Alcoholic Paralysis Health Article

Health care team roles

Because alcohol is the most widely abused drug in our society, there is a prevalence of people with alcohol-related consequences in all treatment settings. Nearly every member of the health care team, across a broad spectrum of places including hospitals, nursing homes, clinics and even homes will be involved with the patient with alcohol-related neurological disease.

• Physicians, especially primary care physicians, have long been the front line of diagnosis and care for alcoholics, long before a neurologist (a physician who specializes in diseases of the nervous system) becomes involved. In the past education regarding alcoholism was not considered to be adequate, but this has changed considerably over the past two decades. Health care providers should take a comprehensive drinking history as part of any initial examination of a patient, and be aware that people suffering from alcoholism, a disease of denial, often say they drink less than they actually do.
• Nurses will be involved in the day to day treatment of people with alcohol-related neurological disease who are temporarily unable, or no longer able at all, to care for themselves. This may involve caring for and monitoring people in withdrawal or DT's, as well as providing supportive physical and emotional care, which may include administering medications, monitoring vital signs (blood pressure and pulse), providing fluids either by mouth or intravenously, preventing injuries during seizures or from falls, and encouraging sobriety through a calm, non-judgmental attitude.
• Physiotherapists may often become involved in helping the person with an alcohol-related neurological condition to restore their ability to walk safely. This may involve repetitively practicing various steps and providing encouragement to the person.
• Certified alcoholism counselors (CACs) can help the alcoholic patient to come to terms with this most baffling, difficult disease. The CAC can provide information not only on the disease of alcoholism, but the many programs available to help deal with it, including Alcoholics Anonymous and Rational Recovery.

KEY TERMS

Abstinence—Refraining from the use of alcoholic beverages.

Atrophy—A wasting or decrease in size of a muscle or other tissue.

Cerebellum—The part of the brain involved in coordination of movement, walking, and balance.

Degeneration—Gradual, progressive loss of nerve cells.

Delirium—Sudden confusion with decreased or fluctuating level of consciousness.

Delirium tremens—A complication that may accompany alcohol withdrawal. The symptoms include body shaking (tremulousness), insomnia, agitation, confusion, hearing voices or seeing images that are not really there (hallucinations), seizures, rapid heart beat, profuse sweating, high blood pressure, and fever.

Dementia—Loss of memory and other higher functions, such as thinking or speech, lasting six months or more.

Myoglobinuria—Reddish urine caused by excretion of myoglobin, a breakdown product of muscle.

Myopathy—A disorder that causes weakening of muscles.

Neuropathy—A condition affecting the nerves supplying the arms and legs. Typically, the feet and hands are involved first. If sensory nerves are involved, numbness, tingling, and pain are prominent, and if motor nerves are involved, the patient experiences weakness.

Thiamine—A B vitamin essential for the body to process carbohydrates and fats. Alcoholics may suffer complications (including Wernike-Korsakoff syndrome) from a deficiency of this vitamin.

Wernicke-Korsakoff syndrome—A combination of symptoms, including eye-movement problems, tremors, and confusion, that is caused by a lack of the B vitamin thiamine and may be seen in alcoholics.

BOOKS

"Alcohol Withdrawal Delirium." In The Lippincott Manual of Nursing Practice, 7th ed. Edited by Sandra Nettina. Philadelphia: Lippincott, 2001, pp. 1092-3.

ORGANIZATIONS

Canadian Paediatric Society and Canadian Center on Substance Abuse. <http://www.HealthCanada.org>.

National Institute on Alcohol Abuse and Alcoholism. 6000 Executive Boulevard, Willco Building, Bethesda, MD 20892-7003. <http://silk.nih.gov/silk/niaaa1>.

Joan M. Schonbeck