1. NURSES ROLE ON
SUBSTANCE ABUSE
PRESENTED BY : PHILOMINA
Staff Nurse
De-Addiction Centre
NIMHANS
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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
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3. Substances abused by the patients
• Alcohol
• Depressants
• Cannabis
• Opoids
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5. Hallucinogens
• Both natural and synthetic
substances – that produce
illusions, Delusions,
hallucinations Example: LSD
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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.
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7. Cases Admitted…..
• Cannabis induced Psychosis /
Cannabis dependence.
• Solvent Abuse
• Poly substance abuse like
alcohol with combination of
other drugs, Multiple drug
abuse.
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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..
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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.
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10. Treatment options
Treatment
Model
Tertiary
Primary Secondary Prevention
Prevention Prevention (Inpatient
Activities
(Community (Out patient detoxification
Services) Services) and
rehabilitation)
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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.
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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.
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13. Primary Prevention
• Personal Hygiene.
• Health related problems with
substances.
• Nutrition.
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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..
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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)
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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.
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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.
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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
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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.
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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.
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21. Withdrawal Symptoms and Nursing Management…
5) Nicotine
It is an alkaloid substance present in tobacco leaves
Withdrawal symptoms - Management of reliving
Uncomfortable discomfort.
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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.
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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.
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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..
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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.
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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.
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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.
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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.
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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.
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