Question

While you are working as an RN in an outpatient medication clinic, a client comes to an appointment for renewal of his blood pressure, thyroid, and diabetic medications. He has a history of alcohol and opioid abuse. As the patient enters, you notice that he is unshaven, unkempt, and appears agitated, talking loudly and fast and gesturing widely. His gait is ataxic and staggering. He carries with him a bottle of soda, which he occasionally drinks from. As you approach the client to obtain his vital signs, a strong smell of alcohol engulfs you. When you ask the client if he has been drinking, he admits that he has been; furthermore, he confesses that the soda bottle contains alcohol. As you explain to the client that alcohol is not permitted on the clinic premises and ask the client to leave, he loudly tells you that he cannot possibly go because he is completely out of his medications and needs to obtain his prescription refills today. Repeatedly, you reinforce that alcohol is not allowed in the clinic. After several verbal exchanges, the client sobbingly tells you that he needs help. He states that he has heard there is a medication that will make him not want to drink anymore. He asks you to have the nurse practitioner include a prescription for this “anti-drinking” medication along with his other refills. He tells you he will quietly leave without any more trouble if you can just get him his refills and the new prescription.

1. How would you respond to the above situation? Provide a rationale for your stated response.
2. What would you do in response to the patient’s request for an antialcohol agent? Do you believe that the client is an appropriate candidate for an antialcohol agent? If so, which medication?

Answer 1

The man is in mental apathy .he is going through lot of stress and alcohol is the means how he calms his body .he is a chronic alcohol with utmost dependence but somewhere he knows that what he is doing is not right and he will face the consequence of it .I would have stopped shouting or yelling at him would have taken him to the backyard of the clinic as alcohol is not allowed in the clinic made him comfortable in the backyard and wait for all the patients to finish first then I would have a discussion with the nurse practabout this case and he would be called at the end without embarrassing hi. In public and would have helped him refill his medications

Drug of choice for alcohol dependence is naltrexone,acamprosate,and disulfiram.i would give him an injectable naltrexone as ordred by the practitioner.

I would reassure him that alcohol dependence can be eliminated if he has the strong will power I will motivate him to do .I will give contact about self help groups of people with similar stories.i would quote some success stories of alcohol withdrawal.

This client is an appropriate candidate for medication because according to him he has tried all other psychological means to stop dependence and he himself feels the need for withdrawal