| Course | NUR-3450 Nursing Care of Clients with Alterations in Behavioral Health |
|---|---|
| Module | Module 2 |
| Paper type | Behavioral health paper: alcohol withdrawal |
| Length | About 1,028 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3450 Module 2
Shaking on Night Two: Scoring Withdrawal and Treating Symptoms, Not the Clock
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3450: Nursing Care of Clients with Alterations in Behavioral Health
Mentor Name
Month Day, Year
Shaking on Night Two: Scoring Withdrawal and Treating Symptoms, Not the Clock
The Patient
Mr. Brennan is invented for this paper. He is 52, a roofer who fell from a ladder and fractured his ankle. On admission he said he drank a few beers after work. He was scheduled for surgery the next day, which was delayed. About 36 hours after admission, on his second night, he became restless, his hands shook, he was sweating and his heart rate rose to 112. He asked the student why there were bugs on the wall. His blood pressure was 158/96 and his temperature 37.8.
Why Withdrawal Happens
Long-term heavy drinking enhances the brain's inhibitory signaling and suppresses its excitatory signaling, and the brain adapts by reducing inhibition and increasing excitation. Take the alcohol away suddenly and that rebalanced brain swings into overdrive. Tremor, anxiety, sweating and a racing pulse usually start within the first day without alcohol. Seizures, when they occur, tend to come early, within about 48 hours, while delirium tremens, marked by confusion, hallucinations and swings in vital signs, generally emerges on the third or fourth day and may kill.
Scoring Withdrawal
Sullivan et al. (1989) cut an earlier, longer withdrawal instrument down to ten items, known as the CIWA-Ar, which nurses can complete in a few minutes. Its items cover nausea, tremor, sweats, anxiety and agitation, disturbances of touch, hearing and sight, headache and whether the patient knows where and when he is. The maximum score is 67. Scores below about 8 to 10 indicate mild withdrawal, and higher scores indicate moderate to severe withdrawal and a greater risk of seizures and delirium. Different raters scored it consistently, and it was quick enough to repeat every hour.
The student and nurse scored Mr. Brennan at 21: moderate tremor, drenching sweats, moderate anxiety and agitation, visual disturbances and some disorientation to date.
Medication by Symptoms
Mayo-Smith (1997) led a working group that pooled trials of drug treatment for alcohol withdrawal and wrote practice recommendations from them. Benzodiazepines were effective in reducing the severity of withdrawal and the incidence of seizures and delirium tremens. Drugs such as beta blockers and clonidine reduced some symptoms but did not prevent seizures or delirium and should not be used alone. Giving doses only when a scale score called for them, instead of by the clock, used less medication and shortened treatment.
| Source | Key point | Nursing application |
|---|---|---|
| Sullivan et al. (1989) | Ten-item CIWA-Ar is reliable and brief | Score every hour while symptoms are active |
| Mayo-Smith (1997) | Benzodiazepines prevent seizures and delirium; symptom-triggered dosing uses less drug | Give doses by score per protocol |
| Saunders et al. (1993) | AUDIT identifies hazardous drinking | Screen on admission to anticipate withdrawal |
Missed Screening
Saunders et al. (1993) built the AUDIT, a ten-question screen for hazardous and harmful drinking. Had Mr. Brennan been screened with it on admission, with questions about how many drinks he has on a typical day and how often he has six or more, his heavy daily drinking might have been identified, and withdrawal could have been anticipated. When asked again with the AUDIT the next day, he admitted to drinking about a 12-pack each day.
Nursing Care
The nurse gave lorazepam per the hospital's symptom-triggered protocol and rescored him every hour. The student helped reduce stimulation by dimming the lights, keeping the door partly closed and speaking calmly and briefly. Seizure precautions were in place, with padded rails and suction at the bedside. Because he could fall and injure his fractured ankle further, the bed was kept low and he was not left alone while agitated. Thiamine was given before any glucose-containing fluids to prevent Wernicke's encephalopathy, a brain disorder caused by thiamine deficiency that can be triggered by glucose in malnourished patients. The student monitored his fluid intake and electrolytes, since sweating and poor nutrition deplete magnesium and potassium.
Communication and Dignity
When Mr. Brennan became calmer, he was embarrassed. The student acknowledged that withdrawal is a medical condition and asked about his drinking without judgment. He said he drank to sleep after long days on roofs.
His Wife
Mrs. Brennan visited on the third day and said she had worried about his drinking for years but did not know how to raise it. The student, with the nurse, explained that withdrawal is a medical condition and that treatment works best when family understands it. She asked about support groups for family members, and the social worker gave her information about local meetings. Including her made the referral conversation easier the next day, because Mr. Brennan knew she would support him.
Discharge Planning
Because he would be on crutches after surgery, the team planned for his return home carefully. Pain medication was chosen with his drinking history in mind, and he was warned not to combine any sedating medicine with alcohol. A follow-up call was arranged for the week after discharge to check both his ankle and his drinking.
Evaluation
Over 48 hours his CIWA-Ar score fell to 4, the hallucinations stopped and his vital signs normalized. He had no seizures. His surgery was rescheduled.
Pain Control for His Surgery
His ankle surgery added a challenge. Patients in withdrawal often need careful pain control, and benzodiazepines and opioids together can slow breathing. The team coordinated doses and monitored his oxygen saturation and sedation closely after surgery.
Toward Treatment
Before discharge, the student and nurse discussed his drinking using the screening results and offered a referral to an outpatient alcohol treatment program, including information about medications that reduce cravings. He accepted a referral and his wife's number was added to his follow-up plan.
Limits
Symptom-triggered protocols require staff trained in scoring. Patients who cannot communicate may need other approaches. A student assists with scoring and care but does not decide doses. Mr. Brennan is invented.
Conclusion
Withdrawal appeared on Mr. Brennan's second night because his drinking had not been identified. The CIWA-Ar gave the team a reliable score, Mayo-Smith's guideline supported benzodiazepines dosed by symptoms and the AUDIT showed how screening on admission could have anticipated the problem. Safe, calm care, thiamine before glucose and a respectful conversation about treatment completed the nursing role.
References
Mayo-Smith, M. F. (1997). Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. JAMA, 278(2), 144-151. https://doi.org/10.1001/jama.278.2.144
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357. https://doi.org/10.1111/j.1360-0443.1989.tb00737.x
What the NUR 3450 Module 2 instructions ask for
TESU's catalog paragraph for NUR-3450 names substance use disorders directly, and as TESU does not post the syllabus, module two turns to alcohol withdrawal. Set out the timeline from the last drink, explain in plain terms why withdrawal happens, score a validated withdrawal scale item by item and report the evidence on medication and on dosing by symptoms. Then write nursing diagnoses, describe safety measures such as seizure and fall precautions, explain why thiamine comes before glucose, show how screening on admission could have anticipated the problem and plan a referral for treatment. Some sections assign opioid or benzodiazepine withdrawal. Ask whether the full scale should be shown. Mention pain control after surgery if your patient also needs opioids. Show how discharge plans account for both the injury and the drinking.
Inside the NUR 3450 Module 2 example
A fictional roofer with a fractured ankle becomes shaky, sweaty and frightened on his second night in a Neptune hospital. The paper explains the brain changes behind withdrawal and its timeline, breaks down his CIWA-Ar score of 21 and summarizes the scale, Mayo-Smith's guideline and the AUDIT in a table. Missed screening on admission, lorazepam given by score, a calm room, seizure and fall precautions, thiamine before glucose, attention to electrolytes and nutrition and a respectful conversation follow, with sections on his wife and on discharge planning before the referral, limits and conclusion. A section on pain control after surgery is included. Annotations mark each safety step.
Where the marks sit in the NUR 3450 Module 2 rubric
Withdrawal papers earn respect when they give a clear timeline, explain why the brain becomes overexcited, score the CIWA-Ar accurately and connect benzodiazepine dosing by symptoms to evidence. Readers notice thiamine before glucose, fall prevention for a patient with an injured ankle and frequent rescoring. A nonjudgmental conversation that ends with an offer of treatment reflects good behavioral health nursing. Keeping dosing decisions with the nurse and prescriber, while the student scores and monitors, shows a sound sense of scope. Coordinating opioid and benzodiazepine doses after surgery shows attention to sedation risk. Planning follow-up that covers both the ankle and the drinking shows integrated care.
NUR 3450 Module 2 help from the desk
Two problems appear often. Papers describe shaking and sweating without a score, and they ignore the screening that could have predicted the crisis. Give the time since the last drink, show the CIWA-Ar items and total and explain dosing by symptoms. List each safety precaution, give thiamine before glucose and screen with the AUDIT. Talk about drinking without judgment and offer a referral. Involve family if the patient agrees. Describe your own patient when you send the prompt; the free first draft is built around that case. Watch sedation closely if opioids and benzodiazepines overlap. Plan a follow-up call that asks about drinking as well as the injury.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3450 Module 2 questions, answered
Where can I find a free NUR 3450 Module 2 sample paper?
The alcohol withdrawal paper about an invented roofer in a Neptune hospital, from CIWA-Ar scoring to referral, is reproduced here.
What is the CIWA-Ar?
A ten-item scale for rating alcohol withdrawal, with a maximum score of 67, used to guide treatment.
When does alcohol withdrawal begin?
Within the first day without alcohol in most cases; seizures cluster in the first 48 hours and delirium tremens tends to appear on days three or four.
Why give thiamine before glucose?
Glucose can trigger Wernicke's encephalopathy in thiamine-deficient patients, so thiamine is given first.
What is symptom-triggered dosing?
Giving medication according to the patient's withdrawal score rather than on a fixed schedule, which uses less medication.