CHAPTER 17 by vivi07


									Chapter 17

Caring for Chemically Dependent Clients


This chapter discusses clients with substance abuse and chemical dependency

problems. These are serious public health and social problems that contribute

significantly to morbidity and mortality. The primary abuse is with drugs that

produce mind-altering and mood-altering effects. Withdrawal occurs when the drugs

are reduced or stopped and physical symptoms and cravings occur. Alcoholism is

chronic and progressive, a multisystem disease characterized by an inability to

control the consumption of alcohol. It is generally accepted that there may be a

genetic component to this disease. Treatment may include chemical detoxification

and a plan that includes abstinence, counseling, and support groups. Twelve-step

programs are a method to assist individuals to admit their disease and find new ways

to cope with daily stressors. Nursing management for a client with an addiction

includes assessing levels of intoxication, obtaining a health history of drug and

alcohol abuse using the CAGE Screening test, and implementing protocols for

detoxification. Maintaining the client’s safety during the process of detoxification is



1. Assign Chapter 17 one week before a class meeting.
2. Have students complete the Study Guide Exercise in Study Guide Chapter 17.

3. Use PowerPoint Presentation to deliver your lecture.

4. Choose additional assignments from the Teaching Strategies listed below.

5. Administer an examination (using the Test Generator) to test the knowledge and

   application of the material.



aversion therapy


chemical dependence



environmental tobacco smoke

methadone maintenance therapy

opiate dependence

polydrug abuse


rule of one hundreds

substance abuse



1. Assign one of the 12 steps to Recovery from AA to each student to present and

   explain how this step is essential for sobriety.

2. Develop talking points to encourage a smoker to stop smoking.

3. What are the key signs that someone is abusing cocaine?


1. A client is admitted to a detoxification unit with a history of cocaine and alcohol

   abuse. He began having occasional drinks as a teenager and then experimented

   with cocaine while he was in college. His intake of both substances continued to

   increase. He tells the intake nurse that he needed the cocaine to feel good, but

   found that the alcohol helped him to sleep. This client is now 29 years old and

   has been unable to hold a job for 2 years. Last week he was involved in a motor

   vehicle accident while driving under the influence. Although no one was hurt, he

   was convicted of driving under the influence. He has been ordered by the court

   to undergo drug and alcohol detoxification and rehabilitation.

2. A client is admitted to a medical unit with acute respiratory symptoms related to

   chronic bronchitis. The client states that he has smoked two packs of cigarettes

   per day for the past 20 years. He knows that he needs to quit smoking, but

   previous attempts have failed. He asks the nurse for suggestions to help him to

   quit smoking.
3. Sylvia is a 35-year old LPN working on a 35-bed medical-surgical unit. You have

   noticed that she seems forgetful, she claims to have dropped ampules of

   narcotics on more than one occasion, and the narcotic count is always off when

   Sylvia works. You begin to suspect Sylvia is abusing narcotics. What is your

   next step? What is your obligation? With whom will you discuss your concerns?

   What does your state law require? Are employee assistance programs available

   for professionals in your state?

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