What are the 3 eating disorders?
- compulsive overeating
- anorexia nervosa
- bulimia nervosa
Many of these clients have issues with control and anxiety.
Describe:
Compulsive overeating
Binge eating without purging. These clients are overweight.
The client is aware of the problem and may feel guilt, anger or depression.
Describe:
Anorexia nervosa
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 and exercise excessively.
Death can occur due to starvation, suicide or electrolyte imbalances.
Describe:
Bulimia nervosa
When the client has repeated episodes of binging and purging by throwing up, laxatives, or diuretics. These clients are normal weight and have erosion of tooth enamel from the acids in vomit.
Clients usually hide their eating.
What are the interventions for eating disorders during mealtimes?
- set up a daily nutritional plan
- supervise during mealtimes
- supervise after meals to assess for attempts to vomit
- set a time limit to eat
Describe:
Substance dependence
A pattern of repeated use of a substance.
There is a desire to cut down on substance but efforts are unsuccessful.
Describe:
Substance tolerance
The need for increased amounts of the substance to achieve the desired effect.
Describe:
Substance withdrawal
When a client experiences physical symptoms when there is a decrease in blood levels of the substance.
Describe:
Alcohol misuse
- Physical dependence: there is a need to avoid physical withdrawal symptoms
- Psychological dependence: the client craves the subjective effect of alcohol
Risk factors:
Alcohol misuse
- genetic/family predisposition
- depression and anxiety
- poor self-control
- missing school
- poor parental relationships
Physical signs and symptoms:
Alcohol misuse
- slurred speech and uncoordinated
- sneaking drinks and binge drinking
- arguments and missing work
- intoxication of > 0.1% blood alcohol level
- blackouts
Psychological symptoms:
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
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?
Within a few hours after the last drink.
When do signs of alcohol withdrawal peak?
Between 24 - 48 hours after not drinking and then rapidly disappear.
Interventions:
Alcohol withdrawal
- benzodiazepines such as chlordiazepoxide - calms the client
- IM injection of vitamin B1 (thiamine) then oral B1 - to prevent Wernicke’s encephalopathy
What is delirium tremens?
(Immediate complication)
Withdrawal of alcohol that occurs 48 - 72 hours after stopping alcohol.
What are the symptoms of delirium tremens?
Severe “upper” type symptoms:
- sweating (diaphoresis)
- sudden severe confusion
- body tremors
- irritability
- seizures
Interventions:
Delirium tremens
- CIWA protocol (clinical institute withdrawal assessment)
- vital signs, neuro assessment every 15 minutes
- one-on-one supervision
- quiet environment
- seizure precautions
Medications:
Delirium tremens
- benzodiazepines to calm client
- vitamins
- multivitamin
- B1 and C
- folic acid
What medication can be given to a client with alcoholism to prevent the desire to consume alcohol?
Disulfiram.
