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28 Days Prezi

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on 6 October 2013

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Transcript of 28 Days Prezi


Gwen has a drinking problem.
S/T:
Assess client’s level of disorientation to determine specific requirements
for safety.
Knowledge of client’s level of functioning is necessary
to formulate appropriate plan of care.
Place client in quiet, private room.
Excessive stimuli increase client agitation.
Institute necessary safety precautions
(Client safety is a nursing priority.)
28 Days
Diagnosis: Risk for Injury
Definition: A risk for injury as a result of [internal or external] environmental conditions interacting with the individual's adaptive and defensive resources.
Interventions:
Signs and Symptoms of Gwen's Substance Abuse
Character Bio

Name: Gwen Cummings
Age: 20's-30's
Ethnicity: Caucasian
Gender: Female
Occupation: Newspaper columnist
Martial Status : Monogamous relationship
- Audit Score = 24
- Score > 8 indicative
of possible drinking problem.
Character's History
Gwen is financially stable, she is employed and has her own apartment in NYC and
Family history of substance abuse
Strained relationship between Gwen and her sister
In addition to a family history of substance abuse, Gwen is in a relationship with a substance abuser who enables her
Gwen is able to reconcile the issues surrounding her mother and her childhood, as well as put aside her pride and ask for help.
Diagnosis:
Risk for injury related to opioid and alcohol withdrawal as evidenced by risky behavior
S/T: Client's condition will stabilize within the
next 48 hours
L/T: Client will not experience further injuries.
Goal:
Outcomes:
Client shows no signs of
withdrawal symptoms and
shows no signs of injury.
Interventions
I) Establish trusting relationship with client (be honest, keep appointments be available to spend time).
II)Encourage the client to verbalize feelings, fears, and anxieties. Answer any questions she may have regarding the disorder.
III) Explore with client the options available to assist with stressful situations rather than resorting to substance abuse (Townsend,
2008, p. 87).
Interventions:
Diagnosis: Ineffective Coping
Ethical/Spiritual Issue
Lack of Value in Self and in Life
Diagnosis: Dysfunctional Family Processes
DSM-IV-TR AXES OF DIAGNOSES
Axis I: 305.00 Alcohol Abuse, 305.50 Opioid Abuse
Axis II: None
Axis III: Fractured Tibia (Right)
Axis IV: Lack of support systems, in a relationship that increases exposure to substances
Axis V: 60
DSM DX:
305.00 Alcohol Abuse, 305.50 Opioid Abuse

Nursing DX:
Risk for injury related to opioid and alcohol withdrawal as evidenced by risky behavior
Nursing DX:
Diagnosis: Alcoholism
related to abuse of alcohol as
evidenced by enabling to
maintain drinking by her boyfriend.
Nursing DX:
Ineffective coping related to
inadequate support system as evidenced
by inability to meet role requirements.
Definition: The state in which the psychosocial, spiritual, economic, and physiological functions of the family member and the system are chronically disorganized because of the effects of alcohol abuse.
Diagnosis: Alcoholism related to abuse of alcohol as evidenced by enabling to maintain drinking by her boyfriend.
S/T Goals: Boyfriend will identify ineffective coping behaviors and consequences.
L/T Goals: Boyfriend will take action to change self-destructive behaviors and alter behaviors that contribute to the client's addiction.
Outcomes: Boyfriend will determine understanding of current situation and previous methods of coping with life's problems.
I.) Provide information about enabling and addictive disease characteristics for both the user and the boyfriend.
II.) Encourage participation in therapeutic writing. Examples of this would be writing in a journal or diary (narrative or focused).
III.) Encourage involvement with self-help associations, such as alcoholics anonymous, and professional family therapy.
Criteria
“A. A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by one (ore more) of the following, occurring within a 12-month period:

1) Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
2) Recurrent alcohol use in situations in which it is physically hazardous.
3) Recurrent alcohol-related legal problems.
4) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication, physical fights).
B. The symptoms have never met the criteria for Alcohol Dependence.”
Definition: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.
Diagnosis:

Short-term Goal:
Long-term Goal
Ineffective coping related to inadequate support system as evidenced by inability to meet role requirements.
Client will express true feelings associated with use of substances as a method of coping with stress.
Client will be able to verbalize adaptive
coping mechanisms to use, instead of
substance abuse, in response to stress.
Reference List
Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing : care plans and psychotropic medications. Philadelphia: F.A. Davis Co.
National Institute on Alcohol Abuse and Alcoholism. (2003). Assessing alcohol problems: a guide for clinicians and researchers, 2d ed. NIH Pub. No. 03–3745. Washington, DC: U.S. Dept. of Health and Human Services, Public Health Service. Retrieved from http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/index.htm.)
Gwen Cummings has obvious issues with self esteem, that largely stem from growing up with a mother who was an alcoholic.
Some common characteristics of people who grow up with parents who are alcoholics are:
Denial
More comfortable living in chaos than in peace
Fear of abandonment
Suppressed emotions of anger, disappointment, loneliness etc...



Hill, Elizabeth, Nord Janet (2002). Young-adult children of alcoholic parents. American Journal of Addiction.
- History of injury (Fell out of a window trying to retrieve pills she dropped).
- Denial of problem
- Boyfriend visits her in treatment, brings alcohol

Interventions:
1) Assess client’s level of disorientation to determine specific requirements for safety.
2) Place client in quiet, private room.
Excessive stimuli increase client agitation.
3) Institute necessary safety precautions
(Client safety is a nursing priority.)
1) Establish trusting relationship with client
2) Encourage the client to verbalize feelings, fears, and anxieties.
Answer any questions she may have regarding the disorder.
3) Explore with client the options available to assist with stressful
situations rather than resorting to substance abuse.
the guide, Assessing Alcohol Problems: A Guide for Clinicians and Researchers,1 available from the National Institute on Alcohol Abuse and Alcoholism. (1 National Institute on Alcohol Abuse and Alcoholism. Assessing Alcohol Problems: A Guide for Clinicians and Researchers, 2d ed. NIH Pub. No. 03–3745. Washington, DC: U.S. Dept. of Health and Human Services, Public Health Service. Revised 2003, may be accessed online at http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/index.htm.)
1) Provide information about enabling and addictive disease characteristics for both the user and the boyfriend.
2) Encourage participation in therapeutic writing. Examples of this would be writing in a journal or diary (narrative or focused).
3) Encourage involvement with self-help associations, such as alcoholics anonymous, Al Anon, Alateen, as well as professional family therapy.
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