Case Study: Atherosclerotic Patient

Mr. C is a 71-year-old Caucasian male admitted to the cardiac intensive care unit (CICU). He is diagnosed with Atherosclerotic heart disease, chest pain, and shortness of breath. He received coronary artery bypass graft (CABG) surgery to repair 4 blood vessels. This patient has a history of coronary artery disease, hypertension, chronic obstructive pulmonary disease (COPD), hyperlipidemia, and a partial colectomy due to cataracts. My preceptor and I took care of Mr. C the day he received the CABG surgery. The patient returned to the CICU very drowsy and restless. As a few hours went by we noticed he was having multiple hallucinations. My preceptor began asking Mr. C’s family if this was a normal occurrence or if this has ever happened. Mr. C’s wife wanted to speak to my preceptor in confidence, to tell him that the patient was an alcoholic.
The patient failed to let the doctor or any of the nursing staff aware of his addiction. My preceptor told the wife that he need to inform the doctor of these new findings, so the doctor could order something to decrease the withdrawal effects. The wife gave us permission to inform the doctor, because she wanted anything to make him feel betting. The doctor ordered Mr. C a beer three times a day to help reduce the withdrawal symptoms and also a nasogastric tube to ensure he was getting enough nutrition.
Description of Research/Evidence Related to the Activity and Objective As a nurse, managing alcohol withdrawal can be challenging clinically and efficiently.
Research shows, “severe alcohol withdrawal occurs in approximately 40% of intensive care unit (ICU) patients and significantly increases both ICU and hospital mortality” (Ycaza-Gutierrez, 2015, p. 73). Ycaza-Gutierrez (2015) conducted a study to develop and implement a nurse-driven, evidence-based protocol that uses pharmacological and non-pharmacological interventions to manage patients with alcohol withdrawal. The researchers developed an algorithm-based treatment plan, which included early identification of withdrawal through comprehensive medical history, as well as assessment and treatment of pain. By utilizing this algorithm, and also using the Richmond Agitation and Sedation Scale (RASS), nurses know the correct pharmacological management and nursing interventions. The results concluded that by using standardized care, patients’ outcomes of withdrawal were improved by the algorithm. Staff nurses feeling empowered with the knowledge and support necessary while obtaining their goal of decreasing patients’
withdrawal.
Analysis of Observations and Comparison with the Literature Although we did not use a specific scale to measure Mr. C’s withdrawal, we were able to assess that he was showing signs of withdrawal. With the doctor’s orders, we were able to calm Mr. C down and decrease the withdrawal symptoms. His hallucinations disappeared with in an hour after he consumed the first beer. By assessing the patient thoroughly, we the nurses were able to reduce any risk factors that could of occurred from this situation. By knowing the patient’s normal behavior and asking his wife if this was normal, we were able to prescribe the patient alcohol, without any complications arising.
Self-Evaluation of Learning Being aware of your patients’ history is very important. No one informed us as the nurses, that the patient was an alcoholic. When calling the doctor, he informed us that he knew of the patient’s history, but the information was not communicated to us. Withdrawal from alcohol is a very serious matter, which could lead to extreme agitation and confusion, leading to complications such as falls or injury to self and others. I believe this an ethical situation, an example of beneficence, by helping Mr. C meet all of his needs physically and emotionally.