Drug Overdose Nursing Diagnosis and Nursing Care Plan

Drug Overdose Nursing Care Plans Diagnosis and Interventions

Drug Overdose NCLEX Review and Nursing Care Plans

A drug overdose is occurs when the human body obtains an excessive amount of a chemical or combination of substances. An overdose can be either intended or unintended.

Overdose can occur with illegal drugs, alcohol, prescription medicines, and other substances. Overdoses are often fatal, although a patient can be saved if medical assistance is administered promptly enough.

In terms of medicines, there are several ways for the body to get overburdened by substances. However, airway obstruction is the most prevalent cause of mortality during any drug overdose.

Thus, overdose symptoms can vary, and it can be difficult to distinguish between relatively minimal side effects of a substance and symptoms of a potentially fatal overdose. Overdose can occur from a variety of medicines, including:

  • depressants (opioids or benzodiazepines)
  • alcohol
  • stimulants
  1. CNS Depressants Overdose (Opioids o Benzodiazepines)

Central nervous system (CNS) depressants include opioids and benzodiazepines. CNS depressants decrease blood pressure and body temperature while slowing the heart rate and respiration. These medications have sedative effects, reducing anxiety and a rise in a tranquil and euphoric impact. Hence, excessive usage of depressants can result in significant side effects such as respiratory distress, intoxication, unconsciousness, or even death.

  1. Alcohol Overdose

An alcohol overdose occurs when a person consumes more liquor than their body can safely absorb. The body can adequately metabolize around one unit of pure alcohol every hour. Suppose a person consumes more alcohol in a shorter period. In that case, the alcohol accumulates due to the body’s inability to digest the alcohol quickly enough, and a buildup of alcohol distributes all through the body, resulting in an alcohol overdose, often known as alcohol poisoning.

  1. Stimulant Overdose

Stimulants act on the CNS but perform oppositely compared to opioids and benzodiazepines. They will raise the pulse rate, heart rate, core temperature, and respiratory rate. If the cardiovascular, respiratory, or blood circulation rate breaks down, this is known as a stimulant overdose.

Signs and Symptoms of Drug Overdose

The symptoms of a drug overdose might differ based on the person, drug, and amount consumed. Nevertheless, common symptoms include:

  • Vomiting and nausea
  • Delusions or hallucinations
  • Loss of consciousness
  • Tremors
  • Breathing difficulties
  • Walking difficulties
  • Restlessness
  • Lethargy
  • Aggression or violence
  • Enlarged pupils
  • Convulsions

Individuals should obtain medical attention immediately if they experience these symptoms or see them in someone else and fear they have overdosed. Getting medical aid as soon as possible can make a substantial difference in the success of drug overdose therapy.

Causes of Drug Overdose

The cause of drug overdose can either be accidental or unintentional:

  • Accidental overdose. This type of overdose occurs when a person consumes the incorrect substance or combination of substances with excessive amount at the inappropriate time without being aware that it may cause them damage. Accidental drug overdose also includes persons who take a substance to achieve a specific desired result, such as getting ‘high’ or lessening negative sentiments but are clueless about the potency or contents of what they are consuming.
  • Intentional overdose. This type of overdose is when a person intentionally take substances to induce self-harm, which may be a cry for help or a suicide attempt. It is not always evident if an overdose was unintentional or intentional. There could be a mix of the two. It is critical not to judge persons who have overdosed and to have an inquisitive mind about the causes.

Related Factors to Drug Overdose

Several factors can increase the likelihood of a drug overdose. These are some examples:

  • Improper medication storage. Improper storage of pharmaceuticals can be easy targets for inquisitive toddlers and the habit of putting objects in their mouths. It is very easy for toddlers to get into and overdose on medications that have not been correctly packaged and stored from them.
  • Failure to understand or obey dosage instructions. Even grownups can overdose on medicines if they do not follow the dosage instructions. Taking too much or taking the doses too early might easily result in a drug overdose that is definitely  unsafe for the patient.
  • Misuse or addiction history. Purposefully abusing prescription drugs or taking illegal substances might put the patient at risk of a drug overdose, mainly if it occurs frequently or gets dependent. This danger rises if they use many medicines, mix them, or combine them with alcohol.
  • A history of mental illnesses. Mental health conditions might also be a potential risk factor for a drug overdose. Suicidal thoughts and depression might trigger drug overdose, mainly if the symptoms are not addressed.

Diagnosis of Drug Overdose

A physical examination and history taking will be conducted to identify signs of drug toxicity. The doctor may recommend laboratory testing to diagnose drug overdose depending on the major organs affected by the specific drug overdose.

  • Family and significant others are valuable sources of knowledge. They can help the doctor by revealing the description of the medications, the amounts consumed, and the time of the incident.
  • Depending on the substance used and the purpose for the overdose, specific drug levels in the blood may be assessed.
  • Drug testing, including urine or blood analysis, may also be performed.

Treatment for Common Cases of Drug Overdose

  1. Opioid or Narcotic Overdose

Because of the effects of opioids on the region of the brain that regulates respiration, opioid usage can result in death. A combination of three signs and symptoms can indicate an opioid overdose:

  • enlarged pupils
  • loss of consciousness
  • breathing difficulties

Furthermore, death from an opioid overdose is avoidable if the victim receives primary life care and the drug naloxone is administered promptly.

Naloxone is an opioid antidote that, if taken in time, will counteract the effects of an opioid overdose. Naloxone has almost little effect on persons who have never used opioids.

  1. Acetaminophen or Paracetamol Overdose

Acetaminophen poisoning is caused by an overdose of the over-the-counter (OTC) pain reliever acetaminophen, which is usually safe when taken as directed. The maximum daily dose of acetaminophen is four (4) grams, although individuals with chronic conditions, particularly liver disease, may need to restrict their daily intake to three (3) grams. On the other hand, Acetaminophen poisoning can occur due to one large dose or recurrent overdosing.

Furthermore, activated charcoal can prevent acetaminophen absorption from the gastrointestinal tract. While in most situations of toxic acetaminophen overdose, N-acetylcysteine, an amino acid, is administered orally or intravenously as an antidote.

  1. Alcohol Overdose

Alcoholic beverages include ethyl alcohol, sometimes known as ethanol. That is the usual cause of alcohol poisoning. Other types of alcohol also include isopropyl alcohol (rubbing alcohol) and methanol (wood alcohol), which are hazardous in a different manner. Thus, the US Food and Drug Administration (FDA) has approved fomepizole for ethylene glycol poisoning, but it is equally beneficial for treating methanol toxicity.

  1. Benzodiazepine Overdose

The most widely prescribed drugs for anxiety, sedation, and sleep are benzodiazepines. Profound sedation is a crucial symptom of overdose. High dosages can cause unconsciousness, respiratory failure, and even death if not treated properly, especially when combined with other CNS depressants. Furthermore, flumazenil is the sole specific antidote for benzodiazepine (BZD) poisoning and a selective competitive antagonist of the gamma-aminobutyric acid (GABA) receptor. It will slow the progression of BZDs toxicity but should be used with caution.

  1. Stimulant Overdose

Individuals who overuse stimulants are in danger of cardiopulmonary arrest, stroke, irregular heartbeats, and other complications. Stimulant abuse to improve athletic performance is especially harmful since stimulants raise blood pressure. The combination of physical effort and stimulants increases the likelihood of a heart attack or stroke. Athletes have died as a result of stimulant usage. However, there is no specific remedy for stimulant overdose. If a combination of stimulants and opioids causes the overdose, naloxone will momentarily neutralize the effects of any opioids. Thus, use naloxone if in doubt. Even if an opioid is not present, naloxone will not cause serious harm.

Prevention of Drug Overdose

Drug overdose can be avoided by doing the following:

  • Always carefully read medicine labels.
  • Take prescription drugs only as advised.
  • All drugs should be kept in their original container.
  • Drugs of any kind should be avoided unless prescribed by a doctor.
  • If someone ever had an overdose, always inform the doctor or another health expert right away.
  • Do not store medications that are no longer needed.
  • Keep any medicines, alcohol, narcotics, and poisons locked up and out of reach of toddlers.
  • When using multiple substances (including alcohol) simultaneously, take caution since they can have a negative interaction and enhance the chance of accidental overdose.

Drug Overdose Nursing Diagnosis

Nursing Care Plan for Drug Overdose 1

Impaired Gas Exchange

Nursing Diagnosis: Impaired Gas Exchange related to hypoxemia, abnormalities in breathing patterns and arterial blood gas secondary to drug overdose (opioids or narcotics) as evidenced by shortness of breath, rapid heartbeat, and gasping for breath.

Desired Outcomes:

  • The patient will have vital signs that are within standard limits.
  • The patient’s lungs will sound normal and healthy.
  • The patient will deny having any breathing difficulties.
  • The patient will show no evidence of respiratory distress.
Nursing Interventions for Drug OverdoseRationale
Examine the properties of respirations.
Note the following:
-Rate
-Rhythm
-Depth
-Use of auxiliary muscles  
Abnormalities in the properties of respiration indicate the degree of respiratory failure, which may result from an opioid or narcotic overdose. Breathing patterns can be affected by discomfort, immobilization, and substance abuse, resulting in shallow breaths. As a result, lung capacity and gas exchange are diminished. Hypoxia is frequently associated with drug overdose.  
Regularly listen for lung sounds. Keep an ear out for unusual breath noises of the patient. Patients who have overdosed on opioids or narcotics may experience wheezes, crackles, or reduced sound.    Alteration or deterioration in these lung sounds may suggest a decrease in ventilation. Often, lung sounds help to identify the source of inadequate ventilation.  
Check the patient’s hemoglobin (Hbg) levels. Hemoglobin transports oxygen throughout the body.  When Hbg levels are low, the capacity to transport oxygen throughout the body is reduced.  
Supply oxygen as directed to keep oxygen level above 90%.      The introduction of oxygen enhances gas exchange and oxygen saturation. To keep an oxygen saturation above 90%, patients who have overdosed on opioids or narcotics may require a nasal cannula or other devices such as a oxygen mask or respiratory support.  
If noninvasive oxygen delivery treatments fail to sustain adequate breathing, consider the necessity for intubation. This scenario is possible if the patient is experiencing a severe opioid or drug overdose.  In order to ensure enough gas exchange, mechanical ventilation is frequently required.

Nursing Care Plan for Drug Overdose 2

Imbalanced Nutrition Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements related to inadequate dietary intake to achieve metabolic needs caused by psychological, biological, or economic considerations secondary to drug overdose as evidenced by weight loss, weight below the average body mass index, diminished subcutaneous adipose mass, altered taste sensations, lack of interest in food, muscle tenderness, sore and inflamed buccal pouch, and signs of protein or vitamin deficiency in the laboratory tests.

Desired Outcomes:

  • The patient will prove progressive weight gain toward the objective, with normalized laboratory findings and no malnourishment signs.
  • The patient will be able to explain the effects of drug abuse and diminished dietary intake on nutritional status.
  • The patient will exhibit behaviors and changes in lifestyle that will allow them to restore and maintain healthy body weight.
Nursing Interventions for Drug OverdoseRationale
Keep track of the patient’s nutritional intake.    This intervention aims to encourage proper nutrition.  
Consider the height and weight, age, body type, vigor, level of physical activity, and relaxation level of the patient. Take note of the condition of the oral cavity as well.  This intervention provides relevant data which will be the basis of the calorie consumption and dietary plans of the patient. The mucous membranes and teeth condition may influence the type of diet or foods consumed.  
Measure the patient’s anthropometrics such as triceps and skinfold, if possible.        This approach calculates the subcutaneous fat and muscle mass to help determine dietary requirements appropriate for the patient.  
Determine the patient’s energy expenditure (pacing or sedentary) and develop a personalized exercise routine.  The level of activity influences nutritional requirements. Thus, exercise improves muscle strength and may increase appetite.    
Take note of the patient’s total daily calorie intake; keep a diary of their intake and the times and patterns of eating.  This intervention will aid in the identification of nutritional requirements and inadequacies.
Allow the patient to choose the foods and snacks that fit their dietary needs.    This intervention improves participation or a sense of control, may aid in the settlement of nutrient deficiencies, and helps evaluate the patient’s comprehension of dietary learning.    
Speak with a dietitian as needed.    This intervention helps create individual dietary needs and plans and provides an extended learning recourse.  
Monitor the patient’s weight regularly.  This intervention provides data on the effectiveness of a dietary plan.  
Examine the laboratory tests such as glucose, serum albumin, albumin, and electrolytes.  This intervention detects anemias, electrolyte disturbances, and other irregularities that may be visible and necessitate treatment.  

Nursing Care Plan for Drug Overdose 3

Risk for Injury (Liver Function)

Nursing Stat Facts
Nursing Stat Facts

Nursing Diagnosis: Risk for Injury (liver function) related to hepatic cell destruction and fibrotic regeneration secondary to drug overdose (acetaminophen or paracetamol).

As a risk nursing diagnosis, the Risk for Injury (liver function) is unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.

Desired Outcomes:

  • The patient will be able to combat the severe complications in the liver caused by acetaminophen overdose.
  • The patient will be knowledgeable about the various interventions to handle dangers or risks brought by drug overdose.
Nursing Interventions for Drug OverdoseRationale
Advise the patient to have a liver function tests which evaluates the following: alanine aminotransferase [ALT] aspartate aminotransferase [AST]  [total and fractionated] alkaline phosphatase   It is crucial to perform liver function tests to avoid severe complications of acetaminophen overdose.
Avoiding unnecessary and improper acetaminophen or paracetamol intake. Take pain medicines only when necessary and only when the pain is unbearable.    Limiting the intake of pain medicines like acetaminophen or paracetamol is one of the most remarkable ways to avoid liver failure.
If the patient exhibits signs of acetaminophen or paracetamol toxicity or overdose, provide an immediate response.      Since timing is critical in managing acetaminophen poisoning, clinicians start treating acetaminophen overdoses within eight hours of intake to get the best potential outcomes for patients.  
The attending physician may recommend liver transplantation if the preceding therapies fail and the patient develops liver failure.  If the following tests are markedly aberrant and the patient has acquired hepatic encephalopathy, a brain condition caused by a defective liver, doctors will decide whether transplantation is essential.  
Determine whether a patient is at risk of hepatotoxicity.  Most acetaminophen overdose patients will initially be asymptomatic, as clinical symptoms of end-organ poisoning do not appear until 24-48 hours after an acute consumption. As a result, the clinician should ascertain the time of consumption, the amount, and the formulation of acetaminophen consumed.  

Nursing Care Plan for Drug Overdose 4

Ineffective Individual Coping

Nursing Diagnosis: Ineffective Individual Coping related to personal vulnerability, insufficient support networks, previously unsuccessful or poor coping mechanisms with drug replacement secondary to intentional drug overdose as evidenced by poor adaptive behavior and problem-solving abilities, lower capacity to cope with sickness or hospitalization stress, and verbal expression of the inability to manage or ask for support.

Desired Outcomes:

  • The patient will be able to identify inadequate coping behavioral patterns or consequences, such as the use of narcotics as a coping mechanism.
  • The patient will use good coping strategies and problem-solving techniques.
  • The patient will start making the essential lifestyle modifications.
Nursing Interventions for Drug OverdoseRationale
Determine the patient’s comprehension of the current circumstance, previous situations, and other strategies for dealing with life’s problems.    This intervention offers coping mechanisms that may be applied in the current situation and gives information about the extent of denial, acknowledgment of individual accountability, and desire to change.  
Examine different techniques for coping with the extreme desire to take drugs with the help of peers.  Self-help groups are helpful for learning and sustaining abstinence in each member through understanding, encouragement, and peer influences.  
Discuss the patient’s plans for a drug-free lifestyle.        Allow for the development and refinement of plans. Creating a comprehensive strategy for avoiding relapses assists the patient in entering the recovery period of behavioral interventions.  
Maintain a peaceful, safe setting throughout any drug withdrawal.  The patient may become agitated if there is too much noise. That is why it is necessary to provide them with a peaceful place so they can contemplate.  
Encourage patients to join self-help groups for alcoholics or people who are drug addicts.  This intervention puts the patient in direct communication with the support system needed to maintain abstinence and a drug-free lifestyle.  
Remove any potentially hazardous items from the patient’s room.  This intervention aims to keep the patient safe from danger.  

Nursing Care Plan for Drug Overdose 5

Denial

Nursing Diagnosis: Denial related to difficulties in managing new circumstances, personal or familial value systems, learned response patterns, and cultural factors secondary to intentional drug overdose as evidenced by a delay in obtaining or rejection of medical help that endangers one’s health or life, not recognizing the personal significance of symptoms or danger, nor does he acknowledge the impact of the condition on his life pattern, and avoiding to take responsibility for oneself.

Desired Outcomes:

  • The patient will declare his understanding of the connection between substance misuse and his current situation.
  • The patient will participate in his therapeutic regimen.
Nursing Interventions for Drug OverdoseRationale
Determine the name by which the patient wishes to be addressed.      This approach displays kindness and respect, providing the patient with a sense of purpose and authority.  
Determine the reason for starting abstinence and the patient’s participation in therapy.    This approach provides information about the patient’s decision to accept long-term behavioral change and whether the patient perceives he or she can start changing. Thus, denial is one of the most potent and persistent signs of substance misuse.
Express an accepting attitude while isolating the individual from inappropriate behavior.  This method encourages sentiments of value and respect.  
Examine the concept of substance dependence and the many symptoms groups, patterns of administration, impairment caused by the usage of drugs, and tolerance to the substance.  This information assists patients in making decisions about accepting the problem and treatment options.    
In a peer group, confront and investigate denial and reasoning. Do confrontation with compassion for the patient.    Since denial is the primary defensive mechanism in addictive disorder, confrontation with peers can assist the patient in accepting the reality of the adverse effects of behaviors and the fact that drug use is a big problem. Hence, a caring attitude protects self-concept and aids in reducing defensive responses.
Provide information to the patient about how addiction affects emotions and character.    Individuals frequently misinterpret the effects of addiction and use this to justify or excuse their drug use.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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