Nicotine patches for adolescents on inpatient units

[chicagochildpsych]

I frequently have a kid who smokes and the parents consent (to nurses) for nicotine patches. I usually d/c them because I think that if the kid can't buy it at cvs, I'm not giving to them. Also, I think it speaks volumes that parents are permissive enough to allow this.

Thoughts/opinions?

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[Shikima]

Good job. He needs to work on coping skills to effectively manage his anxiety.

 

[birchswing]

Good job. He needs to work on coping skills to effectively manage his anxiety.

Wrong thread?

 

[F0nzie]

If you have assessed the patient by obtaining a smoking history and have determined that nicotine withdrawal would have a minimal impact, it seems reasonable to withdraw it. If they're only smoking 2-3 cigarettes a day and requesting a 21mg patch there is clearly something wrong with that. Also since when can RNs order medications without physician approval?

 

[chicagochildpsych]

The rns take a list of home meds and get consent (and some offer the patch if the person smokes). It isn't administered until I approve.

 

[strangeglove]

If you want to treat the nicotine dependence, then the patch is standard of care. If there is no dependence, then it's fine to withhold. If there is dependence and you are not treating or the patient is not interested in change, then what you gain in moral or legal rectitude is outweighed by the problems you will face in agitation, insomnia, acting out, poor alliance, etc. in an adolescent who is probably already dysregulated enough to have ended up in the hospital.

 

[smalltownpsych]

Part of my thinking would be how long they are staying and what you are treating. When looking at a few days and the kid has a strong hx of nicotine use, why not give them a patch? If looking at a longer term treatment, say more than a week. Then I makes more sense. You could always taper it pretty quickly too. Legality and morality should not override effective treatment. We give adult smokers the patch so why not teens?

 

[chicagochildpsych]

I get worried about an adverse reaction. Full disclosure, I quit cold turkey so I may be displacing some of my own issues with nicotine.