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 ... ?
I wouldn't mess with her routine, especially if she's been doing this for a long time. Surely if you hold it there will be signs of anxiety (at which time you'll be giving it) and withdrawal. Let her sleep in peace.
I've worked only med-surg and have never seen 10 mg dose but I'll let you guys debate that. I would think that a dose that high would because of a long time use and a tolerance to it's effects. Another reason to give it. But maybe you meant 1.0?
she's 80 and i would happily give it to her. she is use to taking it it, she has MS, i wouldn't worry about her being addicted .. she's probably suffered w/ the MS for years. poor lady. at 80 somethin she can have whatever she wants.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
I too will leave the exact dose to someone else, but I say give her the dose she's accustomed to.
If someone's made it past 80, then as far as I'm concerned, let her have whatever she wants. She's probably been on Ativan or something similar for years, and obviously it hasn't killed her yet. And if she's dependent, then so what??? Let her be calm and comfortable!
It's more than likely just being used as a sleeping aide. See it among a lot of seniors up here. But it's usually 0.5-1.0 mg.
If it's every bedtime, ask to have the order changed from prn to a scheduled time. Makes it easier for casual staff to know to give it. Because let's face it, not every nurse knows a patients bedtime routine and the "new" face doesn't need the hassle of "knowing that I take it every night".
Specializes in LTC,Hospice/palliative care,acute care.
You also stated she takes her darvocet too...We stopped using that in our elderly a few years ago and it's really equal to a couple of extra strength tylenol.Why not try her pain med first before the ativan.Treat her discomfort first and the ativan will work much better,I think....Also-does she have spasms from the MS? We use other drugs for our MS patients-baclofen is common.
Tweety, BSN, RN
36,297 Posts
I wouldn't mess with her routine, especially if she's been doing this for a long time. Surely if you hold it there will be signs of anxiety (at which time you'll be giving it) and withdrawal. Let her sleep in peace.
I've worked only med-surg and have never seen 10 mg dose but I'll let you guys debate that. I would think that a dose that high would because of a long time use and a tolerance to it's effects. Another reason to give it. But maybe you meant 1.0?