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Substance Abuse Ch. 95


Substance Abuse Author: KL Last modified by: winxp Created Date: 3/2/2007 6:26:36 PM Document presentation format: On-screen Show (4:3) Company: Page County Public ... – PowerPoint PPT presentation

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Title: Substance Abuse Ch. 95

Substance AbuseCh. 95
  • Med/Surg Nursing
  • 2013

Substance Abuse
  • Drug-substance that activates the pleasure center
    of the brain
  • Used as a response to stress, low self-esteem,
    obsessed with food, work, sex, gambling
  • Addictions know no racial, religious, age, gender
    or socioeconomic barriers
  • Nursing care requires PATIENCE

Chemical Abuse and Chemical Dependency
  • APA definition-maladaptive pattern of substance
    use leading to clinically significant impairment
    or distress with one or more of the following in
    a 12 month period
  • Failure to fulfill role obligations
  • Use that presents danger to self or others
  • Recurrent use-related legal problems
  • Continued use

Chemical Abuse and Chemical Dependency
  • Drugs that are abused include alcohol,
    marijuana, cocaine, methamphetamines, MD
    prescribed medications, etc.

Chemical Abuse and Chemical Dependency
  • Chemical Dependency (substance dependence) as
    defined by the APA as those listed above
    including at least 3 of the following in a 12
    month period.
  • 1. Tolerance-need more of the drug to produce
    desired effect
  • 2. Withdrawal-occurs when they stop using, must
    take the drug or alcohol to avoid these symptoms
  • 3. Use larger amounts of the drug
  • 4. Would like to cut down or quit but cant
  • 5. Spend time, energy and money to obtain the
  • 6. Give up their former important things in
    life in order to use the drug
  • 7. Continued use of the drug regardless of its
    effect on the body (spiritually, mentally,
    interpersonal relationships)
  • Chemical dependencies are often combined with
    other behaviors such as gambling

Chemical Abuse and Chemical Dependency
  • Dx Tools DIS-specific for alcohol
    ASI-determines degree of addiction to any drug
  • Chemical dependency can lead to mental disorders,
    sexual dysfunction, cirrhosis of the liver,
    organic brain damage, and pancreatitis

Chemical Abuse and Chemical Dependency
  • Causes
  • Several theories
  • Physical Factors Theory excessive consumption is
    the most immediate cause of addiction
  • Use substances to escape from life or to feel
  • Genetic Theory could possibly be based on direct
    biologic transmission or as a learned childhood

Chemical Abuse and Chemical Dependency
  • Emotional and Psychological Theory use to escape
    from stress, or d/t low self-esteem,
    dissatisfaction with life, low tolerance for
    frustration, self-destructive tendencies,
    co-existing mental illness
  • Need the drug to feel good about life

Chemical Abuse and Chemical Dependency
  • Dual Disorders
  • Mental illness combined with chemical dependency
  • Mentally ill clients are usually depressed
  • May use drugs to ease the pain or commit suicide
  • May experience auditory hallucinations (hear
    voices) and use chemicals to make the voices go
  • What the client dont realize is that alcohol,
    sedatives, and narcotics are depressants and this
    accelerates the already depressed clients mood

  • Progressive Nature psychological cause
  • 1. Use to feel better, the drugs temporarily
    relieves the feelings of low self-worth and
  • 2. Use to keep from feeling bad, need increased
    amounts to stop feeling sick or depressed, the
    body needs the drug
  • 3. Lose control-small amounts of the chemical
    causes illness or severe intoxication
  • Blackouts occur with excessive use
  • Need medical attention to save their life!

  • Defense Mechanisms-most commonly used
  • Denial
  • Rationalization
  • Projection

  • Management of Dependency
  • 1. Recognition
  • 2. Intervention
  • 3. Treatment-must be STRUCTURED!!
  • 4. Recovery

Nursing care measures
  • Nursing care can be on an outpatient basis, ECF,
    special treatment centers and clinics, and
  • Insurance companies may not reimburse for a
    substance abuse Dx so the client may be listed
    under another Dx (medical)

Identification of the Chemically Dependent Person
  • Use defense mechanisms regularly
  • Be aware of withdrawal sx tremors, anxiety,

Nursing Assessment
  • Interview Process-see questions to ask on pg.
  • Dealing With an Intoxicated Person in the
    Healthcare Facility
  • Must confirm the drug used by laboratory tests
  • Monitor LOC!!
  • Obtain a thorough history
  • Determine when alcohol or drug was last used
  • Document ALL information

Dx tests
  • Dx test ordered by Md blood alcohol test (do not
    prep site with alcohol) and urine toxicity
    (U-tox) which will determine the drugs used
  • If a visitor is intoxicated-do not allow them
    into the room, notify the charge nurse,
    supervisor or security

Detoxification and Recovery
  • Detoxification-process of removing a drug and its
    physiologic effects from the persons body
  • May take days depending on the drug used, amount,
    level of dependence, liver and kidney function
  • Provide comfort and SAFETY during withdrawal
  • Use sedation and emotional support to allow rest
    and recuperation
  • Detoxification must occur before long-term CD
    treatment can occur

Motivation for CD Treatment
  • Person wants to stop
  • Dont want to rely on the drug
  • Want to cut down on the drug but it is not
    possible-must stop!
  • May be court ordered and they will be angry
    because they may not want to stop
  • Need strong peer pressure to stop

Detox Center
  • Usually escorted by the police
  • Under medical supervision while in the center
  • Need supportive care and referral to continuing
    therapy after detox.

Therapeutic Community
  • Isolated from the substance-oriented environment
  • Recovering abusers usually organize the program
    group therapy
  • May be gender specific and focus on male or
    female problems
  • Goals-address physical and emotional problems and
    understand the cycle of dependence, then they
    begin the true recovery

Immediate Detox TX
  • Complete medical work up
  • Lab work
  • Blood chemistry levels to determine vitamin
    deficiencies, lipid levels, uric acid levels
  • U-tox
  • Determine withdrawal behavior-may still ask for
    the drug even though they dont have symptoms
  • Must experience withdrawal symptoms-n/v, tremors,
    diaphoresis, agitation, anxiety, hallucinations,
    h/a, confusion for drugs to be initiated
  • May have medical problems such as esophageal
    varices, brain damage, CHF, dyspnea
  • Reassess the client at a minimum of q. 1 hour

Withdrawal SX
  • Body is denied access to the drug
  • Withdrawal occurs-mild to severe
  • Depends on the drug, how much was used and for
    how long
  • Present with psychological and medical problems
  • An injury can precipitate withdrawal

Withdrawal SX
  • Alcohol withdrawal-most dangerous
  • Often combined with other drugs
  • Detox begins within 72 hours of last ingestion
  • Suicide risk increases
  • Agitation, anxiety
  • Diaphoresis
  • Delusions
  • HTN, tachycardia, hyperthermia
  • N/V, anorexia
  • Seizures
  • Hypoglycemia
  • Dilated pupils
  • Confusion
  • Blackouts
  • Cardiac arrest
  • May cause FAS in pregnant women

Nutrition and General Health
  • CD clients are usually malnourished
  • Baseline weight
  • May need nutritional supplements
  • Refeeding Syndrome
  • CHOs must be given very carefully
  • This may include dextrose IV solutions,
    tube-feeding mixtures and liquid dietary

Long-Term F/U and Treatment
  • Substance abuser, alcoholic dependent, chemically
    dependent or polysubstance abuser, most people
    are codependent (live with others that abuse)
  • Active interventions must occur or addiction

Inpatient or Outpatient Tx.
  • 12-steps-NA or AA teach that the disease is
    incurable and is considered to be in remission

Dialectical Behavioral Therapy
  • The goal is what Linehan calls the wise mind, a
    midway point between being totally rational and
    totally emotional

Family Counseling
  • They will need intensive counseling
  • Will need to provide support, not encourage the
  • Family recovery can begin even if use continues

  • Chemically dependent person needs detox or
    intensive CD treatment
  • AA and other groups must continue for at least 2

Alcohol Abuse and Dependence
  • Public health problem
  • Contributes to over 100,000 deaths/year
  • MADD
  • DARE
  • FAS
  • If you drink to often/to much, there are negative

  • S/S
  • Chronic alcoholics are at risk for suicide
  • Blood alcohol levels are important to detox
  • Chronic alcoholism can lead to dementia, amnesia,
    sleep disorders and psychotic symptoms including
    delusions and hallucinations
  • Legal level varies state to state
  • Generally between 0.08-0.10 g/dl
  • At 0.3 g/dl-person vomits, and may become
    aggressive or be in a stupor
  • At 0.4 g/dl-coma can occur
  • At 0.5 g/dl-severe respiratory distress and death
    can occur
  • It takes 3-5 glasses of 4 oz wine/hour to reach a
    BAC level of 0.08 g/dl(depending on food
  • Nurses may draw blood alcohol levels-DONT USE

Alcohol Abuse and Dependence
  • S/S
  • CNS depressant
  • slurred speech
  • unsteady gait
  • behavioral changes
  • confusion
  • Chronic abusers have may have swollen nose,
    spidery veins and thickened and reddened palms

S/s of Alcoholism
  • AST, ALT, LDH, ALP AND THE GGTP/SCCT may be used
    to evaluate liver function
  • The GGTP/SGGT is elevated in 75 of chronic
  • Thiamine and folate levels are low \
  • RBCs are often low
  • Lipids and uric acid levels may be increased

disorders resulting from Alcohol Abuse
  • Dietary Deficiencies-vitamin B1, B9
  • Untreated thiamine deficiencies may lead to
    severe neurologic disorder called
    Wernicke-Korsakoff syndrome. S/S dementia,
    ataxia, somnolence, diplopia, horizontal
    nystagmus, mortality rate from this disease is
  • Cirrhosis of the liver and Hepatitis
  • Client has malnutrition and decreased intestinal
    ability to absorb medications
  • Laennecs cirrhosis r/t chronic alcohol abuse
  • Hepatits C is a result from chronic alcohol abuse

Other disorders
  • Esophageal varices
  • Gastritis
  • Gastric ulcers
  • kidney disorders
  • CAD
  • Sexual impotence-decreased desire/ability to
    perform during sex
  • FAS

  • Detox and f/u, must have support program

  • Autonomic hyperactivity
  • Tachy over 100
  • Nervous
  • insomnia, vivid nightmares
  • diaphoresis
  • flushed face
  • anorexia/nausea
  • Neuronal excitement
  • Sensory-perceptual disturbances
  • Severe toxic state is DTs
  • S/s include delusions and vivid auditory, visual
    and tactile hallucinations called alcohol
    hallucinosis which may last from a few days to
    several weeks
  • Vomiting may be present
  • Position on side!

Family Considerations
  • Family disease
  • the alcoholic family have these characteristics
  • control
  • perfectionism
  • mistrust of others
  • Tension
  • Members may have low self esteem!
  • overuse defense mechanisms

Codependent or Enabler
  • Codependent is often the person the alcoholic
    blames for the entire problem!
  • Must understand that alcoholics have a bad
    disease but are not bad people

Medication Therapy
  • Antabuse-used for aversion therapy when the
    alcoholic is unable to maintain sobriety
  • Loading dose is 500 mg/day for 2 weeks followed
    by a daily maintenance dose of about 250 mg
  • If the person drinks while taking Antabuse, they
    become ill d/t the buildup of acetaldehyde s/s
    flushing, h/a, dyspnea, hypotension, nausea,
    tremors, thirst
  • Do NOT give Antabuse within 12 hours of alcohol
  • Naltrexone-Blocking agent used to treat opioid
    abuse and as adjunct treatment for alcoholism
  • Decreases subjective effects of alcohol, which
    results in the person drinking less
  • Dont use this drug if the client has hepatitis
    or liver failure
  • Must be completely detoxified from coexisting
    opioids before beginning treatment

Sedatives, hypnotics and anxiolytic drugs
  • Includes barbiturates and antianxiety drugs such
  • as benzos
  • Barbiturates
  • Amobarbital/Amytal
  • Secobarbital/Seconal
  • Benzodiazepines
  • Alprazolam/Xanax
  • Chlordiazepoxide/Librium
  • Diazepam/Valium
  • Lorazepam/Ativan
  • Others

Symptoms of abuse
  • Delirium
  • Depression
  • Slurred speech
  • Amnesia, irreversible dementia
  • Respiratory depression
  • ANTIDOTE FOR OD-flumazenil/Romazicon

  • Date-rape drug
  • Sx of abuse
  • Labile
  • Incontinent
  • Coma
  • seizures
  • Withdrawal
  • Similar to DTs but vitals are often normal or
    only slightly elevated

Cannabis-related drugs
  • Made from hemp plant and used as hallucinogens
  • SX of abuse
  • Dreamy state, characterized by euphoria
  • Perception of space and time may be distorted
  • Can induce psychological and physical dependence!
  • Withdrawal
  • Diarrhea, ptsosis, rhinorrhea

Opiates and opiate agonists
  • heroin
  • morphine
  • meperidine HCL (Demerol)
  • hydromorphone (Dilaudid)
  • Symptoms of Abuse/narcotic intoxication s/s
    drowsiness/coma, slurred speech, bradypnea,
    depression, suicide risk
  • Withdrawal sore throat, rhinorrhea, insomnia,
    diaphoresis, dilated pupils more severe Gi
    discomfort, joint and muscle pains
  • Naloxone/Narcan is the antidote for narcotic

Agonist and drug replacement therapy
  • Naltrexone-before use, the client must go through
    detox from opiates
  • Originally developed as a treatment for narcotic
  • Must wait 7 days prior to administration
  • If addicted to methadone-must wait 10 days prior
    to tx.
  • Methadone-opiate analgesic used for the tx of
    heroin-dependent individuals, used as a
    substitute for heroin-does not produce a high
  • Powder is mixed in at least 120 ml of OJ to mask
    the taste and dosage of drug
  • Do well on therapy as long as they dont continue
    to use other drugs
  • Can precipitate withdrawal even if client not
    completely detoxified

Cns-stimulants Amphetamines
  • Mood elevators and appetite depressants and they
    combat drowsiness and simple fatigu
  • Street names ecstasy, crystal meth
  • S/S of abuse euphoria, confusion, anger, poor
  • Withdrawal depression, paranoid psychosis,
    nightmares, increased appetite
  • Tweaking
  • Meth user who has not slept for days and is in
    acute withdrawal

  • Use cocaine to feel better
  • Symptoms of abuse
  • Sexual dysfunction
  • Sleep disorders
  • Delirium and mood and anxiety disorders
  • Hallucinations
  • Withdrawal
  • intensive care or 11 staffing!

  • Stimulant
  • Abuse
  • Euphoric and stimulant effects
  • Appear emotionally unstable
  • Induces psychosis, including hallucinations and a
    feeling of being liberated from space and time
  • Withdrawal
  • Drowsy
  • Hallucinations
  • Lethargy
  • Mild depression

  • Not believed to cause actual or physical
    dependence, but produce psychological dependence
    and mild tolerance
  • LSD/Mescaline and Mushroom
  • Auditory hallucinations and intense visual
  • Objects may appear larger-macropsia or
  • Phencyclidine Hydrochloride
  • hallucinogens developed as an animal anesthetic

  • Volatile substances are CNS depressants that when
    inhaled produce altered states of consciousness
    and varied degrees of intoxication
  • Boppers, gluey, locker room, moon gas, poppers
    and is very dangerous
  • Causes addiction
  • Death can result from sudden cardiac arrest,
    suffocation, burns or aspiration of vomitus

Anabolic Steroids
  • Derive from testosterone
  • Promote growth of muscle and increase lean body
  • Take steroids intermittently
  • Side effects liver damage, cancer, edema,
    fatigue and insomnia
  • May experience mood lability and paranoia
  • Death can occur

  • Found in cigarettes and snuff
  • Smokers have a higher than normal risk of cancer
    of the stomach, kidney, pancreas, bladder, or
  • Nicotine also contributes to heart and blood
    vessel disorders
  • Cigarette smoke binds with hemoglobin to diminish
    the bloods oxygen carrying capacity reducing
    tissue oxygenation
  • Verenicline tartrate/Chantix is a nicotine
    receptor antagonist

  • Found in coffee, tea, chocolate, soft drinks
  • CNS stimulant
  • Does not reverse alcohols intoxicating or
    depressant effects and may actually add to
  • Heart rate increases and may become irregular
  • Aggravation of cystic breast disease

OTC drugs/herbals
  • Available without a RX
  • Can be abused if taken in large doses and more
    frequently than normal

  • Pregnant Women drugs, alcohol, caffeine and
    nicotine can complicate pregnancy
  • Babies are preterm, subject to physical and or
    mental disorders
  • Adolescents Peer pressure and low self-esteem
    are problems, cigarette smoking and alcohol are
    on the rise
  • Older Adults Seniors may double dose, attempt
    suicide with medications and may overuse antacids
  • Nurses Drugs are available in healthcare
    facilities, 50 more likely to become chemically
    dependent than the general population