Risk factors elder substance abuse

1
Risk factors elder substance abuse

• Chronic illness-pain (long term use of Rx.
  narcotics etc.)
• Life stress
• Loss
• Social isolation
• Grief
• Depression
• Abundance of free time
• Money (Atkinson, 2004)

2

• Drinking problems fall into two distinct patterns
  in the older adult
• 2/3rds early onset alcoholism
• 1/3rd late onset alcoholism
• (Menniger, 2002)
• Use screening tool AUDIT(Alcohol Use Disorder
  Identification Test) for early identification of
  alcoholism problem in older adults.

3
Psychosocial issues physiologic changes
associates with substance abuse in elderly

• Increase risk for falls/injuries
• Increase risk suicide (especially older
  male,single,caucasian,gt65 w/health problems)
• Increase vulnerability to infection( r/t
  decreased immune system from alcohol abuse)

4
Age related problems include

• Difficulty seeking help
• Exacerbation of Cardiovascular and GI problems
• Increased risk for withdrawal S/Es of ETOH
  drugs r/t more fragile homeostasis
• Ignored by health care system society
• Few age related programs exist
• Little research published

5
SUBSTANCE ABUSE IN HEALTH PROFESSIONALS

• Higher rates of dependence on controlled
  substances (Jaffe Anthony 2005)
• Problems with Reporting colleagues
• Sensitive issue
• Want to avoid conflict
• Fear of falsely accusing colleague
• Feel guilty

6
Legal /ethical responsibility

• Ethical responsibility report suspicious
  behaviors to supervisor!
• Legal obligation defends State Nurse Practice
  Act!
• DO NOT try to handle situation alone!

7
Warning signs of abuse

• Poor work performance
• Frequent absenteeism
• Unusual behaviors
• Slurred speech
• Isolates self from colleagues

8
Specific signs symptoms of substance abuse

• Nurse should watch for
• Incorrect drug counts
• Controlled substances listed as
  wasted/contaminated(occurring more frequently)
• Client reports of ineffective pain relief
• Damages/torn packages of controlled substances

9
Nurse should watch for

• Increased reports of pharmacy errors
• Frequently offers trips to pharmacy to obtain
  controlled substances
• Trips to bathroom after contact with controlled
  substances
• Consistently arrives early or departs late from
  work no apparent reason

10
CA BRN Diversion Program

• Rehab -based program
• Provides early intervention
• Board determines candidacy for program

11
BRN criteria for admission into program

• CA license residence
• No hx. of previous discipline
• Has not failed to complete a previous diversion
  program
• No harm to clients has been determined
• Problems r/t chemical dependency or mental
  illness
• Willingness to comply with practice restrictions
• Not a sex offender

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Additional program eligibility

• Must voluntarily request admission
• Agree to undergo reasonable Psychiatric/medical
  examination
• Cooperate provide medical info.,
  authorizations, release liability
• Agree in writing to comply to all elements
• Not have diverted controlled substances for sale

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Clients with eating disorders

• Underlying emotional conflicts dealt with by
  destructive food related behavior

14
Nursing Dx.Imbalanced nutrition ltbody
requirements r/t intake of nutrients insufficient
to meet body needs

• Assessment characteristics
• Wt loss
• Body wt 15 under ideal body wt.
• Denial or loss of appetite,difficulty swallowing
• Inability to perceive accurately respond to
  internal stimuli r/t hunger or nutritional needs
• Epigastric distress,vomiting,
• Laxative abuse
• Concealing wts on body to ?wt .measurement

15
Anorexia characteristics continued

• Denial of illness or resistance of treatment
• Denial of being too thin
• Excessive exercise
• Multiple related physical problems
• Interventions must be specific to client physical
  and emotional problems and degree /severity of wt
  loss and anorexia

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Examples of interventions

• If critically malnourished
• Parenteral nutrition through a central catheter
  may be indicated(adequate nutrition,electrolytes
  etc. can be provides parenterally,client cannot
  vomit this type of nutrition)
• Tube feedings may be used alone or with oral
  parenteral nutrition(fortified liquid diets can
  be provided through tube feedings)

17
Severe anorexia interventions

• Supervise client for specified time(90 minutes
  decrease to 30 minutes after tube feeding or
  remove NG tube after feeding(supervision
  decreased clients opportunity to vomit or siphon
  feedings)
• Offer client opportunity to eat food orally-use
  tube feeding if amount consumed is
  insufficient(client may prefer to eat food
  orally- however, physical health is priority)

18
Severe malnourishment

• If N/G tube is used be matter-of fact re
  insertion/use DO NOT use as a threat!
• DO NOT permit client to bargain!(limits
  consistency essential in avoiding power struggles
  and decreasing manipulative behaviors)

19
Interventions for the non- critically
malnourished client

• Initially do not allow client to eat with ither
  clients or visitors(other clients may repeat
  family patterns by urging client to eat or
  providing attention to client for not eating)
• Provide structure to mealtime-state limits
  matter-of-factly (clear limits lets client know
  what is expected)

20
Interventions continued

• Do not bribe,coax,threaten or focus on eating at
  all!
• Withdraw attention if client refuses to eat.
• When meal is over remove food without
  discussion(minimizes clients secondary gains
  from not eating- does not reinforce issues of
  control which are central to client)

21
Interventions continued

• Encourage client to seek out staff members after
  eating to talk about feelings of anxiety or guilt
  or if urge to vomit exists.(speaking to staff
  promotes focus on emotional issues rather than
  food)
• Supervise during after meals start with 90
  minutes gradually reduce to 30 minutes.Do not
  permit use of bathroom until at least 30 minutes
  after each meal (client may spill,hide or discard
  food-may use BR to vomit or dispose of concealed
  food)

22
Interventions continued

• Gradually permit client increased choices
  regarding food, mealtime etc.(develops
  independence in eating habits)
• Monitor IO in an unobtrusive and matter-of fact
  manner(minimizes direct attention to eating and
  removes emotional issues)
• Weigh client daily,after client has voided and
  before morning meal client should wear only
  hospital gown(consistency is necessary for
  accurate comparison of wt.over time)
• Observe/record client overt/covert physical
  activity(client may exercise to excess to control
  wt.)

23
Review questionsEating disorders

• The nurse should include which of the following
  interventions in the plan of care for a client
  with bulimia? (select all that apply)
• A. Encourage the client to avoid eating except at
  mealtime.
• B. Promote a weight gain of 3 to 5 pounds per
  week.
• C. Observe the client for one hour after meals.
• D. Encourage the client to identify foods that
  trigger a binge.
• E. Instruct the client to keep laxatives and
  diuretics in a locked area.
• F. Inform the client that there are no
  forbidden foods.

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Review questions

• The nurse is caring for a client with anorexia
  nervosa. Even though client has been eating all
  her meals and snacks her weight is unchanged for
  one week. Which intervention would be indicated
• A. Close Obs.xs2 hrs. p meals/snacks
• B. ? caloric intake from 1500 2000 calories
• C. ?fluid intake
• D. Request Rx for antianxiety med from MD

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• Which of the following nursing interventions
  should the nurse include in the plan of care for
  a client with anorexia nervosa who is
  hospitalized?
• Encourage the client to talk about food during
  mealtime.
• Ask the client if any food, laxatives, or
  diuretics have been brought back to the hospital
  after a pass.
• Discourage the client from participating in
  nutritional counseling.
• Provide highly structured mealtimes with regular
  meals.

26

• During a nutritional assessment of a client with
  binge eating disorder, which of the following
  does the nurse evaluate as most significant in
  contributing to binge eating?
• A rigorous exercise plan
• Periods of fasting
• Weighing too frequently
• Eating a diet low in carbohydrates.

27

• The nurse should assess a client suspected of
  having bulimia for which of the following
  clinical manifestations (select all that apply)
• Constipation
• A20 loss of normal body weight
• Dental erosion
• Languo
• A serum potassium of 3.0mEq/L
• Depression

28

• Which of the following nursing interventions
  should the nurse include in the plan of care for
  a client with anorexia nervosa in the
  outpatient setting? (select all that apply)
• Set minimum weight limits in which the client may
  continue treatment in the outpatient setting.
• Avoid discussing the clients irrational thoughts
  about food and weight with the clients family.
• Encourage the client to be weighed daily at the
  same time of day.
• Instruct the client to avoid preparing ones own
  meal.
• Instruct the client to keep a food diary.
• Assist the client with meal planning.

29
The nurse is evaluating the progress of a client
with bulimia.Which behavior indicates the client
is making progress?

• A. The client identifies calorie content for each
  meal
• B. The client identifies healthy ways of coping
  with anxiety
• C. The client spends time resting in her room
  after meals
• D. The client verbalizes knowledge of former
  eating patterns