Phsyc final pt 1

Understanding Addiction as a Brain Disease

Definition and Characteristics of Addiction

• Addiction is characterized by an inability to control substance use despite a desire to cut down or stop, leading to increased consumption.

• Individuals experience intense cravings for substances, which can dominate their thoughts and behaviors.

• Excessive time is spent either procuring substances or recovering from their effects, indicating a significant impact on daily functioning.

Neurobiological Basis of Addiction

• Addiction is recognized as a brain disease due to its effects on brain structure and function, particularly in the reward pathways.

• Genetic factors play a crucial role; children of alcoholics have a fourfold increased risk of developing alcoholism.

• Neurotransmitters such as dopamine, GABA, and glutamate are involved in the reward system, reinforcing substance use.

Tolerance and Withdrawal Symptoms

• Tolerance occurs when larger amounts of a substance are needed to achieve the same effect, except for respiratory depressants.

• Withdrawal symptoms can be severe and vary by substance; they can include both physical and psychological symptoms.

• The risk of relapse increases with more intense withdrawal symptoms, highlighting the need for careful management.

Substance Intoxication and Its Effects

Symptoms of Intoxication

• Intoxication leads to reversible symptoms that are specific to the substance used, affecting both physical and psychological functioning.

• Common symptoms include impaired judgment, inappropriate behavior, and difficulties in social and occupational settings.

Alcohol Intoxication and Blood Alcohol Concentration (BAC) Levels

• At 0.15 BAC, individuals experience gross motor impairment, blurred vision, and reduced euphoria.

• At 0.20 BAC, blackouts can occur due to the substance blocking memory formation, alongside nausea and vomiting.

• At 0.40 BAC, there is a risk of coma or death due to impaired vital signs.

Chronic Effects of Alcohol Use

Physical Health Consequences

• Chronic alcohol use can lead to Wernicke’s Encephalopathy, characterized by thiamine deficiency and neurological symptoms such as confusion and altered gait.

• Alcoholic Cardiomyopathy can result in heart failure and dysrhythmias, while esophagitis and pancreatitis are also common complications.

• Long-term liver damage can lead to cirrhosis, portal hypertension, and hepatic encephalopathy.

Fetal Alcohol Spectrum Disorders (FASDs)

• FASDs are a range of effects that occur in individuals exposed to alcohol in utero, leading to physical, mental, and behavioral disabilities.

• It is the leading cause of intellectual disability in the U.S., with symptoms including poor coordination, learning disabilities, and behavioral issues.

Alcohol Withdrawal and Treatment Strategies

Symptoms and Management of Alcohol Withdrawal

• Withdrawal symptoms can begin within 4 to 12 hours after cessation of heavy alcohol use, with tremors, nausea, and anxiety being common.

• Delirium Tremens (DTs) can occur within the first 72 hours and is characterized by severe confusion, hallucinations, and seizures, requiring immediate medical attention.

Treatment Approaches for Alcohol Use Disorder

• Medications such as Disulfiram (Antabuse) are used to create aversive reactions to alcohol, promoting abstinence.

• Supportive care during withdrawal includes hydration, thiamine supplementation, and a calm environment to reduce anxiety.

• Counseling and group therapy, including Alcoholics Anonymous, are essential components of long-term recovery strategies.

Addressing Violence and Communication in Treatment

Understanding Violence in Treatment Settings

• Some subcultures may normalize violence, which can complicate treatment and recovery processes.

• Victims of trauma are at risk for PTSD and other psychological disorders, necessitating sensitive approaches in treatment.

Interventions to Promote Effective Communication

• Nurses should teach and model communication skills to help patients express their feelings and needs effectively.

• Monitoring for signs of desperation and engaging patients in conversation can prevent escalation of behaviors.

• Providing alternative outlets for energy and frustration can help manage aggressive impulses.

Understanding Behavioral Crises

Goals During Behavioral Crises

The primary focus during behavioral crises is to ensure safety for both the patient and staff.

• Safety: Everyone remains safe, minimizing risk of harm.

• Arousal Management: Arousal levels are reduced to manageable states, allowing for better communication and intervention.

• Resource Utilization: Patients are encouraged to use both internal and external resources to de-escalate their situation.

• Recurrence Prevention: Strategies are implemented to reduce the likelihood of future crises.

Non-Therapeutic Expectations

Unrealistic expectations can hinder effective crisis management.

• Patient Admission: Expecting patients to admit wrongdoing or apologize is often unrealistic.

• Use of Restraints: Restraints should not be the first line of action; they can lead to further trauma.

• Conflict Management: It is unrealistic to expect no anger or conflict during crises.

Therapeutic Approaches

Employing a partnership approach can facilitate better outcomes.

• Fair Trade Approach: Trade what the patient wants for what the staff needs, fostering cooperation.

• Reframing Situations: Emphasize working together towards common goals to build rapport.

• Concrete Nurturance: Offering food, fluids, and support can help in de-escalation.

Seclusion and Restraints

Indications for Use

Seclusion and restraints are interventions that require careful consideration and a physician's order.

• Safety First: These measures are typically used when immediate safety cannot be ensured by other means.

• Trauma Awareness: Understand that these interventions can be traumatizing, especially for those with a history of abuse.

Nursing Care During Restraint and Seclusion

Nurses play a critical role in managing patients during these interventions.

• Constant Monitoring: Essential to prevent injury, particularly airway restriction.

• Nutritional Needs: Providing high-protein shakes and ensuring hydration is crucial.

• Emotional Support: Help patients understand the purpose of seclusion or restraint post-event.