WK1 ALT NS - Care of Pt w AWD PDF

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Nursing skill template...

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ACTIVE LEARNING TEMPLATE: NURSING SKILL Description of Skill: Care of Patient with Alcohol Withdrawal Disorder Indications: Symptoms of cessation of alcohol consumption by a person with AUD are called Alcohol Withdrawal Disorder (AWD). Early symptoms can include: autonomic hyperactivity, hand tremors, chills, muscle cramps, irritability, palpitations, disorientation, tachycardia, hypertension, fever, slurred speech, impaired gait, hallucinations or illusions, and generalized tonic-clonic seizures. Seizures are an early sign of alcohol withdrawal and may even be the presenting symptom. Late alcohol withdrawal is also known as delirium tremens (DTs) and consists of the worsening autonomic dysregulation that can be a fatal result of alcohol withdrawal. Nursing Interventions: The CIWA-Ar tool is used to rate 10 symptoms to determine the severity of withdrawal. Total score can range from 0 to 67. Any score over 18 indicates severe withdrawal. Generally, a score greater than 9 indicates a benzodiazepine should be prescribed. The tool takes approximately 5 minutes to administer. Another tool used to monitor withdrawal severity is the Withdrawal Trend Profile (WTP). The WTP provides an ongoing record of the patient's condition and can be used with the CIWA-Ar to assess withdrawal trends and response to treatment. The nurse measures breath alcohol concentration (BrAC) or a BAL level should be drawn. The higher the value, the greater the potential for withdrawal symptoms. The nurse then rates key symptoms such as elevated vital signs, nausea/vomiting, tremors, diaphoresis, anxiety, agitation, tactile, hallucinations, headache, and orientation. Combined with the CIWA-AR score, the WTP identifies trends in the patient's condition and helps the nurse determine whether withdrawal symptoms require the PRN use of medication. Patients experiencing seizures require I.V. benzodiazepine administration, so maintain I.V. access for any patient at risk. Outcome/Evaluation: The outcome desired are low scores on the above described scales, vital signs within normal limits, and absence of seizures. Potential Complications: Complications of acute alcohol withdrawal (AW) can cause significant illness and death. Some patients experience seizures, which may increase in severity with repeated AW episodes. Another potential complication is delirium tremens, characterized by hallucinations, mental confusion, and disorientation. Cognitive impairment and delirium may lead to a chronic memory disorder (Wernicke-Korsakoff syndrome). Psychiatric problems associated with withdrawal include anxiety, depression, and sleep disturbance. In addition, alterations in physiology, mood, and behavior may persist after acute withdrawal has subsided, motivating relapse to heavy drinking. Recent advances in neurobiology may support the development of improved medications to decrease the risk of AW complications and support long-term sobriety. Client Education:

Explain the seriousness and long-term risks of the disorder. Provide referrals for short-term and/or long-term rehabilitation centers, counselors who specialize in addiction, psychological therapy, medical and medication management....