Ativan for Everything?

nerdtonurse?, BSN, RN · Apr 25, 2009

How often do I see it prescribed?

Not enough. I mean, we get people who have a 40 year history of psychosis, schizoaffective, etc., and the first thing two of our doctors do is take them off all psych meds because they don't "believe" in psychology. So the poor patients, who may just have come in to get a chole or an appendix removed, have a psychotic break in the hospital. If you're one of our "demerol and diet soda" crowd, you get all the benzos you can swallow, but have a real psych issue that you've had 40 years, and you get told to "deal with your problems."

paging Tom Cruise, paging Tom Cruise.....

Straydandelion · Apr 25, 2009

Too much, at least in a hospital settings where I worked. Personally, my Dad with Alzheimers was prescribed it so often (and Haldol actually made his symptoms worse plus became aggressive) that I started telling everyone he was allergic to it *shrugs*. In dealing with behavoral changes...at least with him, a calm voice, offering a drink of water and soothing music helped the best.

As far as responding to patients, IMO the best approach is to look at the effect of the medication....do they sleep all time, are they more aggressive after being given the medication....can they be calmed in other ways? If the patient appears alert, behavorally fair for their condition etc. then I would say they are receiving the correct medication/amount. If not, I would leave a note on the chart for the doctor describing exactly what I have viewed of the patient then possibly try to catch him on rounds.

smilesandstickers · Apr 25, 2009

Too much, at least in a hospital settings where I worked. Personally, my Dad with Alzheimers was prescribed it so often (and Haldol actually made his symptoms worse plus became aggressive) that I started telling everyone he was allergic to it *shrugs*. In dealing with behavoral changes...at least with him, a calm voice, offering a drink of water and soothing music helped the best.

This is absolutely the situation that made me begin to question this. There was a conference here with the geriatric psychiatrist from a large city and a geriatric internist. They did case studies regarding people in our community, and they raised the point that in some cases giving Haldol does not "calm people down" (in the context that it soothes their emotions) as it is intended, it knocks them out.

Once, I was working as a student in Long term care and there was a demented client who was sitting restrained in a wheelchair who wanted to go for a walk. She required supervision. I was so deep in meds (that were already late). I asked if one of the staff could take her for a walk, and they replied "oh no, she gets Ativan when she gets like that." I was upset but I was a student and didn't want to push it so I gave her the PRN, and she was still upset an hour later! Then someone told me "You waited too long to give her the first, she needs another one now!" Here is where logic kicks in. Did I not give her enough to keep her from being "agitated"? Or is she just a human being who would like to stand? I am left believing the latter.

Jules A, MSN · Apr 25, 2009

I use it often but then again I work in psych. I don't have a clue about geri-psych but can say that I believe whole heartedly in PRNs for my patients when needed. It absolutely is not done so that I don't have to interact with them. Depending on the situation and the patient I will attempt to find other methods of helping them regain composure first however if that isn't successful out come the meds. It is done with the knowledge that they will continue in their present state of agitation and someone will get injured without a swift intervention. It is easy to judge what may seem like free flowing meds if you haven't worked with aggressive, psychotic patients on a regular basis.

RNperdiem, RN · Apr 25, 2009

Sedatives are essential in ICU for a lot of our patients.

I like to use enough so that a patient (usually on a ventilator) can follow commands, but remain drowsy.

I'm more likely to be uncomfortable when docs want to take away the sedatives too quickly on patients who aren't even close to being weaned off the ventilator.

cardiacRN2006, ADN, RN · Apr 25, 2009

It is prescribed every day, and I administer it every.single.day.

Seriously. It's one popular drug.

I'm cool with that.

SunnyAndrsn · Apr 25, 2009

Actually, we rarely see it used. Of the residents in our facility (and I work all three wings) We have two people who have scheduled ativan. One is end-stage alzheimers' type dementia and has become more combative in recent months. It's helped a lot. The other pt. is a hospice pt. who started having seizures. It's used for seizure control.

We have 12 pts. who are on hospice who have it available, but other than the one listed above, they have not used it. One other resident has it available, and since she's been with us (about a month) one nurse found it necessary to give her one due to increased agitation. I doubt she needed it.

nustick · Apr 26, 2009

I work in oncology and we see ativan frequently prescribed for anxiety, ease of death (hospice patients), and reduction of nausea. I don't see it prescribed inappropriately on my floor but the oncology patients have a lot to be anxious about.

allnurses Guide · Apr 26, 2009

I don't like to use it much on elderly patients.... in my experience it seems to make them worse. Haldol usually seems to work better. On the geri-psych ward that I worked on, we had fairly aggressive patients that were getting cocktails containing both. On the whole though, I strongly prefer to use Haldol first on an elderly patient, though I understand that it tends to be worse for causing EPS.

I work in children's psych and again, we rarely use it here. Risperdal is the top used PRN here, followed by Zyprexa.

In adult psych, we used it A LOT, and really didn't care a bit to when needed.

AshiPanda · Apr 26, 2009

I work in a facility with a lot of ventilators...these people have COPD, CHF, a whole in their throat and a machine attached to it! Sometimes they feel like they are just drowning. So you see these patients getting Ativan quite a bit.

I've seen some of the nurses using Ativan as pretty much a sleep aid too though... the patient wouldn't have a PRN sleep med ordered so they just give Ativan. It works though whether it's a pseudo effect or not...soooo... hehe.

Roy Fokker, BSN, RN · Apr 26, 2009

Haldol, Zyprexa, Cogentin, Morphine.

More often than not IM...

If you've ever faced down a 500 lbs, belligerent, violent, psychotic, high on PCP and ETOH; who is spitting, cussing, fighting and using an over turned stretcher as a barricade... you know what I'm talking about...

For the most part, our docs are pretty good about judicious use of sedatives/anti-psychotics. In fact, more often than not, we have to beg them to prescribe more (especially for those vented patients who are maxed out on their Propofol and Ativan drips and who continue to chew on their ETT while trying their best to yank off the wrist restraints...)

cheers,

PS: I know it's not considered a "good" drug - but I like Haldol over Ativan (heck, I'll even take Versed over Ativan).