504.comment 2

Purpose: Comment the Discussion (Class 504 Unit 2 Comment 2

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

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Ammber Sahr posted Nov 16, 2017 12:01 AM

     My original PICOT question was about the risk of intubated patients developing delirium on certain medications versus others, however, in order to be more specific I did end up changing my question.  I now have settled on: do adult patients going throughout ETOH withdrawal and experiencing refractory withdrawal who are requiring a continuous infusion have improved CIWA scores when receiving a benzodiazepine in addition to an adjunct versus receiving a benzodiazepine alone within the first 24 hours?  Now, let’s break this down into the broader, or background question, what medication(s) are approved for treating alcohol withdrawal symptoms?  “Background questions are those that ask for general information about a clinical issue” (Mazurek Melynk & Fineout-Overholt, 2015).  On the other side of the spectrum exists the foreground question, which is far more specific.  “Foreground questions are those that can be answered from scientific evidence about diagnosing, treating, or assisting patients in understanding their prognosis” (Mazurek Melynk & Fineout-Overholt, 2015).  The foreground question is comparable to the PICOT question, which for my particular question again is do adult patients going through ETOH withdrawal and experiencing refractory withdrawal who are requiring a continuous infusion have improved CIWA scores when receiving a benzodiazepine in addition to an adjunct versus receiving a benzodiazepine alone within the first 24 hours?  In order to provide an adequate and educated answer, one must conduct research using evidence-based references.

     There are a variety of different studies involving alcohol withdrawal and different medications that may help treat symptoms, however, it’s proven to be rather difficult to find specific articles or studies relating to adjunct therapy and the CIWA scores.  One article proposes that beta-adrenergic antagonists and clonidine may be beneficial as adjuncts to benzodiazepines in the treatment of autonomic withdrawal symptoms, but as with many medications, there are side effects, such as potentially masking DT symptoms. (Adis Medical Writers, 2014).  According to Hoffman and Weinhouse in Up To Date (2017), adjunct therapies such as barbiturates and dexmedetomidine have proven to be effective in the treatment of refractory DTs. These are only a couple of the different studies regarding refractory alcohol withdrawal symptoms, but the general consensus seems to be that adjunct therapy has proven to be beneficial versus benzodiazepines alone.

                                                                   References

Adis Medical Writers.  (2014).  Benzodiazepines are the mainstay of treatment for acute alcohol withdrawal syndrome.  Drugs & Therapy Perspectives,30, 395-398.  Retrieved from https://web-b-ebscohost-com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?vid= 6&sid=ae1a62c6-b3b4-4214-9cf9-133143f4b508%40sessionmgr104

Hoffman, R.S. & Weinhouse, G.L.  (2017).  Management of moderate and severe alcohol withdrawal syndromes.  Retrieved from https://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes

Mazurek Melynk, B. & Fineout-Overholt, E.  (2015).  Asking Compelling, Clinical Questions.  In Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (3rd ed.).  Philadelphia, PA: Wolters Kluwer Health.