Cardiovascular disease is the major cause of death in the United States and also the leading reason for hospital admission. Within the large population of patients suffering with cardiovascular disease is a very unique sub-population — patients who are demographically “younger than normal” who have a history of past cocaine abuse.
Cocaine use is relatively widespread within the United States, with an estimated 25 million users having tried out the drug along with an approximated 5 million individuals regularly using the drug. It is important to consider the increase in cocaine use in the late 70’s and 80’s among 20 and 30 year olds in large metropolitan cities. Now, as these individuals are in their 40’s and 50’s the ramifications of prolonged cocaine use seem to be coming to the surface
Of the issues associated with cocaine use, heart failure is one of the most serious. Patients with a history of cocaine use and who now present with heart failure will have symptoms similar to normal heart failure patients. A key difference though will be the younger age of the patient (think 40 – 50). Of course, individuals may also present in full pulmonary edema or in cardiogenic shock. Unfortunately, the exact amount and duration of cocaine use necessary to develop heart failure is not understood. Patients which have a history of stimulant use usually tend to have multiple hospital readmissions within brief periods of time.
Nurses must be proficient in acquiring drug backgrounds from their patients. A drug background ought to include use and regularity, as well as patterns and habits in mixing drugs (including alcohol). Self-reported usage is the main means of assessing for drug and alcohol abuse within the health care setting – placing an ever increasing importance on interview skills. The Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) questionnaire can be used in the acute care setting as a helpful tool to spur an intervention.
In short, nurses will encounter patients with a history of drug use and it is crucial that they be able to provide the necessary intervention in order to provide the appropriate level of patient safety. Although a variety of online CNE courses exist for intervention skills and ambulatory care continuing nursing education, nothing is able to replace real on the job experience talking and listening to patients.
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