Question about PRN Ativan...

[jschut]

I know a patient with COPD, who takes Ativan 1mg PO at 3a, 7a and 2mg at 5p. Also has an order for 1mg q4h PRN.

Now here's my delimma....

the pt talks about the "little white pill" and how it helps him, and "makes him 'feel good'. The pt asks for a PRN for 11a, when he gets his routine at 7a....

If I see no s/s of increased anxiety or SOB, am I obligated to gove him the ativan q4h just because he asks for it? Or do I look for the physical s/s and give him the med on his say so. I personally believe he asks for it because of the "other" side effects he's getting from it, and I don't believe it is helping him medically at all...

Other nurses have told me that they hate to give it to him because he's showing no s/s of needing it, but if he doesn't get it, he's a bear to be around.

He has a hx of alcoholism and I am wondering if he is getting like a high from all the PRN's that he requests, or am I way off base here?

Any ideas anyone?

[ShayRN]

i have given ativan in very large doses. as others have said, when they take it that much, they are usually terminal. no, i would never hold an ativan if a patient wanted it and it was ordered. period. his addiction isn't my problem nor is it something i can fix.

smmsfh08, i am very sorry for your loss. just curious, what kind of medical background does your sister have?

[smmsfh08]

She worked for Hospice for about 10 years. Also, she has worked in hospitals and nursing homes.

[SassyRedhead]

I'm very sorry to hear about the loss of your mother. I don't know about the specifics of her situation, perhaps she weighed 80 lbs and was given 2mg, or maybe it was a terrible med side effect or even a med interaction, we just don't have enough information. Irrespective of that, she clearly was not being appropriately assessed afterwards.

In general though, if someone is used to getting PRN Ativan, trying to titrate them down in the hospital without detox orders and a detox care plan is foolish. Also, like Angie stated, getting them to breathe without perceived or actual anxiety is actually a benefit to a COPDer. Obviously the patient's reaction to not receiving the medication would suggest that becoming agitated whether he is physically addicted or scared certainly does not benefit his SPO2. Secondarily, it also sets up an adversarial relationship with you. Give the med, and monitor him afterwards.

In addition, knowing your pharma should help direct you: "Ativan (lorazepam) is readily absorbed with an absolute bioavailability of 90 percent. Peak concentrations in plasma occur approximately 2 hours following administration."

[rachelgeorgina]

Would it be worth while getting a psych consult or an advanced practice nurse with a speciality in additions management to see the patient in conjunction with his doctor and other treating staff to assess the situation? E.g. does he need the ativan (physically vs. mentally/emotionally)? is it helping him (how is it helping him?) what are the detriments? do the risks outweigh the benefits? Is there an alternative solution that everyone (pt included) can be satisfied with?