While you are working as an RN in an outpatient medication clinic, a client comes to an appointment for renewal of his blood pressure, thyroid, and diabetic medications. He has a history of alcohol and opioid abuse. As the patient enters, you notice that he is unshaven, unkempt, and appears agitated, talking loudly and fast and gesturing widely. His gait is ataxic and staggering. He carries with him a bottle of soda, which he occasionally drinks from. As you approach the client to obtain his vital signs, a strong smell of alcohol engulfs you. When you ask the client if he has been drinking, he admits that he has been; furthermore, he confesses that the soda bottle contains alcohol. As you explain to the client that alcohol is not permitted on the clinic premises and ask the client to leave, he loudly tells you that he cannot possibly go because he is completely out of his medications and needs to obtain his prescription refills today. Repeatedly, you reinforce that alcohol is not allowed in the clinic. After several verbal exchanges, the client sobbingly tells you that he needs help. He states that he has heard there is a medication that will make him not want to drink anymore. He asks you to have the nurse practitioner include a prescription for this “anti-drinking” medication along with his other refills. He tells you he will quietly leave without any more trouble if you can just get him his refills and the new prescription.
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