A&E Department: Drug and Alcohol Assessment for James (Case Study)

This report provides a comprehensive drug and alcohol nursing assessment for James, a 34-year-old male admitted to the A&E department due to excessive alcohol consumption. The report details relevant points from James's presentation, outlines necessary information for a complete assessment, and proposes three differential diagnoses, including panic disorder, generalized anxiety disorder, and bipolar disorder. It analyzes key issues in James's treatment, such as potential patient non-cooperation and information gaps, and presents a nursing management plan including discussion sessions, involvement in quit procedures, dietary changes, and motivation strategies. The report also reflects on how personal attitudes and values may influence care, and suggests strategies to overcome these biases, ultimately aiming to guide effective treatment and support for individuals struggling with substance abuse.

DRUG AND ALCOHOL
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TABLE OF CONTENTS
Introduction......................................................................................................................................3
Identify relevant points regarding James’s presentation.............................................................3
Outline further information that might be needed to complete the drug and alcohol assessment
.....................................................................................................................................................4
3 differential diagnoses for James presentation...........................................................................5
Analyse important issues in James’s treatment and create a possible nursing management plan
.....................................................................................................................................................6
Reflect on how your own attitude, values and personal experience might influence the practice
when caring for a client with drug and alcohol problems...........................................................7
Possible strategies that can be employed to overcome such attitudes and values.......................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10
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INTRODUCTION
Assessment is the first part of the nursing procedure and after conducting the process of
assessment, care plan can be formulated. The essential requirement of accurate assessment is to
view patients holistically so as to identify their exact needs (Kelley-Baker and et.al., 2016).
Thus, in such respect the present research study has been describing drug and alcohol nursing
assessment for a patient called James who is 34 year old male and is admitted to A&E
department. He is found with his friend Bill and both of them usually go for drinks once in a
week.
At the time, Bill says that when he picked up James at his house, he and his house found
messy and the bin was also overflowed with bottles which shows that James usually drinks too
much. Bill also reported that when both of them were out of the car, James fell to the ground.
Thus, according to the present situation of James, care plan has been formulated through which
proper care will be given to James so that he can get rid of drug and alcohol consumption habits.
Therefore, accordingly discussion has been included regarding relevant points about
James’s presentation (Evans, Grella, Washington and Upchurch, 2017). Appropriate information
has also been collected from diverse sources so as to complete the drug and alcohol assessment
for James. Similarly, emphasis has also been given towards important issues that might occur in
James’s treatment. Lastly, researcher has formed a nursing management plan for treating James
in the best possible manner.
Identify relevant points regarding James’s presentation
As per the case study, it can be said that James always drink excessively which in turn
leads to unconscious state. Bill is his one of the close friends whose company drives him more to
go for alcohol consumption (Walsh and et.al., 2016). Both of them have been drinking since their
university days and this made James addicted towards alcohol. While giving any sort of medical
assistance to James, it is vital for the health care practitioner to find out the actual causes and
problems that happened to James. Further, actual state of James is also required to be found out
so that he can be provided suitable care and treatment.
As observed, James was not able to stand properly and he fell down after getting out of
the car. Thus, it clearly shows that James is addicted towards alcohol. Further, looking towards
the present situation, it can be predicted that James might be taking drugs as well along with
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alcoholism (Welty and et.al., 2016). This, is not only hampering his present situation; but is also
leading James towards critical health situations. Thus, at early stages it is essential for James to
stop this habit so that he can move towards healthy life.
Outline further information that might be needed to complete the drug and alcohol assessment
Treatment for a drug or alcohol problem usually begins with an addiction assessment and
basically this assessment is conducted so as to determine the co-existing conditions with this
assessment. There must be proper interaction between patient and nurses so that the actual
situation of the drug consumption can be identified. In the drug and alcohol assessment,
professionals needs to be trained so that they can diagnose addictions typically through carrying
out drug and alcohol abuse assessment in private settings (DRUG ADDICTION ASSESSMENT.
2017).
Thus, in the case of James as well, nurse and care practitioner is required to conduct a
private session so that hidden information about the patient and the habit can be ascertained.
Further, the nurse must also ensure that they are keeping confidentiality and the information is
used only for treatment procedure (Wray, Braciszewski, Zywiak and Stout, 2016). In the present
situation, nurses are required to focus on CAGE assessment technique which includes major
categories of ascertaining the addiction of patient.
 Cutting down on drinking: During such question, the practitioner should ask James if he
ever felt to cut down the practice of drinking.
 Annoyance because people criticized your drinking: Nurses are required to ask if James
ever felt irritated when people criticize his drinking habits.
 Guilty feelings: It is crucial for the nurse to know that if James ever felt guilty of his
drinking habit (Walsh and et.al., 2016).
 Eye – openers: Herein, it is vital for the nurse to ascertain if James ever felt the need to
drink immediately in the morning.
Hence, conducting this assessment is essential in this case as that will assist the nurse to
ascertain all the needs of James during different time period. This is also vital in terms of
identifying the needs of patients and according to that changes can also be made to James’s
schedule (Ramirez and et.al., 2016). It is also essential for the nurses to conduct drug and
assessment because the manifestation and development of alcohol and drug problems involve a
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complex combination of biological, psychological and social factors which are unique in each
individual. At the same time, it is essential for the nurses to acquire information about James
personal life regarding how well he is managing his life.
3 differential diagnoses for James presentation
According to the present condition of James, it can be said that it is crucial for the nurse
to diagnose the situation in effective manner so that proper services can be rendered accordingly.
There is a direct relationship between alcohol and bipolar disorder and it also holds importance
in dual diagnosis. Any individual who presents with significant mood fluctuations must be
screened for an alcohol use disorder. Thus, it can be said that there are three major differential
diagnoses which exist in the present case of James (Alcoholism Differential Diagnoses. 2016).
Panic disorder, generalized anxiety order and bipolar disorder exist in the present situation of
James. Alcohol abuse or independence might reflect self- treatment for these conditions. It can
also be said that James is taking much level of alcohol and along with that, he is also taking
drugs similarly in the same quantity (Neale and et.al., 2016).
This might have changed his mental status and as a result, he is developing other
disorders. Thus, considering the situation, it can be said that James is having comorbid disorder
under which several problems are there. It is also analysed that depression, anxiety and antisocial
personality all are more common in persons with alcoholism than in general population. Thus,
the relationship among all such disorders is required to be analysed so that actual situation of
James can be ascertained (Kelly and et.al., 2016). Moreover, it can also be said that Bill has also
confronted that James usually drinks too much and most often they go out for drinking. There
might be different situations that is happening with James and because of that he got addicted for
drinking.
Thus, according to the present situation, it is vital for the nurse to analyse the exact
problems that is prevailing with James. Nurses must also consider that in order to deliver
prominent treatment to James, it is crucial to develop suitable interaction so that all the aspects
can be analysed suitably. However, nurse should also realize that issues and challenges may also
arise at the time of delivering services to James as he is drug and alcohol addicted patient. At the
same time, nurse must set out suitable nursing intervention for James so that accurate and
suitable care can be provided (Jayne, Valentine and Holloway, 2016). While developing nursing
care plan, it is crucial for the nurse to ascertain that dealing with alcohol problems is not easy as
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it requires lot of encouragement and motivation. The nurse must have to develop convincing
skills so that to assist James to quit alcohol and drug consequently.
Analyse important issues in James’s treatment and create a possible nursing management plan
Since, James has admitted to A&E department; therefore it is clear that his condition is
quiet critical. Thus, looking towards the condition, nurse should prominently address how the
habit of alcohol can be resolved in the case. Thus, at the time when nurses are dealing with
James, they have to consider the fact that a person who is drug addicted will take time to quit it.
Thus, several issues may arise consequently (Evans, Grella, Washington and Upchurch, 2017).
While dealing with James, it is possible that James may not respond properly in the situation due
to lack of interest. Thus, his inactiveness can bring certain issues in the case. Further,
unavailability of information can also be one of the challenges in the case. Nurses are required to
acquire all sort of information about James regarding his past and present situation as then only,
the actual reason for alcoholism can be identified.
Similarly, nurses can also experience problems if James will not adopt the routine that is
being given to him. For instance- if the nurse has asked to present on the counselling session;
then it becomes mandatory for James to consider the same. However, failure of such thing can
bring several issues in the nursing procedure. At the same time, nurses can also face problems
because due to improper scheduling (Jayne, Valentine and Holloway, 2016). It is also possible
that within the scheduled time period, other nurses and counsellors are not present. Thus, it may
hamper the entire procedure of nursing and as a result it may also lead to failure of addressing
nursing problems.
Nursing management Plan
Activity Ways to perform it Time table
Discussion session At the initial stage, nurses
will be having discussion
session with James so that to
analyse the actual problems
which he is having. Nurses
need to conduct this session
after every three sessions (8
For 1 hour
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Substance Dependence and
Abuse Nursing Care Plans.
2014).
Involvement of James in quit
procedure
Nurses will be having
discussion about different
nursing intervention so that
appropriate one can be
adopted through the consent
of James (Kelley-Baker and
et.al., 2016). Nurses must
also monitor the same so that
the level of improvement can
be found out accordingly.
For around 4 hours every
week
Changes in dietary plans Changes will also be made in
the dietary plan so that James
can bring healthy habits in his
lifestyle.
Monitoring will be conducted
within every week.
Motivation to quit alcohol
and drugs
It is essential for the nurses to
motivate James towards
physical fitness so that he can
distract himself from
alcoholism (Kelly, Harrison
and Palmer, 2016). This
might also assist in improving
his habits related to drug
consumption and alcoholism.
Monitoring will be done
within every 2 weeks.
Through this, changes will
also be made in the schedule
accordingly.
Reflect on how your own attitude, values and personal experience might influence the practice
when caring for a client with drug and alcohol problems
While working on this case, I can say that it is highly difficult for the nurse to treat with a
patient who consumed alcohol excessively (Kelly and et.al., 2016). While working on this case, I
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came to know that alcoholism is one of the most important issues that needs to be prominently
addressed as that hampers the health aspects in the most affecting ways. At the same time, I can
also say that the patients who are alcoholics needs to focus more on keeping themselves busy so
that they can get rid of the habit of smoking and algorism. In this context, I can also say that I
have analysed different methods through which the habit of alcoholism can be improved
(Mahaffey, Stevens-Watkins and Leukefeld, 2017).
However, while speaking to James, I also came to know that a person when start
consuming alcohol, it takes less time to become addicted. Similarly, I also realized that it takes
much time to encourage the person so that he can quit alcohol and drugs. Therefore, while
working on such case I realized that I must be a motivating personality so that I can deal with
drug addicted patient. This will also assist me to guide others as well to quit smoking. Moreover,
I need to focus on delivering information about ill impacts of drug and alcohol consumption so
that people can realize that whatever they are doing is dangerous for their health.
Further, in this context I also realized that the person who drinks excessively should get
assistance from physical activities and therapies (Neale and et.al., 2016). This is also essential for
the purpose of distracting the patient from drinking and drug consumption. However, I can also
say that in such a case, it is essential for the care practitioner to conduct a thorough analysis so
that the actual situation of the patient can be analysed. In such cases, I will be analysing the past
situation of the patient so that accordingly nursing practices can be carried out. Moreover, in this
aspect I can suggest that proper relationship should be developed with the patient so as to deliver
optimum care. The most important thing that I would like to state is that people should never get
to alcoholism when they are depressed or distressed (Ramirez and et.al., 2016).
Possible strategies that can be employed to overcome such attitudes and values
In general, the issue of drug and alcohol is difficult to treat; hence several problems will
be coming in this situation while dealing with James (Wray, Braciszewski, Zywiak and Stout,
2016). However, there are possible strategies that can be adopted for the purpose of dealing with
such aspects. In the below mentioned section, discussion about a few strategies are being
discussed:
 Appropriate involvement in physical activities: It is essential for the nurses to involve the
patient in physical activities as sports activity can distract people from alcoholism and
drug consumption. At the same time, this can also bring numerous health benefits to
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James respectively. Interesting as well as suitable exercises can be employed in the
present case of James as well so that he can try to engage himself in other practices
(Welty and et.al., 2016).
 Proper communication with alcoholic patients: It is also vital for the nurses to develop
proper communication with alcoholic patients so that the relevant information about the
case can be adopted. Thus, accordingly in the present case as well nurse must
communicate suitably with James so that he can specify all such health problems which
are prevailing in James (Walsh and et.al., 2016).
 Scheduling timely counselling sessions: It is vital for the nurse to schedule timely
counselling session so that improvements in the activities and habits of James can be
identified. Similarly, this is also useful for the purpose of identifying suitability of
nursing intervention.
CONCLUSION
Concluding the entire research work, it can be said that prior delivering any medication
or care services to the patient, it is essential for the nurse to collect past and previous history of
the patient. This is highly useful for reducing the health problems prevailing in patients regarding
alcohol and drug consumption.
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REFERENCES
8 Substance Dependence and Abuse Nursing Care Plans. 2014. [Online]. Available through:
<https://nurseslabs.com/8-substance-dependenceabuse-nursing-care-plans/>. [Accessed
on 7th April 2017].
Alcoholism Differential Diagnoses. 2016. [Online]. Available through:
<http://emedicine.medscape.com/article/285913-differential/>. [Accessed on 7th April
2017].
DRUG ADDICTION ASSESSMENT. 2017. [Online]. Available through:
<http://www.projectknow.com/research/assessment/>. [Accessed on 7th April 2017].
Evans, E.A., Grella, C.E., Washington, D.L. and Upchurch, D.M., 2017. Gender and race/ethnic
differences in the persistence of alcohol, drug, and poly-substance use disorders. Drug
and alcohol dependence, 174, pp.128-136.
Jayne, M., Valentine, G. and Holloway, S. L., 2016. Geographical perspectives on drug and
alcohol studies. The SAGE Handbook of Drug & Alcohol Studies: Social Science
Approaches. p.1717.
Kelley-Baker, T. and et.al., 2016. 2013-2014 National Roadside Study of Alcohol and Drug Use
by Drivers: Methodology (No. DOT HS 812 294).
Kelly, J., Harrison, R. and Palmer, A., 2016. Trauma and youth alcohol and drug use: Findings
from a youth outpatient treatment service. Journal of Applied Youth Studies. 1(2). p.58.
Kelly, S. M. and et.al., 2016. Corrigendum to “Concordance between DSM-5 and DSM-IV
nicotine, alcohol, and cannabis use disorder diagnoses among pediatric patients”[Drug
Alcohol Depend. 140 (2014) 213–216]. Drug & Alcohol Dependence. 168. p.203.
Mahaffey, C. C., Stevens-Watkins, D. and Leukefeld, C., 2017. Alcohol and cocaine use and
drug distribution among formerly incarcerated Black men. Drug & Alcohol Dependence.
171. p.e126.
Neale, J. and et.al., 2016. DEVELOPMENT AND VALIDATION OF ‘SURE’: A PATIENT
REPORTED OUTCOME MEASURE (PROM) FOR RECOVERY FROM DRUG AND
ALCOHOL DEPENDENCE. Drug and alcohol dependence. 165. pp.159-167.
Ramirez, A. and et.al., 2016. Drug and Alcohol Crash Risk: A Case-Control Study (No. DOT HS
812 355).
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Walsh, K. and et.al., 2016. Understanding disparities in service seeking following forcible versus
drug-or alcohol-facilitated/incapacitated rape. Journal of interpersonal violence. 31(14).
pp.2475-2491.
Welty, L. J. and et.al., 2016. Health disparities in drug-and alcohol-use disorders: A 12-year
longitudinal study of youths after detention. American journal of public health. 106(5).
pp.872-880.
Wray, T. B., Braciszewski, J. M., Zywiak, W. H. and Stout, R. L., 2016. Examining the
reliability of alcohol/drug use and HIV-risk behaviors using Timeline Follow-Back in a
pilot sample. Journal of substance use. 21(3). pp.294-297.
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