Substance Abuse

Alcohol Use Disorder

  • Physical dependence: biological need for alcohol to avoid physical withdrawal symptoms

  • Psychological dependence: craving for the subjective effect of alcohol

  • Risk factors → genetic/fam predispositions, anxiety/depression, low self-esteem, poor self-control, hx of rebelliousness/poor school performance/delinquency, poor parenteral relationships

  • Assessment findings in a pt w/ alcohol use disorder → slurred speech, uncoordinated movements, unsteady gait, restlessness, confusion, sneaking drinks/drinking in the am/experiencing blackouts, binge drinking, arguments about drinking, missing work, increased tolerance to alcohol, intoxication w/ blood alcohol content (BAC) of 0.1% or greater

    • NURSE NEEDS TO INCLUDE THE FOLLOWING IN THE ASSESSMENT OF THE PT → type of alcohol, how much, for how long, and when last consumed***

  • Psychological symptoms → depression, irritable/belligerent/hostile, suspiciousness, rationalization, isolation, decrease in inhibitions, decrease in self-esteem, denial that a problem exists

  • Potential complications → vitamin B deficiency, alcohol-induced amnesic disorder, Wernicke’s encephalopathy, hepatitis, cirrhosis, pancreatitis, anemia, immune system dysfunction, brain damage, peripheral neuropathy, cardiac disorders

  • WITHDRAWAL

    • due to an abrupt cessation of alcohol

    • early signs → occur after a few hours - peaking in 24-48hrs then disappear and then progress to delirium

    • severe and life-threatening complications of withdrawal → seizures, delirium tremens

    • assessment performed using CIWA

    • SYMPTOMS → HTN, tachycardia, n/v, tremors (hands), sweating, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, disorientation, DELIRIUM TREMENS

      • DELIRIUM TREMENS → peaks within 24-72 hrs of cessation or reduction of intake → can last for 2-3 days

  • Interventions → admin meds as prescribed, be nonjudgemental, check on pt frequently, v/s & neuro assessment q15mins, monitor glucose & mag, provide a quiet/non-stimulating environment & encourage 1 fam member at a time to stay w/ the pt to minimize anxiety, orient frequently, explain all tx/procedures in a quiet manner, seizure precautions, provide small/frequent high carb meals, I&Os, assist w/ ADLs & ambulation, allow pt to express fears

CNS Depressants

  • includes: alcohol, benzos, barbiturates

  • intoxication: drowsiness, hypotension, impairment of memory/attention/judgment, unsteady gait, irritable, slurred speech

  • withdrawal: n/v, tachycardia, diaphoresis, anxiety & irritable, tremors, insomnia, seizures

  • OD interventions:

    • if pt is awake → induce vomiting & give activated charcoal

    • if pt is comatose → establish & maintain airway & then gastric lavage w/ activated charcoal

  • OD med for benzos → flumazenil IV

IMPORTANT TOPICS HIGHLIGHTED IN SAUNDERS

  • Withdrawal delirium is a medical emergency

    • Death can occur from a → MI, fat emboli, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide

  • The nurse is monitoring a pt in a mental health facility who is receiving tx for an opioid addiction. The nurse is monitoring for opioid withdrawal, and understands the symptoms of this include → tachycardia, diaphoresis, restless, dilated pupils, bone & joint aches, rhinorrhea & lacrimation, diarrhea, vomiting, tremors, yawning, anxiety, irritable

  • What is an expected reexperience in person who has stopped taking a hallucinogenic for a while? flashbacks

    • What is a priority during a flashback? SAFETY