I'm in a detox clinic & this is my first nursing job & first experience in addictions. We have standing PRN orders for 25 mg Vistaril Q6H PRN, Phenergan (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 ridiculous, 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 adamant. I had 4 argue with me last night because I would not give trazodone & vistaril or benadryl & vistaril at the same time at bedtime. 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 phenergan 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 phenergan IM. I offered mylanta and that really ****** her off or phenergan 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 delivering 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 anti anxiety meds. How do you handle drug seekers?
Sometimes I wish we didn't have Vistaril or Phenergan 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)
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
This is honestly highly alarming to read. You've illustrated:
- A dangerous lack of pharmacological knowledge
- Complete lack of understanding of the issue.
- Not just a lack of respect, but contempt for your patients.
- Disregard for professional standards
I have different opinions about this. My background is behavioral health and includes detox. They do need coping skills yes. But I also take into consideration their tolerances to drugs. I have no issues with the lowest doses of Benadryl, Vistaril and Trazodone. We stopped giving phenergan as a standing order because it enhances the effects of some of the other drugs. A lot of them are taking Subutex or Suboxone and it affects those.
I'm generally sympathetic but we got a lot of "repeat" patients. So each patient has a different story or a different game they are playing with you and the docs. There are people truly physically suffering from detox who are there for their first time. Then there are others who have been there 7 times and think it's a joke. So they are treated differently based on needs.
Usually if they have a PRN ordered and they can have it then I give it to them. 🤷🏼♀️ I will not stand there and argue with them though. I also won't let them talk down to me or curse at me. I will walk right away and tell them to come back when they can be respectful. It is tricky to say the least.
- Detox is a medical environment. It is not rehab.
- "Repeat patients"? Like the diabetic who isn't adherrent to medical advice?
- And by the way, diphenhydramine enhances opioids quite well, just as well as promethazine. You may want to watch for serotonergic overload, considering you are giving multiple serotonergic drugs.
I give prns as ordered if the patient asks for them.
There is no benefit to making detox more uncomfortable for the patient. Wanting to feel better is normal. Asking for medications to feel better is normal. Feeling better while detoxing supports recovery.
A gut feeling is not a good reason to refuse to give a comfort med as ordered. Somnolence, low respiratory rate, are reasons. And if the patient is too somnolent to ask for their meds they won't be at your window asking for their meds. Similarly, if they are anxious and yelling, they aren't in respiratory depression.
My advice for dealing with addicts is to treat them the way you would any other sick person. Would you require a person with stage 4 cancer to ask nicely before giving morphine? Or would you understand that their symptoms might make it difficult for them to talk to you in a kind and polite manner? An irate patient is evidence that you should give the med, not the opposite. Agitation should be treated.
Don't take my word for it. Look for peer reviewed articles to guide your practice. Find out what the outcomes are when we withhold medications to treat withdrawal as compared to when we give them.
I have worked in both detox with extended treatment attached. These people are used to having multiple meds together or the "cocktails" to give them an initial alight high and then to sleep. Neurontin and Seroquel is the baby heroin so it is abused a lot. We used to stagger the meds so that at least they could have steady COWS . Its a hard job but if you lay the line and stay to it from the get go the frequent ones will learn quickly. I never had many problems because they knew I didn't tolerate the mess but they also came when I worked because I also treated them like humans and tried to give the best care they could get. Don't BS them but be very honest and empathetic.
Luke79AU
35 Posts
This is honestly highly alarming to read. You've illustrated:
- A dangerous lack of pharmacological knowledge
- Complete lack of understanding of the issue.
- Not just a lack of respect, but contempt for your patients.
- Disregard for professional standards
That's extremely serious,