Must be original work and use attached case study
Must be original work and use attached case study
To complete this assignment, refer to the link located in this weeks course materials regarding alcohol withdrawal treatments and the CIWA. Read the case study of “Mark,” which also includes Marks CIWA at the bottom of the case study.
Write a 750-1,000-word essay response to the following questions:
Include at least three to five scholarly references in your paper.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
Case Study: Mark
You are the intake clinician at a large acute inpatient psychiatric facility, which includes a sizable detoxification unit. It is an unusually busy day and the lobby is full of patients seeking treatment. Half an hour before lunch, you pick up another clipboard from the pending rack and quickly scan the intake information filled in by the prospective patient and receptionist. Mark is a 45-year-old male who has been waiting since 8:15 AM. He is requesting alcohol detox. You notice that Mark has been waiting for over three hours and you are frustrated because you will have to begin yet another interview with an apology for the long wait. You notice that the blood pressure assessed by the receptionist is somewhat elevated you make a mental note to inform the nurse: BP = 149/97, pulse 104, respiration rate 18. You invite Mark into one of the free interview rooms and you notice that he appears much older than his 45 years. Hes dressed casually and is a bit disheveled; his skin looks old/tanned and flushed; in his right hand, he holds an emesis bag. He apologizes and he states that he has been having dry heaves since yesterday evening but he tells you that he is able to keep down some fluids.
You observe that Mark does not look too good and since hes been waiting in your lobby for three hours, you think its a good idea to assess another set of vitals. The receptionist obliges and reports the new vital signs as BP = 154/103, pulse 114, respiration rate 20, oxygen saturation 98% at room air. You become a little concerned by the increase in blood pressure and pulse and you note that while previously Marks shirt was dry, he now has sweat stains on his back and chest; visible sweat beads are also noticeable on his forehead and neck. You noticed that Mark speaks softly now when the door to the interview room is closed to cut down on the noise from the hallway. He asks you if you can turn off the bright ceiling lights and to keep on only the lamp on your desk. You oblige. Mark tells you that he started drinking at the age of 16 simply because it was popular and the fun thing to do on the weekends in high school. His social drinking increased somewhat in his 20s but it became problematic in his early 30s.
Mark works as a plumber, and along with his older brother, he owned his own plumbing business. Somewhat embarrassed, he tells you that for the past 15 years, he has been more drunk than sober. His longest period of sobriety was seven years ago, after a detox and rehab program he managed to stay clean for nine months. Slowly he relapsed into drinking, believing that he is one of the few who can only drink socially. For the past 15 years, he has had several DUIs. Several times, his wife of 20 years threatened divorce; now they have come to a truce of sorts, but he describes a disengage relationship. His brother continues to be very loyal to him, but Mark tells you that this is both a blessing and a curse. On one hand, his brother has covered for him when his drinking and the hangovers made him an unreliable worker. On the other hand, he regrets the fact that had his brother been stricter with him he may have sought serious help a long time ago. Mark tried to quit drinking several times on his own. He reports that on one such occasion when he went cold turkey after a religious conversion of sorts, he experienced a grand mal seizure and had to be taken to the emergency room. The ER doctor strongly advised him to never stop drinking abruptly or you have another seizure. The past two years, Mark has been averaging a six-pack of beer and a pint of vodka every day. This is enough to lead to intoxication. He starts with the beers in the morning and after work, he switches to the vodka. On the weekends, he can drink up to a gallon of vodka per day. Those binges lead to blackouts because he often cannot remember most of his Sundays. He often goes out with his brother to a local casino where he gambles $500 to $1000 each weekend. His wife stopped nagging him about it when he insisted that he works hard for his earned money and that he always pays the bills first. Mark has decided to stop drinking because during a routine doctors visit, his liver enzymes were significantly elevated. His primary care physician warned him seriously about liver cirrhosis. On several occasions during the interview, Mark quickly turns away from you and leans into his emesis bag heaving heavily. He apologizes. You offer him a bottle of water and he takes small sips occasionally. You ask Mark to stand up and to stretch out his arms: you notice visible tremors in both his arms and his shoulders. He reports a headache of 5 out of 10 (subjective units of distress) and he tells you that normally a few Advils help. His last full drink was yesterday morning before going to his doctors office and he had only a sip of beer at lunch. You calculate that by now he has been without any alcohol for approximately 24 hours. He reports mild anxiety, but you observe him to fidget during the interview. You complete the CIWA scale (attached) and you observed that with a score of 25 he is in severe alcohol withdrawals. You notify the nurse immediately, urging her to come and have a look at Mark and to call the doctor for admitting orders.
CIWA scale for Mark
a. Vitals, Assessment Now.
b. If initial score ³ 8 repeat q1h x 8 hrs, then
if stable q2h x 8 hrs, then if stable q4h.
c. If initial score < 8, assess q4h x 72 hrs.
If score < 8 for 72 hrs, d/c assessment.
If score ³ 8 at any time, go to (b) above.
d. If indicated, (see indications below)
administer prn medications as ordered and
record on MAR and below.
Nausea/vomiting (0 – 7)
0 – none; 1 – mild nausea ,no vomiting; 4 – intermittent nausea;
7 – constant nausea , frequent dry heaves & vomiting.
Tremors (0 – 7)
0 – no tremor; 1 – not visible but can be felt; 4 – moderate w/ arms extended; 7 – severe, even w/ arms not extended.
Anxiety (0 – 7)
0 – none, at ease; 1 – mildly anxious; 4 – moderately anxious or guarded; 7 – equivalent to acute panic state
Agitation (0 – 7)
0 – normal activity; 1 – somewhat normal activity; 4 – moderately fidgety/restless; 7 – paces or constantly thrashes about
Paroxysmal Sweats (0 – 7)
0 – no sweats; 1 – barely perceptible sweating, palms moist;
4 – beads of sweat obvious on forehead; 7 – drenching sweat
Orientation (0 – 4)
0 – oriented; 1 – uncertain about date; 2 – disoriented to date by no more than 2 days; 3 – disoriented to date by > 2 days;
4 – disoriented to place and / or person
Tactile Disturbances (0 – 7)
0 – none; 1 – very mild itch, P&N, ,numbness; 2-mild itch, P&N, burning, numbness; 3 – moderate itch, P&N, burning ,numbness; 4 – moderate hallucinations; 5 – severe hallucinations;
6 extremely severe hallucinations; 7 – continuous hallucinations
Auditory Disturbances (0 – 7)
0 – not present; 1 – very mild harshness/ ability to startle; 2 – mild harshness, ability to startle; 3 – moderate harshness, ability to startle; 4 – moderate hallucinations; 5 severe hallucinations;
6 – extremely severe hallucinations; 7 – continuous.hallucinations
Visual Disturbances (0 – 7)
0 – not present; 1 – very mild sensitivity; 2 – mild sensitivity; 3 – moderate sensitivity; 4 – moderate hallucinations; 5 – severe hallucinations; 6 – extremely severe hallucinations; 7 – continuous hallucinations
Headache (0 – 7)
0 – not present; 1 – very mild; 2 – mild; 3 – moderate; 4 – moderately severe; 5 – severe; 6 – very severe; 7 – extremely severe
Total CIWA-Ar score:
PRN Med: (circle one)
Dose given (mg):
Time of PRN medication administration:
Assessment of response (CIWA-Ar score 30-60 minutes after medication administered)
Scale for Scoring:
Total Score =
0 9: absent or minimal withdrawal
10 19: mild to moderate withdrawal
more than 20: severe withdrawal
Indications for PRN medication:
a. Total CIWA-AR score 8 or higher if ordered PRN only (Symptom-triggered method).
b. Total CIWA-Ar score 15 or higher if on Scheduled medication. (Scheduled prn method)
Consider transfer to ICU for any of the following: Total score above 35, q1h assess. x more than 8hrs required, more than 4 mg/hr lorazepam x 3hr or 20 mg/hr diazepam x 3hr required, or resp. distress.
Our Unique Features
Custom Papers Means Custom Papers
This is what custom writing means to us: Your essay starts from scratch. Plagiarism is unacceptable. We demand the originality of our academic essay writers and they only deliver authentic and original papers. 100% guaranteed! If your final version is not as expected, we will revise it immediately.
Qualified and Experienced Essay Writers
Our team consists of carefully selected writers with in-depth expertise. Each writer in our team is selected based on their writing skills and experience. Each team member is able to provide plagiarism-free, authentic and high-quality content within a short turnaround time.
Free Unlimited Revisions
If you think we missed something, send your order for a free revision. You have 10 days to submit the order for review after you have received the final document. You can do this yourself after logging into your personal account or by contacting our support.
Prompt Delivery and 100% Assuarance
We understand you. Spending your hard earned money on a writing service is a big deal. It is a big investment and it is difficult to make the decision. That is why we support our claims with guarantees. We want you to be reassured as soon as you place your order. Here are our guarantees: Your deadlines are important to us. When ordering, please note that delivery will take place no later than the expiry date.
100% Originality & Confidentiality
Every paper we write for every order is 100% original. To support this, we would be happy to provide you with a plagiarism analysis report on request.We use several writing tools checks to ensure that all documents you receive are free from plagiarism. Our editors carefully review all quotations in the text. We also promise maximum confidentiality in all of our services.
24/7 Customer Support
We help students, business professionals and job seekers around the world in multiple time zones. We also understand that students often keep crazy schedules. No problem. We are there for you around the clock. If you need help at any time, please contact us. An agent is always available for you.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our services are second to none. Every time you place an order, you get a personal and original paper of the highest quality.
While a college paper is the most common order we receive, we want you to understand that we have college writers for virtually everything, including: High school and college essays Papers, book reviews, case studies, lab reports, tests All graduate level projects, including theses and dissertations Admissions and scholarship essays Resumes and CV’s Web content, copywriting, blogs, articles Business writing – reports, marketing material, white papers Research and data collection/analysis of any type.
Any Kind of Essay Writing!
Whether you are a high school student struggling with writing five-paragraph essays, an undergraduate management student stressing over a research paper, or a graduate student in the middle of a thesis or dissertation, homeworkmarketpro.com has a writer for you. We can also provide admissions or scholarship essays, a resume or CV, as well as web content or articles. Writing an essay for college admission takes a certain kind of writer. They have to be knowledgeable about your subject and be able to grasp the purpose of the essay.
Quality Check and Editing Support
Every paper is subject to a strict editorial and revision process. This is to ensure that your document is complete and accurate and that all of your instructions have been followed carefully including creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.
Prices and Discounts
We are happy to say that we offer some of the most competitive prices in this industry. Since many of our customers are students, job seekers and small entrepreneurs, we know that money is a problem. Therefore, you will find better prices with us compared to writing services of this calibre.