Nursing Care for People with Substance Disorders - Case Study Example

?Running head: NURSING CARE OF PEOPLE WITH SUBSTANCE RELATED DISORDER AND DUAL DIAGNOSIS Nursing Care Of People with Substance Related Disorder and Dual Diagnosis Insert Name Insert Course Title Insert Instructor’s Name 28 September 2011 Nursing care of people with substance related disorder and dual diagnosis Introduction The subject of this case study is a 28-year-old male named Joe Fielding, who previously worked in advertising, but of late, he has been working as a laborer. He was married to Fiona with whom they have a child named Liam but now they are divorced, with Fiona taking custody of their child. Currently, he is a client of Alcohol and Drug services. Joe has a drinking problem that has developed gradually over years. Initially he liked drinking with his friends but over past few years, his drinking has become quite escalated to the extent he is alcohol dependent in order to cope with daily cores. His convulsive consumption of alcohol is very pronounced, since he says that normally he takes a couple of beers in the morning and ends in the evening by consuming two or three bottles of wine and some mixers. Joe also appears to be very depressed and hopeless as he explained that he was feeling very low and regrets about having lost the only things that matters to him. Looking at his medical history, he appears to have lost considerable weight, which he explains by saying that he does not like eating, and he lacks appetite most of times due to nausea. It appears that Joe is in need of nursing care of people with substance related disorder and dual diagnosis. Dual diagnosis refers to the comorbid condition of a person who is suffering from a substance abuse problem and mental illness (Elder, Evans & Nizette, 2009). High-risk alcohol consumption is not a problem that affects Joe alone, but it is prevalent in Australia, with about 3200 people dying as a result of excessive alcohol consumption and around 81000 people being hospitalized annually (Australian Government, 2011). Moreover, the Australian community incurred approximately $15.3 billion in 2004/05 from alcohol-related social problems (Australian House of Representatives, 2010). Assessment: Biopsychosocial assessment It involves interview or interviews combined with physical and psychological examinations that are aimed at gathering all the information related to physical, psychological, and social issues that may be affecting problems such as addiction, emotional and personality difficulties (Myers & Salt, 2007). Joe, in his late 20s, appeared to have all signs of a late stage alcoholic developing into alcohol withdrawal. He looked sweaty, eyes dilated and his hands were trembling badly. His blood/alcohol level was at that moment low. His nose and cheeks were red with tiny spider veins and when asked to extend his hands out in front, they were very tremulous. He looked more of a featherweight person with a distended abdomen. He scored high on the CAGE assessment test and did not have other drug substances in his system. Mental health status assessment Mental health assessment helps a healthcare practitioner to get the overall picture of how well a patient feels emotionally and their ability to think, reason, and remember (Fabricius, Langa & Wilson, 2008). He appears to have a memory lapse, as he cannot remember people close to him - he kept confusing their names. His thinking was relatively slow, and the speech was somehow slurred. It was apparent that he had lost control of his drinking and now his drinking has escalated. He was confused and depressed by his situation. The divorce and custody of his child appear to have added hopelessness and misery to his predicament. For most of the time, he was feeling guilty and worthless for losing interest in things that were important in his life. His sleeping habit is quite troubled since he has to take alcohol in order to sleep. Substance use history Substance use history helps a doctor to assess dual diagnosis patient history of how they have been abusing substances, for what given timeframe and whether they have a family history of substance use (American Psychiatric Association, 2000). Joe has no family history of alcoholism. He began drinking as a social drinker with the company of his friends but during the last few years, his drinking has become much escalated to extent now he is fully dependent on alcohol. Mental Health Problem Diagnosis From experts’ point of view, Joe is in late stage of alcoholism and he is suffering from severe depression. According to the Board of Directors of the National Council on Alcoholism and Drug Dependence, alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations it’s mostly progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably, denial (Signs of Alcoholism, 2011). Thus, alcoholism is an addiction that causes alcoholics not to control their drinking patterns and stay in denial of fact that it is causing problems and complications in their life. Moreover, depression is a lowering of mood that is characterized by feelings of sadness, despair and discouragement, which range from mild to severe and persist for a period of time (Department of Health Australia, 2011). Mild depression is a common emotional state that is easily controllable. Severe depression is an acute mental illness that is characterized by symptoms such as slowness of movement, loss of interest in most activities, sleep and appetite changes, feeling of hopelessness, delusion, and agitation (Curtis, 2005). Severe depression victims may also experience suicidal thoughts and may even carryout the suicidal actions. Treatment Treatment for Joe’s alcoholism will involve the following measures: counseling, detoxification, prescription of Antabuse to discourage drinking and recommendation to join Alcoholics Anonymous program (Alcoholism Helpline Online, 2011). For depression, Joe will require a combination of antidepressants and psychological treatments such as counseling and psychotherapy. There are three common classes of antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs), and Irreversible Monoamine Oxidase Inhibitors (MAOIs), with each working in different ways and having different applications, thus they can be combined for an effective treatment (Reach Out Australia, 2010). Joe’s treatment regime can be improved through hospitalization for a short time and Electro Convulsive Therapy (ECT) that has been quite effective in treating delusions. Nursing care interventions Nursing care interventions for Joe should be approached in a patient nonjudgmental manner, using firm, consistent, accepting and reasonable manner so has to under stands his situation, how he is responding to the treatment and offer encouragement (Brunner, et al, 2009, p.2183). These interventions will include the following measures: first, Joe will require harm reduction strategies involving regular ECT as prescribed and detoxification, which is mainly achieved by administering Chlordiazepoxide orally every 4 to 8 hours in decreasing doses until the withdrawal, is complete (F.A. Davis Company, 2011). Secondly, a comprehensive self-care plan should be developed together with Joe so that he can understand topics related to alcoholism, depression, hygiene, nutrition and exercising, in order to interpret their value in the context of positive self-regard and support for sobriety. This should be followed by a brief intervention in form of counseling interviews that review the current and potential outcomes of alcohol use. Fourthly, a secure, trusting, and credible therapeutic nurse patient relationship should be developed to facilitate care delivery. This will require considerable time, assurance, and trust with Joe, and contact with other health care providers. Further, Joe’s case will require interventions that include family and community by involving aspects of health education, support, and counseling needs for families with alcoholic members. This can be achieved through use of reliable community resources such as Alcoholic Anonymous, and educating the family and community on need to support Joe to overcome his problems. More so, regular motivational interviewing for Joe is highly recommended to show that to understand how he feels about his problem and support him in making his decisions. Studies have shown that motivational interviewing significantly helps people to cut down or stop using drugs and alcohol (Smedslund, et al, 2011). Additionally, tertiary prevention that consists of relapse counseling and health maintenance that enables the client to acquire new learning in the psychotherapeutic relationships. Lastly, for future prospects, Joe should set small achievable goals then build on them for bigger goals, and he should exercise regularly and eat well as advised by the nutritionist. Conclusion Nursing practitioners can successfully intervene with individuals and their family with alcohol dependence, depression, and their co morbidity. This is achievable through interventions such as screening, treatment and outcome evaluations for individuals and their families. In essence, this is more successful when the practitioner involves the individuals, their families, and the community in the intervention measures. References Alcoholism Helpline Online, (2011). What Alcoholism Treatment Options are Available? Retrieved from http://www.alcoholismhelponline.com/ American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. Elder, R., Evans, K., & Nizette, D. (2009). Psychiatric and Mental Health Nursing. Second edition. Elsevier Australia. Australian Government. (2011). National Alcohol Strategy 2006 – 2011. Retrieved from http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/nas-06-09 Australian House of Representatives. (2010). Substance abuse. Retrieved from http://www.aph.gov.au/house/committee/fca/subabuse/report/chapter2.pdf Brunner, L.S., et al (2009).Brunner and Suddarth's textbook of medical-surgical nursing. PA: Lippincott Williams & Wilkins. Curtis, J. (2005). Substance-related disorders and dual diagnosis. Psychiatric and mental health nursing, Pp 304–323. Department of Health Australia (2011). A Guide to Mental Health Terminology. Retrieved from http://www.health.vic.gov.au/mentalhealth/termnlgy.htm F.A. Davis Company. (2011). Additional Nursing Care Plans. Retrieved from http://www.fadavis.com/townsend4e/additionalnursingcareplans.htm Fabricius, V., Langa, M., & Wilson, K. (2008). An exploratory investigation of co-occurring substance-related and psychiatric disorders. Journal of Substance Use, 13(2), 99-114. Myers, P.L. & Salt, N.R. (2007). Becoming an addictions counselor: a comprehensive text. NY: Jones & Bartlett Learning. Reach Out Australia, (2010). Depression Management and Treatment. Retrieved from http://au.reachout.com/find/articles/depression-management-and-treatment-options Signs of Alcoholism. (2011). Definition of Alcoholism: Understanding Alcoholism. Retrieved from http://signsofalcoholism.org/definition-of-alcoholism/ Smedslund, G., Berg, R.C., Hammerstrom, K.T. (2011). Motivational interviewing for substance abuse. NJ: John Wiley and Sons, Ltd. Retrieved from http://www2.cochrane.org/reviews/en/ab008063.html. Read More