Ativan - her problem, or mine?

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Specializes in LTC.

I have an LTC resident, 80-something, with an order for 10mg Ativan BID PRN for anxiety. She has been asking for it routinely in the morning and at bedtime, calling it her "relaxing pill". I pass her pills on evening shift.

I am ... concerned. She does seem to have panic attacks, but last night she appeared to be sleeping when I came to give her routine meds, and she asked me for the ativan. I did not observe any signs or symptoms of anxiety, so I asked, "Do you feel anxious?" She said, no, that she wanted to have something to relax her, and "I like the way that pill makes me feel."

She has a diagnosis of MS, and also takes her PRN Darvocet every night at 12:30am. I am feeling uncomfortable with my assessment of this. Should I dump it on her doctor, or do patient education, or both, or something else ... ?

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10 mg? That would drop a horse.

Give her the pill with her Darvocet and let her sleep. Who gives a rat's rear if this dying old woman with MS takes an Ativan and a Dargocet at night? Cripes, I don't care if she wants morphone. If I had it and she had an order for it she could have it.

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I have an LTC resident, 80-something, with an order for 10mg Ativan BID PRN for anxiety. She has been asking for it routinely in the morning and at bedtime, calling it her "relaxing pill". I pass her pills on evening shift.

I am ... concerned. She does seem to have panic attacks, but last night she appeared to be sleeping when I came to give her routine meds, and she asked me for the ativan. I did not observe any signs or symptoms of anxiety, so I asked, "Do you feel anxious?" She said, no, that she wanted to have something to relax her, and "I like the way that pill makes me feel."

She has a diagnosis of MS, and also takes her PRN Darvocet every night at 12:30am. I am feeling uncomfortable with my assessment of this. Should I dump it on her doctor, or do patient education, or both, or something else ... ?

10 mg!!??!? It can't be 10 mg. The recommended dosage for the elderly is 3 mg max per day.

I'm going on the assumption that the 10 mg was a typo and maybe only 1 mg.. If that's the case.........medicate away! It obviously doesn't do anything significant to her except let her sleep.

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Specializes in neuro, med/surg/, cardiac care.

That is a very large dose, especially for an elderly person. How long as she been getting it and what was the original order, maybe somebody mistook the 1mg for 10mg. I would not be just giving it because everyone else has , would follow through as you suggested with calling the doc, notifying supervisor you are not comfortable giving this person this drug.

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Specializes in LTC,Hospice/palliative care,acute care.
I have an LTC resident, 80-something, with an order for 10mg Ativan BID PRN for anxiety. She has been asking for it routinely in the morning and at bedtime, calling it her "relaxing pill". I pass her pills on evening shift.

I am ... concerned. She does seem to have panic attacks, but last night she appeared to be sleeping when I came to give her routine meds, and she asked me for the ativan. I did not observe any signs or symptoms of anxiety, so I asked, "Do you feel anxious?" She said, no, that she wanted to have something to relax her, and "I like the way that pill makes me feel."

She has a diagnosis of MS, and also takes her PRN Darvocet every night at 12:30am. I am feeling uncomfortable with my assessment of this. Should I dump it on her doctor, or do patient education, or both, or something else ... ?

Ativan comes in .5mg,1mg and 2 mg tabs-you can't be giving 10 mg-must be a typo...We have to complete behavior monitoring assessment sheets every time we give a prn anti-anxiety med.It's a DOH requirement here.We have to document other interventions we've tried (1 to 1 time,re-assurance and validation,snack,drink,etc) prior to administering the med.How is the use of this resident's med being documented? What about other resident's? I would want to make sure I am documenting properly but I imagine this gal has taken ativan for years and I can't see stopping her now...Anxety is like pain-it is what the patient says it is.Maybe the MS makes her face a bit wooden so she can't really LOOK distressed.Many elderly people have difficulty verbalizing things like pain and anxiety.If she is not relaxed then she must be anxious,IMHO..The benefits also out weigh any risks for her if she does not have a history of unsteady gait with falls after the med...Ask your supervisor or talk to the charge nurse about the documentation..

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I have an LTC resident, 80-something, with an order for 10mg Ativan BID PRN for anxiety. She has been asking for it routinely in the morning and at bedtime, calling it her "relaxing pill". I pass her pills on evening shift.

I am ... concerned. She does seem to have panic attacks, but last night she appeared to be sleeping when I came to give her routine meds, and she asked me for the ativan. I did not observe any signs or symptoms of anxiety, so I asked, "Do you feel anxious?" She said, no, that she wanted to have something to relax her, and "I like the way that pill makes me feel."

She has a diagnosis of MS, and also takes her PRN Darvocet every night at 12:30am. I am feeling uncomfortable with my assessment of this. Should I dump it on her doctor, or do patient education, or both, or something else ... ?

10 mg BID???? meaning 20 mg total in a day? Are you sure about this? It appears to be a typo on your part, can you double check please.

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Specializes in Geriatrics/Family Practice.

I just looked at a rx website and 10mg of ativan can be given, not a normal dose, but used at bedtime. The norm on this website said 2-6mg. If this order for ativan is prn, I would talk to the doctor and see if he wants it to be continued prn, or put as scheduled. If the resident is coherent enough and has MS, I would just give her her drugs. If she's 80 something and her respirations are not depressed, she's not gonna become a junky, so let her have it.

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I would document in the nurses notes to cover myself, her request for the PRN and state why she said she needed it, her LOC before and after, etc.

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Specializes in Licensed Practical Nurse.

where i work, ativan 10 mg is standard, most of the time thats what i pass 10 mg, but let me check!

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

as long as i have been working in geri and psych i have never given ativan 10mg.... i have given 6 mg and 4 mg and i have given intensol every hour for dying patients... what we have here is the missing of a decimal point, it's not 10 mg it's 1.0 mg... i say let her have it ,cause in the end you will be giving it anyway..she will become so mad and upset she didn't get her little pill...

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Specializes in neuro, med/surg/, cardiac care.
where i work, ativan 10 mg is standard, most of the time thats what i pass 10 mg, but let me check!

10mg is standard??? holy cow!!! we give our overweight preops 3mg and they are almost comatose. our usual prn is the .5-1mg q6-8 and some of the "dependants" might be on 2mg bid or a bit more. our docs are really backing off on it due to the addictive nature of it and are now prescribing trazadone more for patients. would like to know what sort of area gt4everpn works and if it is truly 10mg. keep us posted.

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

i think she is just mistaken and it's really 1 mg...10 mg is not standard especially in geri.. i worked in geri locked down units all my career and never got anywhere near 10 mg...6 mg and 4 mg yes, but never 10 mg ... i just thought about it that is 10-1 mg tabs 20-0.5 tabs and 5 ml of injectable ativan..cause our ativan comes in 2mg/ml..:eek::eek::eek::eek:

10mg is standard??? holy cow!!! we give our overweight preops 3mg and they are almost comatose. our usual prn is the .5-1mg q6-8 and some of the "dependants" might be on 2mg bid or a bit more. our docs are really backing off on it due to the addictive nature of it and are now prescribing trazadone more for patients. would like to know what sort of area gt4everpn works and if it is truly 10mg. keep us posted.
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