Medication administrationAn emergency situation must be present for the charge nurse to use seclusion or restraints without first obtaining aprovider’s written order. If this treatment is initiated, the nurse must obtain the written order within a specified period of time (usually 15 to 30 min).Table 6-2IssueExamplesPatient safetySuicide risksRestraintsMiscommunicationMedication errorsBoundary violations (e.g., sexual misconduct)
IssueExamplesMisdiagnosisDefamation of character• Slander (spoken)• Libel (written)Harms patient’s reputationConfidential information divulgedTruth is a defenseSupervisory liability (vicarious liability)Inappropriate delegation of dutiesLack of supervision of those supervisingIntentional torts• May carry criminal penalties• Punitive damagesmay be awarded• Not covered by malpractice insuranceVoluntary acts intended to bring a physical or mental consequencePurposeful actsCarelessness or recklessnessNo patient consentSelf-defense or protection of others may serve as a defense to charges of an intentional tortNegligence or malpracticeCarelessnessForeseeability of harmAssault and batteryPerson apprehensive (assault) of harmful or offensive touching (battery)Threat to use force (words not enough) with opportunity and ability
IssueExamplesTreatment without patient’s consentFalse imprisonmentIntent to confine to a specific areaIndefensible use of seclusion or restraintsDetain voluntarily admitted patient with no agency or legal policies to support detainingPsychopharmacologyAntidepressants - is a substance that prevents/relieves depression. oSSRI (Selective Serotonin Reuptake Inhibitor) – (Associated NT: Serotonin). Anti-Depressant drugs that blocks reuptake of Serotonin. SSRI’s have fewer side effects than TCA’s. (Ex: fluoxetine, citalopram, sertraline). Black Box Warning: increased suicidal thoughts are possible. Takes 2-4 weeks to work. Helps treat Depression, ETOH withdrawal, OCD, Side Effects: Anxiety, tremors, sexual dysfunction, H/A, agitation, sleeplessness.S/S of Overdose: Serotonin Syndrome (fever, Hyper-Reflexia, sweating, high BP, delirium, hostility). Wait 2 weeks before starting an MAOI or vice-versa. Box 15-4 S/S of serotonin syndromeoHyperactivity or restlessnessoTachycardia -> cardiovascular shockoFever -> hyperpyrexiaoElevated blood pressureoAltered mental status (ex. Delirium)oIrrationality, mood swings, hostilityoSeizures -> status epilepticusoMyoclonus, incoordination, tonic rigidity oAbdominal pain, diarrhea, bloatingoApnea -> deathContraindications: Those who have attempted suicide don’t use! Pregnancy, Renal/Liver issuesoTricyclic Antidepressant (TCA) – (Associated NT: Norepinephrine & Serotonin). Anti-Depressant drugs that block reuptake of Norepinephrine & Serotonin (so there’s more available). Helps elevate mood. Used for Depression, anorexia,
insomnia, ODC, Panic disorder, and neurogenic pain (Mosby’s Pocket Dictionary, 2015). Takes 10-14 days to become effective. Provider will choose this drug if (1) it worked on family member in past and (2) severity of adverse effects. Start with LOW dose and gradually increase if necessary.
You've reached the end of your free preview.
Want to read all 29 pages?
- Fall '18