treating patient anxiety

Sis123 · Apr 4, 2008

If it means making the difference between a patient having trouble sleeping at night and the patient being able to sleep like a log (hospitals are noisy at night), then why not give it? It's fairly stressful just being a hospital patient, and people recover better, quicker if they can relax and recover.

PsychNurseWannaBe, BSN, RN · Apr 4, 2008

If the medication is ordered PRN, then as a nurse you should be asking the patient questions regarding their anxiety. Assessment is the first step in the nursing process. From your assessment you might be able to find that distractions works for the patient (watch TV, read a book, call a friend) or some 1:1 time. Where I work we are not supposed to just sling PRN meds at request but try to use non-pharm measures if we think it might work.

If someone is suffering from insomnia (with that as a dx) then I would just provide the med.

SchnauzersRock · Apr 4, 2008

How often do you give Ativan or another med for anxiety? We have it as a standing order for most patients. It seems that many patients, once they discover it's available, request it regularly.
Since Ativan is for anxiety and anxiety is a response to a real or imagined threat, I try to assess my patient's need by asking, "what is your anxiety about?" My motive is also to get them to address the nature of their anxiety -- if they are truly having anxiety. Many times they are not. They just like the Ativan effects. (I'm not including patients with obvious anxiety disorders or who are in etoh withdrawal).
My question often angers the patient. One even reported me to the rights advisor. They think if it's ordered, they're entitled. Many of the other nurses don't ask any questions. They just hand it over. Granted, that might be easier. Is that the right thing to do? I could probably do that if I detach myself and behave as a robotic-type nurse. Any insights?

As a nurse, you are showing good judgement by asking the appropriate questions regarding why the patient may or may not need the PRN medicine. The fact that many patients just want the "effect" of the drug, such as Percocet, Ativan, or whatnot, is reason enough in my book to dig a little deeper when doing your assessment. We as nurses, and doctors for that matter, are not doing our patients any favors by just passing out medicines like candy. The indiscriminate use of these types of medicine is completely out of hand. I see it all the time.

Poochee · Apr 4, 2008

how often do you give ativan or another med for anxiety? we have it as a standing order for most patients. it seems that many patients, once they discover it's available, request it regularly. it is probably helping them
since ativan is for anxiety and anxiety is a response to a real or imagined threat (when a person feels this way, such a direct, blunt approach, may not help elicit the effect you want), i try to assess my patient's need by asking, "what is your anxiety about?:stone (alot of counselers, for these types of illnesses are well trained, and i find alot of them, will first offer ways to help them, verbal reassurance, different mental skills to help combat, what they are going through, i dare say, that, if your only approach, is, what you stated *highlighted in blue*, then you will probably get poor responses/feedback)" my motive is also to get them to address the nature of their anxiety -- if:nono: they are truly having anxiety. many times they are not (anxiety is alot subjective, albiet vitals signs, behavior, that is so judgemental to say, when you are not a trained counseler, social worker, therapist, may have had 1 sememster in psych, also, you do not know what they are feeling/ experiencing, in all honesty, it seems if you can not relate to them, then you should at least respect them.). they just like the ativan effects (exactly what effect do you think about ativan is so looked down upon?????). (i'm not including patients with obvious anxiety disorders or who are in etoh withdrawal). (i wonder what "obvious anxiety disorder, looks like to you, really")
my question often angers the patient (i bet it does, their they are, on the verge of, or in the middle of an anxitry attack, feeling, trying to prevent a full-fledged, attack, and your sitting there, with alot of questions, that real or imagined danger for them, is what they are seeking to decompress from, and it seems you may be agitating their condition/s). one even reported me to the rights advisor (i would have done more than that). they think if it's ordered, they're entitled (if it's ordered, they are entitled, dear). many of the other nurses don't ask any questions. they just hand it over. granted, that might be easier. is that the right thing to do? i could probably do that if i detach myself and behave as a robotic-type nurse. any insights?

i have an anxiety disorder, also a cardiac arrhythmia, in which i was looking at heart surgery for. when i am anxious, that small patch of cardiac tissue excitability, in my heart can and has sent me into arrhythmia, while i was hospitalized, from treatment of a fellow rn, who had a dissposition much like yours. you bet, when i felt better, and was released, oh yes, the hospital did hear from me. from the floor charge, to administrators, to the bon. unless you are well trained, i wouldn't assume anything about someone's disposition, and act against the grain, when a patient says, nurse, i am having a problem, i need help.

leslie :-D · Apr 4, 2008

as a nurse, i would think just by virtue of being hospitalized, would create anxieties.

i do try to address the source of their anxieties, but not right before i'm giving an ativan.

i prefer to approach them when their defenses are down...

you know, when the ativan has taken its effect.

leslie

Virgo_RN, BSN, RN · Apr 4, 2008

If the patient has a documented anxiety disorder, it will be in their H&P. You can also look up what meds they normally take at home. If the person is someone who has known anxiety, and takes an anxiolytic at home, then I don't bother them with a bunch of questions. They know what they need and what works for them.

On the cardiac floor where I work, almost everyone has a PRN anxiolytic. Some patients become anxious as a result of their change in medical condition and/or a PTSD type of reaction, for example, with an acute MI. AMI is a life changing traumatic event, and many patients will be very much on edge following such an experience.

I just give them the med, because anxiety is not a good thing for someone with a heart condition. Verbalization of feelings is important and can go a long way to decrease anxiety, but in the acute phase of illness, medication is often the more appropriate initial approach. Talking with the patient is more appropriate when they are NOT feeling anxious. At that time, you can broach the subject of how to handle those feelings of anxiety, including nonpharmacological approaches.

Virgo_RN, BSN, RN · Apr 4, 2008

I try to assess my patient's need by asking, "what is your anxiety about?" .

Well, I'm in a hospital bed that doesn't feel like my own bed at home, I'm wearing a hospital gown that leaves nothing to the imagination, there are people, complete strangers coming in and out of my room all day (and night) long to poke and prod at me and look at my butt, I don't feel well and am afraid I might die.....how's that for starters?

elkpark · Apr 4, 2008

How often do you give Ativan or another med for anxiety? We have it as a standing order for most patients. It seems that many patients, once they discover it's available, request it regularly.
Since Ativan is for anxiety and anxiety is a response to a real or imagined threat, I try to assess my patient's need by asking, "what is your anxiety about?" My motive is also to get them to address the nature of their anxiety -- if they are truly having anxiety. Many times they are not. They just like the Ativan effects. (I'm not including patients with obvious anxiety disorders or who are in etoh withdrawal).
My question often angers the patient. One even reported me to the rights advisor. They think if it's ordered, they're entitled. Many of the other nurses don't ask any questions. They just hand it over. Granted, that might be easier. Is that the right thing to do? I could probably do that if I detach myself and behave as a robotic-type nurse. Any insights?

When I was younger and a lot more energetic, I used to try to "do the right thing," as you describe here, but I've gotten a lot more jaded over the years. People luuuuuuv those benzos, and, in the long run, whether or not they take a few more or less Ativan tablets isn't going to make much difference. People do feel terribly entitled and make your life miserable if you even hesitate to drug them up, so I say, hey, if they want to be benzo junkies, it's not my problem. If the doc orders it, I'll give it -- I'm not the one who has to live with the consequences ... :)

Poochee · Apr 5, 2008

when i was 1. younger and a lot more energetic, i used to try to "do the right thing," as you describe here, but i've gotten a lot more jaded over the years. 2. people luuuuuuv those benzos, and, in the long run, whether or not they take a few more or less ativan tablets isn't going to make much difference. 3. people do feel terribly entitled and 4. make your life miserable if you even hesitate to drug them up, so i say, hey,5. if they want to be benzo junkies, it's not my problem. if the doc orders it, i'll give it -- 6. i'm not the one who has to live with the consequences ... :)

1. we are all less assuming, when we are young and energetic, we give people, the benefit, of our doubt.

2. i think alot of ppl luv alot of meds, from viagra to insulin, for that per, that med, may just be thier godsend.

3. if a doc rx's them, their health warrants it, then i would hope they are educated enough to know, that indeed, thay are entitled.

4. now, i would only imagine, them making your life terrible, if, you were not too timely, or not so nice, abt giving their, rx;d med, based on your own beliefs.

5. this is the first time i have heard the term benzo junkie, wow. are we talking abt more than just ativan. b/c if we are speaking of ativan, i sure can say, he does not have an addictive quality, like some other meds, persay, oxycontin and the like.

6. exactly, so why so much fuss, i am glad and sad, to see this other side of the coin.

i know moderators usually, moderate, meaning not too much to the left, not too much too the right, so i will say, i was a bit sorprised at, your comment, then i thought, you know, we may all be nurses, but firstly, we are humans. each, has his own view and opinion, to the world.

so, with that said, i wouldn't want you to feel like i am stepping on your toes.

you have a right to assert, your beliefs, and still be respected. just as much as i, to mine, and the same regard be kept.

best wishes. :nurse:

P_RN, ADN, RN · Apr 5, 2008

what I'd say is OK, now I need to document the need. Say it non threateningly and usually you'll get an honest reply "I'm worried about Mama" "I cant seem to think straight and just need a nap." Just let them know the documentation requires it.

Don't give the impression that you hold the big old key that unlocks the medication.

pebbles, BSN, RN · Apr 5, 2008

Don't give the impression that you hold the big old key that unlocks the medication.

Agreed!

"What is your anxiety about", etc.... sometimes how you say it can make a big difference.

Is there anything in particular that's making you feel anxious? Is there anything I can do to help besides the ativan?

Those types of conversations will open the dialogue a bit more. I do think we have a responsibility to see if the person's anxiety can be helped without having to throw a pill at it. But if they need the pill, they need it.