CASE STUDY OF Mr. JOHNSON BABU WITH ALCOHOL DEPENDENCE, Exams of Nursing

Download CASE STUDY OF Mr. JOHNSON BABU WITH ALCOHOL DEPENDENCE and more Exams Nursing in PDF only on Docsity!

CASE STUDY

OF

Mr. JOHNSON BABU

WITH

ALCOHOL DEPENDENCE

GENERAL INFORMATION

IDENTIFICATION DATA

Name :- J.P Johnson Babu Address :-Manjunatha Chicken Center 2 nd^ main Bapuji Nagar Bangalore Age :- 24 yrs Sex :- Male Ward :- De addiction centre Address :- P Religion :- Christian Education :- 10th^ Std. Martial Status :- Single Occupation :- Non agriculture labor Income :- 1000 Rs Date of Admission :- 16/1/ Diagnosis :- Alcohol dependancy Reliability :- Reliable Language :- Hindi/ English/kannada Informant

1. Patient
2. Father **COMPLAINTS AND THEIR DURATION
3. According to patient** Patient is regularly taking alcohol since 2003.Dailly around half litre. After taking alcohol quarrels with father and brother. Uncontrolled anger, Decreased apetite and sleep. 2. According to Father Patient is taking alcohol and cigarette daily with friends, shows anger towards father and brother. Sleep is reduced and taking less food. Many time tried to hospitalize. Now he

No h/o. sleep disturbances, no thumb sucking, no tics and mannerism, no h/o bed wetting, no sibling rivalry

3. Physical illness during childhood No history of ant major physical illness during childhood. No h/o epilepsy, head injury, encephalitis during childhood. 4. School Patient studied till 10th^ std. Relationship with peers and teachers normal. He was an average student. 5. Occupation He is non-agriculture labor. Running a poultry farm near Bangalore 6. Sexual history Normal sexual history. No abnormalities reported. 7. Martial History Not Married 8. Use and abuse of alcohol, tobacco He is using alcohol and tobacco since six years. Daily take half litre of alcohol and 15- cigarette. **PREMORBID PERSONALITY

1. Social relations** Normal behavior toward family and friends 2. Intellectual activities No significant intellectual activities noted. 3. Mood Subjective – satisfied Objective – looks cheerful 4. Character a) Attitude to work and responsibility Shows a responsibility towards home b) Interpersonal relationship Normal interpersonal relationship 5. Energy and initiative He was active

6. Fantasy life Not reported 7. Habits No habit of using tobacco and alcohol MENTAL STATUS EXAMINATION: A. General appearance and behaviour:

1. General appearance:

• Body built and physical experience: moderately built and healthy, young and wheatish in complexion
• Grooming : well groomed
• Hygiene : maintained
• Dress : dress well and appropriate to season
• Facial expression : Pleasent
• Eye contact : maintained
• Posture : normal

2. Attitude towards examiner : co-operative
3. Rapport : rapport maintained
4. Motor behaviour : no abnormal motor behaviour like tics, Mannerism, pacing, motor retardation B. Thought and speech:
5. Form of thought: Q. Why do you come here with your father? A. I am using alcohol a lot and making problems .So to stop alcohol drinking I came here. Inference: normal form of thought.
6. Content of thought

A. 14th^ may 1985 Inference: Remote memory is intact. G. Attention and concentration: Q. How many days in a week and tell them? A. 7 days, he says from Monday to sunday Q. Subtract 100-5? A. 95 Reference: Attention is aroused and concentration is also sustained. H. Orientation: Q. what must be the time now? A. it must be 10’o clock Q. who brought you here? A. I came along with my father. Q. who is that lady wearing white saree? A. she is a ward sister. Q. Where are you now? A. I am in NIMHANS hospital. Inference: he is oriented to time, place, and person. I. Abstraction: Q. what is the different between the potato and stone? A. Potato is eatable and stone is hard. Q. What is the similarity of banana and orange? A. both are fruits Inference: Abstraction is good. J. Comprehension:

Q. What will you do, if u miss the bus? A. I’ll catch another bus. Q. what you will do if you feel cold? A. I’ll wear sweater. Inference: comprehension is good. k. Intelligence: Q. What is the capital of India? A. Delhi Inference: Intelligent is good. L. Judgment: -Personal judgment: Q. What are you planning to do after discharging from here? A. I want to settle my life. -Social judgment: Q. What will you do when you saw a person drowning? A. I will call other people because I don’t know swimming -Test judgment: Q. What you will you do if your ward is fire? A. I’ll pour water to stop the fire. Inference: Judgment of the patient is good. M. Insight: Q. Why you are coming and staying here? A. I have to stop alcohol drinking. Inference: Insight is present. Physical examination

F.EYES:

a.Expression: pleasant b.Eye brows: equal, evenly distributed and no dandruff noted. c.Eye lids: no lesion and scars, eye lashes are equally distributed d.Lacrimation: clear fluid expressed, no discharges present. e.Conjunctiva:appears pale and clear G.EARS a.Appearance: No masses or lesions present in the external ear. b.No discharge c.Hearing: is able to hear in both ears; Weber test-negative; Rinne test-positive d.No lesions or mass. H.NOSE: a.Appearance: septum not deviated; no growth or lumps externally noted b.Discharge: no discharge present c.Patency: Both nostrils are patent d.Sense of smell: good I.MOUTH AND THROAT: a.Lips, tongue: normal, no lesions or ulcers b.Teeth: intact in the upper and in lower jaw J.NECK: a.Trachea is normal position, no palpable mass. b.Lymph nodes: no palpable K.CHEST AND RESPIRATORY SYSTEM : a.Inspection: Size and shape is normal. Chest expansion equal in both the sides and respirations are normal. b.Palsation: No local sweeling; no lymph node palpated

c.Percussion: No fluid collection d. Auscultation: Breath sounds are loud, high pitch in both sides; no consolidations, respiratory rate-20/mt L.CARDIOVUSCULAR SYSTEM: a.Inspection: size and shape of the chest is with the normal limits; no surgical scar b.Palpation: carotid pulse and peripheral pulses are regular; normal sinus rhythm; rate-80/mt c.Percussion: cardiac borders well within normal limits, no cardiac or supracardiac dullness d.Auscultation: S1 S2 auscultated. No abnormalities noted, pulse-80/mt M.ABDOMEN: a.Inpection: size and shape of the abdomen normal, no distention and tenderness. b.Palpation: no abnormalities found. Firm musculature noted c.Perscussion: no ascitis and fluid collection. d.auscultation: peristalsis heard in the right lower quadrant N.BACK: a.Spine and curvature: no abnormalities noted; no lymphs or lesions present b.Movement: all movements are possible c.Tenderness: no tenderness noted O.GENITALIA: Normal male genitalia; has no discharges P.UPPER EXTREMITIES: a.Deformity: no deformities noted b.Sweeling/edema: no swelling or edema c.Muscles: no emaciate

Nurse: What is your date of birth? Patient: 14th^ may 1985 Remote memory intact. Nurse: Do you like your parents and brother? Patient: Yes, I like my parents and brother Nurse: why you are quarrelling with brother? Patient: When I drink alcohol I will lose my control. Nurse: What is your plan after discharge? Patient: I want to go for a good job or start a business. Nurse: Once you get discharged you must come for regular follow-up and continues taking the medicines till doctor says. Patient: OK brother. Nurse: Do you want to ask any question? Patient: No, tomorrow I will talk to you brother. Nurse: OK, we will stop here and thank you for answering my questions. Patient: Bye! Brother. Patient is attached with his family. Willing to work after discharge. Concentration is good. LAB INVESTIGATIONS Sl No Investigations Patient’s value Normal value Interence

1. Hemoglobin 11.2 gm % 13-18 gm% Slightly anemic
2. Total WBC count 6.600 cu mm 4,000-11,000 cu mm Normal
3. Polymorph 58% 60-70% Normal
4. Lymphocyte 36% 20-30% Normal
5. Eosinophil 4% 1-4% Normal
6. Serum creatinine 0.6 mg/dL 0.7-1.4 mg/dL Normal MEDICATIONS Drug Name Pharmacological Name Dose Route Action Side effects Nurses responsibil ity T. chlordiazepoxid e Chlordiazepoxid e Oral 15- 100 mg IV 50-100 mg slowly Oral and IV Anti- anxiety agent. Nausea, vomiting, epigastric pain, diarrhea, impotence, impairment of In injection should be given deltoid and is gluteal

driving skills, irritability. muscle. T. Rantac Ranitidine Oral 150- 300 mg Oral IV Histamine H2recepto r antagonist Headache,Dizzi ness,rarelyhepati tis,thrombocyto penia,breast symptoms, hypersensitivity, confusion, Administer correct dose T. BC BC 32.5mg oral Vitamin B and C complex supplemet . Hypervitaminosi s,G.I.Symptoms, yellow coloured urine. Look for side effects,exp lain about urine colour change T. Liv 52 sihymanin 140mg oral Liver protectant Occasional laxative effects See for hypersensit ivity. T. Fluoxtine fluoxtine 20mg oral Antidepre ssant Nervousness, insomnia, anxiety, tremor, headache, drowsiness, nausea and drymouth. CASE STUDY INTRODUCTION From time immemorial human beings have looked for substances to make life more pleasurable and to avoid or decrease pain, discomfort and frustration. Despite definite improvements in health care in most countries, problems related to drug and alcohol abuse are increasing almost everywhere. DEFINITION Alcohol dependence was earlier called as “alcoholism”. Alcoholism is defined as a chronic disease by repeated drinking that produces injury to the drunken health or to his social or economic functioning. EFFECT Low to moderate consumption produces a feeling of well-being and reduced inhibitions. At higher concentrations motor and intellectual functions are impaired, mood becomes very labile and behavior characteristic of depression, euphoria and aggression are exhibited.

Synonym Milieu limited Milieu – limited Sex Both sexes Mostly in males greater than 25 years. Age of onset >25 years. <25 years. Etiological Genetic factors Heritable Factors Important, strong Environmental influences are Contributory Environmental influences are limited. Family history May be positive. Parental alcoholism and antisocial behavior usually present Loss of control Present No loss of control Other features Psychological dependence and guilt present Drinking followed by aggressive behavior, spontaneous alcohol seeking. Pre-morbid personality traits Harm avoidance, high reward dependence Novelty seeking. Under classification client comes under Type- BOOK STUDY PATIENT STUDY ETIOLOGICAL FACTORS  BIOLOGICAL FACTORS  PSYCHOLOGICAL FACTORS  SOCIAL FACTORS

1. BIOLOGICAL FACTORS  Genetic vulnerability (family history of substance are disorder, eg, is type II alcoholism).  Co-morbid psychiatric disorder or personality disorder.  Co-morbid medical disorders.  Reinforcing effects of drugs (explains continuation of drugs)  Withdrawal effects and caring. (Explain continuation of drugs).  Biochemical factors (e.g. role of dopamine and non epinephrine in cocaine, ethanol and opiod dependence.  2. PSYCHOLOGICAL FACTORS  Curiosity, need for novelty seeking.  General rebelliousness and social non-conformity.  Early use of alcohol and tobacco.  Poor impulse control.  Sensation – seeking (high)  Low – self esteem (anomia) Client was influenced both by psychological and Social factors.  Concerns regarding personal autonomy.  Poor stress management skills.

 Child hood trauma or loss.  Relief from fatigue and for boredom.  Escape from reality.  Lack of interest in conventional goals.  Psychological distress.

3. SOCIAL FACTORS  Peer pressure (often more important than parental factors.)  Modeling (imitating behavior of important other).  Ease of availability of alcohol and drugs.  Strictness of drug law enforcement.  Intra-familiar conflicts. OTHER CAUSES  Interpersonal factors.  Socioeconomic factors.  Cultural and ethnic factors.  Pharmacological factors.  Ecological factors. AVAILABILITY  Alcohol is easily available and drinking is accepted as a norm in functioning and social gathering. GENETIC FACTORS  Some excessive disorders have a family history of excessive drinking. There is a genetic relation between alcoholism, depression and antisocial personality disorder. He was also influenced by easy availability and socioeconomic factors BIOCHEMICAL FACTORS Several biochemical factors have been suggested including abnormality in alcohol dehydrogenates in the neurotransmitter mechanism. LEARNED BEHAIVOR It has been suggested that learning processes may contribute in a more specific way to the development of alcohol dependence through the repeated experience of withdrawal symptoms. Alcohol may act as a reinforce for further drinking. Children especially boys tend to follow their parents drinking pattern. Some people drink to get away from pain. PERSONALITY FACTORS Alcoholism is more common in anxiety, prone or cyclothymic personalities. Drinking alcohol is also more common among antisocial personalities. POOR COPING STRATERGIES The person enable to face stress often resort to alcoholism. The disease mechanism involved in alcoholism include denial, rationalization and projection.

MIDDLE STAGES

Loss of control over amount, time and occasion of drinking. Keeping away from alcohol for sometime but going back to obsessive drinking after each such abstinent period. CHRONIC STAGE Getting drunk ever on small amounts of alcohol. Willing to i.e., beg, borrow, or steal to maintain supply to alcohol. Living to drink – alcohol takes priority over family or job. DIAGNOSTIC EVALUATION Certain laboratory makers of alcohol dependence have been suggested. There include: Physical examination. History collection. Neurological examination. Mental status examination. GGT (gamma glutyl transfarase) MCV (mean corpuscular volume) GGT is raised to about 40 IU/L in 80% of alcohol dependant individuals. An increase in GGT of more than 50% in an abstinent individual signifies a resumption of heavy drinking. MCV is more than 92 fi (normal= 80-90 H) is 60% of alcohol dependent Individuals. In case of client’s physical examination, history, collection, neurological examination, MSE and blood investigation done. BOOK STUDY PATIENT STUDY OTHER LAB MARKETS It includes, Alkaline phosphatase. AST ALT Uric acid Blood triglycerides CPK COMPLICATIONS I PHYSICAL OR MEDICAL COMPLICATIONS A GASTRO-INTESTINAL SYSTEM Gastritis. Dyspepsia Vomiting Peptic ulcer Cancer Esophageal varices Mallory-weiss syndrome Achlorohydria Carcinoma stomach and esophagus. Client developed the

LIVER

Fathy degeneration of the liver. Alcoholic hepatitis Cirrhosis Liver cell carcinoma Liver failure complication of vomiting, muscle wastage and vitamin deficiency. PANCREASE Acute and chronic pancreatitis. B CENTRAL NERVOUS SYSTEM Peripheral neuropathy. Delirium tremors. Rum fits. Alcoholic hallucinosis. Alcoholic Jealousy Wernicke- Korakoff psychosis Alcoholic dementia. Suicide Cerebellar degeneration Central posture myelinosis Head injury and fractures. C CARDIO VASCULAR Alcoholic cardiomyopathy High risk for myocardial infarction. Cardiac beri-beri. Alcoholic myopathy. Risk for coronary artery disease. D BLOOD Folic acid deficiency aneamia. Decreased WBC production. Anemia, thrombocytopenia, vilk factor deficiency, hemolytic anemia. BOOK STUDY PATIENT STUDY E MUSCLE Peripheral muscle weakness and wasting of muscles. F SKIN Spider angiomas. Acnerosacea Palmar erythema Rhinophyma Spider revi Parotid enlargement Ascitis. G NUTRITION Protein malnutrition. Vitamin deficiency disorders like pellagra and beri-beri. Client does not develop the reproductive complications