Ciwa Ar is an artist, curator, and arts educator originally from Milwaukee, Wisconsin. She relocated to Los Angeles in 2006 and has since exhibited her work nationally and internationally. In addition to her studio practice, Ciwa is the founder of the artist-run space CH Projects. As an arts educator she has worked with various organizations including The Museum of Contemporary Art, Los Angeles (MOCA), The Hammer Museum, LACE (Los Angeles Contemporary Exhibitions), and Educational Center for the Arts (ECA). She currently lectures in the Department of Design at California Institute of the Arts (CalArts) where she also earned her MFA in 2009.
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Question | Answer |
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Form Name | Ciwa Ar |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | ciwa scale pdf, ciwa assessment tool, ciwa pdf, ciwa assessment pdf |
Alcohol Withdrawal Assessment Scoring Guidelines (CIWA - Ar)
Nausea/Vomiting - Rate on scale 0 - 7
0 - None
1 - Mild nausea with no vomiting
2
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4 - Intermittent nausea
5
6
7 - Constant nausea and frequent dry heaves and vomiting
Anxiety - Rate on scale 0 - 7
0 - no anxiety, patient at ease
1 - mildly anxious
2
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4 - moderately anxious or guarded, so anxiety is inferred 5 6
7 - equivalent to acute panic states seen in severe delirium or acute schizophrenic reactions.
Paroxysmal Sweats - Rate on Scale 0 - 7.
0 - no sweats
1- barely perceptible sweating, palms moist
2
3
4 - beads of sweat obvious on forehead
5
6
7 - drenching sweats
Tactile disturbances - Ask, “Have you experienced any itching, pins & needles sensation, burning or numbness, or a feeling of bugs crawling on or under your skin?”
0 - none
1 - very mild itching, pins & needles, burning, or numbness 2 - mild itching, pins & needles, burning, or numbness
3 - moderate itching, pins & needles, burning, or numbness 4 - moderate hallucinations
5 - severe hallucinations
6 - extremely severe hallucinations
7 - continuous hallucinations
Visual disturbances - Ask, “Does the light appear to be too bright? Is its color different than normal? Does it hurt your eyes? Are you seeing anything that disturbs you or that you know isn’t there?”
0 - not present
1 - very mild sensitivity
2 - mild sensitivity
3 - moderate sensitivity
4 - moderate hallucinations
5 - severe hallucinations
6 - extremely severe hallucinations
7 - continuous hallucinations
Tremors - have patient extend arms & spread fingers. Rate on scale 0 - 7.
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 w/ arms not extended
Agitation - Rate on scale 0 - 7 0 - normal activity
1 - somewhat normal activity
2
3
4 - moderately fidgety and restless
5
6
7 - paces back and forth, or constantly thrashes about
Orientation and clouding of sensorium - Ask, “What day is this? Where are you? Who am I?” Rate scale 0 - 4
0 - Oriented
1 – cannot do serial additions or is uncertain about date
2 - disoriented to date by no more than 2 calendar days
3 - disoriented to date by more than 2 calendar days 4 - Disoriented to place and / or person
Auditory Disturbances - Ask, “Are you more aware of sounds around you? Are they harsh? Do they startle you? Do you hear anything that disturbs you or that you know isn’t there?”
0 - not present
1 - Very mild harshness or ability to startle
2 - mild harshness or ability to startle
3 - moderate harshness or ability to startle
4 - moderate hallucinations
5 - severe hallucinations
6 - extremely severe hallucinations
7 - continuous hallucinations
Headache - Ask, “Does your head feel different than usual? Does it feel like there is a band around your head?” Do not rate dizziness or lightheadedness.
0 - not present
1 - very mild
2 - mild
3 - moderate
4 - moderately severe
5 - severe
6 - very severe
7 - extremely severe
Procedure:
1.Assess and rate each of the 10 criteria of the CIWA scale. Each criterion is rated on a scale from 0 to 7, except for “Orientation and clouding of sensorium” which is rated on scale 0 to 4. Add up the scores for all ten criteria. This is the total
2.Document vitals and
3.The
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Assessment Protocol |
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a. Vitals, Assessment Now. |
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b. If initial score 8 repeat q1h x 8 hrs, then |
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if stable q2h x 8 hrs, then if stable q4h. |
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c. If initial score < 8, assess q4h x 72 hrs. |
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If score < 8 for 72 hrs, d/c assessment. |
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If score 8 at any time, go to (b) above. |
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O2 sat |
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d. If indicated, (see indications below) |
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administer prn medications as ordered and |
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record on MAR and below. |
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Assess and rate each of the following |
Refer to reverse for detailed instructions in use of the |
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Nausea/vomiting (0 - 7) |
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0 |
- none; 1 - mild nausea ,no vomiting; 4 - intermittent nausea; |
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7 |
- constant nausea , frequent dry heaves & vomiting. |
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Tremors (0 - 7) |
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0 |
- no tremor; 1 - not visible but can be felt; 4 - moderate w/ arms |
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extended; 7 - severe, even w/ arms not extended. |
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Anxiety (0 - 7) |
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0 |
- none, at ease; 1 - mildly anxious; 4 - moderately anxious or |
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guarded; 7 - equivalent to acute panic state |
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Agitation (0 - 7) |
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0 |
- normal activity; 1 - somewhat normal activity; 4 - moderately |
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fidgety/restless; 7 - paces or constantly thrashes about |
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Paroxysmal Sweats (0 - 7) |
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0 |
- no sweats; |
1 - barely perceptible sweating, palms moist; |
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4 |
- beads of sweat obvious on forehead; |
7 - drenching sweat |
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Orientation (0 - 4) |
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0 |
- oriented; 1 - uncertain about date; 2 - disoriented to date by no |
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more than 2 days; 3 - disoriented to date by > 2 days; |
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4 - disoriented to place and / or person |
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Tactile Disturbances (0 - 7) |
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0 |
- none; 1 - very mild itch, P&N, ,numbness; |
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burning, numbness; 3 - moderate itch, P&N, burning ,numbness; |
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4 |
- moderate hallucinations; 5 - severe hallucinations; |
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6 – extremely severe hallucinations; 7 - continuous hallucinations |
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Auditory Disturbances (0 - 7) |
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0 |
- not present; 1 - very mild harshness/ ability to startle; 2 - mild |
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harshness, ability to startle; 3 - moderate harshness, ability to |
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startle; 4 - moderate hallucinations; 5 severe hallucinations; |
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6 |
- extremely severe hallucinations; 7 - continuous.hallucinations |
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Visual Disturbances (0 - 7) |
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0 |
- not present; |
1 - very mild sensitivity; |
2 - mild sensitivity; |
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3 |
- moderate sensitivity; 4 - moderate hallucinations; 5 - severe |
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hallucinations; |
6 - extremely severe hallucinations; |
7 - |
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continuous hallucinations |
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Headache (0 - 7) |
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0 |
- not present; 1 - very mild; 2 - mild; 3 - moderate; 4 - moderately |
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severe; 5 - severe; 6 - very severe; 7 - extremely severe |
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Total |
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PRN Med: (circle one) |
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Dose given (mg): |
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Diazepam |
Lorazepam |
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Route: |
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Time of PRN medication administration: |
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Assessment of response |
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minutes after medication administered) |
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RN Initials |
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Scale for Scoring:
Total Score =
0 – 9: absent or minimal withdrawal
10 – 19: mild to moderate withdrawal
more than 20: severe withdrawal
Indications for PRN medication:
a.Total
b.Total
Patient Identification (Addressograph)
Signature/ Title
Initials
Signature / Title
Initials
Alcohol Withdrawal Assessment Flowsheet (revised Nov 2003)