Do you sedate your pts to make them sleep?

Rapheal · Jan 9, 2004

I have personally never given PRN haldol or ativan on an A&O patient without their request or consent for a sleep aid.

I really just expect patients to stay up all night, and expect certain ones to fuss and be noisy and be ringing the call night every 5 minutes. Makes for a hard shift but some days/nights it's just like that.

I have seen some elderly patients get very combative and confused after Ativan or Haldol. Your co-worker may get more than she bargained for oneday when she hopes to have a quiet night.

mattsmom81 · Jan 9, 2004

If sedation is required and applicable, yes I use it. The patient who is awake at night, stressed out, and unable to relax, and in need of rest deserves some compassionate use of meds to ease suffering.

Meds should be given for the patient's sake, not the nurses sake.

We use our nursing skills and judgment to determine what is appropriate and what is not. I have heard a few day nurses suggest that some night nurses'oversedate so patients won't bother them' but I don't know anyone who does this. If patients don't rest they don't heal. In the ICU they develop ICU psychoses when they don't rest.

CoffeeRTC, BSN, RN · Jan 9, 2004

Let me start by saying I work in LTC. I have never medicated for staff convience (sp). I cant stand it when Im asked to give so and so a pill to shut her up.. the other nurse always does. Most often they just need or want something and have no other way to express their selves except for a noise or behavior. Sometimes something as simple as a postion change, back rub or snack will calm a resident.

That being said.. a patient who is constantly awake and unable to sleep or rest may need a med to help. Often times they are afraid to take a sleeping pill (dont want to be an addict) and will need some encouragement. In that case... I do encourage (sometimes strongly) them to take a pill or get an order for a prn..

bellehill, RN · Jan 10, 2004

I usually suggest a sleeping pill for my patients, if they say no that is fine. Most of pts complain about only getting 3-4 hours of sleep and how noisy the hospital is at night. A good nights sleep will work wonders for some patients.:zzzzz

I don't do it to "shut them up", only for their confort and wellness.

nyapa, RN · Jan 10, 2004

Originally posted by rncopper
Last noc, I had a patient (I have taken care of him a lot in the past couple of weeks) that makes noises - grunting, funny noises - when he is awake. When he is asleep, he doesn't make the noises. Trying to clear is throat? At one time he had an NG down, HUGE bugger! , and he accidently pulled it out (we were all so glad! ). He was getting TF down it.

Well they put down a Dobhoff. He still makes the noises, but not quite as bad. Today, he was going to get a peg.

My question is: A nurse I was working with (the patient was in a room for 4 patients; 3 of them, including him, were WACKO!) "jokingly" said that I should "knock him out" so he would stop making the noises!

Now, mind you, the pt is in NO distress, 75 yo, VS stable, just makes noises! She told me how she had given him Ativan a week or so ago, and he "slept all noc! Didn't make any noises! But, of course, they DC'd the Ativan, but he does have HALDOL!"

What she was suggesting was that I give him the Haldol to make him sleep: shut him up!

The patient is alert and oriented. I nervously laughed, DIDN'T give him the Haldol, kept checking on him and making him comfortable, he slept for a couple of hours, snoozed on and off also.

My question: Do you give Ativan/Haldol/pain meds just so the patient with sleep (read that: leave me alone all night!!! ) all night?

You suggested that the grunting noises were possibly to clear his throat, and that he didnt make them when he was asleep? Sounds to me you made the right decision...considering some of these medications can affect respiratory status. And if your pt was able to make an informed decision re: care, then the implications of giving such medication without consent are also something to consider

Long Term Care Columnist / Guide · Jan 10, 2004

I never sedate patients because they're driving me crazy. I don't sedate them when they're driving the patient in the other bed crazy. I do go for the Vitamin "A" or Vitamin "H" when they're driving THEMSELVES crazy........when they can't sleep, they're worrying about their illness or their finances or their families, they're in pain and can't relax, or when they are so agitated that they keep themselves in a lather all night. :)

kmchugh · Jan 10, 2004

"Do you sedate your pts to make them sleep?"

Well, yeah. Usually, I sedate them so heavily they stop breathing! I chemically paralyze them too! Isn't that the objective of anesthesia?

(small levity)

KM, CRNA

rncopper · Jan 10, 2004

Thank you all for your responses. I wanted to see what others opinions were.

I have NEVER sedated a patient just to "make them sleep - shut them up". But in my travels I have found some night nurses do this on a regular basis.

IF the patient is in pain, IF the patient is agitated, IF the patient really hasn't gotten any sleep, I MIGHT consider using something. But, just to shut them up for MY consideration: NO!

Even when some elderly patients have been agitated and have been given Haldol or Ativan, I have seen where the opposite had happened: THEY BECOME MORE AGITATED!

So, again, thank you for confirming what I already do: Consider the patient first, NOT making a NICE night for me!!!!

:kiss

fab4fan · Jan 10, 2004

LOL, Kevin.

And to answer the question, yes, I have given fussy babies tyelnol when nothing else seemed to work, but beyond that, no, I haven't medicated pts for my convenience.

TiffyRN, BSN, PhD · Jan 12, 2004

Not all night shift nurses just sedate people to shut them up. I was very generous with the sleepers/anxiolytics when I worked med/surg tele but that's after years of experience teaching me that most oriented people only want one thing at night and that's sleep. Please don't lecture me on the potential bad side effects of sleepers, I know all about them. Especially older folks, their reaction to them can be quite distressing (to themselves and their nurses). Sleeping in a hospital is an unnatural act and these special situations may need help from pharmaceuticals on a temporary basis.

Now it sounds like the situation you described was a whole 'nother ball game needing further assessment and diagnosis, not just sedation.

laurakc · Jan 12, 2004

My preceptor told me "go with your gut" and "always listen to your patient"

It sounds like you did just that.

A sleeping pill certainly should not hurt him, but it sounds like he has irritation in his throat from the tube. Did he need something for pain or discomfort??

Just hope he is not choking on his secretions.