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Alcoholic patient history - ✔️ ✔️ Last drink Use any other substances amount and time been drinking Medical and BH hx Previous withdrawals (seizures DT etc) audit - ✔️ ✔️ ID at risk of alcohol issues Low 0- 7 Moderate 8- 15 High 16- 19 Benzodiazepines - ✔️ ✔️ First line treatment to prevent severe withdrawals Treats psychomotor agitation with alcohol withdrawal Beta blockers - ✔️ ✔️ may be used to control hypertension and tachyarrhythmias. binge drinking - ✔️ ✔️ 5 or more drinks in one sitting Acamprosate - ✔️ ✔️ Campral Alcohol abstinence GABA agonist and glutamate antagonist acute detoxification phase, the main goal of nursing care - ✔️ ✔️ manage symptoms by keeping the patient safe and comfortable, giving drugs as ordered, and minimizing complications. Provide nonjudgmental supportive care, perform a general assessment, evaluate nutrition and hydration status, and implement the management protocol. Be sure to assess the patient's risk for falls and seizures, and use precautions as indicated. If the patient must be restrained, assess skin around the restraints hourly for breakdown and provide treatment, if needed. avoid restraints whenever possible. alcohol abuse disorder - ✔️ ✔️ Primary chronic disease Alcohol Depresses what System - ✔️ ✔️ CNS Alcohol metabolism - ✔️ ✔️ the alcohol is metabolized by the liver (about 90%) and the other 10% is excreted in the urine or in your breath
Averages 1 oz per 3 hours Alcohol treatment - ✔️ ✔️ Overall Goal: •Achieve and maintain abstinence •Medical/psychological/self-help •Tranquilizers, caffeine NOPE Early Intervention before dependence Detox: how to manage: •Immediate emergencies-fractures, internal bleeding, etc. •Hospitalization may reveal: supervision is available, no access to alcohol Goal of therapy: •Treat the complications •Restore to health and nutritional status Relief acute withdrawal: •Short term tranquilizers •Vitamins-thiamine (B) alcohol withdrawal delirium - ✔️ ✔️ A medical emergency usually occurring 2 to 3 days following alcohol withdrawal and lasting 2 to 3 days. Characterized by paranoia, disorientation, delusions, visual hallucinations, severe hypertension, dysrhythmia, vomiting, diarrhea, and diaphoresis. Also known as delirium tremens. Alcohol withdrawal symptoms - ✔️ ✔️ -appear within 4-12 hrs
- abd cramping
- vomiting
- tremors
- restlessness
- inability to sleep
- TACHYCARDIA
- HTN
- transient hallucinations or illusions
- anxiety
- increased RR, temp
- tonic clonic seizures
- diaphoresis CAGE - ✔️ ✔️ cut down, annoyed, guilty, eye opener Negative < Positive > Carbamazepine - ✔️ ✔️ Tegretol Anticonvulsant
wernickes encephalopathy korsakoffs psychosis cardiomyopathy esophagitis gastritis pancreatitis alcoholic hepatitis cirrhosis of liver leukopenia thrombocytopenia sexual dysfunction How alcohol abuse and dependency affect laboratory values - ✔️ ✔️ Albumin Decreased Aspartate aminotransferase (ALT) Increased Ratio of ALT to alanine aminotransferase may exceed 1.0 with alcoholic cirrhosis. Gamma glutamyl transferase Increased Mean corpuscular volume Elevated in liver disease and alcoholism Total bilirubin Increased Uric acid Increased How blood alcohol levels affect the body - ✔️ ✔️ blood alcohol concentration (BAC). 0.08% is the illegal BAC for adult drivers. Most deaths from alcohol poisoning occur at BACs of 0.35 to 0.50. 0.02 Mild alteration of feelings Slight intensification of mood 0.05 Feelings of relaxation, giddiness, lowered inhibitions Slight impairment of judgment and motor skills 0.08 Impaired muscle coordination and reaction timeTingling and numbness of face, hands, arms, and legs 0.10 Flushed appearance Ataxia (imbalance and difficulty walking) Impaired fine muscle coordination Impaired mental abilities, judgment, attention span, and memory More improvement in mood Increased sociability and self-confidence 0.15 Irresponsible behavior Euphoria Delayed reactions
0.20 Slurred speech Staggering Measurable effects on motor and emotional control centers Loss of balance Blurred or double vision Urinary incontinence Sedation Amnesia 0.40 Lapses in and out of consciousness Amnesia Vomiting (with the risk of pulmonary aspiration) Reduced heart rate Decreased circulation to extremities, causing cold or numb extremitiesRespiratory depression Depressed eye reflexes 0.45 Life-threatening respiratory depression and possible cessation.Markedly decreased heart rate.Coma 0.50 Death Korsakoff's syndrome - ✔️ ✔️ an alcohol related disorder marked by extreme confusion, memory impairment, and other neurological symptoms Long acting Vivitrol: - ✔️ ✔️ Injectable may help improve adherence compared to oral formulation Lorazapam - ✔️ ✔️ Benzo used for pt with liver issues because it does not metabolize in liver Measurable desired Outcomes (Goals ) - ✔️ ✔️ Enhance knowledge of treatment modalities Health Promotion Understand ethical and legal issues Medication and alcohol interactions - ✔️ ✔️ Barbiturates Benzos General anesthetics Solvents Anticonvulsants Increases sedative affect with Antihistamines Increase change of upper GI bleed with Tylenol Gastric irritation NSAIDS Medication for Agitation and Delerium - ✔️ ✔️ Haloperidol with lorazapam Minnesota Model - ✔️ ✔️ A major model in the treatment of alcohol and drug abuse, involving a month-long stay in an inpatient rehabilitation facility, a multidisciplinary treatment team, systematic assessment, and a formal treatment plan with long and short term goals Adaptation of 12 step program Most frequent labs for alcohol use - ✔️ ✔️ CBC CMP Blood alcohol concentration UDS
poor nutrition due to alcohol use - ✔️ ✔️ replacement- thiamine, calcium, potassium, phosphorus Multivitamins electrolyte replacement Propofol side effect - ✔️ ✔️ Resp depression, hypotension, pancreatitis may need to be on vent Recommended alcohol intake - ✔️ ✔️ Men: No more than 4 drinks daily and 14 per week Women and 65 and older: No more than 3 drinks per day and 7 per week Role of neurotransmitters - ✔️ ✔️ Excessive alcohol consumption depresses neuronal excitability and impulse conduction and enhances the effects of (GABA). Chronic alcohol use suppresses GABA, and the person needs increasing amounts of alcohol to obtain the desired effects. Chronic alcohol use inhibits activity of the excitatory neurotransmitter glutamate; as a result, glutamate functions at a far higher level in alcoholics. When a heavy drinker suddenly cuts back sharply or stops drinking entirely, neurotransmitters that had been suppressed by chronic alcohol use rebound, causing brain hyperexcitability and mild to severe AWS. SBIRT - ✔️ ✔️ Screening, Brief Intervention, and Referral to Treatment Side effects of Benzos - ✔️ ✔️ Confusion Drowsiness Resp depression Wenicke's encephalopathy - ✔️ ✔️ most serious form of thiamine deficiency in alcoholic pts Causes vomiting, dysfunction of the extraocular muscles, fever, ataxia and mental deterioration. Wernicke-Korsakoff syndrome - ✔️ ✔️ Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers. What happens is you give glucose before thiamaine - ✔️ ✔️ Wernicke's encephalopathy What to monitor with Benzos - ✔️ ✔️ Liver function Resp rate
What to monitor with IV lorazapam - ✔️ ✔️ BUN/Creat and osmol gap Stages of AWS - ✔️ ✔️ Stage 1 5 to 8 hours after the last drink. Signs and symptoms may include anxiety, restlessness, mild nausea, anorexia, insomnia, diaphoresis, mild tremors, fluctuating tachycardia and hypertension, and mild cognitive impairment. Stage 2 24 to 72 hours after the last drink, manifesting as increased restlessness and agitation, increased tremors, hallucinations, disorientation, diaphoresis, nausea and vomiting, 0diarrhea, tachycardia (heart rate faster than 120 beats/minute), systolic pressure above 160 mm Hg, and seizures (usually grand mal). Untreated patients have a 25% chance of experiencing grand mal seizures 1 to 5 days after alcohol cessation. Stage 3 (DT) typically arises 72 to 96 hours after the last drink. Patients may experience fever, severe hypertension, tachycardia, delirium, drenching sweats, and severe tremors. Death may ensue from arrhythmias, fluid and electrolyte imbalances, aspiration pneumonia, or infection. standard alcoholic drink - ✔️ ✔️ 14.5 grams of pure alcohol 12 ounces of beer 5 ounces of wine 1.5 ounces of 80 prof distilled spirits or liquor Structured Mediation Regimens - ✔️ ✔️ Some providers feel withdrawal should be presented in certain patients having MI Chlordiazepoxide 50mg q 6 hr 25 mg q 6 h for 8 doses Diazepam 10mg q 6 h 5 mg q 6 for 8 doses Lorazepam 2-4 mg q 6 h 1 mg q 6 for 8 doses Symptom Triggered Medication regimen - ✔️ ✔️ Give one of the following meds q 1 hr when CIWA-AR is > 8- 10 Chlordiazepoxide 50-100 mg Diazepam 10-20 mg Oxazepam 30-60 mg Lorazepam 2-4 mg Repeat CIWA-AR in 1 hour Thiamine deficiency - ✔️ ✔️ Wernicke's encephalopathy Korakoff syndrome
