Dual Diagnosis and Community work

Assignment Task

Case 1
Mike, a 45-year-old car technician, is admitted to the alcohol unit of the hospital because of his declining physical health. For the past 2 days, he has been confused and unable to take care of himself. His sister, who accompanied him to the hospital, states that he had a stable life until 5 years ago, when his wife left. After that, he began to drink increasingly larger amounts of alcohol; currently, he drinks a case of beer a day, as well as any other liquor he can get his hands on. He often misses work, has blackouts, and goes on drinking binges; consequently, he has been fired from many jobs. She lets him stay with her occasionally, but she limits his visits because she feels he is a bad role model for her children.

Mike is alternately confused and bright when he speaks to the nurse, Marie. His hands are tremulous, and his forehead is sweaty. His vitals are: BP 150/100, pulse 120, respirations 16, and temperature 38. While talking with his nurse, he picks at bugs that he says are on the sheets of his hospital bed. He states that he hasn't slept for 2 days and is craving a drink. At first he recognizes Marie as his nurse, but then he identifies her as his sister.

Question

Discuss actions that the mental health nurse should take to ensure his safe withdrawal from alcohol. Identify the kinds of information you would provide to Mike and his family at discharge.

Case 2 
Jason is a 35-year-old married chef, who was brought and admitted into ED by the Crisis Assessment and Treatment Team at midnight. On admission, Jason was agitated and distressed. His breathing was irregular and rapid. Jason believed that gang members were out to kill him, and reported that he heard voices of people discussing to kill him. Jason was conscious and orientated. The nurse noticed old needle scars on his arms from methamphetamine injections.

Jason lives with his wife and 2 young children 200 Km east of Melbourne. He had been using methamphetamine for several years to cope with sleepiness and fatigue at work. In the past 6 months, he constantly thought about the drug and started to increase the dosage. His wife learned of his substance abuse and attempted to persuade him to stop. Jason finally decided to quit a week before the ED admission when his wife threatened to divorce him. Once he stopped using, he felt very tired, gloomy and stayed at home doing nothing. 3 days after stopping methamphetamine, Jason told his wife that he did not want to leave home because he heard voices. He had all doors and windows locked and he refused to eat in fear that the food maybe poisoned.

Question

Discuss therapeutic approaches that clinicians should take to address Jason’s methamphetamine withdrawal, and the role of mental health nurses in managing post-withdrawal drepession and potential relapse.

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