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

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 34
NURSING CARE OF
THE CLIENT:
SUBSTANCE ABUSE
Substance: Defined as:

A drug, legal or illegal, that may cause
physical or mental impairment.
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.
Classifications of Substance
Disorders

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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).
Factors Related to Substance
Abuse
Individual factors (e.g. genetic factors;
personality traits).
 Family patterns.
 Lifestyle.
 Environmental factors.
 Developmental factors.

Detoxification: Defined as:

The elimination of the substance from the
body.
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.

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.
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.

Pancreatitis
An alcoholic has a higher risk of
developing pancreatitis than an abstainer.
 Severe pancreatitis can result in death.

Wernicke’s 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.

Korsakoff’s 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.

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.

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.

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).
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.”
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.
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.

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.

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
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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.
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.
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.

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
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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.
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.
Characteristics of the
Codependent Person
Caretaking (“I always give to others. No
one gives to me”).
 Obsession (“I can’t stop worrying about
___problems”).
 Denial (“I pretend I don’t have problems”).
 Poor communication (“No one trusts me”).
 Lack of trust (“I don’t trust myself”).
 Anger (“I resent feeling controlled and
manipulated”).

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.
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