The documents provide a false sense of security, because they are not always honored. For instances, in some states, the directives become invalid if someone is experiencing a psychotic crisis (., a loss of touch with reality). Some states also allow doctors to override instructions if they have made reasonable efforts to follow the directives. Also, in most states, involuntary commitment (., hospitalizing someone "against their will" because they are a danger to themselves or others) laws supercede the advance directives.
Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension , although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don’t receive treatment. The nurse should monitor the client’s vital signs carefully throughout the entire alcohol withdrawal process.