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Townsend Psychiatric Mental Health Nursing Ch 14 Substance-Related & Addictive Disorders

Terms in this set (39)

Define addiction
A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled
Define intoxication
A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor
Define withdrawal
The physiological and mental readjustment that accompanies the discontinuation of an addictive substance
List classes of psychoactive substances that are associated with substance use and substance-induced disorders:
Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco
An individual who grew up in a home where alcohol was consumed regularly is now using alcohol to relieve stress on a day to day basis. What stage of alcoholism is she in?
Phase 1: The prealcoholic phase. pg 369
What stage of alcoholism is an individual in when they are experiencing physiological addiction and are unable to choose whether or not to drink?
Phase III: The Crucial Phase
Binge drinking is common. Drinking is the total focus. Anger and aggression are common manifestations. Individual may experience: loss of job, marriage, family, friends, self-respect. Pg. 370
Describe events associated with phase II of alcoholism:The Early Alcoholic Phase
Blackouts. Drinking is no longer pleasurable but required. Secret drinking begins. Preoccupation with drinking, maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. Individual experiences guilt and is defensive. Excessive use of denial and rationalization is evident.
What are characteristics of Phase IV: The Chronic Phase of alcoholism?
Emotional and physical disintegration. Intoxicated more than they are sober. Profound helplessness and self-pity are evident. Impairment in reality testing may result in psychosis. Life threatening physical manifestations may be evident in every part of the body. Abstention results in: hallucinations, tremors, convulsions, severe agitation, and panic. Depression and thoughts of suicide are common.
What nutritional deficiency is thought to be linked to both peripheral neuropathy and alcoholic myopathy?
A. Magnesium
B. Thiamine
C. Calcium
D. Potassium
B. B vitamins, especially thiamine, are strongly suspected to cause both peripheral neuropathy, nerve damage that causes pain, burning, tingling and prickly sensation of the extremeties, and alcoholic myopathy (acute condition: sudden onset of muscle pain, swelling, weakness, reddish tinged urine from myoglobin, and a rapid rise of muscle enzymes in the blood.
Symptoms of acute alcoholic myopathy include (select all that apply):
A. Elevations of CPK
B. Red-tinged urine
C. parasthesias
D. Calf swelling
A, B, D. In acute alcoholic myopathy creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (AST) are elevated. Urine is red-tinged from myoglobin, a product of muscle breakdown. Parasthesias are characteristic of peripheral neuropathy, not myopathy. Calf swelling, as well as swelling of other muscle groups is also a sign.
A very serious form of thiamine deficiency in alcoholics can cause:
Wernicke's encephalopathy. S/S: paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. Death will result without replacement of thiamine.
What condition may follow Wernicke's encephalopathy?
Korsakoff's psychosis: a syndrome of confusion, loss of recent memory, and confabulation (making up stories to compensate for memory loss). It is frequently encountered with pts recovering from Wernicke's encephalopathy.
S/S of alcoholic hepatitis
Enlarged liver and tender liver, nausea and vomiting, lethargy, anorexia, elevated white blood cell count, fever, and jaundice. Ascites and weight loss may be evident in more severe cases.
S/S of Cirrhosis of the liver
Widespread destruction of liver cells which are replaced by fibrous tissue. Nausea, vomiting, anorexia, weight loss, abd. pain, jaundice, edema, anemia, and blood coagulation abnormalities.
Common complications of cirrhosis of the liver include:
Portal hypertension: elevation of BP through the portal circulation
Ascites: Excess serous fluid accumulation in the abd.
Esophageal varices: Veins in the esophagus become distended and may rupture
hepatic encephalopathy: Liver can't convert ammonia to urea for excretion so it build up and causes impaired mental functioning, apathy, euphoria, depression, sleep disturbance, increasing confusion and eventually death if not treated.
Features of FAS
Skin folds at corner of eye, low nasal bridge, short nose, indistinct groove between nose and upper lip, small head circumference, small eye opening, small midface, thin upper lip
Characteristics of children with FAS
Abnormal facial features, small head size, smaller than average height, low body weight, poor coordination, hyperactivity, difficulty paying attention, difficulty in school, learning disabilities, speech and language delays, intellectual disability or low IQ, poor reasoning and judgment skills, sleep and sucking patterns as a baby, vision or hearing problems, problems with the heart, kidneys or bones.
Naturally derived opioids:
Opium, morphine, coideine.
Opioid derivatives:
Heroin, hydromorphone (dilaudid), oxycodone (percodan; OxyContin), hydrocodone (Vicodin)
Trade name for ecstasy
3,4-methylene-dioxyamphetamine (MDMA)
In treating codependency, there are four stages. Describe stage I: The Survival Stage
First, the codependent person must begin to let go of the denial that problems exist or that their personal capabilities are unlimited. This may be a very painful and emotional period. pg 404
What occurs in the second stage of recovery for codependency?
This is the Reidentification Stage. The individual is able to see their true self through a break in the denial system. Accept label of codependent. Take responsibility for their dysfunctional behaviors. Accept their limitations.
What is the focus of the the "Core Issues Stage" (III)?
The codependent person must face the fact that they can't manage relationships by force of will. They must recognize that each partner is autonomous. The goal is to be able to detach from all of the struggles that exist in their life because they are trying to control what they cannot.
The stage of recovery where the codependent accepts himself, is willing to change, and experiences integrity through awareness, honesty and being in touch with one's spiritual consciousness is:
Stage IV: The Reintegration stage
Which of the following medications is the physician most likely to order for client experiencing alcohol withdrawal syndrome?
A. Holoperidol (Haldol)
B. Chlordiazepoxide (Librium)
C. Methadone (Dolophine)
D. Phenytoin (Dilantin)
B. Chlordiazepoxide (Librium). Rationale: Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) are the most commonly used. Sometimes physicians order anticonvulsants. Also multivitamins and thiamine are commonly administered. Pg. 408
Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he had been a heavy drinker for a number of years. Labs report he has a blood alcohol of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected?
A. Several hours after the last drink
B. 2-3 days after the last drink
C. 4-5 days after the last drink
D. 6-7 days after the last drink
A. Several hours after the last drink
Within 4-12 hours of cessation of or reduction in heavy and prolonged drinking (several days or more), the following symptoms may occur: coarse tremor of the hands, tongue or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated BP; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; insomnia
Symptoms of alcohol withdrawal include:
A. Euphoria, hyperactivity, and insomnia
B. Depression, suicidal ideation, and hypertension
C. Diaphoresis, nausea and vomiting, and tremors
D. Unsteady gait, nystagmus, and profound disorientation
C. Diaphoresis, nausea and vomiting, and tremors
Dan, who's been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states the to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is:
A. "Maybe your boss is mistaken, Dan."
B. "You are here because your drinking was interfering with your work, Dan."
C. "Get real, Dan! You're a boozer and you know it!"
D. "Why do you think you boss sent you here, Dan?"
B. "You are here because your drinking was interfering with your work, Dan."
Dan, who's been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states the to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is:
A. Denial
B. Projection
C. Displacement
D. Rationalization
A. Denial
Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization?
A. "They claim they'll help me stay sober."
B. "I'll dry out in AA, the I can have a social drink now and then."
C. "AA is only for people who reach the bottom."
D. "If I lose my job, AA will help me find another."
A. "They claim they'll help me stay sober."
From which of the following symptoms might the nurse identify a chronic cocaine user?
A. Clear, constricted pupils
B. Red, irritated nostrils
C. Muscle aches
D. Conjuctival redness
B. Red, irritated nostrils
An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal?
B. Tremors, insomnia, and seizures
A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement?
A. The ct abuses amphetamines and anxiolytics
B. The Ct abused alcohol and cocaine
C. The Ct is psychotic
D. The ct abuses narcotics and marijuana
A. The ct abuses amphetamines and anxiolytics
The nurse monitoring a client admitted for withdrawal from a benzodiazepine knows the client may experience: (Select all that apply)
A. Vivid dreams and hallucinations
B. Rebound hypertension
C. Polyuria
D. Sweating
E. Nausea or vomiting
A. Vivid dreams, D. Sweating, E. Nausea or vomiting. Additional withdrawal symptoms: pulse greater than 100, increased hand tremor, insomnia, illusions, psychomotor agitation, anxiety, or grand mal seizures. Pg. 376
Withdrawal symptoms from CNS depressants may begin:
A. 4-8 hours after cessation
B. 24-72 hours after cessation
C. 5-10 days after cessation
D. 12-24 hours after cessation
D. 12-24 hours after the last dose. They reach peak intensity between 24-72 hours later and subside within 5-10 days. pg.376
Within _____ an individual quitting or reducing their intake of habitual cocaine use will experience a "crash"-fatigue, depression, nightmares, headache, profuse sweating, muscle cramps, and hunger.
2-4 days is the peak time for withdrawal symptoms from amphetamine. Intense dysphoria can also occur, peaking between 48-72 hours after the last dose of stimulant.
A client in detox for heroin can expect what symptoms as he goes through withdrawals?
A. Nausea, vomiting, and euphoria
B. Runny nose, bristling of the arm hairs and yawning
C. Pupillary dilation, somnolence, and fever
D. Muscle aches, diarrhea, and slurred speech.
B. Runny nose or rhinorrhea, piloerection, and yawning are symptoms of withdrawal. Other symptoms: nausea and vomiting, pupilary dilation, insomnia, fever, muscle aches, diarrhea, dysphoric mood, lacrimation, and sweating.

Euphoria, somnolence, and slurred speech are not withdrawal symptoms. pg 383
Which is not a physiological effect of hallucinogenic drugs?
A. Elevation in blood sugar
B. Loss of appetite
C. Pupil constriction
D. Chills
C. Pupil constriction is not a physiological effect of hallucinogens. Effects include: N & V, chills, pupil dilation, increased pulse, increased BP, increased temp, mild dizziness, trembling, loss of appetite, insomnia, sweating, a slowing of respirations, and elevation in blood sugar.
A student nurse asked how marijuana affects the cardiovascular system. Which response from the preceptor accurately explains the affects?
A. "Cannabis does not affect the cardiovascular system."
B. "Cannabis induces bradycardia as well as orthostatic hypotension, which decreases cardiac output."
C. "Cannabis induces orthostatic hypotension and tachycardia. This increases the demand for oxygen while decreasing its supply."
D. "Because of the increase in blood pressure, the work load of the heart increases greatly, putting the user at risk of MI."
C. "Cannabis induces orthostatic hypotension and tachycardia. This increases the demand for oxygen while decreasing its supply." pg. 386
THIS SET IS OFTEN IN FOLDERS WITH...