WNCVAHCS Phenobarbital Protocol 2024
Naomi Roster-Romero
Created on February 6, 2024
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Transcript
treating alcohol withdrawal with phenobarbital protocol
2024 Ongoing competency
Utilizing the current phenobarbital protocol, complete the following questions
consumption
pain management
antiepileptic
blood alcohol levels
treatment
antipsychotic
FILL IN THE BLANKS GAME
Verify alcohol related history and most recent _____________ and quantity to determine risk for withdrawal.
consumption
A relative contraindication to phenobarbital in the treatment of alcohol withdrawal includes chronic use of phenobarbal as an _____________ agent .
antiepileptic
Type & Screen
A
D
CBC
Liver Function Test
C
FILL IN THE BLANKS GAME
Which of these lab studies DO NOT necessarily need to be ordered per this protocol? _____________ .
Type & Screen
Provider will admit to the appropriate level of care (refer to Appendix _____________ and initiate the protocol.
D
Thiamine should be supplemented with _____________ mg orally ASAP.
100
20mg/kg
100
0
3
200
5mg/kg
5
-1
+1
7
10mg/kg
250
FILL IN THE BLANKS GAME
Addtionally, thiamine should be supplemented 100mg daily for _____________ days .
5
When dosing phenobarbital, a loading dose of ____________ of ideal body weight should be infused over 30 minutes.
10mg/kg
RASS score must be at _________________ or greater to receive IV phenobarbital loading dose.
-1
Assess and document the RASS score prior to and _____________ minutes post administation to determine the need for additioanl dosing.
30
150 or 200
30
20-30
-1 and -2
15
100 or 150
0 and -1
15-30
30-60
+1 and 0
130 or 260
60
FILL IN THE BLANKS GAME
Goal RASS: Between _____________ .
0 and -1
If Veteran does not meet 10mg/kg dosing criteria, consider administer a smaller dose of ____________ mg slow IV push, depending on severity of symptoms.
130 or 260
Addtional dosing for RASS >0 after inital load dose include: 130mg IVP every _________________ minutes.
15-30
intramuscular
q 4 hrs
once per shift
buccal
SQ
q 8 hrs
FILL IN THE BLANKS GAME
Oral or _____________ phenobarbital may be substituted if necessary. Follow protocol route dosing recommendations.
intramuscular
Nursing to assess for signs and symptoms of delirium tremens utilizing CIWA-Ar at minimum of _____________ .
once per shift
20-30
50
30
10-20
30-40
40
FILL IN THE BLANKS GAME
Typical cumulative dose for treatment is between _____________ mg/kg of IDEAL BODY WEIGHT .
20-30
Providers should NOT exceed _____________ mg/kg without critical care consultation.
30
Concurrent _____________ therapy is not recommended and may result in pardoxical agitation and/or delirium .
benzodiazepine
+5 to -5
benzodiazepine
B
schizophrenia
H2 Blocker
+2 to -2
alternative etiologies
C
D
dementia
+4 to -5
SSRI
FILL IN THE BLANKS GAME
Veterans with persistent symptoms despite receiving maximum dosing should be evaluated for _____________ .
alternative etiologies
The Richmond Agitation Sedation Scale (RASS) ranges from ____________.
+4 to -5
The CIWA-Ar Scoring Guidelinees can be found in Appendix _________________ of the current Phenobarbital Protocol PRO-NUR-07. I
C
Take a screen shot of this page and send it to a qualified observer for competency credit
Withdrawal Protocol Competency 2024