Case Study Ammonia

Case Study # 01

Instructions:

Read the following case study scenario and briefly answer the questions provided below within minimum 2-3 pages. Include scholarly references in APA where required.

Scenario:

Jim is a 49 year-old man brought in to the ER by ambulance for decreased LOC.  PMHx included ETOH use, Cirrhosis, Chronic liver disease, and ETOH withdrawal.  Jim denies that he has an alcohol problem but later admits to drinking approximately 10-15 oz of vodka daily for the past 2 months. He admits to having had seizures while withdrawing from alcohol in the past. He tells you that he “just can’t help it” and has strong urges to drink, but that he never means “to drink very much.” He has had trouble keeping a job over the past several months.

You are assigned to admit and care for J.G. for the remainder of your shift.  On initial assessment, you note that J.G.’s Vs are blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed.

BIOChemistry
Ammonia	11-35 μmol/L	47
ALT	<30 U/L	90
AST	10-32 U/L	187
Bilirubin, Direct	0.0 – 0.4 mg/dL	3.0
Bilirubin, indirect	0.2-0.8 mg/dl	2.6
Bilirubin, Total	0.2 – 1.4 mg/dL	5.8
GGT	5-38 U/L	260

 

Questions:

1. Which data from your assessment of Jim are you concerned of the most at this time? List any 4.

2. Which of the previous laboratory results specifically reflects chronic alcohol ingestion?

3. What is the most likely time frame for someone to have withdrawal symptoms after abrupt cessation of alcohol?

4. You Asses Jim’s history of alcohol use by talking to Jim’s brother and conclude that he is showing indications of alcohol use disorder. Name the criteria for alcohol use disorder outlined the Diagnostic and Statistical Manual of Mental Disorder. List 5 indicators that Jim has alcohol use disorder and provide a brief rationale.

5. Based on the DSM-V criteria, how would you rate the severity of J.G.’s alcohol use? Explain your decision.

6. What other data would need that would be helpful to know regarding Jim’s substance abuse history? List any 4.

7. Jim.’s physician comes to assess Jim and tells you to “watch out” because Jim is about to go into alcohol withdrawal delirium. What medications are commonly prescribed for patients withdrawing from alcohol? Select all that apply.

· Benzodiazepines, such as chlordiazepoxide (Librium)

· Naltrexone (Revia), an opioid-reversal agent

· Acamprosate (Campral), an alcohol deterrent agent

· Clonidine (Catapres), an alpha-adrenergic blocker

· Antiepileptic drugs, such as carbamazepine (Tegretol)

· Disulfiram (Antabuse), an alcohol deterrent agent

· Atenolol (Tenormin), a beta-adrenergic blocker

8. Explain the rationale for each of the drugs used during acute alcohol withdrawal.

· Benzodiazepines, such as chlordiazepoxide (Librium)

· Clonidine (Catapres)

· Antiepileptic drugs (carbamazepine [Tegretol])

· Beta-adrenergic blockers (atenolol [Tenormin]).

9. What chronic health problems are associated with alcoholism? Give your top 3 choices and provide rationale for each that would link these chronic health problems to alcoholism.

10. What medications might be prescribed to Jim upon discharge? List 2 medication. What is the usual treatment regimen and what side effects and precautions should you educate the client about concerning each medication?

11. What type of education and referral will be done before Jim’s discharged from the hospital. List 2 with rationale.

12. J.G. is referred to the local Alcoholics Anonymous (AA) program. What strategy can be implemented to increase his likelihood of attendance at these meetings? List 5 strategies.

 

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