Substance related disorders and Nursing Role

Substance related disorders

Substance: any drug, medication or toxin that has the potential to be abused.
Addiction: psychological and physical dependence.
Dependence : Craving, tolerance, withdrawal and compulsive use.
Examples of substances– Alcohol
– Amphetamine
– Caffeine
– Cannabis
– Cocaine
– Nicotine
– Opioids

Etiology
– Genetics and family influence: modeling effect. Identification. In case of alcoholism, 50% risk in first generative relatives.
– Peer pressure
– Psychosocial stress
– Chronic disease
– Personality disorder

diagnostic criteria of alcohol intoxication.

-recent ingestion of alcohol
-significant mal adaptive behavior or psychological changes like inappropriate sexual or aggression ,lability of affect, or impaired judgment  developed during or shortly after alcohol use.
-one or more of the following signs developed during or shortly after alcohol intake:
slurred speech-incoordination-unsteady gait-nystagmus-impairment of attention or memory-stupor or coma.
-symptoms not resulted from other medical condition or another mental disorder .

diagnostic criteria for alcohol withdrawal

-cessation and reduction of alcohol that have been heavy and prolonged
-two or more of the following have been resulted from several hours to few days : autonomic hyperactivity-increased tremors-insomnia-nausea and vomiting –transient hallucinations usually visual-psychomotor agitation-severe anxiety-grand mal seizures.
-criteria in B causes marked significant distress or impairment.
-not resulted from general medical condition or another mental disorder

management of alcohol withdrawal symptoms

investigations : MCV,AST,GT,BIOCHESTRY PROFILE, PLASMA URIC AID CNCENTRATION.
seizures: diazepam 10mg iv state
DT: increase BP ,sweating, fever anxiety , insomnia , and hallucinations ,(+-)psychomotor activity
The condition treated by Librium 25-50mg every 2-4 hours.
Alcoholic encephalopathy and dementia:
Wernicke encephalopathy:
ataxia , confusion and nystagmus. treated by thiamine iv 100mg-300mg
Korsakoff syndrome :Recent memory impairment, antrograde amnesia, confabulation .my need administration of antipsychotics

Nurses role in alcoholic patient :

*Seizure measures should be taken
* DT measures should be put in your agenda
*Monitoring( vital signs every 2-4 hours(pulse-temp-BP) -Respiratory rate. Pupillary signs.
*In case you give iv line don’t give glucose before giving parental vitamin B Complex and thiamine
Otherwise the patient might go to wernick,s encephalopathy.
*Assess need for  seclusion and restrain , take care that BZ to sedate them, it might be followed by respiratory depression or failure and death.

Alcohol-related disabilities.

*Physical related disabilities:
– GIT PROBEMS includes gastritis and gastric ulcer ,mal nutrition and hepatic damage, Pancreatitis.
– Iron deficiency anemia, arrhythmia, macrocytosis  ,cardiomyopathy,
– Polyneurropathy, myopathy, encephalopathy, dementia.
– Accidents and traumas.
*psychiatric complications includes
depression, suicide, personality changes, alcohol hallucinosis, delusional disorder, gambling, and sexual disorders, blackouts an amnestic syndrome,

SEDATIVES HYPNOTICS AND ANXIOLYTICS

THESE GROUP INCLUDES SUBTANCES WHICH ARE DEPRESSANTS TO THE CENTRAL NERVOUS SYSTEM AND HAVING CROSS TOLERANCE WITH ALCOHOL
DIAGNOSTIC CRITERIA FOR SEDATIVES HYPNOTICS AND ANXIOLYTICS intoxication
*recent use . *significant maladaptive behavior or psychological changes(mood liability, impaired judgment, aggression, impaired functioning.)*one or more of these signs during or shortly after use(slurred speech, incoordination, unsteady gait, nystagmus, impairmement of attention or memory, stupor or coma.
*symptoms not due to medical condition or psychological problem.

Diagnostic criteria for its withdrawal

*Cessation or reduction after prolonged use . *two or more of the following develops within several hours to days (*hypervigilance, insomnia, nausea and vomiting, hallucinations, agitation, anxiety, fits, ). *symptoms causing significant distress or impairment. *not due to medical or psychological problem.
In acute intoxication flumazenil(anexate) is life saving.

amphetamine use

– amphetamine is used in narcolepsy,ADHD,depression.
– Amphetamine like substances  N,methyle D,asppertate (NMDA)

  Amphetamine intoxication

*mal adaptive behavior resulted during or shortly after intake.
*clinically significant maladaptive behavior or psychological changes  including euphoria ,irritability, hpervigilance, anger , impaired judgment.
*two or more of the following (tachycardia or bradicardia. pupillary dilatation. elevated or lowered BP.CHILLS. nausea or vomiting. weight loss. agitation or retardation. muscular weakness.
Confusion, seizures, dystonia, and coma.
*symptoms are not due too general medical condition or other psychiatric disorders .

Amphetamine withdrawal :

on cessation or decrease after prolonged use .
*dysphoria mood with two or more of the following (fatigue. vivid unpleasant dreams. Insomnia or hypersomnia. increased appetite. Agitation or retardation.)
*symptoms above cause significant distress or impairment.
*symptoms are not due to other medical or psychiatric problems.

OPIOID ABUSE

– EG heroin and morphine
*Morphine is analgesic and sedative it works on opioid receptors on brain
*our own endogenous opioids are present in the form of endorphin , and ankaphaline
* they work as pain suppressors.
*they cross blood brain barriers BBB .has rapid onset of action . with low tolerance and high dependence.

Diagnostic criteria for opioid intoxication

*Recent use of opioid .* mal adaptive behavior or psychological changes that developed during or shortly after opioid use (euphoria followed by dysphoria agitation or retardation. impaired judgment and functions)
*pupillary constriction  with one or more of the following drowsiness or coma –slurred speech-impairment of attention or memory. *not due to general medical or psychological problems.*with or without perceptual disturbances.

Diagnostic criteria for opioid withdrawal

*cessation or reduction of opioids after prolonged use or administration of opioid antagonist
*one or more of these symptoms develop few minutes  up to few days(dysphoria nausea and vomiting muscle aches lacrimation and rhinorrhea ,pupillary dilatation ,sweating ,diarrhea, yawning, fever, insomnia.
*Symptoms above clinically causing distress or impairment.*symptoms not due to other medical or psychological problems.
As in alcohol psychotherapy is very important illustration of how to over come withdrawal manifestations and craving . overdose .and how to avoid complications.

Hashish abuse

Tetrahydrocanabinol is the active ingredient it is mainly cns depressant but might do the reverse
(sense of happiness and euphoria-overeating that might lead to death from vagal over stimulation
distortion of perception  (size height distance shape ) also might go to hallucinatory experiences.
The nurse should put in mind patient safety from violence and over eating) keep patient calm .

Petrol patex and other inhalants

They are CNS depressants –during intake patient experiences flashes of light coming. With or without hallucinatory experiences ,Sedation even drowsiness .
Long term use might lead to dementia. or severe psychotic changes

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