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Week 13 Assignment

The document outlines a patient's subjective feelings of distress and physical pain linked to work and family problems, leading to substance abuse as a coping mechanism. The assessment indicates the patient is using alcohol and drugs to manage symptoms of an undiagnosed mental disorder. The plan includes abstaining from substances, expressing feelings, and developing coping skills, with evaluation showing successful achievement of these goals.

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Baylon Angelica
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36 views2 pages

Week 13 Assignment

The document outlines a patient's subjective feelings of distress and physical pain linked to work and family problems, leading to substance abuse as a coping mechanism. The assessment indicates the patient is using alcohol and drugs to manage symptoms of an undiagnosed mental disorder. The plan includes abstaining from substances, expressing feelings, and developing coping skills, with evaluation showing successful achievement of these goals.

Uploaded by

Baylon Angelica
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

S (Subjective)

“Na iistress kase ako lagi na lang may sumasakit sa katawan ko at wala ng
ganang mabuhay kase laging may problema sa work tapos sa family ko, itong
pagiinom na nga lang at yung pag gamit nung ano yung nagpapagaan ng loob ko”

O (Objective)
Temp.= 37.5
BP= 130/90
RR= 21
PR= 60
O2 Sat= 97

A (Assessment)
The patient abuse alcohol and drugs to ease the symptoms of an undiagnosed
mental disorder, to cope with difficult emotions, or to temporarily change their
mood.

P (Planning)
 The client will abstain from alcohol and drug use.
 The client will express feelings openly and directly.
 The client will verbalize acceptance of responsibility for his or her own
behavior.
 The client will practice nonchemical alternatives to deal with stress or
difficult situations.
 The client will establish an effective after-care plan
 The patient will undergo some laboratory exam and check up

I (Intervention and Rationale)


 Providing health teaching for client and family. Clients and family
members need facts about the substance, its effects, and recovery.
 Addressing family issues. Without support and help to understand and
cope, many family members may develop substance abuse problems of
their own, thus perpetuating the dysfunctional circle; treatment and
support groups are available to address issues of family members.
 Promoting coping skills. Nurses can encourage clients to identify problem
areas in their lives and to explore the ways that substance use may have
intensified those problems.

E (Evaluation)
Goals are met as evidenced by:

 The client was able to abstain from alcohol and drug use.
 The client was able to express feelings openly and directly.
 The client was able to verbalize acceptance of responsibility for his or her
own behavior.
 The client was able to practice nonchemical alternatives to deal with stress
or difficult situations.
 The client was able to establish an effective after-care plan.

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