Hans Seyle’s stress adaptation syndrome may be applied. According to him, stress is a non-specific response of the body to any demand made upon it.

Seyle’s general adaptation syndrome:

1. Alarm stage: body prepares by fight or flight
2. Stage of resistance: defense mechanisms to repair damage the body suffered or adapt to the stressor. If you adapt you, do not go to the next stage.
3. Stage of exhaustion: if continues physical or emotional diseases of adaptation occur (migraine, mental disorder). If this stage is not reversed, death will occur.

DSM IV

For dependence: @ least three of the following in past 12 mo.:

Tolerance, withdrawal, substance taken in larger amounts than intended, persistent desire or unsuccessful attempts to cut down or quit, great deal of time spent to obtain substance, substance interferes with social or occupational activities, substance is continued with the knowledge of the adverse effects it has on the body.

For abuse: @ least one of the following in past 12 mo.:

Recurrent substance use resulting in failure to fulfill role obligations at work, school, or home.

Substance use in situations in which it is physically hazardous (drinking and driving)

Recurrent substance related legal problems.

Substance use despite persistent interpersonal problems caused or exacerbated by the effects of the substance.

Dual diagnosis = substance dependency and MJR psychiatric disorder.

Substance induced disorders are mental disorders caused by a substance.

There is no single cause of abuse and dependency

Drug abuse personality factors:

Come from a wide variety of people.

Negative self-concept

Sense of failure, inadequacy, guilt, shame, loneliness and despair.

Self-destructive behaviors

Increased in northern/cold countries

Some feel it is a learned behavior but we feel it is a disease

There is a higher incidence in families.

ETOH – affects memory, judgment, and reasoning. CNS depressant.

Rate of absorption varies with the following factors:

1. Substances in the beverage (soda, water)
2. The rate of ingestion affects the rate of absorption (the slower you drink the slower the absorption and it is metabolized by the liver at a steady rate) if you drink fast the alcohol spills over into the blood.
3. Alcohol leaves the body at a fixed rate.
4. Food in the stomach slows absorption
5. The body metabolized alcohol at a rate of one ounce per hour.
1. 1 oz = 1 (12 oz) beer
2. 1 oz = 1 shot of liquor
3. 1 oz. 4 oz of wine
6. Drinkers emotional state may affect absorption
7. Body size affects the concentration of alcohol in the blood
8. Body chemistry and cultural influences may alter behavioral effects of alcohol.

9. 0.08 is the state limit.

Black out- the person appears to be functioning normally but later is unable to remember what occurred. It is not the same as passing out.

Medical consequences: esophageal varicies, cirrhosis, ulcers, cardiomyopathy, esophagitis, alcoholic hepatitis. High risk for cancer of the mouth, pharynx, larynx, esophagus, cardia of the stomach and colon.

Intoxication

Alcohol withdrawal: AKA abstinence syndrome

Tremor of hand, tongue, and eyelids may occur. N/V, malaise, autonomic nervous system hyperactivity (increased BP and pulse), anxiety, depressed mood, orthostatic hypotension, sleep disturbances and nightmares.

Alcohol withdrawal delirium: can occur up to 1 week after cessation of drinking.

Unawareness of environment, inability to shift focus, misinterpretations, hallucinations that are usually visual and vivid, incoherent speech, frequent agitation, increased BP, increased sweating and temperature. Seizures can occur. This syndrome can cause serious medical complications like fluid and electrolyte imbalances, pneumonia, and dehydration.

Suicidal.

Alcoholic Hallucinosis:

Usually occur within the first 48 hours after cessation. Vivid auditory hallucinations usually experienced as voices but may be hissing or buzzing sounds.

Alcoholic Amnesic disorder: Wernicke-Korsakoff syndrome

Unable to learn new information or recall old information. Loss of short term and long-term memory

Alcoholic’s dementia: Associated with long chronic alcohol dependence. Loss of intellectual ability that is severe enough to interfere with social or occupational functioning. Impairment in memory, abstract thinking, and judgment. The degree of impairment ranges from mild to severe and may include permanent brain damage.

Nursing Diagnosis:

Risk for self directed violence

Altered nutrition less than body requirements

Ineffective individual coping

Spiritual distress

Implementation:

Establish proper nutrition

Provide safe and calm environment

Side rails up

IM or IV vitamins- especially thiamin

Rehab and recovery treatment center

Avoid sympathy, scorn or moralizing

Watch for manipulation, set limits, enforce rules.

Help patient make realistic goals for self.

A.A- lifetime abstinence goal

Anabuse- aversion medication.

Can be absorbed from all mucus surfaces. It can be snorted, injected or smoked. It produces an intense desire to experience the pleasurable effects repeatedly.

INTOXICATION:

Marked by maladaptive behavioral effects, such as fighting, impaired judgment, and problems in occupational and social functioning. Physical and psychological symptoms occur within minutes to an hour after taking the drug.

Increased sense of well being, increased awareness of sensory input, psychomotor agitation, elation, talkativeness, pacing and pressured speech.

Physical symptoms: increased heart rate, dilated pupils, increased BP, chills, sweating, N/V.

A severely intoxicated person may experience confusion, incoherent speech, anxiety, paranoid thoughts, H/A, and palpitations. The user is likely to feel anxious, irritable, depressed, and tremulous. This state is known as crashing and the user craves more cocaine for the relief of these symptoms.

DELIRIUM:

Usually occur within one hour of use (immediately if taken IV) and subsides within 6 hours. Labile affect, tactile and olfactory hallucinations, and violent aggressive behavior.

DELUSIONAL DISORDER:

Occurs soon after the use of the drug. Rapid development of persecutory delusions, distorted body image, and misperception of faces. Persecutory delusions may lead to violent aggressive behavior. Tactile hallucinations also occur.

COCAINE WITHDRAWAL:

Follows abrupt cessation or reduction in prolonged use. Symptoms include dysphoric mood ( depression, anxiety, irritability), fatigue, psychomotor agitation, insomnia or hypersomnia, paranoid and suicidal thoughts may occur. Symptoms last over 24 hours. Suicide is a major concern.

MEDICAL CONSEQUENCES:

Severe skin ulcerations may develop as a result of the client trying to "dig out insects". Formication- tactile feelings of bugs crawling on them.

Cardiac arrhythmias, convulsions and respiratory distress. Snorting the drug can cause tissue ulcerations in the nasal septum. Paranoid psychosis that may require prolonged treatment with Antipsychotic medications.

Cocaine street names- coke, cecil, Bernice, rock, friskie powder, crack, paradise.

HALLUCINOGENS:

Street names: sugar cubes, big D, ghost, LSD, mushrooms, acid, and California sunshine.

Generic: lysergic acid diethylamine

AKA: psychomimetics

Hallucinogens alter mood and perception. Ingestion of these drugs alters time and space perception, illusions, & delusions. Character and intensity of the reaction depend on the drug dosage and the personality of the user.

HALLUCINOGEN HALLUCINOSIS:

Begins 1 hour after ingestion and lasts several hours. The person fears loss of sanity and fears that this will be a permanent state.

Perceptual changes, increased heart rate, incoordination, blurred vision, palpitations, sweating, tremors. Maladaptive behaviors such as severe anxiety or depression, ideas of reference, paranoid ideation, impaired judgment, interference with occupational or social functioning.

HALLUCINOGEN DELUSIONAL DISORDER:

Lasts longer than 24 hours perceptual changes occur but the client believes that the misperceptions and thoughts are based on reality.

HALLUCINOGEN MOOD DISORDER:

A depressed mood accompanied by guilt, fearfulness and restlessness. The client may be talkative and unable to sleep.

MEDICAL CONSEQUENCES:

FLASHBACKS, passive introspective and loses ability to concentrate. Risk for self-injury during periods of impaired judgment or delusions.

TCH (tetrahydrocannabinol)

INTOXICATION:

Increased heart rate, blood shot eyes (conjunctival injection), increased appetite, dry mouth, euphoria, intensification of perception, sensation of slowed time and apathy.

Suspiciousness, Paranoid, panic attacks, excessive anxiety, interference with social or occupational functioning.

CANNIBIS DELUSIONAL DISORDER:

Persecutory delusions while intoxicated or immediately following the use of pot not longer than 6 hours after cessation of use.

Medical consequences:

Acute and chronic bronchitis and sinusitis. Increased heart rate and decreased strength of cardiac contractions.

Link between pot use and brain damage, link between pot use and decreased sperm count and chromosomal damage.

Hash Hish is the flowers and marijuana is the stems and dry leaves it is more potent.

Drugs that affect the CNS cross the placenta. Psychological cravings to get the desired effects from the drug and to eliminate the dysphoric aspects of abstinance motivates the woman to keep taking the drug. Health professionals recognize that the woman and the fetus are victims of disease. ANA opposes criminal prosecution of the drug dependent mother and supports early detection of women at risk and rapid treatment of mothers and infants.

The nurse needs to assess her own attitudes and feelings. You need to be nonjudgmental and objective. Approach the client with compassion and gentle firmness. Use terms such as, alcohol use, feeling good and feeling high instead of getting drunk, boozing it up, or addict.

OVERDOSE: occurs most frequently with alcohol, sedative-hypnotics, and narcotics

The following drugs are used in treatment of withdrawal syndrome:

Barbiturates – barbiturate withdrawal

Anxiolytics- valium (diazepam) and Librium (chlordiazepoxide) for alcohol withdrawal

Codiene and darvon are for narcotic withdrawal if symptoms are severe Methadone or morphine may be used.

Dilantin is given for alcohol and sedative-hypnotic withdrawal seizures.

Thiamine- alcohol and to prevent Werneke-Korsakoff

Multi vitamins are administered because the client is usually has a poor nutritional state.

DEFENSE MECHANISMS:

DENIAL

PROJECTION

RATIONALIZATION

INTELLECTUALIZING

MINIMIZING- MAY ADMIT SOME DRUG ABUSE OR DEPENDANCY BUT MAKES IT SEEM LIKE A MINOR PROBLEM.

DIVERSION

ANGER

CNS depressants also called sedative/hypnotics and anxiolytics. They are the most common drugs abused in America after alcohol.

They are taken PO, IM, or IV. The liver metabolizes most barbiturates. They cross the placental barrier.

Physical withdrawal symptoms occur in the infant up to 7 days after delivery and may include high pitched crying, tremors, restlessness, disturbed sleep, increased reflex action, hyperphagia, diarrhea, vomiting, and major motor seizures.

Cross-tolerance does not occur between opiates and barbiturates but it does occur between barbiturates and alcohol.

Intoxication- similar to alcohol intoxication

Withdrawal- occurs hours to several days after decrease or cessation of prolonged heavy use of barbiturates. Signs and symptoms of withdrawal are similar to those of alcohol withdrawal. The severity depends on individual differences, doses and duration of use. Detoxification should take place in a medical setting.

Withdrawal Delirium- usually occurs within one week of cessation or reduction of use. Similar to alcohol withdrawal delirium. Some experience delirium without seizures, some experience seizures without delirium, and some experience both. This condition is a MEDICAL EMERGENCY that requires hospitalization and medical intervention.

Medical consequences:

Cellulitis and vascular complications, serum hepatitis, pneumonia, tetanus and other bacterial infections. Syphilis and malaria may result as well as allergic reactions to substances that may have been added to the drug.

Barbiturates are frequently used in suicides.

It is crucial to asses whether the person used alcohol or other drugs concurrently with alcohol or other drugs without alcohol.

Trade names:

Amytal, Nembutal, luminal, seconal.

Generic:

All end in barbital

Street:

Candies, peanuts, blue dots, yellow bullets, downers, Christmas trees, Mexican reds, pink ladies, to name a few.

THE OPIATES: Morphine and Heroine

Narcotics that produce depressant effects on the CNS. They are taken PO, IM, IV, rectally or smoked. They produce analgesia, mood changes and sedation. They depress respirations, inhibit coughing, and are effective pain relief medications.

Generic name: diacetylmorphine

Street names: brown sugar, Mexican mud, junk, horse, smack, cube, and thing to name a few.

Heroine is 4-5 times more potent than morphine

INTOXICATION:

Marked by papillary constriction, drowsiness, slurred speech, impaired attention or memory, euphoria, dysphoria, apathy and psychomotor retardation. Problems in social or occupational functioning and impaired judgment may result in maladaptive behavior.

OPIOD WITHDRAWAL:

Occurs after cessation or reduction in prolonged heavy use. Signs and symptoms include the following:

Tearing, runny nose, dilated pupils, yawning, gooseflesh (piloerection), sweating, diarrhea, mild hypertension, tachycardia, fever, and insomnia. Accompanying symptoms may be irritability, depression, restlessness, tremor, weakness, N/V, and muscle and joint pain. It resembles flu symptoms. Withdrawal symptoms are usually not life threatening unless the client has a concurrent serious medical condition such as cardiac disease.

MEDICAL CONSEQUENCES:

Prolonged opiate use often results in decreased motivation to engage in high quality life experiences. The client usually has problems with law enforcement. Other consequences include, abscesses and infections of the skin and muscle, tetanus, malaria, liver disease, hepatitis, HIV, gastric ulcers, endocarditis, arrhythmias, anemia, infections of bones and joints, TB, pneumonia, lung abscesses, kidney failure