Alcohol Use Disorders

Question 1

What is a standard drink? How do the measurements differ per type of alcohol?

Answer 1

Any drink with 14 grams of pure alcohol

Question 2

Differentiate the classifications of alcohol consumption.

Answer 2

Light
(0.01 - 0.21 fl oz daily ethanol consumption, not daily use)

Moderate
(0.22 - 0.99 fl oz)
Male <2 drinks/day or 4 to 14 drinks/ week
Female < 1 drink/day or 3 to 7 drinks/week

Heavy
= > 1.00 fl oz
Males > 15 drinks/week
Female > 8 drinks/week

Question 3

What are different patterns of drinking?

Answer 3

Daily drinking
- Moderate Consumption
- Heavy consumption

Binge Drinking
- pattern of drinking that brings BAC to 0.08 g/dL
(usually after 4 drinks for female and 5 for males within 2 hours)

Question 4

Discuss the effects of alcohol use.

Answer 4

CNS
- impacts neurotranspition
- changes in impulse control, mood, behavior, and coordination
( nausea, blurred vision , slurred speech, slowed reaction time, impaired memory etc)

Nontolerant individuals,
- BAC

Tolerant
- BAC does not determine the effects (no impairment even with high BAC)

Question 5

What are some complications of alcohol use?

Answer 5

Short term
- inc risk for injury MVC (motor vehicle crashes)
- falls, firearms, assault, drawing, burns

Long Term
- HTN (inc fluid but vasoconstriction), Stroke,
- Anemia, leukopenia (suppression of RBC), Thrombocytopenia
-Cancer
- Alcholic Demenia
- Liver damage or cirrhosis

Chronic Use: Wernick Encephalopathy
C - onfusion
O ophthalmoplegia (weakness of eye muscles)
A ataxia
T thiamine deficiency

Korsakoff (thiamin , vit B1 deficency)
R retrograde amnesia refers to the loss of information that was acquired before the onset of amnesia.
A anterograde amnesia - Anterograde amnesia (AA) refers to an impaired capacity for new learning.
C confabulation
K Korsakoff psychosis

Question 6

What is Alcohol Use Disorder (AUD)?

Answer 6

Problematic pattern of alcohol use leading to clinically significant impairment or distress

Question 7

What are some risk factors associated with AUD?

Answer 7

Being a woman (has a higher blood conc, higher body fat, lower % of water) , higher conc of alcohol in blood , less dehydrogenase that breaks down alcohol in the stomach

Genetic
- more prone due to AUD due to certain genes

Fam Hx
- fam with AUD , growing up around them

Age of onset drinking
- exposed to alcohol at an early age (normalization) or experimenting at an early age

Psychosocial
- Culture
- Personal experience
- Stress

Question 8

How would you screen for AUD?

Answer 8

Questionare:

1. Have you ever felt you ought to cutdown on drinking?
2. Have people annoy you by critizing your drinking?
3. Have you ever felt bad or guilt about your drinking?
4. Have you ever had a drink first thing in the morning (eye opener) to study your nerves or get rid of a hangover?

DSM - 5 Criteria , manifesting 2 or more of the certain criteria

Mild: 2 -3 warning signs

Moderate : 4-5

Serve - 6 or more

Lab Values : BAC, AST, ALT, MCV

physical assessment

Question 9

What does interprofessional management of AUD consist of? What are the overall goals of nursing management?

Answer 9

Assessment and determination of treatment goals
* substance use disorders? mental health, other medical history

Nonpharmacological treatment
( Motivational enhancement therapy - make them want to abstain from alcohol use)
Cognitive heavier therapy - relationships, feeling thoughts, (help manage urges and triggers to drink)

Pharmacological treatment
(Acamprosate - monitor kidneys
Disulfiram - contraindicated with active alcohol use
Naltrexone - reduce effectiveness of opioids , monitor the liver)

Nursing Management Goals: Prevent progression of symptoms, provide safety, encourage patient to engage in long term treatment

Question 10

What is alcohol toxicity?

Answer 10

High blood alcohol level

BAC of 0.40% ( 9-10 drinks/hour)
suppression of CV and respiratory system —> coma and death

0.45% BAC, alcool suppress major organ systems —> death

Question 11

List the clinical signs and symptoms associated with alcohol toxicity.

Answer 11

• mental confusion , stupor (unconsciousness), coma, person cannot be aroused
• Hypothermia
• tacky , weak pulse
• rsp depression
• vomiting
  -seizures

Question 12

How is alcohol toxicity managed/treated?

Answer 12

• intubation
• o2
• IV hydration (replace electrolytes and volume repletion)
• may need hemodialysis to remove ethanol and toxins from blood

NURSING MANAGEMENT:
- maintain ABCs
- freq neuro assessmnt
- freq vital sign assessment
- prevent aspiration/chocking
- protective measures of risk for injury

Question 13

Differentiate the stages of alcohol withdrawal symptoms.

Answer 13

Stage 1 ( 6 - 12 hours post alcohol) :
- anxiety
chills, sweats or fevers
chest pain or palpitations
insomnia
headache
N/V
adominal pain

Stage 2 (24-72 hours)
- marked agitation
tremulous with constant eye
movemets
SBP > 160
hallucinations
withdrawal seizures

Stage 3 (48 - 96 pos )
Delirium Tremens

Question 14

Describe the tool used for early detection.

Answer 14

Clinical Institute Withdrawl Assessment of Alcohol Scale, Revised (CIWA-Ar)
monitor every 4 hours and score (cause , vomitin, anxiety, etc)

Question 15

What is delirium tremens and when does it occur?

Answer 15

(48 to 96 hours post-alcohol)

• Visual hallucinations
  -Disorientation
• severe tachy and hypertension
• severe agitation
• tremulousness
• fever, severe diaphoresis

Question 16

What are the risk factors for delirium tremens?

Answer 16

• age > 65 years
• long duration of heavy and regular alcohol consumption
• experience withdrawal symptoms when abstinent
• history of withdrawal seizures
• hepatic cirrhosis
• lab abnormalities

Question 17

How might you prioritize your treatment plan for alcohol withdrawal?

Answer 17

Get supplements up and toxins out

Thiamine
Folate
Multivatimain
Treat low mg
IVF therapy

Benzo
Antiepliepileptic