Dependency States
Dependency States
Dependency States
ABUSE .
Definitions .
Teetotaler: Person who do not drink alcohol at all
Social drinker: Person who drinks moderately but
who may get drunk from time to time.
Excessive drinker: Person who may drink excessively
and may show either by the frequency with which they
become intoxicated .
Tolerance: The need for markedly increased amount
of alcohol to achieve the desired effect.
Withdrawal: The development of symptoms like
morning shakes after cessation or deduction in
drinking alcohol.
Abuse of substance: Use of illegal substances such as
drugs, for purposes other than those fore which they
meant to be use or in excessive amount, which lead to
impairment in social or occupational functioning, with
the duration of the abuse.
Alcohol :
Alcohol (ethyl alcohol or ethanol) is a substance most
intensively used for non-medical purpose.
It can be produced by the growth of yeast in a sugar-
containing medium (fermentation).
Alcohol acts on every cell of the body; however the
CNS is its prime target.
Its effects occur more rapidly in the CNS than in any
other tissue of the body.
It affects every level of organization with in the CNS
from its chemistry to its molecular structure and the
integrated functions that govern thought process,
emotions, motor function and behavior.
A single dose of alcohol results in non - specific
general depression of the CNS and subsequent
behavioral changes. These changes are dose
dependent.
They are related to the blood alcohol concentration
(BAC).
However, some of the CNS changes may be longer
lasting.
Elimination of alcohol from the system, or a marked
decrease in BAC after long term use may cause the
alcohol withdrawal syndrome (AWS)
Characteristics of alcohol withdrawal
syndrome(AWS).
Characteristics of AWS include hyper-excitability
(opposite of depression) evidenced by tremors and
agitation, convulsions, ataxia, dizziness, dilation of
pupils and hallucination.
The depression of the CNS by alcohol is dependent on
the amount consumed.
The effects on mood and behavior differ between
individuals and depend not only on the amount
consumed but also to a large extent, and the mental
state of the individual and their environment.
Small amounts of alcohol will produce sedation and
relief of anxiety.
As the blood level increases, these symptoms become
more pronounced.
When a large amount is consumed depression,
inadequate muscular coordination (ataxia),
impaired psychomotor performance, and inhibited
or irresponsible behavior may be manifested.
Excessive consumption will produce unconsciousness
and may be lethal in the presence of other depressant
drugs.
Alcohol is mainly absorbed directly in small intestine,
but also in stomach.
In the presence of food the rate of absorption
decreases.
Treatment
Treatment includes providing reassurance in a quiet
place and diazepam may be given.
EPILEPSY
Learning objectives:
After this unit, the student should be able to:
1. Define epilepsy
2.Describe different classifications of epilepsy
3.Identify different clinical features of epilepsy
4. Diagnose epilepsy
5. Identify differential diagnoses of epilepsy
6. Explain appropriate medical and nursing management of epilepsy
7.Give health teaching for clients and family members (care takers)
of epileptic patient.
Definition: Epilepsy is derived from the Greek word
‘epilepsia’ which means to take hold of or to seize. It
is paroxysmal neurological disorder causing
recurrent episodes of:
1. Loss of consciousness
2. Convulsive movements or motor activity
3. Sensory phenomena or
4. Behavioral abnormalities
The following are important characteristics of
epilepsy:
Seizure A paroxysmal, uncontrolled, abnormal
discharge of electrical activity in the gray matter with
in the brain causes events that interfere with normal
function, a symptom rather than a disease.
Prodromal phase: This Phase precedes some seizures
and may last minutes or hours: a vague change occurs
in emotional reactivity or affective responses.
Aura: A brief sensory experience occurs e.g. a feeling
of weakness, dizziness strange sensations in an arm or
leg numbness, an odor that occurs at the onset of some
seizures
Epileptic cry: A cry, occurring in some seizures,
caused by a thoracic and abdominal spasm which
expels air through the narrowed spastic glottis.
Ictus, post ictus, post ictal refers to the time
immediately after a seizure during which the client
usually experiences some change in consciousness,
behavior, or activity.
Etiology
The etiology of seizures varies remarkably in adults
and includes:
1. - Brain tumor is the most common cause for organic
seizure (intracranial mass)
2. - Head injury
Clinical manifestations
There are various types and classifications of seizures.
They can be classified into two major groups:
1.Generalized seizures:
- Tonic clonic seizures (grand mal)
- Absence (petit mall) -
- Minor motor seizures (akinetic, atonic)
2. Partial seizures (focal epilepsy)
- Partial seizures with motor components
-Partial seizures with sensory components
- Partial seizures with complex symptoms
- Partial seizures that secondarily generalize
Diagnostic assessment
Assessment of a client experiencing seizures involves:
- History: including, prenatal, birth, and developmental
history, family history, age of seizure onset, trauma, illness
and complete description of seizure including
precipitating factors
- Psychosocial assessment, including mental status
examination - Complete physical examination, including a
detailed neurological examination
- Skull radiographs
- EEG and CT scan to detect tumor
Medical management:
Medical management includes:
1- Eliminating factors that may cause or precipitate
seizures.
2- Improving the client’s physical and mental health
3 - Specific medical treatment, and Possible surgical
treatment.
The main focus in intervention for epilepsy is
preventing seizures from occurring
Drug treatment
Drug treatment include:
1. Phenobarbital 30 - 100 mg po/daily (for grand mal
epilepsy)
2. Phenytoin (dilantin) 100 mg po/day
3. Carbamazepine (tegretol)
Side effects of anti epileptic drugs include mental
dullness, ataxia, diplopia, hypertrophy of gums, emotional
and mental changes including depression, irritability,
impotence, withdrawal seizures, if drug is not
discontinued slowly
Nursing care help
the client identify factors that precipitate seizures and
ways of avoiding these factors. Such factors include:
- Increased stress
- Lack of sleep
Emotional upset and
Alcohol use
Emotional effects of epilepsy
Clients with epilepsy often have a poor self-image,
they may experience:
- Feelings of inferiority
- Self-consciousness
- Guilt
-Anger
- Depression
Observation (assessment during the seizure attacks):
Nurses should make the following observations during
seizures:
Duration of the seizure (tonic clonic 30 - 60 seconds)
Were the seizure begun?
Did eyes deviate?
Were the respiration’s labored or frothy?
Was client incontinent?
Status epilepticus (persistent and uncontrollable
seizure).
Family education: The client's family needs to know what
to do for the client in the event of a seizure, Nurses can
advise the family about:
- Protecting the patient from self injury
- Loosening their clothing
- Protecting the patients head from impact and sharp
objects
- Not to restrain the patient forcibly during seizure.
Not to insert hard object or finger in the mouth
Position the patient to their side when the seizure is over.
END.