LOC
• Alert: responsive, answer questions appropriately, opens eyes spontaneously.
• Lethargic: open their eyes, can answer questions but easily fa... [Show More] lls asleep.
• Stupor: barely responds to painful stimuli (like rubbing the patients’ sternum)
• Comatose: unconscious/does not respond to painful stimuli
• Decorticate: flexion/ internal rotation of upper extremities, joints and legs
• Decerebrate: neck/elbows extension, wrist and finger flexion
Torts: unintentional torts- negligence: forgetting to set the bed alarm for a patient who is at risk for falling and falls out of bed.
Malpractice- giving the wrong medication to the patient, error that harms the patient.
Intentional torts:
Assault vs Battery:
• Assault is if you threaten someone, “If you do not take this pill, I will smack you.”
• Battery: when you actually hurt someone, “You actually act by smacking the patient.”
• False imprisonment: Nurse will purposely restrain the patient or give them a chemical to a pt. for the nurse convenience, instead of doing alternatives techniques.
Six Ethical Principles
• Beneficence – Doing good by the patient, what is best for the patient. Making the patient feel safe in the environment that their in.
• Autonomy- respecting their rights by what they decide for their health care. Clients making decisions but the patient must accept consequences of those decisions.
• *Veracity- truthfulness “Being honest with the patient’s treatment”
• Justice- fair/equal rights for everyone.
• *Fidelity- being loyal to the patient, keeping promises.
• Non-maleficence: Doing No Harm
Legal Rights of the patients in Mental Health
• Pt has the right to refuse treatment even if they’re in a mental health facility.
• Pts confidentiality: HIPPA: cannot be released without the consent of the patient
• If someone calls the unit asking about the patient refer them to contact the patient’s family regarding the patient well being
• Over hear a conversation in a public place: tell them to go have the conversation in a private setting.
• Mandated that abuse is reported, with a child or an older adult.
• Our duty to warn third parties if they’re at risk for harm.
Informed Consent: Provider:
• Communicate the purpose of the procedure
• Give a clear description of the procedure in the patient primary language.
• Explain the risks vs the benefits
• Other options in treating the condition
RN Role:
• make sure the provider gives this information to the patient.
• Pt is competent in receiving the information, they must be an adult or an emancipated child, THERE CAN BE NO IMPAIRMENTS!
• If they do not understand the information then we do not answer the questions, have the provider answer the questions.
Restraints:
• Physical- vest, belt, and mittens. LAST RESORT
• Chemical- sedative/antipsychotic medications
• Alternatives before restraints: verbal interventions, calm/quiet environment, diversions.
• Prescriptions must be written
• Write an order for restraints to be placed on patient. If the orders need to be renewed it has to be renewed within 24 hours.
•
Care for the Patient:
• Assessing the patient vital signs q 15 mins
• Offer them food and fluid- Every hour
• Make sure they get the chance to toilet- Every hour
• Monitor vital signs.
Emergency Restraints Placed:
• get an order from the doctor within 15-30 mins
• Time limits: 18 and older: 4 hours, 9-17: 2 hours, 8 and under= 1-hour, extra documentation: event that caused the restraints to be placed, alternative interventions that were attempted, time treatment began, med administered, patient assessment including current behavior, v/s, pain. Pts care provided: food, helping them to the bathroom.
Therapeutic Communication:
• *Always try to get more information from the patient. You never want to shut down communication between you and the patient. *“Always go for tell me more response”
• Intrapersonal communication: self-talk, thinking thoughts, not verbalizing them.
• Interpersonal communication: one on one communication with another person.
• Open ended questions: promote interactive discussions “Tell me more, can you share more about x y,z
• Closed ended= when looking for a specific answer/ Medical History. Yes/no answers Clarifying techniques:
Restating = repeating back the patient exact words Reflecting= returning focus back to the patient
Paraphrasing = restating the patients’ feelings and thoughts to confirm what has been communicated. “What I think I hear you saying is this”
Exploring= gathering more information about something that the patient has mentioned. “You mentioned this can you tell me little more about that.”
General leads= allows the patient to guide the discussion
*Presenting reality= focus on what is actually happening to stop the hallucination, delusions, faulty beliefs. “Must be really scary to hear voices can you tell me what their saying”
Offering self: demonstrates a willingness to spend time, and the nurse has a genuine concern.
.........................................................................................................................................................................................................................CONTINUE. [Show Less]
