Question about Ativan

[mandaaRN]

I always look into things too far but it's something that bothers me. I had a patient last night who had prn orders for two seperate Ativan orders. 2mg PO every 4 hours and 4mg IV every 2 hours. However, there was nothin written for breakthrough anxiety or such. My question is, if I give Ativan PO then decide pt needs IV dose, would I wait the 4 hours before giving it? What if it was the other way around and I gave IV Ativan then decided to give PO, would I wait 2 hours as the order for IV calls or wait the 4hours in between before I give PO? Ugh it's been bothering me all night. Simply how do I space out the two different routes of Ativan? I asked a nurse last night who just went on with a flight of ideas and never gave me a straight forward answer. Luckily the pt was not that agitated to need much Ativan, but if it were the case, how would I do it? Please help me :)

[ddunnrn]

I have no experience with IV Ativan, but have given lots of IM, up to 4 mg every 2 hours or so for really agitated patients. My main issue with the IV is that the cns depressive effects would come on so quickly I'd be scared to leave the patient alone. If it were me, I'd get the orders clarified, and maybe ask for IM instead of IV. I speak from psych experience, not med/surg or ICU/ED.

[Meriwhen, ASN, BSN, MSN, RN]

Agreed: Ativan IV works FAST, so both desired (sedation) and undesired (respiratory depression, delirium) will set in ASAP, much sooner than you think.

I wouldn't play around with any IV benzo because there's too much risk to the patient: you NEED get the orders clarified by the MD.

[turnforthenurse, MSN, NP]

Yup, the order needs to be clarified with the MD. It could be that the MD forgot to d/c one of those orders, whether it be the PO or IV dose. I also typically do not see 4mg ordered unless the patient is seizing. I typically see anywhere from 0.5-2mg for anxiety/agitation, both IV and PO. PO can cause respiratory depression, too, but of course has a much slower onset than the IV preparation.