Serious, multifactorial sequelae following abrupt cessation of an addictive compound

• Developed dependence to addictive substance
• Inadequate knowledge of consequences of sudden cessation of addictive substance

• Significant comorbidity

• History of patient use of ethyl alcohol (ETOH), recreational drugs, or other addictive compounds
• Symptoms of withdrawal which may include nausea and vomiting, anxiety, insomnia, perspiration, muscle cramps, and diarrhea
• Mental status changes including disorientation, confusion, and hallucinations
• Seizures
• Vital signs including resting pulse rate
• Restless behavior
• Neurologic assessment with pupil size and reaction
• Presence of tremors
• Excessive yawning
• Hot or cold flashes
• Teary eyes
• Runny nose
• Perceptual distortions
• Nutritional status, including dietary intake, appetite, current weight, and change from normal weight

• Acute confusion (00128)
• Excessive anxiety (00400)
• Impaired physical comfort (00380)
• Inadequate protein energy nutritional intake (00359)
• Ineffective sleep pattern (00337)
• Risk for physical injury (00336)

• Patient will remain free from harm.
• Patient will not experience seizure activity.
• Patient will comply with treatment regimen.
• Patient will develop effective coping behaviors.
• Patient will have decreased anxiety.
• Patient will experience undisturbed sleep.
• Patient will have balanced electrolytes.
• Patient will consume ______ calories per day.

Suggested NOC Outcomes

• Perform thorough nursing history and head-to-toe assessment and document to establish baseline of patient's condition for future comparison and to ensure continuity and consistency of care among nursing staff.
• Monitor and record level of consciousness (LOC), temperature, heart rate and rhythm, and blood pressure at least every 4 hours, or more often if necessary, to detect deterioration from possible hypoxia or decreased cardiac output.
• Report complaints of anxiety, confusion, dizziness, or syncope promptly; these may indicate neurological decline.
• Assess sleeping patterns. Rest reduces symptoms of anxiety and fosters patient coping.
• Include patient in plan of action to promote self-care.
• Have a staff member stay at patient's bedside if necessary to protect patient from harm during episodes of confusion.
• Limit noise and environmental stimulation to prevent patient from becoming overstimulated.
• Use appropriate safety measures to protect patient from injury. Avoid physical restraints to prevent agitating patient.
• Provide positive feedback when patient assumes responsibility for own behavior to reinforce effective coping behaviors.
• Convey attitude of acceptance, separating individual from unacceptable behavior. Promotes feelings of dignity and self-worth.
• Provide nonjudgmental care. Monitor for changes in behavior (restlessness, increased tension). Agitation can lead to compromised patient safety.
• Assist patient to assess current life situation and impact of substance use. Allows patient to see the relationship between substance use and physical problems.
• Assess patient's support system. Family involvement can help patient feel more in control.
• Encourage patient to attend recovery support and therapy groups regularly. Attendance fosters healing relationships and maintenance of a long-term substance-free existence.
• Refer the patient to a mental health specialist and/or social worker for follow-up treatment after hospitalization. Continuing therapy is usually necessary to assist the patient in coping with health care status.

Suggested NIC Interventions

• Patient doesn't exhibit self-harming behaviors.
• Patient maintains neurologic, cardiovascular, respiratory, GI, nutritional, genitourinary, musculoskeletal, and integumentary functioning.
• Patient does not experience seizure activity.
• Patient complies with treatment regimen and plan of care.
• Patient doesn't exhibit altered LOC, mental status, sensory ability, or motor ability.
• Patient develops healthy effective coping strategies.
• Patient's anxiety level remains at a manageable level.
• Patient experiences undisturbed sleep.
• Patient electrolyte levels remain within normal limits.
• Patient consumes ______ calories per day.

• Patient's vital signs
• Patient's concerns or perceptions of circumstances; willingness to accept and participate in treatment
• Assessment of body systems at risk for deterioration
• Observations of patient's behaviors
• Interventions to provide preventive or supportive care and prescribed treatment
• Treatment given to patient and patient's understanding and demonstrated ability to carry out instructions
• Patient's response to nursing interventions
• Evaluations for expected outcomes

• Grover, S., Kate, N., Sharma, A., Mattoo, S. K., Basu, D., Chakrabarti, S., … Avasthi, A. (2016). Symptom profile of alcohol withdrawal delirium: Factor analysis of Delirium Rating Scale-Revised-98 version. American Journal of Drug and Alcohol Abuse, 42(2), 196-202.
• Heron, N. (2018). Opioid use disorder in critical care: Recognizing, managing, and advocating for our patients. Canadian Journal of Critical Care Nursing, 29(2), 38-39.
• Lee, K. Y., & Park, J. Y. (2018). Pediatric nurses' knowledge and attitude on iatrogenic narcotic analgesic withdrawal symptoms management. Journal of Korean Critical Care Nursing, 11(3), 107.
• Stockmann, T., Odegbaro, D., Timimi, S., & Moncrieff, J. (2018). SSRI and SNRI withdrawal symptoms reported on an internet forum. International Journal of Risk & Safety in Medicine, 29(3/4), 175-180.