Alcohol Withdrawal Nursing Care Plans

Alcohol, a central nervous system depressant, 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.

It is rapidly absorbed from the stomach and small intestine into the bloodstream. On the other hand, alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.

Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 – 72 hours, but may persist for weeks. Common symptoms include: anxiety or nervousness, depression, fatigue, irritability, jumpiness or shakiness, mood swings, nightmares and not thinking clearly.

Nursing Care Plans

Nursing care planning for patients who are undergoing alcohol withdrawal includes: maintaining physiological stability during the acute withdrawal phase, promoting safety, providing appropriate referral and followup, and involvement of SO in the process.

Here are five (5) alcohol withdrawal nursing care plans (NCP):

  1. Anxiety/Fear
  2. Sensory-Perceptual Alterations
  3. Risk for Injury
  4. Risk for Decreased Cardiac Output
  5. Risk for Ineffective Breathing Pattern
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Anxiety/Fear


Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

Fear: Response to perceived threat that is consciously recognized as a danger.

May be related to

  • Cessation of alcohol intake/physiological withdrawal
  • Situational crisis (hospitalization)
  • Threat to self-concept, perceived threat of death

Possibly evidenced by

  • Feelings of inadequacy, shame, self-disgust, and remorse
  • Increased helplessness/hopelessness with loss of control of own life
  • Increased tension, apprehension
  • Fear of unspecified consequences; identifies object of fear

Desired Outcomes

  • Verbalize reduction of fear and anxiety to an acceptable and manageable level.
  • Express sense of regaining some control of situation/life.
  • Demonstrate problem-solving skills and use resources effectively.
Nursing Interventions Rationale
Determine cause of anxiety, involving patient in the process. Explain that alcohol withdrawal increases anxiety and uneasiness. Reassess level of anxiety on an ongoing basis. Person in acute phase of withdrawal may be unable to identify and accept what is happening. Anxiety may be physiologically or environmentally caused. Continued alcohol toxicity will be manifested by increased anxiety and agitation as effects of medication wear off.
Develop a trusting relationship through frequent contact being honest and nonjudgmental. Project an accepting attitude about alcoholism. 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.
Maintain a calm environment, minimizing noise. Reduces stress.
Inform patient about what you plan to do and why. Include patient in planning process and provide choices when possible. Enhances sense of trust, and explanation may increase cooperation and reduce anxiety. Provides sense of control over self in circumstance where loss of control is a significant factor. Note: Feelings of self-worth are intensified when one is treated as a worthwhile person.
Reorient frequently. Patient may experience periods of confusion, resulting in increased anxiety.
Orient the patient to reality. He may also experience hallucinations and may try to harm himself and others.
Monitor patient for signs of depression. To prevent suicidal attempts.
Administer medications as indicated:
Antianxiety agents are given during acute withdrawal to help patient relax, be less hyperactive, and feel more in control.
These drugs suppress alcohol withdrawal but need to be used with caution because they are respiratory depressants and REM sleep cycle inhibitors.
Arrange “Intervention” (confrontation) in controlled setting Process wherein SO and family members, supported by staff, provide information about how patient’s drinking and behavior have affected each one of them, helps patient acknowledge that drinking is a problem and has resulted in current situational crisis.
Provide consultation for referral to detoxification and
crisis center for ongoing treatment program as soon as medically stable (oriented to reality).
Patient is more likely to contract for treatment while still hurting and experiencing fear and anxiety from last drinking episode. Motivation decreases as well-being increases and person again feels able to control the problem. Direct contact with available treatment resources provides realistic picture of help. Decreases time for patient to “think about it,” change mind or restructure and strengthen denial systems.
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See Also


You may also like the following posts and care plans:

Mental Health and Psychiatric Care Plans


Care plans about mental health and psychiatric nursing:

Other Care Plans


Miscellaneous nursing care plans that don’t fit other categories:

Further Reading


Recommended books and resources:

  1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes
  2. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  3. Nursing Diagnoses 2015-17: Definitions and Classification
  4. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
  5. Manual of Psychiatric Nursing Care Planning
  6. Maternal Newborn Nursing Care Plans
  7. Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
  8. Maternal Newborn Nursing Care Plans