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How do I deal with an alcoholic patient?

alcoholicAlcohol abuse is so incredibly common that you may not even realize you have an alcoholic patient on your hands until she starts exhibiting symptoms of alcohol withdrawal. So ask all patients about alcohol use on admission; in particular, ask when they had their last drink. Alcohol withdrawal symptoms—including anxiety, hand tremors and heart palpitations—may occur within 12 hours of her last drink.

About 36 hours after her last drink, your patient may develop full-blown alcohol withdrawal syndrome (AWS). The severity of AWS depends on the alcohol abuse; the patient who drinks a pack a day (and has for the last five years) will experience more intense symptoms than a patient who drinks less.

Symptoms of alcohol withdrawal include hand tremors, sweating, nausea, vomiting, seizures, anxiety, agitation and hallucinations. Notify the patient’s physician as soon as you suspect alcohol abuse or withdrawal; the physician may prescribe an anti-anxiety or anti-psychotic med to control withdrawal symptoms and prevent seizures. Keep the patient safe and comfortable. The room should be calm, quiet, uncluttered and dimly lit. Monitor the patient’s vital signs and orientation frequently, reorienting as necessary. Avoid the TV, as it may increase agitation and hallucinations and institute seizure precautions.

Encourage oral intake, if your patient is up to it, and carefully monitor I & O. Call for a nutritional consult, since many alcoholic patients are nutritionally depleted.

Watch for progression to delirium tremens (DTs), a medical emergency with a two to ten percent mortality rate. Symptoms include auditory and visual hallucinations, confusion, disorientation, hypertension, tachycardia, increased respiratory rate and tremors, and usually occur two to three days after the last drink.

Upon discharge, relate the patient’s medical condition (admission with a GI bleed, for instance) to her alcohol abuse, if appropriate. Provide information about community treatment options and support. Your patient may not take you up on your offer of continued treatment, but you owe it to her to try.

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2 Responses to How do I deal with an alcoholic patient?

  1. Alcoholics and drug addicts are some of the more difficult patients to care for b/c their main focus in that immediate time frame is how to get their next fix. They want to hear nothing of what you have to say. Get social work involved as soon as possible for severe cases to see if these people can be convinced of rehab after hospitalization. These patients, although they may act out and be nasty, are not horrible people so try to treat them with empathy and treat their addiction as a disease process. These patients are at high risk for leaving AMA, so if possible place them in a room near the nurse’s station so they can be watched more closely. And TALK to them, they may need somebody to talk to about their addiction that they were unable to find outside of the hospital.

  2. GrannyRN

    The BIGGEST problems with alcoholic/addicts seem to occur in Emergency situations/settings, although as Visitors they pose a huge problem for the entire unit and may need to be supervised by Security Staff.
    If the patient is admitted, most of the ‘hard core’ ones can be ‘made’ easily enough by observant staff. Early intervention with sedatives is critical especially if the patient is postop or in an ICU. This is NOT the time or place to rehab someone. Your goal is to get them through the acute event and safely detox them in order to prevent the most dangerous results of ‘cold-turkey’ withdrawal (seizures, hypertensive crisis, injury to self/others, etc.).
    Rehab for permanent recovery should be OFFERED after the patient is safely detoxed as it is still a personal choice unless they are under arrest.
    The MOST effective programs for successful rehab are based on the 12 Steps of Alcoholics Anonymous. However, it is STILL up to the individual to decide that he/she wants to get ‘clean’.

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