Advice needed on first shift in Detox

mentalhealthRN · Jan 26, 2011

Many of your questions will depend on your specific facility and its rules and policies. We didn't do any visitors or let pts go out at all unless with staff for an appt. but that was just our policy--too much risk to get their hands on something and it takes away their focus. As far as tasks be sure to review your CIWA and COWs assessments. If that is what they use. You will be monitoring the withdrawal and medicating to keep them from seizing, etc and to manage the symptoms. A lot of anxiety, GI uset, and pain. For ETOH you are watching for any impending DTs/seizures. For Opiates--as I tell pts you will feel like hell but the good news is you can't really die from opiate w/d. You can, however, die from ETOH w/d and from heavy benzo w/d. Review the S/S for DTs, review your assessment tools as its important for them not to realize you are assessing for this as they sometimes will fabricate symptoms and manipulate to get meds. Its an art learning to assess without them knowing. ie..You can take a pulse on the wrist and feel for diaphoresis at the same time. If you know what you are looking for with out the tool in front of you--memorize it basically--this will help. Like in psych-- watch for cheeking....they will cheek and save up for them selves to crush and snort or take all at one time or sell or give to another pt. Watch like a hawk. Wait for suboxone to be dissolved before you let a pt leave your sight--it is given SL, incase you didn't know--I didn't LOL--

Lots of PRNs given for the headaches, body aches and the N/V/D.

And last.......I call it "the wall" and every pt I had in detox hit it......most around 24-48 hours into their stay. The "I can't do this, I want to leave" wall. They feel like crap, they miss family and friends and are realizing that detox isn't easy. You can get good at talking them into staying. I found when it didn't work and they left, they were on the phone or at the door begging to come back and saying they screwed up and shouldn't have left. The Wall. They all hit it. Encourage them to talk to staff and to talk to other pts who have been there a little longer and have just gotten past where he/she is at now and you would be suprised how that can help. They can convince each other to stay. That is cool to see actually. Remind them of what they have at home, the family, the kids, etc that are rooting for them and need for them to get better. Much of the job of a detox nurse is emotional support and being a cheerleader for the pts. Showing them that they are worth it. So many of them have so little self-esteem left.

Detox nursing can feel frustrating many times and like you are not helping but then you get the ones who break into tears thanking you for your care and support. That is awesome. And the stories I have heard that drove people to use can be heart breaking. Take the time to listen to those stories. I had one guy who watched his 5 year old daughter get hit and killed by a car. He turned to ETOH. He was a great guy who blamed himself for her death and had given up. We got him started on the road to recovery. That was awesome.

Good luck and bring a smile with you every day. The patients with appreciate it. They are so disrespected and judged everywhere they go so it means more then you could know when you can be respectful and kind to them and asure they know you are not there to judge them but help.

Anagray, BSN · Jan 27, 2011

Thank you so much, it was very helpful! a lot of what you are talking about is familiar and I agree, most people have a story behind their addiction.

Thank you again and I am glad that patients have such a patient and caring nurse as you are.

reneclover88 · May 5, 2014

Wow! I am a new graduate and will be working in rehab, can't wait! You give me hope and I know I can help make a difference! Thank you for sharing. I will take your advise with me!

dayna.tulip · May 5, 2014

How hard is it to get into rehab nursing? I am currently a new nursing student, and work in the ER, which I would like to continue to work in the future. However, I am also very interested in rehab and psych facility nursing, as these kind of problems hit home and I feel like I could make a big difference. I don't know how competitive it is to get that type of a nursing job as a graduate

Kisa12 · May 17, 2014

How hard is it to get into rehab nursing? I am currently a new nursing student, and work in the ER, which I would like to continue to work in the future. However, I am also very interested in rehab and psych facility nursing, as these kind of problems hit home and I feel like I could make a big difference. I don't know how competitive it is to get that type of a nursing job as a graduate

In my opinion, psych nursing isn't hard to get into. Most nurses don't want to work psych, so there is always a ton of openings, and the unit really could use the help. In psych they usually only take "medically stable" patients, that is patients that need minimal medical intervention. So medical training isn't all that important, knowledge of psych drugs, communication style, and a willingness to enforce boundaries and rules is what matters most in psych nursing.

I love psych nursing 100% as it also hits home for me, and I hope you find a lot of enjoyment there.. just don't expect much in the ways of medical care for physical problems, because you don't get much of that.

I don't know anything about rehab, so I can't really give you much help there.

Been there,done that, ASN, RN · May 23, 2014

Your questions regarding detox protocols / daily routine will be set by your facility.

Your role will be managing symptoms . My experience has been pushing pills...

and trying to handle manipulative patients that want more.

puravidaLV · Jun 11, 2014

ohhh the manipulation how i enjoy it...."I WANT A BENADRYL AND HALDOL"...get them po....." WHERE IS MY SHOT"....i just threw it to the charge nurse and said do what you want I'm not giving that shot or calling the doctor for one based on a patient request.

PEB- · Jun 13, 2014

I worked in psych for five years and loved it too. I believe you have to have the patience for it though. when I worked in psych I worked the night shift, but there was always what I call the true Manic's that never slept until their lithium level was obtained and you could see the transformation. Like night and day, I was not told to get a real job or give me a cigarette every 5 minutes and they would sleep. I actually missed when they left because they kept me on my toes. The majorly depress patients where sad because it was hard to tear down the wall that the medication had not penetrated, but once again when the wall fell down it was refreshing.

I now work with HIV infected client's who mostly have a history of Intravenous Drug Use and are still in their addiction. When I fist started working I would get the sad stories every two hours when the client wanted something. Manipulation is a drug addict co-occurring disorder.

icuRNmaggie, BSN, RN · Jun 19, 2014

Withdrawal from heroin and methadone is life threatening. A patient can dehydrate and die in twenty fours hours from vomiting.