Tuesday, November 07, 2006

ETOH

Alcohol abuse and dependence.Alcohol has no nutritional value. The alcohol content varies by beverage, but they all have the same effect depending on the rate that they are consumed. Behavior changes may not be noted if the person drinks one average sized drink per hour. It is the third leading cause of death in this country. It is the cause of 20% of the patients in mental institutions. It is related to suicide by 30%. The leading cause of cirrhosis of the liver in this country is due to alcoholism. It is the most widely abused drug.Effects of alcohol on the body-- It is rapidly absorbed into the bloodstream through the stomach and intestinal wall. It is not digested like food and it goes straight to the brain. The liver eliminates 90% of the ETOH. 10% is eliminated unchanged by the breath, sweat, urine, and other body fluids. At low doses is produces relaxation, loss of inhibitions, drowsiness, slurred speech, sleep and lack of concentration.Chronic abuse causes many physiological impairments. Some complications…1.Peripheral neuropathy= peripheral nerve damage. Signs & Symptoms= burning tingling feeling in the extremities. Caused by a deficiency in b vitamin-thiamine. This is reversible by abstaining from ETOH, and restoring nutritional deficiencies. If not permanent muscle wasting and paralysis can occur.
2.Alcoholic myopathy= acute or chronic condition. Acute= sudden onset of muscle pain, swelling, weakness, a red tinge to the urine caused by a breakdown product of muscle, increase of muscle enzymes in the blood. Labs= increase of CPK, LDH, AST. The chronic symptoms= gradual wasting and weakness of skeletal muscles, no pain or elevation of enzymes. Caused by b vitamin deficiency. Treatment= abstinence and nutrion support.
3.Wernicke’s encephalopathy= serious thiamine deficiency. Signs and symptoms= paralysis of eye muscles, diplopia, ataxia, somnolence and stupor. Need thiamine replacement or death will follow.
4.Korsakoff’s psychosis=syndrome of confusion, loss of recent memory, and confabulation. Usually seen with wernickes, the two together. Treatment = parenteral or oral thiamine replacement.
5.Alcoholic cardiomyopathy= heart enlargement and weakness due to an accumulation on lipids in the heart muscle cells. Symptoms relate to CHF=decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, non-productive cough. Labs =increase enzymes CPK,AST,ALT, LDH. CHF may be seen on x ray. Treatment= total abstinence and treatment as CHF. Death rate is high not treated early.
6.Esophagitis= inflamation and pain in the esophagus. From toxic effect of alcohol and vomit.
7.Gastritis= inflamation of the lining of the stomach. Signs and symptoms= epigastric distress, nausea and vomiting, distention. The alcohol can break down the mucosal lining of the stomach, this lets the hydrochloric acid erode the stomach wall. If blood vessels get damaged, hemorrhage may occur.
8.Pancreatitis= acute or chronic. Chronic can lead to malnutrion, weight loss, and diabetes mellitus. Signs and symptoms= constant, severe epigastric pain, nausea vomiting, and distention.
9.Alcoholic hepatitis= follows severe long term drinking and usually affects an already damaged or weakened liver. Signs and symptoms= enlarged tender liver, nausea vomiting, lethargy, tiredness, anorexia, increased WBC count, jaundice. Ascites and weight loss. Treatment= strict abstinence of alcohol, proper nutrition, rest. Can lead to cirrhosis of the liver.
10.Cirrhosis of liver= the leading cause of cirrhosis of liver is alcohol abuse. It is the end stage liver disease for alcoholics; the result of long term chronic use of alcohol. The liver cells are destroyed and replaced by scar tissue. Signs and symptoms=nausea vomiting, lethargy, tiredness, anorexia, weight loss, abdominal pain, edema, anemia, blood coagulation abnormalities. Treatment= abstinence, nutrition and supportive care to prevent the complications of cirrhosis.

Alcohol withdrawal= within 4-12 hours of prolonged heavy use ( several days or longer). Signs and symptoms= coarse tremors of hands, tongue or eyelids, nausea and vomiting, sweating, increased blood pressure, weakness, tachycardia, anxiety, depressed mood or irritability, transient hallucinations or illusions, headache, insomnia. Delirium can happen on the 2nd or 3rd day or with a reduction of amount. This can be a very serious condition. Nursing Care=The nurse should be aware of own feelings or bias attitudes. The nurse should have a strong understanding of self and attitudes to be able to be empathetic toward the patient. The nurse should be able to accept the patient unconditionally and separate the past behaviors of the patient from who the patient is and accept the patient for themselves.
1.Ineffective denial related to weak, underdeveloped ego evidenced by statements such as, “ I do not have a problem.” Outcome=Patient will demonstrate acceptance of responsibility for behavior and verbalize the relationship between substance abuse and medical problems. Interventions= Develop trust. Ensure to patient that it is the behavior that is not acceptable, but the person is acceptable--unconditional acceptance leads to self-worth and dignity.Correct misconceptions about the problem in a way that is nonjudgmental.--this helps the patient see that it is an illness that needs help. To clear denial identify maladaptive behavior and how substances may have had a role in the problem. For example lab studies.--trying to decrease the role of denial.Do not allow the patient to rationalize or blame others for behaviors associated with abuse.--to decrease the denial time.
2.Ineffective coping related to inadequate coping skills as evidenced by the use of substances to cope. Outcomes=Verbalize adaptive coping mechanism to use instead of substance abuse in response to stress. Interventions= set limits on manipulative behavior/--may not be able to set own limits or delay gratification. Explore options to relieve stress other than substance abuse and practice these techniques--gratification is obtained and related to the oral stage of development (freud), and the patient may not know how to be more adaptive with coping strategies. Give positive reinforcement when the patient is able to delay gratification and respond to stress with adaptive coping methods--patient needs lots of positive feedback to increase self esteem and to promote ego development.
3.Imbalanced nutrition: less than the body requires; fluid volume deficit; related to drinking alcohol instead of eating evidenced by weight loss, poor skin turgor, pale mucus membranes, electrolyte imbalance, anemia, or other signs of poor nutrition or dehydration.Outcomes=Patient will be free of signs and symptoms of malnutrition/dehydration. Interventions=parenteral support may be needed initially-- to correct fluid and electrolyte imbalance, hypoglycemia, and vitamin deficiency. Encourage cessation of smoking--to help repair damage to GI tract. Consult dietician, find out how many calories the patient needs, document intake and output, calorie count, weigh daily--to maintain nutritional assessment for early interventions. Maintain adequate protein intake to maintain nitrogen equilibrium, but if hepatic problems protein should be eliminated or decreased--diseased livers can not metabolize protein and can cause a build up of ammonia in the blood which can lead to serious problems with consciousness. Sodium may be restricted--to decrease fluid retention- ascites and edema. Provide small frequent meals of favorite foods, supplement with vitamins and mineral supplements--to encourage intake and facilitate adequate nutrition.
4. Risk for infection related to malnutrition and altered immune condition.
5. Risk for injury related to withdrawal evidenced by the signs and symptoms of withdrawal.There is medical treatment protocol for the detox process of alcohol withdrawal.
The list could go on....

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