Alcoholism Case Study Section 4

Section 4 Management of Alcohol Withdrawal The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-AR) is a 10-item scale that monitors a client's response to treatment. It is a tool that determines the need for medication and can be used for management of alcohol withdrawal. Without effective management of alcohol withdrawal, the client can experience seizures or alcohol withdrawal delirium, which is characterized by impairment of memory, attention, thinking, perception, and orientation. Question 13 of 25 What mechanism of action accounts for symptoms of alcohol withdrawal delirium? Increased dopamine. Alcohol intake represses GABA, which inhibits dopamine and keeps dopamine levels low. When alcohol is eliminated, dopamine rebounds above the normal level, resulting in excitation and alterations in thought, perception, and orientation. Halter, M. (2018), Varcarolis' Foundations of Psychiatric Mental Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 40. Keltner, N., Steele, D. (2019), Psychiatric Nursing (8th edition). St. Louis, Missouri. Elsevier. Pp. 380. Increased GABA. Increased GABA will have a calming effect. Decreased norepinephrine. Decreased norepinephrine resalts in fatigaie, the inability to experience pleasure, and feeling "blah" Increased serotonin. Increased serotonin results in feelings of happiness and boosts feelings of self-esteem and self-confidence. Eight hours after admission, a new nurse is assigned to care for the client. After receiving report, the nur reviews the recent information in the chart. Vital Signs Blood pressure 146/98 mmHg Heart rate 100 beats/min Respirations 22 breaths/min Temperature 99.8° F (37.7° C) AST: 80 U/L (1.34 ukat/L) Laboratory Data ALT: 96 U/L (1.60 ukat/L) Sodium: 145 mEq/L (145 mmol/L) Potassium: 3.6 mEq/L (3.6 mmol/L) Orders 1. Perform withdrawal assessment every 4 hours. 2. Lorazepam 2 mg PO every 6 hours prn per alcohol withdrawal protocol. 3. Continue suicide precautions. The nurse performs the withdrawal assessment and observes moderate tremors and the client reports nausea. Question 14 of 25 Which interventions should the nurse implement? (Select all that annlv1 Question 14 of 25 Which interventions should the nurse implement? (Select all that apply.) Ask the primary HCP if the client can receive a prescription for chlordiazepoxide. The client's liver function test results are high. Normal AST is between 5 to 40 U/L (0.08 to 0.67 ukat/L), and normal ALT between 7 to 56 units/l. (0.12 to 0.94 ukat/L). Since the client has a compromised liver function, a benzodiazepine such a chloradiazepoxide with active metabolites should not be given because it can adversely affect a diseased liver. Administer lorazepam 2 mg PO. The client has compromised liver function; therefore, a short-acting benzodiazepine such as lorazepam is best to give fo withdrawal because it does not have active metabolites that can affect a diseased liver. Lorazepam is often given if a clien has known liver disease or decreased liver function. Halter, M. (2018). Varcarolis' Foundations of Psychiatric Mental Health Nursing. (8th edition). St. Louis, Missouri. Elsevie Pg. 410, 420. Reassess vital signs in 2 hours. The nurse can reassess the vital signs to monitor for changes. Halter, M. (2018), Varcarolis' Foundations of Psychiatric Mental Health Nursing. (8th edition). St. Louis, Missouri. Elsevie Pg. 420. Place the client on a continuous pulse oximetry monitor. The client's respirations are within normal range and there is no evidence of respiratory compromise. Provide an antiemetic. The client reports feeling nauseous, so administering an antiemetic is advised. Halter, M. (2018), Varcarolis' Foundations of Psychiatric Mental Health Nursing. (8th edition). St. Louis, Missouri. Elsevie Pg. 420.