treating patient anxiety

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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?:banghead:

We all have our opinions, and I am not going to dissect them. I myself would give the medication if someone asked for it and it was due.

Specializes in trauma, ortho, burns, plastic surgery.

Ok look my point of view:

1. Anxiety is symptom not a diseaase. What you need to know is included in what diganosis appered anxiety symptom.

2. Cause of anxiety..WHY?

3. Time, regularities of anxiety?

4. Manifestation of anxiety?

5. Is acute or chronic?

4. regular or irregular in time

5. Hystory

Hystory of ativan dosages, talk with DR.

Asses again, again reasses, talk again with DR, alternative medications

Other therapies???

This is a team working TOGHETER close to the bed patient side The BEST IS ONLY THE PATIENT! He deserve a good care!

Slap me to wake at reality, looooooool! Hugs a Zuzi unable to not dream!

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.

I totally agree but the hospital usually sides with the patient. It's a no win situation.

Same with pain and JCAHO. I had a PURE drug addict cop that was out of control. I made the mistake of thinking it was time to go from IV to PO. That guy had it in for me for YEARS. Said he had been doing this for YEARS.....clearly with renal failure, major 3rd spacing, multi system failure, frequent visits. The doses he was getting was NOT treatig pain any more.

I love how people come in for one diagnosis and then get MS IV for chronic back pain that they didn't come in for or for HEADACHES. Then the RN is the bad guy. Oh and pain and anxiety are "punctual" - right on time q2 or q3 hours.

Thanks for all of your responses. Did I mention I work in a psychiatric unit? As such, I'm attempting to be therapeutic with patients by helping them to look at prospective causes of their anxiety. I'm not anti-benzo. I give it freely if the need is there. But around here it seems we do hand it out like candy. The patient isn't even encouraged to do the necessary work toward their own self-care. Granted, I do prefer a more holistic approach than throwing meds at every problem. For example, I know if I have feelings of anxiety, I try to identify the cause. I don't just pop a pill. Is there a psych forum I should have addressed this to?:rolleyes:

Did I mention I work in a psychiatric unit? If I was a cardiac nurse, the approach would be entirely different. And btw, I do have more than one semester of psych training. Thank you for taking time to reply.

Thanks for all of your responses. Did I mention I work in a psychiatric unit? As such, I'm attempting to be therapeutic with patients by helping them to look at prospective causes of their anxiety. I'm not anti-benzo. I give it freely if the need is there. But around here it seems we do hand it out like candy. The patient isn't even encouraged to do the necessary work toward their own self-care. Granted, I do prefer a more holistic approach than throwing meds at every problem. For example, I know if I have feelings of anxiety, I try to identify the cause. I don't just pop a pill. Is there a psych forum I should have addressed this to?:rolleyes:

how long are the pts typically on the unit, before discharge?

if short term (1-3 wks), i don't really see the benefit of behavioral/cognitive interventions.

in short term admissions, the goal is to basically stabilize them and get them started on their regimen.

anything longer term would be more realistic in attaining desired goals.

just my opinion.:)

leslie

Good point. Thanks.

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.

??? you're not aware that ativan, like every other member of the benzo family, is highly addictive and commonly abused? "he" certainly does have an addictive quality!

Specializes in LTC.

amen, the dr gave an ativan order for a reason. sounds to me like you are questioning just to act above your practice, give the prescribed ativan for heaven sake and leave the poor pt alone!!!!!!!!!!

I'm feeling affirmed by some of you and downright attacked by some others. If I paint a typical picture for you, what would you do?

A patient presents at the window precisely 4 hours after last request for Ativan. Pt. states, "can I have my Ativan?" Prn order either states "for mild to moderate anxiety or agitation" or "for moderate to severe anxiety or agitation." Pt. was last seen sitting in lobby laughing and joking with peers. Current presentation could be described as neutral. In report I learn that this is the patients common practice. Do I hand over Ativan w/o even a question? This is in a short-term psychiatric department. Our typical census consists of the standard 30-50% co-occurring disorder patients (sub abuse and psych disorder), a handful of genuinely mentally ill patients, and a whole lot of borderline or other personality disorders.

I'm willing to look at other points of view, but so far I'm not convinced that passing benzodiazapines so freely is the right thing to do. I also would like to point out that I'm pretty mild-mannered and not the type to withhold a medication just because I can (as some have implied). Please reply. This is of utmost interest.

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

Perhaps it's all in the approach. When they ask for their Ativan, say, "of course, I'll get that right now for you." Then after an hour or so, approach the patient sweetly and ask how they are doing and if the medication is helping, is there anything you can get or help them with. Then steer the conversation to their anxiety. "Is there anything else we can do here to help you with your anxiety?" "Have you found what may trigger your episodes?" "Has your hospitalization worsened it?"

That may help your patients open up more.

I'm feeling affirmed by some of you and downright attacked by some others. If I paint a typical picture for you, what would you do?

A patient presents at the window precisely 4 hours after last request for Ativan. Pt. states, "can I have my Ativan?" Prn order either states "for mild to moderate anxiety or agitation" or "for moderate to severe anxiety or agitation." Pt. was last seen sitting in lobby laughing and joking with peers. Current presentation could be described as neutral. In report I learn that this is the patients common practice. Do I hand over Ativan w/o even a question? This is in a short-term psychiatric department. Our typical census consists of the standard 30-50% co-occurring disorder patients (sub abuse and psych disorder), a handful of genuinely mentally ill patients, and a whole lot of borderline or other personality disorders.

I'm willing to look at other points of view, but so far I'm not convinced that passing benzodiazapines so freely is the right thing to do. I also would like to point out that I'm pretty mild-mannered and not the type to withhold a medication just because I can (as some have implied). Please reply. This is of utmost interest.

I also work in acute, inpt. psych and know exactly what you're talking about -- I've been a psych nurse for nearly 25 years, and I've seen lots of changes (NOT for the better, IMHO) in that amount of time. I certainly don't mean to sound like I'm attacking you; I used to have exactly the same concerns that you do, and, as I said earlier, used to try very hard to do what I knew was the right thing. However, most of the clients you see in inpt., short-term, acute psych settings are very accustomed to dealing with their feelings, problems, frustrations, etc., by either self-medicating (whether with Rx'd or "recreational" chemicals) or getting handed pills by us, in inpt. units. In my experience, the vast majority of them have no interest whatsoever in learning any new/better coping skills, etc.; they just want their "quick fix" so they don't have to feel any emotional/psychological discomfort. That's certainly not how I choose to live my life and deal with the world (and you've indicated you feel the same way), but neither you nor I is going to change their mind about that. In our society, there's a whole lot more support for their approach (the "quick fix," immediate gratification, "the customer is always right", no one should ever have to feel any psychological discomfort, there's a pill for every problem, etc.) than there is for ours.

So, now, when the client who has been laughing and joking in a card game with peers for the last 20 minutes gets up, walks over to me, and says, "I need my Ativan," I just smile and give 'em the pill. Maybe their long-term, outpatient physicians and therapists can work with them about the dangers and downfalls of benzo dependence and developing healthier coping skills and better tolerance for the basic, universal vicissitudes of life, but I'm not going to be able to change their attitudes or behaviors, in the limited amount of time that I'm going to interact with them, and it's not worth the hassle to me to engage in a battle of wills over them about it ...

I agree with you completely that handing out benzos like they're breath mints is a horrible idea, and certainly not, in the long run/big picture, doing clients any favor :uhoh21:. But, unless you're in a setting where the nursing staff present a "united front" about that and the physicians support you and back you up in conflicts with clients, you're just going to be setting yourself up to be the "mean nurse" on the unit (as far as the clients are concerned) and spending lots of your time in power struggles with clients. But, hey -- the docs order the pills, the clients are adults who are legally and ethically entitled to make their own choices about their tx, and if they choose to make very different choices than I would, that's their choice to make (the same as in any other healthcare setting/specialty) -- and it ain't my problem.

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