00:00
So, again, this substance will intoxicate. And what do we see as symptoms of intoxication?
Well, not unlike other CNS depressants, we see that slurred speech, the person starts not
being able to relaying out what they are saying out right. And it's hard to understand
that kind of slurred speech. They may be uncoordinated. You might see them sort of
they almost look like they have had too much to drink, they might be swaying, they may
not be able to keep their eyes open, they may not be able to pay attention to what
you're saying, they lose that attention, and they have a hard time recalling things
because they are sedated and therefore they are not paying attention. What is memory
but being able to be paying attention in the moment and then recalling what you were
paying attention to. If you can't pay attention in the moment, then that memory starts
to fail you. When a person has too many sedatives, hypnotics, or anxiolytics, they can
fall into a stupor and then into a comma. How do we know if a person is beginning to show
signs of withdrawal? Well, what does the medication do? The medication is a depressant.
01:37
It actually is a sedative. It slows everything down. So when you stop taking it,
there is this rebound phenomena. So they have higher anxiety than they had before
they took the medication. They may have nausea, they may have vomiting, you will find
that they are sweating, insomnia, you will see those hand tremors, they may have
tachycardia so we expect to have their pulse go over 100. And during withdrawal from
sedative hypnotics and anxiolytics, they may have hallucinations and they may have
seizures. So what are our nursing interventions when a person presents with a substance
use disorder? Let's think about safety. Safety, safety, safety. So, as we want to establish
a safe environment, we want to look at that surroundings. We want to reduce any
stimulation in that environment. We want to reorient the patient to being here present.
02:50
You are now in the hospital. What is the year? What is your name? My name is... So
frequent, frequent reorientation. And we must continually assess their level of
consciousness. We want to make sure if there is any change in the level of consciousness,
we're ahead of the game. If delirium is setting in, we want to know if they are becoming
somnolent we want to know. And we want to make sure that we assess for any
hallucinations. We want to ask the question "Are there other things that you are seeing
that are causing you some distress? Can you hear other voices besides my own as I'm
speaking to you now? Do you have any feelings on your skin that are unusual? Are there
any smells that you are smelling that seem to be particularly pungent?" If we can do
these things, we are able to start establishing that safe environment. What do we see as
common nursing diagnosis for patients who have substance use disorders? Well, if the
patient says to you "Hey, I don't have a drinking problem." Or "Hey, I don't smoke much,
I only smoke when I drink." That patient is denying the fact they have a problem.
04:19
So that is denial. We expect a certain level of denial from our patients. Remember,
any one of these disorders come with a great deal of stigma and so a person wants to
deny that this is a problem that they are facing. Other people might say "Hey, I only use
my anxiolytics because I'm a little bit nervous and so it helps me relax so instead of
taking 1 a day, I'm taking 4." Well 4 is wrong, 4 is misused. And if you are taking 4
anxiolytics a day when you've been prescribed 1, you're demonstrating to us that you
are not coping well with your anxiety. So, sometimes what we see is ineffective coping,
a perfect nursing diagnosis for a person with substance use disorder.