The Goals Of Therapy / Previous Meds

Client reported alcohol as his drug of choice with the last use date of March, 2017. No acute intoxication or withdrawal symptoms were reported. No treatment plan was developed in this dimension. Client appears to be stable at this time.

Major depressive disorder affects nearly 15 million of American adults in a given year. (Kessler, Chiu, Demler & Walters, 2005). With the impact it has on the society as well as the well-being of the individual, it must be in the interest of the healthcare to be able to provide patients with the most effective treatment method. Extensive research has been conducted on the efficacy of antidepressant medication and cognitive therapy, the two main treatment methods used for depression today. The discussion has, however, been characterized by conflicting claims, resulting in a debate over what should be used rather than us having a definite conclusion of how patients are best helped.

My patient is a 64-year-old that came in for upper abdominal pain. She felt her pain was worse when she lied down flat, so she had been trying to sit up and lean forward for most of the day. As the day went on her pain got worse, so she came into Emergency Department for further evaluation. She did not have any nausea or emesis and no change in her bowel habits. No fevers or chills. No trauma to the abdomen. In the hospital, she is diagnosed with acute pancreatitis.

“Each year, acute pancreatitis sends more than 200,000 Americans to the hospital. Many of those who suffer from pancreatic problems are also heavy drinkers” (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15). The pancreas is an important organ which aids in digestions and energy conversion. The pancreas directs enzymes to the small intestine to digest nutrients and it also secretes insulin and glucagon. The body’s main source of energy is glucose and insulin allows additional glucose to be stored away in the body properly. Too much alcohol damages cells in the pancreas, causing complications with insulin, leaving the organ open to inflammation. Alcohol causes the pancreas to discharge the enzymes intended for the small intestine back into the pancreas which can lead to inflammation and the swelling of tissues and blood vessels. Pancreatitis is the inflammation which causes the organ to malfunction and if one continues to drink, it can magnify into chronic pancreatitis when the inflammation is constant (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15-16). Pancreatitis causing severe abdominal pain, persistent diarrhea, and is not curable. Sixty-percent of circumstances result from alcohol; although, some have been linked to gallstones (Freeman).

The principle of treatment therapy is to helping the patients to reduce problematic drinking, deterring relapse back to heavy drinking and achieving and maintaining abstinence from alcohol (Edmunds, 2014). An oral naltrexone (ReVia) or injectable Vivitrol, Acamprosate and Disulfiram are used for the treatment of alcohol abuse (Edmunds, 2014). Disulfiram are used more often if unpleasant physical symptoms when alcohol is ingested but is reported to be more expensive and have reported to have adverse reaction to the patients (Edmunds, 2014). Benzodiazepines such as Lorazepam and Diazepam are also widely used for treatment of alcohol withdrawal. With the side effects and overdosing of benzodiazepines remains controversial in treating alcohol withdrawal and is always in need to monitor the patient for abuse (SAMHSA, 2013). Additionally, social detoxification and lifestyle management would benefit the whole treatment process such as referring the patient to social support groups and encouraging the family to support the patient during the treatment

The practice that assist a therapist in determining a client diagnosis and the proper treatment plan that would resolve the issue surrounding the clinet’s diagnosis is Case Conceptualization and Treatment Planning. The clinet’s treatment plan must be appropriate and relational and this will alow any type of medication and adaptions to be adjusted if needed so that modifications and adaptations can be adjusted as needed (Altman, Briggs, Frankel, Gensler, and Pantone, 2002). The ultimate goal of case conceptualization and treatment planning is to discover complete findings in relation to the client. One approach is Existential Therapy. The human

Combing medication with counseling and behavior therapy to treat substance abuse is Medication-Assisted Therapy (MAT). It provides an “all-around” treatment approach and research shows that this treatment approach can be very successful in treating people with addictions. The treatment is mainly used for the addiction of opioids and prescription pain relievers that contain opiates. All the medications used for this therapy is required to be approved by the Food and Drug Administration and if mixed with certain medications, can be fatal. MAT can be helpful for an addict going through recovery.

The emergency department physician inserts a central venous catheter via the subclavian vein and prescribes Lactated Ringer's solution at 1,000 ml/hr via infusion pump.

Reducing body fat helps to reduce the workload on the body cause by excessive weight. Also, avoiding the consumption of alcohol will help prevent any complications in the future. Attending to Alcoholic Anonymous meetings could help on the cessation of alcohol. The U.S. Department of Veterans Affairs offers programs to support veterans that can’t quit drinking by visiting www.maketheconnection.net in which will also assign you a support companion from the same zip code. Reducing and controlling stress by using controlled breathing muscle relaxation and counseling is recommended to relieve dyspnea (breathing complications) and fatigue. A sodium restricted diet should be enforced by replacing it with spices, herbs, lemon juice, or vinegar or visit a nutritionist for further care. Rest between activity periods to reduce cardiac workload and conserve energy. Taking ACE inhibitors help to decrease blood pressure and help to reduce the possibility of heart failure. Patient is currently on benazepril (Lotensin) and is recommended to take the medication as directed. Take missed doses as soon as remembered unless it is almost time for next dose. It is required to review the patient’s knowledge of medications and

Mr. Jones is in healthy condition and has family support to assist with recovery after surgery. He does not drink alcohol or smoke. The patient does have HTN and takes Cozaar 10 mg daily. He also takes one vitamin supplement per day. Mr. Jones walks 30 minutes daily with wife for

Gil’s assessment, we can look back to see the relatable factors. First, Hispanics usually carry high rates of abstinence from alcohol than other ethnicities, but those that do consume alcohol, often have higher rates of binge drinking (NIH, 2017). Not only does higher rates of binge drinking occur, but Hispanics also have a higher risk for developing alcohol-related liver disease, more so than whites (NIH, 2017). His health history shows that he, at times, consumes alcohol excessively, which is one of the main causes of cirrhosis (Nordqvist, 2015). Excessive consumption of alcohol for men is considered as drinking more than 21 units per week (Nordqvist, 2015). His chronic back pain is showing to affect his physical activity and although an evaluation should be done to see its underlying cause, this is a typical finding in ascites (Health Reference Center, 2017). Ascites is an accumulation of fluid within the abdominal cavity, which is a common complication of cirrhosis. His diagnosis of hyperlipidemia may cause fat to gather in the liver and lead to worsening of the disease (NIH, 2017). His stressful living situation can have a negative impact, physically and mentally, to the body. Stress releases natural killer cells (NKT) that expand in the liver (Franciscus, 2015). This contributes to worsening of liver disease by causing cell death (Franciscus, 2015). Sometimes impaired blood flow can be detected by the part of the brain, controlling

Based on 2014 hepatic encephalopathy guideline, NA’s hepatic encephalopathy is classified as type C and recurrent due to the cirrhosis and 2 episodes of HE occur with a time interval of 6 months or less. Typical signs and symptoms consistent with his HE includes confusion, forgetfulness, and anxiety. According to the guideline, the goals for the treatment are maintaining two to three bowel movements per day, decreasing elevated ammonia level, prevention of recurrent episodes of HE, and improvement of daily functioning. Lactulose is the first choice for treatment of overt HE. Currently, patient is on lactulose only once a day because of his noncompliance. The dose frequency is incorrect since he does not have at two to three bowel movements per day. Increasing frequency back to three times a day is recommended for the patient. Moreover, rifaximin is an effective add-on therapy to lactulose for prevention of OHE recurrence. Also, counseling the effects of lactulose and rifaximin, importance of adherence, early signs of recurring HE, and actions to be taken if recurrence are also beneficial for the patient.

The symptom is merely a front for the family’s larger stress. And we do not determine who the family consists of – the family does.

Imagine that your best friend in the entire world had been seeming dejected or sad. He/she doesn’t seem to want to come out of the house, hang out, or anything that they used to like, they don’t like anymore. These are two of many signs that they are dealing with depression. Should depression continue to be treated with medication and therapy, or should depression not be treated with medication and therapy? Depression should be treated with medication and therapy for the following reasons, medication can balance out their serotonin levels and help them feel more relaxed, talk therapy can help them to open up and possibly find the good from every situation, as well as medication and therapy can help “cure” the depressive symptoms.

It is often a concern when a patient present with abnormal symptoms. The assessment sequencing differs in the abdomen because you have to inspect and auscultate first before you percuss and palpate the abdomen. The abdomen or abdominal cavity houses different organs and with that we need to prevent false elicited bowel sounds (Jarvis, 2016). Due to M.M.’s presenting symptoms, I would perform a complete full abdominal assessment in order to have a baseline information, especially if he had not been to the clinic for a long time. Although subjectively the patient reported that he completed an alcohol rehabilitation program, it is not a guarantee that he is currently sober. I would gather more information regarding his alcohol use, the amount,