You assess J.G.'s history of alcohol use by talking to J.G. and ...

[mspears3]

You assess J.G.'s history of alcohol use by talking to J.G. and his brother and conclude that he is showing indications of alcohol use disorder.
 
  Name the criteria for alcohol use disorder as outlined in the Diagnostic and Statistical
  Manual of Mental Disorders,Fifth Edition (DSM-V) and put an asterisk or star next to the
  ones J.G. demonstrates.
 
   Drinking that interferes with important activities
  Based on the DSM-V criteria, how would you rate the severity of J.G.'s alcohol use? Explain
  your decision.
  a. No problem
  b. Mild
  c. Moderate
  d. Severe
 
  What would be helpful for J.G.'s physician to know regarding J.G.'s substance abuse history?

Question 2

J.G., a 49-year-old man, was seen in the emergency department 4days ago, diagnosed with alcohol intox-ication, and released after 8 hours to his brother's care
 
  He was brought back to the ed12 hours ago with
  an active gastrointestinal (GI) bleed and is being admitted to the intensive care unit (ICu); his diagnosis is
  upper GI bleed and alcohol intoxication.
  you are assigned to admit and care for J.G. for the remainder of your shift. according to the ednotes,
  his admission vital signs (Vs) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV
  fluids and transfused 6 units of packed red blood cells (PRBCs) in the ed. On initial assessment, you note
  that J.G.'s Vsare blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anx-ious. He complains of a headache and appears flushed. you note that he has not had any emesis and has
  not had any frank red blood in his stool or melena (black tarry stools) over the past 5 hours. In response
  to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a
  fifth of vodka daily for the past 2months. He reports that he was drinking vodka when he got home from
  the edthe first time. He admits to having had seizures while withdrawing from alcohol in the past. He tells
  you that he just can't help it and has strong urges to drink, but that he never means to drink very much.
  He has had trouble keeping a job over the past several months.
 
  Admission Lab Work
  Hgb 10.9g/dL
  Hct 23
  ALT(formerlySGPT) 69units/L
  AST(formerlySGOT) 111units/L
  GGT 75units/L
  ETOH 291mg/dL
 
  Which data from your assessment of J.G. are of concern to you?
 
  What do the admission laboratory results indicate?
 
  Which of the previous laboratory results specifically reflects chronic alcohol ingestion?
 
  What are the two most likely causes of J.G.'s symptoms?
 
  What is the most likely time frame for someone to have withdrawal symptoms after abrupt
  cessation of alcohol?

[Hikerman221]

Answer to Question 1

 Drinking in a hazardous situation
 Missing school or work
 Having a craving for alcohol
 Having a tolerance to alcohol
 Continuing to drink despite personal or social problems
 Continued drinking despite health problems
 Unsuccessfully trying to quit
 Drinking more than intended
 Experiencing withdrawal symptoms when trying to quit drinking
 Increased alcohol-seeking behaviors
 Drinking that interferes with important activities

Answer: d
The presence of six or more criteria indicates a severe level of alcohol use disorder. J.G.
demonstrates at least 7 of the 11 criteria.

 Other substances J.G. uses or has used in the past
 History of complications, including seizures, while withdrawing from substances
 Current medical problems
 Any current or past mental health treatment (e.g., for depression or anxiety) and any substance
abuse treatment

Answer to Question 2

Elevated BP and heart rate, tremor, anxious and flushed appearance, headache, amount and
frequency of alcohol use, and history of seizures with withdrawal from alcohol.

The Hgb and Hct indicate blood loss from the GI bleed. The ALT, AST, and GGT results indicate liver
disease or damage. Last, the blood alcohol level is dangerously high.

The GGT can reflect chronic alcohol ingestion and is elevated in almost 75 of patients who are
long-term alcohol users.

Active GI bleed and alcohol withdrawal

Early signs of withdrawal after cessation of alcohol intake start to develop within a few hours. They
peak after 24 to 48 hours, then disappear rapidly unless the person's withdrawal progresses to
alcohol withdrawal delirium. This delirium will peak 48 to 72 hours after alcohol intake stops and
lasts 2 to 3 days or longer.

[mspears3]

Gracias!

[ghepp]

Excellent