Author: Thompson, Stacia
Last saved by: Soloth, Michelle
Company: FACSTAFFBASE

Ineffective Coping
•	Definitions
•	Anger:
•	Aggression: 
o	Physical aggression
o	Verbal aggression
•	Passive aggression:
•	Assertiveness: 
•	Manipulation:
•	Aggression
o	Assault
o	Battery
o	Verbally aggressive attacks
Etiology of Aggression
o	Biological based explanation
o	Social-psychological models 
o	Sociocultural models
o	Stress models
Goals
o	Strengthen pt’s control of feelings and impulses
o	Balance- least restrictive care and restrictions of rights to protect pt and others while providing quality care
o	Calm, positive approach
Assault Cycle
o	Triggering phase
o	Escalating phase
o	Crisis phase
o	Recovery phase
o	Post-crisis depression phase

Addictions
Common terms
•	Substance
•	Misuse
•	Abuse
•	Dependence
•	Co-dependence
•	Tolerance
•	Withdrawal (Abstinence syndrome)
•	Addiction
•	Craving
•	Sobriety
•	Detoxification
•	Relapse
The Problem
o	Mood altering substances lead to diverse complications
o	Abuse of AOD 
Risk Factors Associated With Substance Abuse
o	Availability and encouragement
o	Adverse social conditions
o	Environmental or biologic factors
o	Psychological influence
o	Disabilities
o	Developmental influence
o	Cultural influence
Addictive Process
Interaction between:
•	Substance
•	Individual
•	Environment

Assessment Strategies
o	S/S raise suspicion
o	Interview approach
•	How do you get accurate information?
Abused Substances
o	Stimulants
o	Depressants
o	Narcotics
o	Hallucinogens
o	Cannabis
o	Inhalants
DSM-IV Criteria
o	Substance dependence
o	Substance abuse
o	Substance intoxication
o	Substance withdrawal
Alcohol Abuse
o	Why start???
o	Why continue??
o	Blackouts
o	Alcoholic hallucinosis
o	DT’s
o	Wernicke-Korsakoff syndrome
o	Cirrhosis
o	Peripheral neuritis
o	Gastric ulcers (can perforate)
o	Pancreatitis and diabetes
o	Loss of peripheral and night vision
o	Hypertension
o	Impotence

Diagnostic Tools
o	DSM-IV
o	MAST- Michigan alcoholism screening test
o	CAGE questionnaire

Medications to Treat
Alcohol
•	Librium, Valium, Ativan
•	Thiamine
•	Antabuse
•	Naltrexone
Opiods
•	Narcan
•	Methadone
Stimulants
•	Dopamenergics, anticonvulsants, tricyclic antidepressants
Effects on Family
o	Co-dependence
o	Children 
Nursing Management: Assessment
o	Must be alert to cues of substance use/abuse
o	Recognize pt behaviors that influence hx data
o	Be aware of personal feelings and attitudes
Assessment
o	Always inquire about amount/type of use of rx drugs AND AOD
o	May need drug screen tests to get accurate info
Nursing Diagnosis
o	Sensory perceptual alteration
o	Altered thought processes
o	Ineffective individual coping
o	Altered family processes: alcoholism
Goals
o	Abstain from use of addicting substances
o	Cooperate with proposed treatment plan
o	Make appropriate life style adjustments to support abstinence
o	Practice healthy lifestyle behaviors to foster sobriety
Nursing Implementation
o	Health promotion
o	Acute
•	Withdrawal
•	Overdose
•	Intoxication
•	Pain management

Interventions- Milieu Management
o	Drug free environment
o	Suicide prevention
o	No inappropriate sexual behavior
o	Active, meaningful schedule
o	Openness, feedback, no non prescription drugs
o	Limit setting
o	Recognize symptoms of addicted mind
Nursing Implementation
o	Home care
•	Rehab inpatient vs outpatient
•	Requires long-term therapy
•	AA/ NA
•	Anabuse
•	Methadone
•	Relapse and follow up care
o	This workforce solution is funded by the IHUM Consortium which is 100% financed through a $15,000,000 grant from the U.S. Department of Labor’s Employment & Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
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