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ALCOHOL: ACUTE WITHDRAWAL Alcohol, a CNS depressant drug, is used socially in our society for many reasons: to enhance the flavor of food, to encourage relaxation and conviviality, for celebrations, and as a sacred ritual in some religious ceremonies. Therapeutically, it is the major ingredient in many OTC/prescription medications. It can be harmless, enjoyable, and sometimes beneficial when used responsibly and in moderation. Like other mind-altering drugs, however, it has the potential for abuse, and, in fact, is the most widely abused drug in the United States (research suggests 5%–10% of the adult population) and is potentially fatal. CARE SETTING May be inpatient on a behavioral unit or outpatient in community programs. Although patients are not generally admitted to the acute care setting with this diagnosis, withdrawal from alcohol may occur secondarily during hospitalization for other illnesses/conditions. A short hospital stay may be required during the acute phase because of severity of general condition, or a delayed discharge from acute care can be the result of alcohol withdrawal beginning within 6–48 hr of admission. RELATED CONCERNS Cirrhosis of the liver Upper gastrointestinal/esophageal bleeding Heart failure Psychosocial aspects of care Substance dependence/abuse rehabilitation PATIENT ASSESSMENT DATABASE Data depend on the duration/extent of use of alcohol, concurrent use of other drugs, degree of organ involvement, and presence of other pathology. ACTIVITY/REST May report: Difficulty sleeping, not feeling well rested CIRCULATION May exhibit: Generalized tissue edema (due to protein deficiencies) Peripheral pulses weak, irregular, or rapid Hypertension common in early withdrawal stage but may become labile/progress to hypotension Tachycardia common during acute withdrawal; numerous dysrhythmias may be identified EGO INTEGRITY May report: Feelings of guilt/shame; defensiveness about drinking Denial, rationalization Multiple stressors/losses (relationships, employment, finances) Use of alcohol to deal with life stressors, boredom ELIMINATION May report: Diarrhea May exhibit: Bowel sounds varied (may reflect gastric complications, e.g., hemorrhage) FOOD/FLUID May report: Nausea/vomiting; food intolerance May exhibit: Gastric distension; ascites, liver enlargement (seen in cirrhosis)
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Muscle wasting, dry/dull hair, swollen salivary glands, inflamed buccal cavity, capillary fragility (malnutrition) Bowel sounds varied (reflecting malnutrition, electrolyte imbalances, general bowel dysfunction) NEUROSENSORY May report: “Internal shakes” Headache, dizziness, blurred vision; “blackouts” May exhibit: Psychopathology, e.g., paranoid schizophrenia, major depression (may indicate dual diagnosis) Level of consciousness/orientation varies, e.g., confusion, stupor, hyperactivity, distorted thought processes, slurred/incoherent speech Memory loss/confabulation
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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