The agitated patient Flashcards
Tips for when a patient may become violent
Violent actions do not usually occur without warning.Watch for signs of anxiety including pacing, clenching of fists, pressured or angry speech, defensiveness, verbal threats, or yelling.
Agitation treatment
Do not position the patient between yourself and the door.) Leave the room immediately if you feel in any danger.
Remember thatearly attention to agitation and escalating violence allows better safety for both patients and staff.
What is the most important part of de-escalation techniques?
The most important concept in verbal de-escalation is for the physician to convey professional concern and respect for the patient.
Pay attention to your body language and avoid potentially threatening stances such as crossed armsor waving a finger.
Acknowledge thepatent’s discomfort but speak in a controlled manner and put clear limits on disrupted and dangerous behaviors. The patient should be advised of consequences for such continuedbehavior.
After de-escalation techniques, what do you do?
Non pharmacological Restraints. Use them for the least amount of time as possible.
Explain why you have to put them on.
What is 5 point immobilization?
Using 5 people to help restrain a person.
Team leader talks to the patient and may control the head
One person per limb at a major joint
Grasp all extremities at the same time
Place the patient supine on the bed
Apply restraints to each ankle and wrist—attach to bedframe, not rails
What monitoring is required for restrained patients?
Thus, fortheir safety restrained patients should have a provider in the room constantly and have continual monitoring of vital signs.
What follow up do you have to do on a patient with restraints?
Whenever placing a patient in restraints it is essential to comply with safety procedures and document appropriately and an attending should evaluate the patient soon after restraints are placed, usually in less than one hour.
Must set a clear plan for when they can be removed.
What is the goal of using chemical restraints?
Endpoints of restraint are to resume a more normal patient-physician interaction, to obtain informed consent and the secure patient and staff safety.
What medications can you use to minimize side effects to commonly prescribed anti-psychotics that are used for sedation in agitated patients?
Anticholinergic medications such as benztropine and diphenhydramine may be used for prophylaxis against extrapyramidal symptoms caused by some antipsychotic administrations.
Medications Lorazepam Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Benzodiazepine Drug: Lorazepam Dose: 2-4 mg Route of Administration: IM/IV/PO Onset of Action: 5-30 min Side Effects: Respiratory depression, excessive sedation
Medications Midazolam Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Benzodiazepine Drug: Midazolam Dose: 5 mg Route of Administration: IM/IV/PO Onset of Action: 10-30 min Side Effects: Respiratory depression, excessive sedation
Medications Haloperidol Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Typical Antipsychotic Drug: Haloperidol Dose: 2.5-10 mg Route of Administration: IM/IV/PO Onset of Action: 30-60 min Side Effects: Extrapyramidal symptoms, NMS
Medications Ziprasidone Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Atypical Antipsychotic Drug: Ziprasidone Dose: 10 mg q2h or 20 mg q4h Route of Administration: IM/PO Onset of Action: 15-20 min Side Effects: QTc prolongation
Medications Risperidone Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Atypical Antipsychotic Drug: Risperidone Dose: 2 mg q2h Route of Administration: PO Onset of Action: <90 min Side Effects: QTc prolongation, orthostatic hypotension
Medications Olanzapine Class Drug Dose Route of Administration Onset of Action Side Effects
Class: Atypical Antipsychotic
Drug: Olanzapine
Dose: 5-10 mg q2-4h
Route of Administration: PO/IM
Onset of Action: 15-45 min IM; 3-6 hours po
Side Effects: QTc prolongation, orthostatic hypotension
