Nurses Role On Substance Abuse By Philo


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Nurses Role on Substance Abuse. Prepared & Presented by Philomina Arnold @ NIMHANS, Bnagalore

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Nurses Role On Substance Abuse By Philo

  1. 1. NURSES ROLE ON SUBSTANCE ABUSE PRESENTED BY : PHILOMINA Staff Nurse De-Addiction Centre NIMHANS Nurses role on substance 1 Abuse
  2. 2. What is Substance Abuse? When substances are taken for reasons other than medical, wrong use, too much, too often, too long or in a wrong combination with certain other drugs to enhance the overall effect ( Physical/ Mental/ Social/ Financial) it becomes substance Abuse Nurses role on substance 2 Abuse
  3. 3. Substances abused by the patients • Alcohol • Depressants • Cannabis • Opoids Nurses role on substance 3 Abuse
  4. 4. Stimulants • Drugs - Amphetamine, Cocaine & Caffeine • Solvents – Glue, Paint Thinner, Insecticides, Chloroform, NO2 • Nicotine – Cigarettes, Pann Snuff Nurses role on substance 4 Abuse
  5. 5. Hallucinogens • Both natural and synthetic substances – that produce illusions, Delusions, hallucinations Example: LSD Nurses role on substance 5 Abuse
  6. 6. Cases admitted in De-Addiction Centre • ADS with simple withdrawal symptoms like tremors, PR, Sleep • ADS with complicated withdrawal symptoms like Delusion, illusion, hallucinations, delirium tremens, seizures. • Alcohol with Physical illness like Gastritis, HTN, Diabetes, TB, HIV, Cardiovascular diseases, Neuropathy, Liver diseases. • Substances with Psychiatric illness like Depression, Suicide, Anxiety, Schizophrenia, Phobic disorders. Nurses role on substance 6 Abuse
  7. 7. Cases Admitted….. • Cannabis induced Psychosis / Cannabis dependence. • Solvent Abuse • Poly substance abuse like alcohol with combination of other drugs, Multiple drug abuse. Nurses role on substance 7 Abuse
  8. 8. Activities Performed By a Nurse on Admission • Meeting the Basic needs. • Developing therapeutic relationship. • Carefully monitoring the vitals. • Collecting comprehensive history. • General Physical Examination & Mental status examination. • Explain about ward rules, regulations, Charges & activities. • Lab Investigations • Carrying out stat medications like Inj. Thiamine, HPL, LZM etc.. Nurses role on substance 8 Abuse
  9. 9. Activities on Admission … • Measuring the toxicity of the alcohol by using the Intoximeter or Breath Analyzer. • Measuring the substances in Urine by using various cassettes like THC, BZO, amphetamine, cocaine, opioids etc. Nurses role on substance 9 Abuse
  10. 10. Treatment options Treatment Model Tertiary Primary Secondary Prevention Prevention Prevention (Inpatient Activities (Community (Out patient detoxification Services) Services) and rehabilitation) Nurses role on substance 10 Abuse
  11. 11. Activities • A) Group Therapies – Conducted by Psychiatric social Workers, attended and supervised by Nursing staff. * Relapse Prevention Skills * Motivation * Triggers of craving and how to handle it. * Problem solving techniques * Developing activity plan. * Planning substance free life. Nurses role on substance 11 Abuse
  12. 12. Activities • B) Self help groups like AA, NA. • C) Daily Ward Activities * Exercise * Entertainment Programs * Spiritual Activities • Health Education on complications and management of substance abuse. Nurses role on substance 12 Abuse
  13. 13. Primary Prevention • Personal Hygiene. • Health related problems with substances. • Nutrition. Nurses role on substance 13 Abuse
  14. 14. Secondary Prevention • Referrals to Cardiologist. • Referrals to Diabetologist/ Endocrinologist. • Referrals to Physician • Referrals to Surgeon. • Referrals to Ortho • Referrals to Dermatologist • Referrals to Ophthalmologist Etc.. Nurses role on substance 14 Abuse
  15. 15. Tertiary Prevention (Detoxification & Rehabilitation) • Detoxification *Medicines used BZD like long acting DZM & Librium. *Provide safe and supportive environment. * Symptomatic Treatment. • Rehabilitation * Encourage participation in long term plan. * Assist in identifying alternative sources of satisfaction. * Provide support for health promotion and maintenance. * Talk with the family. • Other Needs * Dressings * Investigations. * Referrals (TCC, OCTD & BT) Nurses role on substance 15 Abuse
  16. 16. Withdrawal Symptoms and Nursing Management Depressants 1)Alcohol With in 6 – 8 Hrs - Tremors, anxiety, A) Monitoring vital signs restlessness, insomnia. B) Vigilant for manifestations of shock, cardiac arrhythmias, electrolyte With in 2 – 3 Days - Disorientation, imbalance Abdominal pain, nausea, Increased BP, C) IV fluids to prevent dehydration - Inj. TPR & AV Thiamineir before starting the dextrose. D) BZD treatment like long acting DZZM, Librium & short acting LZM. Later - Risk for cardiac arrhythmias, E) Close Medical Supervision. hypertension, increased respiration, F) Promoting safe calm & comfort profuse sweating, insomnia etc. environment. G) address the patient about health effects of alcohol. Nurses role on substance 16 Abuse
  17. 17. Withdrawal Symptoms and Nursing Management… 2) Cannabis Euphoria, mood change, memory impairment, tremors, Increased BP, HR, Decreased Temperature A) Monitoring patient's physical & emotional responses to the drug. B) Arrange family member to stay with the family. C) Provide re-assurance talk to the patient during anxiety. Nurses role on substance 17 Abuse
  18. 18. Withdrawal Symptoms and Nursing Management… 3) Opioids Anxiety, lacrimation, dilated pupil, A) Monitoring withdrawal flowing nose, goose flesh symptoms using clinical (Piloerection), insomnia, Body opioid withdrawal scale. aches, diarrhea. B) Providing rest, Nutrition & comfortable environment. C) Establish on Airway. D) Monitoring cardiac functioning. E) Maintaining hydration. F) Giving detoxification treatment using clonidine or buprenorphine. G) Nutritional support Nurses role on substance 18 Abuse
  19. 19. Withdrawal Symptoms and Nursing Management… Stimulants 1) Caffeine Sleep disturbance, mood change, Giving orientation about the increased urine out put, anxiety, withdrawals of excessive panic, headache, caffeine's use. Gastrointestinal discomfort. 2) Cocaine A) Management of delirium respiratory distress. B) Intensive monitoring if any Depression, Euphoria, Craving, medical problems. suicidal risk C) Giving awareness of the complications of IV use & how to develop coping skills. Nurses role on substance 19 Abuse
  20. 20. Withdrawal Symptoms and Nursing Management… 3) Amphetamine A) Frequent assessment of vital signs. B) Sedatives HTN, Delusion, Panic reactions, C) Providing rest. psychosis, agitation, anxiety & D) Monitoring both Physical & depression. emotional changes. 4) Inhalants Chemical that giving of fumes/ Vapors pass through blood through brain to produce alteration in consciousness. A) Prompt interventions in emergencies like less of conscious, Withdrawal symptoms varies with respiratory arrest. specific substance used. B) Effective management for Life threatening dysarrathemia, patient's acute chronic & Hypoxia. Physiological problems. Nurses role on substance 20 Abuse
  21. 21. Withdrawal Symptoms and Nursing Management… 5) Nicotine It is an alkaloid substance present in tobacco leaves Withdrawal symptoms - Management of reliving Uncomfortable discomfort. Nurses role on substance 21 Abuse
  22. 22. Critical Management Nurses role on substance 22 Abuse
  23. 23. Nurses Role on Substance Abusing Patient’s • Nurse play a vital role in the care of clients experiencing intoxication and withdrawal • Nurses also meet the basic needs like safety, Hygiene, comfort, calm & quite environment of the patients. • Administer substitution therapy as ordered. • Help the patient to understand & identify the causes of substance dependence or substance abuse and the need of life changes. • Develop trust, correct misconceptions, do not allow blaming others, identify the mal adaptive behaviors for ineffective denial. Nurses role on substance 23 Abuse
  24. 24. Nurses Role on Substance Abusing Patient’s • Maintenance of strict self discipline by ongoing supervision. • ASPD – Set limits on manipulative behavior, explore options of deleing with stress & to give positive reinforcement for ineffective coping. • Restrict access to addicting substances. • Teach about skills like relapse prevention, supportive skills & developmental sessions. • Advice on health hazards of injecting (Abscess HIV, HBs Ag etc..) • Encourage the patient to focus on the present and future not the PAST. Nurses role on substance 24 Abuse
  25. 25. Nurses Role on Substance Abusing Patient’s • Behaving to patients in such a consistent manner confronting them in a non judgmental, non punitive manner. • Helping the patients and family to follow the ward discipline effectively by strict rules of smuggling the substances inside the ward. • Random check of patients and his belongings. • Monitoring the signs and symptoms of intoxication. • Violation of rules must be handled by all the treating members. • On discharge the patients are instructed about the need for regular follow up and to continue the medications. • Advice the patient to get involved in AA, NA etc.. Nurses role on substance 25 Abuse
  26. 26. Nurses Role on Substance Abusing Patient’s • Patients who are receiving Disulphiram must be carefully instructed. * It is not a cure for alcohol. Only discourages drinking. * Before initiating patient's are asked about the allergic reaction like sulfites, preservatives or dyes. * History seizures * Severe mental illnesses * Cardiac & Kidney diseases * Diabetes • Instruct the patient not to use alcohol or any products containing alcohol with in 12 hours before & while taking disulphiram and for at least 14 days after discontinuing. • Explain the patient that it is necessary to read the labels on all products, because alcohol is found in many foods, medicines & personal hygiene products. Nurses role on substance 26 Abuse
  27. 27. Nurses Role on Substance Abusing Patient’s • Tell the patient not to use alcohol containing products that are applied topically during the treatment of disulphiram. • Explain the patient that Headache, fatigue, skin rash etc may be experienced till the body gets adjusted to the medication. • Ingestion of alcohol during disulphiram leads to Blurred vision, Chest pain, Confusion, Dizziness, flushing etc.. • If the patient consumes larger quantity of alcohol may lead to seizures, MI, unconsciousness or Death. • Instruct the patient to carry the card. Nurses role on substance 27 Abuse
  28. 28. Nurses Role on Substance Abusing Patient’s & Family • Teaching the family about the substance abuse & its effects on the entire family. • Meeting the potential health problems & nutrition advices for Patients and the family members. • Explain the family members about the need of care, support and concern towards the patient. Nurses role on substance 28 Abuse
  29. 29. Conclusion Substance abuse remains a major health issue affecting the patient family and the community. The nurse should take challenge to inform about both the effects of drugs and the appropriate strategies for treatment. Keen assessment skills, decision making skills and compassion are the prerequisites for comprehensive nursing care of the physiologic and psychological needs presented by the patient. Nurse play a vital role in developing and implementing drug and alcohol prevention strategies, how to handle crisis? And how to develop support systems? Are the primary steps must be incorporated to the care. All Nurses have a role to play in reducing the harmful effects of drugs in common use today. Nurses role on substance 29 Abuse
  30. 30. Bibliography • Nurses clinical guide to Psychiatric and mental health nursing Edition : 2 Springhouse, P.A. Springhouse & Copel.L.C, 2000. • Watson’s clinical nursing and related sciences 6th edition by Mike Walsh. • Burns, E.M. Thompson, A & Cicione J.K (1993) Addictions curriculum for Nurses and other helping professionals. Vol 2, New York, Springer – Verlag. Nurses role on substance 30 Abuse
  31. 31. THANK YOU Nurses role on substance 31 Abuse