(in alcoholism) the individual cannot control the amount of alcohol use on any given occasion, although he/she is not driven to drink

(in other chemical substance use) the inability to stop using the drug

mainlining

• The inability to decrease drugs despite trying to stop
• continual use of drugs despite consequences
• a developing tolerance
• gets withdrawals when trying to stop or decrease

Denial: they deny that they have a problem or minimuze the consequences

Projection: project or blame their difficulties on others, especially a spouse

Rationalization: Making exucsed for using substances. "I know I shouldn't but I will stop for.."

Behaviors are means for clients to get what they want

Worsening lifestyle/choices over time

Conning/Manimulating: abusers con themselves first

Bargaining: "I'll just use a little and stop."

Feigning: fake injury or illness to get drugs

• Cage Questionaire
• Make accurate assessment of kind of substance used
• find out when use occurred to anticipate potential toxic and withdrawal effects
• Assess client's basic need (physiological and safety) and higher needs (love and belonging, esteem, etc)
• Assess body systems affected by chronic use
• Assess client's ability to meet their own needs

Physiological

Safety

Higher Level Needs

Risk for aspiration (N/V-alcholo, opiods, sedatives)

Impaired gas exchange (shallow breathing-alcohol,opiods)

(rapid heart rate-stimulants, resp failure-cocaine)

Pain (muscle aches-opiods)

Activity Intolerance

Imbalanced Nutrition

Hyperthermia (Alcohol/Sedatives)

Self-care Deficit

Fluid volume deficit

What are some examples of Nursing DX for Safety Needs?

Risk for Violence

Disturbed sensory perception

Risk for Injury

Anxiety

Fear

Ineffective Denial

Ineffective Coping

Defensive Coping

Powerlessness

Hopelessness

Impaired adjustment

Anxiety

Decisional conflict

Dysfunctional Family Process: alcoholism

Ineffective therapeutic regimen management

1. Have you ever felt you should Cut down on your drinking?

2. Have people Annoyed you by criticizing your drinking?

3. Have you ever felt bad or Guilty about your drinking?

4. Have you ever had a drunk first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Acute Detoxification Care Plan

Long Term Rehabilitation Care Plan

Provide a safe and supportive environment

1. attend to life threatening physiological symptoms first (withdrawal)

2. Monitor vital signs and withdrawal symptoms

3. Assess thinking and perception

4. Apply Ice pack for fever

5. Decrease stimulation, provide a darkened quiet room

6. Point out reality: "I konw that you are seeing things, and I know that you are frightened. There are no bugs or monsters here. You are safe and will feel better soon."

Administer substitution therapy as ordered

Used during detoxification for clients who abuse alcohol.

It controls anxiety and agitation

What is the name of the drug that is used in the treatment of alcohol dependence, heoin abuse/opiod intoxication?

I long acting (24-36 hours) safe, synthetic opiod that is adminsitered daily. Produces pleasure like heroin and opiate but there is no high.

It alleviates the cravings for opiates. It is addictive.

It lasts from Day 1-5. Clients receive methadone for 3-5 days in decreasing doses.

Methadone is then discontinued.

Withdrawal symptoms often appear.

Clonidine (catapres) is begun and given in incrasing doses until withdrawal symptoms are alleviated.

Clonidine blocks withdrawal symptoms, making detoxification process less painful and more rapid that with methadone alone.

Psychologically, the client feels less anxious and depressed.

first symthetic opiod medication approved for the treatment of opiod dependence in an office-based setting.

Users can come once a day in an office setting for treatment

You can give it sublingually, taked 5 minutes to disolve

1. Develop a trusting relationship

2. Encourage participation in outpatient rehabilitation programs

a. Therapy/counseling

b.psycho-education classes

3. Promote Utilizing other support services when needed

1. commitment/motivation (can come from courts)

2. Initiating change

3. Maintaining change/relapse prevention

Higher level needs (esteem&recognition)

 Management of illness

-health promotion

-coping skills

-life changes

-decision making

Utilize confrontation and limit setting

Don't allow the client to rationalize or blame others for behavior associated with substance abuse.

Set limits on manipulative behavior

Never talk to someone who is high

Nature of Illness

Negative effects of substance on the body

ways in which use of substance affects life

promote understanding and identify cause of dependency

correct any misconceptions

identify recent maladaptive behaviors

Management of illness

relapse prevention

Exhaustion                                  Complacency

dishonesty                                   Expecting too much

impatience                               Letting up on discipline

argumentativeness            Use of mood altering chemicals

depression                                Wanting too much

Frustration                                 Forgetting gratitude

Self-pity                                    "it can't happen to me"

cockiness

Relaxation techniques

Problem solving skills

good nutrition

Lifestyle changes

-EMPHASIS requirement of total lifestyle change is needed

-Learning to stay away from people that foster abuse

-learning to make new friends who are substance free

-discover new interests

-stress management skills

-helping the family may need treatment for co-dependence

-creative expression,artwork

DARE program

Education

Detoxification/initial hospitalization

Relapse prevention

Rehabilitation/aftercare

relapse prevention