Terrified Patient

I went into work last night (11-7), we admitted a new Lady (late 80s) the day before. Poor thing, I almost cried looking at her. She had been living in AL and had fallen, ending up in the ER. I walked into the room & her eyes were like saucers,() she was moaning (denied pain) wringing her hands and/or cluching her arms around herself. I don't understand why someone, anyone hadn't called for Ativan or something to help her (). This type of anxiety is not healthy, sometimes I wonder just what goes on in peoples minds that they can let a patient suffer in such a manner. Dr's dont want us calling for (what they think is) "non-emergencies" (). Aside from the fact that we now have to contact Dr for the order, contact pharmacy to relay order, wait for Dr to fax order, wait for pharmacy to call with new order number, before we can open the Emergancy Kit to retrieve the drug. At night this can take hours, if the covering Dr/NP/PA has a fax machine in thier homes, if they don't we have to wait until morning to get the needed number. In the mean time poor LOL lays in bed scared out of her mind.

I understand that the 7-3 & 3-11 shifts are busy, I have worked both, but they also know it's alot easier (& faster) to get orders on thier shifts than mine. When I questioned the 7-3 shift, the nurse said she had noticed the fear the day before, never explained why she didn't talk to Dr about it then. I guess I'm just whining.
You are not whining. Maybe an inservice is in order, if this is a recurrent theme.

Many people don't understand anxiety. I don't understand it. Of course, there is also the issue that we now tend to the "other way," when it comes to giving sedatives and anti anxiety meds. It used to be that we gave them to patients, particularly older ones, like candy at night - now it's gone the other way.I agree with the inservice on assessing anxiety. You can't help a patient get better if they're all twisted up inside. Poor lady. But good on you for at least recognizing it.

Did the woman have a head injury making it unwise to use sedation?Did she have dementia that can be worsened by Ativan? Don't always assume sedation is a good thing, I've seen very bad reactions to Ativan esp. Any of these could be why the previous shifts didn't get sedation orders. Did she have a history of anxiety? Did you ask her what she was scared of? Offer her some emotional support? Move her out into the hall where she could see people and be less afraid?

We have to exhaust other interventions first.And isn't some anxiety appropriate in that kind of situation and is is always appropriate to try to alleviate it? Isn't it part of the adjustment to a new living situation? Maybe a drink , a snack and 10 or 15 mins talking would assure her that staff do care and she can trust that she will be cared for....just another way of looking at things

Ativan may increase fall risk. Does the patient have any family who could visit et comfort, is there any familiar object (momento, picture, etc.) which could be obtained from the AL facility. Is there a clergy who could visit. Was the routine Rx regimen changed from AL to acute care? Unfortunately, all the above are no quick fix, especially for 11-7.

Does this patient have any type of dementia/confusion? I would suspect pain if she was moaning, even if she denied it. I would try routine pain medication first & see if this helped with her anxiety. I've seen too many "anxious" patients who really had pain issues.

Reassurance is always a good thing, but when anxiety reaches a level like this it is almost impossible to stop without pharmaceutical intervention. Once the anxiety is under control, reassurance, listening and counseling may be effective.

Quote from gentlegiverDr's dont want us calling for (what they think is) "non-emergencies" (). Aside from the fact that we now have to contact Dr for the order, contact pharmacy to relay order, wait for Dr to fax order, wait for pharmacy to call with new order number, before we can open the Emergancy Kit to retrieve the drug. At night this can take hours, if the covering Dr/NP/PA has a fax machine in thier homes, if they don't we have to wait until morning to get the needed number. In the mean time poor LOL lays in bed scared out of her mind.