Substance Abuse: Alcohol

Question 1

Adverse Effects of Alcohol

Answer 1

Blackouts, Cirrhosis, pancreatitis and Pancreatic Cancer, Gastric Ulcers, Esophageal Cancer, Gastritis, Thrombocytopenia, High risk for injury to self and others, Fetal Alcohol Syndrome, Vitamin B1(Thiamine) Deficiency

Question 2

Blackouts

Answer 2

Transients Global Amnesia. Remote memory not affected. The patient will appear to function normally to observers during blackout but will not be able to remember what they did during this time period. Passing out IS NOT having a blackout.

Question 3

Cirrhosis

Answer 3

With chronic Alcohol use, the liver begins to accumulate fat and protein which result in chemical cirrhosis. This results in scarring of the liver with the loss of healthy functioning tissue. EARLY S/S Include: Anorexia, Dyspepsia, Flatulence, N/V, and Changes in Bowel Habits.

LATER SIGNS Include: Portal Hypertension, Jaundice, Spider Angiomas, Ascites, Hematological Disturbances.

Because of the liver scarring, the portal veins are obstructed resulting in the development of collateral vessels (Varicosities) in the lower esophagus, stomach, and rectum. *** These Varicosities often Rupture resulting in hemorrhage and death.

The nurse should assess any report of blood in the stool or coughing of blood by a patient with a hx of alcoholism as an EMERGENCY.

Question 4

Thrombocytopenia

Answer 4

Decreased platelet production due to poorly functioning liver

Question 5

Fetal Alcohol Syndrome

Answer 5

Microcephaly, cranio-facial defects, limb and heart defects. Risk is 35% for babies born to mother’s using alcohol.

Question 6

Vitamin B1 (Thiamine) Deficiency

Answer 6

1. Peripheral Neuropathy (Nerve Damage with pain, tingling, burning and numbness)
2. Alcoholic Myopathy- Muscle Pain, Swelling, and Weakness of primarily lower extremities - Myoglobin can turn urine Red
3. Wernicke- Korsakoff Syndrome-
   WERNICKE- ACUTE PHASE with paralysis of ocular muscles, diplopia (double-vision), ataxia, somnolence & stupor

KORSAKOFF: CHRONIC PHASE with confusion, LOSS OF RECENT MEMORY & CONFABULATION (Patient makes up a story to cover the inability to remember a story or information)
***With loss of recent memory, then patient has probably moved into chronic stage=Korsakoff-Dementia Stage

Question 7

Treatment of Vitamin B1 (Thiamine) Deficiency

Answer 7

Is” Thiamine. This is usually given orally but can be given IV for severe symptoms. When a patient presents with KORSAKOFF S/S the treatment with Vitamin B1 may not be helpful as many times these S/S are IRREVERSIBLE.

Question 8

Portal Hypertension

Answer 8

An elevation in BP through the portal circulation that results from defective blood flow through the cirrhotic liver

Question 9

Ascites

Answer 9

A Condition in which an excessive amount of serous fluid accumulates in the abdominal cavity that occurs in response to portal hypertension. The increased pressure results in the seepage of the fluid from the surface of the liver into the abdominal cavity

Question 10

Esophageal Varices

Answer 10

veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. As this pressure increases, these varicosites can rupture, resulting in hemorrhage and sometimes death

Question 11

Hepatic Encephalopathy

Answer 11

Serious complication that occurs in responce to the inability of the diseased liver to convert ammonia to urea for excretion. The continues rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbance, increasing confusion, and progression to coma and eventual death.

Treatment requires complete abstinence from alcohol, temporary elimination of protein from diet, and reduction of intestinal ammonia using neomycin or lactulose

Question 12

Varices

Answer 12

usually found in base of esophagus, stomach, and rectum. Patient DOES NOT KNOW they have them until they rupture.

Question 13

What happens when fat and protein replace healthy liver tissue?

Answer 13

1. Less functioning liver tissue available
2. Portal veins become blocked
3. Because of pressure- trying to get blood to go thru damaged liver- varices will develop

Question 14

Alcohol POST WITHDRAWAL drugs

Answer 14

POST WITHDRAWAL DRUGS:

1. Antabuse-
   - 2 weeks till therapeutic level
   - Chemical aversion- like a chemical spanking if alcohol consumed while taking it
   - Patient becomes violently ill if drinking ANY alcohol while on it
   - increased VS, GI symptoms (N/V/D)
   - patient education for OTC items containing alcohol- They MUST be AVOIDED. Teach patient to READ LABELS!