This section will apply the nursing process to caring for a hospitalized client diagnosed with a substance use disorder who is receiving withdrawal treatment. Show AssessmentThe following client history should be obtained from a client diagnosed with a substance use disorder:
The client should receive a comprehensive physical examination to evaluate signs related to current withdrawal symptoms, as well as symptoms of concurrent medical and mental health diagnoses. If the client has been diagnosed with alcohol use disorder, signs of complications such as liver or pancreatic disease should be assessed. Screening ScalesScreening scales may be administered such as CIWA-aR (for alcohol withdrawal symptoms) and COWS (for opioid withdrawal symptoms). Read more information about these scales in the “Withdrawal Management/Detoxification” section of this chapter. Diagnostic and Lab WorkLaboratory testing for clients admitted for withdrawal treatment may include these items:
DiagnosesA nursing diagnosis related to the abrupt cessation of a psychoactive substance is a syndrome diagnosed as Acute Substance Withdrawal Syndrome. As a syndrome diagnosis, defining characteristics are the related nursing diagnoses, including Acute Confusion, Anxiety, Disturbed Sleep Pattern, Nausea, Risk for Electrolyte Imbalance, and Risk for Injury. Review information about syndrome nursing diagnosis in the “Diagnosis” section of the “Nursing Process” chapter of Open RN Nursing Fundamentals. Outcomes IdentificationAn example of a broad goal related to withdrawal treatment is the following:
These are some sample SMART outcomes:
Planning InterventionsIn addition to implementing the withdrawal treatment plan prescribed by the provider, the nurse collaboratively develops a post-withdrawal treatment plan with interprofessional health care team members. The plan should be client-centered and include their goals and readiness for change. Motivational interviewing is a helpful therapeutic technique when planning individualized treatment goals and programs. ImplementationNursing interventions provide a supportive environment while the client undergoes withdrawal treatment. Vital signs are monitored closely because increases in temperature, pulse, and blood pressure are signs of withdrawal. After ensuring that an individual’s physiological needs of airway, breathing, and circulation are met, safety measures receive top priority. Safety measures during withdrawal treatment may include interventions such as fall precautions, seizure precautions, or implementing restraints as needed to maintain the safety of the individual or those around them. Review information on fall precautions in the “Preventing Falls” section of the “Safety” chapter in Open RN Nursing Fundamentals. Seizures can occur in clients experiencing alcohol withdrawal. Seizure precautions include keeping the bed in the lowest position with side rails padded. Suction and oxygen equipment must be available at all times at the patient’s bedside. Review information on safely implementing restraints in the “Workplace Violence” section of the “Trauma, Abuse, and Violence” chapter. Medications are administered as prescribed to keep the client safe and comfortable, so they do not suffer. Review medications used during withdrawal treatment in the “Withdrawal Management/Detoxification” section of this chapter. Clients with substance use disorders may exhibit a poor nutritional status due to long-term use of substances taking precedence over food and fluid intake. Nurses provide hydration and gradually reintroduce healthy foods while also promoting rest. Clients with alcohol use disorder are specifically at risk for thiamine (B1) and magnesium deficiencies that can lead to cardiac arrest. Thiamine and other electrolyte replacement is typically included during withdrawal treatment. Developing a therapeutic nurse-client relationship can encourage the client to explore harmful feelings of anxiety, hopelessness, and spiritual distress. Encouraging self-care and hygiene helps improve clients’ self-esteem. Nurses educate clients about healthy coping skills and evidence-based treatment and recovery services available in the community. Review evidence-based treatments and recovery services in the “Treatment of Substance Use Disorders” section of this chapter. EvaluationEvaluation occurs on several levels by assessing the individualized SMART outcomes related to the effectiveness of the withdrawal treatment plan, symptom management, and the client’s readiness and progress towards changes in their behavior. |