Substance Use Disorders & Eating Disorders Slides

SUBSTANCE USE DISORDERS ANNIE SMITH, RN-BC, MSN, CNE 4/9/2025 1 OBJECTIVES  1.Identify symptomatology and use the information in assessment of clients with various substance-related and addictive disorders.  2.Identify nursing diagnoses and treatments for patients wit...

SUBSTANCE USE DISORDERS ANNIE SMITH, RN-BC, MSN, CNE 4/9/2025 1 OBJECTIVES  1.Identify symptomatology and use the information in assessment of clients with various substance-related and addictive disorders.  2.Identify nursing diagnoses and treatments for patients with substance-related and addictive disorders and select appropriate nursing interventions.  3.Discuss the issue of substance-related and addictive disorders within the profession of nursing. 4/9/2025 2 NEUROBIOLOGY  Pleasure response is triggered by stimulating opioid receptors naturally or artificially.  Stimulation of opioid receptors increases dopamine levels by decreasing inhibition of dopamine pathways.  When dopamine levels rise, a memory of this pleasant feeling is created and may be triggered in the form of “cravings”.  Natural stimulation of opioid receptors stops after repeated consumption.  Artificial substances circumvent the body’s natural satiety mechanisms resulting in chronically elevated dopamine levels which leads to desensitization.  Eventually the substance is needed to maintain normal dopamine levels. 4/9/2025 3 SUBSTANCE USE DISORDER  Use of the substance interferes with the ability to fulfill role obligations  Attempts to cut down or control use fail  Intense craving for the substance  Excessive amount of time spent trying to procure the substance or recover from its use 4/9/2025 4   Use of the substance causes the person difficulty with interpersonal relationships or to become socially isolated  Engages in hazardous activities when SUBSTANCE impaired by the substance USE DISORDER  Tolerance develops and the amount required to achieve the desired effect increases  Substance-specific symptoms occur upon discontinuation of use  SUBSTANCE-INDUCED DISORDERS  Substance intoxication  Development of a reversible syndrome of symptoms following excessive use of a substance  Direct effect on the central nervous system  Disruption in physical and psychological functioning  Judgment is disturbed and social and occupational functioning is impaired. 4/9/2025 6 SUBSTANCE-INDUCED DISORDERS Development of symptoms that occurs upon abrupt Substance withdrawal reduction or discontinuation of a substance that has been used Symptoms are specific to the Disruption in physical and substance that has been used. psychological functioning   Alcohol  Caffeine  Cannabis CLASSES OF  Hallucinogens PSYCHOACTIVE  Inhalants SUBSTANCES  Opioids  Sedatives/hypnotics  Stimulants  Tobacco ALCOHOL INTOXICATION AND WITHDRAWAL  Alcohol intoxication: Occurs at blood alcohol levels between 100 and 200 milligrams per deciliter  Alcohol withdrawal: Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use 4/9/2025 9   Profile of the substance  Amphetamines STIMULANT  Synthetic stimulants USE  Non-amphetamine stimulants DISORDER  Cocaine  Caffeine  Nicotine  STIMULANT-INDUCED DISORDERS  Intoxication  Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, and changes in vital signs (even coma or death, depending on amount consumed).  Caffeine intoxication usually occurs following consumption in excess of 250 milligrams. Restlessness and insomnia are the most common symptoms. 4/9/2025 11  STIMULANT-INDUCED DISORDERS  Withdrawal  Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite.  Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.  Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite. 4/9/2025 12   Profile of the substance OPIOID USE  Opioids of natural origin DISORDER  Opioid derivatives  Synthetic opiate-like drugs OPIOID-INDUCED DISORDERS  Intoxication  Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours.  Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment.  Severe opioid intoxication can lead to respiratory depression, coma, and death. 4/9/2025 14   Symptoms of opioid withdrawal OPIOID-  Dysphoria, muscle aches, nausea/vomiting, INDUCED lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal DISORDERS cramping, diarrhea, yawning, fever, and insomnia  Withdrawal  From short-acting drugs (for example, heroin)  Symptoms occur within 6 to 8 hours, OPIOID- peak within 1 to 3 days, and gradually INDUCED subside in 5 to 10 days. DISORDERS  From long-acting drugs (for example, methadone)  Symptoms occur within 1 to 3 days, peak between days 4 and 6, subside in 14 to 21 days. NURSING PROCESS: ASSESSMENT  Various assessment tools are available for determining the extent of the problem a client has with substances.  Drug history and assessment  Clinical Institute Withdrawal Assessment of Alcohol Scale  C A G E Questionnaire 4/9/2025 17 DUAL DIAGNOSIS  Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis.  Program combines special therapies that target both problems. 4/9/2025 18 THE CHEMICALLY IMPAIRED NURSE  It is estimated that 10% to 15% of nurses suffer from the disease of chemical dependency.  Alcohol is the most widely abused drug, followed closely by narcotics.  High absenteeism may be present if the person’s source is outside the work area.  Or, the person may rarely miss work if the substance source is at work. 4/9/2025 19 THE CHEMICALLY IMPAIRED NURSE  Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs for other nurses may be present.  Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall  Problems with relationships  Irritability, tendency to isolate, elaborate excuses for behavior 4/9/2025 20 CODEPENDENCY  Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions  Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control.  Derives self-worth from others  Feels responsible for the happiness of others  Commonly denies that problems exist 4/9/2025 21 PHARMACOTHERAPY FOR ALCOHOLISM  Disulfiram (Antabuse)  Alcohol withdrawal  Benzodiazepines  Anticonvulsants  Multivitamin therapy  Thiamine 4/9/2025 22   Other medications PSYCHOPHARMACOLOGY  Naltrexone (ReVia) FOR SUBSTANCE INTOXICATION AND  Selective serotonin reuptake inhibitors (S S R I’s) SUBSTANCE WITHDRAWAL  Acamprosate (Campral) 4/9/2025 23   Opioids  Narcotic antagonists PSYCHOPHARMACOLOGY  Naloxone (Narcan) FOR SUBSTANCE INTOXICATION AND  Naltrexone (ReVia) SUBSTANCE WITHDRAWAL  Buprenorphine  Methadone  Clonidine GAMBLING DISORDER ▪ Persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress. ▪ As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction. 4/9/2025 25 GAMBLING DISORDER ▪ Gambling behavior usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood. ▪ The disorder usually runs a chronic course, with periods of waxing and waning. ▪ The disorder interferes with interpersonal relationships, social, academic, or occupational functioning. 4/9/2025 26 EATING DISORDERS ANNIE SMITH, RN-BC, MSN, CNE MORGAN AND TOWNSEND- CHAPTER 21 4/9/2025 27 OBJECTIVES 2. Describe symptomatology associated 1. Identify and differentiate among several with anorexia nervosa, bulimia nervosa, eating disorders. and obesity and use the information in patient assessment. 4. Formulate nursing diagnoses and outcomes of care for patients with eating 3. Identify predisposing factors in the disorders and describe appropriate development of eating disorders. interventions for behaviors associated with eating disorders 4/9/2025 28 4/9/2025 29 INTRODUCTION It regulates the body’s ability The hypothalamus contains to recognize when it is the appetite regulation center hungry, when it is not hungry, within the brain. and when it has been sated. 4/9/2025 30 INTRODUCTION  Eating behaviors are influenced by  Society  Culture  Historically, society and culture also have influenced what is considered desirable in the human body. 4/9/2025 31 BODY MASS INDEX (B M I) ▪ A B M I range for normal weight is 20 to 24.9. ▪ Obesity is defined as a B M I of 30 or greater. ▪ Anorexia nervosa is characterized by a B M I of 17 or lower, or less than 15 in extreme cases. 4/9/2025 32  Characterized by a morbid fear of obesity Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. ANOREXIA Weight loss is extreme, usually more than 15% of expected weight. NERVOSA Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of metabolic changes. Amenorrhea is typical and may even precede significant weight loss. There may be an obsession with food. Feelings of anxiety and depression are common. 4/9/2025 33   Bulimia nervosa is an episodic, uncontrolled, compulsive, BULIMIA rapid ingestion of large quantities of food over a short period (bingeing). The episode is followed by inappropriate compensatory NERVOSA  behaviors to rid the body of the excess calories (self- induced vomiting or the misuse of laxatives, diuretics, or enemas).  Fasting or excessive exercise may also occur.  Most patients with bulimia are within a normal weight range; some are slightly underweight, and some are slightly overweight.  Depression, anxiety, and substance abuse are not uncommon.  Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances. 4/9/2025 34 BINGE EATING DISORDER  The D S M-5 identifies binge eating disorder (B E D) as an eating disorder that can lead to obesity.  The individual binges on large amounts of food, as in bulimia nervosa.  B E D differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories. 4/9/2025 35   Biological influences  Genetics: A hereditary predisposition to eating disorders has been hypothesized.  Anorexia nervosa is more common among sisters and mothers of those with the disorder than it is among the general population.  Neuroendocrine abnormalities  There has been some speculation about a primary hypothalamic dysfunction in anorexia nervosa.  Neurochemical influences PREDISPOSING FACTORS  Bulimia nervosa may be associated with the neurotransmitters serotonin and norepinephrine.  Anorexia nervosa may be associated with high levels of endogenous opioids. 4/9/2025 36 PREDISPOSING  Family influences  Historically, family influences were heavily considered as factors, but FACTORS there is not sufficient evidence to support these claims.  Family members should be involved in treatment rather than blamed for the issue. 4/9/2025 37  Has achieved and maintained at least 80% of expected body weight OUTCOMES: Has vital signs, blood pressure, and laboratory serum studies THE PATIENT within normal limits Verbalizes importance of adequate nutrition 4/9/2025 38 PLANNING AND IMPLEMENTATION  Hospitalization may be necessary in cases of:  Malnutrition  Dehydration  Severe electrolyte imbalance  Cardiac arrhythmia or severe bradycardia  Hypothermia  Hypotension  Suicidal ideation 4/9/2025 39  Issues of control are central to the etiology of these disorders. TREATMENT MODALITIES: For the program to be successful, the client must perceive that he or she is in control of BEHAVIOR the treatment. MODIFICATION Successes have been observed when the client: Is allowed to contract for Has input into the care Clearly sees what the privileges based on weight gain plan treatment choices are 4/9/2025 40 TREATMENT MODALITIES: PSYCHOPHARMACOLOGY  No medications are specifically indicated for eating disorders.  Various medications have been prescribed for associated symptoms.  Anxiety  Depression 4/9/2025 41 TREATMENT MODALITIES: PSYCHOPHARMACOLOGY  Medications that have been tried with some success for anorexia nervosa include:  Fluoxetine (Prozac)  Clomipramine (Anafranil)  Cyproheptadine (Pariactin)  Chlorpromazine (Thorazine)  Olanzapine (Zyprexa) 4/9/2025 42 TREATMENT MODALITIES: PSYCHOPHARMACOLOGY  Medications that have been tried with some success for bulimia nervosa include:  Fluoxetine (Prozac)  Imipramine (Tofranil)  Desipramine (Norpramine)  Amitriptyline (Elavil)  Nortriptyline (Aventyl)  Phenelzine (Nardil) 4/9/2025 43 TREATMENT MODALITIES: PSYCHOPHARMACOLOGY  Medications that have been tried with some success for B E D with obesity include:  Topiramate (Topamax)  Lisdexamfetamine (Vyvanse) 4/9/2025 44