Transcript Depression
Addictive Disorders Clinical Picture for all Substances Define Substance Abuse Define Substance Dependence (or Addiction) Define tolerance Define withdrawal Abuse or Dependence? Criteria for Substance Dependence 1- tolerance-needing more of the substance to achieve desired effect 2-withdrawal-withdrawal symptoms for the substance seen and a substitute drug taken instead 3-substance taken in larger amounts over time 4-a persistent desire to cut down or control 5- great deal of time spent in activities trying to get the substance 6- social activities given up or reduced 7- substance use continues despite knowledge of persistent physical or psychological problems neurotransmitters Some have direct brain changes affecting neurotransmitters: 1- cocaine and amphetamines- changes norepinephrine and dopamine 2- alcohol and benzodiazepines change GABA to produce a sedating effect Neurotransmitters influence Mood Appetite Sexual function Sleep Pain sensitivity Alcohol-Related D/Os Alcohol-Related Disorders Assessment Assess for Physiological Problems Assess for Psychiatric Comorbidity Assess Hx of Use Assess Current Use Labs CAGE Assessment BAL Risk for Suicide Admission for Detoxification? Assess S/S of ETOH Intoxication S/S of ETOH Overdose One too Many Drinks? ETOH - Most widely abused drug Assess for Withdrawal S/S ETOH Withdrawal Symptoms Symptoms of ETOH Withdrawal Delirium Am I Withdrawing? Nursing process Interview- Assessment Have you ever drunk/used drugs more than you met to in the past year? Have you felt you needed to cut down? Can you go 1 year without it? Plan to and Implement the following: Keep free from injury Treatment programs AA,NA, CA,GA Support group attendance regularly Sponsor Evaluate Have they abstained? Have they developed new coping skills? Alcohol Withdrawal (DT) Peaks in 24-48 hours without drink Hyperalertness Jerky movements Startles easy Shaking inside Seizures illusions After 48 hours either the withdrawal will stop or delirium will begin DT.’s S/sx Delirium HTN Extreme tremors Medical intervention required like medication Medications used Librium Valium Tegretol Magnesium Thiamine Vitamins Antabuse (desulfriam) sometimes used as an alcohol aversion technique. The drug interferes with the metabolism of alcohol. Compulsive-Addictive Like Behaviors Gambling Shopping & Spending Internet Abuse Sexual Addiction The Three C’s 1. Craving to Compulsive use 2. Continued use 3. Loss of Control Have a Nonchemical Addiction? What is meant by “codependent” behaviors What Else? Heroin S/S of use Euphoria, nodding, constricted pupils, decreased BP & respirations, drowsiness, slurred speech, constipation S/S of overdose Possible dilation of pupils as a result of anoxia Respiratory depression or arrest Cardiac arrest & death Coma, shock, convulsions Treatment Naloxone (Narcan) Heroin Assess for S/S of withdrawal Money Ran Out - What Now? Heroin Teaching Relapse prevention NA Coping skills Need Treatment? Heroin users also can develop: Hepatitis HIV Renal failure Seizures Cardiac arrest Coma Respiratory failure and death Names of StimulantsMeth,Cocaine S/S of Use Dilated Using Stimulants? pupils increased b/p n/v insomnia decreased appetite euphoria paranoia hallucinations overdose Respiratory distress Convulsions Coma MI Stroke death withdrawal Depression Lethargy Sleepiness Chills, fever Illicit Drugs Hallucinogens Inhallants Club drugs Prescription Drugs Anabolic-Androgenic Steroids Nicotine Caffeine What’s New On The Drug Scene What Else? Caffeine: Nicotine: GI reflux ds Emphysema Peptic ulcers Lung cancer tachycardia HTN PVD Nicotine alters mood,appetite and alertness Prescription drug misuse accounts for 2 ½ million abusers Ex- opiates Narcotics Ie- oxycodone Which assessment data should the nurse gather when confirming a diagnosis of substance dependence? Eating Disorders Characteristics HUNGER Has obsession with food & weight Underweight or emaciated Needs go unmet because of controlling parents or parent conflict Gross distortion of body image Excessive exercise & dieting Refuses to eat Anorexia Nervosa Assessment Refusal to maintain minimal weight FEAR of obesity Peculiar handling of food Perfectionist, controlling Rigid family rules & high expectations Interventions Monitor vital signs, I & O, & electrolytes Weigh client daily Provide structure & support during mealtimes Monitor mood and healthy expression of feelings Monitor for excessive exercise Nursing Process Characteristics RIDS BODY Recurrent binge-eating episodes Intense exercise Diuretics, laxatives, & enema use Self-induced vomiting Body image distortions Ordinary eating alternating with episodes of binging & purging Depression and anxiety Yo-yo effect of tension relief & pleasure experienced with binging Bulimia Nervosa When using a behavioral modification approach to the treatment of eating disorders, which nursing intervention whould be most likely to produce positive results? 1. 2. 3. 4. A matter-of-fact, directive approach with the input of the entire treatment team Clients should perceive that they are in control of clearly communicated treatment choices Appropriate treatment choices are presented to the client’s family for consideration The treatment team develops a system of rewards and privileges that can be earned by the client 2- there is a need to give a sense of control back to the individual therefore they need to feel in control of their treatment choices. Contracts help gain this sense of control Refeeding Problems Major early concern with refeeding in anorexia is metabolic complications 1-giving carb’s causes insulin to be released 2-this triggers cellular uptake of potassium, phosphate, and magnesium 3-when serum concentrations of these electrolytes are reduced, problems occur with neurologic, pulmonary and cardiac systems 4- This complication is usually seen around 4 days after feeding starts Binge Eating Disorder A variant of compulsive overeating No compensatory behaviors Frequently symptom of an affective disorder Cognitive-behavioral therapy, behavior therapy, & interpersonal therapy most effective 43