When a person regularly consumes large amounts of alcohol over a prolonged period of time (usually years), the body becomes physically dependent upon that substance. Alcohol withdrawal syndrome (AWS) is a set of symptoms that occur when a heavy drinker suddenly stops or significantly reduces their consumption of alcohol. The neurological and physical symptoms that ensue typically worsen over a period of 2-3 days before subsiding and mild symptoms may continue for weeks. The most severe symptom of withdrawal is delirium tremens (DT) which constitutes a medical emergency as it may be life-threatening. Treatment for AWS and DT is geared toward initially managing symptoms and continuing with medications and counseling or psychotherapy to treat the underlying cause of alcoholism.
Symptoms are not caused by any other medical condition or mental illness, or withdrawal from another substance.
Client will maintain or regain appropriate level of consciousness with absence of hallucinations. Client will demonstrate ability to regain control of daily activities and functioning. Client will remain free from injury. Client will have vital signs that are within normal limits for that client.
Get baseline to determine effectiveness of interventions.
The sympathetic nervous system response may cause elevated temperature, high blood pressure, tachycardia and severe respiratory depression.
Help determine appropriate interventions and prevent progression of symptoms
Monitor for cardiac dysrhythmias and irregularities.
Severe respiratory depression may occur and requires immediate intervention.
Clients with vomiting and respiratory depression are at risk for aspiration. Advanced airway may be required.
Vomiting may lead to dehydration and fluid imbalance. Maintain cardiac function and cardiac output.
Dehydration, diaphoresis and vomiting may result in electrolyte imbalances that can cause cardiac dysrhythmias.
Seizures are often contributed to low magnesium, hypoglycemia or elevated blood alcohol levels.
Antiepileptic drugs are not indicated for seizures associated with AWS as they typically resolve spontaneously. Symptomatic treatment and safety are recommended.
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.
Confusion and anxiety may prompt client to attempt suicide or self-destruction.
During periods of excessive psychomotor activity, hallucinations and anxiety, restraints may be required temporarily to prevent harm to client or others.
Confusion, anxiety and hallucinations may cause periods of delirium. Reorientation helps calm fears and relieve anxiety.
Anti-anxiety medications may be given to reduce hyperactivity and promote sleep.
Antidepressants may be given to help client regain control of daily functioning and improve ability to concentrate and participate in therapy or counseling.
Resources, support groups and counseling services may help client and family members manage client’s needs going forward and help maintain relationships and daily functioning
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