Surgery and the alcoholic

[Happeetxn]

Howdy all,

I am interested in learning more about how a pt. with a history of chronic alcohol abuse who has major surgery (CABG or Valve replacements etc.....) have faired after surgery. I ask this because in my extensive nursing career (I passed my boards on 2/9/07 ) I have had two pts recently (within last 3 weeks) who were essentially "alzheimer's like" after surgery. They had no complications r/t to the surgery it was all neuro. Alert at times but only oriented to self on a good day. Both ended up going to specialty hospitals after discharge.

I know to compare apples to apples more information is needed, so I am really asking in a general way what experiences and outcomes y'all have had with these patients.

Thanks,

Craig

[traumaRUs, MSN, APRN]

It is always important that the pt be honest about drug/ETOH use/abuse prior to surgery.

[nursetim, NP]

I have recently been through this with my step father. He was A&O x4 prior to hip Fx. They gave him Morphine 1mg (after we told them of previous bad reactions) sent him over the edge. He was sent up for cardiac stress test, where he was agitated so they gave him Ativan. He really didn't like that at all so they kept him until he calmed down. I want to say that cardiac didn't tell (via rport) anyone that they 1) didn't do the stress test due to agitation. 2) That they gave hin Ativan. So we get him up to his room and he needs a foley. They give him Ativan (totally unaware of what had happened in cardiac) so that gave his son and me 3 hrs of fun and him 3 hrs of hallucinations. He never lost himself and almost always knew people he had known for years. His short term memory was shot. He had pinning done with a spinal. At the rehab facility he had wave dementia for lack of a better word. you check his orentation once and he is A&O x 1, wait 15 mins and he is A&) x2 and knows the who the president is. He had two distinguishing problems that were both transient 1) confabulation, hand him a pretend book and he would take it. 2) Hallucinations.

My cousin a nephrologist of 40 years seems to think it is Wernecki's encephalopathy due to the confabulation and history of ETOH abuse. I think it's lewey bodies due to the hallucinations and parkinsonian type symptoms.

and wave dementia.

It's all academic now, my step brother has moved him to SC on a POA signed in the rehab facility. The whole thing is very complicated with details not mentioned. But to get back to the OP, the standard of care for ETOH withdrawl is Tx with benzos. Sometimes elderly ETOHers don't handle opiates well and if they don't handle opiates they usually have a bad time with benzos.