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Saunders: CH75 Addictions
Terms in this set (32)
disorders that are characterized by uncertain self-identification & grossly disturbed eating habits?
- (Fig 75-1)
- bingelike overeating without purging?
- food consumption is out of individuals control & occurs in stereotyped fashion.
- repulsed by eating, the eating relieves tension but does not produce pleasure.
- aware of abnormal behavior = depressed after eating.
- eats secretly during a binge. Consumes high-calorie & easily digestible food.
- repeatedly tries to diet w/o success.
- feels helpless/hopeless about weight.
*Responds to feelings of guilt, anger, depression, boredom, loneliness, inadequacy, or ambivalence by "eating"
- an eating disorder whose onset is often associated w/ a stressful life event?
- intense fear of (Obesity).
- Body image = disturbed/distorted.
- Preoccupied w/ foods that prevent weight gain. Phobia w/ foods that --> weight gain.
- can be (Life Threatening).
- Death can occur from (starvation, suicide, Cardiomyopathies, Electrolyte imbalance).
- (Fig 75-1).
Anorexia Nervosa (Assessment)
- refusal to eat & appetite loss.
- Appetite denial.
- Feelings of lack of control.
- Compulsive exercising.
- Overachiever & perfectionist.
- decreased Temp
- Pulse, BP.
- GI disturbances (constipation).
- weight loss.
- teeth & gum deterioration.
- (Esophageal varices) from induced vomiting
- Electrolyte imbalances.
- Dry, scaly skin.
- Sleep disturbances.
- Hormone deficiencies.
- Amenorrhea (for at least 3 consecutive menstrual
- Cyanosis & Numbness of extremities.
- Bone degeneration.
- eating disorder that indulges in eating Binges followed by Purging behavior?
- most pt's remain w/in normal weight, but think that their lives are dominated by the (eating-related conflict)
Bulimia Nervosa (Assessment)
- preoccupied w/ body shape & weight.
- consumption of high-calorie food in secret; guilt about secretive eating.
- Binge-purge syndrome.
- attempts to lose weight through = Diets, vomiting, Enemas, cathartics, & amphetamines or Diuretics.
- Has a need to control, yet experiences feelings of powerlessness or loss of control.
- Low self-esteem.
- Poor interpersonal relationships.
- Decreased interest, or absence of interest in sex.
- Mood swings.
- Electrolyte imbalances.
- Physical alterations: Similar to those like anorexia.
- (Fig 75-1).
Interventions: Pt's w/ an Eating disorder
- Assess Nutritional status & severity of medical problems.
- establish a One-to-one therapeutic relationship.
- contract regarding Nutritional Plan for the day.
- ID Precipitants to eating disorder.
- encourage pt to [Express feelings] about eating disorder.
- be accepting & Nonjudgmental.
- help pt to explore [self-concept] & [establishing identity].
- Supervise during mealtimes & for period after meals. Monitor I&O.
- monitor for signs of [Physical complications] related to the eating disorder.
- Weigh daily @ same time after pt voids (weighing each day may decrease anxiety).
- Assess & Limit pt's Activity level (Anorexia & Bulimia).
- assess [Suicide potential].
- administer [Antidepressant med's].
- encourage Psychotherapy.
- refer to [Support group].
Substance Abuse Disorders
- these type of disorders --> [Behavioral & Physiological changes]?
- pattern of repeated use of a substance --> Tolerance, Withdrawal, & compulsive drug-taking behavior.
- Larger amounts over longer periods.
- Daily activities revolve around use of a substance.
- screening tools to assess substance abuse = Michigan Alcohol Screening test (MAST), Drug Abuse Screening Test (DAST), & CAGE screening questionnaire (Box 75-1).
- Substance Tolerance = need to increase substance for desired affect.
- known as the use of Substances recurrently?
- recurrent, harmful consequences.
- involvement w/ Legal system is common.
- with this, physiological & substance specific cognitive sxs occur?
- occurs when an individual experiences a decrease in Blood levels of a substance?
Other Factors in Pt w/ Substance-related Disorder
- Rebellion & Peer group pressure in adolescence --> onset of substance use.
- [Coping Mechanism] for decreasing physical & emotional pain.
- Depression may precede or result w/ substance abuse.
- Grief & Loss may be associated w/ substance use.
Dysfunctional Behaviors related to Substance Abuse
- Preoccupation w/ Obtaining substance.
- Manipulation to avoid consequences.
- Anger --> physical & verbal abuse.
- Avoidance of relationships.
- Relationships w/in the family become dysfunctional as children take Atypical roles to protect family unit.
- sense of [Self-importance] & requiring special treatment.
- Denial - blames everything but the substance use for problems.
- use of [Rationalization & Projection] to justify unacceptable behavior.
- Low Self-esteem.
*Codependency = coexistig behaviors present in a significant other, which serves to enable the addict/alcoholic --> irresponsible patterns of use w/o experiencing consequences.
- Ex, paying bills for which addict is responsible, bailing the addict from jail, helping addict call in sick from employment agency.
- Address Codependency issues w/ family to maximize chance for recovery from addiction.
- Alcohol is a CNS depressant affecting all body tissues.
*Physical Dependence = biological need to avoid physical withdrawal sxs.
*Psychological Dependence = craving for the subjective effect of alcohol.
- Biological predisposition, Genetic & Familial
- Depressed & Highly anxious characteristics.
- Low Self-esteem.
- Poor self-control
- Rebelliousness, Poor school performance,
- Poor parental relationships.
- Slurred speech.
- Uncoordinated movements.
- Unsteady gait.
- Sneaking drinks, drinking in the morning, blackouts.
- Binge drinking.
- Arguments about drinking.
- missing work.
- Increased tolerance to alcohol.
- Intoxication, w/ Blood Alcohol Content (BAC) of 0.1%
(100 mg alcohol/dL blood) or greater (legal BAC may
vary state to state).
- Decrease in Inhibitions
- Decrease Self-esteem
Complications Associated w/ Chronic Alcohol Use
- Vit B deficiency --> Peripheral neuropathies.
- Thiamine deficiency --> Korsakoff's syndrome.
- Alcohol-induced persistent Amnesic disorder --> severe memory problems.
- Wernicke's Encephalopathy --> confusion, ataxia, abnormal eye movements.
- Hepatitis; Cirrhosis of liver.
- Esophagitis & Gastritis.
- Immune system dysfunctions.
- Brain damage.
- Peripheral Neuropathy.
- Cardiac disorders.
- Early signs develop w/in Few hours after cessation of alcohol intake.
- signs Peak after [24-48 hrs] then rapidly disappear, unless withdrawal progresses to alcohol withdrawal delirium.
- Onset of withdrawal (Box 75-2).
- Chlordiazepoxide* commonly prescribed for Acute alcohol withdrawal. PO
- any Benzodiazepine* would decrease withdrawal sxs due to cross-tolerance.
- IM injection of vitamin B1 (Thiamine) prevents Wernicke's Encephalopathy.
*Withdrawal Delirium = state of delirium usually peaks 48-72 hours after cessation or reduction of intake (although can occur later) & last 2-3 days (Box 75-3).
*Withdrawal delirium is a medical emergency. Death can occur from MI, Fat emboli, Peripheral vascular collapse, Electrolyte imbalance, Aspiration pneumonia, or Suicide.
Alcohol Withdrawal (Interventions)
- The following are interventions for? :
- provide care in Non-judgmental manner.
- VS & Neurological signs (every 15 min).
- Quiet, nonstimulating environment.
- Explain all txt's & procedures.
- Seizure precautions!
- Sedating & Anticonvulsant Rx's.
- Small, frequent, high-Carbohydrate foods (administer Antiemetic before meals as needed).
- Administer vitamins (Multivitamin, Vitamin B complex including Thiamine, & Vitamin C).
Disulfiram (Antabuse) Therapy.
- an Alcohol deterrent prescribed for alcoholic dependence?
- the med sensitized the pt to alcohol, so a (?) reaction occurs if alcohol is ingested.
- must abstain from alcohol for at least 12 hrs before initial dose.
- Adverse effects usually begin w/in minutes-0.5 hr after consuming alcohol.
- AVOID drinking alcohol for 14 days after (?) has been discontinued. Risk for a (?) reaction.
- facial flushing.
- throbbing headache.
- Neck pain
- Respiratory distress
- ensure agreement to Abstain from alcohol.
- effects of Rx may occur for several days after
- other Rx's to assist w/ cravings = Acamprosate
Calcium (Campral) & Naltrexone (ReVia).
Disulfiram (Antabuse) Therapy
- instruct pt who is on Disulfiram (Antabuse) Therapy to avoid the use of substances that contain alcohol, such as (cough medicines, rubbing compounds, vinegar, mouthwashes, aftershave.
- Pt should read all label products.
BOX 75-4 (Dealing w/ the Pt who Abuses Alcohol)
- pg 1063
BOX 75-5 (Therapies for Pt's w/ Substance Abuse & for Their Families)
- pg 1063.
- Behavior therapy, Aversion conditioning w/ Medication.
- Psychotherapy (individual, group, family).
- 12-Step support groups such as AA, Narcotics Anonymous, Pills Anonymous, Al-Anon, Al-a-Teen or Narc-Anon.
- Transitional living programs (halfway houses).
- addiction to these Rx's include [Alcohol, Benzodiazepines, Barbituates] and act as a depressant, sedative, or hypnotic.
- Intoxication (Box 75-6)!
- Overdose = Cardiovascular or Respiratory depression, coma, shock, Seizures, & death.
- Overdose = if the pt is awake, vomiting is induced & Activated Charcoal admin. If pt Comatose, Establishment & maintenance of an airway & Gastric lavage w/ Activated Charcoal. Seizure precautions!
- Flumazenil (Romazicon)* IV used for Benzodiazepine overdose to reverse effects.
- Withdrawal effects = N&V, tachycardia, Diaphoresis, Irritability, tremors, insomnia, & seizures. Treated w/ carefully titrated similar Rx. (abrupt withdrawal can lead to death).
- Withdrawal from Barbituates = treated w/ a barbituate such as Phenobarbital or long-acting Benzodiazepine.
- addiction to these Rx's include [Amphetamines, Cocaine, & Crack].
- Intoxication (Box 75-7)!
- Overdose = respiratory distress, ataxia, Hyperpyrexia, seizures, coma, stroke, MI, & Death.
- Overdose treated w/ (Antipsychotics) & management of associated effects.
- Withdrawal effects = fatigue, depression, agitation, apathy, anxiety, insomnia, disorientation, lethargy, & craving.
- Withdrawal treated w/ (Antidepressants, Dopamine agonist, Bromocriptine [Parlodel]). primarily supportive.
- addiction to these type of Rx's include Opium, Heroin, Meperidine (Demerol), Morphine sulfate, Codeine sulfate, Methadone (Dolophine), Hydromorphone (Dilaudid), Oxycodone (OxyContin), Hydrocodone (Lortab), & Fentanyl (Sublimaze).
- Intoxication (Box 75-8)
- Overdose = Respiratory depression, shock, coma, seizures, death.
- Overdose treated w/ Opioid antagonist (Naloxone).
- Withdrawal effects = yawning, insomnia, irritability, Rhinorrhea, Diaphoresis, cramps, N&V, muscle aches, chills, fever, lacrimation, & diarrhea.
- withdrawal txt w/ (Methadone detoxification) or tapering dosage w/ other opioids.
- Clonodine (Catapres), an a-adrenergic blocker = reduces severity of sympathetic nervous system generated withdrawal discomfort.
- specific measures for sxs management:
Bismuth subsalicylat for Diarrhea.
Acetaminophen for muscle aches.
- addiction to these type of Rx's include Lysergic Acid Diethylamide (LSD), Mescaline (peyote), Psilocybin (mushrooms), & Phencyclidine (PCP).
- Intoxication (Box 75-9).
- Overdose (LSD, Peyote, & Psilocybin) = psychosis, brain damage, & death.
- Overdose effects of (PCP) = psychosis, hypertensive crisis, hyperthermia, seizures, & respiratory arrest.
- Txt (LSD, Peyote, Psilocybin) = low environmental stimuli & meds to txt anxiety.
- Txt (PCP) = Gastric lavage [if alert], txt to Acidify urine to assist in excreting the drug & interventions to txt Behavioral disturbances, hyperthermia, hypertension, & R. Distress.
- Management of withdrawal, primarily supportive.
- Flashbacks can be unexpected re-experiences of the effects of taking a Hallucinogenic drug, can occur for extended periods of time after its original use.
- Safety during flashbacks is a priority.
- addiction to these type of substances include gases or liquids such as Butane, Paint thinner, paint & wax removers, airplane glue, Nail polish remover, & Nitrous Oxide.
- Intoxication (Box 75-10).
- Overdose = damage to nervous system & Death.
- Management of withdrawal, mainly supportive. Including txt of affected body systems.
Marijuana (Cannabis sativa)
- addiction to this substance is generally smoked, but can be ingested.
- Causes = euphoria, detachment, relaxation, talkativeness, slowed perception of time, Anxiety & Paranoia.
- Long-term dependence = Lethargy, difficulty concentrating, memory loss, & possibly chronic respiratory disorders.
- withdrawal management mainly supportive.
Other Recreational & Club Drugs
- addiction to these substances include Methylenedioxymethamphetamine (MDMA, ecstasy), Hydroxybutyrate (GHB), Methamphetamine (crank, meth, crystal meth), & Ketamine (special K).
- effects = Euphoria, increased energy, increased self-confidence, & increased sociability.
- Adverse effects = hyperthermia, rhabdomyolysis, kidney failure, hepatotoxicity, depression, panic attacks, psychosis, cardiovascular collapse, & death.
- programs for addiction also address Nicotine withdrawal = nicotine patches, nicotine inhalers, & Bupropion (Zyban) for the reduction of withdrawal sxs & cravings.
Substance Abuse Disorders (INTERVENTIONS)
- (Box 75-11)
- initiate seizure precautions.
- Hydrate pt.
- monitor I&O.
- Orient the pt frequently.
- minimal stimuli.
- be nonjudgemental.
- Direct focus to substance abuse problem.
- ID situations that precipitate angry feelings.
- Assist to deal w/ emotions.
- Limit placing blame or Rationalizing to explain substance abuse problem.
- Assist pt to use [Assertive techniques] rather than manipulation to meet needs.
- Set Limits on Manipulative behavior.
- Consistently reinforce rules w/ reasonable consequences for breaking rules.
- Hold accountable for all behaviors.
- Focus on strengths if the pt is losing control.
- encourage participation in Unit Activities.
- Group therapy & Support groups.
- sometimes the use of alcohol & drugs masks underlying psychiatric pathology.
- Psychiatric pathology may also be precipitated by substance use & abuse.
- when psychiatric disorders & substance abuse are present together, it is often referred to as [?].
Addictions & Abuse in Healthcare Professionals
- Frequently reporting that Rx's have been wasted w/o being witnessed by another nurse.
- Administering maximum dosages to pts when other nurses do not.
- A variance in usual pain relief in the absence of change in dosage or frequency of administration in their patients.
- Work Patterns:
- always volunteering to carry narcotic (opioids) keys.
- choosing shifts in which less supervision is present.
- choosing work areas where the use of controlled
substances is high.
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