Substance Abuse Medical Notes PDF

**Substance Abuse, pg. 5794 Table 67-1 (this is pages long, do we need to know this??)** - Most common in very young, teenagers and mid-30s - Accidental or intentional - OD may trigger a person's chronic disease - SUD is the misuse of drugs, alcohol or medication that alter mood or b...

**Substance Abuse, pg. 5794 Table 67-1 (this is pages long, do we need to know this??)** - Most common in very young, teenagers and mid-30s - Accidental or intentional - OD may trigger a person's chronic disease - SUD is the misuse of drugs, alcohol or medication that alter mood or behavior - s/s may be anything from VS changes to comatose - **Management**: Toxicology screen, initiate IV, O2 monitoring, antidote administration - **Acute Alcohol Intoxication (a lot of this information below is not in the book)** - Affects balance, reasoning, & concentration, CNS depression & hypotension - Management: Needs IV fluids & airway assessment/maintenance (aspiration prevention), assess for trauma, monitor ABCs, - Cannot give sedatives, may need thiamine injection, more aggressive if police present - **s/s:** anxiety, uncontrollable fear, tremor, irritability, agitation, insomnia, and incontinence, confused, obtunded, seizures, slurring speech, vomiting \[aspiration risk\], aggressive, grandiose ideation, uninhibited behavior, **??** - Obtain blood specific to analyze the blood alcohol level - Tx**: detoxification of the acute poisoning, recovery, and rehabilitation** - Vitamin B1 for wernicke encephalopathy prevention (not in book) - Meds: Haloperidol, esmolol, or midazolam, benzos - Be familiar w/ facility\'s policy about restraints - Supplemental vitamin therapy and high protein diet are provided - **Stimulants -- Cocaine** - S/sx → rapid HR/tachycardia, Increased BP, muscle cramps, vomiting, hyperthermia, panic attack, seizures, hallucinations, psychosis, delusional, very hypervigilant - Treat hyperthermia \[cool via cold fluids, blanket, ice bags, fans\] and arrhythmias - **Opioids -- Heroin, Opium, Morphine** - s/sx: dizzy, n/v, bradycardia, hypotensive, dyspnea (**resp. depression**), **pinpoint pupils**, altered LOC, flash pulmonary edema - **KNOW Antidote → Narcan (Naloxone)** - Lasts about 15 minutes (not in book) - Repeated doses may be necessary - Management: ABC, IV access, O2 monitor, UA, ECG - **Barbiturates -- Nembutal (Phenobarbital), GHB** - s/sx: Can mimic ETOH intoxication, respiratory depression, flushed face, Decreased HR/BP, agitated, decreased LOC, sluggish pupils, decreased DTR, coma/death - Management: Maintain airway, maintain neuro status - **Inhalants -- Freon, Toluene, helium, propane, helium, paint thinner, gasoline, glue** - Absorbed very rapidly; results in cravings - s/sx: HA, euphoria, dizzy, altered LOC, drunk-like feeling, vasodilation, nose bleeding, sluggish pupils, resp depression - Monitor: ABC, Resp status, treat hypotension - **Amphetamine -- Crystal Meth, Ecstasy, Ritalin = "Uppers"** - s/sx: N/V, tachycardia, increased BP/RR, irritable, agitation, fear, decreased inhibition, tweaking, fearfulness, anxiety, depression, CV collapse, tachypnea, palpitations - Management: Airway support and cardiac status, insert IV - Watch for rhabdo - Keep calm, quiet and cool env't, place in a protective env't - Tx: Small doses of IV Valium and Haldol for CNS and muscular hyperactivity and treat seizures with benzos - **Hallucinogens/Psychedelics -- LSD, PCP, Marijuana, Special K** - s/sx: Mild hypertension, confusion, withdrawn, hallucinations, seizures, nystagmus, pupil dilation - Management: ABC's, UA - **Benzos -- diazepam (Valium), lorazepam (Ativan), midazolam (Versed)** - s/sx: Decreased LOC, drowsiness, confusion, mimics being drunk, slurred speech - **KNOW Antidote → flumazenil (Romazicon)** - Management: ABC's, respiratory depression/circulatory collapse - **Salicylate Poisoning -- Aspirin** - s/sx: **tinnitus**, blurred vision, sweaty, respiratory alkalosis/metabolic acidosis, bleeding \[gums, nose bleeds, etc\] - Tx: Sodium Bicarb, fluids, diuretics, hemodialysis \[if severe enough, give activated charcoal to absorb aspirin - Management, pg. 5804: monitor serum salicylate level, administer prescribed meds, monitor platelets - **Acetaminophen-- Tylenol** - \> 4 grams in 24 hours - S/sx: **Hepatic failure**, coagulopathies, lethargy, encephalopathy, diaphoresis, hepatomegaly, RUQ pain, hypoglycemia, GI upset, and metabolic acidosis (pg. 5805) - Charcoal affective w/in first hour - Lab: ABG, LFT, CBC**,** PT/PTT, BUN/Cr, ?? - **Antidote → Acetylcysteine (Mucomyst)** - Do not administer charcoal with NAC (mucomyst) **Violence, Abuse and Neglect, pg. 5809** - Intimate Partner Violence (IPV) + Family Violence - **Chart 67-8, assessing for abuse, maltreatment, and neglect** - IPV may include physical violence, sexual violence, stalking, psychological agreesion, neglect, financial abuse, or intimidation by a former or intimate partner - Story inconsistent with injuries, injuries in various stages of healing \[new/old bruises, fractures, anxiety, a lot of stress\] - Those who are disabled are at a higher risk - Gerontological considerations: - Elderly signs of abuse: poor hygiene, ulcers, infections, poor nutrition, missed Dr. appointment, unfilled Rx (not in book) - Elder abuse could include physical, sexual, emotional, and verbal abuse - The majority of elder abuse is perpetrated by family members - Nursing management: - maintain high level of suspicion, talk to pt alone, mandatory reporting for children - Ask pt alone if they feel safe at home or if they're afraid of people close to them - Clear & concise in documentation of what was seen & talked about for future legal - **Sexual Assault: Crisis intervention starts immediately** - Sexual assault nurse examiner \[SANE\] - Can testify in court - Goal of tx: let the victim know they're safe, good legal & medical evidentiary care, psychological care, SANE follows them throughout legal process - Anxiety: provide psychological counseling/support - Chain of evidence MUST be maintained; nurse collects if SANE is unavailable. - Evidence is collected through photos, videos, and analysis of specimens - Management: - The pt is asked whether they have bathed, douched, brushed teeth, changed clothes, urinated, or dedicated since the attack (these could cause alteration in the assault) - Urine drug test must be completed within 96 hours of the event; emesis may also be collected - Laboratory specimens collection: vaginal aspirate, secretions, smears from the oral/vaginal/anal areas, culture of body orifices for gonorrhea, blood serum for syphilis, pregnancy test, any foreign material (leaves, grass, dirt), and pubic hair samples - **Psychiatric Emergencies -- Safety (where is all of this in the book? i don\'t see it on pg 5816)** - s/s: Overactive, underactive, depressed, or suicidal pts or those w/ violent behavior - Management: safety, non-judgemental, hx of psychiatric disorder - RN must remain calm - Crisis intervention utilized if available, typically for episodes of SI & determine if need to be involuntarily committed - Provide specific text based on what type of psychiatric emergency it is