CARE STUY

ON

ACOHOLIC DEPENDENCE SYNDROME

BY

Ugala Chinenye lovely.

Eu/He/Nur/19/132

(Student)

Presented to

Evangel University Akaeze Ebonyi state.

March 2023
 DEDICATION

I Dedicate this work to God Almighty Who has Given me the knowledge, understanding, Strength and wisdom to complete this work, May his name be

Praisi....Amen.

ACKNOWLEDGEMENT

My gratitude goes to God Almighty,my provider who has showered me with grace and strength in this nursing career to complete my client care,may his

name be praised.

I wish to use this opportunity to express my profound gratitude to my Wonderful parents

My special thanks also goes to my supervisor,who always use her time to read through , correct and encourage me in order to make this study successful.

My appreciation also goes to my provost and all the staff of Evangel University Akaeze.
 Table of content

DEDICATION

Acknowledge

Chapter one

Introduction.

Chapter two.

Patient profile

Family Composition

Social history

Past medical history

Past psychiatric history

Case presentation

Admission.

Nursing responsibility.

Compliant and their duration.

History of present illness.

Personal history.

Premorbid personality.
CHAPTER three.

Definition.

Types of alcoholics dependence syndrome.

Causes

Risk factors.

Pathophysiology

Clinical manifestation

Complications

Treatment.

Chapter four.

Nursing Management using nursing proces.

Nursing Assessment

Nursing diagnosis

Nursing care plan and goal.

Nursing intervention

Evaluation

Doctor's prescription.

Pharmacological review of drug's.

Progress note.

Health Education.
Advice on discharge.

General Evaluation of care.

Termination of patient Relationship

Nursing Implications

Summary

Recommendation

Reference.
 CHAPTER ONE.

INTRODUCTION

Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol

or continuing to use alcohol even when it causes problems. This disorder also involves having to drink more to get the same

effect or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder includes a level of

drinking that's sometimes called alcoholism.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems.

It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at

least four drinks within two hours. Binge drinking causes significant health and safety risks.

If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have

alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious

problems, so early treatment is important.Alcohol dependence syndrome is mental or physical dependence on drinking. Alcohol

problems affect more than 16.3 million adults across the nation. People who can recognize the symptoms of alcohol

dependence syndrome and similar issues can potentially save themselves and their family members from physical, mental, and

social health problems. They may also be able to curtail the situation before a loved one becomes debilitated by alcohol

use.There are a variety of disorders associated with the excessive use of alcohol. Since the terms are so often misused, there’s

quite a bit of confusion about the differences between them. Many people mistake alcohol abuse for alcohol dependency or
alcoholism. Abuse is defined as drinking too much and/or too often. Dependency is the inability to quit. Both conditions are

serious, but not being able to stop poses a bigger issue and a greater risk to the drinker.

CHAPTER TWO.

PATIENTS PROILE

Name of patient: Mr. O.E.

Age: 47ys

Sex: male

Date of birth: 7/01/1976

Home town: Ebonyi State

L.G.A: lshielu

Home address:

Nationality: Nigerian

Religion: Christianity

Occupation: Trader

Next of kin: Uchd.O.E

Relationship of next of kin: son

Religion: Christianity

Date of Admission: 4th February 2023

Ward: Female Medical Ward

Diagnosis: alcoholic dependence syndrome.

Consultant name: Dr O.

Date of Discharge: 13th February, 2021

Family Composition: Monogamous family (1st child)

Socioeconomic Status: Lower class

FAMILY COMPOSITION.

Mr.O.E is from a monogamous family and the first son of his family. He has 7 siblings, three girls and fours boy's.

SOCIAL HISTORY.

He Love's to play football and table tennis

PAST MEDICAL HISTORY

History of anxiety and Depression

PAST PSYCHIATRIC HISTORY

Mr.O.E reports that he has struggled with severe anxiety and mild depression from an early adolescent age. He stated that he

cannot remember the time when he was free of anxiety without using some kind of drugs. According to the patient, he was

never hospitalized for anxiety or depression. However, he states that he did have suicidal ideations in the past, but not suicidal

attempts. He denies any history of self-inflicted cuts or injuries. He has been prescribed benzodiazepine (Xanax) a medication

for anxiety and seroquel, antipsychotic (an atypical type for depression, but stopped taking both medications two years ago. “I

am not crazy and don’t want to be hooked on it.” Currently he is not under either a psychologist’s or psychiatrist’s care and

does not take any psychiatric medication.

PAST SURGICAL HISTORY

●NO past surgical history

Case presentation.

46 year-old man was evaluated for acute altered mental status after being hospitalized for alcohol withdrawal.The patient was

homeless but had recently been enrolled in an addiction treatment program in a residential clinical stabilization service. He

reportedly left the program 4 days before admission to this hospital and then “blacked out” daily in tandem with drinking 0.5 to

1 gallon of vodka throughout the day. On the evening before admission, he decided to stop drinking alcohol. Approximately 10
hours later, he awoke on the ground without recollection of lying down; he had had vivid dreams and tremulousness and was

worried that he may have had a seizure. He presented to the emergency department of this hospital.The patient reported

diffuse headache, nausea, nonbloody and nonbilious emesis, restlessness, auditory hallucinations, and a sensation of insects

crawling on the skin. A review of systems was notable for heartburn and was negative for confusion, ataxia, dizziness, focal

weakness and numbness, tongue laceration, incontinence, visual hallucinations, fever, chills, dyspnea, chest pain, abdominal

pain, diarrhea, and dysuria. His medical history was notable for seizure disorder in childhood, hypertension, and glaucoma, and

he had undergone umbilical hernia repair.

ADMISSIONS

Mr .O.E taking to the psychiatric ward by his father due heart Burns worse after meal and not help by antacids.He denies

weight loss,vomiting or blood stool/melena.He has some trouble falling asleep because of worries about something. Admisson

procedure was carried out which include,history taking, taking vital signs which was actually recorded, consent form was signed

by the father after he was admitted in bed one (1) the patient and the Father was oriented on the policies guiding the ward

which they both agreed to stand by them.

On physical examination, he look weak and was in pain,his vital signs and weight was checked which read this.

Temperature. 37.0°C

Pulse. 78b/m

Respiration. 22c/m

Blood pressure. 130/88mmg

Consent was signed by the father Mr O .was admitted on a well made bed and was allowed to assume a comfortable position

that does not contraindicate the condition. The patient husband was taken around the ward, show the toilet, bathroom, finally

the patient was registered and treatment commence.

Nursing Responsibility.
1.patient was admitted in a well made bed.

2.the patient was reassured.

3.the patient vital signs checked and recorded.

4.input and output recorded

5.patient was weighed daily.

COMPLAINTS AND THEIR DURATION.

1.According to patient. :patient is regularly taking alcohol since 2012 daily around half litre.After taking alcohol quarrels with

father and brother. Uncontrolled anger, decreased appetite and sleep.

2.Acorrding to father. Patient is taking alcohol with friends,show anger towards father and brother. Sleep is reduced and taking

less food.

HISTORY OF PRESENT ILLNESS.

1.onset. gradual.

2.precipitating factor. His friend use alcohol

3. Associated disturbances. decreased sleep and anger burst

4.Family History: No history of alcohol dependence and psychiatric disease in family. History of diabetes mellitus and

hypertension present.

PERSONAL HISTORY.

1.Birth and Early Development:Full term normal home delivery, No pre and post natal complication. Normal growth and

development.

2.Behavior during Childhood:No sleep disturbance,no thumb sucking,no tics and mannerism,no siblings rivary.
3.physical illness during childhood:No history of ant major physical illness during childhood. no epilepsy, head

injury,encephalitis during childhood.

4.SCHOOl:patient studied till secondary. Relationship with peers and teachers normal. He was na average student.

5.occupation.a farmer

6.sexual History. Normal sexual history. No abnormalities

7.marital history. Married

8.use and abuse of alcohol, tobacco:he is using alcohol and tobacco since 6 year's. Daily take half litre of alcohol.

PREMORBID PERMORBID PERSOBALITY.

1.Social relation:Normal behaviour toward family and friends.

2.intellectual activities:No significant intellectual activities noted

3.Mood.

Subjective- satisfied.

Objective - looks cheerful.

CHAPTER THREE.

LITERATURE REVIEW.

Definition:Alcohol dependence is a previous (DSM-IV and ICD-10) psychiatric diagnosis in which an individual is physically or

psychologically dependent upon alcohol (also chemically known as ethanol).

Incidence.

Types of alcoholic dependence syndrome. Or Stages. What are the stages of alcohol use disorder?Alcohol use that turns into a

use disorder develops in stages.

1.At-risk stage: This is when you drink socially or drink to relieve stress or to feel better. You may start to develop a tolerance

for alcohol.

Early alcohol use disorder: In this stage, you have progressed to blackouts, drinking alone or in secret, and thinking about

alcohol a lot.

2.Mid-stage alcohol use disorder: Your alcohol use is now out of control and causes problems with daily life (work, family,

financial, physical and mental health). Organ damage can be seen on lab tests and scans.

3.End-stage alcohol use disorder: Drinking is now the main focus of your life, to the exclusion of food, intimacy, health and

happiness. Despair, complications of organ damage and death are now close.
Causes of alcoholic dependence syndrome.

A.Biological Factors

Research has shown a close link between alcoholism and biological factors, particularly genetics and physiology. While some

individuals can limit the amount of alcohol they consume, others feel a strong impulse to keep going. For some, alcohol gives

off feelings of pleasure, encouraging the brain to repeat the behavior. Repetitive behavior like this can make you more

vulnerable to developing alcoholism.

There are also certain chemicals in the brain that can make you more susceptible to alcohol abuse. For instance, scientists have

indicated that alcohol dependence may be associated with up to 51 genes in various chromosome regions. If these genes are

passed down through generations, family members are much more prone to developing drinking problems.

B.Environmental Factors

In recent years, studies have explored a possible connection between your environment and risk of AUD. For example, many

researchers have examined whether or not a person’s proximity to alcohol retail stores or bars affect their chances of

alcoholism. People who live closer to alcohol establishments are said to have a more positive outlook on drinking and are more

likely to participate in the activity.

Additionally, alcohol manufacturers are bombarding the general public with advertisements. Many of these ads show drinking

as an acceptable, fun and relaxing pastime. In just four decades – between 1971 and 2011 – alcohol advertising in the United

States increased by more than 400%.

Another environmental factor, income, can also play a role in the amount of alcohol a person consumes. Contrary to popular

belief, individuals who come from affluent neighborhoods are more likely to drink than those living below poverty. Gallup’s

recent annual consumption habits poll showed that roughly 78% of people with an annual household income $75,000 or more

consume alcohol. This is significantly higher than the 45% of people who drink alcohol and have an annual household income of

less than $30,000.

C.Social Factors
Social factors can contribute to a person’s views of drinking. Your culture, religion, family and work influence many of your

behaviors, including drinking. Family plays the biggest role in a person’s likelihood of developing alcoholism. Children who are

exposed to alcohol abuse from an early age are more at risk of falling into a dangerous drinking pattern.

Starting college or a new job can also make you more susceptible to alcoholism. During these times, you’re looking to make

new friends and develop relationships with peers. The desire to fit in and be well-liked may cause you to participate in activities

that you normally wouldn’t partake in. Before you know it, you’re heading to every company happy hour, drinking more

frequently and even craving alcohol after a long workday – all warning signs of AUD.

D.Psychological Factors

Different psychological factors may increase the chances of heavy drinking. Every person handles situations in their own unique

way. However, how you cope with these feelings can impact certain behavioral traits. For example, people with high stress,

anxiety, depression and other mental health conditions are more vulnerable to developing alcoholism. In these types of

circumstances, alcohol is often used to suppress feelings and relieve the symptoms of psychological disorders.

E. Trauma

Childhood abuse and domestic or sexual abuse are likely to mentally scar anyone, and these are high-risk factors for alcohol use

disorder. When you don’t properly address past abuse in therapy, you might turn to heavy drinking to temporarily feel better

about your situation. This is a dangerous practice, as it turns into a destructive cycle.

To better deal with trauma and move past it, talk to a therapist. He or she will talk to you about how these incidents have

affected you long-term, and you’ll learn how to cope with trauma without turning to alcohol.

F.. Self-Medicating: Drinking to Cope

If you’ve lost a loved one, gotten divorced or got fired from your job, you’re likely dealing with grief, pain and loss. These are all

emotions that can cause people to drink. For the time being, alcohol might make you feel joyful and carefree, but if you develop

alcoholism, your grief and pain will get worse.

People tend to self-medicate because it’s convenient and less expensive than going to a doctor or psychologist. In addition, the

internet has become a widely available resource for information. People visit websites like WebMD to research their symptoms,

but this is not how they should go about a self-diagnosis.

Self-medicating also happens when people are too scared to confront their feelings and talk to someone about them. This is

part of what causes alcoholism.

G. Lack of Family Supervision

Someone who didn’t have present parents in their childhood or had a poor family foundation is a prime candidate for

alcoholism. A lack of support can lead to abandonment issues in children, and they may turn to alcohol for comfort.

Risk Factors of alcoholic dependence syndrome

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at

any age.

Risk factors for alcohol use disorder include:

1.Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis

can lead to alcohol-related problems or alcohol use disorder.

2. Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of

alcohol use disorder.

Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems

with alcohol. This may be influenced by genetic factors.

3.Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety,

depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.

4.History of trauma. People with a history of emotional trauma or other trauma are at increased risk of alcohol use disorder.
5.Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing

alcohol use disorder or of relapsing after recovering from alcohol use disorder.

6.Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use

disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink

too much. For young people, the influence of parents, peers and other role models can impact risk.

Pathophysiology of alcoholic dependence syndrome

Chronic use of alcohol leads to changes in brain chemistry especially in the GABAergic system. Various adaptations occur such

as changes in gene expression and down regulation of GABAA receptors. During acute alcohol withdrawal, changes also occur

such as upregulation of alpha4 containing GABAA receptors and downregulation of alpha1 and alpha3 containing GABAA

receptors. Neurochemical changes occurring during alcohol withdrawal can be minimized with drugs which are used for acute

detoxification. With abstinence from alcohol and cross-tolerant drugs these changes in neurochemistry may gradually return

towards normal. Adaptations to the NMDA system also occur as a result of repeated alcohol intoxication and are involved in the

hyper-excitability of the central nervous system during the alcohol withdrawal syndrome. Homocysteine levels, which are

elevated during chronic drinking, increase even further during the withdrawal state, and may result in excitotoxicity. Alterations

in ECG (in particular an increase in QT interval) and EEG abnormalities (including abnormal quantified EEG) may occur during

early withdrawal.Dysfunction of the hypothalamic–pituitary–adrenal axis and increased release of corticotropin-releasing

hormone occur during both acute as well as protracted abstinence from alcohol and contribute to both acute and protracted

withdrawal symptoms. Anhedonia/dysphoria symptoms, which can persist as part of a protracted withdrawal, may be due to

dopamine underactivity.Kindling is a phenomenon where repeated alcohol detoxifications leads to an increased severity of the

withdrawal syndrome. For example, binge drinkers may initially experience no withdrawal symptoms, but with each period of

alcohol use followed by cessation, their withdrawal symptoms intensify in severity and may eventually result in full-blown

delirium tremens with convulsive seizures. Alcoholics who experience seizures during detoxification are more likely to have had

previous episodes of alcohol detoxification than patients who did not have seizures during withdrawal. In addition, people with

previous withdrawal syndromes are more likely to have more medically complicated alcohol withdrawal symptoms.Kindling can

cause complications and may increase the risk of relapse, alcohol-related brain damage and cognitive deficits. Chronic alcohol

misuse and kindling via multiple alcohol withdrawals may lead to permanent alterations in the GABAA receptors. The

mechanism behind kindling is sensitization of some neuronal systems and desensitization of other neuronal systems which
leads to increasingly gross neurochemical imbalances. This in turn leads to more profound withdrawal symptoms including

anxiety, convulsions and neurotoxicity.

Binge drinking is associated with increased impulsivity, impairments in spatial working memory and impaired emotional

learning. These adverse effects are believed to be due to the neurotoxic effects of repeated withdrawal from alcohol on

aberrant neuronal plasticity and cortical damage. Repeated periods of acute intoxication followed by acute detoxification has

profound effects on the brain and is associated with an increased risk of seizures as well as cognitive deficits. The effects on the

brain are similar to those seen in alcoholics who have detoxified repeatedly but not as severe as in alcoholics who have no

history of prior detox. Thus, the acute withdrawal syndrome appears to be the most important factor in causing damage or

impairment to brain function. The brain regions most sensitive to harm from binge drinking are the amygdala and prefrontal

cortex.People in adolescence who experience repeated withdrawals from binge drinking show impairments of long-term

nonverbal memory. Alcoholics who have had two or more alcohol withdrawals show more frontal lobe cognitive dysfunction

than those who have experienced one or no prior withdrawals. Kindling of neurons is the proposed cause of withdrawal-related

cognitive damage. Kindling from repeated withdrawals leads to accumulating neuroadaptive changes. Kindling may also be the

reason for cognitive damage seen in binge drinkers.

Clinical manifestations of alcoholic dependence syndrome

1.Blood Alcohol Level – Developing a pattern to maintain one’s blood alcohol level. People who are dependent on alcohol will

start to drink at the same time every day. The point is to remain intoxicated as much as possible and avoid any symptoms of

withdrawal.

2.Prioritizing Alcohol – For addicts, the consumption of alcohol will take precedence over their wellbeing. No matter what

condition their bodies or lives are in, drinking will be more important.
3. Increased Tolerance – The more someone consumes alcohol, the higher the resistance to the effects. A noticeable increase in

the amount someone is drinking could be cause for concern.

4.Signs of Withdrawal – When the concentration of alcohol in the blood lowers, it can trigger some unpleasant side effects.

Tremors, nausea, sweating, itching, muscle cramps, hallucinations, and even seizures can occur. Two to three days after

cessation, the individual can experience even more severe symptoms from delirium tremens.

5.Drinking at Strange Hours – Consuming alcohol at random times to stop or prevent withdrawal symptoms is called relief

drinking. Some people will wake up in the middle of the night to drink or start with alcohol first thing in the morning.

Signs of alcohol use disorder include:

● Blacking out or not remembering things that happened.

● Continuing to drink even if it causes distress or harm to you or others.

● Drinking more or longer than you planned.

● Feeling irritable or cranky when you’re not drinking.

● Frequent hangovers.

● Getting into dangerous situations when you’re drinking (for example, driving, having unsafe sex or falling).

● Giving up activities so you can drink.

● Having cravings for alcohol.

● Having repeated problems with work, school, relationships or the law because of drinking.

● Needing to drink more and more to get the same effect.

● Not being able to stop drinking once you’ve started.

● Spending a lot of time drinking or recovering from drinking.

● Wanting to cut back but not being able to.

● Obsessing over alcohol.

● A person with alcohol use disorder also might experience symptoms of withdrawal when they cut back or stop drinking, such

as:Anxiety,Depression,Irritability,Nausea, dry heaves,Racing heart,Restlessness,Shakiness,Sweating,Trouble

sleeping,Seizures,Seeing things that aren’t there (hallucinations) Delirium tremens,Coma and death.

Complications of alcoholic dependence syndrome .

1.Physical Repercussions

Alcohol addicts suffer from neurological, gastrointestinal, liver, cardiac, and skin conditions, among others. One of the most

prominent risks is brain damage. The deterioration is both structural and functional, and it can lead to chemical imbalances and

cognitive issues. Alcohol also increases the risk of several types of cancer—mouth, throat, and liver cancer are the most

common, but it has also been linked to breast cancer.

Someone dependent on alcohol will likely have a damaged heart too. Hypoglycemia, myopathy, arrhythmias, and even cardiac

failure can occur. These problems become more dangerous in older individuals, especially if they combine other poor habits

such as smoking.

2.Mental Health Effects

Alcohol works as a depressant and can strongly alter chemistry in the brain. People who become dependent are at risk for a

variety of mental health issues. Depression and anxiety are the most common, but mania, hallucinosis, and “blackouts” are

recognized as well. There’s a high prevalence of alcohol use found in those who commit suicide as well, presenting a 7% lifetime

risk for the addict.

3.Social Consequences

The most prominent social problem with alcohol dependence is traffic accidents; sufferers are often unable to access when they

should and shouldn’t drive. People who drive under the influence are far more likely to wreck, and many accidents involve
fatalities. Even without an accident, a DUI or DWI can affect work and social interactions. Other incidents can happen at home.

Dependency on alcohol boosts the chances of violence, child abuse, homicide, and general crime.

Alcohol abuse damages personal relationships as well. Divorce can be a result of alcohol addiction, both from the psychological

changes that occur and poor decisions like infidelity. It’s not uncommon for people to lose friends in direct relation to their

behavior.

4. Occupational Dangers

High-stress jobs like this are more likely to lead to alcohol abuse. With alcohol dependency syndrome, the individual’s

performance can suffer greatly. He or she may be unable to focus because of withdrawal symptoms or simply because of the

“urge” to go home and drink. Alcohol dependence syndrome should be treated as early as possible to increase the likelihood of

long-term success

Prevention of alcoholic dependence syndrome.

Treatment of alcoholic dependence syndrome.

1.Behavioral therapies: Counseling, or talk therapy, with a healthcare provider like a psychologist or mental health counselor

can teach you ways to change your behavior. Motivational, cognitive-behavioral, contingency and 12-step facilitation are the

most commonly used techniques.

2.Medications: The U.S. Food & Drug Administration has approved naltrexone and acamprosate for the treatment of alcohol

use disorder. Topiramate and gabapentin can also decrease cravings in some people. An older medication — disulfiram — is

now used only rarely. These medications seem to help decrease the background obsessional thinking around alcohol.

3.Support groups: Group meetings with other people who have alcohol use disorder can help you stay sober. Alcoholics

Anonymous (AA) meetings are usually free and are available in most communities. Other styles of recovery groups include:

Celebrate! Recovery (Christian focus), Rational Recovery (non-spiritual) and Recovery Dharma (mindfulness/Buddhist focus).
CHAPTER FOUR.

NURSING MANAGEMENT

APPLICATION OF NURSING PROCESS

Assessment (Nursing History)

Past medical history: he was diagnosed of hypertension 10ycars ago. She was said to have collapsed after hearing the news of

his husband's death,known for Consuming too much alcohol, Seizure disorder in childhood and glaucoma.

Past surgical history: Patient has undergone appendectomy.

Nutrition: patient eating pattern is normal

Elimination: frequent urine as a result of diuretics, bowel movement satisfactory.

Activity/ exercise: patient chat with his family.

Sleep and rest: patient could not sleep or rest well as a result of the headache at first but subsequently when the headache

subsided, patient can now sleep well 2 hours in the day and 8 hours in the night.

Communication and special senses: they are all intact.

Feeling about self-image: She feels good about herself.

Coping about stress: She copes very well with stress.

Values and Beliefs: She believes in God almighty

Physical Examination:

Temperature: 36.8c

Pulse: 106 b/m

Respiration: 32c/m

Oxygen saturation: 86%

Weight: 92 kg

Blood pressure: 130/80 mmHg.

General Inspection:

Head: his head is structurally normal.

Face: he looks worried.

Hair: it’s black in colour and look normal.

Eyes: the sclera is clear, there is no yellowish discoloration of the eye (jaundice) and no discharge.

Neck: no rashes, and bumps, no swelling or enlarged lymph nodes

Ears: she has normal ears, symmetrical in shape, size and location. No discharge.

Mouth: absence of oral thrush or artificial dentures. Lips are dry. The tongue is not inflamed, teeth are complete and white in

colour.

Nose: both nostrils are patent and symmetrical in shape and size. No mucous discharge Seen.

Upper Limbs: the arms are symmetrically equal, no wound detected. She has five fingers each with short nails.

Abdomen: right iliac fossa scar and no swelling.

Lower limbs: there is slight swelling due to lack of ambulation

Back: no abnormality detected

Buttocks: they are both of the same size.

Genitalia: they are in good shape

Palpation: there was no presence of abdominal swelling

Percussion: presence of bowel sound.

Abdomen: abdomen is not distended, right iliac fossa scar due to appendectomy in the past.

Auscultation: patients breath sound is normal, no wheezing.

Pulse rate: 100 b/m.

Bowel sound: Bowel sound is present.

Systemic Review:

Central Nervous System: The patient is fully conscious

Urinary system: Patient passes frequent urine

Respiratory system: Patient is having breathlessness

Urogenital system: Normal female external genitalia

Integumentary system: No skin lesion.

Digestive system: abdomen is not distendedCardiovascular system: Pulse rate: 106b/m (irregular), Blood pressure: 220/108??

Musculoskeletal system: No deformity.

● NURSING Diagnosis:

1.Anxiety related to irrational thoughts secondary to absence of support system.

2.Alterd thought processes related to unmet depending needs.

3.impaired concentration and attention related to alcoholic intake.

4.impaired verbal communication related to incoherent speech pattern and side effect of medication

5.inffective family coping related to depression secondary to alcohol dependence

6.knowledge deficits related to alcoholic dependence treatment and its effects.

Nursing Care Planning and Goals

The major nursing care planning goals for alcoholic dependence syndrome.

●.Patient will maintain adequate hydration.

● Patient will consume adequate nutritional requirements.

●.Patient will prevent onset of alcohol dependence

●.Patient will maintain Good thought processes

●.Patient will prevent anxiety.

●. Insomnia will be prevented.

●.Food appetite will be improved

●.Anger will be reduced.

Nursing Interventions

●.The nursing interventions on a patient diagnosed with alcohol dependence syndrome

Monitor intake and output. Note number, character, and amount of stools; estimate insensible fluid losses like diaphoresis;

measure urine specific gravity and observe for oliguria.

●.Weigh daily. Daily weight is an indicator of overall fluid and nutritional status.

●.Maintain hydration. Replace ongoing fluid losses

●.Administer medications as indicated.

●. Daily weight of the patient

●.Frequent blood pressure check.

●.Daily urine estimate.

●.Check the nose

●.Check the oral mucous membrane

●.Check the eye,pupils.

●.Check the tonenial and fingernails

●.Obtain informed consent.

Evaluation

●.Nursing goals are met as evidenced by:

●.Patient was able to maintain adequate nutrition.

●.Patient addiction was arrested

●.Patient was able to consume adequate nutritional requirements.

●.Patient was able to prevent onset of anger.

●.Patient was able to prevent anxiety.

●.Verbal communication was established.

●.Impaired concentration and attention related to alcohol was stopped.

Doctor's prescription

1.Disulfiran 250mg.dly.7/12

2. Naltrexone 50mg.b.d 7/12

3.Acamprosate.333mg dly.7/12

4.vitamin c 500mg.t.d.s.1/52.

5.vitamin B complex ¡¡ dly. 1/52.

6.vitamin A,E dly .1/52.

Pharmacological review of drug's.

1..Name: Disulfiran.

Mode of Action:Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage during alcohol metabolism following

disulfiram intake causing an accumulation of acetaldehyde in the blood producing highly unpleasant symptoms.

.indication.For the treatment and management of chronic alcoholism.

Dosage:250mg

Route of Administration.orally.

Contraindication :Disulfiram is not a safe option for everyone. Disulfiram is contraindicated absolutely in patients with

significant coronary artery disease or heart failure. Cases of heart failure and death have occurred in patients with severe

myocardial disease shortly after the initiation of disulfiram. Disulfiram is contraindicated with psychosis as it may worsen the

patient's psychosis.

Adverse effect:Psychosis, confusional states, mutism, headbanging, memory impairment,headache, sleepiness, tiredness, and

halitosis (or metallic taste).

Nursing Responsibility.

1. Administer tablet whole or crushed before meal or at bed time.

2. Counsel patient and relatives that the drug should be withdrawn gradually to prevent worsening of condition and avoid

hazardous activities if dizziness occurs or blood pressure, apical and radial pulses, respirations

3. Monitor blood pressure, apical and radial pulse, respirations and circulation in extremeties before and during therapy.

4. Monitor fluid input and output, and daily weight.

5. Teach patient to take pulse at home and when to report to the doctor.

2.Naltrexone.

Mode of Action:

Indication:to treat alcohol dependence for the blockade of the effects of exogenously administered opioids. To prevent relapse

to opioid dependence, after opioid detoxification.

Dosage:50mg

Route of administration:Orally

Contraindication:Naltrexone should not be used by persons with acute hepatitis or liver failure, or those with recent opioid use

(typically 7–10 days)

Adverse effect:The most common side effects reported with naltrexone are gastrointestinal complaints such as diarrhea and

abdominal cramping.[1] These adverse effects are analogous to the symptoms of opioid withdrawal, as the μ-opioid receptor

blockade will increase gastrointestinal motility.

Nursing responsibility:

1. Administer tablet whole or crushed before meal or at bed time.

2. Counsel patient and relatives that the drug should be withdrawn gradually to prevent worsening of condition and avoid

hazardous activities if dizziness occurs or blood pressure, apical and radial pulses, respirations

3. Monitor blood pressure, apical and radial pulse, respirations and circulation in extremeties before and during therapy.

4. Monitor fluid input and output, and daily weight.

5. Teach patient to take pulse at home and when to report to the doctor.

Name:Acamprosate.

Mode of Action:Acamprosate is a putative anticraving drug used to maintain abstinence in alcohol-dependent patients. Its

mechanism of action is uncertain, but the drug is thought to interact with neuronal NMDA receptors and calcium channels, and

these proteins are implicated in the induction of alcohol dependence

Dosage:333mg.

Route of Administration:Orally
Contraindication:Acamprosate is primarily removed by the kidneys and should not be given to people with severely impaired

kidneys (creatinine clearance less than 30 mL/min). A dose reduction is suggested in those with moderately impaired kidneys

(creatinine clearance between 30 mL/min and 50 mL/min).It is also contraindicated in those who have a strong allergic reaction

to acamprosate calcium or any of its components.

Adverse effect:adverse effects include headache, stomach pain, back pain, muscle pain, joint pain, chest pain, infections, flu-

like symptoms, chills, heart palpitations, high blood pressure, fainting, vomiting, upset stomach, constipation, increased

appetite, weight gain, edema, sleepiness, decreased sex drive, impotence, forgetfulness, abnormal thinking, abnormal vision,

distorted sense of taste, tremors, runny nose, coughing, difficulty breathing, sore throat, bronchitis, and rashes.

Nursing Responsibility:

1. Administer tablet whole or crushed before meal or at bed time.

2. Counsel patient and relatives that the drug should be withdrawn gradually to prevent worsening of condition and avoid

hazardous activities if dizziness occurs or blood pressure, apical and radial pulses, respirations

3. Monitor blood pressure, apical and radial pulse, respirations and circulation in extremeties before and during therapy.

4. Monitor fluid input and output, and daily weight.

5. Teach patient to take pulse at home and when to report to the doctor.

PROGRESS NOTE.

DAY 1.10/3/2023.

The patient was admitted in the male psychiatric ward around 10:am in d morning accompanied with the father.the patient was

admitted in a well bed in a comfortable position after ward deposit. The nurses on call that received the patient reassued the

patient and the relatives. Ward orientation was given, the doctor on call was called upon. Dr Agama,who diagnosed the patient.

Prescription was and the due medications were served,tab Disulfiran 250mg,Naltrexone 50mg,Acamprosate 333mg,I.v Normal

saline 500mg,Vitamin C.500mg,Vitamin, A,E,B.complex.ii given.patient vital signs checked and recorded.

Bp=130/70mmg,R=22c/m,P=80b/m,T=36.6°C,SPO2=98%.
DAY 2:11/3/2023.

The patient was meet lying in his cot in a well made bed,close to the father. The patient addiction is gradually reducing. The

family is being reassured the early morning vital signs checked and

recorded,Bp=126/70mmg,R=22c/m,P=80b/m,T=36.8,Spo2=98%.due medications was served and documented. Maintain input

and output was recorded .patient education on nutritional requirements was given.

DAY 3:12/3/2023.

The patient was meet section his cot, in a well made with his father and relatives. Psychological care rendered to the patient,

social therapy and group therapy use to allivate thinking and bost personality of the patient. The patient was adverse on the

effect of alcohol consumption and its consequences in time to come.the patient due medications where served,and recorded.

Vital signs checked and recorded. Bp=124/70mmg,P=76b/m,R=20c/m,Spo2=99%.

DAY 4:13/3/2023.

The doctor on call came for review and added tab ciprofloxacin 500mg,Tab pcm 500mg.which was given to the patient,plus his

routine drug's. Vital signs checked and recorded. Bp=126/70mmg,T=36.4°C,R=22c/m,Spo2=99%.

DAY 5:14/3/2023.

Patient was meet lying on the bed, in a good condition much oriented on the effect of alcohol, much reassured both the patient

and relatives. Due medications served, vital checked and recorded.

DAY 6:15/3/2023.

The patient was meet lying down on his bed,discussing with the father about the extent the gradual withdrawn from taking

alcohol and his happy with his self now.he can now sleep very well and eat good food. The patient due durgs served and

recorded. Vital signs =Bp=124/70mmg,R=20c/m,T=36.8°C.Spo2=99%.

Day 7:16/3/2023

Mr.O.E.morning vital signs was checked and charted .his drugs was given and documented.when the doctor came for ward

round he reviewed him and discharged the patient on request, which the doctor later did,he was advised not to follow bad

friends that will influence him to take any drug addiction. And ,to take his drugs reguraly and come back to hospital in the next

two weeks for review,the patient was discharged on 16/3/2023.his Bill was made ,his take home drug was collected and was

advised in how to take them .He left the in good condition.

Health Education or Advice on Dischar

Mr.E.O was advised to take his drugs as prescribed and also to come for check up on the date given to him.To avoid bad friends,

improve more of his spiritual life.

General evaluation of care

Mr.E.Owas discharged on 16th March 2023 and settled his bill and left the ward in good condition with the company of his

relatives in good condition.

Termination of Nurse patient Relationship

The nurse patient Relationship which began on 20 feb 2023 was terminated on 22 feb 2023.this relationship was explained to

mr w. i and relatives explained their profound gratitude to the care team of their effective car towards them and after

exchange of pleasantries,they left the ward in good condition.

Implication to Nursing .

1.this study will help nurses in understanding the risk factors to alcoholic dependence syndrome.
2.this study will help nurses on the various physiological and medical management of patient down with alcoholic dependence

syndrome.

3.this study will help nurses on the Consequences of alcoholic dependence syndrome

Summary.

This is a care study of 46 years old Man who was admitted into the psychiatric ward, on 10/3/2023 around 10:am.with a history

of acute altered mental status after being hospitalized for alcohol withdrawal.The patient was homeless but had recently been

enrolled in an addiction treatment program in a residential clinical stabilization service. He reportedly left the program 4 days

before admission to this hospital and then “blacked out” daily in tandem with drinking 0.5 to 1 gallon of vodka throughout the

day. On the evening before admission, he decided to stop drinking alcohol. Approximately 10 hours later, he awoke on the

ground without recollection of lying down; he had had vivid dreams and tremulousness and was worried that he may have had

a seizure.vital sign on admission were T-36.8°C P=80b/m,R=24c/m,Spo2=98%.the observation and investigations was done were

history taking was done. Vital sign on discharge were T=36.4°C,P=76b/m,R=22c/m,Spo2 =98%.the patient and relatives where

properly counselled on the Dangers of substance abuse,its preventive measures. They where given an appointment on the to

come back for check up.

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