Dereks Social History - Case Study Example

 1. a) Review Derek’s social history and use information gained from the videos to estimate the amount of alcohol Derek is currently consuming per day in standard drinks per day. Then estimate Derek’s average blood alcohol level. Derek admits to drinking a small tumbler of whiskey on the way to work before his 7am shift at Fulton Prison where he works as a prison officer. In addition, he drinks several cans of lager and cider daily. He gets through 2-3 bottles of vodka each week. His average daily consumption of alcohol can be estimated at one average tumbler of whiskey (300 ml)/6 shots, 2 cans of lager (660 ml), cider (500 ml), and 6 shots of vodka since one shot is 50 ml(2.5 bottles × 750 ml per week). The following are the standard ounces of alcohol contained in various drinks 1 can/beer (5% alcohol) - 60 ounces 1 can of cider (5% alcohol) - 60 ounces Shot of vodka (40% alcohol) - 50 ounces Shot of whiskey (40% alcohol) - 50 ounces Total number of alcohol liquid ounces (A) Beer-2 × 60 =120 Cider- 2 × 60 = 120 Vodka- 6 × 50 = 300 Whiskey- 6 × 50 = 300 A- 840 ounces % BAC(blood alcohol concentration) = (A x 5.14/W x r) - .015 x H W- weight of individual in pounds = 220.46 r- alcohol distribution ratio (in men its 0.73) H- hours that have elapsed after last drink and the time of calculation = 36 hours % BAC = 840 x 5.14/220.46 x 0.73) - 0.015 x 36 = 13.76% b) Discuss the biological effect of alcohol on the brain. Include in your answer the biological effects of intoxication and alcohol withdrawal. An individual who drinks excessively may suffer from a brain deficit that may persist after sobriety. Indeed heavy drinking elicits far-reaching effects on an individual’s brain, ranging from mild memory lapse to severe conditions that would place the individual in custodial care for life. (NIAAA., 2004). Aside excessive drinking, moderate drinking causes short-term impairment as can be deduced from the effects of drunk driving. The extent of alcohol damage on the brain is dependent on the following factors: amount and frequency of drinking, age at which the individual began drinking and duration of drinking thereafter. Other factors include genetic background, alcoholism history in the family, prenatal alcohol exposure, and general health status. Alcohol causes impairments in the following brain regions. Impairment of the parietal lobe results to the loss of fine motor skills, shaking and abnormally slows reaction time. Impairment of the frontal lobe leads to loss of caution, inhibitions, reason and exacerbates intelligence, talkativeness and sociability. Impairment of the temporal lobe leads to slurred speech and impaired hearing. Impairment of the occipital lobe results in blurred vision hence poor judgment of distance. Impairment of the cerebellum and brain stem results in poor muscle coordination and loss of vital functions respectively (Dekker, 1999). Long-term excessive drinking causes the brain to shrink and deficiencies in the fibers of the white matter that relay information to the gray matter. This has been elucidated using techniques such as magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Intoxicating levels of alcohol lead to vasodilation of blood vessels and at higher levels it leads to vasoconstriction thereby triggering blood pressure and migraine headaches. The effects of alcohol on a developing fetus are well documented. The babies are born with Fetal Alcohol Syndrome and are highly predisposed to central nervous system (CNS) dysfunctions that are manifested as impaired IQ and Attention Deficit Disorder (ADD). Alcohol withdrawal leads to pathological brain excitation after episodes of initial brain quieting caused by alcohol (DuPont, 2010). Alcohol withdrawal also creates nightmares, sleeplessness and anxiety. If drinking ceases abruptly, the individual will sink into a severe withdrawal syndrome known as delirium tremens. This is a fatal disease and symptoms include: epileptic seizures, hallucinations, and high fever. This disorder is observed more in maintenance drinking than binge drinking. 2 a) Derek is at risk of developing coronary heart disease. Identify modifiable and non-modifiable risks that Derek exhibits and outline how Derek can reduce these risks. Modifiable risk factors that predispose one to coronary heart disease and fortunately they can be controlled or treated. In fact there is evidence that treatment results in significant reduction of coronary heart disease. Modifiable risk factors are divided into medical conditions and lifestyle factors. Derek mainly exhibits lifestyle factors (MacGregor & Kaplan, 2006). The modifiable factors presented by Derek include excessive consumption of alcohol (alcoholism), cigarette smoking, lack of exercise, unhealthy diet (consumption of junk food that largely contains fried food with high calories and trans-fats), and stress. To address the modifiable risk factors, Derek needs the will power to acknowledge his shortcomings in life and he should develop a positive attitude in order to reduce and even eliminate these modifiable risk factors. It is unfortunate that he lacks family and friends, but the nurse/doctor can liaise with a social worker to follow up on Derek’s recovery. Derek needs psychological help in order to address lifestyle issues such as stress and alcoholism. Moreover, he should be enrolled in a rehabilitation program to treat alcoholism. Thereafter, Derek will have the sobriety to address the remaining modifiable factors. With a positive outlook on life and sobriety, Derek can get and maintain a job. He will be in a position to afford a healthy diet that comprises of plenty of fruits and vegetables, and minimal calories. In addition, he can adopt a healthy lifestyle that comprises of exercise and no consumption of alcohol and cigarettes. The reduction of the aforementioned modifiable risk factors will greatly reduce the chances of coronary heart disease. Non-modifiable risk factors for coronary heart disease cannot be changed. In the case of Derek, his advanced age of 53 presents a non-modifiable risk factor. Computations made by the American Heart Association show that advanced age predisposes an individual to coronary heart disease (UCSF, 2013) and for males this refers to the age of 45 and above. In addition, his gender (male) is also another non-modifiable risk factor. According to studies, men are more likely than menstruating women to develop coronary heart disease. b) Describe how two of Derek’s risk factors alter the normal functioning of the heart. An inverse proportion has been established between CHD mortality and alcohol consumption in the United States and in international comparisons. This observation persists even in control of other risk factors. Excessive consumption of alcohol has adverse effects on the myocardium resulting in cardio-myopathy (Ronksley et al., 2011). There is ample evidence that binge drinkers such as Derek are highly predisposed to cardiac arrhythmias and in most cases sudden cardiac death. In addition, a temporal and dose-response relationship was established for myocardial infarction (MI) and sudden cardiac death .Alcohol consumption greatly triggers factors that lead to inflammation, atherosclerosis and thrombosis. Alcohol consumption raises the blood levels of triglycerides and this predisposes one to coronary heart disease (USDA, 2010). Nicotine and other chemical substances contained in cigarettes damage heart function as well as the structure of blood vessels. These chemical substances also trigger the build of plaque in the arteries thereby increasing the risk of atherosclerosis (Kaplan, 2006). In this case, the flow of oxygen rich blood to the rest of the body is highly limited. Coronary heart disease develops when plaque is accumulated in the coronary heart arteries. CHD will later result in heart failure, heart attack, chest pain (angina) and arrhythmias. Cigarette smoking is a risk factor for the development of peripheral arterial disease (PAD), a condition that results from plaque accumulation in the arteries carrying blood to the limbs, head and organs. Individuals with PAD are highly predisposed to stroke, heart attack and heart disease (NIH, 2011). 3. Derek is admitted to the emergency department critically unwell. Consider the presenting symptoms as outlined in the emergency department medical notes and discuss the medical management to correct the pathophysiology of Derek’s presentation. Please ensure your answer addresses all Derek’s co-morbidities and that each intervention considered is explained from a pathophysiological perspective. Upon arrival, Derek exhibits chest pain and visual hallucinations. Further medical investigations reveal that Derek has cyanosis, shallow irregular respiration (12 breaths/ minute) and is conscious but confused (GCS 10). His blood pressure (BP) of 150/100 is indicative of stage 1 high blood pressure. The heart rate of 120 is above the normal range of (60-100) beats per minute. Chest pain, shortness of breath/shallow breathing, and visual hallucinations are symptoms indicative of malignant high blood pressure. Stabilization will entail reduction of Derek’s blood pressure within the first two hours after hospitalization. Blood pressure should be closely monitored to avoid a rapid drop that may affect blood flow to vital organs. After 2 hours, antihypertensive therapy is administered using drugs such as beta blockers (beta-adreno receptor antagonists) (Kaplan &Victor, 2009). Propranolol is a beta blocker that treats hypertension and angina. Patient rehabilitation will include exercise to improve heart functioning and an ECG (electrocardiogram) will be used to record the electrical muscle activity during exercise. Stress is a serious co-morbidity and Derek needs psychological help in order to enable behavioral change. He needs the will power to quit alcohol consumption and cigarette smoking. This will be a starting point to a healthy lifestyle and proper management of health. References Dekker, A.(1999). What are the effects of alcohol on the brain? Retrieved from http://www.scientificamerican.com/article.cfm?id=what-are-the-effects-of-a DuPont, R.L. (2010). The Selfish Brain: Learning from Addiction. New York: Hazelden Publishing. Kaplan, N.M.(2006). Kaplan’s Clinical Hypertension. New York: Lippincott Williams & Wilkins. Kaplan, N.M. & Victor, R. (2009). Kaplan's Clinical Hypertension. New York: Lippincott Williams & Wilkins. MacGregor, G.A. & Kaplan, N.M. (2006). Fast Facts: Hypertension. New York: Health Press. NIAAA(National Institute of Alcohol Abuse and Alcoholism). (2004). Alcohol’s damaging effect on the brain. Retrieved from http://pubs.niaaa.nih.gov/publications/aa63/aa63.htm NIH.(2011). How Does Smoking Affect the Heart and Blood Vessels? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/smo/ UCSF. (2013). Non-modifiable Risk Factors. Retrieved from http://www.healthyheart.ucsf.edu/heartdisease-riskfactors.shtml USDA.(2010). What is the relationship between alcohol intake and coronary heart disease? Retrieved from http://www.nutritionevidencelibrary.com/evidence.cfm?evidence_summary_id=250176 Ronksley, P.E., Brein, S.E. and Turner, B.J., Mukamal, K.J. (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.BMJ. 342, 1-10. Read More