Question

1. Three hours after being given a hypnotic, a patient is still awake. She is having major surgery in the morning. Describe the actions that you should initiate and the rationale for performing each.

2. Why should patients be cautioned against the use of alcohol when taking sedative-hypnotics?

3. An older disoriented patient remains awake at 0300; she is calling out frequently. The nurse notes the patient has a PRN order for a sedative-hypnotic. Describe nursing actions that you will use in the care of this patient. Cite nursing interventions that can be implemented as an alternative to administering a sedative-hypnotic.

4. An actress is taking a barbiturate to help with her stage fright. She has noticed spotting and breakthrough bleeding. What steps must she take for proper care of these side effects?

5. An elderly patient with chronic cardiovascular problems shows signs of confusion and speaks of hallucinations. What drug may be causing these symptoms and what steps would a healthcare provider take to correct the situation?

Answer 1

Ans) Hypnotherapy, also referred to as guided hypnosis, is a form of psychotherapy that uses relaxation, extreme concentration, and intense attention to achieve a heightened state of consciousness or mindfulness. In other words, it places the individual into a “trance” or altered state of awareness.

- U.S. hospitals are offering hypnosis to patients to lessen preoperative anxiety, to manage postoperative pain and even to substitute for general anesthesia.

2) Patients who are prescribed sedative-hypnotics should be told not to drink alcoholic beverages while taking the drug since the alcohol could intensify the drowsiness effect.

3) The use of sedative/hypnotics in the inpatient units (excluding the critical care unit), is somewhat prevalent, and many patients may be on more than one sedative/hypnotic, which could potentially cause cumulative harm. During the intervention phase, 25% of the total in-hospital orders for sedative/hypnotics were discontinued following recommendations made by a pharmacist, and significantly lower number of patients receiving duplicate sedative/hypnotics was noted.

- So, although there is PRN order for sedative hypnotics, the nurse must call the doctor and further ask the need for management.

4) Bleeding is common during the first three months of OCP use; counseling and reassurance are adequate during this time period. If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAIDs).