5 Alcohol Withdrawal Nursing Care Plans

Anxiety/Fear

Patients with alcohol withdrawal are at risk for anxiety and fear related to the cessation of alcohol intake and physiological withdrawal symptoms. Hospitalization and the threat to self-concept can further exacerbate these feelings, as patients may feel a loss of control over their own lives and worry about the impact of their condition on their relationships and daily activities.

Nursing Diagnosis

• Anxiety
• Fear

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 an object of fear

Desired Outcomes

• The patient will verbalize the reduction of fear and anxiety to an acceptable and manageable level.
• The patient will express a sense of regaining some control of the situation/life.
• The patient will demonstrate problem-solving skills and use resources effectively.

Nursing Assessment and Rationales

1. Determine the cause of anxiety, involving the patient in the process. Explain that alcohol withdrawal increases anxiety and uneasiness. Reassess the level of anxiety on an ongoing basis.
A person in the 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 the effects of the medication wear off.

2. Monitor the patient for signs of depression.
To prevent suicidal attempts.

Nursing Interventions and Rationales

1. 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. Patients will be able to detect the biased or condescending attitudes of caregivers.

2. Maintain a calm environment, minimizing noise.
Reduces stress.

3. Inform the patient about what you plan to do and why. Include patients in the planning process and provide choices when possible.
Enhances a sense of trust, and explanation may increase cooperation and reduce anxiety. Provides a sense of control over self in circumstances where the loss of control is a significant factor. Note: Feelings of self-worth are intensified when one is treated as a worthwhile person.

4. Reorient frequently.
The patient may experience periods of confusion, resulting in increased anxiety.

5. Orient the patient to reality.
He may also experience hallucinations and may try to harm himself and others.

6. Administer medications as indicated:

• 6.1. Benzodiazepines: chlordiazepoxide (Librium), diazepam (Valium)
  Antianxiety agents are given during acute withdrawal to help the patient relax, be less hyperactive, and feel more in control.

• 6.2. Barbiturates: phenobarbital, or possibly secobarbital (Seconal), pentobarbital (Nembutal)
  These drugs suppress alcohol withdrawal but need to be used with caution because they are respiratory depressants and REM sleep cycle inhibitors.

7. Arrange “Intervention” (confrontation) in a controlled setting.
Process wherein SO and family members, supported by staff, provide information about how the patient’s drinking and behavior have affected each one of them, helps the patient acknowledge that drinking is a problem and has resulted in the current situational crisis.

8. Provide consultation for referral to detoxification and crisis center for ongoing treatment programs as soon as medically stable (oriented to reality).
The patient is more likely to contract treatment while still hurting and experiencing fear and anxiety from the last drinking episode. Motivation decreases as well-being increases and the person again feel able to control the problem. Direct contact with available treatment resources provides a realistic picture of help. Decreases time for patients to “think about it,” change minds or restructure and strengthen denial systems.