A 25 –year old client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?
A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strength.
Correct Answer: B. The client will work with the nurse to remain safe.
The priority goal in alcohol withdrawal is maintaining the client’s safety. Alcohol withdrawal can range from very mild symptoms to the severe form, which is named delirium tremens. The hallmark is autonomic dysfunction resulting from the excitation of the central nervous system. Mild signs/symptoms can arise within six hours of alcohol cessation. If symptoms do not progress to more severe symptoms within 24 to 48 hours, the patient will likely recover.
Option A: Delirium tremens is the most severe form of alcohol withdrawal, and its hallmark is that of an altered sensorium with significant autonomic dysfunction and vital sign abnormalities. It includes visual hallucinations, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis. Symptoms of delirium tremens can last up to seven days after alcohol cessation and may last even longer.
Option C: The diagnosis of alcohol withdrawal can be made by taking an excellent history and performing a thorough physical examination. It is a clinical diagnosis based on mild, moderate, or severe symptoms. Patients with suspicion for alcohol withdrawal should be evaluated for other underlying disease processes such as dehydration, infection, cardiac issues, electrolyte abnormalities, gastrointestinal bleeding, and traumatic injury. Laboratory studies (electrolytes, blood counts) may be drawn, but will likely be nondiagnostic.
Option D: Patients with prolonged altered sensorium or significant renal abnormalities should have an evaluation for the potential ingestion of another toxic alcohol. Patients who become financially strapped due to alcoholism could ingest other alcohols to become intoxicated. These can include isopropyl alcohol, commonly known as rubbing alcohol, which can lead to acidemia without ketosis as well as hemorrhagic gastritis.