NURS310 Lecture Notes - Lecture 6: Hypoesthesia, Itch, Antiemetic
22 Jun 2018
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•Rate of AWS for Inpatients
•20% of inpatient adults have alcoholism
•Challenge - providing nursing care for the critically ill patient – AWS DEVELOPS
FOLLOWING ADMISSION
•Symptoms seen as early as 6 TO 12 HOURS after the patient’s last drink
•Range from mild to severe, can be mistaken for other serious medical conditions – such
as stroke, sepsis, hypoglycemia and hypoxia – and can increase the associated risk of
morbidity and mortality
•Assessment
•Assess drug and alcohol use
•Start with the CAGE – if positive – further assess
•Rule out other physical causes such as infections, electrolyte imbalance
•CAGE Questions Adapted to Include Drug Use (CAGE-AID)
•1. Have you ever felt you ought to cut down on your drinking or drug use?
•2. Have people annoyed you by criticizing your drinking or drug use?
•3. Have you felt bad or guilty about your drinking or drug use?
• 4. Have you ever had a drink or used drugs first thing in the morning to steady your
nerves or to get rid of a hangover (eye-opener)?
•Scoring on the CAGE
•0 for "no" and 1 for "yes" answers
•Higher score being an indication of alcohol problems.
•Total of 2 or greater is considered clinically significant
•Some recommend lowering the threshold to one positive answer…
•To cast a wider net and identify more patients who may have substance abuse disorders
•Scoring The Alcohol Use Disorder Identification Test
•Total for each question 0-4
•Total for the interview could be 40
•Scores 8-15 represent medium level of alcohol problems
•16 above represent high level
•AWS Mortality Rate
•Severe alcohol withdrawal and delirium tremens (DTs) have been shown to be as high as
20% if untreated
•AWS Symptoms
•Using the CIWA
•Encompasses 10 areas—nausea and vomiting, tremor, paroxysmal sweats, anxiety,
agitation, tactile disturbances, auditory disturbances, visual disturbances, headache or
fullness in the head, and orientation and clouding of sensorium
•Assess the patient at least every 4 to 6 hours around the clock. If the score exceeds 20,
reassess in 1 to 2 hours, depending on symptom severity
•Patients with significant hepatic disease, symptom onset may be delayed up to several
days
•Using the CIWA
•Assessing tremor - patient extend the arms with fingers spread. But be aware that many
patients hyperextend their arms, which can cause difficulty evaluating extent of the
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Document Summary
Challenge - providing nursing care for the critically ill patient aws develops. Symptoms seen as early as 6 to 12 hours after the patient"s last drink. Range from mild to severe, can be mistaken for other serious medical conditions such as stroke, sepsis, hypoglycemia and hypoxia and can increase the associated risk of morbidity and mortality: assessment, assess drug and alcohol use. Start with the cage if positive further assess. Rule out other physical causes such as infections, electrolyte imbalance. 0 for no and 1 for yes answers: higher score being an indication of alcohol problems. Total of 2 or greater is considered clinically significant. Some recommend lowering the threshold to one positive answer . To cast a wider net and identify more patients who may have substance abuse disorders. Scores 8-15 represent medium level of alcohol problems. 16 above represent high level: aws mortality rate.
