Chapter 63: Addictions

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Welcome to the Deep Dive.

Today we're tackling a really important area, addictions.

We've got a wealth of information here, specifically drawing from, you know, a comprehensive review for the NCLE -XPN exam.

That's right, the nursing exam review.

So think of this as your direct route, kind of a shortcut, to understanding the essential nursing knowledge surrounding addictions.

You're seeing its stick.

Exactly.

Our aim is just to make this, well, sometimes complex topic clear and really memorable for you.

And we know you're looking to get this knowledge efficiently but thoroughly.

So this Deep Dive, it's designed for that.

We'll be getting into everything from, say, eating disorders to the big challenges of substance use and withdrawal.

Yeah, the whole spectrum.

Our goal is really to pull out those crucial nursing insights from this specific material, make them clear, make them relevant for you.

Okay, let's start then.

Let's unpack eating disorders first.

The source material introduces these as conditions marked by, well, an unstable sense of self and some severely disrupted eating patterns.

And what's interesting right off the bat is compulsive overeating.

This isn't just eating a lot.

It's characterized by these binge -like episodes.

But without the purging behaviors you might see elsewhere.

There's often a feeling of being out of control during the eating itself.

And these episodes, they tend to follow a pretty stereotyped pattern.

And it's not really driven by pleasure in the typical sense, is it?

The source flags that individuals often feel, well, a sense of revulsion towards eating, even though it might temporarily

Exactly.

No real pleasure derived from it.

They're usually aware that their eating is abnormal.

And this awareness often leads to feelings of depression afterwards.

You often see secret consumption, especially of high calorie, easily digestible foods during these binges.

And this is often paired with repeated but unsuccessful attempts at dieting.

There's this pervasive sense of helplessness and hopelessness about their weight.

And the eating itself becomes a response to negative feelings.

Precisely.

It's often a response to things like guilt, anger, depression, boredom, loneliness, feeling inadequate, even ambivalence.

It really becomes a maladaptive coping mechanism.

Okay, so that's compulsive overeating.

And let's turn to anorexia nervosa.

Our material suggests its onset is often linked to stressful life events.

And at its core is this intense fear of obesity, of gaining weight.

But it's more than just fear, isn't it?

Absolutely.

The source really emphasizes a distorted perception of their own body, a fundamentally disturbed self -concept.

There's often a preoccupation with specific foods they think prevent weight gain, and almost a phobia of foods associated with gaining weight.

And it's crucial to stress this is life -threatening condition.

Extremely.

The risks are severe.

Death from starvation, suicide, cardiomyopathy, which is a weakening of the heart muscle, or serious electrolyte imbalances, those essential minerals your body needs.

The data points, the things nurses look for with anorexia are really telling.

It's not just appetite loss and refusal to eat.

No, sometimes it's even denying they feel hungry at all.

Right.

And feelings of lacking control, often alongside compulsive exercising.

And the source notes these tendencies towards being like an overachiever, a perfectionist.

And the physical impact.

Oh, it's significant.

The material details things like decreased body temperature, pulse and blood pressure, obvious weight loss,

gastrointestinal issues like constipation, problems with teeth and gums, esophageal varices, those are enlarged veins in the esophagus, often from vomiting.

Right.

Then you have electrolyte imbalances, dry, scaly skin, maybe lanugo that find downy hair, sleep disturbances are common,

hormone deficiencies, amenorrhea that's missing periods for three months or more.

Wow.

And in severe cases, even cyanosis, like a bluish tint to the skin, especially hands and feet, numbness and bone degeneration.

It really affects the whole body.

Okay, let's move to bulimia nervosa then.

Here, the key feature is that cycle,

eating binges followed by purging behaviors to prevent weight gain.

Exactly.

And interestingly, the source mentions that many individuals with bulimia actually maintain a weight within the normal range.

Oh, that's interesting.

Yeah.

But despite the normal weight, they feel completely controlled by this conflict around eating.

So what stands out in the data collection for bulimia?

Well, the element of secrecy and that intense internal struggle, a strong preoccupation with body shape and weight,

secret eating of high calorie foods, usually followed by intense guilt.

The binge purge syndrome.

That's the defining characteristic.

They might try all sorts of things to lose weight, dieting, vomiting,

using enemas or cathartics, which are strong laxatives, even misusing amphetamines or diuretics.

But underlying at all.

Is often this need for control battling against these overwhelming feelings of powerlessness or lack of control.

The data also points to low self -esteem difficulties in relationships.

Yes, maybe decreased or absent interest in sex, mood swings.

And again, those electrolyte imbalances we saw with anorexia.

And the physical changes can be similar to.

They can be.

Yes.

Our source indicates quite a bit of overlap in the potential physical complications.

Okay.

So regardless of the specific eating disorder, anorexia, bulimia, compulsive overeating,

what are the core nursing interventions?

Well, the absolute first step is a thorough assessment.

You need to gauge their nutritional status and the severity of any immediate medical problems.

Right.

Safety first.

Always.

Then building that therapeutic relationship.

A strong, trusting one -to -one connection is vital and you have to be prepared for reluctance, for resistance to treatment.

Makes sense.

What about planning?

Creating a structured daily nutritional plan is key.

Working with the individual to pinpoint the specific triggers for their disordered eating behaviors is also crucial.

And encouraging them to talk about it.

Essential.

Encouraging expression of feelings about the eating, about their body image.

And throughout all this, the healthcare team needs to maintain an accepting, non -judgmental attitude.

That's critical.

It really is.

Therapy should also explore their self -concept, help them build a healthier sense of identity.

Behavior modification techniques often play a big role too.

What about in a hospital setting?

If they're inpatient,

supervising meals, and the time immediately after meals is usually necessary.

You're monitoring intake, output,

sometimes setting time limits for meals, trying to create a pleasant, calm eating environment.

And constantly watching for physical issues.

Continuously monitoring for physical complications.

Regular weighing, you know, same time, same scale, same clothes after voiding can be helpful for some, maybe even reduce anxiety for certain individuals.

Consistency.

And correcting fluid and electrolyte imbalances is a top medical priority.

Monitoring elimination patterns like bowel movements is important too.

What about activity?

You need to assess their activity level and sometimes limit it, especially if it's compulsive exercise.

Encouraging diversional activities, things they might enjoy that aren't focused on food or body can be helpful.

And safety again.

Always assessing suicidal potential, that's paramount.

Antidepressants might be prescribed.

And psychotherapy, along with referrals to support groups, are really cornerstones for long -term recovery.

Okay, the source includes several review questions here.

Let's touch on those.

Question 6 INS kicks.

A client with anorexia doing vigorous push -ups.

What's the action?

The appropriate action is to interrupt the excessive exercise, but redirect it.

Suggesting a walk instead acknowledges the need for some movement, but sets limits.

Got it.

Question 698 about a care plan for bulimia.

What would be an incorrect element that needs intervention?

The plan mentions monitoring for excessive exercise.

While activity is a concern, excessive compulsive exercise is much more characteristic of anorexia, not typically the primary issue in bulimia in the same way.

So that part of the plan would need questioning.

Makes sense.

Question 703.

A client with anorexia needs a roommate.

Who's the best fit?

Someone stable, perhaps undergoing diagnostic tests.

You'd want to avoid someone with an infection, obviously, but also someone who might be overly controlling or demanding, which could be detrimental.

Okay, question 706.

Anorexia client gets clothes, perceives them as tight, and immediately restricts calories further.

What does this show?

This clearly demonstrates the client's distorted body image and disturbed self -perception.

That reaction is a classic sign.

Alright, let's shift gears now to substance -related and addictive disorders.

Our source describes these as causing cognitive, behavioral, and physiological changes.

It mentions Box 63 -1, the CAGE test.

Right, we'll get to CAGE.

But first, substance use disorder itself.

It's defined as that repeated pattern leading to tolerance.

Needing more for the same effect.

Exactly.

And withdrawal symptoms when they stop or cut down, and that compulsive drive to keep using the drug despite negative consequences.

People often end up using more or for longer than they meant to.

Very common.

And they often have unsuccessful attempts to cut down or quit.

Daily life can really start to revolve around obtaining and using the substance.

You mentioned screening tools.

CAGE.

Yes.

Besides MAST and DAST, CAGE is a quick one.

C -A -G -E.

Have you ever felt you should cut down?

Have people annoyed you by criticizing your drinking drug use?

Have you ever felt guilty about it?

Have you ever needed an eye -opener first thing in the morning?

Simple but powerful questions.

They can be very revealing.

We already touched on tolerance needing increased amounts.

Substance abuse is a bit different in definition.

How so?

It refers more specifically to recurrent use where there are significant harmful consequences.

Often there's involvement with the legal system.

And substance withdrawal.

That's the set of physiological and cognitive symptoms specific to the substance that occur when blood levels drop after someone has developed physiological dependence.

Our source also mentioned some other contributing factors.

Like adolescent rebellion, peer pressure.

Yes, those can play a role.

Also using substances to cope with physical or emotional pain.

There's often a strong link with depression, either pre -existing or resulting from the substance use.

Grief and loss, too.

Absolutely.

Substance use can become a way to numb or avoid difficult emotions associated with loss.

The text lists several dysfunctional behaviors often seen.

Preoccupation with the substance.

Definitely.

A strong focus on getting and using it.

An intense uncontrolled craving, physical, mental, emotional.

Manipulate.

Often used to avoid consequences.

Impulsiveness, anger, sometimes verbal or physical abuse.

Avoiding relationships or having troubled ones.

The sense of self -importance.

Yeah, needing special treatment.

Denial is huge.

Blaming others for their problems.

Rationalization, projection, justifying their behavior.

And underlying it all.

Often low self -esteem, depression,

and then there's codependency.

Right, enabling behaviors.

Exactly.

Behaviors by loved ones that inadvertently allow the addiction to continue without the person facing the full consequences.

Like paying their bills, bailing them out, calling in sick for them.

And addressing that is key for recovery.

Crucial.

For the whole family system, not just the individual with the addiction.

Okay, let's zero in on alcohol abuse now.

The source calls it a CNS depressant affecting all body tissues.

It distinguishes physical versus psychological dependence.

Right.

Physical dependence is that biological need to avoid withdrawal symptoms.

Psychological dependence is the craving, the desire for the subjective effects of alcohol.

What about risk factors for alcohol abuse?

Several are mentioned.

A biological predisposition, cultural, genetic, familial links.

Certain characteristics like being prone to depression, high anxiety, low self -esteem, poor self -control.

History of rebelliousness.

Yes.

Poor school performance delinquency.

And strained parental relationships are also noted as potential risk factors.

When collecting data, what are the signs nurses look for?

Physical signs like slurred speech, poor coordination, unsteady gait, restlessness, confusion.

Behavioral signs.

Things like sneaking drinks, drinking in the morning, experiencing blackouts, binge drinking, frequent arguments about drinking, missing work, increased tolerance is a big one.

And blood alcohol content.

Intoxication is generally legally defined at or above 0 .08 % in many places, though the source mentions 0 .1 % as a threshold for data collection too.

The key is getting details.

Type of alcohol, amount, frequency, and when the last drink was consumed.

What about psychological symptoms?

You might see depression, irritability, belligerence, hostility, suspiciousness, lots of rationalization, social isolation, lowered inhibitions, lower self -esteem, and often strong denial of having a problem.

And the long -term complications of chronic use are serious.

Very serious.

Vitamin deficiencies, especially B1, thiamine.

This can lead to peripheral neuropathies, nerve damage, and Korsakoff's syndrome, which involves significant memory loss, amnesia.

Vortices encephalopathy too.

Yes, another severe brain disorder from thiamine deficiency causing confusion, ataxia, that lack of coordination and abnormal eye movement.

And damage to other organs.

Absolutely.

Hepatitis, cirrhosis of the liver, esophagitis, gastritis, pancreatitis, anemia, weakened immune system, brain damage beyond Wernicke -Korsakoff, more peripheral neuropathy, and various cardiac disorders.

It's systemic.

Okay, let's talk about alcohol withdrawal.

When does it start?

Early signs usually pop up within a few hours after stopping or significantly reducing intake.

They typically peak around 48 hours, then start to subside, unless it progresses to withdrawal of delirium.

And there are specific signs to watch for early on, box 63 -2.

Right, that box lists things like anorexia, loss of appetite, nausea, vomiting, anxiety, being easily startled,

hyper alertness, hypertension, high blood pressure, insomnia, irritability, jerky movements.

Hallucinations.

Possibly hallucinations, illusions, or nightmares.

That feeling of shaking inside.

Seizures are a major risk, especially between 7 and 48 hours after the last drink.

Tachycardia, rapid heart rate, and tremors are also common.

Medications might be used.

Yes.

Benzodiazepines are often prescribed because they have cross tolerance with alcohol, helping manage the withdrawal safely.

And thiamine, vitamin B1, usually given intramuscularly first, then orally, is crucial to prevent Mernichese encephalopathy.

What about withdrawal delirium?

That sounds more severe.

It is, often called DTs, delirium tremens.

It typically peaks 48 to 72 hours after cessation, but can occur later and last maybe 2 to 3 days.

And the signs, box 63 -3.

That box lists agitation, anorexia, anxiety, delirium itself, confusion, disorientation, diaphoresis, heavy sweating,

disorientation with fluctuating consciousness,

fever, often 100 to 103 degrees F -free, vivid hallucinations and delusions, severe insomnia, tachycardia, and hypertension.

And this is a medical emergency.

Absolutely.

Our source stresses it's potentially failed due to complications like heart attack, MI, fat emboli, vascular collapse, severe electrolyte imbalance, aspiration pneumonia, or even suicide.

So interventions for withdrawal focus heavily on safety and monitoring.

Definitely.

Non -judgmental care, frequent checks, vital signs, neuroscience, maybe every 15 minutes if needed, often requires one -to -one supervision.

Environment matters.

Yes.

A quiet, non -stimulating environment.

Encouraging maybe one familiar family member to stay can help reduce anxiety.

Frequent reorientation is key.

Explaining treatments simply, calmly.

Seizure precautions.

Essential.

Initiating seizure precautions.

Assisting with prescribed sedating or anticonvulsant medication.

Nutrition and hydration.

Offer small, frequent, high -carbohydrate foods.

Maybe an anti -medic before meals if nausea is bad.

Monitor intake and output closely.

Assist with those prescribed vitamins, multivitamin, B -complex, including thiamine, vitamin C.

Helping with basic needs.

Assisting with ADLs, activities of daily living.

And walking if they're stable.

And importantly, allowing them space to express their fears.

Okay, after they've stopped drinking,

what medications might help maintain sobriety?

Nultrexone is one that helps block that high feeling if they were to drink.

Acamprosate helps reduce the physical and emotional discomfort of quitting.

And then there's Dysulphuram.

Dysulphuram.

That's the one that causes a reaction.

Exactly.

It causes a severe adverse reaction if any alcohol is consumed.

They must abstain from alcohol for at least 12 hours before the first dose.

What does the reaction look like?

It can start within minutes to half an hour of drinking alcohol.

Facial flushing, sweating, a throbbing headache, neck pain, nausea, vomiting, hypotension, low blood pressure, tachycardia, and even respiratory distress.

It can last 30 minutes to two hours.

And they need to avoid alcohol even after stopping the drug.

Yes, for up to 14 days after the last dose because the risk of reaction persists.

Client agitation is absolutely critical here.

They need to understand the effects, agree to abstain fully.

Including hidden alcohol?

Definitely.

Things like cough medicines, rubbing alcohol, vinegar, some mouth washes, aftershaves.

They have to be incredibly careful.

The source mentions boxes 63 -34 and 63 -5 about dealing with clients and family therapy.

Key takeaways.

Keep the focus on the alcohol problem itself.

Help them identify anger triggers.

Set firm limits on manipulation or abuse.

Be consistent with rules and consequences.

Hold them accountable.

Focus on strengths too.

Yeah, explore strengths and weaknesses, but focus on strengths.

Encourage group therapy.

Support groups like AA for the individual and Al -Anon or Alatine for family members.

Let's look at the review questions for alcohol.

Question 697, interventions during withdrawal.

Monitoring vitals closely, ensuring safety, addressing hallucinations therapeutically, providing reality orientation.

All are appropriate.

Question 699, signs of withdrawal delirium to monitor for.

Hypertension, disorientation, and hallucinations are key signs listed.

Question 700, spouse of someone in withdrawal wants to leave.

Best initial response.

An open -ended question like,

what do you find difficult about this situation?

It invites the spouse to share their feelings and concerns without judgment.

Question 702, recommended community support group.

Alcoholics Anonymous, AA.

Question 704, when do first withdrawal signs typically appear?

Within a few hours after cessation.

Question 705, a statement from a wife indicating benefit from Al -Anon.

A statement like, I no longer feel that I deserve the beatings my husband inflicts on me.

This shows a shift away from self -blame and codependency, recognizing the abuse isn't her fault.

Question 707, client wants to leave against medical advice.

AMA, initial action.

Notify the nursing supervisor immediately.

Okay, now let's broaden out to other drug dependencies.

Starting with CNS depressants, besides alcohol.

This includes benzodiazepines and barbiturates.

Right.

Intoxication signs are similar to alcohol.

Drowsiness, hypotension, poor coordination, unsteady gait, slurred speech,

memory issues, maybe irritability.

Overdose.

Very dangerous.

Cardiovascular and respiratory depression.

Coma, shock, seizures, potentially death.

Treatment depends on consciousness.

If awake, maybe induced vomiting, give activated charcoal.

If comatose, airway management is priority, gastric lavage with charcoal, seizure precautions.

Is there an antidote for benzodiazepines?

Yes, flumazenil can be used specifically for benzodiazepine overdose reversal.

And withdrawal from these depressants.

Can cause nausea, vomiting, tachycardia, sweating, irritability, tremors, insomnia, and importantly, seizures.

Abrupt withdrawal can be fatal, so it needs careful management, often titrating a similar drug slowly downwards.

Okay, moving to CNS stimulants.

Amphetamines, cocaine, crack, intoxication signs, box 63 -6.

Yeah, that box lists things like dilated pupils, euphoria, hypertension, potential for violence, tachycardia.

Stimulant overdose.

Also very dangerous.

Respiratory distress, ataxia, incoordination, hyperpyrexia, high fever, seizures, coma, stroke, heart attack, MI, death.

Treatment might involve antipsychotics for agitation psychosis and managing the associated physical effects.

And withdrawal from stimulus.

Often called a crash.

Fatigue, depression, agitation, apathy, anxiety, insomnia, or hypersomnia,

disorientation, lethargy, intense cravings.

Treatment is mainly supportive, especially watching for severe depression and suicidal thoughts.

Antidepressants or dopamine agonists like brahmacryptine might be used.

Next category, opioids.

Heroin, morphine, codeine, methadone, fentanyl, etc.

Intoxication, box 63 -7.

Key signs include constricted pupils, pinpoint pupils, decreased respirations, drowsiness, euphoria, hypotension, impaired memory attention judgment, psychomotor retardation, slowed movement, slurred speech.

Opioid overdose.

The biggest danger is respiratory depression leading to coma, shock, seizures, death.

Treatment is immediate administration of an opioid antagonist, naloxone, Narcan.

And opioid withdrawal.

It's very unpleasant but usually not life -threatening like alcohol or barbiturate withdrawal.

Symptoms include yawning, insomnia, irritability, rhinorrhea, runny nose, dipheresis, sweating, cramps, nausea, vomiting, muscle aches, chills, fever, lacrimation, tearing, diarrhea.

Treatment for opioid withdrawal.

Can involve methadone detoxification or tapering with another opioid?

Clonidine might help with some autonomic symptoms.

Other medications target specific symptoms like nausea or diarrhea.

Hallucinogens now, like LSD, PCP, intoxication effects, box 63 -8.

It can be unpredictable.

Agitation, belligerence, anxiety, depression, bizarre or violent behavior, blank stare, sweating, dilated pupils, elevated vital signs, hallucinations obviously, impaired judgment, incoordination, muscle rigidity, paranoia, seizures, tachycardia, tremor,

psychosis, potential brain damage, hypertensive crisis, hypothermia, seizures, respiratory arrest.

Treatment involved creating a low stimulation environment, calm communication, maybe anti -anxiety meds.

Gastric lavage might be considered for some overdoses soon after ingestion.

What about withdrawal from hallucinogens?

There isn't a typical physiological withdrawal syndrome like with opioids or alcohol.

Management is primarily supportive.

Medications might target specific behaviors like agitation.

One unique thing is flashbacks.

Re -experiencing the effects later.

Exactly.

Unexpectedly.

Long after use.

Safety is the priority during those episodes.

Inhalance glue, paint thinner, nitrous oxide, intoxication, box 63 -9.

Can cause enhanced sexual pleasure initially, euphoria, excitation, then drowsiness,

lightheadedness, disinhibition, agitation, maybe giggling or laughter.

What are those concerns?

Significant risk of nervous system damage and death.

Withdrawal.

Mainly supportive care, treating whatever body systems are affected.

Marijuana or cannabis.

Smoked or ingested.

Effects include euphoria, detachment, relaxation, talkativeness, slowed perception of time, but also anxiety and paranoia in some.

Long -term issues.

Long -term dependence can lead to lethargy, difficulty concentrating, memory problems, and potentially chronic respiratory issues if smoked heavily.

Withdrawal is generally mild, supportive care is usually sufficient.

And other recreational or club drugs.

This is a broad category of often illegal street drugs.

Nurses need awareness of their effects, signs of use, and immediate treatment.

They often cause euphoria, increased energy, confidence, sociability,

serious risks.

Hyperthermia, rhabdomyolysis, muscle breakdown, kidney failure, liver damage, depression, panic attacks, psychosis, cardiovascular collapse, death.

Addiction programs also often address nicotine withdrawal using patches, inhalers, and anabolic steroid use is linked to many adverse events, including death.

So general interventions for withdrawal across substances.

Box 6310 provides a summary.

Yes, it reinforces key principles.

Seizure precautions if relevant.

Hydration, monitoring INO.

Anticipating and managing anxiety, often with prescribed meds like lorazepam or diazepam.

Maintaining that accepting, non -judgmental approach.

Directly focusing on the substance abuse problem.

Helping identify anger triggers and find healthy coping ways.

Setting limits.

Limiting blame and rationalization.

Teaching assertiveness instead of manipulation.

Setting firm, reasonable limits on manipulative or abusive behavior.

Consistency with rules and consequences is vital.

Accountability.

Holding them accountable for their behaviors.

Exploring strengths and weaknesses.

Focusing on strengths when they feel out of control.

Encouraging participation in unit activities, group therapy, and support groups.

Lastly, the source tackles addiction and abuse among healthcare professionals.

A sensitive topic.

Very.

It flags suspicious signs.

Frequent reports of unwitnessed drug wastage.

Administering maximum controlled substance doses more often than peers.

Changes in patient pain relief without order changes.

Work patterns too.

Volunteering for keys.

Choosing less supervised shifts.

Favoring areas with high controlled substance use like critical care, OR, anesthesia, trauma.

There's a professional and ethical duty to report suspected impairment.

Is recovery possible for impaired nurses?

Absolutely.

Most can return to work safely through State Board of Nursing Assistance and Monitoring Programs.

These involve strict rules, regular reports, and drug screening.

Okay, final review questions.

Question 701.

Asking about drug abuse.

A non -judgmental, direct question is best.

Like,

how much do you use and what effect does it have on you?

Question 709.

Manifestations specific to opioid withdrawal.

Key ones listed include yawning, irritability, diaphoresis, sweating, muscle cramps, and diarrhea.

And, well, I think that brings us through the entire chapter's worth of material.

We've covered the landscape of addictions as presented in the Songers Comprehensive Review for the NCLE -XPN Examination, Seventh Edition.

Yes, quite comprehensively.

From eating disorders, through substance use definitions, focusing heavily on alcohol abuse and withdrawal.

Right, and then detailing CNS depressants, stimulants, opioids, hallucinogens, inhalants, marijuana, club drugs, and finally the issue within the healthcare profession itself.

Plus, all the related nursing interventions and review questions.

So we've really unpacked the critical nursing concepts, the assessment guidelines, safety protocols, priority actions, and defined key terms all directly from that source.

Hopefully this gives you a solid, applicable foundation.

Absolutely.

A complete overview to build upon.