What is a standard drink? How do the measurements differ per type of alcohol?
Any drink with 14 grams of pure alcohol
Differentiate the classifications of alcohol consumption.
Light
(0.01 - 0.21 fl oz daily ethanol consumption, not daily use)
Moderate
(0.22 - 0.99 fl oz)
Male <2 drinks/day or 4 to 14 drinks/ week
Female < 1 drink/day or 3 to 7 drinks/week
Heavy
= > 1.00 fl oz
Males > 15 drinks/week
Female > 8 drinks/week
What are different patterns of drinking?
Daily drinking
- Moderate Consumption
- Heavy consumption
Binge Drinking
- pattern of drinking that brings BAC to 0.08 g/dL
(usually after 4 drinks for female and 5 for males within 2 hours)
Discuss the effects of alcohol use.
CNS
- impacts neurotranspition
- changes in impulse control, mood, behavior, and coordination
( nausea, blurred vision , slurred speech, slowed reaction time, impaired memory etc)
Nontolerant individuals,
- BAC
Tolerant
- BAC does not determine the effects (no impairment even with high BAC)
What are some complications of alcohol use?
Short term
- inc risk for injury MVC (motor vehicle crashes)
- falls, firearms, assault, drawing, burns
Long Term
- HTN (inc fluid but vasoconstriction), Stroke,
- Anemia, leukopenia (suppression of RBC), Thrombocytopenia
-Cancer
- Alcholic Demenia
- Liver damage or cirrhosis
Chronic Use: Wernick Encephalopathy
C - onfusion
O ophthalmoplegia (weakness of eye muscles)
A ataxia
T thiamine deficiency
Korsakoff (thiamin , vit B1 deficency)
R retrograde amnesia refers to the loss of information that was acquired before the onset of amnesia.
A anterograde amnesia - Anterograde amnesia (AA) refers to an impaired capacity for new learning.
C confabulation
K Korsakoff psychosis
What is Alcohol Use Disorder (AUD)?
Problematic pattern of alcohol use leading to clinically significant impairment or distress
What are some risk factors associated with AUD?
Being a woman (has a higher blood conc, higher body fat, lower % of water) , higher conc of alcohol in blood , less dehydrogenase that breaks down alcohol in the stomach
Genetic
- more prone due to AUD due to certain genes
Fam Hx
- fam with AUD , growing up around them
Age of onset drinking
- exposed to alcohol at an early age (normalization) or experimenting at an early age
Psychosocial
- Culture
- Personal experience
- Stress
How would you screen for AUD?
Questionare:
- Have you ever felt you ought to cutdown on drinking?
- Have people annoy you by critizing your drinking?
- Have you ever felt bad or guilt about your drinking?
- Have you ever had a drink first thing in the morning (eye opener) to study your nerves or get rid of a hangover?
DSM - 5 Criteria , manifesting 2 or more of the certain criteria
Mild: 2 -3 warning signs
Moderate : 4-5
Serve - 6 or more
Lab Values : BAC, AST, ALT, MCV
physical assessment
What does interprofessional management of AUD consist of? What are the overall goals of nursing management?
Assessment and determination of treatment goals
* substance use disorders? mental health, other medical history
Nonpharmacological treatment
( Motivational enhancement therapy - make them want to abstain from alcohol use)
Cognitive heavier therapy - relationships, feeling thoughts, (help manage urges and triggers to drink)
Pharmacological treatment
(Acamprosate - monitor kidneys
Disulfiram - contraindicated with active alcohol use
Naltrexone - reduce effectiveness of opioids , monitor the liver)
Nursing Management Goals: Prevent progression of symptoms, provide safety, encourage patient to engage in long term treatment
What is alcohol toxicity?
High blood alcohol level
BAC of 0.40% ( 9-10 drinks/hour)
suppression of CV and respiratory system —> coma and death
0.45% BAC, alcool suppress major organ systems —> death
List the clinical signs and symptoms associated with alcohol toxicity.
- mental confusion , stupor (unconsciousness), coma, person cannot be aroused
- Hypothermia
- tacky , weak pulse
- rsp depression
- vomiting
-seizures
How is alcohol toxicity managed/treated?
- intubation
- o2
- IV hydration (replace electrolytes and volume repletion)
- may need hemodialysis to remove ethanol and toxins from blood
NURSING MANAGEMENT:
- maintain ABCs
- freq neuro assessmnt
- freq vital sign assessment
- prevent aspiration/chocking
- protective measures of risk for injury
Differentiate the stages of alcohol withdrawal symptoms.
Stage 1 ( 6 - 12 hours post alcohol) :
- anxiety
chills, sweats or fevers
chest pain or palpitations
insomnia
headache
N/V
adominal pain
Stage 2 (24-72 hours)
- marked agitation
tremulous with constant eye
movemets
SBP > 160
hallucinations
withdrawal seizures
Stage 3 (48 - 96 pos )
Delirium Tremens
Describe the tool used for early detection.
Clinical Institute Withdrawl Assessment of Alcohol Scale, Revised (CIWA-Ar)
monitor every 4 hours and score (cause , vomitin, anxiety, etc)
What is delirium tremens and when does it occur?
(48 to 96 hours post-alcohol)
- Visual hallucinations
-Disorientation - severe tachy and hypertension
- severe agitation
- tremulousness
- fever, severe diaphoresis
What are the risk factors for delirium tremens?
- age > 65 years
- long duration of heavy and regular alcohol consumption
- experience withdrawal symptoms when abstinent
- history of withdrawal seizures
- hepatic cirrhosis
- lab abnormalities
How might you prioritize your treatment plan for alcohol withdrawal?
Get supplements up and toxins out
Thiamine
Folate
Multivatimain
Treat low mg
IVF therapy
Benzo
Antiepliepileptic
