Chapter 17 Caring for Chemically Dependent Clients CHAPTER OVERVIEW 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 paramount. LESSON PLAN 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. WORDS TO KNOW alcoholism aversion therapy blackouts chemical dependence cross-tolerance detoxification environmental tobacco smoke methadone maintenance therapy opiate dependence polydrug abuse relapse rule of one hundreds substance abuse tolerance withdrawal TEACHING/LEARNING ACTIVITIES 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? CASE STUDIES 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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