Posted by King from IP 71.196.92.103 on September 30, 2006 at 12:19:49:
A 58-year-old woman is admitted to the hospital with a 2-day history of lethargy and decreased oral intake. She is unable to give a clear history, but her daughter who brought her to the hospital says that she lives alone and she usually calls her every few days. When her mother did not answer her phone she went to her home and found her asleep on the couch with alcohol on her breath. She was difficult to arouse and walked with an unsteady gait. Her mother is reluctant to go to doctors and has lived alone since her husband died 5 years ago. Her mother has always enjoyed drinking but in the last few years has increased the frequency and quantity. She has a history of hypertension but is on no medications. On admission, she appears disheveled and has a non-focal neurological examination. Laboratory studies are normal except for an elevated alcohol level. A CT scan of the head is normal. After 3 days of inpatient hydration and feeding, the patient is feeling much better and is scheduled for discharge. The most important intervention prior to her discharge is
A. abdominal pelvic CT scan to evaluate for ascites
B. health care proxy
C. liver biopsy to assess the extent of alcohol damage
D. social work consult to evaluate her living situation and arrange referral to an alcohol abuse program
E. benzodiazepines to prevent alcohol withdrawal