Pathophysiology of Alcohol Withdrawal and Nursing Responsibilities (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 So, there is a chart that assesses all the different 10 areas of the withdrawal including, you know, their whether they have tremors.

    00:16 So, we have to know that if a person starts going through withdrawal, if these 10 symptoms start going worse and worse, we need to know that we are headed for a medical emergency.

    00:32 These are rapid response emergencies.

    00:36 These are codes. So, those tremors. We are looking for those tremors.

    00:42 We are looking for increasing tremors.

    00:44 Just like you'd be looking for increasing pulse, decreasing blood pressure.

    00:49 If a person's having a heart attack or bleeding, internal bleeding, we want to know, is this person having tremors? So, we're first looking and you will be able to on the CIWA register if the tremors are not there, it's zero.

    01:05 If it's slight tremors, it's like a one. If it's bigger tremors.

    01:10 If you're noticing it in the body, if the body is starting to have full body tremors.

    01:15 You also are going to be assessing for auditory or visual hallucinations.

    01:22 You're going to be asking the patient, are you hearing voices besides mine? Are you seeing anything in the room that is disturbing you? Again, that delirium shows up. Remember, delirium is short.

    01:34 You're going to see the change in their level of consciousness, the change in their behaviors within a couple of hours.

    01:42 And then, you have the agitation. This agitation is very difficult.

    01:47 It is when the patient also becomes very unruly.

    01:51 It's a difficult time for the nurse because the person can start throwing things at you.

    01:56 They are delirious. They need to be able to have some sort of - some sort of intervention.

    02:06 And then that temperature starts to rise.

    02:08 We find that we have arrhythmias.

    02:11 Remember, alcohol affects the cardiac muscles, so, you have cardiac myopathies.

    02:17 You're going to be seeing diaphoresis.

    02:19 You're going to be seeing that change of level of consciousness.

    02:23 So, we have to be really, really careful.

    02:25 If we are not monitoring this patient, this patient is going to start going through changes and again, it starts pretty early on.

    02:35 You start seeing those very small changes happening.

    02:39 So, you want to be very careful to see if, is there any change in their level of consciousness? Are they going from what we would consider your patient who is easygoing talking to in the morning and then, suddenly, a little somnambulant, a little drowsy, a little bit unable to wake up and then, suddenly, really agitated.

    03:05 We want to make sure that if we see any of these 10 symptoms that we are telling the practitioner who's in charge.

    03:12 We want to be able to stay with the patient and if we can't stay with the patient and we believe that this patient is now seriously going through withdrawal, you may want to get constant observation.

    03:23 You might want to have a CO sitting there just at the door to make sure that this patient is not rapidly declining.

    03:31 You want to make sure that you have an airway.

    03:35 That you have, you know, easy to access airways so that if this patient does start to decline and decompensate, that we can maintain their airway and quickly get them to the ICU where they can be monitored, where they can have their IV's, where they can be stabilized.

    About the Lecture

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

    Included Quiz Questions

    1. Hyperthermia
    2. Delirium
    3. Arrhythmia
    4. Seizure
    1. “I will assess my client for signs of worsening withdrawal by completing the CAGE questionnaire hourly.”
    2. “I double-checked this morning and made sure there was an oral airway at the bedside.”
    3. “I advocated for my client to be changed from q15 minute observation to constant observation.”
    4. “My client’s tremors are worsening. I have notified their provider.”
    1. It is a medical emergency.
    2. It can cause agitated delirium.
    3. It can be assessed using the AUDIT-C.
    4. It is always self-limiting.
    5. It only affects the nervous system.

    Author of lecture Pathophysiology of Alcohol Withdrawal and Nursing Responsibilities (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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