16.2 Nutrition and Chronic Renal Illness
5 min read•june 18, 2024
Opioid use disorder is a complex condition affecting the brain's reward system. Repeated opioid use leads to neuroadaptations, tolerance, and withdrawal symptoms when use is reduced. Understanding these mechanisms is crucial for effective treatment and care.
Treatment options include medications like methadone, buprenorphine, and naltrexone. These drugs work differently to reduce cravings and withdrawal symptoms. Nurses play a vital role in assessing patients, administering medications, and providing education on addiction treatments and recovery strategies.
Opioid Use Disorder
Mechanisms of opioid use disorder
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- Opioids bind to and activate opioid receptors in the brain
- Mu opioid receptors primarily responsible for rewarding and analgesic effects (euphoria, pain relief)
- Repeated opioid use leads to neuroadaptations in the brain's reward system
- Increased dopamine release in the nucleus accumbens reinforces drug-seeking behavior (positive reinforcement)
- Decreased sensitivity of the reward system to natural reinforcers (food, social interaction)
- Chronic opioid use results in the development of tolerance
- Higher doses required to achieve desired effects (analgesia, euphoria)
- Withdrawal symptoms occur when opioid use is abruptly discontinued or reduced
- Dysregulation of the noradrenergic system contributes to withdrawal symptoms (increased norepinephrine release)
Signs of opioid use disorder
- Compulsive opioid use despite negative consequences (legal, financial, social)
- Increased tolerance to opioids over time (need for higher doses)
- Withdrawal symptoms when opioid use is reduced or stopped
- Anxiety, restlessness, insomnia
- Muscle aches, abdominal cramps, diarrhea
- Nausea, vomiting, sweating
- Neglect of personal responsibilities and relationships (work, family)
- Continued opioid use despite physical or psychological problems (health issues, depression)
Causes and diagnosis of opioid addiction
- Risk factors for developing opioid use disorder
- Genetic predisposition (family history of addiction)
- Chronic pain conditions (back pain, fibromyalgia)
- Mental health disorders (depression, anxiety, PTSD)
- Early exposure to opioids (prescription pain medications)
- Diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria
- Presence of at least two symptoms within a 12-month period
- Symptoms include tolerance, withdrawal, loss of control, social impairment
- Screening tools for opioid use disorder
- Drug Abuse Screening Test (DAST) assesses problematic drug use
- Current Opioid Misuse Measure (COMM) identifies aberrant medication-related behaviors
Neurobiology of opioid addiction
- Opioids interact with the brain's reward system by increasing dopamine release
- Endogenous opioids, such as endorphins, play a role in pain modulation and reward
- Chronic opioid use alters neurotransmitter systems, leading to dependence and addiction
- Repeated use can result in neuroplastic changes, affecting decision-making and impulse control
Treatment of Opioid Use Disorder
Medications for opioid addiction treatment
- Methadone
- Full opioid agonist binds to and activates opioid receptors
- Long-acting oral medication provides stable blood levels
- Reduces withdrawal symptoms and cravings by preventing opioid withdrawal
- Requires daily dosing at a specialized clinic (methadone maintenance treatment)
- Buprenorphine
- Partial opioid agonist binds to opioid receptors with lower intrinsic activity than full agonists
- Sublingual or buccal administration (Suboxone, Zubsolv)
- Reduces withdrawal symptoms and cravings with a lower risk of respiratory depression (ceiling effect)
- Can be prescribed by certified physicians in office-based settings (DATA 2000 waiver)
- Naltrexone
- Opioid antagonist binds to opioid receptors and blocks their activation
- Oral or long-acting injectable formulations (Vivitrol)
- Blocks the effects of opioids and reduces cravings by preventing euphoria
- Requires complete detoxification before initiation to avoid precipitated withdrawal
Effects of opioid addiction treatments
- Methadone
- Effects: Reduces withdrawal symptoms and cravings, blocks the effects of other opioids
- Side effects: Sedation, constipation, sweating, respiratory depression (in high doses)
- Drug interactions: CYP450 inducers (rifampin) and inhibitors (fluconazole) can affect methadone levels
- Buprenorphine
- Effects: Reduces withdrawal symptoms and cravings, partially blocks the effects of other opioids
- Side effects: Nausea, headache, insomnia, constipation
- Drug interactions: CYP3A4 inhibitors (ketoconazole) can increase buprenorphine levels
- Naltrexone
- Effects: Blocks the effects of opioids, reduces cravings by preventing euphoria
- Side effects: Nausea, headache, dizziness, insomnia
- Drug interactions: Opioid-containing medications (codeine, oxycodone) should be avoided
Nursing care for opioid addiction patients
- Assessment
- Evaluate patient's history of opioid use and current withdrawal symptoms (COWS scale)
- Monitor vital signs (blood pressure, heart rate) and pain levels (numeric rating scale)
- Planning
- Collaborate with the healthcare team to develop an individualized treatment plan (medication, therapy)
- Set goals for medication adherence and participation in behavioral therapies (counseling, support groups)
- Implementation
- Administer medications as prescribed and monitor for side effects (constipation, sedation)
- Provide patient education on the medication, its effects, and potential side effects
- Encourage participation in behavioral therapies and support groups (Narcotics Anonymous)
- Evaluation
- Assess the patient's response to treatment and progress towards goals (urine drug screens, self-reported cravings)
- Modify the care plan as needed based on the patient's response and changing needs (dose adjustments, additional therapies)
Patient education on addiction treatments
- Explain the purpose and benefits of medication-assisted treatment (MAT)
- Reduces withdrawal symptoms and cravings (methadone, buprenorphine)
- Blocks the effects of opioids and prevents relapse (naltrexone)
- Describe how each medication works to reduce withdrawal symptoms and cravings
- Methadone and buprenorphine activate opioid receptors to prevent withdrawal
- Naltrexone blocks opioid receptors to prevent euphoria and relapse
- Discuss the importance of adherence to the prescribed medication regimen
- Taking medications as directed ensures consistent blood levels and therapeutic effects
- Skipping doses or taking extra doses can lead to withdrawal or overdose
- Emphasize the role of behavioral therapies and support groups in recovery
- Counseling helps address underlying psychological and social factors contributing to addiction
- Support groups provide a sense of community and accountability in recovery
- Provide information on potential side effects and when to contact a healthcare provider
- Common side effects include constipation, nausea, and sedation
- Severe side effects like respiratory depression require immediate medical attention
- Include resources for additional support and information, such as helplines and websites
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)
- National Institute on Drug Abuse (NIDA) website: www.drugabuse.gov
- Discuss relapse prevention strategies and the importance of ongoing support
- Explain harm reduction approaches for patients who continue to use opioids
Key Terms to Review (54)
Acid-Base Balance: Acid-base balance refers to the body's ability to maintain a delicate pH equilibrium within a slightly alkaline range, typically between 7.35 and 7.45. This balance is essential for the proper functioning of various physiological processes and is primarily regulated by the respiratory and renal systems.
Anemia: Anemia is a condition characterized by a reduced number or impaired function of red blood cells, leading to a decrease in the oxygen-carrying capacity of the blood. This can have significant implications for an individual's overall health and wellness, particularly in the context of nursing practice and the management of various medical conditions.
Azotemia: Azotemia is a medical condition characterized by an abnormally high level of nitrogen-containing compounds, such as urea and creatinine, in the blood. This is often an indicator of impaired kidney function, as the kidneys are primarily responsible for filtering and removing these waste products from the body.
Benign prostatic hyperplasia (BPH): Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly affects older men. It can lead to urinary symptoms such as difficulty starting urination, weak stream, and frequent urination, especially at night.
Bladder cancer: Bladder cancer is a type of cancer that begins in the cells of the bladder, which is responsible for storing urine. It can impact renal health and may require specific nutritional adjustments to support treatment and overall well-being.
Calcium Oxalate Stones: Calcium oxalate stones are the most common type of kidney stones, formed by the crystallization of calcium and oxalate in the urinary tract. They are a significant concern in the context of chronic renal illness, as the development of these stones can further exacerbate kidney dysfunction and lead to additional health complications.
Calcium stones: Calcium stones are hard deposits primarily composed of calcium oxalate or calcium phosphate that form in the kidneys. They can cause severe pain and are a common type of kidney stone.
Catabolism: Catabolism is the set of metabolic pathways that break down complex molecules into simpler ones, releasing energy in the process. It is the opposite of anabolism, which involves the synthesis of complex molecules from simpler ones. Catabolism plays a crucial role in various physiological processes, including energy production, nutrient utilization, and the breakdown of waste products.
Chemotherapy: Chemotherapy is a type of cancer treatment that uses drugs to eliminate or slow the growth of cancer cells. It can have significant side effects, including impacts on renal health and nutritional status.
Child and Adult Care Food Program: The Child and Adult Care Food Program (CACFP) is a federal program that provides reimbursements for nutritious meals and snacks to eligible children and adults. It aims to improve dietary quality and promote healthy eating habits among participants in child care centers, adult day care centers, and after-school programs.
Chronic Kidney Disease: Chronic kidney disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. It is a significant public health concern, as it can lead to end-stage renal disease and the need for dialysis or kidney transplantation if left untreated.
Chronic pelvic pain syndrome: Chronic Pelvic Pain Syndrome (CPPS) is a persistent pain in the lower abdominal or pelvic region lasting more than six months. It can significantly impact a patient's quality of life and may have multifactorial causes, including urological, gastrointestinal, and musculoskeletal issues.
Commodity Supplemental Food Program: The Commodity Supplemental Food Program (CSFP) is a federal program that provides nutritious food packages to low-income elderly individuals. It aims to improve the health and nutrition of participants by supplementing their diets with healthy foods.
Creatinine: Creatinine is a waste product that is produced by the body's normal breakdown of muscle tissue. It is filtered out of the blood by the kidneys and excreted in urine. The level of creatinine in the blood is an important indicator of how well the kidneys are functioning.
Cysteine stones: Cysteine stones are a type of kidney stone that form due to an inherited disorder called cystinuria, which causes excessive cysteine in the urine. They are less common than other types of kidney stones and require specific dietary management.
Cystine Stones: Cystine stones are a type of kidney stone that form when the amino acid cystine accumulates and crystallizes in the urinary tract. These stones are a common complication associated with the chronic kidney disorder known as cystinuria.
Dialysis: Dialysis is a medical procedure that filters and purifies the blood when the kidneys are unable to perform this function effectively. It is a critical intervention for individuals with kidney failure or end-stage renal disease, as it helps maintain the balance of fluids, electrolytes, and waste products in the body.
Edema: Edema is the abnormal accumulation of fluid in the body's tissues, resulting in swelling. This condition can occur in various parts of the body and is often associated with underlying medical conditions or factors that affect fluid balance and circulation.
Electrolytes: Electrolytes are minerals that carry an electric charge when dissolved in body fluids such as blood, urine, and other bodily fluids. They are essential for maintaining proper hydration, regulating nerve and muscle function, and supporting cardiovascular and renal health.
Fluid Balance: Fluid balance refers to the equilibrium between the amount of fluids entering and leaving the body, ensuring the proper hydration and functioning of various bodily systems. It is a crucial physiological process that is closely tied to the regulation of water, electrolytes, and acid-base balance within the body.
Food insecurity: Food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food. It can lead to malnutrition, chronic health issues, and increased vulnerability among at-risk populations.
Glomerular Filtration Rate: Glomerular filtration rate (GFR) is a measure of the kidney's ability to filter waste and excess substances from the blood. It represents the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit of time, and is a key indicator of overall kidney function.
Hyperkalemia: Hyperkalemia is a medical condition characterized by an abnormally high level of potassium in the bloodstream. This imbalance can have significant impacts on the body's overall health and wellness, particularly in the context of hydration, treatments, nutrition, and renal function.
Hypertension: Hypertension, also known as high blood pressure, is a chronic medical condition characterized by an elevated force of blood pushing against the walls of the arteries. It is a major risk factor for several cardiovascular diseases, including heart attack, stroke, and kidney disease. Understanding hypertension is crucial in the context of evidence-based practice, mineral intake, cardiovascular wellness, and the impact of nutrition across the lifespan and in chronic illnesses.
Interstitial Cystitis: Interstitial cystitis is a chronic and often debilitating bladder condition characterized by pelvic pain, pressure, and discomfort associated with an inflamed or irritated bladder wall. It is a complex disorder that can significantly impact an individual's quality of life, particularly in the context of chronic renal illness.
Interstitial cystitis,: Interstitial cystitis (IC) is a chronic bladder condition characterized by recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region. It often includes urinary frequency and urgency without an infection or other identifiable cause.
Kidney cancer: Kidney cancer is a type of cancer that begins in the cells of the kidneys. It can significantly affect renal function and overall health, often requiring specialized medical and nutritional care.
Low-Protein Diet: A low-protein diet is a dietary plan that restricts the intake of protein-rich foods, typically to less than 0.8 grams of protein per kilogram of body weight per day. This type of diet is often recommended for individuals with certain medical conditions, such as chronic kidney disease, to help manage the progression of the disease and reduce the strain on the kidneys.
Low-sodium diet: A low-sodium diet restricts the intake of sodium, usually to less than 2,300 mg per day, to manage or prevent high blood pressure and reduce fluid retention. It is particularly important for individuals with chronic renal illness to prevent further kidney damage and complications.
Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.
Metabolism: Metabolism is the sum of all chemical reactions that occur within the body to sustain life. It encompasses the processes of breaking down nutrients to release energy (catabolism) as well as the synthesis of complex molecules from simpler ones (anabolism). Metabolism is a crucial concept that underpins various aspects of nutrition, including energy balance, chronic illnesses, endocrine function, renal health, and treatment strategies.
National School Lunch Program: The National School Lunch Program (NSLP) is a federally assisted meal program operating in public and nonprofit private schools. It provides nutritionally balanced, low-cost or free lunches to children each school day.
Nephrolithiasis: Nephrolithiasis is the medical term for kidney stones, which are hard deposits of minerals and salts that form inside the kidneys. These stones can cause pain, urinary issues, and potential kidney damage if not managed properly.
Nephron: The nephron is the basic functional unit of the kidney, responsible for the filtration, reabsorption, and secretion of substances in the process of urine formation. It is a crucial component in the renal system that plays a vital role in maintaining fluid and electrolyte balance, as well as eliminating waste products from the body.
Older Americans Act: The Older Americans Act (OAA) is a federal law that supports a range of social services and programs for individuals aged 60 and older. It aims to enhance the lives of older adults by providing essential services like nutrition, health care, and community engagement.
Overactive Bladder: Overactive bladder (OAB) is a condition characterized by a sudden, uncontrollable urge to urinate that is difficult to suppress. It is often associated with increased frequency of urination and nighttime waking to urinate, and can significantly impact a person's quality of life.
Overactive bladder (OAB): Overactive bladder (OAB) is a condition characterized by a sudden, uncontrollable need to urinate. It often leads to urinary frequency and urgency, sometimes accompanied by incontinence.
Phosphate Binders: Phosphate binders are medications that help control the levels of phosphorus in the blood for individuals with chronic kidney disease. They work by binding to phosphorus in the digestive system, preventing its absorption and reducing the overall phosphorus load on the body.
Potassium chloride: Potassium chloride is a chemical compound often used to manage potassium levels in the body. It is particularly important for patients with chronic renal illness who need to monitor their electrolyte balance.
Renal cancer: Renal cancer, also known as kidney cancer, originates in the kidneys and can impair their function. It often requires specific dietary adjustments to manage symptoms and support overall health during treatment.
Renal Diet: A renal diet is a specialized dietary plan designed to support individuals with kidney-related health conditions, such as chronic kidney disease (CKD), end-stage renal disease (ESRD), or kidney failure. The primary goal of a renal diet is to help manage the progression of kidney disease and prevent or mitigate the associated complications by carefully regulating the intake of certain nutrients.
Renal illnesses: Renal illnesses are medical conditions that impair kidney function, affecting the body's ability to filter waste and maintain fluid balance. Chronic renal illnesses can lead to long-term health complications requiring specialized nutritional management.
Renal Osteodystrophy: Renal osteodystrophy is a condition that occurs in individuals with chronic kidney disease, where the kidneys are unable to properly regulate the levels of minerals and hormones essential for maintaining healthy bones. This imbalance leads to abnormal bone formation, mineralization, and remodeling, resulting in weakened and deformed bones.
Salt substitutes: Salt substitutes are products used to replace table salt (sodium chloride) with alternatives that typically contain potassium chloride. They are often recommended for individuals needing to reduce sodium intake, such as those with chronic renal illness.
School Breakfast Program: The School Breakfast Program (SBP) is a federally funded initiative in the United States that provides low-cost or free breakfasts to children in public and nonprofit private schools. The program aims to ensure that all students have access to a nutritious morning meal, which is especially important for their academic performance and overall health.
Sodium substitution: Sodium substitution involves replacing sodium chloride with other salts such as potassium chloride in the diet. This practice is often recommended for individuals with chronic renal illnesses to manage sodium intake and maintain electrolyte balance.
Struvite stones: Struvite stones are a type of kidney stone composed primarily of magnesium ammonium phosphate. They often form in response to urinary tract infections and can lead to serious complications if untreated.
Struvite Stones: Struvite stones, also known as magnesium ammonium phosphate stones, are a type of kidney stone that forms due to a buildup of certain minerals in the urinary tract. These stones are particularly problematic for individuals with chronic renal illness, as they can contribute to further kidney damage and impairment.
Supplemental Nutrition Assistance Program: The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to purchase nutritious food. It aims to alleviate hunger and improve health outcomes, particularly among vulnerable populations.
Supplemental Nutrition Program for Women, Infants, and Children (WIC): The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal assistance program in the United States designed to provide nutritional support to low-income pregnant women, breastfeeding mothers, infants, and children up to age five. The program aims to promote health during critical developmental periods through access to nutritious foods, nutrition education, and healthcare referrals.
Uremia: Uremia is a condition that occurs when waste products, such as urea and creatinine, accumulate in the blood due to impaired kidney function. This buildup of waste products can have significant impacts on the body's overall health and wellness, particularly in relation to the renal system.
Uric Acid Stones: Uric acid stones are a type of kidney stone that forms when there is too much uric acid in the urine. Uric acid is a waste product created when the body breaks down purines, which are found in certain foods. When there is an excess of uric acid, it can crystallize and form hard deposits in the kidneys, leading to the development of uric acid stones.
Uric stones: Uric stones, also known as uric acid stones, are a type of kidney stone formed from the crystallization of uric acid in the urinary tract. They are often associated with high purine intake and acidic urine.
Urologic illnesses: Urologic illnesses encompass a range of conditions affecting the urinary tract and male reproductive organs. These illnesses often impact renal function and necessitate specific nutritional considerations.