Problem
Name: Lisa Tremblay
Gender: female
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5'6 Wt 146lbs
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates, approximately $100 daily. She admits to cannabis 1-2 times weekly ("I have a medical card"), and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest. Her admission labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Allergies: azithromycin
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).