CIWA woes

[Indy]

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 the patients!

This is a vent and if you think I'm a horrible person, just think... there are probably people you don't like either. 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.

Sigh. It's so predictable. And not one of them ever has a different presentation when the DT's start, although some are more severe. No one wakes up nice a few days later. Nope, some of 'em put cheerios in their hair and ears when they have regained control of themselves. And you never know when you will go to do something simple to a properly medicated, snoring, limp patient and have all heckfire and brimstone erupt. No matter how much you bathe them, the stench is amazing. Also you can't actually bathe them until you have medicated them into a somnolent state. While they are wiggling, they are gonna be icky because of the safety factor. I need my skin intact, thanks.

I dislike people who have gotten themselves into this mess by deliberately ingesting poison for years on end. It gets you drunk, yes, that is how you know it's poison. That's your liver working overtime to get the crap out of your system. There are folks that just don't care, about life or other people, or apparently about the humiliating extremes that they can wind up in when it all goes south either. Most of these folks have relatives that would have a duck if they saw the stuff their loved one gets into, and since ICU doesn't have a rubber room, they are restrained while going through the worst of it. I would be horrified to see a loved one in that situation, maybe that's one reason I choose not to surround myself with alcoholics. I do not understand this patient population, and to be honest, I don't like them either. Ok rant is done.

[garnetgirl29, BSN, RN]

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".

[ParkerBC,MSN,RN, PhD, RN]

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.

[TerpGal02, ASN]

Ok, old I know, and I surely understand the frustration. No one wants to deal with a nasty psychotic, no matter the reason they are psychotic or behaving bizzarely. I am an inpt psych nurse and we have a VERY nasty psychotic pt that is verbally abusive and threatening to staff AND other patients. When she's cussing you out for the thousandth time, yeah it gets old real fast.

My concern is how the mentally ill/addicts are treated on medical floors. I have seen (more than once) this phenomena among somatic caregivers. If its an elderly person with an anti depressant, its one thing, but if its a younger person on any psych med, or on multiple psych meds no matter the age, they are immediately discounted as "the psych patient" and immediately everything is all in their head. It's a known fact that the mentally ill die 25 years earlier than the general population, and a lot of it is substandard medical care. A lot of them are diabetic through no fault of their own. Some of the meds cause it.

I am bipolar type 2. Granted I am a very functioning bipolar, but I'm on a cocktail of meds to control it. I don't drink or do drugs. My only vice is smoking. With negative attitudes toward the mentally ill so pervasive, it worries ke how I might be treated if I ever had to be hospitalized on a somatic floor. As soon as someone sees antidepressants and anticonvulsants on my MAR, I don't want to be treated as "that psych patient"

[canoehead, BSN, RN]

Everyone has days when they've had it up to -here- with their job and everything it entails. You can know you're being unreasonable and illogical, but having a good whine and a break can make everything right again. It doesn't mean the OP is a horrible nurse, or disrespectful, s/he just had to get the poison out, and move on.

[NRSKarenRN, BSN, RN]

Thread has run its course. Thanks for the links re CIWA protcoals.