Alcoholism Case Study

Meet the client:
Nick Davis, a 42-year-old, is accompanied to the emergency room by the police who found him standing on a bridge and threatening to jump. He planned to jump off the bridge because his girlfriend moved out on him and he lost his job as a cook several days ago. Vital signs upon admission are BP 146/94, P 92, R 20, and T 98.7° F. Nick has a strong odor of alcohol on his breath, but reports drinking only four beers in the last 12 hours. He denies use of illegal drugs or any medications in the past 72 hours. Nick is well known to the nursing staff for previous admissions related to alcohol abuse. Nick’s affect is angry and uncooperative, and the nurses won’t let him leave. Nick states that he has been feeling sad for several weeks and he drinks alcohol to help him cope with his feelings. He sleeps 5 to 6 hours a night and reports a poor appetite with significant weight loss in the past month. Physical health problems include a history of compromised liver function.
One of the simplest tools that a nurse can use to screen for alcoholism is the CAGE questionnaire. CAGE is an acronym that represents the four questions it contains.

What is the first question that the nurse should ask Nick?

“Have you ever thought that you should cut down on your drinking?”
Nick answers “yes” to two of the four questions on the CAGE questionnaire.

What should the nurse do next?

Further assess the client’s drinking behaviors.
Which question is most likely to predict the onset of withdrawal symptoms if the client is dependent on alcohol?
“When did you last have something to drink?”
What data supports the need for admission to the hospital?
Thoughts of wanting to jump off a bridge.
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Which item(s) can the nurse allow Nick to keep in his room? (Select all that apply.)
Unlaced tennis shoes.
A personal photo.
What is the priority nursing problem for the initial crisis plan?
Thoughts of wanting to jump off a bridge.
What other priority nursing diagnosis should be addressed within 72 hours of admission?
Altered nutrition.
The nurse recognizes that which finding supports Nick probably has liver disease?
Increased aspartate aminotransferase (AST).
Which goal is most important for alcohol detoxification?
Physiologic stabilization.
Which assessment is most important for safe alcohol detoxification?
Vital signs at least every 4 hours.
When should the nurse begin assessment for withdrawal?
Within 4 to 6 hours of the client’s last drink.
What should the nurse anticipate if Nick experiences symptoms of early withdrawal from alcohol?
Tremors, nausea, and vomiting.
What mechanism of action accounts for symptoms of alcohol withdrawal delirium?
Increased dopamine.
The nurse performs the withdrawal assessment and observes that Nick has moderate tremors and reports nausea.

Which intervention should the nurse implement?

Administer lorazepam (Ativan) 2 mg PO.
What is the therapeutic action of benzodiazepines?
Potentiate effects of GABA.
What is the rationale for giving thiamine (B1) and a multivitamin?
Reduce the risk of Wernicke’s disease.
When the nurse takes Nick his medications, he states that he wants to take a shower.

Since the nurse needs to give medications to a few other clients, what is the nurse’s best response?

“Let me find one of the staff to help you.”
A mental health technician proceeds to help Nick take a shower. Nick slips and falls on the floor. The technician reports this to the nurse.

Who should the nurse ask to complete the incident report?

The nurse should ask the technician helping the client to complete the report.
Nick asks the nurse how Antabuse works. How should the nurse respond?
Inhibit absorption of alcohol.
Which nursing intervention is most important to obtain before beginning disulfram (Antabuse) therapy?
Obtain Nick’s written consent to comply with instructions.
Consequences of drinking alcohol while taking disulfiram (Antabuse) include which of the following? (Select all that apply.)
Severe headache.
Nausea and vomiting.
Chest pain.
Hypotension.
Which product is acceptable for Nick to use?
Petroleum jelly.

(The client should avoid any product with alcohol: cough medicines, rubbing compounds, vinegar, aftershave lotions, and some mouthwashes.)

Which question should the nurse ask Nick in order to determine whether or not he is able to return to a pre-crisis level of functioning?
“Do you have support and people who can help you?”
What is the most important consideration for discharge planning?
Resources available to the client after discharge.
The nurse enters Nick’s room to assess his readiness for teaching related to local 12-step programs, and observes the UAP already providing Nick with information about local programs.

What action should the nurse take?

Instruct the UAP that initial client teaching must be performed by the nurse.
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