Substance related disorders and Nursing Role

Substance related disorders

Substance: any drug, medication or toxin that has the potential to be abused.
Addiction: psychological and physical dependence.
Dependence : Craving, tolerance, withdrawal and compulsive use.
Examples of substances– Alcohol
– Amphetamine
– Caffeine
– Cannabis
– Cocaine
– Nicotine
– Opioids

– Genetics and family influence: modeling effect. Identification. In case of alcoholism, 50% risk in first generative relatives.
– Peer pressure
– Psychosocial stress
– Chronic disease
– Personality disorder

diagnostic criteria of alcohol intoxication.

-recent ingestion of alcohol
-significant mal adaptive behavior or psychological changes like inappropriate sexual or aggression ,lability of affect, or impaired judgment  developed during or shortly after alcohol use.
-one or more of the following signs developed during or shortly after alcohol intake:
slurred speech-incoordination-unsteady gait-nystagmus-impairment of attention or memory-stupor or coma.
-symptoms not resulted from other medical condition or another mental disorder .

diagnostic criteria for alcohol withdrawal

-cessation and reduction of alcohol that have been heavy and prolonged
-two or more of the following have been resulted from several hours to few days : autonomic hyperactivity-increased tremors-insomnia-nausea and vomiting –transient hallucinations usually visual-psychomotor agitation-severe anxiety-grand mal seizures.
-criteria in B causes marked significant distress or impairment.
-not resulted from general medical condition or another mental disorder

management of alcohol withdrawal symptoms

seizures: diazepam 10mg iv state
DT: increase BP ,sweating, fever anxiety , insomnia , and hallucinations ,(+-)psychomotor activity
The condition treated by Librium 25-50mg every 2-4 hours.
Alcoholic encephalopathy and dementia:
Wernicke encephalopathy:
ataxia , confusion and nystagmus. treated by thiamine iv 100mg-300mg
Korsakoff syndrome :Recent memory impairment, antrograde amnesia, confabulation .my need administration of antipsychotics

Nurses role in alcoholic patient :

*Seizure measures should be taken
* DT measures should be put in your agenda
*Monitoring( vital signs every 2-4 hours(pulse-temp-BP) -Respiratory rate. Pupillary signs.
*In case you give iv line don’t give glucose before giving parental vitamin B Complex and thiamine
Otherwise the patient might go to wernick,s encephalopathy.
*Assess need for  seclusion and restrain , take care that BZ to sedate them, it might be followed by respiratory depression or failure and death.

Alcohol-related disabilities.

*Physical related disabilities:
– GIT PROBEMS includes gastritis and gastric ulcer ,mal nutrition and hepatic damage, Pancreatitis.
– Iron deficiency anemia, arrhythmia, macrocytosis  ,cardiomyopathy,
– Polyneurropathy, myopathy, encephalopathy, dementia.
– Accidents and traumas.
*psychiatric complications includes
depression, suicide, personality changes, alcohol hallucinosis, delusional disorder, gambling, and sexual disorders, blackouts an amnestic syndrome,


*recent use . *significant maladaptive behavior or psychological changes(mood liability, impaired judgment, aggression, impaired functioning.)*one or more of these signs during or shortly after use(slurred speech, incoordination, unsteady gait, nystagmus, impairmement of attention or memory, stupor or coma.
*symptoms not due to medical condition or psychological problem.

Diagnostic criteria for its withdrawal

*Cessation or reduction after prolonged use . *two or more of the following develops within several hours to days (*hypervigilance, insomnia, nausea and vomiting, hallucinations, agitation, anxiety, fits, ). *symptoms causing significant distress or impairment. *not due to medical or psychological problem.
In acute intoxication flumazenil(anexate) is life saving.

amphetamine use

– amphetamine is used in narcolepsy,ADHD,depression.
– Amphetamine like substances  N,methyle D,asppertate (NMDA)

  Amphetamine intoxication

*mal adaptive behavior resulted during or shortly after intake.
*clinically significant maladaptive behavior or psychological changes  including euphoria ,irritability, hpervigilance, anger , impaired judgment.
*two or more of the following (tachycardia or bradicardia. pupillary dilatation. elevated or lowered BP.CHILLS. nausea or vomiting. weight loss. agitation or retardation. muscular weakness.
Confusion, seizures, dystonia, and coma.
*symptoms are not due too general medical condition or other psychiatric disorders .

Amphetamine withdrawal :

on cessation or decrease after prolonged use .
*dysphoria mood with two or more of the following (fatigue. vivid unpleasant dreams. Insomnia or hypersomnia. increased appetite. Agitation or retardation.)
*symptoms above cause significant distress or impairment.
*symptoms are not due to other medical or psychiatric problems.


– EG heroin and morphine
*Morphine is analgesic and sedative it works on opioid receptors on brain
*our own endogenous opioids are present in the form of endorphin , and ankaphaline
* they work as pain suppressors.
*they cross blood brain barriers BBB .has rapid onset of action . with low tolerance and high dependence.

Diagnostic criteria for opioid intoxication

*Recent use of opioid .* mal adaptive behavior or psychological changes that developed during or shortly after opioid use (euphoria followed by dysphoria agitation or retardation. impaired judgment and functions)
*pupillary constriction  with one or more of the following drowsiness or coma –slurred speech-impairment of attention or memory. *not due to general medical or psychological problems.*with or without perceptual disturbances.

Diagnostic criteria for opioid withdrawal

*cessation or reduction of opioids after prolonged use or administration of opioid antagonist
*one or more of these symptoms develop few minutes  up to few days(dysphoria nausea and vomiting muscle aches lacrimation and rhinorrhea ,pupillary dilatation ,sweating ,diarrhea, yawning, fever, insomnia.
*Symptoms above clinically causing distress or impairment.*symptoms not due to other medical or psychological problems.
As in alcohol psychotherapy is very important illustration of how to over come withdrawal manifestations and craving . overdose .and how to avoid complications.

Hashish abuse

Tetrahydrocanabinol is the active ingredient it is mainly cns depressant but might do the reverse
(sense of happiness and euphoria-overeating that might lead to death from vagal over stimulation
distortion of perception  (size height distance shape ) also might go to hallucinatory experiences.
The nurse should put in mind patient safety from violence and over eating) keep patient calm .

Petrol patex and other inhalants

They are CNS depressants –during intake patient experiences flashes of light coming. With or without hallucinatory experiences ,Sedation even drowsiness .
Long term use might lead to dementia. or severe psychotic changes

Related posts:

Posted in General, Nursing Care Plans, Nursing Intervention

FaceBook Page

(function(i,s,o,g,r,a,m){i[\'GoogleAnalyticsObject\']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,\'script\',\'\',\'ga\'); ga(\'create\', \'UA-69237529-7\', \'auto\'); ga(\'send\', \'pageview\');