Alzheimer’s Delirium and Dementia Q 10
A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:
A. Rhinorrhea, convulsions, subnormal temperature
B. Nausea, dilated pupils, constipation
C. Lacrimation, vomiting, drowsiness
D. Muscle aches, papillary constriction, yawning
Correct Answer: D. Muscle aches, papillary constriction, yawning
These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates. According to Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid withdrawal include lacrimation or rhinorrhea, piloerection “goose flesh,” myalgia, diarrhea, nausea/vomiting, pupillary dilation and photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning.
Option A: Opioid withdrawal syndrome is a life-threatening condition resulting from opioid dependence. Opioids are a group of drugs used for the management of severe pain. They are also commonly used as psychoactive substances around the world. Opioids include drugs such as morphine, heroin, oxycontin, codeine, methadone, and hydromorphone hydrochloride. They produce mental relaxation, pain relief, and euphoric feelings.
Option B: The principal site in the brain that triggers the onset of opioid withdrawal syndrome is the locus coeruleus at the base of the brain. Neurons present in locus coeruleus are noradrenergic and have an increased number of opioid receptors. The locus coeruleus region is the main source of NAergic innervation of the limbic system and cerebral and cerebellar cortices. The NAergic activity in locus coeruleus neurons, an opioid receptor linked mechanism, is a prime causative site of opioid withdrawal symptoms. Furthermore, research has also shown that gray matter and nucleus raphe magnus is also involved in the presentation of opioid withdrawal syndrome.
Option C: Sedative-hypnotic withdrawal symptoms may resemble opioid withdrawal characteristics, but opioid withdrawal is also characterized by lacrimation, rhinorrhea, and pupillary dilation. Hallucinogen and stimulant intoxication can also cause pupillary dilation, but other symptoms of opioid withdrawal-like nausea, diarrhea, vomiting, lacrimation, and rhinorrhea are usually not present.