NCLEX-PN · Psychosocial Integrity · 6 min read
Substance Use, Withdrawal and Eating Disorders
- Differentiate clinical manifestations, risks, and nursing interventions for clients experiencing substance intoxication, withdrawal, and overdose.
- Identify physical findings, life-threatening electrolyte imbalances, and refeeding risks in clients with anorexia nervosa, bulimia nervosa, and binge-eating disorder.
- Apply the practical nurse's scope of practice when collecting focused data, reinforcing education, administering prescribed medications, and maintaining a structured therapeutic environment.
Foundations of Substance Use and Support Systems
Substance use disorders involve compulsive drug-seeking behavior despite harmful physical, psychological, or social consequences. A primary defense mechanism encountered in these disorders is denial, in which the client refuses to acknowledge their addiction. For example, a client may insist they can stop drinking at any time despite experiencing significant health or legal difficulties.
Family dynamics often play a critical role in substance use disorders. Enabling occurs when family members or loved ones shield a client with a substance use disorder from the consequences of their actions, such as paying overdue fines or making excuses for missed responsibilities. In addition, codependency involves maladaptive behaviors where a person derives self-worth from controlling, rescuing, or pleasing an individual with an addiction.
Recovery often requires ongoing community and social support. The licensed practical nurse (LPN) reinforces teaching about 12-step support programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). To help those surrounded by addiction, Al-Anon supports family members and friends affected by someone else's drinking, while Alateen is designed specifically for adolescents affected by someone else's drinking.
Pharmacological therapies support long-term recovery. Disulfiram acts as an alcohol deterrent by causing severe nausea, vomiting, flushing, and tachycardia when ethanol is ingested; the LPN reinforces that clients taking disulfiram must strictly avoid hidden alcohol sources such as mouthwash, cough syrups, aftershave, and cooking extracts. Naltrexone is an opioid receptor antagonist prescribed to decrease alcohol cravings and block the euphoric effects of opioids. Acamprosate helps clients maintain abstinence from alcohol after withdrawal by reducing persistent withdrawal-related symptoms and the urge to drink.
Common mistakes
- Assuming clients with bulimia nervosa are always noticeably underweight; they often maintain a normal or higher body weight, making physical findings like dental erosion, parotid enlargement, and Russell's sign essential for data collection.
- Stopping respiratory and neurologic checks immediately after giving naloxone, rather than performing frequent checks for recurrent opioid toxicity and respiratory depression as naloxone wears off.
- Focusing mealtime discussions on food intake, calories, or weight, instead of keeping mealtime conversation neutral and addressing nutrition education at designated appropriate times.
- Basing client privileges strictly on scale weight rather than reinforcing privileges based on agreed treatment behaviors under the care plan.
Key points
- Substance use disorders involve compulsive drug-seeking behavior, denial, and interpersonal patterns such as enabling and codependency; support includes AA, NA, Al-Anon, and Alateen.
- Early alcohol withdrawal commonly begins within 6 to 12 hours (tremors, diaphoresis, tachycardia, hypertension), while delirium tremens typically begins about 48 to 96 hours after cessation and may occur later; benzodiazepines and thiamine are key medical interventions.
- Opioid overdose causes pinpoint pupils and respiratory depression requiring immediate naloxone and frequent ongoing monitoring; uncomplicated opioid withdrawal is distressing with dilated pupils and cramps, but rarely fatal.
- Stimulant withdrawal can cause fatigue and depression of varying severity; the LPN promptly reports suicidal statements or behavior to the RN. PCP intoxication can cause horizontal or vertical nystagmus and aggressive behavior.
- Anorexia nervosa leads to severe restriction, bradycardia, hypotension, amenorrhea, and lanugo; bulimia nervosa involves binging and purging, parotid enlargement, dental erosion, and Russell's sign.
- Vomiting commonly causes metabolic alkalosis, while diarrhea from laxative abuse commonly causes metabolic acidosis; either can cause dangerous hypokalemia, and falling serum phosphorus is a hallmark of refeeding syndrome.
- The RN completes the initial comprehensive assessment and care plan; the LPN collects focused data, observes meals and obtains blind morning weights when specified in the care plan, administers medications within state scope, and reports abnormalities.
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