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

1. I believe nurses are skilled and educated well in risk factor identification and its management both clinically and socially. They are the one who are skilled in counselling and care for patients with alcohol related problems. I will respond to him positively when he tell he will stop drinking. Alcohol abuse and their dependance related social problems are quit common in clinics and primary health centres. I strongly believe that it is our duty to prevent, detect treat the patient like this. We should screen the patients, assess and intervention the data obtained. A holistic approach is the suitable option of alcoholic patients. A brief health education should be given to the client regarding the effect of his alcoholic behaviour on his current health condition. As he have the history of blood pressure, thyroid and diabetes, the consequences he will face due to the alcohol should be educated to him. The interaction of his medication with the alcohol is one of the factor that will give a negative outcome to him. He should be counselled for all of the above facts. The nurses should not blame the abused client regarding their illness that may or may not by the use of alcohol, because this will make a negative impact on the mind of the client.

2. Usually the antialcoholic medications are given in additional to counselling and rehebilitation. It cannot given to the patient on his suddent request. He should be first educated about the importance of counselling and rehebilitaion. The medication will not work possitively in this patient if he is given this time at this condition. Those drugs are given to reduce cravings of alcohol some patients will show avertion if he have a drink. So i did not think that this client is appropriate for antialcoholic medication at this current situation.

I think he can be given with the medication after admitting him in Rehabilitation centres and to have a proper counselling with his own willing. In addition to this for the better outcome he can be given with antialcoholic medications.

The antialcoholic drug include Naltrexone which is a anti craving agent which is used in the serious alcoholics. Some temporary symptoms as withdrawal of alcohol can be shown in the clients like pain in stomach area, fatigue, nausea etc.

Acamprosate is another anti craving agent which will enter the brain in more relaxed state, and make the individual to drink less frequently. This drug when given with psychotherapy will give a better results. Other anti alcoholics given for anti craving are Disulfiram, Topiramate and Baclofen.

Note that Disulfiram cannot be prescribed in this client since he have the problem with blood pressure.