Question

The emergency department nurse is assessing a 38-year-old man who was in a motor vehicle accident. The patient was an unrestrained driver of the vehicle. The vehicle was traveling approximately 42 miles per hour. Upon impact, the driver collided with the windshield and sustained a head injury. The patient is now stable, complaining of pain 9/10 in the head, neck, and shoulder region. Neurologic status: cranial nerves 2-12 intact; patient is awake, alert, and oriented; computed tomography scan was negative for hematoma or hemorrhage. Vital signs: T 97.5, P 68, R 16, BP 130/70. The patient is asking the nurse for pain medication; however, the nurse smells alcohol on the patient’s breath. Toxicology reports are pending.

1. Based on the information presented, what subjective data will assist the nurse in making a decision to treat this patient’s pain?

2. The nurse is teaching the patient about the standard amount of alcohol in various beverages. How would the nurse explain a standard drink in the United States?

3. The laboratory findings showed evidence of chronic alcohol abuse. What risk factors are associated with this patient's alcohol use?

4. What interventions should the nurse incorporate into the plan of care for this patient?

Answer 1

1. Based on the information presented, what subjective data will assist the nurse in making a decision to treat this patient’s pain?

Subjective data is the patients own words of what he is experiencing.

In this case, the subjective data the nurse has to consider is the complaining of pain, 9/10 (as per the numerical pain scale) in the head, neck and shoulder region.

The immediate care of the patient must involve the management of pain as he has severe pain and the Neurologic status is stable. (The cranial nerves 2-12 intact; the patient is awake, alert, and oriented; computed tomography scan was negative for hematoma or haemorrhage)

2. The nurse is teaching the patient about the standard amount of alcohol in various beverages. How would the nurse explain a standard drink in the United States?

The different types of drinks -beer, wine, or malt liquor can have very different amounts of alcohol content. For example

The regular beer: 5% alcohol content and light beers: 4.2% alcohol content

It is very important to know the amount of alcohol in the drink.

One "standard" drink In the United States contains roughly 14 grams of pure alcohol.

Examples are:

·         12 ounces of regular beer, with 5% alcohol

·         5 ounces of wine, with 12% alcohol

·         1.5 ounces of distilled spirits (Gin, Rum, whiskey, Vodka) with 40% alcohol

·         8-9 fl oz of malt liquor with 7% alcohol

3. The laboratory findings showed evidence of chronic alcohol abuse. What risk factors are associated with this patient's alcohol use?

Chronic alcohol consumption is an important risk factor for many health problems and it always increases the global burden of disease. Alcohol is considered as the necessary underlying cause for more than 30 conditions and a contributing factor to many more.

Conditions for Which Alcohol Is the sure Cause

a. alcohol use disorders (AUDs), includes alcohol dependence and harmful use or alcohol abuse.

b. Alcoholic liver disease and alcohol-induced pancreatitis

Conditions for Which Alcohol Is a contributory Cause

They outnumber the alcohol-specific conditions.

• Infectious disease
• Cancer
• Diabetes
• Neuropsychiatric disease
• Cardiovascular disease
• Liver and pancreas disease
• Unintentional and intentional injury.

4. What interventions should the nurse incorporate into the plan of care for this patient?

A. Immediate management:

It should be focused on trauma care, like:

• Pain management
• Wound care
• Ambulation
• Activities of daily living
• Health teaching on alcoholism

B. Long-term management

a. Alcohol interventions:

1.   Primary Care

• Social Work and Behavioral Health can assist in assessments/engagement.

• Ambulatory treatment/management of alcohol withdrawal.

• Medications for managing alcohol craving and alcohol use disorder.

2. Behavioral Health

• Mental health care: individual and group psychotherapy, psychiatric care and psychological testing.

• Chemical dependency care (through a contracted network of providers): assessment and evaluation, chemical dependency counselling, and residential treatment.

• Inpatient detoxification (through a contracted network of providers) when determined medically necessary.

3. Resources (Outside) that can be helpful to the patient.

• Alcoholics Anonymous groups.

• Smart Recovery

• Washington Recovery Help Line: 1-866-789-1511 or www.warecoveryhelpline.org

• Women for Sobriety: www.womenforsobriety.org.

• Al-Anon/Alateen: www.al-anon.alateen.org.

• Celebrate Recovery® Ministry

b. Pharmacological management of the Alcoholic patient.

c. Prevention of Motor vehicle accidents

d. diversional therapy

e. Yoga and meditation