1.9 Applying the Nursing Process to Substance Use Disorders
1.9 Applying the Nursing Process to Substance Use Disorders
Open Resources for Nursing (Open RN)
This section will apply the nursing process to caring for a hospitalized client diagnosed with a substance use disorder who is receiving withdrawal treatment.
Assessment
The following client history should be obtained from a client diagnosed with a substance use disorder[1]:
- History of substance use: Include names of the substances used, the time of last use, the duration of use, the quantity and frequency of use, and the method of use (e.g., oral, intravenous, inhaled, intranasal). A detailed substance use history helps determine the expected time frame for emergence of withdrawal symptoms and the potential for severe withdrawal syndromes.
- Detailed history of previous withdrawal treatments: For clients who have previously undergone withdrawal management, a history of these treatments should be obtained.
- Treatment history: The history of any previous treatment programs should be obtained. History should include previous treatments (such as inpatient or outpatient programs, 12-step programs such as Alcoholics Anonymous, or medications such as naltrexone or acamprosate), as well as what treatments have been helpful or not helpful.
- Mental health history: Concurrent mental health illness can impact the client’s withdrawal symptoms. Clients should receive integrated post-withdrawal treatments for multiple diagnoses of mental health and substance use disorders.
- Social history: Identification of social supports (such as a supportive family member who can encourage abstinence and potentially dispense withdrawal medication), as well as barriers (such as poor transportation), can also help determine the most appropriate post-withdrawal treatment plan (e.g., residential, outpatient, and recovery programs).
- Medical history and recent physical symptoms: Medical problems can contribute to the client’s symptoms and/or worsen withdrawal symptoms.
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.[2]
Screening Scales
Screening 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 Work
Laboratory testing for clients admitted for withdrawal treatment may include these items[3]:
- Complete blood count
- Serum electrolytes, including potassium, magnesium, and phosphate
- Glucose
- Creatinine
- Liver function tests
- Amylase and lipase
- Blood alcohol level
- Urine drug testing for benzodiazepines, cocaine, and opioids. (The opioid test may include testing for heroin, codeine, morphine, bupren