Physiological and Psychological Risk Effects of Alcohol - Essay Example

Case analysis By and Case analysis Depression is a mood disorder that is associated with persistent sadness and marked loss of interest in pleasurable activities most of the time. The patient will also exhibit sleep disturbance sleep pattern, loss of appetite, loss of energy, feeling of guilt and most importantly the suicidal thoughts and attempts. Depression can be caused by various events in life that affect our feeling and by extension our mood such as loss of a job or a loved one. In this scenario, the main cause of depression to Hilary is the loss of her husband 2 years ago. Something might have gone wrong with the process of grieving and Hilary did not adapt well to accept the loss. However, Hilary is still at a high risk of developing other medical conditions alongside the relapse of depression even after hospitalization as seen in her behaviours presented as her coping mechanism. The loss of interest in cooking, long hours of watching TV, alcohol indulgence, excessive smoking, and the significant gain of weight threaten to compromise Hilary’s health. A number of health risks are presented in excessive consumption of alcohol; this is both in the light of physiological and psychological effects. Alcohol virtually affects all body systems depending on the amount and frequency of consumption. Physiological and psychological risk effects of alcohol Alcohol in most cases will precipitate to liver cirrhosis through continuous destruction of hepatocytes. At first alcoholic hepatitis will develop an inflammation of the liver cells due to the interaction of ethanol and the cellular content of hepatocytes(J. Chaloupka 2002). Irreversible scarring and destruction of liver hepatocytes will then lead to permanent liver damaged interfering with the metabolic functions. Other liver diseases such as liver fibrosis and steatosis will occur. An unhealthy liver will lead to poor generation of heat, poor drug metabolism and reduced detoxification of blood. The patient is likely to develop anaemia due to a number of factors brought by alcohol consumption. Iron deficiency is common since there is inadequate absorption of vitamin B 12 that acts as a necessitating factor in cellular iron absorption, with reduced liver function; the synthesis of red blood cell is slowed down leading to a general reduction in the number of mature reticulocytes available to carry oxygen (Guerri & Pascual 2010). Gastritis will also occur due to constant irritation of gastric mucosa by ethanol. The epithelial lining is weakened with repeated exposure to alcohol. The oesophageal and cardiac sphincters are also weakened causing gastric content reflux that results to frequently uncontrolled emesis (Hahn et al. 2012). Gastric absorption of vitamin B12 is reduced significantly, pancreatic damage results casing interference in production of insulin and glucagon hormones significant in controlling blood sugar levels. The inability to have a controlled glycemic index will leading to diabetes. Production of Bilirubin production and pancreatic enzymes is reduced in the process causing digestive problems. Gastric motility and emptying is also affected in most cases leading to diarrhea and loss of electrolytes with water in the body. Alcohol also predisposes to cardiovascular diseases ranging from hypertension, heart failure to stroke as well as dysrhythmias. Platelets can agglomerate in cerebral blood vessels causing stroke while stretching and drooping of cardiac muscles will lead to heart failure through reduced cardiac output (Anderson et al. 2012). Anxiety seen in alcoholic people predisposes to irregular heartbeats and abnormalities in the sequence of Sino atrial firing and conduction of the electric impulses through the bundle of His, bundle branches and the purkinje fibers. Habitual drinking of alcohol escalates the risk of cancer in and individual. Conversion of alcohol into acetaldehyde increases the generation of carcinogenic substances in the body. Oncogenesis will mostly present through various parts of the body such as the larynx, pharynx, liver, breasts, esophagus, colon, and mouth. Heavy drinking will also cause alcoholic neuropathy through nerve damage (Becker 2012). The sensational numbness and the irritating painful-pins and needles feeling are an indication of abnormality in impulse conduction. Ethanol is toxic to the nerve cells and may limit absorption of nutrients. Dementia is another psychological effect of heavy alcohol consumption. The patient will experience reduced ability to plan, make sound judgments using a logical order, and lose of executive function. The inability to solve problems and think realistically is adversely affected. More so, there is loss of both immediate and recent memory (Sayon-Orea et al. 2011). The overall function of brain is affected leading to mood disruption and behaviours, binding of ethanol to serotonin-receptors will precipitate to mood swings and altered level of reality. A drastic change made in the brain chemistry by excessive alcohol consumption can also provoke excessive firing of neurons causing seizures and epileptic episodes in and individual. The hallmark of psychological changes is mainly associated with possible brain atrophy that is brought by inadequate supply of nutrients to brain cell and nervous system. Physical trauma and accidents are increases in the event of these abnormal brain activities causing general ill health to the patient. There is significant weakening of immune system in excessive alcohol intake. The person becomes susceptible to infections ranging from pneumonia, tuberculosis, and venereal diseases such as HIV/AIDS. Reckless sexual behaviours prompted by impaired judgment and decision-making will increase chances of infections and the general ability for self-care. In aging individuals, the risk of osteoporosis is increases. Bone calcification is slowed and phosphorous absorption reduced, long bone fractures with joint dislocation are common. Involuntary rapid ocular movements are observed in individuals who drink excessively. The weakening and paralysis of eye muscles is caused by the thiamine deficiency caused by malabsorption of vitamin B complex in gastric and intestinal mucosa. Visual disturbances are therefore common as well as external eyelid infections (Paul et al. 2008). Heavy drinking can also provoke depression due to altered sense of reality and doing of socially unacceptable actions effected by poor decision-making and impaired judgment. The social isolation brought by drinking and inactivity will often worsen preexisting depression in a patient. Physiological and psychological risk effects of heavy smoking Smoking affects almost all organs in the body. Prolonged smoking will even cause pose serious health hazards to an individual. Hilary’s smoking is dangerous to her health in a number of ways. Smoking causes atherosclerosis through deposition of waxy substances in the arteries, continuous smoking leads to a steady built up of plaque causing narrowing and hardening of arteries. Coronary heart disease, heart attack, and hypertension will result. Aneurysms due to bulging of blood vessels have also been diagnosed in smokers. The combination of peripheral arterial disease with occlusion of major blood vessels will often result to stroke development in advanced cases (Conner & Higgins 2010). Nicotine and tar deposits in lungs reduce the surface are of alveoli and causes apoptosis of goblet cells in the respiratory tract lining. Shortness of breath and wheezing come as a result of chronic obstructive pulmonary disease (COPD). Loss of elastic recoil of lungs will also occur precipitating to emphysema increasing the breathing effort. Pneumonia and asthma attacks will also occur due to increases immunological and inflammatory actions in the respiratory tract. Gaseous exchange process is interfered with since there will be inadequate absorption of oxygen and release of carbon dioxide, arterial blood gases will be below normal range on a pulse oxymeter (van den Putte et al. 2009). The ineffectiveness in coughing and clearing of secretions increases the susceptibility to tuberculosis infection. Smoking will increase the incidents of tracheal, bronchial, nasopharyngeal and lung cancer. Nicotine and tar are carcinogenic substances that are deposited in the body during smoking (Glass et al. 2009). Incorporation of these substances body cells will cause altered cellular process facilitating oncogenesis. Several organs are affected due to the diffuse effects of the carcinogens once absorbed in blood. The risk of cataracts and macular degeneration is increased. This will lead to blindness or visual disturbances. The effects of the active ingredients of smoke on the pancreas and the kidneys will cause diabetes more commonly type 2 diabetes. The interference in hormonal production and function is the main cause. Smoking will also alter the normal mechanism by which the brain uses to make dopamine. The stimulants found in cigarette will heavily condition production of dopamine such that a slight withdrawal will cause a marked reduction in dopamine; a vital chemical whose deficiency causes depression. Hilary is likely to have a relapse in depression since smoking will interfere with dopamine levels in the brain as well as downgrade the effect of the antidepressants in treating depression. Psychological and physiological risk effects of long hours of watching (inactivity) One of the major signs of depression is loss of interest in pleasurable activities and inactivity in general. The risks associated by physical inactivity are alarming and have a great impact on the mental and physical health of an individual. Hilary has been observed to spend of her time watching TV that is a polite form of saying she is physically inactive and a sedentary behavior (Thijssen et al. 2010). It we can also associate weight gaining with lack of exercise to burn excess calories. Physical inactivity contributes to coronary artery diseases, lack of exercise leads to deposition of high amounts of cholesterol in coronary arteries narrowing the lumen and thereby leading to inadequate supply of blood rich in nutrients and oxygen to the cardiac cells and muscles. Skeletal muscles are helpful in enhancing blood flow during a physical exercise; the contraction and relaxation of muscles propel blood flow in both arteries and veins contributing to increased blood flow and venous return (Dolenc & Pišot 2011). Cardiac failure and myocardial infarction will develop leading to compromised functioning of the cardiovascular system. Increased deposition of fat in the adipose tissue will interfere with the normal muscle mass leading to body mass index of over that 24.5 causing overweight and obesity. In this state, the risk of getting diabetes type 2 and other chronic diseases is drastically increased. The bones become weak and fragile due to lack of exercise in helping compaction of calcium and phosphorus. The risk of developing bone fractures is also increased by the excessive weight of the body on bones due to obesity. The immune system is compromised where by certain cancers develop as well as frequent ailments. Physical inactivity will reduce the efficiency of digestion and intestinal motility leading to constipation and adherence of waste products causing colon cancer at last. The respiratory system also becomes ineffective in gaseous exchange. The frequent expansion and relaxation of lungs is affected by stagnation in positions that allow little expansion, inadequate lung volume will affect the oxygen carbon dioxide ratio in blood leading to tachypnea and increase diaphoresis. The social and psychological aspect of life is affected especially when the level of interaction with the external environment is restricted by being confined in a room and watching TV. Social connections and interpersonal relationships are lost with a lifestyle that permits little exposure to gatherings involving different people (Dolenc & Pišot 2011). Inactivity interferes with the normal uptake and release of chemicals in brain and development of neural pathways, the feeling of mental fatigue and easily getting bored will often aggravate depression. Little involvement in physical exercise will affect the quality of sleep one gets. A considerably long tiring exercise is found to promote long hours of sleep required to attain brain relaxation. Inactivity will scale down the quality of sleep with most instances causing sleepless nights as a result leading to inadequate mental rest. Irritability and mood instabilities are the indicators of lack of enough sleep and mental rest. Management and nursing interventions In an effort to cure depression, provide promotive and preventive health services to Hilary, the Community Mental Health Team (CMHT) together with the Community Psychiatry Nurse (CPN) must work in collaboration to manage excessive smoking, drinking, and the sedentary lifestyle. Basic physical examination must be done to ascertain the cause of breathless and excessive coughing. Bronchodilators and antitussives are administered to enhance comfort of the patient. Sputum test must be done to rule out tuberculosis and pneumonia; the community psychiatry must also perform the mental status examination to determine mental stability of Hilary. Management of alcoholism Hilary seems to be in an alcohol dependency state. The fact the she has lost interest in leisure activities and now drinks excessively strongly affirm dependency. Before treating, Hilary on this problem the CPN must obtained her consent and explains the purpose and procedure for treatment given. The CMHT and CPN will ensure daily supervision of Hilary to detect possible complications of alcohol intake early enough. Daily physical examination is relevant in obtaining information useful on Hilary’s health. Information on gastrointestinal system is helpful in determining GIT problems associated with drinking. Intravenous pabrinex is administered to counter vitamin B deficiency, thereafter-oral thiamine and other relevant multivitamins are given to prevent Wernicke-korsakoff syndrome. Long acting benzodiazepines such as diazepam are administered to reduce possible alcohol induced tremors, agitation, and seizures by reducing the rate of brain activity. This will also promote sleep and enough mental rest as diazepam is a known sedative. In the absence of benzodiazepines, beta-blockers are used to lower the autonomic hyperactivity and excitability. The side effects of these drugs must be monitored and stopped with any significant drug reaction and toxicity. After Hilary has successively withdrawn, calcium acetyl-homotaurinate is administered to prevent relapse by blocking gamma-aminobutyric acid and N-methyl-D-aspartate receptor glutamate related agitation. This drug is effect in lowering alcohol cravings and protecting neurons during detoxification. One on one counseling therapy must be provided through talking and listening session. The CPN and CMHT elaborate on the need to stop drinking and the benefit of treatment compliance. This will ensure that Hilary fully understands why she needs to take drugs as prescribed and ask questions relevant in helping her deal with her condition. Management of smoking The approach used should be gradual and steady to prevent Hilary from experiencing nicotine withdrawal side effects such as irritability, loss of concentration and aggravated depression. Nicotine replacement therapy is useful in treating heavy smoking, nicotine coated tablets and lozenges are used to release nicotine in small but steady amounts of nicotine in blood stream. In doing so, inhalation of tar, carbon monoxide and other toxic gases from tobacco smoke is avoided. 24-hour skin patches can be used in case where the oral form proves ineffective in heavy smokers. The CPN must also monitor the side effects of nicotine replacement therapy such as skin irritation, disturbed sleep, headache, and gastric upset. Pharmacological treatment of smoking can be attained by administration of bupropion and varenicline. Apart from treating depression, bupropion is useful in helping an individual to quit smoking. Bupropion is administered once daily (OD) for 7-14 days. However, the liver function tests must be done to rule out liver cirrhosis that can interfere with drug metabolism and absorption. Varenicline inhibits nicotine from binding to nicotinic receptors in brain and at the same time stimulating the receptors thus reducing the cravings to smoke. Varenicline is administered for a maximum period of 6 months to help quit smoking and prevent relapse. Management of physical inactivity Attention is directed toward reducing the hours Hilary spend in watching TV. The CP will help Hilary reduce the time of watching to 2 hours in a day. The patient is encouraged to participate in other activities of choice that involve walking. During group therapy, activities such as dancing, clapping, and singing will promote physical activity. Encouraging the Hilary to think of her best games and activities will help trigger the desire to get involved in physical activities (Zeng et al. 2010). The CPN draws a schedule in agreement with Hilary where regular physical exercise such as walking for a certain distance and use of a tread mill daily to enhance cardiovascular and muscular fitness in the effort to cut on weight. The nursing role in nonpharmacological management of depression The CPN will employ cognitive behavioural therapy (CBT) in helping Hilary change her way of thinking. The nurse will teach her how negative thinking affects her mood and that this habit of thinking can be altered just like any other habit. The nurse performs 6-10 one on one sessions with Hilary training her to logically analyze the evidence of her negative thinking and make suitable adjustments. Interpersonal therapy (IPT); the nurse helps Hilary evaluate her personality and social functioning in 12-16 sessions. Depression is closely linked with unhealthy interpersonal relationship and the main goal is to help Hilary understand that factors such as work, relationships and social roles can cause or worsen depression if fault is found in them. The nurse will focuses on evaluating Hilary’s social history, exploring on interpersonal problems where treatment is needed and the recognition and integration by Hilary on what has been taught in an effort to devising ways of managing future depressive symptoms (Berk et al. 2013). Mindfulness – based cognitive therapy; with the help of the CPN, Hilary practices mindful meditation in trying to beware of events past and present without developing mixed reactions of her findings. This is done for a period of 8 weeks preferably during group therapy sessions. The nurse will also use Positive Psychology (PP) in determining conditions that enhance Hilary’s normal and optimal level of functioning. The nurse helps the patient to identify activities in everyday life that will build positive thoughts. The nurse encourages Hilary to make a gratitude diary, do some charity work and a variety of pleasant encounters to avoid routine (Howell et al. 2008). Psychotherapy and counseling; the nurse builds a cordial relationship with Hilary with the intention of exploring her past in greater details and to expound on how these issues have brought about depression. Hilary’s ability to link the past and present will help her gain insight of her condition and gear towards finding a lasting solution. In counseling, the nurse helps Hilary to set goals and objectives, develop several solutions to the problem and have a guided path of executing the interventions with monitoring and evaluation. Narrative therapy; the nurse provides sessions during which Hilary tells her story and the problems she is facing. The nurse encourages Hilary through active listening and noting down important points along the story (Houle et al. 2013). The nurse using identified strengths and weakness helps Hilary strategize on dealing with depression. In conclusion, use of pharmacological and no pharmacological therapy in management of depression will help curb the problem of relapse and other associated behavioural activities that can compromise health. Holistic care is required in helping Hilary overcome smoking drinking and sedentary lifestyle. It is compulsory that the CPN and CMHT work in collaboration to identify Hilary’s health needs and risks associated with her coping mechanism. Use of cognitive behavioural therapy and group therapy will be of value in facilitating quick recovery and cessation of smoking and drinking. Speech therapy will be handy in cultivating social and interpersonal skills necessary to develop long lasting relationships with family members as well as addressing latent issues that significantly affect wellbeing. Reference list Anderson, P., Møller, L. & Galea, G., 2012. Alcohol in the European Union: Consumption, harm and policy approaches, Becker, H.C., 2012. Effects of alcohol dependence and withdrawal on stress responsiveness and alcohol consumption. Alcohol research : current reviews, 34, pp.448–58. Berk, M. et al., 2013. Lifestyle management of unipolar depression. Acta Psychiatrica Scandinavica, 127, pp.38–54. Conner, M. & Higgins, A.R., 2010. Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: a cluster randomized controlled trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 29, pp.529–538. Dolenc, P. & Pišot, R., 2011. Effects of long-term physical inactivity on depressive symptoms, anxiety, and coping behaviour of young participants. Kinesiology, 43, pp.178–184. Glass, J.M. et al., 2009. Effects of alcoholism severity and smoking on executive neurocognitive function. Addiction, 104, pp.38–48. Guerri, C. & Pascual, M., 2010. Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence. Alcohol, 44, pp.15–26. Hahn, R.A. et al., 2012. Effects of alcohol retail privatization on excessive alcohol consumption and related harms: A community guide systematic review. American Journal of Preventive Medicine, 42, pp.418–427. Houle, J. et al., 2013. Depression self-management support: A systematic review. Patient Education and Counseling, 91, pp.271–279. Howell, C. et al., 2008. Management of recurrent depression. Australian family physician, 37, pp.704–708. J. Chaloupka, 2002. The effects of price on alcohol consumption and alcohol-related problems. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 26, pp.22–34. Paul, C.A. et al., 2008. Association of alcohol consumption with brain volume in the Framingham study. Archives of neurology, 65, pp.1363–1367. Van den Putte, B. et al., 2009. The effects of smoking self-identity and quitting self-identity on attempts to quit smoking. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 28, pp.535–544. Sayon-Orea, C., Martinez-Gonzalez, M.A. & Bes-Rastrollo, M., 2011. Alcohol consumption and body weight: A systematic review. Nutrition Reviews, 69, pp.419–431. Thijssen, D.H.J. et al., 2010. Impact of inactivity and exercise on the vasculature in humans. European Journal of Applied Physiology, 108, pp.845–875. Zeng, F. et al., 2010. Utilization management for smoking cessation pharmacotherapy: Varenicline rejected claims analysis. American Journal of Managed Care, 16, pp.667–674.  Read More