ASSESSMENT Subjective: Hindi ko kayang tumugil sa pagiinum ko as verbalized by the patient Objective: -fear -helplessness -tension - nausea and

vomiting -rapid heart rate (130bpm) -loss of appetite -insomnia

DIAGNOSIS Anxiety related to cessation of alcohol intake, physiological withdrawal as evidenced by increased helplessness, fear, tension, hopelessness with loss of control of own life.

PLANNING After 4 hours of nursing interventions, the patient will verbalize reduction of fear and anxiety to an acceptable and manageable level.

IMPLEMENTATION Identify cause of anxiety, involving client in the process. Explain that alcohol withdrawal increases anxiety and uneasiness. Reassess level of anxiety on an ongoing basis. Develop a trusting relationship through frequent contact and being honest and nonjudgmental. Project an accepting attitude about alcoholism.

RATIONALE Persons in acute phase of withdrawal may be unable to identify and/or accept what is happening. Anxiety may be physiologically or environmentally caused. Provides client with a sense of humanness, helping to decrease paranoia and distrust. Client will be able to detect biased or condescending attitude of caregivers. Enhances sense of trust, and explanation may increase cooperation and reduce anxiety. Provides sense of control over self in circumstance where loss of control is a significant factor. Client may experience periods of confusion, resulting in increased anxiety Anti-anxiety agents are given during acute withdrawal to help client relax, be less hyperactive, and feel

EVALUATION After 4 hours of nursing interventions, the patient verbalized reduction of fear and anxiety to an acceptable and manageable level

Inform client about what you plan to do and why. Include client in planning process and provide choices when possible

Reorient frequently

Administer medications, as indicated, for example: Benzodiazepines, such as chlordiazepoxide

(Librium), and diazepam (Valium).

more in control..

Administer Barbiturates, such as phenobarbital, or possibly secobarbital (Seconal) or pentobarbital (Nembutal)

These drugs are sometimes used to treat or prevent alcohol withdrawal seizures, but need to be used with caution because they are respiratory depressants and REM sleep cycle inhibitors. Client is more likely to contract for treatment while still hurting and experiencing fear and anxiety from last drinking episode. Motivation decreases as well-being increases and person again feels able to control the problem.

Provide consultation or referral to detoxification or crisis center for ongoing treatment program as soon as medically stable