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:

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. Dopamines Normal Action

The normal activity is regulated by an enzyme called monoamine oxidase (MAO). When dopamine is released it is quickly reabsorbed back into the neuron that released it. This is why the euphoria felt after these pleasurable activities only lasts a short while.

# Amphetamines increase Dopamine levels

They stimulate excessive release of dopamine which overwhelms the ability of the neurons to reabsorb it quickly. The net result is an elevated level of dopamine and a high feeling.

2. The physiology behind the need to take “more and more medication” is called Tolerance . When you take medications or drugs your body begins to get used to the drug. As a result, you may need to take more and more of it in order to get the same effects. This reduced effect of the drug is tolerance - your body is getting used to the drug causing a reduction in its effectiveness.

3. Priority nursing diagnosis in this condition is - Risk for self harm related to low self -esteem .

4. Priority nursing interventions include :-

- Removal of all injury causing article from the patient's environment

- Not leaving the patient alone

- 24 hours patient should be under observation

- Encourage the patient to express concerns and relive stress out

- Allowing to spend time alone but under observation at a distance

- providing medications as per the instructions .