A client who uses heroin is admitted for detoxification. The nurse anticipates symptoms of opioid withdrawal will include which of the following?

OPIOID WITHDRAWAL is highly uncomfortable but generally NOT life-threatening (contrast with alcohol or benzodiazepine withdrawal, which CAN be life-threatening). TIMELINE for heroin withdrawal: onset 6-24 hours after last use; peak 36-72 hours; resolution 5-7 days for most symptoms (some protracted symptoms persist weeks). SIGNS AND SYMPTOMS — remember with the mnemonic 'WASHOUT': WATERY EYES AND NOSE (lacrimation, rhinorrhea); AGITATION AND ANXIETY; SWEATING AND SHIVERING; HYPERTENSION AND TACHYCARDIA; OUTRAGEOUS GI SYMPTOMS (nausea, vomiting, diarrhea, abdominal cramps); URGE TO USE; TERRIBLE MUSCLE ACHES (myalgia); PILOERECTION (gooseflesh — where the term 'cold turkey' comes from). Also: YAWNING, INSOMNIA, DILATED PUPILS (mydriasis — opposite of the pinpoint pupils seen with opioid intoxication). CLINICAL OPIATE WITHDRAWAL SCALE (COWS): standardized tool to assess withdrawal severity; scored 0-48; used to guide medication-assisted treatment. MEDICATION-ASSISTED TREATMENT (MAT) for opioid use disorder and withdrawal: METHADONE (full agonist, controlled, dispensed at clinics); BUPRENORPHINE/NALOXONE (Suboxone — partial agonist, outpatient prescription, reduces misuse potential); CLONIDINE (alpha-2 agonist, helps with autonomic symptoms but not a controlled substance; used for comfort); LOPERAMIDE for diarrhea; NSAIDS for muscle pain; ANTI-NAUSEA medications.

Nursing care: vital signs monitoring (BP, HR — elevated in withdrawal); administer medications as ordered; comfort measures; non-judgmental attitude; harm reduction counseling; connect to MAT program for long-term management; do not abandon client due to substance use disorder — it is a medical condition.