Substance Use Disorders/Addictions

  1. Nursing diagnoses and interventions with substance use disorders

Assessment tools:

  • Drug history and assessment

  • CIWA-Ar

  • SBIRT



Nursing diagnosis 

  • Risk for injury related to CNS agitation secondary to intoxication or withdrawal from alcohol or other CNS depressants 

  • Outcome: patient will not experience physical injury 



Nursing interventions 

  • Detoxification 

  • Provide safe and supportive environment 

  • Administer substitution therapy 

  • Intermediate care 

  • Provide explanation of physical symptoms 

  • Promote understanding and identify the causes of substance dependency 

  • Rehabilitation 

  • Encourage continued participation in long-term treatment

  • Promote participation in outpatient support systems

  • Assist patient to identify alternative sources of satisfaction 

  • Provide support for health promotion maintenance 




  1. Client education & outcomes r/t substance use d/o




  1. Symptoms & treatment of ETOH withdrawal

Alcohol Use Disorder Effects on the Body 

  • Peripheral neuropathy

  • Alcoholic myopathy

  • Wernicke’s encephalopathy

  • Korsakoff’s psychosis 

  • Alcoholic cardiomyopathy 

  • Esophagitis 

  • Gastritis 

  • Pancreatitis

  • Alcoholic hepatitis

  • cirrhosis of the liver

  • Leukopenia 

  • Thrombocytopenia

  • Sexual dysfunction 


Alcohol withdrawal:

  • Occurs within 4-12 hours of cessation of or reduction in heavy and prolonged alcohol use 

Symptoms 

  • Coarse tremor of hands, tongue, or eyelids

  • Nausea, vomiting 

  • Malaise or weakness

  • Tachycardia

  • Sweating 

  • Hypertension 

  • Anxiety, depressed mood, transient hallucinations or illusions 

  • Headache

  • Insomnia 

Treatment 

  • Benzodiazepines are a widely used group of drugs for medication-assisted treatment in alcohol withdrawal

  • Most commonly used agents are Chlordiazapoxide (Librium), oxazepam (Serax), lorazepam (Ativan), diazepam (Valium) 



  1. Symptoms & treatment of opiate withdrawal

Symptoms:

  • Dysphoria

  • Nausea, vomiting

  • Muscle aches 

  • Lacrimation or rhinorrhea

  • Pupillary dilation 

  • Piloerection 

  • Sweating 

  • Diarrhea 

  • Yawning 

  • Fever 

  • Insomnia 



Short-acting drugs like heroin can have withdrawal symptoms after 6-8 hours of last dose, peak after 1-3 days, and subside over a period of 5-10 days 

Longer-acting drugs such as methadone can have withdrawal symptoms within 1-3 after last dose, peak between 4-6 days, and are complete in 14-21 days 



Treatment 

  • Rest 

  • Adequate nutritional support 

  • Medication-assisted treatment with drugs such as methadone or buprenorphine 




  1. Recovery and family education

Nature of the illness

  • Effects of substance on the body

  • Alcohol 

  • Hallucingens 

  • Inhalants 

  • Opioids

  • Cannabinoids

Ways in which substance affects life 

Management of the illness

  • Activities to substitute for substance in times of stress

  • Relaxation techniques such as progressive relaxation, deep breathing, problem-solving skills, essentials of good nutrition, dysfunctional family dynamics

Support services 

  • Financial assistance 

  • Legal assistance

  • AA, Al-Anon, Co-dependents anonymous 

  • One to one person support

Educating family about common dysfunctional processes such as enabling and codependency 

Referral to support groups designed for family members 



  1. Gambling d/o symptoms

  • Persistent and recurrent problematic gambling behavior leading to clinically significant  impairment or distress

  • Physical sensation of restlessness and anticipation that can only be relieved by placing a bet 

  • Problem gamblers increasingly use gambling to try to cope with stress and regain a sense of control 



  1. Impaired nurse (symptoms and referral) 

Symptoms:

  • Irritability

  • Tendency to isolate 

  • Elaborate excuses for behavior 

  • Poor concentration 

  • Difficulty meeting deadlines

  • Inappropriate responses 

  • Poor memory or recall 

  • Problems with relationships 

  • Unkept appearance

  • Impaired motor coordination

  • Absenteeism if substance is outside of work

  • May rarely miss work if substance is found within workplace 

  • Mood swings

  • Discrepancies in documentation 



Referral 

  • A report can be made to the state board in which they decide each case on an individual basis 

  • Community resources

  • State nurse association assistance programs 

  • Peer assistance programs