Halter: Varcarolis' Foundations of Psychiatric Mental Health Nursing, 7th Edition

Chapter 22: u!stance "elated#$ddicti%e &isorders

$ns'er (ey)Critical *hin+ing ,uidelines
1. Write a paragraph describing reactions you could have to a patient who uses drugs.
A. Would your response be different depending on the substance (e.g., alcohol versus heroin or
marijuana versus cocaine)? ive reasons for your answers.
!or me, " have seen the devastation brought into the lives of people affected by drug use. #eroin
is e$tremely addictive, and cocaine is dangerous as well. #owever, " see more individuals
hospitali%ed withdrawing from alcohol, sedatives, and pain medications than anyone else. &any
also admit to smo'ing marijuana, so there is a polypharmacy component as well. "n short, if "(m
treating an individual in the hospital for a drug)related problem, " consider all of these problems
to be very serious.
*. -ould your response !e different if the person using the su!stance 'ere a professional
colleague. Ho'.
"t adds another factor or complication to the problem. +ow we have chemical use, may affect a
professional(s ability to provide competent care to patients. ,hat becomes a different issue. $n
e/ployer is !ound to report che/ical /isuse to the state !oard of nursing. "f " 'now of an
instance or instances of a colleague endangering patients as a result of impairment, "(m also
morally and ethically bound to report this to my superiors. " may discuss the issue with my
colleague first to see what route we should ta'e, because " would li'e to give that person the
opportunity to ta'e the high road and be accountable for his or her actions. $lcohol 'ithdra'al
deliriu/ is considered a /edical e/ergency and can result in death e%en if the condition is
treated0 &eath is usually caused !y sepsis, /yocardial infarction, fat e/!olis/, peripheral
%ascular collapse, electrolyte i/!alance, aspiration pneu/onia, or suicide0
-. .osetta /eymour is a 10)year)old patient who has started using heroin nasally.
A. *riefly discuss the trend in heroin use among teenagers.
#eroin use among teenagers is e$ploding in every state in the nation. ,his is particularly true in
the suburbs where parents did not thin' they needed to worry about this urban drug. 1ften
future heroin users begin with prescription drugs such as 1$ycodone and move on to heroin,
which provides a similar high at a fraction of the price. 2rug traffic'ers from 3olombia and
&e$ico often put a flashy label such as 4rada or 3hevrolet on pac'ets of the drug.
3opyright 5 -617, -616, -668 by /aunders, an imprint of 9lsevier "nc.
Answer :ey;3ritical ,hin'ing uidelines --)-
1verdosing is often deadly among teenagers. "n 1<<< in the =./., 1<> people between the ages
of 10 and -7 died of a heroin overdose, compared with 016 deaths in -66<, the latest year data
was ta'en.
*. When &s. /eymour as's you why she needs to ta'e more and more to get ?high,@ how would
you e$plain to her the concept of tolerance?
As a person uses a substance more and more over a period of time, the body metaboli%es it more
Auic'ly, and more and more of the substance is reAuired to achieve the same results.
3. "f she had just ta'en heroin, what would you find when assessing physical and behavioral)
psychological signs and symptoms?
1f she 'ere still under the effects of heroin, she 'ould de/onstrate the follo'ing signs and
sy/pto/s:
Physical:
3onstricted pupils
2ecreased respiration
2rowsiness
2ecreased blood pressure
/lurred speech
4sychomotor retardation
4sychological)perceptualB
"nitial euphoria followed by dysphoria and impairment of attention, judgment, and memory
2. "f she came into the emergency department with an overdose of heroin, what would be the
emergency care? What would be effective long)term care?
!irst and foremost, because heroin is an opiate, an overdose would drastically suppress the
respiratory system and lead to respiratory arrest. ,imely assessment of respiratory function is
vital, so she may need respiratory support. "f she were unresponsive, you 'ould anticipate
ad/inistration of Narcan to antagoni2e the effects of the narcotic0 $n 1V line 'ould !e
started to pro%ide access for e/ergency drug ad/inistration and pro%ision of fluids0
Continued /onitoring of respiratory functioning 'ould !e necessary in the e%ent that the
Narcan is depleted0
3ong4ter/ care /ay include arranging for Ms0 ey/our to register 'ith a /ethadone
clinic for a 'ithdra'al progra/0 he should also suggest a 524step reco%ery progra/, such
as that offered !y Narcotics $nony/ous0
C. ,ony armond is a 70)year)old mechanic. #e has a -6)year history of heavy drin'ing, and he says
he wants to Auit but needs help.
3opyright 5 -617, -616, -668 by /aunders, an imprint of 9lsevier "nc.
Answer :ey;3ritical ,hin'ing uidelines --)C
A. .ole)play with a classmate an initial assessment. "dentify the 'inds of information you would
need to have to plan holistic care.
*iologicalB
" would assess the patient for signs and symptoms of impending withdrawalB tremors,
fasciculation of the tongue, an$iety, insomnia, irritability, nausea, vomiting, and elevated blood
pressure, pulse, and respirations. What is his history of drin'ing habits and and the amount?
When was the last time he had anything to drin'? "n my head)to)toe assessment, " would inAuire
about gastrointestinal disorders (ulcers, hepatic involvement, gastritis, etc.) #e should also be
chec'ed closely for drug paraphernalia.
4sychologicalB
As previously mentioned, does the patient complain of an$iety, irritability, depression, difficulty
concentrating? #as he had any thoughts of suicide? "n terms of his personality, since he has a
-6)year history of drin'ing, it may be safe to assume he has an addictive personality. 2oes he
lac' tolerance for frustration or pain? #as he e$perienced a lac' of success in life? #as he had a
lac' of affectionate and meaningful relationships? 2oes he have low self)esteem and a
propensity to ta'e ris's?
/ocioculturalB
2oes .obert belong to any particular high)ris' groups such as American "ndians? ,he fact that
he is male puts him at higher ris' for substance abuse than if he were female. !inally, does
substance abuse run in his family? A child of a parent with alcoholism is predisposed to
alcoholism.
*. &r. armond tried to stop by himself, but ended up in the emergency department with delirium
tremens. What are the dangers for &r. armond? What are the appropriate medical
interventions?
Alcohol withdrawal delirium is considered a medical emergency and can result in death, even if
the condition is treated. 2eath is usually the result of sepsis, myocardial infarction, fat
embolism, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide
(&c:eon et al., -66D). +ot all people who stop drin'ing reAuire management of withdrawal.
,his decision depends on the length of time and the amount the patient has been drin'ing, the
prior history of withdrawal complications, and overall health status. &edication should not be
given until the symptoms of withdrawal are seen. 2rugs that are useful in treating alcohol
withdrawal delirium include the followingB ben%odia%epines, such as lora%epam, to decrease
withdrawal symptomsE )adrenergic bloc'ers, such as propranolol, to stabili%e vital signs,
decrease cravings, and reduce autonomic withdrawal symptomsE )adrenergic bloc'ers, such as
clonidine, to reduce autonomic withdrawal symptomsE and antiepileptics, such as
carbama%epine, to reduce withdrawal symptoms and prevent sei%ures.
3opyright 5 -617, -616, -668 by /aunders, an imprint of 9lsevier "nc.
Answer :ey;3ritical ,hin'ing uidelines --)7
3. What are some possible treatment alternatives for &r. armond when he is safely deto$ified?
#ow would you e$plain to him the usefulness and function of Alcoholics Anonymous (AA)?
What are some additional treatment options that could be useful to &r. armond? What
community referrals for &r. armond are available in your area?
.obert could continue with medical treatment of his alcoholism with such medications as
naltre6one, aca/prosate, topira/ate, or disulfira/0 +onpharmacological relapse prevention
would include such entities as AA, residential programs, or intensive outpatient treatment
programs.
,welve)step programs at AA were developed for many types of addiction. ,hese programs offer
the behavioral, cognitive, and dynamic structure needed in recovery. ,he premise of AA is
threefoldB
1. "ndividuals with addictive disorders are powerless over their addiction, and their lives are
unmanageable.
-. Although individuals with addictive disorders are not responsible for their disease, they are
responsible for their recovery.
C. "ndividuals can no longer blame people, places, and things for their addictionE they must
face their problems and their feelings.
"n terms of opportunities for community referrals for .obert, outpatient drug)free programs
and employee assistance programs are available. ,hese centers may offer vocational
education and placement, counseling, and individual or group psychotherapy.
3opyright 5 -617, -616, -668 by /aunders, an imprint of 9lsevier "nc.