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Alcohol withdrawal unit?

Nurses   (746 Views 18 Comments)
by Nurse Pompom Nurse Pompom (New Member) New Member

68 Visitors; 5 Posts

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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!!

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6,981 Visitors; 943 Posts

Lots of agitation, anger, hallucinations.  And patients seizing.  They will be trying to get out of bed constantly.  How is the pt ratio?

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Emergent has 25 years experience and works as a Emergency Room RN.

6 Followers; 2 Articles; 63,499 Visitors; 2,675 Posts

It sounds like something most wouldn't want to do. You'll get good experience though.  Use it as a springboard for a more diverse patient population. 

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6,221 Visitors; 541 Posts

Treat everyone with respect.  Many in this patient population have comorbid mental health issues, as well as issues like homelessness, lack of access to health care, etc. However, certainly not all.  Educate yourself on addiction.  

The patients with long standing untreated alcoholism have many, many other health issues. They can be pretty complex.  

It probably isn’t a unit that keeps nurses long term.  It’s a tough gig. However, stick with it and use it as a spring board to something else. Who knows, you might like it. I like working with this population.

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68 Visitors; 5 Posts

I would like to stay, so I am hoping that I will have a good team. I feel like support from your peers is the most important factor.

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6,981 Visitors; 943 Posts

I will also say, learn to laugh and let things roll off your back.  Don’t take their anger personally.  They are detoxing.

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68 Visitors; 5 Posts

3 minutes ago, LovingLife123 said:

I will also say, learn to laugh and let things roll off your back.  Don’t take their anger personally.  They are detoxing.

That's why I am hoping for a decent team. I totally love the humor in nursing.

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CalicoKitty has 6 years experience as a BSN, RN and works as a Med-Surg Nurse.

1 Follower; 15,256 Visitors; 578 Posts

I'm sure you can keep an amusing "$*** my patients say" collection. Maybe make sure you have an extra set of scrubs at all times, I notice that many of the withdrawing patients I've had become incontinent of urine.  I think patience will be important. And a concept of personal space and safety. But, don't forget that they are humans, probably with many issues and some may have terrible lives (perhaps of their "own doing") and may not realize how much their intoxication is affecting it.

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Tomascz has 3 years experience as a ASN, CNA, RN and works as a CMSRN.

2,600 Visitors; 74 Posts

OK; so, I work with a lot of "CIWA" pt's (CIWA is the algorithm for assessing withdrawal where I work), and it's pretty much of an art. Lose whatever attitudes you have about addiction and substance abuse and focus on the pathophys of withdrawal from whatever they came in on. Ask a lot of questions of those with the most experience.
We're given guidelines (which are often under revision) for what to treat our pt's with, but we're left with a fair amount discretion in dosing and titration. The CIWA scale is largely subjective.
You need to get whatever Hx you can from pt's who are not usually entirely candid about their usage.😆 Make sure you've got a current UA for random other substances. If you're having a lucid conversation with a guy whose BAL is over 300, and he quit drinking yesterday, you better watch your butt.

Just be upfront with your pt's. Alcohol withdrawal kills people all the time; that's why they're doing this in a hospital. You and your admitting Docs need to be able to tell the difference between someone who has withdrawal potential and someone who's just hungover.
Know when your pt's need to be transferred to an ICU!
Also, what beekee said.

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NightNerd has 5 years experience as a ASN, BSN, RN and works as a Med-psych nurse.

15,360 Visitors; 762 Posts

I actually rather enjoy taking care of alcohol withdrawal patients! As Tomascz said, it's a bit of an art. Everyone's withdrawal process is a little different, and you will develop a certain intuition for how a patient may experience the process. Some people vomit for days; some try to downplay their symptoms when they're shaking like a leaf and so sweaty they're positively glistening; some start hearing the IV pole talking to them and you know it's going down. It's fascinating, and very gratifying to help people get through to the other side.

Seizure precautions are a must. Be prepared for agitation, hallucinations, and combativeness, though not everyone will get that bad. Monitor for adverse effects as you would with anything, but don't be afraid to medicate - these patients can handle an impressive amount of meds! There will probably be frequent flyers who will break your heart, so just remember to give yourself credit for the small miracles you work. Keeping these patients safe and showing them some kindness is not to be underestimated in importance.

I'm actually dying to know where this unit is; I want to work there too! It can be exhausting, but it feels good when you can keep someone from going into DTs, or get them to the proper level of care to manage it safely. 

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gonzo1 has 15 years experience.

22,932 Visitors; 1,692 Posts

I often work with these patients.  There is no "usual" course.  Some pts go through quick and easy.  Some are "out of their minds" for weeks, and you finally tell the family they probably have brain damage and will never be themselves again, and the next day they break through and fully recover.  True story.  I was so happy.  

Also study up on meds for DTs and detox and withdrawal because "things are a changing."  Some docs love Precedex, some hate it.  Some docs think we should stop using Ativan, an oldie but a goodie.  Some docs think diazepam and phenobarbital are better choices, and do not like scheduled librium.  Look at the length of stays associated with each of these meds.  

Be kind.  Alcohol and drug abuse are not character flaws, they are diseases that deserve treatment.  

Check out Dr Spencer Greene

 

Edited by gonzo1

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TriciaJ has 37 years experience as a RN and works as a Retired.

6 Followers; 31,611 Visitors; 2,989 Posts

Congratulations on your new job!  It might turn out to be the toughest job you'll ever love.  I really hope you have a good team with a sense of humour and a supportive management.  This is a difficult population to work with and your team makes all the difference.

There definitely is an art to getting someone safely through withdrawal.  My advice is pay close attention to vital signs.  I was helping people to withdraw long before CIWA was invented and my biggest criticism of CIWA is not giving more weight to vital sign changes.  The VS will start to elevate before other withdrawal symptoms become apparent.  Get on that with the drug of choice and you'll be less likely to see withdrawal seizures.

Since you'll have frequent flyers, you'll get to know a lot of your patients.  A lot of sad stories.  But you'll learn a lot about a lot  of things in this position.  Congratulations again!

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