Alcohol Use Disorder: Intoxication and Withdrawal (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 So, let's think about the difference between whether a person is intoxicated, or whether the person we have to start worrying about, whether that person is going to start going through withdrawal.

    00:14 When a person is intoxicated their mood might shift quite rapidly.

    00:19 One minute they might be telling a funny story, and shortly thereafter they might become very morose and start to cry.

    00:28 We also find that they have disinhibition, and what is that mean, that means that they're more likely to if they are shy person to start becoming quite familiar with people they don't know.

    00:42 They might end up wanting to be more attractive and removing some outer clothing.

    00:49 In fact, if they are intoxicated enough they might be sexually engage with the person they don't know because they become so disinhibited. That brings us to judgement.

    01:03 Your judgement when you're under the influence of alcohol becomes impaired.

    01:09 Oftentimes people don't think that their judgement is impaired because they're feeling quite fine.

    01:15 But because alcohol disinhibits the person, changes their mood, Impacts their thinking, their judgement becomes impaired.

    01:28 They may be driving when they should not be driving.

    01:32 They might be going home with someone they don't know. They feel euphoric.

    01:39 There is a sense of everything is good in the world and everything is fine.

    01:44 And oftentimes, you might know a person who says, "You know, if I have a drink or two, I am so much more fun to be around." Well, that is that sense of euphoria and disinhibition that a person will experience.

    02:00 But as they take more alcohol, and with some people it doesn't take very much we find that their movements become a little less coordinated.

    02:10 We seem them kind of not being able to stand up straight.

    02:13 We see kind of a - the muscles in their face relax sometimes to a point where they almost looks stuporous even though they're still standing.

    02:26 They may have a flushed face because those peripheral veins will start to expand and we'll see that flushed face.

    02:37 Now, as I said sometimes with that disinhibition they have sexual disinhibition but sometimes it can move to the other side, to aggression.

    02:49 Where we see people who would normally not be getting into a fight over anything suddenly willing to jump into a fight over nothing.

    02:59 One of the things that we like to use to check the level of alcohol that has been consumed, is called the Blood Alcohol Concentration or BAC level.

    03:09 What about withdrawal? What does that happen? When does that happen? And what does that look like? Well, withdrawal usually occurs within 4 to 12 hours of cessation that last drink that the person has, that's what we consider cessation.

    03:26 So, as I was saying before if a person goes out in the evening and they have their chronic number of drinks and they pass out they wake in the morning, it's now been 6 or 7 hours since their last drink, they might start feeling the effects of withdrawal where their body has become dependent, can't function well without the alcohol and now they're looking to see how do I put a little bit more back in so that I can get back to what my norm is.

    03:57 So that can happen usually anytime between 4 and 12 hours.

    04:03 And what is it look like? The first thing that we maybe noticing are tremors, and they might be very small.

    04:11 And so, when you're seeing a person reach for a cup of coffee, for example, their hands and oftentimes when we're going to admit somebody, we'll say, "Hold your hands out." And we look to make sure that their hands are still, but if someone reaches their hand out and you see this tremor like this, or they go to get a cup of coffee, or they go to pick up a piece of paper, and oftentimes, if I think I see a tremor and I'm not sure, I'll put a piece of paper on their hand and ask them to hold it out.

    04:42 Not hold it next to themselves because they can anchor their hands on to their sides.

    04:48 But hold out their hand in front of them, with a paper on it.

    04:52 If there is any tremor you will see that movement on the paper.

    04:57 They will complain of just not feeling so well, sort of like flu-like symptoms.

    05:03 "Huh, I'm just not feeling so well. Little down today.

    05:07 I got a little bit of a nagging headache." As the withdrawal progresses they will start vomiting. They will start sweating.

    05:18 That headache will become far more difficult to deal with.

    05:23 We'll see that their pulse starts going up. So we expect tachycardia.

    05:29 We expect their pulse to be over up a 100 beats per minute.

    05:33 And then we will start seeing their blood pressure go up.

    05:37 One of the important thing is to have a baseline blood pressure on a person who has alcohol use disorder.

    05:43 Because quite often they have portal hypertension and they have metabolic hypertension.

    05:50 And so, we have to be knowing, what is their normal blood pressure? Irritability is a cardinal symptom, so as a person is withdrawing it's important to remember this is a struggle for them.

    06:04 And so, instead of saying, "Oh, gosh alcohol withdrawal.

    06:09 Huh, I can't take alcohol withdrawal." Think about how you would refer to somebody who is starting to have a heart attack.

    06:17 You wouldn't say, "Huh, a heart attack. Huh, I just can't take it.

    06:21 Yeah, their goes his pulse. It's going down.

    06:25 Oh, yeah, he's complaining about that. Heavy chest feeling.

    06:29 Yeah, it's coming." We would never do that to a person who's having a heart attack.

    06:34 Well, going with through withdrawal, for that person who's experiencing it, is its bad as feeling a heart attack coming on.

    06:45 And we need as nurses to be able to hear what those symptoms are.

    06:49 Because the earlier we know what those symptoms are, the sooner we're able to get in.

    06:55 And make some sort of medical or give some medication, and step in to avoid the full blown withdrawal because as it progresses, we're going to find that these patients are going to start hallucinating, they're going to start becoming very unruly, because they're going to start seeing things.

    07:19 They're going to start feeling bugs crawling on their skin.

    07:22 And when a person starts hallucinating, tactile hallucinations, that there are bugs all over them, and when they look down they see bugs all over them, even if we say, "No, there are no bugs.

    07:34 This is part of your alcohol withdrawal." They won't hear us.

    07:38 And so we want to be able to actually intervene before this.

    About the Lecture

    The lecture Alcohol Use Disorder: Intoxication and Withdrawal (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Alcohol Use Disorder (Nursing).

    Included Quiz Questions

    1. Disinhibition
    2. Euphoria
    3. Uncoordinated movements
    4. Improved judgment
    5. Flat affect
    1. Within 4–12 hours
    2. Within 1–8 hours
    3. Within 24–48 hours
    4. Within 16–24 hours
    5. Within 8–16 hours
    1. Tremors
    2. Vomiting
    3. Increased blood pressure
    4. Lack of sweat
    5. Bradycardia
    1. The client with a broken leg with a pulse of 120 and a blood pressure of 145/93 who is complaining of headache and nausea, presents as irritable and has a bilateral hand tremor.
    2. The client with a history of schizophrenia with a pulse of 70 and a blood pressure of 110/78 who tells the nurse that there are bugs crawling on their legs.
    3. The client with appendicitis with a pulse of 105 and a blood pressure of 87/62 who is diaphoretic and complaining of nausea and abdominal pain.
    4. The client with a dislocated shoulder with a pulse of 63 and a blood pressure of 125/76 who has tremors to their affected arm, is irritable and is complaining of neck pain.

    Author of lecture Alcohol Use Disorder: Intoxication and Withdrawal (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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