1. Timby/Smith: Introductory Medical-Surgical Nursing, 11/e
Chapter 71: Caring for Clients With Chemical Dependence

2. Substance Abuse and Chemical Dependence
Substance abuse: using meds for different reasons than accepted purpose
Withdrawal: physical symptoms; craving for drugs when stopped
Chemical dependence: need of drug to avoid withdrawal symptoms
Addiction: drug-seeking behaviors; interference with life, relations, and work
Tolerance: reduction in drug’s effect via persistent use; demands increased dosage

3. Question Is the following statement true or false?
Substance abuse will produce a tolerance to the drug ingested.

4. Answer
True
Rationale: Substance abuse will produce a tolerance to the drug ingested. Persistent use of a drug will produce a decrease in its effects, demanding a larger dose to produce the same euphoria.

5. Substance Abuse and Chemical Dependence—(cont.)
Pathophysiology and Etiology: chemical dependence: complex; psychobiologic factors
Substance abuse: experimentation, habituation, addiction, and dependence
Factors: self-reinforcing pleasurable effects
Effects of stimulant and depressant drugs
Psychosocial dynamics: influence on family members; peers
Alcohol promotion; coping with stressors

6. Other Abused Substances
Hallucinogens, amphetamines, marijuana, barbiturates, tranquilizers
Signs and symptoms: similar to other substances
Experimental use: until dependence and addiction occur
Consequence: increased defensive mechanisms; disturbances in mood
Treatment: withdrawal, abstinence, enrollment in support group

7. Chemical Dependence Treatment
Treatment: difficult to initiate treatment as clients deny addiction, rationalize substance use, blame life situations
Treatment, withdrawal managed: coping with stressors; relationships
Chemical detoxification
Treatment plan: abstinence, counseling, support of peers, 12-step program

8. Question Is the following statement true or false?
It is easy to receive treatment for substance addiction.

9. Answer
False
Rationale: Although there may be many opportunities for treatment, it is difficult for someone to admit his or her addiction and take personal responsibility in the situation, which is the most important step toward successful treatment.

10. Alcohol Dependence
Chronic, progressive, multisystem disease: uncontrolled consumption
Unchecked—fatal; medical consequences
Women: health problems earlier than in men
Pathophysiology and Etiology: unknown
Theories: genetic factor; altered metabolism; neurotransmitter connection

11. Alcohol Dependence—(cont.)
Assessment Findings: Signs and Symptoms
Deny problem drinking; increasing consumption; alcohol tolerance; cross-tolerance for drugs; alcoholic behaviors
Acute intoxication; hospitalization
Withdrawal: nervous system stimulation
Complications: impaired memory, CVA, metabolic deficiencies, cardiomyopathy, neurologic disorders, fetal alcohol syndrome
Diagnostic Findings: blood alcohol level: extent of alcohol toxicity; elevated liver and pancreatic enzymes reflect alcohol-induced liver disease

12. Alcohol Dependence—(cont.)
Medical Management and Rehabilitation
Detoxification: withdrawal without detox—fatal
Nutritional therapy
Psychotherapy: helps clients gain greater insight into emotional problems; family therapy
Drug therapy: aversion therapy—Antabuse
Support groups: Alcoholics Anonymous (first 12- step self-help program), includes family
Emphasis: personal accountability, spirituality, powerlessness over alcohol
Nursing Management

13. Question Is the following statement true or false?
In treating alcohol dependence, it is vitally important to undergo detoxification during withdrawal.

14. Answer
True
Rationale: In treating alcohol dependence, it is vitally important to undergo detoxification during withdrawal as death may result by omitting detoxification.
Additionally, it is also important to include nutritional, medication, and psychological therapies (including support groups) to foster successful rehabilitation.

15. Nicotine Dependence
Nicotine: stimulant drug in tobacco; addictive, mood- altering substance
Absorption: inhalation; mucous membranes of the mouth
Effects:  carbon monoxide blood levels; gastric ulcers; peripheral blood vessel constriction; overstretched, inelastic alveoli
Consequences: smoking: 90% lung CA, COPD deaths; coronary artery disease; peripheral vascular disease; low- birth-weight babies
Environmental tobacco smoke effects

16. Nicotine Dependence—(cont.)
Medical Management: cessation recommendation with minimal approach; relapse common
Brief counseling, follow-up
Intense measures: behavior modification programs
Pharmacologic therapy: nicotine substitutes; avoid withdrawal symptoms
Nursing Management

17. Cocaine and Methamphetamine Dependence
Central nervous system (CNS) stimulants: produce extreme pleasure, euphoria, stimulation
Cocaine forms: powder; dissolved; injected
Crack: purified form of cocaine; mixed with tobacco, marijuana; freebased
Methamphetamine: combining OTC meds, chemicals; smoked or IV injection
Intense physical experience; rapid metabolism; cravings recur after abstinence
Risk of toxic effects; overdose reactions

18. Cocaine and Methamphetamine Dependence—(cont.)
Assessment Findings: Signs and Symptoms
Brief effect, rapid metabolism
Signs correlate: route of administration; consequence of chronic use
Snorting: ulceration of nasal mucosa, perforation of nasal septum
Injection: needle marks
Smoke, freebase: burns, chronic cough; pulmonary congestion
Polydrug abuse: offset agitation and irritability

19. Cocaine and Methamphetamine Dependence—(cont.)
Complications: long-term abusers
Anorexia; memory impairment; weight loss, behavioral changes, paranoia, and hallucinations
HTN, seizures, cerebral hemorrhage, MI, respiratory arrest, cocaine bugs; mothers using cocaine: withdrawal symptoms in newborns
Methamphetamine added risks: contracting HIV, hepatitis B
Diagnostic Findings: blood, urine toxicology tests; stimulant abuse

20. Cocaine and Methamphetamine Dependence—(cont.)
Medical Management and Rehabilitation
Referral to Cocaine Anonymous; group psychotherapy
Medications: increase, mimic effects of dopamine; antidepressants: relieve dysphoria; amino acid precursors
Cocaine toxicity: immediate treatment
Nursing Management

21. Opiate Dependence
Opioid: synthetic narcotics; sedation after initial euphoria
Rate of tolerance and chemical dependency: drug, dose, and frequency of use
Assessment Findings: Signs and Symptoms
Pinpoint pupils, constipation, respiratory depression; neonates: symptomatic
Chronic use: anorexia, constipation, malnutrition, needle marks, and scarring
Diagnostic Findings: urine drug screen
Antidote: Narcan

22. Opiate Dependence—(cont.)
Medical Management and Rehabilitation
Withdrawal medications: clonidine; methadone
Heroin addiction: methadone maintenance therapy
Role of opiate antagonists in addiction
Psychotherapy; Narcotics Anonymous
Nursing Management