NUR213: Comprehensive Study Notes
Unit Objectives
Etiologies of Chemical Dependency
Dual/Co-occurring Diagnoses and Nursing Care
Acute Withdrawal Process
Cannabis Use Across the Life Span
Evaluate the Effects of Addiction During the Child-bearing Period
Impact of Addiction on the Individual, Family, and/or Significant Others
Ethical and Legal Responsibilities When a Colleague is Chemically Impaired
Examine Family Issues, Enabling Behaviors, and Family Roles
Clinical Judgments Related to Patients with Substance Use Disorder
Teaching and Learning Principles for Patients and Family
Medication Treatment Options and Implications
Benzodiazepines
Central Nervous System Depressants
Antipsychotics
Vitamins
Narcotic Agonists
Narcotic Antagonists
Anticonvulsants
Multidisciplinary Treatment Planning and Collaborative Caring Interventions
Values and Challenges that a Nurse May Face in Caring for Patients with Substance Use Disorder
Substance Use and the Brain
Drugs of Abuse Target the Brain's Pleasure Center
Brain Reward Pathways
Drugs of abuse increase dopamine levels.
Dopamine Transporters and Receptors play critical roles.
Cocaine specifically affects areas such as the Frontal Cortex, Ventral Tegmental Area, and Nucleus Accumbens.
Natural Rewards vs. Drug-Induced Rewards
Normal increases in dopamine occur with natural rewards (e.g., food, music, sex).
Cocaine results in exaggerated dopamine increases and altered communication pathways.
Central Concepts of Substance Use Disorder
Definition: “A pathological use of a substance that leads to a disorder of use.” (American Psychiatric Association)
Key Terms:
Intoxication
Tolerance
Withdrawal
Abuse
Dependence
Substance Addiction Characterization:
Compulsive use and impaired control of use
Social impairment resulting from use
Physical effects including risky use
Un-treated addiction leads to cycles of chronic disease, disability, and death.
Common Use Disorder Drug Classes
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedative/Hypnotics/Antianxiety
Stimulants
Tobacco
Process Addictions:
Gambling, Gaming, Shopping, Sex, Exercise, etc.
Drug Scheduling
Schedule I:
Drugs with no currently accepted medical use and a high potential for use disorder (e.g., heroin, LSD, marijuana).
Schedule II:
High potential for use disorder, leading to severe psychological or physical dependence (e.g., Vicodin, cocaine, methamphetamine).
Schedule III:
Moderate to low potential for dependence (e.g., Tylenol with codeine).
Schedule IV:
Low potential for use disorder (e.g., Xanax, Ativan).
Schedule V:
Lower potential for use disorder than Schedule IV (e.g., Robitussin AC).
Health Impacts
Short-term Use:
Temporary effects on brain function.
Long-term Use:
Permanent brain damage, increased risk of withdrawal, alterations in motivation, learning, and memory networks leading to loss of control and compulsive substance seeking.
Comorbidity
Psychiatric Comorbidity:
Co-occurring substance use disorders and mental disorders (6 out of 10 patients with substance use disorder have a co-occurring mental health disorder).
Importance of treating both disorders simultaneously.
Nursing Implications:
Diagnostic challenges require collaboration.
Increased crisis situations, longer treatment durations, and more severe medical, social, and emotional problems.
Greater risk of relapse and worsening psychiatric disorders.
Specific Substance Use Disorders
Caffeine Use Disorder
Overview:
Most widely used psychoactive substance globally.
Causes intoxication, overdose, and withdrawal symptoms.
Associated with psychiatric disorders (bipolar disorder, sleep disorders).
Intoxication Symptoms:
Restlessness, nervousness, flushed face, gastrointestinal disturbances, tachycardia, etc.
High Doses:
Severe effects such as fever, tachycardia, hypertension, seizures.
Treatment:
Hydration, gastric lavage, and medications to decrease symptoms.
Tobacco Use Disorder
Prevalence:
13% of adults use tobacco; most begin before age 18.
Dependence Timeline:
Develops quickly.
Withdrawal Symptoms:
Irritability, anxiety, depression, insomnia, etc.
Treatment:
Replacement therapies, Bupropion (Zyban), Varenicline (Chantix).
Vaping Epidemic:
Rapid rise in use among adolescents.
Contains harmful substances leading to lung diseases.
Tobacco and Health
Conditions resulting from tobacco use include:
Cancers (e.g., lung, cervix)
Chronic Diseases (e.g., stroke, heart disease, COPD)
Reproductive effects in women (reduced fertility).
Stimulant Use Disorder
Overview:
Includes amphetamines and cocaine; second most widely used illicit substances in the US.
Intoxication Symptoms:
Hypervigilance, anger, chest pain, etc.
Withdrawal Symptoms:
Nightmares, insomnia, exhaustion, and depression.
Nursing Interventions:
Monitor vital signs and provide adequate fluids.
Group and individual therapy.
Cannabis Use Disorder
Legal Status:
Medical use legal in 38 states, recreational use in 24 states.
Terms and Effects:
Thc (tetrahydrocannabinol) is responsible for mind-altering effects.
Intoxication symptoms: tachycardia, red eyes, increased appetite, cognitive effects.
Withdrawal Symptoms:
Aggression, anxiety, decreased appetite, and sleep disturbances.
Assessment and Treatment:
Patient history & lab tests; stabilize and monitor symptoms focusing on safety.
Opioid Use Disorder
Historical Context:
Opium has been used historically for medical and recreational purposes; heroin proliferation in the late 19th century led to addiction crises.
Prescription Opioids:
Common prescriptions: oxycodone (OxyContin), hydrocodone (Vicodin), methadone.
Fentanyl:
Powerful synthetic opioid, significantly intensifying the overdose epidemic.
Statistics on Overdose:
Opioid use has significantly increased overdose death rates, with a notable part being due to synthetic opioids.
Alcohol Use Disorder
Prevalence and Epidemiology:
Most prevalent substance use disorder; disproportionately affects specific demographics (American Indians/Alaska Natives).
Risk Factors:
Genetic, neurobiological, social, and cultural influences on development of alcohol use disorders.
Intoxication Definition and Effects:
Person typically intoxicated over 80 mg/dL exhibits various effects like disinhibition and slurred speech.
Withdrawal Symptoms:
Autonomic hyperactivity, tremors, nausea, hallucinations, seizures.
Can lead to severe withdrawal symptoms known as Delirium Tremens.
Nursing Process in Substance Use Disorders
Assessment
Self, patient, family consideration. Key risks:
Injury
Fluid imbalance
Disturbed sensory perception.
Outcomes Identification
Goals focused on detoxification, motivation, and individual-centered treatment planning.
Implementation
Safety measures, anxiety reduction, nutrition, and educational interventions.
Evaluation
Assess overall treatment effectiveness and physical/behavioral changes related to goals set.
Treatment Modalities
Psychotherapy:
Cognitive Behavioral Therapy
Motivational Interviewing
Continuum of Care:
Detoxification, residential rehabilitation, partial hospitalization, intensive outpatient programs, and recovery groups focusing on relapse prevention strategies.
Substance Use and Childbearing
Impact of Substance Use Disorder During Pregnancy:
High rates of absent prenatal care, child behavioral difficulties, fetal alcohol syndrome.
Chemically-Impaired Nurse
Prevalence:
Significant occurrence in nursing; often goes unreported due to stigma and denial.
Risks and Outcomes:
Substance use leads to unsafe judgment and practice violations.
Action Steps for Addressing Impairment:
Prioritize patient safety, document incidents, seek support from peers and supervisors, and lead interventions on institutional policies.
Summary of Nursing Interventions
Engage in supportive discussions, offer treatment options, and maintain a compassionate yet firm stance on patient and institutional policies.