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NURS 432 Jonathan Herman | Interview the Patient | Review| Complete Solutions
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NURS 432 Jonathan Herman | Interview the Patient | Review| Complete Solutions
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Lee ArthurJonathan Herman
Jonathan Herman | Interview the Patient | Review
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Answers and Rationale
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1.
How long have you had a problem with alcohol?
Your
Rationale Relevancy Answer
Because the criteria for withdrawal reflects cessation of
(or reduction of) heavy and prolonged substance abuse, it
is important to determine the length of use. Relevant Relevant
Client’s Mother: Jonathan’s drinking has been out of control for at least 7 years. He is a
binge drinker. Sometimes he is able to control his drinking and then he has periods when
he drinks heavily for several weeks at a time. Recently, he lost 25 pounds, broke up with
his girlfriend, and was charged with DUI but kept drinking and then I have to look after
him.
Client: I have tried to quit before, but just can’t seem to stop. When my life gets out of
control and is so stressful, I need it just to get through the day.
2.
Do you only drink alcohol, or have you also used other substances?
Rationale Relevancy Your Answer
It is important to determine if the client has used or is
using other substances. Relevant Relevant
Client’s Mother: Jonathan told me he only drank alcohol. He said he had never touched
any other type of drug.
Client: I have never used any other drugs or substances.
3.
Have you ever tried to cut down on your drinking?
Relevanc Your
Rationale y Answer
It has already been established that Jonathan began
withdrawal symptoms when he abruptly quit drinking. It is not
necessary to repeat gathering information on this portion of
the history. The nurse should concentrate on the withdrawal
symptoms for which Jonathan is admitted. Irrelevant Irrelevant
Client’s Mother: Several times, and he has been for court mandated treatment in the
,past. He comes home and starts drinking again. I have had to call in sick for him when he
is still too drunk to go to work.
4.
Do you feel that you have needed more alcohol in recent months in order to become
intoxicated?
Your
Rationale Relevancy Answer
It has already been established that Jonathan has substance
dependence. It is not necessary to repeat gathering
information on this portion of the history. The nurse should
concentrate on the withdrawal symptoms for which Jonathan
is admitted. Irrelevant Irrelevant
Client’s Mother: Yes, he seemed to continue to drink more and more. Sometimes I find
bottles of alcohol hidden in the basement, so I hide them where he cannot find them. At
other times he has gone to a motel and spent several days there drinking. I’ve had to drive
around to find him and bring him home to sober him up.
5.
Have you lost jobs or employment opportunities as a result of your drinking?
Relevanc Your
Rationale y Answer
Substance abuse is characterized by failure to fulfill a major
role obligation (e.g., his role as a carpenter). Because Jonathan
has already been diagnosed with a substance abuse problem, it
is not necessary to repeat gathering information on this portion
of the history. The nurse should concentrate on the withdrawal Irrelevan
symptoms for which Jonathan is admitted. Irrelevant t
Client’s Mother: Yes, he has lost some very good jobs. Employers say he is a good
worker but he has been fired for drinking on the job. He lost his latest job a couple of
weeks ago when he was caught drinking at work. Then his girlfriend broke up with him.
6.
Did your symptoms begin when you quit drinking?
Your
Rationale Relevancy Answer
Signs and symptoms that manifest once the client
significantly reduces or ceases taking the substance
characterize substance withdrawal. Relevant Relevant
Client’s Mother: Yes, before that he didn’t have any of these symptoms. This is how he
always gets when he quits drinking.
Client: Yes, I have gone into withdrawal before, but it seems to be worse this time.
, 7.
Have you been sweating more or felt like your heart is racing?
Relevanc Your
Rationale y Answer
Withdrawal symptoms from alcohol include two or more of the
following: autonomic hyperactivity (sweating, pulse rate greater
than 100 beats per minute), increased hand tremor, insomnia,
psychomotor agitation, anxiety, nausea or vomiting, and rarely,
grand mal seizures or transient visual, tactile, or auditory
hallucinations or illusions. Relevant Relevant
Client’s Mother: Yes, over the last 2 days he’s said he feels like his heart is “beating out
of his body.”
Client: My mom just stresses me out, she just won’t stop. She is always at me. I need to
drink just to try to deal with her.
8.
Did you take a drink over the past 12 hours before being admitted and, if so, did your
symptoms get any better?
Rationale Relevancy Your Answer
If a client is truly in withdrawal, administration of the
offending substance will relieve symptoms. Relevant Relevant
Client’s Mother: Yes, I gave him several drinks last night to try to control the symptoms
and he got a little better. I have done that before to help him get off the alcohol. This
morning I put him in the car and brought him here.
9.
When did you quit drinking?
Your
Rationale Relevancy Answer
Alcohol withdrawal symptoms typically begin when blood
concentrations of alcohol decline sharply, generally within 4 to
12 hours after alcohol consumption has been stopped or
reduced. Peak symptoms are generally noted during the second
day of abstinence. Relevant Relevant
Client’s Mother: He stopped completely 2 days ago. The only thing he has had since
then was last night when I gave him several drinks to control his shakes. I wouldn’t let him
drink any more since I was afraid it would start all over again, so I brought him here.
10.
Have you noticed that Jonathan is slurring his speech or having difficulty walking?
Relevanc Your
Rationale y Answer
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