 Sally, a 33 year old legal secretary, is admitted to your ward after being involved in a MVA  She has a past history of poly drug use and last used 12 months ago  Sally has used alcohol daily over the last 12 months  On day 2 of her admission, Sally becomes anxious and scores 6 on the AWS and 16 on the CIWAR-Ar  On day 4 she is confused and disorientated scoring 6 -9 on the AWS and on the CIWA-Ar. She seems to be hallucinating and has received no sedation Alcohol withdrawal case study (1) Outline (from N Miles, NSCCAHS)

Alcohol withdrawal case study (2) Questions – in small or large group(s) 1. How will you manage her nursing care day 2 & 4? 2. On day 4, what are the potential problems with Sally’s management? 3. What is the medication of choice to manage this situation? 4. Where could you find further information and support regarding alcohol withdrawal? 5. What role can you play in linking Sally into services?

Alcohol withdrawal case study (3) Brief guide to answers for the questions 1.Assess, reassure, inform, hydrate and monitor on withdrawal scales, look for other causes (see Guidelines Chapter 9.1) 2. Escalation into delirium tremens, possible self harm, other causes for symptoms that may have not been diagnosed (see Chapter 9.1) 3.Diazepam: either oral or IV if too disorientated to take orally. (Refer to NSW Drug and Alcohol Withdrawal Clinical Practice Guidelines NSW Health Local Drug & Alcohol Services, NSW D&A Specialist Advisory Service (DASAS) (24hr) & the Withdrawal Guidelines as above 5.Important to refer Sally to hospital D&A services and/or the community, give her information on alcohol use and perform opportunistic intervention