatitis is a physical complication related to alcohol use disorder.
Perforation of the nasal septum is a physical complication related to intranasal cocaine use.
Permanent short-term memory loss is a physical complication related to marijuana use.
The oncoming RN does a bedside assessment and notes the patient is begining to experience hallucinations. The patient is shaking profusely, unable to answer questions, and vitals are elevated. What does the RN suspect?
The RN suspects Delirium Tremens (DTs) or alcohol withdrawal delirium, which is the most severe alcohol withdrawal and is a medical emergency. There is danger of seizure, hypertensive crisis and dysrhythmia. The doctor must be notified and the patient will need close monitoring in the ICU.
The patient has successfully completed detox on the mental health unit. The patient is preparing for discharge and asks why they have been prescribed disulfiram. What should the RN tell the patient?
disulfiram is used to help the patient maintain sobriety and abstinence from alcohol. If the patient consumes alcohol, disulfiram creates an unpleasant reaction such as n/v, flushing, anxiety, etc..
Addiction has the potential to harm entire families. What is one support group that families struggling with alcoholism can attend? (hint: table 14.11 pg 327)
Al-Anon (families of alcoholics), ACOA (Adult children of Alcoholics) or ALateen (Adolescents children of Alcoholics) or Children are People (Children with an alcoholic family member)
Which of these conditions are an effect of alcoholism? Select all that apply:
A. peripheral neuropathy B. pancreatitis, C. cardiomyopathy D. hepatitis E. cirrhosis
All of the above! Some other conditions are sexual dysfunction, cancer, wernickes encephalopathy, korsakoff's psychosis, gastritis, thrombocytopenia....
The CIWA is a commonly used withdraw assessment for alcohol withdraw. Name a component of the CIWA scale. (hint: 313 Morgan & Townsend)
n/v, tremors, headaches, agitation, tactile, auditory or visual disturbances, sweating or orientation
A nurse is monitoring a client who is experiencing opioid withdrawal. What symptoms might the nurse observe?
Yawning, muscle aches, tachycardia, restlessness, sweating, tremors, anxiety, goosebumps, anxiety, dilated pupils or GI upset
Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant like lorazepam during alcohol withdrawal?
A. Antagonist therapy
B. Deterrent therapy
C. Codependency therapy
D. Substitution therapy
Substitution! A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.
Codependency can occur in families struggling with alcohol, as well as the nursing profession. Name a characteristic of a codependent RN or family memeber. (pg. 324)
need to be in control, unrealistic, accept responsibility for the happiness of others, nuture dependency, rarely express true feelings, deny personal needs, preserve harmony, like feeling "needed",