Question

_____________________________________________________________________________________

Kelly, age 23, is a first-year law student. She is engaged to a surgical resident at the local university hospital. She has been struggling to do well in law school because she wants to make her parents, two prominent local attorneys, proud of her. She had never aspired to do anything but go into law, and that is also what her parents expected her to do.

Kelly’s mid-term grades were not as high as she had hoped, so she increased the number of hours of study time, staying awake all night several nights a week to study. She started drinking large amounts of coffee to stay awake, but still found herself falling asleep as she tried to study at the library and in her apartment. As final exams approached, she began to panic that she would not be able to continue the pace of studying she felt she needed in order to make the grades she hoped for.

One of Kelly’s classmates told her that she needed some “speed” to give her that extra energy to study. Her classmate said, “All the kids do it. Hardly anyone I know gets through law school without it.” She gave Kelly the name of a source.

Kelly contacted the source, who supplied her with enough amphetamines to see her through final exams. Kelly was excited, because she had so much energy, did not require sleep, and was able to study the additional hours she thought she needed for the exams. However, when the results were posted, Kelly had failed two courses and would have to repeat them in summer school if she was to continue with her class in the fall. She continued to replenish her supply of amphetamines from her “contact” until he told her he could not get her anymore. She became frantic and stole a prescription blank from her fiancé and forged his name for more pills.

She started taking more and more of the medication in order to achieve the “high” she wanted to feel. Her behavior became erratic. Yesterday, her fiancé received a call from a pharmacy to clarify an order for amphetamines that Kelly had written. He insisted that she admit herself to the chemical addiction unit for detoxification.

On the unit, she appears tired, depressed, moves very slowly, and wants to sleep all the time. She keeps saying to the nurse, “I’m a real failure. I’ll never be an attorney like my parents. I’m too dumb. I just wish I could die.”

Answer the following question related to Kelly:

Remember to include in-text citations and your references at the end

1.Explain the role of dopamine in the pathophysiology of addiction

2.Explain the physiology behind the need to take “more and more medication”

3.What is the priority nursing diagnosis for Kelly?

4.Describe priority nursing interventions to be implemented with Kelly (minimum of 3- no more than 5).

5.In addition to maintaining physiologic integrity, what would be an important short-term goal the nurse would strive to achieve with Kelly?

Answer 1

1.Dopamine is a chemical in our brain,otherwise known as neurotransmitters that sends signals acroos our brain.It is derived from tyrosine and is activated by epinephrine and norepinephrine.When something we perceive good,here Amphetamines in case of Kelly, provides feeling of pleasure ,the dopamine neurons are activated.So in Kelly's case,her drug of choice is Amphetamines which gives her energised feeling and taking away fatigueness and so these drug when used by her, overstimulates her brain thereby activating her dopamine neurons.As a result she gets the reward of euphoric behaviour where she is not feeling sleepy and is constantly energised.This feeling of excited dopamine neurons giving ecstastic feels, is remebered by the drug user and thereby she feels the urge to undergo this pattern of feelings by repeated intakes. Addiction occurs when the user relies too frequently on the drug to get the reward of good feeling.

2.The need for 'more and more medication' refers the user feeling the need of need of more dopamine induced euphoric feeling.This literally refers to the addiction phase.The brain remembers the rewards(here good,alert feelings) from previous use and the drug user feels the urge to take more drugs to get that specific feeling.

3.Priority nursing diagnosis is Low self esteem related to life choices perpetuating failure(Failure in tests);loss of control over life events ,as evidenced by self negative verbalization'i am a failure',expression of shame over her inability to deal with events(Exams in her case).

4.Nursing Interventions:

a)Encourage verbalization ,encourage expression of individual situations bringing out the stress factors to evaluate the mental status.

Rationale:Kelly may have problem expressing her self and the nurses role is to make her understand how her life is becoming dependant on the drug.Kelly should understand that use of the drug is her problem.

b)Spending time with Kelly and talking to her in a non judgemental way.

Rationale: To make her feel worthy and save her from negative thoughts leading to severe depression or suicidal attempts.

c)Ensuring family support and make sure that the parents /fiancee do not make Kelly feel more depressive.Positive conversation may be encouraged involving positive accomplishments in the past reminding her confidence.

Rationale:Pressure from family or too much expectation is the root cause why the patient took up drug abuse.Family members can provide maximum positive mental support which can help her feel wanted,worthy and gain confidence again.This may help her to gain appetite and address her muscular weakness and fatigue too ,resulting in an active individual.

d)Use techniques of role play or involve patient in group therapy.

Rationale:Involvement of Kelly in group activities can bring a positive change in her due to change of ambience or interactions with other patients/nurses.Role play emphasizing importance to enjoy education and not to succumb to pressure may help.Thses sessions may help her to open out her shame,guilt in a positive way.