Alcohol Abuse

Mr. Wilko is a 40-year-old salesperson with a wife and three teenage children. He has recently begun to have a beer at lunch and a few drinks after work to reduce his work-related stress. An economic downturn in the housing industry has reduced the need for new home appliances and his income and sales record has been affected. Several other salespeople have been laid off at his firm. He has been told that if his sales and attendance records do not improve he will be fired. He and his wife are constantly arguing about finances and the children’s increasing demands for money. His drinking has increased to several beers at lunch and continued drinking after dinner. When he returns to work with alcohol on his breath, he is dismissed from his job. He continues to consume alcohol during the day as he attempts a job search. His wife is very concerned, as are his teenage children.

• Mr. Wilko states he is a social drinker and “can stop at any time.” How accurate is his self-assessment?
• What stressors are present in Mr. Wilko’s case?
• Why does Mr. Wilko continue to increase his alcohol intake?
• What changes in liver function can Mr. Wilko expect if he continues to drink large amounts of alcohol?
• Mr. Wilko complains to his wife that all the stress is causing “indigestion.” How do stress and alcohol consumption affect GI function?
• Why is Mr. Wilko at greater risk of trauma?

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.

To prepare:

• Review “Asthma” in Chapter 26 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.
• Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
• Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.

To complete:

Write a 2- to 3-page paper that addresses the following:

• Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.
• Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.
• Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Access-to-Care in Different Situations

For this assignment you are provided with four scenarios. For each scenario, you are required to answer the following question:

• What are the access-to-care issues in the given situations? Suggest at least two solutions to address the access-to-care issues in these scenarios.

Scenarios:

• Mr. A is a 30-year-old African American male. His employer provides for his health insurance, which covers emergency room visits, hospitalization, and some preventive-care services such as yearly physicals. Whenever he schedules appointments for preventive-care services, he has to spend one to three hours at the doctor’s office. Additionally, he has to schedule follow-up appointments for laboratory tests after each office visit.
• Mrs. B is a 30-year-old African American woman with two children. She is employed at a workplace that does not provide the employees with health insurance. Mrs. B and her children make frequent visits to the emergency room for healthcare services.
• Mr. C is an unemployed 52-year-old Asian male who has not seen a doctor in at least eight years. He speaks limited English. He has been experiencing some health problems. He was recently told about a free clinic located within a couple of miles of his apartment. There are no Asian healthcare providers at the local health clinic. He has some concerns about healthcare provided by anyone other than Asian healthcare providers.
• Mrs. D and her husband, a middle-aged Caucasian couple, recently moved to a rural community. They are both on medications for chronic health conditions, which require them to go for bimonthly doctor visits. Their car recently broke down and there is limited bus service in their community. They are having a difficult time going for their appointments and obtaining their medications. They are also less motivated to seek care because they have some major disagreements with the primary care doctor who is a young woman in her early thirties.

Patient Presentation of Dementia, Delirium, and Depression

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?

Case Study 1:

HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.

Review of Symptoms (ROS): Unable to obtain at this time.

Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.

General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.

Her physical exam is unremarkable except –

Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.

Psych: A & O x 1 to person only.  She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.

Case Study 2:

CC: “irritable and forgetful”

HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.

On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.

Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.

Objective data: Her physical examination is within normal limits.

Case Study 3:

HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”

PMH: He has been in good health with the exception of hypertension, which is well controlled.

Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.

Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.

To prepare:

• Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
• Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
• Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.

Post on or before Day 3 an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.