WORK Flashcards
Sennosides - max daily dose and use?
(max 30mg daily) Constipation
Omeprazole - max daily dose and use?
(max 40mg daily) Gastroesophageal reflux disease, peptic ulcer disease
Acamprosate - max daily dose and use?
(max 666mg) will help you maintain abstinence
Docusate - max daily dose and use?
(max 500mg daily) constipation
Hyoscine Hydrobromide - max daily dose and use, and if oral?
(max 900mg per day into 3 doses) Salvation. Oral - dissolve on tongue.
Furosemide
(max 40mg daily) Hypertension. Oedemia.
Ramipril
(max 10mg daily) hypertension
Lisinopril
(max 80mg per day) hypertension
●OD …
OD - Once daily. ●BD - Twice daily. ●TID - Three times daily. ●QID - Four times daily. ●OM - omni mane (every morning). ●ON - omni nocte (every night). ●UDS - Urine drug screen
Urinalysis
Urine sample sent to lab
UDS
Urine drug screen
High dose antipsychotic monitoring
Is onto high dose when over 100%. 100% Clozapine and 10% of another dose would be over.
High temperature what could this mean and what is this?
Sepsis - Own body attacking itself.
SYMPTOMS OF LOW BM:
●Feeling hungry. ●Feeling dizzy. ●Feeling anxious or irritable. ●Sweating. ●Shaking. ●Tingling lips. ●Heart palpitations. ●Feeling tired or weak. ●Changes in your vision such as blurred vision. ●Confused. ●Seizure or fit. ●Become unconscious.
SYMPTOMS OF HIGH BM:
●Thirst and a dry mouth. ●Frequent urination. ●Tiredness. ●Blurred vision. ●Weight loss. ●Infections.
Olanzapine SIDE EFFECTS
●Weight gain. ●Diabetes. ●Sedation. ●Anticholinergic.
Quetiapine
●Diabetes. ●Sedation.
Haloperidol
Extrapyramidal
Clozapine requires differential…
Clozapine requires differential leukocyte monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly as part of the clozapine patient monitoring service.
Clozapine CATEGORY
Green - category 1: continue treatment. Amber - category 2: continue treatment with caution and more frequent blood tests. Red - category 3: stop treatment with clozapine immediately.
Anticholinergic:
Typical symptoms include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating.
Clozapine - Side effects
●Hypotension. ●Tachycardia. ●Myocarditis/ cardiomyopathy (palpitations, arrhythmias and chest pain). ●Lower respiratory rate when used with other drugs. Diabetes - Need to BM. ●Weight increase. ●Sedation. ●Anticholinergic. ●Haematological malignancies. ●Mortality due to lymphoma (cancer that begins in cells of the lymph system) and leukemia (cancer of the blood cells). Agranulocytosis (Neutrophil (type of leukocytes (white blood cell)) Count (ANC) is less than 100 neutrophils per microlitre of the blood).
Signs and symptoms of agranulocytosis:
●Fever. ●Chills. ●Weakness. ●Sore throat. ●Sores in the mouth or throat. ●Bleeding gums. ●Bone pain. ●Low blood pressure. ●Fast heartbeat. ●Trouble breathing.
Lithium - Possible long term side effects
●Weight gain. ●Kidney and thyroid gland problems. Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. Signs of kidney problems include swollen hands or ankles, feeling tired and short of breath, changes in your pee and feeling sick.
Common signs of an underactive thyroid
are tiredness, weight gain and feeling depressed.
Signs of kidney problems INCLUDE…
swollen hands or ankles, feeling tired and short of breath, changes in your pee and feeling sick.
Anaphylaxis SIGNS
●Suddenly swollen lips, mouth, tongue. ●Throat feels tight - struggling to swallow. ●Breathing fast. ●Struggling to breathe - may become very wheezy or feel like choking or gasping. ●Skin, tongue, lips turn blue, gray or pale - If skin is black or brown: might be easier to see on palms of hands or soles of feet. ●Swollen rash, raised, itchy, blistered, or peeling. ●Sudden confusion, drowsy, or dizzy. ●Someone faints and cannot be woken up.
Treatment for Anaphylaxis
Adrenaline 500 Micrograms
Serious side-effects of antipsychotic drugs:
T
S
T
D
BC
S
NMS
PE
●Twitching or jerking movements in the face, tongue, or other parts of the body. ●Shuffling when walking. ●Trembling. ●Drooling. ●Blood clots - Swelling, pain and redness in one leg, or chest pain with difficulty breathing. ●Stroke - Weakness in one side of the body, trouble speaking or thinking, blurred eyesight. ●Neuroleptic Malignant Syndrome - High temperature, muscle stiffness, sweating, anxiety, excess saliva. ●Painful erection lasting for more than 2 hours.
Atorvastatin
(max 80mg daily) Cholesterol
Naltrexone - max daily dose and use?
(max 150mg daily) Alcohol
PRN - what i need to focus on
PRN - MR and non MR different. PRN - If patient ask for PRN - Don’t panic if they are distressed - Take a breath - Do some research - 1:1 with patient to discuss it. Look on HEPMA. PRN - Check last PRN, check regular. Slow down and count numbers. PRN - Urgent patient. Say to a staff member - ???? has asked if you would speak with them. Feel the discomfort of slowing down.
Extrapyramidal Symptoms:
They include movement dysfunction such as dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism characteristic symptoms such as rigidity, bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
Can not pick up hospital pass drugs from…
GP
CIWA is for? Title means?
D?
Dependence after how much?
- Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar)
Diazepam stops a person going into seizures. Seizures can cause death.
Alcohol dependence = bottle vodka per day. 10 pints per day.
ALCOHOL Withdrawal start after and lasts how long?
Signs of withdrawal
Withdrawal symptoms start around 8 hours after the last alcoholic drink, and then may intensify over the next 24-48 hours.
Signs of alcohol withdrawal: Nausea and vomiting. Anxiety. Insomnia. Tremor, craving for alcohol, vivid dreams, hypervigilance, 2 agitation, irritability, loss of appetite (i.e., anorexia), headache, shaking, and sweating. Delirium tremors. Psychosis.
Questions to other nurses for handover sheet: -
Did any patients refuse any of their regular medication? - Did any patients have any PRN? - How did 1:1’s and NE go? - Any information to hand over from Dc or anyone else? - New patients. - Dc notes. - Obs/BM/weight. - Important stuff from previous handover. - What dc needs to be aware of - medical clerking. - Symptoms - have they been passed to dc? - New patient - how had he been on the ward? - Date of medication on next day. - REMEMBER -IF ANOTHER PERSON SAYS SOMETHING IT’S MORE LIKELY TO BE RIGHT THEN WHAT THOUGHT.
what i need to communicate in rapid rundown
What happened last night ● Jobs for the medical team (patient that need seeing, changes in passes, PRN needs, medication not being used)
what i need to do Before and after ward round
Scampers ● Passes, legal status, DD. ● Call other wards to see how patients are doing.
● Put it in the book. ● Hand it over. ● Put stuff on the board.
-IF ANOTHER PERSON SAYS SOMETHING…
IT’S MORE LIKELY TO BE RIGHT THEN WHAT THOUGHT.
Non-consent drugs can be given from when?
Apply for CTO before when? Or what?
Non-consent drugs from STDC.
Apply for CTO before end of STDC or don’t get 7 day grace period for waiting for tribunal.
Tribunal happens when?
Placed on detention by who?
Tribunal happens within a week after applying for CTO.
Placed on detention by MHO and consultant psychiatrist.
Patient chokes:
● Pull alarm. ● Encourage them to keep coughing to try to clear the blockage. ● Ask them to try to spit out the object if it’s in their mouth. Don’t put your fingers in their mouth - Bite accidentally. ● Ask staff to call 2222 and say medical emergency, patient choking on B ward. Call 999 and ask for ambulance ● Strike five separate times between the person’s shoulder blades with the heel of your hand. ● If not cleared, give up to 5 abdominal thrusts. - Stand behind the person who’s choking. Place your arms around their waist and bend them forward. Clench 1 fist and place it right above their belly button. Put the other hand on top of your fist and pull sharply inwards and upwards. Repeat this movement up to 5 times. ● After dislodge - Ask for Obs machine. ● Possible 1:1. - ask Dc and tell CCN. ● Repeat obs every 15 minutes for an hour then hourly.
Patient faints/collapses:
Pull alarm. ● Gently tilt their head back and lift their chin to clear the airway. ● Check if the person is breathing abnormally or not breathing at all after 10 seconds. ● If they are not breathing normally, tell staff to call 2222 and 999 (ambulance) and say cardiac arrest on B ward - patient not breathing. Ask staff to bring green mask and oxygen, and Obs machine. Ask someone to go outside and wait for ambulance. ● If they are breathing normally, place them in the recovery position and stay with them. ● Possible 1:1. - ask Dc and tell CCN. ● Repeat obs every 15 minutes for an hour then hourly.
Patient found to have low blood sugar:
Below 4: ask patient to take sugar, or glycogel.
Planned restraint:
● Ask CCN for extra staff.
Lithium - Possible short term side effects
●Nausea/feeling sick. ●Diarrhea. ●Dry mouth. ●Metallic taste in mouth. ●Tremor. ●Tired/sleepy.
Patient wants to leave:
● If informal - Ask patient if they would wait for Dc to come speak with them. ● If won’t wait - Nursing holding power. ● Tell Dc to come and speak with patient.
Patient anaphylactic shook:
● Pull alarm. ● Tell staff member to draw up adrenaline. ● Ask staff to call 2222 and 999 (ambulance) and say medical emergency, patient in B ward Ask someone to go outside and wait for ambulance. ● Obs, Dc, possible 1:1. ● Repeat obs every 15 minutes for an hour then hourly.
Patient side effect:
● Obs ● Tell dc Patient any other physical compliant: ● Obs ● Tell dc.
Patient has a seizure and then sleep and then seizure:
● Pull alarm. ● If they have food or fluid in their mouth, roll them onto their side immediately - Would we open mouth to check? ● Time seizure. ● Place something soft under their head and loosen any tight clothing. ● After the seizure is over, roll them on their side. ● Time sleep. 2222 if sezuire longer then 5 minutes. Ask someone to go outside and wait for ambulance. ● Reassure the person until they recover. ● Do/allocate obs. ● Do/allocate nero obs. ● Tell dc. Possible 1:1. Tell CCN. ● Repeat obs every 15 minutes for an hour then hourly.
Patient found bleeding:
Pull alarm. ● Ask staff to call 2222 and 999 (ambulance) and say medical emergency, patient in B ward bleeding heavily. ● Compress bleeding site. ● Measure blood loss. ● Obs, Dc, possible 1:1. ● Repeat obs every 15 minutes for an hour then hourly. Ask someone to go outside and wait for ambulance.
Patient tries to escape and is agitated:
● Pull alarm. ● Ask if they would take oral Lorazepam. ● If won’t take this - Call CCN to ask for extra staff needed to give IM Lorazepam (if prescribed)(1mg = 0.5ml ● 0.5ml saline - check instructions). ● If not prescribed - Ask Dc for Lorazepam to be prescribed. ● Obs, Dc, possible 1:1. ● Repeat obs every 15 minutes for an hour then hourly.
Patient attacks another patient:
Pull alarm. ● Restrain patients needing restrained. ● Ask if they would take oral Lorazepam (1mg = 0.5ml ● 0.5ml saline - check instructions). ● If won’t take this - Call CCN to ask for extra staff needed to give IM Lorazepam (if prescribed). ● If not prescribed - Ask Dc for Lorazepam to be prescribed. ● Obs, Dc, possible 1:1. ● Repeat obs every 15 minutes for an hour then hourly.
Patient found to have a ligature around neck:
● Pull alarm. ● Ask staff to bring scissors. ● Cut ligature. ● Obs, Dc, possible 1:1. ● Repeat obs every 15 minutes for an hour then hourly.
Patient delusion causes them to target another patient and thinks they should be in there room / be in prison:
Your ideas about this person are not true. Everyone here has mental health challengers. The best thing you can do right now is to give this person some space and chance to recover without any extra stress. Please have compassion for everyone thats here and also give yourself some time to breathe and recover yourself.
Patient asks to be discharged when is going to rehab:
You and your dc have made an agreement for you to go to rehab; since this person is organizing this its best to speak to them about it next time you see them.
Patient wants to be discharged:
Will you wait for the dc to come so that you can discuss this with them. They might agree with you or they might ask you to stay. If will not stay and tries to leave - I’m now holding you here in hospital under nursing holding power - this lasts 6 hours and the dc will come and see you at some point whilst this is in place.
Patient does not want to come back into hospital, and dc would like to see them today:
The dc has asked for you to return to the hospital today for review. If says im doing something else even if sounds meaning full: Say, that sounds like a nice plan however the dc has asked you to return to hospital for good reason - state reasons. Please can you just come back in right now? Patient filming/been filmed: We take this very seriously, it is actually illegal to film others without valid consent. To the person whos been filmed - do you want to involve police?
Metronidazole use dose
Antibiotic - 500 mg every 8 hours
Carbamazepine
Epilepsy up to 1.6–2 g daily
Patient refused drugs. paient from another ward - what to do?
Report patient developments to their ward:
Naloxone - what does it do to opioids and benzos and alcohol?
Naloxone will not reverse overdose resulting from non-opioid drugs, like cocaine, benzodiazepines (“benzos”), or alcohol.
When does codine wear off
24 hours.
NHP - how many hours - what to say on phone
Say to dc - i HAVE A p who wants to leave and i feel is detainable. Can you come immediately.
DC cant come - im putting p on NHP.
Dunior dc put on EDC for assessment - later - senior with MHO put p on STDC
Haliperidol - what need to provide this?
need ECG - ask for p to have ECG so that p can have h.
Cant prescribe h with heart issues.
hand over from…
Get hand over from rapid rundown and from medical review
After overdose or when ever pupils not reactive
- note when pupils are reactive again
If say going to do something every 15 minutes
- do it - even if it doesnt seem worthwhile - as continuity supports other persons confidence.
Snoring
- sign of overdose.
opiod cause what to respiratory
Respiratory depression
family asks whats happening?
State only dc opinion. How do you feel about that. If mixed - state reasons for both.
If someone gives task…
write it on board on on task page in note book
HR range
HR below/above what cause score 2?
51-90
lower then 41 and higher then 111
BP range
BP below/above what cause score 2?
111-219
lower then 101 and higher then 220 (score 3)
RESP range
RESP below/above what cause score 2?
12-20
lower then 9 and higher then 21
TEMP range
TEMP below/above what cause score 2?
36.1-38
lower then 35.1 and higher then 39
O2SAT range
O2SAT below/above what cause score 2?
higher then 96
lower then 94 and higher then 96
O2SAT range L2
O2SAT L2 below/above what cause score 2?
88-92
lower then 86
What is Bibasilar atelectasis
Collapse of the lower lobes of both lungs
What is asperating
Choking
What drug is a cough depressant
Methadone
