Intro
SUD Risk Factors?
- Cognitive Development
- Family-Related
- Social
- Individual
Inhalants
Short term mild high
Bath salts
Stimulates, euphoria, stimulant
Screening Tools?
- Should be utilized for every patient
- One example is the CAGE questionnaire
OTC Drug?
Dextromethorphan
Special Considerations: Patients with Substance Use Disorders?
- Surgical Patients
- High risk problems:
- Drug interactions, post-op complications, death
- Screening tools
- Post-operative period:
- Monitor for drug interactions, withdrawal symptoms
- Adverse Effects:
- Delirium, delirium tremens
- Seizures, withdrawal syndrome
- Pain management
- Pain: higher priority than SUD
- Treat all patients with dignity and respect
Ketamine
Abrupt high, hallucinations
Kratom and LSD
Kratom: Low-stimulates, High-sedates
LSD: Hallucinations, “tripping”
Alcohol Withdrawal?
- Symptoms may develop anytime between 6 hours and 5 days after the last drink
- Delirium, tremors, seizures, and even death
Dextromethorphan SE?
- N/V, abdominal pain, confusion, dizziness, vision changes, slurred speech, drowsiness, tachycardia
Types of Use Disorders?
•Alcohol
- Cannabis
- Opioid
- Tobacco
- Cough/Cold Products
- Steroids
Cocaine
Stimulates, paranoia, hallucinations, violent
Heroin and GHB
Heroin: Sedates, intense pleasure, downer
GHB: Sedates, euphoria, sexual arousal
Pain Management?
- Pain management is a higher priority than substance use disorder!
Prescription Drug?
Promethazine (Phenergan) and Codeine
Nurses with Substance Use Disorder: Most Common? Factors? Red Flags? S/S?
- Most used drugs: Cannabis, Cocaine, Opioids, Alcohol, Nicotine
- Contributing factors: Job stress, emotional demand of nursing, long hours, shift rotations, easy access to drugs, internalization of feelings during a crisis with no time to decompress, and taking care of others before nurses take care of themselves
- S/S: Personality/behavior change, alterations in job performance, unexplained absences from the unit, arriving late for work and leaving early from work, poor judgements, medication errors, alteration of verbal and telephone orders, illegal documentation
- Red Flags: Narcotic count discrepancies and frequent reports of uncontrolled pain from patients
Methamphetamine
Speed, violent, hallucinations
PCP
Detachment, hallucinations
Opioid Withdrawl?
- Pain! N/V/D, muscle cramps, anxiety, restlessness, nervousness, flu-like symptoms, dilated pupils
Promethazine (Phenergan) and Codeine SE?
- Drowsiness, confusion, N/V, constipation, dose-related respiratory depression
Nursing Process Example: Tobacco Use Disorder
- Assessment
- Patient problem
- Planning (Measurable Outcomes)
- Interventions
- Evaluation
- Concepts: Coping, Safety
MDMA and Rohypnol
MDMA: Stimulates, euphoria, sexual arousal
Rohypnol: Sedates, euphoria, sexual arousal
Synthetic Cannabinoids
Euphoria, relaxation
Withholding pain meds?
- Withholding pain medication causes unnecessary pain and suffering
- Is a breach of the ethical principles central to nursing care
Dextromethorphan versus Promethazine/Codeine Effect?
- Promethazine/Codeine: Relaxation and euphoria
- Dextromethorphan: Euphoria, dissociative effects, hallucinations