1. Slide 1 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Chapter 36 Care of the Patient with an Addictive Personality 2 - Assessment - Diagnostic Tests - Nursing Diagnoses - Nursing Interventions - Rehabilitation Chapter 36 Care of the Patient with an Addictive Personality 2 - Assessment - Diagnostic Tests - Nursing Diagnoses - Nursing Interventions - Rehabilitation

2. Slide 2 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment Subjective Data  Normal using or drinking pattern  Date and time of the last drink or use of a drug  Specific substance and the quantity used  Complaints of nausea, indigestion, sleep disturbance, or pain may indicate another disease process occurring  Normal dietary patterns  Presence of any disease requiring treatment with prescribed medications  Regular use of over-the-counter drugs  Drug allergies

3. Slide 3 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment Subjective Data – cont’d  History of tremors, hallucinations, delusions, Sz & DTs  Problems with occupation, family, legal matters  Family history of substance dependency  Denial is very strong in person with untreated substance abuse or dependence

4. Slide 4 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment: CAGE Questions 1. Have you ever felt you ought to cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or for your hangover? (i.e. eye opener) Two or more affirmations to these questions indicates probable alcoholism

5. Slide 5 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment Objective Data  Height, weight, vital signs, and physical assessment  Presence of tremors  Skin conditions Needle tracks and small scabs on the forearms, backs of hands, and insteps indicate IV use Acne-like facial rash related to MDMA (ecstasy) use  Frequent sniffing, stuffy nose, or harsh nonproductive cough related to drug use  Tachycardia, hypertension, petechiae, and neuropathies  Presence of ascites, positive urine or blood sample or drugs or alcohol should alert the nurse to take further history

6. Slide 6 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Diagnostic Tests Blood and urine tests will screen for toxins. Some foods can cause a false-positive reading in a urine screen (poppy seeds)  Person ate a poppy seed roll and later gave a urine for drug screen, it could test positive for heroin Abnormalities in blood test can be directly related to alcoholism  Liver enzymes, hypoglycemia, blood protein levels, and magnesium maybe decreased Anemia and poor nutrition Hepatitis and HIV

7. Slide 7 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Diagnosis Nursing diagnoses and interventions for the patient with an addiction include emotional needs as well as physical needs Table 36-4, pg 1168 Physical needsEmotional needsEducational needs Ineffective airway clearance Ineffective copingDeficient knowledge Activity intoleranceIneffective denialDisturbed personal identity Risk for fallsAnticipatory grieving noncompliance

8. Slide 8 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions Detoxification  Removal of poisonous effects of a substance  A controlled setting where the patient can be closely observed and treated for complications Medication to reduce withdrawal symptoms  Chlordiazepoxide (Librium)  Naltrexone (ReVia)  Safety of a patient is primary concern Patient is intoxicated, maintain patent airway Side lying position and oral suction if oral secretions or vomiting may be aspirated

9. Slide 9 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions Detoxification – cont’d  IV fluids administered to correct fluids and electrolyte balance  Institute facilities seizure precaution Padded side rails, floor pads, moving patient to a room near nurse’s station  Tremors, nervousness, and restlessness are treated with chlordiazepoxide (Librium) or naltrexone (Revia) Give doses on time Reduce environment stimuli

10. Slide 10 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions Detoxification (continued)  Cardiorespiratory distress Occur from stimulant abuse Beta-adrenergic agents like propranolol (Inderal) and calcium blockers like nifedipine (Procardia) and oxygen Continuous cardiac monitoring; vital signs  Maintain therapeutic communication. Simple explanations; speaking in a calm voice Use therapeutic conversation techniques to assist patient in self realization Reinforce teaching about disease concept of addiction Confront denial in nonjudgmental manner Encourage family to participate in planning for sobriety

11. Slide 11 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions Detoxification (continued)  Extremely restless patient Physician may order magnesium sulfate to raise seizure threshold or another anticonvulsant like phenytoin (Dilantin)  Reorient as needed. Disorientation may occur, especially at night. Night lights in the room and frequent nurse visits Notify supervisor if patient appears fearful or panicky and can not be reoriented Physical restraint may escalate aggressive behavior but needed if patient could harm self or others Provide physical care as needed.  Encourage proper nutrition: give thiamine and vitamins

12. Slide 12 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Rehabilitation After detoxification, the acute phase of recovery, rehabilitation starts Object of treatment  Assist patient to abstain from substance abuse  No cure, abstinence is the control of disease Disulfiram (Antabuse) given to encourage abstinence  Causes facial flushing, nausea, tachycardia, dyspnea, dizziness, confusion when alcohol is consumed  Purpose is to reduce alcohol by aversion

13. Slide 13 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Rehabilitation Group Therapy  Provides a caring, emotionally supportive atmosphere  Helps patient see the relationship of substance abuse and negative consequences in his or her life  Group can point out negative defense mechanisms like denial or displacement and offer solutions  Families are encouraged to attend support groups  Continued after completion of inpatient program

14. Slide 14 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Rehabilitation Alcoholics Anonymous  International nonprofit organization, 1935  Abstinent alcoholics helping other alcoholics to become and stay sober through group support, shared experiences, and faith in a power greater than themselves  Foundation of AA is a 12-step program that assists the dependent person in admitting powerlessness over alcohol; box 36-2, pg 1170

15. Slide 15 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Rehabilitation Residential Treatment Centers  Provide detoxification without direct medical intervention  Provide close physical monitoring by trained nurses, counselors, and recovered peers  After detoxification, the patient is placed in a drug- and alcohol-free residence  Goal: to rebuild social skills that do not involve drug use as primary method of interaction  Length of stay 1 to 6 months  Ability-to-pay basis

16. Slide 16 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Rehabilitation Pain Management  It can involve the use of addicting substances.  Regimen of effective pain management using combinations of nonopioid, opioid, and antianxiety agents with nonchemical interventions  Nursing interventions require not only careful assessment of pain but also observation for developing patterns of drug-seeking behavior.  Encouraging the patient to practice and use nonchemical interventions to ease pain will reduce the risk of chemical dependency for relief.