Substance Abuse in Babies & Adolescents

Signs of Neonatal Withdrawal - From Neonatal Abstinence Syndrome): Apnea Diarrhea Fever High Pitched / ShrillCry Hyper-reflexia Poor Feeding Tremors Seizures Irritability/ Restlessness Poor Feeding/ Failure to gain weight/ Weight loss Tachypnea (Rapid breathing)   Facial dysmorphism is apart of Fetal Alcohol Syndrome, what are some of the characteristics? Short palpebral fissure (<10th percentile for age)Thin upper lip or vermillion border Smooth philtrum The face should be examined for the following features: flat midface large ears with "railroad-track" ear abnormality, epicanthic folds hypertelorism (wide-spaced eyes), ptosis (droopiness of the eyelids),micrognathia (small jaw),microphthalmia (small eyes) Cleft lip and/or palate. microcephally (small head)    

Cocaine Users Require Seizure Precautions The laboring woman who has recently used cocaine is at risk for seizures. Take seizure precautions to protect her from injury in case of seizures. 1.) Keep the bed in a low, locked position. 2.) Pad the side rails and keep them up at all times. 3.) To prevent aspiration, make sure suction equipment functions properly. Reduce environmental stimuli (lights, noise) as much as possible.   PRIORITY IS MONITORING VITAL SIGNS Cocaine can cause tachycardia, hypertension, and dysrhythmias. The patient’s physiologic status is jeopardized by cocaine use and disruptions are revealed most quickly by changes in vital signs. For this reason, vital signs monitoring should be prioritized.

Signs of Substance Addiction

Failing Grades Skipping School Aggressive, rebellious behavior, like punching walls Refuse to spend time with friends or family. Lack of concern for hygiene

Personal/social history findings of Substance Abuse

Diagnosis of depression Recently remarried parent Recent death in the family Parents who work an evening shift

GATEWAY DRUGS - Remember M.A.T   All drugs of abuse directly or indirectly target dopamine in particular, the neurotransmitter present in areas of the brain that regulates emotion, cognition, movement, and pleasure. This overstimulation creates the euphoric, energized feeling sought by users. Alcohol (Gateway Drug) Alcohol is associated with behavioral changes, a lack of coordination, and disinhibition. Euphoria followed by depression or hostility  Decreased inhibitions  Impaired judgment  Lack of coordination  Slurred speech Cocaine Cocaine causes weight loss, appetite suppression, tachycardia (Over 100bpm), hypertension (130/80 or higher), and diaphoresis.   Tobacco (Gateway Drug) Tobacco leads to a cough and increased phlegm production. Chronic cough  Wheezing  Increased phlegm production  Atherosclerosis Marijuana (Gateway Drug) Marijuana leads to dry mouth, red eyes, and a sense of euphoria. Relaxation Euphoria  Loss of inhibition  Decreased motivation  Red eyes  Dry mouth Amphetamines “Crystal meth” Methamphetamine Adderall   Euphoria  Agitation and insomnia  Weight loss  Tachycardia and hypertension  Psychosis

Amphetamines

Types Include  “Crystal meth” Methamphetamine Adderall

Effects Include Euphoria Decreased appetite Agitation  insomnia Weight loss Tachycardia and hypertension Psychosis

Nursing Interventions For Overdose

PROBLEM:  Central nervous system depression caused by an opiate that is compromising cardiac and respiratory function.   SIGNS: Low blood pressure (Less than 90/60) Low Respiratory Rate (Less than 12) Low Pulse Ox (Less than 95%)   GIVE: PRIORITY (naloxone or flumazenil) and should provide supportive care until the patient is stabilized. SECONDARY The child should be monitored for respiratory depression, given oxygen therapy if necessary, and action should be taken to prevent aspiration.

Nursing Priority Assessments For Drug Abuse

All Vital Signs  Urine drug screen with patient consent if under 18yrs old

Opiate Abuse Signs

Poor skin turgor Signs of malnurtrition Disheveled Appearance        

Risk factor for Drug Abuse

Family history of substance abuse (linked to genetic factors and patterns of observed behavior) Poor coping skills and social skills Low self-esteem Poor interpersonal relationships Emotional and behavioral disorders, such as anxiety disorders, attention deficit hyperactivity disorder, depression, and conduct disorder Abuse (emotional, sexual, physical) Unstable or unsafe home environment Lack of supervision Ready access to substances

Protective Factors to Prevent Drug Use

Strong family and peer relationships Academic achievement Extended family support Consistent discipline Strong coping and problem-solving skills Engagement with religion, athletics, culture, and employment High self-esteem