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SPECIFIC COURSE LEARNING OUTCOMES:
1. Apply the different knowledge of physical, social, natural and health
sciences and humanities in situation, Acute and chronic.
2. Practice nursing in accordance with existing laws, legal, ethical, and
moral principles.
3. Communicate effectively in speaking, writing, and presenting using
culturally-appropriate language
4. Report/document client care accurately and comprehensively.
5. Collaborate effectively with inter-, intra-, and multi-disciplinary and
multi-cultural teams.
EATING is part of
everyday life. It is
necessary for survival, but
it is also a social activity
and part of many happy
occasions. Yet, for some
people, eating is a source
of worry and anxiety.
Millions of women are
either starving themselves
or engaging in chaotic
eating patterns that can
lead to death.
1. ANOREXIA NERVOSA: A life
threatening eating disorder
characterized by the client’s
restriction of nutritional
intakes necessary to maintain a
minimally normal body weight,
intense fear of gaining weight
or becoming fat, significantly
disturbed perception of the
shape and size of the body, and
steadfast inability or refusal to
acknowledge the seriousness
of the problem or even that
one exists.
SUBTYPES:
A. BINGE-EATING: Consuming a large
amount of food far greater than most
people eat at one time in a discreet
period of usually 2 hours or less.

B. PURGING: involves compensatory

behaviors designed to eliminate food by
means of self-induced vomiting or
misuse of laxatives, enemas, and
diuretics.
2. BULIMIA NERVOSA: Often simply called Bulimia is an eating disorder
characterized by recurrent episodes of binge eating followed by
inappropriate compensatory behaviors to avoid weight gain, such as
purging, fasting, or excessively exercising.
ETIOLOGY: A specific cause for
eating disorders is unknown. It is
posited that a family history of
mood disorder places a person at
risk for eating disorders (Sadock
et al., 2015). The biologic theory
suggests that disruptions of the
nuclei of the hypothalamus may
produce many of the symptoms
of eating disorders particularly in
many aspects of hunger and
satiety.
DEVELOPMENTAL FACTORS: Two essential
tasks of adolescence are the struggle to
develop autonomy and the establishment of
a unique identity. Autonomy or exerting
control over oneself and the environment,
may be difficult in families that are
overprotective or in which enmeshment
exists. Adolescent girls who express body
dissatisfaction are most likely to experience
adverse outcomes such as emotional eating,
binge eating, abnormal attitudes towards
eating and weight, low self-esteem, stress
and depression (Black and Andreasen, 2014).
FAMILY INFLUENCES: Girls
growing up amid family problems
and abuse are at higher risk for
both anorexia and bulimia.
Disordered eating is a common
response to family discord which
becomes a distraction for
emotions. Childhood adversity
has been identified as a significant
risk factor in the development of
problems with eating and weight
in adolescence and early
adulthood.
CULTURAL CONSIDERATIONS:
Eating disorders appear to be
equally common among
Hispanic and Caucasian
women and less common
among African-American and
Asian women. Minority
women who are younger,
better educated and more
closely identified with middle-
class values are at increased
risk for developing an eating
disorder (Quick & Byrd-
Bredbenner, 2014).
TREATMENT AND PROGNOSIS: Clients with Anorexia can
be very difficult to treat because they are often resistant,
appear uninterested and deny their problems. Treatment
settings include inpatient specialty eating disorder units,
partial hospitalization or day treatment programs and
outpatient therapy. Major life-threatening conditions that
require hospital admission are: severe electrolyte
imbalances, metabolic imbalances, cardiovascular
complications, severe weight loss and it, consequences
(Black & Andreasen, 2014).
Medical management focuses on
weight restoration, nutritional
rehabilitation, and correction of
electrolyte imbalances.
Psychotherapy involves: family
therapy, individual therapies.
Enhanced Cognitive Behavioral
Therapy has been successful in
addressing body image
disturbance in both Anorexia and
Bulimia. It also addresses
perfectionism, mood intolerance,
low self-esteem and
interpersonal difficulties (Groff,
2015).
ADDICTION
Prepared by:
Leidelyn A. Emock
SPECIFIC COURSE LEARNING OUTCOMES:
• 1. managing client with life threatening condition/ acutely ill/ multi organ
problems/ high acuity and emergency Apply the different knowledge of
physical, social, natural and health sciences and humanities in situation,
Acute and chronic.
• 2. Practice nursing in accordance with existing laws, legal, ethical, and
moral principles.
• 3. Communicate effectively in speaking, writing, and presenting using
culturally-appropriate language
• 4. Report/document client care accurately and comprehensively.
• 5. Collaborate effectively with inter-, intra-, and multi-disciplinary and
multi-cultural teams.
TERMS:

1. Polysubstance abuse
• More than ONE
2. Intoxication
• Is use of substance that results in maladaptive behavior
3. Withdrawal syndrome
• Refers to the negative psychological and physical
reactions that occur when use of a substance ceases or
dramatically decreases
4. Detoxification
• The process of safely withdrawing the patient from a
substance
5. Substance abuse
• Using a drug in a way that is inconsistent with medical or
social norms and despite negative consequences.
• Problems: SOCIAL, VOCATIONAL, LEGAL areas of persons life
• 50% of people with substance abuse disorder also have a
mental health diagnosis “DUAL DIAGNOSIS”
DETOXIFICATION is the initial priority
ONSET and CLINICAL COURSE
• 15 – 17 years of age
• Middle twenties to middle thirties
• Alcohol related breakup
• Arrest for public intoxication or
DRIVING WHILE INTOXICATED
• Health problems
• BLACKOUTS
• Person continues to function but has
no conscious awareness of his or her
behavior at the time or any later
memory of the behavior
ETIOLOGY
1. Biological
• Children of Alcoholic Parents
• Partly Genetics (e.g. Adoption)
2. Psychological Factors
• Family dynamics
• Parents behavior
• Poor Modeling
• Stormy Relationship
• LACK OF ADAPTIVE COPING SKILLS
3. Social and Environmental Factors
• CULTURE
• MUSLIMS – WINE but no ALCOHOL
• KOREANS - Soju
1.ALCOHOL – most abused substance
• Physiologic effects: Initially, RELAXATION and
DISINHIBITIONS, Relief of anxiety; As the CNS
becomes more irritated the normal drinkers
feels sick and irritable , “HANGOVER” but lives
through it, perhaps vowing “never again”; For
the alcoholic/heavy drinker they have to drink
again to RESEDATE.
• INTOXICATION: Slurred speech, Unsteady gait,
Lack of coordination, Impaired attention,
concentration, memory and judgment, Some
becomes aggressive or display inappropriate
sexual behavior, Intoxication can lead to
BLACKOUT
• OVERDOSE OR EXCESSIVE ALCOHOL: People
DIE of alcohol because it depresses the CNS;
Vital centers becomes anesthesized causing
Vomiting, unconsciousness, respiratory
depression, Alcohol induced hypotension, GI
bleeding or hemorrhage, Heat loss due to
vasodilating effect, ASPIRATION
PNEUMONIA, PULMONARY OBSTRUCTION,
ALCOHOL HYPOTENSION – CV SHOCK and
DEATH
• Treatment:Gastric Lavage; Dialysis, Supportive care, RESPI and CARDIO in the ICU
• LONG TERM ALCOHOL USE: Cardiac Myopathy, Wernicke’s Encepalopathy,
Korsakoff’s Psychosis, Pancreatitis, Esophagitis, Hepatitis, Cirrhosis – obstructed
BF, Portal HPN, Ascites
• Esophageal varices, Peripheral neuritis, Leukopenia, Thrombocytopenia
• WITHDRAWAL AND DETOXIFICATION:Symptoms usually begins 4 – 12 hours ,
Peaks on second day and is over by day 5 (1 – 2 weeks), Withdrawal is life
threatening, detoxification needs to be accomplished under medical
supervision.Coarse hand tremors – HALLMARK, Sweating, Elevated pulse and BP,
Insomnia, Anxiety, Nausea and vomiting
• SEVERE/UNTREATED: Delirium Tremens (HALLUCINATIONS, SEIZURES or
DELIRIUM)
• Vitamin B1 (thiamine) 100 mg
• To prevent or to treat Wernicke’s Encephalopathy and Wernicke-Korsakoff
syndrome ; neurologic conditions that can result from heavy alcohol use.
• Vitamin B12 (cyanocobalamin) and Folic acid
• For nutritional deficiencies
DISULFIRAM (ANTABUSE)
• To help deter clients from drinking
• Inhibits breakdown of acetaldehyde by
the enzyme aldehyde dehydrogenase
• If taken with alcohol a severe adverse
reaction occurs: Flushing, A throbbing
headache, Sweating, Nausea and
vomiting, Severe hypotension,
Confusion, Coma, Death
• AVOID! Products that contain alcohol:
Cough syrup
Lotions
Aftershaves
Mouthwash
Perfume
Vinegar
• Naltrexone (REVIA) - For overdose and
dependence; Reduce cravings for alcohol
2. SEDATIVES, HYPNOTICS, AND ANXIOLYTICS

A. Barbiturates

• Relieve anxiety or to produce sleep

• Thiopental (anesthesia)
• Phenobarbital (epilepsy)

Non barbiturates

Anxiolytics (benzodiazepines)

INTOXICATION: Slurred speech, Lack of coordination, Unsteady gait, Labile

mood, Impaired attention , Stupor or coma

OVERDOSE

Benzodiazepines (Rarely fatal)

• Lethargy and confusion

• Management: Gastric lavage followed by ingestion of activated CHARCOAL and SALINE
cathartic; Dialysis if severe
• BARBITURATES (Lethal)
• Coma, respiratory arrest, cardiac
failure and death, Same with
Alcohol
• WITHDRAWAL AND DETOXIFICATION:
Depends on the half life of the drug,
Like lorazepam, actions typically last
after 10 hrs. produces withdrawal
symptoms in 6 to 8 hours.Longer
medications such as diazepam may not
produce withdrawal symptoms for 1
week.
• WITHDRAWAL SYNDROME: Autonomic
hyperactivity (Increased PR, BP, RR and
TEMP), Hand tremors, Insomnia, Anxiety,
Nausea, Psychomotor agitation, Seizures
and hallucination (severe withdrawal of
benzodiazepine)
• DETOXIFICATION:Tapering the amount of
the drug, 10% each day
• E.g. Valium 10 mg 4 times a day, Decreased
every 3 days, 3 times a day
• 3. OPIOIDS - Popular drug abuse because they
desensitize the user to both physiologic and
psychological pain and induce a sense of euphoria
and well being, Primarily used for Analgesia(
Morphine, Meperedine, Codeine, HEROIN,
methadone, hydromorphone, hydrocodone,
oxycodone, oxymorphone, propoxyphene,
NORMETHADONE. Cocaine + heroin = speed
balling
• INTOXICATION: EUPHORIA, Apathy, Lethargy,
Impaired judgment, Psychomotor agitation or
retardation, Constricted pupils, Drowsiness, Slurred
speech, Impaired attention and memory
• OVERDOSE: Coma, Respiratory depression –
primary effect, Pupillary constriction,
Unconsciousness, Death
• MANAGEMENT
• Naloxone (NARCAN) - Given every few hours until the level
drops to non toxic; may take for days (ANTIDOTE FOR
OPIOID TOXICITY)
• Clonidine (CATAPRES)- Is an alpha 2 adrenergic agonist used
to treat HYPERTENSION
• For opiate dependence to suppress some effects of
withdrawal or abstinence.

• WITHDRAWAL AND INTOXICATION: “painful”, Early:

Yawning, Tearing, Rhinorrhea, Sweating, Gooseflesh;
Intermediate: Flushing, Piloerection, Tachycardia, Tremor,
Restlessness, irritability
• Late: Muscle spasm, Fever, Nausea and vomiting, Repetitive
sneezing, Abdominal cramps, backache
• METHADONE (Dolophine)- A potent synthetic
opiate to prevent withdrawal symptoms
especially HEROIN
• Which meets the physical needs for opiates but
does not produce cravings for more.
• DECREASED every 2 weeks
• LEVOMETHADYL- Treatment of opiate
dependence
• 4. INHALANTS- CNS depressants, most common
substances in this category are ALIPATHIC and
AROMATIC hydrocarbons
• 3 Basic forms of Inhalants
• Solvents (gasoline, glues)
• Aerosol propellants (spray cans)
• Anesthetic (chloroform, nitrous oxide)
• INTOXICATION: Dizziness, Nystagmus ,Lack of
coordination, Slurred speech, Unsteady gait, Tremor,
Muscle weakness, Blurred vision, Stupor and coma,
Belligerence, Aggression, Apathy, Impaired judgment,
Inability to function, Acute toxicity: anoxia, respiratory
depression, vagal stimulation, dysrhythmia, death from
bronchospasm, cardiac arrest, suffocation, aspiration of
the compound or vomitus.
• MANAGEMENT: Supportive
• No specific treatment for INHALANTS

5. STIMULANTS (Amphetamines, Cocaine, Others)

• Amphetamines
• “uppers” “speed” or “Crank”
• for losing weight and staying awake,
• ADHD
• Cocaine
• illegal drug, no clinical use in medicine, highly addictive and
popular recreational drug because of intense and immediate
feeling of EUPHORIA it produces.
• Snorting best way “NASAL SEPTUM PERFORATION”
• Methamphetamines (SHABU)
• dangerous, highly addictive and causes psychotic behavior. Brain damage.
• INTOXICATION (develops rapidly): High or euphoric feeling, Hyperactivity,
Hypervigilance, Talkativeness, Anxiety, Grandiosity, Hallucinations,
Stereotypic or repetitive behavior, Anger, Fighting, Impaired judgment,
Physiologic effects

• OVERDOSE: Arrhythmia and Respiratory Collapse, Seizures, Coma, Death

(rare)
• MANAGEMENT: Induction of vomiting, Forced diuresis, Chlorpromazine
• Odansetron (ZOFRAN)
• A 5HT3 antagonist that blocks the vagal stimulation effects of serotonin in
the small intestine is used as an antiemetic.
• WITHDRAWAL DETOXIFICATION: Withdrawal
occurs after few hours or several days
• Suicide ideation, Depression = CRASHING
DETOX, NO treatment fatigue, vivid
unpleasant dreams, insomnia and
hypersomnia, Increased appetite,
psychomotor retardation or agitation
• 6. HALLUCINOGENS- “psychosis like reaction”
• “Psychomimetics” or “psychedelics”, Distorts the user’s perception of
reality and produces symptoms similar to psychosis including
hallucinations (visual and depersonalization)
• 2 basic groups
• a. Natural
• Mescaline (peyote) from cactus
• Psilocybin from mushrooms
• Marijuana
• b. Synthetic
• Lysergic acid diethylamide (LSD)
• “Designer drugs”
• ecstasy
• phencyclidine (PCP), anesthetic
• Increased PR, BP and TEMP, Dilated pupils,
Hyperreflexia
• Physiologic symptoms: sweating, tachycardia,
palpitations, blurred vision, tremors and lack
coordination.
• INTOXICATION: Anxiety, Depression, Paranoid ideation, Ideas of reference,
Fear of losing one’s mind
• Jumping out of the window
• PCP: belligerence, aggression, impulsivity and unpredictable behavior.
• Toxic reactions to hallucinogens = primarily psychological Except PCP
• PCP TOXICITY: Seizures, hypertension, hyperthermia, Respiratory
depression
• TREATMENT: Supportive
• FATALITIES have occurred from related accidents, aggression and hostilities
• MANAGEMENT: Valium, Psychotic reactions – isolation from external
stimuli
• WITHDRAWAL AND DETOXIFICATION: None, Cravings, Flashbacks
“NIGHTMARES”, Months to years
7. CANNABIS SATIVA
• Is an Indian hemp plant similar to ABACA, Widely known for its
psychoactive resin; RESINS contains 60 cannabinoids; Delta 9 –
tetrahydrocannabinol, Refers to the upper leaves, flowering tops,
stems of the plant; Hashish – is the dried resinous exudate from
leaves of female plant. Most often smoked in cigarettes “joints”.
Known to decrease the IOP; Relieving nausea & vomiting associated
with cancer chemotherapy and the anorexia of weight loss of AIDS.
• Tetrahydrocannabinol: Changed into metabolites and stored in fatty
tissues; Remains in the body up to 6 weeks, Acts less than 1 minute
after inhalation, PEAK is 20 – 30 minutes and last at least 2 – 3 hours,
Ingested – 12 hours, Effects similar to your alcohol, lowered
inhibition, relaxation, euphoria, increased appetite “munchies”,
conjunctival injection (bloodshot eyes), dry mouth, hypotension and
tachycardia.
• Dronabinol (marinol)
• Nabilone (Cesamet)
• For nausea and vomiting from cancer chemotherapy
• INTOXICATION: Impaired motor coordination, Inappropriate laughter,
Impaired judgment, Short term memory, Distortions of time and
perception, Others: anxiety, dysphoria and social withdrawal
• Therapeutic Nurse-Patient relationship for Substance
Abuse:
• Education
• The nurse must dispel the following myths and
misconceptions:
• “it’s a matter of will power”
• I can’t be an Alcoholic if I only drink beer on weekends
• I can learn to use drugs socially
• I’m okay now; I could handle using it once in a while.
Education about relapse:
1. Any alcohol can be abused
2. Prescribed medications can be an
abused substance
3. Continued participation in an aftercare
program is important
4. Addressing family issues
5. Alcoholism and other substance often
is called a FAMILY ILLNESS
• CODEPENDENCE is a maladaptive coping pattern on the part of the
family members or others
• All those who have close relationship with a person who abuses
substance suffer emotional, social and sometimes physical anguish
from prolonged relationship with the person who uses substance.
• MANAGEMENT: Promoting coping skills, Focus on here and now with
clients, Set realistic goals such as staying sober today.
• PHARMACOLOGIC TREATMENT: To permit safe withdrawal from
alcohol, sedatives/hypnotics, benzodiazepines; To prevent relapse
• MILIEU: Safety - Drug free environment, Structure,
Active meaningful schedule provide for less
downtime
• Norms: Non-violent behavior, Openness, feedback,
Limit setting, Balance and Environmental
Modification
12 steps of ALCOHOLICS ANONYMOUS
1. We admit we are powerless over alcohol, that our lives have
become unmanageable.
2. We come to believe that a Power greater than ourselves could
restore us to sanity.
3. We make a decision to turn our wills and lives over to the care
of God as we understood Him.
4. We make a searching and fearless moral inventory of
ourselves.
5. We admit to God, to ourselves, and to another human being
the exact nature of our wrongs.
6. We are entirely ready to have God remove all these defects of
character.
7. We humbly ask Him to remove our shortcomings.
8. We make a list of all persons we have harmed and are willing to make
amends to them all.
9. We make direct amends to such people whenever possible, except when
to do so would injure them or others.
10. We continue to take a personal inventory and when we are wrong
promptly admit it.
11. We seek through prayer and meditation to improve our conscious
contact with God as we understand Him, praying only for knowledge of His
will for us and the power to carry that out.
12. Having had a spiritual awakening as a result of these steps, we try to
carry this message to alcoholics and to practice these principles in all our
affairs.
DISRUPTIVE
DISORDERS
Prepared by:
Leidelyn A. Emock
1. CONDUCT DISORDER A
persistent behavior that violates
social norms, rules, laws and the
rights of others. These children
have significantly impaired
abilities to function in social,
academic or occupational areas.
S/S: aggression to people and
animals, destruction of property,
deceitfulness, theft and serious
violation of rules.
ETIOLOGY: genetic vulnerability, environmental
adversity and factors like poor coping
Risk factors: poor parenting, low academic
achievement, poor peer relationships and low self-
esteem
Treatment: Early intervention and geared towards
developmental age, individualized and parental
support; medications only as last option and for
aggression (Antipsychotics- Risperidone (Risperdal);
mood stabilizers)
2. OPPOSITIONAL DEFIANT DISORDER- an enduring pattern
of uncooperative, defiant, disobedient and hostile behavior
toward authority figures without major antisocial violations.
Children with ODD have limited abilities to associate
between their behavior and the consequences of behavior
due to a reduction in rewards and punishments.
Treatment for ODD is proper parent management training
models of behavioral interventions.
 NEURODEVELOPMENTAL DISORDERS:
1. AUTISM SPECTRUM DISODERS:
The child with ASD has severe impairments in social
interactions and communication skills, often accompanied
by stereotypical behavior, interests, and activities. The
stress on the family can be severe, owing to the chronic
nature of the disease. The severity of the impairment is
evident in the degree of responsiveness to or interest in
others, the presence of associated behavioral problems
(e.g., head banging), and the ability to bond with peers
2. ATTENTION DEFICIT HYPERACTIVITY DISORDER
Individuals with attention deficit hyperactivity disorder (ADHD) show
an inappropriate degree of inattention, impulsiveness, and
hyperactivity. Some children can have attention deficit disorder without
hyperactivity (ADD). In order to diagnose a child with ADHD symptoms
must be present in at least two settings (e.g., at home and school) and
occur before age twelve. In adults, fewer symptoms are necessary to
gain a diagnosis
• Children with ADHD are often diagnosed
with comorbid disorders such as
oppositional defiant disorder or conduct
disorder. The behaviors and symptoms
associated with ADHD can include
hyperactivity, difficulty taking turns or
maintaining social relationships, high levels
of impulsivity, poor social boundaries,
intrusive behaviors, or frequently
interrupting others. Those with inattentive
type of ADHD may exhibit high degrees of
distractibility and disorganization; they may
be unable to complete challenging or
tedious tasks, become easily bored, lose
things frequently, or require frequent
prompts to complete tasks.
• Paradoxically, the mainstay of treatment for ADHD is the use of
psychostimulant drugs.
• Responses to these drugs can be dramatic and can quickly
increase attention and task-directed behavior while reducing
impulsivity, restlessness, and distractibility (Lehne, 2010).
• Methylphenidate (Ritalin) and amphetamine salts (Adderall) are
the most widely used psychostimulants because of their relative
safety and simplicity of use. As with any controlled substance,
however, there is a risk of abuse and misuse, such as the sale of
the medication on the street or the use by people for whom the
medication was not intended.
3. Intellectual development disorders (IDD),
previously called mental retardation, are disorders
that are characterized by deficits in three areas.
• The first, intellectual functioning, is characterized
by deficits in reasoning, problem solving, planning,
judgment, abstract thinking, and academic ability
as compared to same-age peers.
• The second, social functioning, is impaired in terms
of communication and language, interpreting and
acting on social cues, and regulating emotions.
• Finally, practical aspects of daily life are impacted
by a deficit in managing age-appropriate activities
of daily living, functioning at school or work, and
performing self-care.
ASSESSMENT GUIDELINES
Intellectual Development Disorders
• 1. Assess for delays in cognitive and physical development or lack of ability to
perform tasks or achieve milestones in relation to peers. Gather information from
family, caregivers, or others actively involved in the child’s life.
• 2. Assess for delays in cognitive, social, or personal functioning, focusing on
strengths and abilities.
• 3. Assess for areas of independent functioning and the need for
support/assistance to meet requirements of daily living (examples are hygiene,
dressing, or feeding).
• 4. Assess for physical and emotional signs of potential neglect or abuse. Be aware
that children with behavioral and developmental problems are at risk for abuse.
• 5. Be knowledgeable about community resources or programs that can provide
family and caregivers with the needed resources and support to meet the child’s
need for intellectual and social development and the family’s need for education
and emotional support.
ABUSE AND
VIOLENCE
Bogan/Bogs Emock
NCC/NCD
 Concepts
1. Abuse
2. Violence
3. Perpetrator
4. Victim
 1. Family Violence
A pattern of coercive behavior of one family member or significant others.
Cycle of Violence – tension building, acute battering incident, honeymoon
phase.
Reasons why battered women stay in abusive relationship.
Profile of an Abuser – social Isolation, low self esteem, abused as a child,
poor impulse control, poor coping skills, extreme jealousy, drug or alcohol
abuse.
2. Child Abuse
The intentional injury of a child. It includes physical or sexual abuse,
injuries, neglect or abandonment.
Warning signs of child abuse ;
1. Child or parent giving a history inconsistent with the severity of the
injury.
2. High incidence of swollen or bruised rectum and genitalia
3. Injuries not usual for child’s age and level of development.
4. Lacerations, scars, multiple bruises on various stages of healing.
5. Delay in seeking treatment for significant injury.
 Other abuse
Elder abuse – maltreatment of older adults
Sexual abuse- is pressured forced sexual activity
Physical abuse
Psychological abuse (emotional abuse)
Rape – perpetration of sexual intercourse with a female against her
will and without her consent.
Date rape(acquaintance rape)
Marital rape(spousal rape)