Is Ativan 10 mg po per dose too much?

Marylou1102 · Feb 18, 2006

You were right to question the dose. I would never have given it. If you had given it and the patient suffered consequences you would have been in trouble for not questioning it.

UM Review RN, ASN, RN · Feb 18, 2006

For that instance that is way too much ativan 10mg sounds more like a Valium dose.

My first thought too.

Blee O'Myacin, BSN, RN · Feb 18, 2006

poor oncology patient who may have built a tolerance! Though I have never seen the doseage as high as 10mg PO, we once gave a patient 2mg IV q1h - for 3 weeks! He was dying and it helped ease the aggitation he was feeling.

Given this set of circumstances I definately would have questioned the dosage too - I hope you documented everything down to the tantrum!

Blee

babynurselsa, RN · Feb 18, 2006

I get nervous anytime I would have to draw out 5 tabs to get the ordered dose.

He is just trying to cover his butt, "Yeah I meant to do that."

Had a neo one time order 10mg/kg of IM lasix on a 600gm baby. First of all we normally give 1mg/kg. Second of all I had NEVER given IM lasix. I looked it all up in the NeoFax. Yes you can give 10 mg kg, Not IM. Yes you can give it IM but at 1 mg kg.

Got the order changed by the moonlighter. Just figuring maybe a small brain fart. Well In the am I reported to the Neo that I had questioned the order and what we had done. He proceeded into a tirade about nurses not following his orders as he had written them. I proceeded to inform him that if I could not justify it per some sort of WRITTEN reference I WAS NOT giving it.

We ended that one in a draw.

Scarier part of the story was new nurse on a poorly supervised orientation had given the dose earlier in the day.

tridil2000, MSN, RN · Feb 18, 2006

Last night a 49 year old male patient was admitted to our med surg unit with R/O PE which was later ruled out. He also had a history of anxiety. Admitting doctor ordered 5 to 10 mg Ativan po Q 4hrs prn. Evening shift nurses questioned it and called the doc on call who quickly changed it to 1 mg Q 4 hrs prn. This morning, the primary doctor comes in and throws a huge fit on the floor. Why didn't my patient get 10 mg Ativan last night???. I explained to her that we have a right to question orders like that and her partner on call changed it. Our pharmacy states max daily dosage should be 10 mg divided over 2 to 3 doses. Also, this patient had taken Ativan only one other time in his life. So...could I get some feedback? I had to write an incedent at the doctors request. Thanks fellow nurses :)

that's a toxic amount.

no ands, ifs or buts.

if you gave it, the pt could have ended up in icu on a vent.

an incident report is senseless. it only validates his error!

tell him that he is more than welcome to fill one out and send it off for quality review! he'll be the one called in to explain his knowledge, or lack there of, of ativan.

DusktilDawn · Feb 18, 2006

that's a toxic amount.
no ands, ifs or buts.
if you gave it, the pt could have ended up in icu on a vent.
an incident report is senseless. it only validates his error!
tell him that he is more than welcome to fill one out and send it off for quality review! he'll be the one called in to explain his knowledge, or lack there of, of ativan.

This is why I would gladly fill out an incident report with a great bit ole smirk on my face!!! ESPECIALLY since the physician requested the incident report be filed. :D

realmean1 · Feb 19, 2006

I have seen some pts., that I would have liked to give 10mg of Ativan to. LOL Standard Ativan dose PO is 0.5mg to 1mg PO. Tend to think the doctor forgot the decimal point there somewhere. Ambien is for sleep not anxiety. Sometimes giving a "sleeper" to someone who is anxious just makes them worse, i.e, drowsy, but still anxious, so they get out of bed and fall. Ativan IV is sedation pure and simple, but can also be used for seizures, hence ETOH withdrawal = delirum tremors, etc

sharann, BSN, RN · Feb 21, 2006

Help a non med/surg RN here. What is CIWA score? Is it a agitation/sedation scale? Ativan 10mg is a hefty dose which I would question as well. We give 1-2mg IVP on occasion in PACU for very agitated persons.

weesyanne · Feb 21, 2006

I certainly would have questioned the order. And as someone else pointed out, gladly have written it up. She's the one who's going to have to answer to the QI committee when that incident report gets in their hands! :eek: You did the right thing.

she.lpn · Feb 21, 2006

WOW! that would be alot of ativan. I've seen 2mg q 2hr but never 10mg po. I question anything that takes more than a couple pills to get the dose. though I have given 5 or 6 pills of methadone to get the right dose but thats a little different. Doc should of looked at what he was writing and maybe try something different because it doesn't look like the ativan works for this guy.

lady_jezebel · Feb 21, 2006

Please let us know if that doc eventually apologizes to you personally, as she should.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 21, 2006

I also think the doc confused Ativan with Valium and was then embarrassed. I never gave more than 2mg of Ativan PO in one dose. I worked both psych and med/surg. However I have given a lot of Valium 5 and 10mg. I would absolutely refuse to give Ativan 10mg in one dose! I don't care what the doc said! He could come and give it himself.