Care Plan for Managing Alcoholism and Substance-Seeking Behaviors

Category / Primary Body System

• Psychosocial and Mental Health

Problem

• Resident has a history of alcoholism with potential for substance-seeking behaviors.

Goal

• Resident will have no signs or symptoms of substance-seeking behavior and no adverse effects from prior alcohol use for the next 90 days.

Plan/Approach

1. Assessment and Early Intervention

   • Determine the resident's typical alcohol consumption in a 24-hour period as early as possible.

2. Medical Management

   • Notify the MD of prior alcohol use and formulate a plan for managing withdrawal and substance-seeking behaviors, which may include:
     • Limiting the number of drinks allowed per shift.
     • Prescribing benzodiazepines or other medications as needed.
     • Implementing behavior modification strategies.

3. Monitoring for Complications

   • Monitor for signs of pancreatitis, including fluid shifts, edema, and pulmonary congestion secondary to abdominal distention. Notify the MD of any new symptoms and document accordingly.
   • Monitor for gastrointestinal (GI) complications, such as paralytic ileus, vomiting, abdominal distention, diarrhea, abdominal pain, tenderness, and changes in stool characteristics. Notify the MD and document any findings.
   • Monitor for integumentary involvement, such as jaundice, bruising, and poor skin turgor. Notify the MD and document findings.
   • Monitor for mood and behavioral issues, including anxiety, hallucinations, agitation, insomnia, poor coping techniques, inability to follow directions, decreased cognition, and decline in task sequencing. Notify the MD and document accordingly.
   • Monitor for renal impairment, including oliguria, anuria, and elevated BUN. Notify the MD and document findings.
   • Monitor for nutritional status, including poor intake, changes in taste, and anorexia. Notify the MD and document accordingly.
   • Monitor for respiratory involvement, including shortness of breath (SOB), changes in sputum, dyspnea on exertion (DOE), and anxiety. Notify the MD and document findings.
   • Monitor for neurological involvement, including hyperthermia, hypersensitivity, seizures, and other neurological symptoms. Notify the MD and document accordingly.

4. Laboratory Monitoring

   • Monitor labs as ordered and report results to the attending physician.

5. Family Involvement

   • Notify the family of the need to follow the plan of care regarding alcohol usage and involve them in the care plan.

6. Patient and Family Education

   • Provide education to the resident and family about the risks of alcohol use, the importance of following the care plan, and strategies for managing cravings and withdrawal symptoms.

Rationale

1. Assessment and Early Intervention

   • Early assessment of alcohol consumption helps inform the care plan and manage withdrawal symptoms effectively.

2. Medical Management

   • Proper medical management, including the use of medications and behavior modification strategies, helps prevent withdrawal symptoms and substance-seeking behaviors.

3. Monitoring for Complications

   • Regular monitoring for complications associated with alcoholism ensures early detection and prompt intervention, reducing the risk of severe health issues.

4. Laboratory Monitoring

   • Routine lab tests provide essential data for assessing the resident’s health status and guiding treatment decisions.

5. Family Involvement

   • Involving the family in the care plan promotes compliance and provides additional support for the resident.

6. Patient and Family Education

   • Educating the resident and family about the risks of alcohol use and the importance of adhering to the care plan empowers them to participate actively in the resident’s care.

Actions

1. Assessment and Early Intervention

   • Determine the resident's usual alcohol intake and document it in the medical record.

2. Medical Management

   • Notify the MD of prior alcohol use and develop a specific plan for managing withdrawal and substance-seeking behaviors.
   • Administer medications as ordered and monitor for side effects.

3. Monitoring for Complications

   • Regularly assess for signs of pancreatitis, GI complications, integumentary changes, mood/behavioral issues, renal impairment, nutritional deficiencies, respiratory symptoms, and neurological involvement.
   • Document findings and notify the MD promptly for any new or worsening symptoms.

4. Laboratory Monitoring

   • Draw labs as ordered and monitor results, reporting any abnormalities to the attending physician.

5. Family Involvement

   • Communicate the care plan to the family and involve them in monitoring and supporting the resident’s adherence to the plan.

6. Patient and Family Education

   • Educate the resident and family about the importance of the care plan, signs and symptoms of withdrawal, and strategies to manage cravings and avoid relapse.