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57 Cards in this Set
- Front
- Back
Physical Dependence |
Need for increasing amounts to produce the desired effects
Syndrome of withdrawal upon cessation |
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Psychological Dependence |
Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort |
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Substance Addiction |
-Use interferes with ability to fulfill role obligations -Attempts to cut down or control use fail -Intense craving for the substance -Excessive amount of time spent trying to procure substance or recover from use -Use causes difficulty with relationships/become isolated -Engages in hazardous activities while impaired -Tolerance develops -Substance-specific symptoms occur upon discontinuation of use |
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Substance Intoxication |
-Development of a reversible syndrome of symptoms following excessive use of a substance -Direct effect on the central nervous system -Disruption in physical and psychological functioning -Judgment is disturbed and social and occupational functioning is impaired |
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Substance withdrawal |
-Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time -Symptoms are specific to the substance that has been used -Disruption in physical and psychological functioning, with disturbances in thinking, feeling, and behavior |
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1. Which of the following has been implicated in the predisposition to substance abuse? a) Hereditary factor b) Fixation in the adolescent stage of psychosexual development c) Punitive ego d) Narcissistic and dependent personality traits |
Correct answer: A Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism. |
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Phase I: Prealcoholic phase |
characterized by use of alcohol to relieve everyday stress and tensions of life.
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Phase II: Early alcoholic phase |
Early alcoholic phase: begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person. |
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Phase III: The crucial phase |
Person has lost control; physiological dependence is clearly evident. may go into withdrawal if they don't have the substance. |
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Phase IV: The chronic phase |
Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober. relationships start to dissolve, fired from work, fail school, etc… |
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Wernicke’s encephalopathy |
most serious form of thiamine deficiency in alcoholic patients |
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Korsakoff’s psychosis |
syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients |
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Alcoholic cardiomyopathy |
effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition |
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Esophagitis |
inflammation and pain in the esophagus occurs because of the toxic effects of alcohol on the esophageal mucosa and also because of frequent vomiting associated with alcohol use |
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Gastritis |
effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention |
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Pancreatitis |
Acute: usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention
Chronic: leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus |
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Alcoholic hepatitis
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-Caused by long-term heavy alcohol use -Symptoms: enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white cell count; fever; and jaundice. Also ascites and weight loss in severe cases. |
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Cirrhosis of the liver |
Cirrhosis is the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.
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Portal hypertension |
elevation of blood pressure through the portal circulation results from defective blood flow through cirrhotic liver |
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Ascites |
a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity; occurs in response to portal hypertension |
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Esophageal varices |
veins in the esophagus become distended because of excessive pressure from defective blood flow through the cirrhotic liver |
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Hepatic encephalopathy |
occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion. The continued rise in serum ammonia, if allowed to progress, leads to coma and eventual death. |
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Leukopenia |
impaired production, function, and movement of white blood cells |
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Thrombocytopenia |
platelet production and survival are impaired as a result of the toxic effects of alcohol |
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Sexual dysfunction
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-In the short term, enhanced libido and failure of erection are common -Long-term effects include gynecomastia, sterility, impotence, and decreased libido |
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2. A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician’s orders is thiamine. Which is the rationale for this intervention? a) To prevent nutritional deficits b) To prevent pancreatitis c) To prevent alcoholic hepatitis d) To prevent Wernicke's encephalopathy |
Correct answer: D Wernicke’s encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue. |
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Alcohol Intoxication |
Occurs at blood alcohol levels between 100 and 200 mg/dl |
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Alcohol withdrawal |
Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use |
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Sedative/Hypnotic Use Disorder
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- A profile of the substance: Barbiturates Non-barbiturate hypnotics Antianxiety agents Club drugs |
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Effects on the body: Sedatives/hypnotics |
Effects on sleep and dreaming Respiratory depression Cardiovascular effects Renal function Hepatic effects Body temperature Sexual functioning |
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Intoxication from sedative/hypnotics |
With these CNS depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug).
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Withdrawal from Sedative/hypnotics |
Onset of symptoms depends on the half-life of the drug from which the person is withdrawing.
Severe withdrawal from CNS depressants can be life threatening. |
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Stimulant Use Disorder |
Amphetamines Synthetic stimulants Non-amphetamine stimulants Cocaine Caffeine Nicotine |
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Effects on the body: Stimulant use |
CNS effects Cardiovascular effects Pulmonary effects Gastrointestinal and renal effects Sexual functioning |
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Intoxication: Stimulants |
Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, changes in vital signs (even coma or death, depending on amount consumed).
Caffeine intoxication usually occurs following consumption in excess of 250 mg. Restlessness and insomnia are the most common symptoms. |
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Withdrawal: Stimulants |
Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite.
Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.
Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite. |
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Inhalant Use Disorder |
Aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners |
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Effects on the body: Inhalants |
CNS effects Respiratory effects Gastrointestinal effects Renal system effects |
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Intoxication: Inhalants |
Develops during or shortly after use of or exposure to volatile inhalants
Symptoms include: -Dizziness, ataxia, muscle weakness -Euphoria, excitation, disinhibition, slurred speech -Nystagmus, blurred or double vision -Psychomotor retardation, hypoactive reflexes -Stupor or coma |
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Opioid Use Disorder |
Opioids of natural origin Opioid derivatives Synthetic opiate-like drugs |
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Effects on the body: Opioids |
CNS effects Gastrointestinal effects Cardiovascular effects Sexual functioning |
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Intoxication: Opioids |
Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours.
Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment.
Severe opioid intoxication can lead to respiratory depression, coma, and death. |
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Withdrawal: Opioids |
From short-acting drugs (e.g., heroin): Symptoms occur within 6 to 8 hours, peak within 1 to 3 days, and gradually subside in 5 to 10 days
From long-acting drugs (e.g., methadone): Symptoms occur within 1 to 3 days, peak between days 4 and 6, and subside in 14 to 21 days
From ultra-short-acting meperidine: Symptoms begin quickly, peak in 8 to12 hours, and subside in 4 to 5 days |
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Symptoms of Opioid Withdrawal |
Dysphoria, muscle aches, nausea/vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia |
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Hallucinogen Use Disorder |
A profile of the substance Naturally occurring hallucinogens Synthetic compounds Patterns of use Use is usually episodic |
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Intoxication: Hallucinogens |
Occurs during or shortly after using the drug
Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, palpitations |
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Physiological Effects on the Body: Hallucinogens |
Nausea/vomiting Chills Pupil dilation Increased BP, pulse Loss of appetite Insomnia Elevated blood sugar Decreased respirations |
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Psychological Effects on the Body: Hallucinogens |
Heightened response to color, sounds Distorted vision Sense of slowed time Magnified feelings Paranoia, panic Euphoria, peace Depersonalization Derealization Increased libido |
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Cannabis Use Disorder |
Marijuana Hashish |
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Effects on the body: Cannabis |
Cardiovascular Respiratory Reproductive Central nervous system Sexual functioning |
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CAGE Questionnaire |
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 your nerves (Eye-opener) |
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Plan for Detox |
Provide safe and supportive environment
Administer substitution therapy |
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Clues for recognizing substance impairment in nurses |
High absenteeism may be present if the person’s source is outside the work area
Or, the person may rarely miss work if the substance source is at work
Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs than for other nurses may be present
Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall
Problems with relationships
Irritability, tendency to isolate, elaborate excuses for behavior
Unkempt appearance, impaired motor coordination, slurred speech, flushed face
Patient complaints of inadequate pain control, discrepancies in documentation |
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Codependency |
Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions |
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Pharmacology for alcoholism |
Disulfiram (Antabuse) Naltrexone (ReVia) Nalmefene (Revex) SSRIs Acamprosate (Campral) Benzos (withdrawal) Anticonvulsants (withdrawal) Multivitamin Therapy (withdrawal) Thiamine (withdrawal) |
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Pharmacology for Opioid Use |
Narcotic antagonists Naloxone (Narcan) Naltrexone (ReVia) Nalmefene (Revex) Methadone Buprenorphine (subutex) Clonidine |
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3. A client diagnosed with chronic alcoholism says to the nurse, “I’m tired of using and I want to stop. Is there a medication that can help me maintain sobriety?” About which medication would the nurse provide information? a) Carbamazepine (Tegretol) b) Clonidine (Catapres) c) Disulfiram (Antabuse) d) Folic acid (Folvite) |
Correct answer: C Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug. |