Ativan for Everything?

[smilesandstickers]

I read a joke about nurses thinking everyone needs "Vitamin A" (Ativan). Now I am not one to knock anyone for jokes that they are not serious about. Absolutely, we all have times where we must have something of a morbid sense of humour to survive. And it seems more appropriate to make those jokes in nursing circles such as this one.

In all seriousness though. How often do you see Ativan or other benzos (even antipsychotics such as Haldol) used in situations which make you uncomfortable? Why or why not? If you do, how do you respond to these situations?

[VivaLasViejas, ASN, RN]

Versed..........now you're talking some GOOD stuff!! It's a good thing they don't make that available to the general public, because I'd be all over it I've had it for my last four or five procedures, and I'm telling you it's the best stoned I've ever been---the doctors and nurses can be doing whatever evil things they want to me, and I'm lying there going "Yeah, it hurts, but oh, WOW, look at all the colors!!!!!!"

Seriously, though: I never medicate people because they're driving me crazy by yelling, calling out, perseverating, crying etc. I don't medicate them if they're driving other patients crazy. I medicate only when they are driving themselves crazy and they can't be redirected any other way. And I've noticed that the ones who don't do well on Ativan seem to respond to Haldol, and vice-versa.............I don't usually ask a doctor for Haldol first, I'd rather try a benzo, but some elderly folks simply get even more wound up when you give those.

Just my .02 worth....

[diane227, LPN, RN]

I work on a med surg floor and I would say that we use benzo's occasionally but not routine. We do use small doses of Haldol at times but most of the time we don't. We cannot transfer out to a NSF patient who has had Haldol or a sitter within 24 hours of discharge. If we have a patient with an anxiety disorder we might give them a small dose of Xanax or Ativan but it is not used routinely. Our only routine use of benzo's come with the CIWA protocol used for alcohol withdrawal.

[Roy Fokker, BSN, RN]

"Yeah, it hurts, but oh, WOW, look at all the colors!!!!!!"

Reminds me of the time I had serious work done on my molars (root canal done for the 4th time on the same blessed tooth! AND a crown on another. Same day, same procedure). The endodontist was kind enough to prescribe Percocets for me.

Now keep in mind, I never ever have taken opiates for pain control [Yes, despite 6 broken bones and 40+ odd stitches all over my body and despite being T-boned by a bus while I was on my motorcycle etc.)

After a few hours, my jaw(s) started hurting as the 'local anesthesia' started wearing off... So, I took HALF a percocet.

Now, I'm a nurse; right? I know the "effects and side effects" of medications, right?

So I was prudent. I had food in my stomach and I wasn't driving that day. I'd kept myself as best hydrated as best as I could (swollen jaw notwithstanding).

Not even 30 minutes in, I started feeling "funny". I thought my eyes saw a flicker of 'hamsters' running on the ceiling. My 'mind' tried to dismiss it as nothing and attributed it to 'fatigue'. But not long after, I started "hearing pink elephants" (don't ask!) Soon enough, I was seeing "bright BLUE Horseshoe flowers talking to each other".

ALL this from just 1/2 a Percocet!!!

LOL!

Makes me wonder sometimes - what the heck am I to do I I need to have some real surgery at some point...

cheers,

[cjcsoon2bnp, MSN, RN, NP]

I'm not a nurse I'm a CNA but I do know that on the med/surg. floor I work on Ativan is commonly ordered for quite a few patients (we have at least a 3 or 4 psych patients on the floor at any one time.) But in general I wouldn't say its over ordered, the nurses usually don't give the Ativan unless the person is getting to the point where they are a danger to themselves (or someone else) or the person is so wound up that they are begging for something to help them relax. I don't think that its over ordered in most cases and there are a few patients that I think should have gotten good old Vitamin A or Haldol but the physician said that they didn't feel it was necessary (even if they had never met them or come to the floor to see them yet.) Oh well...

!Chris

[mama_d, BSN, RN]

Too much for some, not enough for others. Seems like when you really need something, the docs won't give it to you...but when you don't need it, you've got three PRNs to choose from.

Ativan is great for things other than "sedating" people...seizures, DTs, and chemo induced nausea is what I actually use it most often for. There's been a real move away from "chemical restraints", which I think in general is a good thing, but sometimes I really wish I had an order for Ativan + Haldol for some patients.

Personally, I have come to LOVE Geodon IM. Seems like it has less side effects and works better in our older patients than either Ativan or Haldol for those dementia-induced psychotic episodes.

If you're driving yourself nuts or being totally inappropriate for the environment, I'm giving you whatever PRN you have that I think will work. We had one last night who was refusing their bipap, screaming the f-word at the top of her lungs, and threatening to knife the nurses. She's schizo and they took her off of ALL of her meds b/c she was "too sedated" on them. Have we heard of cutting back, anyone? You can't just stop these people from all of their long-term psych meds cold turkey and expect everything to be hunky-dory.

[Bugaloo]

IMO, on our busy Med-Surg floor where almost half of the patients are Psych, drug overdoses or drug-seekers, Ativan is a God-send. I also think that Ativan should be available in spray bottles for family members that are getting out of line

[Jules A, MSN]

Personally, I have come to LOVE Geodon IM. Seems like it has less side effects and works better in our older patients than either Ativan or Haldol for those dementia-induced psychotic episodes.

The thing I hate about Geodon IM is that it takes so freaking long to reconstitute. A psychotic patient can do a lot of damage while I'm standing there shaking the bottle and tweedling my thumbs. Give me Zypreza over Geodon during a code any day.

[Midwest4me]

versed..........now you're talking some good stuff!! it's a good thing they don't make that available to the general public, because i'd be all over it i've had it for my last four or five procedures, and i'm telling you it's the best stoned i've ever been---the doctors and nurses can be doing whatever evil things they want to me, and i'm lying there going "yeah, it hurts, but oh, wow, look at all the colors!!!!!!"....

i hear good things about versed---but your last statement has me concerned---i'm due to have versed with ...i think i was told demerol....when i have my colonoscopy done next month. i do not tolerate pain well and have asked for general anesthesia but been denied---assured i shouldn't feel any pain. your statement makes me think that i will still be experiencing it but won't care.

[color=#483d8b]

[color=#483d8b]regarding the ativan issue---i work on a psychiatric ward and we use the ativan as well as zyprexa zydis.

[nerdtonurse?, BSN, RN]

Midwest -- talk to your doc about diprivan. That's what we use for folks who need extra help during a 'scope. They actually call it "Diprivan rescue" on the chart.

[Midwest4me]

midwest -- talk to your doc about diprivan. that's what we use for folks who need extra help during a 'scope. they actually call it "diprivan rescue" on the chart.

thanks for the suggestion. i've never heard of that so i'll look it up and convey that as a suggestion to the doc.