Monday, September 7, 2009
Controlled substances are labeled as such because they are federally regulated under the jurisdiction of the Controlled Substances Act of 1970. They are regulated because they either have high abuse potential and/or some level of dependence liability. They are divided into five categories ranging from high abuse and no accepted medical use to limited abuse potential and no prescription required in some states.
Early in my nursing career (it's still early, but I'm referring to VERY early-on) I really was apprehensive about administering some of these medications to patients. Benzodiazepines and opioids in particular. In some instances I hesitated to administer ... or to even consider ... these medications out of fear. I feared causing over-sedation, respiratory depression, paradoxical effects, allergic reaction. I feared causing adverse effects and having to manage common side effects as well. My fear was paralyzing! I'm sure there were instances it may have worked to my advantage. Perhaps it helped me avoid placing a patient in a dangerous situation. (Safety first! It's my top priority as a nurse. I know I'm overly cautious compared to many nurses.) I realize it's also possible a patient had to bear undue distress because of my hesitation to administer an assistive drug(s).
Now, I can say my fears do not carry as much weight in my practice. I have definitely grown to appreciate the effect midazolam (Versed) can have on an agitated, violent patient. Effects are relatively short-lived, but 30 minutes of quiet can feel like a lifetime in paradise when you've been putting up with spitting, biting, kicking and hitting. However, I feel I still maintain a healthy respect for midazolam because I have seen its adverse and paradoxical effects as well.
Looks like I will be focusing even more of my practice on these types of medications as I am considering taking on a side-job monitoring patients under conscious sedation for plastic surgery. I had the opportunity to witness a couple of procedures on Monday and gained a newfound perspective. It's amazing how little diazepam and fentanyl are used in healthy patients for conscious sedation compared to the massive quantities we use for sick, long-term patients in the ICU. Definitely gives me a better understanding of these medications which makes me feel much better about using them!
This week I am feeling grateful for controlled substances, for a variety of work experiences and I am looking forward to spending more and more time in the nursing field.
