CIWA woes - page 5

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

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    I think there is a difference between judging how people take care of themselves and judging how a person is in general. I don't pass judgement on patients who continue to drink, smoke, or eat fast food. I understand that disease can consume someone and cause them to make mistakes. However, I do judge a patient when they spit on me, hit me, urinate over the side of the bed because you won't get them a cab voucher, cuss you out because you didn't inform them that their girlfriend is here at the same time as their wife, request only white nurses because they are racist, or pull out their IV and throw it at your face because you didn't let them leave with it, so it can be used to mainline the new oxycodone prescription. My judgement comes from who they are as a person. It doesn't change the way I care for them or get in the way of doing my job. It's hard to not be judgmental when you are caring for a pt who is handcuffed to the bed because they were arrested for murder. Or, caring for someone who got a laceration from a wife that was defending herself while he was beating her. Not everyone that comes through the hospital door is a victim of misfortune.

    I think the OP had a very bad rotation. It was very stressful and she needed to vent. She had some opinions that she felt needed sharing for her own sanity. A lot of the feelings we have to deal with as nurses can be overwheling. In my humble opinion, I don't like the fact that a nurse wanted to share her opinions and other people responded with "how dare you." If anything, she needed constructive criticism or a pat on the back. I felt the same way years back. I was frustrated seeing frequent flyers or people who just didn't care. As the years have gone by, I have learned to just roll with the punches. There are things in this world that I can't control. It's probably funny that we cope with ETOHers at work by cracking open a beer at home after work.

    I can't say that I've never judged a patient and I think it's ignorant to say how dare you pass judgement. That's too much of pointing your finger on top of a soap box. Almost the pot calling the kettle black. Maybe the OP had a really bad experience with other alcoholics. I don't mind that people have opinions about patients or want to vent on a forum. I don't always agree with others.

    So, to the OP....As your career moves forward, you will learn to deal with your feelings toward others. You'll see that there are things are you can't control. ETOHers can have a wide range of behavior. Some are just severely altered and don't realize whats going on and there are those who are just mean and abusive in general. They do ingest alcohol, knowing it's something they can change, but there are so many other factors that are literally controlling their response to ETOH. One thing that might help is talking to them after the withdraws have subsided. If you find out that the drinking was a mechanism to cover the pain from an abusive past, it might help you gain a new perspective. Don't worry about other people on this forum....um...passing judgement on you for passing judgment. For every person that looks down upon you from their soap box, there are a dozen who are here to listen and lift you up.
    canoehead, macfar28, not.done.yet, and 1 other like this.

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    Ahh, well thanks Hodgie, that was really sweet. I'm just gonna let this discussion fizzle out if it will be kind enough to do so...
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    I love working in Substance Abuse detox and enjoy working with this population of people who need someone to care for them while they are in withdrawal. Guess it's not for everyone, but it is for me. I've only had 1 problem in the 3 yrs I've been doing this. Even when my patients go into DTs (Delirium Tremens) it's okay. We help them to recover, put them back on their feet and refer them to aftercare. CIWA is an Alcohol Withdrawal Assessment Scoring Tool that nurses, doctors and clinicians use to assess where the patient lies in their detox from alcohol. Hallucinations "can be" a part of their withdrawal symptoms, but this does not apply to most. Ativan doesn't work on someone with DT's, they need a stronger Benzo than that. Imagine giving them Ativan for anxiety versus Librium 25mg/Q4hrs with a sleeping pill and sometimes even Vistaril...or Benadryl. Ativan is for you and me (if we ever needed to take it). It's not for someone hallucinating r/t: DTs. Hope this helps.
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    Quote from Indy

    It's not luck, I chose to not marry one. I'm sorry you had a rough time with your family. Mine was not fun either. I just didn't want to talk about my family in this rant, but it is relevant I guess, in that it taught me early what to avoid later on.
    "Growing up around them" doesn't imply marriage. It implies that relatives, maybe even parents, were alcoholics. You don't always get to CHOOSE.
    Anoetos likes this.
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    Venting is good for the soul! Good to get it out. After After 13 years of working various "medical" nursing jobs (CCU, ACU/PACU, Endoscopy, geriatrics.. etc) I found my niche. I have now been in the psych and addictions field for 4 years and LOVE it! Yes, it's crazy.. mentally and emotionally exhausting and frustrating are these patients. So much of this field is just not a tangable type of nursing and there are skills that we develope to navigate and care for these patients. They are sick. It's a different kind of sick than a medical illness, but addiction is a disease that encompasses more than physical ailments and moral choices/ willpower. Like many others that work in this field, I have been in recovery for several years. I understand where they are coming from and cry with them at times. However, I also get frustrated and long for them to "just get it"! It took me a long time to find my "home" in nursing, but I am so glad that I did. I promise that they are paying attention. It takes what it takes and for some that's numerous trips to detox, etc. The unfortunate ones never get it at all. Explaining what being an alcoholic or addict is somewhat like trying to explain parenthood. You never truly understand unless you have been there! Now, I don't propose that anyone pick up an addiction to learn the workings of an addicts mind, but I do suggest that EVERYONE that works in this field should learn and practice the coping skills that we teach. It is also highly suggested that we all attend Alanon. That is a wonderful place for anyone that lives with or works with addicts. If you continue to find yourself unhappy in the field of addictions then maybe another area would suit you better. Have you ever had a nurse that seemed like she really hated her job? There is no therapeutic value there… especially in this field! Good luck with your situation… and remember.. BREATH!
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    AMEN!
    You were born to be a nurse, weren't you!
    That was great
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    Looks like I need to brush up on my "reply" skills here! The above reply was meant for somewhere else….
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    I am going to jump on the band wagon here although I know the OP was hoping that the thread would fizzle out. I hope that what I share with you will help someone in the future. It sounds as though the doctors writing the orders do not understand ETOC withdraw. The goal is to medicate before DT’s. When I get orders, I always request an order for Phenobarbital to prevent seizures and it helps to calm the patient. However, if the patient is elderly or on Coumadin, I will ask for Librium instead. I generally get an order for Ativan q2h for 24 hours. I don’t experience the things you do. I think the reason is because our physicians are proactive in treating the patient.
    The orders are a taper. In other words, the order may be PB 60 down by 15, or for the heavy drinkers, PB 80 down by 10. Alcoholics have trained their brain to seek out what it needs to prevent withdraw, which happens to be alcohol. It’s a vicious cycle. Regardless, you should not be put in a dangerous position, especially if it can be prevented. We also dose with Vistaril for anxiety. I know it’s an antihistamine, but it works!

    Good luck! J
    canoehead and KristieRae71 like this.
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    I work in a mental health/detox clinic & we see a lot of people for ETOH detox. They are all put on the librium protocol which includes B vitamins & neurontin to prevent seizures. Many are also put on an antidepressant, but not all. We monitor for s/s of DT's, but our goal is to detox while preventing DT's. We also have Vistaril PRNQ6H for anxiety (though I usually offer a PRN librium for ETOH depending on last/next dose & nursing judgement). I've only been here for 3 months, but if we see signs of DT's, we send the client to the ED because we are not equipped to handle that. I would not want to be on that side of the detox client's treatment, so I am thankful that my clinic doesn't deal with that. Though lately, our doc has been accepting clients who are intoxicated upon arrival! I HATE this. We cannot begin their protocol until they are sober & we have no private rooms, so the drunken client is put in the mix with the rest. I see this as disrespectful to the other clients & staff and dangerous! Sometimes I think our doctor has so much on his plate that he doesn't think before he says "take him".
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    Quote from garnetgirl29
    I work in a mental health/detox clinic & we see a lot of people for ETOH detox. They are all put on the librium protocol which includes B vitamins & neurontin to prevent seizures. Many are also put on an antidepressant, but not all. We monitor for s/s of DT's, but our goal is to detox while preventing DT's. We also have Vistaril PRNQ6H for anxiety (though I usually offer a PRN librium for ETOH depending on last/next dose & nursing judgement). I've only been here for 3 months, but if we see signs of DT's, we send the client to the ED because we are not equipped to handle that. I would not want to be on that side of the detox client's treatment, so I am thankful that my clinic doesn't deal with that. Though lately, our doc has been accepting clients who are intoxicated upon arrival! I HATE this. We cannot begin their protocol until they are sober & we have no private rooms, so the drunken client is put in the mix with the rest. I see this as disrespectful to the other clients & staff and dangerous! Sometimes I think our doctor has so much on his plate that he doesn't think before he says "take him".
    We generally start the protocol if the PBT is 0.2 or less. We get alot who come in under the influence. However, we do have our share who have to sit until they are able to blow the 0.2 or less, which makes for a fun evening.


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