Case study from Elsevier on Alcohol abuse Scenario.
JH is a 49 yo man was seen in the ED 2 days ago, diagnosed with alcohol intoxication and released after 8 hours to his brothers care. He was brought back to the ED 12 hours ago with an active GI bleed and is being admitted to the ICU, his diagnosis is upper GI bleed and alcohol intoxication.
You are assigned to admit and care for JH for the remainder of your shift. According to the ED notes, his admission vital signs were 84/56,110,26 and he was vomiting bright red blood. His labs were remarkable for Hct 23%, alanine transaminase ALT 69 IU/ml. aspartate transaminase (AST) 111 IU/ml and serum alcohol 271 mg/dl. He was given IV fluids and transfused 6 units of packed RBC’s in the ED. On initial assessment, you note that JH’s VS are BP 154/90mmHG, pulse 98 beats/min, he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed. You note that he has not had any emesis and has not had any frank red blood in his stools or black tarry stools over the past 5 hours. In response to your questions, JH denies that he as a alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months. He reports having been drinking just before his admission to the ED. He admits to having had seizures while withdrawing from alcohol in the past.
- Which data from your assessment of JH are of concern to you? Explain your points.
- What are the two most likely causes of JH symptoms?
- What is the most likely time frame for someone to have withdrawal symptoms after abrupt cessation of alcohol?
- Is JH exhibiting any withdrawal symptoms now? if so identify them.
- If JH does not receive any additional treatment for his alcohol withdrawal what additional symptoms might he exhibit and identify the timeframe for them to occur.
- Identify what medications would you recommend JH receive for this alcohol withdrawal and why?
- What assessment tool or tools would you use to assess JH withdrawal symptoms?
- What are 3 priority nursing diagnosis that you would indicate on JH’s care plan and explain why they are a priority for you?
- What are at least 3 nursing goals or outcomes for JH?
- Identify and give rationales for at least 3 nursing interventions per each nursing goal for JH.
- How you would evaluate JH if he was accomplishing the goals identified?
Case study progresses:
JH has stabilized and is ready to return to his home in a few days. He lives alone. The only family he has is his brother who lives in the same town. JH has a factory job what he will return to if he can stay sober.
As you help prepare JH to return home,
- What additional assessment information do you need to obtain before his discharge?
- JH has little understanding of the effects of alcohol on his body. No one has spent time teaching him about this.
Identify what would you teach JH about the effects of alcohol on one body? 5 main points
What else would you as his nurse want to teach JH about alcohol use? 5 items
- As he is readying for discharge, JH was prescribed Antabuse while in the hospital and he asks you what this new medication is supposed to do?
What is your teaching plan for JH about this medication?
- Identify 3 resources- websites that JH could use after he is discharged and explain the reason you picked these resources for your patient.
