A 45-year-old married man presents to his primary care physician with a chief complaint of fatigue lasting for the past 12 months. He states that he goes to sleep easily enough but then wakes up repeatedly throughout the night. He has had this problem since he was injured on the job 12 months ago. On further questioning, he reports low mood, especially regarding not being able to do his job. He states that his alcohol consumption is 6 to 12 beers a day, as well as several ounces of hard liquor to “take the edge off the pain.” He discloses that it takes more alcohol than it used to in order to “get me relaxed.” The patient claims he has experienced several blackouts caused by drinking during the past 2 months and admits that he often has a drink first thing in the morning to keep him from feeling shaky. Despite receiving several reprimands at work for tardiness and poor performance in addition to his wife threatening to leave him, he has been unable to stop drinking. The doctor convinces the patient to admit himself into a local psychiatric hospital for detoxification and rehabilitation for his alcohol dependence.
On his mental status examination during admission to the psychiatric hospital, the patient is alert and oriented to person, place, and time. He appears rather haggard, but his hygiene is good. His speech is of normal rate and tone, and he is cooperative. His mood is noted to be depressed, and his affect is congruent, although full range. Otherwise, no abnormalities are noted.
- On admission, the hospital protocol is to screen the patient for potential alcohol abuse and/or dependence. List two (2) screening techniques for alcohol abuse/dependence.
- During the first 24 – 36 hours of withdrawal from the alcohol, what symptoms do you expect to see? List two (2) symptoms.
- Aside from death, what two (2) withdrawal complications should the nurse be most concerned about?
- The patient was started on the detoxification protocol, a symptom-based dosing Valium (diazepam) schedule. Explain the reasoning behind using Valium (diazepam) as a medication to detox the patient.
- The provider also ordered a daily dose of thiamine (100 mg PO qday X 5 days). What is the most likely reason for the patient being thiamine deficiency? List one (1) severe consequences of thiamine deficiency.
o (Most likely reason):
istically significant at an error probability less than 0.05 (p<0.05). Chapter-IV Result Baseline demographic data Baseline data such as Gender (Male/Female), Age (Geometric mean”SD), Parasitaemia/”l (mean”SD & range) and previously drug intakes information was captured in Case record form (CRF). Residual antimalarial Out of 295 samples, 289 samples were processed for monitoring residual antimalarials levels. Out of 289 patient samples, 70 (24.2%) had residual antimalarials levels on day 0. Out of these patients, 25(31.6%) patients from Madhya Pradesh had highest residual antimalarials followed by 18(25.4%) patients from Jharkhand, 17(25%) patients from Chhattisgarh and 10(14.1%) patients from Odisha. Levels of residual antimalarials Out of 289 patients, the presence of antimalarial drug was detected in 70 (24.2%) patients: 49(17.0%) had mean concentration SDX of 10765.3ng/ml (100-54100ng/ml), 27(9.3%) of them showed mean concentration of CQ is 147.0 ng/ml(49-263ng/ml), 5(1.7%) had mean concentration of PYR is 980ng/ml(100-1600ng/ml), 4(1.4%) had mean concentration of QN is 184.5 ng/ml(100-279 ng/ml), while MQ was present in only 2 (0.7%) patients at mean concentration of 317ng/ml (267-367ng/ml). Therapeutic level of SDX on day 7 The level of SDX was monitored on day 7, patients enrolled and treated with AS+SP, from Chhattisgarh (n=50), Madhya Pradesh (n=48), Jharkhand (n=58) and Odisha (n=63) found SDX concentration (range between 43.7 to 48.8 ”g/ml) is; 48.8”13.3, 45.8”18.2, and 43.7”18.8 and 45.5”12.9 ”g/ml blood, respectively. Probable time of previous SDX intake SDX concentration on day 0 and on day 7, the back estimation method indicated a means of 29 days prior to enrolment and drug administration in the study(range 5-69 days; 90% CI), the most likely time for previous SDX intake. Majority of the patients i.e. 23 (46.9%) showed previous SDX intake estimated time of more than 28 days. Residual antimalarial in different age groups The patient samples were divided in three groups on the basis of age viz. ‘ 6 month to <5yrs, ‘5 yrs to <15yrs and ’15yrs to observe the effect of irrational practices in different age groups. Since, 70 patients ha>GET ANSWER