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 clients want the vistaril like it's candy, and are lining up at the nurses station every 6 hrs (or less) to get it. It's rediculous, but it's that addicted mentality, I know. I'm trying to be as therapeutic as I can & try to tell them that they do not need another vistaril just because the 6 hours is up. Some walk away, but others are VERY adament. I had 4 argue with me last night because I would not give trazodone & vistaril or benadryl & vistaril at the same time at bed time. I tried to explain that trazodone also helps with anxiety & they don't need both or that benadryl & vistaril are both antihistamines and I cannot give that much at once. Now, my standing orders do not say anything about giving meds together, but my gut and nursing judgement tell me that's just too much. Also, they beg me for phenergen all the time, and I have two whom I'm sure are making themselves vomit to get it. One (heroin addict) was begging my for phenergen IM. I offered mylanta and that really ****** her off or phenergen suppository, but she said she had diarrhea & couldn't do that.
So, can anyone give me some advice on handling these situations? I'm often the only nurse on & don't have anyone to back me up. I don't feel that handing out meds every time they ask is doing them any good. It gets exhausting when they are constantly knocking on my door and shouting out med orders while I am delivereing scheduled meds to others. (I ignore the shouts because that's just rude and I am no one's servant).
These people are here to detox and learn coping skill (well, not everyone has good intentions), but I want to know that I'm doing right by not handing out a med when I don't think it's legitimately needed.
Now, some of these people who are demanding Vistaril from me are already on Buspar or other antianxiety meds. How do you handle drug seekers?
Sometimes I wish we didn't have Vistaril or Phenergen to offer.
Also, a few weeks ago, we had a client who was soliciting others to get Vistarils for him cuz he wanted to snort them. What wold be the effects of snorting a vistaril? (this client was kicked out)
Jan 15, '13
When I worked addictions and clients were rude, I became conveniently deaf until they asked politely, or at least quit yelling and demanding whatever "right now!" I felt (sorry, the bold won't go off)that was a big part of the respect I required they give me and the psych aides on my shift. When they would ask for meds it wasn't time for yet, not ordered by the MD, or whatever, I'd tell them, over and over if necessary, that we could only give what their doctor had ordered. I documented very very thoroughly and in detail -- vile and vulgar language and my responses included. If necessary, I kept repeating the same thing over and over. Rely on the psych aides because they're a great source of patient info. I take Neurontin for simple and partial complex seizures along with Keppra and Neurontin was never intended to be a stand alone drug. The way my neuro orders it for most of his adult patients is to order 100 mg capsules with a range dosage instead of a set dosage. For example, I must take a total of 700 mg spread out through the day, but during summer, humid weather, when it thunderstorms, when I have a temp, etc., I may add up to 500 mg more. The patient claiming to be having seizure may actually have been having one. When I have a seizure, it's nearly invisible. I can talk, follow a conversation,and except for muscle contractions of vice grip strength, very few people know. If Neurontin alone was ordered for seizures, your patient might indeed be having a few.
Last edit by Meriwhen on Jan 16, '13
: Reason: formatting (removing extra bolding)