drug/alcohol pt questions

[sassyann85]

Hi everyone!

So, I'm going to be re-entering into psych nursing. I did psych for about 6 years in the past. I'm trying to think ahead of any thing I want to brush up on before my hospital orientation. Does anyone have any insight into withdrawal protocols? I remember we used the "COWS" for opiate withdrawal. Pts were assessed something like q 4 hours and if they scored high enough, they got clonidine. They also had PRNS on board. For ETOH, we used a scale where they were asesed q 4 and sometimes q 2 depending on their s/s. Two questions:

1. For opiate withdrawl, if a pt scored high enough to get the clonidine, and was ALSO requesting, say PRN tylenol for body aches (body aches are part of the assessment in whether they need clonidine), would you give the clonidine AND tylenol at the same time? Or would you give clonidine and then see if that helps their body aches and if not, THEN give the tylenol?

2. For the ETOH withdrawal, if they are getting scheduled taper meds (say, Serax or Ativan) at set times...and you go in to assess them and give scheduled med, if they score high enough at that time, do they also get the PRN taper med along with the scheduled med at the same time? If they are on a taper, in my mind that should be 'covering' them enough to where they wouldn't score high on the withdrawal scale, but if they still scored high I would give them the scheduled taper med + the PRN taper med at the same time. Is this correct? (sorry if this is confusing)

Thanks for any insight!!

[MrChicagoRN, RN]

The CIWA scale is used for alcohol withdrawal. It's not a taper. It's reassessing the patient every 4 hours or less, and administering the dose according to the score. Their score may ebb and flow at times, and the patient may be getting Ativan every 30-60 minutes at times, with the current dose possibly being higher than what was recently given.

I saw saw a nice protocol the other day. I think it was Seattle Hospital in Washington. Just Google CIWA.

[Meriwhen, ASN, BSN, MSN, RN]

You can give clonidine and Tylenol together. Though consider that clonidine is NOT an analgesic and won't do much for moderate to severe pain. Clonidine is a blood pressure medication that happens to help alleviate the discomforts of withdrawal. It shouldn't be used as a replacement for Tylenol because it simply isn't. Also, clonidine also can't be given if the patient is severely hypotensive, as it will cause the patient's pressure to bottom out.

To be honest, if the patient is in pain, I'd give the Tylenol regardless of whether they scored enough for clonidine.

Other analgesics that can be used instead of--or along with--Tylenol are Motrin, Naproxen, Toradol (short-term use only) and Tramadol (with caution--it has an addiction potential even though it's not a narcotic). Baclofen may also be ordered to help with muscle cramping.

[Mandychelle79, ASN, RN]

We do not do a taper for ETOH withdrawal. Depending on the doctor we do a WAS score and treat based on their score, monitor vs/subjective symptoms and give PRN Librium, or a high dose, limited number of doses, long acting Benzo to help prevent. The one I think works the best, the high dose benzo. Usually 1 set of the order and the patient has no s/s of withdrawal

[chevyv, BSN, RN]

We use CIWA for ETOH and for long term alcoholics that are withdrawing, we often use a librium taper. Other than that, we rarely have scheduled Ativan, only if the pt scores high enough.

We don't use COWs for opiate, although I don't know the rationale behind that. New residents will often put pts on CIWA, which confuses me even more (but they are new residents so perhaps they know less than this nurse, lol). We do use clonidine, with bp parameters in place.