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to drug withdrawal

Other Drugs: Desipramine hydrochloride (Norpramin), bromocriptine mesylate (Parlodel), amantadine hydrochloride (Symmetrel), and melphalan (phenylalanine mustard) have been prescribed to decrease the craving for cocaine during withdrawal. Phenoth-iazines in low doses may be ordered to control the flashbacks that can occur after the last dose of a hallucinogen. Because the patient has built up a tolerance for drugs, the amount of medication needed to keep the patient safe may be more than what is considered a safe dosage. Methadone is used to stabilize individuals during withdrawal from narcotics, which is then followed by withdrawal of the methadone over a period of a week.

Independent

During the acute phase, keep the patient safe. Use strategies for continuous monitoring of airway, breathing, and circulation, and implement emergency measures as needed to support life. Monitor for seizure activity and place the patient on the seizure precautions regimen. Examine the environment for safety risks such as falls from the bed or self-discontinuation of tubes. Assess the potential for a suicide attempt, and if necessary, initiate suicide precautions and never leave the patient unattended.

Meet the self-care deficits related to hygiene, nutrition, and elimination. Promote a sense of security: approach the patient in a calm, nonthreatening, and nonjudgmental way. Building a trusting relationship with the patient provides a foundation for addressing the more long-term goals that are associated with becoming drug-free.

Following the acute phase, initiate the process of rehabilitation, and implement a treatment plan to maintain abstinence. The first goal is to work toward getting the individual to break through the denial of drug abuse and take responsibility to begin the recovery process. Provide educational materials and arrange a consultation with a chemical abuse counselor to begin the process before discharge from an acute care setting. Often, individuals are admitted from an acute care setting to an inpatient or outpatient treatment facility where nursing staff and other healthcare providers can begin specialized treatment programs. These programs include peer group programs in which confrontation, support, and hope are part of the treatment process. Treatment goals for the individual include development of a healthy self-concept, self-discipline, adaptive coping strategies, strategies to improve interpersonal relationships, and ways of filling leisure time without the use of drugs.

• Physical findings: Vital signs; adequacy of airway, breathing, and circulation; response to medication protocols for overdose or withdrawal, nutrition, intake and output, elimination patterns

• Mental/neurological findings: Anxiety levels, depression, delusions, hallucinations, presence or absence of seizures

• Understanding of the need for consultation with drug abuse counselor

• Understanding of the need for continued treatment for self and family

The patient should be discharged to an inpatient or outpatient treatment program to address the long-term effects of substance abuse. After discharge from a treatment program, the individual may continue with groups such as Narcotics Anonymous (NA), Cocaine Anonymous (CA), or Alcoholics Anonymous (AA). Family dynamics often play a role in the use of drugs. It is important for the family to be involved in the treatment plan through individual and family therapy and support groups that address issues dealing with family members who abuse drugs.

Pulmonary embolism (PE) is a potentially life-threatening condition in which a free-flowing blood clot (embolism) becomes lodged within the pulmonary vasculature. Approximately 650,000 cases of PE are reported yearly and approximately 60% of patients who die in a hospital are found to have a PE on autopsy. It is viewed as the most commonly missed diagnosis in the elderly.

When an embolism becomes lodged within a pulmonary vessel, platelets accumulate around the thrombus and trigger the release of potent vasoactive substances. The pulmonary vasculature constricts, which leads to an increased pulmonary vascular resistance, increased pulmonary arterial pressure, and increased right ventricular workload. Blood flow abnormalities result in a ventilation/perfusion mismatch that is initially dead-space ventilation (ventilation with no perfusion). As atelectasis occurs, shunting (perfusion without ventilation of the alveolus) results. If the right side of the heart (accustomed to pumping out against a relatively low-resistance pulmonary circuit) cannot empty its volume against the increased pulmonary vascular resistance, right-sided heart failure occurs. Ultimately, cardiac function may deteriorate with decreased cardiac output, decreased systemic blood flow, and shock.

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