MODULE 22: CONCEPT OF ADDICTION Case Study: Parts 1, 2, & 3 Case Study, Part 1 Paul is the 19-year-old son of Mark and Susan John. The Johns have been married for 20 years. Mrs. Johns is a full-time stay-at-home mom. Paul‘s dad is a corporate attorney who has always been somewhat demanding of his wife and children. He drinks alcohol daily, but has always been employed and has maintained a middle-class lifestyle for his family. Paul has two younger sisters: Mara, the younger of the two, has been treated for anorexia since the age of 12. His 15-year-old sister, Jess, is doing well in high school. Paul did well in high school, where he played varsity soccer and did fairly well academically. Paul has just returned home from his first full year at college. His mother is concerned because he doesn‘t seem like his old self; he shows no interest in his old friends or in getting a summer job. On the other hand, he seems secretive and has left the house on many occasions claiming that he has new friends who ―get it.‖ He is very short tempered with his sisters, constantly irritable and discontent. He is very evasive when asked about his grades or any college activities. He has noticeable weight loss and appears unkempt. His father is intolerant of his behavior. His mother is concerned and has arranged to accompany him on a visit to his primary care provider. She is hoping to find out what his problem is so it can be treated before his father becomes angrier with him and his behavior. You are the nurse who is assessing Paul. Question 1 Describe the elements of the interview/assessment environment that you should consider before beginning Paul‘s patient assessment. Answer 1 A. The physical environment should be calm, quiet, and private. B. Confidentiality is essential; you will need to explain to Paul‘s mother that you need to spend some time alone with Paul to get some information and get to know him. C. Plan for enough time to establish rapport with Paul. D. Review the steps of beginning a therapeutic relationship. Question 2 What questions would be appropriate in assessing Paul‘s physiologic, emotional, and psychologic status? Answer 2 A. After establishing rapport, provide Paul broad openings by asking questions such as: a. ―Tell me why you are seeing the (primary care provider) today?‖ b. ―How have you been feeling lately?‖ c. ―Are you having any physical problems?‖ d. ―Any changes since you went away to college?‖