Substance Use Disorders in Acute Care | Chapter 11 - Lewis’s Medical-Surgical Nursing (12th Edition)

Chapter 11 of Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems (12th Edition) addresses the challenges of identifying and managing substance use disorders (SUDs) in the acute care setting. SUD is defined as the recurrent use of alcohol, tobacco, or other drugs causing significant impairment in health, responsibilities, and relationships, and is classified as mild, moderate, or severe. Nurses play a central role in recognizing SUD, managing withdrawal, and motivating patients toward treatment using interventions such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). The chapter reviews major substances associated with SUD and their complications: 🚬 Nicotine (Tobacco Use Disorder, TUD) – Highly addictive stimulant causing lung cancer, COPD, cardiovascular disease, oral cancers, and EVALI (e-cigarette or vaping-associated lung injury). Cessation strategies include counseling, nicotine replacement (patches, gum, lozenges, inhalers), and non-nicotine agents like varenicline (Chantix) and bupropion (Zyban). Nurses are mandated by The Joint Commission to identify tobacco use and provide cessation resources. 🍷 Alcohol (Alcohol Use Disorder, AUD) – Widely used depressant linked to liver disease, GI bleeding, hypertension, stroke, cancers, and injuries. Acute alcohol toxicity can cause CNS and respiratory depression, while Alcohol Withdrawal Syndrome (AWS) and alcohol withdrawal delirium can be life-threatening, requiring benzodiazepines, thiamine, multivitamins, and CIWA-Ar assessment. 💊 Stimulants (Amphetamines, Cocaine, Methamphetamine) – Increase cardiac activity and CNS stimulation, leading to euphoria, psychosis, dysrhythmias, seizures, and myocardial infarction. Toxicity requires supportive emergency care, while withdrawal produces fatigue, vivid dreams, depression, and craving. 💤 Depressants (Sedative-Hypnotics, Opioids) – Rapid tolerance and dependence. Overdose can cause respiratory arrest and death; opioids are reversed with naloxone, while benzodiazepine overdoses may require flumazenil. Withdrawal from sedatives is life-threatening and managed with tapering benzodiazepines; opioid withdrawal causes severe GI distress, anxiety, insomnia, and is treated with methadone, buprenorphine, or clonidine. 🌀 Inhalants – CNS depressants causing brief euphoria followed by drowsiness, lightheadedness, and long-term neurologic damage. Toxicity may lead to dysrhythmias, seizures, or renal failure, managed with supportive care. 🌿 Cannabis (Marijuana, THC) – Produces euphoria, relaxation, increased appetite, but long-term use is linked to psychiatric disorders, impaired cognition, and cardiopulmonary effects. Synthetic cannabinoids (K2, Spice) are unpredictable and toxic. Withdrawal symptoms include irritability, insomnia, anorexia, and anxiety. ☕ Caffeine – The most widely used stimulant; excessive intake can cause arrhythmias, hypertension, seizures, and anxiety, while withdrawal produces headache, irritability, and drowsiness. The chapter emphasizes nursing management, including: ✨ Screening & Assessment – Use tools like AUDIT, DAST-10, and SMAST-G for older adults; assess for polysubstance use, medical complications, and psychosocial impact. 📋 Planning & Implementation – Priorities include airway management, hemodynamic stability, seizure precautions, safe environments, hydration, and nutritional support. 🧠 Health Promotion – Prevention through education about risks, motivational interviewing, and linking patients to treatment programs. 👵 Gerontologic Considerations – Older adults often use alcohol or medications to cope with grief, pain, or loneliness, with symptoms mistaken for dementia. They are more vulnerable to toxicity and withdrawal due to physiologic changes, requiring careful screening and tailored interventions. 📘 Read full blog summaries for every chapter: https://lastminutelecture.com 📘 Have a book recommendation? Submit your suggestion here: https://forms.gle/y7vQQ6WHoNgKeJmh8 Thank you for being a part of our little Last Minute Lecture family! ⚠️ Disclaimer: These summaries are created for educational and entertainment purposes only. They provide transformative commentary and paraphrased overviews to help students understand key ideas from the referenced textbooks. Last Minute Lecture is not affiliated with, sponsored by, or endorsed by any textbook publisher or author. All textbook titles, names, and cover images—when shown—are used under nominative fair use solely for identification of the work being discussed. Some portions of the writing and narration are generated with AI-assisted tools to enhance accessibility and consistency. While every effort has been made to ensure accuracy, these materials are intended to supplement—not replace—official course readings, lectures, or professional study resources. Always refer to the original textbook and instructor guidance for complete and authoritative information.