Case Studies on Drug Abuse

Mrs. Z's Case

After the introduction of new prescription rules, the narcotic prescription has been sufficient to last Mrs. Z a month. Therefore, the fact that Mrs. Z suddenly indicates that she has run out of drugs before the end of the month is a major concern. I am also concerned about the increased severity of the back pains that she is experiencing, although she is on pain medication. Further, the fact that she now lives with her granddaughter, who has a somewhat troublesome history interests me. I am, therefore, questioning the impact that her (granddaughter) stay could have on Mrs. Z. It would be essential to understanding whether the granddaughter made any progress concerning drug abuse once she was out of rehab.

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I would ask Mrs. Z why she thinks that the prescription narcotics have suddenly become insufficient to last her at least a month. I would ask her to give me the details of the number of times a day she takes the drugs so that I can determine whether she is following the prescription. It will also be important to question whether there are any complications in the relationship between her and her granddaughter. This line of questioning will determine whether the granddaughter is troublesome, hence causing Mrs. Z stress and worsening of the back pains (Nachemson, Jonsson, & Jonsson, 2000). Additionally, I would inquire about her granddaughter's recovery journey from drug abuse as it could be possible that she is taking her grandmother's drugs.

I will be very friendly towards Mrs. Z as I question her, as this will encourage her to open up to me about any challenges in her life. It is possible that the granddaughter is stressing her, hence the increased severity of the back pains. It is also possible that Mrs. Z has been overdosing on the pills to deal with the said pain, hence the reason she is running out of the prescription. I will also employ some level of firmness in my questioning so that I can get precise information from Mrs. Z as this will determine my ability to address the primary cause of the pain and drug shortage problems.

According to the facts presented in this case, several possibilities emerge. It is likely that Mrs. Z's granddaughter is using the narcotics behind her grandmother's back. If this is true, the possible intervention would be to question the granddaughter and if she confesses she should be sent back to rehab with her (granddaughter) consent. Otherwise, she should be supervised if she continues to live with her grandmother. It is also possible that Mrs. Z is overdosing on the prescription drugs to ease her back pain. The best intervention, in this case, would be to identify the reason for the increased pain. If it is determined that her granddaughter is stressing her, then it would be wise that she (granddaughter) vacates Mrs. Z's house. In case the medication has become ineffective, then her prescription should be changed or the dosage adjusted accordingly.

Mr. G's Case

I would begin by confiscating Mr. G's plastic bag full of pills. The fact that the patient presents with a +2 pitting edema in bilateral lower extremities and a rapid three-pound weight gain indicates a possibility for congestive heart failure (Hosenpud & Greenberg, 2007). It means that Mr. G requires immediate attention which involves applying the standing orders that govern the emergency department. These include placing the patient on a cardiac monitor and oxygen. Also, an intravenous site (IV) may be started. Alternatively, a triage nurse may administer an electrocardiogram (EKG) within the first 10 minutes followed by a chest X-ray before administering any further medications.

Once the patient is admitted to the hospital, I would ensure that the professionals manage his condition at the coronary care unit or the acute cardiac unit until he stabilizes. Afterward, he may be transferred to the cardiology ward where he will be attended to by cardiology-trained nurses and heart failure specialist nurses (Riley & Masters, 2016). Mr. G will be hospitalized long enough for the symptoms, such as the pitting edema, to be controlled and for the introduction of evidence-based medicine. Part of the discharge plan will involve an evaluation of the Mr. G's environment and his ability to care for himself (Morton, Masters, & Cowburn, 2017). He will be informed on whether to avail himself for any future tests, and he will be educated on the available health and social care services that are relevant to the management of his condition. I will then ensure that follow-up and monitoring initiatives are places including that Mr. G attends community clinics or he is called by a heart failure physician to determine his progress.

Mr. G should be taught to monitor his weight daily. It will involve checking his weight before breakfast, and any sudden increase may be an indication of heart failure. Also, he should be educated on the use of medication. It will entail enlightening him on how to differentiate one drug from the other. For instance, the drugs can be stored in different containers that are labeled appropriately. He should also be educated on the physical activities and rest schedules that are necessary to facilitate his recovery.

Mr. G's medications should be stored in separate containers for easy identification. These should be labeled accordingly, assuming that he can read so that he can differentiate one from the other. These containers should indicate each drug's dosage and schedule to avoid a case of drug misuse. Where applicable, a table depicting the name and time of the medication may be drawn. Emphasis should be made on the names, schedules, indications, and side effects.

References

Hosenpud, J. D., & Greenberg, B. H. (Eds.). (2007). Congestive heart failure. Lippincott Williams & Wilkins.

Morton, G., Masters, J., & Cowburn, P. J. (2017). Multidisciplinary team approach to heart failure management. Heart, heartjnl-2016.

Nachemson, A. L., Jonsson, E., & Jonsson. (2000). Neck and back pain: the scientific evidence of causes, diagnosis, and treatment (Vol. 10). Philadelphia: Lippincott Williams & Wilkins.

Riley, J. P., & Masters, J. (2016). Practical multidisciplinary approaches to heart failure management for improved patient outcome. European Heart Journal Supplements, 18(suppl_G), G43-G52.