This document summarizes information from multiple sources on alcohol dependence and withdrawal. It discusses the pathophysiology of alcoholism and how alcohol affects the body. It presents a case study of a patient in the intensive care unit undergoing alcohol withdrawal and receiving various medications to manage symptoms. It also covers nutritional assessments and how dietitians can help patients, guidelines for screening alcohol-related problems, potential health benefits of alcohol consumption, and recommendations for alcohol intake.
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
Sexual Disorders
Sexuality
One of the most personal area of life. Each of us is sexual being with preferences and fantasies that may surprise or even shock us from time to time. Usually these are part of normal sexual functioning. But when our fantasies or desire begin to affect or other in unwanted or harmful ways, they begin to qualify as abnormal.
For perspective, we begin by briefly describing norms and healthy sexual behavior. Then we consider two forms of sexual problems: sexual dysfunctioning and paraphilias.
Sexual Norms and Behavior
Consider contemporary Western worldviews that inhibition of sexual expression causes problems. Contrast this with nineteenth-and-early-twentieth-century views that excess was culprit; in particular excessive masturbation in childhood was widely believe to lead to sexual problems in adulthood. Von Krafft-Ebing (1902) postulated that early masturbation damage the sexual organs and exhausted a finite reservoir of sexual energy, resulting in diminishing ability to function sexually in adulthood. Even in adulthood, excessive sexual activity was thought to underlie problems such us erectile failure. The general Victorian view was that sexual appetite was dangerous and therefore had to be restrained.
Sexual Norms and Behavior
Other changes over time have influence people attitudes and experiences of sexuality.
Aside from changes over time and across generation, culture influences attitudes and beliefs about sexuality. In some culture, sexuality is viewed as an important part of well-being and pleasure, wheras in others, sexuality is viewed as relevant only for procreation (Bhurga, Popelyuk & McMullen, 2010). Cultures also vary in their acceptance of variation in sexual behavior.
In other culture it is common to stigmatize same-gender sexual behavior. Clearly, we must keep varying cultural norms in mind as we study human sexual behavior.
Gender and Sexuality
Across wide range of indices, men reported more engagement in sexual thought and behavior that do women.
Compared to women, men report thinking about sex, masturbation, and desiring sex more often, as well as desiring more sexual partner and having more partners.
Beyond these differences in sex drive Peplau (2003) has described several other ways in which the genders tend to differ in sexuality. Women tend to be more ashamed of any flaws in their appearance than the men, and this shame can interfere with sexual satisfaction (Sanchez & Kiefer, 2007)
Gender and Sexuality
For women, sexual appears more closely tied to relationship status and social norms that for men (Baumeister, 200).
Among women with sexual symptoms, more than half believe their symptoms are caused by relationship problems (Nicholls, 2008).
Men are more likely to think about their sexuality in terms of power than are women (Andersen, et al. 1999).
Gender and Sexuality
There are many parallels in men’s and women’s sexuality.
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
Pharmacology - 10 Nursing Mnemonics and TricksKelghe D'cruz
Pharmacology isn’t the easiest to study and master. Apart from drug names, you also have to know what they do, how they interact with each other, and who they are for.
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
Herbs are proven to effect AED levels and lower the effectiveness of a patient's epilepsy medication. In some cases, people will benefit from THC; however, some are likely to develop worsening seizures. There have been no positive studies about THC and it is generally agreed that the probable costs outweigh the possible benefits. Nevertheless, It is crucial to stay updated and informed. Lastly, patients should communicate regularly with doctors about current herbal treatments they are trying and research with doctors, the side effects of such herbs.
The Interstitial Cystitis Association (ICA), a non-profit health association, hosted a Patient Forum in Atlanta on Sunday, August 23, 2009. This CDC-funded event offered healthcare providers, patients and caregivers a chance to meet with leaders in the field to learn more about interstitial cystitis - a severely painful and chronic bladder condition affecting an estimated 3 million women and 1 million men in the United States. Speakers included Dr. Jeffrey Proctor, Dr. Anna Kelly and Susan Bilheimer.
6. Delirium Tremens
"Pharmacotherapy for Alcohol Dependence: Summary of Evidence Report/Technology
Assessment No. 3." Agency for Healthcare Research and Quality (AHRQ) Home. Web. 30
Apr. 2011. <http://www.ahrq.gov/clinic/epcsums/alcosumm.htm>.
7. How Alcohol Affects the Body
DePetrillo, Paolo., and Mark McDonough. "Index of /resources." Alcohol Withdrawal
Treatment Manual. Web. 30 Apr. 2011. <http://www.sagetalk.com/resources>.
12. Medications
Folic Acid prevent deficiency of folic acid Anorexia, nausea, vomiting,
1 mg
Thiamine HCL To treat low levels of vitamin Nausea sweating
100 mg B1
Sodium Chloride Increase fluid intake in the
0.9% body and prevent dehydration
1000 ml/day
Multivitamin To prevent micronutrient Gi discomfort: ie gas, nausea
5ml deficiencies
Fentanyl Narcotic for patients with Constipation, diarrhea, dizziness,
100cc/hr chronic pain management. drowsiness, dry mouth, headache,
indigestion, loss of appetite, nausea,
nervousness or anxiety
Zofran Prevents nausea and vomiting Diarrhea, constipation, and headache
4mg every 6 hours
Propolfol reduces anxiety and tension, Swelling/pain tiredness
1.5mg/kg and promotes relaxation and
sleep or loss of consciousness
Ativan used to treat anxiety disorders Nausea, vomiting, diarrhea,
2mg constipation, or appetite changes
Pronsky ZM. Food Medication Interactions. 15th ed. Birchrunville, PA: Food Medication
Interactions; 2008.
13. Nutritional Assessment
"Monitoring Gastric Residual Volume." ADA Evidence Library. American Dietetic
Association. Web. 30 Apr. 2011. <http://www.adaevidencelibrary.com>.
18. Guidelines for Alcohol Related Problem
National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too
Much: A Clinician’s Guide. NIH Pub No. 05–3769. Bethesda, MD: the Institute, 2005.
19. Alcohol Benefits
Wannamethee SG, Field AE, Colditz GA, Rimm EB. Alcohol intake and 8-year weight gain
in women: a prospective study. Obes Res. 2004 Sep;12(9):1386-96
Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford
GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of
randomized controlled trials. J Hypertens. 2006 Feb;24(2):215-33.
20. Alcohol Benefits
"Alcohol D-7." USDA Center for Nutrition Policy and Promotion. Web. 01 May 2011.
<http://www.cnpp.usda.gov/dietaryguidelines.htm>.
21. Bofetta, P, and Garfinkel, L. "Alcohol drinking and mortality among men enrolled in an American
Cancer Society prospective study." Epidemiology 1:342-348, 1990.
Werinicke’s encephalopathy- may cause brain damage id left untreatedThiamine supplementation will aid in the treatment and cessation from alcohol.Complications? Alcohol withdrawal S/SS/SConfusionLoss of muscle coordination (ataxia) Leg tremorVision changes Abnormal eye movements (back and forth movements called nystagmus)Double visionEyelid drooping
Chronic use of alcohol leads to malnutrition because there are calories in alcohol and no essential nutrients. Hunger is satisfied by the calories provided in the beverage so muscle mass will decline and fat mass increases leading to many chronic diseases seen later in life. Malabsorption is associated with damage to gastric and intestinal mucosa. Those who chronically consume alcohol are at an increased risk for malnutrition because they are drinking empty calories and not eating the correct amount of nutrients from food. Folate: Alcohol interferes with dietary folate intake,absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver.Vitamin B12: Studies have shown that both moderate and heavy alcohol consumption will affect vitamin B12 levels.One study showed a 5% decrease in mean serum vitamin B12 concentrations when consumption of alcohol increased from 0 to 30 grams of alcohol/day.Vitamin A: Alcohol has been found to promote a deficiency of vitamin A Alcohol enhances its toxicity when taken in excessive amounts.Calcium: Alcohol consumption can cause a loss of calcium in the body by increasing urinary calcium excretion.
The patient was found on the floor of a grocery store heavily intoxicated and nonresponsive. She was immediately sent to the ICU for rapid treatment.With an ETOH level of 296 a person will show signs of: Sleep or stupor, marked muscular incoordination, markedly decreased response to stimuli, incontinenceThe patient went for a tracheostomy and was intubated because she was unable to breath on her own. It was also easier for the nurses to clear secretions, and because a trach was administered, the patient was unable to speak nor eat by mouth.The patient was sedated because she was pulling on her tubes while awake and she had delerium tremors due to the alcohol withdrawal syndrome. Also, propolfolThis was when the dietitian was notified and the patient needed a nutrition consult. Before I begin about the diet, I would like to review some of the medications that typically seen for a patient with alcohol withdrawal syndrome.
Folic acid was supplemented because when a patient abuses alcohol this will decrease the absorption of thiamine. Also, if one is deficient in folic acid this can also lead to a decrease in the absorption of thiamine. This will promote the best absorption of thiamine as to prevent Wernicke- Korsakof syndrome which can lead to a further disruptence in mental status.The patient was experiencing episodes of constipation and episodes of diarrhea on various days. This was related to some of the medications like:fentanyl was causing her diarrhea and when they were finished with the dose, she slowly returned to her normal bowel patternZofran to prevent nausea and vomiting since she was on a ventilator They noticed that she was then constipated and had no bowel movements for a few days and once she was given a smaller dose of Zofran, they symptoms seemed to improve. Also, the patient maintained her weight throughout her time in the ICU showing that the medications did not cause a shift in her weight. The patient was sedated throughout her time in the ICU for comfort reasons and avoid any anxiety because she was intubated, on a ventilator, and initially suffering from delerium tremors.
The patient has micronutrient malnourishment because her chronic intake of alcohol has caused a thiamine and b12 deficiency. The patient is 59 years old which puts her at risk for malnourishment because her body has decreased absorption for the vitamins. As we age, the body’s absorption of vitamins decrease along with the loss of lean body mass which can increase the risk for falls.Note: Gastric residuals were noted to be 50-75ml and feedings were stopped until it cleared up. However, this was not necessary because according to the Evidence Analysis Library, when gastric residuals are > 250 ml is when a feeding should be held.
A standard formula which maintained her weight and provided enough energy to allow her body to recover and heal.The patient was on a tube feed for roughly 10 days and provided the correct amount of nutrition because her weight was maintained. The patient tolerated her feeds well and there were no signs of discomfort when the rate was increased. When the patient is hemodynamically stable, speech shall provide an evaluation to incorporate PO intake.Tube feed rate was Jevity 1.2 @ 30 ml/hr because that was where the rate began and it was slowly increased to 65 ml/hr after the propofol was administered
The focus is on helping the person arrive at the conclusion that they need to change a behavior.Ie. Alcohol and focus on a balanced dietUse open-ended rather than closed-ended questions."Tell me about your drinking.""What concerns do you have about your drinking?""How can I help you with your drinking?"Use reflective listening to focus on students' concerns and ambivalence toward their alcohol use."I hear you.""Please say more."Use affirmative statements in order to gain students' trust and confidence."You are very courageous to be so revealing about this.""I can understand why drinking feels good to you."Use summary statements.Elicit self-motivational statements - these statements fall into four categories.Problem recognition - "I never realized how much I am drinking." "Maybe I have been taking foolish risks."Expression of concern - "I am really worried about my grades and how alcohol may be affecting them."Intention to change - "I don't know how but I want to try."Theme about optimism - "I think I can do it. I am going to overcome this problemThe best diet for a recovering alcoholic is one that is balanced and full of fruit, vegetables, and whole grains. It is important for the client to try new things in order to break the habit that was instilled while they were drinking.Avoiding caffeine and sugary foods prevents the sensation for another addiction. When one recovers from an addiction they may feel inclined to cling on to another food item.
identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted.
In a meta-analysis of 35 observational studies, Reynolds et al. (2003) found that, compared with abstainers, consumption of more than 4 drinks per day was associated with an increased risk of total stroke, increased risk of ischemic stroke, and increased risk of hemorrhagic stroke. First National Health and Nutrition Examination Study (NHANES), Liu et al. (1994) reported that drinkers were less likely to have either major weight gain or weight loss than nondrinkers over 10 years of follow-up.
heavy drinking and episodes of binge drinking impairs short- and long-term cognitive function as we agesmall to moderate amounts of alcohol consumption were associated with reduced incidence of dementia and Alzheimer’s disease CHD“Except for those individuals at particular risk… consumption of [up to] 2 drinks a day for men and 1 for women is unlikely to increase health risks” (NIAAA, 2003). On average, the relative risk of CHD associated with moderate drinking as defined by the DGAC is between 0.50 and 0.80 and is directly related to the benefits of alcohol on HDL-C, glucose, and clotting factors such as fibrinogen (Mukamal, 2005).
While drinking can lower the risk of cardiovascular disease, it does increase other health risks. In the following chart, mortality rates for non-drinkers serve as the baseline health risk (1.0 on the vertical axis). The risk for coronary heart disease even for heavy drinkers remains below the baseline; but risk of death from other causes goes up. The risk of death from liver disease skyrockets off the chart after only a couple of drinks a day.As dietitians, we never want to recommend alcohol to our clients because of the risk of abuse; however, these are the guidelines.
According to the Dietary Guidelines Advisory Committee