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Discussion

Ativan

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.

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    It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing, yelling at times and startles. Ativan intensol seems not working.

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    Are you looking for suggestions?

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    How much Ativan are you giving?

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    It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing yelling at times and startles. Ativan intensol seems not working.[/quote']

    I don't work MICU/SICU, but I often request Roxanol q hour prn in addition to routine Roxanol, along with prn Ativan with my residents that have been admitted to Hospice. I lay eyes on them often, and will medicate as much as I can, when needed, even if asleep.

    At this point, the name of the game is comfort, and just because they appear to sleep, or comatose, it doesn't mean they are comfortable. Not necessarily pain, but comfort.

    ETA: If she startles and screams, even occasionally, IMHO, it sounds like her management of Morphine q 2, with the Ativan, isn't enough.

    One more edit for spelling, format and grammar. Wow!

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    Thank you for your input. Really helpful.

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    We do Ativan IV and morphine IV or SL for pain/anxiety; atropine SL and scopalomine TD for secretions. The atropine we use is eyedrops--we just give them SL.

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    It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing, yelling at times and startles. Ativan intensol seems not working.

    I'm not sure how many mg "2 ml" of morphine is since you don't give the concentration... But in the actively dying, you give as much as you need to to keep them comfortable. If she's screaming, and since the Ativan isn't helping, my thought is she's still having pain and I'd increase the morphine. I want to say our palliative dr. starts with up to 4 mg q 1 hr prn. If she's already maxed out I'd call the dr. and get the order increased. But yeah, no need to worry "is it ok to give this much" if she's on comfort care and not comfortable. :yes:

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    We do atropine eye drops and do it SL

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    Would you give your patient oral Ativan even though they have the death rattle when secretions aren't moving?

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    Would you give your patient oral Ativan even though they have the death rattle when secretions aren't moving?

    Oral as in needs to be swallowed or oral as in SL?? Many hospice pts don't have IV's and SL is the route in which they get their medications.

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    Needs to be swallowed

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