Drug overdose is a critical medical emergency requiring immediate nursing intervention and careful monitoring. This nursing diagnosis focuses on identifying and treating overdose symptoms, preventing complications, and supporting recovery. Understanding the comprehensive care approach is essential for nurses managing overdose cases.
Causes (Related to)
Drug overdose can occur due to various factors, with several circumstances contributing to its severity and presentation:
- Intentional overdose of prescription or illicit drugs
- Accidental overdose due to medication errors
- Drug interactions
- Substance use disorder
- Mental health conditions
Patient Risk Factors include:
- History of substance use
- Depression or anxiety
- Chronic pain conditions
- Previous suicide attempts
- Access to multiple medications
Environmental Factors including:
- Limited access to mental health care
- Social isolation
- Stressful life events
- Easy access to substances
- Lack of support systems
Signs and Symptoms (As evidenced by)
Drug overdose presents with various signs and symptoms depending on the substance involved. Nurses must recognize these indicators for proper diagnosis and immediate intervention.
Subjective: (Patient reports)
- Chest pain
- Difficulty breathing
- Nausea or vomiting
- Confusion
- Anxiety or agitation
- Dizziness
- Physical discomfort
Objective: (Nurse assesses)
- Altered mental status
- Respiratory depression
- Changes in vital signs
- Pupil changes (pinpoint or dilated)
- Seizure activity
- Loss of consciousness
- Skin color changes
- Cardiac arrhythmias
Expected Outcomes
The following outcomes indicate successful management of drug overdose:
- The patient will maintain stable vital signs
- The patient will demonstrate improved mental status
- The patient will maintain a patent airway
- The patient will avoid complications
- The patient will receive appropriate substance use treatment referrals
- Patient will demonstrate an understanding of overdose prevention
- The patient will engage in follow-up care
Nursing Assessment
Monitor Vital Signs
- Check respiratory rate, pulse, blood pressure, and temperature
- Monitor oxygen saturation
- Assess the level of consciousness
- Document cardiac rhythm
Assess Airway Status
- Monitor breathing pattern
- Check for airway obstruction
- Assess the need for intervention
- Document respiratory effort
- Note the presence of secretions
Evaluate Neurological Status
- Assess the Glasgow Coma Scale
- Check pupillary response
- Monitor consciousness level
- Document mental status changes
- Evaluate orientation
Monitor for Complications
- Check for aspiration
- Assess for trauma
- Monitor for organ dysfunction
- Watch for withdrawal symptoms
- Document seizure activity
Review Risk Factors
- Assess substance use history
- Document psychiatric history
- Review medication list
- Check the social support system
- Evaluate access to care
Nursing Care Plans
Nursing Care Plan 1: Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to central nervous system depression secondary to drug overdose as evidenced by decreased respiratory rate and oxygen saturation.
Related Factors:
- CNS depression
- Respiratory muscle weakness
- Airway compromise
- Altered consciousness
Nursing Interventions and Rationales:
- Monitor respiratory rate and depth
Rationale: Identifies the need for immediate intervention - Position patient for optimal breathing
Rationale: Maintains airway patency - Administer oxygen as ordered
Rationale: Improves oxygenation
Desired Outcomes:
- The patient will maintain respiratory rate within normal limits
- The patient will demonstrate improved oxygen saturation
- The patient will maintain a patent airway
Nursing Care Plan 2: Risk for Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to effects of drug toxicity as evidenced by irregular heart rate and blood pressure changes.
Related Factors:
- Cardiotoxic effects
- Hemodynamic instability
- Electrolyte imbalances
- Altered cardiac conduction
Nursing Interventions and Rationales:
- Monitor cardiac rhythm continuously
Rationale: Detects life-threatening arrhythmias - Maintain IV access
Rationale: Ensures route for emergency medications - Document vital signs frequently
Rationale: Tracks cardiovascular status
Desired Outcomes:
- The patient will maintain a stable cardiac rhythm
- The patient will demonstrate adequate perfusion
- The patient will maintain stable blood pressure
Nursing Care Plan 3: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to respiratory depression as evidenced by decreased oxygen saturation and altered mental status.
Related Factors:
- Ventilation-perfusion imbalance
- Altered consciousness
- Respiratory muscle weakness
- Airway secretions
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Detects deterioration early - Suction airway as needed
Rationale: Maintains airway clearance - Prepare for intubation if necessary
Rationale: Ensures readiness for respiratory failure
Desired Outcomes:
- The patient will maintain oxygen saturation >95%
- The patient will demonstrate clear breath sounds
- The patient will show improved mental status
Nursing Care Plan 4: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to altered mental status and impaired physical mobility as evidenced by confusion and unsteady gait.
Related Factors:
- Altered consciousness
- Impaired judgment
- Motor incoordination
- Seizure potential
Nursing Interventions and Rationales:
- Implement safety precautions
Rationale: Prevents falls and injury - Monitor neurological status
Rationale: Tracks mental status changes - Provide constant observation
Rationale: Ensures immediate response to deterioration
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate improved coordination
- The patient will maintain a safe environment
Nursing Care Plan 5: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to substance use risks and overdose prevention as evidenced by repeated overdose episodes and lack of understanding about harm reduction.
Related Factors:
- Limited health literacy
- Lack of exposure to information
- Misconceptions about substance use
- Barriers to healthcare access
Nursing Interventions and Rationales:
- Provide overdose prevention education
Rationale: Increases awareness of risks - Teach harm-reduction strategies
Rationale: Promotes safer behaviors - Connect with community resources
Rationale: Ensures continuity of care
Desired Outcomes:
- Patient will verbalize understanding of overdose risks
- The patient will demonstrate knowledge of prevention strategies
- The patient will engage with support services
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Boslett AJ, Denham A, Hill EL, Adams MCB. Unclassified drug overdose deaths in the opioid crisis: emerging patterns of inequity. J Am Med Inform Assoc. 2019 Aug 1;26(8-9):767-777. doi: 10.1093/jamia/ocz050. PMID: 31034076; PMCID: PMC6696491.
- Friedman J, Godvin M, Shover CL, Gone JP, Hansen H, Schriger DL. Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021. JAMA. 2022 Apr 12;327(14):1398-1400. doi: 10.1001/jama.2022.2847. PMID: 35412573; PMCID: PMC9006103.
- Merigian KS, Blaho K. Diagnosis and management of the drug overdose patient. Am J Ther. 1997 Feb-Mar;4(2-3):99-113. doi: 10.1097/00045391-199702000-00008. PMID: 10423599.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
