Comprehensive exams for Mental Health Q 91
A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink six (6) hours before admission. Based on this response, nurse Lorena should expect early withdrawal symptoms to:
A. Begin after seven (7) days.
B. Not occur at all because the time period for their occurrence has passed.
C. Begin anytime within the next one (1) to two (2) days.
D. Begin within two (2) to seven (7) days.
Correct Answer: C. Begin anytime within the next one (1) to two (2) days
Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink. Moderate symptoms include alcohol withdrawal seizures (rum fits) that can occur 12 to 24 hours after cessation of alcohol and are typically generalized in nature. There is a 3% incidence of status epilepticus in these patients. About 50% of patients who have had a withdrawal seizure will progress to delirium tremens.
Option A: Mild signs/symptoms can arise within six hours of alcohol cessation. If symptoms do not progress to more severe symptoms within 24 to 48 hours, the patient will likely recover. However, the time to presentation and range of symptoms can vary greatly depending on the patient, their duration of alcohol dependence, and volume typically ingested.
Option B: Most cases should be described by their severity of symptoms, not the time since their last drink. Noting the time of their last drink is essential in any patient with an alcohol dependence history who may be presenting with other complaints. Mild symptoms can be insomnia, tremulousness, hyperreflexia, anxiety, gastrointestinal upset, headache, palpitations.
Option D: Delirium tremens is the most severe form of alcohol withdrawal, and its hallmark is that of an altered sensorium with significant autonomic dysfunction and vital sign abnormalities. It includes visual hallucinations, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis. Symptoms of delirium tremens can last up to seven days after alcohol cessation and may last even longer.