ELDER TIP Because the older patient may be more sensitive to these drugs, withdrawal may take longer (weeks or months) and be more severe than in a younger adult.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are helpful. In AA, a self-help group with more than 1 million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA’s members stay sober as long as 5 years, and 30% stay sober longer than 5 years.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alzheimer's disease:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Therapy consists of attempts to slow disease progression, manage behavioral problems, modify the home environment, and elicit family support. Some medications have proven helpful. Tacrine, a centrally acting anticholinesterase agent, is given to treat memory deficits. It has slowed progression of the disease and improved cognitive function in some patients. Other agents include donepezil and rivastigmine. Underlying disorders that contribute to the patient’s confusion, such as hypoxia, are also identified and treated.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Treatment
(Handbook of Diseases)
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous, may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding. Acute withdrawal is also treated with oral multiple B vitamins, including thiamine. Administer fluids as needed, but avoid overhydrating the patient.
CLINICAL TIP: The possibility of intoxication with other drugs should be considered and a blood or urine sample sent for toxicology as appropriate.
Treatment of chronic alcoholism involves counseling, education, and cognitive techniques; psychotherapy (consisting of behavior modification techniques, group therapy, and family therapy); and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy may involve a daily oral dose of disulfiram to prevent compulsive drinking. (See Avoiding the risks of disulfiram therapy.)
UNDER STUDY: The opioid-antagonist drug naltrexone has been shown to reduce the ability to return to drinking and shorten periods of relapse. Longer-term trials are needed.
Tranquilizers, particularly the benzodiazepines, are used to decrease withdrawal symptoms of the central nervous system and are administered routinely to decrease risk of seizures. These drugs are administered and decreased over 3 to 5 days. Status epilepticus should be treated aggressively; initial treatment with lorazepam I.V. is effective.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are also helpful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Alzheimer's disease:
Treatment
(Handbook of Diseases)
A cerebral vasodilator (such as ergoloid mesylate or isoxsuprine) is prescribed to enhance the brain’s circulation; hyperbaric oxygen, to increase oxygenation to the brain; a psychostimulator (such as methylphenidate), to enhance the patient’s mood; and an antidepressant, to treat depression, if that seems to exacerbate the patient’s dementia. Donepezil and nivastigmine, which are centrally acting anticholinesterases, are given to treat memory deficits.
Most drug therapies being used are experimental. These include choline salts, lecithin, physostigmine, enkephalins, and naloxone, which may slow the disease process. Antioxidant therapy is also being investigated. Another approach to treatment includes avoiding the use of antacids containing aluminum, aluminum cooking utensils, and aluminum-containing deodorants to help decrease aluminum intake.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Confusion:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities with specific dates and times. Always reintroduce yourself to the patient each time you enter his room.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Confusion:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Never leave a confused patient unattended, to prevent injury to himself and others.
▪ Take measures to ensure patient safety.
▪ Keep the patient calm and quiet, and plan uninterrupted rest periods.
▪ Correct the underlying cause of the patient's confusion.
Patient teaching
▪ To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities with specific dates and times.
▪ Always reintroduce yourself to the patient each time you enter his room.
▪ If possible, explain to the patient and his family the cause of his confusion.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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