ALCOHOLISM

GROUP 4
Case scenario

Patient Profile:
Name: Ariel B.
Gender: Male
Age: 30 years old, Single
Ht: 5’ 5” Wt: 46 Kg
Address: Maginhawa St., Teacher’s Village, Q.C.
Allergy: Crustaceans
Occupation: BPO Account Executive
Reason for Admission: For Detoxification

Chief Complaint:
According to patient: “I just had an instance of having one drink too many. I just need to sleep
this off. I’m fine. They are exaggerating the situation.”

According to his brother: “He was unruly at the Club. He had Tequila and spilt salt all over
the bar then begins dancing sloppily; he was shouting insulting things to his date. He cannot
be pacified and is challenging those around him for a fight, then he blacked out. I was called
after the ambulance crew found my number in his wallet.”
HPI: Few hours prior to admission patient went to the Club with a female companion. When
he picked her up, he offered her a small bottle of whiskey; when she refused, he drank both
bottles before they left. Two hours later at the club, Ariel has drunk two beers and some shots
of tequila. He was then observed to be boisterous and refused to be pacified. As the
personnel were trying to persuade him to leave, he lost consciousness.

Physical Examination:
Admitted to history of passing out while out with friends/ Company Team.
Noted weight loss in the past three months.
Other systems: Unremarkable; within normal limits. (-) history of previous confinement.
Review of Systems:
HEENT: NC/AT, Bilateral external ears, oropharynx moist, nose normal, Eyes normal
Neck: Normal ROM, No JVD, carotid upstrokes are preserved without audible bruits.
Cardiovascular: RRR, Normal S1 and S2. No rubs, gallops or murmurs.
Lungs: Clear to auscultation
GI: BS normal, soft, No tenderness, no masses, no masses, no splenomegaly
/hepatomegaly
Extremities: Intact distal pulses, no pedal edema, no tenderness.
Skin: Warm and dry, no erythema, no rash
Admission CIWA-Ar Score: 11
Social History:
Patient shares an apartment with his brother and is not in a relationship.
He has a very active social life. Almost every night of the week, Ariel can be
found at some form of gathering at a bar, club or restaurant. In almost all
of these occasions, liquor is noted to be present. He often jokes about
how he must look like an alcoholic because in most pictures he is holding
a drink. He casually mentions that his mother has asked him to promise
not to drink; however, he believes that his drinks help him function and
sleep better.
The woman he has begun to be close with finds that every time she calls him, he is
drinking. She thought nothing of it, since this man must just enjoy one or two social drinks.
The fact that he drinks every night does not flag him as an alcoholic in her eyes. They have
spoken on the phone scores of times, spent time together and been in constant
communication for a two-month period. She believed that he really is such a nice guy.
However, with the recent incident at the Club, she does not want to have anything to do
with him anymore.

Ariel was noted by his brother to drink excessively, regardless of the concern expressed by
his family and friends. He insists that he does not have a problem and does not seek help.
Developmental History:

Ariel’s father worked as an accountant in an oil firm in Jeddah and his mother, a housewife.
He is the oldest of five kids. His conception was planned, and his early years were uneventful.
His mother enrolled him in a public elementary school claiming that finances are short. As he
was asked to help care for the younger siblings, he often misses school. He was described
as a sociable child. He made enough friends who looks out for him and helps him with the
lessons he missed and eventually finished elementary. He remembers the Christmas Parties
as fun times in school. While growing up, Ariel looks up to his paternal Grandfather. He
knows his friends and he was in Grade 5 when he died of liver cirrhosis. He remembers his
angry Grandmother whenever Ariel is asked to buy Gin bilog when his workday ends.
He was in high school when he started to notice that his mother had expensive tastes and hobbies. When he
tried to discuss this with his mother, she got angry and told him to find a job to support himself. He tried telling
his father about their needs; but he was told to talk with his mother. He was 14 years old when he learned to
smoke and drink. He found a part time job at a local fast-food company and used his earnings for his needs. He
had a girlfriend when he was in his third year in high school; the relationship ended when they separated to
pursue their College degrees.

He went on to College as a self-supporting student; during this time, he described his relationship with his
mother as distant and his father, non-existent. His Grandmother lends her support as needed and he managed
to finish his course in Business Administration (majored in Marketing), in record time. On his final year in
college, his internship was with the BPO company; it eventually employed him; after three years, he was made a
junior executive. It was around this time that his brother noticed his late nights out and an increase in his
alcohol consumption.
Admitting Diagnosis: Substance Use DO: Alcohol

Medications:
1. Chlordiazepoxide (Librium) to start at 75 mg PO every hour x 4 hours. Repeat CIWA-Ar1
assessment hourly after initial dose; adjust dosage according to CIWA-Ar Score Management
Protocol. Refer for score of 16.
2. Gabapentin (Neurontin) 300 mg every 4 hours X 48 hours.
3. Folic Acid 100 mg daily after breakfast.
4. Request for CBC, Na and K levels.
5. Monitor patient closely for untoward signs and symptoms and refer.
6. Naltrexone 25 mg twice a day x one week upon discharge.
Identify the etiology and
epidemiology
EPIDEMIOLOGY
Alcoholism has been known by a variety of terms, including
alcohol abuse and alcohol dependence. Today, it’s referred to
as alcohol use disorder. It occurs when you drink so much that
your body eventually becomes dependent on or addicted to
alcohol. When this happens, alcohol becomes the most
important thing in your life. People with alcohol use disorder
will continue to drink even when drinking causes negative
consequences, like losing a job or destroying relationships with
people they love. They may know that their alcohol use
negatively affects their lives, but it’s often not enough to make
them stop drinking. Some people may drink alcohol to the
point that it causes problems, but they’re not physically
dependent on alcohol. This used to be referred to as alcohol
abuse.
What are the symptoms?
Symptoms of alcohol use disorder are based on the behaviors and physical outcomes that
occur as a result of alcohol addiction.
People with alcohol use disorder may engage in the following behaviors:
drinking alone
drinking more to feel the effects of alcohol (having a high tolerance)
becoming violent or angry when asked about their drinking habits
not eating or eating poorly
neglecting personal hygiene
missing work or school because of drinking
being unable to control alcohol intake
making excuses to drink
continuing to drink even when legal, social, or economic problems develop
giving up important social, occupational, or recreational activities because of alcohol
use
What causes it?
The cause of alcohol use disorder is still unknown. Alcohol use disorder develops when you
drink so much that chemical changes in the brain occur. These changes increase the
pleasurable feelings you get when you drink alcohol. This makes you want to drink more
often, even if it causes harm.
Eventually, the pleasurable feelings associated with alcohol use go away and the person
with alcohol use disorder will engage in drinking to prevent withdrawal symptoms. These
withdrawal symptoms can be quite unpleasant and even dangerous.
Alcohol use disorder typically develops gradually over time. It’s also known to run in
families.
Behavioral Treatments
Also known as alcohol counseling, behavioral treatments involve working with a health professional to
identify and help change the behaviors that lead to heavy drinking. Behavioral treatments share certain
features, which can include:
Developing the skills needed to stop or reduce drinking
Helping to build a strong social support system
Working to set reachable goals
Coping with or avoiding the triggers that might cause relapse
Types of Behavioral Treatments
Cognitive–Behavioral Therapy can take place one-on-one with a therapist or in small groups. This form of
therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking and
managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol
misuse and to develop the skills necessary to cope with everyday situations that might trigger problem
drinking.
Motivational Enhancement Therapy is conducted over a short period of time to build and strengthen
motivation to change drinking behavior. The therapy focuses on identifying the pros and cons of seeking
treatment, forming a plan for making changes in one’s drinking, building confidence, and developing the
skills needed to stick to the plan.
Marital and Family Counseling incorporates spouses and other family members in the treatment process
and can play an important role in repairing and improving family relationships. Studies show that strong
family support through family therapy increases the chances of maintaining abstinence (stopping
drinking), compared with patients undergoing individual counseling.
Brief Interventions are short, one-on-one or small-group counseling sessions that are time limited. The
counselor provides information about the individual’s drinking pattern and potential risks. After the client
receives personalized feedback, the counselor will work with him or her to set goals and provide ideas for
helping to make a change.
Ultimately, choosing to get treatment may be more important than the approach used, as long as the
approach avoids heavy confrontation and incorporates empathy, motivational support, and a focus on
changing drinking behavior.
Current Medications
The U.S. Food and Drug Administration (FDA) has
approved three medications for treating alcohol
dependence, and others are being tested to determine
whether they are effective.
Naltrexone can help people reduce heavy drinking.
Acamprosate makes it easier to maintain abstinence.
Disulfiram blocks the breakdown (metabolism) of
alcohol by the body, causing unpleasant symptoms
such as nausea and flushing of the skin. Those
unpleasant effects can help some people avoid
drinking while taking disulfiram.
Describe the Modifiable and Non-modifiable
factors that may have contributed to the
development of Alcohlism
Modifiable factors:
*drinks almost every night in a week - Drinking
alcohol in moderation generally is not a cause for
concern. According to the National Institute on
Alcohol Abuse and Alcoholism, drinking is
considered to be in the moderate or low-risk range for
women at no more than three drinks in any one day
and no more than seven drinks per week. For men, it
is no more than four drinks a day and no more than 14
drinks per week.
*experience a high level of stress (a junior executive
at a BPO Company) - Alcohol causes higher amounts
of cortisol to be released altering the brain's
chemistry and resetting what the body considers
"normal." Alcohol shifts the hormonal balance and
changes the way the body perceives stress and
changes how it responds to stress.
NON-Modifiable factors:
*have a close relative with alcohol use disorder
(grandfather who died for liver cirrhosis) - Our
genetic structure determines all our human traits. Our
DNA dictates our physical characteristics (such as eye
color) and also our behavioral characteristics (such as
aggression). These genes are passed on to us by our
parents. Among those abusing alcohol, people who are
genetically predisposed to alcoholism have a higher
risk of developing an alcohol use disorder. Although
people can inherit alcoholic tendencies, the
development of an alcohol use disorder is also
dependent on social and environmental factors. Some
who have inherited genes making them susceptible to
alcoholism are responsible drinkers or never take a
drink in their life.
Psychopathology
 Predisposing factors:
failure/delayed developmental stages
grandfather was seen as alcoholic
Ariel looks up to his paternal
Grandfather
He remembers his angry
grandmother whenever Ariel is asked
to buy Gin bilog when his workday
ends
His mother enrolled him in a public
elementary school claiming that
finances are short. As he was asked
to help care for the younger siblings,
he often misses school
College: He described his
relationship with his mother
as distant and his father, non
existence
Infancy: Primary need are met conception
was planned,and his early years were
uneventful
Childhood:Delayed gratification;
-Shift to parataxic mode
-Paternal grandparents/parents
viewed as praise and acceptance
Juvenile: neglected in negotiating needs
and wants
Shift to syntaxic mode begins
Preadolescence: capacity for attachment,
love and collaboration failed to develop
Major shift to synatxic mode
Precipitating factor:
works at a BPO company as
junior executive
-He started to notice that his
mother had expensive tastes and
hobbies. When he tried to discuss
this with his mother, she got angry
and told him to find a job to support
himself.
-He tried telling his father about
their needs, but he was told to talk
with his mother
- found a part time job at a local fast-
food company and used his earnings for
his needs
-At 14, Ariel learns to smoke and drink to
cope
Fixation
- Almost every night of the week, Ariel
can be found at some bar, club or
restaurant. In almost of these occasions,
liquor is noted to be present
Adolescence: New opportunities for social -His brother nnoticed his late nights out
and an increasein his alcohol
experimentation lead to the consolidation of self-
consumptiion
esteem or self ridicule(leads to substance abuse;
Alcohol
Denial
- "I just had an instance of having one
drink too many. I just need to sleep this
off. I'm fine. They are exaggerating the
situation."
Substance Abuse:
Alcohol
Drug Study
Nursing Care Plan #1
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective denial SHORT TERM: INDEPENDENT: INDEPENDENT: SHORT TERM:

The patient verbalized: related to inadequate After 8 hours of nursing After 8 hours of nursing
“I just had an coping skills with intervention, the patient Ascertain by what name Shows courtesy and intervention, the patient
instance of having alcohol as evidence by will be able to: patient would like to be respect, giving patient a was able to:
one drink too patient verbalized and Verbalize awareness addressed. sense of orientation and Verbalize awareness
many. I just need to insists that he does not of relationship of control. of relationship of
sleep this off. I’m have a problem and substance abuse to Convey attitude of Promotes feelings of substance abuse to
fine. They are does not seek help and current situation. acceptance, separating dignity and self-worth. current situation.
exaggerating the believes that his drinks Engage in individual from Engage in
situation.” help him function and therapeutic program. unacceptable behavior. therapeutic program.
He believes that his sleep better Ascertain reason for Provides insight into
drinks help him LONG TERM: beginning abstinence, patient’s willingness to LONG TERM:
function and sleep After 1 month of nursing involvement in therapy. commit to long-term After 1 month of nursing
better. intervention the patient Review definition of drug behavioral change, and intervention the patient
He insists that he will be able to: dependence and whether patient even was able to:
does not have a categories of symptoms believes that he or she
problem and does The patient will be (patterns of use, can change. (Denial is one The patient will be
not seek help. able to diminished impairment caused by of the strongest and most able to diminished
drinking alcohol. use, tolerance to resistant symptoms of drinking alcohol.
Objective: Verbalize acceptance substance). substance abuse.) Verbalize acceptance
-Noted weight loss in of responsibility for Answer questions This information helps of responsibility for
the past three months. own behavior. honestly and provide patient make decisions own behavior.
-Family history of factual information. Keep regarding acceptance of
alcoholism. your word when problem and treatment
-Drinking excessively. agreements are made. choices.

6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective denial SHORT TERM: SHORT TERM:

The patient verbalized: related to inadequate After 8 hours of nursing Provide information Progression of use After 8 hours of nursing
“I just had an coping skills with intervention, the patient about addictive use continuum is from intervention, the patient
instance of having alcohol as evidence by will be able to: versus experimental, experimental or was able to:
one drink too patient verbalized and Verbalize awareness occasional use; recreational to addictive Verbalize awareness
many. I just need to insists that he does not of relationship of biochemical or genetic use. Comprehending this of relationship of
sleep this off. I’m have a problem and substance abuse to disorder theory. process is important in substance abuse to
fine. They are does not seek help and current situation. combating denial. current situation.
exaggerating the believes that his drinks Engage in Education may relieve Engage in
situation.” help him function and therapeutic program. patient’s guilt and blame therapeutic program.
He believes that his sleep better and may help awareness
drinks help him LONG TERM: of recurring addictive LONG TERM:
function and sleep After 1 month of nursing characteristics. After 1 month of nursing
better. intervention the patient Discuss current life First step in decreasing intervention the patient
He insists that he will be able to: situation and impact of use of denial is for patient was able to:
does not have a substance use. to see the relationship
problem and does The patient will be between substance use The patient will be
not seek help. able to diminished and personal problems. able to diminished
drinking alcohol. Provide information Individuals often mistake drinking alcohol.
Objective: Verbalize acceptance regarding effects of effects of addiction and Verbalize acceptance
-Noted weight loss in of responsibility for addiction on mood and use this to justify or of responsibility for
the past three months. own behavior. personality. excuse drug use. own behavior.
-Family history of
alcoholism. Remain nonjudgmental. Confrontation can lead to
-Drinking excessively. Be alert to changes in increased agitation, which
behavior, (restlessness, may compromise safety
increased tension). of patient and staff. 6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective denial SHORT TERM: SHORT TERM:

The patient verbalized: related to inadequate After 8 hours of nursing Provide positive feedback Necessary to enhance After 8 hours of nursing
“I just had an coping skills with intervention, the patient for expressing awareness self-esteem and to intervention, the patient
instance of having alcohol as evidence by will be able to: of denial in self and reinforce insight into was able to:
one drink too patient verbalized and Verbalize awareness others. behavior. Verbalize awareness
many. I just need to insists that he does not of relationship of of relationship of
sleep this off. I’m have a problem and substance abuse to Maintain firm expectation Attendance is related to substance abuse to
fine. They are does not seek help and current situation. that patient attend admitting need for help, current situation.
exaggerating the believes that his drinks Engage in recovery support and to working with denial, Engage in
situation.” help him function and therapeutic program. therapy groups regularly. and for maintenance of a therapeutic program.
He believes that his sleep better long-term drug-free
drinks help him LONG TERM: existence. LONG TERM:
function and sleep After 1 month of nursing After 1 month of nursing
better. intervention the patient Encourage and support Denial can be replaced intervention the patient
He insists that he will be able to: patient’s taking with positive action when was able to:
does not have a responsibility for own patient accepts the reality
problem and does The patient will be recovery (development of of own responsibility. The patient will be
not seek help. able to diminished alternative behaviors to able to diminished
drinking alcohol. drug urge and use). Assist drinking alcohol.
Objective: Verbalize acceptance patient to learn own Verbalize acceptance
-Noted weight loss in of responsibility for responsibility for of responsibility for
the past three months. own behavior. recovering. own behavior.
-Family history of
alcoholism.
-Drinking excessively.

6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective denial SHORT TERM: DEPENDENT: DEPENDENT: SHORT TERM:

The patient verbalized: related to inadequate After 8 hours of nursing Administer medications Used to suppress craving After 8 hours of nursing
“I just had an coping skills with intervention, the patient as indicated such as: for opioids and may help intervention, the patient
instance of having alcohol as evidence by will be able to: Naltrexone prevent relapse in the was able to:
one drink too patient verbalized and Verbalize awareness patient abusing alcohol. Verbalize awareness
many. I just need to insists that he does not of relationship of Current research of relationship of
sleep this off. I’m have a problem and substance abuse to suggests that naltrexone substance abuse to
fine. They are does not seek help and current situation. suppresses urge to current situation.
exaggerating the believes that his drinks Engage in continue drinking by Engage in
situation.” help him function and therapeutic program. interfering with alcohol- therapeutic program.
He believes that his sleep better induced release of
drinks help him LONG TERM: endorphins. LONG TERM:
function and sleep After 1 month of nursing After 1 month of nursing
better. intervention the patient COLLABORATIVE: COLLABORATIVE: intervention the patient
He insists that he will be able to: Use peer support to was able to:
does not have a examine ways of coping Self-help groups are
problem and does The patient will be with drug hunger. valuable for learning and The patient will be
not seek help. able to diminished promoting abstinence in able to diminished
drinking alcohol. each member, using drinking alcohol.
Objective: Verbalize acceptance understanding and Verbalize acceptance
-Noted weight loss in of responsibility for support as well as peer of responsibility for
the past three months. own behavior. pressure. own behavior.
-Family history of Encourage family
alcoholism. members to seek help To assist the patient deal
-Drinking excessively. whether or not the appropriately with the
abuser seeks it. situation.
6
Nursing Care Plan #2
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Dysfunctional family SHORT TERM: Independent: Independent: Short Term:

Developmental History: process related to family Within 8 hours of nursing Review family history; explore This information determines Within 8 hours of nursing
While growing up, Ariel intervention during the roles of family members, areas for focus and potential intervention during the
history of alcoholism as
looks up to his nursing duty the patient’s circumstances involving for change. nursing duty the patient’s
evidenced by disruption
paternal Grandfather. family will: alcohol use, strengths, and family was able to::
Ariel was constantly of family roles, Participate in individual areas of growth. Participate in individual
asked to buy Gin bilog vulnerability, and closed family programs and family programs and
by his grandfather communication systems. support groups. Explore how family members Persons who enable also support groups.
when his workday Identify ineffective have coped with the client’s suffer from the same feelings Identify ineffective
ends coping behaviors and addiction (e.g., denial, as the client and use coping behaviors and
He described his consequences. repression, rationalization, ineffective methods for consequences.
relationship with his Initiate and plan for hurt, loneliness, projection). dealing with the situation, Initiate and plan for
mother as distant and necessary lifestyle necessitating help in learning necessary lifestyle
his father non- changes. new and effective coping skills changes.
existent. GOAL MET
He was in high school LONG TERM: Determine their understanding Provides information on which
when he started to Within 1 week of nursing of the current situation and to base the present plan of Long Term:
notice that his mother intervention the family previous methods of coping care. Within 1 week of nursing
had expensive tastes members will be seen with life’s problems. intervention, the family
and hobbies. taking action to change self- members was seen taking
When he tried to destructive Assess the current level of This affects the individual's action to change self-
discuss this with his behaviors and alter functioning of family members. ability to cope with the destructive
mother, she got angry behaviors that contribute to situation. behaviors and alter
and told him to find a client’s addiction. behaviors that contribute to
job to support himself. Determine extent of enabling This provides information client’s addiction.
He tried telling his behaviors being evidenced by about who is enabling the GOAL MET
father about their family members; explore with patient and for them to
needs; but he was told each individual and client. understand the
to talk with his mother destructiveness of this
behavior
6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Dysfunctional family SHORT TERM: Independent: Independent: Short Term:

Developmental History: process related to family Within 8 hours of nursing Provide information about This provides the family an Within 8 hours of nursing
While growing up, Ariel intervention during the enabling behavior and opportunity to begin the intervention during the
history of alcoholism as
looks up to his nursing duty the patient’s addictive disease process of change since this nursing duty the patient’s
evidenced by disruption
paternal Grandfather. family will: characteristics for both the enhances their awareness family was able to::
Ariel was constantly of family roles, Participate in individual Participate in individual
user and nonuser. and knowledge about the
asked to buy Gin bilog vulnerability, and closed family programs and family programs and
situation.
by his grandfather communication systems. support groups. support groups.
when his workday Identify ineffective Identify ineffective
Identify and discuss Even though his mother
ends coping behaviors and coping behaviors and
He described his sabotage behaviors of family mentioned that she wants
consequences. consequences.
relationship with his Initiate and plan for members. him to promise to stop Initiate and plan for
mother as distant and necessary lifestyle drinking, their distant necessary lifestyle
his father non- changes. relationship may also mean changes.
existent. that she unconsciously does GOAL MET
He was in high school LONG TERM: not want him to recover.
when he started to Within 1 week of nursing Long Term:
notice that his mother intervention the family Serves as a release for Within 1 week of nursing
had expensive tastes members will be seen Encourage participation in feelings which helps to move intervention, the family
and hobbies. taking action to change self- therapeutic writing, e.g., individual(s) forward in the members was seen taking
When he tried to destructive journaling (narrative), guided treatment process action to change self-
discuss this with his behaviors and alter destructive
or focused.
mother, she got angry behaviors that contribute to behaviors and alter
and told him to find a client’s addiction. behaviors that contribute to
Many people are unaware of
job to support himself. client’s addiction.
He tried telling his
Provide factual information the nature of addiction.
GOAL MET
father about their to the client and family
needs; but he was told about the effects of addictive
to talk with his mother behaviors on the family and
what to expect after
discharge. 6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Dysfunctional family SHORT TERM: Independent: Independent: Short Term:

Developmental History: process related to family Within 8 hours of nursing Encourage family members When the enabling family Within 8 hours of nursing
While growing up, Ariel intervention during the to be aware of their own members become aware of intervention during the
history of alcoholism as
looks up to his nursing duty the patient’s feelings, and to look at the their own actions that nursing duty the patient’s
evidenced by disruption
paternal Grandfather. family will: situation with perspective perpetuate the client’s family was able to::
Ariel was constantly of family roles, Participate in individual Participate in individual
and objectivity. problems, they need to
asked to buy Gin bilog vulnerability, and closed family programs and family programs and
decide to change
by his grandfather communication systems. support groups. support groups.
themselves. If they change,
when his workday Identify ineffective Identify ineffective
the client can then face the
ends coping behaviors and coping behaviors and
He described his consequences of own
consequences. consequences.
relationship with his Initiate and plan for actions and may choose to Initiate and plan for
mother as distant and necessary lifestyle get well necessary lifestyle
his father non- changes. changes.
existent. Note how the enabling Determines enabling style. A GOAL MET
He was in high school LONG TERM: family member relates to the parallel exists between how
when he started to Within 1 week of nursing treatment team and staff. family members relate to the Long Term:
notice that his mother intervention the family client and to staff, based on Within 1 week of nursing
had expensive tastes members will be seen the family’s feelings about intervention, the family
and hobbies. taking action to change self- their self and their situation. members was seen taking
When he tried to destructive action to change self-
discuss this with his behaviors and alter destructive
Explore conflicting feelings This is useful in establishing
mother, she got angry behaviors that contribute to behaviors and alter
the enabling family member the need for therapy for the
and told him to find a client’s addiction. behaviors that contribute to
may have about treatment. partner. This individual’s own
job to support himself. client’s addiction.
He tried telling his
identity may have been lost
GOAL MET
father about their —he or she may fear self-
needs; but he was told disclosure to staff and may
to talk with his mother have difficulty giving up the
dependent relationship
6
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Dysfunctional family SHORT TERM: Independent: Independent: Short Term:

Developmental History: process related to family Within 8 hours of nursing Involve family members in Alcohol abuse is a family Within 8 hours of nursing
While growing up, Ariel intervention during the discharge referral plans. illness. Because the family intervention during the
history of alcoholism as
looks up to his nursing duty the patient’s has been so involved in nursing duty the patient’s
evidenced by disruption
paternal Grandfather. family will: dealing with the substance family was able to::
Ariel was constantly of family roles, Participate in individual Participate in individual
abuse behavior, family
asked to buy Gin bilog vulnerability, and closed family programs and family programs and
members need help
by his grandfather communication systems. support groups. support groups.
adjusting to the new
when his workday Identify ineffective Identify ineffective
behavior of
ends coping behaviors and coping behaviors and
He described his sobriety/abstinence. The
consequences. consequences.
relationship with his Initiate and plan for incidence of recovery is Initiate and plan for
mother as distant and necessary lifestyle almost doubled when the necessary lifestyle
his father non- changes. family is treated along with changes.
existent. the client. GOAL MET
He was in high school LONG TERM:
when he started to Within 1 week of nursing Collaborative: Collaborative: Long Term:
notice that his mother intervention the family Refer the client to self-help Puts client and family in Within 1 week of nursing
had expensive tastes members will be seen associations and direct contact with support intervention, the family
and hobbies. taking action to change self- professional family therapy systems necessary for members was seen taking
When he tried to destructive such as Alcoholics continued sobriety and action to change self-
discuss this with his behaviors and alter destructive
Anonymous, Al-Anon, and assists with problem
mother, she got angry behaviors that contribute to behaviors and alter
Alateen resolution.
and told him to find a client’s addiction. behaviors that contribute to
job to support himself. client’s addiction.
He tried telling his GOAL MET
father about their
needs; but he was told
to talk with his mother

6
Discharge Plan
 Observation/Out-
Medication Environment/ Treatment Health Teaching Diet
patient
Exercise
Naltrexone - Drug is Encourage patient Cognitive Behavioral Advise patient to find an Observe patient of signs Advise patient to
administered to return and Therapy (CBT) outlet to divert attention and symptoms of alcohol consume
immediately after maintain to a social Cognitive Behavioral Therapy from drinking. Yoga and withdrawal. recommended
discharge. Medication is life once discharged (CBT) is a proven method for other relaxation Educate SO to observe amounts of water to
alleviating the burdens of
taken orally. Helps in from former techniques are popular for patient while at home maintain hydration
alcoholism. The basic
reducing heavy drinking condition of an activities for health. if patient consumes status and to
premise of CBT is the
and relapse. alcoholic. Encourage patient to alcohol and does not provide a substitute
importance of identifying
Physical health is negative thoughts and
avoid alcohol and to set follow set plan at to previous liquid
Silymarin - Medication also vital post behaviors and replacing realistic goals in discharge. consumption.
is used to improve and treatment. Advise them with positive thoughts abstaining from alcohol. Strictly advise
maintain liver function. patient to stay and behaviors. This promotes patient patient to cut off
Given to patient if not active and Motivational from not being alcohol completely
contraindicated. participate in group

dependent on alcohol.
Interviewing from diet.
exercise with non- In counseling, motivational Encourage patient
alcoholic peers. interviewing (MI) is a method to consume copious
Strictly advise for encouraging a patient to amounts of natural
patient to not reach overcome ambivalence, set
foods especially
direct goals for self-
out to former fruits and
improvement, and stay
friends who were of vegetables which
motivated to realize them.
negaative influence. 12-Step Facilitation contain high
A 12-Step Program is a amounts of fiber as
supportive community well as folate and
where people openly discuss Vitamin A, which are
their struggles with often deficient if
substance abuse. . drinking heavily.

6
CIWA-Ar Assessment
Tool/Form
Group members
Marbida, Dianne Nicole
Marcelo, Janiel Cynth
Marquez, Trisha Mae
Nunez, Neil Fernandez
Oliva, Michael
Orias, Alyssa Morielle
Peligrino, Rain Chloe
References:
Nursing Diagnosis in Psychiatric Nursing: Care Plans and Psychotropic Medications
Psychiatric Mental Health Nursing Eighth Edition by Shiela Videbeck
https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
https://nurseslabs.com/substance-abuse-nursing-diagnosis-care-plan/2/
https://www.alcoholrehabguide.org/treatment/types-therapy-alcoholism/