Monday, March 29, 2010
Sara Gerrie, MSN
Prolonged and chronic ethanol (ETOH) use has devastating effects on the gastrointestinal (GI) tract. ETOH is easily absorbed from the intestine and diffuses quickly throughout the body. The bulk of the ETOH is metabolized in the liver. ETOH abuse produces functional and structural changes in the GI tract, such as in the stomach, small intestine, liver, and pancreas (Geokas, Lieber, French, & Halsted 1981). The National Institute on Alcohol Abuse and Alcoholism website (2005) sites statistics indicating 28,175 deaths in 2005 were a direct result of liver cirrhosis. The website goes on to state, “In 1997, liver cirrhosis was the 10th leading cause of death and accounted for approximately 25,000 U.S. deaths, more than half of which were from alcohol-related cirrhosis” (National Institute on Alcohol Abuse and Alcoholism, 2001). Individuals struggling with chronic ETOH abuse have specific educational needs. Patient Description
Ms. A is a 29 year old who grew up in a comfortable mid-western town. Both of her parents and younger brother are still living. Her younger brother is in college. Ms. A had been relatively healthy with no prior medical history until she began to drink heavily with her current boyfriend of several years. She was hospitalized in 2008 because of a GI bleed. Lab studies revealed liver damage. Her parents, brother, and grandparents staged an intervention. Ms. A agreed to participate in a rehabilitation program. She was successful for several months until she moved to California to live with her boyfriend. She began to consume alcohol once again. Recently, her boyfriend brought her to the emergency department when he found her to be non-responsive. She currently remains hospitalized with hepatic encephalopathy and liver failure. Educational background
Ms. A is a high school graduate. She began to attend a four-year university, but she did not graduate. Her mother states that Ms. A was very interested in learning and enjoyed school. However, once she became involved with her boyfriend and started drinking, she lost the focus and motivation necessary to complete her educational goals. Preferred Learning Method
Ms. A is very intelligent and enjoys reading and studying. Her mother states that while she was in school she was very studious and received very good grades. Needs Assessment
During this recent hospitalization Ms. A has demonstrated a willingness to cooperate with hospital staff. Due to her current condition, she requires frequent reminders and guidance with specific instruction. Since her admission date she has become increasingly more alert and is responding to staff appropriately.
Her educational needs are centered around her ability to successfully self-manage her alcohol dependency, dietary needs, and adherence to prescribed medications. Some challenges to her sobriety include a geographically distant support system and a significant other who continues to abuse alcohol.
A care plan must focus on the reasons why previous alcohol treatment failed. Assessment of her personal motivation to implement change and adhere to treatment is necessary. The nurse in this situation should act as an agent of change while providing encouragement and guidance. The nurse must also be a sounding board for the patient with the goal of helping the patient determine why she continues to use alcohol by connecting the alcohol with the negative outcomes she is experiencing (McMahon & Jones, 1992). Given that the alcohol rehabilitation program requiring strict abstinence was ineffective for Ms. A, perhaps consideration of harm reduction therapy would yield sustained results. Ballard states, “Traditional substance abuse programs call for elimination of the substance of abuse or dependence and then identifying and managing the problem. Harm reduction therapy calls for identifying and managing the underlying problem while...