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Formal written order to free the person. Procedural mechanism used to challenge unlawful detention by the government.
Writ of Habeas Corpus
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Doctrine that mandates that the least drastic means be taken to achieve a specific purpose.
Least restrictive alternative doctrine
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Admission when no formal or written application is used. Voluntary - sought by the patient
Informal admission
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Sought by pt or guardian through a written application to the facility
Voluntary admission
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Used for people who are confused or demented and cannot make decisions on their own
For people who are so ill they need emergency admission
Initiated by physician for observation, diagnosis and treatment if danger to themselves or others
Temporary admission
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Admission without patient's consent, necessary when pt is in need of psych tx, presents danger to self or others, unable to meet his own needs.
Involuntary admission
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Rules of involuntary admission
- Multiple physicians must certify it is justified
- family members are notified
- Pt can be kept 60 days
- Pt can file writ of habeas corpus to challenge
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How does a person become involuntary?
- Law enforcement (ED, mentally ill, likely to harm) AND
- Physician confirms (likely to harm)
- Interested party (mentally ill, likely to harm) AND
- Physician confirms (mentally ill and likely to harm)
TEAM MUST file petition for involuntary TX by 5pm next biz day.
Ex Parte Emergency Custody Order issued by District Court (only on biz days)
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Voluntary to involuntary after admission
Voluntary admit lacks capacity to make informed decision and is refusing reasonable tx efforts.
Team must file petition for involuntary treatment by 5pm of next biz day.
-
May or may not use
Application for emergency admit and hold for observation after admitted to inpatient unit
May NOT
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Request for Discharge from Voluntary Care and Treatment
Pt must file if on an inpatient unit and insists on leaving. 3 Days to respond.
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Behavioral restraints/seclusion authorized when:
- Prevent harm to pt or other party
- Less restrictive measures insufficient to protect
- Decrease in sensory stimulation is needed (seclusion)
- Pt requests seclusion because he feels he needs it
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Rules for restraint/seclusion
- Written order of physician
- Orders confined to specific time-limited period
- Pt condition reviewed and documented regularly
- Original order extended after review/reauthorization and specifies type of restraint
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Contraindications to Seclusion
- Estremely unstable medical/psych status
- Delirium/dementia & can't tolerate seclusion
- Severe suicidal tendencies
- Severe drug reaction/overdose/need for close monitoring of drug doses
- Desire for punishment of Pt or convenience
-
New order needed how oftern for restraints/seclusion
3hr 18yo +
2hr 9-17yo
-
Seclusion / restraint one-on-one face assessment by house manager how often?
qHr
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Physician to see restrained pt how often?
q8h
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Clozaril/Clozapine
Tx of Schizhophrenia / Bi-polar
Atypical antipsychotic
- Concerns: Agranulocytosis - suppresses bone marrow
- Clozaril registry: WEEKLY WBC check
- Check WBC wkly 6 mo. If stable q2wk.
- Teach r/t bone marrow suppression
- S/s infection: fever, malaise, fatigue
- Causes sedation - careful with tasks
- Wt gain - nutrition and eating habits
- Avoid other OTC CNS depressants (ETOH)
- Smoking decreases effects of drug
-
Zoloft/sertraline
SSRI antidepressant
Elevates well-being
- Serotonin syndrome: avoid w/other SSRIs (Celexa)
- Monitor s/s SI (spec child/adolesc) "Suicide thoughts?"
- SE: N/D Ha Wt loss Common
- Same time each day; w/food if dyspepsia
- SEXUAL side effects
- Not if pregnant
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Lithium
ONLY mood stabilizer for Bi-Polar
- Li levels checked qam
- Small therapeutic range
- Maint .6 - 1.2
- Acute 1.0 - 1.5 till stabilized then to maint
- THYROID levels .5 - 5.0
- Na levels (Na up, Li down)
- Kidney fcn (Creatinine .6 - 1.2)
- SE: sligt tremor, drowsy, wt gain, thirsty, dry mouth
- SA: dizzy, n/v, tremors, flu-like
- ***Bi-Polar*** Best med for prevention SI
- No caffeine
- Not if pregnant
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Depakote / Valproic Acid
Anticonvulsant
Mood stabilizer, migrain tx
- Gabba regulation - slows things down
- Ck levels w/in 7 days, then q6months
- Regular 50 - 100
- XR 50 - 125
- Liver fcn: Albumin 3.5-5; ALT 9-52, AST 30-120
- Decr Platelets: prolonged bleeding; CBC w/diff
- Not w/pregnancy
SE: wt gain, drowsi, jaundice (if liver prob, give lithium)
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Goedon/Ziprasidone IM PRN
Atypical antipsychotic
Aggitation/crisis intervention
(only for out of control = heavy sedation!)
First try: deescalation, time out, prn meds
- IM is only for acute aggitation!
- 10mg IM q2h max 40mg/day
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Serax/oxazepam
Benzodiazepine / anxiolytic
ETOH w/d, detox
Safer for liver than Ativan (more water soluable)
Replaces ETOH in system; prevents sz (DT's) after ETOH out of system.
- Not until after ETOH-free.
- When was last drink?
- Give when start to see 2+ S/S W/D:
- *Tremors
- *Tachy >100
- *Htn >160/100
- *Diaphoresis
Give q1hr
-
RN responsibility prior to giving psych med?
- Know what med is
- Why given
- Action
- Route
- Correct dose
- Time
- S/E
- Related lab needed
-
Non-adherence factors
- Money
- Transportation
- Home health availability
- Case management
- Education
- Pharmaceutical assistance
- Time involved
- Side effects
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