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Substance Abuse

by Joanna Jackson
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    00:01 Hi, my name is Jonna Jackson. I am a registered nurse and I am gonna talk to you about Substance Abuse.

    00:08 I am really excited to talk to you about substance abuse.

    00:10 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.

    00:17 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.

    00:36 Substance abuse can also have a variety of physiological complications.

    00:40 So it can result in problems with your heart, with your lungs and any of your other body systems.

    00:48 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.

    01:04 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.

    01:13 It's important to think of this way so that you remain non-judgmental and an open to helping the patient.

    01:21 So let's take a second and think about it. Use our critical thinking skills.

    01:25 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.

    01:38 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.

    01:48 So let's start with key terms.

    01:50 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.

    01:58 Whenever you hear some of these words during a lecture you don't understand it, write it down and look at that.

    02:04 The more you do this, the more you learn the words.

    02:08 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.

    02:19 Let's talk about the difference between substance use, substance abuse, and substance dependence.

    02:26 This is a continuum, a patient could start with substance use which can develop into substance abuse and eventually into dependence.

    02:35 Substance use is the occasional use in social settings.

    02:39 It does not effect the activities of daily life.

    02:43 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.

    02:55 Substance dependence, can develop into tolerance withdrawal, using large amounts in persistent abuse.

    03:03 Now let's get into the nursing process.

    03:05 The first part of the nursing process as you know is assessment.

    03:10 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.

    03:19 Some classes of these drugs are: Cannabis, Depressants, Stimulants, Hallucinogens and Opiates.

    03:28 Really take time to learn the side effects of each of these drugs so that you can treat the patient.

    03:35 Now let's use our critical thinking skills.

    03:38 You notice that many of the drug classes have very similar or the same side effects.

    03:42 For instance Cannabis and Hallucinogens both have the side effect of Euphoria.

    03:47 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.

    04:05 Now let's talk about withdrawal symptoms.

    04:08 Each drug classification comes with a unique set of side effects and symptoms that a patient will exhibit when coming down off the drug.

    04:16 Alcohol, Opiates, Cocaine and Benzodiazepines all have these unique set. But you will see some similarities between them.

    04:24 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.

    04:31 Alcohol that has a withdrawal time of 20-48 hours comes with nausea, vomiting, diarrhea.

    04:40 Benzodiazepines which has a withdrawal time also 24-48 hours.

    04:46 You will see dry mouth and headaches.

    04:48 Opiates which has an onset of 24 hours but can last for several days.

    04:54 Comes with body aches, nasal congestion and even yawning.

    04:58 The yawning is pretty unique and that should make pretty easy for you to notice if it comes upon a test question.

    05:05 Cocaine which can last for 2-4 days comes with sleeplessness, depression, and paranoia.

    05:12 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.

    05:21 In this toolbox we have drugs that we use to help a patient from comfortable inner-suffering from withdrawals.

    05:27 Or help the patient to struggling with dependence not use anymore.

    05:32 In the Opiate drug classification, we have a variety of tools because Opiate Addiction can be really intense and so can't withdrawals.

    05:40 The first of these drugs we will talk about is Nalaxone. Normally referred to as Narcan.

    05:45 Narcan is really important for nurses to understand especially you are working in emergency rooms or aetna community setting.

    05:53 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.

    06:02 Next is the Nethadone.

    06:04 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.

    06:17 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.

    06:27 Buprenorphine, sometimes referred to as Suboxone or Subutex, is very similar to Methadone except it's generally described as a thin or small tablets.

    06:37 It reacts in a same way Methadone does and that keeps the patient from needing to use drugs and manages a withdrawal symptoms.

    06:45 Suboxone is really important; because, Suboxone actually has Naloxone/Narcan in it. This prevents patients from abusing this medication and helps keep them healthy.

    06:58 Treatment of Alcohol Addictions.

    07:00 This drug class is pretty difficult; because, we don't have a medication like with Opiate Addiction.

    07:05 That will substitute for the Alcohol.

    07:09 Instead we help keep the patient comfortable decrease their symptoms and try to prevent for a good use.

    07:15 Disulfiram, also known as antabuse, is an important tool.

    07:20 These deters the use of alcohol.

    07:23 When taking daily, a patient who also ingest alcohol will then exhibits some very uncomfortable side effects like nausea and vomitting.

    07:31 It's important for nurse who is caring for patient under Dislfiram to know that any product containing alcohol will elicit that response.

    07:39 So things like mouthwash can actually make the patient sick.

    07:43 Be careful to monitor the patient's intake and use of alcohol in daily products.

    07:51 Benzodiazepines are also used in alcohol addiction to help ease the patient's discomfort.

    07:57 Withdrawal from alcohol can be very uncomfortable.

    08:01 and benzodiazepines decrease anxiety and stress related to that.

    08:04 Now let's do a little critical thinking.

    08:07 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.

    08:28 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.

    08:37 Risk for injury and ineffective denial are both in really important nursing diagnosis.

    08:42 A patient who is abusing prescription medication, for instance is at increase risk of overdose.

    08:48 So risk for injury is a priority nursing diagnosis for the nursing care plans.

    08:53 Ineffective denial is also important.

    08:56 Sometimes it's difficult for patient to see how these drugs are effecting their lives and think that it's still manageable.

    09:02 Unable to see that they are on a continuum have with from substance use, abuse and now into dependence.

    09:09 Make sure you are using the entire nursing process in care for these patients. Assess, diagnose, plan, implement, and then evaluate.

    09:19 Now let's talk about nursing interventions.

    09:22 It's not enough for the nurse to identify which one.

    09:25 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.

    09:32 First the nurse should always assess the mental status of patient suffering from substance abuse, use or dependence.

    09:38 Checking that the oriented to person, place and time is vitally important to understand how they treat whatever is going on.

    09:46 Now let's talk about nursing interventions that are related to therapeutic communication.

    09:50 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.

    10:02 This allows patient to speak openly with you about what's going on give you a better insight when have a treatment.

    10:10 The next nursing interventions are related to alternatives.

    10:14 So exploring alternative coping strategies is really important.

    10:18 Patients who suffer from substance use, abuse and dependence use the drugs as the coping mechanism.

    10:24 In order to encourage positive coping mechanisms spend time, getting to know the patient to help find other ways if they can do this.

    10:36 Tips for success. It's important when you are going to take your test to known the difference between substance use, abuse and dependence.

    10:46 Know the difference between withdrawal and intoxication.

    10:50 And know the commonly abused drugs like cannabis, opiates, alcohol or cocaine.

    10:57 When in doubt always assess, diagnose, plan and then implement.

    11:03 Frequent you get questions, asking the nurse "what to do next?" Make sure you are following the order of the nursing process.

    11:11 This is important because you always want to assess before taking action.

    11:17 If given four options and asking "what you do first?" assess is always the correct answer.

    11:25 This is true even in emergency situations.

    11:27 You can't jump to conclusions about what to do if you have not conducted an assessment.

    11:33 Next if two answers feel correct one of those is the right answer to choose the most correct.

    11:41 It's so common in nursing to get two correct answers.

    11:45 Spend time re-read the question and the decide the one that is most important and the most correct.

    11:53 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.

    12:04 Again re-read the question, re-read the answers and make the best guess.


    About the Lecture

    The lecture Substance Abuse by Joanna Jackson is from the course Psychosocial Integrity. It contains the following chapters:

    • Substance Abuse
    • Withdrawal Symptoms
    • Nursing Diagnosis

    Author of lecture Substance Abuse

     Joanna Jackson

    Joanna Jackson


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