Addiction, Chemical Dependency, and Withdrawal
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Simultaneous consumption of alcohol and sedative-hypnotics increases the risk of death.undefined#ref4">4
Alcohol withdrawal is a potentially life-threatening health condition requiring medical attention.15 Severe alcohol or sedative-hypnotic withdrawal (e.g., from sedatives or barbiturates) can be fatal; rapid treatment is required for both conditions.
Alcohol and substance use are widespread in the United States, and alcohol is commonly abused.15 People who are addicted to drugs have a higher incidence of mood and anxiety disorders than the general population,12 and people with mood and anxiety disorders have a higher risk of developing an addiction to drugs (including prescription medications used for nonmedical purposes) and alcohol.11
The rate of alcohol-related emergency department visits has increased steadily in recent years.14 Alcohol and drug abuse affects adolescents, adults, and older adults.15 Although opioid and cocaine withdrawal produce nonlife-threatening symptoms (opioid withdrawal resembles the flu; cocaine withdrawal leads to restlessness and agitation), alcohol and sedative-hypnotic withdrawal may be fatal.
Nurses working in emergency departments, trauma units, and other medical-surgical settings must be educated about alcohol and drug intoxication and withdrawal so that they can treat patients adequately. The nurse’s role in caring for these patients includes conducting a thorough patient assessment and substance abuse history, maintaining safety for the patient and health care team members, and monitoring the patient’s vital signs and electrolyte status.
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Rationale: Sedative-hypnotic withdrawal can occur within 20 days of stopping substance use.8
Rationale: Alcohol withdrawal symptoms appear 6 to 72 hours after alcohol use is significantly decreased or discontinued but can appear up to 1 week after discontinuing use.7
Rationale: Taking vital signs as soon as possible can assist in detecting the risk of organ damage (e.g., detection of hypertension, hyperventilation, and tachycardia).3
Rationale: Nurses should assess all patients with a validated instrument. The CAGE-AID is a questionnaire that helps patients identify drug and alcohol usage trends in their lives.5
If the patient has a positive response to the screening tool, perform more in-depth assessment or refer the patient for further assessment.
Rationale: Alcohol withdrawal can result in agitation and aggression toward others. Dysphoria is a withdrawal symptom experienced by opioid abusers that may provoke self-harm. Alcohol and sedative-hypnotic withdrawal can also result in seizures, and alcohol withdrawal can lead to a potentially life-threatening condition called delirium tremens.13 Taking precautions, such as implementing falls protocols, can prevent injury.4
Rationale: Dehydration is common with diaphoresis, nausea, and vomiting related to alcohol and sedative-hypnotic withdrawal. Diarrhea and diaphoresis are related to opioid withdrawal.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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