what would nurse do when patient has an overdose of a drug when doing incident report

by Prof. Chyna Fisher Sr. 9 min read

Reflection on Incident: Care of Drug Overdose Patient

32 hours ago Nursing Interventions for Drug Overdose: Rationale: 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 … >> Go To The Portal


Once a substance abuse disorder is suspected, the nurse is typically placed on leave until an investigation can be conducted. The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority.

Full Answer

How should nurses treat overdose behaviour?

By avoiding an emotional and/or moralistic interaction with the patient, the nurse can treat overdose behaviour as a ‘matter-of-fact’ response to emotional suffering, explore the perceived benefits of this to the patient, and also the less positive consequences.

What happens when a nurse is accused of substance abuse?

Once a substance abuse disorder is suspected, the nurse is typically placed on leave until an investigation can be conducted. The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority.

Should the public be trained to detect early signs of drug overdose?

Apart from being trained on how to administer CPR, the public is educated on how they can detect early signs of drug overdose. The training is meant to equip the public on expected drug overdose response behaviors which lead to fewer adverse consequences.

What should I do if a drug overdose occurs?

If the patient becomes dangerous and is too large to be safely restrained, it may be necessary to call the police. Find items to help with treatment. You will need to know what drug was taken, when, how much, and by what method.

What do you do when someone has a drug overdose?

How to Respond to an Overdose​STEP 1: CALL FOR HELP (CALL 911) ... STEP 2: CHECK FOR SIGNS OF OPIOID OVERDOSE. ... STEP 3: SUPPORT THE PERSON'S BREATHING. ... STEP 4: ADMINISTER NALOXONE (if you have access to it) ... STEP 5: MONITOR THE PERSON'S RESPONSE. ... Do's and Don'ts in Responding to Opioid Overdose.

What are the 6 steps that should be done when you suspect that someone has overdosed on a substance?

How to respond to an overdose using NaloxoneCheck for signs of an overdose. Slowed or stopped breathing. ... Call 911. Call 911. ... Give Naloxone. Place tip into one nostril of person's nose. ... Give rescue breaths. Make sure mouth is clear. ... Stay until help arrives. Repeat Steps 3 and 4 until help arrives.

What do nurses do when someone overdoses?

Nursing ManagementAssess breathing and oxygenation.Assess any respiratory distress.Provide oxygen if saturations less than 89%Assess coughing ability and productivity.Listen to the lungs for crackles, wheezing, and airflow.Start one to two large bore IV's.Administer opioid reversal drugs as instructed.More items...•

Which of the following has the steps for responding to an opioid overdose in the correct order select best order for responding?

The steps outlined in this section are recommended to reduce the number of deaths resulting from opioid overdoses.STEP 1: EVALUATE FOR SIGNS OF OPIOID OVERDOSE. ... STEP 2: CALL 911 FOR HELP.STEP 3: ADMINISTER NALOXONE. ... STEP 4: SUPPORT THE PERSON'S BREATHING. ... STEP 5: MONITOR THE PERSON'S RESPONSE.

Which of the following should be done if you encounter a victim of an opioid overdose?

It is recommended that you call 911 in the case of an overdose because it is important to have trained medical professionals assess the condition of the overdosing person.

What is the key to determining the clinical effects of an overdose?

The key is identifying the important clinical effects. That means figuring out if the overdose is activating (or deactivating) the central nervous system , causing cardiac arrhythmias or depressing myocardial function, or causing anion gap acidosis.

What is the reminder for hospitalists dealing with drug overdoses?

Dr. Heard also had this reminder for hospitalists dealing with drug overdoses: “Toxicology is one of the few areas in medicine where 24 hours a day, seven days a week, you have the option to call a friend in the poison center when you have questions.”

What drugs do hospitalists use?

Most hospitalists are well-versed in drugs that depress the central nervous system: benzodiazepines, seizure medications, opioids, muscle relaxants, antipsychotics and, of course, alcohol. Most antidepressants “both tricyclics and the newer agents “and valproic acid, clonidine and carbon monoxide are also common culprits. While barbiturate overdoses “aren’t seen much anymore,” Dr. Heard noted, alcohol overdose is very common.

Why is noninvasive ventilation not recommended for overdose patients?

Dr. Heard said he doesn’t advise noninvasive ventilation in overdose patients because the issue is rarely hypoventilation or failure to oxygenate. Instead, it’s usually an airway issue, and physicians should err on the side of reducing the risk of aspiration.

Why are toxicology screens important?

That’s particularly true of urine screens, because drugs tend to be more concentrated in urine than in blood “provided the screens are specific enough.

What is the first line of treatment for a widened QRS circuit?

Because these patients can also be hypotensive and comatose, your first-line treatment should be sodium bicarbonate in boluses of one or two amps.

Why do people die from drugs?

“With drugs that deactivate the CNS,” he noted, “probably the most common reason that people die is because they lose their airway. If you manage patients’ airway, they’re going to survive.”

What to do if you overdose on naloxone?

Call 911 if an overdose is suspected. Even if the patient wakes up or seems better after one or two doses of naloxone, emergency medical assistance is still necessary. A medical professional should evaluate anyone who has experienced an overdose as soon as possible.

How to tell if someone is overdosed on opioids?

Try to wake up the person by speaking loudly or rubbing the breastbone with knuckles. A person experiencing opioid overdose often shows the following signs: 1 Unconsciousness, or inability to wake up 2 Limp body 3 Falling asleep, extreme drowsiness 4 Slow, shallow, irregular or no breathing 5 Pale, blue, cold and/or clammy skin 6 Choking, snoring or gurgling sounds 7 Slow or no heart beat 8 Very small or “pinpoint” pupils

How long does it take for naloxone to reverse?

Note that it may take 5 minutes or more for signs of overdose to reverse.

What to do if your breathing stops?

If breathing stops at any time, begin rescue breathing or CPR, if trained to do so. 6. Monitor. Naloxone temporarily reverses the effects of the opioid, including sedation. Monitor the person suspected of overdose for any changes in condition. Serious side effects from naloxone, including allergic reaction, are very uncommon.

What are the symptoms of opioid overdose?

Unconsciousness, or inability to wake up. Limp body. Falling asleep, extreme drowsiness. Slow, shallow, irregular or no breathing. Pale, blue, cold and/or clammy skin. Choking, snoring or gurgling sounds. Slow or no heart beat. Very small or “pinpoint” pupils. Recognizing an opioid overdose may be difficult.

What to do if you see drug residues?

Do not enter any area that appears unsafe for any reason. If you see drug powders or residues, do not risk exposure. Wait for professional emergency responders. Avoid contact with drug containers, needles and other paraphernalia.

Can naloxone help with overdose?

Overdose symptoms may not fully improve or may quickly return after initial treatment with na loxone. Other medical complications also are possible. Note that an incapacitated individual’s symptoms may be unrelated to opioids.

What to do if you have an overdose?

Call 911 or your emergency response number. Never wait to see if the overdose will wear off, and call even if the person seems not to be experiencing overdose symptoms. Some effects of an overdose are insidious and don’t present themselves right away.

What are the symptoms of a drug overdose?

General symptoms of a drug overdose include: Shallow, labored, or irregular breathing, or no breathing. Confusion, disorientation, or hallucination. Loss of coordination or motor control. Drowsiness or collapse. Loss of consciousness. Clammy, pale skin.

How long does Naloxone last?

However, Naloxone only lasts for about 30-90 minutes. If the body hasn’t processed all the opioids by then, the overdose symptoms may return.

How to inject Naloxone into a muscle?

Draw 1cc of Naloxone into the provided syringe. Using a 1 or 1.5-inch intramuscular needle, inject the Naloxone into a large muscle such as the thighs, upper or outer section of the buttocks, or shoulder. Go straight in to be sure of hitting a muscle. Continue providing rescue breaths for 2-3 minutes after injection.

What is the color of Naloxone?

Blue or bluish-purple skin tone (on light-skinned people); ashen or grayish skin tone (on dark-skinned people) Naloxone comes in injectable and nasal spray form. The injectable form comes in a kit that includes two auto-injectors as well as a dummy device you can use to practice. Call 911 immediately.

What to do if a patient is not awake?

If the patient is not awake, you may need to locate drug containers, syringes, needles, and other items. Remove unnecessary clothing. Some drugs cause the patient to quickly overheat. If that occurs, remove clothing to expose skin to the air and cool it down. Call 911 or your emergency response number.

How to deal with a drug patient who is violent?

Don’t try to reason with or restrain a violent person; you could wind up hurting the patient or getting hurt yourself. Instead, call the police or medical help immediately.

What are the interventions used in treating overdose?

If possible, the amount and type of substance (s) taken, and length of time since ingestion should be ascertained. Four interventions are traditionally used in treating overdose (Clegg and Hope, 1999): - Induced vomiting; - Gastric lavage; - Whole bowel irrigation; - Absorbed charcoal.

What is intentional overdose?

Intentional overdose is usually an attempt to stop suffering, and anyone has the potential to consider it if they perceive their suffering to be intolerable, interminable and inescapable (Chiles and Strosahl, 1995). Those who lack the psychosocial resources that ameliorate suffering are therefore at risk.

How long should you stay in hospital after a valproate overdose?

Observations should continue for at least four hours following overdose, but symptoms can be prolonged, requiring hospitalisation (McCrea, 2002). A mild overdose of sodium valproate results in gastrointestinal disturbance, drowsiness, dizziness, confusion, ataxia, and irritability.

Why do people overdose?

Consistent with this, most patients explain their overdose as a reaction to being in ‘a terrible state of mind’ or ‘an unbearable situation’, feeling a loss of control, wanting to die or wanting to escape from an impossible situation (Schnyder et al, 1999). Patients also commonly describe feelings of despair, emptiness, and anxiety or panic prior to overdosing (Schnyder et al, 1999). Most deny that it was intended to simply ‘manipulate’ others, although some admit wanting people to understand how desperate they were feeling or to seek help from someone or thinking that their death would make things easier for others (Schnyder et al, 1999). Thus, they take intentional overdoses to escape from emotional suffering when they have exhausted all other attempts to cope. Some will be motivated by a serious intent to die, while others will be ambivalent. They may be desperate to find alternative ways of responding to their suffering, yet may die for want of an answer (Chiles and Strosahl, 1995).

How long does oedema last after overdose?

Cerebral oedema can occur up to 72 hours after overdose. Any cardiac effects are usually mild (for example, prolonged QTc interval). Electrolytes and blood gases should be monitored for a minimum of six hours after overdose, and 12 hours for modified-release preparations (McCrea, 2002). Antipsychotics.

What is the first aim of resuscitation?

The first aim is to ensure the patient’s survival using a logical system of acute assessment and intervention (Clegg and Hope, 1999). Standard resuscitation assessment and interventions should be used (ABC - assess airway, breathing, circulation, and neurological status) (Advanced Life Support Group, 2001). If possible, the amount and type of substance (s) taken, and length of time since ingestion should be ascertained.

Which drug has the longest half life?

Amlodipine has the longest half-life, with a significant overdose producing a toxicity that can last 10 days (Finnell and Harris, 2000). Whole bowel irrigation can be considered following overdose with modified-release preparations. The antidote to calcium channel antagonist overdose is intravenous calcium chloride (Finnell and Harris, 2000) or calcium gluconate (Nelson, 2001). However, digoxin levels should be checked first, as calcium salts can interact with digoxin to produce cardiac arrhythmia. Glucagon can be used to reverse cardiac instability (Finnell and Harris, 2000). Overdose-induced hypotension and bradycardia do not respond to any of the usual treatments.

How to prevent drug overdose?

Drug overdose cases can be significantly minimized with the following steps: Prescription drugs, including supplements, should be kept in a place that’s out of reach of small children or ensure that they have child-proof lids. Take the right dose at the recommended time.

What are the symptoms of overdose?

However, there are general signs and symptoms of overdose which include: Nausea and vomiting. In some instances, these are accompanied by diarrhea. Dizziness, loss of balance, or lack of coordination . Abdominal cramping. Seizures.

Why is Narcan training important?

The training is meant to equip the public on expected drug overdose response behaviors which lead to fewer adverse consequences. Due to the opioid crisis, agencies are advocating for the availing of Narcan to: Family members or companions of patients who are taking prescription drugs with opioids.

How does the prognosis of drug overdose depend on the type of drug?

Drug overdose prognosis depends on the type of drug, amount consumed, the symptoms’ severity, the time that has lapsed between overdose and treatment, and the patient’s general wellbeing . In cases of mild and moderate overdose, prompt management of the symptoms normally leads to a good prognosis.

How many people died from opioid overdose in 2017?

According to the Centers for Disease Control and Prevention, of the 70,237 overdose deaths which occurred in 2017, 47,600 were as a result of opioids overdose. As opioids affect the section of the brain that regulates breathing, an overdose could slow or stop breathing and in severe cases, death.

What are opiods used for?

Opioids or narcotics refer to prescribed medications, which include hydrocodone, Vicodin and OxyContin, as well as illegal drugs such as heroin. These prescription drugs are prescribed in the case of chronic pain due to an injury, after surgery or due to diseases such as cancer. Unfortunately, these have become some of the most abused drugs in the United States. According to the Centers for Disease Control and Prevention, of the 70,237 overdose deaths which occurred in 2017, 47,600 were as a result of opioids overdose.

What is the meaning of "drug overdose"?

Drug overdose takes place when a person ingests a huge amount of one or more drugs which overwhelm the body. A drug refers to anything, except food and water, which has a psychological or physical effect on the body’s functions.

Who report abuse to the Board of Nursing?

The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority. Each BON has a process for investigation and varying levels of programs to assist nurses through recovery.

When did nurses have their licenses revoked?

Prior to the 1980s, before substance abuse was recognized as a disease, nurses were relieved of duty and/or had their nursing license revoked with little recourse or treatment options when found to have a substance abuse disorder. Since that time, many states have enacted non-disciplinary rehabilitation programs to assist nurses with recovery.

Why is it important for nurses to protect patients?

Nurses are entrusted to protect the patients in their care from harm at all times. This protection includes the ability to perform at a high level of critical thinking. Caring for patients while under the duress of substance abuse puts the entire nursing process in harm's way.

What is the challenge of nursing?

A unique challenge to the nursing profession and substance abuse is the access to narcotic medications. Diversion of these drugs for self-use is not only harmful to the nurse, but is also unethical in the failure to protect the patient from harm by diverting the drugs from the patient. Furthermore, the impairment of the nurse may endanger ...

What is the nurse practice act?

The Nurse Practice Act for each state will define the process for programs in the state to assist the nurse with returning to work once they are safe to practice. Many states offer a graduated program of returning to work where there is oversight of the nurse with strict restrictions on the work environment.

How much of medication errors are prevented by nurses?

Nurses have always played a major role in preventing medication errors. Research has shown that nurses are responsible for intercepting between 50% and 80% of potential medication errors before they reach the patient in the prescription, transcription and dispensing stages of the process.

Which stage of the nursing process is most vulnerable to errors?

The administration stage is the most vulnerable to error because this is where there are fewer system checks and balances. In the hospital setting most medication is administered by a single nurse with the result that nurses’ errors are those most likely to reach the patient.

Why is medication error devastating?

Unintentionally harming of a patient through a medication error is devastating because it is in complete conflict with our nursing goal of caring and helping. Here are six things nurses need to know if they commit a medication error: 1. Medication errors happen all the time. Human error is a fact of life and mistakes with medication are ...

How many deaths are caused by medication errors?

Studies have shown that, besides increasing hospital stays and inpatient expenses, medication errors cause more than 7,000 deaths annually in the United States.

What happens if you don't report a mistake?

Should you not report the incident and the patient dies or suffers permanent disability from your mistake you will have to live with the guilt for the rest of your life. A cover-up may also be discovered and do more harm to your reputation, and possibly your career than that the mistake you made.

What happens when you make a medication error?

You immediately experience a physical and psychological stress response. Your blood pressure and pulse rate go up, your muscles tense and you are overcome by disbelief, panic, fear, anger and shame.

What is the second victim syndrome?

In the days and weeks that follow you will experience the psychological trauma widely known as the second victim syndrome. The first casualty is the patient who has been hurt by the error and the second victim is the person who has to live with its consequences.