How to Care for Patients Who Abuse Alcohol
Terri Polick | NursingLink
It’s possible to pick up signs of alcohol abuse by conducting a complete physical and psychosocial assessment. Cahna’s advice for nurses is:
• During the physical assessment, start at the patient’s mouth and then go through the entire digestive system when they are conducting their physical assessment.
• Look for a history of physical problems such as esophagitis, gastritis, pancreatitis, and liver tenderness.
• Patients who abuse alcohol may also have bleeding within the digestion track related to stomach ulcers or esophageal varices.
• Heavy drinkers could suffer from malnourishment due to the malabsorption of food nutrients caused by damaged internal organs.
• Long-term alcohol dependency will lead to thiamine deficiency, a contributing factor to the pathophysiology of AWS.
• Review lab results for an accurate picture of the patient’s health. Patients who abuse alcohol have an elevated SGOT; an elevated GGT indicates that the patient has been drinking recently.
The CAGE Tool
The Cut Down, Annoyed, Guilty, and Eye Opener (CAGE) tool has been suggested as an assessment questionnaire for alcohol use. Canha said that patients with a CAGE score of greater than 2, or a score greater than 1 and at least 1 positive laboratory result, should be considered alcohol-dependent and at risk for AWS. The CAGE tool is user-friendly and easy to score. The tool has been used successfully in multiple studies and clinical settings.
The CAGE Questionnaire:
More than 2 positive responses to the questions suggest alcohol dependence.
1) Have you ever thought you ought to cut down on drinking?
2) Have people annoyed you by criticizing your drinking?
3) Have you ever felt guilty about your drinking?
4) Have you ever had a drink first thing in the morning (eye opener) to steady your nerves, or to get rid of a hangover?
Cahna warns that patients who abuse alcohol may try to sneak liquor into the hospital. He recalled a case where a patient obtained vodka that was disguised as a bottle of mouthwash. The friend had even added blue food coloring to make it look like the original product. Patients who are going through alcohol withdrawal can easily lose control of their behavior; they will do whatever it takes to get their next drink and it’s up to the nurse to keep the patient safe.
Signs, Symptoms, and Care of AWS
Patients with AWS develop signs and symptoms of autonomic hyperreactivity and neuropsychiatric alterations, and are at risk of serious complications or even death if their nurse is not alert to changes in the patient’s condition.
Autonomic hyperreactivity includes sweating, nausea and vomiting, and tremors. Neuropsychiatric alterations include agitation, anxiety, auditory disturbances, and disturbances in tactile or visual senses. Cahn cautions nurses that these symptoms are sometimes overlooked because they are easily confused with other problems such as electrolyte imbalances, infection, and pain. The signs and symptoms of AWS usually occur within 24 hours after the patient’s last drink. They peak in 24 to 36 hours and end after 48 hours.