A client is admitted for cocaine intoxication. Which assessment findings does the nurse MOST expect?

COCAINE INTOXICATION produces classic CNS STIMULANT effects because cocaine blocks the reuptake of dopamine, norepinephrine, and serotonin — flooding the reward pathway and activating the sympathetic nervous system.

Clinical presentation:

Neurological/behavioral: Euphoria (intense but brief — 15-30 minutes for intranasal; seconds to minutes for smoked 'crack'); agitation, grandiosity, talkativeness; impaired judgment; potential paranoia or psychosis with heavy use; CARDIOVASCULAR (most dangerous): Tachycardia; hypertension; cardiac dysrhythmias; coronary artery vasospasm (can cause MI even in young people with no underlying heart disease); cocaine-induced chest pain must be evaluated seriously.

Sympathomimetic: Mydriasis (dilated pupils); diaphoresis; hyperthermia; tremors; APPETITE SUPPRESSION.

Respiratory: Nasal septum damage with intranasal use; pulmonary edema with 'crack lung'; CRASH (post-intoxication): As cocaine wears off: profound fatigue, depression, hypersomnia, intense drug craving.

Nursing care: Cardiac monitoring (MI risk); vital signs; benzodiazepines for agitation, hypertension, seizures (NOT beta-blockers — unopposed alpha stimulation can worsen hypertension); cool environment for hyperthermia; watch for cocaine-associated chest pain; CONTRAST WITH OPIOID INTOXICATION (often confused on tests): Opioids produce sedation, respiratory depression, MIOSIS (pinpoint pupils) — opposite of cocaine.