A nurse on the telemetry unit receives a client admitted from the emergency department with acute alcohol intoxication, confusion, and a diabetic toe ulcer. Which intervention would be the priority?

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Alcohol is a toxin that causes central nervous system depression. Acute alcohol intoxication can cause confusion, coordination impairment, drowsiness, slurred speech, mood swings, and uninhibited actions. Alcohol can also cause hypoglycemia, especially in clients with diabetes mellitus. Although the client is intoxicated, it is difficult to determine if the confusion is caused by alcohol or hypoglycemia or both. The priority is to monitor blood glucose during the night to watch for hypoglycemia, which would require immediate intervention. (Option A) Alcohol withdrawal generally starts within 8 hours after the last drink and peaks at 24-72 hours. (Option B) Alcohol rehabilitation referral can be addressed when the client is sober and is not a priority. (Option C) The client should be allowed to sleep, but monitoring glucose levels is the priority. Educational objective: Alcohol can cause hypoglycemia, but intoxication can make it difficult to differentiate between the effects of alcohol and hypoglycemia. Clients with acute alcohol intoxication, especially those who have diabetes mellitus, should have their blood glucose levels monitored.

A Nurse on the Telemetry Unit Receives a Client Admitted