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TERMS Psychoactive substance DEFINITIONS A substance that affects a persons mood or behavior Continued use of a psychoactive substance despite the occurrence of physical, psychological, social, or occupational problems

Substance abuse

Substance dependence

A range of physiologic, behavioral, and cognitive symptoms indicating that a person persists in using the substance, ignoring serious substance-related problems

Physiologic dependence The bodys physical adaptation to a drug, whereby withdrawal symptoms occur if the drug is not used

Psychological dependence


The emotional need or craving for a drug either for its effect or to prevent the occurrence of withdrawal symptoms A compulsion, loss of control, and progressive pattern of drug use; characterized by behavioral changes, impaired thinking, unkept promises to stop usage, obsession with the drug, neglect of personal needs, decreased tolerance, and physiologic deterioration

Polysubstance abuse

Concurrent use of multiple drugs An altered physiologic state resulting from the use of a psychoactive drug Accidental or deliberate consumption of a drug in a dose larger than is ordinarily used, resulting in a serious toxic reaction or death




Tolerance is the need for the increasing amount of a substance to produce its desired effect. It also refers to the decreasing effect of the drug.

Cross-tolerance A state whereby the effect of a drug is decreased and greater amounts are required to achieve the desired effect because the person has become tolerant to a similar drug Predisposition Any factor that increases the likelihood of an event occurring


Drug misuse

The ability of one drug to increase the activity of another drug when taken at the same time Any use of a drug that deviates from medical or socially acceptable use

Dual diagnosis The coexistence of a major psychiatric illness and a psychoactive substance abuse disorder An acute situation in which a Blackout person experiences a period of memory loss for actions as a direct result of using drugs or alcohol


Discontinuation of a substance by a person who is dependent on it The process of withdrawing a person from an addictive substance in a safe manner The amount of a drug that produces a poisonous effect The tendency to relapse into a former pattern of substance use and associated behaviors


Toxic dose


The return to a normal state of health, whereby the person does not engage in problematic behavior and continues to meet lifes challenges and personal goals Complete abstinence from drugs while developing a satisfactory lifestyle Voluntarily refraining from activities or the use of substances that cause problems in the physiologic, psychological, social, intellectual, and spiritual arenas of a persons life

Sobriety Abstinence


ASSESSMENT FINDINGS History. Academic or job failures, marital failures, stealing to support habit, personality change, violent acting out Physical Examination: Malnutrition; abdominal cramps; diaphoresis, yawning, lacrimation, rhinorrhea 10 hours after the last opiate injection; needle marks on arms along path of a vein (wearing of longsleeves); nasal discharge with nasal septum perforation (cocaine) Social: Inability to maintain ADL and fulfill role responsibilities and obligations

B. NURSING DIAGNOSES, POTENTIAL: Altered health maintenance/nutrition related to chemical dependence; lack of interest in food High Risk for Violence: Directed toward self or others related to feelings of suspicion or distrust; intake of mindaltering substances; misinterpretation of stimuli Defensive Coping related to denial of problem; projection of responsibility or blame; rationalization of failures



OPIATE Euphoria or Anxiety NARCOTI Sadness CS: Insomnia

Chills and PERSPIRATI ON Tremors Narcotic Withdrawal causes muscle ache, rhinorrhea

Naloxone (NARCAN) the #1 antidote for Opioids or Narcotic intoxication

A CNS depressan t can cause decreased blood pressure, pulse, respiratio n, and temperatu re. Demerol Morphine Codeine Nalbuphine

anxiety 1st 12-72 hrs: -sleep disturbances, piloerection, irritability, tremors, weakness, diarrhea, muscle spasm (legs), abdominal pain, VS changes, decreased selfesteem, depression

METHADON E for Heroin Withdrawal :

HEROIN(Horse, smack, junk, Smack, ,Horse and Fine China)

Marked respiratory depression PinpointPup ils , Hyperpyrexi a Ventricular dysrhythmi a

Lacrimation (Watery eyes) RUNNY NOSE YAWNING BP Dilated pupils Cramps Muscle SPASM Nausea, VOMITING Panic, diaphoresis, and weight loss/anorexia

ANXIOLYTI CS: Minor tranquilizer s Valium Librium Barbiturates - (Downes, rainbows, pink ladies) Phenobarbit al Nembutal

Slurred speech Respiratory depression BP and PR Ataxia/ impaired coordinatio n Drowsiness Seizures, Coma Memory

Fatigue Anxiety Depression BP and PR Tachycardia Tremors Convulsion s Delirium Hallucinatio ns Anxiety Insomnia

Sodium bicarbonate excretion Activated charcoal, gastric lavage

STIMULANTS (Upper, meth, speed, pep, pills, crystal, Ice, Uppers, Crank Amphetamine s Dexedrine Methampheta mine

Euphoria Agitation BP, PR, RP, Temp Hyperactivit y, dilated pupils, Grandiosity Hypervigilan ce, Euphoria, Appetite suppression , Personality changes, Antisocial behavior

Depression Fatigue Apathy Disorientatio n Irritability Altered sleep

Activated charcoal, use gastric lavage

Cocaine (Oral, Injected, Inhaled) Coke Crack Snow Blow Lady Powder

Nasal septum perforation Irritability, Seizure Coma, Insomnia, Dilated pupils

Cocaine is characterized by, vivid dreams and hypersomnia or insomnia and psychomotor agitation. Psychosis similar to paranoid schizophrenia

Cocaine use leads to dopamine deficiency. Amino acid therapy is utilized to facilitate restoration of depleted neurotrans mitters.

Hallucinoge ns: LSD (acid) :Oral, Injected, Inhaled)Ang el dust, Hog,rocket fuel)

Hallucination None Incoherence confusion Dilated pupils BP, Temp Delirium, Mania, Agitation Convulsions Coma

Small doses of Valium

Cannabis Derivatives: Marijuana (mary jane, joint, grass, weed, Pot, Hash, Weed)

#1 sign RED EYES(irritat ed conjunctiva) Fatigue Conjunctiva lCongestion appetite Euphoria Relaxed inhibition Dilated pupils Psychosis

Hyperactivit yInsomnia Dry mouth Sexual arousal Visual hallucinatio ns

Most effects wear off in 5-8 hr talk down client

Another word for alcohol is Booze Brew GENERAL PRINCIPLES OF CARE: ALCOHOL DETOXIFICATION 3 As = Alcohol Withdrawal Aversion Therapy (Punishment) Antabuse (Disulfiram) = no effect unless mixed with alcohol

Action: Inhibit Antabuse effect Acetaldehyde dehydrogenase

> Dosage: Acute phase = 500 mg in 1st 2 wks. Maintenance Phase = 250 mg & >Prohibited Household items with alcohol: mouthwash, cough syrup/elixir, vinegar, fruitcake, shaving cream, astringent, and toner, acetone/nail polish Cough medicines and other over-thecounter medicines are alcohol-based and may cause antabuse reaction when it is combined with antabuse. Antabuse may worsen renal damage thus it is contraindicated for patients with renal problems.

Effect of Antabuse with Alcohol 1. Nausea & Vomiting 2. Diarrhea 3. Intense headache 4. Abdominal cramps > Short term objective for an alcoholic: To stop/cut denial
Long term objective: Abstinence (similar with STD/HIV/AIDS)

> # 1 group therapy for Alcoholics (12 step recovery program AA (Alcoholic Anonymous) for victims of alcoholics: AL-ANON for alcoholic teens: ALATEEN Correct response of an RN to alcoholic patient who says, I dont want to attend group meeting, I dont need their alcoholic advice. Is a statement like, The group activity may not seem helpful to you but you can help them.

> Screening Questions for alcohol abuse: 1. When was the last time you have taken alcohol? 2. How much alcohol have you taken for the last 24-48 hrs? In a detoxification unit, the nurse asks the pt when was the last time he drink alcohol to determine the onset of alcohol withdrawal syndrome. Goal in alcohol detoxification includes maintaining maximum physical integrity during withdrawal period. Statement of a pt who is alcoholic and undergoing detoxification saying, I can quit whenever I want. shows denial

CAGE SCREENING QUESTION FOR AN ALCOHOLIC C cut down alcohol (Do you need to cut down alcohol?) A annoyed (Are you annoyed when someone will ask you Are you an alcoholic?) G guilty (Are you guilty of taking too much alcohol?) E eye opener (stimulant) Do you use an eye opener early in the morning to decrease the after effects of alcohol?

3 Stages of Alcohol Intoxication I. Alcohol Serum Level = 0.04 -0.05% > unsteady gait > social & sexual inhibition
II. ASL = 0.08-0.1 or 100 mg/dl > slurring of speech > Fruity odor similar to ketoacidosis > Legal intoxication

III. ASL = 0.15-0.2 severe alcohol intoxication

> 4 Common Complications with History of Alcoholism 1. Liver Cirrhosis 2. Gastritis inflammation 3. Pancreatitis 4. Wernickes Korsakoffs peripheral neuritis lack of Vit. B1 (thiamine) (Sx: Tingling sensation/numbness of extremities: Avoid electric blankets!) Wernickes psychosis is due to thiamine deficiency. Confabulation or making up of stories is one of the initial manifestations of Korsakoffs syndrome.

Two categories of Wernickes Korsakoffs:

A. Wernickes Aphasia / Receptive Aphasia: Problems in interpretation (temporal lobe) B. Korsakoffs Psychosis irreversible (the best drug is Risperidone (Risperdal): It has Decrease extrapyramidal symptoms (EPS)

4 Stages of Alcohol Withdrawal

I. Early/Initial Fine tremors, restlessness, tachycardia, diaphoresis, hyperventilation & nervousness

Symptoms of alcohol withdrawal is observed when the cup rattles to the side when the patient stirs his coffee
II. Hallucination #1 hallucination of Alcohol withdrawal is TACTILE Nursing diagnosis for patient with delirium tremens who says, There are bugs in my bed crawling over me is Altered Thought Process

2. Visual hallucination Intervention: > Use lampshade to shadow (illusions) Leaving a light on the patients room will decrease visual hallucinations, which frequently occur in alcohol withdrawal syndromes. Shadow stimulates hallucination
dont leave the patient (Offering of self)

Assigning a staff to the patient promotes safety especially during withdrawal episodes.

III. Pre-seizure/RUM FITS Impending signs of Seizure 1. Epigastric pain (early sign in eclampsia) 2. High pitch cry/projectile 3. Eye pain/periorbital pain (scotomas) usually in eclampsia 4. Headache & Aura- ICP 5. Restlessness cerebral hypoxia = 02 & glucose

IV. Delirium Tremens Active Seizure = Grand mal/TonicClonic Delirium tremens is initially manifested by anxiety, restlessness, illusions, hallucinations and elevated vital signs. Observation indicating a need to be included during endorsement to next shift in an alcoholic patient in the ER include observations of becoming fearful (delirium tremens)

Anticonvulsants Antidepressants Antipsychotics Barbiturates Cardiac glycosides Hypoglycemic agents Narcotics Reserpine

Anticholinergics Antihistamines Aspirin Benzodiazepines Cimetidine(Tagamet) Insulin Propranolol (Inderal) Thiazide diuretics


Physiologic Hypoxemia, electrolytes disturbances, or renal or hepatic failure, hypo- or metabolic hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and related substances


Systemic: Sepsis, urinary tract infection, pneumonia Cerebral: Meningitis, encephalitis, HIV, syphilis Intoxication: Anticholinergics, lithium, alcohol, sedatives, and hypnotics Withdrawal: Alcohol, sedatives, and hypnotics Reactions to anesthesia, prescription medication or illicit (street) drugs


Valium (Diazepam) best drug for delirium tremens 2. Librium (Clordiazepoxide) Positive) outcome of Librium in alcoholic depressed woman includes an observation that client can pick an object on floor w/ smooth coordination 3. Klonopin (Clonazepam)

4. Phenytoin (Dilantin) best anticonvulsant for children SE: Gingival hyperplasia & red orange urine Intervention: Massage the gums & use soft bristle toothbrush Adverse Effect: Blood dyscrasia thrombocytopenia S/SX: Bleeding of the gums Lab test: Platelet count = 150,000-400,000; if 100,000-active bleeding Special Considerations: The only COMPATIBLE I.V. Solution for Phenytoin (dilantin) is NSS (Normal Saline Solution)

5. Carbamazepine (Tegretol): Anticonvulsant trigeminal neuralgia (tic douloureux) A/E: Agranulocytosis/neutropenia S/Sx: Sore throat - Neutrophils 54-56 %
6. Valproic Acid (Depakene/Depakote) therapeutic serum level: 40-100 mcg. Adverse Reaction: Hepatotoxic (assess SGPT or ALT) 7. Ethosuccimide (zarontin) Chlordiazepoxide (Librium), multivitamins, thiamine and folic acid help decrease withdrawal symptoms.

A. B. C. D. E.

GENERAL PRINCIPLES OF CARE: DETOXIFICATION/OVERDOSE Maintain airway: Intubation (keep airway on hand), suction Start IV line Monitoring: BP, respiration, pulse, temperature, LOC Prevent and control seizures; Keep in calm, quiet environment Check for trauma, protect from injury A pt taking phencyclidine (PCP), shouts & walks back & forth, appropriate nursing intervention includes seclusion, staying w/ the pt, and decreasing stimuli.

F. Administer ordered drugs; Detoxify / treat overdose

NALOXONE (NARCAN) Pure antagonist to narcotics-induces withdrawal and stimulates respiration; DRUG OF CHOICE when in doubt the substance used because NALOPHINE (NALLIN), a partial antagonist to narcotics, will respiratory depression if barbiturates have also been used METHADONE drug substitute used for acute withdrawal and long-term maintenance; changes an illegal to a legal drug, which is administered under supervision. Antidepressants block the high from stimulant abuse

G. Nutrition: High-calorie, high-protein, highvitamin


SEXUAL DISORDER: Deviations in sexual behavior; sexual behaviors that are directed toward anything other than consenting adults or are performed under unusual circumstances and are considered abnormal PARAPHILIA: Sexual fantasies or urges that are directed toward nonhuman objects, the pain to self or partner, or children and other nonconsenting individuals.





EXHIBITIONISM: Sexual gratification from exposing genitalia FETISHISM: Sexual gratification from an inanimate object (usually clothing material) substituted for the genitals FROTTEURISM: Sexual gratification from toughing or rubbing against a nonconsenting person (usually in crowds, public transportation) MASOCHISM: Sexual gratification from self-suffering used as an accompaniment of the sexual act or substitute for it

5. PEDOPHILIA: Sexual gratification from children 6. SADISM: Sexual gratification from inflicting pain or cruelty to others used as an accompaniment of the sexual act or a substitute for it 7. TRANSVESTISM: Sexual gratification from wearing clothes of the opposite sex 8. VOYEURISM: Sexual gratification from watching the sexual play / act of others 9. ZOOPHILIA: Sexual gratification from animals

C. SEXUAL DYSFUNCTION: Generalized or situational, acquired or lifelong inhibition or interference with any of the phases of the sexual responses which may be due to psychogenic factors alone or psychogenic and biologic combined.
D. NURSING DIAGNOSES 1. Anxiety related to threat to security and fear of discovery

2. Anxiety related to conflict between sexual desires social norms 3. Sexual dysfunction related to actual or perceived sexual limitations 4. Sexual dysfunction related to inability to achieve sexual satisfaction without the use of paraphilic behaviors 5. Potential for infection related to frequent changes in sexual partners or sadistic or masochistic acts 6. Potential for injury / violence related to sexual behavior and retaliation for sexual behaviors


1. Acceptance NOT of the behavior but of the client who is in emotional pain 2. Protection of the client from others 3. Setting limits on the sexual acting out 4. Supporting of self-esteem: Avoidance of punitive remarks or responses 5. Provision of diversional activities


Autism, Conduct Disorder, Attention Deficit Hyperactive Disorder (ADHD),

AUSTITIC DISORDER A. A type of developmental disorder for an unknown; probable underlying problem: failure to develop satisfactory relationships with significant adults - mostly males - talented in music or math - # 1 screening test DDST (Denver Developmental Screening Test) - Autism is usually diagnosed during the toddler stage.

1. Blank stare 2. Repetitive movement: head banging padded room/helmet 3. Likes to follow bright moving objects 4. Catatonic 5. Temper tantrums 6. Clings to inanimate objects

B. ASSESSMENT FINDINGS: 1. Disturbance in sense of self-identity, in ego system formation: Inability to distinguish between self and reality / environment speaks of self in the third person 2. Withdrawal from reality. 3. Lacks meaningful relationship with outside world; turns to inanimate objects and self-centered activities for security 4. Personality alteration adaptive, inhibitory, steering mechanisms due to profound interference in intellect 5. SEVERE AUTISM Severe apathy, Association looseness, Autistic thinking, Poor grasp of reality, Ambivalence, Poor communication skills, Poor interpersonal relations, Poor intellectual functioning

C. NURSING DIAGNOSIS: Potential for Injury D. NURSING IMPLEMENTATION: 1. Provide consistent, routine ADL in familiar environment 2. Set consistent and firm limits for his behavior 3. Make physical contact on a regular basis. Accept the clients need to push but still maintain regular contact. 4. Prevent acts of self-destructive behavior 5. Provide appropriate therapy:

Removal from home, if necessary; consistent loving home care is still favored over hospitalization; consistent care giver; never leave alone; and always provide safety. Psychotherapy: Play, group, individual therapy Primary treatment goal to facilitate the recovery of an autistic child should include playing with blocks not with balls . Occupational Therapy #1 behavior modification #2 Behavior modification in an autistic child enables the nurse to modify the childs maladaptive behavior. Pharmacology: Tranquilizers and amphetamines to reduce symptoms Caring autistic children requires specialized skills.



Disruptive behavioral disorder evident before 7 years old and lasting at least 6 months and characterized by hyperactivity and inattentiveness Norepinephrine,Serotonin


- #1 Screening Test DDST

CHARACTERISTICS: 1. Hyperactive could not sit and stay in 15 minutes 2. metabolism fatigue 3. handwriting not legible 4. Easily agitated by noise & color (orange/yellow)

ASSESSMENT 1. Severe inattentiveness with or without hyperactivity 2. Short attention span 3. Excessive impulsiveness 4. Squirming and fidgeting 5. 5. Hyperactive could not sit and stay in 15 minutes metabolism fatigue handwriting not legible Easily agitated by noise & color (orange/yellow)

1. 2.


Set realistic, attainable goals Provide firm, consistent discipline with opportunities to experience satisfaction and success Provide a structured environmentWith a balance of energy expenditure and quiet time With learning experience utilizing childs ability With exercise in perceptual-motor coordination With LESS STIMULATION The priority needs of the child with ADHD are safety and provision of inadequate nutrition. Catching attention of a child with ADD includes getting him to look at his mom & give him simple directions.

4. Administer drugs as ordered: RITALIN (methylphenidate) or dextroamphetamine sulfate 5. #1 Therapy: Occupational Therapy using behavior modification DIET: caloric content finger foods Vitamin B Complex appetite Do not mix Caffeinated food/drinks with ACA/alcohol Tx: 1. RITALIN (Methylphenidate: BEST GIVEN AFTER BREAKFAST) Always with meals

Ritalin, the drug of choice for ADHD causes growth suppression, insomnia and suppression of appetite. 1. Psychostimulant to increase attention span 2. Dextroamphetamine (Dexedrine) 3. Pemoline (Cylert) very hepatotoxic!!! 4. Stratera ( Atomoxetine) newest psychostimulant!! Contraindication: Do not give below 6 yo hepatotoxic SGPT Stratera, a drug for ADD/ADHD enhances catecholamine effect. Statement like, My son is able to accomplish his task better, indicates efficacy of the drug.