alcohol and substance abuse information for psych exam 3

alcohol s/s of intoxication

slurred speech, incoordination, unsteady gait, impaired attention, concentration and memory, mood lability, impaired judgement and social/occupational function, stupor or coma if severe

alcohol s/s of OD

v, respiratory depression or failure, cold clammy skin, hypothermia, cyanosis, hypotension, weak thready pulse, possible seizures, unconsciousness --> coma --> death if untreated

alcohol s/s of withdrawal

-tremors, n/v, elevated pulse/BP/temp, sweating, anxiety, irritability, HA, insomnia, visual/tactile/auditory hallucinations, seizures

-delirium tremors (DTs) 48-72 hrs after last drink --> diorientation, confusion, hallucinations, severe autonomic hyperactivity, potentially fatal

alcohol intoxication management

-supportive care: ABCs, monitor VS and LOC, IVFs with vitamins to prevent Wernicke-Korsakoff syndrome

-NI: maintain airway and prevent aspiration, assess for injury risk/falls, monitor for aggression or disinhibition, provide calm environment and frequent reorientation, evaluate for polysubstance use

alcohol OD management

-CIWA scoring for tx and management: emergency airway management and oxygenation, gastric lavage or activated charcoal if recent, IVFs, warming measures, hemodialysis for severe, tx electrolyte imbalances and hypoglycemia

-NI: continuous monitoring of respiratory and cardiac status, position on side to prevent aspiration, maintain IV access and monitor fluid balance, frequent neuro checks, provide reassurance and reduce environmental stimuli

alcohol withdrawal management

-benzos, thiamine, folic acid supplements, anticonvulsants, IVFs, electrolyte correction, continuous monitoring for DTs

-NI: monitor VS every 1-2 hr initially, maintain seizure precautions in a quiet well lit room, reorient frequently, encourage fluids and adequate nutrition, provide reassurance and nonjudgemental emotional support

barbiturates and benzo s/s of intoxication

slurred speech, incoordination, unsteady gait, drowsiness, sedation, disinhibition, mood lability, impaired judgement and attention, decreased BP and pulse if severe, respiratory depression

barbiturates and benzo s/s of OD

respiratory depression --> apnea, hypotension, weak thready pulse, cardiac arrest if severe, coma shock death possible, pinpoint or dilated pupils, cold clammy skin

barbiturates and benzo s/s of withdrawal

24-74 hr after last use and can be life threatening, anxiety, agitation, tremors, insomnia, diaphoresis, n/v, orthostatic hypotension, tachycardia, psychomotor agitation, hallucinations, seizures, delirium, disorientation, autonomic hyperactivity

barbiturates and benzo intoxication management

-supportive care --> maintain airway and oxygenation, monitor VS and mental status, avoid CNS depressant combinations, no stimulant use r/t risk of cardiac dysrhythmias

-NI: assess respiratory rate, O2 sat, LOC, keep side lying to prevent aspiration, prevent falls and injury, provide calm low stimulation environment

barbiturates and benzo overdose management

-maintain airway assist ventilation --> flumanzenil for benzo OD, activated charcoal or gastric lavage if recent, IVFs and vasopressors as needed, continuous ECG monitoring and respiratory monitoring

-NI: prepare for possible intubation and mechanical ventilation, monitor ABGs, cardiac rhythm and BP, maintain IV access and monitor urine output, document substance type/route/time of use, provide emotional support to patient and family

barbiturates and benzo withdrawal management

-usually symptoms based and anti convulants, gradual tapering with long acting benzos, IVFs, anticonvulsants if needed inpatient detox for high risk patients, symptomatic management

-NI: monitor VS, institute seizure precautions, provide low stimulus well lit environment, offer reassurance and therapeutic communication, reinforce importance of slow taper and follow up treatment

CNS stimulants s/s of intoxication

euphoria, increased energy, alertness, grandiosity, hypervigilance, talkativeness, dilated pupils, increased BP and HR, n, chest pain, cardiac arrhythmias, restlessness, tremor, irritability, paranoia, psychotic symptoms with high doses

CNS stimulants s/s of OD

respiratory distress, hyperthermia, severe HTN or arrythmias, MI or stroke, seizures coma death possible, paranoia, extreme agitation, psychosis

CNS stimulants s/s of withdrawal

fatigue, depression, vivid unpleasant dreams, hypersomnia/insomnia, increased appetite, psychomotor retardation or agitaiton, intense cravings but not life threatening

CNS stimulant intoxication mangament

-calm quiet environment, minimize external stimuli, montior cardiac status and VS, benzos for agitation or seizures, antipsycotics if severe psychosis occurs

-NI: assess for cardiac complications, maintain safety, reorient and reassure during confusion or agitation, educate on risks of stimulant induced cardiac damage and stroke

CNS stimulant OD management

-supportive care: manage airway and oxygenation, cooling for hyperthermia, benzos for agitation and seizures, antipsychotics if psychosis persists, treat arrhythmias and cardiac ischmeia

-NI: continuous cardiac and respiratory monitoring, IVFs, cooling blanket, oxygen, maintain calm nonjudgemental presence, avoid confrontation during paranoia, restraints as a last resort for safety

CNS stimulant withdrawal management

-supportive care no specific pharmacologic detox, antidepressants, sleep aids and nutritional support, counseling and cognitive behavioral therapy

-NI: provide rest and low stimulation environment, monitor mood for SI, encourage fluids, balanced diet, gradual activity, facilitate referral to long term treatment, reinforce relapse prevention education

opiate s/s of intoxication

constricted pupils, slurred speech, drowsiness, sedation, psychomotor retardation, impaired attention and judgement, euphoria --> apathy or dysphoria, decreased respiratory rate and BP, impaired memory and concentration

opiates s/s of OD

triad: respiratory depression, coma, pinpoint pupils, shallow respirations --> apnea, bradycardia, hypotension, pulmonary edema, possible death

opiate s/s of withdrawal

onset 6-8 hrs after last dose, peak 1-3 days, duration 5-10 days, dilated pupils, yawning, muscle aches, bone pain, piloerection, chills, sweating, abdominal cramps, n/v, d, insomnia, irritability, anxiety, elevated HR, BP, temp, intense cravings

opiate intoxication management

-supportive care, monitor LOC, VS, avoid CNS depressant combinations

-NI: assess respiratory effort frequently, maintain airway and provide oxygen if RR <12, monitor for hypoxia, cyanosis, provide calm safe environment, minimize stimulation

opiate OD management

-naloxone and repeat every 2-3 min, provide mechanical ventilation or O2 if needed, continuous cardiac and respiratory monitoring

-NI: maintain airway and monitor O2 sat, prepare for emergency resuscitation, stay with pt until fully responsive, educate patient/family about OD prevention and narcan use

opiate withdrawal management

-methadone for taper, bupenorphine or buprenorphine/naloxone, clonidine for autonomic symptoms, non opioid comfort meds

-NI: monitor VS, hydration, and electrolytes, administer prescribed withdrawal meds and assess response, provide supportive non judgemental care, encourage verbalization of feelings and coping strategies, educate about relapse prevention, MAT and community resources