Question

Mandy Adams is a 45-year-old woman who was brought to the emergency room (ER) by her family because she seemed disoriented and confused. She has a chronic history of drinking alcohol but has been able to maintain a job at UPS for the past 22 years. On presentation to the ER, Ms. Adams is confused, she does not seem to know where she is, or how she got there.

1. What medical care will be ordered for Ms. Adams? Please include ongoing diagnostic testing, lab work and treatment options.

2. What outcomes measures will indicate positive medical response?

3. What is the focus of nursing care for Ms. Adams? Please address the significant problems identified including the use of holistic care measures.

4. What are the areas for patient education?

Answer 1

Mandy Adams is a 45-year-old woman who was brought to the emergency room (ER) by her family because she seemed disoriented and confused. She has a chronic history of drinking alcohol but has been able to maintain a job at UPS for the past 22 years. On presentation to the ER, Ms. Adams is confused, she does not seem to know where she is, or how she got there.

1-What medical care will be ordered for Ms. Adams? Please include ongoing diagnostic testing, lab work and treatment options.

Altered mental status comprises a group of clinical symptoms rather than a specific diagnosis, and includes attention disorders, arousal disorders, and decreased level of consciousness, confusion disorientation etc. AMS is a very common emergency case, but the exact aetiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency department. An in-depth understanding of the root cause of the condition and complete patient assessment will help increase the diagnosis rate and ensure treatment accuracy.

Medical / Physical Assessment- Quick physical and verbal assessment should be taken to assess the orientation, registration, attention and calculation, recall, and language. This help the nurse to get picture of level of mental status of the patient. Check for associated symptoms such as chest pain increased heart rate, breath rate, breathlessness. The nurse should also consider checking fatigue, fear, excessive sweating, restlessness insomnia etc.

Diagnostic Procedure-

Vital Signs- BP, HR, O2 Saturation

ECG, or an electrocardiograph, checks for abnormalities in the electrical activity in your heart. Because some going through alcohol withdrawal experience heart palpitations or arrhythmias, this can evaluate heart health and the severity of withdrawal.

EEG, or electroencephalogram, can detect electrical abnormalities in your brain. This may be used to evaluate people undergoing severe alcohol intoxication, especially in those who are prone to or are experiencing seizures.

Blood Examination- Blood routine, Blood Glucose Urine Analysis.

Blood Magnesium level- Evaluating blood magnesium level, or serum magnesium level, can be done with a simple blood test. Low magnesium levels can indicate alcoholism or severe alcohol withdrawal. Normal magnesium levels are necessary to keep the heart functioning properly.

Blood phosphate level: This can also be evaluated with a blood test. Low phosphate levels may also indicate alcoholism.

Management-

Intravenous fluids- to make the patient enough hydrated, to administer drugs.

Benzodiazepines- Will relax the patient, induce sleep, and reduce the chance of seizures

Symptomatic treatment if needed.

2. What outcomes measures will indicate positive medical response?

When patients gets aware of where she is, time and to recollect the past events and people denotes the positive medical response. Then she can be shifted from the emergency room to private care and supervision. Counselling and exercise sessions needed to be started to maintain mental and physical strength. Detox regimes needed to be initiated with the supervision of clinical psychologist.

3. What is the focus of nursing care for Ms. Adams? Please address the significant problems identified including the use of holistic care measures.

Nursing care of the patient include regular monitoring of the vital signs. Dietary advices in order to get necessary nutrition. Physical exercise needed to be initiated with the help of a physiotherapist. Monitor the patient for continuation of medication at regular intervals.

4. What are the areas for patient education?

Alcohol Avoidance- Set a goal for yourself to completely stop drinking. This will stop you from being dependent on it. This will also prevent you from developing alcohol withdrawal and other more serious health problems

Avoid stress: Stress may make your alcohol dependence and withdrawal worse and cause other problems later. Learn ways to control stress and your unwanted behaviour.

Learn more about alcohol dependence and withdrawal. The more you know about alcohol dependence and withdrawal, the better you will be able to help yourself.

Be patient and keep your hopes up for improvement. Be more patient and not too hard on yourself. Always be the first one to encourage yourself and find ways to boost your self-esteem. Work together with your family and friends and give each other support. This will help during hard times.