2. Alcohol is a CNS depressant. It can be harmless, enjoyable and sometimes beneficial when used in moderation. It has a potential for abuse and is potentially fatal.
3.
4. 15.1 million alcohol-abusing or alcohol-dependent individuals in our country alone! National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov Prevalence
7. The patient is a 63 year old male with a past medical history of alcohol abuse and multiple cessation attempts that required acute hospital care. He has a suprapubic catheter in place for 10 years because of a botched exploratory prostate surgery. His labs were notable for transaminitis (ALT 120, AST 324) and hypokalemia (potassium 3.2).
8. He arrived the previous evening by ambulance stating that he was trying to quit drinking on his own but he had the shakes so bad he called 911.
9. Assessment findings revealed uncontrollable tremors in all four extremities. He also had nystagmus of the eyes. He reports anxiety, has a rapid heart beat (98-109 bpm), and increased blood pressure (135/92), all typical symptoms of early ETOH withdrawal.
28. The presence of elevated transaminases, commonly the transaminases alanine transaminase (ALT) and aspartate transaminase (AST), may reflect liver or pancreatic damage. Alcoholism occasionally results in hypokalemia. About one half of alcoholics hospitalized for withdrawal symptoms experience hypokalemia. This occurs in alcoholics for a variety of reasons, usually poor nutrition, vomiting, and diarrhea. Hypokalemia can result in dysrhythmias. Hgb & Hct are on the very low end of normal, possibly r/t an iron-deficiency anemia.
29. Several factors account for the association between occurrence of hypocalcemia and severe alcoholism. In alcoholics, poor diet or liver disease results in diminished albumin levels, thereby limiting the amount of calcium that can remain dissolved in the blood.
30. Alcohol Toxicity: Blood Alcohol Level, Classification, and Assessment Findings 80-200mg/dL ( mild to moderate intoxication ). Mood and behavior changes, impaired judgment, and poor motor coordination. Hypotension may occur in patients with levels >100 mg/dL. 250-400mg/dL ( marked intoxication ). Staggering ataxia and emotional lability. Symptoms may progress to confusion and stupor or coma. Greater than 500 mg/dL ( severe intoxication ). Death is due to respiratory depression. Ignatavicius,D. D., Workman, M. L., âMedical-Surgical Nursing, â Patient-Centered Collaborative Care, 6 th ed.,Saunders Elsevier, Missouri, 2010, pp.83
31. This patients blood ETOH level upon arrival to the hospital was 394, though he states his last drink was in the morning and he arrived in the evening.
32. The doctor explained to the patient that if he was not serious about giving up ETOH then he would be sent home to drink. That is how serious this situation can be. The doctor further explained to me the cardiac risk factors of quitting ETOH. The patient can suffer from severe, possibly fatal dysrhythmias.
60. The basics of disease concept of alcoholism and the addictive process
61. The need to continue treatment in a rehabilitative program
62.
63. Discharge Goals 1. Homeostasis achieved 2. Complications prevented/resolved 3. Referral to AA or similar program/support group 4. Condition and therapeutic regimen understood 5. Understanding of the need for follow-up by physician
80. Provides patient with a sense of humanness, helping to decrease paranoia and distrust. Patient will be able to detect biased or condescending attitude of caregivers
81. GABA/Dopamine ETOH intake represses GABA, which inhibits dopamine, keeping levels low, when ETOH is eliminated dopamine rebounds to normal level causing excitation and alterations in thought, perception and orientation
84. Before I administered the Ativan I had to perform a CIWA (Clinical Institute Withdrawal Assessment) interview
85. CIWA What it Measures: The CIWA can measure 10 symptoms. Scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal (marked autonomic arousal); and scores of 15 or more indicate severe withdrawal. The assessment requires 2 minutes to perform (Sullivan, et al, 1989).
96. Which question is most likely to predict the onset of withdrawal symptoms if client is dependent on alcohol? A. What is your experience with alcohol? B. How much alcohol do you usually have? C. When did you last have something to drink? D. How often do you usually drink? Questions
97. Answer C- this question is important since withdrawal symptoms can begin as early as 4-6 hours after substance use
98. Question What priority nursing diagnosis should be addressed within 72 hours of admission? A. Ineffective coping B. Ineffective denial C. Risk for injury D. Altered nutrition
99. Answer D- nutrition is very important, because a client with alcohol dependency drinks instead of eating nourishing food, causing malabsorption of essential vitamins. Deficiency and malabsorption if vitamin B can lead to Wernicke's disease, a severe problem with decreased cognitive functioning.