Alcohol Withdrawal (Addiction)
You're watching a preview. 300,000+ students are watching the full lesson.
Included In This Lesson
Study Tools For Alcohol Withdrawal (Addiction)
NURSING.com students have a 99.25% NCLEX pass rate.
Outline
Overview
- Definition: a set of symptoms that result after one attempts to quit or abruptly stops consuming alcohol for a long period of time.
- The brain gets used to chronic regular alcohol (ETOH) consumption resulting in changes in brain chemistry, so once it abruptly stops, it goes into withdrawal.
Nursing Points
General
- Most hospitals have a protocol: assessment screening and PRN administration of a benzodiazepine (Librium, Ativan)
- MINDS
- CIWAA
- It’s important to assess when the last drink was and how much they drink daily
- Very early signs can begin within a few hours
- Signs and symptoms typically peak around 48-72 hours and then go away after 2-3 days…unless they go into delirium
- Goal is to treat symptoms and prevent seizures, delirium
Assessment
-
- Minor Withdrawal (6+ hours after last drink)
- Tremor
- Anxiety
- Nausea
- Vomiting
- Insomnia
- Typically they look malnourished
- **Note – this feeling is what drives alcoholics to keep drinking – to avoid feeling this way**
- Major Withdrawal (10+ hours after last drink)
- Above symptoms plus:
- Whole body tremor
- Seizures
- Hypertension
- Diaphoresis
- Hallucinations
- Withdrawal delirium (delirium tremens/DT’s) (3-10 days after last drink)
- Above symptoms plus:
- Global confusion (hallmark)
- High Fever
- Autonomic Instability (Hypertension, Tachycardia)
- Disorientation
- Severe Hallucinations
- Agitation
- Severe Diaphoresis
- Minor Withdrawal (6+ hours after last drink)
Therapeutic Management
-
- Monitor for withdrawal delirium – this is a medical emergency
- People die from this from an MI, aspiration pneumonia, fat embolism.
- Meds
- Benzodiazepines for withdrawal
- Usually utilize CIWAA scoring protocol to drive administration of meds
- Vitamin replacement
- Banana bag / rally pack / IV fluids with added vitamins (especially thiamine)
- Vitamin B12 injection + PO for several days to attempt to prevent encephalopathy
- Antabuse: deterrent for ETOH, produces an acute sensitivity to ETOH.
- Become violently ill within about 5 min and can last up to 2 hours.
- No alcohol 12 hours before first dose.
- Educate patients about not consuming mouthwashes, cold meds, various aftershaves or anything else that may contain alcohol, as it may elicit a reaction
- Educate that effects of Antabuse may continue for several days after they stop taking it
- Benzodiazepines for withdrawal
- General interventions for the patient experiencing alcohol withdrawal
- Assess and monitor vitals and neuro checks frequently
- Assess alcohol withdrawal protocol and provide meds per protocol
- Seizure and fall precautions
- May need a sitter
- Reorient as needed
- May need to give antiemetics meds before eating, if they do eat
- Maintain a safe, quiet, calm environment
- After acute withdrawal phase is over, patient will need long term therapy and support (Connect with Social Work)
- Alcoholics Anonymous
- Halfway houses
- Meds
- Therapy (one-on-one or group)
- Family support and therapy (support groups available for family members)
- Interacting with a patient addicted to alcohol
- Assess risk for self-harm and suicide
- Try to identify what triggers alcohol use
- Promote boundaries and accountability
- be consistent with rules and consequences
- Identify strengths, focus there
- Promote various support groups, therapy
- Monitor for withdrawal delirium – this is a medical emergency
Nursing Concepts
- Mood Affect
- Coping
- Gastrointestinal/Liver Metabolism
Patient Education
- Identify and avoid triggers
- Help them understand what to expect in the coming days to ease anxiety
- “You’re in a safe place”
- “Things might get worse before they get better, but we’re going to take good care of you”
- s/s to report to nurse or provider
[lesson-linker lesson=221441 background=”white”]
Unlock the Complete Study System
Used by 300,000+ nursing students. 99.25% NCLEX pass rate.
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Alcohol Withdrawal (Addiction)
Transcript
Let’s talk about Alcohol Withdrawal. Now, technically the withdrawal portion of this is a medical condition, not mental health. But alcohol use disorder is a mental health condition that can cause some pretty serious medical issues, so we’re going to kind of touch on all of it here.
So what is Alcohol Withdrawal – it is a set of symptoms that results after someone attempts to quit or abruptly stops consuming alcohol after regular long-term consumption. With Alcohol Use Disorder, someone drinks compulsively, can’t control how much they drink, and tends to be super anxious or irritable when they aren’t drinking. When you consume that much alcohol for a long period of time, your brain starts to get used to it and it changes some of your brain chemistry. So when someone stops drinking – their brains can go haywire. Now keep in mind, this might not be someone who is trying to quit – this might be someone who was in a car accident and is now hospitalized and can’t drink like they usually would.
So, we always want to ask the question and be very specific – how much do you drink on a daily basis and when was your last drink? This helps us to start to establish a timeline and be able to predict when their symptoms will progress. Symptoms of withdrawal can occur as early as 6 hours after the last drink and usually involve tremor, anxiety, nausea and vomiting, and trouble sleeping – THIS feeling is usually what drives someone with alcohol use disorder to take another drink. This is what makes it really hard to quit. These symptoms will peak at about 48-72 hours and will get worse and worse before they start to get better – including a severe version of these initial symptoms plus hypertension, diaphoresis, hallucinations and even seizures. Left untreated, these symptoms can progress to what’s known as Withdrawal Delirium or Delirium Tremens.
Delirium Tremens, also sometimes called “DT’s” is a medical emergency. It usually comes on about 3 or more days after their last drink. They’ll have all the previous symptoms at severe levels – so severe tremors, diaphoresis, nausea, hypertension, etc. PLUS global confusion and disorientation, which is the hallmark sign. They’ll also have agitation, a high fever, autonomic instability, and seizures. This condition CAN and WILL kill someone if left untreated. So, even if you have a client come in for something completely unrelated, like a car accident – it’s SO important to ask them if they drink regularly and when their last drink was – that way we can get them some treatments early and monitor them closely to prevent it from getting this bad.
So when we are assessing a client who is at risk for alcohol withdrawal, there is usually a protocol to follow. We’ve attached a couple of examples to the lesson under references – the MINDS score and the CIWAA score. So our primary intervention will always be anything having to do with safety – that might include airway protection, seizure precautions, and possibly even a sitter or restraints if they’re super agitated. Then we’re going to assess the symptoms and give them a score based on the method we’re using. Most protocols then have a guideline as to how to intervene based on that score. For example, at one facility I’ve worked at, we would assess the CIWAA score every 2 hours and if their score was over 25, we would give 1 mg of Lorazepam and reassess in 1 hour. Again, you just need to know YOUR facility’s specific protocols and make sure you’re following them.
We want to assess frequently, institute seizure and fall precautions, and reorient them as needed. Again, maintain safety at all times, and perform a self-harm assessment. With alcohol use disorder, clients may be so dependent on the alcohol for their coping strategies that it can be very difficult not to have that. And we definitely want to encourage them to seek long-term therapy or support, including things like Alcoholics Anonymous meetings. Expressing their feelings can be very therapeutic. As far as medications for Alcohol Withdrawal, we use Benzodiazepines almost every time – I already mentioned Lorazepam is common. We’ll also use antiemetics for the nausea and we’ll give Vitamin replacements. Those who overuse alcohol tend to be quite deficient in B12 and Thiamine and other micronutrients so we will give them something called a Banana Bag or a Rally Pack that’s full of vitamins like Thiamine and electrolytes and can prevent encephalopathy. Check out the neuro lesson on encephalopathies to learn more about why that occurs. Another medication we can give for someone trying to quit drinking is called Disulfiram or Antabuse. Essentially if they take this medication and then get even one sip of alcohol in their system, it makes them violently ill. This includes things like mouthwash or over-the-counter cough medicine – so make sure you educate your patient that they shouldn’t start the Antabuse until they haven’t had alcohol for 12 hours and that the effects can last for days after taking it. So no alcohol!
Priority nursing concepts for a patient with Alcohol Withdrawal are safety, nutrition, and coping.
Okay, so let’s recap – Alcohol Withdrawal occurs after someone who uses alcohol chronically or excessively for an extended period of time stops abruptly or attempts to quit. Make sure you’re assessing the timeline because symptoms can start as soon as 6 hours after the last drink and will peak at about 48-72 hours. We need to monitor them closely and assess them frequently to intervene and prevent Withdrawal Delirium or Delirium Tremens, which is a medical emergency and can be deadly. So we give benzodiazepines and vitamins to manage the symptoms to get them through the dangerous period of withdrawal, and we always prioritize safety, including fall and seizure precautions. If they have severe agitation, they may even require a sitter or restraints, so just make sure you’re following your facility’s protocol for those things.
So that’s it for Alcohol Withdrawal. Make sure you check out the resources attached to this lesson to learn more. Now, go out and be your best self today. And, as always, happy nursing!
Study Faster with Full Video Transcripts
99.25% NCLEX Pass Rate vs 88.8% National Average
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
Nursing School Doesn't Have To Be So Hard
Go from discouraged and stressed to motivated and passionate
Kaiser Ann Pajulas, USRN
Concepts Covered:
- Basics of Sociology
- Statistics
- Communication
- Fundamentals of Emergency Nursing
- Musculoskeletal Disorders
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Medication Administration
- Gastrointestinal Disorders
- Pregnancy Risks
- Labor Complications
- Factors Influencing Community Health
- Respiratory Disorders
- Emergency Care of the Neurological Patient
- EENT Disorders
- Newborn Complications
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Adult
- Substance Abuse Disorders
- Hematologic Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Microbiology
- Disorders of Pancreas
- Oncology Disorders
- Anxiety Disorders
- Neurologic and Cognitive Disorders
- Personality Disorders
- Basics of NCLEX
- Studying
- Newborn Care
- Basics of Mathematics
- Note Taking
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Respiratory Emergencies
- Developmental Considerations
- Digestive System
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Postpartum Care
- Basic
- Infectious Respiratory Disorder
- Integumentary Disorders
- Eating Disorders
- Circulatory System
- Cardiovascular Disorders
- Test Taking Strategies
- Musculoskeletal Disorders
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Cognitive Disorders
- Concepts of Population Health
- Community Health Overview
- Noninfectious Respiratory Disorder
- Delegation
- Depressive Disorders
- Terminology
- Postpartum Complications
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Renal and Urinary Disorders
- Developmental Theories
- Fetal Development
- Endocrine and Metabolic Disorders
- Prenatal Concepts
- Trauma-Stress Disorders
- Psychological Emergencies
- Adulthood Growth and Development
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Renal Disorders
- Hematologic Disorders
- Liver & Gallbladder Disorders
- Tissues and Glands
- Disorders of Thermoregulation
- Urinary Disorders
- Urinary System
- Shock
- Labor and Delivery
- Oncologic Disorders
- Emotions and Motivation
- Peripheral Nervous System Disorders
- Bipolar Disorders
- Infectious Disease Disorders
- Immunological Disorders
- Sexually Transmitted Infections
- Disorders of the Thyroid & Parathyroid Glands
- Male Reproductive Disorders
- Central Nervous System Disorders – Spinal Cord
- Female Reproductive Disorders
- Acute & Chronic Renal Disorders
- Prioritization
- Somatoform Disorders
- Pediatric
- Perioperative Nursing Roles
- Concepts of Pharmacology
- Psychotic Disorders
- Concepts of Mental Health
- Neurological Trauma
- Health & Stress
- Respiratory System