Mount Saint Joseph University
School of Health Sciences, Department of Nursing
514 Gardner/Clephane
MEDICATION ADMINISTRATION SHEET
Generic and Product name of the drug _______Lorazepam ___/___Ativan______________________
Classification & sub-classification (if applicable) of the drug _______Anxiolytic_____/______sedative-hypnotic,
benzodiazephine ________
Normal dose range specific for indication and patient population:
Child:PO/IV0.05mg/kgq48h
(max:2mg/dose)
PEDS: Safe dose range calculation for your patients weight in Kg (show work)
mg
______
kg/day
mg
_____ =
dose
22.8 kg
_______
1
0.05 mg
_______
1
1 day
______
6 dose
= 1.14 mg/dose
Is the ordered dose on MAR safe for patient per dose (yes/no)?
= 0.19 mg/dose
YES
Is the ordered dose on MAR safe for patient per daily (24hr) total (yes/no)?
YES
1. What are the patient specific indications and uses
of this medication?
Management of anxiety disorders and for short-term relief
of anxiety symptoms. Preanesthetic medication to produce
sedation, reduce anxiety, and recall of events related to
surgery, can also be used for status epilepticus.
This patient is receiving this drug for relaxation and anxiety
for eye examinations.
2. What is the action of this medication in the body?
How would you evaluate its effectiveness?
Mediated by the inhibitory neurotransmitter GABA. Takes
action in the thalamic, hypothalamic, and limbic levels of
CNS.
You can evaluate the effectiveness by monitoring behavior.
3. What are the major side effects/adverse effects of
this medication?
Adverse effects: drowsiness, sedation, weakness,
disorientation, depression, sleep disturbance, restlessness,
blurred vision, depressed hearing, nausea, vomiting, and
abdominal discomfort.
4. What are the important nursing considerations
IM or IV injection of 2-4 mg is followed by
Mount Saint Joseph University
School of Health Sciences, Department of Nursing
related to administering this medication?
5. Are there any other special considerations related
to administering this medication based on the
patient population? (i.e. if giving an IM injection to a
newborn, what size needle is needed. If giving a
medication to a pediatric patient, how will it be
given?)
Source: Wilson,
514 Gardner/Clephane
drowsiness/sleepiness that permits patient to respond to
simple instructions
Supervise ambulation and patient who exhibits depression
with anxiety
Monitor CBC and LFTs
Drug Interactions: Alcohol, cimetidine, levodopa, phenytoin,
Kava, valerian
B. A., Shannon, M. T., & Shields, K. M. (2015). Pearson nurses drug
guide 2015. Upper Saddle River, NJ: Pearson Education.