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Chapter 7Chapter 7

Substance Abuse and Substance Abuse and Medical-Surgical NursingMedical-Surgical Nursing

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Terms Terms

Substance abuseSubstance abuse——excessive use of a excessive use of a chemical substance and the resulting chemical substance and the resulting physical and psychological dependence physical and psychological dependence that interferes with life’s activitiesthat interferes with life’s activities

DependenceDependence——condition that causes a condition that causes a habitual, compulsive, and uncontrollable habitual, compulsive, and uncontrollable urge to use a substanceurge to use a substance

Substance useSubstance use——taking a chemical for taking a chemical for pleasure without dependencepleasure without dependence

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Terms (Cont’d)Terms (Cont’d)

Substance misuseSubstance misuse——use of chemicals for use of chemicals for reasons other than their intended actionreasons other than their intended action

AddictionAddiction——negative outcomes after negative outcomes after abusers stop using substancesabusers stop using substances

Withdrawal syndromeWithdrawal syndrome——symptoms that symptoms that may result if the drug is eliminated may result if the drug is eliminated suddenlysuddenly

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Commonly Abused Substance Commonly Abused Substance CategoriesCategories

AlcoholAlcohol NicotineNicotine StimulantsStimulants HallucinogensHallucinogens DepressantsDepressants Opioids (narcotics)Opioids (narcotics)

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Substance Abuse or Misuse and Substance Abuse or Misuse and the Hospitalized Patientthe Hospitalized Patient

Substance abuse is a documented nursing Substance abuse is a documented nursing diagnosis when these criteria are met:diagnosis when these criteria are met: Loss of control in use of the drugLoss of control in use of the drug Ingesting the drug even though the drug has Ingesting the drug even though the drug has

caused adverse conditions in the bodycaused adverse conditions in the body Demonstrating cognitive, behavioral, and Demonstrating cognitive, behavioral, and

physiologic disturbances with the abuse of physiologic disturbances with the abuse of drugs or inhalantsdrugs or inhalants

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Substance Use and Abuse Among Substance Use and Abuse Among NursesNurses

Safeguard your own practice by Safeguard your own practice by demonstrating responsibility and demonstrating responsibility and accountable professional behaviors when accountable professional behaviors when giving medication.giving medication.

Report any colleague to the board whom Report any colleague to the board whom you suspect of substance use or abuse, you suspect of substance use or abuse, even though it may be difficult. Public even though it may be difficult. Public safety is your primary responsibility as a safety is your primary responsibility as a nurse.nurse.

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Alcohol Alcohol

At-risk drinkingAt-risk drinking AlcoholismAlcoholism Alcohol abuseAlcohol abuse Assessment:Assessment:

Blood alcohol level (BAL)—0.08 legal limitBlood alcohol level (BAL)—0.08 legal limit CAGE questionnaire and T-ACECAGE questionnaire and T-ACE WithdrawalWithdrawal——delirium tremens (DTs)delirium tremens (DTs)

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Nicotine Nicotine

Cigarettes, pipe tobacco, chewing Cigarettes, pipe tobacco, chewing tobacco, spit tobaccotobacco, spit tobacco

Second-hand smokeSecond-hand smoke Smoking cessation programsSmoking cessation programs Pharmacologic interventionsPharmacologic interventions

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StimulantsStimulants

Stimulants are drugs that excite the Stimulants are drugs that excite the cerebral cortex of the brain, such as cerebral cortex of the brain, such as caffeine, nicotine, amphetamines, and caffeine, nicotine, amphetamines, and methamphetamines.methamphetamines.

Agents that are illicit and abused Agents that are illicit and abused stimulants are “crack” cocaine and illegally stimulants are “crack” cocaine and illegally produced methamphetamines.produced methamphetamines.

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Amphetamines and Amphetamines and MethamphetaminesMethamphetamines

Amphetamines are stimulants that Amphetamines are stimulants that increase the body’s activities.increase the body’s activities.

Effective in the treatment of ADHD.Effective in the treatment of ADHD. Use results in heightened energy, Use results in heightened energy,

excitement, relief of fatigue, decreased excitement, relief of fatigue, decreased appetite, insomnia, aggression, and a appetite, insomnia, aggression, and a tendency toward menstrual problems in tendency toward menstrual problems in women.women.

A safe environment is the priority in cases A safe environment is the priority in cases of overdose or withdrawal.of overdose or withdrawal.

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Methamphetamine (Desoxyn)Methamphetamine (Desoxyn)

Methamphetamine is more powerful and Methamphetamine is more powerful and addictive than amphetamines.addictive than amphetamines.

Methamphetamine results in release of Methamphetamine results in release of high levels of the neurotransmitter high levels of the neurotransmitter dopamine.dopamine.

Symptoms of parkinsonism can be found Symptoms of parkinsonism can be found in long-term users.in long-term users.

Life-threatening conditions can occur such Life-threatening conditions can occur such as hyperthermia and convulsions.as hyperthermia and convulsions.

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CocaineCocaine

Physiologic action of cocaine is the Physiologic action of cocaine is the interference with the reabsorption process interference with the reabsorption process of dopamine.of dopamine.

Cocaine use is severely addicting, with Cocaine use is severely addicting, with psychological and physiologic dependence psychological and physiologic dependence resulting.resulting.

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Cocaine (Cont’d)Cocaine (Cont’d)

Even moderate use will create increased Even moderate use will create increased alertness, euphoria, anorexia, high blood alertness, euphoria, anorexia, high blood pressure, increased heart rate, and dilated pressure, increased heart rate, and dilated pupils.pupils.

Nursing interventions are necessary for Nursing interventions are necessary for overdose or withdrawal.overdose or withdrawal.

Assess for signs of depression and Assess for signs of depression and potential suicide gestures during the potential suicide gestures during the withdrawal period.withdrawal period.

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Hallucinogens and Related Hallucinogens and Related CompoundsCompounds

Hallucinogens are chemical substances Hallucinogens are chemical substances that possess mind-altering or mental that possess mind-altering or mental perception-altering properties:perception-altering properties: Lysergic acid (LSD)Lysergic acid (LSD) Phencyclidine (PCP)Phencyclidine (PCP) KetamineKetamine 3,4-Methylenedioxymethamphetamine 3,4-Methylenedioxymethamphetamine

(Ecstasy)(Ecstasy) MarijuanaMarijuana

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MarijuanaMarijuana

Sometimes used experimentally for Sometimes used experimentally for chronic pain controlchronic pain control

Affects critical thinking skills related to Affects critical thinking skills related to attention, memory, and learningattention, memory, and learning

Frequent long-term use can cause upper Frequent long-term use can cause upper respiratory system weaknessrespiratory system weakness

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Marijuana (Cont’d)Marijuana (Cont’d)

High doses can cause:High doses can cause: ParanoiaParanoia RestlessnessRestlessness Anxiety attacks Anxiety attacks Panic attacksPanic attacks Increased appetiteIncreased appetite Impaired coordinationImpaired coordination Altered perceptionsAltered perceptions

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DepressantsDepressants

Reduce the activity of the CNSReduce the activity of the CNS BenzodiazepinesBenzodiazepines BarbituratesBarbiturates Therapeutically used to treat anxiety and Therapeutically used to treat anxiety and

emotional disorders and to aid sleepemotional disorders and to aid sleep Nursing care focused on assessment of Nursing care focused on assessment of

signs and symptoms associated with signs and symptoms associated with withdrawal or overdosewithdrawal or overdose

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Gamma-Hydroxybutyrate (GHB)Gamma-Hydroxybutyrate (GHB)

GHB is another “date rape” or club drug GHB is another “date rape” or club drug called “liquid ecstasy.”called “liquid ecstasy.”

Small amounts reduce social inhibitions Small amounts reduce social inhibitions and increase libido.and increase libido.

Results of high doses can range from Results of high doses can range from dizziness to death, especially when dizziness to death, especially when combined with alcohol.combined with alcohol.

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Gamma-Hydroxybutyrate (GHB) Gamma-Hydroxybutyrate (GHB) (Cont’d)(Cont’d)

Nursing assessment looks for signs and Nursing assessment looks for signs and symptoms of overdose, including symptoms of overdose, including respiratory depression, memory loss, respiratory depression, memory loss, bradycardia, muscular fatigue, and coma.bradycardia, muscular fatigue, and coma.

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BarbituratesBarbiturates

Drugs that depress the CNS can create Drugs that depress the CNS can create dependency with use over a short period dependency with use over a short period of time.of time.

Initial withdrawal symptoms include Initial withdrawal symptoms include anxiety, restlessness, insomnia, irritability, anxiety, restlessness, insomnia, irritability, and impaired attention.and impaired attention.

Chronic use can result in more severe Chronic use can result in more severe symptoms.symptoms.

Toxic or overdose symptoms can be life Toxic or overdose symptoms can be life threatening.threatening.

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Opioids (Narcotics)Opioids (Narcotics)

Narcotics include codeine, morphine, Narcotics include codeine, morphine, heroin, methadone, hydromorphone, heroin, methadone, hydromorphone, meperidine, and oxycodone—drugs made meperidine, and oxycodone—drugs made from the Asian poppy or synthetically from the Asian poppy or synthetically produced drugs that will render the same produced drugs that will render the same effect as the opium plant.effect as the opium plant.

A high potential for addiction, tolerance, A high potential for addiction, tolerance, and dependence occurs with abuse of this and dependence occurs with abuse of this class of drug.class of drug.

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Opioids (Narcotics) (Cont’d)Opioids (Narcotics) (Cont’d)

Withdrawal symptoms can range from mild Withdrawal symptoms can range from mild to life threatening and death:to life threatening and death: Grade 0Grade 0——drug craving, anxiety, and drug-drug craving, anxiety, and drug-

seeking behaviorsseeking behaviors Grade 1Grade 1——yawning, sweating, lacrimation, and yawning, sweating, lacrimation, and

rhinorrhea (“runny nose”)rhinorrhea (“runny nose”) Grade 2Grade 2——mydriasis, gooseflesh, muscle mydriasis, gooseflesh, muscle

twitching, and anorexiatwitching, and anorexia Grade 3Grade 3——increased pulse, respiratory rate, increased pulse, respiratory rate,

and blood pressure; abdominal cramps; and blood pressure; abdominal cramps; diarrhea; vomiting; and weaknessdiarrhea; vomiting; and weakness

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InhalantsInhalants

Inhalants are breathable chemical vapors Inhalants are breathable chemical vapors that produce psychoactive effects.that produce psychoactive effects.

Solvents produce a high when inhaled.Solvents produce a high when inhaled. Gases are a source of inhalants.Gases are a source of inhalants. Nitrites are a source of inhalants:Nitrites are a source of inhalants:

Cyclohexyl nitriteCyclohexyl nitrite Amyl nitriteAmyl nitrite Butyl nitriteButyl nitrite

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Inhalants (Cont’d)Inhalants (Cont’d)

Sniffing highly concentrated chemicals can Sniffing highly concentrated chemicals can result in death from cardiac failure or result in death from cardiac failure or suffocation.suffocation.

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SteroidsSteroids

Anabolic steroids are used in muscle Anabolic steroids are used in muscle building to increase strength and building to increase strength and performance. performance.

An increased feeling of aggression comes An increased feeling of aggression comes with the use of steroids.with the use of steroids.

Steroids may cause mental illness as the Steroids may cause mental illness as the result of mood disturbances.result of mood disturbances.

Discontinuation of steroids can result in Discontinuation of steroids can result in depression.depression.