Educational Company Healthcare Training Simplified CEP 15273 Objectives At the completion of this program the learners will Define inhalants Identify classes and examples of inhalants ID: 907917
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Slide1
Inhalant Abuse
Creativeresol-ve
Educational Company
Healthcare Training.
Simplified.
CEP #
15273
Slide2Objectives
At the completion of this program, the learners will:
Define inhalants
Identify classes and examples of inhalants
Recognize reasons why youths are using inhalants
Acknowledge inhalant practices by gender and ethnicity
State methods of inhalation and the most frequent site of usage
Explain the effects of inhalants on the body
Define inhalant intoxication, withdrawal, tolerance and addiction
Identify emergency treatment
Recognize fatal and long-term consequences of inhaling
Correlate the relationship of inhalant abuse and delinquent behavior
List three clinical/nursing interventions to assist the patient who abuses inhalants
Complete exam components at a 70% competency
Slide3Introduction
I
nhalant
abuse
is a growing trend and it can be challenging to recognize the early warning signs, which makes it more difficult to
treat.
There are an alarming number of youths inhaling chemicals for euphoric
purposes.
I
nhalants
are being used increasingly by preteen aged
children (5-6 years old).
These substances are physically and psychologically addicting and can cause death.
American Family Physician (AFP)
revealed that
about one-quarter of school aged children
'huff‘.
Nurses
need to be able to recognize the signs of inhalant abuse.
Slide4Statistics from 2008 show a decline in the use of inhalants by youths. In the past decade there has been a concerted effort to educate healthcare professionals, educators, law enforcement, retailers, youths and parents about inhalants
.
Monitoring the Future (MTF)
is an ongoing study for the National Institute of Drug Abuse (NIDA) of the behaviors, attitudes, and values of American secondary school students, college students, and young adults.
Statistics
Slide5MTF Data
Drug Usage
Slide6Inhalant Usage
Slide7Perceived Risk of Inhalants
Slide8Prevalence of Inhalant Abuse
Most children and adolescents say they are aware of people who breathe in fumes of household
products.
The abuse of inhalants is widespread across the United
States but may be underreported
law enforcement officials and healthcare providers are often unfamiliar with the signs of inhalant abuse.
Inhalants are the 4th most abused substances in the United States among 8th, 10th, and 12th graders; alcohol, cigarettes, and marijuana are the top three according.
Slide9Facts about Inhalant Abuse
Start
by inhaling deeply and taking several more breaths.
sniffing or snorting chemical
vapor
directly from open containers
huffing fumes from rags that are soaked in a chemical substance and held to the face or stuffed to the mouth
spraying aerosols directly into the nose or mouth
pouring inhalants onto the user’s collar, sleeves, or cuffs
bagging or inhaling substances sprayed or deposited in a bag or plastic bag
Slide101.
Volatile solvents
are liquids that vaporize at room temperature when left in unsealed containers.
Categories of Inhalants
Slide11Categories of Inhalants
2. Aerosols
are spray containers containing propellants and solvents such as
toluene.
Slide12Categories of Inhalants
3.
Gases
are substances with no definite shape or volume. The most commonly abused gas, nitrous oxide, is found in whipped cream dispensers and products that boost octane levels in racing cars.
Slide13Categories of Inhalants
4. Nitrites
which are mainly use to enhance sexual experiences. These are commonly available in adult bookstores and over the internet.
Slide14Huffing
- inhaling
vapors from a cloth soaked in a volatile substance, which is
then
held over the mouth and nose.
Sniffing
-
inhaling vapors from an open
container
Spraying
-
implies spraying an aerosol directly into the
mouth
Bagging
-
placing the volatile substance into a plastic bag which is then
held over
the mouth and nose.
Abusers use several different techniques to inhale:
Slide15Street Terms for Inhalants
Amys
Bolt
Bullet
Glading
Hardware
Hippie crack
Locker room
PoppersSnappers
Bang
Boppers
Climax
Gluey
Head Cleaner
Kick
Poor man’s pop
Rush
Toncho
(octane booster)
Slide16When someone sniffs or huffs, the toxic gases rush into the
lungs.
the oxygen cannot reach the brain and suffocates the person who huffs the toxic
chemical.
They have direct effects on both central nervous system (brain and spinal cord) and the peripheral nervous system (nerves throughout the body)
Inhalant can be smelled on skin and breath.
Can cause permanent damage to the brain, nervous system, kidneys, liver, heart and muscles because toxic chemicals are stored in the body fat forever.
“sudden sniffing death”- most serious effect that leads to death.
What are the Effects
Slide17Rapid Onset Effect
or “High”- reached within minutes of inhaling. This effect provides instant gratification to users.
Quality and Pattern of High-
euphoria
, giddiness, and
lightheadedness, surge of creativity and excitement.
Low Cost-
Poverty and lack of opportunity potentiate inhalant
use.
Easy to Conceal-
Youths frequently carry the product they abuse with them, often for use in the classroom or at social
functions.
Legality
-
Purchase and possession of these substances is not restricted or illegal in most areas
.
Easily available-
unlike other forms of drugs, these products are readily available from numerous retail stores.
Why are Inhalants Used?
Slide18Some nitrite abusers (who tend to be adults rather than adolescents) seek to enhance the sexual experience. Inhaled nitrites dilate blood vessels, increase the pulse rate, and produce a sensation of heat and excitement that can last several minutes.
Slide19Characteristics of Users
Parents frequently deny the possibility that their child has used inhalants.
Such youths may have the following characteristics
:
Emotional stress
-
crisis has recently occurred either at school or at
home
Dysfunctional Home
-
one or both parents use alcohol or
drugs
Risk taker
-
Youths are frequently risk takers and use inhalants even though they have heard of the detrimental effects
.
Low self
esteem-
often vulnerable to peer pressure.
Slide20Gender and Inhalant Use
Inhalants were considered a drug abused by males yet according to studies, there is a continued increase of inhalant use among females.
Slide21Ethnicity
In the 80’s typical
user of inhalants
are
Native American or Hispanic
males.
New data has found that there is a strong pattern of decreases in inhalant use among Native American adolescents over the last decade
.
Slide22Where do Inhalers Use?
Slide23Transient social abusers tend to be preteens or teenagers who use substances in the presence of others. Legal problems include minor offenses while
intoxicated.
Transient isolate abusers are in the same age group but tend to abuse solvents while alone. This group is unlikely to have legal problems.
Transient abusers have a short-term history of
abuse
Slide24Chronic social abusers tend to be in their 20’s and 30’s and have used substances in the presence of other for years. Legal problems include
misdemeanors
Chronic isolate abusers are in the same age group, but abuse drugs while alone. Legal problems include significant offenses including assaults.
Chronic abusers of inhalants
started using
inhalants early in
life and have chosen a certain inhalant as their drug of choice.
Chronic abusers have used for
years
Slide25Signs of Use
Unusual breath odor or chemical odor on clothing
Sitting with a pen or marker near the nose
Slurred or disoriented speech
Anxiety, excitability, irritability or restlessness
Drunk, dazed or dizzy appearance
Constantly smelling clothing sleeves
Showing paint or stain marks on the face, fingers or clothing
Hiding rags, clothes or empty containers (such as air fresheners) of the potentially abused products in closets and other places
Signs of paint or other products where they wouldn’t normally be, such as on the face or fingers
Red or runny eyes or nose
Spots or sores around the mouth
Nausea or loss of appetite
Lack of coordination
Nausea or loss of appetite
Failing grades, chronic absence and general apathy
Slide26W
ithdrawal
syndrome
can
begin 24-48 hours after cessation of use and last from 2 to 5 days
.
Symptoms include:
Sleep disturbances
Tremor
Irritability
Diaphoresis
Nausea and fleeting illusions
Headaches or abdominal cramps (youths)
Additional symptoms exhibited by
long-term
inhalant abusers include weight loss, muscle weakness, disorientation, inattentiveness, irritability, and
depression.
Withdrawal- Tolerance- Addiction
Slide27Sweating
Rapid pulse
Hand tremors
Insomnia
Nausea
Vomiting
Grand mal seizures
Liver disease (hepatitis or cirrhosis)
Acute or chronic renal failure
Sleep disturbances
Bone marrow depression
Cardiac arrhythmias
Respiratory damage (lung or sinus damage, pneumonitis, emphysema, ling changes or respiratory depression
)
Withdrawal symptoms (long-term use)
Slide28Assessment
Careful assessment of persons who are potentially using inhalants is vital in helping individuals avoid the serious
complications.
Clients can be encountered in a number of health care
settings (schools, clinic, psychiatric/addiction counseling environments, emergency rooms and acute care settings).
The assessment process should include a
history
,
physical
,
psychological
and
diagnostic
evaluation.
Slide29The quality and quantity of data elicited will depend on the practitioner’s sensitivity to the client.
Information
must be collected on the inhalant abused; the manner, duration, and frequency of abuse, and the use of other chemicals (alcohol).
It is recommended that the person who is performing the assessment obtain information pertaining to childhood disease, history of injuries and acute or chronic infections (including STDs).
Change in
behavior
or attendance at school; teachers will frequently report a change in grades or conduct in the classroom
Arrest for substance abuse offense.
Youths frequently display deviant, disruptive or delinquent
behavior
Personality changes
History
Slide30It should include objective and subjective data. The following systems should be
assessed:
Cardiovascular-
After a solvent is inhaled, a peripheral vasodilatation results, with variable degrees of hypotension and reflex
tachycardia.
Chronic exposure to volatile substances may cause dilated cardiomyopathy or myocarditis and additionally cases of cardiac arrhythmias and myocardial
infarction.
Neurologic
-
Cerebral cortex damage can cause changes in personality, memory loss, hallucinations and learning problems. Cerebellum damage can cause problems in balance and movement. Hippocampus damage may result in memory problems. Peripheral neuropathy has been reported secondary to chronic inhalant
abuse.
Respiratory
-
Coryza, pharyngitis, and pulmonary failure from aspiration are consequences of inhaling.
Rales
, rhonchi, bronchitis and pneumonia may be noted. The diagnosis of Inhalant abuse is often missed, and the respiratory condition may be treated without an evaluation of the
cause.
Physical Assessment
Slide31Gastrointestinal
-
Nausea, vomiting, and abdominal pain may be noted during intoxication and withdrawal. Manifestations of chronic abuse include anorexia and weight loss. Impaired liver function may be
noted.
Musculoskeletal
- Muscle weakness has been noted from using products that contain toluene, such as lacquer
thinner
Urological
- The renal tubules may suffer damage from inhalants, altering electrolyte
levels.
Hematology
- Bone marrow depression is a complication of inhalant abuse. Toxic effects of inhalant abuse include anemia, thrombocytopenia, leukemia, and
hemolysis
HEENT-
Huffing causes sores or a rash in and around the mouth. Sniffing
causes chronic nosebleeds and sores in the nose. Freezing of the lips and mouth can occur when the substance is inhaled directly from a
cylinder.
. Other manifestations include tinnitus, sneezing, hyper salivation and
conjunctival
irritation.
Physical Assessment
Slide32Psychological Assessment
The inhalant abuser may appear apathetic or belligerent and exhibit impaired judgment. Other behaviors to observe: Difficulty concentrating
Irritability
Depression
Apathy
Hostility
Violent temper outbursts
Paranoia
Hallucinations Anxiety
Lack of motivation
Mood swings
Slide33Specific questions should be asked in the following areas
:
Previous suicidal ideation/plan
Actual suicide attempts in past (dates and methods)
Current suicidal ideations/plan
Previous psychiatric care/current psychiatric care
Symptoms of depression
Recent loss of significant others, including pets
Feelings of hopelessness/helplessness
Sleep and appetite disturbances
Social withdrawal
Psychological Assessment
Slide34Diagnostic Evaluation
Inhalant users should be assessed with computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain. New research suggests inhalants also dissolve the myelin sheath of neurons in the
brain.
R
outine
drug screen is recommended to rule out other drugs
.
Laboratory identification of inhalant abuse most often requires analysis of body fluids by gas
chromatography.
A complete blood count (CBC) should be performed to determine if any of the following are present: infection, anemia, leukocytosis, thrombocytopenia, thrombocytosis, or platelet
defects
Creatinine, blood urea nitrogen (BUN) and urinalysis to assess kidney
function.
Serum electrolytes should be assessed to determine if there is an electrolyte imbalance such as
hypercholeremia
, hypokalemia and
hypophosphatemia.
Electrocardiogram (ECG) and chest x-ray should be used to determine heart and lung
damage
Visual and auditory-evoked potentials are abnormal in children
Neuropsychologic
testing is recommended
Slide35Death from using inhalants can occur from several factors:
Injury
-
Impaired judgment is a consequence of inhalant abuse.
Asphyxiation and Suffocation
-
Asphyxiation is caused from repeated
inhalations
displacing the available oxygen in the lungs. Suffocation occurs from blocking air from entering the lungs when
inhaling.
Choking
- Users can choke on their own
vomit.
Suicide-
the inhaler passes out from the inhalant and suffocates to
death.
Sudden
death-
caused from a cardiac
arrhythmia. “
Sudden sniffing death
” is the sensitizing of heart to a rush of adrenaline combined with the inhalant used which causes the heart to stop instantly. This is responsible for more than half of all deaths to inhalant abuse.
Fatal Consequences of Inhalant
Use
Slide36Kaposi’s Sarcoma-
Amyl and butyl nitrates have been associated with Kaposi’s sarcoma, the most common cancer reported with AIDS patients.
This is due to use of volatile nitrates.
Long-term Consequences
Inhalant Induced Persisting Dementia
-
This disorder is termed "persisting" because the dementia persists long after the individual has experienced the effects of inhalant intoxication and
withdrawal.
T
here
must be evidence from the history, physical exam or laboratory findings that the deficits are etiologically related to the persisting effects of inhalants.
Slide37Long-term Consequences
Burns-
Inhalants cause impaired judgment.
The
highly flammable nature of inhalants
leads to burns.
Development Harm to
Fetuses
-
Abuse of inhalants during pregnancy may place infants and children at increased risk of developmental harm.
Slide38Children could have
evidence of retardation in growth and development and residual deficits in cognitive, speech, and motor
skills.
It is recommended that infants born to women who have recently used inhalants be observed carefully for an alcohol-like withdrawal
syndrome
I
nhalant
abuse places children at increased
risk.
P
renatal
exposure to toluene or
trichlorethylene
(TCE) can result in reduced birth weights, occasional skeletal abnormalities, and delayed neurobehavioral
development.
A number of case reports note abnormalities in newborns of mothers who chronically abuse solvents. There is also evidence of subsequent developmental impairment in some of these children.
Developmental harm to fetuses
Slide39More minor criminal activity has been reported among inhalant
users. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use.
Delinquent Behavior & Inhalant Use
Slide40Addiction Treatment Effectiveness
Treatment facilities for inhalant abusers are hard to find.
Program directors of drug user treatment programs perceive a great deal of neurological damage incurred through inhalant use. They also have a general pessimism about treatment effectiveness and recovery.
Detoxification averages 40 days and treatment for inhalant abusers is usually long-term, sometimes as long as 2 years.
Detoxification must also include:
Support of the child's family
Moving the child away from unhealthy friendships with other abusers
Teaching and fostering better coping skills
Building self-esteem and self-confidence
Helping the child adjust to school or another learning setting
Slide41Relapse
Inhalant abusers have high relapse rates, making aftercare and follow-up extremely important
.
The warning signs of relapse include
:
returning to old
habits
Friends
hangouts or
denial
The following are recommended:
Aftercare
-
includes a structured plan for relapse prevention and active participation in treatment issues
.
Support Group
-
Groups such as NA or AA use a 12-step approach to help the recovering person develop a different life style.
Sponsor
-
a recovering person who is always available to the new member by telephone for encouragement, for clarification, and as a sounding board, particularly during the early stages of recovery.
Slide42General Clinical/Nursing Interventions
During the acute phase of inhalation intoxication and detoxification, care focuses on maintaining the patient's vital functions, ensuring his/her safety, and easing discomfort.
During
the rehabilitation, caregivers help the patient acknowledge his/her substance abuse problem and find alternative ways to cope with stress
.
C
linical/nursing
interventions
during and after acute intoxication:
During an Acute Episode
Continuously monitor the patient's vital signs and urine
output
Maintain a quiet safe environment. Remove harmful objects from the
room.
Institute appropriate measures to prevent suicide attempts and
assaults
Approach the patient in a nonthreatening
way. Limit sustained eye contact.
Implement seizure precautions
Give medications, as ordered, monitoring and recording their
effectiveness. (Haldol, sedatives, anticholinergic and antidiarrheal agents, antianxiety)
Slide43General Clinical/Nursing Interventions
2. During Drug Withdrawal
Administer medications, as ordered, to decrease withdrawal symptoms, monitoring and recording their effectives
Maintain a quiet, safe environment because excessive noise may agitate the patient.
3. When the Acute Episode has Resolved
Carefully monitor and promote adequate nutrition
Administer drugs carefully to prevent hoarding. Check the patient's mouth to ensure that (s) he has swallowed oral medication.
Refer the patient for rehabilitation as
appropriate.
Encourage
family members to seek help regardless of whether the abuser seeks it.
Develop self-awareness and an understanding and positive attitude toward the patient.
Set limits when dealing with demanding, manipulative behavior
Slide44Prevention is the Key
Prevention of inhalant abuse is the goal. This involves the entire community, including healthcare professionals, teachers, parents, peers, law enforcement and retailers. This section provides information for nurses to assist in the education of others.
Slide45Teaching children about inhalants
Children need to be able to differentiate between "good smells" (i.e., cookies baking). and "bad smells" (i.e., gas).
Six
year-old children are not too young to be taught the dangers of inhalants.
Slide46Parents frequently deny that inhalants could be a problem in their families, schools or communities
.
The
American Academy of Pediatrics recommends that the best way to fight inhalant abuse is to educate children about how harmful these products are.
Parents and teachers should also be able to recognize the warning signs of inhalant abuse
.
Talking to parents about inhalants
Slide47Suggestions
Do not shut children out by simply saying something is 'bad for you'.
Educate yourself and then give your child the right information.
Talk about dangerous behavior, such as inhalant abuse, and explain the consequences.
Help your child develop refusal skills—how to say 'no'.
Listen to your child
Ask your child questions such as 'where are you going?' or 'who will you be with
If you think your child is into inhalant abuse, remain calm. Upsetting them may make them more violent or trigger a physical response such as sudden sniffing death.
Slide48Classes and Examples of Inhalants
Slide49Diagnostic criteria for 292.89--Inhalant Intoxication
The following is the American Psychiatric Association (APA) DSM-IV-TR (2000
):
Recent intentional exposure to short-term, high dose volatile inhalants (excluding anesthetic gases and short-acting vasodilators
)
Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, use of or exposure to volatile
inhalant.
Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure:
Dizziness,
Nystagmus
, Incoordination,
Slurred
speech,
Unsteady
Gait, Lethargy,
Depressed
reflexes,
Psychomotor
retardation, Tremor,
Generalized muscle
weakness,
Blurred vision or
Diplopia,
Stupor or
Coma, Euphoria
The
symptoms are not due to a general medical condition and are not better accounted
for by
another mental disorder.
Slide50Emergency
Treatment
Medical
Airway Management-
Prevention of aspiration is essential. High-flow oxygen via
a
mask or by endotracheal tube is
recommended, if indicated.
Vital
signs and cardiac monitoring
;
IV for hydration and access for administration of emergency
drugs
Calm environment- Inhalants cause an increased release of
catecholamines
leading
to increased heart rate and blood pressure.
In the event of accidental ingestion of an inhalant, it is recommended that a nasogastric tube be placed and aspirate the stomach contents within one hour of
ingestion.
Medication-
There is no recommended medication for withdrawal of inhalant abuse
. However, individual symptoms can be treated with medication for manifestations of inhalation abuse.
Slide51Mental Health
Psychological and addiction
evaluation-
denial is
a
common symptom of addiction
.
The abuser may be anxious to
convince
healthcare personnel that they will never abuse inhalants
again.
A psychological evaluation is necessary to rule out concurrent mental health problems.
Slide52Conclusion
Inhalant abuse is
growing
and
frightening problem
that can
be challenging to recognize early.
Easy accessibility and the relatively low cost of the substances
will
attract new users and continue to be a problem
.
inhaling may lead to addiction or other drug
usage.
The most effective way to prevent inhalant abuse is by educating providers, healthcare workers, teachers, and parents.
Parents may not realize that they have only a few short years in which they can influence their child’s decision not to abuse inhalants.
It is important that nurses have full access to information that would help them identify inhalant abuse.
Nurses need to take the leadership in assessing youth, in educating other health care professionals, educators and the public
.
Nurses need to play an integral role in identification, prevention and education.
Slide53