Care Plan: Alcohol Withdrawal Syndrome (AWS) and Delirium Tremens (DT)

Overview

• Medical Diagnosis: Alcohol Withdrawal Syndrome (AWS)
• Key Symptoms: Delirium tremens, autonomic hyperactivity, nausea, vomiting, hallucinations, psychomotor agitation, anxiety, generalized tonic-clonic seizures.
• Cause: Occurs after cessation or reduction in prolonged alcohol consumption causing physical dependence.

Desired Outcomes

• Maintain or regain appropriate level of consciousness
• Stable vital signs
• Absence of hallucinations
• Patient remains free of injury
• Regain control of daily activities and functioning

Subjective Data

• Common Patient Feelings:
  • Headaches
  • Anxiety and confusion
  • Nausea
  • Heart palpitations

Objective Data

• Physical Symptoms:
  • Restlessness, agitation, tremors
  • Uncontrollable sweating
  • Potential cardiac dysrhythmias (tachycardia, hypertension)
  • Seizures

Nursing Interventions

1. Perform Complete Assessment

• Vital Signs: Monitor respiratory system, neurological system, and cardiac status.
• Withdrawal Stages:
  • Stage 1: Hyperactivity
  • Stage 2: Hallucinations and seizures
  • Stage 3: Delirium tremens (confusion, fever, anxiety)

2. Maintain Airway and Oxygenation

• Keep airway patent
• Initiate oxygen if pulse oximetry drops (per doctor's orders/protocols)

3. Monitor Psychological State

• Check for suicidal ideations due to confusion and anxiety
• Isolation or restraints as needed for safety (following facility protocol)

4. Monitor Cardiac Health

• EKG/Telemetry: Obtain 12-lead EKG baseline and continuous heart monitoring

5. Address Wernicke-Korsakoff Syndrome

• Administer "Banana Bag" (IV vitamins) to prevent or treat confusion

6. Ensure Hydration

• Initiate IV hydration to prevent dehydration and cardiac dysrhythmias

7. Seizure Precautions

• Bedside suction and potential room camera for seizure monitoring

8. Create Calm Environment

• Reorient patient to decrease anxiety and overstimulation

9. Administer Medications

• Administer Lorazepam or Diazepam as per CIWA protocol based on withdrawal severity scores

10. Provide Education and Resources

• Educate patient and family on future care and support options post-hospitalization

Conclusion

• Importance of Support: Guidance and support are crucial for patients to stop drinking and prevent future complications.
• Additional Resources: Encourage the use of educational resources to better understand AWS and its management.

Note

• Always refer to facility protocol and doctor's orders for specific patient care and medication administration.

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