#TREMULOUS BEHIAVIOR LICENSE#

I'm not comfortable enough with that to be able to say when a patient needs a PRN or not.

I've been in a similar situation - just not with ETOH withdrawal. Thanks for taking the time to reply to me, I do appreciate the insight Had I been with an experienced nurse that day, I would have been able to just talk to them. I've said in the past that Im new to this site and I also have limited experience and little to no guidance on my unit, so when I come here and ask things it really is coming from a place of genuine interest and a desire to work with this population and do right by them. From the responses, Ive gathered that I did the right thing by being cautious and giving the prn. Instead of looking at me in a negative light maybe I came here for justification of not withholding it? Because I often do feel like im too 'soft' with the patients in my care. I came here seeking advice on whether or not it would have been an appropriate circumstance to withhold and get into that 'pissing match' you spoke of and see if maybe there were any other interventions I could have implemented. He did receive the prn as ordered, I did not withhold it. FWIW I usually give a standing order taper to the patients I have concerns of w/d to avoid the nasty peaks and valleys as well as the off chance a RN isn't able to administer prns as indicated.Р”Р„gain in the case of even suspected ETOH or benzo w/d I'm more cautious and is it really worth getting into a pissing match over 1mg of Ativan? Do you want to be righteous or do you want a mellow milieu? In the instance you gave again I would usually tend to err on the side of caution but it sounds like you withheld the prn and thats cool if it all ends well.

#TREMULOUS BEHIAVIOR LICENSE#

What I used to use is the internal question 'am I so certain this person has no history of withdrawal seizures and is not at risk that I am willing to wager my license and their life?' If so then 'here is some vistaril for you' and there were times I was that confident just not that often. It sounds like you are looking for justification not to give a prn that a person is angling for and that is also subjective and totally your preference but imo should depend on your comfort level and assessment skills. So to generalize, am I to go along with any behavior regardless of whether it seems genuine based on observed behavior and assessments, because to question its 'genuineness' would be judgemental and subjective? I do understand this and should have given more objective information in my original post. With that being said, I do always err to the side of caution because etoh withdrawal can be dangerous, so he WAS being medicated according to Md orders. In this specific instance he was being observed without knowing and while doing so he was found to have zero tremor or symptoms, was eating and drinking perfectly fine, but upon entering the room he was suddenly so tremulous he could not sit still long enough for a blood pressure check. You absolutely don't want that to happen and I'd much rather a patient get an unnecessary 1mg of Ativan than seize and possibly not recover. There have been instances where a patient goes into DTs because a nurse thought they were faking and didn't give them ordered PRNs. I'm all about not playing into enabling substance abuse however be very cautious with alcohol withdrawal. Observing a patient when they don't know you are watching if you really doubt their tremors is another method to add your your assessment but just be careful. As a provider I have to fight it out with them at times when I won't prescribe their wish list meds but as a RN you don't need to get into a struggle over something that has been ordered, if the time is right and it isn't contraindicated just give it. It covers your butt in the off chance they actually are having withdrawal s/s and also reduces the conflicts with those who have raging cluster B traits. I like what you said about if the medication is ordered and the patient meeting the criteria.

We can only present the option, we can't make them recover. Substance Abuse treatment is like the old leading the horse to water axiom. Not a 100% accurate test, but it is worthy documentation.Р”Р„nd remember: we are not Nurses to judge and pass sentence on our Patients. Fine pseudo-tremors can be more difficult to fake without moving the entire limb. Have the Patient turn their palms downward. Have your Patient extend their arms toward you, face up. The BP is usually risen in alcohol withdrawal. If it's prescribed and time for a dose, give it and objectively chart the behavior, s/sx and VS. 'Obviously faking' is a subjective interpretation.

Tremulous behiavior