Case Study Substance Abuse
A 45-year-old married man presents to his primary care physicianwith a chief complaint of fatigue lasting for the past 12 months.He states that he goes to sleep easily enough but then wakes uprepeatedly throughout the night. He has had this problem since hewas injured on the job 12 months ago. On further questioning, hereports low mood, especially regarding not being able to do hisjob. He states that his alcohol consumption is 6 to 12 beers a day,as well as several ounces of hard liquor to “take the edge off thepain.” He discloses that it takes more alcohol than it used to inorder to “get me relaxed.” The patient claims he has experiencedseveral blackouts caused by drinking during the past 2 months andadmits that he often has a drink first thing in the morning to keephim from feeling shaky. Despite receiving several reprimands atwork for tardiness and poor performance in addition to his wifethreatening to leave him, he has been unable to stop drinking. Thedoctor convinces the patient to admit himself into a localpsychiatric hospital for detoxification and rehabilitation for hisalcohol dependence.
On his mental status examinationduring admission to the psychiatric hospital, the patient is alertand oriented to person, place, and time. He appears rather haggard,but his hygiene is good. His speech is of normal rate and tone, andhe is cooperative. His mood is noted to be depressed, and hisaffect is congruent, although full range. Otherwise, noabnormalities are noted.
- On admission, the hospitalprotocol is to screen the patient forpotential alcohol abuse and/or dependence. List two (2) screeningtechniques for alcohol abuse/dependence.
- During the first 24 – 36 hours ofwithdrawal from the alcohol, what symptoms do you expect to see?List two (2) symptoms.
- Aside from death, what two (2)withdrawal complications should the nurse be most concernedabout?
- The patient was started on thedetoxification protocol, a symptom-based dosing Valium (diazepam)schedule. Explain the reasoning behind using Valium (diazepam) as amedication to detox the patient.
- The provider also ordered a dailydose of thiamine (100 mg PO qday X 5 days). What is the most likelyreason for the patient being thiamine deficiency? List one (1)severe consequences of thiamine deficiency.
- (Most likely reason):
- (Severe consequence):
- Upon discharge, the patientconsents to take disulfiram (Antabuse) to help abstain from usingalcohol. The nurse knows he/she needs to educate the patient aboutthis mediation. What is the most importantteaching pointthat needs to be emphasized to the patient?
