Psychosocial Integrity
Substance Use Disorder: Planning Care for Alcohol Withdrawal
● Pathophysiology: Chronic alcohol use leads to CNS adaptation. Abrupt cessation results
in hyperexcitability.
● Withdrawal Symptoms:
○ Early (6–12 hr): Tremors, diaphoresis, nausea/vomiting, anxiety.
○ Peak (24–48 hr): Seizures.
○ Late (48–72 hr): Delirium tremens — hallucinations, hypertension, tachycardia,
fever.
● Medications:
○ Benzodiazepines (Lorazepam, Diazepam): Prevent seizures.
○ Thiamine (Vitamin B1): Prevent Wernicke’s encephalopathy.
○ Multivitamins and Folic Acid.
● Nursing Priorities:
○ Seizure precautions.
○ Quiet, calm environment.
○ Monitor vital signs, mental status.
○ Fluid replacement.
● Complications:
○ Seizures.
○ Delirium tremens.
, ○ Cardiac dysrhythmias.
Pharmacological and Parenteral Therapies
Adverse Effects, Interactions, Contraindications
1. Penicillin: Priority Findings
○ Adverse Effects: Anaphylaxis (hypotension, angioedema, wheezing), rash.
○ Nursing Actions:
■ Discontinue drug immediately.
■ Administer epinephrine, oxygen.
■ Maintain airway; prepare for intubation if needed.
○ Teaching:
■ Cross-sensitivity with cephalosporins (10%).
2. Methotrexate: Client Education
○ Uses: Cancer chemotherapy, rheumatoid arthritis.
○ Adverse Effects: Bone marrow suppression (neutropenia, anemia,
thrombocytopenia), hepatotoxicity, stomatitis.
○ Contraindications: Pregnancy (Category X).
○ Nursing Actions:
■ Monitor CBC, liver function.
■ Avoid alcohol.
, ■ Folic acid supplementation.
■ No live vaccines.
■ Use birth control during and for 6 months after therapy.
3. Aspirin: Client Education
○ Uses: Pain, fever, inflammation, antiplatelet.
○ Adverse Effects:
■ Bleeding (GI bleeding, hemorrhagic stroke).
■ Tinnitus (toxicity).
○ Interactions:
■ Anticoagulants (warfarin, heparin).
■ Corticosteroids (increase GI risk).
○ Teaching:
■ Take with food.
■ Avoid alcohol.
■ Watch for black stools, coffee-ground emesis.
4. Ketorolac: Contraindications
○ Uses: Short-term management of moderate to severe pain.
○ Adverse Effects:
■ GI bleeding, peptic ulcers, renal toxicity.
○ Contraindications:
Substance Use Disorder: Planning Care for Alcohol Withdrawal
● Pathophysiology: Chronic alcohol use leads to CNS adaptation. Abrupt cessation results
in hyperexcitability.
● Withdrawal Symptoms:
○ Early (6–12 hr): Tremors, diaphoresis, nausea/vomiting, anxiety.
○ Peak (24–48 hr): Seizures.
○ Late (48–72 hr): Delirium tremens — hallucinations, hypertension, tachycardia,
fever.
● Medications:
○ Benzodiazepines (Lorazepam, Diazepam): Prevent seizures.
○ Thiamine (Vitamin B1): Prevent Wernicke’s encephalopathy.
○ Multivitamins and Folic Acid.
● Nursing Priorities:
○ Seizure precautions.
○ Quiet, calm environment.
○ Monitor vital signs, mental status.
○ Fluid replacement.
● Complications:
○ Seizures.
○ Delirium tremens.
, ○ Cardiac dysrhythmias.
Pharmacological and Parenteral Therapies
Adverse Effects, Interactions, Contraindications
1. Penicillin: Priority Findings
○ Adverse Effects: Anaphylaxis (hypotension, angioedema, wheezing), rash.
○ Nursing Actions:
■ Discontinue drug immediately.
■ Administer epinephrine, oxygen.
■ Maintain airway; prepare for intubation if needed.
○ Teaching:
■ Cross-sensitivity with cephalosporins (10%).
2. Methotrexate: Client Education
○ Uses: Cancer chemotherapy, rheumatoid arthritis.
○ Adverse Effects: Bone marrow suppression (neutropenia, anemia,
thrombocytopenia), hepatotoxicity, stomatitis.
○ Contraindications: Pregnancy (Category X).
○ Nursing Actions:
■ Monitor CBC, liver function.
■ Avoid alcohol.
, ■ Folic acid supplementation.
■ No live vaccines.
■ Use birth control during and for 6 months after therapy.
3. Aspirin: Client Education
○ Uses: Pain, fever, inflammation, antiplatelet.
○ Adverse Effects:
■ Bleeding (GI bleeding, hemorrhagic stroke).
■ Tinnitus (toxicity).
○ Interactions:
■ Anticoagulants (warfarin, heparin).
■ Corticosteroids (increase GI risk).
○ Teaching:
■ Take with food.
■ Avoid alcohol.
■ Watch for black stools, coffee-ground emesis.
4. Ketorolac: Contraindications
○ Uses: Short-term management of moderate to severe pain.
○ Adverse Effects:
■ GI bleeding, peptic ulcers, renal toxicity.
○ Contraindications:
