Drug Therapies for Psychiatric Disorders and Substance Abuse Case Studies

After completing the following case study, submit 2 NCLEX style questions related to the topics covered in the case study. (Students are expected to write their own questions. Refrain from using outside resources). Please provide a rationale for the correct answers to your questions.

Case Study 1:

A client is newly diagnosed with schizophrenia and will be treated with a first-generation anti-psychotic. The nurse knows this client is at risk for extrapyramidal effects (EPS).

1. Discuss the assessments and potential plan of care for EPS.

Case Study 2:

Differentiate between the following:

1. Antidepressant discontinuation syndrome
2. Serotonin Syndrome

Case Study 3:

Lorraine Terrance, an 83-year-old widow who has lived alone since her husband died 6 months ago, is in the early stages of Alzheimer’s disease. She has a history of cardiovascular disease and hypertension and has been admitted to the local hospital for observation after complaints of chest pain. At present, she is very anxious and agitated. The admitting nurse received a telephone call from Mrs. Terrence’s daughter, who lives out of town. The daughter states that her mother has experienced anxiety and depression for many years and her symptoms have worsened since her father died. The daughter does not know what medications her mother currently takes, and she is concerned that her mother lives alone and wants her to move to a nursing home. The provider orders the following medications: Alprazolam (Xanax) for anxiety, Citalopram (Celexa) for depression, and Zolpidem (Ambien) for sleep.

Mrs. Terrence’s two sons come to visit her in the hospital. They complain to the nurse that their mother seems oversedated. In denial about her mental status, the sons request that their mother’s medication be discontinued, but the nurses are concerned that if she is agitated, she may pull out her IV lines and Foley catheter as well as possibility strike out at staff.

1. How does the nurse handle this situation while respecting the family’s concerns, based on his or her knowledge and skills of patient-centered care?

Mrs. Terrence receives alprazolam 0.25 mg PO at 2:00 PM. Later, when the nurse brings in her supper tray, the patient seems relaxed. The supper tray contains roast beef, salad, chocolate pie, and hot tea. Visitors arrive at 5:00 PM and remark to the nurse that Mrs. Terrence is agitated and wringing her hands. She says that she is afraid to verbalize her anxiety to the nursing staff. The nurse prepares to give Mrs. Terrence another dose of medication.

1. What does the nurse prepare and why?
2. What foods on the supper tray contribute to the patient’s safety?
3. What patient teaching is necessary?

Case Study 4:

Brian Connor received a diagnosis of attention deficit hyperactivity disorder at 7 years of age. He is now 9 years old and is taking methylphenidate (Ritalin) 15 mg daily, which he takes each morning before school. With drug therapy and individual counseling, his attention span and school performance have improved. However, Brain’s most recent physical examination shows that his height and weight are less than normal for his age and that he has lost weight since his examination last year. The school nurse talks with Brian’s teachers, who report that he seems more restless in class after lunch. He has had more difficulty getting along with his classmates due to his impulsive behaviors.

1. What patient teaching can the school nurse provide to Brain and his parents to increase his weight?

Based on your recommendations, Brain has been managing his weight. It is now late spring, and his health care provider wants to try a drug holiday in the summer. Brain’s parents are concerned about their son’s being able to function at summer camp without any pharmacologic interventions. They voice their worries to the school nurse.

1. What information should the school nurse provide to Brian’s parents?
2. What are the advantages and disadvantages of their decision to support a drug holiday?

Case Study 5: 

Bryan Wilson is a 24-year-old man who regularly uses marijuana, alcohol, and tobacco. He was involved in a physical altercation at a local nightclub, and the owner called the police. The police brought Mr. Wilson to the emergency department, where he received a diagnosis of acute alcohol intoxication. He is admitted for treatment of alcohol withdrawal. The provider prescribed benzodiazepine.

1. What are the alcohol withdrawal symptoms?
2. What are some symptoms for which the nurse should monitor after administering Benzodiazepine?

Mr. Wilson is scheduled to be discharged after completing an alcohol withdrawal protocol for several days. After discharge, he is scheduled to attend outpatient chemical dependency treatment. His health care provider has prescribed disulfiram (Antabuse) for the patient to take on an outpatient basis. 

1. Is this an appropriate treatment choice for the patient?
2. What symptoms will Mr. Wilson have if he drinks alcohol and takes disulfiram?