Pyramid Points- Addictions PDF

PYRAMID POINTS- Quick highlights Addictions Slide Elsevier Inc. All rights reserved. 1  PYRAMID POINTS I. Eating Disorders  Description ...

PYRAMID POINTS- Quick highlights Addictions Slide Elsevier Inc. All rights reserved. 1  PYRAMID POINTS I. Eating Disorders  Description  Characterized by grossly disturbed eating habits  Compulsive overeating  Binge-like overeating without purging  Responds to feelings of guilt, anger, depression, boredom, loneliness, inadequacy, or ambivalence by eating  Anorexia nervosa  Client has distorted body image and disturbed self- concept.  Death can occur from starvation, suicide, cardiomyopathies, electrolyte imbalances.  Assessment  Refusal to eat, appetite denial, feelings of lack of control, compulsive exercising MENTALElsevier HEALTH: Inc. All rights reserved. Slide 2 Addictions  PYRAMID POINTS I. Eating Disorders (continued)  Bulimia nervosa  Client indulges in eating binges followed by purging behaviors.  Preoccupied with body shape and weight and has a low self-esteem  Most clients remain within a normal weight range but think that their lives are dominated by the eating-related conflict.  Assessment  Binge-purge system  Low self-esteem  Poor interpersonal relationships MENTALElsevier HEALTH: Inc. All rights reserved. Slide 3 Addictions  PYRAMID POINTS I. Eating Disorders (continued)  Interventions: Clients with an eating disorder  Assess for suicide potential.  Assess nutritional status.  Established a contract concerning nutritional plan.  Implement behavior modification techniques.  Monitor for physical complications and attend to physiological alterations.  Encourage psychotherapy and support groups. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 4 Addictions  PYRAMID POINTS II. Substance Abuse Disorders-many substances being abused!  Description  Abuse of a harmful substance that causes behavioral and physiological changes  Screening tools available: MAST, DAST, CAGE (alcohol abuse risk)  Substance dependence  Pattern of use resulting in tolerance, withdrawal symptoms, and compulsive drug-taking behavior  Substance tolerance  Need for increased amounts of the substance to achieve the desired effect  Substance abuse  Uses substances recurrently (craving)  Substance withdrawal  Occurs when an individual experiences a decrease in blood levels of a substance to which the individual is physiologically dependent MENTALElsevier HEALTH: Inc. All rights reserved. Slide 5 Addictions  PYRAMID POINTS II. Substance Abuse Disorders (continued)  Other factors to consider in client with substance- related disorder  Rebellion and peer group pressure  Depression  Grief and loss  Method of coping to decrease physical and emotional pain MENTALElsevier HEALTH: Inc. All rights reserved. Slide 6 Addictions  PYRAMID POINTS II. Substance Abuse Disorders (continued)  Dysfunctional behaviors related to substance abuse  Preoccupation with substance  Manipulation  Impulsiveness  Anger  Avoidance of relationships  Sense of self-importance  Denial  Rationalization and projection  Co-dependence MENTALElsevier HEALTH: Inc. All rights reserved. Slide 7 Addictions  PYRAMID POINTS III. Alcohol Abuse  Description  Alcohol is a central nervous system (CNS) depressant that affects all body tissues.  Risk factors  Biological, genetic, and familial predisposition  Depression  Low self-esteem  Poor self-control  History of rebelliousness, poor school performance, delinquency  Assessment  Slurred speech, unsteady gait, belligerence, confusion  Type of alcohol, how much, for how long, and when last consumed MENTALElsevier HEALTH: Inc. All rights reserved. Slide 8 Addictions  PYRAMID POINTS III. Alcohol Abuse (continued)  Psychological symptoms  Depression, hostility, irritability, isolation, denial  Complications associated with chronic alcohol use  Vitamin B and thiamine deficiencies  Korsakoff’s syndrome  Severe memory problems  Wernicke’s encephalopathy  Cirrhosis of the liver  Esophagitis and gastritis  Esophageal varices  Pancreatitis  Peripheral neuropathy  Immune system dysfunction  Anemias  Cardiac disorders  Brain damage MENTALElsevier HEALTH: Inc. All rights reserved. Slide 9 Addictions  PYRAMID POINTS IV. Alcohol Withdrawal  Description  Early signs develop within a few hours after cessation of alcohol intake, peak after 24 to 48 hours, and then disappear unless progression to alcohol withdrawal delirium occurs.  Withdrawal delirium (DTs)  A medical emergency  Death can occur from myocardial infarction, fat emboli, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide.  The state of delirium usually peaks 48 to 72 hours after cessation or reduction of intake (although can occur later) and lasts 2 to 3 days. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 10 Addictions  PYRAMID POINTS IV. Alcohol Withdrawal (continued)  Interventions  Monitor vital signs and neurological signs.  Provide one-to-one supervision.  Provide nutrition and vitamins.  Orient frequently.  Allow client to express feelings.  Medication therapy for alcohol abuse and dependence  Prescribed only for those who have stopped drinking  Naltrexone  Acamprosate  Disulfiram (Antabuse)  Disulfiram (Antabuse) therapy  Educate about effects of medication: Avoid use of substances that contain alcohol such as mouthwashes and cough medicines. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 11 Addictions  PYRAMID POINTS IV. Alcohol Withdrawal (continued)  Dealing with client who abuses alcohol (Boxes 70-4 and 70-5)  Focus on the substance abuse problem.  Set limits on manipulative behavior.  Hold client accountable for all behavior.  Group therapy and support groups MENTALElsevier HEALTH: Inc. All rights reserved. Slide 12 Addictions  PYRAMID POINTS V. Drug Dependency (continued)  Opioids  Include opium, heroin(CSS1 and illegal), CSS 2: meperidine, morphine, codeine sulfate, methadone, hydromorphone, oxycodone, hydrocodone, fentanyl and RNs give a lot by HCP Rx  Withdrawal effects include yawning, insomnia, irritability, rhinorrhea, diaphoresis, cramps, nausea, vomiting, muscle aches, chills, fever, lacrimation, and diarrhea.  REVIEW OF OPIOIDS NEXT because RNs give them to pts often  Hallucinogens  Include lysergic acid diethylamide (LSD), mescaline (peyote), psilocybin (mushrooms), phencyclidine (PCP)  Treatment (PCP) involves possible gastric lavage (if alert); treatment to acidify the urine to assist in excreting drug; and interventions to treat behavioral disturbances, hyperthermia, hypertension, and respiratory distress.  Safety during flashbacks is a priority. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 13 Addictions  PYRAMID POINTS V. Drug Dependency  CNS depressants  Include alcohol, benzodiazepines, barbiturates and act as depressant, sedative, or hypnotic  Overdose: If client awake, vomiting is induced and activated charcoal is administered; if client comatose, establishment and maintenance of an airway and gastric lavage with activated charcoal are priorities; seizure precautions are indicated.  CNS stimulants  Include amphetamines, cocaine, and crack  Withdrawal is treated with antidepressants, a dopamine agonist, or bromocriptine (Parlodel); withdrawal is primarily supportive, particularly when dealing with the severe depression and suicidal ideation that accompanies stimulant withdrawal. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 14 Addictions  PYRAMID POINTS V. Drug Dependency (continued)  Inhalants  Include gases or liquids such as butane, paint thinner, airplane glue, nail polish remover, nitrous oxide  Overdose can cause damage to the nervous system and death.  Marijuana (Cannabis sativa)  Other recreational and club drugs  Interventions: Withdrawal  Initiate seizure precautions.  Hydrate client.  Monitor vital signs and I&O.  Dual diagnoses  Psychiatric and substance abuse problem are both present.  Addiction and abuse in health care professionals: Report suspicious signs of impaired coworkers, work patterns, behaviors. MENTALElsevier HEALTH: Inc. All rights reserved. Slide 15 Addictions  Audience Response System Question (for use with iClicker) The nurse is performing an assessment on a client who abuses alcohol. The nurse checks for which behavior, understanding that it is a risk factor for alcohol abuse? 1. Managed self-control 2. Overexaggerated self-esteem 3. History of depression in spouse 4. History of rebelliousness and poor school performance MENTALElsevier HEALTH: Inc. All rights reserved. Slide 16 Addictions