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?
