|
Withdrawal Scale
|
|
|
Nausea and Vomiting
• • •
|
GI Upset
• • •
|
|
Yawning
• • •
|
Sweating
• • •
|
|
Tremor
• • •
|
Anxiety/Irritability
• • •
|
|
Skin
• • •
|
Resting Heart Rate
• • •
|
|
Visual Disturbances
• • •
|
Auditory Disturbances
• • •
|
|
Headache
• • •
|
Orientation
• • •
|
|
Runny Nose or Tearing
• • •
|
Pupil
• • •
|
|
Goosebumps
• • •
|
Restlessness
• • •
|
|
Sleep
• • •
|
Bone/Joint Aches
• • •
|
|
Total
• • •
|
|
|
Instructions:
|
|
|
Vitals
|
|
|
Date and Time of Vitals
|
Heart Rate
|
|
Blood Pressure
|
O2 level
|
|
Temperture
|
|
