How to Coach Yourself and Others Empowering Coaching And Crisis Interventions | Page 173
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Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
Patient:__________________________ Date: ________________ Time: _______________
Pulse or heart rate, taken for one minute:_________________________ Blood pressure:______
NAUSEA AND VOMITING
Ask "Do you feel sick to your stomach? Have you vomited?"
Observation.
0 no nausea and no vomiting
1 mild nausea with no vomiting
2
3
4 intermittent nausea with dry heaves
5
6
7 constant nausea, frequent dry heaves and vomiting
TACTILE DISTURBANCES
Ask "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs
crawling on or under your skin?"
Observation.
0 none
1 very mild itching, pins and needles, burning or numbness
2 mild itching, pins and needles, burning or numbness
3 moderate itching, pins and needles, burning or numbness
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
TREMOR
Arms extended and fingers spread apart.
Observation.
0 no tremor
1 not visible, but can be felt fingertip to fingertip
2
3
4 moderate, with patient's arms extended
5
6
7 severe, even with arms not extended
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