MINOR TRANQUILIZER

GN: Diazepam
BN: Valium

INDICATIONS

ACTION
Potentiates the action of GABA, especially in limbic system, reticular formation;
enhances presympathetic inhibition, inhibits spinal polysypnaptic afferent paths.
Therapeutic effects:
Decreased anxiety, restlessness, insomnia.

CONTRAINDICATIONS
Pregnancy D, hypersensitivity to benzodiazepines, narrow-angle glaucoma,
psychosis, coma, respiratory depression.

Precautions:
Elderly, debilitated, hepatic disease, renal disease, addiction, child <6 months.

NURSING IMPLICATIONS
Assessment
 Assess degree of anxiety; what precipitates anxiety and whether drug controls
symptoms; other signs of anxiety: dilated pupils, inability to sleep, restlessness,
inability to focus.
 Assess for alcohol withdrawal symptoms, including hallucinations (visual auditory),
delirium, irritability, agitation, fine to coarse tremors.
 Monitor B/P (with patient lying, standing) pulse, respiratory rate; if systolic B/P drops
20 mmHg, hold drug, notify prescriber; monitor respirations q5-15 min if given IV
 Monitor blood studies: CBC during long term therapy; blood dyscrasias have
occurred (rarely)
 Monitor for seizure control; type, duration, and intensity of seizures; what precipitates
seizures
 Monitor hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alkaline phosphatase
 Assess mental status: mood sensorium, affect, sleeping pattern, drowsiness, dizziness,
suicidal tendencies, and ability of drug to control these symptoms: headache, nausea,
vomiting, muscle pain, weakness after long term use
Potential Nursing Diagnoses
 Anxiety (uses)
 Injury, risk for (uses, adverse reactions)
 Coping ineffective (uses)
 Knowledge, deficient (teaching)
 Noncompliance (teaching)
Implementation
PO route
 Give with food or milk for GI symptoms
 Crush tab if patient is unable to swallow medication whole
 Use sugarless gum, hard candy, frequent sips of water for dry mouth
 Reduce opoid dosage by 1/3if given comitantly with diazepam
  Check to see PO medication has been swallowed.
Rectal route
 Do not use more than 5x/month or for an episode q5 days
IV route
 Administer IV into large vein; do not dilute or mix with any other drug; give IV 5mg
or less/1 min or total dose over 3 min or more (children, infants)
 Check IV site for thrombosis or phlebitis, which may occur rapidly
Patient/Family Teaching
 Advice patient that drug may be taken with food; that drug is not to be used for
everyday stress or used longer than 4 months unless directed by prescriber; take no
more than prescribed amount; may be habit forming.
 Caution patient to avoid OTC preparations unless approved by a prescriber; to avoid
alcohol, other psychotropic medications unless prescribed; that smoking may decrease
diazepam effect by increasing diazepam metabolism; not to discontinue medication
abruptly after long-term use.
 Inform patient to avoid driving, activities that require alertness; drowsiness may
occur, especially in elderly
 Advice patient not to become pregnant while using this drug.
 Inform patient that drowsiness may worsen at beginning of treatment.
EVALUATION
Positive therapeutic outcome
Decreased anxiety, restlessness, insomnia.