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Substance abuse

A 45-year-old married man presents to his primary care physician with a chief complaint of fatigue lasting for the past 12 months. He states that he goes to sleep easily enough but then wakes up repeatedly throughout the night. He has had this problem since he was injured on the job 12 months ago. On further questioning, he reports low mood, especially regarding not being able to do his job. He states that his alcohol consumption is 6 to 12 beers a day, as well as several ounces of hard liquor to “take the edge off the pain.” He discloses that it takes more alcohol than it used to in order to “get me relaxed.” The patient claims he has experienced several blackouts caused by drinking during the past 2 months and admits that he often has a drink first thing in the morning to keep him from feeling shaky. Despite receiving several reprimands at work for tardiness and poor performance in addition to his wife threatening to leave him, he has been unable to stop drinking. The doctor convinces the patient to admit himself into a local psychiatric hospital for detoxification and rehabilitation for his alcohol dependence.
On his mental status examination during admission to the psychiatric hospital, the patient is alert and oriented to person, place, and time. He appears rather haggard, but his hygiene is good. His speech is of normal rate and tone, and he is cooperative. His mood is noted to be depressed, and his affect is congruent, although full range. Otherwise, no abnormalities are noted.

  1. On admission, the hospital protocol is to screen the patient for potential alcohol abuse and/or dependence. List two (2) screening techniques for alcohol abuse/dependence.
  2. During the first 24 – 36 hours of withdrawal from the alcohol, what symptoms do you expect to see? List two (2) symptoms.
  3. Aside from death, what two (2) withdrawal complications should the nurse be most concerned about?
  4. The patient was started on the detoxification protocol, a symptom-based dosing Valium (diazepam) schedule. Explain the reasoning behind using Valium (diazepam) as a medication to detox the patient.
  5. The provider also ordered a daily dose of thiamine (100 mg PO qday X 5 days). What is the most likely reason for the patient being thiamine deficiency? List one (1) severe consequences of thiamine deficiency.
    o (Most likely reason):
    o (Severe consequence):
  6. Upon discharge, the patient consents to take disulfiram (Antabuse) to help abstain from using alcohol. The nurse knows he/she needs to educate the patient about this mediation. What is the most important teaching point that needs to be emphasized to the patient?

Sample Solution

he significant impact of Keynesianism throughout the World War II is widely attributed to the obliteration of mass employment, which occasioned in an extreme influence and spread of Keynesianism connecting to the government’s duty of upholding full employment.( (Higgs, 1995) For example, in 1944, the UK government espoused a plan towards ensuring a “high and stable level of employment” as a part of its employment policy (, 2012). In the USA, the Employment Act of 1946 displayed the commitment of the Federal Government in embracing measures to accomplish “maximum employment, production and purchasing power”. The dedications by both the UK and the USA were of ultimate importance concerning the spread and influence of Keynesianism, even though they were lacking the ways of reaching the stated aims of maximum employment (, 2012) When looking at the case of the United Kingdom, Keynes had an opinion that the target 3 per cent of average employment was tremendously optimistic and said that there was no possible harm in putting it into practice. It is obvious that the post-war success enjoyed by the United Kingdom and the United State can be credited to the stabilization policy of Keynesianism. James Tobin, the most well-known US Keynesian economist, once claimed that a strong case had been proven for the success of Keynesianism (, 2013). Tobin disputed that most of the developed democratic and capitalist states adopted Keynesian demand policies managed after the World War II. 1950-1975 echoed unrivaled prosperity proven by an increase in the global trade and stability (TOBIN, J. 1983). It was around that time that most economies observed low inflation and unemployment rates. It is obvious that UK and western economies experienced maximum employment in the post-war era, because governments kept their dedications when it comes to full employment, basing on Keynesianism methods (pethoukokis, 2011). Before the 1980s, there was conventional knowledge suggesting stabilization of the real output in America’s economy because of the integrated and discretionary stabilization approaches putting in place after 1946, and specifically after 1961, just before the Second World War. This is an example of a vastly held empirical overview concerning the USA’s economy (pethoukokis, 2011).

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