Question

PN 200 Fundamentals of Nursing II Alcohol Use - Dependency LM, a 57 year old man, is admitted to the surgical unit in preparation for back surgery, after conventional treatment for a recent back injury has not relieved his pain. His wife tells the nurse that she hopes that the surgery will be successful. She confides that her husband as just been sitting around the house, drinking more beer than usual, because he has not been able to work. LM appears relaxed and unconcerned about his upcoming surgery. He jokes with the nurse, telling her that his back would be cured if a cute young thing like her, would rub his back." 1. What assessments of LM's alcohol use should the nurse make and communicate to the surgeon and anesthesiologist before he is further prepared for surgery? 2. How would the nurse's approximation of LM's BAC (blood alcohol content) affect his surgical experience? 3. During LM's postoperative period, when will the nurse expect signs of withdrawal syndrome to occur being sure to include your rationale for your answer? 4. What early signs and symptoms would alert the nurse to the development of withdrawal syndrome? 5. What drug regimens might be used during LM's postoperative period to manage problems associated with his alcohol use? 6. Prepare a list of medications that could be used if Mr. LM went into acute alcohol withdrawal Reviewed 10/19

Answer 1

1. currently the assessment used for the assessment of patient alcohol is called alcohol use disorders identification test(AUDIT) developed by WHO

In that 10 questionerrs are available

1.How often do you have a drink containing alcohol?

2.How many drinks containing alcohol do you have on a typical day when you are drinking?

3.How often do you have six or more drinks on one occasion?

4.How often during the last year have you found that you were not able to stop drinking once you had started?

5.How often during the last year have you failed to do what was normally expected from you because of drinking?

6.How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

7.How often during the last year have you had a feeling of guilt or remorse after drinking?

8.How often during the last year have you been unable to remember what happened the night before because you had been drinking?

9.Have you or someone else been injured as a result of your drinking?

10.Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

each questions have a score of 0 to 4

A score of 8 or more is considered to indicate hazardous or harmful alcohol use. The AUDIT has been validated
across genders and in a wide range of racial/ethnic groups and is well suited for use in primary care settings.

The nurse should do this assessment and based on the score she or he should report to the surgeon and the anaesthetist.

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2.Blood alcohol concentration (BAC), also called blood alcohol content, blood ethanol concentration, or blood alcohol level, is most commonly used as a metric of alcohol intoxication for legal or medical purposes.

Blood alcohol concentration is usually expressed as a percentage of ethanol in the blood in units of mass of alcohol per volume of blood or mass of alcohol per mass of blood, depending on the country. For instance, in North America a BAC of 0.10 (0.10% or one tenth of one percent) means that there are 0.10 g of alcohol for every 100 ml of blood. The following measures in grams indicates the effects of alcohol correspondence to the blood alcohol content.

0.001–0.029

Average individual appears normal

0.030–0.059

Mild euphoria Relaxation Joyousness Talkativeness Decreased inhibition

00–0.500

Severe central nervous system depression Coma Possibility of death

A new study shows drinking even moderate amounts prior to surgery could slow down recovery and weaken the immune system.Claudia Spies, an intensive care specialist at the Charité University hospital in Berlin, said: "A significantly high rate of complications can develop in patients who consume alcohol at levels that are less than excessive."

She said that around 20% of adults admitted to hospital drink three beers or two glasses of wine every day for a prolonged period, and they were more likely to fall victim to pneumonia or heart muscle disease or suffer complications such as bleeding after surgery. "In addition," Spies said, "some 50% of patients who are committed to hospitals after an accident suffered their injuries under the influence of alcohol. Consequently, the rate of immune-system complications in emergency medicine is also very high."

........................................................................................................................................................................................................3.The surgical stress response was greater in alcohol abusers, which may further compromise the already dysfunctioning organs, thus leading to the documented increase in postoperative morbidity. Withdrawal from alcohol reverses organic dysfunction in non-surgical patients. Haemostasis normalises after one to four weeks, cardiac function after one month, immune function after two months, and response to external stress after three months. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re-operation. The personal and economic consequences are tremendous.

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4. The signs and symptoms of Alcohol Withdrawal syndrome may appear anywhere from six hours to a few days after your last drink. These usually include at least two of the following:

• tremors
• anxiety
• nausea
• vomiting
• headache
• an increased heart rate
• sweating
• irritability
• confusion
• insomnia
• nightmares
• high blood pressure

The symptoms may worsen over two to three days, and some milder symptoms may persist for weeks in some people. They may be more noticeable when you wake up with less alcohol in your blood.

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only four questions are supposed to answer