Case Study Alcoholism
Case Study Alcoholism
Case Study Alcoholism
OF
Mr. JOHNSON BABU
WITH
ALCOHOL DEPENDENCE
GENERAL INFORMATION
IDENTIFICATION DATA
1. 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
voluntarily came treatment.
a) Onset :- gradual
d) Associate disturbance :- not taking food, decreased sleep and anger outbursts.
FAMILY HISTORY
49 years Healthy
44 years DM
26years 24years
PERSONAL HISTORY
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
PREMORBID PERSONALITY
1. Social relations
Normal behavior toward family and friends
2. Intellectual activities
No significant intellectual activities noted.
3. Mood
Subjective – satisfied
4. Character
b) Interpersonal relationship
He was active
6. Fantasy life
Not reported
7. Habits
No habit of using tobacco and alcohol
1. General appearance:
- Body built and physical experience: moderately built and healthy, young and wheatish in
complexion
- Hygiene : maintained
- Posture : normal
1. Form of thought:
A. I am using alcohol a lot and making problems .So to stop alcohol drinking I came here.
2. Content of thought
Q. what is your problems?
3. Speech:
A. I am not ok .
D. Perception:
Q. when you are alone, can you seeing anything that other person can’t see and hear?
A. No
F. Memory
A. yes
Q. Subtract 100-5?
A. 95
H. Orientation:
A. I am in NIMHANS hospital.
I. Abstraction:
J. Comprehension:
Q. What will you do, if u miss the bus?
k. Intelligence:
A. Delhi
L. Judgment:
-Personal judgment:
-Social judgment:
-Test judgment:
M. Insight:
Physical examination
1. General information:
A..GENERAL OBSERVATION:
B. VITAL SIGNS:
a. Temperature : 98.6F
b. Pulse : 80/mt
c. Respiration : 20/mt
Height : 5.5”
Weight : 48kg
b. Edema : absent
E. HEAD:
a.Expression: pleasant
c.Eye lids: no lesion and scars, eye lashes are equally distributed
G.EARS
b.No discharge
H.NOSE:
J.NECK:
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
M.ABDOMEN:
a.Inpection: size and shape of the abdomen normal, no distention and tenderness.
N.BACK:
O.GENITALIA:
P.UPPER EXTREMITIES:
c.Muscles: no emaciate
Q.LOWER EXTREMITIES:
b.Swelling/edema: absent
R.NERVOUS SYSTEM:
CONVERSATION COMMENTS
Nurse: Good morning! Gait normal
Patient: Good morning, brother!
Nurse: Do you think drinking alcohol is right? Realizes his mistake and analysis
Patient: No, it’s wrong and feels shame for this habit. his behavior.
LAB INVESTIGATIONS
MEDICATIONS
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
EFFECT
Alcoholic beverages are widely used in many societies because of which their abuse potential
is often under estimated. Commonly used alcohol preparations are beer, wine, brandy,
whisky, rum, gin, arrack and toddy.
EPIDEMIOLOGY
Epidemiological survey carried out in India reveal that 20 to 40 percent of subjects aged
above 15 are current users of alcohol and nearly 10 % of them are regular or excessive
users.
Nearly 15 to 30 percent of patients seeking admission in psychiatric facilities are for
alcohol related problems.
Among the acute medical admissions in a general hospital 10to 20 percent are due to
alcohol related problems.
ETIOLOGICAL FACTORS
BIOLOGICAL FACTORS
PSYCHOLOGICAL FACTORS
SOCIAL FACTORS
1. BIOLOGICAL FACTORS
OTHER CAUSES
Interpersonal factors.
Socioeconomic factors.
Cultural and ethnic factors.
He was also
Pharmacological factors.
Ecological factors. influenced by
AVAILABILITY easy availability
Alcohol is easily available and drinking is accepted as a norm in functioning and
and social gathering. socioeconomic
GENETIC FACTORS
factors
Some excessive disorders have a family history of excessive drinking. There
is a genetic relation between alcoholism, depression and antisocial personality
disorder.
BIOCHEMICAL FACTORS
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
PSYCHIATRIC DISORDERS
Some patients with depressive disorders take to alcohol is the mistaken hope
that it will activate low mood. Persons suffering from anxiety disorders are
prone to take alcohol as an escape
SOCIAL CAUSES
Isolation, unemployment, loss, injustice and other social causes may lead to
Alcoholism
EXPERIMENTAL
To begin with, persons start drinking alcohol due to pressure and curiosity.
RECREATIONAL
Gradually, whenever they meet in functions like marriages, hostel day or
college day, parties, conferences, they drink occasionally.
RELAXATIONAL
Further, whenever they want relaxation, on holidays and weak ends they start
enjoying their drink and continue to do so. Hence the frequency gradually
increases.
COMPULSIVE
Some people who started drinking occasionally, start drinking almost daily or
drinking heavily for a period of time for pleasure or to avoid the discomfort of
withdrawal symptoms.
STAGES
EARLY STAGE
INCREASED TOLERANCE: Needing more and more alcohol to experience
the same pleasure as experienced earlier.
BLACK OUTS: Inability to recollect incidents which happened under the
influence of alcohol.
PREOCCUPATION: Always thinking about how, when and where to drink.
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 In case of client’s
include: physical examination,
Physical examination. history, collection,
History collection. neurological
Neurological examination. examination, MSE and
Mental status examination. blood investigation
GGT (gamma glutyl transfarase) done.
MCV (mean corpuscular volume)
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
complication of
LIVER vomiting, muscle
Fathy degeneration of the liver. wastage and vitamin
Alcoholic hepatitis deficiency.
Cirrhosis
Liver cell carcinoma
Liver failure
PANCREASE
Acute and chronic pancreatitis.
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.
G NUTRITION
Protein malnutrition.
Vitamin deficiency disorders like pellagra and beri-beri.
H JOINTS
Gouts due to increase in uric acid level.
I REPRODUCTIVE SYSTEM
Sexual dysfunction in males.
Failure of ovulation in females.
Pseudo-cushing’s syndrome, hypogonadium, gynecomastia (in men).
Ammenorhea, infertility, decreased testosterone and increased LH levels.
J PREGNANCY
Fetal alcohol syndrome- fetal abnormalities like mental retardation and growth
deficiency.
WITHDRAWAL PHENOMENOM
The general withdrawal symptoms are – tremors, nausea and vomiting,
malacia, tachycardia, elevated BP, irritability, anorexia, insomnia, fits.
6. ALCOHOLIC DEMENTIA
A chronic organic mental disorder due to long term alcohol drinking.
Irreversible impairment in memory, orientation, impulse control,
ability to solve problems etc may be there.
OCCULAR SIGNS
Coarse nystagmus and opthalmopligia with bilateral external rectus
paralysis occur early. Pupillary irregularities, retinal haemorhages and
papilladema can occur causing impairment of vision.
2. KORSAKOFF’S PSYCHOSIS
As korsakof’s psychosis often follows wernicke’s encephalopathy, there
are together referred to as wernicke-kossakoff syndrome.Clinically,
korsakoff’s psychosis presents as an annestic syndrome,characterized by
gross memory disturbances with confabulation. In sight
is often impaired.
IV OTHERS
Alcoholic dementia.
Cerebellar degeneration.
Peripheral neuropathy
TREATMENT
Before starting any method of treatment, it is important to follow these steps.
i) Ruling out or diagnosing any physical disorder.
ii) Ruling out or diagnosing any psychiatric disorder.
iii) Assessment of motivation for treatment.
iv) Assessment of social support system.
The treatment can be broadly divided in to two types, which are often
interlinked. There are detoxification and treatment of alcohol dependence.
ASSESSMENT OF THE PATIENT
i) His drinking pattern. In case of clients’s
ii) Work spot assessment and
iii) Family psychological methods
iv) Environment of treatment are
carried out.
PHYSICAL METHODS
I) Detoxification
II) Disulfiram therapy.
PSYCHOLOGICAL METHODS
I) Counselling
II) Individual and group psychotherapy.
III) Marital/ family therapy.
IV) Behavioral modification conversion therapy.
V) Relapse prevention therapy.
Rehabilitation
Alcoholic anonymous.
1.DETOXIFICATION
Detoxification is the process by which an alcohol dependent person
recovers from the intoxicating effects of alcohol in a supervised
way. It includes,
2. BEHAIVOR THERAPY
The most commonly used behavior therapy is aversion therapy. Using
either a sub-thrushed electro shock or an emetic, like apomorphine.
3. PSYCHOTHERAPY
Supportive psychotherapy and individual psychotherapy have been
used.
The patient should be educated about the risks of continuing alcohol
use, asked to resume personal responsibility for change and given a
choice of options for change.
4. GROUP THERAPY
Of particular importance is a voluntary self help group AA (alcoholics
anonymous) with branches all over the world and a membership in
5. DETERRENT AGENTS
The deterrent agents are also called sensitizing drugs.
CONTRAINDICATIONS
First trimester of pregnancy.
Coronary artery disease.
Liver failure
Chronic renal failure
Peripheral neuropathy
Muscle disease and history of psychosis in past.
6. ANTI-CRAVING AGENTS
A comprosate, naltrexme and SSRIs eg. Fluoxetine are among the
medications tried as anti-craving agents in alcohol dependence.
7. OTHER MEDICATIONS
A variety of other medications like benzodiazepines, anti-deprosants,
anti-psychotics, lithium, carbamazepine, narcotics have been tried.
There should be used only if there is a special indication for their use
MEDICATION
Follow medications as advised by doctor.
Anti-anxiety drugs like chlordiazepoxide (Librium) and diazepam, if
necessary, parenterally given.
Plenty of vitamins, especially Inj.B1, B6 land B12 and Tab B complex and
vitamin C.
Antacids to relieve gastritis.
Correct fluid and electrolyte in balanced by IV fluids.
NUTRITION
Take care of the nutrition of the patient.
Document intake, output and calorie content.
Weight daily.
Ensure that the patient receives small frequent feedings rather than large
meals.
Ask family members to bring food that the patient enjoys.
3. Impaired verbal communication related to incoherent speech pattern and side effects of
medication.
Peplau emphasized that problems in the patient can be solved by prominent interpersonal
relationship. According to Peplau there are our stages in the relationship. They are
1. Orientation
During the orientation phase the individual has a felt need seeks professional assistance. The
nurse help the patient recognize and understand his problem and determine his need for
help.
2. Identification phase
The nurse identifies with those who can help him. The nurse explores the feelings of
the patient to aid in coping with the undergoing illness as an experience the reorients
feelings and strengths positive forces satisfaction.
3. Exploitation
During this phase the patient makes more demands than they did when they were
seriously ill. They make many minor requests, or may use other attention getting
techniques, depending on their individual needs. The nurse use communication tools
such as clarifying, listening, accepting, teaching, and interpreting to offer services to
the patient. The patient then takes advantage of the services offered based on his/her
needs of interest. In this phase, the nurse aids the patient to use the services to help
solve the problem
4. Resolution
The patients needs have already been met by collaborative efforts between the patient
and the nurse. The patient and the nurse now need to terminate the relationship and
dissolve the links between them.
Nurses roles
Role of a stranger
Role of a resource person
Role of a teacher
Leadership
Surrogate role C
Counseling role
D
A
Energy transformation
CLIENT EDUCATION
Help the patient to develop social support for helping him quit the habit.
FAMILY EDUCATION
Help family members to recognize the danger situations and explain the chance of
relapse.
Avoid others drinking in front of patient
Remove all products of alcohol from the surro8unding prior to alcohol cessation
Accomplish life styles that reduce stress.
Improve quality of life or produce pressure learning cognitive and behavioral activities
to cope.
CONCLUSION
2. Sreevani.R.A Guide to Mental and Psychiatric nursing.2nd edition. New Delhi. Jaypee
publishers.2007;p.129-134