Nursing Process: Outcome Criteria and Planning

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Questions and Answers

Which medication is specifically indicated for aiding in the cessation of alcohol use?

Gabapentin (Neurontin)

Naltrexone (ReVia) (correct)

Topiramate (Topamax)

Disulfiram (Antabuse) (correct)

What effect can severe opioid intoxication have on a person's health?

Increased cardiac output

Respiratory depression (correct)

Enhanced sexual function

Elevated mood

Which of the following is a common withdrawal symptom associated with short-acting opioids?

Euphoria

Severe agitation (correct)

Impaired judgment

Psychomotor retardation

Why is thiamine administered in the treatment of alcohol withdrawal?

To prevent neurological complications Signup and view all the answers

What is a characteristic sign of opioid use disorder?

Social withdrawal Signup and view all the answers

What is the blood alcohol level (BAL) at which a person is generally considered intoxicated?

0.10% Signup and view all the answers

Which phase of alcohol use disorder is characterized by emotional and physical decline due to alcohol consumption?

The Crucial phase Signup and view all the answers

What condition is characterized by widespread destruction of liver cells replaced by fibrous tissue due to chronic heavy alcohol use?

Cirrhosis of the liver Signup and view all the answers

Which of the following is NOT a common effect of long-term heavy alcohol use?

Lactose intolerance Signup and view all the answers

Which of these conditions is characterized by acute symptoms usually occurring 1-2 days after a binge?

Acute pancreatitis Signup and view all the answers

Which syndrome is specifically associated with chronic alcohol consumption leading to memory disturbances and confusion?

Korsakoff’s psychosis Signup and view all the answers

What is the primary cause of alcoholic hepatitis?

Long-term heavy alcohol use Signup and view all the answers

What condition often presents with symptoms of jaundice, ascites, and elevated liver enzymes in heavy alcohol users?

Cirrhosis Signup and view all the answers

Which symptom is NOT associated with cannabis intoxication?

Violated judgment Signup and view all the answers

What is the duration of motor skill impairment due to cannabis use?

8-12 hours Signup and view all the answers

Which of the following is a common symptom of nicotine withdrawal?

Increased appetite Signup and view all the answers

What effect does nicotine typically have on blood pressure?

Increases blood pressure Signup and view all the answers

Which treatment is commonly used for nicotine addiction?

Varenicline (Chantix) Signup and view all the answers

Which of the following is true regarding the history of cannabis use?

It has therapeutic uses dating back nearly 5,000 years. Signup and view all the answers

What cardiovascular effect is commonly associated with MDMA (Ecstasy) use?

Increased heart rate Signup and view all the answers

Which of these substances is most closely associated with aggressive behavior in its intoxication state?

Phencyclidine (PCP) Signup and view all the answers

Which criterion indicates a client has successfully acknowledged their substance use problems?

They have accepted responsibility for their behavior. Signup and view all the answers

What is an important indicator of progress in a client undergoing treatment for substance use?

Demonstrating less defensive behavior towards others. Signup and view all the answers

What is one of the DSM-5 criteria for substance use disorders?

Increased tolerance Signup and view all the answers

Which of the following is NOT a criterion for outcome evaluation in a client undergoing substance treatment?

Exhibiting signs of withdrawal. Signup and view all the answers

Which organization provides a definition of addiction?

American Society of Addiction Medicine Signup and view all the answers

Which assessment question addresses a key mental health aspect of substance use treatment?

Does the client understand the effects of substance abuse on the body? Signup and view all the answers

When evaluating if a client has completely cooperated with treatment, what should be assessed?

Their ability to verbalize motivation toward coping strategies. Signup and view all the answers

Which of the following is a source of statistics about drug use among youth?

National Center for Drug Abuse Statistics Signup and view all the answers

Why is the acknowledgment of personal problems correlated with substance use important for recovery?

It facilitates acceptance of accountability. Signup and view all the answers

What is a standard drink according to guidelines provided by health organizations?

12 ounces of beer Signup and view all the answers

Which of the following aspects is most closely related to effective coping mechanisms in clients?

Utilizing adaptive strategies instead of substances. Signup and view all the answers

Which criterion is necessary for diagnosing substance use disorders in the DSM-5?

Social impairment Signup and view all the answers

In evaluating a client, which sign would indicate that they are still in denial about their substance use?

They frequently justify their substance use behavior. Signup and view all the answers

Which publication discusses medications for opioid overdose and addiction?

National Institute on Drug Abuse Infographic Signup and view all the answers

What aspect of addiction does Goldblatt and colleagues’ article focus on?

Superego distortions and self-attack Signup and view all the answers

What demographic factor is linked to substance use according to research?

Age of first use Signup and view all the answers

What is the purpose of administering a "banana bag" during alcohol withdrawal treatment?

To provide vitamins and minerals Signup and view all the answers

Which medication is commonly associated with causing unpleasant reactions when alcohol is consumed?

Disulfiram Signup and view all the answers

Which of the following is a key characteristic associated with opioid withdrawal symptoms?

Muscle aches and pains Signup and view all the answers

What is one of the significant adverse effects of severe opioid intoxication?

Respiratory depression Signup and view all the answers

Which of the following factors can contribute to the development of opioid use disorder?

Recreational use of synthetic opioids Signup and view all the answers

Which of the following best describes the goals of the special program targeting dual diagnosis?

It combines behavioral therapies to address both substance use and mental health disorders. Signup and view all the answers

What is the importance of motivational interviewing in the nursing assessment process for clients with substance abuse problems?

It explores and resolves the client's ambivalence towards changing their substance use behavior. Signup and view all the answers

Which assessment tool is specifically designed to monitor withdrawal symptoms from alcohol?

Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) Signup and view all the answers

What emotional responses should nurses consider during the assessment of clients with substance abuse issues?

The client's distress, which may impact their relationships, jobs, and self-respect. Signup and view all the answers

Why is it critical for nurses to examine their own attitudes towards substance use when working with substance-abusing clients?

To provide a supportive environment free from personal biases and judgments. Signup and view all the answers

What is the primary cause of substance withdrawal symptoms?

Immediate cessation of use Signup and view all the answers

Which factor is considered a biological predisposition to substance use disorders?

Genetic factors Signup and view all the answers

What role do social learning factors play in substance use in adolescents?

They model substance use behavior. Signup and view all the answers

Which of the following is a psychological factor that increases the tendency toward addiction?

Punitive superego Signup and view all the answers

How do pleasurable effects from substance use influence continued use?

They act as positive reinforcement. Signup and view all the answers

Which of the following substances is least likely to cause substance-induced disorders according to the classes of psychoactive substances?

Antidepressants Signup and view all the answers

What type of psychological changes can a substance-induced withdrawal cause?

Disturbances in thinking and feeling Signup and view all the answers

Which factor is NOT considered a sociocultural influence on substance use?

Irrational thinking Signup and view all the answers

What is the primary characteristic of Alcoholics Anonymous as a treatment modality?

It emphasizes peer support and shared experiences. Signup and view all the answers

Which effect of alcohol is caused by long-term heavy alcohol use?

Wernicke's encephalopathy Signup and view all the answers

What is a significant sign of the Chronic phase of Alcohol Use Disorder?

Increased tolerance and withdrawal symptoms Signup and view all the answers

Which of these symptoms is most commonly associated with acute alcoholic hepatitis?

Enlarged, tender liver Signup and view all the answers

Why is total abstinence emphasized as the only cure in Alcoholics Anonymous?

To prevent increased cravings for alcohol. Signup and view all the answers

What is a common consequence of alcohol intoxication at a Blood Alcohol Level (BAL) of 0.15%?

Diminished judgment and motor control Signup and view all the answers

Which phase follows the Early alcoholic phase in the pattern of Alcohol Use Disorder?

The Crucial phase Signup and view all the answers

Which of these is a physical manifestation of significant alcohol-related disorders?

Peripheral neuropathy Signup and view all the answers

Which characteristic is associated with substance use disorders as defined by the DSM-5 diagnostic criteria?

Engagement in hazardous activities when impaired by the substance. Signup and view all the answers

What is a key nursing intervention aimed at reducing risk factors for substance use disorders across the lifespan?

Implementing age-specific and culturally sensitive educational programs. Signup and view all the answers

In what way does the nursing process support age-appropriate care for clients with behavioral disorders?

It guides the tailoring of interventions to meet the developmental needs of clients. Signup and view all the answers

Which complication is frequently associated with substance use disorders?

Development of co-occurring mental health disorders. Signup and view all the answers

Which assessment skill is crucial when managing disorders associated with substance use?

Conduct a holistic assessment considering both physical and psychological aspects. Signup and view all the answers

What constitutes a common therapeutic use of psychoactive substances in clinical settings?

Specific psychoactive substances may be used to treat certain mental health conditions. Signup and view all the answers

How does the concept of tolerance impact individuals with substance use disorders?

It leads to a need for increased amounts of the substance to achieve similar effects. Signup and view all the answers

What is a primary goal of implementing evidenced-based nursing care for clients with behavioral disorders?

To deliver care that is informed by the latest research and best practices. Signup and view all the answers

Which of the following best describes a characteristic feature of substance use disorder as per the DSM-5 criteria?

Development of tolerance to the substance. Signup and view all the answers

What occurs during substance withdrawal?

Experiencing a syndrome that includes physical signs and psychological changes Signup and view all the answers

What is a primary goal when applying the nursing process to clients with disorders of behavior?

To provide culturally sensitive and age-appropriate care. Signup and view all the answers

Which of the following complications is commonly associated with chronic addiction?

Cardiovascular diseases. Signup and view all the answers

Which psychological factor is considered a predisposing factor in substance use disorders?

Developmental influences like punitive superego Signup and view all the answers

Which class of psychoactive substances includes Anxiolytics?

Sedatives and Hypnotics Signup and view all the answers

When planning nursing care for a client with a substance use disorder, which strategy is most effective?

Incorporate evidenced-based treatments that address both behavioral and pharmacological aspects. Signup and view all the answers

Which factor best explains the observed behavior of children using substances?

Social learning from parental models of substance use Signup and view all the answers

What factor is considered a significant risk for developing behavior disorders across the lifespan?

Genetic predisposition and environmental influences. Signup and view all the answers

Which neurobiological change is linked to the development of addiction?

Modifications in brain structure and neurochemistry Signup and view all the answers

Which medication management strategy is crucial for patients undergoing withdrawal from opioids?

Providing supportive care alongside appropriate medications to manage withdrawal symptoms. Signup and view all the answers

What role does cultural influence play in substance abuse?

Certain cultures are more prone to substance abuse patterns. Signup and view all the answers

In terms of holistic assessment, which aspect should nurses prioritize when working with clients experiencing substance use disorders?

Considering social support and mental health simultaneously with physical health. Signup and view all the answers

Which of the following represents an effective teaching strategy for clients with disorders of behavior?

Utilizing practical examples and role-playing scenarios to illustrate coping mechanisms. Signup and view all the answers

What is a common psychological change observed in substance withdrawal?

Disturbances in thinking, feeling, and behavior Signup and view all the answers

Which factor can reinforce continued substance use?

Pleasurable effects and positive reinforcement Signup and view all the answers

What is the peak time for symptoms to occur after methadone onset?

4-6 days Signup and view all the answers

Which medication is primarily used to treat withdrawal symptoms from opioids?

Clonidine Signup and view all the answers

What is the common effect of stimulation by psychomotor stimulants?

Dilation of pupils Signup and view all the answers

Which symptom is most commonly associated with caffeine intoxication?

Restlessness Signup and view all the answers

What is a common symptom experienced during amphetamine withdrawal?

Fatigue Signup and view all the answers

How do CNS stimulants generally exert their action on the body?

Augmenting neurotransmitter activity Signup and view all the answers

What is the duration for symptoms to subside after using short-acting opioids?

4-5 days Signup and view all the answers

Which combination of symptoms manifests prominently in stimulant intoxication?

Euphoria and impaired judgment Signup and view all the answers

Which of the following medications is used for treating both alcohol dependence and opioid use disorder?

Naltrexone (ReVia) Signup and view all the answers

What is a primary focus of nursing care during alcohol withdrawal management?

Preventing seizures Signup and view all the answers

Which combination of substances can lead to severe respiratory depression in overdose situations?

Benzodiazepines and alcohol Signup and view all the answers

Which effect is commonly observed in chronic opioid use, impacting overall health?

Gastrointestinal motility issues Signup and view all the answers

What characterizes the withdrawal syndrome from short-acting opioids?

Rapid onset of symptoms within minutes Signup and view all the answers

What long-term effect of alcohol can lead to reduced sexual functioning in men?

Impotence Signup and view all the answers

Which of the following is NOT a complication arising from portal hypertension?

Decreased libido Signup and view all the answers

Which characteristic is associated with fetal alcohol syndrome?

Poor memory Signup and view all the answers

What is a common symptom of delirium tremens (DTs) during alcohol withdrawal?

Agitation Signup and view all the answers

Which complication is specifically characterized by the development of varices in esophageal tissues?

Portal hypertension Signup and view all the answers

Which physical characteristic indicates a child may have been affected by fetal alcohol exposure?

Abnormal facial features Signup and view all the answers

What behavioral issue is commonly observed in children with fetal alcohol spectrum disorders?

Hyperactive behavior Signup and view all the answers

Which blood condition is commonly associated with liver dysfunction due to chronic alcohol use?

Thrombocytopenia Signup and view all the answers

Study Notes

Nursing Process: Outcome Criteria

Client has not experienced any physical injury.
Client has not harmed themselves or others.
Client accepts responsibility for their own behavior.
Client acknowledges the link between personal problems and substance use.
Client demonstrates more adaptive coping mechanisms to manage stressful situations instead of using substances.
Client shows no signs of infection or malnutrition.
Client exhibits increased self-worth by trying new challenges without fear of failure and showing less defensive behavior towards others.
Client verbalizes the importance of abstaining from substances to maintain optimal wellness.

Nursing Process: Planning/Implementation

Risk for injury: Monitor for signs of withdrawal, provide a safe environment, and implement safety precautions.
Denial: Utilize therapeutic communication to help client confront their substance use.
Ineffective coping: Teach coping strategies to manage stress and triggers. Encourage participation in support groups.
Dysfunctional family processes: Encourage family therapy to address communication and support systems.

Nursing Process: Evaluation

Detoxification: Evaluate for complications during detox, including withdrawal symptoms.
Denial: Assess if the client has moved beyond denial and acknowledges their substance use problem.
Responsibility: Determine if the client accepts responsibility for their actions and behaviors.
Acceptance: Evaluate if the client has recognized the connection between personal problems and substance use.
Substance-free: Assess if the client has maintained abstinence from substances during treatment.
Treatment Cooperation: Determine if the client is actively participating in treatment.
Manipulative Behavior: Monitor for manipulative behavior or boundary violations.
Adaptive Coping Strategies: Identify the client's progress in developing and using alternative coping mechanisms.
Positive Reinforcement: Observe if the client shows increased use of adaptive coping strategies due to positive reinforcement.
Nutritional Status: Evaluate the client's nutritional intake and progress in restoring their nutritional status.
Infection & Substance Abuse Effects: Assess the client's understanding of infection risks and the effects of substance abuse on the body.

The Chemically Impaired Nurse

Approximately 10% of nurses suffer from chemical addiction, mirroring the general population.
Alcohol is the most widely abused drug among nurses, followed closely by narcotics.

Support Groups: Various support groups for different substances, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and similar groups for other substances.
Counseling: Individual therapy to address underlying issues contributing to addiction.
Group Therapy: Group sessions to provide support and share experiences with other individuals facing similar challenges.

Alcohol Use Disorder

Standard Drink: A standard drink contains about 0.6 fluid ounces of pure alcohol, which is roughly equal to:
- 12 ounces of beer (5% alcohol)
- 5 ounces of wine (12% alcohol)
- 1.5 ounces of distilled spirits (80 proof)

Alcohol Intoxication

Sedative and CNS Depressant: Alcohol acts as a sedative and central nervous system depressant.
Respiratory Depression: High doses of alcohol can cause respiratory depression, leading to coma and potentially death.
Blood Alcohol Level (BAL):
- Intoxication typically occurs with a BAL of 0.10% to 0.20%.
- The legal drunk driving limit is 0.08%.

Alcohol Use Disorder: Patterns of Use

Phase I: Pre-alcoholic phase: Initial experimentation with alcohol, primarily for social purposes.
Phase II: Early alcoholic phase: Increased tolerance, dependence on alcohol, and occasional blackouts.
Phase III: The Crucial phase: Loss of control over alcohol consumption, experiencing withdrawal symptoms, and experiencing job, relationship, and legal problems.
Phase IV: The Chronic phase: Physical and psychological deterioration, severe health problems, and social isolation.

Effects of Alcohol on the Body

Peripheral neuropathy: Damage to nerves, causing numbness, tingling, and pain in the extremities.
Alcoholic Myopathy: Muscle weakness, pain, and atrophy, often affecting the legs.
Wernicke's Encephalopathy: Neurological disorder caused by thiamine deficiency, resulting in confusion, vision changes, and balance problems.
Korsakoff's Psychosis: A long-term neurological disorder caused by thiamine deficiency, resulting in memory impairment, confabulation, and disorientation.
Alcoholic Cardiomyopathy: Damage to the heart muscle, resulting in heart failure.
Esophagitis: Inflammation of the esophagus, caused by the irritation from alcohol.
Gastritis: Inflammation of the stomach lining, caused by alcohol.

Effects of Alcohol on the Body (Continued)

Pancreatitis: Inflammation of the pancreas:
- Acute: Occurs 1-2 days after a heavy drinking episode, causing intense abdominal pain and nausea.
- Chronic: Leads to pancreatic insufficiency, causing digestive problems and malabsorption.
Alcoholic Hepatitis: Inflammation of the liver caused by long-term heavy drinking.
- Signs & Symptoms: Enlarged and tender liver, nausea, vomiting, lethargy, anorexia, elevated white blood cell count, fever, jaundice, ascites, and weight loss (in severe cases).
Cirrhosis of the Liver: End-stage alcoholic liver disease, caused by chronic heavy drinking, resulting in widespread destruction of liver cells replaced by scar tissue.

Alcohol Withdrawal: Nursing Care

Monitor Fluid Status: Assess and manage fluid balance.
Administer Magnesium Sulfate: Replace magnesium levels, which can be depleted during withdrawal.
Administer Thiamine: Treat thiamine deficiency, which is common in alcohol withdrawal.
IV "Banana Bag": Administer a mixture of fluids, electrolytes, vitamins, and medications.
Benzodiazepines: Administer to manage withdrawal symptoms, including anxiety, tremors, and seizures.
Anticonvulsants: Administer to prevent and treat seizures.
Seizure Precautions: Ensure a safe environment and implement seizure precautions.

Medications for Alcoholism

Disulfiram (Antabuse): Inhibits acetaldehyde dehydrogenase, causing aversive reactions to alcohol consumption.
Naltrexone (ReVia): Blocks opioid receptors, reducing alcohol cravings and reducing the reinforcing effects of alcohol.
Acamprosate (Campral): Modulates neurotransmitters, reducing cravings and supporting abstinence.
Selective serotonin reuptake inhibitors (SSRIs): Treat depression and anxiety, which can be common in alcohol withdrawal.
Topiramate (Topamax) & Gabapentin (Neurontin): Anticonvulsants that can help with alcohol cravings and withdrawal symptoms.
Milk Thistle: Protects the liver from alcohol-induced damage.

Opioid Use Disorder

Opioids of Natural Origin or Derivatives: Include morphine, codeine, and heroin, which are derived from the opium poppy.
Synthetic Opiate-Like Drugs: Include fentanyl, oxycodone, and methadone, synthesized in laboratories.
Patterns of Use: Opioids are used for medical pain relief, recreationally, and are obtained illegally.

Opioid Use Disorder: Effects on the Body

CNS effects: Euphoria, sedation, slowed breathing, respiratory depression, and coma.
GI effects: Constipation, nausea, vomiting, and abdominal pain.
Cardiovascular effects: Decreased heart rate, low blood pressure, and potentially heart failure.
Sexual functioning: Decreased libido and erectile dysfunction.

Opioid Intoxication

Signs and Symptoms:
- Initial euphoria, apathy, and dysphoria.
- Psychomotor agitation or slowing.
- Impaired judgment.
Severe Intoxication: Can lead to respiratory depression, coma, and death.
Duration: Typically lasts for several hours.

Opioid Withdrawals

Symptoms:
- Muscle aches, bone pain, restlessness, and insomnia.
- Diarrhea, nausea, and vomiting.
- Yawning, sneezing, and sweating.
- Runny nose, dilated pupils, and increased tear production.
Duration: Symptoms gradually decrease over 5-7 days and can last for several weeks.

Treatment for Hallucinogens & Cannabinols

Benzodiazepines: Used to manage anxiety, agitation, and seizures.
Antipsychotics: Used to treat psychosis and hallucinations.

Cannabis Use Disorder

Substances: Marijuana and hashish, both derived from the Cannabis sativa plant.
Historical Use: Used therapeutically for nearly 5,000 years.
Current Use: 22.2 million Americans aged 12 years or older are current illicit users of marijuana, representing 8.4% of the population.

Cannabis: Effects on the Body

Cardiovascular: Increased heart rate and blood pressure.
Respiratory: Bronchitis, lung infections, and impaired lung function.
Reproductive: Decreased fertility and reproductive problems.
Sexual Functioning: Decreased libido and erectile dysfunction.
CNS: Euphoria, relaxation, cognitive impairments, anxiety, and paranoia.

Cannabis: Intoxication

Signs and Symptoms:
- Impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia.
Duration: The impairment of motor skills typically lasts for 8-12 hours.

Cannabis Withdrawal

Onset: Symptoms usually start within a week following cessation of use.
Symptoms:
- Irritability, anger, or aggression.
- Nervousness, restlessness, and anxiety.
- Sleep difficulties (insomnia, disturbing dreams).
- Decreased appetite or weight loss.
- Depressed mood.
- Physical symptoms (abdominal pain, tremors, sweating, fever, chills, or headache).

Treatment for Hallucinogens & Cannabinols

Benzodiazepines: Used to manage anxiety, agitation, and seizures.
Antipsychotics: Used to treat psychosis and hallucinations.

Nicotine

CNS Stimulant: Nicotine, found in tobacco products, is considered a stimulant, increasing alertness and arousal.
Duration: Effects typically last for 30 minutes to several hours.

Nicotine: Effects on the Body

Increased Alertness: Boosts mental focus and concentration.
Relaxation: Provides a temporary feeling of relaxation.
Increased Heart Rate: Accelerates heart rate and blood pressure.
Lightheadedness: May cause temporary lightheadedness or dizziness.
Increased Blood Pressure: Elevates blood pressure.
Increased Metabolism: Speeds up metabolism.
Increased Risk of Heart Attack: Contributes to heart attacks and other heart problems.
Reduces Appetite: Suppresses appetite.
Muscle Tremors: Can cause tremors and muscle twitching.
Convulsions: High doses of nicotine can lead to seizures.
Chronic Lung Infections/Diseases: Causes chronic lung infections and diseases, including bronchitis, emphysema, and lung cancer.

Nicotine Withdrawal & Treatment

Withdrawal Symptoms: Agitation, weight gain, anxiety, headaches, and intense cravings.
Treatment Options:
- Patches and Gum: Provide a consistent, controlled dose of nicotine to reduce withdrawal symptoms.
- Bupropion (Zyban): An antidepressant that can help reduce cravings and aid in quitting.
- Varenicline (Chantix): Acts as a partial nicotine agonist, reducing cravings and preventing the pleasurable effects of smoking.

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Description

This quiz focuses on the key components of the nursing process related to outcome criteria and planning for clients with substance use issues. Explore how to assess and implement effective strategies to ensure client safety and promote adaptive coping mechanisms.