Chapter 14 - Substance Abuse - Exam 3

Question 1

what is the difference between substance use disorder and substance induced disorder?

Answer 1

substance use disorder = addiction
substance induced disorder = byproducts of addiction

Question 2

what does an opiate withdrawal timeline look like?

1. 72 hours after last dose
2. 1 week after last dose
3. 2 weeks after last dose
4. 1 month after last dose

Answer 2

1. physical symptoms at their peak: chills, fever, body aches, diarrhea, insomnia, muscle pain, nausea, dilated pupils
2. physical symptoms start to lessen: tiredness, sweating, body aches, anxiety, irrtability, nausea
3. psychological and emotional symptoms: depression, anxiety, irritability, restlessness, trouble sleeping
4. cravings and depression; symptoms can linger for weeks or months

Question 3

what is a psychoactive substance

Answer 3

substances that, when taken in or administered into one’s system, affect mental processes, e.g. perception, consciousness, cognition or mood and emotions.

Question 4

A child of an alcoholic is ____ times as likely to become an alcoholic

Answer 4

4

Question 5

which addiction is linked to genetics

Answer 5

alcoholism

Question 6

Alcohol use disorder:
Explain phase 1 - prealcoholic phase

Answer 6

a person might have one or drink after a long day at work in an effort to reduce tension, stress, and to relax

Question 7

Explain phase 2 - early alcoholic phase

Answer 7

person starts to drink more, brief periods of amnesia/blackouts, alcohol stops being a source of please and more of a need, this person can get defensive if confronted with drinking use

Question 8

Explain phase 3 - the crucial phase

Answer 8

this person has lost the ability to choose to drink and it is “required” i.e. they “have to have it.” This person is angry/aggressive, they may have lost their job, they may feel a sense of shame

Question 9

Explain phase 4 - the chronic phase

Answer 9

this person is drunk more than they are sober; they have an emotional and physical dependence on alcohol. At this stage, withdrawal needs to be managed carefully

Question 10

which of the following are substance-induced disorders?

-intoxication
-withdrawal
-delirium
-neurocognitive disorder
-psychosis
-bipolar
-depressive disorder
- ocd
-anxiety
-sexual dysfunction
-sleep disorders

Answer 10

all of them

Question 11

addiction: a compulsive or chronic requirement. the need is so strong as to generate distress (either physical or ______) if left unfulfilled

Answer 11

psychological

Question 12

individuals are considered to have a _________disorder when use of the substance interferes with their ability to fulfill role obligations (work, school, home)

Answer 12

substance

Question 13

true or false
individuals with substance use disorders often participate in dangerous activities when they are impaired by a substance

Answer 13

true

Question 14

true of false
once individuals realize they have a problem it is easy for them distoninue use since they know that it is contributing to a physical or psychological problem

Answer 14

false

Question 15

substance intoxication is defined as the development of a _________ syndrome of symptoms following excessive use of a substance

Answer 15

reversible

Question 16

once intoxicated there is a direct effect on the _____ and a disruption in physical and psychological functioning occurs

Answer 16

cns

Question 17

true or false
caffeine is considered a psychoactive substance that is associated with substance use

Answer 17

true,
along with all the classic ones, plus tobacco

Question 18

hereditary factors appear to be involved in the development of substance use disorders, especially ____

Answer 18

alcoholisim

Question 19

true or false
children of alcoholics are 4 times more likely than other children to become alcoholics

Answer 19

true

Question 20

although there is no single factor that determines whether someone will develop a substance use disorder, it is estimated that _______ accounts for 40 to 60 percent of a person’s vulnerability

Answer 20

genetics

Question 21

there is good evidence that changes in brain structure and brain neurochemistry occur in the process of addiction.
Alcohol has demonstrated effects on almost all neurotransmitters, but those most strongly linked to sub abuse include

Answer 21

opioid, dopamine, glutamate, and gaba

Question 22

once activated, neuronal pathways that are responsible for sensing pleasure and reward are believed to be responsible for pleasurable sensations associated with addictive substances as well as creating a memory that triggers a desire for repeated use

these pathways are referred to as

Answer 22

the brain-reward circuitry

Question 23

certain personality traits have been associated with an increased tendency towards addiction.

can you name a few?

Answer 23

low self esteem, depression, passivity, antisocial, high risk taking, trouble communicating, anxiety

Question 24

irrational thinking patterns have long been identified as a problem that is central in addiction
some example of irrational thinking patterns associated with addiciton include…

Answer 24

denial “im not addicted!”
projection “its my wifes fault i take drugs!”
rationalization “i have to take the drugs im in pain”

Question 25

Exploring irrational thought patterns is the basis for ________ therapy and has shown benefits in addiction treatment

Answer 25

CBT

Question 26

__________ is a learned response that occurs after repeated exposure to a stimulus

Answer 26

conditioning substance abuse can become a learned response from the substance, environment, etc

Question 27

an abbreviation for alcohol often seen in medical records is

Answer 27

ETOH

Question 28

alcohol is thought to have more profound effect when an individual is _________ stressed or fatigued

Answer 28

emotionally

Question 29

most alcohol metabolized in the liver, the outcome of this process is the produciton of

Answer 29

acetaldehyde

Question 30

increased exposure to acetaldeyde leads to CNS ______

Answer 30

depression

Question 31

phase 1 the prealcoholic phase this phase is characterized by the use of alcohol for its effects in relieving the everyday _____ and ______ of life the individual may have at some point learned the use of alcohol is an acceptable method of coping with stress

Answer 31

stress and tension

Question 32

phase 2: early alcoholic phase this phase begins with ____. now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is _____ by the individual

Answer 32

blackouts, required

Question 33

phase 3: crucial phase now the individual has lost ______ and _______ addiction is clearly evident. binge drinking is common - these episodes include sickness, loss of consciousness, squalor, degradation. In this phase the individual is extremely ill. _____ has become the total focus, this person is willing to lose everything that was once important in order to maintain addiction

Answer 33

control, physiological,

Question 34

Phase 4: chronic phase this phase is characterized by emotional and physical disintegration. This person is usually ____ more than they are sober. _______ disintegration is evidenced by profound helplessness and self pity impairment in reality testing may result in _____

Answer 34

intoxicated, emotional, psychosis

Question 35

phase 4: chronic phase unmanaged withdrawal results in terrifying symptoms that include

Answer 35

hallucinations, tremors, convulsions, agitation, panic, depression, thoughts of suicide

Question 36

alcohol is considered a food since it has calories, but unlike other food it does not have to be digested because...

Answer 36

the blood carries 20% of the alcohol directly to the brain where it acts on the brains central control areas, slowing or depressing activity

Question 37

Effects on the body: peripheral neuropathy is characterized by peripheral ______damage, this results in pain, burning, tingling/prickling sensations

Answer 37

nerve

Question 38

peripheral neuropathy: ****remember this one! researchers believe that peripheral neuropathy is a direct result of deficiencies in

Answer 38

the B vitamins - particularly THIAMINE

Question 39

peripheral neuopathy: this process is often reversible with abstinence, but with chronic alcohol use ________ wasting and ________ can occur

Answer 39

muscle, paralysis

Question 40

alcoholic myopathy: this may be an acute or chronic condition, (aka alcoholic RHABDOMYOLYSIS <--- remember this term it comes up a lot) the man (Im just using man because its quicker to type obviously could be man or woman) experiences:

Answer 40

muscle pain, swelling, weakness,

Question 41

alcoholic myopathy: the man may have myoglobinuria evidenced by

Answer 41

red tinge in urine

Question 42

alcoholic myopathy: __________ may be elevated before the appearance of symptoms

Answer 42

creatine kinase

Question 43

alcoholic myopathy: lab studies show elevations of the enzymes creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (_____)

Answer 43

AST

Question 44

alcoholic myopathy: again, the main point is that chronic alcoholic myopathy produces symptoms which are

Answer 44

gradual muscle wasting and weakness in skeletal muscles

Question 45

alcoholic myopathy: alco myopathy is thought to be the result of the same _______ deficiency that contributes to peripheral neuropathy

Answer 45

vitamin B

Question 46

**** important wernicke's encephalopathy represents the most serious form of ______ deficiency in alcoholics

Answer 46

thiamine

Question 47

wernicke's encephalopathy: symptoms include

Answer 47

paralysis of ocular muscles, diplopia, ataxia, somnolence, and stupor

Question 48

paralysis of OCULAR muscles, diplopia, ataxia, somnolence, and stupor are symptoms of what

Answer 48

wernicke's encephalopathy

Question 49

Korsakoff's psychosis is identified by the syndrome of

Answer 49

confusion, recent memory loss, and confabulation

Question 50

confusion, recent memory loss, and confabulation are symptoms of

Answer 50

korsakoff's psychosis

Question 51

Korsakoff's psychosis: it is frequently encountered in clients recovering from

Answer 51

wernicke's encephalopathy

Question 52

korsakoff's psychosis: treatment includes

Answer 52

parenteral or oral thiamine replacement

Question 53

why is thiamine so important?

Answer 53

Thiamine, also known as Vitamin B1, is an essential nutrient that plays a crucial role in maintaining proper function of the nervous system, muscles, and heart. Here are some key functions of thiamine: Energy Metabolism: Thiamine is a coenzyme in important metabolic pathways, particularly in the breakdown of carbohydrates, such as glucose, to produce energy. It helps convert food into energy that the body can use. Nervous System Function: Thiamine is essential for the proper functioning of the nervous system. It is involved in the synthesis of neurotransmitters, which are chemicals that transmit signals in the brain and nervous system. Thiamine deficiency can lead to neurological symptoms such as confusion, memory problems, and muscle weakness. Heart Health: Thiamine is important for the proper functioning of the heart muscle. It helps maintain the integrity of the cardiovascular system and supports normal heart function. Gastrointestinal Function: Thiamine plays a role in the digestion of carbohydrates in the gastrointestinal tract. It helps in the production of hydrochloric acid, which is necessary for the digestion of food. Healthy Growth and Development: Thiamine is important for normal growth and development, particularly during periods of rapid growth such as infancy, childhood, and pregnancy. Overall, thiamine is essential for maintaining overall health and well-being, and a deficiency can lead to a variety of health problems, including beriberi and Wernicke-Korsakoff syndrome. It's found naturally in many foods, including whole grains, legumes, nuts, seeds, and pork, among others.

Question 54

alcoholic cardiomyopathy: the effect of alcohol on the heart is an accumulation of ____ in the myocardial cells, resulting in enlargement and a weakened condition

Answer 54

lipids

Question 55

alcoholic cardiomyopathy: symptoms include:

Answer 55

exercise intolerance, tachycardia, dyspnea, edema, palpitations, nonproductive cough

Question 56

alcoholic cardiomyopathy: lab studies may show and elevation in enzymes

Answer 56

CPK, AST, ALT, LDH

Question 57

true or false alcoholic cardiomyopathy results in the heart shrinking

Answer 57

false, the enlargement of the heart

Question 58

what the hell is esophagitis

Answer 58

inflammation and pain in the esophagus, this occurs due to the toxic effects of alco on the mucosa

Question 59

Gastritis: how does alcohol affect our stomachs?

Answer 59

inflammation of lining, nausea, vomiting, distension

Question 60

gastritis: alcohol breaks down the stomach's protective mucosal barrier, allowing _______to erode the stomach wall

Answer 60

hydrochloric acid

Question 61

pancreatitis: usually occurs 1 to 2 days after a binge. Symptoms include constant, severe epigastric pain, N/V, and abdominal distention. chronic pancreatitis leads to

Answer 61

pancreatic insufficency leading to steatorrhea, malnutrition, weight loss, and diabetes mell

Question 62

alcoholic hepatitis is _________ of the liver caused by long term heavy alcohol use

Answer 62

inflammation

Question 63

alcoholic hepatitis: clinical s/s include: N/V, lethargy, anorexia, elevated WBC, fever, jaundice, and most notably

Answer 63

an enlarged and tender liver

Question 64

Severe alco hepatitis can lead to cirrohis or

Answer 64

hepatic encephalopathy

Question 65

cirrhosis of the liver: may be caused by anything that results in chronic injury to the liver. it is the ____stage of alco liver disease and results from long term abuse

Answer 65

end

Question 66

Cirrhosis of the liver patho

Answer 66

widespread destruction of liver cells, which are replaced by fibrous (scar) tissue

Question 67

cirrohsis of the liver: clinical manifestations include: N/V, anorexia, weight loss, ab pain, edema, anemia, blood coagulation abnormalities, and most notably

Answer 67

jaundice

Question 68

Complications of cirrhosis of the liver include: - portal hypertension - ascites - esophageal varies - hepatic encephalopathy tell me the main points of these conditions

Answer 68

- portal hypertension: elevation of bp thru the portal circulation results from defective blood flow - ascites: excessive serous fluid accumulates in th abdomen, occurs in response to portal hypertension -esophageal varices: distended veins in esophagus from excessive pressure of defective blood flow thru the cirrhotic liver. **varies can rupture resulting in dangerous hemorrhaging - hepatic encephlopathy: *** serious complication in response to the inability of the dis liver to convert ammonia to urea for excretion --> leads to impaired mental functioning

Question 69

complications of cirrhosis: elevation of bp thru the portal circulation results from defective blood flow thru the cirrotic liver is called

Answer 69

portal HTN

Question 70

complications of cirrhosis: a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal HTN. the increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity

Answer 70

ascites

Question 71

complications of cirrohosis: veins in the esophagus that become distended because of excessive pressure from defective blood flow thru cirrohitc liver. as pressure increases variscosities can rupture

Answer 71

esphageal varices

Question 72

complications of cirrhosis: this serious complication occurs in response to the inability of the dis liver to convert ammonia to urea for excreation. the continued rise of ammonia results in progressively impaired mental functioning, apathy, euphoria, depression, CONFUSION, coma, death

Answer 72

hepatic encephalopathy

Question 73

leukopenia

Answer 73

production, function, and movement of WBCs are impaired ---> infections

Question 74

thrombocytopenia

Answer 74

platelet production and survival are impaired -> hemorrhage

Question 75

fetal alcohol syndrome includes mental, physical, behavioral and/or learning disabilities There may be problems with:

Answer 75

learning, memory, attention span, communication, vision, hearing,

Question 76

true or false every infant develops FAS whose mother drinks during pregnancy

Answer 76

false, not every child, several factors determine consequences of maternal drinking: pattern, metabolisim, genetics, timing,

Question 77

neuroimaging of child with FAS shows that the _____ and _____ are often smaller than normal

Answer 77

frontal lobes, cerebellum

Question 78

intoxication usually occurs at blood alcohol levels between 100 to ____ mg/dL

Answer 78

200

Question 79

alcohol withdrawal: 4 to 12 hours after a binge the following w/d symptoms may appear:

Answer 79

tremors, N/V, malaise, weakness, tachycardia, sweating, increased bp, anxiety, depression irritability, hallucinations, illusions,

Question 80

ugh okay i didnt realize how long this chapter is so moving on to main points of sedative, hypnotic, or anxiolytic use disorder: these types of substances in relation to addiction are divided into 3 categories what are they

Answer 80

barbiturates, nonbarbiturates, and antianxiety agents

Question 81

effects on body

Answer 81

general depressant effect

Question 82

okay sorry i cant read all this, im skipping ahead to nursing assessment stuff: motivational interviewing is an approach that can be used with any disorder. Its focus is on using skills such as empathy and reflection to explore a client's motivation, strengths, and readiness for change through this process the client becomes _____to become an active partner in treatment goals while exploring feelings for any resistance to change

Answer 82

empowered

Question 83

motivational interviewing: for example, rather than telling a client he must abstain from alcohol and attended AA, the health care provider helps the client ______ what he wants to achieve and then facilitates the process of exploring advan and disadvan of desired behavior change

Answer 83

articulate

Question 84

motivational interviewing: what are some questions we could ask that client that have this approach of exploring the clients attitudes and feelings toward their addiction

Answer 84

are you comfortable with your drinking patterns? have your attitudes towards drinking changed? do you see alcohol abuse as a sign of weakness? what did you learn from your parent about drinking?

Question 85

nursing assessment: one of the most popular screening tools is

Answer 85

CIWA, (the clinical institute withdrawal assessment of alcohol scale)

Question 86

what does CIWA assess

Answer 86

monitoring of alcohol withdrawal symptoms

Question 87

what are some nursing diagnosis we could use for the patient with sub abuse

Answer 87

denial ineffective coping imbalanced nutrition risk for infection chronic low self esteem deficient knowledge risk for injury risk for suicide

Question 88

what outcomes could we use for this patient

Answer 88

no physical injury has not harmed self or others accepts responsibility acknowledges association between personal problems and use of substance adaptive coping mech no signs of infect evidence of increased self worth verbalizes importance of abstaining

Question 89

codependency is able to achieve a sense of _____ only thru fulfilling the needs of others

Answer 89

control

Question 90

the codependent person disowns his own needs and wants in order to respond to external _____ of others

Answer 90

demands

Question 91

codependence has been referred to as "a dysfunctional realtionship with ______"

Answer 91

oneself

Question 92

treating codependency: explain the main points of these stages stage 1 - the survival stage stage 2 - the reidentification stage stage 3 - the core issues stage stage 4 - the reintegration stage

Answer 92

1. let go of denial that problems exist 2. individual gains glimpse of true self thru a break in denial 3. individual must face that relationships cannot be managed by force of will 4. self-acceptance and willingness to change - relinquish power over others and reclaim personal power

Question 93

pharmacotherapy: what is disulfiram?

Answer 93

drug that can be used as a deterrent to drinking - drinking causes uncomfortable symptoms

Question 94

pharmacotherapy: ________ are the most widely used group of drugs for treatment in alcohol withdrawal

Answer 94

benzodiazepines (ativan, valium)