Chapter 7

1. Chapter 7 Substance Abuse and Medical-Surgical Nursing

2. Terms • Substance abuse—excessive use of a chemical substance and the resulting physical and psychological dependence that interferes with life’s activities • Dependence—condition that causes a habitual, compulsive, and uncontrollable urge to use a substance • Substance use—taking a chemical for pleasure without dependence

3. Terms (Cont’d) • Substance misuse—use of chemicals for reasons other than their intended action • Addiction—negative outcomes after abusers stop using substances • Withdrawal syndrome—symptoms that may result if the drug is eliminated suddenly

4. Commonly Abused Substance Categories • Alcohol • Nicotine • Stimulants • Hallucinogens • Depressants • Opioids (narcotics)

5. Substance Abuse or Misuse and the Hospitalized Patient • Substance abuse is a documented nursing diagnosis when these criteria are met: • Loss of control in use of the drug • Ingesting the drug even though the drug has caused adverse conditions in the body • Demonstrating cognitive, behavioral, and physiologic disturbances with the abuse of drugs or inhalants

6. Substance Use and Abuse Among Nurses • Safeguard your own practice by demonstrating responsibility and accountable professional behaviors when giving medication. • Report any colleague to the board whom you suspect of substance use or abuse, even though it may be difficult. Public safety is your primary responsibility as a nurse.

7. Alcohol • At-risk drinking • Alcoholism • Alcohol abuse • Assessment: • Blood alcohol level (BAL)—0.08 legal limit • CAGE questionnaire and T-ACE • Withdrawal—delirium tremens (DTs)

8. Nicotine • Cigarettes, pipe tobacco, chewing tobacco, spit tobacco • Second-hand smoke • Smoking cessation programs • Pharmacologic interventions

9. Stimulants • Stimulants are drugs that excite the cerebral cortex of the brain, such as caffeine, nicotine, amphetamines, and methamphetamines. • Agents that are illicit and abused stimulants are “crack” cocaine and illegally produced methamphetamines.

10. Amphetamines and Methamphetamines • Amphetamines are stimulants that increase the body’s activities. • Effective in the treatment of ADHD. • Use results in heightened energy, excitement, relief of fatigue, decreased appetite, insomnia, aggression, and a tendency toward menstrual problems in women. • A safe environment is the priority in cases of overdose or withdrawal.

11. Methamphetamine (Desoxyn) • Methamphetamine is more powerful and addictive than amphetamines. • Methamphetamine results in release of high levels of the neurotransmitter dopamine. • Symptoms of parkinsonism can be found in long-term users. • Life-threatening conditions can occur such as hyperthermia and convulsions.

12. Cocaine • Physiologic action of cocaine is the interference with the reabsorption process of dopamine. • Cocaine use is severely addicting, with psychological and physiologic dependence resulting.

13. Cocaine (Cont’d) • Even moderate use will create increased alertness, euphoria, anorexia, high blood pressure, increased heart rate, and dilated pupils. • Nursing interventions are necessary for overdose or withdrawal. • Assess for signs of depression and potential suicide gestures during the withdrawal period.

14. Hallucinogens and Related Compounds • Hallucinogens are chemical substances that possess mind-altering or mental perception-altering properties: • Lysergic acid (LSD) • Phencyclidine (PCP) • Ketamine • 3,4-Methylenedioxymethamphetamine (Ecstasy) • Marijuana

15. Marijuana • Sometimes used experimentally for chronic pain control • Affects critical thinking skills related to attention, memory, and learning • Frequent long-term use can cause upper respiratory system weakness

16. Marijuana (Cont’d) • High doses can cause: • Paranoia • Restlessness • Anxiety attacks • Panic attacks • Increased appetite • Impaired coordination • Altered perceptions

17. Depressants • Reduce the activity of the CNS • Benzodiazepines • Barbiturates • Therapeutically used to treat anxiety and emotional disorders and to aid sleep • Nursing care focused on assessment of signs and symptoms associated with withdrawal or overdose

18. Gamma-Hydroxybutyrate (GHB) • GHB is another “date rape” or club drug called “liquid ecstasy.” • Small amounts reduce social inhibitions and increase libido. • Results of high doses can range from dizziness to death, especially when combined with alcohol.

19. Gamma-Hydroxybutyrate (GHB) (Cont’d) • Nursing assessment looks for signs and symptoms of overdose, including respiratory depression, memory loss, bradycardia, muscular fatigue, and coma.

20. Barbiturates • Drugs that depress the CNS can create dependency with use over a short period of time. • Initial withdrawal symptoms include anxiety, restlessness, insomnia, irritability, and impaired attention. • Chronic use can result in more severe symptoms. • Toxic or overdose symptoms can be life threatening.

21. Opioids (Narcotics) • Narcotics include codeine, morphine, heroin, methadone, hydromorphone, meperidine, and oxycodone—drugs made from the Asian poppy or synthetically produced drugs that will render the same effect as the opium plant. • A high potential for addiction, tolerance, and dependence occurs with abuse of this class of drug.

22. Opioids (Narcotics) (Cont’d) • Withdrawal symptoms can range from mild to life threatening and death: • Grade 0—drug craving, anxiety, and drug-seeking behaviors • Grade 1—yawning, sweating, lacrimation, and rhinorrhea (“runny nose”) • Grade 2—mydriasis, gooseflesh, muscle twitching, and anorexia • Grade 3—increased pulse, respiratory rate, and blood pressure; abdominal cramps; diarrhea; vomiting; and weakness

23. Inhalants • Inhalants are breathable chemical vapors that produce psychoactive effects. • Solvents produce a high when inhaled. • Gases are a source of inhalants. • Nitrites are a source of inhalants: • Cyclohexyl nitrite • Amyl nitrite • Butyl nitrite

24. Inhalants (Cont’d) • Sniffing highly concentrated chemicals can result in death from cardiac failure or suffocation.

25. Steroids • Anabolic steroids are used in muscle building to increase strength and performance. • An increased feeling of aggression comes with the use of steroids. • Steroids may cause mental illness as the result of mood disturbances. • Discontinuation of steroids can result in depression.