3. Analysis/nursing diagnosis:
   • Risk for altered physical regulation processes (cardiac, circulatory, gastrointestinal, sleep pattern disturbance) related to use of mind-altering drugs.
   • Risk for injury due to altered judgment related to misinterpretation of sensory stimuli and low frustration tolerance.
   • Altered conduct/impulse processes related to rebellious attitudes toward authority.
   • Altered social interaction (manipulation, dependency) related to hostility and personal insecurity.
   • Altered feeling states (denial) related to underlying self-doubt and personal insecurity.


4. Nursing care plan/implementation: generally the same as in treating antisocial personality and alcohol abuse and dependence.
   • Maintain safety and optimum level of physical comfort. Supportive physical care: vital signs, nutrition, hydration, seizure precautions.
   • Assist with medical treatment and offer support and reality orientation to reduce feelings of panic.
     1. Detoxification (or dechemicalization) - give medications according to detoxification schedule.
     2. Withdrawal - may be gradual (barbiturates, hypnotics, tranquilizers) or abrupt (“cold turkey” for heroin). Observe for symptoms and report immediately.
     3. Methadone (Dolophine) - person must have been dependent on narcotics at least 2 years and have failed at other methods of withdrawal before admission to program of readdiction by methadone.
        • Characteristics:
          1. Synthetic.
          2. Appeases desire for narcotics without producing euphoria of narcotics.
          3. Given by mouth.
          4. Distributed under federal control (Narcotic Addict Rehabilitation Act).
          5. Given with urinary surveillance.
        • Advantages:
          1. Prevents narcotic withdrawal reaction.
          2. Tolerance not built up.
          3. Person remains out of prison.
          4. Lessens perceived need for heroin or morphine.
   • Participation in group therapy - goals: peer pressure, support, and identification.
   • Rehabilitation phase:
     1. Refer to halfway house and group living (e.g., Day-top).
     2. Support employment as therapy (work training).
     3. Expand client’s range of interests to relieve characteristic boredom and stimulus hunger.
        • Provide structured environment and planned routine.
        • Provide educational therapy (academic and vocational).
        • Arrange activities to include current events discussion groups, lectures, drama, music, and art appreciation.
   • Achieve role of stabilizer and supportive authoritative figure; this can be achieved through frequent, regular contacts with the same client.
   • Health teaching: how to cope with pain, fatigue, and anxiety without drugs.


5. Evaluation/outcome criteria: replaces addictive lifestyle with self-reliant behavior and a plan formulated to maintain a substance-free life.