Grand Par Psychia Manuscript Final

FATHER SATURNINO URIOS UNIVERSITY
San Francisco St. Butuan City 8600, Region XIII Caraga, Philippines
Nursing Program
A Case Analysis Presentation on
Substance Use Disorder

(June 28- August 7, 2021)
Pia Mae Buaya
Preiffel Grace Bueno
Roselle Bustamante
Joann Marie Calo
Afzella Hillary Caniga
Christelle Castillo
Angelica Marie Cocon
Myra Grace Comandante
Lou Lindsay Datahan
Charles Kevin Donoso
Rose Jean Ejos
Nadine Genesis Sumilhig

N31- Level III Student Nurses
APRIL LOVE R. OJA, RN, MN

Supervising Clinical Instructor
Introduction
Substance use disorders (SUDs) as defined in the DSM-V, are a group of substance-related
disorders that are associated to the abuse of a specific substance or drug, including alcohol
(Substance Abuse and Mental Health Services Administration, 2016). The criteria for DSM-V
substance use disorder includes hazardous use, interpersonal problems related to use,
neglected major roles to use, legal problems, withdrawal, tolerance, larger or longer amounts
of use, repeated attempts to control or quit use, increased time spent using, physical or
psychological problems related to use, activities given up to use and craving (Hasin et.al, 2013).
In the case of the client presented in this study he was addicted to the substance called
methamphetamine chloride also known as “shabu”. Methamphetamine is a stimulant that
affects the central nervous system and is extremely addictive. Methamphetamine crystals
resemble glass shards or gleaming, bluish-white rocks. Methamphetamine can be consumed
through smoking, swallowing (pill), snorting, or injecting the powder that has been dissolved in
water/alcohol. Because the drug's "high" begins and fades quickly, users frequently take many
doses in a "binge and crash" pattern. In some circumstances, people use methamphetamine in
a binge known as a "run," where they give up food and sleep while taking the drug every few
hours for many days. Methamphetamine raises the amount of dopamine, a natural substance
found in the brain. Dopamine is involved in physical movement, motivation, and rewarding
behavior reinforcement. The drug's ability to swiftly release large levels of dopamine in the
brain's reward centers powerfully encourages drug-taking behavior, making the user desire to
repeat the experience (National Institute on Drug Abuse,2019).
In most cases, substance abuse disorder is usually developed due to many social,
personal, and environmental causes. However, some of these causes give the victim no control
over them due to the size of their complexity (Pinnacle Treatment Centers, 2020). Predisposing
risk factors for substance abuse includes a person’s family history of any addiction, genetic
vulnerability specifically on the variation of the protein PSD-95, mental issues such as
depression and post-traumatic stress disorder, Race specifically those who are Hispanic,
Americans and African-Americans, gender where in men are found to be more prone than
women, age specifically among adults 26 years old or older, early life experiences of being
aggressive, lack of self-control and difficult temperament and lastly the socioeconomic status of
the client. On the other hand, precipitating factors for substance abuse includes, environmental
stressors, social pressures, individual personality characteristics, ineffective parenting, poor
classroom behavior and social skills, academic failure, association with drug abusing peers, drug
availability, trafficking patterns, and lack of attachment or nurturing by parents or caregivers.
All of these factors could trigger a person to enter illegal drug use which may lead to addiction.
Fortunately, researchers know more than ever about how drugs affect the brain and
have found treatments that can help people recover from drug addiction and lead productive
lives. Addiction is a chronic disorder that cannot be healed by just stopping consuming drugs for
a few days. To permanently stop using and reclaim their life, the majority of individuals require
long-term or recurring treatment. Addiction treatment includes stop using drugs, staying drug
free and be productive in the family, at work, and in society (NIDA, 2019). While research is
underway, there are currently no government-approved medications to treat drug addiction
specifically methamphetamine addiction. The most effective treatments for drug addiction so
far are behavioral therapies, such as cognitive-behavioral therapy, which helps patients
recognize, avoid, and cope with the situations likely to trigger drug use and motivational
incentives, which uses vouchers or small cash rewards to encourage patients to remain drug-
free. Research also continues toward development of medicines and other new treatments for
illegal drug use, including vaccines, and noninvasive stimulation of the brain using magnetic
fields. People can and do recover from drug addiction if they have ready access to effective
treatments that address the multitude of medical and personal problems resulting from long-
term use (NIDA 2019).
According to the latest World Drug Report issued by the United Nations Office on Drugs
and Crime, over 269 million individuals used drugs worldwide in 2018, with over 35 million
suffering from drug use disorders. Cannabis was the most commonly used drug in the world in
2018, with an estimated 192 million individuals consuming it globally. Opioids, on the other
hand, continue to be the most dangerous, with the overall number of fatalities related to opioid
use disorders increasing 71% over the last decade, with a 92% rise among women compared to
a 63% increase among males. Drug usage increased far more rapidly in developing nations than
in industrialized countries from 2000 - 2018. Adolescents and young adults make up the
majority of drug users, and they are also the most sensitive to the effects of drugs since they
use the most and their brains are still growing (United Nations, 2020). On the other hand,
locally there are around 1.67 million or two out of one hundred Filipinos aged 10 to 69 are
current users of drugs, according to the results of the 2019 National Household Survey on the
Patterns and Trends of Drug Abuse, released by the Dangerous Drugs Board. Cannabis or
marijuana (57%) was found to be the most commonly abused dangerous drug followed by
methamphetamine hydrochloride or shabu (35%). The 2019 Drug Survey estimates the current
user prevalence rate at 2.05 percent, significantly lower than the 2018 global estimates of 5.3
percent published in the World Drug Report 2020 (Dangerous Drug Board, 2020).
Mr. X is a 44-year-old male, and was born on August 18, 1975. He was 5 feet and 2
inches tall and his weight is 48.4 kg. The client admitted to be taking illegal drug specifically
Methamphetamine Hydrochloride also known as “shabu”. The client started using the
substance on the year 2013 due to the influence of his peers, after several years of addiction he
was caught and put to jail on the year 2016 which prompts him to stop his drug use. After
several years of imprisonment, he was released from jail and was referred to the DOH to start
his outpatient rehabilitation. According to the client he has stop his drug addiction for almost 4
years but he had a relapse twice specifically on the dates, June 10, 2021 and July 19, 2021
where he was found positive on a drug test conducted to him on July 23, 2021. A mental status
examination was conducted to the client on July 23, 2021. On the client’s general appearance,
according to his case manager he has shoulder length blonde hair and he has a good hygiene.
Based on the initial interaction with the client, it was observed that he was responsive on the
questions asked by the interviewer and also likes to share his own thoughts and insight about
the topic that was asked about him. The conversation with the client is spontaneous and quest
ions are answered appropriately where in the client had also tried to further explain his
situation and circumstance. But, as observed there are certain topics where the client is
hesitant to answer specifically on the questions about his relapse because according to the
client, he feels ashamed and guilty of what happened and explained the reason behind it which
is he can't say no to his peers. During the interaction the client’s mood differ from the topic or
questions asked to him, he appears happy when talking about good memories he had, sad and
guilty when recalling difficult times of his life which are all appropriate on the situations and
feelings he had verbalized. According to the client he had no history of any hallucinations,
delusions, derealization, thought broadcasting, deja vu and jamais vu. The client also
acknowledges that sometimes he got thoughts that people may be talking behind his back
because of the stigma attached to people who had history of addiction but he knows that these
thoughts could also not be real. The client was also oriented to the time and date as observed
when he was asked about it. The client also recognizes the interviewer and was able to recall
recent and past experiences such as the things he did the day before the interview, and his
memories back when he was still in elementary. He was also aware about the recent news and
issues in Butuan and in the Philippines. The client was also able to recall the words he was
asked to remember on the first part of the interview. In terms of the clients thought content, he
sees himself better compared back when he was still using drugs, he also thinks that he was
better and recognize that he has no illness except from high blood pressure. He also does not
demonstrate any signs of obsessions, compulsions and phobias. He also had no thoughts of
killing somebody and he thinks that holding grudges would not help him, but according to him if
somebody would try to hurt him or try to kill him, he has the tendency of fighting back. He also
mentioned a history of hurting his nephew due to his anger as this person was talking back to
his mom, but after doing that he became resentful about what he did and knew that it was
something he should have not done. The client had also mentioned that he had thoughts of
doing suicide back when he was still using drugs, as this was a time of his life wherein, he felt
really depressed and he just want to isolate himself from everybody, but he also shared that all
of those are just his thoughts as he had not come to the point of preparing and doing
something that would kill him. On the other hand, when the client was asking about a situation
where in he was able found a money in the street, what would he do with it he answered that
he would try to find the owner of the money but if he would not be able to find who owns it, he
would keep it and put half of it to the bank and the try to spend the remaining money for
himself and his mom. In terms of the client’s awareness, the client was well aware about his
own status regarding his health and his addiction. He also mentioned that the DOH-TRC had
really helped him throughout his recovery and that he was thankful towards the institution. He
also verbalized that therapies and lectures given in the DOH-TRC should really be followed as
this would really help a person recover. The client also view self as in a state of recovery and
knew that temptations are just really there, it is up to him if he would be tempted and repeat
his addiction specially that he had a relapse in which he felt really ashamed and guilty of doing.
The use of illegal drugs specifically methamphetamine chloride has been rampant in the
Philippines, for this reason the group had chosen this case to learn and explore more about
how this drug influence a person’s life. In the case of the client mentioned in this study he had
undergone several relapse making the study more interesting as to what are the different
reasons a client may engage to this act and how can we help this clients to cope and be treated.
 Introduction of the client is too long

- Detailed description must be in the MSE and Anamnesis section
 Please include in the discussion the common symptoms a person will experience when
addicted to drugs (very briefly)
 What are the possible complications if no interventions will be given
- Social aspect
- Psychological aspect
 How to diagnose/confirm drug addiction (tests to perform)
DEFINITION OF TERMS
Aneurysm- an abnormal swelling or bulge in the wall of a blood vessel, such as an artery. This
can occur anywhere throughout the circulatory system, but most commonly develop along the
aorta and in blood vessels of the brain.
Anxiety- a feeling or apprehension about what is about to happen.
Arrhythmia- an issue with the heartbeat's rate or rhythm. It indicates that the heart is beating
too fast, too slowly, or in an uneven rhythm.
Cardio embolism- happens when the heart pumps undesired materials into the cerebral
circulation, occluding a blood artery in the brain and causing tissue damage.
Central corticosteroid receptors- the central action of cortisol and corticosterone on stress
coping and adaptation, which is mediated by mineralocorticoid receptors (MR) and
glucocorticoid receptors (GR).
Depression- a common and serious medical illness that negatively affects how a person feels,
think and act.
Dopamine- a neurotransmitter in the brain that causes pleasure. It is released in enjoyable

situations, and it encourages people to seek out rewarding activities or occupations.
GABA receptors- a broadly distributed chemical messenger in the brain. The natural function of
GABA is to decrease the activity of the neurons it binds to. One of the functions of GABA,
according to some experts, is to regulate the dread or anxiety that occurs when neurons are
overexcited.
Glucocorticoid- is a cholesterol-derived steroid hormones synthesized and secreted by the

adrenal gland. They are anti-inflammatory in all tissues, and control metabolism in muscle, fat,
liver and bone. Glucocorticoids also affect vascular tone, and in the brain influence mood,
behavior and sleep‒wakefulness cycles.
Hemorrhagic stroke- caused by a weakened vessel that ruptures and bleeds into the
surrounding brain. The blood accumulates and compresses the surrounding brain tissue.
Hippocampus- a complex brain region located deep within the temporal lobe. It is crucial for
memory and learning. It is a malleable and sensitive structure that is susceptible to a wide
range of stimuli. A range of neurological and mental problems have been linked to it, according
to studies.
Hypothalamic-pituitary-adrenal axis- describes the interaction between the hypothalamus,

pituitary gland, and adrenal glands. The hypothalamus and pituitary gland are located just
above the brainstem, while the adrenal glands are found on top of the kidneys.
Hypoxia- a condition in which the body's cells and tissues do not receive adequate oxygen.
Intoxication- affected by alcohol or drugs especially to the point where physical and mental
control is markedly diminished.
Ischemic stroke- caused by a blockage in an artery that supplies blood to the brain. The
blockage reduces the blood flow and oxygen to the brain, leading to damage or death of brain
cells.
Mesocorticolimbic dopamine system- The release of dopamine from the mesolimbic pathway
into the nucleus accumbens regulates incentive salience (e.g. motivation and desire for
rewarding stimuli) and facilitates reinforcement and reward-related motor function learning; it
may also play a role in the subjective perception of pleasure.
Necrotizing vasculitis- term used to describe vessel wall necrosis due to neutrophil infiltration.
Neurobiology- is the study of nervous system cells and how these cells are organized into
functional circuits that process information and mediate behavior.
Nucleus accumbens- involved in the cognitive processing of motor function related to reward
and reinforcement and the regulation of slow-wave sleep. Specifically, the core encodes new
motor programs which facilitate the acquisition of a given reward in the future.
Prefrontal cortex- the cerebral cortex covering the front part of the frontal lobe. This brain
region has been implicated in planning complex cognitive behavior, personality expression,
decision making, and moderating social behavior.
Psychoanalytic- a method of analyzing psychic phenomena and treating emotional

disorders that involves treatment sessions during which the patient is encouraged to talk freely
about personal experiences and especially about early childhood and dreams.
Psychobiologic- describes the interaction between biological systems and behavior.

Psychodynamic- an approach to psychology that emphasizes systematic study of the
psychological forces that underlie human behavior, feelings, and emotions and how they might
relate to early experience.
Psychosocial- concerning the interaction of social influences with individual cognition and
behavior.
Relapse- the act or an instance of backsliding, worsening, or subsiding.
Sociocultural- used to describe the differences between groups of people relating to the social
class and culture in which they live.
Socioeconomic- the interaction between the social and economic habits of a group of people.
Stigma- a mark of embarrassment connected with a certain situation, trait, or person and in the
case of this paper, drug use.
Substance Use Disorder - Drug addiction, also called substance use disorder, is a disease that
affects a person's brain and behavior and leads to an inability to control the use of a legal or
illegal drug or medication. Substances such as alcohol, marijuana and nicotine also are
considered drugs.
Anamnesis
The Nursing Health History or anamnesis serves as a baseline data for the nursing
students to study the case of their patients. Its contents play a significant role in discovering
underlying factors that may have contributed to the medical or mental condition of the patient.
Having this information from the patient will help the student nurses learn more about the
present condition especially in their views about their present health status. This also gives us
the appropriate measures to take in researching this study and attaining the goals.
In accordance with the principle of confidentiality and in the maintenance of the client’s
dignity, the client was asked not to use a video during the video conference and we, the
student affiliates, made a decision to address him as Mr. X.
CLIENT’S DEMOGRAPHIC PROFILE
Mr. X is a 44-year-old male, single, Filipino, Roman Catholic, Highschool graduate, born on
August 18, 1976, and is currently living alone in his Bachelor's Pad.
I. Informant
The gathering and completion of the data was gathered through a virtual
interview with the client and his case manager.
II. Family History
Grandmother on the maternal side was hypertensive which puts his

grandmother at risk for stroke and sudden death. Client X was raised and grew up within
the four walls of his grandmother’s house for ten years when his mother had to work
abroad. His grandmother took good care of him and his siblings. He also described his
grandmother as a caring and loving grandma.
His father died because of lung cancer. His father was kind of strict in their
childhood. Mr. X did not have a close relationship with his father, and one of the
reasons for this is his sexual identity. When he was little, like under 10 years old,
spanking with a belt is the usual punishment used by his father if ever they have done
something wrong such as going out of their house without permission. For serious
offences, Mr. X was held and locked in the storage room with food for 24 hours.
However, Mr. X understands his father’s disciplinary actions before but has realized that
it is not right to ever lay a hand or spank a child. His father had also committed an
extramarital affair that made his mother resentful of him. She has sworn to never
forgive him until the day that she dies. On the other hand, his mother would calmly
discipline them in their childhood and avoid harsh discipline. Mr. X was closer to his
mom since his mother will defend them if they are punished too harshly by their father.
Mr. X described his mother as a caring parent. And, just like normal parents, his parents
disagree and sometimes argue because of financial issues and wrong decisions in life but
never fought in front of them.
Mr. X has four siblings. His two siblings both worked abroad, and one of them is
a nurse in Singapore who helps to support their family financially and provides the day-
to-day needs of the family. Mr. X has a special relationship with his sister who is a nurse
in Singapore because when he has health problems his sister sends him money without
hesitation. He described her as a family-oriented person and one of his pillars of support
during difficult times. They all have a good sibling relationship, and if there are any
sibling fights or arguments, they quickly resolve them. One of his siblings, a lesbian has
also been diagnosed with breast cancer and is undergoing chemotherapy.
III. Personality History

Prenatal/Perinatal
Mr. X was born via normal spontaneous vaginal delivery at the hospital, attended
by a midwife. There were no birth complications or defects. According to Mr. X, his
mother was fond of eating pomelo while he was still in his mother’s womb. A common
Filipino myth called “paglilihi” of that certain fruit was believed to be the cause of the
spider veins in his face.
Infancy and Childhood characteristics
The primary caregiver of Mr. X was his mother but when his mother had to work
abroad, his grandmother did offer to take care of him and his siblings. Mr. X has no
knowledge about milestones and certain details during his infancy and toddlerhood. His
mother did not mention if he was breastfed or bottle-fed. He also does not know how or
when he was toilet trained and what age he started walking.
Mr. X also had a childhood head injury after a slip and fall accident, for which he
underwent a minor head operation, and still has this slit in his head that reminds him of
the surgery and the childhood incident.
Psychosexual History
Mr. X has described himself to be “feminine” and identifies himself as a

homosexual. Moreover, according to his case manager, Mr. X is aware of sex such as
impulsive and intimate sex, as it is one of their topics during lectures.
Play Life
Mr. X likes to play “bahay-bahayan” or “home simulation” in his childhood. He

says he likes to play the role of a mother and really enjoyed this role. He likes to play
with older children and they usually play this group game in an open area under their
house.
School History
Mr. X entered school at the age of 6-years-old, Mr. X was an achiever and school
banner roll student during elementary. He is also an honor student in high school, he
also joined school clubs and became the first gay majorette or baton twirler and became
one of the popular students in their school band. Mr. X experienced transferring from
one school to another due to his father’s job, it was difficult for Mr. X at first because of
the changes in environment and friends, but he was able to get through the situation
and managed to make a lot of friends again. As he entered college this was the time he
left school at the age of 18, he was a second-year college student at that time. Mr. X
only finished second-year level due to financial problems as well as the wrong choice of
course. Mr. X wants to take up Bachelor of Science in Physical Therapy (PT) but instead,
he took up AB Political Science when he was in 1st year and 2nd-year college because
that time they can’t afford to pay for the course he wanted and because he didn’t like
the course he took, it affected him to the point that he stopped because he is not
interested with the course anymore.
Religious and Social Adaptability
Mr. X is a Roman Catholic by faith and every Sunday they had the spiritual
activity at the rehabilitation facility where Mr. X goes to church. Mr. X is a friendly
person, he has had a lot of friends ever since he was still studying back then until now
however, Mr. X believes that friends are only there for him when he has everything.
There was one time that one of his friends even betrayed him, it was when his friend
borrowed his hair razor and didn’t return it. It turns out that his friend already sold the
razor in exchange to buy drugs, Mr. X was frustrated that time because he trusted his
friend. And at the time, when he was in jail no one even remembered to visit him and at
the end of the day, it was just his family that was there for him, especially his sister who
supported him. Mr. X is a person who always believes that failure in life will always be
part of success.
Occupational History
Mr. X is currently a self-employed hairdresser and is in the process of building his

own salon business. Mr. X used this talent as a sideline inside the jail, he can earn up to
5000 pesos for cutting inmate's hair and even jail guard officers. Mr. X also worked as a
hairdresser for several years in Bahrain.
Marital History
The first relationship that Mr. X considers significant was the one he had in high
school. It was his first love, whom he referred to as their school campus heartthrob and
for whom he had the guy's name tattooed on his hand while still in high school, but it
turns out that his first love is cheating on him with a girl, he found out when they
watched a movie in a cinema together and Mr. X’s boyfriend brought a girl with him
whom he referred the girl as his cousin but Mr. X caught them on the act while holding
hands together. At that moment Mr. X felt betrayed, however, he still remembers his
first love until today. At the time when Mr. X was inside the jail, Mr. X had built a
romantic relationship with a guy, and the two had been together for three years. He was
very happy and in love with his partner, and they even lived together in the same room
and were sexually intimate inside the jail. He usually shares his problem with his
partner. After he was released, they continued to communicate through video calls but
the guy still cheated on him, Mr. X was devastated when he found out through the
messenger that his partner was cheating on him with another girl, he felt angry and
resentful towards his partner to the point that he posted the picture of the girl on social
media and referred to her as “kabet”.
The onset of Present Illness
When Mr. X was the one who looked after his father while hospitalized, he
began using illegal drugs. He was encouraged by his neighbors back then and finds meth
or the addictive drug helpful since it keeps him awake and alert during that time. He
occasionally smokes and drinks alcohol with his friends, but he prefers to use illegal
drugs constantly. The drug he consumed escalated and it even helped him perform well
in his job especially when doing rebond since he can accommodate more customers as
he feels more awake and energetic due to the drugs consumed. A few years later he was
imprisoned because he was apprehended in a buy bust operation and was caught selling
illegal drugs. After serving a term of imprisonment of three years, he started his drug
rehab in March 2020. Unfortunately, he struggled with relapse during his recovery. It
was June 10, 2021 where he went to Surigao with his relatives and resumed drug use,
“Natingala nalang ko naa silay gihatag sako. Ingon ko ‘dili ko gaw kay naa koy record sa
DOH, basin ma positive ko’. Pero ingon siya ‘sge na gaw ka isa ra bitaw’. Ambot unsa
akong nakaon, syempre sakong kaulaw sakong mga ig-agaw mao to ni sugot ko” as
verbalized by the client. While taking them, Mr. X had been experiencing symptoms of
anxiety that time. During a separate interview, the client's case manager also informed
us about Mr. X's second relapse, “To tell you frankly maam ha right after sainyong
interview gipa drug test nako siya and nag positive siya. So during that time na gi
interview ninyo sya, nag take diay syag drugs adto. Kay natingala man ko na murag lain
naman iyang behavior, over confident man ug hyper kaayo. Nag high gid diay sya adto
na time. Ang iyang rason ma’am dili siya makabalibad kung naa mo hagad saiya. Labi
nag gwapo daw ” as reported by the Case Manager. Hence, Mr. X used drugs again on
July 19, 2021, and was found positive during a drug test on July 23, 2021.
Course in the Hospital
Mental Status Exam
Mental Status Examination (MSE) are the most important diagnostic tools a psychiatrist
has to obtain, wherein are the information used to make an accurate diagnosis. The Mental
health Examination was conducted on July 23, 2021 via an online video call using zoom
application at 9 o’clock in the morning, the student nurses utilized a prepared guide questions
in order to assess and obtain the client’s health history and as well as the following mental
status:
Appearance and Behavior
Upon initial interaction with Mr. X, the student nurses were not able to observe for his
appearance as the interview was done through a virtual platform and that the client’s camera
was turned off. This was done in order to ensure the privacy and confidentiality of the client’s
identity.
The client however as described by his case manager was well groomed with his hair fix
and tidy but it was colored blonde, and has dress appropriately for the interview. Additionally,
as mentioned by his case manager the client previously has a tattoo, however after being
enrolled into the rehabilitation center, he has his tattoo removed. His posture was relaxed, but
as the student nurses were not able to observe for his gestures, his case manager, however,
mentioned that he has unconscious gestures, but has not specifically describe what kind of
gestures it was.
The client was responsive and coherent when asked by the student nurses. As observed,
the client was attentive throughout the whole interview, as he was able to answer questions
immediately and appropriately. The client was also able further explain on the questions asked
about him, specifically his relationship with his family, the influence of his peers, and his
experiences when he was locked in the city jail and was later on enrolled in the rehabilitation
center.
However, there are certain topics during the interview wherein the client appears to be
hesitant to talk about initially, specifically about his relapse, which he later on shared with the
student nurses when the interview was about to end. One unusuality that was also observed at
the end of the interview was that the client remained energetic all throughout the duration of
the interview despite that the interview ended almost past lunchtime. Additionally, after an
interview with the client’s case manager, he stated that the client tested positive for the drug
test the day he was interviewed, which may explain his behavior upon the time of the
interview.
Attitude
As observed, the client’s attitude was respectful and polite towards the student nurses,
the clinical instructor and the staff. It was also observed that the client was serious about the
interview and is cooperative and attentive when asked.
Emotions (Mood and Affect)
The client appears to be energetic and lively during the interview, however when topics
about his family, particularly about the relationship of his father and mother, his voice sounded
sad and melancholic, as he reminisces his experiences when his mother found out about his
father having a third party. There were also instances wherein the client verbalizes hatred and
anger during the interview, especially when he talked about being set-up by his friend during a
buy-bust operation, and also when he shared about his boyfriend cheating on him with another
girl. Additionally, he also happily shared a few of his achievements such as being able to be part
of the honor roll in his elementary and high school years, and some of his achievements in the
city jail and rehabilitation center. However, since the client’s camera was turned off during the
virtual interview the affect was not observed.
Speech
The quantity of his speech was long, and the client further explain his answers on the
questions that was asked by the student nurses. The rate of his speech was normal, it was
neither fast nor slow, the volume of his voice was medium and audible, and the client was
observed to understand some medical jargons such as illusion and hallucination. During the
interview, the client mainly used the bisaya language when conversing; however, he sometimes
switches to using English and tagalog during the interview. There were no other speech
disturbances observed such as stuttering, flight of ideas, looseness of association and word
salad. Additionally, the client was able to respond immediately to the student nurses’
questions.
Thought Content and Processes
Throughout the whole interview, the client thoughts are coherent and relevant to the
questions asked by the student nurses. The client stated that he did thought of ending his life,
according to the client there was a time wherein he isolated himself from others, when he
preferred to be left alone, and to give up on everything, and that he had thought of suicide, but
he added that it was all only in his thoughts, and have never tried of implementing it.
Additionally, on the topic of revenge and hurting others, the client mentioned that he
really did hated the person, who he once treated as friend but have set him up, and he wanted
to get even with her, however he added that he realized that it wasn’t good and that not
everything was her fault but he also must take the blame for his actions and take responsibility
for its consequences. But then again, he also added that if ever she later on provokes him, then
he would fight back.
In terms of phobias, the client stated to have no phobia of any situations or objects, his
case manager has also mentioned that according to his record the client does not have any
known phobias, but during the interview the client stated that he has a fear of having relapse.
Apart from that, there were no other observed difficulties or oddness noted (such as flight of
ideas, circumstantiality, and loose of associations).
Perceptual Disturbances
The client verbalizes to have not experience any kind of hallucination or delusions, his
case manager has also mentioned that he does not have any hallucination or other perceptual
disturbances such as derealization, depersonalization, illusion, and thought broadcasting.
Impulse Control
The client mentioned that there was a time wherein he was not able to control his
emotions, he described that he was about to take a nap that time when he heard his mother
and nephew arguing, he mentioned that earlier on that day he has taken drugs and said that he
may still be under the influence of drugs when he was not able to control his anger and hit his
nephew. However, this only happen once and the client mentioned that he cannot and is not
able to hurt others under normal circumstances, he reasoned that his aggression that time was
all the influence of drugs. Additionally, the client also shared when asked about his relapse and
what triggers him at that time, he mentioned that he was not able to say ‘no’ to his peers,
causing him to follow along with their invitations of taking drugs, he also added that aside from
that he may also be tempted of taking drugs which was why he agreed in the end.
Orientation and Memory

The client was able to answer correctly, of what is the current date, time, place and
person who is interviewing him. He was also able to recall his birthday, his parent’s birthday
and the current local and national news that he heard from the radio and the television.
Furthermore, he was also able to repeat the three words that was given by the student nurses.
Knowledge, Insights, and Judgment
The client stated that substance abuse disorder is a chronic brain disease; he mentioned
that taking drugs takes everything away from you. He added that he realized that the activities
of the Department of Health pertaining to the rehabilitation of the drug addicts is for the good
of everyone, as he reiterates that drugs would not do anyone good, and mentioned a few of the
bad impacts that drugs would have to anyone, which was it would cost money, it will destroy
the user’s body and mind and it will also destroy the addict’s relationship with others.
The client mentioned that the program taught them of how they would be able to
distract themselves when they feel tempted of taking drugs. Additionally, they taught him that
he could use a rubber band and wear it on his wrist and pull it and snap himself when he
thought of drugs, and through doing this, he said that it would help in distracting those
thoughts.
Furthermore, he also mentioned some non-pharmacologic coping strategies that was

taught to them such as exercising, music and dance, counseling, socializing and other strategies
that would help him cope with his problems. The client’s case manager also mentioned that the
client has a good record and is the top in his batch, however he added that recently due to his
relapse the client misses some of the activities. The client shared that he felt ashamed of his
relapse, and that he felt guilty when he faced his instructors and the staff, which he said to be
the reason why he recently does not want to go to the rehabilitation center.
But then again, the client was also grateful to the rehabilitation center for all their help
to him, he also added that his relapse was not right and that what his instructors taught is the
right thing to do. He also felt happy and moved by the support that his family has given him and
that he felt grateful have them, he also added that when things go wrong only our family would
support and give assistance.
Laboratory and Diagnostic Tests
Type of Definition Normal Result Interpretation Clinical Significance

Test Result
Chest X- Chest x-ray uses Normal chest -- The result was Chest X-ray is
ray a very small X-ray shows not disclosed generally used in
dose of ionizing normal size for the combination with
radiation to and shape of purpose of other clinical data
produce the chest confidentiality. such as, physical
pictures of the wall and the examination and
inside of the main the patient's history
chest. It is used structures in and symptoms. It
to evaluate the the chest. can also be used in
lungs, heart and combination of
chest wall and other radiology test
may be used to to support, confirm,
help diagnose or exclude many
shortness of conditions or
breath, diagnoses.
persistent
cough, fever,
chest pain or
injury.
Type of Definition Normal Result Result Interpretation Clinical

Test Significance
HIV Human False-positive Negative The client has HIV testing is
Testing immunodeficiency and false- no HI virus essential
virus (HIV) testing negative test detected. part for
determines results can client who
whether you're occur. Doctors have active
infected with HIV, will use a variety sex life, and
a virus that of tests in to determine
weakens your sequence (an the recent
immune system algorithm) until exposure to
and can lead to they determine HIV. This is
acquired for certain that to set a safe
immunodeficiency you are atmosphere
syndrome (AIDS). either HIV- to de-
negative or HIV- stigmatizing
positive. Thus, a people who
negative test have this and
result to protect
from HIV testing others as
may mean one well
of two things: especially
You don't the
have HIV, or it's healthcare
too soon yet to workers who
tell. are handling
them.
Type of Definition Normal Result Interpretation Clinical Significance

Test Result
Urine A urine drug A negative The client Individuals A positive result on
Drug test, also result undergone recovering a drug test tells the
Testing known as a indicates 39 times of from any kind clinician that the
urine drug that the drug test of addiction patient had a
screen or a drugs tested within the often detectable amount
UDS, is a for are not span of experience at of a substance
painless test. present or admission least one present during a
It analyzes are not in the relapse, certain window of
your urine for present in a facility, and according to time. Some kit will
the presence high enough 3 drug tests the National detect within 3
of certain quantity to during Institute on days window frame
illegal drugs detect. It home visit. Drug in
and does not Throughout Abuse (NIDA). methamphetamine.
prescription indicate the whole Addiction is a This result does not
medications. that the course of chronic typically indicate
person has stay of the disease, that impairment is
never used client, he making the result of any
the drugs or tested relapse a particular
that they positive possibility no substance or that
will not use twice matter how the patient has a
the drugs in during his long a person substance use
the future. drug has abstained disorder. A major
relapse. from consideration when
Dated June substance using drug testing is
10, 2021 abuse. Once regarding the
and July 23, relapse significance of a
2021 occurs, it can negative result.
be difficult for Clinicians should
an individual bear in mind that a
to get back on negative result
the road to simply means that
recovery. the particular
substance could
not be detected.
Diagnosis
Mr. X’s diagnosis is substance use disorder.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
the revised chapter of “Substance-Related and Addictive Disorders” includes substantive
changes to the disorders grouped there plus changes to the criteria of certain conditions.
Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse
and substance dependence into a single disorder measured on a continuum from mild to
severe. Each specific substance (other than caffeine, which cannot be diagnosed as a substance
use disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use
disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria.
In this overarching disorder, the criteria have not only been combined, but strengthened.
Whereas a diagnosis of substance abuse previously required only one symptom, mild substance
use disorder in DSM-5 requires two to three symptoms from a list of 11. Drug craving will be
added to the list, and problems with law enforcement will be eliminated because of cultural
considerations that make the criteria difficult to apply internationally.
Criteria for Substance Use Disorder
Substance use disorders are classified as mild, moderate, or severe, depending on how
many of the diagnostic criteria a person meets. In order to be diagnosed with a substance use
disorder, you must meet two or more of these criteria within a 12-month period. If you meet
two or three of the criteria, you have a mild substance use disorder. Four to five is considered
moderate, and if you meet six or more criteria, you have a severe substance use disorder.
The 11 DSM-5 criteria for a substance use disorder are:
I. Hazardous use: You have used the substance in ways that are dangerous to yourself
and/or others.
II. Social or interpersonal problems related to use: Substance use has caused relationship
problems or conflicts with others.
III. Neglected major roles to use: You have failed to meet your responsibilities at work,
school, or home because of substance use.
IV. Withdrawal: When you stop using the substance, you experience withdrawal symptoms.
V. Tolerance: You have built up a tolerance to the substance so that you have to use more
to get the same effect.
VI. Used larger amounts/longer: You have started to use larger amounts or use the
substance for longer amounts of time.
VII. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but
haven't been successful.
VIII. Much time spent using: You spend a lot of your time using the substance.
IX. Physical or psychological problems related to use: Your substance use has led to physical
health problems, such as liver damage or lung cancer, or psychological issues, such as
depression or anxiety.
X. Activities given up to use: You have skipped activities or stopped doing activities you
once enjoyed in order to use the substance.
XI. Craving: You have experienced cravings for the substance.
Based on the client's interview last July 23, 2021, these are the DSM-5 criteria for
substance use disorder that were determined.
 Hazardous use:
Mr. X asked if there was a moment he thinks to end his life, he said “Kadto nga time
na nag drugs ko maam, ni abot nako sa point na gusto nako maghikog maam, kay kanang
murag nag self-pity ko, kay syempre akong igsuon ing ana, ug ako lahi na, basta ing ana
ako tag bati sauna, kanag murag gusto na nako wakasan akong life”. “Ni abot gyud ang
time maam na grabe nako ka depressed, di nako gusto mugawas, di ko gusto makig storya
sa mga taw, gusto ko naa rako sa sulod, ug di pud ko gusto maka kita ug hayag, kadtong
grabe na gyud kayo to maam, grabe na gyud to na stage sa ako pag drugs” he added.
 Social or interpersonal problems related to use:
Mr. X shared, “Naa toy isa ka time maam, na sumbagan gyud nako akong pag
umangkon tapos na black-eye-yan gyud sya, kay lagi sabaa man nila sa akong mama,
nangayo siguro tug baon tapos wala mahatagan ni mama, nag lalis sila, tapos ako gisabaan
na kayko gusto matulog kay wala pa lagi koy tugpa, so mao to ni gawas ko ug nasumbagan
gyud nako akong pag umangkon, kay lagi iya pud tag yawa yawa niya akong mama, ug
tigulang na baya pud akong mama tapos iya ra tag tubag tubag tapos pag umangkon ra
siya, nag gi sipa gyud nako sya maam, ug iyang mata na black-eye-yan jus sya sa akong
kalagot kay napuno na gyud ko”. Mr. X said that after what happened he and his siblings
was not in good terms because of what he did especially to his brother the father of his
nephew. “Mouli lang ko timan-e, mag abot ra gahapon tang duha, unsay imo tag himo
sakong anak. Akong mga igsuon nasuko sa ako kay gi ing ana nako akong pag umangkon
ngano daw nadapatan nako nga sobra ra kay na black-eye-yan man gyud sya maam”, he
added.
 Neglected major roles to use:
Mr X shared one about his neglected work, “Kadtong nag rebond gyud ko maam,
nahingag kayko ato na time kay akong isa ka amigo ni adto man sa parlor nanghagad ug
manuyop daw mi, magshabu, so ang ako pud, nag dali2 pag rebond wala na na natarung
ug ni abot rami ato ug 4 hours pag rebond na kasagaran raba gyud ko mag rebond kay 10
to 13 hours, kay mao lagi to akong amigo nag hulat naman nako, ako rang tagdali-dali
akong trabaho, ug mao to wala na tarung, ni balik pa lang ng akong customer after ambot
pila to days maam, gi pa utro, so ako tag utro napud, nag balik2 rakos akong trabaho kay
lagi na hingag kay manuyop na lagi mi”.
 Withdrawal:
According to Mr. X, he experienced insomnia, irritability, craving and drooling lips.

“Normal ra withdrawal sa na addict gyud na tao”, Mr. X said.
 Tolerance:
Mr. X has mentioned that he really started taking drugs as a way to cope up with his
situation in taking his hospitalized father until in no time, he has been using it 4 days in a
week, even after his father died.
 Repeated attempts to control use or quit
When Mr. X questioned if he ever quitted taking drugs he responded, “Nagsisi ko

maam ngano ni sulod ko ani, dili ko maka tulog ug tarung labi na tong first day nakos
prisohan, naghunahuna ko nganong nabuhat to naho, naa man tana koy talent, naa koy
igsuon na supportive, naa koy trabaho”.
“Pag gawas nakos sa city jail kadtong January 8, 2020 maam, wala na gyud ko ni
gamit, ug di na pud gyud ko mugamit, so nag pa enrol ko dnhi sa rehab last January 22,
2020.” Moreover, client also shared that he relapsed, “Nag relapse ko ka isa maam, na
relapse ko atong June man siguro, karun na year maam, mao nadaot akong record, tapos
naulaw na ko mag anhian dayon dinhi, naulaw kos akong mga teacher ug nila sir”.
However, the case manager stated that, during our interview with the client, he tested
positive for taking drugs, “To tell you frankly maam ha, nasuko gyud ko sa iyaha kay after sa
interview ninyo ako man shang tag pa drug test, nag positive man sya, so during the time
diay nga gi interview ninyo siya, nag take diay sya drugs. Natingala man gyud k okay lahi
iyang behaviour, so mao to to after sa interview ninyo, it turned out nga nag positive siya. ”
This indicates that the client has yet to succeed in attempting to control the substance's
use.
 Much time spent using:
Mr X. asked if how long he has taken drugs and he said, “Kung baga ni gamit ko
atong mga time na nag sige na kasakit akong papa, kada gabie man ko magbantay, naa
poy mga silingan na mga temptations, mag gamit kuno ko para dili katulog para alive-alive,
para kusgan, unsa patong mga dram uban para maka bantay ko sa akong papa, mga year
namatay akong papa 2015, nadakpan ko year 2016 so kibali mga 3 years nako nag gamit”.
“Mugamit ko ka-upat sa is aka semana, pahuway rag isa ka adlaw or duha”.
 Physical or psychological problems related to use:
Mr X. asked if he has illness upon enrolling to the rehab he said, “So far wala
ma’am”. However, the case manager reported that he experienced anxiety later on.
 Craving:
Mr. X asked when was the time he started taking drugs and he said, “Nakatry ko
tungod sa akong mga silingan, unya na sigundahan, ug mao na dayon to sige sige na. Ug
hangtud ni abot ang time na dili nako makatostos sa akong kaugalingon, unsaon man naho
ni oy, dili naman ko maka suyop so kinahanglan ko aning mupalit kog worth 500 paulian
nakog worth 1000 so naa koy 500, so ang 500 akong paulian, ang isa ka 500 akong
gamiton, so malibre ko paggamit everyday”, “Lami kayo ma’am, na adik gyud ko maam
magsige ko pangita sauna”.
Medical Treatment
Substance use recovery involves much more than clearing drugs or alcohol from the
body. Overcoming the disease of addiction requires an understanding of the origins of
substance use, the motivating factors for recovery, and the reasons for resistance to healing.
Mr. X enrolled in the rehabilitation center as an outpatient last March 2020. Group
Therapy attended by Mr. X are as follows:
 Narcotics Anonymous
Narcotics Anonymous describes itself as a “nonprofit fellowship or society of men

and women for whom drugs had become a major problem”, and has helped countless
people across the world escape substance abuse and addiction. Narcotics Anonymous (NA)
is a global association of self-help groups providing assistance to individuals struggling with
a drug addiction who have committed to a life of abstinence. Using the twelve-step model
initially developed by the founders of Alcoholics Anonymous (AA), Narcotics Anonymous is
the second-largest twelve-step organization globally and is the world’s largest recovery
programme for drug addiction specifically.
The 12 Steps of Narcotics Anonymous:
1. WE ADMITTED THAT WE WERE POWERLESS OVER OUR ADDICTION — THAT OUR LIVES
HAD BECOME UNMANAGEABLE.
- People battling addiction must admit that they have no control over the illness. As a result,
they have lost power over many aspects of their lives.
2. WE CAME TO BELIEVE THAT A POWER GREATER THAN OURSELVES COULD RESTORE US

TO SANITY.
- Whether you’re an agnostic, an atheist or a believer, trusting a higher power could help

you turn your life around.
3. WE MADE A DECISION TO TURN OUR WILL AND OUR LIVES OVER TO THE CARE OF GOD
AS WE UNDERSTOOD HIM.
- It is important to understand the significance of a higher power in overcoming addiction.

Through step three, people with addiction turn their loves over to this superior entity.
4. WE MADE A SEARCHING AND FEARLESS MORAL INVENTORY OF OURSELVES.

- People with addiction should reflect on their lives, honestly evaluating their past.
Evaluating past mistakes could steer people toward recovery.
5. WE ADMITTED TO GOD, TO OURSELVES, AND TO ANOTHER HUMAN BEING THE EXACT

NATURE OF OUR WRONGS.
- After evaluating past mistakes, the next step asks people battling addiction to admit to the
root of past wrongdoings. Sharing the nature of these mistakes with oneself, loved ones and
a higher power is an important step toward recovery.
5. WE WERE ENTIRELY READY TO HAVE GOD REMOVE ALL THESE DEFECTS OF CHARACTER.
- Individuals with addiction should prepare for their higher power to eliminate their
addictive behaviours.
7. WE HUMBLY ASKED HIM TO REMOVE OUR SHORTCOMINGS.
- People with addiction allow a higher power to eliminate character flaws. However, it is
important that they separate themselves from factors that influence addictive behaviours.
8. WE MADE A LIST OF ALL PERSONS WE HAD HARMED AND BECAME WILLING TO MAKE
AMENDS TO THEM ALL.
- Addiction strains relationships and harms loved ones. The addicted person should make a
list of those whom they have wronged and be willing to admit their past transgressions.
9. WE MADE DIRECT AMENDS TO SUCH PEOPLE WHEREVER POSSIBLE, EXCEPT WHEN TO DO

SO WOULD INJURE THEM OR OTHERS.
- Individuals should find time to apologize to those they have wronged in the past, except
when doing so would cause further harm. They should tell the truth about past actions and
offer a genuine apology.
10. WE CONTINUED TO TAKE PERSONAL INVENTORY AND WHEN WE WERE WRONG

PROMPTLY ADMITTED IT.
- The 10th step promotes vigilance against triggers. People with addiction must address
their addictive behaviors should they arise. Taking a personal inventory should become a
daily process.
11. WE SOUGHT THROUGH PRAYER AND MEDITATION TO IMPROVE OUR CONSCIOUS
CONTACT WITH GOD AS WE UNDERSTOOD HIM, PRAYING ONLY FOR KNOWLEDGE OF HIS
WILL FOR US AND THE POWER TO CARRY THAT OUT.
- This step provides daily spiritual maintenance. Maintaining a relationship with a higher
power can help a person with addiction reach recovery.
12. HAVING HAD A SPIRITUAL AWAKENING AS THE RESULT OF THESE STEPS, WE TRIED TO
CARRY THIS MESSAGE TO ADDICTS, AND TO PRACTICE THESE PRINCIPLES IN ALL OUR
AFFAIRS.
- This spiritual awakening allows people in recovery to share their techniques with those
suffering from addiction. Helping others through these tough times is a significant aspect of
NA’s 12-step program.
“Mga tao na nabiktima ug drugs na nag recover na, nag sober na sila , wala nay
drugs sa ilang lawas, mo attend sila ana na meeting, para to maintain sobriety’. case
manager said.
 Community Support Group Meeting
Support groups allow you to interact and connect with people who have been in a
similar situation to you. Sharing information about similar experiences can help you
understand more about your own situation and give you an opportunity to feel ‘heard’.
 Group Dynamics
The term "group dynamics" describes the way in which people in a group interact
with one another. When dynamics are positive, the group works well together. When
dynamics are poor, the group's effectiveness is reduced.
Group dynamics elaborates the effects of the roles and behaviours being played by
an individual as they maintained membership within a group. Recent researchers
strengthen Lewin's ideas, and this work has become central to good management practice.
A group with positive dynamism is easy to spot for team members (Garan, 2020).
 Spiritual Enhancement Activities
Spirituality enhancement can be described as the experience of a shift in a person’s

personal beliefs regarding their existence and place within the universe, their relationship
to others, and what they value as meaningful in life. It results in a person rethinking the
significance they place on certain key concepts, holding some in higher regard than they did
previously, and dismissing others as less important.
 Relapse Prevention
Relapse Prevention Therapy is a type of cognitive-behavioral therapy. It primarily

treats addiction and substance abuse but also treats mental health disorders like
depression, OCD, and more.
According to a foundational study on Relapse Prevention (RP), the therapy “seeks to

identify high-risk situations in which an individual is vulnerable to relapse and to use both
cognitive and behavioral coping strategies to prevent future relapses in similar situations”
(Marlatt & Witkiewitz, 2005).
RP helps patients limit relapses in their recovery by teaching them to anticipate

scenarios that may trigger their addictive behavior. It also teaches skills to cope with these
triggering situations. Some factors that contribute to relapse include one’s personal moods
and environmental triggers.
Individual Therapy attended by Mr. X are as follows:
 Art Therapy
Art therapy is a form of experiential therapy, an approach to recovery that

addresses emotional and spiritual needs through creative or physical activity. It is not
necessary to have a background in the arts or artistic talent to participate; individuals
only need to be open to the experience and to engage actively to benefit from these
sessions. Many clients find that art therapy is a relaxing and enjoyable way to address
some of the more complex aspects of rehab. Creative activity provides a way to process
some of the stressful emotions and anxieties that can emerge during treatment. After
rehab, activities like painting or drawing, can be used throughout the individual’s life as
a way to express feelings, explore creativity, and reduce stress.
Attitude of Mr. X to the Treatment
Case manager was asked by the student nurse, what are the attitudes of the client when
it comes to his therapies and for some, he responded, “With regards to the attitude and
behaviors, active na sila during the therapy, active then talkative, then they dominate the
conversation kay most of them we called them narcissist, narcissism behaviour gyud na maam.
Kanang bilib sila sa ilang sarili, sobra ra sila ka confident sa ilang kauglaingon , gusto nila nga
gina appreciate sila permi, tagaan silag importansya , gusto nila nga sila ang labaw sa ilang
grupo, ing ani ilang behaviour maam, most of them”. Student nurse asked,”Including the
patient sir?” and he responded, “Ou, ing ana gyud sila, kasagaran ilang behaviors kailangan
dapat na tagaan gyud silag importansya permi. Kay during the time na nag adik adik pana sila,
wala sila nahatagan ug koneksyon sa ilang pamilya bitaw. Kay ang ilang ginabuhat para
lamang sa ilang kauglingon nga maka suyop sila , nga maka take silag drugs without thinking
na ang ilang pamilya ila ng napasagdan nya karun this time nga nag recover na sila, they give
more importance about their families”.
During the interview with the client the student nurse asked him, “Of all the therapies
you’ve attended, what are the progress or changes you’ve experienced so far?”, the client
responded, “Kanang dili na parehas sa una, kay syempre sa una naga crave mi, kinahanglan mo
gamit ko, kinahanglan mangita ko ug drugs kay gusto ko mugamit so ang nabag-o is dili name
mag crave, kay naa naman mi mga therapy kibali na e divert namo among kaugalingon sama
sa pag exercise, sa pag read ug bible or magazine, music, spirituality, mao ra”.
List of Prioritized Nursing Diagnosis
Date Identified Rank Identified Problem Date Evaluated

July 23, 2021 1st Fear related to
embarrassment to self
in front of others
secondary to substance
abuse
July 23, 2021 2nd Ineffective coping

related to previous
ineffective/inadequate
coping skills with
substitution of drug
abuse
July 23, 2021 3rd Denial related to
episodic compulsive
indulgence secondary
to substance abuse
July 23, 2021 4th Powerlessness related

to failure to say no due
to peer pressure and
temptation of drugs
abuse
July 23, 2021 5th Low self-esteem
related to failure to
achieve self-
expectations secondary
to substance abuse
July 23, 2021 6th Noncompliance related

to failure to adhere to
treatment regimen as
evidenced by not
taking the prescribed
medication for
hypertension
NURSING CARE PLAN NO. 1
Cues Nursing Diagnosis Planning Nursing Interventions Rationale Evaluation
Subjective Fear related to Short term Independent

embarrassment to self in
When asked what his fears front of others secondary Within 8 hours of nursing 1. Assess the behavioral 1. This information
and verbal expression provides a foundation
are, the client hesitated to substance abuse interventions, the client
of fear. for planning
and said: will be able to discuss
interventions to
“Mahadlok jud ko mag situations or triggers that
support the client’s
relapse… Naulaw ko may lead to relapse and coping strategies.
ma’am. Naulaw ko sakong express feelings of fear Nurses should use a
kaugalingon ug nahadlok related to the experience range of verbal and
ko kay nag relapse ko. of relapse. non-verbal
Ingon akong maestro communication
topnotcher daw ko diri sa methods to better
amo, gwapo akong record understand and
unya ako gi hugawan. Long term respond to client’s
Dapat gani adtong personal and health
Monday ipatunga ko pero Within 4 weeks of nursing needs (Ali, 2018).
wako ni tunga. Kumbaga interventions, the client
nagpatigas galing ko will be able to reframe the
ma’am, kay diko gusto mo relapse as a learning
2. This approach validates
anhi kay mahadlok ko sa experience and not as an
the feelings the client is
ilang ma ingon” as embarrassing situation. holding and
verbalized by the client. demonstrates
recognition of those
feelings. Clients who
feel understood are
Objective often more open and
2. Open up about your responsive to their
- Relapse during
nurse’s advice (Tayal, et
treatment as awareness of the
reported client’s fear. al., 2016).
- Worried and
embarrassed in
voice tone noted 3. The client’s feeling of
stability increases in a
- Voice went soft peaceful and non-
when opening up threatening
about not wanting environment.
to go back to the
center
4. Familiarity with the
3. Maintain a relaxed and setting promotes
accepting demeanor comfort and a decrease
 positive for drug while communicating in fear.
test with the client.
5. This reassure client that

4. Familiarize the client asking for help is both a
with the surrounding as sign of strength and a
necessary. step toward resolution
of the problem.
Empathy is described as
the recognition and
5. If client’s fear is a validation of a client’s
reasonable response, fear, anxiety, pain, and
empathize with him. worry; and the ability
Avoid false to understand clients'
reassurances and be feelings to facilitate
truthful. more accurate
diagnoses and more
caring treatment
(Tayal, et al., 2016).
6. Maintaining a calm,
quiet environment
alleviates client’s fears
and concerns (Holzman
& Raffel, 2015).
7. Recognition and
explanation of factors
leading to fear are vital
in developing
alternative responses.
6. Maintain a quiet
environment. 8. Relaxation improves
ability to cope. This will
increase the client’s
sense of control and
help lessen anxiety
(Schultz & Videbeck,
7. As the fear subsides, 2013).
encourage the client to
involve himself to
specific events
9. Meditation, prayer,
preceding the onset of
music, therapeutic
the fear.
touch, and healing
8. Allow the client to have touch techniques help
lighten fear.
rest periods.
10. Cognitive behavioral

therapy are aimed to
prevent anxiety
disorders as early as
possible (Wolgensinger,
2015). A reward that
comes from
9. Initiate alternative participating in a group
treatments. Provide is the opportunity to
verbal and nonverbal meet others with the
(touch and hug with same problem. Even if
not, everyone will have
permission)
the same triggers or
reassurances of safety.
severity of symptoms, it
is helpful to know that
the client realizes that
10. Refer to cognitive he is not alone.
behavioral group
therapy.
11. Maintain the client’s

ability to accurately
interpret and respond
to the environment.
Collaboration
11. Coordinate and
collaborate with the
case manager to
monitor conduct of the
following treatment
plans and therapies of
12. A variety of community
the client such as
agencies provides
Group Therapy;
resources, information
Narcotic Anonymous;
and support group that
Sound and Music may help to understand
Therapy; Art Therapy; the best approaches to
Social Therapy; Talking client’s adaptation and
to a Counselor; independence.
Spiritual Enhancement
and Relapse Prevention
activities.
12. Make appropriate

referrals to community
resources.
Subjective Ineffective coping related Short term Independent

“To tell you frankly maam to previous
Within 8 hours of nursing 1. Determine 1. Provides information
ha right after sainyong ineffective/inadequate
interventions, the client understanding of about degree of denial,
interview gipa drug test coping skills with
will be able to identify current situation, acceptance of personal
nako siya and nag positive substitution of drug
ineffective coping previous, and other responsibility and
siya. So, during that time secondary to substance
behaviors and identify methods of coping with commitment to
na gi interview ninyo sya, abuse
triggers to substance use. life’s problems. change; identifies
nag take diay syag drugs
adto. Kay natingala man coping skills that may
ko na murag lain naman Long term be used in present
iyang behavior, over situation (Vera, 2020).
confident man ug hyper Within 4 weeks of nursing
2. Client has learned
kaayo. Nag high gid diay interventions, the client
manipulative behavior
sya adto na time. Ang will be able to modify 2. Set boundaries and
and needs to learn a
iyang rason ma’am dili siya lifestyle as needed by oppose attempts to new way of getting
makabalibad kung naa mo participating routinely in offer special privileges, needs met. Following
hagad saiya. Labi nag drug free activities making excuses for not through on
gwapo daw” as reported provided by the DOH that following through on consequences of failure
by the Case Manager. give satisfaction and behaviors agreed on,
pleasure. to maintain limits can
and attempting to help the client to
Objective continue drug use. change ineffective
- Relapse during behaviors (Vera, 2020).
treatment as
reported 3. May help client begin
- Inability to meet to come to terms with
long unresolved issues.
role expectations 3. Encourage verbalization Expressing emotion is a
- Reported positive in of feelings, fears, and tool for improving goal
a drug test anxiety. attainment (Wong,
- High during the 2013). Client atient
interview as may have little or no
reported knowledge of adaptive
responses to stress and
needs to learn other
options for managing
time, feelings, and
relationships without
drugs. Finding new
ways of coping may
help in the recovery
process of the client
(Kilburn & Whitlock,
2015).
4. Relaxation techniques
encompass an array of
strategies to increase
feelings of calm and
decrease feelings of
stress (Norelli, 2020).
4. Explore alternative
coping strategies such
as medidation; keeping
busy by watching tv, 5. Helps client to relax,
reading a book, and develop new ways to
listening to music; deal with stress,
journaling, exercise. problem-solve.
5. Assist client to learn 6. Discovery of alternative
and encourage use of methods of coping with
relaxation skills, guided drug hunger can
imagery, visualizations. remind client that
addiction is a lifelong
process and
6. Structure diversional
opportunity for
activity that relates to
changing patterns is
recovery (social activity
available (Townsend,
within support group),
2011).
wherein issues of being
chemically free are 7. Self-help groups are
examined. valuable for learning
and promoting
abstinence in each
member, using
7. Use peer support to
understanding and
examine ways of coping
support as well as peer
with drug hunger.
pressure. Participating
in a support group can
be important elements
of recovery because it
prevents relapse as it
decreases feelings of
loneliness and risk of
isolation which can be
a common trigger for
relapse (Addiction
Center, 2021).
8. Narcotics Anonymous
is a 12-step program
where people addicted
to drugs can find
support in recovery. It
is a group where
8. Encourage consistent people recovering from
attendance to Narcotics drug addiction can help
Anonymous. each other pursue
healthy choices. This
support group can help
the client prevent from
relapse as it decreases
feelings of loneliness
and risk of isolation
(Buddy, 2021).
9. Encourages client to
talk freely without fear
of judgment.
10. Therapeutic writing or
journaling can enhance
participation in
treatment; serves as a
9. Provide safe, non- release for grief, anger,
threatening and stress; provides a
environment. useful tool for
monitoring client’s
10. Encourage involvement
safety; and can be used
in therapeutic writing.
to evaluate client’s
Have client begin
progress (Nyssen,
journaling or writing
2020).
autobiography.
11. Provide opportunity to
develop and refine
plans. Devising a
comprehensive
strategy for avoiding
relapses helps client
into maintenance
phase of behavioral
11. Discuss client's plans for change.
living without drugs.
12. To identify the
triggering factors and
determine how they
might be
prevented/avoided.
13. Positive feedback can

12. Explore with the client provide the client a
the triggers that lead sense of
him to substance use accomplishment and
and the ways he may repetition of desired
avoid them. behavior. The client
can build on his
13. Discuss with the client successful coping skills
events in the past to deal with the
wherein he has current situation.
successfully avoided
substance use and the
ways he may use these
coping skills in the
present.
to the environment.
Collaboration
14. Coordinate and
case manager to
following treatment
the client such as Group
Therapy; Narcotic
Anonymous; Sound and
Music Therapy; Art
Therapy; Social
Therapy; Talking to a
Counselor; Spiritual
Enhancement and 15. A variety of community
Relapse Prevention agencies provides
activities. resources, information
15. Make appropriate and support group that
referrals to community may help to
resources. understand the best
approaches to client’s
adaptation and
independence.
Subjective Denial related to episodic Short term Independent

compulsive indulgence
“Denial man gyud nang secondary to substance Within 8 hours of nursing 1. Convey attitude of 1. An attitude of
acceptance, separating acceptance promotes
mga tao na mag gamit ug abuse interventions, the client
individual from feelings of dignity and
drugs ma'am. Dili mo tug- will be able to divert
unacceptable behavior. self-worth (Townsend,
an sa tinuod. Kadtong last attention away from
2011).
siya nag positive, external issues and focus
gipangutana nako siya, ug on behavioral outcomes 2. This information helps
di gyud mo angkon na nag associated with substance client make decisions
gamit. Ni ana ang client use. regarding acceptance
'ngano mag positive man 2. Review definition of
of problem and
ko sir nga wala man ko drug dependence and
treatment choices.
categories of symptoms
migamit, naay nibuhot na Education of all care
Long term (patterns of use,
aso nakasimot rako sir'." as providers about the
impairment caused by
reported by the Case nature of and
Within 4 weeks of nursing use, tolerance to
Manager. treatment for addiction
interventions, the client substance).
may be needed to
will be able to verbalize improve health care
(Bartlett et.al 2013).
Objective acceptance of
responsibility for own
- Denies using drugs
behavior.
again 3. First step in decreasing
- Reported positive in use of denial is for
a drug test client to see the
- Relapse during relationship between
treatment as substance use and
reported personal problems.
- Client’s answers
and his progression 3. Discuss current life
in the center does situation and impact of
4. Because denial is the
not match substance use.
major defense
mechanism in addictive
disease, confrontation
by peers can help the
client accept the reality
of adverse
consequences of
4. Confront and examine behaviors and that drug
denial and use is a major problem.
rationalization in peer Caring attitude
group. Use preserves self-concept
confrontation with and helps decrease
caring. defensive response
(Vera, 2020).
5. Confrontation can lead

to increased agitation,
which may compromise
safety of client and
staff. Nonjudgmental,
holistic care helps
promote well-being
and may improve the
client’s mental,
physical, emotional and
spiritual health
(Arkansas State
University, 2017).
6. Denial can be replaced

with positive action
5. Remain when client accepts the
nonjudgmental. Be reality of own
alert to changes in responsibility.
behavior (restlessness, Supporting client to be
increased tension). actively involved in
their own care and
treatment can improve
positive outcome
(Zamanzadeh et.al,
2015).
7. To assist the client deal

appropriately with the
situation. Family is the
primary source of
attachment thus
encouraging family to
seek help provide a
positive outcome for
the client (Lander,
2013).
6. Encourage and support

client’s taking 8. Necessary to enhance
responsibility for own self-esteem and to
recovery (development reinforce insight into
of alternative behaviors behavior.
to drug urge and use).
Assist client to learn
own responsibility for
9. Attendance is related
recovering.
to admitting need for
help, to working with
denial and for
maintenance of a long-
term drugfree
existence (Vera, 2020).
7. Encourage family
members to seek help
10. The establishment of
whether or not the
trust is the foundation
abuser seeks it.
of all interpersonal
relationships and is
vitally important to the
development of the
therapeutic
relationship in nursing.
Clients need to believe
that nurses are honest,
knowledgeable,
dependable, and
accepting of who they
8. Provide positive are as people (Sheldon,
feedback for expressing n.d.).
awareness of denial in
self and others.
11. Peer feedback is often
more accepted than
9. Maintain firm feedback from
expectation that client authority figures. Peer
attend recovery pressure can be a
support and therapy strong factor as well as
group regularly. the association with
individuals who are
experiencing similar
problems.
10. Answer questions
honestly and provide
factual information. 12. Maintain the client’s
Keep your word when ability to accurately
agreements are made. interpret and respond
to the environment.
11. Encourage participation
in group activities at
DOH TRC.

agencies provides
may help to understand
the best approaches to
client’s adaptation and
independence.
Collaboration
12. Coordinate and
case manager to
following treatment
the client such as
Group Therapy;
Narcotic Anonymous;
Sound and Music
Therapy; Art Therapy;
Social Therapy; Talking
to a Counselor;
activities.

resources.
Subjective Powerlessness related to Short term Independent

“Natingala nalang ko naa failure to say no due to
Within 8 hours of nursing 1. Assist client to 1. Nonjudgmental,
silay gihatag sako. Ingon peer pressure and
recognize problem holistic care helps
ko ‘dili ko gaw kay naa koy temptation of drugs interventions, the client
exists. Discuss in a promote well-being
record sa DOH, basin ma secondary to substance will be able to identify
caring, nonjudgmental and may improve the
positive ko’. Pero ingon abuse ways to avoid trigger
manner how drug has client’s mental,
siya ‘sge na gaw ka isa ra situations (such as peer interfered with life.
bitaw’. Ambot unsa akong pressure) that makes him physical, emotional and
nakaon, syempre sakong prone to substance abuse. spiritual health
kaulaw sakong mga ig- (Arkansas State
agaw mao to ni sugot ko” University, 2017).
as verbalized by the client. 2. Client participation
Long term means involvement of
the client in decision
Within 4 weeks of nursing 2. Involve client in
Objective making or expressing
development of
interventions, the client opinions about
- Relapse during treatment plan, using
will be able to effectively different treatment
treatment as problem-solving process
problem-solve ways to methods, which
reported in which client identifies
take control of his life includes sharing
- Feeling of pressure goals for change and
situation, thereby information, feelings
- Can’t say no agrees to desired
decreasing feelings of and accepting health
- Easily tempted outcomes.
powerlessness. team instructions
- Voice went soft (Vahdat, et al., 2014).
when opening up
about relapse
3. Client may need

assistance in
expressing self,
speaking about
powerlessness,
3. Explore support in peer admitting need for help
group. Encourage in order to face up to
sharing about drug problem and begin
hunger, situations that resolution.
increase the desire to
indulge, ways that
substance has
influenced life. 4. Learning to empower
self in constructive
areas can strengthen
ability to continue
recovery. These
activities help restore
4. Assist client to learn natural biochemical
ways to enhance health balance, aid
and structure healthy
diversion from drug use detoxification, and
by maintaining a manage stress, anxiety,
balanced diet, getting use of free time. These
adequate rest, and diversions can increase
exercise. self-confidence,
thereby improving self-
esteem. In addition,
exercise promotes
release of endorphins,
creating a feeling of
well-being (Vera,
2020).
5. Understanding these
concepts can help the
client to begin to deal
with past problems or
losses and prevent
repeating ineffective
coping behaviors and
self-fulfilling
prophecies.
6. Surrendering to and
faith in a power greater
than oneself has been
5. Provide information found to be effective
regarding for many individuals in
understanding of substance recovery;
human behavior and and may decrease
interactions with sense of powerlessness
others.
(Puchalski, 2010).
7. Effective in helping
refrain from use, to
stop contact with users
and dealers, to build
healthy relationships,
and regain control of
own life.
6. Assist client in self-

8. Client’s emotional
examination of
condition interferes
spirituality, faith.
with his ability to solve
problems. Assistance is
required to perceive
the benefits and
consequences of
available alternatives
accurately (Townsend,
2011).
9. The client can learn to

ventilate feelings in a
safe situation with the
nurse. Positive support
encourages the client
to continue to do so
(Schultz & Videbeck,
7. Instruct in and role-play 2013). Expressing
assertive emotion is a tool for
communication skills. improving goal
attainment (Wong,
2013).
10. Increasing the client’s

support system by
establishing new
relationships may help
decrease future
8. Help identify areas of depressive behavior
life situation that client and social isolation.
can control. Having a support
system, one should
strive to focus on the
several important
relationships with a
handful of people in
their social circle and
strengthen these
relationships
(Umberson, 2010).

to the environment.
9. Encourage the client to

express feelings,
including anger,
hostility, worthlessness,
or hopelessness. Give
the client support for
expressing feelings
openly and honestly.

identify supportive
people outside the
center and to develop
these relationships.

agencies provides
may help to
understand the best
approaches to client’s
adaptation and
independence.
Collaboration
11. Coordinate and
case manager to
following treatment
Therapy; Narcotic
Music Therapy; Art
Therapy; Social
Therapy; Talking to a
Counselor; Spiritual
Enhancement and
Relapse Prevention
activities.

resources.
Subjective Low self-esteem related to Short term Independent

“Mao to pagka relapse failure to achieve self-
1. Establish rapport with 1. To build trust to the
nako grabe jud nakong expectations secondary to Within 8 hours of nursing
interventions, the client the client. client.
pagmahay. Ana gani substance abuse
akong mga maestro diri will be able to verbalize
kay kaila naman sila nako, feelings and identify
nganong ing ana ko, underlying dynamics for 2. Assess mental status. 2. According to
nganong nag relapse daw negative perception of self. Silverstone lowered
ko. So mao na ma'am self-esteem has been
murag nawad an kog consistently found to
gana. Huna-huna nako, occur in several
grabe unsa man diay ko Long term
psychiatric disorders.
oy. Murag na hulog nako These include major
Within 4 weeks of nursing
sya nga weakness jod” as depressive disorder,
interventions, the client
verbalized by the client. eating disorders,
will be able to exhibit
anxiety disorders, and
increased feelings of self-
alcohol and drug
Objective worth as evidenced by
abuse.
verbal expression of
- Relapse during positive 3. Clients often have
treatment as
difficulty expressing
reported aspects about self, past self, even more
- Expressed guilt and accomplishments, and
regret about the difficulty accepting the
future prospects. degree of importance
relapse
- Sad tone of voice substance has assumed
noted in life and its
- Feelings of relationship to present
worthlessness and situation.
hopelessness noted
4. Self-concept is viewed
broadly as the meeting
3. Provide client the ground of the
opportunity for and individual and society
encourage verbalization and represents the
and discussion of individual's efforts to
individual situation. find personal meaning
and understanding.
Once the client has
expressed past feelings
and experiences, he
can put them in the
past and “let go” of
them, which can
provide opportunities
4. Assist the client to view for growth (NRC,
himself realistically in 2015).
the present and to allow 5. Positive feedback
the past to become increases the
history. frequency of desired
behavior. It promotes
engagement by sharing
thoughts and feelings
(Hardavella et al.
2017).
6. The client needs to
identify the most
comfortable and
beneficial ways of
appropriately
expressing feelings.
7. There are things in

everyone’s life that
have been successful.
Often when self-
esteem is low, it is
difficult to remember
these successes or to
view them as
5. Give positive feedback
successes.
for honest expression of
feelings. 8. Group sharing helps
encourage
verbalization because
other members of
group are in various
stages of abstinence
from drugs and can
address the client’s
concerns and denial.
6. Suggest appropriate The client can gain new
ways of expressing skills, hope, and a
feelings, such as talking sense of family and
and writing in a journal. community from group
participation.
9. Failure and lack of self-
esteem have been
problems for this
client, who needs to
learn to accept self as
7. Encourage client to list an individual with
and review past positive attributes.
accomplishments and
10. To lift self-esteem.
positive happenings.
8. Involve client in group

therapy.

to the environment.
9. Provide reinforcement
for positive actions and
encourage client to
accept this input.

10. Offer support and agencies provides
empathy when client resources, information
expresses and support group that
embarrassment at may help to
inability to remember understand the best
people, events, and approaches to client’s
places adaptation and
independence.
Collaboration
11. Coordinate and
case manager to
following treatment
Therapy; Narcotic
Music Therapy; Art
Therapy; Social Therapy;
Talking to a Counselor;
activities.

resources.
Subjective Noncompliance related to Short term Independent

failure to adhere to
“Naa koy tambal para sa treatment regimen as Within 8 hours of nursing 1. Develop a therapeutic 1. This allows the client to
relationship with the gain trust from the
high blood ma’am pero evidenced by not taking interventions, the client
client. nurse and will boost
wala nako gina tumar the prescribed medication will be able to express
confidence in the
karon kay dili man gyud ko for hypertension feelings about treatment
completion of the
gusto na ma anad akong regimen. treatment.
lawas sa tambal. Unya
kadto raman pod to
ma’am na taas akong BP”
as verbalized by the client. Long term 2. Clients who are
included in the
Within 4 weeks of nursing planning have greater
interventions, the client 2. Involve the client in stake in achieving a
Objective will be able to identify risk planning the proper positive outcome.
of noncompliance (e.g., treatment for him.
- Nonadherence exacerbation of symptoms
behavior
related to not taking the 3. Side effects of
- Refusal to follow
medication). medications is usually a
instructions or
suggestions commonly reported
- Doesn’t believe the problem.
benefits of the
medication 3. Explain that side effects
- Has its own thought can be controlled or
4. The client must ingest
about the eliminated.
medications because
medication he is being evaluated
for the drug’s
effectiveness, side
effects, or any
4. Observe the client problems associated
closely to ensure that with the prescribed
medications are medication. This is also
ingested. Remain with to ensure that desired
the client long enough outcomes are achieved
to see that the (Jin et.al, 2008).
medication was
swallowed.
5. Rewards provides
positive reinforcements
for compliant behavior.
6. Honest and complete

explanations foster
trust. The client may be
more likely to comply if
he feels fully informed.
5. Create with the client a
Moreover, explaining
system of rewards that
to clients is important
follow successful
in order to understand
compliance.
and manage their own
health and medical care
throughout their lives
6. Explain the need for (Marcus, 2014).
medications honestly
and directly. Give the
client full explanations.
7. The client may not have
made this connection
previously. The client is
more likely to comply if
he can see the benefits
of compliance.
8. The client may be

hesitant to express
feelings, especially
negative ones, without
explicit permission
from the nurse.
Discussing feelings
about chronic illness
and the continued need
for medication can be
an initial step toward
7. Help the client to draw the client’s acceptance
a connection between of his health status. The
noncompliance and the client may begin to see
exacerbation of long-term medication
symptoms. as a positive way to
remain more healthy
rather than a negative
indication of an illness.

express his feelings 9. Many people believe
about having a chronic that people take
illness and the medications when they
continued need for are sick and should not
medication. have to take them
when they are not sick
or feel better. The
client on long-term or
maintenance therapy
needs a different
perspective to remain
compliant.
10. Allowing the client to

make choices or
decisions about some
aspects of the
therapeutic regimen
enhances a sense of
personal control, thus
decreasing feelings of
helplessness and
dependency.
9. If the client has

stopped taking
medications when he
“feels better,” discuss
the role of the
medication in keeping
the client free of
symptoms.
11. If the client perceives a
greater reward for
honesty than for strict
compliance, he is more
likely to report
accurately. It is
essential to have
accurate information
before decisions
regarding changes in
medication or dosages
10. If the client is are made; therefore, it
noncompliant because is necessary to know
he feels “dependent” whether the client is
on the medication, taking the medication.
assist the client to gain If the client refuses to
a sense of control over comply and
the medication subsequently
regimen. This may experiences the return
include supervised self- of symptoms or
administration of rehospitalization, you
medication, selecting can use these data for
convenient and future discussions
acceptable times to about compliance.
take the medication, or
setting limits on
essentials and allowing
control of 12. Maintain the client’s
nonessentials. ability to accurately
to the environment.
11. If the client still refuses
to be compliant,
encourage him to
report this decision
accurately. Remain
matter-of-fact and non-
judgmental in your
agencies provides
approach to the client
when he is discussing
this decision. Give
may help to understand
positive feedback for
the best approaches to
honest reporting.
client’s adaptation and
independence.
Collaboration
12. Coordinate and
nurses or healthcare
workers to monitor
prescribed medical and
treatment plans.

resources.
PROGNOSIS AND RECOMMENDATION
Prognosis
The table presents the list of manifestations of the client whether it belongs to good and
poor prognostic factors:
PROGNOSIS JUSTIFICATION
Onset of Illness Poor Prognosis Drugs such as
methamphetamine are one
of the most potent
dopamine-increasing drugs,
Client X started using illegal and repeated misuse can
drugs in 2013 (around 37/38 years lead to severe sleep
old). His friends in his neighborhood deprivation (Volkow, 2020).
influenced him to take drugs for the According to the Australian
reason that he could stay awake and Government Department of
be energized when taking care of his Health, when the effects
father. Client X mentioned that he wear off, a person can
got curious about the drugs and experience a ‘come down’
since then, he used the drugs several including insomnia or
times, making sure that the client sleepiness and extreme
maintains a supply of the drug tiredness.
through buying with his friends.
(Where is the onset of illness
here?)
Symptoms including:
 Experienced trouble sleeping
for 2-3 days
 Felt light-weighted, very
active, talking fast
 Aggressive behavior
 Lack of self-control
 Body weakness after wear-off
of effects of the drugs
 Urge to use drugs regularly
Duration of Illness Poor Prognosis Drug addiction affects the
brain and behavior, resulting
in an inability to control the
use of illegal drugs. Users
Client X used illegal drugs for 3 physically feel as though they
years (2013-2016). He finds ways to need drugs to function
supply himself through his friends, normally (Mayo Clinic, 2017).
buying and selling to earn money The unpleasant reality is that
even with his job as a hairdresser. relapse after a period of
His symptoms including sleep recovery is all too prevalent.
deprivation, extreme tiredness, etc., Approximately, half of all
have been manifesting those years recovering addicts have a
of taking drugs. brief period of weakness,
which leads to relapse
(Juergens, 2021).
However, in June 2021, Client X
had a relapse when one of his (Where’s the duration of
father’s side passed away. He was illness here?)
encouraged by his cousin to drink
alcohol and use drugs. He verbalized
that he refused the offer, but he was
dazed due to the alcohol and
eventually accepted the offer. His
second relapse was in July 2021,
respectively.
Predisposing and Precipitating Poor Prognosis These risk factors can
Factors increase a person’s chances
of drug abuse. Ages among
26 years or older have
greater chances of continuing
Drug addiction has many risk to use them and becoming
factors that can be observed in the addicted later in life
client. However, these are the (MedlinePlus, 2021). Some
following predisposing and older adults may take the
precipitating factors manifested and substance to get through
reported by the client: with big life changes or
 Age: Among 26 years or older changes in living situations.
(including elderly) Trend data shows that more
 Prevalent in adults and the men than women use illicit
elderly drugs because women are
 Gender: Men are more likely
more open to their problems
than women to use almost all
than men (Scnitman, 2007).
types of illicit drugs
Family members, even
 Family History
distant relatives could
 Ineffective parenting
influence a person from using
 Experienced child abuse as a
child illegal drugs. Lack of parental
 Social pressures supervision could lead a
 Individual personality person to use illegal drugs
characteristics because there will be no one
 Academic failure who’s going to monitor him
 Drug availability and being exposed from
 Association with drug- violence in their home could
abusing peers exaggerate the person’s
 A lack of attachment and aggressive behavior when
nurturing by parents or using illicit drugs.
caregiver
Another important risk factor
is associating with peers who
engage in risky behaviors or
use drugs. Moreover,
research has shown that the
availability of drugs in a
person’s community is one of
the primary risk factors for a
person acquiring drug issues.
Adults who have no higher
education are more likely to
engage in health-impairing
behaviors. Individual
personality characteristics
signify our uniqueness of
how we will react to a certain
situation and being involved
in a drug addiction requires
strong and sensible decision
making. While others are
avoiding drugs because they
have firm decisions, some
people tend to try them out
of curiosity (Scholastic,
2008).
Mood and Affect Good Prognosis Appropriate mood and affect
during interaction means
that his emotion and
reactions are inlined of those
During the interaction, the questions that are asked by
client’s mood differs from the topic the interviewer. Assessing
or questions asked to him. Client X the client’s affect during the
appears to be happy when talking mental status examination
about good memories that he had, will help determine if there
sad and guilty when recalling difficult are any changes that will
times of his life which are all differentiate if the client has
appropriate on the situations and a psychiatric condition
feelings he had verbalized. (AMBOSS, 2020).
Attitude and willingness to take Poor Prognosis Relapse triggers, or reasons

medication and treatment for relapse, differ from one
person to the next. Some are
caused by the environment,
while others are caused by
Client X verbalized that he has no mental and emotional
prescribed medication that needs to factors. Drug-related stimuli
be taken during his recovery. that activate memories of
However, the client seldomly uses using in a person's brain are
amlodipine for his elevated blood typically the environmental
pressure and omega 3 for his heart reasons for relapse. These
since the client verbalized that he include places where the
doesn’t want to be dependent on his person used to take drugs
medicine. and a person whom he
associates with prior to
Furthermore, since his relapse, substance abuse. Relapse can
Client X has lost interest in going to also be triggered by
the facility for his recovery. He was emotional or mental factors.
not active, especially in online Due to the profound effects
it can have on a person's
meetings. brain, stress is one of the
most common reasons for
relapse (Turnbridge, n.d.).
Thus, making an individual
avoid things that he used to
do during his recovery.
Any Depressive Features Good Prognosis Depression can drain a
person’s energy, feeling him
empty and fatigued.
However, when a person
Client X verbalized that there was looks for support from
a time that he felt depressed during people that cares about him,
those years of using illegal drugs. this will help the client look
He’s contemplating about what on the bright side. A good
happened in his life because he felt listener who is attentive and
different from all his siblings. compassionate will aid the
However, the client realizes that he client’s emotions and
shouldn’t do something bad to strengthen his self-esteem.
himself because he believed that he Furthermore, positive
is stronger than his bad thinking. thinking can increase a
person’s motivation to
succeed and be out of any
depressive thoughts (Legg,
2018).
Family Support System Good prognosis Family support is the most
important aspect of people's
success. Individuals can be
persuaded to be successful in
Client X verbalized that his older their lives by their family's
sister has been a great help in their love and affection, as well as
family especially to him. He was their inspiration. Their
supported by his sister during his family's support will amplify
hard days up until he was recovering. their successful
He mentioned that no one’s going to characteristics, assisting
help him aside from his family and them to achieve whatever
he was thankful for their support. challenges that they will
encounter (Wongyeemoh,
2015).
Family History Poor Prognosis According to the National

Institute on Alcohol Abuse
and Alcoholism, one of the
most important risk factors
Client X has mentioned that his for addiction is family history.
cousin from his father’s side uses This means that everyone
drugs in June 2021. This was when who has a family member
the client had his first relapse due to who has struggled with
the influence of his cousin and substance misuse is at a
alcohol. However, the client does not higher risk of developing
their addiction (Destinations,
recall any other information about 2021).
the history of his family related to
drugs.
Results:
3 Good Prognosis
 Mood and Affect
 Any Depressive Features
 Family Support System
5 Poor Prognosis
 Onset of Illness
 Duration of Illness
 Predisposing and Precipitating Factors
 Attitude and willingness to take medication and treatment
 Family History
Analysis:
Based on the results, the client may have a poor prognosis during recovery for the reason
that some categories have a poor prognostic factor. These factors need to be intervened to
help the client from staying sober and not be dependent on illegal drugs to function normally in
his activities of daily living. The client may be referred to an inpatient facility depending on the
recommendations of the DOH-TRC. Furthermore, taking action on these poor prognoses will aid
the client from having another relapse.
RECOMMENDATION
Based on the findings obtained, recommendations have been made for consideration:
To the Patient and Family

 Instruct the client to evaluate stress if he’s experiencing it. Being aware of this stress can
help the client prevent actions that can trigger him from abusing drugs.
 Encourage the client to make changes in his lifestyle including regular exercise,
practicing mindfulness, be more open to his family and his counselor to prevent relapse.
 Advise the client to stay near his family’s home or be with his family in the meantime to
avoid any temptation especially that the client is living alone in his apartment.
 Learn to say no when family members or distant relatives, and friends invite him to
drink alcohol because being influenced by alcohol is more likely will put him in a
scenario where he can’t decide appropriately and do impulsive actions.
 Avoid places that can activate the client’s memories where he used to take drugs and
those people whom he’s associated with prior to substance abuse.
 Encourage the family to keep an eye on the client to watch for any signs of abuse or
relapse including isolation, mood changes, not attending his recovery meetings, and
denial.
 Instruct the family to make changes in the home environment such as eliminating or
ensuring that things are out of the client’s sight such as alcoholic beverages, foil, lighter,
which may trigger a relapse.
 The client may require extra attention, especially in the home. Be there to listen and do
not judge their feelings.
 Be aware of the client’s friends and their activities to avoid any triggers especially those
individuals that are known to be using drugs.
 Educate the family regarding drug addiction to give a better understanding and promote
awareness.
To the Nurses
 Assess the client’s feelings and emotions as well as his behavior regularly and promote a
therapeutic nurse-patient relationship.
 Be aware of the verbal and nonverbal cues of the client to enhance understanding and
establishes a better perspective as to what the client is exactly saying.
 Be consistent in reminding the client regarding the consequences of using illegal drugs.
 Confront and examine denial to help the client accept the reality of adverse
consequences of behaviors and that drug use is a major problem.
 Provide positive feedback for expressing awareness of denial in self to reinforce insight
into behavior.
 Allow random visits to the client’s home especially when he’s not attending his meetings
and therapies to identify any other possible reason why the client refused to show up.
 Develop coping strategies and skills to avoid high-risk situations such as helping the
client discover and participate in alternative behaviors with the family to combat a
possible lapse.
 Collaborate with the case manager, health workers, and therapist for referral of
treatment to provide a thorough intervention to the client that fits his status.
To the Community
 Educate the community comprehensively regarding drug addiction to raise awareness
and reduce the stigma placed on people under rehabilitation.
 People in the community should be open-minded and accept the client as to what he is
as a person.
 Ensuring that everyone with whom the client socializes during his work as a hairdresser
especially his co-worker understands that the client needs to be drug-free and shouldn’t
be forced to do something that can interrupt his recovery and trigger him from relapse.
Classification Indication Mechanism of Contraindications Side Effects/ Nursing C
Action
Adverse Effects
ntihypertensive; Alone or with other Inhibits the Contraindicated with Headache Assess b
alcium channel agents in the transport of allergy to periodically,
ocker management of calcium into amlodipine, Dizziness normal va
hypertension. myocardial and impaired hepatic or document
vascular smooth renal function, sick Hypotension effects.
muscle cells, sinus syndrome,
resulting in heart block (second Palpitations
inhibition of or third degree),
Bradycardia Assess dizzin
excitation- lactation.
contraction that migh
Prolonged headache balance, and
coupling and
subsequent activities.
Fatigue problems
contraction.
limitations t
Nausea
and caution
family/careg
Warmth/flushing
against falls a
skin
Educate clie
orthostatic
client shou
when assu
upright positi
Remind pa
medication
control hy
other cardiac
if they are as
Educate patie
medication, s
cause blood
and this may
heart attack
ietary Adjunct to diet to Mechanisms may Hypersensitivity to Bad breath Monitor for s
upplement reduce include inhibition fish or any symptoms of
hypertriglyceridemia. of component of the Unpleasant taste in those with
medication. fish.
acyl-CoA, Diarrhea
decreased lipo-
Provided as daily genesis in liver, Nausea
supplements. increased Educate patie
lipoprotein lipase Heartburn diet and exer
activity. to treatment
Headache
Back pain
Lab tests: Ba
Flu syndrome periodic lipid
Diarrhea
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FATHER SATURNINO URIOS UNIVERSITY

A Case Analysis Presentation on

Substance Use Disorder

Pia Mae Buaya

Preiffel Grace Bueno

Joann Marie Calo

Afzella Hillary Caniga

Angelica Marie Cocon

Myra Grace Comandante

Lou Lindsay Datahan

Charles Kevin Donoso

Rose Jean Ejos

Nadine Genesis Sumilhig

APRIL LOVE R. OJA, RN, MN

 Introduction of the client is too long

Anxiety- a feeling or apprehension about what is about to happen.

Dopamine- a neurotransmitter in the brain that causes pleasure. It is released in enjoyable

Glucocorticoid- is a cholesterol-derived steroid hormones synthesized and secreted by the

Hypothalamic-pituitary-adrenal axis- describes the interaction between the hypothalamus,

Psychoanalytic- a method of analyzing psychic phenomena and treating emotional

Psychobiologic- describes the interaction between biological systems and behavior.

Relapse- the act or an instance of backsliding, worsening, or subsiding.

CLIENT’S DEMOGRAPHIC PROFILE

II. Family History

Grandmother on the maternal side was hypertensive which puts his

III. Personality History

Infancy and Childhood characteristics

Mr. X has described himself to be “feminine” and identifies himself as a

Mr. X likes to play “bahay-bahayan” or “home simulation” in his childhood. He

Religious and Social Adaptability

Mr. X is currently a self-employed hairdresser and is in the process of building his

The onset of Present Illness

Mental Status Exam

Appearance and Behavior

Emotions (Mood and Affect)

Thought Content and Processes

Orientation and Memory

Knowledge, Insights, and Judgment

Furthermore, he also mentioned some non-pharmacologic coping strategies that was

Type of Definition Normal Result Interpretation Clinical Significance

Type of Definition Normal Result Result Interpretation Clinical

Type of Definition Normal Result Interpretation Clinical Significance

Mr. X’s diagnosis is substance use disorder.

Criteria for Substance Use Disorder

The 11 DSM-5 criteria for a substance use disorder are:

 Social or interpersonal problems related to use:

According to Mr. X, he experienced insomnia, irritability, craving and drooling lips.

 Repeated attempts to control use or quit

When Mr. X questioned if he ever quitted taking drugs he responded, “Nagsisi ko

 Much time spent using:

“Mugamit ko ka-upat sa is aka semana, pahuway rag isa ka adlaw or duha”.

 Physical or psychological problems related to use:

Narcotics Anonymous describes itself as a “nonprofit fellowship or society of men

The 12 Steps of Narcotics Anonymous:

2. WE CAME TO BELIEVE THAT A POWER GREATER THAN OURSELVES COULD RESTORE US

- Whether you’re an agnostic, an atheist or a believer, trusting a higher power could help

- It is important to understand the significance of a higher power in overcoming addiction.

4. WE MADE A SEARCHING AND FEARLESS MORAL INVENTORY OF OURSELVES.

5. WE ADMITTED TO GOD, TO OURSELVES, AND TO ANOTHER HUMAN BEING THE EXACT