-use of seclusion rooms may be warranted and authorized for clients in some cases.
-seclusion should be ordered for the shortest duration possible, and only if restrictive measures are not sufficient.
-for the physical protection of the client/protection of other clients and staff.
-a client may voluntary ask for seclusion if environment is too stimulating.
Must never be used for the convenience of the staff, punishment of the client, for clients who are extremely physically or mentally unstable, or for those who cannot tolerate the decreased stimulation of a seclusion room
-treatment ordered by primary care provider (unless emergency, then need after 15-30 minutes).
-order must specify duration of treatment.
-provider must rewrite every 24 hours
-nursing responsibilities must be listed (assessed, offered food and fluid, toileted, monitored for vital signs)
-completed documentation (precipitating events, alternative actions to avoid seclusion, time, client's current behavior, what foods and fluids offered, vital signs, med administration).
P: perceptions of client, presenting symptoms, previous psychiatric treatment, previous meds, previous mental illness, precipitating evens, physical assessment.
E: educational background, employment background, environments of home life.
R: relationships (with family, significant others, support systems); review of systems.
S: substance use and abuse.
O: objective observations (of thought content, thought processes, mood/affect and behavior, physical examination), obstacles to treatment (including financial and environmental)
N: needs that are specialized (language, hearing, reading/writing, cultural spiritual)
S: safety assessment (suicide potential, homicidal ideation, victimization issues such as abuse or neglect)
-sexual dysfunction (anorgasmia, impotence, decreased libido)
-CNS stimulation (inability to sleep, agitation, anxiety)
-Weight loss early/weight gain long term
-Serotonin syndrome (2-72 hours after beginning treatment): manifestations are mental confusion, agitation, fever, anxiety, hallucinations, hyperreflexia, incoordination, diaphoresis, tremors.
-withdrawl syndrome (headache, nauseau, visual disturbances, anxiety, dizziness, tremors)
-hyponatremia (adults on diuretics)
-sleepiness, faintness, lightheadedness
-bruxism (grinding of teeth)
Indications: used in clients whom all therapeutic interventions have failed/lives are at risk
-major depression (85%), remainder for schizoaffective disorders, mania, schizophrenia, and sometimes Parkinson's disease.
-2x/week on nonconsecutive days
-few to 15 sessions
-lasts less than one hour
-tapering for severe life threatening conditions.
-can experience relapse and require maintenance treatment.
Nursing Role and Care:
-explain procedure, assess, etc.
-immediately after, closely observe cardiovascular status and airway patency.
-position on side to facilitate drainage/prevent aspiration
short term memory loss common-orient to place and time.
-watch for postictal confusion, record duration and severity.
-fasting: provide small sips of water, ice chips, juice.
-Thought disorders, chpt. 29
-primarily treat hallucinations and delusions
-include chlorpromazine, fluphenazine, haloperidol
-Acute extrapyramidal side effects!!
-orthostatic hypotension, anticholinergic effects, breast enlargement,male erectile dysfunction, photosensitivity, weight gain, NMS, severe EPS
Though disorders chpt. 29
-Paranoid: clients are preoccupied with delusions of persecution or grandeur (organized around a coherent theme), ideas of reference, or frequent auditory hallucinations. They may appear tense, suspicious, guarded, reserved, hostile, or aggressive.
-Disorganized: clients demonstrate markedly regressed, disorganized, silly, inappropriate, and uninhibited behavior; disorganized speech, flat or inappropriate affect; poor reality contact; poor grooming and social skills; a prominent thought disorder; and possibly grimacing, strange mannerisms, and other odd behaviors.
-Catatonic: clients show motoric immobility or stupor, rigidity, excessive motor activity, extreme negativism, and peculiarities of movement, such as posturing, echolalia, and echopraxia, mutism, and waxy flexibility.
-Undifferentiated: behavior and speech clearly indicate schizophrenic psychosis but fail to meet the criteria of paranoid, disorganized, or catatonic types
-Residual: clients do not have active, positive symptoms such as hallucinations and delusions, but continue to demonstrate negative symptoms, such as withdrawal from others or flat affect.
-irritability and impatient behavior.
-coarse tremor of the hands, tongue, eyelids may follow, n/v, weakness, ANS hyperactivity, headache, paroxsymal sweats, anxiety, depressed or irritable mood, orthostatic hypotension. Sleep disturbances, insomnia, nightmares, or hallucinations are possible.
-Delirium tremens is the most serious form, occurs within 48 hours after cessation of prolonged heavy drinking and can continue for as long as one week. May experience hallucinations, but consciousness is not clouded. Auditory sounds include hissing or buzzing sounds. Treated with prompt sedation.