Case Study: Alcohol Withdrawal Delirium
Sam, a 45-year-old construction worker, is brought into the emergency room by his
brother, John. Sam is incoherent, disoriented, tremulous, and shifts in and out of
consciousness. At times he makes comments about bugs crawling on his skin. Sam has
lived alone for 6 years since his wife died of cancer. They had no children. John brought
Sam to the ER after receiving a call from Sam’s neighbor, who reported seeing Sam
weaving in and out of traffic on the street in front of their houses. John reports that he
sees Sam infrequently but believes that Sam drinks whiskey on a daily basis and probably
has increased the amount he drinks over the last few years. Sam lost his job a few weeks
ago and has been drinking heavily ever since. John postulates that Sam ran out of whiskey
a few days ago and hasn’t had money to buy more. John could find no food or alcohol in
the house when he went to pick up Sam. The physician admits Sam to the psychiatric unit
with a diagnosis of Alcohol Withdrawal Delirium. Lorazepam (Ativan) is ordered on a
scheduled and prn basis. Answer the following questions:
1. Explain the etiology of Alcohol Use Disorder.
Genetic, psychological, social and environmental factors impact how drinking alcohol
affects the body and behavior. Theories suggest that for certain people drinking has a
different and stronger impact that can lead to alcohol use disorder. Continually drinking
too much alcohol may change the normal function of areas in the brain associated with
the experience of pleasure, judgment and the ability to exercise control over your
behavior. This may result in craving alcohol to try to restore good feelings or reduce
negative ones.
2. Provide clinical manifestations of this condition. What are the criteria of this
condition according to the DSM-V?
A. Alcohol is often taken in larger amounts or over a longer period than was
intended.
B. There is a persistent desire or unsuccess ul e orts to cut down or control
alcohol use.
C. A great deal of time is spent in activities necessary to obtain alcohol, use
alcohol, or recover from its effects.
D. Craving, or a strong desire or urge to use alcohol.
E. Recurrent alcohol use resulting in a failure to fulfill major role obligations
at work, school, or home.
F. Continued alcohol use despite having persistent or recurrent social or
G. Interpersonal problems caused or exacerbated by the effects of alcohol.
H. Important social, occupational, or recreational activities are given up
I. or reduced because of alcohol use.
J. Recurrent alcohol use in situations in which it is physically hazardous.
K. Alcohol use is continued despite knowledge of having a persistent
L. or recurrent physical or psychological problem that is likely to have
M. been caused or exacerbated by alcohol.
N. Tolerance, as defined by either of the following:
A need or markedly increased amounts of alcohol to achieve intoxication
or desired effect.
A markedly diminished effect with continued use of the same amount of
alcohol.
O. Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome or alcohol (refer to Criteria A and
B of the criteria set or alcohol withdrawal)
Alcohol (or closely related substance, such as a benzodiazepine)
is taken to relieve or avoid withdrawal symptoms.
3. Develop a nursing care plan for this patient (Assessment, Nursing Diagnosis,
Plan, and Intervention).
Assess the patient appearance and behavior; flushed face, aggressive, restless,
slurred speech, irritable, labile, clouding of consciousness, disturbance in
movement, and headaches.
Nursing Diagnosis -Ineffective coping r/t use of alcohol to cope with life events.
Plan – Patient will demonstrate and verbalize adaptive coping strategies as
alternatives to alcohol use in response to stress.
Nursing Intervention- Set limits on manipulative behavior. Give positive feedback
for delaying gratification and using adaptive coping strategies. Practice
alternative, more adaptive coping strategies.
4. What do you know about benzodiazepines such as Ativan? What should you teach
this patient?
Benzodiazepine such as Ativan, also known as lorazepam, these are used to treat
alcoholism and alcohol withdrawal symptoms. Advise patients not to drive a
motor vehicle or operate dangerous equipment when taking anxiolytics because
sedation is a common side effect. One patient not to consume alcohol or other
CNS depressants while taking anxiolytics. Inform patient that an effective
response may take one to two weeks. Encourage patients to follow drug regimen
and not to abruptly stop taking a medication. Teach patient ways to control excess
stress and anxiety with relaxation techniques. Continuous use can cause
withdrawal symptoms. The drug does usually tapered when a drug is
discontinued.