Substance Sleuth
A client has pinpoint pupils, decreased level of consciousness, and a respiratory rate of 6/min. This substance class is the most likely cause.
What are opioids?
Tremors, anxiety, insomnia, and nausea may be early manifestations of withdrawal from this substance.
What is alcohol?
Needing progressively larger amounts of a substance to obtain the same effect describes this physiologic phenomenon.
What is tolerance?
This type of care focuses on symptom relief and quality of life and can be provided while a client continues disease-directed treatment.
What is palliative care?
When an actively dying client stops requesting food, nursing care should emphasize this rather than forcing nutritional intake.
What is comfort?
A client says, “I know I'm dying, but I wish I could have just one more Christmas with my family.” This statement is most consistent with this grief response.
What is bargaining?
A client who has used a stimulant has severe restlessness, tachycardia, hypertension, and paranoia. The nurse should decrease this in the client's environment.
What is environmental stimulation?
Yawning, rhinorrhea, muscle aches, abdominal cramping, and diarrhea are characteristic of withdrawal from this drug class.
What are opioids?
Calling an employer with excuses every time a family member misses work because of substance use is an example of this behavior.
What is enabling?
This type of end-of-life care is generally appropriate when a terminal illness is expected to result in death within approximately six months if it follows its usual course.
What is hospice care?
Moist swabs, gentle mouth cleansing, and lip moisturizer help manage this common problem in a client who is no longer drinking.
What is dry mouth/oral dryness?
Grief that begins before an expected death or other significant loss occurs is called this.
What is anticipatory grief?
After taking a hallucinogen, a frightened client reports that objects in the room are changing shape. The nurse should use this type of approach rather than arguing about the client's perceptions.
What is calm reassurance/reality-based therapeutic communication?
The medication class most commonly used to control CNS hyperexcitability and prevent complications during acute alcohol withdrawal.
What are benzodiazepines?
This medication used in opioid use disorder can decrease cravings and prevent withdrawal while supporting long-term recovery.
What is methadone?
A living will and designation of a healthcare power of attorney are examples of these documents.
What are advance directives?
This opioid may be administered at end of life to decrease air hunger even when the client does not report pain.
What is morphine?
When assessing spirituality, the nurse should begin with an open-ended question about what gives the client's life this.
What are meaning and purpose?
Confusion, impaired coordination, abnormal eye movements, and memory problems in a person with chronic alcohol use should make the nurse suspect a deficiency of this vitamin.
What is thiamine (vitamin B1)?
Severe confusion, hallucinations, autonomic hyperactivity, and agitation developing after alcohol cessation indicate this potentially fatal withdrawal complication.
What is alcohol withdrawal delirium/delirium tremens (DTs)?
A client taking this medication must avoid alcoholic beverages as well as hidden alcohol in products such as mouthwash, cough preparations, and some foods.
What is disulfiram?
A competent client decides that a previously established DNR no longer reflects their wishes. The nurse recognizes the client has this right.
What is the right to revoke/change the DNR or advance directive?
A dying client develops noisy upper-airway secretions. Turning the client onto the side and administering an anticholinergic medication are intended to manage this common end-of-life symptom.
What are terminal respiratory secretions/the “death rattle”?
A spouse says, “I don't know what I'm going to do when she's gone.” Rather than giving advice or false reassurance, the nurse should first do this.
What is acknowledge/validate the spouse's feelings and encourage expression?
A client arrives after consuming large amounts of a CNS stimulant found legally in coffee, tea, sodas, and many energy drinks. Palpitations and severe restlessness may indicate intoxication with this substance.
What is caffeine?
A hospitalized client undergoing alcohol withdrawal suddenly becomes extremely restless and disoriented. The nurse should institute this safety intervention because of a potentially life-threatening neurologic complication.
What are seizure precautions?
Before caring for a client with a substance use disorder, the nurse should examine these internal beliefs because they can interfere with development of a therapeutic relationship.
What are personal biases, attitudes, or judgments?
A client lacks decision-making capacity, but a valid advance directive clearly describes the client's treatment preferences. When family members disagree, this should guide the healthcare team's decisions.
What are the client's documented wishes/advance directive?
Family members are concerned because an unresponsive dying client no longer speaks to them. The nurse encourages them to continue speaking calmly because this sense may remain intact late in the dying process.
What is hearing?
A competent client refuses additional life-prolonging treatment despite the family's objections. Respecting the client's decision demonstrates this ethical principle.
What is autonomy?