Alcohol, a CNS depressant drug, is used socially in our society for many reasons: to enhance the flavor of food, to encourage relaxation and conviviality, for celebrations, and as a sacred ritual in some religious ceremonies. Therapeutically, it is the major ingredient in many OTC/prescription medications. It can be harmless, enjoyable, and sometimes beneficial when used responsibly and in moderation.
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.
- Anxiety/Fear — Alcohol Withdrawal Nursing Care Plan (NCP)
- Sensory-Perceptual Alterations— Alcohol Withdrawal Nursing Care Plan (NCP)
- Risk for Injury — Alcohol Withdrawal Nursing Care Plan (NCP)
- Risk for Decreased Cardiac Output — Alcohol Withdrawal Nursing Care Plan (NCP)
- Risk for Ineffective Breathing Pattern — Alcohol Withdrawal Nursing Care Plan (NCP)
Diagnostic Studies - Alcohol Withdrawal
- Blood alcohol/drug levels: Alcohol level may/may not be severely elevated, depending on amount consumed, time between consumption and testing, and the degree of tolerance, which varies widely. In the absence of elevated alcohol tolerance, blood levels in excess of 100 mg/dL are associated with ataxia; at 200 mg/dL the patient is drowsy and confused; respiratory depression occurs with blood levels of 400 mg/dL and death is possible. In addition to alcohol, numerous controlled substances may be identified in a poly-drug screen, e.g., amphetamine, cocaine, morphine, Percodan, Quaalude.
- CBC: Decreased Hb/Hct may reflect such problems as iron-deficiency anemia or acute/chronic GI bleeding. WBC count may be increased with infection or decreased if immunosuppressed.
- Glucose/Ketones: Hyperglycemia/hypoglycemia may be present, related to pancreatitis, malnutrition, or depletion of liver glycogen stores. Ketoacidosis may be present with/without metabolic acidosis.
- Electrolytes: Hypokalemia and hypomagnesemia are common.
- Liver function tests: LDH, AST, ALT, and amylase may be elevated, reflecting liver or pancreatic damage.
- Nutritional tests: Albumin is low and total protein may be decreased. Vitamin deficiencies are usually present, reflecting malnutrition/malabsorption.
- Other screening studies (e.g., hepatitis, HIV, TB): Depend on general condition, individual risk factors, and care setting.
- Urinalysis: Infection may be identified; ketones may be present, related to breakdown of fatty acids in malnutrition (pseudodiabetic condition).
- Chest x-ray: May reveal right lower lobe pneumonia (malnutrition, depressed immune system, aspiration) or chronic lung disorders associated with tobacco use.
- ECG: Dysrhythmias, cardiomyopathies, and/or ischemia may be present because of direct effect of alcohol on the cardiac muscle and/or conduction system, as well as effects of electrolyte imbalance.
- Addiction Severity Index (ASI): An assessment tool that produces a “problem severity profile” of the patient, including chemical, medical, psychological, legal, family/social, and employment/support aspects, indicating areas of treatment needs.
Nursing priorities - Alcohol Withdrawal Nursing Care Plan (NCP)
- Maintain physiological stability during acute withdrawal phase.
- Promote patient safety.
- Provide appropriate referral and follow-up.
- Encourage/support SO involvement in “Intervention” (confrontation) process.
- Provide information about condition/prognosis and treatment needs.
Discharge goals - Alcohol Withdrawal Nursing Care Plan (NCP)
- Homeostasis achieved.
- Complications prevented/resolved.
- Sobriety being maintained on a day-to-day basis.
- Ongoing participation in rehabilitation program/attending group therapy, e.g., Alcoholics Anonymous.
- Condition, prognosis, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.