Since I am so new in this profession, just graduated, passed the NCLEX and my 4th.day on the floor, I know I got tons to learn.
My question is in connection to my previous post about the hospice pt.that i have. He has an order for ativan .5 mg 2 tabs q hs, this was ordered because of his severe agitation few weeks ago. it helped, he was calm and less anxious. Now another order came 2 days ago for fentanyl patch 12 mcg q 72 hrs... since we started the patch a day ago, he was very lethargic and looks very sedated. My question is, do i still have to give the routine ativan? I am so not comfortable giving it but i have to give it otherwise, what would be my reason of holding it? can i call the hospice nurse and discuss this? how should i tell it?
Specializes in critical care, PCU, PACU, LTC, HHC, AFC.
Hello everyone,
Since I am so new in this profession, just graduated, passed the NCLEX and my 4th.day on the floor, I know I got tons to learn.
My question is in connection to my previous post about the hospice pt.that i have. He has an order for ativan .5 mg 2 tabs q hs, this was ordered because of his severe agitation few weeks ago. it helped, he was calm and less anxious. Now another order came 2 days ago for fentanyl patch 12 mcg q 72 hrs... since we started the patch a day ago, he was very lethargic and looks very sedated. My question is, do i still have to give the routine ativan? I am so not comfortable giving it but i have to give it otherwise, what would be my reason of holding it? can i call the hospice nurse and discuss this? how should i tell it?
Your insights are greatly appreciated.
thanks alot.
I think this is a great question and alot of the other posters added great points. I also wanted to point out that depending on how lethargic your patient is, giving them something to swallow isn't a great idea (not sure if this person has a peg tube, but assuming if they dont). I would consider them at risk for aspiration, since the order is for tablets. Since the fentanyl patch seems to be working, you could call the doctor to get the order changed or even change the route it is given, just in case you happen to need it.
Thank you for all the reply. Yes, I did call the Hospice Nurse because there is no way I can give that routine ativan for a very lethargic person. She gave me an order to hold it just for that night and she will come to check on the resident. I transcribed it in the Physician's order, noted it in the Mar & documented it well on my nurses notes. I am off today & so glad to survive the first 4 days of being myself on the floor. THANK YOU SO MUCH AGAIN TO ALL OF YOU!
there is no way I can give that routine ativan for a very lethargic person
I agree great call on getting a more experienced opinion before just holding anything. Please keep in mind that absolutes like your above statement aren't always correct and with experience you will have a better read on when to give and when to get permission to hold a standing order. Keep up the good work.
FWIW if any of you happen to be caring for JulesA in hospice some day please note that my advanced directive says to give the maximum amount of medication even if it hastens my death!
FWIW if any of you happen to be caring for JulesA in hospice some day please note that my advanced directive says to give the maximum amount of medication even if it hastens my death!
i saw that, jules.
except, it said the give the minimum amt of medication, even if it delays my death.
you might wanna check that out, before you die (duh).
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hello everyone,
Since I am so new in this profession, just graduated, passed the NCLEX and my 4th.day on the floor, I know I got tons to learn.
My question is in connection to my previous post about the hospice pt.that i have. He has an order for ativan .5 mg 2 tabs q hs, this was ordered because of his severe agitation few weeks ago. it helped, he was calm and less anxious. Now another order came 2 days ago for fentanyl patch 12 mcg q 72 hrs... since we started the patch a day ago, he was very lethargic and looks very sedated. My question is, do i still have to give the routine ativan? I am so not comfortable giving it but i have to give it otherwise, what would be my reason of holding it? can i call the hospice nurse and discuss this? how should i tell it?
Your insights are greatly appreciated.
thanks alot.
I would hold the Ativan until I speak with the hospice nurse. Your reason to hold it would be lethargy. I am glad you are asking these questions it tells me you have a good head on your shoulders and a gut instinct to know to question with the maturity to ask for help.
except, it said the give the minimum amt of medication, even if it delays my death.
you might wanna check that out, before you die (duh).
leslie
That is actually something my lawyer included at my request and it definitely says give the maximum but it specifies pain medication. Maybe I need to add Benzos by name though because when I'm on my way out I prefer to be snowed, lol.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I appreciate facility nurses who call me when they are uncertain about a med or the status of a patient. We are partners in the care and I encourage their use of the nursing process.
It is always best, with a hospice patient, to collaborate with the hospice staff when a medication change needs to be made. This insures that when you call hospice later, for other symptoms or evidence of decline, they are aware of the entire medication POC and can make intelligent recommendations.
Thanks for taking the time to get your questions answered!
The Ativan was for ordered because the patient was agitated. The patient is not agitated, so holding it would be the right choice, then documenting why. Calling the MD to inform to change the order to "PRN agitation QHS" is also a good option.
Good question. ANd yes, these sort of calls will come to you in time.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
To be clear...
It is appropriate to hold the benzo when the symptom is resolved. It is the job of the hospice to change the orders. The bedside nurse in the LTC should contact the hospice and collaborate with them, not the MD.
When LTC staff seek order changes outside of the hospice's knowledge the poc becomes fragmented and risks becoming ineffective. It is the job of the hospice professionals to anticipate the "next need" of the patient or family; this cannot occur if the LTC staff change orders without collaborating with the hospice.
strength4unityRN
27 Posts
I think this is a great question and alot of the other posters added great points. I also wanted to point out that depending on how lethargic your patient is, giving them something to swallow isn't a great idea (not sure if this person has a peg tube, but assuming if they dont). I would consider them at risk for aspiration, since the order is for tablets. Since the fentanyl patch seems to be working, you could call the doctor to get the order changed or even change the route it is given, just in case you happen to need it.