CIWA woes

[Indy, LPN, LVN]

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.

[classicdame, MSN, EdD]

what is CIWA? sorry, do not know

[nrsang97, BSN, RN]

what is CIWA? sorry, do not know

It is an etoh withdraw protocol.

[transducen, BSN, RN]

Preach it! Sick of it too, 60 percent of our patients are ETOHrs! Sick of it!

[RNperdiem, RN]

I remember my first experience with a patient in withdrawl when I was a very young CNA. The man had ripped out all of his lines and was standing holding his IV pole like a javelin. His eyes were wild and he seemed ready to spring. Somehow the nurse managed to calm him down and medicate him. I supose restraints were needed too.

I do understand how agitated CIWA people can wear you out.

I agree that nights does have it the worst. The drugs seem to have a delayed effect sometimes. The patients want to sleep all day. If you get a report like "Oh, I didn't give him anything, he just slept all day" be prepared for chaos.

[Indy, LPN, LVN]

Yeah, that "he's been ok today" always makes me nervous. My last one was such a doozy that I really don't want to talk about it online, but I left there in the morning shaking my head, going wow, why do people do that?! At least I got him relatively calm, sitting up in a clean bed, and I left him, snoring, lying in a clean bed. What goes in the linen hamper stays in the linen hamper.

[MN-Nurse, ASN, RN]

maybe that's one reason I choose not to surround myself with alcoholics..

Well how lucky for you, some of us had no choice and grew up in families full of them.

[Indy, LPN, LVN]

Well how lucky for you, some of us had no choice and grew up in families full of them.

It's not luck, I chose to not marry one. I'm sorry you had a rough time with your family. Mine was not fun either. I just didn't want to talk about my family in this rant, but it is relevant I guess, in that it taught me early what to avoid later on.

[jadelpn, LPN, EMT-B]

ETOH is an addiction. No one wakes up and says "I think that I would like to become a roaring alcoholic". If an addictions nurse is not your thing, it is not your thing. There's plenty of psych nurses who have 3-4 patients just like what you describe every day. And with that, unfortunetely there are a fair number that can not be medicated into la la land. It is interesting that there's all kinds of people who start with a glass of wine at supper, and before they know it are horribly addicted. There's all kinds of nursing that people are not drawn to. However, with your logic, it is irritating that the person who smoked their whole lives is COPD and on the call bell every 2 seconds because of anxiety and they can not breathe. Or the diabetic who has sugar food snuck into the hospital and you are dealing with critical highs all shift. Or the alzehimer's patient who is gonna fall and break a hip with the wandering (and they can fight you like 2 cats in a bag) and forget about getting an alzehimer's patient into a shower or not finding cheerios just about everywhere. Or perhaps the patient who did not follow MD orders, end up with diverticulits so badly that they have a colostomy, and the stench is overwhelming.....oh ya, and the C-diff patient that the stench is so over-powering, oh, and the need to get fully gowned and masked before you can go take care of that.....and most of the stool is on the floor in a trail to the bathroom. In other words, guess what? Nursing is filled to the brim with uncooperative, acting out, smelly patients--a number of whom do or don't do something to end up on your ward. So it is not exclusive to alcoholic patients.

If you have a family history of ETOH abuse, then it can be hard to seperate your feelings for family who are alcoholics from your patients that are alcoholics. But it is not the place as a nurse to judge ones' patients due to their diagnosis. No one chooses to cross that line to alcoholism. But I can think of a number of other patient types that are equally "offensive" on the surface, but because someone is an alcoholic they are put in a different category. CIWA scales don't just have ativan as a choice. Librium is also a viable option. And if the going gets tougher, some haldol.....ETOH phycosis is no joke--but I would wonder what a tox screen would show as well. I have seen some pretty over the top ETOH withdrawal, but with it some drug addiction that adds to it. There are medicines that can assist in this process. If you are mostly dealing with ETOH patients, it could be in your best interest to familiarize yourself with them. Because like it or not, real people--who are someones child, parent, best friend, spouse--doctors/lawyers/accountants and homeless can be alcoholics. And how devestating to get caught up in addiction, and have one's nurse believe them to be less of a human because of it.

[sapphire18]

What jadelpn said x 1000. Could not have said it better myself.

[amarilla, RN]

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.

I hear you, OP, and I'm not going to step on your vent. On my last floor, I was stuck in this never-ending assignment of confused/restraints, isolations and CIWA patients. The unit was L-shaped, with one hallway true general surg post-ops and the other 'the pits' - a mix of private rooms to accomodate prisoners and isolations along with all the other long-term boarder patients. You'd walk on the unit and see that whole hall lit up with call bells going off, day or night. If you were a float or PD, you were guaranteed to show up and work the pits while others read magazines and had potluck parties. Now you know why it was my last floor. :)

Point being: do something for you and take your mind off this. Any way you can take a different assignment and get a brief respite? Float? Take PD in another area or floor? Or, away from work - indulge a hobby, take a mini vacation, plan a cool trip? In any case - good luck and a nod from someone else who has BTDT.

[classicdame, MSN, EdD]

Agree these must be very difficult patients. Takes special nurses for sure.