PSYCHIATRIC HISTORY

BIO-DATA OF THE PATIENT

NAME : Suman Dass

AGE : 26 years

SEX : Male

REG. No. : 09-12-45552

WARD : De-addition ward

MARITAL STATUS : Unmarried

RELIGION : Hindu

EDUCATION : till 8th class

OCCUPATION : unemployed

LANGUAGE : Hindi

D.O.A : 30/12/02021

DIAGNOSIS : Alcohol dependence syndrome with

nicotine dependence

INFORMANT : Patient, relatives, ward incharge

RELIABILITY OF INFORMANT : Reliable

PRESENTING COMPLAINTS

ACCORDING TO THE PATIENT:

 Ek saal se sharaab peeta hoon.

 Teen saal se gutka khata hoon.

1
  Main yahan khud aaya hun, main yeh dono cheezein chodhna chahta hun.

ACCORDING TO RELATIVES:

Patient was presented to the hospital with C/O:

 Alcohol intake x 1 year

 Gutka intake x 3 years

HISTORY OF PRESENT ILLNESS

ONSET: Onset of illness is insidious, continuous and progressive

PRECIPITATING FACTORS: Breakup with girlfriend.

COURSE OF ILLNESS: Continuous

Patient was brought to hospital with H/O having started intake of gutka 3 years back (initially
started sharing with friends) used to consume 1 packet/day. In next 3 years there had been no
period when he had stopped taking gutka. He also started consuming alcohol (whisky). 1 month
back when family members refused to provide him money; he made slash marks on right
forearm using blade. No previous history of self harming behaviour in past. However, never any
such issue occurred with patient, as patient had easy availability of alcohol through friends. He
started with 1 quarter/day, and then continued its intake in amount of 1-2 quarter/3 rd day. He used
to take it occasionally, never alone. When he was not taking alcohol, patient had no desire to take
alcohol or any withdrawl symptom associated with it.

DRUG USE HISTORY:

NAME OF DRUG AGE OF AGE AT ONSET AGE AT ONSET OF

INITIATION OF DAILY USE DEPENDENCE USE
FOR ATLEAST 1
MONTH

Alcohol (Whisky) 25 26 26

Tobacco 24 25 26

PAST HISTORY OF ILLNESS

MEDICAL: There is no significant past medical history.

SURGICAL: Patient does not have any significant surgical history.

2
PSYCHIATRIC: No significant past psychiatric history.

FAMILY HISTORY

Patient lives with his father and mother. Patient is unmarried and has one brother and four sisters,
he is the youngest in the family. It is a nuclear family. No significant history of family mental
illness and substance abuse.

FAMILY TREE:

Father (60 yrs.) Mother (60 yrs.)

Brother Sister Sister Sister Sister Patient

40 yrs. 35 yrs. 30 yrs. 29 yrs. 28 yrs. 26 yrs.

PERSONAL HISTORY

BIRTH AND EARLY DEVELOPMENT:

Patient was born by full term normal vaginal delivery at home with no pre natal; natal and post
natal complications. Patient gasped and cried soon after birth. He had normal milestones and
development.

CHILDHOOD:

Patient used to do thumb-sucking during childhood. His relationship with his parents, friends and
teachers was good.

PHYSICAL ILLNESS DURING CHILDHOOD:

There is no significant history of physical illness during childhood.

SCHOOL:

Patient started his school at 4 years of age and continued his schooling till 13 years of age. His
performance in school was average but patient does not have any interest in studies. Patient had
fair relationship with his peers as well as teachers.
3
OCCUPATION: Patient is unemployed and does not have any future ambitions related to
occupation.

SEXUAL HISTORY: Patient attained puberty at 14 years of age. He is heterosexual and is

unmarried.

MARITAL HISTORY: Patient is unmarried.

SUBSTANCE ABUSE: Patient is a known case of tobacco and alcohol intake from past 1 year
for which patient is admitted and is being treated.

PRE MORBID PERSONALITY

SOCIAL RELATIONS: Patient had good relationship with all his family members, friends,
teachers and neighbourers.

INTELLECTUAL ACTIVITIES: Patient’s hobbies include watching cricket on TV, playing

cricket with his friends and listening to music.

MOOD: Patient had stable mood and used to behave in normal pattern.

HABITS: Patient was well adjusted in the society.

INVESTIGATIONS

INVESTIGATIONS RESULT NORMAL VALUES

Sugar (Random) 132 mg/dl 70 – 120 mg/dl
Bilirubin (Total) 0.6 mg/dl 0.2 -1.2 mg/dl
Bilirubin (Direct) 0.2 mg/dl 0.0 – 0.5 mg/dl
SGOT 20 U/L Upto 40 U/L
SGPT 26 U/L Upto 38 U/L
ALP 148 U/L 100 – 290 U/L
Sodium 145 mmol/L 135 – 158 mmol/L
Potassium 4.2 mmol/L 3.8 – 5.6 mmol/L
Calcium 8.4 mg/dl 8.1 – 10.4 mg/dl
Phosphorus 3.1 mg/dl 2.5 – 5.0 mg/dl
Magnesium 0.72 mmol/L 0.66 – 1.07 mmol/L

MEDICATIONS

DRUG DOSE ROUTE TIME ACTION

Tab. Deadict 100 mg Orally BD Adjunct in the
treatment of
alchoholism

4
Tab. Nodict 50 mg Orally OD Opioid
Antagonist
Tab. Campral 250 mg Orally BD

Tab. Ativan 2 mg Orally BD Antianxiety

SUMMARY OF NURSING CARE

DAY 1

 Rapport maintained with the patient.

 Vital Signs checked.
 Intake-Output chart recorded.
 Medications given.
 Psychiatric History taken.

DAY 2

 Vital signs checked.

 Intake-output chart recorded.
 Medications given.
 Mental status examination done.

DAY 3

 Vital signs checked.

 Intake-output chart recorded.
 Medications given.
 Health talk given on substance abuse.
 Pamphlet given to enhance knowledge.

MENTAL STATUS EXAMINATION

PHYSICAL EXAMINATION

Vital signs
Temperature : 98.20F
Pulse : 80/mt
Respiration : 26/mt
B.P. : 110/70 mmHg

I. APPEARANCE-
5
 1. GROOMING AND DRESS

Inference: Patient is wearing appropriate dress which is according to the place.

2. HYGIENE
Inference: Hygienic condition of the patient is good. Clothes and shoes of patient are
clean. Nails of the patient are clean and are cut properly.

3. PHYSIQUE
Inference: Patient is of average built and tall height.

4. POSTURE
Inference: Patient is having an open posture. He is sitting upright on a chair.

5. FACIAL EXPRESSIONS
Inference: Facial expressions of the patient are normal.

6. LEVEL OF EYE CONTACT

Inference: Patient maintains eye-to-eye contact throughout the conversation.

7. RAPPORT
N: Namaste suman!
P: Namaste!
N: Main M.Sc Psychiatric Nursing ki student hoon. Aaj main aapse kuch sawal
karungi, jo aapke ilaj aur meri padai mein mujhe sahayeta karenge. Kya aap mujhse
baat karenge?
P: Haanji Zarur! Poocho kya poochna hai.
Inference: A comfortable rapport is maintained with the patient. He took part in the
conversation well and responded to all the questions asked to him.

II. MOTOR ACTIVITY

Inference: Patient’s level of activity is normal. Patient is active.

III. SPEECH
Inference: Patient speaks in Hindi language. Rate of speech is normal and he speaks in
normal volume. Content of speech is appropriate.

IV. EMOTIONS

1. MOOD

6
 N: Kaisa mehsoos kar rahe ho aaj aap?
P: Aaj toh kaafi behtar mehsoos kar raha hoon. Kal kafi dard tha badan mein aur
bahut thakan mehsoos ho rahi thi.
Inference: Patient feels better than a day before and he is in a good mood.

2. AFFECT
Inference: Patient’s emotional response is congruent with the speech content.

V. THOUGHT

1. FORMATION LEVEL
N: Aap jab yahan dakhil hue the, toh aapko kya taklif thi?
P: Ji main nasha bahut karta tha, jiske kaaran mujhe bahut taklif rehne lagi, koi kaam
karne ka mun nahi karta tha, ghabrahat hoti rehti thi, mujhe mere kaam mein bhi
bahut nuksaan hua.
Inference: Formation level of the patient is intact.

2. CONTENT LEVEL
N: Kya aapko kabhi aisa lagta hai ki aapke aas-paas ke log aapke bare mein baat kar
rahe hain yaan aapko koi marna chahta hai?
P: Nahi mujhe aisa nahi lagta.
N: Aapko kisi cheez se dar lagta hai?
P: Nahi.
Inference:Content level of thought is also intact.

3. PROGRESSION LEVEL
N: Kya koi baat aisi hai jo aap baar-baar sochte hai.
P: Nahi bus yahan se jaldi theek ho kar jana chata hoon.
Inference: Progression level of thought is intact.

VI. PERCEPTION
N: Kya aapko kabhi koi ajeeb aawazein sunai deti hain?
P: Nahi.
N: Woh jo udhar pada hai woh kya hai?
P: Woh toh jhadu hai.
N: Kya kuch aisa dikhayi deta hai, jo kisi aur ko na dikhta ho?
P: Nahi aisa kuch nahi hota.
Inference:Perception in patient is intact. Patient is not having any kind of
hallucinations or illusions.

7
VII. SENSORIUM AND COGNITIVE ABILITY

1. LEVEL OF ALERTNESS/CONSCIOUSNESS
Inference: Patient is alert as well as conscious. He is actively listening to all the
questions and giving answers.

2. ORIENTATION
N: Woh jo kursi par baithe hain kya aap unhe jaante hain?
P: Haan. Woh yahan par attendant ka kaam karte hai.
N: Abhi aap kahan ho?
P: Mental hospital.
N: Abhi kya waqt hua hoga?
P: 12 baje honge.
Inference: Patient is oriented to place, person and time.

3. MEMORY
a. Immediate memory
N: Main jo bolu usse dhyan se sunna aur phir vaisa hi bolnna: 8, 1, 24,
63, 48.
P: 8, 1, 24, 63, 48
Inference: Immediate memory of the patient is intact.

b. Recent memory
N: Aap hospital mein kab bharti hue?
P: 3 tarikh ko.
Inference: Recent memory if patient is impaired.

c. Remote memory
N: Aapka janam kaun se saal mein hua tha?
P: 1983.
Inference: Patient’s remote memory is intact.

2. CONCENTRATION AND ATTENTION

N: Ek sawal hai isse solve karo: 86 + 17 =?
P: 103
N: Jo paanch shabd main bolu usse mere piche bolna: Paani, kursi, pen, deewar,
ghadi.
P: Paani, kursi, pen, deewar, ghadi.
Inference: Patient is having good concentration and attention.

8
 3. INFORMATION AND INTELLIGENCE
N: Bharat ka prime minister kaun hain?
P: Manmohan Singh
N: Bharat ki rajdhani kya hai?
P: Nai Delhi
Inference:Patient has good information and intelligence.

4. ABSTRACT THINKING
N: “Aam ke aam guthliyon ke daam” se aap kya samajhte hain?
P: Matlab ek hi cheez se dugna fayda hona.
Inference: Abstract thinking of the patient is good.

5. JUDGMENT
a. Social
N: Aagar aapke aas-pados mein kabhi aag lag jaye toh aap kya karoge?
P: Fire brigade ko phone karunga. Aur utni der tak paani se aag bujhane ki koshish
karunga.
Inference: Patient has logical social judgment.

b. Personal
N: Agar aapko 500 ka note sadak par gira hua mile toh aap kya karoge?
P: Kuch nahi. Main kisi aur ka paisa kabhi nahi leta.
Inference:Patient has good personal judgement.

VIII. INSIGHT
N: Aapko kya lagta hai ki kya aapko koi bimari yan taklif hai jiske kaaran aap is haspatal
mein bharti hai?
P: Ji haan bimari hi hai, naasha karne ki.
Inference:Patient is having grade III insight.

IX. GENERAL ATTITUDE

Inference:
Patient is in good mood. He is communicating well. He is very co-operative. He talks
very confidently.

X. SPECIAL POINTS
N: Aapko bhukh theek se lagti hai?
P: Nahi jab se yahan aaya hoon bhukh achche se nahi lagti. Kuch khaane ka mun nahi
karta.
N: Neend theek se aati hai?

9
 P: Nahi, Neend bhi achche se nahi aati.
N: Kabji vagerah ki takliph toh nahi rehti?
P: Nahi aisa toh kuch nahi.
Inference:
Patient’s appetite and sleep patterns are disturbed.

XI. PSYCHOSOCIAL FACTORS

1. STRESSORS
N: Aapko kya lagta hai aapke nasha karne ka kya kaaran hai?
P: Bus shuru mein toh kaam par doston ke kehne par shuru kar diya. Nasha karne ke
baad bahut achcha lagta tha. Aur phir jab main jis ladki se pyaar karta tha ,jab woh
mujhe chodh kar chali gayi, toh bus phir din raat peene laga.
Inference: Patient used to take alcohol or gutka when he had break-up with his girl
friend.

2. COPING SKILLS
N: Jab aap kabhi udaas hote hai yan dukhi hote hain tab aap kya karte hain?
P: Apne papa se baat kar leta hoon.

Inference:Patient tries to cope up with his stress by sharing his feelings with family
members.

3. RELATIONSHIPS
N: Kya aap apne ghar ke sabhi logon se pyar karte hai?
P: Ji haan! Sabse karta hoon.
Inference :Patient has good relationship with his family members.

4. SOCIO CULTURAL

N: Kya aapko kabhi aisa lagta hai ki is samaaj ke asool sakht hai aur aap unhe
badalna chahte hain?
P: Nahi. Aisa nahi lagta.
Inference :There are no socio-cultural factors related with the symptoms of the
patient.

5. SPIRITUAL
N: Kya aap bhagwan mein vishwas rakhte hain?
P: Haan! Bhagwan ko toh main bahut manta hoon.
Inference: Patient is religious and believes in God.

10
 6. OCCUPATIONAL
N: Kya aap koi kaam karte hai?
P: Haan main apne office mein kaam karta hoon.
Inference:
Patient works as a serviceman andhe is fully satisfied with his job. He is willing to
work in the same job once he gets discharged.
ABOUT THE DIAGNOSIS

SUBSTANCE / DRUG ABUSE

INTRODUCTION

Man had used psychoactive drugs for a very long period, not only to enhance pleasure and
relieve discomfort but also to facilitate the achievement of social, religious and ritualistic aims.
Earlier, the range of available psychoactive substance was not large. Also in the past, the use of
psychoactive or “mind-altering” drugs was limited largely to persons who had an “elder
person’s” role in the community. These drugs were taken more by men than woman.

Only a certain proportion of those who took these drugs for recreational purposes became
dependent on them. But now drug addiction is a social problem. It is the problem of society,
family and individual. It is widely recognized that non-medical use of dependence-producing
drugs involves dynamic interactions among three major factors:

a) The properties of the drug taken and the manner of use.

b) The characteristics of the user, and

c) The nature of the immediate and larger socio-cultural environment in which the drug use
occurs. Drug addicts or ‘junkies’, as they are called by peers, take in drugs for a number
of reasons ranging from – to relax, to forget problems, to be sociable at parties. Some use
because it is fun, or drugs help them to feel better when they are under stress, some use
because of pressure of friends. Some even use the drugs for experimental purposes.

DEFINITIONS

In examining the human problem associated with the use of drugs outside approved medical
practice, the following concepts and definitions are explained.

DRUG

It is derived from a French word ‘dregue’. A medical substance used in the treatment of disease.

11
DRUG ABUSE/SUBSTANCE ABUSE (According to Longman dictionary)

A term applied to the pathological use of drugs or alcohol with impairment in social and
occupational functioning (e.g. failure to meet family obligations, erratic or criminal behaviour,
missing work or school) and a minimal duration of disturbance of at least one month.

DRUG DEPENDENCE / SUBSTANCE DEPENDENCE

A state psychic, sometimes also physical, resulting from taking a drug, characterized by
behavioural and other responses that always include a compulsion to take a drug on a continuous
or periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort
of its absence.

PHYSICAL DEPENDENCE

Physical dependence occurs when the drug user’s body becomes so accustomed to a particular
drug that he can function normally only if the drug is present in his body chemistry, without the
drug the user may experiences symptoms of mild discomfort to convulsions. These symptoms
will only be relieved by re-administration of the same drug or of another drug or a similar
pharmacological quality. Physical dependence is a powerful factor in reinforcing upon
continuing the drug use.

PSYCHIC DEPENDENCE

Psychic or psychological dependence occurs when the drug is central to a person’s thought,
emotions and activities. It is difficult for the person to stop thinking of the drug which causes
intense craving for it and its effect. It is reduced only on read ministration of the drug like in
physicals dependence.

TOLERANCE

It is “an adaptive state characterized by a diminished response to the same quantity of a drug or
by the fact that a larger dose is required to produce the same degree of pharmacodynamic effect”.

CROSS TOLERANCE

The ability of one drug to produce the effect of another when the body has developed a tissue
tolerance for effect of the first substance. A person who has developed dependence upon alcohol
can substitute with another drug to prevent withdrawal symptoms and vice versa.

WITHDRAWAL

It is an organic mental disorder following cessation or reduction in the intake of a substance such
as alcohol, an opioid, tobacco or sedatives that have previously been used regularly to indices
intoxication. Withdrawal symptoms vary in intensity depending upon the substance or drug, but
12
they usually include some degree of anxiety, restlessness, insomnia, impaired attention and
irritability.

PREVALENCE OF DRUG ABUSE

Findings and recommendations made in a report of the National Committee on \Drug Addiction
(1977) focused on the following dependence-producing drugs and other substances commonly
misused in India.

1) Cannabis and its products (e.g. Bhang, Ganja and Charas).

2) Hallucinogen e.g. LSD (Lysergic Acid Diethylamide).
3) Tranquillizers, hypnotics and sedatives )e.g. diazepam methaqualone and chloral
hydrate).
4) Barbiturates (e.g.phenooarbital and secobarbital).
5) Amphetamines (e.g. dextro-amphetamine and methyl amphetamine).
6) Tabacco
7) Other narcotic drugs (e.g. opium, pethidine, morphine, heroin and cocaine and
8) Alcohol.

Nationwide information on the incidence and magnitude of the problem of alcoholism and drug
dependence is not available. However, a large number of studies have been conducted in the
country. For example, in 1964 a study team on prohibition estimated that drinking was common
among 12 per cent of the working class families in India. The use of intoxication among factory /
industrial workers is quite high. For instance, a study conducted on industrial workers in Delhi
brings out that amongst users alcohol is most common, followed by cannabis and opiates. That
college and university campuses in the country have a sizable prevalence rate which was brought
out by several researchers (Khan and Singh, 1979, Murthy and Kapoor 1981).

ETIOLOGY OR CAUSES

There seems to (1982) be no unitary theory to explain drug dependence. Wilson and Kneisl have
classified the theories of drug dependence as psychological, sociological and physiological.
Causative factors for narcotics and other substance abuse can be studied under the following
headings:

i) Interpersonal and Psychosocial

ii) Socio-economic
iii) Cultural and Ethnic
iv) Youth culture
v) Pharmacological
vi) Ecological

13
INTERPERSONAL AND PSYCHOSOCIAL FACTORS
Drug dependents have difficulty in their relationship with members of their families. Wursmer
(1972) has stated that families where the parents are self-centered and are pre-occupied with
success and prestige may lead their children in drug addiction.

SOCIO-ECONOMIC FACTORS
In the early sixties, writers emphasized that the drug addiction problem is due to low socio-
economic status. The difficult life style, poverty and hopelessness lead to frustration and then to
drug addiction. Broken families, unloving parents where there is no meaningful relationship are
also contributory factors. However, the trend of drug addiction is increasing in middle socio-
economic status people also.

CULTURAL AND ETHNIC FACTORS

Literature reveals that in the United States Minorities such as black, Spanish and native Indian
are high-risk potential because they are disproportionately poor. So frustration leads them to
drug. The slum youth take model of drug addicts, whose level they try to reach.

YOUTH CULTURE
Adolescents try to follow the peer group. They also try to be a part of the group, use the drugs
and get addicted.

PHARMACOLOGICAL FACTORS
Some substances/drugs are likely to cause an addictive effect more than others. For instances,
opium produces tolerance and physical dependence more in comparison to other drugs.

ECOLOGICAL FACTORS
Freedman (1972) suggests that people and their drug environment are interwoven. To achieve a
sense of belongingness some youth may join the group of drug abusers. Social groups are
another environmental pressure for drug addiction.

CLASSIFICATION OF DRUGS

COMMONLY ABUSED SUBSTANCES / DRUGS

The drugs which are commonly abused can be classified as follows:

I. Narcotics
II. Sedatives & Depressants
III. Stimulants
IV. Psychedelics and Halluncinogens
V. Minor Tranquillizers.
VI.
SEDATIVES/DEPRESSANTS: Depressants and sedatives are drugs which slow down or
depress the functions of the central nervous system. the drugs which come under this group are:

a) Ethyl Alcohol or Ethonol such as toddy, bear, arrack, whisky, brandy and rum.
14
 b) Sedatives and hypnotics such as barbiturates; pentobarbital (Nembutal) Amobarbital
(amytal) seconbarbital (seconal) Phenobarbital (luminal). Hypnotics include Doriden,
Hypentex, Nitresum, dornin, nindral and dalmane.

c) Ethyl alcohol is a central nervous system depressant. Reduces tension and facilitates
social interaction. It is known as spirit among the users.

A. ETHYL ALCOHOL OR ETHONOL

EFFECTS

Small doses of alcohol can produce euphoria, drowsiness, dizziness, flushing, release of
inhibition and tension. Larger doses produce an aggressive and violent behaviour, staggering of
gait, double vision. Excessive consumption of alcohol within 8 to 12 hours may produce
headache, nausea, shakiness and vomiting. Very large doses may cause respiratory centre
depression and death. Regular consumption of alcohol causes cirrhosis of liver, peptic ulcer,
pancreatitis. It also disrupts the social, family and working life of the person.

WITHDRAWL SYMPTOMS

The withdrawl symptoms include sleeplessness, sweating and poor appetite, tremors,
convulsions, hallucinations and even death.

TREATMENT

Alcoholism is regarded as a social problem. So a rapport needs to be established with the alcohol
user and members of his family. Social support from the family is required because alcoholics
have a dependent personality. Behaviour psychotherapy and group psychotherapy are effective,
specially the Alcoholics Anonymous group. In this group the attitude of each member towards
the addict is tolerant and constructive. There is a desire to help each other. An opportunity for
self-expression is provided and experiences are shared with the same intensity. Each one has
experienced the social isolation, the rejection from friends and family members so they are able
to help each other better.

The antabuse therapy or disulfiram under constant medical supervision is given. Calcium
carbamide (Temposil) also produces results similar to disulfiram. Calcium carbamide is more
acceptable to the patient as it produces lesser hypotension and ECG changes in comparison to
disulfiram.

DIAGNOSTIC CRITERIA FOR SUBSTANCE ABUSE DSM-III-R

Kaplan et al have described DSM-III-R diagnostic criteria for psychoactive substance

At least three of the following:

15
 1. Substance often taken in larger amounts or over a longer period than the person intended.

2. Persistent desire or one or more unsuccessful efforts to cut down or control substance
use.

3. A great deal of time spent in activities necessary to get the substance (e.g. theft), taking
the substance (e.g. chain smoking) or recovering from its effects.

4. Frequent intoxication or withdrawal symptoms when expected to fulfil a major role

obligation at work, school, home (e.g. does not go to work because hung over, goes to
school or work “high”, intoxicated while taking care of his or her children). Or when
substance use is physically hazardous (e.g., drives when intoxicated).

5. Important social, occupational, or recreational activities given up or reduced because of

substance use.

6. Continued substance use despite knowledge of having a persistent or recurrent social,

psychological, or physical problem that is caused or exacerbated by the use of the
substance (e.g. keeps depression, or having an ulcer made worse by drinking).

7. Marked tolerance; need for markedly increased amounts of the substance (i.e. at least a
50% increase) in order to achieve intoxication or a desired effect, or a markedly
diminished effect with continued use of the same amount.

8. Characteristic withdrawal symptoms.

NURSING MANAGEMENT

NURSING DIAGNOSIS

 Fatigue and body ache related to withdrawal symptoms as evidenced by activity intolerance.

 Altered nutritional pattern related to disease process as evidenced by lack of appetite.

 Altered sleep pattern related to hospitalization as evidenced by restlessness.

 Anxiety related to hospitalization.

 Knowledge deficit related to disease and its management.

GOALS
SHORT TERM GOAL
1) To relieve pain and discomfort.
2) To improve the sleep pattern.
3) To maintain optimum nutritional pattern.
4) To enhance self concept by being active.
5) To maintain glucose level within normal limits.
16
 6) To maintain fluid and electrolyte balance. To cope with any physical stress.

LONG TERM GOALS

1. To rehabilitate the patient.

2. To make the patient independent.
3. To relieve anxiety.
4. To give health education to the patient regarding ill effects of alcohol.
5. To encourage the patient for follow up after discharge.

17