Question

identify 3 primary client problems to address with patient with delirium due to alcohol withdrawal?

Answer 1

Delirium due to alcohol withdrawal

Disease processes or events that accompany acute alcohol withdrawal (AW) can cause significant illness and sometimes death. Alcohol withdrawal delirium (AWD) is the most serious form of alcohol withdrawal. It causes sudden and severe problems in brain and nervous system. Mismanaged alcohol withdrawal can be fatal – and untreated severe withdrawal often ends up with your patient seizing, or maybe progressing to delirium tremens.

According to guidelines from American Family Physician withdrawal can be broken down into four stages with distinct symptoms.

Stage 1: 6 to 12 hours after last drink

The first stage of alcohol withdrawal usually sets in 6 to 12 hours after the last drink. These minor withdrawal symptoms can include:

• anxiety
• insomnia
• nausea
• loss of appetite
• sweating
• headache
• increased or irregular heartrate

Stage 2: 12 to 24 hours after last drink

Alcoholic hallucinosis may occur 12 to 24 hours after the last drink, and may continue up to 48 hours after the last drink. It can involve the following types of hallucinations:

• tactile hallucinations, such as having a sense of itching, burning, or numbness that isn’t actually occurring
• auditory hallucinations, or hearing sounds that don’t exist
• visual hallucinations, or seeing images that don’t exist

It’s rare for people going through alcohol withdrawal to experience hallucinations more than 48 hours after their last drink.

Stage 3: 24 to 48 hours after last drink

Withdrawal seizures are most typically experienced 24 to 48 hours after the last drink.

Stage 4: 48 to 72 hours after last drink

AWD sets in 48 to 72 hours after the last drink. Most symptoms will typically peak five days after they begin and will begin to decrease about five to seven days after they begin.

The primary client problems of AWD are:

• hand tremors
• irregular heart rate
• dehydration
• fever

In advanced stage of AWD client may experience:

• Severe confusion
• Nervous or angry behavior
• Extreme hyperactivity
• Global confusion
• Loss of consciousness
• Hallucinations
• Sleep disturbances
• Fever
• High blood pressure
• Rapid heartbeat
• Excessive sweating
• Dehydration

Nurses responsibility:

• Monitor respiratory status and administer supplemental oxygen in case of Severe respiratory depression
• Maintain patent airway and monitor for aspiration -Clients with vomiting and respiratory depression are at risk for aspiration. Advanced airway may be required
• Initiate IV access and administer fluids. Vomiting may lead to dehydration and fluid imbalance.
• Monitor lab results and administer supplemental electrolytes as needed
• Initiate seizure precautions per facility protocol - Antiepileptic drugs are not indicated for seizures associated with AWS as they typically resolve spontaneously. Symptomatic treatment and safety are recommended.
• Provide calm and safe environment, free from clutter, noise and shadows -Sensory disturbances, hallucinations and confusion can lead to severe injury. Hallucinations often occur more at night and clients in advanced stages may experience anxiety and fear.
• Monitor client for signs of depression or suicidal ideation. Initiate suicide precautions as necessary per facility protocol
• Provide isolation or restraints as necessary per facility protocol - During periods of excessive psychomotor activity, hallucinations and anxiety, restraints may be required temporarily to prevent harm to client or others
• Reorient client to reality as often as needed in a calm and supportive manner- confusion, anxiety and hallucinations may cause periods of delirium. Reorientation helps calm fears and relieve anxiety.
• Administer medications as appropriate and required (as per doctor’s order)
• Provide education and resources for client and family members