How to Care for Patients Who Abuse Alcohol
Terri Polick | NursingLink
Alcohol withdrawal delirium, or delirium tremens, can occur within 48 to 72 hours after the patient’s last drink. Alcohol withdrawal delirium is a serious, life-threatening complication of alcohol withdrawal, and its development is a medical emergency. The peak time for alcohol withdrawal delirium is four days after the patient’s last drink, and it can last for two to three days, or in some cases two weeks.
Approximately 15% of AWS patients in the hospital experience withdrawal seizures. About 5% of patients being treated for AWS develop the combination of central nervous system excitation, hyperadrenergia, and delirium tremens. (http://www.medscape.com/viewarticle/458862). The signs and symptoms of delirium include hypertension, tachycardia, tachypnea, and tremors. If untreated, the patient can go into respiratory and cardiovascular collapse.
Benzodiazepines are commonly used to treat AWS symptoms. Adjunctive agents such as clonidine and haloperidol are also used when symptoms fail to respond to standard benzodiazepine therapy.
The Clinical Institute Withdrawal Assessment (CIWA) of alcohol is a measure used to objectively assess patients for the development of AWS. This tool allows health care teams to monitor the severity of the patient’s condition by measuring 10 signs and symptoms of AWS, including agitation, anxiety, auditory disturbances, headache, nausea and vomiting auditory disturbances, orientation and clouding of sensorium, tactile disturbances, tremors, and visual disturbances. The CIWA scale is also used as a basis for pharmacological management of the condition. Medication management is based on the total CIWA score, and the scores are generally calculated by the nurse every four hours, or as ordered by the physician.
Helping Patients Find a New Way of Life:
Nurses can’t change a patient’s drinking habits, but they can help patients look at themselves, and help them evaluate their life. Cahna advises nurses to have a nonjudgmental manner, “Approach the patient with concern and start a conversation in a trusting fashion. Ask non-threatening questions such as, ‘Do you drink any alcoholic beverage?’ Start talking honestly to the patient or their family members about what is going on with the patient’s health. You can also ask them if they think that their drinking is contributing to their physical condition. Don’t take insults personally if your patient becomes belligerent or insulting.”
Treating a patient who abuses alcohol requires compassion and commitment. By being aware of the pervasiveness of alcohol abuse, you can help your patient achieve a better outcome.