Clustered Cues I could never stop drinking alcohol. I need it, else it would kill me when I stop.

I want to drown out all my problems. It gets better when I drink. I feel like Ive done nothing remarkable in my life, nothing at all. Inability to meet role expectations of finding a job and working for his familys sustenance. Drinks alcohol when beset with problems rather than working to find solutions.

Nursing Diagnosis Ineffective coping related to learned response pattern of dependence to alcohol.

Rationale (Scientific Basis) Alcoholism is a chronic disease in which people become physically dependent on alcohol and cannot control how much they drink even though their drinking is damaging their health, schoolwork or job performance, friendships or family relationships. It is a progressive disease that without treatment, gets worse over time. Risk factors include genetics, family history of alcoholism, the age at which a person started to drink (<16 y.o.), gender (men),

Goals of Care The client will continue to learn and practice effective coping skills as evidenced by reduced frequency of drinking alcoholic beverages. The client will continue to modify lifestyle as needed by participating routinely in at least four alcohol-free activities that give satisfaction and pleasure. The client will report a decrease in triggers that drive him to drink alcoholic beverages.

Nursing Interventions Determine alcohol intake, smoking habits, sleeping and eating patterns. Determine previous methods of dealing with life problems.

Rationale (Scientific Basis) To identify frequency of habitual intake of alcohol and assess smoking habit as well as nutrition and sleep
To identify successful techniques that can be used in current situation.

Indicators Gathers data related to the problem.

Obtains comprehensive client information.

Have client write notes and self-memos in order to keep appointments and follow treatment plan. Encourage to join relapse prevention groups (alcoholics anonymous).

Cognition usually gets better with long-term abstinence, but initially memory aids prove helpful.

Establishes means of providing continuous patient care.

Helps client anticipate and rehearse healthy responses to stressful situations.

Refers client to allied health team partners. Acts as liaison/advocate of the client.

Encourage to find role models (counselors or other recovering people).

Role models serve as examples of how client can learn effective ways to make necessary life changes.

Refers identified problem to appropriate individuals/agencies.

Thumbsucks until he was 6 years old, and was scolded by his mother to stop. Bites the end of his pencil during elementary grades. Failed to develop autonomy in doing simple household chores. Started to drink alcoholic beverage and to smoke cigarettes when he was a teenager (15 y.o.) due to peer pressure. Dropped out of college (2nd year) due to failing grades, cutting classes and lack of interest in studying. Tries to seek jobs

race and ethnicity, and a history of depression. Some people turn to alcohol to cope with anxiety and depression. They may begin to drink heavily to look grownup or because their friends are encouraging them. Also, heavy drinking may be seen as proof of masculinity. Longterm drinking alters the levels of various chemicals in the brain, leading the person to crave alcohol either to get rid of bad feelings or to restore good feelings. Some find that they eventually need alcohol just to feel normal. Thus, these lead to the inability to form a valid

Work with client on identifying triggers (people, feelings, situations) that help drive the clients addiction. Practice and role play with client alternative response to triggers.

Mastering the issues that perpetuate substance use allows for effective change and targets areas for acquiring new skills.

Spends time with client to facilitate conversation that allows client to express concerns.

Increases client confidence of handling drug triggers effectively.

Demonstrates knowledge of method appropriate for the clinical problem identified.

Give positive feedback when client applies new and effective responses to difficult trigger situations.

Validates clients positive steps toward growth and change.

Provides reassurance through therapeutic touch, warmth, and comforting words of encouragement. Acts according to clients condition and needs.

Continue to empathetically confront denial throughout recovery. Continue to work with client on the following three areas: a. personal issues (relationship) b. social issues c. feelings of selfworth Stress the fact that substance abuse is a

Denial can surface throughout recovery, and can interfere with sobriety during all stages of recovery.

These areas of human life need Determines to find healing so that growth and change can take place. appropriate nursing

care to be provided.

Family members also need encouragement in their own

Includes client and his family in care

but never had one due to lack of interest in finding it. Dependent on his mother and siblings for financial support. Continues to consume alcohol regardless of parents and physicians advice. Impaired adaptive behavior Employment difficulties

appraisal of stressors, inadequate choices of practiced responses, and/or inability to use available resources.

disease the entire family must conquer. Expect slips to occur. Reaffirm that sobriety can be achieved as emotional pain becomes endurable. Collaborative Disulfiram (Antabuse)

struggles.

planning.

Helps minimize shame and guilt, and rebuild self-esteem.

States expected outcomes of nursing intervention.

An effective adjunct to a comprehensive treatment program for reliable, motivated clients whose drinking is triggered by events that suddenly increase alcohol cravings. Produces intolerance to alcohol by blocking oxidation of acetaldehyde by enzyme aldehyde dehydrogenase, resulting in high blood levels of acetaldehyde and unpleasant physical symptoms.

Conforms to the 10 golden rules in medication administration and health therapeutics.

Naltrexone (Revia)

An opiate antagonist, can attenuate some of the reinforcing effects of alcohol and decrease cravings. In 1995 the U.S. Food and Drug Administration approved the use of the medication naltrexone (ReViaTM) as an aid in preventing relapse among recovering alcoholics who are simultaneously undergoing

psychosocial therapy. This approval was based largely on two randomized controlled studies that showed decreased alcohol consumption for longer periods in naltrexonetreated patients compared with those who received a placebo. However, one recent study reported a high rate of side effects, which probably explains why this study, in contrast with most other studies, failed to find naltrexone effective Opiate antagonist similar to naltrexone. Effective in heavy drinkers with fewer side effects than naltrexone.

Nalmefine (Revex)

Acamprosate (Campral)

An amino acid derivative that has a benign side effect profile and shows value in alcohol dependence. Affects both GABA and excitatory amino acid neurotransmission. Acamprosate showed promise in treating alcoholism in several randomized controlled European trials involving more than 3,000 alcoholic subjects who were also undergoing psychosocial treatment. Analysis of combined results showed that more than twice as many alcoholics receiving acamprosate remained

abstinent up to 1 year compared with subjects receiving psychosocial treatment alone