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Substance Abuse and Addiction in Geriatrics.

Substance Abuse and Addiction in Geriatrics.

Sample Answer 

Substance Abuse and Addiction in Geriatrics

Pertinent Positives.

The patient is a 69-year-old female who presented to the clinic after falling at home. She has had fatigue and tremors in the last two days, woke up with a mild headache, and shakes. She reports an increase in fatigue. Fell when going to get a drink from the kitchen. She has nausea and reduced appetite. She’s currently on gabapentin and levothyroxine. She smokes 1PPD for the last 40 years and drinks alcohol daily, has an elevated HR of 107, BP of 139/89, and a low O2 saturation of 94%. She’s also underweight with a BMI of 18.3, has a normal liver span, with bilateral hand tremors noted with hand movements. Lastly, she has Ecchymosis on the left buttock and has a positive family history of hypertension

Pertinent Negatives.

  • No head trauma, loss of consciousness, visual changes, numbness, or tingling.
  • No fever, chills, or vomiting.
  • No pain.
  • No bruises or trauma.
  • No swelling or joint pain.
  • No history of depression/anxiety.
  • No chest pain, palpitations, heart disease, or shortness of breath.

Missing Information

There is no information on blood glucose levels and whether the fall was preceded by lightheadedness, vertigo, or dizziness.

List of Differential Diagnosis and Actual Diagnosis

  1. Alcohol withdrawal syndrome (AWS)
  2. Risk of fall
  • Acute pain (typically headache)
  1. Risk for decreased cardiac output
  2. Imbalanced nutrition: Less than body requirements
  3. Anxiety/fear

Plan for the Priority Diagnosis

Diagnosis: Alcohol withdrawal syndrome related to the frequent use of alcohol, as evidenced by tremors, headache, nausea, and tachycardia.

Goals: To regain control of daily functioning.

To keep the patient from injury.

To ensure the patient’s vital signs are within normal limits.

Outcome: the patient will be free of injury, as evidenced by the absence of falls. The patient’s vitals will revert to normal limits.

Nursing intervention:

1.      Identify the stage of AWS, i.e., Stage 1 is associated with nausea, tremors, tachycardia, and hypertension

 

 

2.      Consult with a physician regarding the plan for detoxification and the medications to be used and administer medications as indicated: Atenolol, Potassium, benzodiazepines, clonidine

 

 

 

3.      Monitor the vital signs during acute withdrawal

 

 

 

4.      Monitor the heart rate and rhythm and document any irregularities.

 

Rationales:

1.      Early recognition and intervention may stop the progression of symptoms and improve the prognosis. Progression of symptoms indicates the need for drug therapy to prevent death (Gulanick, 2016)

2.      Benzodiazepines alone are usually enough to control hypertension during the initial stages of withdrawal. Some patients, however, require more specific therapy. Atenolol may speed up the withdrawal process and help in lowering the heart rate, blood pressure, as well as in eliminating the tremors. (Ackley, 2019)

3.      Hypertension is associated with catecholamine release, which increases heart rate and peripheral vascular resistance which together compound to cause high BP (Ackley, 2019)

4.      Tachycardia is a common occurrence in alcohol abusers because the sympathetic system responds to increased circulating catecholamines (Gulanick,2016)

 

 

Evaluation:

All the set goals and outcomes should be met after the completion of therapy. Evaluate the patient’s vitals. Evaluate for any incidences of falls and risk of injury.

References

Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.

Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

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Question 


Substance Abuse and Addiction in Geriatrics

NU DT 13 Instructions

Unit 13 Discussion – Substance Abuse and Addiction in the Aging Family

Instructions

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Substance Abuse and Addiction in Geriatrics

Substance Abuse and Addiction in Geriatrics

Discussion Prompt

It has been projected that the older population will grow from 40.3 million in 2010 to 72.1 million in 2030.  This population is unique because they grew up in a time (1960-1970s) where the stance on alcohol and drugs were different.  We are left with learning how to identify and manage this unique situation (Kuerbis, Sacco, Blazer & Moore, 2014).

Kuerbis, A., Sacco, P., Blazer, D.G., & Moore, A.A. (2014).  Substance abuse among older adults.  Clinics in Geriatric Medicine, 30(2): 629-654.  doi: 10.1016/j.cger.2014.04.008

Initial Post Instructions: 

  • Please critically evaluate the subjective and objective information provided to you in the attached file below.
    The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
  • Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
    Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
  • Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.

 

NU 627 Week 13 Case Study C.C. “I fell.” HPI: Ms. G is a 69 y.o. F who presented to the HU Clinical after falling at home today. Reports over the last two days has had fatigue and tremors. This morning she woke, felt unsteady with a mild headache and shaky, tried to walk to the kitchen to get a drink when she had fallen. Fall was from a standing height, landed on her buttocks on the carpeted floor. She denies hitting her head, loss of consciousness, visual changes, numbness or tingling. She denies pain. She denies fever, chills, or vomiting, but has had some nausea. Denies chest pain or SOB. She denies any aggravating factors. Allergies: NKDA Medications: Gabapentin 100 mg PO Daily Levothyroxine 75 mcg PO daily PMH: Hypothyroidism Fibromyalgia Social Hx: Divorced, lives home alone. Has 2 adult children. Retired preschool teacher. Smokes 1PPD for the last 40 years. Drinks a “few vodka tonics” a day. Denies illicit drug use. Family Hx: Mother: HTN, Father: unknown, Brother: HTN Health maintenance: Mammogram 2017, Cervical screening negative completed 2014. ROS: General: Denies fever, chills or recent ill contacts. Reports increase fatigue. Denies weight loss or weight gain. Appetite has been decreased last couple of days. Skin: Denies rashes, bruises or trauma. HEENT: Denies headache, visual changes, eye irritation, nasal drainage/congestion, difficulty swallowing. Neck: Denies swelling or stiffness. Respiratory: Denies cough, shortness of breath or wheezing. Cardiovascular: Denies chest tightness/pain. Denies swelling to lower extremities, palpitations or heart disease. GI: Denies vomiting and diarrhea. Has been having some nausea. GU: Denies dysuria, hematuria or decrease urine output. Musculoskeletal: Denies swelling or joint pain. Neuro: Denies weakness, numbness or tingling. Has noticed mild headaches and tremors worse in the morning but improves with a drink. Denies confusion. Endo: Denies increase thirst, urination, cold/hot intolerance. Psych: Denies depression/anxiety. Denies hallucinations. PE: VS: 36.7, 107, 18, 139/89, 94% RA Wt: 117 lbs, Ht: 5’7” General: Pleasant female, appears mildly anxious, speaking in full complete sentences. Appearance kept clean. No ecchymosis, or trauma noted from fall to face. HEENT: Extraocular eye movements intact, PERRLA, moist mucous membranes, nares/oropharynx clear. No enlargement or nodules of thyroid. CV: regular rhythm, heart rate elevated 110s, S1/S2 normal Lungs: Normal work of breathing. Bilaterally clear to auscultation. ABD: Soft, non-distended, non-tender. Normoactive bowel sounds present in all four quadrants. Liver measure 10 cm by percussion. EXT: No BLE edema. +2 radial/pedal pulses bilaterally. MSK: No joint deformities or effusions. Ecchymosis 4cm x 6cm to L buttocks. Neuro: AAOx3, PERRLA +4mm, cranial nerve 2 to 12 intact. Reflexes intact +2. Upper and lower extremity strength equal 5/5. Cerebellar examine intact. Bilateral hand tremor noted with hand movements and not at rest

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