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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.
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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.
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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.
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