Primary Nursing Diagnosis

Self-esteem disturbance related to immaturity, personal vulnerability

OUTCOMES. Self-esteem; Body image; Hope; Mood equilibrium; Role performance; Social interaction skills

INTERVENTIONS. Counseling; Substance use treatment: Withdrawal and/or overdose; Therapy group; Support group; Emotional support; Mood management; Substance use treatment and prevention

H PLANNING AND IMPLEMENTATION Collaborative

The immediate goal after depressant ingestion is to keep the individual safe during a drug overdose or withdrawal. The long-term goal is for the patient to remain drug-free. In the acute phase, the immediate effects of narcotics can be reversed with naloxone (Narcan). In the case of barbiturate overdose when the patient is conscious, mild intoxication can be treated by letting the individual "sleep it off." More severe cases of overdoses need to be handled in an acute or critical care environment where continuous monitoring can occur. Of paramount importance is to make sure the patient has adequate airway, breathing, and circulation during the time period that depressants may lead to severe respiratory depression.

Generally, if the patient is unconscious and the substance is unknown, the following steps are taken in management: (1) Begin supplemental oxygen; (2) insert intravenous line with saline infusion or dextrose in water; (3) administer dextrose, thiamine, and naloxone; (4) protect airway with endotracheal intubation; (5) pass orogastric tube, lavage, and administer activated charcoal; (6) admit the patient for ongoing observation and management. Activated charcoal is produced from the destructive distillation of organic materials. The substance absorbs toxic substances because of large external pores and a large internal surface area that binds with toxic ions. A cathartic such as magnesium citrate is given to help gastrointestinal excretion of the toxic substance bound with activated charcoal. Activated charcoal is also given for overdoses when the substance is known, such as phenobarbital, carbamazepine, cyclic antidepressants, amphetamines, and cocaine.

Management of stimulants can be similar to that of depressants, with the administration of activated charcoal. Seizures are a possibility in the case of an overdose with stimulants, but note that amphetamines and cocaine have a short duration time of 2 to 4 hours. Phenytoin (Dilantin) can be ordered to prevent seizure activity, and benzodiazepines are also used to treat agitation or seizures. External cooling may be used to reduce hyperthermia, and intravenous fluids may be used to replace fluid loss and to prevent myoglobin damage in the kidneys. All patients with substance abuse and overdoses need counseling and therapy to manage their substance use patterns.

788 Psychoactive Substance Abuse

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Naloxone

2 mg IV; use smaller

Opioid antagonist

Blocks the action of opioids that can

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