Vancouver Clinic Case: Heroin Addiction and Pregnancy Dilemma Analysis

This case study presents a 22-year-old woman, Suzanne, struggling with heroin addiction and facing an unplanned pregnancy. The scenario details her history of substance abuse, social background, and current concerns, including her dilemma about whether to continue using heroin during pregnancy. The assignment requires an analysis of the relevant data, identification of the central dilemma, and recommendations for nursing interventions. It explores the need for additional information, appropriate communication strategies to build trust and address resistance, and the ethical considerations of advising the patient. The student also reflects on the impact of the case study on their practice, emphasizing the importance of compassion and knowledge in managing substance abuse and pregnancy.

PATIENT Dilemma
Heroin Addiction/Pregnancy
STUDENT Worksheet
Suzanne Smith, 22 years’ old
Overview
Heroine is one of the most dangerous, and most addictive, substances known to man. It is also relatively
inexpensive and when an addiction forms it seems impossible to feel normal without it and addicts can spend
hundreds of dollars a day on the habit. In this case study dilemma, you will look at all the aspects surrounding
heroin addiction and how to guide clinical decision making without being judgmental is the essence of this
patient dilemma.

© 2015 Keith Rischer/www.KeithRN.com
Clinical Dilemma Activity: STUDENT
Heroin Addiction and Pregnancy
I. Scenario
History of Present Problem:
Suzanne has come by the free “drop -in” nursing clinic where you work to get some information and advice. Suzanne is a 22-year-old
single woman who has been living with her boyfriend Jack in Vancouver's east side for the last four years. She and Jack have been
heroin addicts for as many years. When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom
and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at
18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to
function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works
the streets at night. She usually drinks four or five beers each night before going out to work.
If she can’t score enough heroin, she will try to score either some Valium or Clonazepam to “tide me over until I can get some ‘horse".
She says she has tried cocaine but, “I really didn’t care for the high all that much.”
Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all
that much. When they do make love he never wears a condom. He says that’s what makes him different from her “john’s” “Which is
true because I won’t work without a condom.”
What data from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Suzanne is having substance abuse problems such as
heroin.When she is unable to get heroin she uses
valium or clonazepam instead.Suzanne is also using
alcohol to help her feel high.
The clinical significance is that heroin is that while it produces the euphoria it
causes long term effects to the body such as risk of infections due to the use of
injectables.In severe cases there could be cardiopulmonary collapse and eventually
death.Alcohol causes liver cirrhosis and long term liver damage.One is unable to
make rational decisions while using alcohol.
RELEVANT Data from Social History: Clinical Significance:
Suzanne comes from a home where the parents
separated.Her mom is a heavy drinker.She dropped
out of high school Suzanne lives with her boyfriend
who does not work living her to work to get rent and
money to buy heroin.
Suzanne most likely learned the behavior from her parents and especially due the
separation which affected her while she was growing up.Her mother may not have
been present to guide her on what decisions to make especially her
education.Suzanne has to work while her boyfriend relies on her to meet their
needs.
II. The Dilemma Begins…
Current Concern:
Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12
weeks. She is pretty sure she is pregnant and knows it’s her boyfriends’ baby. However, she not sure she can stop using
dope or work to have the baby even though Jack wants her to keep it. She is really confused at what she should do and is
asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if
she is pregnant “Because it’s worse for the baby than to keep using.”. “I just don’t know what I should do?”
What data from the current concern is important & RELEVANT; therefore, it has clinical
significance to the nurse?
RELEVANT Data from Current Concern: Clinical Significance:
Suzanne is unable to choose whether to stop using
drugs since she is pregnant.Her boyfriend Jack
wants her to keep the baby.Suzannne’s friend
convinces her that she should stop using drugs as it
would harm the baby.
Suzanne is unable to make decisions regarding her own health and that of her baby
especially in terms of drug abuse.Suzanne relies on others to give her information
on her pregnancy and the welfare of her baby.There is need to note that she is
unable to make decisions and some of the advice she is getting is not right.

© 2015 Keith Rischer/www.KeithRN.com
III. Resolving the Dilemma
1. Identifying data that is RELEVANT, what is the essence of this current dilemma?
Suzanne is vulnerable in terms of decisionmaking and how to stop use of drugs(Latuskie, Leibson, Andrews, Motz,
Pepler & Ito, 2018).Suzanne has advice from her friend who says that not using the drugs is harmful for her.This
dilemma is essential in that Suzanne needs guidance to make the right decision for her and for her
pregnancy.Suzanne is at risk since pregnancy brings a lot of physiological changes to the body and drug abuse
predisposes her to many complications.However there is need to approach the issue in a nonjudgemental way.
2. What additional information is needed by the nurse that would help clarify the current dilemma?
The nurse needs to know the diet of Suzanne.Whether Suzanne is able to afford a balanced diet to help her meet
the nutritional requirements of pregnancy.The nurse needs to inquire what work she does at night as some
occupational hazards may endanger the fetus such as radiation.The nurse needs to inquire if her boyfriend is
willing to support her especially financially now that she is the only one working.
3. How would you respond to Suzanne at this time?
I would discuss with Suzanne the pregnancy changes that may occur to her body and what to expect as her
she progresses and what is required of her in terms of nutrition and attending clinics to ensure that her
progress is monitored.I will engage other health professionals to help her in terms of monitoring the drug
abuse and coming up with means to decrease it.I would advice Suzanne medically about the drug abuse and
its side effects to her pregnancy such as low birth weight,intrauterine fetal death and dependency
syndrome(Lind et al ,2017).
4. What communication strategies could you use with this patient to build rapport and trust?
Provide examples of what you would say and do.
I would engage her by eye contact with non judgemental attitude such as smiling.I will ask her questions and allow
her time to answer without making my own conclusions.I would for example ask how do you feel about the whole
situation as a way to show empathy.I would also show her empathy while at the same time requiring her
accountability in terms of managing the heroin abuse.

© 2015 Keith Rischer/www.KeithRN.com
5. What barriers to effective communication do you anticipate? How might these barriers be eliminated?
Some of the barriers anticipated is inability to give the right information especially regarding the use of drugs and
adherence to treatment options that may be available.Other barriers include lack of cooperation especially due to
some of the advice she may be getting from her friends.This barriers may be eliminated by ensuring close
followup of Suzanne by the nurse while at the same time potraying a nonjudgemental attitude towards her so that
she can open up.
6. What are useful communication strategies to use when Suzanne begins to resist treatment options or
care?
The useful communication strategies to use is to educate her regarding the consequences of resisting treatment
options or care such as intrauterine fetal death and withdrawal of her fetus due to the use of heroin(Nørgaard,
Nielsson & Heide-Jørgensen,2015).This will make her realize she is in charge of her pregnancy and needs to
adhere to her treatment options.
7. Is her girlfriend correct in her advice for Suzanne not to stop her heroin use if she is pregnant? If
she is, why? How will you communicate your knowledge to Suzanne?
Suzanne girlfriend is partially correct and wrong at the same time.This is because sudden stop of heroin use will
cause her fetus to go into withdrawal and hence may cause intrauterine death.However continued use of heroin
during her pregnancy may lead to other complications such as low birth weight and placenta abruptio.I will
communicate my knowledge to Suzanne by informing her about the various cons to use of heroin during
pregnancy and some of the consequences that may occur and the solutions available such as methadone(Chen,
Chiang, Yuan, Kuo, Lai & Hung, 2015).
8. What is the patient likely experiencing/feeling right now in this situation?
She is confused about the whole situation.She is aware that the actions she is doing may cause harm to her

© 2015 Keith Rischer/www.KeithRN.com
unborn child at the same time she is not certain whether is will stop the heroin abuse.Even if she does it may
harm the fetus.She may be confused as her girlfriend is giving her contradicting information from the health
preofessionals.She is scared due to the financial implications of her baby after delivery.
9. What can I do to engage myself with this patient’s experience, and show that she matters
to me as a person?
I can connect her to people who have been through her experiences and have overcome to show her that
she is not alone and she can overcome.I can listen to her worries and her emotions that this whole dilemma
may bring to her.I can bring a counsellor who is thorough with such issues to help her cope with her
situation.
SELF-REFLECTION
10. What was learned from this case study that you will incorporate into your practice?
I have learnt that it is extremely important to be compassionate with people with substance abuse disorders
while at the same time helping them make decisions that will be of positive impact to them.It is also important to
be knowledgeable regarding the issues of substance abuse and pregnancy(Volkow,2016).

© 2015 Keith Rischer/www.KeithRN.com
REFERENCES
Chen, H. H., Chiang, Y. C., Yuan, Z. F., Kuo, C. C., Lai, M. D., & Hung, T. W. (2015). Buprenorphine,
methadone, and morphine treatment during pregnancy: behavioral effects on the offspring in rats.
Neuropsychiatric disease and treatment, 11, 609.
Latuskie, K. A., Leibson, T., Andrews, N. C., Motz, M., Pepler, D. J., & Ito, S. (2018). Substance Use in
Pregnancy Among Vulnerable Women Seeking Addiction and Parenting Support. International Journal
of Mental Health and Addiction, 1-14.
Lind, J. N., Interrante, J. D., Ailes, E. C., Gilboa, S. M., Khan, S., Frey, M. T., ... & Creanga, A. A. (2017).
Maternal use of opioids during pregnancy and congenital malformations: a systematic review. Pediatrics,
139(6), e20164131.
Nørgaard, M., Nielsson, M. S., & Heide-Jørgensen, U. (2015). Birth and neonatal outcomes following opioid use
in pregnancy: a Danish population-based study. Substance abuse: research and treatment, 9, SART-
S23547.
Volkow, N. D. (2016). Opioids in pregnancy. National Institute on Drug Abuse, National Institutes of Health. DOI:
10.1136/bmj.i19