CIWA woes - page 2

by Indy 13,006 Views | 52 Comments

I don't really have any complaint with the CIWA protocols, I am grateful they exist and enable me to sorta get a handle on the ETOH'ers when they decide it's time for withdrawal. It's a lovely thing. What I really dislike are... Read More


  1. 1
    Quote from Indy
    The pattern for me has been that when I show up to work, it's magically day 3 for this or that one and that means it's freak out night, they look fine for dayshift and by midnight it is ON like donkey kong. They are tied up, spitting, yelling, cursing, hallucinating, wriggling, doing all sorts of damage to equipment and themselves, and I am giving ativan every thirty minutes until they snore.
    I hear you, OP, and I'm not going to step on your vent. On my last floor, I was stuck in this never-ending assignment of confused/restraints, isolations and CIWA patients. The unit was L-shaped, with one hallway true general surg post-ops and the other 'the pits' - a mix of private rooms to accomodate prisoners and isolations along with all the other long-term boarder patients. You'd walk on the unit and see that whole hall lit up with call bells going off, day or night. If you were a float or PD, you were guaranteed to show up and work the pits while others read magazines and had potluck parties. Now you know why it was my last floor.

    Point being: do something for you and take your mind off this. Any way you can take a different assignment and get a brief respite? Float? Take PD in another area or floor? Or, away from work - indulge a hobby, take a mini vacation, plan a cool trip? In any case - good luck and a nod from someone else who has BTDT.
    GrnTea likes this.
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    Agree these must be very difficult patients. Takes special nurses for sure.
    canoehead, not.done.yet, GrnTea, and 2 others like this.
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    Wouldn't nursing be so much easier if patients could die less irritatingly?If they could just be a bit less inconvenient to us?

    How annoying it is that the patient in 7 wants to get his life together, wants to make the effort to NOT make poor choices anymore. Or even if he's here just to detox, having been brought in by the police or concerned family members, wouldn't it be more convenient for us if they just didn't? If he just didn't come here at all? If he could just go somewhere and tough it out? And if he dies (yes, a person can die from ETOH withdrawal), well, at least I wont have to deal with it, and, after all, it's his own fault anyway.
    /sarcasm

    How dare you sit in judgment. Who are you to judge these people? There but for the grace of god...
    unreal, Simply Complicated, diva rn, and 2 others like this.
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    I'm with you on everything OP.

    I also hate "How dare you" posts - sign of lack of experience. Funny how it all changes with the first bloody nose. Heh.
    Sadala, canoehead, GrnTea, and 4 others like this.
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    By what? Working in an occupation that is full of patients who make choices that are less than desirable? ETOH addiction doesn't hold the exclusive rights.

    And Netglow.....lots of experience, I happen to like addictions nursing.....

    It takes all kinds and experiences. If you don't want to deal with the good the bad and the ugly, then I am not sure what kind of a job one could tolerate working.....
    Last edit by Esme12 on Nov 15, '12 : Reason: TOS/removed quote
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    Eh, I don't mind the detoxers. At least we have CIWA protocols now. To me they're like all my other pts who have contributed significantly to their poor health and shortened life span. I don't get ruffled over them (though I can certainly understand it), I figure most everyone could be living better than they are, myself included. COPDers, CHFers, diabetics, and others who have been unhealthy and noncompliant for years don't really disturb me, either.

    Years and years of treating these people has made me realize that whether I get my panties in a wad or not, makes no difference. I can worry, cray, cajole, rage, fret, and pray, but in the end, I'm only responsible for doing my job. I can't chenge most people, and I refuse to bear their burdens. I will give then good care and a smile, and support when they tell me they're quitting drinking, smoking, eating at McDonalds this time. Even when I know 99.9% of the time it's absolute crap. It's no skin off my back one way or another, so I might as well take them at their word.
    ackiepieRN, unreal, subee, and 1 other like this.
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    Sorry for all the typos. I have fat old fingers.
    unreal, NutmeggeRN, and Esme12 like this.
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    Lets move this to addictions nursing.
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    OP.....I sounds like you have had bad few shifts. I hope you feel better. There was a time when we as professionals that we didn't try to cure everyone. We had orders for a cocktail or two.....or used alcohol drips to help them while they were under our care. Alcohol is an addiction....like any other addiction. whether from food, drugs, sex, pets, or alcohol. It is a chemical response that they really have no control over. Some people DT and some will not.

    Some act crazed and others do not. I think the was they are snowed with Ativan disturbs their psyche and they wake up combative and confused. I think now that we try to help them by taking away the alcohol....I have seen an increase of these crazed individuals. While they suck up a ton of our time.....we still need to have empathy for their plight. But I do feel your pain.

    To the poster asking about CIWA....Clinical Institute Withdrawal Assessment for Alcohol Appendix A€”Pharmacotherapy - A Guide to Substance Abuse Services for Primary Care Clinicians - NCBI Bookshelf

    That utilize standard assessment criteria and medication protocol. Appendix C€”Screening and Assessment Instruments - A Guide to Substance Abuse Services for Primary Care Clinicians - NCBI Bookshelf

    With standardized orders.....http://www.reseaufranco.com/en/asses...hol (ciwa).pdf
    lemmyg likes this.
  10. 0
    Quote from netglow
    I'm with you on everything OP.

    I also hate "How dare you" posts - sign of lack of experience. Funny how it all changes with the first bloody nose. Heh.
    Yeah, "how dare you" is a bit dramatic, but I was struggling to capture my utter disdain for nurses who pass judgment on their patients. I'm not a 22 year old kid, I am a new nurse yes, but I am looking down the barrel of fifty and I can say with absolute certainty that I will never do this.


    Yes, this makes me better than you.
    Last edit by Esme12 on Nov 15, '12


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