Scenario J.G., a 69-year-old man, was seen in the emergency department (ED) 2 days ago, diagnosed (Dx) with alcohol intoxication, and released after 8 hours to his brother’s care.

Scenario J.G., a 69-year-old man, was seen in the emergency department (ED) 2 days ago, diagnosed (Dx) with alcohol intoxication, and released after 8 hours to his brother’s care. He was brought back to the ED 12 hours ago with an active gastrointestinal (GI) bleed and is being admitted to ICU; his diagnosis is upper GI bleed and alcohol intoxication. You are assigned to admit and care for J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) 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 (ETOH) 271 mg/dl. He was given IV ?uids and transfused 6 units of packed RBCs (PRBCs) in the ED. On initial assessment, you note that J.G.’s VS are blood pressure (BP) 154/90 mm Hg, pulse 98 beats/min; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears ?ushed. You note that he has not had any emesis and has not had any frank red blood in his stool or “black tarry stools” over the past 5 hours. In response to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a ?fth 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.

1. Which data from your assessment of J.G. are of concern to you?

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2. What is the 2 most likely causes of J.G.’s symptoms?

3. What is the most likely time frame for someone to have withdrawal symptoms after abrupt cessation of alcohol? 4. What are the characteristics of alcohol withdrawal syndrome (delirium tremens)?

CASE STUDY PROGRESS

You note that J.G.’s physician has not diagnosed J.G. as having alcohol dependence, and his orders do not include treatment for alcohol withdrawal.

5. What action is necessary before you continue to care for J.G.?

6. What is the difference between alcohol dependence and alcohol abuse?

7. What would be helpful for J.G.’s physician to know regarding J.G.’s substance abuse history?

8. What are the 3 main objectives of treatment of chronic alcoholism?

9. Which clinical assessment tool is commonly used to monitor withdrawal symptoms? Explain how it is used.

10. What class medications are commonly prescribed for patients withdrawing from alcohol? List 2 examples of each class.

11. What chronic health problems are associated with alcoholism? Give 2 examples of each.

12. What other medical problems will you need to be aware of as he provides J.G.’s treatment for alcohol withdrawal? How could you help assess for these problems? List 5 assessment questions.

13. What lab tests might be ordered to assess for nutritional de?ciencies or other medical problems J.G. is experiencing?

14. What types of education and referral should be done before J.G.’s discharge from the hospital? List 4

15. What medications (List 3) might be prescribed to J.G. to assist him with sobriety? What is the usual treatment regimen, and what side effects and precautions should you educate the patient about concerning each?