Med confusion for newbie nurse, need facts.

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Okay I'm new to all this and I need someone to give me the straight explanation on a couple issues.

1: Ativan po dose compared to Ativan SC dose. ( like 0.5mg po and 4-8 mg. SC) Both routes ordered. How to explain to the family why there is such a difference in dose between po and SC. Sounds like the patient is really getting a huge dose increase when SC is used.

2: Nebulizers: Combivent vs. Ventolin nebs.and puffer. Pt. can take a ventolin puffer but can't tolerate the Ventolin neb, barely tolerates Comibivent. Why is that?

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I would check the orders again. It is more likely to be 1.0mg SL. Never heard of a 10mg dose or SC route.

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Yes we are giving Ativan through a butterfly needle so it's SC or IV prescribed. I do believe it is 10-20 mg.

I would check the orders again. It is more likely to be 1.0mg SL. Never heard of a 10mg dose or SC route.
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yikes! please check before giving anyone 10mg's of ativan. I've given tons and 2mg's was always the max at one time, granted you can give it q 2hr but 10 at once is alot.

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I just checked the drug insert online and a nursing drug guide because I've never heard of ativan being given SQ--only PO/IM/IV and I'm pretty sure I've heard of SL here and there. Neither resource mentioned SQ at all. I think you'd be better off questioning the doctor on that order, or maybe a nurse that works in your facility with more experience--maybe it's just a facility thing. I KNOW I've never heard of giving 10mg all at once! But I work on a step down, I know ICU gives slightly higher doses than we do. Good luck! :)

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Sorry for the confusion. It is 4-8mg. in a subcutaneous butterfly. This person is palliative care. :imbar

I just checked the drug insert online and a nursing drug guide because I've never heard of ativan being given SQ--only PO/IM/IV and I'm pretty sure I've heard of SL here and there. Neither resource mentioned SQ at all. I think you'd be better off questioning the doctor on that order, or maybe a nurse that works in your facility with more experience--maybe it's just a facility thing. I KNOW I've never heard of giving 10mg all at once! But I work on a step down, I know ICU gives slightly higher doses than we do. Good luck! :)
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Specializes in NICU.

I seem to remember from school that PO doses are sometimes higher since they have to go through the gut and then the liver (where some of it is metabolized) before being bioavailable in the circulation. But your example, Jellybean, mentioned a lower PO dose than SQ, so sorry, I guess don't know.

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Sorry for the confusion. It is 4-8mg. in a subcutaneous butterfly. This person is palliative care. :imbar

I'm pretty sure I know what a subcutaneous butterfly is, but never had to deal with one. Where you're in palliative care I'm SURE you use different routes than I do. Try asking the pharmacy? They're a GREAT resource for these types of questions! My best guess is maybe the Ativan isn't quite as well absorbed through the subcu tissue? I'm curious to know once you find out! As far as the Ventolin, what symtoms does the patient display as far as not tolerating the nebs? I'm pretty sure you get much more med in a neb than in an MDI--might just be too much for the patient. :)

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Is it 4-10 mg/24hr on a pump via sq site? 4-10mg in one bolus dose is not reasonable even for palliative care.

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The ventolin thing might be all in the mind.

My son could only take Prednisone in tablet form (he was three at the time). Stuck in jam it would stay down. Any other way he brought it back up.

Might have to do with taste or a residue left in mouth.

Never heard of SC Ativan either. Check with Pharmacy is the best way.

Also, you'd be surprised how much Ativan a senior can take at bedtime! LOL

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