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?
Apr 11, '06
by Tweety, BSN
If you don't give it then he is going to start exhibiting those signs and symptoms and you're going to have to give it to him anyway. This could be what exactly is holding those symptoms you describe at bay. Why wait until it gets bad before intervening?
When he asks at 7am for a prn in four hours, simply tell him you'll be back to assess the situation and make a judgement at that time.
I usually don't argue and give it to them when they ask, because there will be hell to pay if you don't.
You must also include subjective infomration that the patient provides you, as well as what you see when deciding to give a prn. Since you're not inside his body nor with him but a brief moment in time, don't judge that he isn't in need of a prn based on outward appearances. (Even though you might feel in your heart of hearts he's abusing and substituting one chemical for the other.)
Last edit by Tweety on Apr 11, '06
I would give you a word of caution . I know that ativan can cause resp. depression and CO2 retention in COPD'rs. However, Benzo's are VERY addicting. If he regularly takes his ativan like that at home, you are asking for trouble if you withhold. Also, you say he has an alcoholism problem. I would ask if he still drinks, or just did in the past. Because if he is still a drinker, ativan can prevent ETOH withdrawl & this will be a double wammy if he is used to getting his ativan AND his drink -and then doesn't get either to the level he is used to. Sometimes it is too late before you see the signs. I cannot tell you how many patients I have received in the ICU in full blown DT's, that had prn benzo's ordered the whole time which they were not getting- untill it was too late. Now, if he is showing no signs of resp. depression, and he is not CO2 retaining, as evidenced by his abg's (or he may be a chronic CO2 retainer, but compensated as evidenced by his pH), then I would give it. But then I have seen the other side way too many times.
Last edit by dorimar on Apr 11, '06
Anyone with COPD should not be taking Ativan. My mother went into the hospital for Pneumonia and she also had COPD. She began having signs of anxiety so the doctor gave her a shot of ativan against my sisters wishes. Her coming from a medical background she knew the side effects of the drug in people with COPD. The Doctor then decided to give her another shot. It caused her oxygen level to go way down. She had respitory failure, causing her to have a heart attack. She lost oxygen to her brain because they let her sit in her room for 30 minutes before checking in on her again. She was then put into ICU where she was completely brain dead and had to have machines breathe for her. She was in a coma, we had to make the difficult decision of taking our mother off of life support. I had to help make that decision at 22 years old. We now are motherless because a certain doctor felt the need to make a wrong choice. My mother was only 47 years old. There are plenty of other anxiety medications out there that doctors could prescribe. Her doctor chose to take the idiot way out. All people with COPD BEWARE!!!!!!!
Last edit by smmsfh08 on Jun 23, '09
: Reason: Added info