What are the 3 eating disorders?
The 3 eating disorders are:
- compulsive overeating
- anorexia nervosa
- bulimia nervosa
Many of these clients have issues with control and anxiety.
Compulsive overeating
Compulsive overeating is binge eating without purging. These clients are overweight.
The client is aware of the problem and may feel guilt, anger or depression.
Anorexia nervosa
Anorexia nervosa is when the client has a distorted body image and doesn't eat due to fear of obesity. It is usually associated with a stressful event. These clients are extremely underweight.
Death can occur due to starvation, suicide or electrolyte imbalances.
Bulimia nervosa
Bulimia nervosa is when the client has repeated episodes of binging and purging by throwing up, laxatives, or diuretics. These clients are normal weight.
Clients usually hide their eating.
What are the interventions for eating disorders during mealtimes?
- set up a daily nutritional plan
- supervise during mealtimes
- set a time limit to eat
Substance dependence
Substance dependence is a pattern of repeated use of a substance.
There is a desire to cut down on substance but efforts are unsuccessful.
Substance tolerance
Substance tolerance is the need for increased amounts of the substance to achieve the desired effect.
Substance withdrawal
Substance withdrawal is when a client experiences physical symptoms when there is a decrease in blood levels of the substance.
Alcohol misuse
-
Physical dependence: there is a need to avoid physical withdrawal symptoms
-
Psychological dependence: the client craves the subjective effect of alcohol
Alcohol misuse
- genetic/family predisposition
- depression and anxiety
- poor self-control
- missing school
- poor parental relationships
Alcohol misuse
- slurred speech and uncoordinated
- sneaking drinks and binge drinking
- arguments and missing work
- intoxication of > 0.1% blood alcohol level
- blackouts
Alcohol misuse
- depression
- anger
- denial
- isolation
What vitamin deficiencies are caused by chronic alcohol misuse?
-
vitamin B deficiency
- causes peripheral neuropathies
-
thiamine deficiency
- causes Korsakoff's syndrome
- causes peripheral neuropathies
- causes Korsakoff's syndrome
What neuromuscular problems are caused by chronic alcohol misuse?
- brain damage
- severe memory problems
- confusion
- ataxia
- peripheral neuropathy
Alcohol slows down neural connections.
What gastrointestinal problems are caused by chronic alcohol misuse?
- cirrhosis
- esophagitis and gastritis
- pancreatitis
What are the early signs of alcohol withdrawal?
"upper type" symptoms:
- irritability, tachycardia, tremors, anxiety
- possible hallucinations and delusions
When can alcohol withdrawal occur?
Alcohol withdrawal can occur within a few hours after the last drink.
When do signs of alcohol withdrawal peak?
Signs of alcohol withdrawal peak between 24 - 48 hours after not drinking and then rapidly disappear.
Alcohol withdrawal
-
benzodiazepines such as chlordiazepoxide
- calms the client
-
IM injection of vitamin B1 (thiamine) then oral B1
- to prevent Wernicke's encephalopathy
- calms the client
- to prevent Wernicke's encephalopathy
What is delirium tremens?
Delirium tremens is withdrawal of alcohol that occurs 48 - 72 hours after stopping alcohol.
What are the symptoms of delirium tremens?
Severe "upper" type symptoms:
- sudden severe confusion
- body tremors
- irritability
- seizures
Delirium tremens
- vital signs, neuro assessment every 15 minutes
- one-on-one supervision
- quiet environment
- seizure precautions
Delirium tremens
- benzodiazepines to calm client
- vitamins
- multivitamin
- B1 and C
- folic acid
- multivitamin
- B1 and C
- folic acid
What is the treatment after the client is stable from alcohol withdrawal?
- therapeutic communication
- group therapy
- encourage support groups
- disulfiram medication
What are the general psych interventions for a client with a drug dependency problem?
- accept the client and be non-judgemental
- focus on substance abuse and situations that precipitate use of drug
- assist with dealing with emotions
- limit placing blame
- help client with assertive training
- set limits on manipulative behavior
What are signs of addiction and substance misuse in a healthcare provider?
- reports drugs were wasted without being witnessed by another nurse
- reports that client takes maximum dose when other nurses report smaller doses
- always volunteers to carry the narcotic keys or work in areas that narcotics are highly used such as ICU, OR and ER
If there is suspected drug abuse by a coworker or a med count is incorrect, who should be notified?
Notify the nurse supervisor immediately.
Can nurses return back to work after being caught stealing and using drugs at work?
Yes, nurses can return back to work.
However, the nurse will go through a monitoring program through the State Board of Nursing assistance and monitoring program.
