Perinatal, Neonatal, Pediatric Conference Presented By: Cheryl - - PowerPoint PPT Presentation

Perinatal, Neonatal, Pediatric Conference

Presented By: Cheryl Piper, R.N., CADC

Vice-President of Clinical Services

Remedies Renewing Lives

Objectives

 Learn about drug trends in Illinois/Winnebago County  Identify Symptoms of Substance use Disorders  Recognize the impact of addiction on our Nursing practice  Identify strategies to work with chemically dependent pain patients

Drug Trends in Illinois

 Drug arrests are above national average (828 arrests per

100,000 vs. average 620 arrests per 100,000 in other states)

 Alcohol and Marijuana are the most abused drugs

(68%)

 Cocaine is making a big comeback (Up from 35% to 40%)

 Opiates are the fastest growing drug of abuse (48%)

 Hallucinogens are losing popularity (K2, Molly, Methamphetamines) Down from 18% to less than 10%

Drug Trends in Illinois (continued)

• Pregnant/childbearing age female admissions

to Illinois treatment facilities have increased from 32% to 46.5 % over the past five years

• Approximately 3 of every 1,000 babies born

in Illinois have experienced neonatal abstinence

• Non-medical use of prescription
• piates/heroin addiction is admitting

diagnoses for 55% of treatment admissions

Drug Trends in Illinois

(continued)

• Illinois rates for non-medical use of pain

meds runs at 5.3 % of population (highest range is 7.2 % in Western States)

Barriers to “Treatment for Pregnant/Parenting Females

• Treatment costs/availability of appropriate

services.

• Shame and guilt “How could I do this to my

baby, my family?” “What will my caregivers think of me?”

• Fearful of withdrawal
• Fearful of potential loss of child (children)

custody.

Barriers to Treatment for Pregnant/Parenting Females continued

• Need for child care for their current children

if hospitalized for treatment.

Addiction Impact on Health Care

 10-15% of the general population are chemically dependent  National studies indicate that between 20-40% of all acute care hospitalizations are alcohol/drug related  Over 3,000 patient ED visits recorded in two of the three Rockford hospitals r/t opiate withdrawal/overdose in 2017  Rockford Fire Department reports ‘911’ calls for overdose

Addiction Impact on Health Care

• Rockford Fire Department reports ‘911’

calls for overdose victims a minimum of 4 calls daily.

• Winnebago County Coroner reports 124
• verdose deaths in Winnebago County for
• 2017. Over 40% were female.

Symptoms of Addiction

Early Stage

• Occasional relief drinking/drug use
• Urgency of first drink/use
• Feelings of guilt-“not normal use”

Chronic Phase

• Decrease of alcohol/drug tolerance
• Significant physical/psychological

deterioration

Crucial Phase

• Increase in alcohol/drug tolerance
• Onset of memory “blackouts” Falling out
• Grandiose/aggressive behaviors
• Efforts of control fail
• Life difficulties related to social, financial,

vocational, scholastic, legal, and health

Screening Tool

CAGE

C----------------Have you ever tried to Cut down on your use? A----------------Do you get Annoyed when people talk about your

drinking/drug use?

G----------------Do you feel Guilty about your drinking/drug use? E----------------Have you ever had an Eye-Opener?

(Drinking or using the morning after)

Narcotic Withdrawal Symptoms

 Drug cravings/Anxiety  Yawning, sweating, lacrimination, rhinorhea  Gooseflesh, muscle twitching  Insomnia, abdominal cramping, vomiting, diarrhea

Detox Protocols

 Clonidine 0.1 mg-0.2 mgs. every 4-6 hours for anxiety PRN  Zofran PO or Tigan 200 mgs. IM or every 6 hours for nausea PRN  Ibuprofen 600 mgs. every 6 hours for aching PRN  Bentyl 20 mgs. every four hours for abd. Cramping PRN  Buprenorphine 8/2mgs. (five day taper) MUST be in active withdrawal before administering.  Methadone Taper is done very slowly (Usually 2-5

• mgs. Every 5-7 days)

Treatment of the Identified Addicted Patient

 Explain use of opiates  Validate Patient’s fear of relapse  Offer support and reinforce that mediation is being utilized for a medical condition  Respect Patient’s right to be involved in decision-making process and refusal of opiates  Involve support system  Explore alternative methods of pain management  Important to remember that methadone maintenance patients will require additional pain medication beyond their daily dose

Treatment of the Unidentified Addicted Patient

 Monitor for Possible withdrawal symptoms  Avoid mood altering drugs that do not relieve pain  Identify appropriate staff as resources: Addiction and Pain  Specialists, one MD for prescribing opiates, Primary Nurses to coordinate care  Arrange regular staff meetings to plan care and “vent”  Examine own attitudes/Do not allow a negative impact on patient care  Acknowledge Limitations

 Pain cannot be proven  Addiction treatment is not possible while patient is in “acute” pain  Patient may not admit addictive disease

Establish Appropriate Goals

• Monitor/medicate for withdrawal symptoms
• Identify pain ratings acceptable to patient and side

effects that are unacceptable

• Dose until patient reports satisfactory pain relief
• Avoid excessive negotiation with patient regarding

pain medications

Reduce Problematic Behaviors

· Be specific with expectations · Be consistent with pain relief · Avoid “rescuing behaviors” · Consider “contracting” with the patient · Make a plan for withdrawal · Give information on chemical dependency treatment services

Pain Contract

• Goals for Pain Management:
• 1. To make me as comfortable as possible during the acute pain phase.
• 2. Relieve my pain without sedation.
• 3. To control my withdrawal symptoms.
• Contract Terms:
• 1. The nursing staff agrees to accept and respect my reports of pain as the best indicator
• f how much pain I am experiencing.
• 2. I may receive as much analgesia as I need to relieve pain unless the dose would put

me at risk for complications.

• 3. I will not tamper with the PCA equipment and, if I do, the PCA will be stopped.
• 4. My other medications will be given on time.
• 5. The medication used to manage my pain will be reduced gradually as I progress

through my recover.

• I have discussed and agree with the terms of this contract.

Summary of Treatment Strategies

 Acknowledgement of recovering addicts fears---RELAPSE  Honor patient’s involvement in pain management process  Provide additional support through involvement of 12 Step Sponsor, addiction counselors and or family  Remember unrelieved pain can itself be a trigger  For patients not in recovery, establish realistic goals for pain management and adhere to those goals  You can lay the groundwork for a trusting relationship that can facilitate drug treatment