Nursing Intervention to Treat Substance Abuse Related Harmful Effects - Mental Illness, Physical Violence, and Depression and Child Maltreatment - Assignment Example

Mental Health Student’s Name Institution Affiliation Question 1 Harry has exhibited some substance abuse disorder symptoms in line with the DSM-IV TR criteria described in the American Psychiatric Association (2008). He has repeatedly failed to fulfil his duties at work because of excessive consumption of alcohol. He has been having problems with punctuality at work. Due to the recurrent failure at work, there has been firing threats which have borne no fruits. Secondly, he has been having social and interpersonal problems more so with his partner. He has been left by his girlfriend after her repeated urges to make him stop using and abusing drugs and alcohol landed on deaf ears. Another indicator of substance use is in regard to legality. Being on the wrong side of the law has led to his involvement with the law enforcers. Although the case is not clear on whether the arrest was his first or not, the fact that it is not the only disorder he has exhibited speaks volumes. Question 2 Cannabis use is very common in Australia and remains the most consumed drugs. According to Stafford and Burns (2012), 76 per cent of the sampled individuals had used cannabis within the six month period prior to the interview. Although in the past decade the consumption has been following the downward trend, from 86 per cent in 2002 to the current rate (76%), its popularity is still alarmingly high. The daily usage rate remains prevalent with the relatively older age group (40-49) being the most affected. According to a survey conducted by Amanda et.al (2010), cannabis related harmful effects have been steadily increasing in the general population. The numbers of presentations to the hospitals in the regard to cannabis related complications have been on the rise among the older age groups (40-49). On the other hand, the hospital presentations among the younger age groups (14-19 and 20-29), have been declining from 24 per cent to 22 per cent from 2009 to 2010. This has been attributed to heavy patterns of use which indicate “acute short term cannabis- related harms (intoxication and drug induced psychosis)” (Amanda et.al, 2010). The general statistics disregarding the age groups, however, indicate an increase in the number of hospital presentations for cannibal- related problems from 23 per cent to 24 per cent in one year. Arrests related to use of cannabis have remained relatively stable and this explains the lack of major changes in law enforcements against the drug. This is also attributed to low changes in the percentage of people who have been forced through legal channels into rehab and other form of rehabilitations or medical treatments (Amanda et.al, 2010). Question 3 Although the exact causes of substance use are not very clear, there are a few factors that are attributable to it. According to the “Department of Health and Human Services” in the U.S (2009), families affected by substance use disorders tend to have numerous problems ranging from mental illness, physical violence, stress and depression and child maltreatment. In addition children from such families are likely to undergo emotional and social problems which may also lead to substance use disorders. In Harry’s case, one factor that may have led to substance use may be related to mental health conditions such as depression and anxiety. In his childhood, Harry was at the centre of domestic violence where his mother was physically abused by the husband. This may have had a long term effect on Harry affecting his behaviour, causing anxiety and high levels of stress. These are closely linked with substance use. The second most likely factor contributing to the development of substance use disorder in Harry’s case is heredity. This does not mean that he inherited the substances use habit; rather he inherited susceptibility to be lured into the habit (Kendler & Prescott, 2006). Other factors have to come into play as well in such situations such as environmental factor. A person who may have inherited these genes may be brought up in an environment where the exposure to such substances minimal to none. Such an individual may end up being “sober”. The scientific proof of heredity of genes and susceptibility to substance use was revealed in the identical twin study. The twins were brought up in different environments. The inheritability factor for alcoholism was 66 per cent for alcoholism and 33 per cent for drugs (Kendler & Prescott, 2006). This study has attributed the domestic violent environment that Harry’s was brought up in to the substance use effects on the father. Putting the heredity factor into play, there is a high likelihood that Harry inherited these genes. This coupled with the environment where alcohol and cannabis among other drugs are readily available and affordable; Harry could not escape the grip of substance use. Question 4 The problems or risks that may be adverse to Harry’s mental health may be as a result of alcohol withdrawal. These have been comprehensively covered in the following table: Problems/Risks Description Risk for Injury This may be due to response of the nervous system following the sudden cessation of alcohol use, seizures, and having difficulties in maintaining body balance, poor coordination of muscle and hand or eye. Harry had a small laceration on one arm. Sensory- Perceptual Alterations From the case study, his friends claim that he has changed in behaviour. This may be evidence of this problem. The problem is also related to lack of enough sleep, anxiety/ fear and chemical alteration (exogenous and endogenous). Anxiety/ Fear Harry says he has lost control of his life. He is hopeless and feels inadequate and remorseful. Question 5 Problems/Risks Nursing Interventions Risk for Injury 1. Monitor seizure tendencies and provide risk-free environment such as installing side rails on a bed and keeping it in a low position. 2. Assist him with the self-care measures and ambulation. 3. When needed ensure that the safety of the environment is provided. Sensory- Perceptual Alterations 4. Give a thorough assessment of the response to stimuli, speaking ability and consciousness level. 5. Provide a calm and quiet environment and ensure that the lighting is regulated and stereos and televisions are switched off when the patient sleeps (Erickson, 2007). 6. Examine the laboratory results especially regarding the levels of the electrolytes magnesium, the performance of the liver, ammonia, glucose, BUN (Hurst, 2012). Anxiety/ Fear 7. Let the patient understand that one of the symptom of the alcohol withdrawal is anxiety and uneasiness. Ensure that the basis for anxiety is well known and keep tabs with the anxiety level on a continuous basis (Solberg, Maciosek & Edwards, 2008). 8. Be honest and avoid judgmental remarks or attitude. Enhance trust with the patient by maintaining close contact and have an-it’s-okay-to-drink attitude ((Levy & Kokotailo, 2011). 9. Ensure that you actively involve the patient in the planning healing process and give them the liberty to make choices where necessary. Let them know what you are planning to do and the reason behind it (Shattell, & Andes, 2011). Question 6 Nursing Intervention No. Rationale 1. According to Centre for Substance Abuse Treatment (2009), The most common type of seizure is Grand mal and is normally caused by low levels of magnesium, hypoglycaemia or history of seizure disorder. It is worth noting that if these pathologies are not linked with seizure in a particular patient, the problem stops spontaneously and this only call for symptomatic treatment. 2. The rationale is to ensure that patient does not get injured if they fall. 3. This is necessary in instances where the patient has a problem with the equilibrium coordination of the eye and hand. 4. The speech may be incoherent or misconstrued. The response to stimuli assessment reveals the ability to speak, judge and muscle coordination. 5. During the hyperactive stage, this intervention ensures that the external stimuli is significantly reduced. Some patients provide a desirable response when placed in the quiet and dark surroundings (Jarvis & Blad, 2010). 6. Sensory-perceptual insufficiencies may result from the variation in the organ functions. The function of the liver is compromised in the chronic alcoholic. Improper functioning of the liver can hamper the conversion of ammonia into urea. For heavy smokers and chronic alcoholics hypoxemia and hypercarbia are heavily manifested (Levy & Kokotailo, 2011). 7. In some cases people may fail to identify their problem or accept it. Harry, for instance, insists that he has no drinking problem. Increased anxiety and agitation are symptoms of alcohol toxicity especially after medication has worn off (Madras et.al, 2010). 8. The rationale is to provide the human touch, create a trust relationship. A situation where the patient detects a condescend attitude the therapeutic process will be impaired and unsuccessful (Levy & Kokotailo, 2011). 9. According to Shattell and Andes, (2011), the rationale here is to reduce anxiety and enhancing the cooperation of the patient. It also serves to provide a sense of worthiness to the patient. This makes them to feel they have control over their problem. References Amanda, R., Wayne, D., Louisa, D., Jennifer, M., Emma, B., Jan, C., & Richard, P. (2010). The Epidemiology of Cannabis Use and Cannabis- Related Harm in Australia. Retrieved from http://www.eurad.net/filestore/PDF/CannabisharmolderusersAustraliaMarch2010.pdf American Psychiatric Association (2008).American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. Arlington, Va: American Psychiatric Association. Center for Substance Abuse Treatment. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK83253/#_ncbi_dlg_citbx_NBK83253 Erickson C. (2007). The Science of Addiction:From Neurobiology to Treatment. New York: W. W. Norton. Hurst, G. (2012). Caring for patients in alcohol withdrawal. Journal of American Nurse Today, 7(6). Jarvis, S., & Blad, D. (2010). Nursing care for patients with alcohol withdrawal syndrome. Retrieved from http://www.sccm.org/Communications/Critical Connections/Archives/Pages/Nursing-Care-of-Patients-with-Alcohol-Withdrawal Syndrome.aspx Kendler, K. S., & Prescott, C. A. (2006).Genes, environment, and psychopathology: Understanding the causes of psychiatric and substance use disorders. New York: Guilford Press. Levy, S.,&Kokotailo, P. (2011).Substance Use Screening, Brief Intervention, and Referral to treatment for Paediatricians. Journal of American Academy of Paediatrics, 128(5), 1330- 1340. Madras, B., Compton, W., Avula, D., Stegbauer, T., Stein, J., & Clark, H. (2010). Screening, Brief Intervention, Referral to Treatment (SBIRT) for Illicit Drug and Alcohol Use at Multiple Healthcare Sites: Comparison at Intake and Six Months. PubMed Central Journal, 99 (1-3), 280-295. NursingCEU. (2011). Psychiatric Emergencies: Caring for people in crisis. Retrieved from http://www.nursingceu.com/courses/358/index_nceu.html Shattell, M., & Andes, M.(2011). Treatment of persons with mental illness and substance usedisorders in medical emergency departments in the United States.Issues in Mental Health Nursing, 32(2), 140-141. Rassool, W.(2006).Framework for Multidimensional Assessment. In: Rassool GH (ed) Dual Diagnosis Nursing. Oxford: Blackwell Publishing Solberg, L., Maciosek, M.V., & Edwards, N.M. (2008). Primary Care Intervention to Reduce Alcohol Misuse. Ranking its Health Impact and Cost Effectiveness.American Journal of Preventive Medicine, 34(2), 143-152. Stafford, J., & Burns, L. (2012).Australian Drug Trends 2012: Findings From the Illicit DrugReporting System (IDRS). Retrieved from http://ndarc.med.unsw.edu.au/resource/ndarc-2012-annual-report U.S Department of Health and Human Services. (2009). Protecting Children in Families Affected by Substance Use Disorder. Retrieved from http://www.d.umn.edu/sw/snydersfiles/AdvCW/week15/Protecting_Children_in_F milies_Affected_by_Substance_Use_Disorders.pdf Read More