To medicate or not to medicate

[SuperMomBob]

So I generally work 3p-11p. I always scope out the PRN's to see if my patients like to take sleeping meds or anxiety before bed and always ask if they want them. I otherwise use my best judgement if I feel they need or don't need them. Basically I don't like to just give everything to get them to bed. It never fails though, as I am giving report to the next shift, I get chewed out for not giving all that is possible! I don't understand why you would just give everything possible...even if not needed. I like to always have something on hand if necessary and leave something available for the next nurse. I get told I should have already gave it or "wouldn't you rather them have a good-nights sleep?". I can recognize when someone needs it, I just don't like to over medicate. Am I wrong in this thinking?

[hppygr8ful, ASN, RN, EMT-I]

Thanks for that! Luckily he had just ate supper. I don't have much experience with Geodon. Before I was a nurse I worked in group home with DD adults. I noticed then that alot of those folks had reactions to Geodon. Do you have any thoughts as to why that population would have so many reactions? Nobody at the time could answer that for me and I completely forgot about until now.

My first love in nursing will always be psych and do lot of reading. Last year I read and article on the gene P450 2D6. This is a genetic anomaly that when expressed prevents certain medication especially those used for psychiatric conditions ineffective and in some cases toxic. I have attached a link - It's very heavy reading though so I apologize.

Polymorphism of human cytochrome P450 2D6 and its clinical significance: part II. - PubMed - NCBI

Hppy

[SuperMomBob]

Thanks for the info! I always felt like it was something like that but at the time there wasn't much information out there about that. Pysch is not my favorite but I appreciate that there people out there that love it!

[homeralvarez]

No you are not wrong. But the incoming nurse would rather have you give out all p.r.n. medications which will put the patient into a deep sleep thereby allowing the nurse to catch up with 24 hour chart checks and other night shift assignments they may have. Night nurses want their patients sleeping because this is the time for sleep. Also, the night nurse probably feels that if the patient isn't fully asleep, they may get out of bed and fall down. Filling out an incident report, calling family at 1:00 am, calling the doctor, and the house supervisor is extra work that could have been avoided if the patient was completely medicated.

Completely medicated involves pain med, sleep med, and anxiety med. You have to remember that if the patient has all these medications ordered in their m.a.r.s., they most likely take them at home also. And they will wake up and ask for them.

[Adele_Michal7, ASN, RN]

Personally, coming in at 2300, I prefer if there is still a PRN available (not always possible I know). If eve shift has thrown everything at them, I then have to go in at wake them up for my assessment & pray that they will be able to go back to sleep easily. They often do go back to sleep, but not always & it's nice to have a little backup. Do these night shift nurses not bother to do assessments in order to avoid waking the pt?

Excellent point!

[stephenoxuna]

I feel like the schedule should be revised, to answer your question I feel your approach on the use of the medication is best. After all it is as needed; thanks for sharing.

[Caffeine_IV]

If she's been taking a Xanax and Norco every night at HS for 5 years, then nursing ought to have spoken with the physician about making those meds scheduled for that time.

I agree and I've been one to make it happen but it didn't always happen that way in these LTCs where I worked years ago.

[midazoslam]

Hi all,

Interesting discussion. My 2 cents worth below from a +65 POV:

1.) No need to medicate if it is not required. If the person doesn't require a PRN, than there is no reason to give it.

2.) BZO/antipsychotic agents can be particularly detrimental to an older person (think increased falls risk, orthostatic hypotension, drug induced delirium)

3.) BZOs/antipsychotics can also have a paradoxical effect, where it makes the person increasingly agitated, anxious, restless etc.

4.) This leads me to my final point, non-pharmacological strategies should be tried first and foremost to manage insomnia, anxiety, pacing/wandering/restlessness and other BPSDs. This is because of the undesired effects of said medications, and lack of supporting evidence.

So, OP... you're doing well. If your clinical judgement indicates that the person doesn't require a PRN, than you're right in not using it.

Cheers,

Midazoslam.

[Dogen]

Awesome points.

[midazoslam]

Thanks Dogen!!

[amoLucia]

Personally, coming in at 2300, I prefer if there is still a PRN available (not always possible I know). If eve shift has thrown everything at them, I then have to go in at wake them up for my assessment & pray that they will be able to go back to sleep easily. They often do go back to sleep, but not always & it's nice to have a little backup. Do these night shift nurses not bother to do assessments in order to avoid waking the pt?

Maybe ... This issue has always fascinated me.

I've seen 3-11 medicate about 8p (Oh, that's the pt bedtime! ???). Pt is quiet for the next 3 to 4 hours. But then 11-7 comes on, and the next nurse SHOULD be doing some type of assessment and/or the CNAs should be doing first rounds incontinence care.

Sleep meds are short-acting, so now they're wide awake and needing something to go back to sleep. Of course, there's no order for a repeat sleeper, so that necessitates a call to the MD (Oh, yeah!). And then there usually some house rule that we can't sleep-medicate much after 1:30-2am (Too groggy when in morning therapy...).

But make sure they're medicated at 8p...

Just fascinates me in LTC.