Understanding Substance Use Disorders: Signs, Classifications, and Impact on Health, Exams of Nursing

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NUR-3018 MENTAL HEALTH FINAL EXAM STUDY GUIDE 2024 UPDATE RATED A+ Module 9: SUD ● Epidemiology: Alcohol most abused, then marijuana. o 192 drug overdose deaths each day (now a leading cause for Americans under 50) o The younger the person is at the time of initial substance use, the higher the incidence of developing SUD. ● Treatment and Recovery o The goal is to recover from the abuse. o Recovery involves a partnership between health care providers and the individual/family. o Specific withdrawal symptoms depend on the substance. ▪ Typically involves detoxification and then recovery can begin o A primary concern is relapse. ▪ Relapse is an expected part of chronic disease addiction. ● Therapeutic Communication o See slide 7 for appropriate language o Ex: person with SUD/AUD vs addict/alcoholic; person in recovery vs former addict. ● Language: You go to the hospital with chest pain and are found to be having a cardiac arrest…and you were o Told it was your fault because of your choices? o Denied treatment because you did it to yourself? o Given a list of cardiologists and cath labs to call? o Only given aspirin if you agreed to counseling? ● Key terms o Addiction - continued use of substances (or reward-seeking behaviors) despite adverse consequences o Use - ingestion, smoking, sniffing, or injection of mind-altering substance o Abuse - use for purposes of intoxication or beyond intended use o Withdrawal - symptoms occurring when substance no longer used o Detoxification - process for safe withdrawal (medical oversight) o Relapse - recurrence o Tolerance - a state of acquired resistance to the drug o Psychological Dependence - craving or compulsion to continue the use of drug because it gives sense of well being o Physiological Dependence - specific syndrome follows cessation or reduction in intake of substance; need higher and higher doses of the drug for effect ● Signs of SUD o Change in school or work performance/attendance o Change in appearance o Change in mood or attitude o Withdrawal from family contacts (sometimes isolation) o Withdrawal from responsibility o Unusual patterns of behavior o Unresponsive to environmental stimuli ● Classifications o CNS Depressant (dopamine flood – see slide 23) ▪ Alcohol ▪ Sedatives/hypnotic ▪ Inhalants ▪ Opiates o CNS Stimulant (↑ dopamine, ↑ norepinephrine, ↑ serotonin) ▪ Amphetamines ▪ Cocaine ▪ Nicotine ▪ Caffeine ▪ Hallucinogens ● Defense Mechanisms ● Alcohol Use Disorder - problematic pattern of alcohol use leading to clinically significant impairment.- Alcohol withdrawal can be life threatening if not treated o Moderate drinking = 1 drink/day- All 50 states: 0.8% blood alcohol concentration legally intoxicated o Heavy drinking: females = 8 drinks/week, males = 15 drinks/week o Physical impact- ▪ Wernickes syndrome – thiamine deficit ▪ Korsakoff psychosis – confusion, loss of recent memory, confabulation ▪ Often called Wernicke-Korsakoff o Intoxication Behaviors ▪ Recent ingestion of alcohol ▪ Problematic behavior: aggressive, label, impaired judgment ▪ Slurred speech ▪ Incoordination ▪ Unsteady gait ▪ Nystagmus rapid eyes movement see in neurological disorder ▪ Impairment in memory or attention ▪ Stupor or coma ▪ Flushed skin ▪ decreased inhibitions ▪ cognitive impairment o Withdrawal: life threatening ▪ Timing ● Early signs (4-12hrs) after cessation after abrupt discontinuation ● Grand mal seizures possible 7-48hrs after cessation ● Peaks within 24-48hrs ● DTs - 2nd-3rd day ● Detoxification - safe and effective withdrawal usually under medical supervision. ▪ anxiety ▪ tremors Module 10 ● Child/Adolescents o Children with ACEs are more likely to have: ▪ Learning and behavior issues ▪ ADHD ▪ Oppositional behaviors ▪ Early initiation of sexual activity ▪ Adolescent pregnancy o Prevalence- ¼ of all chronic mental illness begins by the age of 14 ▪ In in juvenile justice systems: 70% of youth have 1 (or more) mental health condition and over 20% live with a severe mental illness. ▪ Worldwide - approx 20% of children experience a mental health disorder ● Of that, 20% are considered severe. o Common Disorders ▪ Intellectual disability ● There is a limit to their intellectual function – impacts daily life. ▪ Autism spectrum disorders (including Asperger Syndrome) ● Neurodevelopmental delays w/ or w/o intellectual disability ● Severe and sustained impairment in social interaction ● Repetitive patterns of behavior (rocking) ● Highly restricted areas of interest (ex: train schedules) ● Prevalence: 1 in 54 children; 4x more common in boys ● No medications have been proven to be effective at changing the core social/language deficits of the disorder. ▪ Attention-deficit hyperactivity disorder (ADHD) ● Prevalence: 9% from age 12-17; more common in boys ● Persistent pattern of inattention and impulsiveness ● Risk factors: family history of ADHD, substance abuse during pregnancy ▪ Learning disorders/learning disability ● Verbal: reading (dyslexia) and spelling ● Nonverbal: mathematics ▪ Communication disorders ▪ Disruptive behavior disorders ● Oppositional defiant disorder ● Conduct disorder (children) antisocial personality disorder (adult) o Symptoms of ADHD ▪ Neurotransmitter: dysregulation of serotonin and dopamine ▪ Persistent pattern of inattention and impulsiveness o ADHD meds ▪ Stimulants-first line drug of choice Paradoxical calming effect & work by inhibiting the action of the dopamine transporter protein at the synapse; increase norepenephrine level in brain Rapid effect- 20 minutes, short-acting give several daily doses; longer acting – morning dose ▪ First line treatment: Psychostimulants (give in AM, after breakfast to avoid inhibiting appetite) ● Ritalin ● Adderall ● Concerta ● Vyvanse ● Adzenys ▪ Nonstimulant: Atomoxetine/Strattera (if stimulant is contraindicated, ex: cardiac issues) ▪ Bupropion, tricyclic antidepressants, alpha2A agonists o Therapeutic communication ▪ Use of more specific, fewer open-ended questions ▪ Children need simple phrases ▪ Corroboration of information with adult ▪ Use of artistic and play media ▪ Possible problems with accurate sequencing of events o Interventions ▪ Prevention Primary Prevention (Education)- Secondary prevention- not symptomatic (screening) Tertiary prevention - treating the disease with meds and counseling. ● Allow maximal autonomy; keep the family intact ● Provide appropriate level of care ▪ Early intervention programs ▪ Psychoeducational programs ▪ Social skills training ▪ Bibliotherapy (reading) o Factors that influence ▪ Death & grieving Loss and Early Childhood (ages 2–6) o React more to others’ responses than to death itself o Need reassurance; honesty o Avoid euphemisms (e.g., “he went to sleep”) ▪ Loss and the Middle Childhood Years (ages 6–11) o Unable to express feelings in a grown-up way o Express grief through somatic complaints, regression, behavior problems, withdrawal, and hostility. ▪ Loss and Adolescents o Idealistic and think in extremes o Understand death as an abstract concept o May have a romantic idea of death ▪ Separation and divorce ▪ Sibling relationships ▪ Bullying ▪ Physical illness o Chronic illness: significantly more likely to experience psychiatric symptoms o Common childhood reactions: regression, somatic complaints, sleep/eating difficulties, behavior problems, depression ▪ Adolescent risk-taking behaviors ● Techniques for Data Collection ▪ Preschool children o Difficulty putting feelings into words, thinking concretely o Use of play o Assessment tools; drawings, play therapy ▪ School-aged children o Ability to use constructs, provide longer explanations o Rapport through competitive games; thinking–feeling–doing game ▪ Adolescents o Egocentric with increased self-consciousness, fear of being shamed ● Eating Disorders (anorexia nervosa/bulimia) o Neurotransmitter involved – decreased serotonin o Nursing Diagnoses ▪ Imbalanced nutrition: less than body requirements, related to inadequate food intake/self-induced vomiting as evidenced by body weight 15% (or more) below expected range/excessive hair loss/amenorrhea/ bradycardia/hypotension ▪ Risk for deficient fluid volume related to inadequate intake of food and liquid, as evidenced by dry skin/increased HR & body temp/output greater than input/weakness/change in mental state/altered electrolyte balance ▪ Disturbed body image related to morbid fear of obesity, as evidenced by distorted body image/expressions of shame or guilt o Risk Factors ▪ Higher risk if a first degree relative had eating disorder ▪ ↑ BMR; overexercising; elite athlete ▪ Low self-esteem, body dissatisfaction, feelings of ineffectiveness ▪ Family: overprotective, enmeshed, rigid boundaries, inability to solve conflicts o Resulting Medical Conditions Module 11 ● Caring for Adults o Challenges for Adults ▪ Married vs Unmarried ▪ Peak Marriage Age ▪ “Empty Nest” and “Sandwich Generation” o Risk factors ▪ Age ▪ Marital status ▪ Unemployment and other job stresses ▪ Gender ▪ History of child abuse ▪ Prior mental disorder ▪ Coping ▪ Well-being ▪ Lack of health promotion behaviors ▪ Parenting stress ▪ Factors associated with suicide o Protective Factors ▪ Older age ▪ Education ▪ Marriage ▪ Social support ▪ Exercise o Young (18-44 y/o) o Middle (44-65 y/o) - changes noted ▪ Risk factors: genetics, biologic, environment, cultural, and in some instances gender o Older (Young-Old = 65-74, Middle-Old = 75-84, Old-Old = 85+) ▪ Risk Factors Specific to Older Adults ● Chronic illnesses ● Alcohol and substance abuse ● Polypharmacy (refer to Box 18.3) ● Bereavement and loss ● Poverty ● Social Isolation ● Lack of social support and suicide ● Shared living arrangements and elder mistreatment ▪ Protective Factors Specific to Older Adults ● The marriage effect ● Education and income ● Resilience and positive outlook ● Healthy lifestyle ● Nutrition ● Physical activity ▪ Elder Abuse ● Nurses are mandated reporters! ● Abuse or neglect older than age 60 years o Physical o Sexual o Emotional o Neglect o Abandonment o Financial ● Risk factors: older age, impaired ADLs, cognitive disability, dependency on caregiver, isolation, stressful events, history of intergenerational conflict ● Neurocognitive Disorders o Terms ▪ Aphagia – alteration in language ▪ Dysphagia – difficulty swallowing ▪ Apraxia – inability to execute motor function ▪ Plaques – protein fragment beta-amyloid outside of the neurons ▪ Tangles - twisted strands of the protein tau inside neurons o Defense Mechanisms ▪ Denial ▪ Confabulation ▪ Perseveration o Ted Talk Video ▪ Dr. Alois Alzheimer treated patient named Auguste Deter – first ever Alzheimer’s patient ▪ We’ve made essentially no progress in treating/curing the disease. ▪ People, even scientists, thought “becoming senile is part of aging”. ▪ Lack of awareness is causing lack of funding, even though: ● Alzheimer’s care costs more than cancer care ● Causes a similar number of deaths annually. o Alzheimer’s Disease (AD) ▪ Neurotransmitters involved ● Acetylcholine (decreased) ● Norepinephrine (decreased) ▪ Onset ● Early (65 and under) – rapid progression ● Late (65+) – more common, slower progression ▪ Role of RN ▪ Communication ● Communicate in a calm, reassuring tone. ● Speak in positively worded phrases. Do not argue or question hallucinations or delusions. ● Reinforce reality. ● Reinforce orientation to time, place, and person. ● Introduce self to client with each new contact. ● Establish eye contact and use short, simple sentences when speaking to the client. Focus on one item of information at a time. ● Encourage reminiscence about happy times. Talk about familiar things. ● Break instructions and activities into short time frames. ● Limit the number of choices when dressing or eating. ● Minimize the need for decision-making and abstract thinking to avoid frustration. ● Avoid confrontation. ● Approach slowly and from the front. Address the client by name. ● Encourage family visitation as appropriate o Delirium vs Dementia vs Depression o Interventions