physical dependence-appearance of withdrawal signs and symptoms after stopping drinking.loss of control-inability to stop drinking when drinking has begun.craving-a strong need or urge to drink alcohol.Coming to termsĪUD, also called alcoholism, is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. This article discusses how to assess patients at risk and how to use these assessment findings as a basis for nursing interventions for improved safe patient outcomes. 12Ī focused nursing assessment is essential in identifying the potential for AWS in all hospital units. 10,11 Alcohol abuse is not uncommon in patients with traumatic injuries, with 1 in 10 experiencing DTs requiring prompt and aggressive treatment. 9 AUD accounts for 21% of medical ICU admissions and approximately 44% of these patients die within 7 years. ICUs, EDs, CCUs, and trauma unit healthcare providers routinely treat patients with AUD, and up to 33% of patients progress to severe AWS and delirium tremens (DTs). The ED staff plays an important role as the initial or only medical care for some patients with AUD. A large percentage of patients in the ED are at risk for AWS because of increased lengths of stay and unrecognized signs and symptoms. The urgency of critical care admissions leads to abrupt alcohol cessation with potential for serious AWS. 4 As a result of this population's high acuity, incomplete assessments, misinterpretation of signs and symptoms, and/or the inability to identify these patients, management of patients with AWS is extremely challenging. Patients with unhealthy alcohol use are prevalent in hospitals, particularly young men who consume more than 2 to 4 drinks daily or more than 14 drinks per week. 8 Patients who drink heavily may not recognize that they have a problem, or be embarrassed and minimize their drinking pattern, not realizing that alcohol withdrawal can be life-threatening. Yet, patients at risk are not always obvious and signs of alcohol abuse can be obscure. Consequently, hospital nurses caring for these complex patients are on the front line for preventing, recognizing, and helping treat patients with AWS. So, it is important to determine the likelihood of withdrawal from other substances as well. Nurses should be aware of the possibility of polysubstance abuse in their patients. 6 Alcohol use plays a significant role in other substance and opioid use disorders, contributing to the opioid mortality epidemic. 4,5 One study found that 50% of people with AUD will develop AWS when they reduce or discontinue their alcohol consumption. 3 Data indicate that 40% of US-admitted hospital patients suffer from this disease with approximately 500,000 episodes of alcohol withdrawal syndrome (AWS) per year. 1,2 In 2016, AUD accounted for around 3 million or 5.3% of all deaths globally. Approximately 16 million American adults meet criteria for alcohol use disorder (AUD), which is the third-leading cause of preventable death in the US.
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