A patient is having multiple scratches at his veins. The patient may be habitual to which drug?

Central Institute of Psychiatry - 9 July 2022

Mental Health Nursing

Medium

Appeared in: Central Institute of Psychiatry - 9 July 2022

Explanation

The clinical sign described as 'multiple scratches at his veins' is commonly known as 'track marks.'.
Track marks are linear patterns of scarring and hyperpigmentation that result from repeated intravenous (IV) injections into the same veins.
Opiates, particularly heroin, are the class of drugs most frequently administered via the intravenous route, making this the most likely cause of the observed signs.
Chronic IV administration leads to venous scarring, thrombosis, and cutaneous lesions, which are telltale signs of opiate addiction.

Option A: LSD is a hallucinogen that is almost always taken orally (e.g., on blotter paper or as a liquid). It is not associated with intravenous injection or the formation of track marks.
Option B: Phencyclidine (PCP) is a dissociative anesthetic that is typically smoked, snorted, or ingested orally. IV use is uncommon, so it does not cause track marks.
Option C: While cocaine can be injected intravenously, a more specific dermatological sign is formication ('cocaine bugs'), which causes generalized itching and excoriations all over the body, not just along veins. Opiates are more classically associated with track marks.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of signs related to substance abuse, specifically intravenous drug use to guide bedside assessment, documentation, and the next nursing action.
Nurses are often the first healthcare professionals to identify physical signs of substance abuse during routine assessments. Recognizing track marks is a critical patient safety skill.
Identifying IV drug use prompts the nurse to assess for serious associated complications, including skin and soft tissue infections (cellulitis, abscesses), systemic infections (endocarditis, sepsis), and blood-borne viruses (HIV, Hepatitis B & C).
This finding is a crucial opportunity for patient education on harm reduction (e.g., needle exchange programs, safe injection practices) and to offer non-judgmental support and referral for addiction treatment.

How to Approach the Question

First, analyze the key clinical sign presented in the question: 'multiple scratches at his veins.'
Translate this lay description into a clinical term. Scratches along veins are indicative of 'track marks,' which are a result of repeated intravenous (IV) injections.
Next, evaluate each drug option based on its common routes of administration.
Consider LSD and Phencyclidine. Recall that these are primarily taken orally, snorted, or smoked, making IV use and track marks unlikely.
Compare Cocaine and Opiates. Both can be injected. However, recall that opiates (like heroin) are most classically associated with IV use and track marks. Cocaine has a more specific sign of generalized scratching from formication.
Conclude that Opiates are the most probable cause for the specific sign of scratches localized to the veins.

Concept Tested & Keywords

Concept Tested: Identification of signs related to substance abuse, specifically intravenous drug use.
Stem keywords: multiple scratches, veins, habitual, drug
Lead-in keywords: which drug
Clinical cues: The location of the scratches ('at his veins') is the key diagnostic clue, pointing towards injection sites rather than generalized itching.

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