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NR 547 Differential DiagnosisNR547_Week 8 Exam Review Study Guide
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- Chamberlain College Of Nursing
NR 547 Differential Diagnosis
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12/19/23, 6:30 PM NR547 Week 8 Study GuideWeek Eight Exam Review
Substance Abuse and Addiction
· Define addiction, substance use disorder, dependence (both physical and
psychological)-
Addiction- A change in behavior caused by biochemical changes in the brain after continued
substance use characterized by preoccupation with and repeated use of a substance despite of
negative outcomes.
Substance use disorder-Substance use disorders take a significant toll on the
lives of individuals and their families, contributing to poor health outcomes
and high costs. Substance use disorders are complicated and are impacted
by both biological and environmental factors. Neurotransmitters and
neurotransmitter receptors are involved with most substances of abuse
besides alcohol. Specifically, the opioid, catecholamine, and y-aminobutyric
acid neurotransmitters are related to the brain-reward circuitry and the
development of substance use disorders. A correlation between mental
health illness and substance use exists; self-medication theory suggests
substance use is a coping mechanism.
Behavioral, physical, and psychological dependence are the hallmark
symptoms of substance use disorders (SUDs). The direct effects of a
substance on behavioral, physical, and psychological function vary
based on the substance used; however, the overall impact of
substance use disorders on functioning is similar regardless of the
substance used. Behavioral dependence refers to substance-seeking
activities and evidence of use patterns. Physical dependence refers to
the physiologic effects of substance use. Psychological dependence
refers to the continuous or intermittent craving for the substance. A
diagnosis of SUD is indicated when a person exhibits two or more
symptoms within 12 months.
Dependence- State of adaptation produced with repeated administration of certain drugs so
that physical symptoms occur when the drug is discontinued abruptly.
· Define behavioral dependence, psychological dependence, addiction and
physiological dependence
Behavior dependence- Behavioral dependence refers to substance-seeking activities
and evidence of use patterns.
Psychological dependence-Psychological dependence refers to the continuous or
intermittent craving for the substance
Physiological dependence-Physical dependence refers to the physiologic effects
of substance use
· Define substance intoxication, substance use disorder, substance-induced mental
disorder, substance withdrawal.
Substance intoxication- Common symptoms of substance intoxication include disturbances in
perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal
behavior. Acute intoxication may have different symptoms than chronic intoxication. Acute
intoxication should only be used as the main diagnosis when intoxication occurs without a
persistent substance use disorder.
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, 12/19/23, 6:30 PM NR547 Week 8 Study Guide
Substance use disorder- Behavioral, physical, and psychological dependence are the
hallmark symptoms of substance use disorders (SUDs). The direct effects of a
substance on behavioral, physical, and psychological function vary based on the
substance used; however, the overall impact of substance use disorders on
functioning is similar regardless of the substance used
Substance induced mental disorder- Substance-induced mental disorders are
potentially severe central nervous system syndromes that develop because of
substance abuse, medications, or toxins. Substance-induced mental disorders are
diagnosed when the following criteria are met:
the symptoms represent a mental disorder presentation
there is evidence that the substance used is capable of causing the disorder
and that the disorder developed within a month of using the substance
there is evidence that the disorder is not likely explained better by the
diagnosis of an independent mental condition
the disorder does not occur exclusively during delirium
the disorder causes significant social, occupational, or other impairment in
functioning
Substance withdrawal- General features of substance withdrawal include the
development of a substance-specific behavioral change, with physical and psychological
symptoms, that is due to the cessation or intake reduction of a substance. Withdrawal is usually,
but not always, associated with a substance use disorder.
· Review scoring and use of substance abuse screening tools
o SBIRT-Screening, brief intervention, and referral to treatment (SBIRT) -
comprehensive and integrated public health approach to identify individuals with
substance use disorders and those at risk of developing these disorders so early
intervention and treatment services can be offered to prevent severe
consequences.
SBIRT can be executed in primary care settings, emergency departments, trauma
centers, and other community settings. SBIRT is a model effective for all types of
substance abuse disorders.
Screening-Quickly assesses the severity of substance use and identifies the
appropriate level of treatment.
Brief intervention -Focuses on increasing insight and awareness regarding
substance use and motivation toward behavioral change.
Referral -Guidance to treatment provides those identified as needing more
extensive treatment with access to specialty care.
o CIWA-Ar- Clinical Institute Withdrawal Assessment-Alcohol is a highly
regarded standardized instrument used to assess the severity of withdrawal
symptoms (as shown below) and directs pharmacotherapy.
Step 1: Administer CIWA-Ar - Administer every 4-8 hours until the score is
lower than 8-10 for 24 hours.
Step 2: Symptom-Triggered Regimen-If the CIWA-Ar score is 8 or higher,
administer benzodiazepine: PO lorazepam (Ativan), diazepam (Valium), or
chlordiazepoxide (Librium) for symptom-triggered therapy.
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