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Alcohol Withdrawal Final

In the nursing aspect. Make sure to click play on a youtube video in the signs and symptoms section
by

riddhi patel

on 4 April 2014

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Transcript of Alcohol Withdrawal Final


Patients are also at an increased risk for suicidal and homicidal ideation
Diagnostic Tools
Alcohol Withdrawal
Nausea/Vomiting
Tactile/Auditory/Visual Disturbances
Signs and Symptoms
Michigan Alcoholism Screening Test
May be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms
AUDIT Tool
CIRWA-AR
CAGE Questionnaire
Nursing Care Plan
Most hospital also check blood alcohol levels and screen for other drug usage
Pharmacotherapy
Anti-Alcohol agent: Disulfiram
Substitution Therapy: Valium, Librium
Anti-convulsant: Tegretol
Anti-anxiety: Ativan
Analgesic: Catapres
Antiemetic: Zofran
Ammonia reducer: Lactulose
Vitamin Therapy: B1-Thamine
Therapy Groups
Alcohol Anonymous
Adult Children of Alcoholics
Al-non
Alateen
Families Anonymous
Women for Sobriety
Case Study
Headache/Disorientation
Nursing Nanda # 3
Acute Confusion
RT Delirium and Substance abuse withdrawal
AEB changes in cognition, altered mental status, impaired perceptions, AAOx2.
Nursing Nanda # 2
Disturbed Sensory Perception
RT altered sensory reception and biochemical imbalances
AEB altered mental status, global confusion, substance abuse, poor concentration, disorientation, impaired communication, altered sense of balance, abnormal chemistry panel and CBC blood profiles
Risk for Injury
RT sensory dysfunction
AEB altered mental status, global confusion, disorientation, muscle rigidity, tremors, altered sense of balance, unsteady gait
Interventions
Acute Confusion
Assess mental status for symptoms such as anxiety, disorientation, tremors, hallucinations, delusions, and incoherence.
Implement helpful communication measures such as speaking slowly and clearly and using short, simple sentences.
Explain reason for confusion and provide appropriate referrals such as substance abuse support groups.
Disturbed Sensory Perception
Assess ability to speak, hear, interpret, and respond to simple commands to obtain an overview of the client’s mental and cognitive status and ability to interpret stimuli
Reorient to time, place, and situation or events, as necessary, to reduce confusion and provide sense of normalcy.
Make sure call bell is in within reach and be sure client knows where it is and how to use it
Review, with patient, ways to prevent or limit exposure to conditions affecting sensory function and the production of delirium tremens
Risk for Injury
Assess stage of AWS and monitor/document seizure activity.
Maintain airway patency and provide environmental safety.
Assist patient with ambulation and self-care activities as needed
Encourage patient to use to the call bell when assistance is needed for ambulating.
Nursing Nanda # 1
Client will verbalize need for assistance and demonstrate proper use of call bell for assistance when nurse is not present in patient’s room to prevent injury/harm upon self throughout shift
Outcome #3
Goal
Outcome #1
Patient will be free of Delirium Tremens experienced from alcohol withdrawal
Client will verbalize understanding of the cause of his Delirium Tremens 1 hr after teaching.
Outcome #2
Client will regain and then maintain usual level of cognition once Delirium Tremen has subsided within shift.
Patient: 48 M Caucasian
Condition: Seizures secondary to eTOH withdrawal
AAO X 2, Vital Signs of: BP: 122/80 T: 98.3 HR:87 RR: 20 O2: 96%
His neighbor found him lying on the ground in the front lawn of his home in a postictal state
Restless, confused, disoriented
Dry skin, wrinkles, matted hair, stained yellow/black teeth
Unclear, slurry speech
Alcoholic Cirrhosis
Hypertension
Anemia
Thrombocytopenia
Delirium Tremens
Withdrawal seizures
Head trauma from previous DT’s
Medical Hx
Ulcer with GI bleed
Depression
Anxiety
Alcohol abuse
Smoking
Hep B&C
Patient Presents as
No Support from family and friends
"falling out of relationship with my siblings"
No motivation to seek employment
No job due to lack of effort
Male Gender
Low socioeconomic status
Depression
Anxiety
Unemployment
Family dysfunction
RBC: 3.26L
Hgb: 9.5L
Hct: 29.3L
RDW: 17.4H
PT: 14.6 H
K+: 3.3L
BUN: 5L
CREAT: 0.5L
ALB 2.7L
Ammonia: 104 H
Labs
ABG’s:
pH-7.51H
pCO2- 30.8L
pO2- 59.4L.
Risk Factors/Stressor
Delirium Tremens/Seizures
Treatments Modalities
Includes: commitment to abstinence, self responsibility, and attendance of self help groups and therapy
Riddhi Patel
Catrina Minnick
Victoria Lopez
Sabrina Palacios
Kristi Swanson

Kasser, C., Geller, A., Howell, E., & Wartenberg, A. (2004). Detoxification: Principles and protocols. Chevy Chase, MD: American Society of addiction Medicine.
Laffan, S, (2013). Dangers of Alcohol Withdrawal. American Jails. pp.17-19
Schuckit, M. (2008). Alcohol and alcoholism. In A. Fauci, D. Kasper, D. Longo, E. Braunwald, S. Hauser, J. Jameson, & J. Loscatzo (Eds.) Harrison’s principles of internal medicine (17th ed.) (pp.2724-2729). Philadelphia, PA: McGraw Hill.
Townsend, M, (2011). Essentials of Psychiatric Mental Health Nursing. 5th ed. Philadelphia: F.A. Davis Company.
References
Full transcript