Exam 2 Flashcards
(164 cards)
0
Q
Caused physiological changes to occur when blood and tissue concentrations of a drug decrease in individuals who have maintained heavy and prolonged use of a substance
A
Withdrawal
1
Q
Occurs when a persons physiological reaction to a drug decreases with repeated administrations of same dose
A
Tolerance
2
Q
What is the most common drug of abuse in the US and poses the treated withdrawal danger?
A
Alcohol
3
Q
Transitory recurrences of perceptual disturbance caused by a persons earlier hallucinogenic drug use when he or she is in a drug-free. Experiences such as visual distortions, time expansion, loss of ego boundaries, and intense emotions are reported.
A
Flashbacks
4
Q
When drugs are taken together, the effect of either or both of the drugs is intensified or prolonged. Ex. is combinations of alcohol plus a benzodiazepine, alcohol plus opiate, and alcohol plus a barbiturate.
A
Synergistic effects
5
Q
Combination of drugs to weaken or inhibit the effect of one if the drugs
A
Antagonistic effect
6
Q
Opiate antagonist that is often given to people who have overdosed on an opiate to reverse respiratory and CNS depression
A
Naloxone (Narcan)
7
Q
Cluster of behaviors originally identified through research involving the families of alcoholic families. These people find excuses for the persons substance abuse and often define their self worth in terms if caring for others to the exclusion of their own needs
A
Codependence
8
Q
________ ________ is more common in men, young people, whites, and those who are unmarried.
A
Alcohol abuse
9
Q
_______ ____________ is highest in men, young people, whites, native Americans, people with low incomes, and those who are unmarried.
A
Alcohol dependence
10
Q
Approximately ___ out of every 10 people affected by a substance abuse disorder are also affected by a mental health disorder
A
6
11
Q
Common examples include the combination of major depression with cocaine addiction, alcoholism with generalized anxiety disorder, alcoholism and poly drug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse
A
Co-curring disorders
12
Q
______ drug users have a higher incidence of infections and sclerosing of veins.
A
IV
13
Q
______ users may have sinusitis and a perforated nasal septum.
A
Intranasal
14
Q
________ a substance increases the likelihood of respiratory problems.
A
Smoking
15
Q
Characterized by loss if control of substance consumption, substance use despite associated problems, and tendency to relapse.
A
Addiction
16
Q
Main systems involved in substance abuse are the
A
Opioid, catecholamine (especially dopamine) and gamma-aminobutyric acid (GABA) systems.
17
Q
What does alcohol and other CNS depressants act on?
A
GABA receptors and increase bioavailability of glutamate, norepinephrine, and dopamine.
18
Q
Cocaine and amphetamines increase levels of
A
norepinephrine, serotonin, and dopamine
19
Q
_______ theories view substance use as a defense against anxious impulses, a form of oral regression, or self-medication for depression.
A
Psychodynamic
20
Q
_______ theories attempt to explain differences in the incidence of substance use in various groups.
A
Sociocultural
21
Q
Current alcohol and other drug problems can be detected by asking 2 questions:
A
- In the last year, have you ever drunk 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?
23
Q
Responses that serve as red flags indicating the need for further assessment are:
A
Rationalizations (You’d smoke dope too if…), automatic responses as if the question were predicted (“I figured you’d ask me that”), and slow, prolonged responses as if the person were being careful about what to say
24
Q
Elements of this style include various defense mechanisms (e.g. denial, projection, rationalization) as well as characteristic thought processes (e.g. all-or-none thinking, selective attention) and behaviors (e.g. conflict minimization and avoidance, passivity, and manipulation)
A
Predictable defensive style
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Can result when an individual has consumed large amounts of alcohol quickly or over time. Signs include an inability to arouse the individual, cool or clammy skin, respirations less than 10 per minute, cyanosis under the fingernails or gums, and emesis while semiconscious or unconscious.
Alcohol poisoning
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Early signs peak after 24 to 48 hours after cessation or reduction of intake. Person may appear hyperalert, manifest jerky movements and irritability, startle easily, and experience subjective distress often described as "shaking inside." Grand mal seizures may appear 7 to 48 hours after cessation.
Alcohol withdrawal
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Misinterpretations, usually of a threatening nature, of objects in the environment
Illusions
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Considered a medical emergency and can result in death even if treated. Death is usually due to sepsis, myocardial infarction, fat embolism, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide.
Alcohol withdrawal delirium
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Common signs of stimulant abuse:
dilation of pupils, dryness of the oronasal cavity, and excessive motor activity
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________ blocks the reuptake of norepinephrine, dopamine, and serotonin and this imbalance of neurotransmitters may be responsible for many of the physical withdrawal symptoms reported by heavy, chronic cocaine users.
Cocaine
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First phase of withdrawal in which users report depression, anergia, and an acute onset of agitated depression. Craving for the drug peaks during this phase along with anxiety and paranoia.
Crash phase
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Phase of withdrawal that is described as a prolonged sense of dysphoria, anhedonia, and lack of motivation, along with intense cravings that can last up to 10 weeks. Relapse is most likely during this phase.
Second phase
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Phase of withdrawal that is characterized by intermittent craving that can last indefinitely
Third phase
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Successful treatments for many individuals during smoking cessation
Wellbutrin (Zyban) and nicotine-replacement therapy
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Phase of heroin intoxication that is described as a euphoria or rush that occurs almost immediately after injection of the drug. Users frequently characterize this euphoria in sexual terms and is characterized physiologically by facial flushing and a deepening of the voice.
First phase
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Phase of heroin intoxication that is classified as "the high" and has been described as a sense of well being and can extend for several hours
Second phase
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Phase of heroin intoxication that is often termed "the nod" is an escape from reality that can range from lethargy to virtual unconsciousness.
Third phase
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Phase of heroin intoxication that is the period before withdrawal occurs. Users often seek more of the drug in order to avoid withdrawal.
Fourth phase
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___________ is the most widely used illicit drug in the United States
Marijuana
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LSD, mescaline (peyote) and psilocybin (mushrooms) are
Hallucinogens
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_______ causes a significant reliease of the neurochemicals serotonin, dopamine, and norepinephrine.
MDMA
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After the effects of MDMA wear off, the user commonly goes through a period of depression that is caused by a depletion of _____
Serotonin
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Odorless, tasteless, and colorless drugs that mix easily with drinks and can render a person unconscious in a matter of minutes.
Date rape drugs such as Rohypnol and GHB
44
`The aim of treatment is ____________, not compliance.
self responsibility
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_________ programs work best for people with substance abuse disorders who are employed and have an involved social support system.
outpatient
46
People who have no support and structure in their day may do better in ___________ programs when these programs are available
Inpatient
47
Primary prevention in children is to get involved in activities because they help to build
Self-confidence and self-esteem
48
What does the the acronym for key interventions, called FRAMES, mean?
```
Feedback of personal risk
Responsibility of the patient (personal control)
Advice to change
Menu of ways to reduce substance use
Empathetic counseling
Self-efficacy or optimism of the patient
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49
Al-anon is a self-help group that offers support and guidance for _______ family members of an addicted person.
Adult
50
Alateen is a self-help group that offers support and guidance for ________ family members of an addicted person
Teenage
51
Agent used for narcotic addiction that is sometimes used in the treatment of alcoholism, especially for those with high levels of craving and somatic symptoms. Works by blocking opiate receptors, thereby interfering with the mechanism of reinforcement and reducing or eliminating the alcohol craving.
Naltrexone (Trexan, Revia)
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Used by people who have quit drinking and wish to remain abstinent; it probably works to reduce intake of alcohol by suppressing excitatory neurotransmission and enhancing inhibitory transmission
Acamprosate (Campral)
53
Works to decrease alcohol cravings by inhibiting the release of mesocorticolimbic dopamine, which has been associated with alcohol craving
Topiramate (Topamax)
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Used with motivated pts who have shown the ability to stay sober
Disulfiram (Antabuse)
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Used in treatment of opioid addiction. Synthetic opiate that blocks the craving for and effects of heroin. Has to be taken every day, is highly addictive, and when stopped produces withdrawal.
Methadone (Dolophine)
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Used as an alternative to methadone and is effective for up to three days
LAAM
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Nonopioid suppressor of opioid withdrawal symptoms
Clonidine (Catapres)
58
A state of crisis is produced by three interconnected conditions:
A hazardous event that poses a threat, an emotional need that represents earlier threats and increased vulnerability, and an inability to respond adaptively.
59
The outcome of crisis depends on
the realistic perception of the event, the adequate situational supports, and adequate coping mechanisms
60
________ ___________ is a short term, therapeutic process that focuses on the rapid resolution of an immediate crisis or emergency using available personnel, family, and/or environmental resources
Crisis intervention
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Type of crisis that is brought on by an unanticipated external life event such as a loss or change (divorce, loss of job)
Situational
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Type of crisis that occurs because the person is transitioning to a new developmental stage
Maturational
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Type of crisis that occurs because of natural disaster, crimes, national disaster (Floods, mass shooting, war)
Adventitious
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What is Erickson's first stage?
Trust vs. Mistrust
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What is Erickson's second stage?
Autonomy vs. Shame and Doubt
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What is Erickson's third stage?
Initiative vs. Guilt
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What is Erickson's fourth stage?
Industry vs. Inferiority
68
What is Erickson's fifth stage?
Identity vs. Role confusion
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What is Erickson's sixth stage?
Intimacy vs. Isolation
70
What is Erickson's seventh stage?
Generativity vs. Stagnation
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What is Erickson's eighth stage?
Ego integrity vs. Despair
72
What is an adjustment disorder?
Short period that lasts approximately 6 months or less that occurs usually because of trouble in a developmental stage
73
What are the symptoms of an adjustment disorder?
Depressed mood, anxiety, mixed depression and anxiety, disturbance in conduct, mixed disturbance in emotion and conduct
74
What is primary care for a crisis?
Promote mental health to decrease the incidence of crisis
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What is secondary care for a crisis?
Provide interventions during an acute crisis to lessen the time a client is mentally disabled or in crisis. Occurs usually in out-patient day treatment settings. May also occur in hospitals, psychiatric units, or clinics.
76
What is tertiary care for a crisis?
Provide support for those who have experienced a severe crisis and are now recovering from a disabling mental state
77
What occurs in phase 1 of a crisis?
Escalating anxiety from a threat to self-esteem and increased anxiety. Mobilizes problem-solving and defense mechanisms to lower anxiety.
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What occurs in phase 2 of a crisis?
Anxiety continues to escalate as defense responses fail, functioned becomes disorganized, client resorts to trial-and-error to resolve anxiety and restore normal balance.
79
What occurs in phase 3 of a crisis?
Trial-and-error methods of resolution fail and client's anxiety escalates to severe or panic, leading to flight or withdrawal behaviors. May compromise or redefine the problem to reach a solution.
80
What occurs in phase 4 of a crisis?
The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality) depression, confusion, and/or violence against others or self.
81
Crisis results first in an increase in
Anxiety
82
Crisis usually lasts how many weeks?
4-6 weeks
83
What should you assess first on a pt in crisis?
Safety - do a suicide assessment
84
What occurs in mild anxiety?
Normal, helps pt to focus
85
What occurs in moderate anxiety?
Pt only sees the anxiety inducing event but is still able to problem solve
86
What occurs in severe anxiety?
Pt has scattered thoughts, is unable to problem solve and paces and wrings hands
87
What occurs in panic?
Pt thinks they're dying or going crazy, may be hyperventilating. Need to constantly watch them.
88
What occurs in a lethality evaluation?
The plan, the means, reversibility, and location
89
What are interventions for severe anxiety?
short commands, offer fluids, observe
90
What are the interventions for panic anxiety?
Small room with minimal stimulation, constant watch, pt may hyperventilate so do paper bag rebreathing
91
What are crisis intervention techniques?
Active and focused on here and now
Avoid false reassurance
Aimed at achieving quick resolution
Listen carefully
Use short sentences, one at a time
Be calm, stable, and consistent
Set limits and establish structure
Encourage the expression of feelings in a nondestructive manner
Clarify relationship between events, behaviors, and that feelings are normal
Reinforce healthy coping efforts
Help client regain confidence in ability to solve problems
92
What does medication administration do for a client in crisis?
Helps to maintain anxiety at a manageable level
Helps to manage depression
Assists the person through the crisis
It may be discontinued after the crisis
93
What medications are not used for crisis?
Antipsychotics
94
Xanax (alprazolam), Librium (chlordiazepoxide), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) are all what kind of medication?
Antianxiety
95
What are the side effects of antianxiety medications?
Drowsiness, lethargy, dizziness, hypotension, tolerance, physical and psychological dependence, paradoxical excitement
96
Elavil (amitriptyline), Sinequan (doxepin), Tofranil (trmipramine), Pamelor (nortriptyline), Ascendin (amoxapine) are all what kind of medications?
Tricyclic antidepressants
97
Celexa (citalopram), Lexapro (escitalopram), Prozac (fluxetine), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline) are all what kind of medications?
Selective Serotonin Reuptake Inhibitors
98
With Prozac and Luvox (both SSRIs) what can you not take with it?
Warfarin
99
Tricyclic antidepressants cause what kind of side effects?
Anticholinergic = can't eat, can't sleep, can't get it up
100
Serzone (nefazodone) and Desyrel (trazodone) are what kind of medications?
Serotonin Antagonist Reuptake Inhibitors (SARIs)
101
Effexor (venlafaxine) is what kind of medication?
Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs)
102
Remeron (mirtazapine) is what kind of medication?
Serotonin-Norepinephrine Disinhibitors (SNDIs)
103
Wellbutrin (buproprion) has a risk for
Seizures
104
Antidepressant side effects include:
```
Headache
Temporary blurred vision
Dry mouth
Constipation
Tachycardia
Urinary retention
Cognitive dysfunction
Dizziness
Erectile Dysfunction
Ejaculatory dysfunction/priapism
Hyper or Hypotension
Tremors
Wt. gain
Nightmares
```
105
How do you evaluate the outcomes for a crisis?
Client returns to pre-crisis level of functioning
Client is able to make decisions between two or more options
Client is able to manage anxiety with daily meditation
106
The critical incident stress debriefing is used with individuals exposed to
trauma and severe stress
107
The focus of CISD is
large groups of individuals affected by accidental, uncommon and unexpected tragedies
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What is the goal of CISD
reduce the impact of a crisis event of those directly involved in a critical incident
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What is the format of CISD
Combines psycho-education and crisis intervention
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The definition of critical incident stress is
A normal reaction to an abnormal event
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What are the factors determining an impact on the individual?
```
Type of threat
Intensity and duration
Suddenness with which it occurs
Past experiences
Coping strategies
Social support available
```
112
What are the consequences of critical incident stress?
Long term consequence is PTSD if unmanaged, long term consequence of PTSD is depression
113
If the individual organizes his life around the trauma, it is
PTSD
114
What are the symptoms of critical incident stress?
Feeling jumpy, anxious, irritable
Difficulty concentrating or thinking clearly
Difficulty with any event that triggers memories of the original trauma (returning to the scene)
Difficulty being around people
Difficulty being alone
Physical symptoms
Disturbing dreams
115
Symptoms of critical incident stress in the workplaces are
```
Poor morale
Decreased productivity
Increased accidents/sick time
Higher disability claims
Greater staff turnover
Individual symptoms as previously discussed
```
116
What is the purpose of CISM debriefing?
Assist participants to express thoughts and feelings about the event
Help them place the event into context
Provide support
Help them bring closure to the crisis
Educate participants about symptoms of PTSD
Identify individuals who need counseling
Provide stress inoculation
Assist participants to express thoughts and feelings about the event
Help them place the event into context
Provide support
Help them bring closure to the crisis
Educate participants about symptoms of PTSD
Identify individuals who need counseling
Provide stress inoculation
They like to do this within 72 hours of the event!
117
Shortened version of debriefing that happens at the event then the person is sent back in. I.e. clean up bodies for 4 hrs, come back for 4 hrs and talk, get rest for 4 hrs
Defusing
118
May be done at the scene and may be done 1-10 days after the event, or 3-4 weeks after a major event
Debriefing
119
What is part one of the Mitchell model?
```
Introduction:
Introduce team members
Give reason for meeting
Set ground rules and expectations
Confidentiality
Explain 7 stages of debriefing
Answer questions
```
120
What occurs in the second phase of the Mitchell Model?
Fact Phase:
Participants introduce themselves
Ask participants to describe their roles and involvement
Ask participants to describe the facts of the event
Describe the event from their perspective (Sounds, smells, temperature, colors)
121
What occurs in the third part of the Mitchell model?
Thought phase:
Ask participants to state their first thoughts when the event occurred
What did they expect?
122
What occurs in the fourth part of the MItchell model?
Reaction phase:
Ask participants to describe their feelings and emotional reactions to the incident
Ask them to identify the most traumatic aspect of the event
Like to forget
123
What occurs in the fifth part of the MItchell model?
Symptom phase:
Discuss the stress reactions that occurred during and after the traumatic event
Assess cognitive, physical, emotional, and behavior changes in their lives
And any other symptom after the initial experience
124
What occurs in the sixth part of the Mitchell model?
Teaching phase:
Reassure participants that symptoms and experiences are normal reactions to a bad incident
Teach about normal reactions and adaptive coping responses
Normalize responses
125
What occurs in the seventh part of the Mitchell model?
```
Re-entry phase:
Provide opportunity for questions and final statements
Summarize responses to incident
Provide information regarding referrals
Provide written materials
```
126
What occurs in debriefing the debriefers?
What went well, who may need follow-up, what should facilitators consider doing differently
127
How long does debriefing usually last?
2-3 hrs
128
Overwhelms usual coping strategies
Involves actual injury or threat of death or injury to self or others
Physical and psychological stress following exposure to severe trauma
PTSD
129
PTSD is classified as
an anxiety disorder
130
Occurring within one month of traumatic event
Persisting for at least 2 days to 4 weeks
Three or more dissociative symptoms:
Numbing, detachment, or absence of emotional response
Reduced awareness of surroundings
Derealization or depersonalization
Amnesia of aspects of the trauma
Event is persistently re-expereinced
Marked avoidance of the stimuli of traumatic memories
Marked symptoms of anxiety
If symptoms persist beyond one month=PTSD
Acute stress disorder
131
What is acute PTSD?
duration less than 3 months
132
What is chronic PTSD?
duration 3 months or more
133
What is delayed PTSD?
Onset of symptoms is at least 6 months after event
134
All symptoms of PTSD must be present for more than how long?
One month
135
What are the symptoms of PTSD?
Re-experiencing the traumatic event
Autonomic hyper-arousal
Emotional numbing and avoidance
136
Reliving the trauma as if it were happening now
Flashbacks
137
Examples of re-experiencing the traumatic event
Intrusive thoughts
Intense memories
Recurrent nightmares of the trauma
Flashbacks: Reliving the trauma as if it were happening now
Possible auditory, visual, olfactory, or tactile hallucinations
138
Examples of autonomic hyper-arousal
```
Stress system goes on permanent alert
Hyper vigilant for signs of danger
Physiologic hyper arousal
Exaggerated startle response
Reacts irritably to small annoyances
Sleeps poorly
Difficulty concentrating
Many people remain at a new baseline of elevated arousal: “Thermostat” is reset
```
139
Examples of emotional numbing and avoidance
Lack interest in activities they previously enjoyed
Survivors try to avoid people or situations that might provoke memories of trauma
Restrict activities=interferes with normal functioning
Lose ability to experience pleasure
Experience emotional numbness
Detachment from life
Impaired interpersonal relationships
Marital problems
Sense of shortened future
Unrelieved guilt=distinguishing characteristic
140
Secondary traumatization can occur with wives of PTSD men, who often:
Verbalize feelings of worthlessness
Experience loneliness and social isolation
Feel confused
Feel they have lost control
50% of wives in treatment report battering
141
Often treatment of choice
Gives clients opportunity to discuss their reactions to trauma with peers
Decreases social isolation
Provides strong social support
Universality: Provides immediate relief, helps them fell less alone and gives sense of validation
Cohesiveness: formed almost instantly by replicating the camaraderie of soldiers in combat
Group therapy
142
What do beta blockers do for PTSD pts?
Prevents panic attacks, keeps heart rate slow
143
What is EMDR?
Eye movement desensitization and reprocessing - talk about the event with eyes closed, then move eyes back and forth
144
You should always avoid what kind of questions?
open ended questions
145
What is the role of the enabler?
Usually a spouse, makes excuses, alcoholic is spared consequences of drinking
146
What is the role of the family hero?
Parents other children, provides self-worth for the family through successful acheivements
147
What is the role of the scapegoat?
Always in trouble; may run away; shifts focus away from family problems
148
What is the role of the lost child?
Feels disconnected; withdrawn and quiet; escapes into fantasy
149
What is the role of the mascot?
Diverts attention by being funny; comic relief; distracts from tension
150
What is the nursing care for an alcohol intoxicated pt?
```
SAFETY FIRST ! !
Monitor blood level, RESPIRATION RATE, pulse, B/P, and temp
Monitor for vomiting and aspiration
Protect from falls and injuries
Maintain hydration
Do NOT attempt teaching or confrontation
```
151
What is the most critical assessment for alcohol withdrawal?
Rule of 100: temp, pulse, and diastolic BP
152
What are the other assessments for alcohol withdrawal?
```
Tachycardia and hypertension
Coarse tremors-hand, tongue, eyelids
N/V, weakness, diarrhea
Anxiety, depression, or irritable mood
Orthostatic HYPOtension
Insomnia and nightmares
Craving for alcohol
```
153
Can occur as long as one week after drinking
Unawareness of environment
Illusions and visual hallucinations (well lighted rooms- no shadowes)
Incoherent speech
Increased B/P, uncontrolled tachycardia
Diaphoresis and elevated temperature
SEIZURES
Alcohol withdrawal delirium
154
What are the pupils like in narcotics intoxication?
Constricted
155
Narcotic withdrawal leads to what symptoms?
Severe flu-like symptoms
156
When you explore discrepancies, what happens with confrontation?
Establish what's positive
Explore discrepancies
Then the struggle statement, "what's going on with you?"
157
What are the symptoms of stimulant intoxication?
Euphoria, elation, grandiosity (~ 30 minutes)
Diaphoresis, anorexia, weight loss, insomnia
Increased temperature, B/P, and pulse
Tachycardia, ectopic heartbeats, chest pain
Inderal (propranolod) 25 mg for intox
Dilation of the pupils
Urinary retention, constipation, dry mouth, itchy skin
158
What occurs in a stimulant overdose?
Marked increase in blood pressure and temperature that can lead to cardiovascular shock and death
Cardiac dysrhythmias, coronary artery spasms, myocardial infarctions
Seizures
Cerebrovascular accidents, transient ischemic episodes
159
What occurs with stimulant withdrawal?
```
The CRASH- fatigue, depression, intense drug craving
Followed by agitation and anxiety
Prolonged sleep
Extreme hunger and anhedonia
May last from days to weeks
“Cocaine Dreams” may cause relapse
```
160
Norpramin (desipramine), Tofranil (imipramine) antidepressants that do what with stimulants
, increases the availability of
| norepinephrine & decreases craving
161
Parlodel (bromocriptine) does what with stimulant withdrawal
counters decreases dopamine transmission by directly activating receptors=decreased craving during withdrawal
162
Symmetrel (amantadine) does what during stimulant withdrawal
counters dopamine depletion by releasing stored reserves = decreased craving during withdrawal
163
Phencyclidine intoxication symptoms include
PSYCHOLOGICAL SYMPTOMS
Violent or bizarre behavior, hallucinations, anxiety, euphoria, labile, synesthesia, sensation of slowed time, paranoia
PHYSICAL SYMPTOMS
Muscular rigidity, salivation, red dry skin, vomiting, increased blood pressure and heart rate
MDMA bruxism = gnashing of teeth
164
Nursing care for phencyclidine withdrawal
```
ENCOURAGE CRANBERRY JUICE
Administer medications as ordered
Antipsychotics- haloperidol (Haldol)
ANTIANXIETY- diazepam (Valium)
Calcium channel blockers -Verapamil
Reorient to reality
Provide a safe environment
Seclusion/restraints
```
