Mr. Smith is a 65 year old male that is accompanied by his wife to your clinic. He is following up after an ER visit for a fall at home that resulted in 6 stitches to his forehead. He admits that he had a few drinks that night before tripping over his dog. His wife adds that he has "a few drinks" every night.
1-How will you proceed with Mr. Smith?
2- What diagnostics will you perform? with intext citations and references?
3- What will potentially be part of your treatment plan with references and intext citations? with intext citations and references?
Guide On Rating System
Vote
1- With Mr. Smith, I would proceed by conducting a comprehensive assessment to evaluate his overall health and potential underlying issues related to his alcohol consumption. This assessment would include a thorough medical history, physical examination, and possibly mental health screening. It is important to explore his alcohol use in more detail, including the frequency, quantity, and any associated problems or consequences.
2- Diagnostics that may be performed include laboratory tests to assess liver function (such as liver enzymes, gamma-glutamyl transferase, and bilirubin) as long-term alcohol use can lead to liver damage. Additional tests may include a complete blood count (CBC) to assess for any hematologic abnormalities, such as anemia, and a comprehensive metabolic panel to evaluate kidney function and electrolyte imbalances. Depending on the findings of the physical examination and medical history, further imaging studies, such as a CT scan or MRI, may be ordered to evaluate any potential head injury or to assess for other complications related to the fall.
References:
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm-iv-and-dsm-5
3- The treatment plan for Mr. Smith would be multifaceted and tailored to his specific needs and goals. It is important to address both the acute injury from the fall and the underlying alcohol use.
For the injury, the treatment plan may include wound care and monitoring for infection, as well as pain management if needed. The stitches would be removed at the appropriate time, and any necessary follow-up appointments would be scheduled to ensure proper healing.
In terms of alcohol use, it is crucial to address the potential alcohol use disorder. Possible treatment options may include:
- Referral to an addiction specialist or substance abuse counselor for further evaluation and counseling, such as cognitive-behavioral therapy or motivational interviewing.
- Encouraging participation in support groups, such as Alcoholics Anonymous or Smart Recovery, to provide peer support, guidance, and accountability.
- Discussion of potential medication-assisted treatment options, such as naltrexone or acamprosate, to reduce alcohol cravings and promote abstinence.
- Involvement of Mr. Smith's wife and other family members in the treatment process, providing education and support for both Mr. Smith and his support system.
The treatment plan should be individualized, taking into consideration Mr. Smith's preferences, goals, and the severity of his alcohol use disorder.
References:
- National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-getting-help
- Soyka, M. (2017). Treatment of Alcohol Craving: Lessons Learned. Frontiers in Psychiatry, 7, 207. doi: 10.3389/fpsyt.2016.00207
Got a question with my answer?
Cheapmath.com is completely free!
Asking question is free.
Getting answers is free.
+99