General
Characterized by loss of control due to substance use or behavior along with participation that continues despite continued problems and a tendency to relapse back into substance use or behavior
What are substance use and addictive disorders
Slurred speech, pupillary changes, memory impairment, decreased RR and LOC, maladaptive behavior
S/S of opioid intoxication
Slurred speech; nystagmus; impaired memory; altered judgement; decreased motor skills, LOC and RR; possible peripheral collapse and death
S/S of alcohol excess
First line of treatment for alcohol withdrawal. Goals with use are to maintain VS within expected limits, decrease seizure risk and intensity of withdrawal manifestations. Before administering obtain baseline VS, monitor neurologic status and provide seizure precautions
Benzodiazepines (chlordiazepoxide, diazepam, lorazepam)
Fall prevention; seizure precautions; close observation; client orientation to person, place, time; maintenance of nutrition and fluids; low stimulation environment; administering medications as ordered; and monitoring for covert substance use are all important in ensuring this fundamental concept of care
Safety
Defense mechanism most commonly used by clients who have problems with substance use or addictive disorder
denial
Reversal agent/antidote for opioid overdose, can be administered IM, SQ, IV, intranasal
Naloxone HCL
Why are nurses at high risk for substance abuse disorders, including alcohol abuse?
Long hours, high-stress job, trauma,
Competitive benzodiazepine receptor antagonist which can reverse effects of benzodiazepine toxicity. Administered IV
Flumazenil
Initial treatment goal when working with substance use and addictive disorders
abstinence
Age range with highest rate of substance use
18-25yrs
Routes of administration for heroin, morphine, hydromorphone
injected, smoked, inhaled, swallowed
Abdominal cramping; vomiting; tremors; sleep disturbance; increased HR, BP, RR and temperature; hallucination; anxiety; tonic-clonic seizure
S/S of alcohol withdrawal
Medication used as type of aversion therapy. Concurrent use with alcohol causes acetaldehyde syndrome to occur which results in N/V, weakness, sweating, palpitations and hypotension. Symptoms have potential to progress to respiratory depression, cardiovascular suppression, seizure and death
Disulfiram
Self assessment of a nurses own feelings related to substance abuse, which may be impacted by their personal views, culture and history are important in ensuring this type of care is provided
Objective, nonjudgmental nursing care
Substance which attaches to CNS receptors altering perception of and response to pain, leading to generalized CNS depression
Opioid / Opioid agonist
Sweating, rhinorrhea, piloerection, tremors, irritability. Can progress to severe weakness, diarrhea, fever, insomnia, pupil dilation, N/V, pain and muscle spasms
S/S of opioid withdrawal
Cardiovascular damage; liver damage (fatty liver, cirrhosis); erosive gastritis; GI bleeding; acute pancreatitis; sexual dysfunction
S/S of chronic alcohol use
Oral opioid agonist used to prevent abstinence syndrome (withdrawal symptoms) by transferring dependence from illegal opioid to this medication, which must be administered at an approved treatment center. Doses can be slowly tapered to suppress withdrawal
Methadone substitution
Behavior in which a family member acts in an overly responsible manner which allows the dependent individual to continue their substance use or addiction disorder
codependency
Alcohol screening tool used to see if the patient has an alcohol dependency problem
CAGE
Opioid withdrawal includes many unpleasant symptoms but it is thankfully NOT this….
life threatening
Severe alcohol withdrawal S/S. Can occur 2-3 days after cessation of drinking. May include severe disorientation; psychosis; severe HTN; cardiac dysrhythmias. Considered a medical emergency and can progress to death
Delirium Tremens
A patient is administer lorazepam for acute alcohol withdrawal symptoms, which is the PRIORITY nursing assessment
Vitals (HR/BP/RR)
Psychotherapeutic technique that uses relaxation and cognitive reframing to decrease anxiety and change behavior
cognitive behavioral therapy