WK#6 Addiction

1. Select one drug to treat the diagnosis(es) or symptoms.
2. List medication class and mechanism of action for the chosen medication.
3. Write the prescription in prescription format.
4. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
5. List any side effects or adverse effects associated with the medication.
6. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
7. Provide a minimum of three appropriate medication-related teaching points for the client and/or family.

NR 546 Week 6 Case Study

9.24 MWS

Subjective Objective

The client L.B. is a 38-year-old, white female

patient seen today for a follow-up visit at her

intensive outpatient program (IOP) treatment

clinic. She has a history of Alcohol Abuse and

Opioid abuse (Typically takes Norco or

Oxycontin). Also has a mental health history

of depression with suicidal ideation.

Client’s Chief Complaints:

“I can’t stop drinking, and I feel like I have no

reason to live.”

History of Present Illness

L.B. presents to the IOP clinic currently

intoxicated. She reports a longstanding history

of alcohol abuse, which has worsened over the

past year as well as occasional opioid abuse.

L.B. describes feeling persistently depressed,

hopeless, and having suicidal thoughts over the

past month. She admits to daily alcohol use as a

way to cope with her depressive symptoms.

Also admits to occasional cannabis use

(smoking)

Additionally, L.B. acknowledges a long-

standing history of alcohol (ETOH) abuse that

started when she was 16 and started abusing

opioids when she was 22 after a car accident.

She attributes her drinking to trying to cope

with stressors in her life. She reports consuming

a bottle of wine daily, often to the point of

intoxication, to numb her emotional pain and

alleviate her depressive symptoms. She

acknowledges that her alcohol use has

worsened over the past few months, coinciding

with the escalation of her worsening depressive

symptoms. She admits to drinking a bottle of

wine a day. Reports she consumed a bottle

today before her arrival at the IOP clinic today.

She also states she last took “a few” OxyContin

2 weeks ago. She reports she will buy this off

the street or from friends/family members.

Physical Examination:

Height: 5’5’ weight: 160 lb.

General: Slightly disheveled appearance, strong odor of

alcohol, appears older than stated age

Vital Signs: BP 138/90, T 97.9°F, P 95, RR 18, SpO2 97%.

Lab work:

AST = 67 IU/L;

ALT = 43 IU/L;

GGT= 36U/L; other liver function tests are WNL.

Hemoglobin =12.5; hematocrit = 38; MCV =95; triglycerides =

200 mg/dl.

Blood alcohol level (BAC)

• 0.20 mg/dL

Toxicology Screen:

• Positive for THC

• Negative for opioids, benzodiazepines, or other

substance

Mental status exam:

Appearance: Disheveled, appears older than stated age, smell

of alcohol. She is tearful and displays minimal eye contact

throughout the examination.

Alertness and Orientation: Fully oriented to person, place,

time, and situation.

Behavior: Cooperative but visibly agitated. She often loses

her train of thought mid-sentence.

Speech: Slurred, slowed.

Mood: Depressed and reports feeling overwhelmed by

emotional pain.

Affect: Flat, incongruent with stated mood.

NR 546 Week 6 Case Study

9.24 MWS

L.B. reports experiencing significant distress in

multiple areas of her life, including strained

relationships with family members, difficulty

maintaining employment due to frequent

absenteeism, and financial instability. She

admits to feeling isolated and disconnected

from loved ones, despite their attempts to offer

support.

L.B. expresses a strong desire to get help. She

acknowledges the severity of her symptoms and

the urgency of seeking help, recognizing that

she is unable to cope with her emotional pain

on her own and her drinking is out of control.

Past psychiatric history:

• Diagnosed with alcohol abuse disorder

and opioid use disorder 8 years ago but

never followed up for treatment.

• Diagnosed with depression 10 years ago

but was not consistently treated.

• No history of psychiatric

hospitalizations. Has been to rehab for

her ETOH abuse 5 years ago but left

because she “didn’t like it” Denies ever

attempting suicide.

Past Medical History: Hypertension,

Gastroesophageal reflux disease (GERD)

Medications:

Lisinopril 20 mg daily

Prilosec 20 mg daily

Substance Abuse History:

• Began drinking at age 16.

• Began abusing opioids at age 22

• Daily alcohol consumption,

approximately a bottle of wine per day.

• Frequent opioid abuse-Last use 2 weeks

ago consisting of several oxycontin.

• Occasional use of marijuana.

• Smokes tobacco ½ pack a day

Thought Process: Linear but slow. Often veering off-topic

and providing excessive detail in her responses.

Thought content: Expresses feelings of hopelessness and

worthlessness, admits to suicidal ideation without a specific

plan. She denies experiencing any delusions or

hallucinations. Denies intent to harm others

Perceptions: Denies experiencing any perceptual

disturbances, such as auditory or visual hallucinations.

Memory: Recent and remote WNL

Judgement/Insight: Poor insight into her alcohol use and its

impact; judgment impaired by intoxication.

Attention and observed intellectual functioning: Appears

intact, with no evidence of cognitive deficits or impairment

in orientation, attention, or memory.

Fund of knowledge: Fair general fund of knowledge and

vocabulary

NR 546 Week 6 Case Study

9.24 MWS

Family History

• Father had alcohol use disorder and died

by suicide.

• Mother has a history of depression.

• One brother with no known psychiatric

or medical conditions.

Social History

• Divorced, lives alone.

• Works as a waitress but has had

increasing absenteeism due to her

drinking.

• Limited social support, estranged from

most family members.

• High school graduate.

Trauma history:

Reports physical abuse by her father during

childhood.

Witnessed father’s suicide at age 14

Review of Systems

• General: Fatigue, low energy levels.

• Cardiovascular: Palpitations

occasionally.

• Respiratory: No shortness of breath or

cough.

• Gastrointestinal: Frequent nausea,

occasional vomiting, poor appetite.

• Musculoskeletal: No joint pain or

muscle aches.

• Neurological: No seizures, occasional

headaches. Exhibits tremors in her

hands.

• Sleep: Difficulty falling and staying

asleep, averaging 3-4 hours per night.

• Allergies: NKDA,

Alcohol Use Disorder (F 10.20)

Opioid Use Disorder (F11.20)

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

General Directions

Review the provided case study to complete this week’s discussion.

Include the following sections:

1.
Application of Course Knowledge: Answer all questions/criteria with explanations and detail.

a. Select one drug to treat the diagnosis(es) or symptoms.

b. List medication class and mechanism of action for the chosen medication.

c. Write the prescription in prescription format.

d. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.

e. List any side effects or adverse effects associated with the medication.

f. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.

g. Provide a minimum of three appropriate medication-related teaching points for the client and/or family.

2.

Integration of Evidence

: Integrate relevant scholarly sources as defined by program expectations:

a. Cite a scholarly source in the initial post.

b. Cite a scholarly source in one faculty response post.

c. Cite a scholarly source in one peer post.

d. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.

e.  Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.

3. NR546 W6 Case Study Discussion Rubric
Criteria	Ratings	Pts
Application of Course Knowledge view longer description	40 pts Excellent All requirements met. 36 pts V. Good 5 requirements met. 33 pts Satisfactory 4 requirements met. 20 pts Needs Improvement 1- 3 requirements met. 0 pts Unsatisfactory No requirements met.	/ 40 pts
Integration of Evidence view longer description	20 pts Excellent All requirements met. 18 pts V. Good 4 requirements met. 16 pts Satisfactory 3 requirements met. 10 pts Needs Improvement 1- 2 requirements met. 0 pts Unsatisfactory No requirements met.	/ 20 pts
Engagement in Meaningful Dialogue view longer description	30 pts Excellent All requirements met. 24 pts Satisfactory 2 requirements met. 15 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met.

Required Prescriptions Components

How to Write the prescription in prescription format.

• Patient name

• Name of medication, including medication strength (e.g. Escitalopram 10 mg)

• SIG: quantity, route, and frequency (1 tab po daily)

• Number of tablets/capsules to dispense (Disp #30)

• Number of refills

• Prescriber name

• License number

• DEA number, if applicable

Include all components for the prescription writing requirement for the case studies.