LEARNING GUIDE / CHEMICAL DEPENDENCY
Chapter 34
General Assessment:
1. Why is a careful nursing assessment of a patient and family’s substance use so important?
2. What areas of data collection will the nurse rely on most in the assessment of a client’s possible substance-related disorder?
3. Fill in the criteria for the following DSM-IV-TR criteria for Substance-Related Disorders:
a. Substance Abuse:
b. Substance Intoxication:
c. Substance Withdrawal:
d. Substance Dependence:
4. What is drug tolerance?
Specific Substances
1. ALCOHOL
a. Compare PSYCHODYNAMIC THEORIES of alcohol dependence with BIOLOGIC
THEORIES. How can theories be useful in addressing and reducing risks for alcoholism?
b. Describe Central Nervous System effects of alcohol.
c. Describe peripheral nervous system effects of alcohol
d. Describe physiologic effects of alcohol ingestion on other body systems
e. What is the effect of alcohol overdose (“alcohol poisoning”) and the interaction with other
CNS depressants?
f. What are physiological complications from long-term use of alcohol and alcohol dependence?
g. What is fetal alcohol syndrome?
h. What are some tools for screening for alcohol abuse and diagnosis of alcohol dependence
i. What are signs and symptoms of alcohol withdrawal?
j. What is alcohol detoxification and how is it managed? (Include pharmacological, and assessment modes.)

k. What pharmacological interventions are used to promote abstinence from alcohol?
2. OTHER CNS DEPRESSANTS: BARBITURATES AND BENZODIAZEPINES (Also see
Chapter 21)
a. Compare the dangers of overdose and withdrawal from barbiturates with those of benzodiazepines.
3. (OTHER DEPRESSANTS, cont’d) INHALENTS
a. What properties of inhalants make them so commonly used? Which populations often use this category?
b. Name common examples of products used as inhalants
c. List the side effects and symptoms of inhalant use
d. Describe adverse effects on body systems of inhalants.
4. (OTHER CNS DEPRESSANTS, cont’d) OPIOIDS
a. List common prescribed opioid agents. What is heroin?
b. What are routes of administration of the opioids? Which routes are most hazardous?
c. Described physiologic effects of opioid abuse
d. What occurs during opioid overdose? How can drug effects be reversed?
e. Describe signs and symptoms of opioid withdrawal.
f. What is the nurse’s role when a client is in detoxification from opioid dependence?
g. What medications are used to support abstinence from opioids?
h. Why is dolophine (Methadone) used in the maintenance of abstinence from other opiods even though it is also an opioid?
5. STIMULANTS: COCAINE AND CRACK
a. Describe physiologic effects of cocaine intoxication
b. Compare cocaine and crack:
i. routes of administration
ii. drug effects

c. What are pharmacological interventions to treat cocaine overdose/withdrawal?
6. (STIMULANTS, cont’d): AMPHETAMINES AND RELATED DRUGS
a. List amphetamines that are frequently drugs of abuse
b. Compare the effects of methamphetamine with cocaine
c. Describe effects and side-effects of amphetamine intoxication
d. What is a hazard of amphetamine withdrawal?
e. Discuss nursing care of the client who is withdrawing from amphetamine dependence.
f. What a pharmacological interventions to treat withdrawal?
7. HALLUCINOGENS
a. Compare and contrast effects of marijuana, LSD, PCP (phencyclidine) and Salvia. Which ones may cause toxic effects or overdose?
b. Describe medical treatment for hallucinogen overdose
c. What are pharmacological interventions for withdrawal from hallucinogens?
Nursing Diagnosis
8. List priority nursing diagnoses for the client in withdrawal from: a. alcohol
b. CNS depressants
c. opioids
d. amphetamines
9. List priority nursing diagnoses for the client who has overdosed.
Goals/Outcomes
10.. a. Using the disease model of substance dependence, what are overall goals of treatment?
b. List goals/outcomes on a nursing plan of care for the client who is withdrawing from specific substances (as listed above in #8).

c. List goals/outcomes for the client who has overdosed on
i. alcohol
ii. barbiturates or benzodiazepines
iii. opioids
d. List goals/outcomes for the client who is in recovery from substance dependence.
Interventions:
11. What are priority nursing communication interventions when working with the chemically dependent client?
12. What milieu interventions and therapeutic inpatient modalities can assist the individual to begin the recovery process?
13. What are community resources for the individual who has a substance-related disorder to promote recovery and prevent relapse?
Related Issues
1. What are effects on the family of substance dependence? Define co-dependence.
2. (Chapter 35) Dual Diagnosis a. What is the meaning of the term dual diagnosis?
b. What are special treatment issues and challenges for the individual who has a dual diagnosis?
3. Why must the nurse examine her/his own attitudes toward the individual who has a substance-related disorder?