SUD

Instructions

  • Presentation uses Mentimeter for audience engagement.

Mental Health and Addiction Discussion

  • Topics Covered:
    • Addiction: Both substance-related and behavior-focused addictions.
    • Overdose: Importance of understanding the risks and management strategies.
    • Mental Health Impacts: Exploring how addiction affects mental health.

Causes of Addiction (MUO)

  • Key Factors Contributing to Addiction:
    • Pain: Chronic pain may lead individuals to seek substances for relief.
    • Stress: High-stress environments or situations can increase the likelihood of substance use.
    • Self-Management: Individuals may attempt to manage their conditions through substance use.
    • Management and Medications: Some individuals misuse prescribed medications.
    • Exposure: Early exposure to substances can significantly heighten the risk of addiction.
    • Use At Early Age: The younger an individual is when beginning to use substances, the higher the risk for developing addiction.

The Brain and Help Seeking

  • The Brain Likes Help: Emphasis on the brain's positive response to supportive interventions.

Risk Factors for Addiction

  • Identified Risk Factors Include:
    • Mental Illness: Certain conditions may predispose individuals to substance use.
    • Stress: Temporal or situational stress that individuals face in their environments.
    • Genetics: Family history can influence susceptibility to addiction.
    • Peer Pressure: Social influences may encourage experimentation with substances.
    • Abuse: History of abuse can increase vulnerability to substance use.

Protective Factors Against Addiction

  • Factors That May Reduce the Risk of Addiction:
    • Positive Family Involvement: Supportive family structures can act as buffers.
    • Caregiver Support: Active involvement of caregivers in adolescents' lives.
    • Positive Relationships: Healthy social interactions support resilience against addiction.
    • Community Resources: Access to community support systems.
    • Employment: Job stability and fulfilling work may decrease the risk of turning to substances.

Comorbidities Associated with Addiction

  • Common Comorbid Conditions:
    • Heart Disease: Often linked with substance abuse.
    • Stroke: Certain substances can significantly heighten risk factors.
    • Dental Issues: Substance abuse can lead to significant oral health problems.
    • Hepatitis: Risk of transmission especially with intravenous drug use.
    • Cirrhosis: Chronic liver damage due to alcohol abuse.
    • Mental Illness: High comorbidity with various psychiatric conditions.

Case Study Example

  • Patient Profile:
    • A 39-year-old male presented for intoxication and bizarre behavior in a grocery store.
    • History includes multiple alcohol detoxes and withdrawal seizures.
    • Reports heavy drinking habits (several bottles of hard liquor daily).
    • Last intake was approximately 6 hours prior to presentation.

Nursing Considerations

  • As a Nurse: Considerations for the patient’s care during detoxification and ongoing monitoring.

Understanding Alcohol Use

  • Importance for NCLEX and Practical Life: Knowledge of complications associated with alcohol use.

Symptoms of Alcohol Use

  • Observable Symptoms Include:
    • Mood and Behavior Changes: Alterations in emotional state and behavior.
    • Poor Movement Coordination: Reduced fine and gross motor skills.
    • Slurred Words: Impaired speech articulateness.

Safety Concerns with Alcohol Use

  • Identified Concerns:
    • Safety: Risk of injury or accidents.
    • Accidents: Increased likelihood of falls and other injury-related incidents.
    • Risk for Bleeding: Hemorrhage risks due to acute intoxication.

Detoxification Process

  • Detox Protocol: Evaluated using CIWA (Clinical Institute Withdrawal Assessment for Alcohol).
    • The assessment performed every two hours.
    • Medications include benzodiazepines and comfort medications.

Alcohol Withdrawal Aspects

  • Severity of Withdrawal: Can be fatal and varies greatly among individuals.
  • CIWA Assessment: A tool to quantify symptoms and determine medication needs.
    • Highly subjective and requires nursing expertise.

CIWA Criteria Specifics

  • Symptoms Assessed Include:
    • Nausea and Vomiting: Score from 0 (none) to 7 (constant nausea and vomiting).
    • Tremors: Score from 0 (no tremor) to 7 (severe tremors).
    • Sweating: Observation of sweating severity from 0 (none) to 7 (drenching).
    • Anxiety: Based on verbal feedback and observation.
    • Agitation: Range from normal activity to severe agitation.
    • Disturbances: Tactile, auditory, and visual disturbances are ranked.
    • Headache: Rated based on severity.
    • Orientation: Assessed based on awareness of time, location, and identity.

Introduction to CIWA Scale

  • CIWA-AR Tool: Each rater assesses based on a maximum possible score of 67, with lower scores indicating less need for medication.

Examples from Clinical Practice

  • Assessment Examples: Indications based on patient reports and observations of symptoms.

Additional CIWA Considerations

  • Patient Behavior: Watch for drug-seeking behaviors and inconsistencies in patient reports.
  • Blood Pressure Monitoring: Crucial during withdrawal phases.

Delirium Tremens (DTs)

  • DTs Explanation: Most severe form of alcohol withdrawal, potentially lethal.
    • Symptoms include seizures, hallucinations, and global confusion.

Alcohol Withdrawal Timeline

  • Stages of Withdrawal:
    • Last Drink: Symptoms onset with anxiety, insomnia, nausea, and abdominal pain within 8 hours.
    • Day 1-3: Peaks with hallucinations, fever, and increased agitation.
    • Prolonged Symptoms: Can last up to weeks without intervention.

Treatment Protocols for Alcohol Withdrawal

  • Short-Term Treatments:
    • Benzodiazepines, antiepileptics, thiamine supplementation, and introduction of supportive resources.

Long-Term Treatment Considerations

  • Medications:
    • Naltrexone: Aids in preventing relapses.
    • Acomprosate: Helps reduce cravings for alcohol.
    • Disulfiram (Antabuse): Can cause adverse reactions if alcohol is consumed.

Benzodiazepine Withdrawals

  • Withdrawal Characteristics: Similar to alcohol, with variations based on drug half-life.

Benzodiazepine Withdrawal Timeline

  • Trusted timelines based on half-life indicate onset and duration:
    • Short half-life: Onset in 1-2 days, lasting 2-4 weeks.
    • Long half-life: Onset in 2-7 days, lasting 2-8 weeks.

Opioid Use and Risks

  • Common Opioids:
    • Fentanyl, heroin, prescribed narcotics (oxycodone, Percocet).

Dangerous Signs of Opioid Use

  • Identified Risks Include:
    • CNS depression, respiratory failure, and potential for overdose.

Opioid Detox Symptoms

  • Common Symptoms Experienced:
    • Restlessness, muscle aches, insomnia, diarrhea, vomiting, cold flashes, flu-like symptoms.

Opioid Detox Treatments

  • Comfort Medications: Control symptoms using naloxone, methadone, Suboxone, Subutex for detoxification.

Drug Use in Healthcare Contexts

  • Key Challenges Within Healthcare:
    • Staff impairments, drug diversion, and burnout due to poor staffing ratios.

Ethical and Regulatory Frameworks

  • Process for Addressing Complaints:
    • Investigative protocols and potential licensure risks for nurses involved in substance use cases.

Conclusion

  • Final Thoughts: Encourage open dialogue and clarity in professional settings concerning addiction and its complexities.