Case 3: SUBSTANCE ABUSE

- 64 y/o, has a bit disheveled in appearance

- accompanied by his landlady
- landlady tells you she found him earlier this evening trying to enter his
apartment door
- he was sweaty, his eyes were dilated, and his hands were trembling so badly that
he could not get the key in the door
- he kept calling her by another name and saying he was trying to get into his
office to do some work
- she knows he retired years ago, has lived in her apartment for several years, and
knows her real name
- blood/alcohol level is low and speech is not slurred
- can correctly identify himself but also appears confused
- unable to tell you the month or season
- nose and cheeks are red with tiny spider veins
- his stomach distended and when he extends his hands out in front of him they are
very tremulous
- his demeanor is polite and high on the CAGE assessment test
- he admits that to an occasional drink every now and then
- did have a few drinks earlier today but can't say exactly when
- however, he is willing to come in the hospital for a brief stay if necessary
--substance abuse person manifestations:
Feeling of exhilaration and excess confidence.
Increased alertness.
Increased energy and restlessness.
Behavior changes or aggression.
Rapid or rambling speech.
Dilated pupils.
Confusion, delusions and hallucinations.
Irritability, anxiety or paranoia.

1. As Mr. Cruz’s nurse, what assessment data must you analyze to determine
priorities and establish plan of care and parallel it to 1 or 2 NANDA nursing
Diagnosis.
- Based on the case, Mr. Cruz appears a bit disheveled, calling the landlady by
other name and said that he was trying to get into his office to do some work but
that's his apartment and he knows the landlady well since he is living there for
several years. he can also identify himself but still confused. He cannot tell the
current month or season.
Risk for injury related to substance intoxication as evidenced by hallucinosis,
confusion, disorientation and inability to identify
2.What are the possible nursing interventions applicable to Mr. Cruz and why?
3. Give at least 2 causes of substance abuse and why?

1. What Transference and countertransference issues might present?

- t: he kept calling her by another name and saying he was trying to get into his
office to do some work
2. What, if any, medical danger(s), do you see or should you consider for either
patient? Why?
- Dependence on drugs can create a number of dangerous and damaging complications,
including:

- Getting a communicable disease. People who are addicted to a drug are more likely
to get an infectious disease, such as HIV, either through unsafe sex or by sharing
needles.
- Other health problems. Drug addiction can lead to a range of both short-term and
long-term mental and physical health problems. These depend on what drug is taken.
- Accidents. People who are addicted to drugs are more likely to drive or do other
dangerous activities while under the influence.
- Suicide. People who are addicted to drugs die by suicide more often than people
who aren't addicted.
- Family problems. Behavioral changes may cause marital or family conflict and
custody issues.
- Work issues. Drug use can cause declining performance at work, absenteeism and
eventual loss of employment.
Problems at school. Drug use can negatively affect academic performance and
motivation to excel in school.
- Legal issues. Legal problems are common for drug users and can stem from buying
or possessing illegal drugs, stealing to support the drug addiction, driving while
under the influence of drugs or alcohol, or disputes over child custody.
- Financial problems. Spending money to support drug use takes away money from
other needs, could lead to debt, and can lead to illegal or unethical behaviors.