2. Addictive Disorders

3. Abuse or Dependence?  Clinical Picture for all Substances  Define Substance Abuse  Define Substance Dependence (or Addiction)  Define tolerance  Define withdrawal

4. Criteria for Substance Dependence  1- tolerance-needing more of the substance to achieve desired effect  2-withdrawal-withdrawal symptoms for the substance seen and a substitute drug taken instead  3-substance taken in larger amounts over time  4-a persistent desire to cut down or control

5.  5- great deal of time spent in activities trying to get the substance  6- social activities given up or reduced  7- substance use continues despite knowledge of persistent physical or psychological problems

6. neurotransmitters  Some have direct brain changes affecting neurotransmitters:  1- cocaine and amphetamines- changes norepinephrine and dopamine  2- alcohol and benzodiazepines change GABA to produce a sedating effect

7. Neurotransmitters influence  Mood  Appetite  Sexual function  Sleep  Pain sensitivity

9. Alcohol-Related D/Os

10. Alcohol-Related Disorders

11. Admission for Detoxification?  Assessment  Assess for Physiological Problems  Assess for Psychiatric Comorbidity  Assess Hx of Use  Assess Current Use  CAGE Assessment  Labs  BAL  Risk for Suicide

12. One too Many Drinks?  Assess  S/S of ETOH Intoxication  S/S of ETOH Overdose  ETOH - Most widely abused drug

13. Am I Withdrawing?  Assess for Withdrawal S/S  ETOH Withdrawal Symptoms  Symptoms of ETOH Withdrawal Delirium

14. Nursing process  Interview- Assessment  Have you ever drunk/used drugs more than you met to in the past year?  Have you felt you needed to cut down?  Can you go 1 year without it?

15.  Plan to and Implement the following:  Keep free from injury  Treatment programs AA,NA, CA,GA  Support group attendance regularly  Sponsor

16.  Evaluate  Have they abstained?  Have they developed new coping skills?

17. Alcohol Withdrawal (DT)  Peaks in 24-48 hours without drink  Hyperalertness  Jerky movements  Startles easy  Shaking inside  Seizures  illusions

18.  After 48 hours either the withdrawal will stop or delirium will begin  DT.’s  S/sx  Delirium  HTN  Extreme tremors Medical intervention required like medication

19. Medications used  Librium  Valium  Tegretol  Magnesium  Thiamine  Vitamins

20.  Antabuse (desulfriam) sometimes used as an alcohol aversion technique. The drug interferes with the metabolism of alcohol.

21. Have a Nonchemical Addiction?  Compulsive-Addictive Like Behaviors  Gambling  Shopping & Spending  Internet Abuse  Sexual Addiction  The Three C’s 1. Craving to Compulsive use 2. Continued use 3. Loss of Control

22. What Else?  What is meant by “codependent” behaviors

23.  Heroin  S/S of use  Euphoria, nodding, constricted pupils, decreased BP & respirations, drowsiness, slurred speech, constipation  S/S of overdose  Possible dilation of pupils as a result of anoxia  Respiratory depression or arrest  Cardiac arrest & death  Coma, shock, convulsions  Treatment  Naloxone (Narcan)

24. Money Ran Out - What Now?  Heroin  Assess for S/S of withdrawal

25. Need Treatment? Heroin  Teaching  Relapse prevention  NA  Coping skills

26.  Heroin users also can develop:  Hepatitis  HIV  Renal failure  Seizures  Cardiac arrest  Coma  Respiratory failure and death

27. Using Stimulants?  Names of Stimulants- Meth,Cocaine  S/S of Use  Dilated pupils  increased b/p  n/v  insomnia  decreased appetite  euphoria  paranoia  hallucinations

28. overdose  Respiratory distress  Convulsions  Coma  MI  Stroke  death

29. withdrawal  Depression  Lethargy  Sleepiness  Chills, fever

30. What Else?  Illicit Drugs  Hallucinogens  Inhallants  Club drugs  Prescription Drugs  Anabolic-Androgenic Steroids  Nicotine  Caffeine  What’s New On The Drug Scene

31.  Caffeine:  GI reflux ds  Peptic ulcers  tachycardia  Nicotine:  Emphysema  Lung cancer  HTN  PVD  Nicotine alters mood,appetite and alertness

32.  Prescription drug misuse accounts for 2 ½ million abusers  Ex- opiates  Narcotics  Ie- oxycodone

33. Which assessment data should the nurse gather when confirming a diagnosis of substance dependence?

34. Eating Disorders

36. Anorexia Nervosa  Characteristics  HUNGER Has obsession with food & weight Underweight or emaciated Needs go unmet because of controlling parents or parent conflict Gross distortion of body image Excessive exercise & dieting Refuses to eat

37. Nursing Process  Assessment  Refusal to maintain minimal weight  FEAR of obesity  Peculiar handling of food  Perfectionist, controlling  Rigid family rules & high expectations  Interventions  Monitor vital signs, I & O, & electrolytes  Weigh client daily  Provide structure & support during mealtimes  Monitor mood and healthy expression of feelings  Monitor for excessive exercise

39. Bulimia Nervosa  Characteristics  RIDS BODY Recurrent binge-eating episodes Intense exercise Diuretics, laxatives, & enema use Self-induced vomiting Body image distortions Ordinary eating alternating with episodes of binging & purging Depression and anxiety Yo-yo effect of tension relief & pleasure experienced with binging

41. When using a behavioral modification approach to the treatment of eating disorders, which nursing intervention whould be most likely to produce positive results? 1. A matter-of-fact, directive approach with the input of the entire treatment team 2. Clients should perceive that they are in control of clearly communicated treatment choices 3. Appropriate treatment choices are presented to the client’s family for consideration 4. The treatment team develops a system of rewards and privileges that can be earned by the client

42.  2- there is a need to give a sense of control back to the individual therefore they need to feel in control of their treatment choices.  Contracts help gain this sense of control

43. Refeeding Problems  Major early concern with refeeding in anorexia is metabolic complications  1-giving carb’s causes insulin to be released  2-this triggers cellular uptake of potassium, phosphate, and magnesium  3-when serum concentrations of these electrolytes are reduced, problems occur with neurologic, pulmonary and cardiac systems  4- This complication is usually seen around 4 days after feeding starts

44. 43 Binge Eating Disorder  A variant of compulsive overeating  No compensatory behaviors  Frequently symptom of an affective disorder  Cognitive-behavioral therapy, behavior therapy, & interpersonal therapy most effective