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Difficulty: MediumChemical and Other Dependencies / Substance Use Disorders

A nurse is admitting a new client to an inpatient addiction treatment unit for the management of severe opioid use disorder. Arrange the following nursing actions in the correct sequence from first to last.

  1. 1Assess the client's airway, breathing, and initial vital signs for any immediate physiological instability.
  2. 2Conduct a thorough search of the client's clothing and personal belongings for contraband.
  3. 3Interview the client to obtain a comprehensive substance use history, including the time of the last dose.
  4. 4Evaluate the client using the Clinical Opiate Withdrawal Scale (COWS) to determine the severity of withdrawal.
  5. 5Administer the prescribed dose of buprenorphine as indicated by the withdrawal score.

Answer

The correct sequence is: 1. Assess airway and initial vital signs, 2. Conduct a search for contraband, 3. Interview the client for substance use history, 4. Evaluate using the Clinical Opiate Withdrawal Scale (COWS), and 5. Administer the prescribed buprenorphine.
The correct sequence strictly follows Maslow's hierarchy of needs and the nursing process tailored to an inpatient addiction setting. Immediate physiological survival (airway, breathing, circulation) is always the first priority. Once the client is medically stable, securing the therapeutic environment by searching for contraband is the most critical safety protocol on a psychiatric or addiction unit. With safety established, the nurse proceeds to a comprehensive assessment (the detailed substance history), followed by a targeted evaluation of current symptoms using a standardized tool (COWS). Finally, based on the objective data gathered, the nurse implements the pharmacological intervention (buprenorphine) safely, ensuring the client is in sufficient withdrawal to avoid precipitating a worse crisis.

Step-by-Step Solution

1
Prioritize physiological safety by checking the ABCs.
Assessing the airway and vital signs rules out acute life-threatening conditions such as respiratory depression.
Life-threatening physiological conditions must be addressed before psychiatric evaluations or unit protocols can begin.
2
Ensure environmental safety by conducting a contraband search.
Searching belongings prevents unauthorized drugs or weapons from entering the locked unit.
The safety of the therapeutic milieu is the immediate next priority in any inpatient addiction setting once the client is physically stable.
3
Gather detailed subjective assessment data.
Obtaining the substance use history identifies the risk profile and timeline for impending withdrawal.
A comprehensive history is required to determine which specific withdrawal protocols and scales the nursing staff will need to utilize.
4
Perform a targeted, objective clinical assessment.
The COWS provides an objective measurement of the client's current withdrawal severity based on physical signs.
Objective data demonstrating active withdrawal is mandatory before initiating specific medication-assisted treatments for opioid dependence.
5
Implement the pharmacological intervention.
Buprenorphine is safely administered based on the documented COWS score.
Administering a partial opioid agonist like buprenorphine too early can precipitate severe, rapid-onset withdrawal, so it must strictly follow the objective assessment.

Key Concept

Prioritization in Addiction Admissions and Opioid Withdrawal Management
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Topics

Chemical and Other Dependencies / Substance Use Disorders

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