Advice for dealing with addicts? - page 3

by garnetgirl29

15,520 Views | 32 Comments

I'm in a detox clinic & this is my first nursing job & first experience in addictions. We have standing PRN orders for 25mg Vistaril Q6H PRN, Phenergen (must see vomit),75-150mg Trazodone for sleep or 50mg Benadryl for sleep. My... Read More


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    I agree. If she felt it right to withhold, then that's her professional judgement at the time. Education is another thing; judgement from knowledge-base, where the RN was at the time, with the tools she had at her disposal, is the key (and the quality the hospital expects via training). It's not her fault...I like it when they put the onus on us (personally); it forces me to make it my business to learn my specialty. After all, patients come to hospitals 'cause they need nurses (not MD's). This is our time--things are changing. Not so long ago, there were no specialty certs. Mark my words, APRN's will be doing surgery within the next 20 years or so. Remember when Doctorate's were PhD's, now they're practice DNP's? We're moving into the fast lane, so buckle up! I worked in an ICU that leaned heavily on RN's...We did all Hosp codes w or w/o MD's; tons of things other hospitals (I later learn) wouldn't fathom leaving up to RN's. I do understand places can vary, just like experience.

    Acute withdrawals {which I was assuming they were in--(again assuming also they were in a hospital type setting)} for me, isn't the time to wean. I try to keep 'em there, keep em comfy, so once they're out of acute withdrawal, we can deal with the PAWS and really "talk." It's not easy understanding addiction, what makes a difference (a real difference), and what's just a treatment nuisance. It's hard not buying into the "bad addict" thinking. I stick to acts that will make the difference, allowing meds they want because after all, it is THEY who need to make the decision. I can't force 'em (it will never work, anyway). My one or two petty things won't "fix" an addict. It's deep within, where they change. I try to connect with that part, soon as I can. I love the manipulative one's (especially when I'm suckered) Every once in a while they get me & I've got a big S on my forehead keeps it fun & interesting!

    I can't understand how phenothiazines could be (physically) addictive...I wouldn't know those withdrawal symptoms (or treatment thereof), if I was hit in the face with 'em Anything, including ibuprophen is psychologically addictive, however.
    Last edit by CASTLEGATES on Aug 13, '13
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    Quote from Topaz7
    Disagree ... I've taken phenergan and it made me feel like I was on Vicodin for a couple hours before it knocked me out. It's not a scheduled med but its naive of you to think people don't abuse phenergan lol. I recently cared for a patient who admitted to being addicted to and abusing neurontin.
    Theres a DIFFERENCE between ABUSE and ADDICTION.. ..

    People dont go through physical withdrawals from not having phenergan. ...nor do people" drug seek" phenergan. (that ive ever heard...)
    sharpeimom likes this.
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    There's psychological addiction then there's physical, I never said a person would need to detox from phenergan, but that doesn't mean it can't be abused or psychologically addictive, and yes our docs have said it can be that's why they order us to withhold phenergan after the person has had and is REQUESTING IM phenergan around the clock.
    Meriwhen likes this.
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    Quote from NC29mom
    Theres a DIFFERENCE between ABUSE and ADDICTION.. ..

    People dont go through physical withdrawals from not having phenergan. ...nor do people" drug seek" phenergan. (that ive ever heard...)
    Actually, some patients do seek Phenergan as it can get them buzzed. I've had MDs cut off patients who were overusing Phenergan. Other docs won't even prescribe it and will use Zofran instead.
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    Just fyi addicts have addictive personalities and can become addicted to Tylenol. ...its addictive behavior of swallowing a pill...ANY PILL....whether they get high or not. So, yes in that respect sure they might request phe
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    Ha @ "the fish bowl". This was what we called our nurse's station on the adult general psych unit!
    sharpeimom likes this.
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    Quote from TriciaJ
    Seems to me the OP is trying to develop the judgement needed to support people in their efforts to get well and not support them when they manipulate to stay sick. It is a very fine tightrope and I think some facilities put way too much on us on the nurse. In a place rife with manipulative behaviours, it is really essential to have very clear MD orders and unambiguous unit policies. Most nurses don't withhold meds for the fun of withholding them; we are trying not to add to the problems people already have. Maybe addictions should be covered more thoroughly in nursing school so we have a better idea how to genuinely help people and not feel like we're sinking or swimming.
    This is EXACTLY what I'm trying to do. Thank you TriciaJ. When I originally posted this tread, I was brand new to this job. I have dealt with addicts before this position, but as a family member; not as a nurse. I am a brand new nurse and this is my first job. I was looking for good advice on how to be therapeutic with these clients. I am not " withholding meds". All of these clients are on either our suboxone protocol or librium protocol. Our doctor is very wishy washy and arrogant. He changes his mind all the time, so it's nearly impossible for all of us to be on the same page and some of our standing orders leave a lot up to the nurses discretion. We've tried clarifying standing orders, and we get nowhere. And it doesn't help that we get contradicting orders between the MD & NP.
    Being new, I was looking to the other nurses, but they all do things differently.

    For example: Our MD wrote orders for 0.1mg clonidine for high BP & if not reduced on recheck, give 25mg HCTZ. Well, in shift report one day, a nurse reported following that protocol for a detox client, and our NP completely exploded & pretty much called us all stupid (for following the MD order). She said detox clients are at risk of dehydration and HCTZ should ONLY be given to psych clients.
    Did she rewrite our orders? Nope. So, any nurse not aware of that outburst, will continue to follow the written order. Several of the nurses there have been there since the clinic opened 7 years ago, and they said they've always followed the order as written because that's what they were trained to do.

    This is not a hospital. It's a very small, 16-bed facility. Most of the time, there is one nurse on duty to handle our current clients, walk-ups(last night I had 6 walk-ups - 3 admissions, all while staying on top of scheduled med passes and PRN meds), phone referrals, etc. It's very inconsistent and too much is left up to the nurse. As a new nurse, I'm just looking for more insight and ways to help my clients succeed and ways to grow and become a better nurse. So, to those of you who offered that....thank you!! To those of you who chose to bash me - well, no comment.
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    This post is very very judgmental. You have no clue what those people go thru. Anxiety is mostly the reason they started using in the first place. And when detoxing the anxiety is unreal. so give them the meds who are you to say they can't have it unless they can't hold there eyes open. Keep on judging !!
    Last edit by Esme12 on Sep 30, '13 : Reason: TOS
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    I had to walk away from this yesterday and come back so I could write this appropriately. I have fibromyalgia that is very severe. Years ago I had a doctor put me on Fentanyl. I had no idea what is was at the time and thought it was ok. I had been on it a few months and I developed gastropariesis. My gastro doc wanted me off of that drug. I talked to my doc about it and he said no that it wasn't causing my stomach paralysis and he would not take me off. My gastro docs begged him to do it and I wanted off because my whole personality changed while I was on it. I eventually went off myself cold turkey. I took two days off of work thinking I would be ok by Monday. Let me tell you, it was the most awful thing I have ever done in my life. It took me a full week to come off of it. I had hallucinations, convulsed, puked, shook for days. It was terrible. To judge the people who are going through this and try to deny them something that would help them through this is cruel. Until you go through it you will never, ever begin to understand how hard it is. You have no idea how any of them got into the situation they are in but your job is to care for them not to judge and think that you know what is best. Their doctor will decide that. I am astounded at the comments I have seen from what should be caring, compassionate nurses. If you have a problem with these people then you need to find a different line of nursing.
    melijm and tsalagicara like this.
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    Ok, if I came off sounding like I'm judging my clients, I am not. I can assure you that my supervisor has shown me numerous comments clients have put in our comment box to show their appreciation for me and many of my coworkers because we don't come off as judgy or condescending. I am far from perfect, but I find it very unprofessional to make my clients feel judged or that I am in any way annoyed by them. I'm very good at not coming off that way. I've hugged them, encouraged them, listened to them when they cried and I've offered numerous comforts meds when they haven't asked because I do not like to see anyone hurt. My concern was about giving too much at a time & causing them to be too sedated to participate in the facility's therapy groups. They get write-ups for missing groups. In the 8 months I've been here, no one has accused me of judging them(outside of this thread). I myself have not battled addiction, but the majority of my family has.
    Many of my loved ones are alcoholics, some are meth addicts and some are opiate addicts. This is what I know. My goal is to help them and educate them about the risks of their lifestyle, but I always love them.
    I am not withholding meds from my clients. They often ask for things I cannot give or want them sooner than I can give. I came here looking for encouragement and advice on how to better do my job & how to handle the disrespect. I have gotten much better at that & developed better judgements over the past months. Some clients have told me that they get a "high" from phenergen & many of them enjoy getting shots. This is why I feel the need to validate giving phenergen, especially IM.

    I was brand new to this position when I started this thread. I had a lot to learn and was trying to develop a good nursing judgement. I still have a lot to learn & often tell my clients that I appreciate their insights because it helps me to understand what they're going through.

    Heathermaizey, coming off fentanyl cold turkey like that was very dangerous. Without a proper detox, I'm surprised it only took a week to recover. I'm glad you're ok & hope you are where you want to be right now. I fully understand that many, many people become addicted due to circumstances out of their control. My cousin is addicted to fentanyl and I love him very much. We spend a lot of time together & when he has tried to detox himself in the past, on his own, I've tried to discourage that because I'm concerned for his well-being and safety - as I am with my clients.

    I got defensive because what I perceived as looking for advice and information to help myself become a better nurse, others saw as me being judgmental. I didn't expect that. No one I work with has called me judgmental & in my performance review, I was told I was very good at what I do & they were receiving a lot of positive feedback about me.


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