Comprehensive Study Guide on Energy Balance, Nutrition, and Substance Abuse Disorder

Energy Balance and Weight Maintenance

  • Establishing Normal Food Choices: When evaluating a client, documentation of their normal food choices, the specific amounts typically eaten, and the distribution of meals throughout the day is essential for establishing a baseline (found on page 271).
  • Energy Balance Principles:
    • Normal Circumstances: Weight is maintained when energy intake equals energy expenditure.
    • Negative Energy Balance: Weight loss occurs when a person enters a state of negative energy balance, meaning they are consuming fewer calories than they are expending.
  • Weight Loss Estimates (Box 15.2):
    • To lose 454 g454\,g (approximately 1 lb1\,lb) per week, there needs to be an energy deficit of at least 500 kcal500\,kcal per day.
    • Calculation: 500 kcal/day×7 days=3,500 kcal/week500\,kcal/day \times 7\,days = 3,500\,kcal/week.

Food Misinformation and Natural Foods

  • Food Misinformation: Often includes food fads, erroneous claims about certain food types, and "food curves." This misinformation can hinder the development of individuals and society and often ignores scientific progress.
  • Natural Foods vs. Artificial Ingredients:
    • Natural Foods: Defined primarily as non-processed foods.
    • Artificial Components to Avoid: Consumers should stay away from added colors, dyes, and artificial ingredients.
    • Claims: Erroneous claims regarding foods can pose a danger to health and require careful scientific examination.
  • Food Allergies:
    • Common Allergen: Peanuts are the most common food allergen for both children and adults.
    • Anaphylaxis Risk: Allergic reactions can lead to the airway closing up dangerously fast. Time is of the essence in treatment.
    • The "Bike Ride" Incident: A case was shared regarding a girl who drank milk at home and went on a bike ride. Halfway through, she felt lightheaded and "funny," calling her mother just before passing out from the reaction.

Substance Abuse: Definitions and Statistics

  • Underweight and Wasting: Being underweight (less than desirable weight) can be caused by "wasting disease," poor food intake, or malabsorption disorders.
  • Substance Abuse Disorder (SUD): Defined as the use of any chemical substance that alters biological function and is not required for health maintenance.
  • Statistics:
    • Approximately 7.1 million7.1\,million people deal with substance abuse.
    • This represents roughly 2.7%2.7\% of the U.S. population aged 1212 and older.
  • Common Substances of Abuse:
    • Alcohol.
    • Cannabis (also known as weed or marijuana).
    • Opiates (e.g., Percocet).
    • Amphetamines.
    • Cocaine.
    • Inhalants (inhaled drugs).
    • Hallucinogens.
    • PCP (Phencyclidine).
    • Sedatives (Benzodiazepines such as Ativan, Klonopin, and Xanax).

Impairment in Healthcare Professionals

  • Signs of Professional Impairment: Impaired nurses or coworkers may stand out through their functioning at work. Common red flags include:
    • Patients chronically asking for pain pills or reporting inadequate medication.
    • The professional frequently leaving the floor, going to their car, or going to the bathroom.
    • Inconsistent controlled substance counts (verification requires primary and secondary signatures).
  • Addiction Mechanics:
    • Tolerance: The person requires more of the substance to achieve the initial high.
    • Compulsion: The use becomes compulsive as the user tries unsuccessfully to recreate the first experience.
  • Diversion Case Studies:
    • A pharmacist was caught stealing medication from Walmart; after being fired, he went to an independent pharmacy and continued stealing during the control counts.
    • A hospice nurse was caught injecting herself with the patient's morphine. This is common in hospice settings because patients are often in the "imminent phase" and cannot report the missing medication.
  • Peer Assistance Programs: There are specific programs (often referred to as PH/PHP) designed to help nurses keep their licenses if they admit to their addiction and undergo treatment rather than losing their license entirely.

Alcohol Withdrawal and Management

  • Screening Tool (CAGE):
    • C: Cut down (Have you ever felt you should cut down on your drinking?)
    • A: Annoyed (Have people annoyed you by criticizing your drinking?)
    • G: Guilt (Have you ever felt bad or guilty about your drinking?)
    • E: Eye-opener (Have you ever had a drink first thing in the morning to steady your nerves?)
  • Withdrawal Symptoms:
    • Seizures are a major risk in alcohol withdrawal.
    • Seizure First Aid: Position the patient on their left side to prevent aspiration and protect the airway. Note: Patients can bite their tongue severely during a seizure.
  • Medical Complications of Alcoholism:
    • Cirrhosis of the Liver: Often accompanied by ascites (fluid accumulation) and jaundice (yellow sclera/eyes).
    • Nutritional Depletion: Chronic alcoholics are severely depleted of nutrients.
  • The "Banana Bag": Also called a "valley pack," this is a yellow-colored IV bag containing thiamine (B1B_1) and other multivitamins/supplements used to prevent a nutritional crash in homeless or severely alcoholic patients.

Opioid and Stimulant Withdrawal Processes

  • Clinical Opiate Withdrawal Scale (COWS): A protocol used every four hours to assess withdrawal severity. It monitors:
    • Sweating (diaphoresis).
    • Heart rate/Pulse.
    • Bone or joint pain.
    • Runny nose (rhinorrhea).
    • Nausea and vomiting.
    • Blood pressure (often becomes hypertensive, e.g., 212/110 mmHg212/110\,mmHg).
  • Amphetamines and ADHD Medications:
    • Commonly prescribed for ADHD (e.g., Adderall), schizophrenia, or depression.
    • Effects: Hyper-alertness, heightened attentiveness, extreme self-confidence, and powerfulness.
    • Usage Patterns: Some users stay awake for 77 to 1010 days.
    • Methamphetamine: Associated with "meth mouth" (teeth grinding and poor hygiene).
  • Cocaine:
    • Withdrawal leads to fatigue, vivid dreams, extreme depression, and insomnia.
    • Relapse rates for cocaine are exceptionally high.

Comprehensive Nursing Assessment and Triage

  • Physical Appearance: Addicts often appear disheveled, have poor hygiene, and may not have bathed for days.
  • Neurological/Psychological:
    • Psychosis: Patients may experience the sensation of "bugs crawling" on their skin, leading them to pick at their skin and create sores.
  • Drug-Seeking Behavior: Patients may attempt "doctor shopping" through telehealth or different hospital systems (e.g., Shands vs. Baptist). However, modern pharmacy databases link these systems, allowing providers to see all recent prescriptions.
  • Triage and Root Causes:
    • It is critical to investigate the patient's history for trauma, PTSD, or grief (e.g., death of a family member) that may have triggered the substance use.
    • Some patients self-medicate for mental health disorders like Bipolar disorder, Schizoaffective disorder, or Schizophrenia (most commonly with marijuana).
  • Health Risks: Substance use is linked to high risks for Sexually Transmitted Diseases (STDs) due to increased sex drive and impaired judgment during the high, as well as high-risk pregnancies.

Pharmacotherapy for Addiction

  • Acamprosate (Campral): A receptor antagonist used for chronic alcoholics to reduce the desire to drink.
    • Side Effects: Diarrhea (most common), drowsiness, fatigue, headache, and impotence.
    • Severe Warning: May increase the risk of suicidal ideation.
  • Disulfiram (Antabuse):
    • Causes severe nausea and vomiting if alcohol is ingested.
    • Adverse Effect: Liver toxicity.
    • Nursing Consideration: Do not administer to acutely intoxicated patients.
  • Naltrexone: Used to prevent relapsing.
  • Antipsychotic Side Effects (Risperdal):
    • Gynecomastia: Male breast enlargement (mentioned phonetically as "gyno mast mastitis"). This can lead to non-compliance, as seen in a case where a patient became combative and yelled, "I don't want female tits!"

Questions & Discussion

  • Question: What is the definition of underweight?
  • Answer: Being less than the desirable weight, often caused by wasting disease, poor intake, or malabsorption.
  • Question: What is another name for weed or marijuana?
  • Answer: Cannabis.
  • Discussion on Airway and Airline Transport: A participant described their job in "intake," where they had their own airline. They would pack lunches (peanut butter and jelly sandwiches, apple chips) and fly transportees for 12 to 16 hours12\text{ to }16\,hours. Because they were in the air and away from TSA/hospitals, an allergic reaction to the peanuts in the lunch forced them to stop giving out those specific foods due to safety risks.
  • Discussion on Sickle Cell Treatment: A participant mentioned a 23−year−old23-year-old patient who underwent a program for 2 years2\,years where doctors edited his stem cells in a lab to stop producing defective cells, effectively treating his sickle cell disease.