Jumat, 31 Agustus 2012

NURSING CARE AS A SERVICE APPROACH TO CASE misuse of psychotropic

Good morning bloggers, I will be on a sunny little sharing of Psychotropic Drugs ...
I hope this information useful for my friend ...



INTRODUCTION
 
http://kspanpetang.files.wordpress.com/2011/10/ecstacy.jpgWe see people with drug misuse first categorized as a criminal, but now it ditanganni as patients with mental disorders. Family environment and place hang out and with whom she befriended a trigger factor recognized by all parties, even the drug dealers are now put to death by his parents diiklaskan with the statement that "my child's mistakes as narcotics traffickers my fault for not educating my child" . From the statement we understand that parents are very dominant role in drug misuse pencegaha.
What about people who are already ill from using drugs improperly or dependence, any problems encountered and how nurses provide nursing care approach to nursing care.

NEGATIVE IMPACT OF HEALTH FOR PSYCHOTROPIKA misuse:
 
http://muhammadmunim.student.umm.ac.id/files/2010/01/anti-narkoba1.gifSome classes of Narcotics and Psychotropic substances are still used by the medical indication for purposes of the patient. While it has expanded the use of Narkatika and Psychotropic substances harmful. Deployment and use of illegal psychotropic substances is known as drug abuse and Psychotropic Substances. The World Health Organization (WHO, 1974) have cited Drugs (Addictive substances or substances that bring dependency, addiction, recovering addict), includes factions alcohol, Opioida or Opiates, cannabis or marijuana, cocaine, Barbiturates, Amphetamines, Hallucinogens, Vilote solvents (volatile addictive substances), Khat, Narkotin, Caffeine, Analgesic.

The types of narcotics and psychotropic groups in Indonesia are incorrectly used highly variable (data RSKO 1972-1994).

   
Organic Mental Disorders Due to Substance
    
Addictive substances cause syndrome or collection of symptoms as a direct result of the effect and substance of the central nervous system. These symptoms are referred to as
Organic Brain Syndrome. Broadly speaking, Organic brain syndrome consists of:

    
Delirium
     
Patients showed clouding of consciousness (decreased clarity of awareness of the environment). Patients difficult to focus, move and maintain attention to stimulation from outside and within. There is often a misinterpretation due to impaired sensory perception. Patients thinking irregularly, unclear and uncertain direction of the goal. He showed disorientation, impaired memory and concentration problems.
The talk became incoherent, and there when I wake up, and unusual bedtime. Physical activity may be reduced or exaggerated. Deleriu condition usually occurs a few hours or days.
      
Delerium usually caused by the immediate effects of the adverse effects of alcohol use (Delerium Putud Alcohol), barbiturates or other Hypnotics Sedatives Amphetamines, Fensiklidin.

      
Dementia
       
The patient showed loss of intellectual abilities such severity that impede social functioning (he acted childish), memory disturbances, difficulty thinking abstractly power, interference assessing reality, often indicate a change or accentuation of personality, often accompanied by disturbances of cortical function such as aphasia, apraxia, agnosia, and other gangguansyaraf. demikiandapat occurs by physical causes such as in Alzheimer's disease, because of trauma capitis, infections, fungus, toksikmetabolik disorders or vascular disorders.
        
Usually dementia occurs as a result of substance immediate effects of alcohol are harmful interference.

        
Amnestic syndrome
        
Patients lose the ability to short-term memory and long-term. He was unable to learn new information, and are not able to recall the information learned in the past. Sometimes accompanied by symptoms of disorientation, confabulation, ignorance and emotions flagstones.
        
Amnesia syndrome usually occurs as a result of chronic alcohol use. There is damage to the brain tissue structure diensefalon and bilateral temporo-medial area.

           
Organic Halusinosis as substance
        
Patients showing symptoms of recurrent and persistent hallucinations, being patient awareness of the environment quite well, communicate with others though sosiolisasinya limited as a result of the hallucination of perception senses. Patients with conscious hallucinations that misery has said that is not true.
         
Usually organic halusinosis there as a result of using hallucinogens (visual hallucinations), alcohol (auditory hallucinations)

         
Organic delusional syndrome
         
the use of certain substances such as some types of Amphetamines, Hallucinogens and cannabis can cause organic delusional syndrome. Syndrome can occur settled so similar to Skizotrenia mentally (though the body was not there anymore addictive substances). Clinically, patients mununjukkan the symptoms of delusions (the belief that patients can not be corrected, and contrary to reality). Awareness of patients in general is quite good. Examination of other organic abnormalities can not be obtained.
         
Aside from addictive substances, organic delusional syndrome can also be due to brain disorders such as epilepsy labus temporal hemisphere brain damage and khorea Hutington.

         
Organic personality syndrome
          
The patient showed clinical personality aberrations is dependent upon the localization of damaged brain tissue. Patients often experience emotional instability, sudden tears, anger or difficulty controlling impulses suddenly cried for a little trivial reasons. Often show a lack of appropriate social behavior such as indecent behavior sexsual, less concerned, ignorance, indifference, loss of hobby and less reactive to environmental conditions.
          
Organic personality syndrome can also be caused by damage to the temporal lobes (eg pressing lobe meningioma brain frontatis), head injury, vascular disease, multiple sklersis, khorea hutington endokrim.

          
Because the substance intoxication
          
Patients exhibit maladaptive behavior in the wake of the GCC using addictive substances.
Generally urinalysis examination showed positive results (ie, substances used are contained within the body of the patient). Maladaptive behavior depends on the type of substance used. Any substance causing clinical symptoms typical for these substances. Due to the direct influence of substances on the brain tissue causing a power deviation values, emotions kandali weakened, the social environment complain, decreased job performance, and failed to fulfill their responsibilities, although in general they are likely in a state case (wakefulness).
         
Almost all addictive substances causing intoxication with clinical symptoms vary according to the uniqueness of each.

         
Disconnect Syndrome Substance
         
Patients exhibit specific symptoms after stopping or reducing the use of substances that have been used in a "less is more" regular order he obtained intoxication conditions. The intensity, duration, and clinical symptoms depend on the type of substance used. For example, a withdrawal syndrome Opioida suffer with the pain of the joints, lacrimation, rhinorrhea, dilated pupils, sweating, piloereksi, diarrhea, yawning constantly, takidardia mild hypertension, fever, and difficulty sleeping.
         
Substance withdrawal syndrome occurs in the termination or reduction of substance use Opioda, Barbiturates, Amphetamines, Nikatin.

         
Organic Brain Syndrome are not typical or Mixed
         
Patients in waking showed complaints that can not be classified in organic brain syndromes such as he complained neurastenia related to the use of addictive substances.

          
Psychiatric Disorders
          
The use of narcotics and psychotropic substances in a non-medically caused tens janis psychiatric disorders. In this paper only explained some psychiatric disorders are common and often occur.
         
         
Substance Dependence Syndrome
          
Patients showed 3 of the following symptoms: presence of withdrawal symptoms, tolerance to subsequent substance use, lack of motivation is the desire nd embodiment strong feelings for substance use, failing or having difficulty controlling substance-seeking behavior, it is only to influence pleasure berpreokupasi sehungga substances in the body do not have time for another keunaan such activity from the use of addictive substances (as encouragement so great), causing the patient to be able to do "anything" even though the reason normal people will not want it to do.
          
Some addictive substances that have the potential for very large dependence are: class Opioida Alcohol, Amphetamines and Nicotine.

          
Substance use disorders are detrimental
           
Patients showed patterns of use of narcotics and psychotropic substances which adverse physical health (eg, hepatitis), or mental (eg depression secondary). So the type of disturbance is clearly no real mental and physical damage as a result of substance use.

         
Homocide
          
Aggressive behavior, loss of emotional control and assess the reality of disorder is the leading cause of action homocide on misuse of addictive substances. When they experience withdrawal syndrome, they get a big push to get the substance condition often becomes a reason to kill someone else. Some forms of intoxication (alcohol, barbiturates, Cannabis, cocaine) can cause a trigger riots and murder. Psychotic conditions due to substances that cause delusions (Cannabis, Amphetamines) often lead to the death of ideology at odds with

          
Suicide Trial
          
Suicide attempts found in patients using barbiturates as benzodiazepun (nitrazepam, Humitrazepam). Often they expressed drink tablets to over 100 items consisting of various types of derivatives Benzodiazepines with disappointment, frusrtasi or demanding something from her family members.

          
Behavior Disorders
          
Usually found in adolescents less than 18 years old who use narcotics or psychotropic substances. kinis behavioral disorder characterized by the attitude of the "rebellion" parents have a history of losing luggage or valuables (without any real evidence that patients "take it" without permission, but the only person who suspected the patient himself), often deceive people old, came home late at night until the morning or not come out at all, often damaging the property of others without charge, ignorance, selfishness, and his will must be obeyed, and difficult to resist the urge for a moment. Generally, the use of addictive substances non-medical done is uncertain, and often used as a "tool" to scare parents to meet permintaanya. Generally, behavior disorders in adolescence is a "signal" would be a more severe deviation personality in adulthood.

          
Depression
          
patients on drug and substance Psikoropika often show symptoms of secondary depression. Although depression has always been a primary reason for them to use substances (known as Part of psychotropic substances has the effect of sedation on patients). The use of repeated substance will bring more severe depression.

          
Schizophrenia Affective
           
Affective disorders occur in the form of substance users: showing mournful emotions sometimes happily changed markedly excessive. Patients showed delusions of greatness or nihilistic delusions about problems in understanding the reality of values, emotions are very unstable and highly reactive sensitive to stimulation from outside.

           
Secondary Insomnia
            
Complaints of insomnia in substance abusers is a very common complaint. Use monthly to yearly often show the same complaint. To overcome the problem of insomnia is not uncommon habit repeat patients using substances and conditions as a reason for relapse. Patients often overcome insomnia by playing songs loudly at night that disturb the environment.
         
Indigestion
         
Group of narcotic and psychotropic substances entered the body through the oral (by mouth) can cause gastrointestinal disturbances. The use of marijuana is smoked through mouth cause damage to the mucous membranes of the oral cavity. Oral cavity becomes dirty, black or brown. The use of cannabis and nicotine increase the weight of the mouth. Oral hygiene becomes memprehatinkan. Alcohol use causes stomach ulcers (peptic and ulcers ilkus ventrikuli). Rupture causes inflammation of ulcers perit cavity causing pain and repeated for years, intestinal bleeding, until the death. Accompanying infections: salmonella, parathypus.
          
one drop Opioida syndrome is severe acute diarrhea. Patients often to the bathroom due to diarrhea and often unconsciously he defecated his pants when subjected to conditions Opioida Disconnect Syndrome.

          
Fluid and Electrolyte Balance Disorders
          
Complications of fluid and electrolyte balance disorder occurs in patients with alcohol use disorders nutrition "hard core heroin addicts," Amphetamines in an overdose, chronic marijuana users with "unmotivated syndrom" nuisance condition requires immediate medical attention that needs to be taken immediately to the Unit Hospital Emergency Room to get the infusion. In most patients can not be helped, because they are in an isolated place. Disorders of fluid and electrolyte balance may also occur because of the symptoms of diarrhea, nausea, vomiting, severe withdrawal syndrome due Opioida. Generally patients showed a lack of attention to hygiene themselves so as to facilitate secondary infection.
         
         
Vascular Disorders
          
Patients are substance users direct intravenous injection (Cocaine, Heroin, Amphetamines, Benzodiazepam) can cause complications in vascular organs. These patients were substance users often wear clothing with long sleeves to cover the scars cicatrix resulting from injections in the arm. Network cicatrix \ is black or brown depending on the duration of the habit of going to form a straight line or curved according to the shape of the blood flow. If the substance is used consisting of a composition which is not hygienic, there will be complications that are in other body organs such as heart, liver, pancreas to the brain. Often, too, the occurrence of gangrene due to lower veins causing impaired avaskularisasi lower limbs. Vascular disorders can lead to death as a result of emboli into the heart.

         
Infection
         
Contaminated blood flow germs can cause an infection in the whole body (sepsis). Frequent infections are: from chronic bronchitis to tuberculosis (padaperokok nicotine and marijuana), typhoid and paratyphus digestive tract (due to alcohol), hepatitis (due to injection of heroin), infections of the oral cavity and teeth (smoking nicotine and marijuana), meningitis (for injection) and others.
Facilities
         
Addictive substance use disorders can be life-threatening for both the individual user or the surrounding environment. In the state of substance intoxication, a patient will cause disruption in the control of emotion and aggression leading to violence and criminal behavior. With mild stimulation, patients often exhibit predictable responses difficult and able to act aggressively due to power are disturbed because of the value of the addictive substance. Traffic accidents caused by using excessive addictive drug can also harm to himself or others in the same traffic.
           
Users addictive substances orally often leads to death Karene the digestive tract disorders such as bowel or stomach perfosi as drinking alcohol, chronic typhoid infection, sirrhosis hepatis, pancreatitis, epidemic dysentery.
           
Alcohol misuse deaths from pneumonia as a result of respiratory tract infections has long been proved by Jellinek. as well as in Indonesia, many cases abusers who show abnormalities in lung rontgenfoto spots showed a lung to tuberculosis. This condition is exacerbated by their habit of smoking cigarettes in large numbers.
           
Deaths from heart disease abusers showed greater frequency in the general population in the United States. Although heart disease is the most common cause of all deaths. The deaths allegedly related to a nutritional disorder, kardiomyopati, improve hypertension, obesity and infection sub-acute bacterial endocarditis can also occur due to injection of Cocaine, Amphetamines Opioda or intra venous.
          
Alcohol abusers of death due to cancer larying oropharynx and esophagus, and liver cancer. Moderate lung cancer is usually a disease of chronic bronchitis due to terminal using nicotine.
           
Patients who suffered from lead poisoning have been reported to be the cause of death of Meth-amphetamine users. Tin is a component that is used to manipulate the composition of the designer by clandestine laboratories. Another death on merth-Amphetamine users are traffic accidents (traffic death), inhalation of hydrogen gas that brings cyanid difficulty breathing, apneu, coma and death.
           
Emboli that enter through the veins by injection can bring death due to sepsis. although common infections also mnimbulkan death in most of abusers. Thrombus occurring enter the blood stream cause brain strokes often cause death.
         
At the Emergency Hospital in Jakarta frequent deaths from excessive use or overdose is lacking substance. Overdose due Opioida use often leads to death from respiratory center so that emphasis be apneu and if not helped immediately face turned blue, cold and died kekaurangan oxygen.
          
Chronic alcohol abusers menghaabiskan diet, giving rise to conditions of malnutrition, and hence can bring fatality.
          
Intravenous substance abusers are prone to terserangnya the HIV virus causing AIDS causes of death:

           
Social Problems
           
Impaired users of narcotics and psychotropic substances as well as various social problems, such as:
                      
* Rape
                      
* Contention
                      
* Divorce
                      
* Bankruptcy bankruptcy, debt
                      
* Wearing teen
                      
* Theft
                      
* Coercion through violence and murder
                      
* Robbery, plunder, jambret
                      
* Traffic accident
                      
* Prostitution
                      
* Employ or melantarkan family (wife, kids)
                      
* Corruption, embezzlement of company money


  
NURSING CARE NURSING PROCESS

Below will be described on the nursing process is used to help patients with drug penyalahgunan, nurses awareness essential that nurses help patients in a comprehensive care kesehatanan a systematic approach of assessment and evaluation.

ASSESSMENT:

Attitudes and feelings of nurses:
The attitude of nurses is a component, is sensitive to the attitude of the nurse or health care team. what. Nurses with personal values, discomfort during patient contact can result in feelings jugment form (think nurses about the patient)
Do not use the word "drunk", "addictive", "alcoholic". Better to use a sentence using alcohol, drugs, heroin, feeling good or feeling fly.

Approach on the client:
 
Clients may be embarrassed by his behavior may also uncooperative. Ways to support that the nurse is showing that nurses receive clients are. Convey stated that the nurse "I care about your health", "" I know that you are uncomfortable "," I will help you to feel better. "

Nurses maintain an empathetic approach during the interview, even if the client defense. Nurses do not respond with defensive and angry. Inquiries were made to obtain information specifik, when the client tried to divert attention, the nurse tried to get back to the focus of the discussion. Because the client is usually denial by the dependency information from family, friends and the people around him. While this information may not be valid due to the influence of emotions. It remains to be considered that it is important to involve the people around him since the beginning.

Behavioral defense
Denial: Denial is often used by clients ketergantungngan drugs. did not realize that dependence has severe consequences both physically and socially.
Projection: the individual is not responsible, always blaming someone else, where everything outside himself.
Rationalization: Clients usually give any reason of the use of drugs became aware that client dependency.
Small problem: He was indeed dependent but it was a minor issue.
Angry: mad expressing Client response to the talks about addiction, clients would rather resolve the confrontation of the problems faced.

Physical and safety needs
Physical conditions and meet their needs continuously implemented.
Potential infection of wounds. Treatment and factors due to the use of drugs such as organic mental disorders.
The potential for injury is a serious problem. Protection and security of client situations that add to the misery adal be considered as a matter of priority. Usually the patient / client was sleep disturbance, nightmares and dreams are always possible.
Anxiety because of the conflict.
Depression or feeling sad sehubunganan with a decrease in self-esteem due to social behavior and legal consequences also need at the assessment and individual treatments.

Nursing Diagnosis.
Due to problems arising very wide range of physical and emotional. Many nursing diagnoses according to the state for clients with drug dependence can be used to plan nursing.
Physical problems such as: Impaired balance (deficiency) of fluid, Altered nutrition: less of a need, potential injuries, potential infections, less able to care for themselves, ineffective airway, impaired skin integrity, impaired sleep, impaired elimination.
Emotional problems: Ineffective Individual Coping, ineffective family coping, impaired self-concept, lack of knowledge, self-destructive potential, impaired social relationships, spiritual distress, impaired perception and impaired thought processes.

PLANNING

Develop a plan with the participation of the client in the process tretmen that will affect the optimal healing. Nursing assessment individually and helping clients generate goals that will help the client in the healing process that will give life to client's satisfaction with the freeing of feeling and thought disorder drug dependency.

GOAL:
Make goals for individuals with drug addiction are as follows:
1. Satisfying their physical needs clients
2. Menjada emasi so stable patients
3. Clients are aware of makanisme defense does is pathology.
4. Clients understand and accept about dependence on drugs
5. Finding peers to exploration.
6. Developing hope for recovery
7. Being able to socialize and improve the ability to relate to others.
8. Improving self-esteem and satisfaction / well being.
9. membangaun alternative coping.
10. Continuously improve motivation for treatment and prevention.
11. Families involved in the treatment and healing process.

INTERVENTION
The rehabilitation process
The rehabilitation process is focused on clients with drug dependence, because they usually lose their jobs, marital conflict, legal issues. Physical problems, family and the law can be addressed with rehabilitation. Another problem whether physical, emotional, and social overcome with clients with addiction treatment.

Rehabilitation phase as follows:
Detoxification by detoxifying the fault of the drug. physical and emotional recovery so stable, action methods to increase motivation in order to continue treatment, addressing defense committed clients, improving client's self-esteem, develop an awareness of the problem, discharge planning and follow-up plan.

Break through the defense that carried the client.
It is a gradual process, Nurse pay attention to the client and understand mngenali use client-specific defense. Gradually nurse assisting clients with face-to-face dialogue with the objective reality that the client might denial. Consistent and appropriate approach is essential.

Understanding and acceptance of the client.
Clients with drug dependence should dipahamkan about the client being sick is not a moral issue. Ketergantungab health education about drugs and clarify misconceptions will help the process of understanding the client about the situation experienced. Intellectual understanding will help the client be true. It will be required levels of emotional distress and healing in a long time but based on the handling of day-to-day.

Find a friend.
Friend or peer group through konfrotasi and identification of problems is very strength helping clients. Individuals will know and realize that the client does not own and then the client will feel the suport and the hope of returning. The group will bring the client to a discussion of defense were not useful to the client and to bring awareness of the client's behavior. Nurses will be as a leader to encourage the group to discuss issues that may be experienced by those who participate in discussions.

Developing expectations.
Clients with a feeling of no hope, no encouragement, and probably immoral. Clients should be aware that the escape from reality makes no hope. Find other people who have similar problems or people who already have hope. The positive attitude of nurses and other health professionals will make the client a chance.

Re-socialization
Drug users are usually only focused his medication and eventually just focused on ourselves. The ability to relate to others is non-existent. It is important to assist clients in the social life as well as building relationships with other people.

Development of self-concept.
Generally akann clients to increase self-esteem if the client is able to recognize that they experienced a client is sick. so the client to change behaviors and attitudes that will result in the satisfaction of achieving a relationship with someone else. And feel responsible for the healing process.
Nurses also help develop self-discipline. For example, nurses assist in the daily routine that may be difficult for clients who are used to living without rules because just thinking about medicine. So the nurse encourages the client to participate actively with the program activities that are part of the healing. From the experience of successful clients, with confidence, self-esteem and hope. This is the motivation in the healing process.

EVALUATION:
Evaluation is a continuous process in which nurses assess client progress by determining the success of the goals set both short term and long term. If successful what influences or failed why? Including team work that has been done, as well as family involvement, ability to relate to others and the ability to live normally in society.

Reference:
1. Beck, CM, Rawlins and Williams, SR, 1996, Mental health psychiatric nursing: A Holistic Life-Cycle Approach, St Louis, Mosby Co..
2. Fortinash, CN and Holoday, PA, 1991, Psychiatric nursing care plan, St Louis, Mosby year Book.
3.Patricia G, O'Brion, Winifred ZK and Karen AB, 1999.Psychiatric nursing, an integration of theory and practice. Mc Graw Hill nursing core serie, New York.
4. Stuart, G.W and Sundeen, S.J, 1995. principles and practice of psychiatric nursing, St. Louis, Mosby Year Book.
5 ........, 1998. Pocket book: Mental Nursing, Interpreting, End Yani, Jakarta: EGC.
6. Townsen, Mary, 1998. Handbook: Diagnosis of psychiatric nursing, over language, Novi Helena, Jakarta, ECG.

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