Transcript Alcohol

Chapter 36
Care of the Patient with an
Addictive Personality
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Addiction
• Addictive behavior patterns can impede the patient’s
recovery from an acute illness.
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Slide 2
Care of the Patient with an
Addictive Personality
• The treatment of patients with addictive behaviors is
an important concern for nurses.
• Definition of Addiction (pg.1158)
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Excessive use or abuse
 Display of psychological disturbance
 Decline in social and economic function
 Uncontrollable consumption indicating dependence
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Slide 3
Addiction
• 44% of adolescents who start drinking at the age
of 14 or younger, will develop alcoholism
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Slide 4
Care of the Patient with an
Addictive Personality
• Addictive Personality
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A person who exhibits a pattern of compulsive and
habitual use of a substance or practice to cope with
psychic pain from conflict and anxiety
Common traits
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Low stress tolerance
Dependency
Negative self-image
Feelings of insecurity
Depression
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Slide 5
Stages of Dependence
• Early Stages
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A tolerance to substance is developed.
 User may decrease or stop to prove he or she can.
 Family and friends comment about the user’s
overinvolvement with drug.
 User may have legal problems or may drive while
intoxicated.
 User may miss work or school or show up late
frequently.
 Mood swings, decreased self-esteem, shame, guilt,
remorse, resentment, and irritability may occur.
 Financial difficulties arise; spending for drug use.
 Recovery may occur without treatment.
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Stages of Dependence
• Middle Stage
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User is moderately impaired.
The user uses just to “feel normal.”
Family relationships weaken.
Physical health declines.
Job loss is common.
Social isolation increases.
Very few in this stage recover without treatment
Abstinence brings on signs and symptoms of
withdrawal.
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Slide 7
Stages of Dependence
• Late Stage
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Dependent user displays severe impairment in all
areas of function.
Use is continuous in an attempt to avoid emotional
and physical pain.
Medical problems worsen; user neglects personal
hygiene.
User may be suicidal or homicidal.
User is manipulative, denies his or her problems, and
has poor problem-solving ability and impaired
judgment.
User is usually unemployed and may be homeless.
People in this stage will not improve without
treatment.
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Slide 8
Alcohol Abuse and Alcoholism
• Alcoholism is a U.S health problem that is surpassed
only by heart disease and cancer.
• Contributing factors
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Genetic: 30% to 50% chance that the son of
an alcoholic man will develop alcoholism.
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Deficiencies in hepatic enzymes necessary to
metabolize alcohol in some people
• Many Asians, American Indians, and Eskimos have
these deficiencies.
• Most teenagers have their first drink between the
ages of 12 and 15 years.
• Alcohol is often referred to as a gateway drug.
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Slide 9
Alcohol
• CNS depressant
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Slide 10
Alcohol Abuse and Alcoholism
• Etiology and Pathophysiology
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Alcohol is a central nervous system depressant.
Stimulating effect occurs because the first areas of the
brain affected are those that govern self-control.
Alcohol poisoning may occur from rapid,
large-quantity consumption.
Alcohol does not require digestion.
Alcohol has a diuretic effect.
Prolonged use has a toxic effect on intestinal mucosa
causing decreased absorption of thiamine (B1), folic
acid and vitamin B12
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Slide 11
Figure 36-1
Limbic system
(Illustration by Lee Hoffman.)
Limbic system.
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Slide 12
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism
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Fetal alcohol syndrome
• Frequently seen in newborns whose mothers drank
heavily during pregnancy
• Congenital anomaly
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Mental retardation
Growth disorders
Wide-set eyes
Malformed body parts
Spontaneous abortion or stillborn
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Slide 13
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism (continued)
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Alcohol withdrawal syndrome
• Seen in a person who has developed physiologic
dependence and quits drinking
• At risk
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Older adults, people who have suffered DTs before,
malnourished people, and those suffering with another
acute illness and seizures
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Slide 14
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism (continued)
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Alcohol withdrawal syndrome (continued)
• Signs and symptoms
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Usually occur 6 to 48 hours after the last drink
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May last for 3 to 5 days
Diaphoresis, tachycardia, hypertension, tremors,
nausea/vomiting, anorexia, restlessness, disorientation,
hallucinations
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Slide 15
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism (continued)
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Delirium tremens
• Acute psychotic reaction to withdrawal of alcohol.
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Usually occurs 1 to 4 days after alcohol cessation.
Lasts 2 days to 1 week
• Result of excessive alcohol consumption over a long
period of time
• Signs and symptoms
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Increased activity to extreme agitation
Disorientation; fear/panic
Hallucinations; elevated temperature
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Slide 16
Delirium Tremens
• Page 1161
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Slide 17
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism (continued)
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Korsakoff’s psychosis and Wernicke’s
encephalopathy
• Brain disorders seen in chronic alcoholics
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Korsakoff’s psychosis
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Short-term memory loss
Disorientation; muttering delirium
Insomnia
Hallucinations
Polyneuritis
Painful extremities
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Slide 18
Alcohol Abuse and Alcoholism
• Disorders Associated with Alcoholism (continued)
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Wernicke’s encephalopathy
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Associated with thiamine deficiency.
Memory loss
Aphasia
Involuntary eye movement and double vision
Lack of muscle coordination.
Disorientation with confabulation
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Fills in memory gaps with inappropriate words
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Slide 19
Assessment
• Subjective Data
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Normal using or drinking pattern
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Date and time of the last drink or use of a drug
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Specific substance and the quantity used
Complaints of nausea, indigestion, sleep disturbance,
or pain
Normal dietary patterns
Presence of any disease requiring treatment with
prescribed medications
Regular use of over-the-counter drugs
Drug allergies
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Assessment
• Objective Data
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Height, weight, vital signs, and physical assessment
Presence of tremors
Skin conditions
• Especially on the forearms, backs of hands, and insteps
• Acne-like facial rash
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Frequent sniffing, stuffy nose, or harsh nonproductive
cough
Tachycardia, hypertension, petechiae, and
neuropathies
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Slide 21
Diagnostic Tests
• Blood and urine tests will screen for toxins.
• Some foods can cause a false-positive reading in a
urine screen (poppy seeds).
• Alcoholism
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Liver enzymes, hypoglycemia, blood protein levels,
and magnesium
• Hepatitis and HIV
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Slide 22
Nursing Diagnosis
• Nursing diagnoses and interventions for the patient
with an addiction include emotional needs as well as
physical needs.
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Denial, ineffective
Coping, ineffective
Refer to table 35-4 on page 1163 for further nursing
diagnosis. Be able to apply a diagnosis if given
information.
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Slide 23
Nursing Interventions
• Detoxification
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Removal of poisonous effects of a substance from a
patient
A controlled setting where the patient can be closely
observed and treated for complications…focus is
SAFETY.
• Medication to reduce withdrawal symptoms
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Chlordiazepoxide (Librium)
Naltrexone (ReVia)
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Medicate according to the amount of withdrawal symptoms
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Slide 24
Nursing Interventions
• Detoxification (continued)
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Monitor for cardiorespiratory distress.
• Continuous cardiac monitoring; vital signs
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Maintain therapeutic communication.
• Simple explanations; speaking in a calm voice
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Reorient as needed.
• Disorientation may occur, especially at night.
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Provide physical care as needed.
Encourage proper nutrition.
Reduce environmental stimuli
Allow patient to ambulate to ease
“nervousness.”
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Slide 25
Rehabilitation
• Group Therapy
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Provides a caring, emotionally supportive atmosphere
Helps patient see the relationship between substance
abuse and negative consequences in his or her life
• Alcoholics Anonymous
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International nonprofit organization
Abstinent alcoholics helping other alcoholics to become
and stay sober through group support, shared
experiences, and faith in a power greater than
themselves
12 step based program
Antabuse (disulfiram): aversion therapy see pg.1164
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Slide 26
Alcoholics Anonymous
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Slide 27
Alcoholics Anonymous
• 12 step based program see box 36-2 pg.1165
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Slide 28
Antabuse (disulfiram)
• Causes facial flushing, nausea,
tachycardia, dyspnea, dizziness and
confusion…considered “aversion therapy”
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Slide 29
Rehabilitation
• Residential Treatment Centers
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Provide detoxification without direct medical
intervention
 Provide close physical monitoring by trained nurses,
counselors, and recovered peers
 After detoxification, the patient is placed in a
drug- and alcohol-free residence
 Goal: to rebuild social skills that do not involve drug
use
 Length of stay 1 to 6 months
 Ability-to-pay basis
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Slide 30
Rehabilitation
• Pain Management
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It can involve the use of addicting substances.
 Nursing interventions require not only careful
assessment of pain but also observation for
developing patterns of drug-seeking behavior.
 Encouraging the patient to practice and use
nonchemical interventions to ease pain will reduce the
risk of chemical dependency for relief.
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Slide 31
Drug Abuse
• Just say NO !!!
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Slide 32
Drug Abuse
• Illegal Drugs
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“Street drugs”
Sold to users by illegal drug dealers
• Manufactured without strict controls
• Illegally obtained prescription drugs
• Drugs not approved for use in the United States
• Prescription or Over-the-Counter Drugs
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When a person takes drugs for other than
recommended medical reasons or more than
recommended dosage
Many commonly abused drugs act on the limbic
system of the brain…may cause permanent damage.
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Slide 33
Drug Abuse
• CNS Depressants( pgs.1166-1167 ) serious problems may result
from sudden withdrawal from CNS depressants such as seizures…
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Alcohol
Sedative-hypnotic medications
• Barbiturates: phenobarbital, Seconal
• Benzodiazepines: flurazepam (Dalmane), diazepam
(Valium), flunitrazepam (Rohypnol:date-rape drug)
• Opioid Analgesics pg.1167
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Heroin: highly addictive, withdrawal symptoms: tachycardia, dilated
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Morphine
Methadone
Narcan (naloxone) : used to treat opioid overdose
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pupils, diaphoresis, HTN, body-aches…see pg.1167
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Slide 34
Rohypnol
• The “date-rape” drug
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Slide 35
Drug Abuse
• CNS Stimulants (pgs.1167-1170)
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Caffeine: coffee, tea, chocolate, soft drinks
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Nicotine: tobacco : abrupt cessation may cause withdrawal
symptoms…see page 1168
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Cocaine: crack (mixed with baking soda and smoked); powder
(snorted) overdose may cause cardio-respiratory distress and
seizures. Cravings may persist for prolonged periods !!
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Amphetamines
• Methylphenidate (Ritalin)
• Methamphetamine (can be made with household
chemicals)
• May cause dopamine depletion resulting in
parkinsonian-like symptoms.
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Slide 36
Drug Abuse
• Hallucinogens pgs.1168-1170
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PCP
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LSD
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MDMA (ecstasy): causes release of the
neurotransmitter serotonin until it is depleted from the
brain cells.
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Ketamine
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Mescaline and psilocybin
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Slide 37
Effect of Ecstasy on the brain
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Brain scans: non drug-user (left); ecstasy (MDMA) user (right).
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Slide 38
Drug Abuse
• Cannabis
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Marijuana, hemp
Amotivational cannabis syndrome :( page 1170) ,
causes decreased goal directed activities, abrupt
mood swings, irritability, decline in self-care etc…
REVERSES WITH ABSTNENCE !!!!
THC : active ingredient, fat soluble: may accumulate in the body
up to a month or longer after last use. Could cause a person to
test positive on a drug screen
• Inhalants – seems to be more popular with “younger” crowd
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Huffing
Glue, lighter fluid, cleaning fluids, paint
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Slide 39
Chemically Impaired Nurses
• Thirty-seven states have programs that offer
chemically impaired nurses treatment and
rehabilitation in order to keep their license.
• Impaired nurses become illogical and careless in
charting and performance of duties.
• They may steal medication and report spillage.
• Peer assistance programs are usually under the
jurisdiction of the state board of nursing.
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Contract agreement
• This requires the nurse to undergo treatment and
monitoring for a certain period of time.
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Slide 40
Chemically Impaired Nurses
• Healthcare Integrity and Protection Data
Bank (HIPDB) or (HIPB)
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Nursing boards and health agencies are required to
report any actions against a health care provider,
supplier, or practitioner.
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Provides incentive for nurses to enter treatment and avoid
any FINAL action that is mandatory to report to HIPDB
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Slide 41
Chemically Impaired Nurses
• Warning Signs
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Alcoholism
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Irritability, mood swings
Elaborate excuses for behavior
Unkempt appearance
Blackouts (temporary amnesia)
Impaired motor coordination, slurred speech, flushed
face, bloodshot eyes
• Numerous injuries, burns, bruises, etc., with vague
explanation
• Smell of alcohol on breath or excessive use of
mouthwash, mints, etc.
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Slide 42
Chemically Impaired Nurses
• Warning Signs (continued)
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Drug addiction
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Rapid changes in mood and/or performance
Frequent absence from unit; frequent use of restroom
Works a lot of overtime; arrives early and stays late
Increased somatic complaints requiring prescriptions of
pain medications
• Consistently signs out more or larger amounts of
controlled drugs than anyone else; excessive wasting of
drugs
• defensiveness
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Slide 43
Chemically Impaired Nurses
• Warning Signs (continued)
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Drug addiction (continued)
• Increased isolation from others
• Patients report that pain medication is not effective or of not
receiving medication
• Excessive discrepancies in signing and documenting
procedures of controlled substances
As “addiction” worsens, the nurse may
become defensive if questioned. We are
obligated to report our suspicions to the
supervisor if we suspect a coworker of
chemical dependency!!!!
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Slide 44
Chemically Impaired Nurses
• Warning Signs (continued)
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Mental health disorder
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Depressed, lethargic, unable to focus or concentrate
Makes many mistakes at work
Erratic behavior or mood swings
Inappropriate or bizarre behavior or speech
May also exhibit some of the same or similar
characteristics as chemically dependent nurse
It is the duty of every nurse to uphold the
standards of the profession. Report
observations objectively to supervisor if you
suspect a nurse may be “under the influence.”
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Slide 45
TPAPN : Texas Peer Assistance Program for Nurses
• Voluntary : a nurse has the right to NOT participate
• Created as a non-punishing, confidential alternative
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to reporting RNs/LVNs to the Texas BON.
Offers opportunities for recovery from chemical
dependency and mental illness.
Maintains confidentiality consistent to state and
federal laws.
A nurse without a record may self refer to TPAPN
Toll free (800) 288 - 5528
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