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Chapter 18

Chapter 18. Addictive Disorders. Tolerance and Withdrawal. Tolerance Person’s physiological reaction to drug decreases with repeated administration of same dose Withdrawal

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Chapter 18

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  1. Chapter 18 Addictive Disorders

  2. Tolerance and Withdrawal Tolerance • Person’s physiological reaction to drug decreases with repeated administration of same dose Withdrawal • Psychological changes occur when blood and tissue concentrations of drug decrease after heavy prolonged use of substance

  3. Synergistic and Antagonistic • Synergistic effect– when drugs are taken together, effect of either or both is intensified or prolonged • Antagonistic effects–whendrugs are taken together, effect of one is inhibited or weakened

  4. Comorbidity • Psychiatric comorbidity– 6 out of 10 people affected by substance-abuse disorder also affected by mental health disorder • Medical comorbidity– alcohol-related medical problems are the comorbidities most commonly seen in medical settings

  5. Etiology • Biological factors • Specific effects on neurotransmitter systems • Psychological factors • Lack of tolerance for frustration and pain • Lack of success in life • Lack of affectionate and meaningful relationships • Low self-esteem, lack of self-regard • Risk-taking propensity • Sociocultural factors • Social and cultural norms • Socioeconomic stress

  6. General Assessment • Two questions of importance • In the last year, have you ever drank or used drugs more than you meant to? • Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? • Details include • Drugs used • Route • Quantity • Time of last use • Usual pattern of use

  7. Psychological Changes Denial Depression Anxiety Dependency Hopelessness Low self-esteem Various psychiatric disorders

  8. Signs of Intoxication and Withdrawal • Alcohol poisoning • Large amounts of alcohol consumed quickly or over time • Alcohol withdrawal • Signs develop within a few hours after cessation • Peaks at 24 to 48 hours • Alcohol withdrawal delirium • Medical emergency • Can result in death, even if treated

  9. A nurse is assigned the care of four patients detoxifying from alcohol. The patient with which symptom would be the nurse’s highest priority?

  10. Fine-motor tremors Diaphoresis Diarrhea Hallucinations and delusions

  11. Central Nervous System Stimulants Common signs of stimulant abuse • Dilation of the pupils • Dryness of the oronasal cavity • Excessive motor activity Cocaine and crack Caffeine and nicotine

  12. Cocaine and Crack • Extracted from leaf of coca bush • When smoked, takes effect in 4 to 6 seconds; a 5- to 7-minute high follows, then a deep depression • Two main effects on body • Anesthetic • Stimulant • Produces imbalance in neurotransmitters • Withdrawal symptoms include • Depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, chills

  13. Opiates Morphine Heroin Codeine Fentanyl Methadone Meperidine

  14. Marijuana (Cannabis sativa) • Indian hemp plant • Tetrahydrocannabinol (THC) is active ingredient • Depressant and hallucinogenic properties • Usually smoked • Desired effects – euphoria, detachment, relaxation • Long-term effects – lethargy, anhedonia, difficulty concentrating, loss of memory

  15. Hallucinogens • Lysergic acid diethylamide (LSD or acid) • Mescaline (peyote) • Psilocybin (magic mushroom) • Phencyclidine piperidine (PCP, angel dust, horse tranquilizer, peace pill)

  16. Inhalants • Volatile solvents • Spray paint • Glue • Cigarette lighter fluid • Propellant gases used in aerosols

  17. Club Drugs • Common drugs • Ecstasy - also called MDMA, Adam, yaba, XTC • MDA – “love” • MDE – “Eve” • Produce subjective effects resembling stimulants and hallucinogens

  18. Date Rape Drugs • Flunitrazepam (Rohypnolor “roofies”) • Gamma hydroxybutyric acid (GHB) • Rapidly produce • Disinhibition • Relaxation of voluntary muscles • Anterograde amnesia

  19. Assessment Guidelinesfor the Chemically Impaired • Assess for withdrawal syndrome • Assess for overdose that warrants medical attention • Assess for suicidal thoughts or other self-destructive behaviors • Evaluate for physical complications related to drug abuse • Explore interests in doing something about drug or alcohol problem • Assess patient and family for knowledge of community resources

  20. Potential Nursing Diagnoses • Imbalanced nutrition: less than body requirements • Disturbed thought processes • Disturbed sleep patterns • Ineffective health maintenance • Hopelessness • Risk for suicide • Risk for other-directed violence • Ineffective airway clearance • Ineffective breathing pattern

  21. Outcomes Identification • Withdrawal • Fluid balance • Neurological status: consciousness • Distorted thought self-control • Initial and active drug treatment • Risk control – alcohol use • Risk control – drug use • Substance addiction consequences • Health maintenance • Knowledge: substance abuse control • Family coping

  22. Implementation • Aim of treatment – self-responsibility • Challenge – matching patients with types of treatment related to various needs • Physiological • Psychological • Sociocultural processes

  23. Health Teaching and Health Promotion • Primary prevention – health teaching FRAMES • Feedback of personal risk • Responsibility of the patient • Advice to change • Menu of ways to reduce substance use • Empathetic counseling • Self-efficacy or optimism of the patient

  24. Intervention Strategies Continued • Relapse prevention • Self-help groups for patient and family • 12-Step programs • Residential programs • Intensive outpatient programs • Outpatient drug-free programs and employee assistance programs

  25. Pharmacological Interventions Treatment of Alcoholism • Naltrexone (ReVia) • Reduces or eliminates alcohol craving • Acamprosate (Campral) • Helps client abstain from alcohol • Topiramate (Topamax) • Works to decrease alcohol cravings • Disulfiram (Antabuse) • Alcohol-disulfiram reaction causes unpleasant physical effects

  26. Pharmacological Interventions Treatment of Opioid Addiction • Methadone (Dolophine) • Synthetic opiate blocks craving for and effects of heroin • LAAM (l-α-acetylmethadol) • An alternative to methadone • Naltrexone (ReVia) • Antagonist that blocks euphoric effects of opioids • Clonidine (Catapres) • Effective somatic treatment when combined with naltrexone • Buprenorphine (Subutex) • Blocks signs and symptoms of opioid withdrawal

  27. Evaluation • Increased time in abstinence • Decreased denial • Acceptable occupational functioning • Improved family relationships • Ability to relate comfortably to other individuals

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