Substance Overdose & Withdrawal Flashcards
The drug is taken only for its effects and to get high instead of for its intended medical purpose.
Taking a drug for a purpose other than intended medical purpose
Taking drug in way not prescriped
Taking someone else’s presscription
The substance is taken in ways that are not prescribed (e.g., in higher or more frequent doses or in other unintended methods or routes of use, such as crushing and snorting pills).
The medication used was prescribed for someone else.
Drug Misuse
An overdose can occur after someone consumes a toxic level of a substance (or multiple substances) and the effects of this interfere with their brain and body’s ability to function correctly. Drug overdose can be fatal; however, when it isn’t, overdose-related toxicity can result in several negative short-term and long-term health consequences.
Consumes drug/alcohol and blood levels at toxic level to point where brain and/or body systems fail to func
Overdose:
Physical and mental symptoms that occur after stopping or reducing drug intake.
The characteristics of withdrawal depend on what drug is being discontinued.
Treatment includes supportive care as well as medications to address symptoms and prevent complications.
Withdrawal:
Focused on Maintain the patient airway, breathing, and circulation
Secondary focus: Prevent further absorption of drug(s) into system
Prevent further absorption of drug(s) continued
Nursing care focus
Reversal agents can be given for specific drugs/medicines
Benzodiazepines (valiums and ativans): Flumazenil
Opioids: Naloxone/narcan
Acetaminophen: Oral acetylcysteine/mucomist
Digoxin: Digibund
Beta-blockers and Calcium channel blockers: Glucagon
Secondary focus: Prevent further absorption of drug(s) into system
Ingested (taken orally) within 1 – 2 hours - prevent further absoprtion into bloodstream
Ingested > 2 hours
Oral/IV/IM/SQ
Prevent further absorption of drug(s) continued
Giving Activated charcoal orally or via NG tube - depending on how A&O
Gastric lavage with the patient in left lateral position or HOB elevated 30-45 degrees (contraindicated in caustic ingestions) - put in NG and aspirate out stomach contents and inject water to lavage it and aspirate out water put in
Purpose: get out residual out stomach so not absorb into stomach
Intubate first if the gag reflex is diminished or absent
Induce vomiting if the patient is awake OR airway is protected (ipecac, apomorphine)
Done with extreme caution
Not know if acidic/basic - more damage to esophagus
Ingested (taken orally) within 1 – 2 hours - prevent further absoprtion into bloodstream
Drug out stomach - present 6 hours later
Cathartics (sorbatol), Bowel irrigation (induce diarrhea to go through system faster - less absorbed into bloodstream)
Ingested > 2 hours
Overdose and not matter how taken in
Hemodialysis - dialyse out drug - use dialysis to take out bloodstream
Forced osmotic diuresis
Oral/IV/IM/SQ
Alcohol is a distilled or fermented drink that can make you drunk.
Alcohol poisoning happens when there is too much alcohol in the bloodstream that areas of the brain that control basic life support functions—such as breathing, heart rate, and temperature control—begin to shut down
Examples: Beer, Vodka, Bourbon, Whisky
Patient Presentation
Withdrawal sx
Alcohol withdrawal syndrome and delirium tremens (DT)
Treatment and reversal
Alcohol
Aka alcohol overdose
So much alcohol in bloodstream that brainstem shuts down - brainstem vital for controlling HR, breathing, temp control
Alcohol poisoning happens when there is too much alcohol in the bloodstream that areas of the brain that control basic life support functions—such as breathing, heart rate, and temperature control—begin to shut down
Alcohol is depressant - everything slow/low
Resp: ↓ respiration rate
CV: bradycardia, hypotension; cool, clammy skin
Neuro: still awake - Poor judgment (attempt to walk/reach), ataxia movement, Decreased LOC (Drowsy → Coma - higher alcohol content less awake and aware they are), hypothermia, seizures
GI: N/V - awake enough present with this
Patient Presentation
Tremor
Anxiety
Nausea
Vomiting
Insomnia
Typically, they look malnourished
Not all pts report when had last drink - fail say how much drink each night or day; ask when last drink and tell us; embedded in routine that forget and not think about mentioning it when asked; not think about saying it every night
Be vigilant - when have sx - not confront because family not know have hidden alcohol
When alone ask about alcohol consumption, can help withdrawal sx and make hospital stay more pleasant because as time goes on sx worsens
Most pts when say that esp if not been through withdrawal again take up on Zwal protocol and getting benzos to help with withdrawal sx
6 - 8 hours after last drink - Withdrawal sx
Above symptoms plus:
Whole body tremor
Hypertension, tachycardia
Diaphoresis
Hallucinations
Agitation - much worse
Sx worsen
24 – 72 hours after last drink - Withdrawal sx
Above symptoms plus:
Global confusion (hallmark)
High Fever
Autonomic Instability (Hypertension, Tachycardia)
Disorientation
Severe Hallucinations - severe auditory, tactile
Severe Diaphoresis
Seizures
Very heavy drinker for long time
2-4 days after last drink - Withdrawal sx
AWS is associated with an increased risk of delirium, visual hallucinations, seizures, need for mechanical ventilation - lot require intubation and mechanical ventilation, and death - higher risk for dying
Delirium tremens (DTs), is the most serious consequence of abstaining from alcohol. This medical emergency typically begins in 3 days but may take a week or more to manifest - usually go into 1-5 days; more extreme end of CM; generally very disoriented, confused, anxiety - hypervigilant and paranoid; primarly visual hallucinations but the hallucinations last long time and cannot convince that what seeing not present; sweaty; seizures as withdrawal and alcohol level drops; extremely HTN, tachycardia; are fine and BP starts creeping up then day 3 or 4 - severe HTN and tachycardia - no other explanation then talk to family and find out is a heavy drinker - could have prevented catastrophic ending
Tremors to point cannot hold glass of water
Very hypothermic
Core temps - 96-97 degrees
When hyperactive agitated delirium is caused by alcohol withdrawal, it is termed delirium tremens (DTs).
Go into these - getting to these - Fewer than 5% experience severe complications such as delirium or a seizure - go into full blown; usually most go into regular withdrawal
Hospitals - Screening tools to identify alcohol dependence, such as the Alcohol Use Disorders Identification Test (AUDIT) - ask questions about drinking to identify those who may need to be started on Cwa withdrawal protocol so not have these
Alcohol withdrawal syndrome and delirium tremens (DT)
