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identify at least two clusters of cues organized into a different order of priority than what you recommended.
Discuss why or why not you agree with these difference choices for priority concerns.
Support your recommendations with rationales and evidence.
Use the question above to answer the passage below. Please just in two paragraph.
Other Information Needed
First, I’m going to list other information that I would’ve liked to have had but was not available in the assessment videos. This information would have been helpful to establish ideas for Claire’s areas of priority concern:
Has Claire had any suicidal thoughts or gestures?
Claire said her labs and physicals were “completely normal” however, I would like to know any pertinent lab values – perhaps results of a urine drug screen, aspirin and acetaminophen levels, LFTs, BMP, CBC.
I would also like to know her vital signs to see if there were any other physiological areas of concern. B/P, HR, RR, Pulse ox, Temperature, pain scale level, recent weight gain or weight loss, etc.
Clusters of Cues Organized by Top Three Areas of Concern
#1 Priority Concern & Cluster of Cues – Potential Substance Abuse/Addiction (Opioids & Alcohol)/Denial of Addiction
Developed tolerance to lower dosages of Lortab & requested increased dosage
Often took more than prescribed dose (20 mg/day) and often split tablets
Solicited and received Lortab prescription from multiple providers (“doctor shopping”)
Solicited and received Lortab from her neighbor
Continued medication even after pain resolved for “stress”
Felt “more productive and less stressed” with Lortab
Continuously requested new prescriptions for Lortab
Fear of stress returning if she stops taking Lortab
Defensive when provider asked if others expressed concern about her Lortab use; stated “I’m not some druggie!”
Denies addiction – news coverage made her more cognizant of opioid dangers so she doesn’t think she’s “like the others” that are addicted
Admits drinking wine daily prior to taking Lortab (sometimes more than 1 glass)
Denies drinking wine is dangerous while on opioids
Takes nighttime Lortab for “sleep”
Admits to driving while on Lortab but waits several hours
“Skips” or “misses” doses to “save up”
Admits to taking increased dosage after “skipping” or “missing” to “double up” or “catch up”
Longest she went without taking was 1 week
Denies withdrawal symptoms
Took Lortab at work because it “helped” but full pill made her “unsteady” on her feet
Irritability when out of meds
Increased pain when not taking
Admitted “messing up” at work (real estate agent), subsequently lost job
Makes excuses for taking Lortab because “so stressed out” “I had to have a life”
Lost second job because employer found out she was taking pain meds and became “intrusive” by providing her pamphlets about getting help
Ended friendships
Mother’s fall was during morning when she felt “extra stressed” so she couldn’t make it downstairs. Mother started making breakfast without her assistance and fell. Blames herself.
Family history of alcohol abuse – Father
#2 Priority Concern Cluster of Cues – Ineffective Coping Mechanisms
Feeling overwhelmed
Reports multiple personal stressors – concerned about oldest son in college, concerned about mom’s recent fall (blames herself), concerned about other 2 sons that just entered High School, financial concerns r/t oldest son’s college tuition, lost 2 jobs
Admits to drinking wine daily (1 or more glasses) but denies it’s dangerous while on opioids
Feels life is “much more manageable” taking opioids
#3 Priority Concern & Cluster of Cues – Lack of Family/Social Support System
Husband supports her opioid use – said “he likes how Lortab helps her manage stress” because “they both suffer” when she’s stressed and worried
Mother unable to provide support due to recent dementia diagnosis
Primary provider (Dr. Laurie) may not be the best support as well since she continuously refilled Lortab without previous referrals
Recently distanced herself from her friends – found them “intrusive”
Denies social/recreational activities
Other Pertinent Patient History
Personal history of cervical spondylosis surgery 1 year ago
Neck pain
H/A’s s/p procedure
Prescribed Percocet then switched to Lortab 5 mg bid s/p surgery for better control of h/a’s
Expressed concerns about her liver due to prolonged acetaminophen use
Family history of liver cirrhosis – Father
Recent physical assessments and labwork “normal”
Rationales/Evidence Supporting Priority Concerns
The reason I listed Claire’s opioid addiction as her priority area of concern is because it has the potential to cause life-threatening health problems, including the risk of overdose (National Library of Medicine, 2017). Both legal and illegal opioids carry a risk of overdose if a person takes too much of the drug or are combined with other drugs. Furthermore, alcohol can enhance the side effects of opioid medications and can even be deadly when individuals mix them. Sometimes, people who are addicted to opioids also abuse alcohol. If a person takes an opioid as prescribed and drinks a small amount of alcohol, the drugs can enhance each other’s effects, making dangerous intoxication and overdose all the more likely (Sharp, 2022). Common signs of opioid addiction include the inability to control opioid use, uncontrollable cravings, drowsiness, changes in sleep habits, weight loss, isolation from family or friends, and new financial difficulties (National Library of Medicine, 2017).
I listed Claire’s ineffective coping as the second priority of concern. A study on the relationship between stress and addiction concluded that “more stressful life events and more ineffective coping strategies in opium addicts may play a considerable role in their development of drug abuse or turning to relapse” (Hassanbeigi et al., 2013, para 1). Therefore, to prevent the occurrence of severe stress and self-treatment through drug use, Claire should be taught some skills to help her cope and prevent her stress.
Finally, I listed Claire’s lack of family and social support as her third priority concern. Family members are more likely to notice when their loved ones are experiencing changes in mood or behavior and are therefore able to offer support by connecting those in need with treatment, resources, and services to begin and stay on their recovery journey (US Department of Health and Human Services, 2022). In Claire’s situation, her husband currently supports her opioid use, and she doesn’t have any other family or friends to help her get the help she needs. The best way that a family can improve their loved one’s chances of a successful recovery is to refuse to ignore or endure their addiction (Jones, 2022).

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