The onset is often associated with a stressful life event
The client intensely fears obesity
Body image is distorted, and the client has a disturbed self-concept
The eating disorder can be life threatening
Death can occur from starvation, suicide, or electrolyteimbalanc
Anorexia Nervosa Assessment:
Refusal to eat and appetite loss
Appetite denial
Feelings of lack of controld.
Self-induced vomiting and self- administered enemas
Exercises compulsively
Overachiever and perfectionist
Decreased temperature, pulse, and blood pressure
Weight loss
Gastrointestinal (GI) disturbance
Constipation
Electrolyte imbalances
Scaly, dry skin
Sleep disturbances
Hormone deficiencies
Amenorrhea for at least three consecutive menstrual periods
Teeth and gum deterioration
Cyanosis and numbness of extremities
Esophageal varices from vomiting
Bone degeneration
Bulimia nervosa
Preoccupied with body shape and weight
Consumes high-calorie food in secret; guilt about secretive eating
Binge-purge syndrome
Lose weight though diets, vomiting, enema, cathartics, and amphetamines or diuretics
experiences feelings of powerlessness or loss of control
Low self-esteem
Poor interpersonal relationships
Mood swings
Self-mutilating behavior, suicide thoughts and attempts at suicide
Electrolyte imbalances
Loss of tooth enamel and dental decay
Stomach ulcers and rectal bleeding
Esophageal varices from vomiting
Cardiac disease andhypertension
Substance abuse
Client recurrently uses substances
Client experiences recurrent, significantharmfulconsequences related to the use of substances
Client has legalproblems related substance abuse
Precipitating factors of substance abuse
Rebellion and peergrouppressure in adolescence
Pleasure-seeking experience, as the substance decreases physicaland emotional pain
Group influence and peer pressure
Depression
Loss and grieving
Risk factors for Alcohol Abuse
Biologicalpredisposition
Depressed and highly anxious characteristics
Lowself-esteem
Poorself-control
History of rebelliousness, poorschoolperformance,delinquency
Poor parentalrelationships
Psychological symptoms for Alcohol Abuse
Depression
Hostility
Suspiciousness
Rationalization
Irritability
Isolation
Decrease in inhibitions
Decrease in self-esteem
Denial that a problem exists
Complications associated with chronic alcohol use
Vitamin deficiencies
Alcohol-induced persistent amnesiac disorder causing severe memory problems
Wernicke’s encephalopathy, causing confusion, ataxia, and abnormal eye movements
Hepatitis; cirrhosis of the liver
Esophagitis and gastritis
Pancreatitis
Anemias
Immune system dysfunctions
Brain damage
Peripheral neuropathy
Cardiac disorders
Withdrawal and Detoxification of Alcohol:
Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.
Can occur 6 to 8 hours after drinking has ended ordecreased, and symptoms can last 5 days or longer.
Symptoms include coarse hand tremors sweating, elevatedpulse and bloodpressure, insomnia, anxiety, and nausea vomiting.
Pharmacology for ALCOHOL WITHDRAWAL:
Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms.
Stages of withdrawal: Stage 1
Anxiety
Anorexia
Insomnia
Tremors
Hyper alertness
Internal shaking
Nausea and vomiting
Headache
Increased pulse and blood pressure
Depression
Stages of withdrawal: Stage 2
Profound confusion
Gross tremors
Nervousness
Disorientation
Illusions
Auditory and visual hallucinations
Nightmares
Stages of withdrawal: Stage 3
Severe hallucinations
Seizures
Stages of withdrawal: Stage 4
Confusion, disorientation, clouding of consciousness, and delirium
Hypertension diaphoresis, tachycardia
Visual and tactile hallucinations
Fluctuating levels of consciousness
Fever (103 to 104 F)
Tremors
Uncontrolled tachycardia
Severe psychomotor activity
Agitationk
Hallucinations
Sleeplessness
Client education for ALCOHOL WITHDRAWAL:
Educate as to the effects of the medication
Instruct the client that the effects of the medication may occur for several days after discontinuance.
Ensure that the client agrees to abstain from alcohol and any alcohol-containing substances.
Instruct the client to avoid the use of substances that contain alcohol, such as cough medicines, rubbing compounds, vinegar, mouthwashes, and aftershave lotions.
It is useful for persons who are motivated to abstain from drinking and who are not impulsive.
Disulfiram
Nursing Consideration for Disulfiram (TO WATCH OUT)
Five to 10 minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and bodyflushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness.
In severe cases, there may be chest pain, dyspnea, severe hypotension, confusion, and even death.
Symptoms progress rapidly and last from 30 minutes to 2 hours.
WARNING: Never give to a client in a state of alcohol intoxication or without the client’s full knowledge. Instruct the client’s relatives accordingly.
Binge-like overeating without purging
Compulsive overeating
Aside from Disulfiram, this drugs sometimes prescribed for persons in recovery from alcohol abuse or dependence.It helps reduce the physical and emotional discomfort encountered during the first weeks or months of sobriety, such as sweating, anxiety, and sleep disturbances.
Acamprosate (Campral):
The client must abstain from alcohol for at least 12 hours before theinitial dose is administered.
The client must avoid drinking for 14 days after disulfiram therapy has been discontinued; otherwise the client is at risk for disulfiram-alcohol reaction.
Disulfiram (Antabuse) therapy
Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms.
Pharmacology for ALCOHOL WITHDRAWAL:
Refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases.
Withdrawal syndrome
use of a substance that results in maladaptive behavior.
Intoxication
When experiencing guilt, anger, depression, boredom, loneliness, inadequacy, or ambivalence
Responds by eating
Food consumption is out of the individual's control and occurs in a stereotyped fashion