Alcohol withdrawal unit?

Nurses General Nursing

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I graduated a few months ago, and I was just hired at a local hospital (I made sure I had my ACLS and I am enrolled in a BSN). I am very happy with everything so far. People are extremely welcoming, and the training has been great (computer training, foleys, etc). I will work on a med-surg alcohol withdrawal floor.

Here is what made me post here.. when I mention my unit, everybody goes "ooooooh.. well good luck" or "ooooooh.. well at least your manager is awesome".

If you have time, I will appreciate any advice on what to expect in an alcohol withdrawals unit (withdrawals right! ?)

Thank you so much!!

Specializes in Ortho, CMSRN.

In the last 5 years, I've taken care of 6 alcohol withdrawal patients that I can think of that actually were in withdrawal. I've done CIWA and had negatives on far more. Out of the 6 patients, 4 were men. And out of the 4 men, 3 were extremely inappropriate and made gross remarks. Is this par for the course? Or am I just unlucky? I've not encountered that level of poor behavior in the general patient population that we normally get.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, ClaraRedheart said:

In the last 5 years, I've taken care of 6 alcohol withdrawal patients that I can think of that actually were in withdrawal. I've done CIWA and had negatives on far more. Out of the 6 patients, 4 were men. And out of the 4 men, 3 were extremely inappropriate and made gross remarks. Is this par for the course? Or am I just unlucky? I've not encountered that level of poor behavior in the general patient population that we normally get.

The general population doesn't have a problem with substance abuse, so they handle things better in general. Anyone with a substance abuse problem has general coping problems so not unusual to see bad behaviour in the hospital. I have cared for people who were perfectly polite while they were withdrawing and going through hell. Those are the bonuses.

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Specializes in CMSRN, hospice.
8 minutes ago, TriciaJ said:

The general population doesn't have a problem with substance abuse, so they handle things better in general. Anyone with a substance abuse problem has general coping problems so not unusual to see bad behaviour in the hospital. I have cared for people who were perfectly polite while they were withdrawing and going through hell. Those are the bonuses.

This. I've also had patients who were absolutely nightmarish during withdrawal who were honestly mortified to find out how they'd acted after the fact. When those patients come back, they are usually very anxious about it happening again. It's really sad.

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Sometimes "the cure can be worse than the drink" at 48-72 hours. We always tried to get our patients home before symptoms started with information on local resource options. Sometimes the realistic doctors will order daily alcohol dosing to prevent symptoms until the patient can go home.

Unfortunately, at times patients have no choice in the matter to detox when recovering from an illness or injury. Safety is the main goal. They can be amusing, nasty, entertaining, combative, funny, etc. The medication management is a lot better now, but there still are risks.

Remember that the likelihood that a patient will stop drinking from an unplanned and unwanted detox is pretty low. It also can be more dangerous than letting them have a drink. Just because the medical community thinks not drinking is the better choice, the patient may not agree.

Keep your sense of humor!

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Specializes in ICU/CVICU.

Precedex, haldol, ativan, restraints and bipap are your best friends.

Sometimes you have to intubate.

I had taken many alcohol withdrawals as a fresh nurse I'm the ICU.

Remember, there are probably (more often than not) several underlying mental health and other physiological comorbidities.

Like some other people have said, extra pair of scrubs, make sure VS are stable, communicate to family (if any) and you'll be fine.

The biggest issue families have (from my own personal truth) is nurses just do what orders say and don't communicate with family on why/how/what you're doing. Trust me it goes light years of distance to just sit next to a family member and tell them (dont just talk to their face in nurse jargon) what is going on. Even when the patient/patient's family has had a bad last shift I always manage to calm their anxieties with explanation. They just want to know what is going on.

ALWAYS respect your patients, talk to them/around them like they can hear you. Explain what is going on (even if they are intubated and sedated etc.....)

No matter socioeconic or cognitive status these are still people and even if they are alone.

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Specializes in Critical Care; Cardiac; Professional Development.

Difficult patient population and one that really exhausted me. They can go from pleasant, grateful and hopeful to deluded, hostile, violent, incontinent in the blink of an eye. The first time I had a patient attack me was in a young attractive person who checked in after trying to quit cold turkey at home. They arrived on day 2 of no alcohol. Pleasant, well groomed and full of hope and gratitude on admission. Within 25 minutes they had my arm torqued up behind me, were screaming, confused and terrified. That one had to go to the ICU.

Expect to give a lot of Ativan. Frequent use of sitters and/or restraints. The first time I saw nystagmus in person was in an alcohol withdrawal patient. Lots of linen changes due to incontinence. Not infrequent escalation to ICU for intubation. Distraught families with very broken relationships, ineffective coping and anxiety.

You can also expect stories that will tear your heart out. Levels of gratitude from your patient that may startle you just for treating them with respectful compassion and tell them your goal is to make this as easy on them as you are able. I personally found this population very difficult and drove me hard into compassion fatigue. They were difficult, often smelled horrible, needed very close monitoring and had the tendency toward extremely challenging and sexually inappropriate behavior.

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That sounds like an amazing floor to work on and I would be thrilled to work there.

The responses to this thread were extremely illuminating.

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