Ensure patient safety. Raise bedrails; place call bell within patient's reach. Lorazepam causes drowsiness and dizziness.

Transcription

1 Assessment Prior to administration: Obtain complete medical history: pulmonary, cardiac, renal, biliary, and mental or sleep disorders, including EKG and laboratory studies: CBC, BUN, creatinine, electrolytes, liver functions tests. Obtain patient s drug history to determine possible drug interactions and allergies Nursing Process Focus: Patients Receiving Lorazepam (Ativan) Potential Nursing Diagnoses Injury, Risk for, related to sedative Memory, Impaired related to side effect of drug Knowledge, Deficient, related to newly prescribed drug Ineffective individual coping Sleep pattern Disturbed, related to side Planning: Patient Goals and Expected Outcomes Patient will: Experience an increase in psychological comfort Report absence of physical and behavioral manifestations of anxiety Demonstrate understanding of the drug's action by accurately describing drug side effects and precautions. Remain free of injury Maintain intact memory Implementation Interventions and (Rationales) Ensure patient safety. Raise bedrails; place call bell within patient's reach. Lorazepam causes drowsiness and dizziness. Monitor patient for signs of digoxin toxicity. (Lorazepam may contribute to digoxin toxicity by increasing the serum digoxin level. Symptoms include visual changes such as yellow auras, blurring or diplopia; nausea, vomiting and diarrhea, paraesthesias, dizziness, confusion, vertigo, profound weakness, syncope, etc.) Monitor vital signs especially pulse, respirations, and blood pressure. Observe respiratory patterns, especially during sleep, for evidence of apnea or shallow breathing. (Lorazepam can reduce the respiratory drive in susceptible patients.) Patient Education / Discharge Planning to request assistance when getting out of bed and ambulating until is known to avoid activities that require mental alertness and good physical coordination until is known also taking digoxin of the symptoms of digoxin intoxication. to immediately report signs and symptoms of digoxin toxicity. Instruct patient Regarding methods to monitor vital signs at home, especially respirations, as needed, and that snoring is NOT normal; it is a sound created by obstruction in the upper respiratory tract.

2 Monitor the patient's intake of ordinary stimulants, including caffeine (in beverages such as coffee, tea, cola and other soft drinks and over-the-counter analgesicssuch as Excedrin ), and nicotine (smoking, tobacco-chewing and nicotine patches). Monitor vital signs and neurological status, especially level of consciousness (LOC). Monitor affect and emotional status. Monitor for depression, especially with suicidal tendencies: use with caution. (Drug may increase risk.) Monitor liver function. (Lorazepam is metabolized in the liver, creating the risk for liver toxicity.) Signs and symptoms include nausea, vomiting, diarrhea, rash, jaundice, abdominal pain, tenderness or distention, or change in color of stool. Use with caution in patients who have or are suspected as having a primary sleep disorder. (The CNS depressant effect of lorazepam can further affect the altered respiratory drive responsible for central sleep apnea and can increase muscle relaxation in the upper airway, enhancing mechanical occlusion of the upper airway, and worsening obstructive sleep apnea. CNS depressants exacerbate hypersomnolence (excessive daytime sleepiness) associated with narcolepsy) Avoid abrupt discontinuation of therapy. (Withdrawal symptoms are possible with abrupt discontinuation after long term use.) Instruct the patient that caffeine and nicotine (and other stimulants) can reduce the drug's effectiveness. Instruct patient to report significant changes in neurological status, such as extreme lethargy, slurred speech, disorientation or ataxia. To report significant mood changes, especially depression. Obtain a verbal "no-self harm" contract from the patient. To keep all follow-up appoints as directed by health-care provider. Instruct the patient: To report signs and symptoms of hepatic toxicity. To adhere to a regular schedule of laboratory testing for liver function as ordered by the health care provider. Advise patient that, if snoring occurs, consult the health care provider before taking this medication. Instruct patient To take drug exactly as prescribed. To keep follow up appointments to monitor response to medication. That abrupt discontinuation may result in rebound anxiety and sleeplessness, possibly of enhanced intensity.

3 Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning )

4 Assessment Prior to administration: Obtain complete medical history, including, allergies, data on sleep habits, mental status and any family history of sleep disorders, and laboratory findings such as CBC, BUN creatinine, and liver enzymes. Obtain patient s drug history to determine possible drug interactions and allergies Nursing Process Focus: Patients Receiving Zolpidem (Ambien) Potential Nursing DiagnoseRisk for, related to sedative effect of drug Sleep pattern, Disturbed, related to effects of drug Memory, Impaired, related to side Knowledge, Deficient, related to new drug regimen Planning: Patient Goals and Expected Outcomes Patient will: Experience comfortable, timely onset of night-time sleep and restoration of normal sleep/wake pattern. Demonstrate understanding of sleep hygiene and factors that facilitate sleep. Demonstrate understanding of the drug's action by accurately describing drug side effects and precautions. Remain free of injury during course of drug therapy. Implementation Interventions and (Rationales) Monitor patients having a primary sleep disorder, especially central sleep apnea. (The CNS depressant effect can further reduce the altered respiratory drive responsible for apnea.) Monitor vital signs especially respiration, pulse and blood pressure. (The drug's CNS effects can slow or diminish breathing.) Provide for patient safety by toileting patient prior to medicating, putting side rails up, placing call bell nearby, etc. (Grogginess can cause the patient to become disoriented, and to forget or disregard object placement.) Monitor mental status and level of consciousness. (The drug's affect on the hippocampus and cerebral cortex may cause confusion or amnesia.) Patient Education / Discharge Planning Advise patient To report symptoms of night time shortness of breath, snoring, or headache upon awakening to the health care provider before taking this medication. That snoring is NOT normal, and is the sign of obstruction in the upper respiratory tract. Instruct patient or caregiver to monitor breathing patterns, and to observe for snoring or apnea. Instruct the patient To request assistance when getting out of bed To remove items from the home that pose a tripping hazard. Instruct the patient or caregiver to report significant changes in mental status, such as extreme lethargy or disorientation, especially occuring in the daytime.

5 Monitor mental health status and evaluate risk potential for suicide. Monitor the environment for signs of hoarding medication. Obtain a no-self harm verbal contract from patients identified as being at risk of suicide. Document patient s sleep patterns and response to medication Monitor gastrointestinal elimination. Observe for nausea, vomiting, and dyspepsia. CNS depressants may reduce gastrointestinal motility. (Gastrointestinal distress may also signal hepatotoxicity. ) Monitor laboratory tests such as CBC, BUN, creatinine, urinalysis and liver enzymes to determine kidney and liver function. (Zolpidem is metabolized in the liver and excreted by the kidneys; impaired organ function can increase serum drug levels.) Advise patient to report signs of depression to the health care provider immediately. Instruct patient or caregivers: To take medication as prescribed. To assure medications are swallowed. Instruct patients at risk for mental depression to demonstrate swallowing of the medication. Advise patient: Of short term use of medications and encourage non-pharmacologic strategies to improve sleep That long-term insomnia may signal another underlying medical disorder and should be investigated by the health care provider. Inform patient that food decreases absorption and will delay onset of effects. Advise patient To inform the health care provider of any history of liver or kidney problems. To report nausea, vomiting, diarrhea, rash, jaundice, abdominal pain, tenderness, distention, or change in color of stool. To adhere to laboratory testing regimen for serum blood level tests of liver enzymes as directed. Instruct the patient to keep all follow-up appoints as directed by the health-care provider. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning )