Medical-Surgical%20Nursing:%20An%20%20Integrated%20Approach,%202E%20Chapter%2034

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Medical-Surgical Nursing An Integrated
Approach, 2E Chapter 34

• NURSING CARE OF THE CLIENT SUBSTANCE ABUSE

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Substance Defined as

• A drug, legal or illegal, that may cause physical
  or mental impairment.

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Substance Disorders

• In the U.S., substance disorders affect males and
  females, all ethnic groups, and persons of all
  levels of education and income. From the newborn
  to the elderly, all ages can be affected.

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Classifications of Substance Disorders

• Intoxication (The reversible effect on the CNS
  soon after the use of a substance).
• Abuse (The misuse, excessive, or improper use of
  a substance, the abstinence of which does not
  cause withdrawal symptoms).
• Dependence (addiction) (The reliance on a
  substance to such a degree that abstinence causes
  functional impairment, physical withdrawal
  symptoms,and/or a psychological craving for the
  substance).

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Factors Related to Substance Abuse

• Individual factors (e.g. genetic factors
  personality traits).
• Family patterns.
• Lifestyle.
• Environmental factors.
• Developmental factors.

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Detoxification Defined as

• The elimination of the substance from the body.

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Alcohol

• Low doses of alcohol depress areas of the brain
  that are inhibitory, causing diminished
  self-control and impaired judgment.
• Continued alcohol ingestion may cause
  unconsciousness and even death.

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Alcohol and the Liver

• Chronic alcohol abuse causes three distinct
  diseases of the liver
• Fatty liver (an accumulation of triglycerides in
  the liver).
• Alcoholic hepatitis.
• Cirrhosis.

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Alcohol and Gastrointestinal Disturbances

• Alcohol damages the lining of the stomach and
  esophagus by irritating the mucosa and causing
  inflammation or ulcer formation.
• Gastric pain, vomiting, and diarrhea are common
  in alcohol abuse.

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Pancreatitis

• An alcoholic has a higher risk of developing
  pancreatitis than an abstainer.
• Severe pancreatitis can result in death.

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Wernickes Encephalopathy

• An inflammatory hemorrhagic and degenerative
  condition of the brain caused by a thiamine
  deficiency resulting from alcoholism.
• Characterized by delirium, memory loss, unsteady
  gait, a sense of apprehension, and an altered
  level of consciousness.

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Korsakoffs Psychosis

• Thiamine and B12 deficiencies contribute to the
  degeneration of the brain and peripheral nervous
  system.
• Disorientation, amnesia, insomnia,
  hallucinations, and peripheral neuropathologies
  characterize this psychosis.

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Alcohol and Cardiovascular Disturbances

• Moderate amounts of alcohol causes cutaneous
  vasodilation (flushed skin). This causes rapid
  heat loss and core temperature may drop to a
  dangerous level.
• Blood pressure decreases with intoxicating doses
  of alcohol.
• Irregularities in cardiac rhythm may result.

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Fetal Alcohol Syndrome

• Excessive use of alcohol in pregnancy may result
  in this syndrome in the newborn, with growth
  retardation, CNS involvement, and craniofacial
  abnormalities.
• Women who are pregnant or are trying to get
  pregnant should abstain from alcohol consumption.

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Withdrawal

• Refers to the symptoms produced when a substance
  on which an individual has dependence is no
  longer used by that individual.
• Alcohol withdrawal occurs in 3 stages Stage
  1/Minor (anxiety, sleep problems, tremors, etc.)
  Stage 2/Major (stage 1 signs plus hallucinations,
  whole-body tremors, vomiting, etc.) Stage
  3/Delirium tremens (fever, disorientation,
  inability to recognize familiar people and
  objects. This is a medical emergency with a 2 to
  5 mortality rate).

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Johnsonian Intervention Defined as

• A confrontational approach to a client with a
  substance problem that lessens the chance of
  denial and encourages treatment before the client
  hits bottom.

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Self-Help Groups

• Alcoholics Anonymous (AA), AL-ANON (for adults)
  AL-ATEEN (for teenagers) and AL-ATOT (for younger
  children in family of alcoholic) are holistic
  approaches that have been very successful.

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Drug Intervention for Alcoholics

• Disulfiram (Antabuse) may be given to some
  alcohol abusers as a deterrent to drinking. It
  inhibits the enzyme needed to metabolize alcohol.
• Drinking alcohol with disulfiram in the body
  causes flushing, blurred vision, nausea, vertigo,
  anxiety, etc.

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Benzodiazepines and Other Sedative-Hypnotics

• Examples include Valium, Seconal, Paral, with
  street names like roofies, tranks, ludes, barbs.
• Low doses produce drowsiness or sedation larger
  doses produce sleep.
• Potential for addiction is high.
• Withdrawal symptoms include anxiety, insomnia,
  anorexia, delirums, tremors, and seizures.

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Cannabis

• Marijuana is most common type of cannabis used.
  Hash or hashish is a potent concentrate of the
  resin from the flowers. Street names are grass,
  pot, reefer, smoke, weed, and Mary Jane.
• Short-term effects include memory and learning
  problems distorted perception loss of
  coordination panic attacks.
• Potential for psychologic addiction is moderate.

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Cocaine

• Extracted from leaves of the coca plant.
• It may be heated and fumes inhaled. This is
  termed free-basing.
• As a white powder, it may be snorted by inhaling
  through the nose. It may also be heated to a
  liquid state and injected intravenously.
• Crack is a crystallized form of cocaine that is
  melted in a water pipe and smoked. Sreet names
  include coke, crack, flake, rocks, snow, C, and
  blow.

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Amphetamines

• Also called uppers, speed, bennies, they include
  Dexedrine, Amphetamine, and Desoxyn.
• Enhances psychomotor performance, induces a
  temporary state of well-being, and gives an
  instantaneous euphoria. Followed by a crash.
• High doses may cause insomnia, tachycardia,
  headache, arrhythmias, hypertension, followed by
  hypotension, nausea, vomiting, cramping,
  diarrhea, convulsions, and death.

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Caffeine

• Probably the best known and most frequently used
  and abused CNS stimulant.
• Found in coffee, tea, chocolate, cocoa, cola
  beverages, and some nonprescription drugs.
• Potential for addiction is moderate. Withdrawal
  produces headache, irritability, and
  tremulousness.

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Nicotine

• Tobacco kills more than 430,000 U.S. citizens
  every year. More than alcohol, cocaine, heroine,
  homicide, suicide, car accidents, fire, and AIDS
  combined.
• Potential for addiction is high.
• Causes respiratory and cardiovascular disease,
  cancer.

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Other Substances

• Hallucinogens (Psilocybin and psilocin, DMT, DET,
  Ecstasy).
• LSD (Lysergic Acid Diethylamide).
• Phencyclidine (PCP).
• Opiods (Morphine, Heroin, Demerol, Percodan).
• Inhalants (glues, kerosene, acetone, naptha,
  fluorcarbons, nitrous oxide).
• Anabolic Steroids.

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Codependency Defined as

• A learned pattern of feeling and behaving.
  Codependence occurs when people feel good about
  themselves only when they fulfill the
  expectations of others.

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Characteristics of the Codependent Person

• Caretaking (I always give to others. No one
  gives to me).
• Obsession (I cant stop worrying about
  ___problems).
• Denial (I pretend I dont have problems).
• Poor communication (No one trusts me).
• Lack of trust (I dont trust myself).
• Anger (I resent feeling controlled and
  manipulated).

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The Impaired Nurse

• Most states now have peer assistance programs to
  help nurses impaired by either alcohol or other
  substances.
• Substance abuse and dependence are greater
  problems among nurses than among the general
  population because nurses have access to many
  controlled substances.