Implement And Monitor Nursing Care For Older Clients

The pathophysiology of alcoholism begins after alcohol the ingestion of alcohol. It is absorbed and unaltered through the stomach and intestines. Next it is distributed throughout the body through the blood and absorbed by all tissues and fluids (Huether, 2012, p. 72). Furthermore, in the liver the alcohol blood content is metabolized into acetaldehyde by the enzymes process of alcohol dehydrogenase (ADH), the microsomal ethanol oxidizing system (MEOS), and catalase (Huether & McCance, 2012). Next, the metabolizing effects the central nervous system (CNS) and exhibits a depressant action. It is first expressed in the subcortical structures of the brain. This has an effect of disorientation of motor skills and intellect. With an increase in blood alcohol concentration, the medullary centers become depressed and as a result affects respiration (Huether & McCance, 2012). In addition, the effects of alcoholism encourage hepatic and gastric changes. The hepatic effect is caused by acetaldehyde, in which, induces inflammation, fatty deposits and enlargement of the liver (Huether & McCance, 2012).

Wernicke-Korsakoff Syndrome: This type of dementia is a chronic memory disorder, caused by thiamine. Thiamine helps conjure energy from sugars. When thiamine levels fall to low, brain cells won’t be able to conjure enough energy.

Excited delirium is a syndrome that may not be easily recognized in the field when a patient presents with it. There is not a complete understand of the cause of the

Alcohol impairs judgment, memory, concentration and coordination, as well as inducing extreme mood swings and emotional

F.C. is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 0.18. F.C.’s family reports that his mental functioning has deteriorated significantly over the past few months.

Alcohol is a liquid substance that can which when consumed slows down the brain. It also alters the brain to increase the risk of depression and anxiety. When too much alcohol is consumed it can cause memory loss.

As we age the body metabolize alcohol faster and alcohol can interact with prescription and over-the-counter medications. Alcohol is especially dangerous for those who take sleeping pills, pain pills, or anti-anxiety medications. The effects of alcohol cause brain damage. The symptoms are similar to Alzheimer’s disease: confusion, short-term memory loss, diminished verbal ease, and loss of problem solving skills. The symptoms decrease after three to four weeks of abstinence. However, unless abstinence is maintained, the person may become permanently demented. One report found that 10% of patients over 60 who were diagnosed with Alzheimer’s disease had brain damage caused by alcohol.

WKS is actually a combination of two different diseases. Wernicke’s Encephalopathy is the first to appear. It is a short-lived, but life-threatening mental condition. It causes ocular disturbances, mental state variation, and unsteady movements and stance (Thomson, 2009). Wernicke’s Encephalopathy is mainly seen in alcoholics, but has been observed in non-alcoholics as well. Korsakoff’s syndrome is the second illness to present.

Someone is sitting at a restaurant bar. A waitress walks over handing out free shots, so he takes one. One leads to two, two leads to three, and so on. Before he realizes it, he is talking louder than ever, tripping over his own feet, and causing a scene. Toward the end of the night, he walks into someone’s table, as he is heading out of the restaurant, knocking over their meals. He tries to say something, but all that comes out is mumbling. The next morning, he is feeling dizzy, has a pounding headache, and does not remember anything from the night before.

Wernicke encephalopathy, a disease that alters brain structure, and Korsakoff syndrome, a memory loss disease, are two conditions that frequently afflict victims together. The sickness occurs in individual who lack vitamin B1 most often due to alcoholism but also because of malnourishment. The condition can also occur in individuals with illnesses or after weight reduction surgery.

Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity

In Oliver Sacks book, The Man Who Mistook His Wife for A Hat, Sacks tells us about one man, Jimmie G, who has Korsakoff’s syndrome. “Korsakoff syndrome (KS) is characterized by dense anterograde and retrograde amnesia. There is often a temporal gradient to the retrograde amnesia, with earlier memories more readily recalled than recent memories. Executive functioning has also been found to be impaired in KS” (Maharasingam, et al., 2013, p. 501). Korsakoff syndrome is most often attributed to the deficiency of thiamin, which can happen in individuals who have a severe drinking problem.

Korsakoff’s syndrome is a neurological disorder caused by the deficiency of thiamine in the brain from eating disorders, AIDS, Crohn’s disease, bariatric surgery, chemotherapy, mercury poisoning, and issues with nutrition absorption and is also often exacerbated by alcohol abuse. This condition is part of a larger group of diseases related to thiamine insufficiency including Wernicke’s encephalopathy. The symptoms and signs may include anterograde amnesia, retrograde amnesia, damage to the dorsomedial nucleus, confabulation, lack of insight, apathy. The syndrome involves neural damage and hemorrage (ICD-9-CM, 1978). However, it leaves the verbal, procedural, spatial memory functioning intact (Oudman, et all, 2011). This is clearly observable

Korsakov's syndrome is a devastating impairment of recent memory that is caused by a thiamine deficiency which can result from alcohol abuse, mal-absorption, hyperemesis or starvation. Furthermore, other causes of Korsakov's syndrome also include heavy metal poisoning, head injury and tumors. A patient suffering from Korsakov's syndrome will most likely have an extensive pathology in the bilateral hippocampus and will actively exhibit confabulation. Confabulation occurs when a patient creates pseudo-memories about what happened during a forgotten episode. Also, during confabulation the patient's recall of the events of the past seem more imaginative than logical. Fortunately, although the patient may exemplify confabulation there

Also to emphasis an area that appears to get misdiagnosed and poorly treated, and other significant factor of risk which is alcohol withdrawal. This presents a different set of risks if not managed with the occurrence of seizure, Delirium Tremens and cognitive impairment, highlighting the need for good history taking (National Clinical Guidelines Centre. 2010).