Male with Alcohol Dependence and at Risk of Withdrawal
Tomat who is a 46 year old, obese, sales manager for a brewery, who was admitted to an alcohol and drug treatment centre 24 hours ago. Tomat has recently been charged with driving under the influence (DUI) and has entered treatment under legal orders. When asked "Are you worried about how much alcohol you drink?" he replies "I'm worried I'll lose my job if I lose my licence. I don't drink any more than the other executives." When asked how much he drinks he says, "I drink about half a bottle of scotch in the evening. I have a couple of beers at lunch time and I like a few wines with dinner." When asked when he had his last drink, Tomat responds that it was lunch time yesterday.
The nurse reads in his chart that Tomat started drinking when he was 13. After leaving school he took a job as a sales representative for an international liquor company, where his drinking on the job was seen as the way to do business. He then took his current job which allows him to conduct much business over lunch and drinking alcohol is encouraged. He keeps a fridge in his office well-stocked with wine and beer.
He has made one previous attempt to stop drinking, when advised to by his doctor after he was diagnosed with gastritis. He stopped for about two months. He is still troubled by stomach discomfort, especially in the morning when he usually feels nauseous and sometimes vomits. He takes antacids regularly. He also states that he has trouble sleeping at night.
Tomat is unsettled and fidgety. He appears anxious and is easily startled; he has a slight tremor of the hands, which is noticeable only when he reaches for something. He has beads of sweat on his face and complains of feeling "full in the head." His vital signs are: P 92, T 38.2, R 20 and BP 170/100. He has a CAGE score of 3.
Tomat is prescribed diazepam 10mg every six hours for four doses, then 5mg every six hours for eight doses; a multivitamin; and thiamine. His vital signs are monitored every four hours and he has been instructed to attend a class on the effects of alcohol on the body and an in-house Alcoholics Anonymous (AA) group.
- Identify the client's strengths and capacities.
- Identify at least 2 complete nursing diagnoses. Ensure that you include the problem and the aetiology.
- Describe the risks involved in caring for this person