Hi, my name is Jonna Jackson.
I am a registered nurse
and I am gonna talk to
you about Substance Abuse.
I am really excited to talk
to you about substance abuse.
That's been majority of my career working
in chemical dependency and substance abuse
and I know how important this
is for nurses to understand.
So substance abuse is a global
health issue. It effects people
all over the world. This
is important to remember
because sometimes we think that
substance abuse effect some people
more that it effects others.
But its really good to know
when you are thinking about substance
about that it can effect anyone.
Substance abuse can also have a
variety of physiological complications.
So it can result in problems
with your heart, with your lungs
and any of your other body systems.
Substance abuse is seen in a
variety of medical specialties
from OB to aging
to pediatrics. It's important for all
nurses to understand substance abuse
and our interventions to treat it.
Substance abuse is a disease. The disease
like diabetes, congestive heart failure
or any of the other 100s of the diseases
you spent the last few years knowing.
It's important to think
of this way so that you
remain non-judgmental and
an open to helping the patient.
So let's take a second and think about
it. Use our critical thinking skills.
Why might a nurse working with newborns
need to understand substance abuse?
It's important because if a
new baby is born to a mother
who suffers from addiction that child
will then have complications as a result.
So just because you are working in an
area that is as happy as OB
it's still important to understand
the basic concepts of substance abuse.
So let's start with key terms.
Key terms are important so that
you know how to talk to the patients about
incident that you pronouncing the word
correctly is that you understand the concepts.
Whenever you hear some of
these words during a lecture
you don't understand it, write
it down and look at that.
The more you do this,
the more you learn the words.
When you see these words,
write the definition
practice using the
words in a sentence,
and visualize yourself using these words as
if you are the nurse talking to a patient.
Let's talk about the difference
between substance use, substance abuse,
and substance dependence.
This is a continuum, a patient
could start with substance use
which can develop into substance
abuse and eventually into dependence.
Substance use is the occasional
use in social settings.
It does not effect the
activities of daily life.
Substance abuse is the recurrent use
that can result in legal problems
that you are to fulfill role obligations in
problems with school, work and family.
Substance dependence, can
develop into tolerance
withdrawal, using large
amounts in persistent abuse.
Now let's get into the nursing process.
The first part of the nursing
process as you know is assessment.
This point is really important
for you to know the
different drugs that are commonly abuse
so that you can identify and
better treat the patient.
Some classes of these drugs are: Cannabis,
Hallucinogens and Opiates.
Really take time to learn the
side effects of each of these drugs
so that you can treat the patient.
Now let's use our critical thinking skills.
You notice that many of the drug classes
have very similar or the same side effects.
For instance Cannabis and Hallucinogens
both have the side effect of Euphoria.
So how may a nurse be able to differentiate
which one the patient is intoxicated with?
If you read over the side effect,
you will see the bizarre behavior is
commonly associated with Hallucinogens
and this is drastically bizarre behavior
and usually it's fairly certain
that it is not Cannabis.
Now let's talk about withdrawal symptoms.
Each drug classification comes with a
unique set of side effects and symptoms
that a patient will exhibit
when coming down off the drug.
Alcohol, Opiates, Cocaine and Benzodiazepines
all have these unique set. But you will
see some similarities between them.
It's important to review these so that
you can find those unique 2 or 3
that you may only see
with that drug class.
Alcohol that has a withdrawal
time of 20-48 hours
comes with nausea, vomiting, diarrhea.
Benzodiazepines which has a
withdrawal time also 24-48 hours.
You will see dry mouth and headaches.
Opiates which has an onset of 24 hours
but can last for several days.
Comes with body aches, nasal
congestion and even yawning.
The yawning is pretty unique and that
should make pretty easy for you to notice
if it comes upon a test question.
Cocaine which can last for 2-4 days
comes with sleeplessness,
depression, and paranoia.
Medication Management: It's
important to know that we have a
huge toolbox that we use to help patient
suffering with substance dependence and use.
In this toolbox we have drugs that we use
to help a patient from comfortable
inner-suffering from withdrawals.
Or help the patient to struggling
with dependence not use anymore.
In the Opiate drug classification,
we have a variety of tools
because Opiate Addiction can be
really intense and so can't withdrawals.
The first of these drugs we will talk about
is Nalaxone. Normally referred to as Narcan.
Narcan is really important for
nurses to understand especially
you are working in emergency
rooms or aetna community setting.
If have a patient has overdosed on an
opioid, Narcan is used immediately to reverse
the respiratory depression. It
can be a life saving drug.
Next is the Nethadone.
Methadone isn't opioid, but unlike
some of the street drugs
Methadone has a long half life. Allowing
patients who are struggling with dependence
to only take it once a day
and not suffer from withdrawal.
Methadone is an important medication;
because, it keeps patients
healthy. It keep us known what they are
using and it helps them get off in medication.
Buprenorphine, sometimes referred
to as Suboxone or Subutex,
is very similar to Methadone
except it's generally
described as a thin or small tablets.
It reacts in a same way Methadone
does and that keeps the patient
from needing to use drugs and
manages a withdrawal symptoms.
Suboxone is really important;
because, Suboxone actually has
Naloxone/Narcan in it.
This prevents patients
from abusing this medication
and helps keep them healthy.
Treatment of Alcohol Addictions.
This drug class is pretty
difficult; because, we don't have
a medication like with Opiate Addiction.
That will substitute for the Alcohol.
Instead we help keep the patient comfortable
decrease their symptoms and
try to prevent for a good use.
Disulfiram, also known as
antabuse, is an important tool.
These deters the use of alcohol.
When taking daily, a patient
who also ingest alcohol will
then exhibits some very
uncomfortable side effects
like nausea and vomitting.
It's important for nurse who is caring
for patient under Dislfiram to know
that any product containing alcohol
will elicit that response.
So things like mouthwash can
actually make the patient sick.
Be careful to monitor the patient's intake
and use of alcohol in daily products.
Benzodiazepines are also used in alcohol addiction
to help ease the patient's discomfort.
Withdrawal from alcohol
can be very uncomfortable.
and benzodiazepines decrease
anxiety and stress related to that.
Now let's do a little critical thinking.
A patient arrives in the emergency room
apparently due to overdose
on a prescription narcotic
what do you think the nurse could do
first? What drug would you give first?
If you remember with
opiate addiction we treat
overdone with naloxone/narcan. This
reverses the respiratory depression
and saves life.
Now let's talk about some nursing diagnosis
that are appropriate with dealing with patient's
who are suffering from substance abuse, use or dependence.
Risk for injury and ineffective denial
are both in really important nursing diagnosis.
A patient who is abusing prescription
medication, for instance
is at increase risk of overdose.
So risk for injury is a priority nursing
diagnosis for the nursing care plans.
Ineffective denial is also important.
Sometimes it's difficult for patient to
see how these drugs are effecting their lives
and think that it's still manageable.
Unable to see that they are on a continuum have with
from substance use, abuse and now into dependence.
Make sure you are using the entire nursing
process in care for these patients. Assess,
diagnose, plan, implement, and then evaluate.
Now let's talk about nursing interventions.
It's not enough for the
nurse to identify which one.
It's important for the nurse to take action
to help make the patient more comfortable
ensure that they are safe and increase
the chances of better outcomes.
First the nurse should always
assess the mental status of patient
suffering from substance
abuse, use or dependence.
Checking that the oriented
to person, place and time
is vitally important to understand
how they treat whatever is going on.
Now let's talk about nursing interventions
that are related to therapeutic communication.
Conveying an attitude
acceptance and empathy,
remaining non judgmental, and encouraging
the verbalization of feelings,
are all really important when try
to develop the report of patients.
This allows patient to speak openly
with you about what's going on
give you a better insight
when have a treatment.
The next nursing interventions
are related to alternatives.
So exploring alternative coping
strategies is really important.
Patients who suffer from substance
use, abuse and dependence
use the drugs as the coping mechanism.
In order to encourage
positive coping mechanisms
spend time, getting to know the patient to
help find other ways if they can do this.
Tips for success. It's important when
you are going to take your test
to known the difference between
substance use, abuse and dependence.
Know the difference between
withdrawal and intoxication.
And know the commonly abused drugs like
cannabis, opiates, alcohol or cocaine.
When in doubt always assess,
diagnose, plan and then implement.
Frequent you get questions, asking
the nurse "what to do next?"
Make sure you are following
the order of the nursing process.
This is important because
you always want to assess
before taking action.
If given four options and
asking "what you do first?"
assess is always the correct answer.
This is true even in emergency situations.
You can't jump to conclusions about what to
do if you have not conducted an assessment.
Next if two answers feel correct
one of those is the right answer
to choose the most correct.
It's so common in nursing to
get two correct answers.
Spend time re-read the question
and the decide the one that is
most important and the most correct.
Lastly, opposites attract! So if
two answers are worded very
similarly may be one or
two words interchanged
the correct answer is
usually in those options.
Again re-read the question,
re-read the answers
and make the best guess.