Answer Happy

Psychiatric Case Study Client-Jeff Client Profile Jeff is a 43-year-old white male who began drinking at age 12. His father kept alcohol in the home and Jeff secretively helped himself to it. He then began skipping school to drink with friends and his grades fell. The police picked him up for underage drinking when he was 17. His mother, who came to get him from jail, had baled Jeff's grandfather out of jail many times for drunkenness and fighting in bars. Several other relatives were alcoholics. Jeff's mother took him to see a professional counselor who diagnosed Jeff as having Attention Deficit Disorder with Hyperactivity (ADHD) and Conduct Disorder traits, including problems with authority figures and breaking rules. The therapist told her, "Counseling would be a waste of money." After high school, Jeff took a job in sales and drank at night with his coworkers. The amount he drank steadily increased. He married, but his wife divorced him and refused to let their two children ride in the car with him. Jeff remarried and continued drinking. He began meeting drinking buddies at the bowling alley. He would arrive before his friends and start drinking vodka on the rocks, his drink of choice. After a night of drinking, he would drive home and fall asleep in his car in the driveway, too drunk to go inside. Jeff often took oranges filled with vodka (via a syringe) to work. He needed the alcohol to keep from having the "shakes". Four Monday's in a row Jeff's wife called his employer to report Jeff being sick. His boss finally fired Jeff. Jeff began to complain of stomach pain; he was diagnosed with gastritis and later pancreatitis. The doctor advised him to stop drinking any alcoholic beverages, but Jeff continues to drink. Jeff smokes nearly two packs of cigarettes a day. His children have unsuccessfully begged him to stop. In Jeff's small town, there are only tow places to socialize: bars and churches. Jeff claims he is an atheist, so he hangs out in bars. Usually the town police overlook his weaving on the way home, but one night the state police pulled him over and charged him with driving while intoxicated (DWI). It was Jeff's second DWI in five years. His wife threatens to leave him if he does not go into treatment. Jeff's lawyer suggest an inpatient alcohol and drug treatment center, indicating things will go better for him in court if he is in treatment. Case Study AL Eat of Foan 10
Case Study Jeff presents to an inpatient alcohol and drug treatment center. His wife tells the nurse that he drank a fifth of vodka the night before. When the nurse later asks Jeff about his alcohol use, he denies having a drinking problem. He indicates he is entering treatment t appease his wife and lawyer. The nurse asks Jeff when he had his last drink. Jeff truthfully responds that it was last night. The health care provider writes orders for lorazepam (Ativan) 0.5-1 mg three times a day and every four hours as needed for agitation; chloridiazepoxide (Librium) 50 mg every six hours for four doses and then 25 mg every six hours for either doses; a multiple vitamin; and thiamine. He also orders vital signs every four hours and instructs the client to attend a class on the effects of alcohol on the body; an in-house Alcoholics Anonymous (AA) group; recreational therapy; and individual, family and group therapy. On the second day of hospitalization, Jeff talks about his alcohol abuse in group therapy, saying how it has affected his life. He tells the group how he would weave while driving home from bars, but the police would let him go because it was a small town and he knew most of the force from high school. He described sleeping in the driveway every night because he was too drunk to walk into the house. On day seven of his hospitalization, Jeff tells the group that he is going to leave treatment because he misses his wife and wants to sleep with her instead of an alcoholic roommate. One of his peers says, "That's crazy. How could you miss her when you were sleeping in the driveway every night?" Jeff decides to stay in treatment for a few more days. He attends AA meetings in the hospital cafeteria at night. He admits to being an alcoholic and being powerless over alcohol. He requests a female AA sponsor but is told he must have a male sponsor. His sponsor asks Jeff if he has completed step two of AA. Jeff says, "No, I am an atheist." Later, Jeff tells some peers that he is not going to change any of his friends, even though the counselor recommended that he do so. He also indicataes he is not going to go to AA. The peer says, "I hear you talking the talk in group. But can you walk the walk?"
3. What are the stages of alcohol withdrawal? When do they typically occur? What signs and symptoms accompany each stage? (4pts)