Substance abuse and eating disorders

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Substance abuse and eating disorders : 

Substance abuse and eating disorders NUR 159 Unit 6

When the use of substances becomes a problem : 

When the use of substances becomes a problem It interferes with the ability to function at work or at home It puts anyone in danger It continues despite negative consequences

Denial : 

Denial It is a common coping mechanism among people with substance disorders. Also, it is common among healthcare workers. Many times, we don’t assess for these disorders. Yet, 20% of all American adults have diagnosable problems with substance abuse. There is a negative perception about substance abuse. Many people don’t seek help until they have physical symptoms, social, legal and/or job problems.

definitions : 

definitions Substance abuse: maladaptive pattern of substance use despite adverse outcomes. Dependency: involves substance tolerance, withdrawal syndrome, unsuccessful attempts to decrease or stop, a great deal of time spent getting, using or recovering from substance use. Addiction: psychological and physiological dependency and drug seeking behavior. Common substances: alcohol, opoids, sedatives, cocaine, amphetamines, hallucinogens, PCP, inhalants, marijuana, caffeine, nicotine

Alcohol : 

Alcohol The most commonly abused substance in the world is ethanol or drinking alcohol. Alcohol is involved in 80% of suicides, 64% of fires. 50% of domestic violence incidents and 50% of all motor vehicle crashes. It is quickly absorbed into the blood stream and is a CNS depressant.

Blood alcohol levels and the intoxication effects on people : 

Blood alcohol levels and the intoxication effects on people 0.05-0.15 g/dL(0.08-0.1 is legal limit in most states): relaxation, euphoria, decreased inhibitions, impaired judgment, changeable moods, decreased concentration, decreased fine motor response 0.15-0.3: slurred speech, decreased motor function, ataxia, mood outbursts, aggressive behavior

Cont. : 

Cont. 0.3-0.4: incoherent speech, mental confusion, stupor, vomiting, labored breathing( any level above this can be life threatening) 0.4-0.5: unconsciousness, coma, death > 0.5: respiratory depression, death

Tolerance and withdrawal : 

Tolerance and withdrawal With continued use, a user can develop tolerance( increasing amounts to achieve the same results). The central nervous system increases it’s stimulation to compensate for the alcohol’s depression. The body makes more CNS stimulant neurochemicals so the person must drink more alcohol to achieve intoxication. When that person stops taking in alcohol, the CNS is still stimulated. This causes withdrawal.

Symptoms of alcohol withdrawal : 

Symptoms of alcohol withdrawal Elevated VS Anxiety Tremors Diaphoresis Slurred speech Vomiting, cramping, diarrhea ataxia Nystagmus Disorientation Hallucinations Seizures Possible death

Diagnosis and tx : 

Diagnosis and tx Delirium tremens(DT) occurs when withdrawal causes terrifying hallucinations, confusion and delusions. Usually happens to alcohol users with a 5-15 year history of alcohol use. Think of DT symptoms as being opposite of alcohol intoxication. The symptoms usually last about 4 days. Benzodiazipines(Ativan,Valium) are used to counteract the symptoms of the withdrawal. They are used only for the short term(app. 4 days)

Alcohol patterns of use : 

Alcohol patterns of use This can vary greatly from daily use to weekend binges.

Effects of alcohol on the body : 

Effects of alcohol on the body Nervous: encephalopathy, hemorrhagic stroke, memory blackouts, peripheral neuropathy Cardiac: hypertension, cardiomyopathy, peripheral edema Reproductive: infertility in women, impotence in men GI: esophagitis, esophageal varicies, gastritis, ulcers, cirrhosis, hepatitis, pancreatitis, malnutrition

Wernicke’s Syndrome : 

Wernicke’s Syndrome Alcoholic encephalopathy caused by severe vitamin B1 deficiency resulting from malnutrition. s/s: ataxias, paralysis of eye muscles, nystagmus, mental confusion. If treated early with large doses of thiamine, this can be reversed. If it is not treated in time, it is irreversible and fatal.

Korsakoff’s Syndrome : 

Korsakoff’s Syndrome Group of symptoms caused by a deficiency of B vitamins: Thiamine, folic Acid, Riboflavin s/s: amnesia, disorientation to time and place, confabulation( filling in memory gaps with made up events), muscle weakness, peripheral tingling, muscle weakness, abnormal sensations in extremities, pain with movement.

Opiate abuse : 

Opiate abuse Another CNS depressant Can be natural, synthetic or mixed. Examples: Morphine, Heroin, Methadone, Meperidine, Oxycodone, Codeine) Effects: prescribed to decrease pain, diarrhea or coughing They can cause dependence and clients can build tolerance, causing them to receive increased doses to achieve pain relief.

Opoid overdose : 

Opoid overdose This is a true medical emergency. s/s: pinpoint pupils, slow and shallow respirations, seizures, coma. Death can result from respiratory depression. Tx: support the ABCs. Narcan to reverse opoid effects.

Patterns of abuse : 

Patterns of abuse Opoids are available by prescription or some are illegal(Heroin) Usually addiction starts in late teens to early 20s. More men than women affected. Dependence can have periods of abstinence and relapses. Opiate abusers have a 2% death rate yearly from overdoses. They have an increased of incidence of crimes related to getting drugs and from blood borne diseases.

Sedative, hypnotic or anxiolytic abuse : 

Sedative, hypnotic or anxiolytic abuse Includes benzodiazepines, barbituates, and similar drugs. Effects are similar to alcohol and opiates. Remember that any CNS depressants taken together intensifies the depressant effects. This is an example of polysubstance abuse. Romazicon is the reversal agent for benzodiazepines.

CNS stimulants(amphetamines and cocaine) : 

CNS stimulants(amphetamines and cocaine) Amphetamines can be used clinically for the treatment of attention deficit disorder and for daytime sleepiness caused by other medications and disorders like narcolepsy. Cocaine can be used clinically as a powerful nasal vasoconstrictor for surgery. It causes an instant euphoria when taken for street use. s/s: hyperactivity, talkativeness, grandiosity, anger, aggression, impaired judgment, hallucinations, hypertension, nausea, chest pain, dilated pupils, confusion, caridac dysrhythmias

Withdrawal to CNS stimulants : 

Withdrawal to CNS stimulants The brain decreases it’s function in response to the CNS stimulants. The pt. experiences CNS depression when the person stops using stimulants. They tend to feel lethargic and depressed. Stimulant withdrawal is uncomfortable but not life threatening and should pass in several days.

Hallucinogens : 

Hallucinogens They distort a person’s sense of reality The most common hallucinogens are LSD, Mescaline(Peyote) and PCP( Phencyclidine). The CNS effects are hard to predict. Ecstasy or MDMA is a mix of amphetamine and methamphetamine. It acts as a stimulant and a hallucinogen.

S/S of hallucinogen use : 

S/S of hallucinogen use Hallucinations, can lead to violent behavior, psychotic experiences When patients with mental disorders like schizo. take hallucinogens, the results can be even less predictable. There is no withdrawal syndrome, but the pt. can have flashbacks for months after the last dose.

inhalants : 

inhalants 2 kinds of inhalants are commonly used: Hydrocarbons: Aerosols , solvents and glues like gasoline, spray paints 2nd group is the nitrites group like amyl nitrite, butyl nitrite and nitrous oxide.

s/s of inhalant use : 

s/s of inhalant use Hydrocarbon use: euphoria, loss of inhibitions, altered sensations, hallucinations. Toxic amounts can cause cardiac depression, renal injury, respiratory depression, death Nitrite use: euphoria, altered perceptions, panic, nausea, confusion, headache, hypotension. Nitrites are vasoconstrictors.

Cannabis/marijuana : 

Cannabis/marijuana THC is the chemical responsible for the psychoactive effects of marijuana and hashish. The most commonly used illegal drug in the US. Therapeutically used to treat nausea, vomiting, anorexia associated with AIDS, cancer. Effects: euphoria, sense of serenity, changes in vision, hearing, taste, touch and/or smell.

Caffeine and nicotine : 

Caffeine and nicotine Caffeine is the most commonly used stimulant. Effects: increased work time, improves mental alertness, elevates mood. Excessive use can cause anxiety, insomnia, irritability, diuresis, tremors, tachycardia Withdrawal symptoms: headache, fatigue, irritability, nervousness. The average adult takes in 360-450 mg of caffeine daily. Amounts greater than 600 mg is considered excessive.

Cont. : 

Cont. Nicotine dependency is the most common substance dependency in the US. Effects: increased performance, decreased appetite, reduced anxiety. Cigarette use is associated with using alcohol or other substances, peer pressure and social acceptance. Users have a significantly higher rate of lung, mouth, esophageal, pancreas, prostate cancer and COPD. Withdrawal symptoms: irritability, restlessness, drow siness, anxiety, craving an intermittent appetite increase. Nicotine and caffeine withdrawal can be a problem for the nurse.

Commonly abused prescription drugs : 

Commonly abused prescription drugs Depressants: barbituates, benzodiazepines, rohypnol Anesthetics: Ketamine Opoids: Codeine, Fentanyl, Morphine, Opium. Oxycodone, Demerol, dilaudid, hydrocodone Stimulants: amphetamines, methamphetamine, cocaine, ritalin Other: anabolic steroids

Cross tolerance : 

Cross tolerance This refers to a person who uses a substance, for ex. alcohol, who develops tolerance to other CNS depressants as well.

Drug treatment : 

Drug treatment Goals of treatment: to abstain from substance use, to develop effective coping mechanisms to replace substances as a way to solve problems. Acute phase of treatment: usually takes place in a hospital, a detoxification center, a drug treatment facility. Usually, the pt. is intoxicated upon admission.

Cont. : 

Cont. Detoxification, the removal of the substance from the body, starts in the acute phase. The withdrawal syndrome symptoms should be monitored closely. Alcohol withdrawal patients are given benzodiazepines in a tapered dose to ease the withdrawal. Also, they are given Thiamine to prevent alcoholic encephalopathy. Alcohol and barbituate withdrawal can be life threatening.

Rehabilitation phase : 

Rehabilitation phase 2nd phase of substance dependency treatment. It continues indefinitely and begins after detoxification. Antabuse is given to discourage clients from drinking alcohol. It causes a throbbing HA, N/V,flushing when the client consumes alcohol. Methadone is a synthetic opiate. It is used as a substitute for Heroin. It can be used to treat chronic pain as well.

Cont. : 

Cont. ReVia is an opiate antagonist used to block the effects of opoids used by the client. Catapres is an anti-hypertensive drug that is used to treat symptoms of opiate withdrawal. Be careful to check the blood pressure before giving.

Cognitive Behavioral therapy : 

Cognitive Behavioral therapy The goals are to alter the thinking and behaviors associated with the addiction. There are many support groups for substance abuse. Most are based on the 12 step program philosophy. Ex: alcoholics anonymous, narcotics anonymous

Substance abuse among nurses : 

Substance abuse among nurses Reasons for an increased risk of addiction: Access to drugs at work Sees medications as a solution to problems Nurses believe they should work even when they are tired or sick Nurses experience pressure, emotional pain, anger and frustration, which drugs help in the very short term.

Signs of impaired nurses : 

Signs of impaired nurses Mood changes, irritability, forgetfulness, isolation from coworkers, multiple medication errors, missed deadlines, sloppy charting, inattention to detail, absenteeism, poor judgment, volunteering to give narcotics for other nurses, excessive wasting of narcotics. If drug impairment is suspected, notify your manager or hospital supervisor. Some state boards of nursing have nurse monitoring or treatment program for the recovering nurse. Your primary responsibility is to protect the patient.

Nursing interventions : 

Nursing interventions Frequent VS during withdrawal Offer quiet environment with dim lights Listen to patient Assess for dehydration Educate pt. on drug use, coping mechanisms

Eating Disorders( Anorexia Nervosa) : 

Eating Disorders( Anorexia Nervosa) Diagnosis criteria: Refusal to maintain body weight of at least 85% of minimal normal weight for age/height Intense fear of gaining weight or becoming fat Disturbance in the way one’s body image is seen Amenorrhea Mortality rate is 5-10% The anorexic patient’s self esteem is tied to their perception of their body image.

2 subtypes of Anorexia : 

2 subtypes of Anorexia Restricting type: weight loss through excessive dieting, fasting, exercise Binge eating purging type: routinely engaged in binge eating and purging afterwards. Purging includes self induced vomiting and/or laxative/diuretic abuse.

s/s : 

s/s 90% of patients are female The normal age range is mid to late adolescence to 40 years old. Can have a pattern of weight gain and losses May collect recipes, hoard food. Inflexible thinking Depression Lack of initiative Perfectionism Strained emotional expression

Bulimia Nervosa : 

Bulimia Nervosa More common than anorexia. Classic features are binge eating, inappropriate methods to control weight gain. A binge is defined as a person eating a large amount of food within a 2 hour period. Methods to control weight include self induced vomiting, excessive exercise. This usually occurs 2 x weekly for at least 3 months.

Treatment for Anorexia and Bulimia : 

Treatment for Anorexia and Bulimia Medications are not very affective. Cognitive behavioral therapy has been used successfully.

Long term effects of eating disorders : 

Long term effects of eating disorders Kidney damage Extreme fatigue Edema Hearing problems Blindness Severe peripheral neuropathy High cholesterol osteoporosis

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