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.
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’