Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

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1 Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

2 Disclaimer: This speaker has no financial disclaimers to report.

3 Objectives: Participants will: Be able to assess for the potential of withdrawal or detoxification during the screening process Discuss the importance of re-assessment and documentation Have knowledge of detoxification protocols for alcohol and drugs (illegal/prescription)

4 Definitions Detoxification: Is the removal or ceasing of toxic substances from the body, and treating symptoms present. Withdrawal: Refers to the characteristic signs and symptoms that appear when a drug, that causes physical dependence is either stopped or greatly reduced.

5 Facts: The severity of withdrawal symptoms is usually dependant upon how chemically dependant the person is to the substance.

6 FACTS: National Institute on Alcohol and Alcoholism (2012) 17 million (18 and older) and an Alcohol Use Disorder in Nearly 88,000 (62,000 male & 26,000 female) die from alcohol-related causes annually. Alcohol contributes to over 200 diseases and injuryrelated health conditions Among all cirrhosis deaths in 2009, 48.2% were alcohol related. Alcohol has been indentified as a risk factor for mouth, esophagus, pharynx, larynx, liver, and breast cancer.

7 The Dilemma Nurses Face What if the patient denies all use of alcohol or drug use???? The proper questions must be asked to get the correct answer from each patient. Information may come from family and friends not from the patient

8 Which withdrawal is worse? Alcohol Or Drugs

9 Assessment and Screening Ask if drugs and/or alcohol are used Ask quantity, frequency, duration, and type used Ask last time used ***extremely important*** Record vital signs Refer to any previous documentation regarding alcohol use: ED record Admission information

10 Alcohol Withdrawal Timeline: Generalizations: hours: visual, auditory, tactile hallucinations, tremors Hours: seizures hours: Delirium tremens Many factors must also be considered: How much is used daily How long has alcohol been used daily The last time alcohol was ingested Patients other medical history

11 CAGE Questionnaire: Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

12 Nursing Assessment includes: Vital signs: Blood pressure Pulse Respirations Pulse Ox Temperature

13 Observed and/or reported Signs and Symptoms Tremors Seizure activity Skin color, texture, warm/dry/moist/cool Nausea/vomiting/diarrhea Abdominal cramps and/or pain Bizarre behavior/hallucinations/speech Pupil responses Track marks

14 What to do with patient? Notify provider Execute all orders Re-assess the patient often *** most important***

15 CIWA-Ar Protocol CIWA-Ar: Clinical Institute Withdrawal Assessment Alcohol related Standardized assessment A score is given based on assessment RN parameters for referral/treatment

16

17

18 CIWA-Ar Scale Exercise: Initial evaluation P=102, R=22, Pulse ox=97%, BP= 142/90 Mild nausea No anxiety Sweaty palms No tactile disturbances No visual disturbances Mild tremors to fingers Mild agitation Oriented to person and place No auditory disturbances C/O mild headache

19 CIWA-Ar Scale Exercise: Follow-up: P= 128, R=24, Pulse ox= 96%, BP= 176/102 Intermittent nausea Pt exhibits anxiety symptoms Skin warm and diaphoretic c/o pins/needles feeling to extremities c/o photophobia Moderate tremors to hands Restless Oriented to person only Easily startled c/o horrible headache

20 Case Study # 1 62 year old male laceration to back of head.? LOC; does not remember events. CT head= depressed skull fracture Family states she drinks to 3-4 drinks a day; more than usual today What should we ask?

21 Case Study # 1 What type of alcohol? How much alcohol today? How often? Time of last drink? Have you ever had withdrawal symptoms? Will this patient experience alcohol withdrawal symptoms?

22 Case Study #2 70 year old female comes to ED with c/o abdominal pain Diagnosis with pancreatitis and admitted to hospital for treatment. Do we need to screen this patient for alcohol withdrawal? Why?

23 Case Study # 2 Patient states I have 1-2 glasses of wine each night What else should we ask? Will this patient experience alcohol withdrawal symptoms?

24 Case Study #3 37 year old male who was a passenger in a car; admitted for fractured pelvis after a motor vehicle crash. Patients states he was at a party and drank a lot Alcohol level upon arrival to ED 240 (or 2.40) (3 times the legal limit) Should this patient be screened for alcohol withdrawal?

25 Case Study # 3 Determining factor if patient will have alcohol withdrawal is? Does this patient need to be monitored for alcohol withdrawal?

26 Case study # 4: 66 year old male admitted for altered mental status. CT of brain=neg. Hx: HTN, high cholesterol, diabetes What could be causing his altered mental status presently or during his hospital stay? Should this patient be screen for alcohol withdrawal?

27 Case Study #4: Patient confused and unable to answer questions regarding medical history, medications or alcohol use. Can we ask family? What if no family is present?

28 Case Study # 5 32 year old female brought to hospital with suicidal ideations; took 24 Advil, admitted for medical observation. Acting appropriate upon arrival 16 hours after arrival having bizarre behavior. Is this alcohol withdrawal or mental illness?

29 Case Study # 5: Patient ripped off ID band and placed it in her mouth What do you think the outcome was?

30 Re-assessment For any treatment, intervention or action provided, you MUST re-assess the response! Lack of re-assessment is: poor nursing practice not following the standard of care May be cause for litigation

31 Documentation Everything must be documented Remember the old saying: If it isn t documented it you did not do it

32 Thank You for Attending! Contact me at:

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