| Course | NUR-3450 Nursing Care of Clients with Alterations in Behavioral Health |
|---|---|
| Module | Module 4 |
| Paper type | Behavioral health paper: opioid use disorder |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3450 Module 4
From Naloxone to a First Dose: Starting Treatment in the Emergency Department
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3450: Nursing Care of Clients with Alterations in Behavioral Health
Mentor Name
Month Day, Year
From Naloxone to a First Dose: Starting Treatment in the Emergency Department
The Patient
Mr. Ruiz is invented for this paper. He is 29, a licensed electrician who injured his back on a job site three years ago and was prescribed oxycodone. When prescriptions ended, he began buying pills and then using fentanyl. Tonight his roommate found him unresponsive with slow breathing, gave intranasal naloxone and called 911. In the emergency department he woke, frightened and ashamed, with withdrawal symptoms beginning: yawning, sweating, gooseflesh and cramping.
Opioid Use Disorder as a Chronic Condition
Opioid use disorder is a chronic, treatable condition in which repeated opioid use changes brain reward and stress systems, leading to craving, loss of control and continued use despite harm. Withdrawal is intensely uncomfortable but rarely fatal in itself; the greatest danger is overdose, especially when tolerance drops after a period without use and when the drug supply contains fentanyl.
Starting Treatment in the Emergency Department
D'Onofrio et al. (2015) enrolled 329 patients with opioid dependence at one city hospital's emergency department and randomized them to a simple referral, a brief intervention with facilitated referral or a brief intervention plus a first buprenorphine dose in the department, with ongoing prescriptions from primary care. A month later, about four in five patients who had started buprenorphine were in addiction treatment, compared with roughly 37 percent after referral alone and 45 percent after a brief counseling session. The buprenorphine group also reported fewer days of illicit opioid use.
Medications Save Lives
Sordo et al. (2017) reviewed cohort studies of mortality among people receiving methadone or buprenorphine. Deaths from any cause ran far lower during treatment than after it ended; for methadone, the rate in treatment was about a third of the rate outside it. The first four weeks after starting methadone and, especially, the first four weeks after stopping treatment carried elevated risk. The authors concluded that keeping patients in treatment is what makes it protective.
Roots in Childhood Adversity
Felitti et al. (1998) surveyed more than 9,500 adults about adverse childhood experiences, such as abuse, neglect and household dysfunction. Adults who reported four or more kinds of childhood adversity faced several times the risk of alcoholism, drug use and suicide attempts compared with those with none, in a graded relationship. When the student later asked Mr. Ruiz about his history with his permission, he described his father's drinking and his parents' violent divorce.
| Source | Key finding | Nursing implication |
|---|---|---|
| D'Onofrio et al. (2015) | ED-initiated buprenorphine doubled treatment engagement | Support starting treatment before discharge |
| Sordo et al. (2017) | Mortality far lower while in treatment; risk high after leaving | Emphasize staying in treatment; plan for transitions |
| Felitti et al. (1998) | Adverse childhood experiences raise risk of substance use | Use a trauma-informed, nonjudgmental approach |
Nursing Diagnoses
The student identified risk for injury related to overdose, acute pain and discomfort related to opioid withdrawal and readiness for enhanced health management, shown by his willingness to discuss treatment.
Nursing Care
The nurse monitored his breathing and oxygen saturation closely, since naloxone can wear off before fentanyl does. The student used a withdrawal scale to rate his symptoms, which showed moderate withdrawal, the point at which buprenorphine can be started without causing sudden withdrawal. The emergency physician offered buprenorphine, and Mr. Ruiz accepted. Within an hour his symptoms eased.
The student spoke with him without judgment, choosing words that put the person before the diagnosis, and acknowledged his shame. He said he had been afraid to ask for help because he thought he would be treated like a criminal.
Overdose Prevention
Before discharge, the student taught Mr. Ruiz and his roommate how to recognize overdose and use intranasal naloxone, and the department provided a kit. The student explained that his tolerance would be lower after even a few days without opioids and that fentanyl in the drug supply makes overdose more likely. Fentanyl test strips and never using alone were discussed as harm reduction steps.
A Warm Handoff
The department's peer recovery specialist, a person in long-term recovery, met Mr. Ruiz before he left and arranged an appointment two days later at a clinic that would continue buprenorphine. He received a prescription to cover the days until then. Following Sordo and colleagues, the student emphasized that staying in treatment is what protects him.
His Roommate and Family
His roommate had saved his life and was shaken. The student included him in naloxone teaching with Mr. Ruiz's permission and gave him a second kit. Mr. Ruiz asked that his parents not be told yet; the student respected that choice and talked with him about who else could support him. He named an older cousin who had been in recovery for six years.
Pain and Work
Mr. Ruiz's use began with a back injury, and his pain had never been fully treated. The student noted that buprenorphine also relieves pain for many patients and that his clinic could refer him to physical therapy. Returning to work safely would matter to his recovery, since his trade and his license were central to how he saw himself.
Evaluation
Mr. Ruiz left with buprenorphine, a naloxone kit, a clinic appointment and a peer specialist's phone number. He could explain overdose signs and how to use naloxone.
Stigma in Health Care
Mr. Ruiz said a nurse at another hospital had once called him a junkie. Stigma from health workers drives people away from care. The student reflected that a single respectful conversation can make the difference between a patient returning for treatment and avoiding it.
Limits
Not every emergency department offers buprenorphine. The trial was conducted in one urban hospital. A student assists and teaches but does not prescribe or decide treatment. Mr. Ruiz is invented.
Conclusion
Mr. Ruiz's overdose was a turning point that the emergency department could use. D'Onofrio and colleagues showed that starting buprenorphine there doubles engagement in treatment, Sordo and colleagues showed that medications protect lives while patients remain in care and Felitti and colleagues showed how childhood adversity contributes to risk. Nonjudgmental care, overdose education, naloxone and a warm handoff to treatment completed the nursing role.
References
D'Onofrio, G., O'Connor, P. G., Pantalon, M. V., Chawarski, M. C., Busch, S. H., Owens, P. H., Bernstein, S. L., & Fiellin, D. A. (2015). Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: A randomized clinical trial. JAMA, 313(16), 1636-1644. https://doi.org/10.1001/jama.2015.3474
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8
Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, Article j1550. https://doi.org/10.1136/bmj.j1550
Reading the NUR 3450 Module 4 assignment instructions
Substance use and vulnerability both appear in TESU's catalog paragraph for NUR-3450, and because the syllabus is not public, module four is planned as an opioid use disorder paper. Describe how the disorder developed for this patient, present it as a chronic, treatable condition, report evidence on starting medication in the emergency department and on mortality during treatment and consider underlying adversity. Write nursing diagnoses, describe monitoring after naloxone, withdrawal scoring before buprenorphine and respectful communication, teach overdose prevention and plan a warm handoff to ongoing care. Some sections assign neonatal withdrawal or pain management instead. Ask which withdrawal scale your clinical site uses. Address stigma in health care settings, since it shapes whether patients return. Explain the role of a peer recovery specialist.
Inside the NUR 3450 Module 4 example
A fictional electrician whose prescribed oxycodone gave way to fentanyl is revived with naloxone and brought to a Toms River emergency department. The paper frames opioid use disorder as a chronic condition, then summarizes D'Onofrio and colleagues' trial, Sordo and colleagues' mortality analysis and Felitti and colleagues' ACE study in a table. Close monitoring of breathing, withdrawal scoring before a first buprenorphine dose, words that put the person first, naloxone and harm reduction teaching, a section on his roommate and family and a peer specialist's handoff precede the evaluation, the limits and a brief conclusion. A short section on stigma in health care is included. Annotations show how each finding shapes a nursing action.
Where the marks sit in the NUR 3450 Module 4 rubric
Opioid use disorder papers succeed when they treat the condition as chronic and treatable, report trial and mortality findings with numbers and connect childhood adversity to risk without excusing or blaming. Readers look for safe monitoring after naloxone, correct timing of the first buprenorphine dose, language that avoids stigma and overdose teaching that includes falling tolerance and fentanyl. A concrete bridge to continuing care, such as a scheduled clinic visit and a peer specialist, shows that the student understands why the weeks after discharge are dangerous. Reflecting on stigma from health workers shows self-awareness. Including the roommate in naloxone teaching shows attention to the people who respond to overdoses.
NUR 3450 Module 4 help: mistakes that cost marks
Avoid stigmatizing words and moral framing; describe a medical condition with medical treatment. Do not end care at discharge without a bridge. Explain the disorder, report the emergency department buprenorphine trial and explain why staying in treatment saves lives. Teach naloxone use to the patient and the people around him, discuss falling tolerance and fentanyl and arrange a warm handoff. Consider trauma history with permission. Share the prompt and your patient's situation, and a free first draft is written for you. Notice your own words and tone; patients remember them. Teach naloxone use to anyone who lives with the patient.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3450 Module 4 questions, answered
Where can I find a free NUR 3450 Module 4 sample paper?
The opioid use disorder paper about an invented patient revived with naloxone, from the ED to a warm handoff, can be read in full here.
Does starting buprenorphine in the emergency department help?
Yes; in D'Onofrio and colleagues' trial, roughly twice as many patients were in treatment a month later as with referral alone.
Do methadone and buprenorphine reduce deaths?
Yes; Sordo and colleagues found mortality far lower during treatment, with high risk in the weeks after leaving it.
Why monitor breathing after naloxone?
Naloxone can wear off before fentanyl or other opioids, so breathing can slow again.
What are adverse childhood experiences?
Abuse, neglect and household dysfunction in childhood, which Felitti and colleagues linked to higher risk of substance use and other harms.