Substance Abuse Flashcards
Substance use disorders (SUD)
1) Involve a variety of substances
•Legal
•Illegal
2) Severity classified by criteria •Mild •Moderate •Severe •Pharmacologic dependence
Nursing management in acute care
- Screen for and recognize substance use
- Manage withdrawal
- Patient education about effects on health
- Encourage change in behavior and refer to treatment program
Nicotine- Tobacco use disorder (TUD)
Most common SUD
Cigarette smoking
“E- cigs”
- Turn nicotine and other chemicals into aerosol
- Not harmless*
- Not FDA approved
- Not for smoking cessation
Tobacco Cessation: Nursing Role
- Nurses are required by The Joint Commission to identify users, provide info, and encourage to quit
- Most health care facilities are tobacco-free
Clinical Practice Guidelines- if willing to quit
The 5 As •Ask •Advise •Assess •Assist •Arrange
Clinical Practice Guidelines- if UNwilling to quit
The 5 Rs •Relevance •Risks •Rewards •Roadblocks •Repetition
Smoking Cessation Products
1) Nicotine replacement products—reduce cravings and withdrawal
•OTC
2) Non-nicotine medications
•Varenicline (Chantix)
•Bupropion (Zyban)
Alcohol
AUD classification for male and female
Alcoholism Use Disorder(AUD)
•Males—5 or more on same occasion
•Females—4 or more on same occasion
Alcohol: Effects of Use
•Affects almost all cells of the body
- All areas and esp. functions of the CNS:
- Centers for impulse control, mood, behavior, motor activity coordination, respiratory, and cardiac function
•Linked to many health problems
- Increased hospital length of stay and mortality rates
•Short-term use
•Long-term use
Alcohol complications
** Numerous drug interactions** •Antihypertensives, antihistamines, antianginals •Aspirin •Acetaminophen •CNS depressants
Management for alcoholism
Management begins with identifying at-risk persons
1) Clinical Institute Withdrawal Assessment of Alcohol Scale(CIWAA);
- 9 categories:
- Agitation
- Anxiety
- Auditory Disturbances
- Headache
- Clouding of Sensorium
- Paroxysmal Sweats
- Tactile Disturbances
- Tremor
- Visual Disturbances
Depressant Use—Overdose Tx
Naloxone (Narcan)
•Used in inpatient and community settings
•Reverses opioid overdose
•May need repeated doses until opioid metabolized
•More publicly available**
Overall goals
- Normal physiologic functioning
- Acknowledge a problem exists
- Explain the physiologic and psychologic effects of use
- Abstain from substance use
- Cooperate with treatment plan
Caring for Patients with Mental Illness and SUD
•The client with mental illness has historically been misunderstood, misdiagnosed, and mistreated.
- Diagnostic Overshadowing
- Nurses working in non-psychiatric areas are the frontline responders in recognizing and intervening!
The Need for Education of Healthcare Providers
- Clients with significant mental illness die 25 years earlier than the general population**
- Clients with mental illness who come to general healthcare settings are at risk for lack of treatment/appropriate referral***
- Every nurse needs education about recognition of mental illnesses to perform competently in any nursing role
- Nurses in nonpsychiatric settings must also have a clear working knowledge of the impact of Depression**
- Bipolar, diseases, suicide
Suicide Screening
- The purpose of screening is to identify significant symptoms that require further assessment and intervention**
- Critical to the success of any tool is the NURSES belief that the tool is essential
- Two item screen for suicide risk:
1) “In the past month, have you had thoughts about suicide?”
2) “Have you ever made a suicide attempt?”
•A yes response to either question prompts a third, “Are you having thoughts of suicide right now?”
Risk for Suicide (not limited to but includes)
- Military Vets with PTSD
- Older adults with depression
- Substance abusers
- Patients with chronic pain
- Patient who self harm {non-suicidal self-injuring behavior (NSSIB)} are more likely to consider suicide
- Diagnosed psychiatric disorder patients
Trauma History Screen
- Screening should be conducted when pts first enter the healthcare setting
- Most individuals affects by violence are women and children.
- 75% of female psychiatric patients have a current or past history of abuse.
- Individuals may not be forthcoming with trauma information, so screening is essential.
- Nurses must conduct screenings in private with a non-judgmental, compassionate attitude.
Priority Issues for SUD Screening
- Opioid abuse has reached epidemic levels OD
- Methamphetamine use has dramatically increased withdrawal and suicide
- Alcoholism rates have increased Depression
- All these facts underscore the importance of screening for SUD in non-psychiatric settings.
- Use the SBIRT tool
SBIRT stands for
Screening, Brief Intervention, and Referral to Treatment
Single-Question Tool
screen for alcohol, drugs, tobacco use in last year.
•“How often in the last year have you had 5(men) or 4(women) or more drinks in a day?”
•“How many times in the past year have you used illegal drugs or Rx meds for non-medical reasons?”
•“In the past year, how often have you used tobacco products?”
Two-Question Tool
screen for alcohol or drug use.
1) “In the past year have you ever drunk or used drugs more than you meant to?”
2) “Have you felt that you wanted or needed to cut down on your drinking or drug use in the past year?”
•If positive, do a detailed assessment
- Alcohol Use Disorders ID - Drug Abuse Screening Test
Barriers to Screening
- Privacy concerns
- May fear legal action
- Nurses own bias
- Nurse work load- prioritizing
- Lack of support / encouragement
Stigmatization
Attitude devaluating a person (cratering a barrier)
Social distancing
Stigma of people, avoiding someone with mental illness or addiction
Silence for a patient (listening skills)
- Can be used to allow the patient to gather their thoughts
- During periods of silence, you can reflect on what already has been shared
- Can be used to observe patient
Humor
- Valued as both an interpersonal skill for the nurse and as a healing strategy for patients.
- Can reduces stress
All interviews should begin with
Explanation of purpose of interview
Open Ended Questions
Allow wide range of responses
Closed Question
- Used to gather specific information on a particular area
* Can be a barrier when used inappropriately
Validating Question
•Overuse may lead the patient to think that the nurse isn’t listening.
Clarifying Question
- When used properly it avoids misconceptions.
- Overuse can make the patient believe that the nurse isn’t listening
Most detail than validating .
Reflecting Question
Question or comment repeating What person has said or describing the persons feelings
Sequencing question
Place events in chronological order
Directing question
comment used to gain more information on something stated earlier or to introduce a new subject
Assertive behavior is the
- The focus is on the issue, not the person.
- Assertive behaviors use “I statements”.
- Characteristics of assertive behavior include: Confident open body posture, good eye contact, sharing feelings, remaining calm
Aggression
can be verbal or physical.
•Characteristics include: tension, anger
Incivility
Incivility is also failing to act when action is warranted, such as NOT sharing important information about a patient’s care or refusing to assist a co-worker.
