Anxiety Disorders and Stress Q 48
The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension, and fever. The nurse should be alert for impending:
A. Delirium tremens
B. Korsakoff’s syndrome
C. Esophageal varices
D. Wernicke’s syndrome
Correct Answer: A. Delirium tremens
Delirium tremens is the most extreme central nervous system irritability due to withdrawal from alcohol. Delirium tremens was first recognized as a disorder attributed to excessive alcohol abuse in 1813. It is now commonly known to occur as early as 48 hours after abrupt cessation of alcohol in those with chronic abuse and can last up to 5 days. It has an anticipated mortality of up to 37% without appropriate treatment. It is crucial to identify early signs of withdrawal because it can become fatal.
Option B: This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B. While there is no consensus for the actual definition of Korsakoff syndrome, it is generally agreed to be a chronic neuropsychiatric syndrome due to thiamine (vitamin B1) deficiency. Damage to multiple areas on the brain leads to amnesia and confusion. While classically associated with chronic alcohol use, Korsakoff syndrome can be the result of other processes that ultimately lead to thiamine deficiency. Korsakoff syndrome is most often seen in the context of chronic alcohol abuse and thought to be on the spectrum with Wernicke encephalopathy.
Option C: This is a complication of liver cirrhosis which may be secondary to alcoholism. Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow, and increased portal venous blood inflow. The most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease correlates with the presence of varices and risk of bleeding.
Option D: This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination. Wernicke’s syndrome, also known as Wernicke encephalopathy, is a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities.