Table of Contents
Part 1: Assessment
Alcohol withdrawal risk assessment
Part 2: Plan and implementation.
Part 3: A Biopsychosocial Approach.
In general hospital environments, withdrawal of alcohol is normal. It constitutes a major part that refers that a psychiatrist receives. Dependency on alcohol is a serious type of alcohol use disorder which may often appear when an individual experiences signs of retreat when drinking ceases-whether because of social distress, self-motivation, poor physical health or drinking development. Regular users sometimes forget that avoiding drinking creates more issues than simply leaving things on. This may be partly true for individuals who have established dependence, because withdrawal symptoms including autonomous excitement, hallucinations, seizures as well as delirium tremens (DT) may occur. Since many people are playing as well as minimize everyone’s drinking behavior, withdrawal symptoms start to experience in hospital for those other physical problems and therefore not alcoholism which form a significant part of the psychiatry of consulting-liaison (Amanda Hanora Lavan, 2016).
Alcohol made Mr. Jungala happy sometimes. He stated that he drink alcohol when he feels he is stressed. Alcohol is making his immune system weak day by day and this is not good for him. So, it’s a good assessment to make him healthy.
An important brain function areas are assessed in a cognitive assessment. These include memory, concentration, speed, language and ability to reason. This has been found in recent years to be important for full well-being as simple cognitive tests provide a tailored measure of brain function for potential comparisons. Much when increases in blood pressure or waistline help your doctor monitor the likelihood of metabolic syndrome, the neuropsychologist's routine cognitive tests will detect improvements in the brain function. It helps the staff to spot early indicators of issues and respond quickly. In the case of complications or issues (including significant ill health or brain damage), a functional status evaluation offers a point of reference for calculation. The staff is encouraged to concentrate on other issues in the creation of a care and intervention program (Haralambous et al., 2018).
Cognitive testing is used for assessing the general reasoning and cognitive ability of a person, often known as mental functioning or IQ. Intelligence tests can evaluate different cognitive capabilities domains of the concerned person. Mr. Jungala does not have any mental problem but as he was taking stress about his daughter and because of that stress he has increased the intake of Alcohol. After some cognitive assessments like verbal Comprehension, working memory, processing speed can be good for him (Haralambous et al., 2018).
Objectives for fall risk reduction include: decreasing the possibility of falling; minimizing the probability of injury; preserving the best stability possible; and providing constant supervision. Check for patients and families to counter dropping risk factors. Suppliers will examine the opinions of older people as to whether they have declined and are able to make adjustments to may their likelihood of decline. Highlighted the implications of balance as well as strength. The most effective single procedure to reduce falls and fall-related injuries is exercise intervention that focuses on improving strength and balance. Prioritize actions to modified risk factors because with the number of risk factors the risk of falling increases, the risk can be decreased by changing some contributing factors. In the case, Mr. Jungala he fell down on the truck by mistake which he regret later. He should be kept aware of fall to make sure that he walk with open eyes and open mind. Different assessments should be repeated with him for fall to make his walk and balance stable. As exercise is good for health so he should be aware of that too (Hrabok, 2016).
Functional assessment has four main objectives: recognizing and distinguishing problems in social skills, helping to distinguish learning, success and fluency in social skills, finding conflicting challenge comport ability that interferes with learning, efficiency, and/or fluent activity and presenting detailed knowledge about potential behavioral functions (Hrabok, 2016). A functional behavioral analysis aims at identifying behavioral functions or causes. This knowledge is important because after a behavioral pattern is established, other behavioral modification techniques can be recommended. Basically, behavior can serve two functions: to obtain something that is desirable or unwanted and/or unwanted, or aversive (for example, difficult tasks, social activities and disruption of favorite activities) (Hrabok, 2016).
Both functions describe the reinforcement processes for both positive and negative reasons. For example, the behavior of even a child's social withdrawal can increase the rate of adults and/or peer requests to be involved in a continuing activity ( i.e., the behavior can provide social care or positive enhancement function). Mr. Jungala should be given the functional assessments as he was not doing nay work and he was sitting at home all day doing nothing which made him more stressful. His social skills should be trained to keep him busy somewhere.
Nutritional evaluation aims at defining the status of a patient in terms of nutrition, identifying clinically significant malnutrition as well as monitoring patient adjustments in nutrition status. It tracks observations by anthropometry, nutrition and biochemistry, health experience and externally tested findings and other parameters. Health appraisal methods include the Contextual Regional Assessment and Micro Diet Assessment. A bonus of nutritional screening instruments is that they need fewer preparation to use them than nutritional testing instruments. The selection of tools depends on the type of hospital, the population to be monitored or evaluated, and the financial budget. Nutritional monitoring helps to easily classify high-risk patients (Hrabok, 2016).
The purpose of the nutritional assessment is, therefore, to identify the nutritional condition of an individual, to assess the clinically related deficiency, and to track nutritional improvements. Throughout clinical practice the nutrient danger is uncertain and understated. Hospitals will establish systematic plans for the diagnosis and management of hunger before admission to the hospital and for tracking patients' food condition before their hospital stay. Mr. Jungala specially needs the nutrition assessments. His health was falling down day by day due to intake of alcohol and stress level. He also belonged to a mediocre family where he got twelve people in one house. Intake of healthy food should be difficult for him.
Reviewing and analyzing the case of Mr Jungala, medicines may be troublesome for the aging demographic, as improvements in biology may influence the mode of ingestion, delivery, synthesis and removal of medications in our bodies. The changes in physiology include an increase in body fat, reduced body water, lower muscle weight, and changes in renal and liver function as well as in the central nervous system. These changes may lead to adverse drug reactions (ADR). In frail older people, alterations to medicine are more likely to be marked. In general, drugs are targeted at symptoms control and help keep them functional in frail older people (Fletcher & Miciak, 2017).
With era, they take more drugs than counters and alternative therapies, like prescription prescriptions. Taking multiple drugs known as 'polypharmacy' increases the risk of involvement of medicinal products in hospital admissions, especially when an elderly person has falls, confusion as well as incontinence. The prescription mistakes, drugs issues and drug reactions may contribute to problems with polypharmacy. We become also at risk if individuals take several medications (Fletcher & Miciak, 2017):
The higher the possibility of drug problems, the more drugs an individual take. Such mistakes can be induced by difficulties in having an exact background and review of drugs, diagnosis and complicated regimes. During an older person's hospitalization, a median of five to seven prescription changes will increase the likelihood of recruitment and adverse prescription events.
Up to 30% of all admissions in hospitals by people aged 65 and above are projected to be medicines-related and almost half may be stopped from doing so. Admissions consistent with treatment can be triggered in older adults by (Spreij et al., 2020):
Unwillingness to take or receive a prescription drug
Take drugs mistakes.
Adverse drug reactions (ADRs) seem to be common in elderly people which are the most similar diagnostic representations of falling, orthostatic hypotension, delirium, failure of the renal system, gastrointestinal as well as intracranial bleeding. The chances of ADR are exacerbated by the age-linked improvements in pharmacokinetics and pharmacodynamics, rising co-morbidity pressures, poly pharmacology, excessive dosage and insufficient medication monitoring. The origin of injury to the individual and needless expenditure of medical care should be prevented. ADRs. There are growing risk tools for ADRs but none have adequate clinical experience predictive benefit. A thorough recording and frequent examination of prescription and over-the-count medications through systematic medical reconciliation are a good clinical practice in the identification and prediction of ADRs in vulnerable patients (
Through individual marks with some accomplishments in each stage of human development and therefore is affected by the preceding stage when influencing the next one. Therefore, the standard of life in old age is determined by the individual's adult life style and planning for senescence throughout adulthood should be achieved. Nevertheless, since this training is important in deciding the standard of life in old age and in some other attitudes linked to safety, appropriate schooling may also from childhood play a significant role. It is essential therefore to examine the mechanism of identification of healthy ageing and identify the factors that cause healthy aging at any stage of life. The stable aging phase provides generational prospects for the enhancement and maintenance of physical, social and mental wellbeing, prosperity and quality of life and the development of positive changes in the life cycle (Hrabok, 2016).
The physical, financial, social and moral health of older adults is part of this concept. It suggests also that the welfare and very well-being of elders are growing progressively optimistic. Several words including aggressive aging, good ageing, optimistic ageing and sustainable aging have been used to suggest stable aging synonymously in recent research. For starters, Chung and Kim are associated with "good aging." While good aging is more of a target in old age, safe aging may nonetheless be viewed as a set of strategies for good aging and is therefore a more fitting term in daily life. Good aging must be taken into account to maintain freedom and flexibility towards a physical health (Intarasirisawat et al., 2019).
Mr. Jungala was having a stressful life because he got to know that his one daughter is diagnosed with cancer. This made him more stressful. He stated that he does not want to put pressure on anyone at home as they are already dealing with one stress. This means that he was suffering from high pain but was unable to share it with anyone. He was bottling himself up with the stress and release that with the intake of alcohol or sometimes with a walk or so. He was dealing with so many all at once which made his life more stressful and may be one day lead to some kind of trauma. He was also suffering from diabetes which means that he must be taking medication. He was also suffering from chronic renal failure and angina and he was taking medicines for that too (Haralambous et al., 2018). Too much intake of medicines in older age also make heart beat faster and many other systems which may lead to something drastic.
Work shows that effective interdisciplinary coordination contributes to better results for patients and families (i.e. high patient care and family happiness, pain management, decreases in stay time and expenses in hospitals). Research has demonstrated, rather than independent health workers employed individually, that interdiscipline research in a team can strengthen the diagnosis and prognostic skills of medical professionals. There has been significant success in recent years in improving team-building technology (e.g. groupware). So, Mr. Jungala should keep himself busy in some work and meet an interdisciplinary team who will help him in future (Sliwinski et al., 2018).
Amanda Hanora Lavan, P. G. (2016). Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf, 7(1), 11-22.
Fletcher, J. M., & Miciak, J. (2017). Comprehensive cognitive assessments are not necessary for the identification and treatment of learning disabilities. Archives of Clinical Neuropsychology, 32(1), 2-7.
Hrabok, D. M. (2016). THE IMPORTANCE OF BASELINE COGNITIVE ASSESSMENTS. Copeman.
Haralambous, B., Tinney, J., LoGiudice, D., Lee, S. M., & Lin, X. (2018). Interpreter-mediated cognitive assessments: Who wins and who loses?. Clinical Gerontologist, 41(3), 227-236.
Intarasirisawat, J., Ang, C. S., Efstratiou, C., Dickens, L. W. F., & Page, R. (2019). Exploring the touch and motion features in game-based cognitive assessments. Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, 3(3), 1-25.
Kubo, Y., Koji, T., Murakami, T., Yoshida, K., Matsumoto, Y., & Ogasawara, K. (2020). Long-term outcomes of cerebral blood flow and neurotransmitter receptor function on 123I-iomazenil SPECT and of cognitive assessments after parent artery occlusion combined with cerebral revascularization for internal carotid artery aneurysms. World Neurosurgery.
Ranson, J. M., Kuźma, E., Hamilton, W., Muniz-Terrera, G., Langa, K. M., & Llewellyn, D. J. (2019). Predictors of dementia misclassification when using brief cognitive assessments. Neurology: Clinical Practice, 9(2), 109-117.
Sliwinski, M. J., Mogle, J. A., Hyun, J., Munoz, E., Smyth, J. M., & Lipton, R. B. (2018). Reliability and validity of ambulatory cognitive assessments. Assessment, 25(1), 14-30.
Schneider, W. J., & Kaufman, A. S. (2017). Let's not do away with comprehensive cognitive assessments just yet. Archives of Clinical Neuropsychology, 32(1), 8-20.
Spreij, L. A., Ten Brink, A. F., Visser-Meily, J. M., & Nijboer, T. C. (2020). Increasing cognitive demand in assessments of visuo-spatial neglect: Testing the concepts of static and dynamic tests. Journal of Clinical and Experimental Neuropsychology, 1-15.
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