Module No. 6 NCM 117

MODULE NO.
6 NCM 117
Alcohol Abuse
Autism
Eating Disorders
ALCOHOL
ALCOHOLISM
 Intergenerational Transmission
 Awake but unconscious
 Blackout
 Confabulation
 Denial, dependence
 Enabling, co-dependence
 Tolerance increases
 Detoxification - doctor
PERVASIVE DEVELOPMENTAL
DISORDERS
Characterized by pervasive and usually severe
impairment of reciprocal social interaction
skills, communication deviance, restricted
stereotypical behavioral patterns. 75% are
also mentally retarded.
• Autistic Disorder
• Best known of these disorders
• More prevalent in boys
• Present by age 3
• Child has little eye contact, few facial
expressions, does not communicate verbally or
with gestures, doesn’t relate to peers or
parents, lacks spontaneous enjoyment;
apparent absence of mood and affect; cannot
engage in play or make-believe with toys
• Hand-flapping, body-twisting, head-banging
• Autism may improve, sometimes substantially,
as language and communication skills are
learned.
• Traits persist into adulthood. Few attain
complete independence, marry, or have
children.
• Most autistic children are
mainstreamed in school.
• Medications may be used to target
specific behaviors but do not treat the
autism.
• Goals are to reduce behavioral
symptoms and promote learning,
development, and language skills.
ATTENTION DEFICIT
HYPERACTIVITY DISORDERS
• persistent inattentiveness, over activity, and
impulsiveness for at least 6 months
Inattentiveness includes:
- Carelessness and inattention to details
- Cannot sustain attention and does not appear to be
listening
- Does not follow instructions and unable to finish
tasks, chores, and homework.
- Difficulty with organization and dislikes activities
requiring concentration and sustained effort.
- Loses things; distracted by extraneous stimuli,
forgetful.
Hyperactivity includes;
- Hyperactivity
- Fidgeting, moving feet, squirming
- Darting around, climbs excessively.
- Difficulty playing quietly.
- Always “on the go”
- Excessive talking
Impulsivity includes;
- Blurts out answers, speaks before thinking

- problem waiting his/her turn.
- interrupts or intrudes
• Affects 3% to 5% of school-aged children;
affects boys more frequently
• Can persist into adulthood
• Often diagnosed when child starts school
• Child may be ostracized by peers due to
behavior
• No known cause; seems to be familial
tendency
Onset and Clinical Course
Most often diagnosed when child

starts school or preschool
ETIOLOGY
Essentially unknown, but likely to be a
combination of factors such as
environmental toxins, prenatal
influences, heredity, damage to
brain structure and function.
TREATMENT
• Combination of behavioral strategies and
psychostimulants (Ritalin)
• Side effects: insomnia, loss of appetite,
weight loss or failure to gain weight
• Behavioral strategies are necessary at home
and school to help the child succeed:
consistent rewards and consequences for
behavior, using time-out, points systems,
structured routine and schedule for activities
Data Analysis
Nursing diagnoses include:
• Risk for Injury
• Ineffective Role Performance
• Impaired Social Interaction
• Compromised Family Coping
Intervention
Can be used in variety of settings and
taught to parents, teachers, and
caregivers:
• Ensuring safety
• Improved role performance
• Simplifying instructions, breaks commands
into simple steps
• Providing a structured daily routine
• Providing client and family education
and support
-Time outs may be needed for cooling down
- Role-playing – helpful in teaching friend-friend
interaction; helps child prepare for interactions
and understand how intrusive behaviors annoy
and drive friends away
- Inform school about the disorder
- Support desired behaviors and immediately
respond to undesired behaviors with
consequences.
- Natural consequences – (loses bicycle) do not
replace; has to save own money to replace it
Stages of Alcohol Withdrawal
 I 8 hours after the last drink
 Mild tremors, tachycardia, increased BP, diaphoresis,
nervousness
 2 8-12 hours after the last drink
 Gross tremors, hyperactivity, profound confusion, loss of
appetite, insomnia, weakness disorientation, illusions,
hallucinations and delusions
 3 12-48 hours after the last drink
 * severe hallucinations, grand mal seizures
 4 3-4 days after the last drink
 Delirium tremens, confusion, agitation, hallucinations, insomnia
and tachycardia
ALCOHOLISM
 Avoid alcohol during therapy
 Aversion therapy
 Antabuse – disulfiram
 Belongings – check for alcohol, mouthwash,
elixir etc.
 B1 deficiency

Complication
 Wernicke’s Encephalopathy (Motor)
 Korsakoff’s Pychosis (Mind)
 Deliruim Tremens
 Fornication
Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Pica
Compulsive
Eating Behavior
EATING DISORDERS
Anorexia Nervosa
Symptoms:
 Refusal to maintain body weight over a minimum
normal weight for age and height
Intense fear of gaining weight or becoming fat,
 even though underweight
Disturbance in the way in which one’s
 bodyweight, shape or size is experienced
In females, absence of menses of at least 3
 consecutive cycles
Inability or refusal to acknowledge the
 seriousness of the problem
 Onset: 12-15, 17-21 years of age
Etiology
 Cultural pressure
 Serotonin imbalance controls appetite
and the satiety control center
 Family Patterns
 Perfectionist
 Does not permit verbalization of feelings
 Marital problems
Clinical Presentation
 Terrified of gaining weight
 Pre-occupied with thoughts of food
 See themselves as fat even when emaciated
 Peculiar handling of food
 Cutting food into small bits
 Pushing pieces of food around the table
 May develop rigorous exercise program
 Self-induced vomiting, laxatives and diuretics
 Cognition so disturbed that they judge their self-
worth by their weight.
 Low weight  Low T3 and T4
 Amennorrhea  Hypotension
 Yellow skin  Bradycardia
 Cold extremities  Hypokalemia
 Peripheral edema  Anemia
 Muscle weakening  Pancytopenia
 Constipation  Decreased bone
density
Signs Related to Purging Behavior
 Gastrointestinal
 Parotid gland tenderness, Pancreatitis,
esophageal and gastric erosion or
rupture
 Metabolic
 Electrolyte abnormalities
hypokalemia
 Dental
 Erosion of dental enamel of the front
teeth
Objectives of care:
 Increasing body weight to at least90% of
average weight for age and height
 Reestablishing good eating
 behavior Increasing self esteem
Nursing Interventions:
 Monitor daily caloric intake, activity level, weight and
electrolyte status.
 Establish nutritional eating patterns
 Sit with client during meals

 Offer liquid protein supplement if unable to complete a meal
 Observe signs of purging 1-2 hours after meals
 Provide accurate information on nutrition and discuss
realistic and healthy diet
 Help the client identify emotions and develop non-food
related strategies.
 Convey warmth and sincerity
 Ask the client to identify feelings
 Assist the client to change
stereotypical beliefs
Nursing Interventions
 Assist in identifying at least three positive
characteristics
 Teach patient about their illness
 Behavior modification : reward increase in
weight with meaningful privileges
 Identify patient’s non weight related interests
to reduce anxiety and refocus attention.
Bulimia Nervosa
Symptoms:
 Recurrent episodes of binge eating
 Feeling of lack of control over eating behaviors
during the eating binges
 Recurrent inappropriate compensatory behavior in
order to prevent weight gain, such as self induced
vomiting
 Binge eating and inappropriate eating behaviors
 Persistent over concern with body shape and
weight
 Binge and Purging behaviors
 Have depressive signs and symptoms
 Disturbed home life
 Major concerns
 Interpersonal relationships
 Self-concept
 Impulsive behaviors
 Chemical dependence is also common
 Normal to slightly low weight
 Dental carries
 Parotid swelling
 Gastric swelling and rupture
 Callusses or scars on the hand
 Peripheral edema
 Hypokalemia, Hyponatremia
Management
 Trust
 Help patient identify feelings associated with
binge-purge behaviors
 Accept patient as worthwhile human beings
because they are often ashamed of their
behavior
 Encourage patient to discuss positive
qualities about themselves
 Teach about bulimia nervosa
 Encourage to explore interpersonal
relationships
 Encourage patients to adhere to meal and
snack schedules
Management:
 Encourage the patient to approach the staff
if she feels like binging or purging
 Encourage to attend group sessions
 Encourage family therapy
 Encourage participation in art, recreation
and occupational therapy
 Encourage the patient to describe their
body image at different ages of their lives.

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MODULE NO.

- Blurts out answers, speaks before thinking

Most often diagnosed when child

 Sit with client during meals

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