TX Substance use disorder

• r/t denial
• outcome: client will be able to demonstrate more adaptive coping mechanism that can be used in stressful situations- not using

• less than body requirements/fluid volune deficit r/t drinking or taking drugs instead of eating
• outcome- client willbe free from s/s of malnutrition/dehydration

• r/t malnutrition and altered immune condition
• outcome- shows no s/s of infection

• r/t lack of positive feedback
• outcomes- exhibits evidence of incr self worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others

• r/t denial of problems with substances evidence by abuse of substances
• outcome- verbalize importance of abstaining from use of substances to maintain optimal wellness

• from the client withdrawing from cns deppressants- alcohol, sedative, benzo barbs
• risk for injury r/t to cns agitation
• for the pt withdrawing from cns stimulants- caffeine, nicotine, cocaine, addrell
• risk for suicide r/t to intense feelings of lassitude and depression, crashing, SI

• provide safe supportive environment
• adminster substitution therapy

• provide explanation of physical symptoms
• promote understanding and identify causes of substance dependency
• help pt accept use of substance as a problem
• provide education and assistance to pt and fam

• encourage cont participation- long term treatment
• promote participation in outpatient support system
• assist pt to identify alternative sources of satisfaction
• provide support for health promotion and maintenance

evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care

• it is est. that 10-15% of nurses sugger from the disease of chemical dependency
• alcohol is the most widely abused drug, followed closely by narcotics

• clues for recognizing this in nurses varies depending on the substance
• high absent from work may be present when the source is outside of work
• or person may rarely miss work if substance is there

• incr wasting of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs than other nurses may be present
• poor concentration, difficulty meeting deadlines, inapproriate responses and poor memory or recall
• problems with relationships
• irriablity tendency to isolate, elaborate excuses for behavior

• unkempt apperance, impaired motor coordination, slurred speech, flushed face, disorganized
• pt compliants of inadequate pain control, discrepancies in documentation

• may deny, suspend, revoke a license based on report of chemical abuse by a nurse
• diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek tx

• succesful completion of inpatient, outpatient, group or individual counseling tx program
• some run by state board of nursing

• evidence of regular attendance at nurse support groups or 12 step program
• random negavtive drug screen
• employment or volunteer activities

• recognize their impairment
• obtain necessary tx
• regain accountablity within profession

defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse other cruelties, or pathological conditions

• codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control
• derives self worth from others
• feels responsible for the happiness of others
• commonly denies that problems exist

keeps feelings in control and often releases anxiety in the form of stress related illness or compulsive behaviors such as eating, spending, working or use of substance

• may have experienced abuse or emotional neglect as a child
• outwardly focused on others and know very little about how to direct their lives from their own sense of self

• caretaking
• perfectionism
• denial
• poor communication

• survival stage- letting go
• re-identification- denial breaks and gets a true sense of self
• core issues stage- facts on manage, cant force/will relationship
• reintegration stage- self acceptance and chx willingness

• a major self-help organization for the treatment of alcoholism
• based on the concept of
• - peer support
• - acceptance
• - understanding from others who have experienced the same problems

• the 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety
• total abstinence is promoted as the only cure; the persona can never safely return to social drinking

• various support groups patterned after AA but for individuals with problems with other substances
• counseling
• group therapy