1 Nursing Management of Chemical Dependence Lecture Outline for Dosette Bush Jones, MSN, RN-BC, APRN-CNS Chemical Dependency -A continuum Use – Abuse – Intoxication – Dependence – Withdrawal - Overdose - I . Drugs of Abuse/Dependence Psychoactive substance: lipid – solubility • Significant impairment in normal Central Nervous System Activity • Destructive in nature • Pervasive in nature – Thought processes; perception, insight – Judgment, rationalization; emotional control – Motivation, animation – Physiologic function – Behavior, activity; socialization - Coping, Problem solving; self care II . Factors influencing Substance Abuse/Dependence Individually determined Desire/behavior to change the way one feel Self-medicating (anxiety, tension, low self-esteem, , depression, guilt, sense of emptiness, rejection, physical pain/illness, mental illness, personality disorder, low frustration tolerance, poor interpersonal relationships, prevention of withdrawal symptoms) Rewarding effect Biologic Factors o Cellular metabolism o Genetic vulnerability o Direct action with dopamine receptors
2 Socio-cultural Factors o Degree of stress produced by society o Attitudes o Peer pressure o Propensity towards risk taking o Availability of substance o Select occupations III. Definition Use of drink or substance has caused impairment in health, relationships, social and occupational functioning. IV. Assessment use of drugs severity of use/abuse intoxication/ overdose Cage Questionnaire o Cut Down o Annoyed o Guilty o Eye Opener
3 V . DSM-5 Criteria for Abuse failure to fulfill responsibilities interpersonal conflict use in hazardous situations recurrent legal problems VI . Objective Signs of Abuse o appearance o speech o behaviors o activity o vital signs o altered mental status o defense mechanisms o motor in-coordination o physical findings o laboratory studies VII. Behavioral Signs of Abuse DSM-5 increasing amounts decreasing effects using more/longer similar substance to avoid withdrawal unsuccessful efforts to curb abuse avoiding important events time and effort spent on obtaining substance use despite health problems
4 VIII. Nursing Diagnosis • Sensory-perceptual disturbances • Potential for injury/violence/agitation • Altered health maintenance •
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- Spring '17
- Benzodiazepine, physical dependence, Alcohol withdrawal syndrome