Opioid withdrawl
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The patient is a 32-year-old male who has been abusing opioids for 11 years. He has a history of withdrawal symptoms when attempting to stop using heroin in the past. A mental status examination found slurred speech, auditory hallucinations, and problems with attention, but intact cognition, judgment, and insight overall. The patient reports taking heroin to relieve withdrawal symptoms and feelings of depression.
Opioid withdrawl
- 2. OPIOID ABUSE
- 3. • Name Madhukant Sahoo • Age 32yr • Gender male • Marital status Married • Religion Hindu • Education Class 3 • Occupation Labour • Address At- Nakhara, Cuttack, • Date of admission 12/07/2018 • Diagnosis Opioid abuse
- 4. • According to patient • I was suffering from loose motion since 20- 22 days. • I had bad headache. • I was vomiting since 18 days. • Fever since 20 days. • I was using abusive words towards my wife. • I was having severe body ache. • I was having difficulty in sleeping.
- 5. • According to observer • Fever • Vomiting • Pain in muscles • Slurred speech • tremors
- 6. History of present illness • Patient was taking heroin since 11 years. Before 25 days his father and mother got to know that he is taking heroin. Then they told him to promise them that he will never take that substance again. Patient did not take any substance then he had withdrawal symptoms like vomiting , low grade fever, diarrohea, muscle ache. After 5 days he started feeling depressed and scolded his wife and other family members. So his family members bring him to the hospital.
- 7. • IV. Treatment history • No history of any previous treatment. • V. PAST ILLNESS • History of past psychiatric illness: • He had cholesystecomy sugery before 3 years ago.
- 8. Personal history • ) Perinatal history Antenatal Period : No history of any infection or exposure to radiation • Intranatal period : Type of delivery- normal • Birth : No complications during birth • Birth cry : Immediately after birth • Birth defects : No birth defect was there • Postnatal complications : No significant post natal complications
- 9. • Childhood history • Primary caregiver : Mother • Feeding : Brest milk for 5 months and liquid diet started in 6 month. • Age at weaning : 6 month • Developmental milestone : Normal • Behaviour and emotional problems : No significant behavioural abnormality • Illness during childhood : General diseases like fever, diarrhea and minor infections.
- 10. • Educational history: Age at Beginning of formal education : 5 years Extra curricular achievements, if any : No achievements. Relationships with peers and teachers : good • School phobia : Yes • Look for conduct disorders, for example truancy/ stealing; No • Reason for termination of studies : No interested
- 11. • Play history • Games played : He played cricket, with his friends. • Relationship with playmates : Very good relationship was there. • (E) Emotional problems during adolescence • No significant problem is there.
- 12. • Puberty • Age at appearance of secondary sexual characteristics : Not known to the patient. • Anxiety related to puberty changes : Not known to the patient • Occupational history • Age at starting work: 16years • He is working as a worker in a company. • Reasons for changes: He is still working there. • Current job satisfaction: Yes • Weather job is appropriate to patients background: Yes
- 13. • Sexual and marital history • Genogram(family of procreation- details of spouse and children): 1 wife and 2sons. • Type of marriage : Arranged marriage • Duration of marriage : 6years • Intrapersonal and sexual relations: Satisfactory/ unsatisfactory : Satisfactory • Extramarital relationships,if any specify: No
- 14. • Premorbid personality • Interpersonal relationship : Extrovert • Family and social relationships : Good • Use of leisure time : Spends with family and friends. • Predominant mood : fluctuating • Usual reaction to stressfull events: He handles every situation • Attitude to self and others: Self appraisal of abilities, achievement and failures • Attitude to work and responsibility: He really likes the responsibility. • Religious beliefs and moral attitude: He believes in God.
- 15. • History of present illness: • First drink causes: During working in company friends told him to take for feeling relax. • First experience with Heroin: First when he took heroin ,he felt something happened in his mind and then he felt very relax and happy. • History of craving: Before 2 years one day he was in home and had not taken heroin that day suddenly he felt urge to taking that , he was profusely sweating. • History of loss of control: No history of loss of control. • History of withdrawal features- Muscle spasm, head reeling, darkness infront of eyes, swaeting.
- 16. • History of blackouts: No history of blackouts. • History of silence: No history of silence. • Maintaining factors/ reasons: When he does not take heroin he felt weakness, depressed, muscle pain. • Previous history of abstinence: He had stopped it before two years ago. • Money spent for Heroin: According to him he does not spend money for that because his rich friends give money for that . He gives 100 rupees sometimes. • Medical problems associated with Heroin: Muscle pain, constipation, head reeling.
- 17. • History of any other substance abuse: No • Motivation level: Moderate • Locus of control: Normal • Family strokes similar problems: • Interpersonal relationship in the family: Good • Family history of psychiatric disorders : No family history of psychiatric illness is there.
- 18. MENTAL STATUS EXAMINATION • Appearance: • Patients height is 163cm and weight is 54kg. He has thin body built. His grooming was appropriate to the time of the day. • Behavior: • Well behaved and seated quietly. • Attitude • Well behaved and cooperative. • Level of consciousness: • Conscious and alert • Orientation: • He is fully oriented to time, place and date. • Speech and Language: • The patient had slurred speech with adequate volume.
- 19. • Mood • Subjective • Student nurse :How are you feeling? • Patient : I am feeling well. • Student Nurse: Do you feel depressed. • Patient : Yes • objective : Looking anxious. • (f) Affect • Range : Full • Appropriateness : Appropriate •
- 20. • Thought: • Student Nurse: What type of the ideas comes in your mind? • Client : I think I should not take the heroin. • Remarks : Patient has normal tempo and logical thought. • Content • Student nurse : What do you think about when you are sad? • Patient : I think about my children. • Remark : logical form of thought and no suicidal ideation. •
- 21. • Perception • Hallucinations • Student Nurse: Sometimes some of the people listen various sounds and visualize the things which are not recognized by others, do you have any of the problem like those? • Client :No I don’t listen or visualize the things like you said but sometimes I listen like sound of high speed wind passing through my ear.. • Remarks : Auditory hallucination is absent. •
- 22. • Cognitive Functions • Orientation • Person • Student Nurse : Who is sitting near by you? • Client : My Wife. • Remarks : Oriented to person • Place • Student Nurse : Where are you now? • Client : At Hospital • Remarks :oriented to place. • iii.Time • Student Nurse : What is the time now? • Client : About 10-11 AM • Remarks : Oriented to time.
- 23. • Attention • Student Nurse: Can you repeat these 5 words in odia Anda, Arata,Akha , Alia, akala, • Client : He told 3 words. • Remarks : Attention is absent. • Concentration • Student Nurse: can you tell three consecutive numbers by adding 3 in 5? • Client : Told correctly. • Remarks : Concentration is intact .
- 24. • Memory • Immediate • Student Nurse : Repeat the word what I say bucket, Pen, mobile, ball, cutton. • Client : Pen, mobile, ball, cutton. • Remarks : Immediate memory intact. • ii. Recent • Student Nurse :Have you taken your morning medication? • Client : Yes I have taken. • Remarks : Patient’s father said that he has taken medication. So Recent memory intact. • iii. Remote • Student Nurse : can you tell when your Son was Born? • Client : in 2014 • Remarks : Remote memory intact. •
- 25. • Abstraction • Student Nurse : What is the similarity and dissimilarity between bird and Aeroplane. • Client : Both can fly , Bird has life but aeroplane has no life. • Student Nurse : Can you say meaning of “ Kumbhira kandana kandiba?” ( A odia Proverb) • Patient : False crying( Correct) • Remark : Abstraction is Present.
- 26. • Judgment: • Test:- • Student Nurse : What will you do if there is fire in this room? • Client : I will poor water and shout . • Personal test:- • Student Nurse :what will you do after discharge? • Client:- :I will go to home. • Social:- • Student nurse :what will you do when a marriage party is there in your neighbor. • Client :I will go there and eat food. • Remarks :judgment is intact.
- 27. • Patient has thin body built. He has dressed appropriate to the time of the day. He is very cooperative. He was oriented and conscious and taking with slurred speech and adequate volume. There is logical form of thought was there. Patient had some auditory hallucination. In cognitive functions attention problem was found. Patient has insight grade V, abstraction and judgement was intact.
- 28. • Patient has normal body built, looking depressed with dull activity. He was conscious and oriented . Skin is dry, increase in temperature. Scalp was dirty and no infections in eye was there. There was presence of cerumen in the ear. No enlargement of lymph node was there. Symmentry expansion of chest during breathing and wheezing sound was found during auscultation. Joints were movable but it was difficult for moving due to muscle pain.
- 29. • No abnormality was found in neurological examination
- 30. • Definition: • Opioids include substances such as morphine, heroin, codeine and oxycodone. These can be bought illegally or prescribed. • Opioid use disorder is a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress. • It often includes a strong desire to use opioids, increased tolerance to opioids, and withdrawal syndrome when opioids are abruptly discontinued. • Addiction and dependence are components of a substance use disorder and addiction represents the most severe form of the disorder.
- 31. Etiology Book picture • Genetic: Individuals who have a first- degree relative who have an addiction disorder are more likely to develop an addiction themselves. While not a precise indicator – not all individuals who have addicts as parents or siblings develop an addiction – it is a factor believed to contribute to addiction. • Biological: It’s been suggested certain individuals may be born with a lack of the neurotransmitter “endorphins.” In an attempt to self-medicate this inborn deficit, individuals may perhaps, turn to external sources, such as opium narcotics, to obtain these neurotransmitters. Patient picture
- 32. • Environmental: Individuals who grow up in a chaotic home environment and are surrounded by addiction are more likely to develop an addiction later in their lifetime. • • Psychological: As many addictions are caused by an individual attempting to self- medicate the symptoms of an undiagnosed co-occurring mental disorder, mental illness can be a strong indicator of addiction potential. • Social: By the influence of friend circle and colleagues one may take the opioid. • Social: By the influence of friend circle and colleagues Patient has taken the opioid.
- 33. Clinical features Book picture • Exhaustion • Muscle pain • Respiratory depression • Sedation • Muscle spasms • Vomiting • Insomnia • Constipation • Itching • Nausea • Vomiting • Sweating • Seizures Patient picture Fever Vomitting Pain in muscles Slurred speech Insomnia
- 34. Diagnostic evaluation • History collection • Mental status examination • History collection • Mental status examination
- 35. Nursing Diagnosis • According to book: • Pain related to withdrawal of opioid. • Risk for violence: Self-directed or other-directed related to anger towards others • Impaired verbal communication related to biochemical changes. • Impaired home maintenance related to disease process. • Impaired sleeping pattern related to anxiety • Fluid balance disturbances: nausea, vomiting related to termination of opioid substances • Ineffective health maintenance related to substance abuse as evidence by patient reports to using heroin.
- 36. According to patient • Pain related to withdrawal of opioid as evidenced by patients facial expression . • Fluid balance disturbances: nausea, vomiting related to termination of opioid substances. • Impaired social interaction related to lack of faith on others as evidenced by Spends time alone by self and unable make eye contact. • Disturbed family process related to drug abuse of a family member as evidenced by depressed mood of family members. • Impaired sleeping pattern related to anxiety as evidenced by report of his attendant(Father).