SLA 7 - Health Promotion Flashcards
(45 cards)
What is the stages of change model?
What is the behaviour change wheel?
Helps to understand behaviour change at the individual, community and population levels.
It can be used by clinicians to help identify and address barriers to behaviour change with individual patients. It can also be used to help develop public health interventions.
What are the current UK guidelines for alcohol consumption?
Men and women are advised not to drink more than 14 units per week on a regular basis.
If a person regularly drinks as much as 14 units per week, drinking should be spread across at least 3 days.
Give some examples of drugs that have significant interactions with alcohol consumption.
Opioids and sedatives may interact with alcohol to cause respiratory depression, which can be fatal.
NSAIDs may interact with alcohol to increase the risk of peptic ulceration and GORD.
Anticoagulants (e.g. warfarin) may interact with alcohol, inducing CYP enzymes and thus causing anticoagulant to reach hypotherapeutic levels, increasing the risk of clots.
What is harmful drinking?
A pattern of alcohol consumption causing health problems directly related to alcohol (e.g. depression, acute pancreatitis).
In the long term, harmful drinkers may go on to develop hypertension, liver cirrhosis, heart disease or some types of cancer.
What is alcohol dependance?
Characterised by craving and tolerance with alcohol and continued drinking in spite of harmful consequences.
Alcohol dependence has also been associated with increased criminal activity and domestic violence.
Suggest some screening tools for alcohol dependence.
CAGE questionnaire can be used to screen for alcohol dependence. Note a score > 2 should prompt further investigation.
CKS also recommends AUDIT questionnaire for further exploration.
Outline the management of a patient with alcohol dependence.
Encouraging the patient to achieve abstinence is the end goal. This may however begin by encouraging the patient to slowly reduce their alcohol consumption to a moderate level, then to little, then none.
Practical strategies to help reduce alcohol consumption may include:
- recognising and avoiding high-risk situations for drinking
- recognising personal cues for drinking (e.g. stress or being alone)
- drinking a soft drink for every alcoholic drink
- trying alternative coping activities to drinking (e.g. exercising, reading, exploring other interests)
- keeping a drinking diary and asking close contacts for help
Note a patient with alcohol dependence is required by law to inform the DVLA.
Note a patient with alcohol dependence should NOT go cold turkey, as this increases the risk of severe alcohol withdrawal (e.g. seizures).
Which psychological interventions may be available for a patient with severe alcohol dependence?
- cognitive behavioural therapies focused on alcohol-related problems.
- social network and environment based therapies (e.g. AA)
What are the symptoms of alcohol withdrawal?
Mild: hypertension, tachycardia, anorexia, anxiety, insomnia, irritability, headache, fine tremor.
Moderate: worsening mild symptoms plus agitation and coarse tremor.
Severe: worsening moderate symptoms plus confusion, tonic-clonic seizures, hallucinations or hyperthermia.
Which medications can be used to help with alcohol withdrawal?
A long-acting benzodiazepine (e.g. diazepam) can be used to attenuate alcohol withdrawal symptoms.
Over 7-10 days follow a dose reduction regime to zero.
Note pts with mild alcohol withdrawal symptoms will not need specific medical intervention.
Note acamprosate is a medication used that can sustain abstinence from alcohol.
When would you consider referring someone who is alcohol dependent for:
a) psychological intervention
b) assisted alcohol withdrawal
a) high-risk drinkers or those with moderate alcohol dependence
b) people drinking over 15 units/day OR score >20 on AUDIT questionnaire.
What is Wernicke-Korsakoff syndrome (WKS)?
A spectrum of disease resulting from thiamine deficiency, usually related to alcohol abuse.
Wernicke’s encephalopathy describes a classic triad of symptoms:
- Mental confusion
- Ataxia
- Ophthalmoplegia
Korsakoff’s syndrome is a late manifestation of Wernicke’s encephalopathy if it is inadequately treated. This can lead to coma and death.
What is the correlation between WKS and alcohol misuse?
Chronic alcohol misuse results in liver cirrhosis, which limits the absorption of thiamine and its respective metabolism to Vitamin B1.
This interferes with numerous cellular functions and can affect the thalamus, hypothalamus and mammillary bodies in the brain.
How is Wernicke’s encephalopathy treated?
Prophylactic oral thiamine prescribed to patients with severe alcohol dependence.
Give some long-term risks of excessive alcohol consumption.
- cancer (e.g. mouth, throat, breast)
- strokes
- heart disease
- liver disease
- diabetes
Give some short-term risks of excessive alcohol consumption.
- alcohol-provoked accidents resulting in injury
- misjudging risky situations
- losing self-control
- alcohol poisoning
What drinking advice should be given to pregnant women?
Encourage patient to abstain from drinking during pregnancy, as alcohol may harm the baby (e.g. fetal alcohol syndrome).
What effects can alcohol have upon a foetus?
Fetal alcohol syndrome:
- restricted growth
- facial abnormalities
- learning and behaviour disorders
What are the benefits of smoking cessation?
- reduces risk of smoking-related diseases (e.g. lung cancer, COPD)
- increases life expectancy
What are some withdrawal symptoms of smoking cessation?
- irritability
- depression
- restlessness
- increased appetite and weight gain
- nicotine cravings
What are the risks of smoking during pregnancy?
- maternal DVT and pre-eclampsia
- preterm birth
- placenta praevia
- ectopic pregnancy
- miscarriage
- infant mortality and stillbirth
- birth defects (e.g. cleft lip)
If a patient discloses that they are smoking while pregnant, you should advise the patients of the risks
Outline NICE guidance on very brief advice (VBA) for smoking cessation.
VBA is given in less than 30 seconds.
- ask about current and past smoking behaviour
- provide verbal and written information on the risks of smoking and the benefits of stopping smoking
- advise the options for quitting smoking including behavioural support, medication and e-cigarettes
- refer the person to their local stop smoking service (if they wish to stop smoking)
How can a patient who does not wish to stop smoking be managed?
Offer a harm-reduction approach to smoking:
- stopping smoking, but continuing to use nicotine replacement therapy (NRT)
- cutting down before stopping smoking, with or without NRT
