Survey on Alcohol Withdrawal

Pudnluv, ASN, RN · Nov 4, 2008

We see a lot of acute withdrawal and seriously, there is very little communication. Standard procedure is to give ativan ATC so we tend to keep them pretty medicated during the acute phase of withdrawal. If need be, they are sent to the ICU where ativan is given sometimes 2mg q5min. If necessary, intubation may be needed. So we really don't do any therapeutic communication, that can come later after the actual physical withdrawal has taken place.

Tweety, BSN, RN · Nov 4, 2008

ETOH withdrawal can be challenging, especially during the DT's when the patient is completely confused. On my unit the patients have injuries so withdrawal can be challenging because they are so confused they forget they have injuries and try to walk on a broken extremity.

During this phase, like the person above, we try to keep them as sedated as necessary to ensure safety and adequate ventilation.

Initially it's important to assess a patient for ETOH withdrawal potential. Here is when you ask direct questions and listen non-judgementally, so you can begin a medication protocol immediately before it gets bad.

wonderbee, BSN, RN · Nov 4, 2008

I work in a psychiatric unit where the prevelance of substance abuse and addiction is very high. The withdrawing pt. requires more monitoring and often times requires more resources placing greater demand on the staff than other patients. If there is any greater anxiety for this patient population than any of my others, it is only for this reason. Withdrawal is a medical condition which can become life threatening. Our staffing, even when it's full, is short in my opinion making for potential safety issues on the unit as a whole when a withdrawing alcoholic enters the milieu. Communication is short, direct and supportive. What works best isn't really talk, it's benzos.

Jailhouse nurse · Nov 5, 2008

Many of my own patients are in various stages of ETOH withdrawal. My personal experience has been that communication is best kept short, sweet, and reassuring ("I will not let you seize-I will not let you down") until they are well through the acute phase. After that, I provide supportive, therapeutic listening techniques-they don't need me to tell them how they got to where they are.

Best of luck with your studies, sir.

queenjean · Nov 5, 2008

Like Jailhouse nurse said, keep it short and sweet.

When I get them, usually they aren't in the DTs yet, and I usually explain our CIWA protocol to them. I tell them I don't want them to go into the DTs, and I'm going to be checking them frequently to make sure they aren't showing any symptoms. I flat out tell them I want to sedate them with ativan to the point that they are not going to be feeling much pain. I tell them that they need to let me know if they are starting to feel ansty, if they think they are seeing or hearing things, or if they feel like their heart is racing or anything out of the ordinary.

We can give ativan IV every hour until their CIWA score is below 10. We don't wake them up for an assessment, and we don't give them ativan if they are sleeping. I find usually I need to give ativan 3-4 times or so initially, then they get to the point where they only need it a couple of times a shift, then nothing.

For some reason, I really like working with the detoxers. They are some of my favorite patients. Maybe it's because you can so readily help them. In the short term, anyhow.

TiffyRN, BSN, PhD · Nov 5, 2008

I didn't quite know how to answer about providing the same level of care to withdrawal patients. Do they get the same high quality?: yes, do the get the same quantity? not even close, they are often placed on medical units in the middle of a 5-7 patient assignment and yet they will easily take 75 % of your time. This creates resentment on the part of the nurse. But that is not the "fault" of the withdrawal patient. Do take in account that I haven't worked with the adult population in over 6yrs but can't imagine too much has changed.

robydoby · Nov 5, 2008

I work in a very busy 12 bed icu/ 7 bed pcu unit. The 7 bed pcu unit has always at least 1 withdrawal pt. Usually more. We also occasionally have 1 withdrawal pt in the Icu on the vent.

We have a protocol for wd pt's which includes mvi, thiamine, folate every day. It also includes either a ativan taper or a librium taper. The doctor of course chooses which one he wants.

We screen all of our pt's on admission, and if they state that they drink alcohol then we must fill out a withdrawal protocol screen. this is done every 8 hours until the pt scores a 0 for 24 hours.

I have worked in several other hospitals and find that this protocol is the most usefull. screen pt's on admission and following up is the key to preventing withdrawal before it gets too late.

Good luck on you project.

:nurse:

mama_d, BSN, RN · Nov 5, 2008

Communication with the doctor to alleviate withdrawal symptoms in anyone who raises red flags is very important. For some reason, it seems like patients are more willing to discuss dependency issues with nurses than with doctors (in my experience at least).

I view acutely withdrawing patients in much the same manner as I do elderly dementia patients who are combative...it's just that the ETOHers are usually stronger. Neither population can help what they're going through, in general neither population would be combative if they were in their right mind. With ETOHers, adequate medical intervention during the withdrawal phase makes for a much smoother stay for both patient and staff.

Now, if they're still butt heads after they're done withdrawing, that's another story entirely.

mpccrn, BSN, RN · Nov 5, 2008

i was once told by a MD that there is a 50% mortality with withdrawl and the odds get worse with each withdrawl episode.......it gets busy but it is no different than a patient presenting with other disease processes....they are patients suffering ....like any other. there is no time or energy for personal moral judgements :smokin:

travelingman · Nov 6, 2008

Many thanks to everyone who has taken the time to share thoughts here on the board and to take part in the survey. I've found both to be thought provoking and informative and you have all given me avenues of exploration for this paper.

It sounds a little corny, but I feel so honored to slowly be becoming part of such a great profession with so many caring, dedicated people in it.

Cheers,

Dan