Nursing diagnosis: Anxiety related to cessation of alcohol intake, physiological withdrawal; situational crisis—hospitalization; threat to self-concept, perceived threat of death
Possibly evidenced by
Feelings of inadequacy, shame, self-disgust, and remorse
Increased helplessness, hopelessness with loss of control of own life
Increased tension, apprehension
Fear of unspecified consequences; identifies object of fear
Desired Outcomes/Evaluation Criteria—Client Will
Anxiety [or] Fear Self-Control
Verbalize reduction of fear and anxiety to an acceptable and manageable level.
Express sense of regaining some control of situation and life.
Demonstrate problem-solving skills and use resources effectively.
Nursing intervention with rationale:
1. 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.
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. Note: Individuals with alcohol use disorders often also have post-traumatic stress disorder (PTSD) (U.S. Department of Veterans Affairs, 2007).
2. Develop a trusting relationship through frequent contact and being honest and nonjudgmental. Project an accepting attitude about alcoholism.
Rationale: 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.
3. Inform client about what you plan to do and why. Include client in planning process and provide choices when possible.
Rationale: 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. Note: Feelings of self-worth are intensified when one is treated as a worthwhile person.
4. Reorient frequently.
Rationale: Client may experience periods of confusion, resulting in increased anxiety.
5. Administer medications, as indicated, for example: Benzodiazepines, such as chlordiazepoxide (Librium), and diazepam (Valium)
Rationale: Anti-anxiety agents are given during acute withdrawal to help client relax, be less hyperactive, and feel more in control.
6. Administer Barbiturates, such as phenobarbital, or possibly secobarbital (Seconal) or pentobarbital (Nembutal)
Rationale: 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.
7. Arrange “intervention” or confrontation in controlled setting, when client has recovered sufficiently from withdrawal to address addiction issues.
Rationale: Process wherein SO and family members, supported by staff, provide information about how client’s drinking and behavior have affected each one of them, helps client acknowledge that drinking is a problem and has resulted in current situational crisis.
8. Provide consultation or referral to detoxification or crisis center for ongoing treatment program as soon as medically stable (e.g., oriented to reality).
Rationale: 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. Direct contact with available treatment resources provides realistic picture of help. Decreases time for client to “think about it,” change mind, or restructure and strengthen denial systems.