Ineffective Coping / AEB cocaine abuse, nursing diagnosis question!! Ugh

jenrninmi, MSN, RN · Jan 23, 2005

Sounds good to me...

HyperRNRachel · Jan 23, 2005

Any other indications of drug use? Nervousness, sweating, increased heartrate, nose bleed, slurred speech, paranoia, pupil size?

mitchsmom · Jan 23, 2005

Hi Jennifer, thanks for responding, are you still counting down those days manually?? LOL... hey at least you are close enough TO count!! :)

Hyperstudent... no b/c he was in jail and then was admitted to this treatment program on 1/4/05... so he's done withdrawing- sort of makes it harder... the blood thing really doesn't apply at this point either but it was the only thing I could think of... now that I think about it I may have to take that off but I don't know what the heck to put for "objective" now that he doesn't have any physical sx????????????

Altra, BSN, RN · Jan 23, 2005

Your other r/t items are inadequate support systems & role modeling -- is there subjective/objective data about these? Pt. states family members w/hx of drug abuse which he witnessed? Pt. states he is not in contact w/family or recent breakup w/spouse or significant other? HTH :)

CarVsTree · Jan 23, 2005

Actually, there are very few physical symptoms of cocaine w/d. There are noticeable psychological issues: Difficulty concentrating, jumps around a lot when speaking, irritability, etc. I can give you a ton of subjective from personal experience, but since I didn't watch myself w/d, I can't give you a lot of objective.

I can tell you that stopping is a lot harder than staying stopped.

mitchsmom · Jan 23, 2005

MLOS... that makes sense and I should be able to come up with something like that pretty easily.

Sue...I just don't notice any visible signs of w/d on this guy, I think it's all emotional now. Unfortunately I think every part of it is hard for him, this is the 4th time he's in a tx program - he's 28 and been using since 13. Also been shot, and served a big chunk of federal prison time, etc. etc..

Glad you were successful in stopping :)... I have always tried to be very cautious with myself b/c there is a lot of S/A in my family.

PMHNP10 · Jan 23, 2005

Ok, I'm using "Ineffective Coping r/t inadequate support systems, negative role modeling AEB cocaine abuse" for a nursing diagnosis (that part is straight from one of my books so I'm ok with it).
My question is.. I have to validate it with subjective/objective data.
Does this sound right?:
Subjective "Client states he inhales powder cocaine on a daily basis"
Objective "Client's blood tests positive for cocaine"
Do you have other ideas?
??? I'm getting toward the end of this thing and my brain is fried.

For this assignment is there a minimum number of data you must provide for each sub/obj category?

I'm guessing the pt. had been clean for periods at a time because it'd be impossible to use that stuff on a regular basis for 15 yrs. So my question would be: What was going on with him that caused the latest relapse? Did a loved one leave (abandon) him or die? Did he lose a job? Become homeless?

As for more objective data to support your nursing diagnosis, wouldn't the fact that he has already been in fed prison and most recently jail qualify as data which supports inadequate support system/negative role modeling? I hope something I type might help.

mitchsmom · Jan 23, 2005

Thanks everyone, I did add family hx stuff for a couple of subjective points and I added court order/jail for another objective one :)

I'm not sure what precipitated this relapse... didn't get to ask... maybe unemployment. I don't think anyone died, no homelessness, etc. I'm also not sure how steadily he's used, what periods of being clean he's had, etc. It was a pretty big chunk of prison time, but I guess we can't assume that he was clean there either huh?