SUBSTANCE ABUSE

NOTES ABOUT SUBSTANCE ABUSE
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines
1. ALCOHOL

ALCOHOL DEPENDENCE AND ABUSE
Etiology:
•Low self –esteem
•Guilt and anxiety
•Limited life goals, unreliable, impulsive and irresponsible
•Fixation
•Learned Behavior
•Inherited traits
•Mass media and sociologic cultural practices
•Poor parenting and poor role modeling

Phases of Alcohol Dependence and Abuse

1. Pre alcoholic:
2. Prodromal:
3. Crucial:
4. Chronic phase:

Common sequence of Alcohol Withdrawal
Tremulousness
Acute hallucinations
Alcohol withdrawal delirium

CAGE ASSESSMENT
•Have you ever felt the need to CUT DOWN alcohol?
•Has anybody ever been ANNOYED by your attitude when you are under the influence of alcohol?
•Have you ever felt GUILTY about your alcohol dependency?
•Is alcohol an EYE OPENER to you when you wake up in the morning?

COMPLICATIONS OF ALCOHOL DEPENDENCY AND ABUSE

1. DELIRIUM TREMENS
•Clinical Manifestations:
–severe memory disturbance
–agitation and hallucinations 1-5 days
–Diaphoresis
–Hypertension
–Tachycardia

2. WERNICKE’S ENCEPHALOPATHY
Clinical Manifestations:
•mental status changes
•ocular abnormalities:
•vestibular dysfunction
•confusion
•disorientation
•ataxia
•apathy

3. KORSAKOFF PSYCHOSIS
Clinical Manifestations:
•Amnesia
•Dementia
•Confabulation and Learning Problems
•Psychosis
•Loss of reality testing
•Loss of taste and smell

Nursing Interventions
•Supportive care
•Balanced diet
•Psychopharmacology
•Abstain from alcohol

2. OPIUM
•Desensitizes
•Euphoria and well being

Overdose of opiods
•Respiratory depression
•Suffocation
•Aspiration of inhaled compounds or vomitus
•Anoxia
•Vagal Stimulation
•Arrythmias
•Death Cardiac Arrest

Nursing Interventions

SAFETY
RESPIRATION
Monitor for signs and symptoms of withdrawal
Medications

3. VOLATILE INHALANTS

•Lack of Coordination
•Blurred Vision
•Dizziness
•Slurred Speech
•Unsteady gait
•Tremor
•Muscle Weakness
•Nystagmus
•Excitation followed by drowsiness, light headedness, loss of inhibition and agitation
•Aggression
•Apathy
•Enhancement of sexual pleasure
•Inability to function well
•Giggling and laughter
•Stupor
•Coma
*NO WITHDRAWAL EFFECTS
*Only supportive treatment is given.

4. CANNABIS
•Clinical Manifestations with the use of Cannabis:
–Lowered Inhibitions
–Relaxed state
–Euphoria
–Inappropriate laughter
–Increased Appetite
–Distortion of time and perception
–Dysphoria
–Impaired Judgment
–Short term memory
–Impaired motor coordination
–Social Withdrawal
–Dry mouth
–Hypotension
–Tachycardia
–Delirium
–“Blood shot eyes”
–“Devil’s Eyes”
*Overdosage does not occur
*No clinically significant withdrawal syndrome
*Some may experience muscle pains, sweating, anxiety and tremors as the withdrawal symptom.

•Nursing Interventions:
–Ensure comfort and safety.
–Orient to person, time and place.
–Ensure environmental safety especially during episodes of delirium.
–Instruct to abstain from using the substance

5. STIMULANTS
Amphetamines
-short term treatment for obesity, attention deficit and narcolepsy
-also speed or crank
-poor person’s cocaine
-psychosis
Withdrawal: cold turkey
craving
b. Cocaine
- rush
- euphoria
-increased mental awareness
-increased strength
-anorexia
-increased sexual stimulation
-bugs (formication)
-respiratory collapse

c. Hallucinogens
•LSD
•PCP
•Mescaline (Peyote)
•Psilocybin

Clinical Manifestations of LSD, Peyote, and Psilocybin during Overdose
•Psychosis
•Brain damage
•Death
•Clinical Manifestations of PCP during overdose:
–Hypertensive Crisis
–Hyperthermia
–Psychosis
–Seizures
–Respiratory Arrest

DEFENSE MECHANISMS
•Denial
•Rationalization
•Projection

NURSING INTERVENTIONS FOR SUBSTANCE ABUSE
–Identify the type of the substance used
–Observe for signs and symptoms of intoxication and overdose
–Observe for withdrawal symptoms
–Maintain a patent airway and regular respiration
–Treat symptoms of overdose if manifested
–Intravenous therapy should be initiated
–Lavage the client if necessary for overdose especially if the substance used is a sedative
–Request for dialysis as ordered if necessary if the substance used contains barbiturates
–Initiate seizure precautions
–Keep airway on hand: oxygenate as necessary
–Naloxone (Narcan)
–Methadone or Naltrexone
–Treat underlying emotional problems
–Behavior modification
–Detoxification
–Rehabilitation


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