Ativan

[Mborn2185]

I am a new RN. I was being oriented by a nurse who had a patient that that was dying. The 79 year old patients HR was 130 and BP 160/90 SaO2 54 . She had entered the phase where secretions weren't moving and was making that death rattle. My preceptor gave her 1ml of Ativan. It appeared to me that she was choking after administrating the Ativan. She told me that because her O2 levels were down she was gasping for air. I have seen many patients die while I was a personal care tech. And personally, I have never seen this before. I've looked on line and books and seriously can't find where giving a liquid med is ok when secretions aren't moving. Is it the norm to give Ativan or any oral meds at that time, outside of roxanol that dissolves in the month.

[Mborn2185]

Needs to be swallowed

[ClearBlueOctoberSky]

Needs to be swallowed

One trick with po tab Ativan is to get it ordered SL, crush and mix in a bit of water. Administer under the tongue with a medicine syringe. It will absorb, or go the easy route and just have the doc order the liquid SL Ativan.

[chillin4me]

Thanks for all the info, this will greatly help me more as i am ending my job in LTC and start a new job in Hospice House.

(2mg/2ml of roxanol)

[kbrn2002, ADN, RN]

During the active dying process [which can be as short as minutes to as long as days] the preferred route remains oral. 1 ml of any liquid med, including crushed meds in a small amount of of water, can be given SL or buccal. Absorption would be similar to Roxanol. The "death rattle" can occasionally be minimized by atropine gtts SL when scopolamine patches are no longer effective, but there are no guarantees. Maybe a silly question, but was that pt comfort cares or hospice? If so I wouldn't have even been checking VS unless the family requested it.

[kbrn2002, ADN, RN]

Thanks for all the info, this will greatly help me more as i am ending my job in LTC and start a new job in Hospice House.

(2mg/2ml of roxanol)

Roxanol is 20 mg/ml so 2 ml is a very large dose of 40 mg. I imagine in a pt with opioid resistance this wouldn't be impossible, but I have personally never administered a dose larger than 1 ml [20 mg] q 2 hrs prn

[chillin4me]

Hospice.. That's what i thought to coz there's no point of checking there vital signs, but pt tend to have high fever and of course we'll give suppository tylenol

[Do-over, ASN, RN]

Ativan (liquid) is sublingual if pt won't be able to swallow, more common scenario when patient is actively dying.

I've done this. Ativan (normally for injection) given sublingual per MD. Worked great.

[ChadlyRN]

I've never heard of giving oral Ativan. That wasn't good judgement. Unfortunately, when you're orienting your preceptor may not be the best fit. Find a RN you want to mirror your style after.

[chillin4me]

Hospice pt usually doesnt have IV

[ktliz]

You might get a better response in the hospice forum. In the ICU, our patients have IV access, so we use it. Hospice nurses will have more experience with PO or SL administration. Although, I probably would have given morphine instead of Ativan.

[chillin4me]

It really depends on the situation on how to manage pain and/or anxiety if pt is in critical conditions. Thanks for all ur info

[sugarmagnolia3]

I don't understand why IV ativan wasn't given, however maybe you could ask next time, maybe not right then but later...Approach is everything: Start with saying, "I'm just really curious but why....?"