Inhalation: A Case Study

3. The patient had informed this writer initially of his goals of wanting to return back to the Hartford Dispensary due to the length of time he has been with the clinic and his positive rapport with his prior counselor at the other facility. The patient was compliant with his individual sessions with this writer and provided cancellation if unable to attend the session in the meantime while he awaits on the process of completion with his intake at Hartford Dispensary.

D-Met with the patient as the Women's Group was cancelled due to low attendance. This writer addressed with the patient about her AWOL status, at which the patient started to get emotional as she is struggling with transportation, borrowing her mother's car, her husband is still having issues getting into the Hartford Dispensary-tested postiive for methadone, and too much stressors in her life, which is causing the patient to not eat. This writer validated the patient's feelings, provided support, and made suggestions. The patient admits to relapsing yesterday by purchasing 10 bags of heroin, but using 6 and gave her husband 4 bags-use of method was IV. The patient feels guility of using, but her stress factors are overbearing her recovery process and the patient struggles with coping. She then says, " When I come to the Women's Group, I feel good....I was hoping there was going to be group today....I don't know." This writer provided empowerment and encouragement to the patient to focus on her recovery process and proceeded to discuss risk factors of what she will lose.

The following case study is of a 37-year old Hispanic male weighing 145 lbs and 70 inches tall found unconscious by his girlfriend. According to her he was unconscious for about 15 hours and she was concerned because he would not wake or respond and was breathing shallow and slow. She then called 9-1-1. The patient entered the ER by emergency vehicle and on my initial assessment Pt had an altered mental status, was very unresponsive showing symptoms of a possible drug overdose. The girlfriend told the physician the Pt had taken 75 mg of methadone and an unknown amount of Xanex and other amounts of Benzodiazepines. On assessment, the doctor noticed his altered mental status and unconscious status. He had a gag

D-This writer met with the patient upon her request to complete the dose change request form to lower her dose as the patient experience she wants to start tapering off methadone as the patient haven't used any illicit drugs for several months. This writer completed the dose change request form with the patient pressence and also, assessed the patient that she has not experience any withdrawals since prior increase based on her order history. The patient denies any cravings and withdrawals. Furthermore, while completing the request, this writer learned that the patient is prescribed with Albuterol inhaler and strongly urges the patient to bring in the RX script tomorrow. The patient complained that no one has ever told her of this and this

Problem # 5 Illicit opiate use Goal(s): to be free from illicit drugs. Status: Active Objectives/Progress: Pt. has struggled with continued use of illicit drugs (marijuana, opiates and amphetamines) and his last quarter UDS reflect a pattern of heavy substance use. Pt. was encouraged to work with the medical staff to achieve a stable dosing level. Pt. is regularly taking his medication as prescribed by AMS Doctor and he stated his current prescribed methadone 90 mg is working "well". During the last quarter, Pt. made progress on developing a therapeutic relationship with his new AMS counselor for the upcoming quarter. Also, Counselor focused therapy session on establishing rapport and building trust with him. Pt. is currently in the contemplation stage of change because he more open to receiving information about his negative habits and willing to use educational interventions which he agreed with this assessment. Pt. was reinforced for any statement that reflected acceptance of his chemical dependence and acknowledgment of the negative consequences that opiates has had on his life. During the upcoming quarter, Counselor will assist Pt. to discuss and weigh the pros and cons of continuing his addictive

D-The patient arrived on time for her appointment. Reports stable on her dose and denies the need for a dose increase when offered by this writer. This writer commends the patient complying with daily dosing; however, this writer addressed the patient UDS result patterns of positive and negative. The patient last two urines were positive for cocaine. According to the patient, a lot has been going on in her life. The patient's father has had a heart attack this past month. Also, the patient has an estranged relationship with her mother and her 17 year old daughter. During the course of the session, the patient discussed her drug history and her dysfunctional family. Alternatives and suggestions were discussed as well.

Patient is a 35 year old male presenting to the ED involuntarily as petitioned by his cousin due to threatening to shoot himself with a gun. At the time of assessment, patient denies feeling suicidal or having a plan. When confronted about admitting being suicidal and having a plan to nursing staff and TACT, Mr. Crowson stated "He is here because he is going through withdrawals and his mother is lying." The Mr. Crowson reports in the past year he has lost his father. Mr. Crowson reported wanting to receive Methadone from hospital to help with withdrawal symptoms. He expressed feeling body aches, stomach cramps, chills, irritability, angry, and verbally aggressive behavior. Patient refuses to finish full assessment.

Objectives/Progress: Pt. developed and shared personal plans to avoid triggers, to break the cycle of procrastination and stay on his successful path of recovery. Pt. has made excellent progress on maintaining his commitment to abstinence as indicated by his clean UDS results since his admission and always attending scheduled AMS therapy groups. Pt. indicated that he is responding as expected to his prescribed 8 mg of subutex medication.

This writer met with the patient to address her non-compliance with treatment, referring to her attendance to the cocaine group and her AWOLs. This writer explained to the patient about the purpose of the clinical intervention as the patient continues to test positive for cocaine, opiates, and fentanyl. The patient appeared to be surprised to learn about the fentanyl results in her UA's and believes that her "dope" could have been laced. The patient is aware of her non-compliance and made excuses by reporting that she tends to oversleep as she often times cannot hear her alarm from her cellphone. In addition, when the patient AWOL from the clinic, she tends to relapse and her most recent was relapse was on 5/29/2017-3 bags of heroin by inhalation.

D-This writer agreed to meet with the patient as he was placed hold to attend group. Reported stability on his current dose and denies the need for a dose increase when offered by this writer. This writer reviewed the patient's record and learned that he obtained his 3rd take home bottle on 01/04/2017. The patient is aware that he in order for him to obtained the 4th take home bottle, he must attend the take home bottle group. Addressing his medication, this writer noticed that the patient has not refilled the following medications:

Counselor met with Pt. for an individual session. Counselor and Pt. discussed her progress in treatment and description of her medication compliance. Pt. reported wanting a higher dosage of methadone to side effects (cold). Pt. mentioned that she would like to switch to Vivitrol medication because she is going to move with her mother house in Lewes, DE and she cant come to the clinic everyday. Pt. requested, discussed and completed an AMS Modality Switch form. Counselor encouraged Pt. to talk about her current triggers and possible solutions she can plan ahead of time. Pt. stated, "I have no triggers." Counselor elicited the client’s perceptions on her several positive urine analysis. Pt. indicated that she use crack cocaine when she is depressed.

D-The patient arrived on time for her appointment and this writer apologized for meeting with the patient late as this writer was meeting with another patient prior, which interefere with this patient appointment time. The patient was clearly understanding and waited patiently. Reports stable on her dose. Denies cravings/withdrawals. However, the patient is still actively using and reported, it has nothing to do with withdrawals or cravings. The patient is unable to provide a proper reason for her use, besides shrugging her shoulder as she says, " i do not know why." Patient last used was yesterday, cocaine- $40 worth. The patient then reported, she only uses cocaine less then once a month. This writer addressed alternatives.

Hundreds of household products are being misused as inhalants. Some of these products include nail polish remover, hair spray, cleaning fluids, spray paint, and the propellant in aerosol whipped cream (“Inhalants“, 2010). Inhalants are breathable chemical vapors that users intentionally inhale because of the chemical’s mind-altering effects (National Institute on Drug Abuse [NIDA], 2010). The trend in inhalant abuse is growing among the young community throughout the country. Surveys have shown in 2008 2 million Americans of 12 or over reported using inhalants (NIDA, 2010). Young children from the age of 12 to 17 are the primary age group of abusers (National Drug Intelligence Center [NDIC], 2001). The numbers reflect that it is becoming

Inhalant abuse in adults is on the rise today. While the exact numbers aren't known, what's known is that between 2002 – 2006 593,000 teens between the ages of 12 – 17 abused inhalants. These are household and industrial chemicals with volatile vapors and pressurized gases. It's these vapors and gases people breathe into their nose or mouth so they become intoxicated.

Inhalation challenges are used for diagnosing occupational asthma (OA). The aim was to design equipment, called the GenaSIC (Specific Inhalation Challenge), that allows and generates various agents regardless of the formulation and to assess the usefulness of its use in patients investigated for occupational asthma (Caron, Boileau, Malo, & Leblond, 2010:1). The GenaSIC is a closed-circuit generation chamber; i.e., it enables continuous generation of low and stable concentrations of agents, dust in an airtight enclosure with controlled atmospheric conditions (Caron et al, 2010:2). Each new agent must be validated before exposure. In short, by expanding the use of such equipment may greatly contribute to a more precise diagnosis of occupational