Nursing Diagnoses
This post contains some Nursing Diagnoses.
This may not mean much to those of you not in a healthcare field, but it is a factor that can help healthcare professional plan the care of individuals recovering from alcoholism.
People experiencing alcoholism may be diagnosed with:
Powerlessness R/T inability to quit drinking AEB mood swings and repeated episodes of alcohol abuse.
Altered Nutrition R/T liver damage AEB body not meeting nutrition requirements
Deficient Knowledge R/T effects of alcohol on body AEB excessive alcohol use
Risk for Injury R/T loss of coordination and lack of judgment AEB risky behavior and unsteady gait and movement
Denial R/T extent of alcohol abuse AEB lack of desire to reduce alcohol consumption
My focus diagnosis is Risk for Injury R/T loss of coordination and lack of judgment AEB risky behavior and unsteady gait and movement
Risk for injury occurs due to lack of coordination, poor judgment, and high pain tolerance. Seizure activity is a possibility during withdrawal symptoms which can also lead to injury.
Goals:
1: The patient will not experience injury throughout the recovery process
2: The patient will exhibit decrease in withdrawal symptoms
Interventions:
-Identify stage of alcohol withdrawal and apply interventions appropriately
-Assess coordination
-Implement fall precautions and safety measures (such as gait belt, bed rails, encouraging walker use.
-Monitor and document seizure activity
-Assist with ambulation and ADLs
-Medication per CIWA assessment scale
-Encourage hydration and nutrition
A good site for assisting in nursing diagnoses is
Source: Nurse Labs
Monday, November 30, 2015
Care and Support Groups for Alcoholics
For this week I will talk about ways to help care for those experiencing Alcoholism.
For Alcoholics:
The first and foremost issue is recognizing there is an issue in the first place.
Care can only be given if the individual is willing to try to get better.
Support, counseling, and therapy are all helpful before, during, and after the situation.
The National Institute of Health has another branch in the National Institute of Alcohol Abuse and Alcoholism. They offer support and resources for those currently experiencing alcoholism as well as their friends and families.
Source: Rethink Drinking-NIAAA
Alcoholics Anonymous is another excellent group for support in quitting alcohol abuse. They are a peer led group that allows individuals to talk about their struggles and issues and know that they are not alone in this fight.
AA meetings are, like the name implies, anonymous meetings thus allowing them this opportunity to discuss issue without judgement or fear. This sense of security and support is key in recovering from any addiction and abstaining from returning to it in the future.
Source: Alcoholics Anonymous
The best source of care is from clinics or hospitals and support from family, friends, or support groups.
Simple steps can be of great help, such as:
-Not offering alcohol to friends who are trying to abstain
-Supporting their decision
-Helping them find transport to and from meetings, and appointments
-Listening to them
Alcoholism is a difficult habit for someone to break on their own. Judgement and disdain will not help them to improve their situation in most cases.
If you, a friend or a loved one is suffering form alcoholism I encourage you to seek help. There is no shame in seeking help, and there is great risk to both those afflicted and those around them if help is not sought.
"Be kind, for everyone you meet is fighting a hard battle".-Ian Maclaren
Regression into addiction can be common, and it is not a sign of permanent failure. Every attempt is an effort that was made and can be made in the future.
For Alcoholics:
The first and foremost issue is recognizing there is an issue in the first place.
Care can only be given if the individual is willing to try to get better.
Support, counseling, and therapy are all helpful before, during, and after the situation.
The National Institute of Health has another branch in the National Institute of Alcohol Abuse and Alcoholism. They offer support and resources for those currently experiencing alcoholism as well as their friends and families.
Source: Rethink Drinking-NIAAA
Alcoholics Anonymous is another excellent group for support in quitting alcohol abuse. They are a peer led group that allows individuals to talk about their struggles and issues and know that they are not alone in this fight.
AA meetings are, like the name implies, anonymous meetings thus allowing them this opportunity to discuss issue without judgement or fear. This sense of security and support is key in recovering from any addiction and abstaining from returning to it in the future.
Source: Alcoholics Anonymous
The best source of care is from clinics or hospitals and support from family, friends, or support groups.
Simple steps can be of great help, such as:
-Not offering alcohol to friends who are trying to abstain
-Supporting their decision
-Helping them find transport to and from meetings, and appointments
-Listening to them
Alcoholism is a difficult habit for someone to break on their own. Judgement and disdain will not help them to improve their situation in most cases.
If you, a friend or a loved one is suffering form alcoholism I encourage you to seek help. There is no shame in seeking help, and there is great risk to both those afflicted and those around them if help is not sought.
"Be kind, for everyone you meet is fighting a hard battle".-Ian Maclaren
Regression into addiction can be common, and it is not a sign of permanent failure. Every attempt is an effort that was made and can be made in the future.
Dietary needs
Dietary needs.
I touched a bit on dietary needs in my last post but I will explain a but more here with some further research.
A study posted by the NIH (National Institute of Health) determined that that with alcoholic cirrhosis have similar metabolism of nutrients as does a person with a normal, healthy liver. Despite this they did find that those with a damaged liver enter into the "starvation state" that our bodies enter after 2 to 3 days without food much quicker than those with a healthy liver (12-24 hours in cirrhotic persons).
Here is a quote in discussion of that study:
"The study showed that after an overnight fast the BMR
of patients with alcoholic cirrhosis were normal, but
the nature of the fuels oxidized were similar to those
consumed in normal humans undergoing 2-3 d of total
starvation."
This goes hand in hand with the information in my last post.
A diet for liver damaged individuals should be balanced and avoid components that could damage the liver such as alcohol and certain drugs. Also if the body is retaining water sodium and large amounts of fluids should be avoided as well.
Source: Liver Disease Diet
It should be spread out over the day. Small meals and small snacks should be frequent. They should be healthy meals that include good amounts of protein.
Supplements may also be recommended. Multivitamins and other nutrient supplements may help with protection from further liver damage and promote liver healing.
Diagnosis, Symptoms, and Treatment
This is another combined post as the Diagnosis, Symptoms, and Treatment of alcoholism and related problems is closely tied to the symptoms shown.
Alcohol Withdrawal
Alcoholics that are trying to quit must go through alcohol withdrawal. Alcohol withdrawal should not be gone through with medical attention. If you are an alcoholic trying to quit contact your healthcare provider immediately. There are several treatment options and it can be accomplished effectively with the help of a trained medical professional staff.
Alcoholics can be assessed for risk using the CAGE or AUDIT method.
Found in this article: Hepatology- Study of liver disease
These methods ask how often and how much alcohol the individual consumes. As well as social and behavioral questions.
Questions on the AUDIT questionnaire include:
-How often do you have a drink containing alcohol?
-How many drinks containing alcohol do you have on a typical day when you are drinking?
-How often do you have 5 or more drinks on one occasion?
-How often during the last year have you found that you were not able to stop drinking once you had started?
-How often during the last year have you failed to do what was normally expected of you because of drinking?
-How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
-How often during the last year have you had a feeling of guilt or remorse after drinking?
-How often during the last year have you been unable to remember what happened the night before because of your drinking?
-Have you or someone else been injured because of your drinking?
-Has a relative, friend, doctor or other health care worker been concerned about your drinking or suggested you cut down?
These questions are assessed on their frequent and a rating is given to determine the likelihood of alcohol abuse and risk of withdrawal.
The most common approach to determining if a person is currently experiencing alcohol withdrawal is assessing them with a CIWA assessment scale 8 hours after their last alcoholic drink.
The CIWA is a Clinical Institute Withdrawal Assessment. Below is an example of one that would be used in a clinical setting (such as a hospital or treatment facility).
CIWA link to larger image
This assessment is done to give the medical professional an idea of hard the body is taking the withdrawal.
Many different treatment option are available and will be discussed later.
Source: Oxford Journal-Management of Alcohol Withdrawal
With this a patient may be given an appropriate dose of a benzodiazepine to calm them.
The most commonly used is Lorazepam also known as Ativan.
Benzodiazepines calm the body helping to reduce many of the symptoms especially agitation and anxiety.
The most common symptoms of alcohol withdrawal are those assessed in the CIWA assessment tool.
-Nausea and Vomiting
-Paroxysmal Sweats
-Tremors
-Anxiety
-Agitation
-Visual Disturbances
-Auditory Disturbances
-Headaches
-Tactile Disturbances
-Disorientation
These all have a high chance of occurring (no specific numbers could be found).
Those experiencing withdrawal can often become confused and disoriented and have a diminished sense of balance. This put them at an increased risk for falls and harm to themselves.
Most facilities will institute fall precautions and monitor the patient every 4 hours (or more often if it is deemed necessary) for symptoms and adjust care as needed. No two people experience withdrawal symptoms the same way and so care must be altered to fir the need of each individual person throughout the length of their care.
Hydration, nutrition, and safety are the highest concerns for those experiencing withdrawal.
IV fluids may be given alongside supervised feeding to ensure the safety of the individual.
Alcoholic Liver Disease
Alcoholic liver disease is scarring of the liver (cirrhosis) or other damage to the liver tissue. The liver is the organ that eliminates alcohol from the body.
Source: Hepatology- Study of liver disease
Merely assessing outward physical appearance makes it difficult to assess the extent of ALD, but some common symptoms are ascites (swelling of the abdomen), erythema (flushed skin), pain in the right upper abdomen (where the liver is located), and malnutrition.
Often a blood test is done looking for elevated liver enzymes. These can indicate damage to the liver.
Hepatic imaging may also be done. A CT scan or an MRI may be done to look at the liver and determine if there is tissue damage or scarring present. Different features being diminished may indicate different forms of liver damage. Doctors can determine if the damage is more likely to have been caused by alcohol, hepatitis infections or other sources by looking at the imaging tests. Repeat testing can observe a trend in liver function and assess the extent of damage and how the treatment team will proceed.
If a patient is found positive for ALD the biggest step for them to begin treatment is to abstain from alcohol consumption. Some cases where there is risk for abuse to recur are managed with Disulfiram. Disulfiram is a medication that makes it difficult for the individual to attempt to consume alcohol by making the nauseous or sick to their stomach when the drink alcohol alongside the medication. It also makes their body and mind associate drinking alcohol with feeling very ill and they develop an aversion to drinking.
There are many combinations of therapies that may be recommended for the liver to recover. Nutrition focused on liver health as well as steroids and other medications may be prescribed by your health care provider.
The key note is for those recovering from ALD to eat balanced diets with small means and additional snacks in the mornings and evenings to help their body balance important nutrients along with nitrogen and bilirubin levels. Moderate levels of protein should also be consumed.
For advanced ALD where the liver is unlikely to be able to recover due to excessive scarring or damage it is often recommended to get a liver transplant. A live transplant may be easier than other transplants as it does not require the host to make a permanent sacrifice as the liver is able to regenerate if part of it is removed. The biggest issue is finding a match that the body will not reject once it is in place. Most people must go on a wait list for a new liver unless they have a next of kin that is a match. While they are waiting for a new liver treatment is much the same to reduce further damage. Those who do receive a liver transplant should go through counseling before receiving it, as the recurrence rate of those drinking alcohol after receiving a new liver can be quite high (with rates between 11 and 49%).
Of course the best way to deal with ALD is to prevent it from occurring in the first place. Consuming low amounts of alcohol or no alcohol greatly increases your liver's health. Whereas heavy use does not guarantee you will suffer from ALD it does put you at a very high risk for developing it.
Alcohol Withdrawal
Alcoholics that are trying to quit must go through alcohol withdrawal. Alcohol withdrawal should not be gone through with medical attention. If you are an alcoholic trying to quit contact your healthcare provider immediately. There are several treatment options and it can be accomplished effectively with the help of a trained medical professional staff.
Alcoholics can be assessed for risk using the CAGE or AUDIT method.
Found in this article: Hepatology- Study of liver disease
These methods ask how often and how much alcohol the individual consumes. As well as social and behavioral questions.
Questions on the AUDIT questionnaire include:
-How often do you have a drink containing alcohol?
-How many drinks containing alcohol do you have on a typical day when you are drinking?
-How often do you have 5 or more drinks on one occasion?
-How often during the last year have you found that you were not able to stop drinking once you had started?
-How often during the last year have you failed to do what was normally expected of you because of drinking?
-How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
-How often during the last year have you had a feeling of guilt or remorse after drinking?
-How often during the last year have you been unable to remember what happened the night before because of your drinking?
-Have you or someone else been injured because of your drinking?
-Has a relative, friend, doctor or other health care worker been concerned about your drinking or suggested you cut down?
These questions are assessed on their frequent and a rating is given to determine the likelihood of alcohol abuse and risk of withdrawal.
The most common approach to determining if a person is currently experiencing alcohol withdrawal is assessing them with a CIWA assessment scale 8 hours after their last alcoholic drink.
The CIWA is a Clinical Institute Withdrawal Assessment. Below is an example of one that would be used in a clinical setting (such as a hospital or treatment facility).
CIWA link to larger image
This assessment is done to give the medical professional an idea of hard the body is taking the withdrawal.
Many different treatment option are available and will be discussed later.
Source: Oxford Journal-Management of Alcohol Withdrawal
With this a patient may be given an appropriate dose of a benzodiazepine to calm them.
The most commonly used is Lorazepam also known as Ativan.
Benzodiazepines calm the body helping to reduce many of the symptoms especially agitation and anxiety.
The most common symptoms of alcohol withdrawal are those assessed in the CIWA assessment tool.
-Nausea and Vomiting
-Paroxysmal Sweats
-Tremors
-Anxiety
-Agitation
-Visual Disturbances
-Auditory Disturbances
-Headaches
-Tactile Disturbances
-Disorientation
These all have a high chance of occurring (no specific numbers could be found).
Those experiencing withdrawal can often become confused and disoriented and have a diminished sense of balance. This put them at an increased risk for falls and harm to themselves.
Most facilities will institute fall precautions and monitor the patient every 4 hours (or more often if it is deemed necessary) for symptoms and adjust care as needed. No two people experience withdrawal symptoms the same way and so care must be altered to fir the need of each individual person throughout the length of their care.
Hydration, nutrition, and safety are the highest concerns for those experiencing withdrawal.
IV fluids may be given alongside supervised feeding to ensure the safety of the individual.
Alcoholic Liver Disease
Alcoholic liver disease is scarring of the liver (cirrhosis) or other damage to the liver tissue. The liver is the organ that eliminates alcohol from the body.
Source: Hepatology- Study of liver disease
Merely assessing outward physical appearance makes it difficult to assess the extent of ALD, but some common symptoms are ascites (swelling of the abdomen), erythema (flushed skin), pain in the right upper abdomen (where the liver is located), and malnutrition.
Often a blood test is done looking for elevated liver enzymes. These can indicate damage to the liver.
Hepatic imaging may also be done. A CT scan or an MRI may be done to look at the liver and determine if there is tissue damage or scarring present. Different features being diminished may indicate different forms of liver damage. Doctors can determine if the damage is more likely to have been caused by alcohol, hepatitis infections or other sources by looking at the imaging tests. Repeat testing can observe a trend in liver function and assess the extent of damage and how the treatment team will proceed.
If a patient is found positive for ALD the biggest step for them to begin treatment is to abstain from alcohol consumption. Some cases where there is risk for abuse to recur are managed with Disulfiram. Disulfiram is a medication that makes it difficult for the individual to attempt to consume alcohol by making the nauseous or sick to their stomach when the drink alcohol alongside the medication. It also makes their body and mind associate drinking alcohol with feeling very ill and they develop an aversion to drinking.
There are many combinations of therapies that may be recommended for the liver to recover. Nutrition focused on liver health as well as steroids and other medications may be prescribed by your health care provider.
The key note is for those recovering from ALD to eat balanced diets with small means and additional snacks in the mornings and evenings to help their body balance important nutrients along with nitrogen and bilirubin levels. Moderate levels of protein should also be consumed.
For advanced ALD where the liver is unlikely to be able to recover due to excessive scarring or damage it is often recommended to get a liver transplant. A live transplant may be easier than other transplants as it does not require the host to make a permanent sacrifice as the liver is able to regenerate if part of it is removed. The biggest issue is finding a match that the body will not reject once it is in place. Most people must go on a wait list for a new liver unless they have a next of kin that is a match. While they are waiting for a new liver treatment is much the same to reduce further damage. Those who do receive a liver transplant should go through counseling before receiving it, as the recurrence rate of those drinking alcohol after receiving a new liver can be quite high (with rates between 11 and 49%).
Of course the best way to deal with ALD is to prevent it from occurring in the first place. Consuming low amounts of alcohol or no alcohol greatly increases your liver's health. Whereas heavy use does not guarantee you will suffer from ALD it does put you at a very high risk for developing it.
Epidemiology, Pathophysiology, Etiology, and other "-ologies".
This post will cover a few sections combined together because I feel they can be better explained if talked about in tandem with each other.
This article is where a lot of my information is gathered on pathophysiology:
Wiley online library-Alcoholic Liver Disease
Along with other sources from the CDC, WHO, and other organizations:
This article is where a lot of my information is gathered on pathophysiology:
Wiley online library-Alcoholic Liver Disease
Along with other sources from the CDC, WHO, and other organizations:
Epidemiology maps; these links go to the WHO database for maps that display countries health statistics in different categories. You can use the drop down menu and select "Alcohol and health" for a selection of maps with information on alcohol consumption around the world.
As you can see by this map in 2012 the percent of DALYs attributed to alcohol was between 5-10% in the US. DALY stands for Disability Adjusted Life Year and account for the percent if projected years of life lost due to medical issues.
This presents a significant proportion of deaths and years lost to health as alcohol related. These deaths come from many sources, the primary ones being Alcoholic Liver Disease (ALD) and physical injury due to accidents, such as motor vehicle accidents (MVA) and falls.
While this shows that 2-5% of deaths are alcohol related in the US.
This is a significant portion of deaths.
There is a direct correlation between alcohol consumed per capita and number of cases of cirrhosis (scarring of the liver).
According to the report by the WHO males are much more likely to partake in alcohol consumption, heavy alcohol use, binge drinking, and alcohol dependence. Whereas the age group most at risk is between the ages of 15-25. Women are much more likely to be abstainers from alcohol, but women are more susceptible to damage caused by alcohol than men if they are heavy users. Children and pregnant women should never drink alcohol as it can be extremely harmful to them.
A variety of genetic and social factors also contribute to the chances of alcohol dependence or abuse.
-Children who are raised in a home with alcoholics show an increased risk
-Children raised in foster homes show an increased risk
-Children or adults who experience abuse are at an increased risk
-Individuals with mental disorders are at increased risk
Many social factors could be mitigated when raised in a home that promotes the child's well being.
Education about the risks of excessive alcohol consumption is a key necessity in societies where alcohol leads to the death and injury of so many.
Definitions
This post will encompass important definitions and key points.
Alcoholism also known as Alcohol dependence is when a person’s
body develops a dependence on ingesting alcohol. This is to be differentiated
form Alcohol abuse, which is not an addiction but where alcohol is consumed in
such a manner that it can put the individual at risk for harm to theirself and
others.
To start lets clear up definitions.
Dependence is a physical need by the body for a substance to
be ingested or present in the body.
Addiction means a psychological desire to consume or ingest
a substance (or engage in an act to produce that substance) even if it is
harmful to the body. Another way to put it is continued use despite repeated
physical, psychological or interpersonal problems.
Alcoholism falls into the dependence category. Where if the
substance is removed from the body, the body will begin experiencing
withdrawal symptoms.
Withdrawal is when a negative reaction occurs due to the
fact that a substance is missing from the body, common in drugs and alcohol. Withdrawal
symptoms can vary depending on the substance withdrawing from.
Tolerance is when a body becomes resistant or tolerant of
the effects of a substance, as to such that to feel the effects of the
substance you must first break past the tolerance level.
Tolerance break is a term to describe a major shift in
functioning when the tolerance level has been breached. (an example being a
chronic alcohol dependent person drinking a large amount of alcohol and not
experiencing intoxication until breaking their tolerance limit and experiencing
rapid, heavy intoxication).
Binge Drinking is drinking enough alcohol to bring the blood
alcohol level(BAC) to 0.08% or more. This usually entails 5 or more standard
drinks for men and 4 or more standard drinks for women. The time frame is
usually within 2 hours.
Heavy drinking is usually defined as 15 or more drinks a
week for men and 8 or more drinks a week for women.
A standard drink is equal to about 14.0 grams (0.6 ounces) of pure
alcohol. Generally, this amount of pure alcohol is found in
-12-ounces of beer (5% alcohol content).
-8-ounces of malt liquor (7% alcohol content).
-5-ounces of wine (12% alcohol content).
-1.5-ounces or a “shot” of 80-proof (40% alcohol content)
distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).
Whenever I refer to drinks in posts it will be based off of this information.
It is the amount of pure alcohol that is important; the type
of drink does not affect the health detriments of the drink (sans calorie
content).
All sources will be posted in my sources page. If you have questions on a specific source please feel free to contact me. (I will attempt to update the blog in the future to have all sources marked clearly for each post that they correspond to.)
Introduction
This Blog is an assignment for a Health Promotion course for a Bachelor's level Nursing program.
In this blog I will be discussing the effects of Alcohol and Alcoholism on the health of individuals and communities.
I will start off by saying this is not a blog which its purpose is saying alcohol is bad; alcohol can actually have some positive benefits (which we will get into later) when consumed in appropriate amounts. This blog is merely meant to be informative and allow people to educate themselves on the risks and challenges that alcohol can pose.
If you have any questions regarding my blog, feel free to leave a comment or message me directly.
In this blog I will be discussing the effects of Alcohol and Alcoholism on the health of individuals and communities.
I will start off by saying this is not a blog which its purpose is saying alcohol is bad; alcohol can actually have some positive benefits (which we will get into later) when consumed in appropriate amounts. This blog is merely meant to be informative and allow people to educate themselves on the risks and challenges that alcohol can pose.
If you have any questions regarding my blog, feel free to leave a comment or message me directly.
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