Page 2309 - Saunders Comprehensive Review For NCLEX-RN

11. Limit placing blame or rationalizing to explain the
substance misuse problem.
12. Assist the client to use assertive techniques rather than
manipulation to meet needs.
13. Set limits on manipulative behavior and verbal and
physical misuse.
14. Maintain firm and reasonable limits, consistently
reinforcing rules, with reasonable consequences for
breaking rules.
15. Hold the client accountable for all behaviors.
16. Assist the client to explore strengths and weaknesses.
17. Encourage the client to focus on strengths if the client
is losing control.
18. Encourage the client to participate in unit activities.
19. Encourage the client to participate in group therapy
and support groups.
I. Dual diagnoses
1. Sometimes the use of alcohol and drugs masks
underlying psychiatric pathology.
2. Psychiatric pathology may also be precipitated by
substance use and misuse.
3. When psychiatric disorders and substance misuse are
present together, it is often referred to as dual
diagnosis.
4. Separating psychiatric diagnosis from substance
dependence can be done only over time after a
sustained period of abstinence.

J. Addiction and substance misuse in health care

professionals: Suspicious signs
1. Frequently reporting that drugs have been wasted
without being witnessed by another nurse
2. Reporting administering maximum dosages of
controlled substances to clients when other nurses do
not administer the maximum dose
3. A variance in usual pain relief in the absence of a
change in dosage or frequency of administration in
their clients
4. Work patterns include the following: Always
volunteering to carry narcotic (opioids) keys (or other
opioid access devices per agency procedure);
choosing shifts in which less supervision is present;
choosing work areas where the use of controlled
substances is high, such as critical care units,
operating room, anesthesia, and trauma units
5. Nurses have a professional and ethical obligation to
report impaired co-workers.
6. Most impaired nurses are able to return to work

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