Substance-Related Disorders Part II Chapter 13 Substance-Related Disorders Part II

Application of the Nursing Process Nurses must begin relationship development with a substance abuser by examining own attitudes and drinking habits

Nursing Process Various assessment tools are available for determining the extent of the problem a client has with substances Michigan Alcoholism Screening Test (MAST) CAGE Questionnaire Drug History and Assessment Clinical Institute Withdrawal Assessment of Alchohol Scale

Nursing Process Assessment CAGE Questionnaire** Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)?

Dual Diagnosis Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis Program combines special therapies that target both problems

Nursing Diagnosis Ineffective Denial related to weak, underdeveloped ego Outcome: client will demonstrate acceptance of responsibility for own behavior and acknowledge association between personal problems and use of substance(s)

Nursing Diagnosis (cont.) Ineffective Coping related to inadequate coping skills and weak ego Outcome: client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances)

Nursing Diagnosis (cont.) Imbalanced Nutrition less than Body Requirements/Deficient fluid volume related to drinking or taking drugs instead of eating Outcome: client will be free from signs or symptoms of malnutrition

Nursing Diagnosis (cont.) Risk for Infection related to malnutrition and altered immune condition Outcome: shows no signs or symptoms of infection

Nursing Diagnosis (cont.) Low Self-Esteem related to weak ego, lack of positive feedback Outcome: exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others

Nursing Diagnosis (cont.) Deficient Knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances Outcome: verbalizes importance of abstaining from use of substances to maintain optimal wellness

Planning/Implementation Detoxification (FYI, this will occur in an acute facility) Provide safe and supportive environment Administer substitution therapy

Planning/Implementation (cont.) Intermediate care Provide explanations of physical symptoms Promote understanding and identify causes of substance dependency Provide education and assistance to client and family

Planning/Implementation (cont.) Rehabilitation Encourage continued participation in long-term treatment Promote participation in outpatient support system Assist client to identify alternative sources of satisfaction Provide support for health promotion and maintenance Alcoholics Anonymous

Client/Family Education Nature of the illness Effects of (substance) on the body Alcohol Other CNS depressants Hallucinogens Inhalants Opioids Cannabinols Ways in which use of substance affects the individual’s life

Client/Family Education (cont.) Management of the illness Activities to substitute for (substance) in times of stress Relaxation techniques Progressive relaxation Tense and relax Deep breathing Autogenics Problem-solving skills Essentials of good nutrition

Client/Family Education (cont.) Support services Financial assistance Legal assistance Alcoholics Anonymous (or other support group specific to another substance) One-to-one support person

Nursing Process Evaluation Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care

Treatment Modalities Alcoholics Anonymous Is a major self-help organization for the treatment of alcoholism Based on the concept of Peer support Acceptance Understanding from others who have experienced the same problem Alcoholics Anonymous

Treatment Modalities (cont.) Alcoholics Anonymous (cont.) The 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety Total abstinence is promoted as the only cure; the person can never safely return to social drinking Alcoholics Anonymous

Treatment Modalities (cont.) Various support groups patterned after AA but for individuals with problems with other substances Disulfiram (Antabuse) Other medications for treatment of alcoholism Counseling Group therapy

Treatment Modalities (cont.) Psychopharmacology for substance intoxication and substance withdrawal Alcohol Benzodiazepines Anticonvulsants Multivitamin therapy Thiamine

Treatment Modalities (cont.) Psychopharmacology for substance intoxication and substance withdrawal (cont.) Opioids Narcotic antagonists Naloxone (Narcan) Naltrexone (ReVia) Nalmefene (Revex) Methadone Buprenorphine Clonidine

Treatment Modalities (cont.) Psychopharmacology for substance intoxication and substance withdrawal (cont.) CNS depressants Phenobarbital (Luminal) Long-acting benzodiazepines

Treatment Modalities (cont.) Psychopharmacology for substance intoxication and substance withdrawal (cont.) CNS stimulants Minor tranquilizers Major tranquilizers Anticonvulsants Antidepressants

Treatment Modalities (cont.) Psychopharmacology for substance intoxication and substance withdrawal (cont.) Hallucinogens and cannabinols Benzodiazepines Antipsychotics