How about this for an order?

Renashia · Feb 7, 2005

You think I should? Will I get fired? Our manager is pro-nurse but he is also an MBA and pro making happy docs.

Definatly!!!! A nurse is a patient advocate. And do you really want to be under investigation in a few years because a breast patient sued the hospital for lack of attention to her pain issues. Especially if you are giving ativan for a pain med and telling the patient it IS their pain med when it is an antipsychotic.

I wonder how that docotr would feel if he got a breast reduction done on him without pain meds afterwards??? :rotfl: Or maybe a reduction at another more "sesnitive" area? Hmmm???? :rotfl:

Renashia · Feb 7, 2005

It's things like this that drove me out of the hospitals. JCAHO is making hospitals unworkable places. I see their policies as more of a hindrance than a help to patients. How can you be there for your patients if you're on the phone with a doctor everytime he/she writes down an abbreviation?

Well considering the inserive I had on this issue last week in my home health agency, I think it is following nurses out of the hospitals. :chuckle

DNS · Feb 7, 2005

Definatly!!!! A nurse is a patient advocate. And do you really want to be under investigation in a few years because a breast patient sued the hospital for lack of attention to her pain issues. Especially if you are giving ativan for a pain med and telling the patient it IS their pain med when it is an antipsychotic.
I wonder how that docotr would feel if he got a breast reduction done on him without pain meds afterwards??? :rotfl: Or maybe a reduction at another more "sesnitive" area? Hmmm???? :rotfl:

DNS response:

Sorry Renashia, but Ativan is not an antipsychotic, it's an anti-anxiety agent. Anti-anxiety agents, anti-depressants & anti-psychotics are all under the umbrella of psychotropic meds, which is maybe what you meant. But Ativan is not mind-altering, it is mood-altering. That's what the patient in severe pain may need. I don't think I'd be under investigation as long as the pain needs were met. Maybe your policies are different. And I'm not sure what you meant by breast patient, I think the original question was just about Ativan. DNS

imnmk_rn · Feb 7, 2005

ativan is lorazepam. an antianxiety, sedative, hypnotic drug. usually used to calm manic patients, relieve anxiety or irritability in pre op patients. not safe to use prn because of tendency to develop dependence. in the elderly or patients with liver dysfunction, not more than 2mg per day should be given.

What patient population do you work with???? As I have known some to call it, "vitamin A" is quite the wonder drug, at least in the ICU population! A little Ativan can go a long way as an adjuvant to pain meds, can be extremely effective for nausea, and is a must-have for DT's! "not safe to use prn..." under that reasoning, a lot of meds (narcotics) are not safe to use - many other drugs can develop dependence, too.

slrafter · Feb 7, 2005

i guess someone should cut off his **** and tell him the pain is all in his head!! :angryfire

oh my gosh you guys! what i meant was this guy is one the the "older"(like 75)and more well known breast surgeons in our area. he is new to our hospital because another near us closed down(again). i don't really know why some of you are so sensetive about the use of the term. his orders are preprinted and he never changes them. i was told "he does not like narcotics". he only orders ativan for pain and tylenol extra strength, for post mastectectomy and lumpectomy pain.
sheesh :chair:
he belives that women in pain are just hysterical because breast surgery shouldn't hurt that bad. just sedate those with female organs i always say!

DutchgirlRN, ASN, RN · Feb 7, 2005

begalli Breast Men

Very Interesting but OH SO WEIRD !!!! I suppose if a man can lactate then perhaps God intended that a man could feed his child if he wanted to but it sure seems awfully un-natural to me. I agree with "Yuck"! That definately puts a whole new spin on breast man.

slrafter · Feb 7, 2005

the anti-anxiety properties of ativan work in much the same way as the vistaril we used to give routinely with demerol-but no :specs: one uses demerol much anymore. :specs:

What patient population do you work with???? As I have known some to call it, "vitamin A" is quite the wonder drug, at least in the ICU population! A little Ativan can go a long way as an adjuvant to pain meds, can be extremely effective for nausea, and is a must-have for DT's! "not safe to use prn..." under that reasoning, a lot of meds (narcotics) are not safe to use - many other drugs can develop dependence, too.

DeniseRNBSN · Feb 8, 2005

Ativan is used for pain at times because of the calming effect which allows the client to relax enough so that the pain eases. I have seen this done in the past several years; mostly with cancer and abdominal diseases.

Ativan does indeed calm restlessness and anxiety but it in no way has an analgesic effect.

That would be like giving Propofol for sedation but not having pain medication on board as well. The patient suffers.

Another example, you would NEVER give a paralytic without pain medication and Ativan does not cut it.

I would absolutely get an order for pain medicine and then add Ativan as an adjunct to restlessness.

But if you have adequate pain medication you may not need Ativan.

Denise RN, BSN, CCRN

webblarsk · Feb 8, 2005

We made up a protocol though, and send that in with their orders. Like for pain meds in pill form...1=mild to moderate, 2= severe so they can add 1-2 on an order.

That is a good idea! I will have to pass that along to the LTC I work PRN at!

steelcityrn, RN · Feb 8, 2005

confused?????

This may just be my naivete or age showing but I saw a prn order from an old "breast man" that read verbatim "Ativan 1 mg p.o q 4-6hrs prn pain".
Yuck :angryfire

apaisRN, RN, CRNA · Feb 8, 2005

I was told by a CRNA that breast surgery patients don't have a ton of pain post-op. I believe her, and maybe that's what your old doc thinks, but you still need to have some morphine or percs ordered! They will have some pain, just not as bad as an ex-lap or something. Ativan alone for pain is NOT acceptable. Definitely an issue for ethics, or if you have a committee dealing with JCAHO or with pain that would be great too. The docs in the ICU I work in would never try to get away with such baloney. We WILL hunt them down, call the attending, the medical director of critical care, etc.

DRIVERRN · Feb 9, 2005

I've seen ativan ordered for agitation, anxiety, restlessness, but I've never seen ativan ordered for pain.
I can see it being an adjuvant to a pain med, but on it's own does it really work? Are they really relaxed and do patients experience less pain or are they just sedated?

If you did have pain you would forget about it!